302 MAGNOLIA ST - WATER DAMAGE REPAIR r �3
6, ,,„„ .s „,,
, CITY OF ATLANTIC BEACH
�' s) 800 SEMINOLE ROAD
6v x
ATLANTIC BEACH, FL 32233
'4L,.si 1r INSPECTION PHONE LINE 247-5814
RESIDENTIAL - ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES18-0005
Description: interior demo to repair water damage &T-11 siding
Estimated Value: 4500
Issue Date: 1/9/2018
Expiration Date: 7/8/2018
PROPERTY ADDRESS:
Address: 302 MAGNOLIA ST
RE Number: 170446 0010
PROPERTY OWNER:
Name: TOKE JONATHAN ET AL
Address: 302 MAGNOLIA ST
ATLANTIC BEACH, FL 32233-4028
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
,
Phone:
Name:
Address:
,
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$7,500.
'01: Building Permit Application Updated 12/8/17
VI/9P' City of Atlantic Beach
`,, 800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)a "lit 247-5826_ Fax:(904)247-5845 q
Job Address: 36lit(i4 5fi� Alia-,ifi- bear-� Permit Number: c�. 0 —vim
Legal Description RE#
Valuation of Work(Replacement Cost)$ '!&v Heated/Cooled SF 494/00 Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteratio Repai► Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial tesid-•
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit off4lo Tree Removal
Describe in detail the type of work to be performed:
Remaa CAI'pet Ce cifc Wt Nta/Ape rep e, oPa-i.fet 54P M 1 k rep t- re gre t yh f cWec',
Ce,(�nr �`15, ace_ oxi-eow- ok4,17'd ill .✓4fe -o )
Florida Product Approval# for multiple products use product approval form
Property Owner Information 1,
Name: Z5 cf4 � A �o(, ✓ (o e-. _ Address: 3t2 j)471 JrQ St-f- /44441`e? t.. c1
City nfi`L c11 State Zip 3012-35 Phone �'0c> 7Sy 0,117
E-Mail roig(L1un - T191c-2 e 1Ia5Ke((• (0"l
Owner or-Agent(If Agent, Power of Attorney or Agency Letter Required) jseiiar, lake
Contractor Information
Name of Company: N/4 Qualifying Agent:
Address City State Zip
Office Phone Job Site/Contact Number
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation
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
RECORDIN •UR NOTICE OF COMMENCEMENT.
r gip
(Signature of Owner or Agent) (Signature of Contractor)
(including contractor) G
Signed and sworn to(or affirmed)before me this- 1 I day of Signed and sworn to(or affirmed)before me this day of
Ja.l1t„tc , ,;:)o�� ,by TO(1 Ct \a.IN ( To ,by
etvP,e•. JENNIFERJOHNSTO
4:, , ���JJJJJ Sig ture o Notary) (Signature of Notary)
i- ��, MY COMMISSION#GG 042
EXP'4 :Octobe{ 7,2020
F .re PggiVa G D2r1I Underwriters [ ]Personally Known OR
"""k1Predycad [ ]Produced Identification
Type of Identification: FL ti( .J!y'S �`Le--11S&. Type of Identification:
`' ` �' CITY OF ATLANTIC BEACH
5iii
-- IS'WNER / BUILDER AFFIDAVIT
-11191-
I.
1119~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.
/1/0744Ov(,V SIF( ,q4(,01 h L- ri� NUMBER c2
ADDRESSPHONE
PRINT NMI
SIGNATI DATE /
Q
Before me this 1 day of Jet-Rao-11/4A ,204 in the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are truetrand accurate.
NotaryPublic at Large,State of f L- ,County of 0"vim 1 ".'r'l!s,
g r°- P o JENNIFER JOHNSTON
- • ah .4'- MY COMMISSION#GC 0421
❑Personally Known .tck = EXPIRES:October 27,2r.
,,produced Identification- «o.• Bonded Thru Notary Public Un;
NotarySignature: \' I . ' �.\" `
9 I
F./BLDG/Owner-Builder Atfadavit ,VISED. 4/16/2009