1723 SEMINOLE RD - BATH REMODEL ,, .'S%;'J\lj
�' ' CITY OF ATLANTIC BEACH
rim ) 800 SEMINOLE ROAD
��� ATLANTIC BEACH, FL 32233
'! 1. INSPECTION PHONE LINE 247-5814
RESIDENTIAL - ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES18-0298
Description: Kitchen-Bath Remodel
Estimated Value: 2000
Issue Date: 9/4/2018
Expiration Date: 3/3/2019
PROPERTY ADDRESS:
Address: 1723 SEMINOLE RD
RE Number: 169643 0010
PROPERTY OWNER:
Name: Ed & Meredith Hines
Address: 1723 SEMINOLE RD
ATLANTIC BEACH, FL 32233-5832
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.
?S�:L�pf��, City of Atlantic Beach
C.
BuildingDepartment APPLICATION NUMBER
`'t,, p (To be assigned by the Building Department.)
800 Seminole Road
�-� _ l-r, Atlantic Beach, Florida 32233-5445 iES'8 (D2�8
i?'..,-'-";.':7" Phone(904)247-5826 • Fax(904) 247-5845
'�!oli10. E-mail: building-dept@coab.us Date routed: biZ�/��
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 11 23 SE---Mt LC De ent review required Yes
/No
_ea
!/
Applicant: 14 owl C 0 IA) )U ERPlanning &Zoning
Tree Administrator
Project: t' K(TCH IJ izEiyi 6.1)6Z_ Public Works
Public Utilities
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: f/pproved. Denied. ❑Not applicable
(Circle one.) Comments:
BUILDINC
PLANNING &ZONING Reviewed by: �).-----TREE ADMIN. Second Review:
Date: d'/3 1/201
'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
(TPA Building Permit Application Updated 12/8/17
' City of Atlantic Beach
lr , 800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904 24 -582 Fax:(9�0�4)�47-5845 /, q Q'
Job Address: 1 7 2 3 S e.Y i ft Olt- t Det i[ beet Permit Number: 1 g�V ( D
Legal Description RE#
o.>
Valuation of Work(Replacement Cost)$ Z CDC)C 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): Commercia Resi ential
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes!'Nd N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Af idavit of No Tree Removal
Describe irk detail the type of work to be performed: ,. f- j �j jr'��
i j,(.l� i C�d�''l �-C G�t� C-4-0(UI-ti.‘.--.i.� YJ<1444�`b us,cAb c itP/Y i; 6t .!�o flu /
0O r- ( alb t---i---( D.(' C '1 f(U/P- 110 Z
Florida Product Appt'val# for multiple products use product al ogrl t O
Property Ower Infor atio)n I• a U Z 1.:.
Gb
Name: e-41,(4,9t i 1-44fitt7,j { Address: 172) 5C-inen.o�� Rd 2 w O o ui
City f -f(C�.vlt. [, 63 e-Ad., State iZ1 Zip 3 ZZ 3 3 Phone q 00 9 9 9j-- 2 ` 7-1H G
E-Mail -it (4 - clgN 614:1 • �l�'\- VVV in U O
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) 0 cJtn2� O 7 Cr Z
Contractor Information 0J O N
Name of Company: Qualifying A:-nt: E" 0 N
Z
Address City State Zip n 5 W
Office Phone Job Site/Co :ct Number 0 w W
O
State Certification/Registration# E-Mail } a UG m
Architect Name&Phone# ',.1::, W Q w
Engineer's Name&Phone# W N W W
Workers Compensation
Exe. pt/Insurer/Lease Employees/Expiration Date �W tu
Application is hereby made to obtain a permit to do e work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit an. at 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 FINA I CING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YO R NOTICE OF COMMENCEMENT.
r
/ lai
.ture of Owner or Agent) (Signature of Contra r)
(includ'•:.contractor)
Igned and orn to(or aff rmed before 's 1.-j day of Signed and sworn to(or affirmed efore me this day of
i,_
(Signature of o any (Signature of Notary)
[ ]Personally Known OR [ ]Personally Known OR . .._:.,, °*�...a..../...•••, '
[ ]Produced Identification �f _ [ ]Produced Identificati .. TONI GINDLESPEI
Type of Identification: L. ` Sz� �� Type of Identification: - MY COMMISSION#
YP `PIRES.()Globe i
CO Z -4 c7 0 motaryPub' tiers
•I L'Uyr..�
r4, ; CITY OF ATLANTIC BEACH OFFICE COPY
'1 f WNER / BUILDER AFFIDAVIT
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 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.
1 ? 23 Seal nt‘_ qA418,441c, eetraz'''-9 0 , °1 -27Sc7
ADDRES PHONE NUMBER
4 � ..O• ( 1")nee
PRINTE
! 2 0 2D °
SIGNAT E DATE
Before me this zC y of Mil ,201On the county of
Duval,State of Florida,has personally a.••are. herin by himself/herself and affirms that 7' TONT GIh1DLESPERGER
all statements and declarations are true I' accurate. ,,,i,47'°;;;:,••
n'F^��,
tom- ( MY COMMISSION�FF 924951
— II \ ' XPIRES:October 6,2019
Notary Public at Large,State of l ,County of U V �'• Q
'%s•... .• Bended Thru Pk,ary Public Undeiwrters
❑Personally Known
❑Produced Identification .M- .-
-M nNIGINDLESF
Notary Signature. ''019
w natd Tntc Nciay Public Underwriters
F.BLDG/Owner-Builder Affadavit;REVISED: 4/16/2009