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566 PLAZA - WALKWAY t - CITY OF ATLANTIC BEACH ss1 . , ..,; l800 SEMINOLE ROAD L\7ATLANTIC BEACH,FL 32233 �,o.i» INSPECTION PHONE LINE 247-5814 RESIDENTIAL OTHER - SINGLE OR TWO FAMILY RESIDENTIAL OTHER MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: RESO18-0006 Description: PAVER WALK WAY Estimated Value: 1000 Issue Date: 2/20/2018 Expiration Date: 8/19/2018 PROPERTY ADDRESS: Address: 566 PLAZA RE Number: 170703 0208 PROPERTY OWNER: Name: HEINE JOHN N Address: 566 PLAZA ATLANTIC BEACH, FL 32233-4123 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. 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. * 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. J riy r1�,, , '� Permit Conditions �W L.001 ze, City of Atlantic Beach Permit Number: RESO18-0006 Description: PAVER WALK WAY Applied: 2/5/2018 Approved: 2/9/2018 Site Address: 566 PLAZA Issued:2/20/2018 Finaled: City,State Zip Code:Atlantic Beach, Fl 32233 Status: ISSUED Applicant: <NONE> Parent Permit: Owner: HEINE JOHN N Parent Project: Contractor: <NONE> Details: OWNER BUILDER LIST OF CONDITIONS SEQ NO ADDED DATE REQUIRED DATE SATISFY DATE TYPE STATUS DEPARTMENT CONTACT REMARKS 1 2/9/2018 ON SITE RUNOFF INFORMATIONAL PUBLIC WORKS Scott Williams Notes: All runoff must remain on-site during construction. 2 2/9/2018 ROLL OFF CONTAINER INFORMATIONAL PUBLIC WORKS Scott Williams Notes: Roll off container company must be on City approved list(Advanced Disposal,Realco Recycling,Shapell's,Inc.,Republic Services,Donovan Dumpsters). Container cannot be placed on City right-of-way. 3 2/9/2018 RIGHT OF WAY RESTORATION INFORMATIONAL PUBLIC WORKS Scott Williams Notes: Full right-of-way restoration,including sod,is required. 4 2/9/2018 RUNOFF INFORMATIONAL PUBLIC WORKS Scott Williams Notes: All runoff must remain on-site. Cannot raise lot elevation. /IN Printed:Tuesday, 20 February, 2018 1 of 1 P. I" City of Atlantic Beach APPLICATION NUMBER Js klhiiikt1 Building Department (To be assigned by the Building Department.) 7,?, 800 Seminole Road. Atlantic Beach, Florda 32233-5445 �`,� �? 000 Phone(904)247 5826 • Fax(904)247 5845a .-J, Sr E-mail: building-dept@coab.us FEB u6 2018 'Date routed: r' City web-site: http://www.coab.us k bY' __ APPLICATION REVIEW AND TRACKING FORM Property Address: fit,j(c., z Department review required Yes No Building Applicant: Planning &Zoning LAD Tree Administrator Project: pVC�-„ LADPcLKL ,fly ,clicWorks2) 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: ]Approved. ❑Denied. ['Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed b Date: --,/, TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. ❑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 � LAPJ: City of Atlantic Beach .�., APPLICATION NUMBER �s f Building Department V (To be assigned by the Building Department.) `i 800 Seminole Road ; } �� Atlantic Beach, Florida 32233-5445 FEB 0 6 2018 �� �OO Phone(904)247-5826 • Fax(904) 247-58 E-mail: , ' Z /I 0;319' building-dept@coab.us .J Date routed: City web-site: http://www.coab.us BY:... - APPLICATION REVIEW AND TRACKING FORM Property Address: �� RA. Z A- Department review required Yes No � ^^J�y Building `./ Applicant: (,) N--,? e Planning &Zoning Tree Administrator Project: p v L./ LK Lt - lic wo- rk / u eat5 iTCUrititiUss Public Safety Fire Services Review fee $ . Dept Signature "v'`-- 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: ❑Approved. (Denied. Not applicable (Circle one.) Comments: BUILDING ,, // PLANNING &ZONING Reviewed by: W` Date: ?lir/i g TREE ADMIN. Second Review: Approved as revised. ❑Denied. Not applicable P O_ RKS1 . Comments: BLIC UTILITIE 2-7—/ PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. ['Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 �rL Building Permit Application Updated 12/8/17 City of Atlantic Beach VW" 800 Seminole Road,Atlantic Beach,FL 32233 Phone:(904)247-5826 Fax:(904)247-5845 Job Address: 566 Pkz-1 n��) 1\k-k1c--Pk`Ade, Permit Number: R coo( ' Legal Description '` .V(o` y RE# Valuation of Work(Replacement Cost)$ �000 00 Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): 3 c& Alteration Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial esidentia • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No 63 • 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: 2 Ada, elves ��1V_�cly &•\ cr }'� fes` , q.q,c, - t50 �t Florida Product Approval# for multiple products use product approval form Property Owner Information A Name: �611rk ��MQ- �1���G15[4 Address: 54( P1°Ctct City Mt-4\c— State L- Zip 322-33 Phone °1 a"} sa 1 3 S7-6, E-Mail rit\055y J°LA C L.-Jo, <,vv-, Owner or Agent(I Agent, Power of Attorney or Agency Letter Required) OW hAq- 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 RECORDING YOUR NOTICE OF COMMENCEMENT. 11-42,14_, ��— (Signature of Owner or Agent) (Signature of Co .ctor) (including contractor) L Sign d and sworn to(or affirm-.) before me this 5. day.of Signed and sworn to(or affir '-d)before me this day of - aoro ,b 411111 44 • �'"" TONT GINDLESPERGER ature o Notary) (Signature of Notary) • :r :4 MY COMMISSION#FF 924951 • '`� ,,gOnaIEKRfRggreMber 6,2019 [ ]Personally Known OR efiTAThrittigftellt*u ,n[ritts_ /► p. [ ]Produced Identification Type of Identification: 1 '0,4� _ST-sal Type of Identification: 4 rL L.L`J!i " 1 CITY OF ATLANTIC BEACH , r OWNER / BUILDER AFFIDAVIT te 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 CONSTRUC'T'ION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS TILE OWNER OF YOUR PROPERTY,TO ACT AS YOUR OWN CON'T'RACTOR 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. 5�(.=. P l r'R Rck . tl is d- Ro-{ 5a l 3 5 ab ADDRESS / �- PHONE NUMBER OVr\-,\ 1`!\Q PRINT .Ael/i^Q a/6/ P t9 SIGNAT RE DATE Before me this'S day of ,20I�iA 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 F ,County of 0 V,/ o Personally Known �� `7�1 C ❑Produced Identification- ( -- �-� f.:;;;;;; TONTGINDLESPERGERNotary Signature: �o MY COMMISSION#FF924951 EXPIRES:October6,2018 Bonded Nu F:BLDG/Owner-Builder Affadavit;REVISED. 4/16/2009 . 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