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469 ATLANTIC BLVD #6 - INTERIOR Allk CITY OF ATLANTIC BEACH -6 V ' _�_ r� 800 SEMINOLE ROAD � 4' ATLANTIC BEACH, FL 32233 011 9' INSPECTION PHONE LINE 247-5814 COMMERCIAL -ALTERATION COMMERCIAL MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: COMM17-0034 Description: INTERIOR -ADD CHASE WALL FOR SINK Estimated Value: 1000 Issue Date: 1/2/2018 Expiration Date: 7/1/2018 PROPERTY ADDRESS: Address: 469 ATLANTIC BLVD 06 RE Number: 170690 0000 PROPERTY OWNER: Name: DIAMOND REAL ESTATE PROPERTIES IV LLC Address: 6517 LOU DR S JACKSONVILLE, FL 32216 GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Name: JOHN MOON PLUMBING Address: 1103 PALM CIR QA JOHN ROBERT MOON JR JACKSONVILLE BEACH, FL 32250 Phone: PERMIT INFORMATION: Please see attached conditions of approval. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. * A notice of Commencement is only required for work exceeding an estimated value of $2,500. For HVAC work, a Notice of Commencement is only required when HVAC work exceeds and estimated value of$7,500. Sy�ir City of Atlantic Beach APPLICATION NUMBER �f Building Department (To be assigned by the Building Department.) _-. 800 Seminole Road II �J /- '' ,, Atlantic Beach, Florida 32233-5445 �M IY1 t l LJ���" Phone(904)247-5826 • Fax(904)247-5845 p " 013 9';' E-mail: building-dept@coab.us Date routed: I £- /I + i l 7 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 4 (09 A TLAN7 i L V.Q Department review required Yes No (� Building Applicant: --- (:)‘'AN--)h'�n©� t L 1146i foo OGt ���' ''ning &Zoning I l Tree Administrator Project: C h,l(y.S G v v A c-L ('- Public Works Public Utilities PL_U rvk.6( LuC� Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: proved. nDenied. ❑Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: 12- r?-j1 ‘.1 TREE ADMIN. Second Review: nApproved as revised. nDenied. Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: nApproved as revised. nDenied. nNot applicable Comments: Reviewed by: Date: Revised 05/19/2017 * yo (073 - '%'c / ,,kc— .1 40,44,,,, Building Permit Application Updated 12/8/17 City of Atlantic Beach y;, 800 Seminole Road,Atlantic Beach,FL 32233 . y Phone:(904)247-5826 Fax:(904)247-5845 Job Address: 56ma( �r / /G &VI) ( Permit Number: C_Co IV\ --7 i \ � / - 00` 4 Legal Description RE# Valuation of Work(Replacement Cost)$ i Heated/Cooled SF / Non-Heated/Cooled • Class of Work(Circle one): New Addition eratioh' Re air Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circ Commer ' I Residential • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes 3 N/A • Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal Describe in detail the type of work to be performed: It/i61) Cl/21S w044, 173 //vi/4“ 3�o,I/mail ,,.. 5/4 ' v-1/ 4 C?'/jr/sr'um1z. t Florida Product Approval# for multiple products use product approval form Property Owner Information Name: pilk1,1101 b REAL S-1,jp' f71 fp?1 • IV Address: 601 LOu _Z. saves City fQ(,IZSonvItu State EL- Zip 32216 Phone 90L/- p3- (-lPV 17 E-Mail iC(Zpi'r1A4anctNo LbUI41 e e6yowL.( ( wn or Agent(If Agent, Power of Attorney or Agency Letter Required) $LWn i2 s#W" M ,tC A onntttrractor Information Name of Company: ,1 1/.) Moo NS Pt,um6,'46 Qualifying Agent: j ' rWrsk/c 'Q Address 1103 fAuncittriC OA O510-0l.;ne zr pio-w,lYz City l/keSD4 ,L4 Vow+ State FL- Zip 3zz1 a Office Phone COY" 1 yq " z 7$-g Job Site/Contact Number 96 V - 1 Y 9 - 9 4i q a State Certification/Registration# E-Mail Architect Name&Phone# Engineer's Name&Phone# — Workers Compensation etT Exempt/Insurer/Lease Employees/Expiration Date Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and there may be additional permits required from other governmental entities such as water management districts,state agencies,or federal agencies. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. y "i /7'1 ,,--SCii9----------- i: (Signature of Owner or Agent) (Signature of Contra r) (including contractor) Signed a d sworn to(or affirmed)before me this 1.0day of :ned an. sworn to(or affirmed)before me this ( day of 21/t1 ,by savvy?... vv,an `4A_A by .'31'e 1Q1t)(,\( 6i _p--- -.%gnatu-re rigliitrer-- of Notary) Si a r of of ry .•'t'a,, KATHLEEN ANN SACA • 's KAMAN ANN BACA ��" Personally Known OR [personally Known O i Notary Public-SOW of Florida + r Notary PI11No.State of Florida [ ) Commission I IN 989377 Produced Identification��. � , ;J� ."- Produced Identificati r`.�� CommialNM I FF 989377 Y CommEY raa Y ?09 ype of Identification: 11-,,.. lit ') Type of Identification: <t y PI ay Q Fo�<< omm.fayirus1N.i 4.zD 0 ''48;, �`` ethoughNational Notary Assn '"'���„ 'hrough NiNOON Nut i'y Assn. , , .;."; / CITY OF ATLANTIC BEACH s ff 13 WNER / BUILDER AFFIDAVIT Oct, ts/ I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU, AS THE OWNER OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE-OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF $25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826) IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. c'69 76 Re-64e, a /- gi3 -iy ge ADDRESS PHONE NUMBER PRINT NE &AV/ SIGNATU DATE Before me this ,Uz,�•�t day of CaCr2j114\2\ ,201)in the county of Duval,State of Florida,has personally appeared herin by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of ,County of NVC I 4Personally Known461 ..4,p4;.,, KA GACA t ID Produced Identification- - r 4'. 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