302 MAGNOLIA ST - SIDING REPAIR Ji 1S!.�L`IjlJy.,�
SSS CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
1.11-01i19 r INSPECTION PHONE LINE 247-5814
RESIDENTIAL -ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES18-0312
Description: T-111 SIDING REPAIR
Estimated Value: 6000
Issue Date: 10/3/2018
Expiration Date: 4/1/2019
PROPERTY ADDRESS:
Address: 302 MAGNOLIA ST
RE Number: 170446 0010
PROPERTY OWNER:
Name: TOKE JONATHAN ET AL
Address: 302 MAGNOLIA ST
ATLANTIC BEACH, FL 32233-4028
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.
11. vift, City of Atlantic Beach APPLICATION NUMBER
(S (I) Building Department (To be assigned by the Building Department.)
r 800 Seminole Road VP(r�...• ,±.t. _ 5r Atlantic Beach, Florida 32233-5445 ' — ` do I Z
Phone(904)247-5826 • Fax(904)247-5845 l 14 ( -
r.;;j9'r E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 3C)7 M, 1G(V rju A nt review required Yes No
Buildinq__—)
Applicant: 0 w N C---g— Planning &Zoning
Tree Administrator
Project: S t tf\� C .pAl p. ., Public Works
Public Utilities
I —
111 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: proved. I 'Denied. I INot applicable
(Circle one.) Comments: '3
,/
/1)OC, g 3i /Y1s i r1 iYO S re S s ill S diue1
BUILDING , Y
9
PLANNING &ZONING Reviewed by: Dater/?8/20/2-
TREE ADMIN. Second Review: Approved as revised. I IDenie . 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
rBuilding Permit Application at
City of Atlantic Beach 0 F F I C` try
800 Seminole Road,Atlantic Beach,FL �.J
32233
�1,,,� I Phone:(904)247-5826 Fax:(904)247-5845 ``�',
Job Address: Jo) frrJ(y J((rc 5"f Permit Number: ►�C,S( `- S I a_
Legal Description Q� c0,1'+'c4t r o- P?,-1 Co )5 IG"aS- .r(L") RE#
Valuation of Work(Replacement Cost)$ (mo i r.00 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration(Repa')- MoykDemo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial (Residentia
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes N/A 0
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal Ntkr,,e f,e
Describe in detail}} the type of work to be performed: z
ref, (r Vl ofei E't r=C j}r i f r�✓f" be Z2`w11 vsi f Y31 i s It-t, ieve!7- ,,i,e-kri- `i.t<7 J Z
i_1 l ( Sccnc' — 4 o o
Florida Product Approval# for multiple products use product aErgl�rm
0COProperty Owner Information 6 O a
Name: „d-4-..trti '7.i Address: s,,,-). .�.cr.,G� :f W — Q U G
• -'tea
City �*cV.=S31vfl(,� State L Zip -�c1'33 Phone 5r 1 c{U`� �a , 0�e_. (6 �_
E-Mail i or)t •4,,r>r; . 'kr�p-k' f i_105Y-t?ll c (0 ri ,i a
Owner o'r)gent(If Agent, Power of Attorney or Agency Letter Required) U FF– cn 19
CC
Contractor Information 0 Q g w
Name of Company: ,4 1,4 Qualifying Agent: U. ' ix 2
Address City State Zip W Ola 25 co
Office Phone Job Site/Contact Number ? F_- w C W
State Certification/Registration# E-Mail IWC.)
N CC W
Architect Name&Phone# �-•'„ W 5
Engineer's Name&Phone# CC W
CC
Workers Compensation
Exempt/Ir. rer/Lease Employees/Expiration Date
Application is hereby made to obtain a permit to do the fork and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and t . all work will be performed to meet the standards of all the laws regulationg
construction in this jurisdiction. I understand th. a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS, POOLS,FURNACES, BOILERS, HEATER , ANKS,and AIR CONDITIONERS,etc. NOTICE:In addition to the requirements of this
permit,there may be additional restriction• applicable to this property that may be found in the public records of this county,and
there may be additional permits required rom 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. I •TICE OF COMMENCEMENT.
.....,
ure of Owner or Agent) (Sig ure of Contractor)
(Indus' : .ontractor) I
need a d sworn to(ogr afl -r) before- e�t ' / d.y of Signed and sworn to(or affirmed)before me this day of
1.111"3121 Z� C 3 b 4k.)
Oh''. .2iC'JC �.� (� by
• .`:?Pk TONI GINDLESPER zER
— (Signature of Notary) :. ', .r: MY CC/MI uF�� 9 ota
rP EXPIRES:October 6,2019
[ ]Personally Known OR Bonded Thru Notary Public Underwriters
[ ]Personall
[ ]Produced Identification 7 2 [ ]Produced Identification
Type of Identification: t ZOO–4-Z ( -�z-ZJ D Type of Identification:
J t, CITY OF ATLANTIC BEACH r A:° ".� t''
''" 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.
ef.0",t 75y OQ()
ADDRESS ` PHONE NUMBER
PRINT NAME/
�^ (-Q,7c (301
SIGNATOR- DATE /
i r/
Before me this i day of S 1 2t� the county of
Duval,State of lori a,has personally a eared herin by imself I herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large, '1— C ,County of [[[-of )(Mar
❑Personally Known
❑Produced Identificatio
111FPARIVIIIA
� n`7 4. TONIGINDLESPERGER
7. 1 . ,,,r MY COMMISSION#FF 924951
Notary Signature: • � EXES: b6
BondedPIRThru NotaOctoc mt
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�eriiers
F:BLDG/Owner•BuilderAffadavit;REVISED:4/162009 -- - •--- -