2233 Seminole Unit 21 RES18-0223 CITY OF ATLANTIC REACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL-ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NE)(T DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES18-0223
Description: install Patio SGD
Estimated Value: 1000
Issue Date: 6/27/2018
Expiration Date: 12/24/2018
PROPERTY ADDRESS:
Address: 2233 SEMINOLE RD UNIT 21
RENumber: 1695`19 0140
PROPERTY OWNER:
Name: KRISTA CARRERE
Address: 2233 SEMINOLE RD
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:.
Phone:
Nam;
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 FIVAC work,a Notice of Commencement is only required when UVAC work
exceeds and estimated value of$7,500.
City of Atlantic Beach
Building Department
800 Seminole Road
Atlantic Beach,Florida 32233-5445
phone(904)247-5826 Faor(904)247-5a45
E-mail: building-dept@wab.us ME
City Weisite: hftp:/A~.wab.us
APPLICATION REVIEW AND TRACKING FORM
Property AddreSS:IZ33 SeMi 6 1 e ant review re uIred Yes 0
Planning &Zoning
Applicant: komeww n er Tree Administrator
Project: PLUO'Lhc� SG h Public Works
Public Utilities
Public Safety
Fire WSerwims 77
Review fee $
Other Agency Review or permit Required Re low or Receipt Date
no of P mfit Verlified MB
Florida Dept.of MEMImnmental Protection
cl
r r
ict
.d
Florida Dept.of Transportation d4
St.Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaurants
se. T
To
0 .
Division of Alcoholic Beverage-
Other
APPLICATION STATUS
Reviewing Department First Review: [B<Proved. E]Denied. [-]Not applicable
(Circle one.) Comments:
q:U1=LDINd — E]Deme E ot app, 'a
PLANNING &ZONING Reviewed by: /" I Date:6 7
TREEADMIN. Second Review: E]Approved as revised. E]Deniad. []Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:_
DDemed. ONot applicable
FIRE SERVICES Third Review. OApproved as revised.
Comments:
Reviewed by: Date:—
RevI,ed06119r201?
OFFICE COPY JUN 2 5 2018
Building Permit Application Updaited 1219/17
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FI.32233
Phone:(904)247-5826 Fe.(90412474845
job Address: 7,7-13 semlojoix R6, hPileal IA8 Permit Number&8(8�-0273
Legal Description 0q_a3_2.7F ' OrCA,,) , avr_-Cw�C2 *aL_RE# 1617 si'l- 0/c/0
Valuation of Work(Replacement Cost)$ /6'00 ee H..Wd/Coi,d SF 1307 Non-Hnted/Cooled
Addition Alteration Repair Mo 0 Pool Wind cor
• a...of work(circle me): New
• Use ofexisting/proposed struct.re(Q(arch,one): Commercial(�eslchentlal
�esidentlo.l
. '. No 0)
• If an existing structure,is afire sprinkler system Installed?(Circle one : Yes
• Submit a Tme Removal Permit Application If any tree,are to be removed or Afficlavit of No Tree Removal
0 -.1._d. _�
;�iZElb Oil t1e7V a of.,k to t.�perfrmed
/96,-4 OF ? 61 h% 1)Dop- -
he,61"R-VT 43� 5L4bJAJ4
for multiple products use product approval form
Florida Product Approval
rinf 111 [on R41)
nf m
Name: L AIV
_Z
city MME�St;.te�_L_;Vp Z.— Phone
C
E-Mail
E MaiV1
owner or Agent(if Agent,power of Attorney or Agency Letter Required)
Contractoor Information
Name of Company: II-iGA 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 n one
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 w 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 CONDMONERS,etc.NOTICE:In addition to the requirements of this
permit,there may be additional restrictions appfica�e to this property that may be found in the public records of this county,and
1 s,or
there may be additional permits required from other governmental entities such as water management districts,state agenc e
federal agencies.
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all wark 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
RECO:RDIN
YOUR JOTICE OF COMMENCEMENT.
Sl'�tua.f�C ..101)
(Signature a Owner or Agent)
(including contractor) dayof Signed and sworn to(or affirmed)before me this day of
beff etl"`7�1� by
T
slit A
Nor Srat.re.fN.toy)
I Personally Known OR I Personally Known OR
[4-rroduced dentification I Produced Identification
T,pe.fidentlification: Type of Idernification:
OFFICE COPY
CITY OF ATLANTIC MACH
/�C
OWNER / BUILDER AFFIDAVIT
Lu
S. PART 1 'CONSTRUCTION 0
1. FLORIDA STATUTES: CHAPTER 489, FLORIDA STATUTE z
CONTRACTING-REQUIRES OWNER I BUILDER TO ACKNOWLEDGE THE LAW:
z
DISCLOSURE STATEMENT FOR SECTION 489.103(7).FLORIDA STATUTES: 0
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED 0 M
() L)
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT
LAW. THE EXEMPTION ALLOWS YOU,AS T14E OWNER OF YOUR PROPERTY,TO ACT AS ul r- <
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE YOU MUST a Z m
SUpEgVjSF THE CONSTgUCIp y L) If
_qVME� YOU MAY BUILD OR IMPROVE A ONE-OR 0 0
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR 0
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25.000.01 OR LESS. THE BUILDING M t:
MUajAEjQ&yQU9j]V,AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE, 0 U. 2
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR U. o Ir
AFTER THE CONSTRUCTION IS COMPLETE.THE LAW WILL PRFSUMETHAT YOU BUILT a W
&
IT FOR SALE OR LEASE WHICH IS IN VIOLATION OF THIS EXEMPTION, YOU MAY NOT Lill w
nON MUST w w
HIM AN UNLICENSED PERSIDN AS YOUR CONTRACTOR, YOUR CONSTRUC
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EA&QYWLAy-XQV�V c w
LICENSES &SOUTRED BY STATE LAW AND By MIINTY OR MUNICIEAL LICENSING
IL INJURY LIABILITY; SINCE OWNERS i,_4&X BE To WORKERS THEY HIRE.
THE BUILDING DEPARTMENT SUGGESTS WORKERS COMPENSATION INSURANCE BE
PURCHASED.
Ill. IRS WITHHOLDING: OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX ANGIOR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLIC:E 1111111) 1,11 RACTOR5
CIRCUMSTANT,U,OWNERS BEII 113 SUBJECT TO $5,000 12ENAL 1 1
455-228(l). AN-QQ0 VA�IONAL LlCrN510 Ir,NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY 'CERTIFICATE OF FLORIDA *CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON 18 A LICENSED CONTRACTOk TELEPHONE THE
BUILDING DEPARTMENT 1247-5826)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.
F�E�W�R
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EVIN�J-mi3,2021