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1851 Selva Marina RES18-0305 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 RESIDENTIAL -ALTERATION RESIDENTIAL MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: RES18-0305 Description: INTERIOR BATHROOM'S REMODELED Estimated Value: 1000 Issue Date: 9/20/2018 Expiration Date: 3/19/2019 PROPERTY ADDRESS: Address: 1851 SELVA MARINA DR RE Number: 1720200842 PROPERTYOWNER: Name: DICKEY STEVEN T Address: 1851 SELVA MARINA DR ATLANTIC BEACH, FL 32233 GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Namei 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 pennit,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 pernnits 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 11VAC work exceeds and estimated value of$7,500. City of Atlantic Beach APPLICATION NUMBER Building Department (ro be assigned by the Building Department.) 800 Seminole Road Atlantic Beach,Florida 32233-5445 C_�EA F,-CDs Phone(904)247-5826 Fax(904)247-5845 Date muted: E-mail: building-dept@coab.us Cityweb-site: hftp:/M�.coab.us APPLICATION REVIEW AND TRACKING FORM b S: �:J_V pt, [�\AP Rye Property Addres review required Y No Idling Applicant: 0 CAD ft-'.)Fq— Prafiltlng-&-Zoning Tree Administrator Project: 6 c�,y-c k K.(p /Y\. R Gff\,o 1)e L Public Works Public Utilities Public Safety Fire Services Review fee $ Dept Signature�� Other Agency Review or permit Required Review or Receipt Date of Pe mit Ve y Florida Dept.of Environmental Protection Florida Dept.of Transportation St.Johns River water Management District Amy Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other APPLICATION STATUS Reviewing Department First Review: 194PI-ved. E]Denied. E]Not applicable (Circle one.) Comments: (FU TOIN PLANNING&ZONING Reviewed by: Dated-AO-4-- TREEADMIN. Second Review: ElApproved as revised. []Denied. E]Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date:— FIRE SERVICES Third Review: ElApproved as revised. []Denied. E]Not applicable Comments: Reviewed by: Date: R.�ized 0511912017 Building Permit Application Updated 12/8/17 City of Atlantic Beach 8005e.m.l.Road,Atlantic Bca,h,I'L 32233 Phone:(904)247-5826 Fax:(904)247-SUS Job Address: \Jbii, UW�Ay%gmck W\rf� Pemit Number: R&—sl '0 — Legal Description RE# LU Valuation ofWork(Replacement Cost)$ Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): New Addition At teration Repair Move Demo Pool Window/Door • Use of existing/proposed struccure(s)(Circle one): Commercial 0!� • If an existing structure,is afire sprinkler system installed?(Circle one): Yes q0 N/A • Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal I the type of work to be performed: mw�r�V%Ak orm Florida Product Approvall! for multiple producits use product a0roval I Property Charnef Information 0 � I Z , e: Address: '11*1\1 ,am Date city. I Zip Zal Ph — 7QX1W'Q1Z'�U E-Mail 7�ftQ a 'i'2 %� 5 0 Owner or Agent(if Agent,Power of Attorney or Aiz�Jn i Ii �X P; Contractor Information 0 0 NameofCompany: QualifyingAge Lu I:= Address city State ZJ 0 0 2 Office Phone Job Site/Cisnitriat'humber State Certiffication/Registration If E-Mai ZZ Architect Name&Phone J! In Engineer's Name&Phone# o ai W Workers Compensation i�— n = 0 Exempt/insurer/Lense Employces/ExPranion Dam Lu a W Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or n4l9on%ill commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws ffFulationg construction in this jurisdiction.I u ruderstand that a separate permit must be secured for ELECTRICAL WORK, PLU M BINCOIG NS, cc 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. gnatum of owner or Ql� 'N� r Agent)U (Signature of Contra or) (including contractor) ed aro sworn to(or affirmEft before me this 7—day of Signed and swornn to(or affirme efore me this day of zbz :�I �'&"t CA Q,4 __b \41 1 11 r , , 4, �'l . � (Sainatureoftloon') (Signature of Notary) )is I Personally Known OR L j I Produced Identification Type of ld.ntifl.ti.n: 1 —7 b�oeapyipe of Identification: CITY OF ATLANTIC BEACH (OWNER/ BUILDER AFFIDAVIT OR >- 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 'CONSTRUCTION CL CONTRACTING'REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW. C) C-) DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLOREDA STATUTES: Lu STATE LAW REQUIRES CONSTRUCTION TO BE DONE By LICENSED T] CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THA LAW. THE EXEMPT10N ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST LjL 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. TIM BUIL MSI BE FORYDITRUSE AND OCCUPANCY. ITMAYNOTBERUILTFORSALEORLEASE. IF YOU SEI T 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 E3wMPTICN. YOU MAY NOT HIRE AN UNLICENSED PER5QN AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSERLITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAU LICENSES REQUIRED By STATE LAW AND By COUNTY OR MUNICIPAL LICENSIN It. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. Ill. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX ANDIOR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER AN CIRCUMSTANCES. OWNERS BEING SUBJECT TO$5,000 PENALTY UNDER FLORIDA STATUTE NO, 455-228(l). AN-OCCUPATIO 4AL 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. kM ADDRESS PHME NUMBER Wiloin TINIkIc Y14 PRINT NAME ckwEkc\ aj3i�g SIGNAIuKh (1 %3 DATE Befiam me Mis ��L.day of e�)+—,2ULSMS county of Du"l,��aFidlid..h..,��.[Y.PO.l�d hernWhimselOheiaeffandaftimsMat C.unty ef ..C)�Qq' 00=1=1 %l G�0111R MY "F111111 EXPRES Oc,,E M,, Nolar,Sgaabuaa: c