612 Sturdivant RES18-0235 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL -ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NE)Cr DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES18-0235
Description: 612 STURDIVANT-WINDOW
Estimated value: 300
Issue Date: 7/17/2018
Expiration Date: 1/13/2019
PROPERTY ADDRESS:
Address: 610 STURDIVANT AVE
RE Number: 1706690000
PROPERTYOVMER:
mom: GEOVANNIORLANDO
Address: 610 STURDIVANT AVE
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name;
Address:
Phone:
Name:
Adchvoc:
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 them may be additional restrictions
applicable to this property that my 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 RVAC work
exceeds and estimated value of$7,500.
City of Atlantic Beach APPLICATIO�N NUMBER
Building Department (To be assigned by the BuiVin;gg Departme]nt.)
'g
800 Seminole Road
Atlantic Beach, Florida 32233-5445
a -7��
7
Phone(904)247-5826 Fax(9D4)247-5845 Date=2uted:: 9
E-mail: building-dept@wab.us
City web-site: hftp:1Avww.coab.Us
APPLICATION REVIEW AND TRACKING FORM
De artment review re uIred Yes No
Property Address: C, UwA,-)� Buildin
Planning Zonin
Applicant: L0 Tree Administra r
Public Works
Project: Wt. Public Utilities
Public Safety
Fire Services
IFT
ReVieW,fee.$_ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Pennit Verified B
Flonda Dept of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management DistnGt
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverage'..d T�
MOtherEM
APPLICATION STATUS
Reviewing Department First Review: MApproved. E]Denied. ONot applicable
(Circle one.) Comments:
(EF�
P p Reviewed by:_ m2k:� at 716 -Ir
LANNING&ZONING _Date: ::1
TREEADMIN. Second Review: [—]Approved as revised. E]DeniecY oNot applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:_
FIRE SERVICES Third Review: RApproved as revised. DDenied. E]Not applicable
Comments:
Reviewed by: Date:—
RIAaed 05119/2017
Building Permit Application Updined 5/5/17
City of Atlantic Beach
0 800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845
/'?T� - 3.�-aa3
JobAddressl AVC A IkAr,�_ 6'W,4 tPreirmit Number: REZIlb-- 07--L'S
Legal Descrip -RE#-
Valuation of Work(Replacement cost) Heated/Cooled SF 1500 - Non-Heated/Cooled_
Repair ove Demo Pool Window/Door
• Class of Work(Circle one): New Addition Alteratiorl�
• Use of existingliproposed structu re(s)(Circle one): Commercial 4�fee=sdenbal
• If a n existing structu re,is a fire sprinkler system installed?(Circle one): Yes �9
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail he pe of work to be performed:
al"id 7
Florida Product Approval for multiple Products use product approval form
Pro Owner Information
Name: 6 Address: &
city State jc:lo zip 32a3.7 Phon
E-Mail
Owner or Agent(if Agent,Power of A mey or Agency Letter Required)
Contractor Information 40
Z
Name of Company: Qualifying Agent: 0
Address Ciry_State ZIP
Office Phone Job Site/Contbict Number 0 r a
W ;-
State Certiffication/Registration# E-Mail Z cic Z
Architect N ame&Phone# U.
Engineer's Name&Phone#
Workers Compensation Exernipt I insumr/uuue Errplc"e�/E,,u.f.n Date W
Application is hereby made to obt n a permit to do the work and installations as indicated.I certify that no work or i I I@ as
commenced priorto the issuanc: of a permit and that all work will be performed to meet the standards of all the law nog
construct-ion in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBI is
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. IX W
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in complian ith all E
applicable laws regulating construction and zoning. cc W
WARNING TO OWNER: YOUR FAILURETO 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 NOT OFCOMMENCEMENT.
(Signature of 0 er or Agent) ftnature of Contractor)
fincludi co actor)
Siped ind sworn to(oraffir e efore me day I fined and worn to(or affirmed)befor e this day of
I�1 ZZ2L5 by b
c'
'N TO RGER
WoOMWM0N#FF924T5l
EXPIRES Wolier 6,2019
Personally I Personally Known OR
I Produced Identifficot I Produced Identification
Type of Identification Type of Identification:
0
OFFICE COP'
CITY OF ATLANTIC BEACH
OWNER/ BUMDER AFFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I "CONSTRUCTION
CONTRACTING"REQUIRES OWNER I 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 T14E 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$25,000.00 OR LESS. =11111112k-0
M=RUQ&yQUR U_$E 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,WITCH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY N
HIRF AN UNLICENSED PERSON AS YOUR CONTRACTO& 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 RAVE
LICENSES REQUIRED BY STATE LAW AND By COUNTY OR MUNICIPAL LICENSING
I QEDDIANM I
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
UL IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1D99 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOY NDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO$5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(l). AN-OCCUPATIONAL Lj�;gbj$E!IS NOT ADEQUATE, THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY 'CERTIFICATE OF COMPETENCY" UK 111i, 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.
5romQuaZ Avir ?rf J� :?2 2 3
ADDRESS PHONE NUMBER
PRINIT 7H
sx!w—'UH, DATE I I
Baud...t1da 7 dayof
count,ol
N.nd. t
all statements and dedamilcia a w nad.
Nots,Public at
00==,J ) C) TOM GINIMSPORIM
MYCOMMISSION ll"',W
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Notarysignatum
A9909& CITY OF ATLANTIC BEACH
800 Seminole Road
Atlantic Beach,Florida 32233
REVISION REQUEST/CORRECTIONS TO PLAN REVIEW COMMENTS
D,t,_ZhZ4t.&__ Revision to I....dP,rmit— Corrections to Continents Pemmt#-RE.S )S-O.L35
ProjectAddress 9j0-6jJ-(W7i-F";1y) STI"d"V'knT AVE AT4,,J�c- fz- 3-2233
Contractor/Contact Name QtD e C�aa��Al Orlajl
y
Phone 20 V-q 7-1 -5q/S Email GCOWIA;Afl,�Lv
e—
Description of Proposed Revision/Corrections: Permit Fee
::W��. ZMOPIAI&Me'T AL�. I
Additional Increase in Building Value$ 1600 Additional S.F.
By signing below,IG&w�,,� Orlo'to affim,the Revision is inclusive of the proposed changes.
(prinwd nvoc)
Z�a 711
Signature of Contractor/Agent(Contractor most sign if increase in valuation) Date
(Office Use Only)
Approved Denied Not Applicable to Department
Revision/Plan Review Comments Lmled /Vrik roo2v irpy
Department Review Required:
K�Buikfing
Marming,&Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities
Public Safety Date
Fire Services
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SEE PERMITS FOR ADDITIONAL
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REVIEWED BY: -IM-10ATE: ?- gal 9
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