2039 SELVA MARINA DR - NEW PERMIT TO FINISH WORK ,0",k- '.;, CITY OF ATLANTIC BEACH
jf 800 SEMINOLE ROAD
y� ATLANTIC BEACH, FL 32233
' INSPECTION PHONE LINE 247-5814
RESIDENTIAL ADDITION - SINGLE OR TWO FAMILY RESIDENTIAL ADDITION
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RESA18-0005
Description: finish work started under 17-RADD-3140-01
Estimated Value: 7500
Issue Date: 2/21/2018
Expiration Date: 8/20/2018
PROPERTY ADDRESS:
Address: 2039 SELVA MARINA DR
RE Number: 169506 1076
PROPERTY OWNER:
Name: BOWLES CHRISTOPHER HF
Address: 2039 SELVA MARINA DR
ATLANTIC BEACH, FL 32233-4554
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$7,500.
o Building Permit Application Updated 12/8/17
•
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
I �� r Phone:(904)247-5826 Fax:(904)247-5845 /)
Job Address: 26 2 J 5el�� '"`Aic J4 Dry Permit Number: J/'f l 0 OO Q
Legal Description RE#
Valuation of Work(Replacement Cost)$ 15 CC' Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): Ne Addition Alterati n Repair MovePool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Residentia 1
• 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
,�toI be performed: �/ /�r/� �f _ r
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Florida
1
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: I 444- Address: 2639 .56/VA-
City , f ck State Zip 2-Z 33 Phone QOV-ye?-7--e6.5--s—
E-Mail bp26)(,y, MGN1.Cc�-i
Owner or Agent(If Agent, Power of Att6rney 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
RECORDING YOUR NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) (Signature of Contractor)
(including contractor)
Signed and sworn to(or affirmed)before me this day of Signed and sworn to(or affirmed) before me this day of
, by , by
(Signature of Notary) (Signature of Notary)
[ ]Personally Known OR [ ]Personally Known OR
[ ] Produced Identification [ ]Produced Identification
Type of Identification: Type of Identification:
(---
...., .... ,.......
s �\
� �sJ' TRAN FER
. - ,, AGREEMENT TO ACCEPT S
' ,---3» , OF UNCOMPLETED BUILDING PERMIT
This agreement and a new Permit Application are required
to transfer an uncompleted building permit.
I ' x1511 p 5°"-.1 , Phone I'O`C - `(c1 -- X ' ,
Address 2._69 e.('i 4- M (N:A ? KC A-1-( 5041 3 Z z ,
Email ic)6u5 a-sr'101"le(k? eim4ff .- cCk1
,
State Certification/Registration # Ni-a , understand that Building
Permit ` 1-(ZAP12 - V`-“: -O I was started by another contractor and is currently
uncompleted.
I agree to, after reviewing the approved plans and the unfinished as-built construction, to
submitting a Revision Form and revised construction drawings to the Building Department to
correct any deviation between the approved plans and as-built construction, where found.
I understand that, based on the current inspection record, I am responsible for the Code
compliance of the finished project.
Details (Optional)
nuk).c4 - )90 11 ,': ✓z -lb,2 /Lem/1 14elz- -f (rzo�•ee
,c,„,,, , , ,,,. 7/7_1/1 e
State of Florida
County of Duval
The foregoing instrument was acknowledged before me this \ day of ._ b (v L, , , )--t- 1
by -7(\S 1'V\ b - Eo,A5 , who personally appeared before me
and acknowledged that he/she/they signed the instrument voluntarily for the purpose'xpressed in it.
J Si nature of Notary Public
[ ] Personally Known OR _
'r•b' JENNIFER JOHNSTON
['',Produced Identification .; GG
Q J �� \°�p „� '.r,'''''''�, MY COMMISSION# 27 042984
Type of Identification: D�1 4 '-1 t =`;o EXPIRES:october27.2o20
;eoF Fro;•' Bonded Thru Notary Public Underwriters
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.. }� CITY OF ATLANTIC BEACH
;1 '3%WNER / BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
IDISCLOSURE 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.
203q SeiVA Mq A `P2. goci-xig 7-8(055-
ADDRESS PHONE NUMBER
•TKISI 1D. P-)CuJL C S
PRINT LAME/ / �(c��LY ,i / /4cW i U
SIGNATURE n"_(,t,1\ DATE
Before me this'_day of Fell. _I ,20 I n the county of
Duval,State of Florida,has persona3lyty appeared he in by himself/herself and affirms that
all statements and declarations are true and accurate. A
Notary Public at Large,State of EL ,County of d/�)VA-1J CI 1
.454",:e",'•;,- JENNIFER JOHNSTON
0 PersonallyKnown �^^y1 n r� C n ^ ( °' = MY COMMISSION#GG 042984
ProducedIdentification- FI— l.l� \q U-1 - `t L�—r `v _*: ';*�
Iii • = EXPIRES:October 27,2020
`-467 ;F o,`moo? Bonded Thru Notary Public Underwriters
, Alk
Notary Signature: Nilli
F:BLDG/Owner-builder Affidavit;• VISED:4/16/2009