70 W 9TH ST - SIDING 61 j Lyr�Jf.
' CITY OF ATLANTIC BEACH
ss1
J 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL - ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES18-0015
Description: install 90 s.f. Hardie-Board siding
Estimated Value: 500
Issue Date: 1/22/2018
Expiration Date: 7/21/2018
PROPERTY ADDRESS:
Address: 70 W 9TH ST
RE Number: 170813 9050
PROPERTY OWNER:
Name: SMITH EARL G
Address: 70 W 9TH ST
ATLANTIC BEACH, FL 32233-3465
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.
1.Jv; City of Atlantic Beach APPLICATION NUMBER
e t ..1 Building Department (To be assigned by the Building Department.)
isl
k A„',- 800 Seminole Road 0-Si ---001S
-6 . �0 Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845 i
�J; 9%' E-mail: building-dept@coab.us Date routed: I 1 [(P M
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: W I S-k- . s v_.� ent review required Yeae No
:uilding I/
Applicant: 0‘”)(V-A1 Planning : Zoning
Tree Administrator
Project: \NS k�\ k-�w",1.i e. b a s;,(,- .,6 Public Works
® S rPublic Utilities
t 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. ❑Denied. ❑Not applicable
(Circle one.) Comments:
3s '- co/1 n- of -s,ra 1 in 3rec ii
BUILDING
PLANNING &ZONING Reviewed by: ill)/ Date: f'/9"'dA/j
TREE ADMIN. Second Review: A roved as revised.
❑ pp ❑Denie Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ❑Denied. ['Not applicable
Comments:
Reviewed by: Date:_
Revised 05/19/2017
OFFICE COFBuilding Permit Application Updated 12/8/17
4
City of Atlantic Beach JAN 1 6
fu 800 Seminole Road,Atlantic Beach,FL 32233 2018
�1
' G Phone:(904)247-5826 Fax:(904)247-5845 Q C
Job Address: 7 0 `w• 67'•• �44 11T/L 8&47 Permit Number: P--e
Legal Description RE#
O
1
Valuation of Work(Replacement Cost)$ Dv 0• Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Rsi ert .
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No
• 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:
NsTA(L 1-1140--N apF ) o As-7- SIt o F itauSE Qo stfii
Florida Product Approval# for multiple products use product approval form
Property Owner Information .
c, �V,�
\
Name: E1 (LA..- G - E V'4 1� ( Address: 7 D (A) • _I r sf-
City 4►(i, L_ State p(_ Zip Phone 9oce
E-Mail -.(24 S Sjm r 7`-L vYle41 SNI
Owner or Agent f Agent, Power bf Attotney or Agency Letter Required)
Contractor Information
Name of Company: _ 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
'"ii RDING YOUR OTICE OF COMMENCEMENT.
g:A? ', / -
ry9Q i j•'
(Signature of Owner or Agent) (Signature of Contracto
(including contractor)
• x Ago and sworn to(or affirmed)before me this i(4 day of Signed and sworn to(or affirmed)befofe me this day of
, cp( ,by •-A! Clt 5v ,by
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of
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▪ Nz ( ignatur Vary) (Signature of Notary)
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.onally Known OR [ ] Personally Known OR
Cd Pr.I•uced Identification [ ]Produced Identification
_._ Identification: FL �.( i\}O-{'S t LQ n,-e Type of Identification:
' `'° CITY OF ATLANTIC BEACH
V
' '1 `'. IP:WNER / BUILDER AFFIDAVIT
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I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION LL
CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
J
DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES: W
0 c`p
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED Z
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT < = _1 z \'
LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS J 0Q O
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST Cl- Z H
SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE-OR 2 W 0 CIuj
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR 0 CO - Z I,,.,
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING 0 0 ❑ 8 p
MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. W H Q p
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR CI Z CC Z clitzzzlo
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT 0 < O c(
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT V N H
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST Le < H Z
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS 0 LL
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE ,-, 0 w w jJ
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING a CC In
ORDINANCES. W V N W Lu
Lu
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE5 CC w
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE Bali 5
w
PURCHASED. CC CC
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.
—7d w. CfA 6 PHONE90_c-7.-� 54/
ADDRESS
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PRINT NAME
.4
SIGNATURE DATE
Before me this I Y/ day of a n Lk cA--4 2011S 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.tr
•
Notary Public at Large,State of ` — County of °t'1 V 41 '
.07.4.4'.; JENNIFER JOHNSTON
o PersonallyKnown n =_° �'= MY COMMISSION#GG 042984
J,,Produced Identircalion- L- (t S t L nS '*; i7oi .*S EXPIRES:October 27,2020
'"•.yam 'o`-'
">/ o?� Bonded Thru Notary Public Undernriters
Notary Signature: \. �1 .1.`
1
F:BLDG/Owner-Builder Affadav,.REVISED: 4/16/2009