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720 SABALO DR - INTERO RENO RESIDENTIAL PERMIT PERMIT NUMBER CITY OF ATLANTIC BEACH RES18-0353 ISSUED: 10/19/2018 °if1 800 SEMINOLE ROAD ATLANTIC BEACH. FL 32233 EXPIRES: 4/17/2019 MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION. ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES . ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY. 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. JOB ADDRESS: PERMIT TYPE: DESCRIPTION: j VALUE OF WORK: RESIDENTIAL ALTERATION 720 SABALO DR RESIDENTIAL Living/Dining Room Drywall $250.00 TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION: CONSTRUCTION: NUMBER: GROUP: 171430 0000 ROYAL PALMS UNIT 02A3.00 COMPANY: ADDRESS: CITY: STATE: ZIP: OWNER: ADDRESS: CITY: STATE: ZIP: W W BERG INC PO BOX 350747 JACKSONVILLE FL 32235-0747 WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR 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. LIST OF CONDITIONS Roll off container company must be on City approved list . Container cannot be placed on City right-of-way. DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT BUILDING PERMIT 455-0000-322-1000 0 $55.00 BUILDING PLAN CHECK 455-0000-322-1001 0 $27.50 STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00 STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00 TOTAL: $86.50 Issued Date: 10/19/2018 1 of 2 •,rs"' \'i)i lir % RESIDENTIAL PERMIT PERMIT NUMBER :'r ; RES18-0353 iit CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ISSUED: 10/19/2018 �`'t O� ATLANTIC BEACH. FL 32233 EXPIRES: 4/17/2019 Issued Date: 10/19/2018 2 of 2 City of Atlantic Beach APPLICATION NUMBER (4c Building Department (To be assigned by the Building Department.) ' 800 Seminole Road C ) �� C ` 3 �__; -e Atlantic Beach, Florida 32233-5445 KES/ J Phone(904)247-5826 • Fax(904)247-5845 .:,JR �? E-mail: building-dept@coab.us Date routed: /C7 / SP! p City web-site: http://www.coab.us !!! APPLICATION REVIEW AND TRACKING FORM Property Address: 7Z0 S/113/17--,O ment review required Yes No m Applicant: 1A) (Adi 6 z _.� Planning &Zoning Tree Administrator Project: Lt 1/1/0 /DiNiiki67 RAN) Public Works Public Utilities "DRY 1,0 "L(„... 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: roved. ❑Denied. nNot applicable (Circle one.) Comments: BUILDIN PLANNING &ZONING Reviewed by: Date:/0/6'cOl( TREE ADMIN. Second Review: ['Approved as revised. ❑Denie . I '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 insOP 1C Building Permit Application FHCE CUpda dY/8 /17 City of Atlantic Beach imiv 800 Seminole Road,Atlantic Beach,FL 32233 Phone:(904)247-5826 Fax:(904)247-5845 Q !x ' 5p4�� LU R . Permit Number: r ` f " '03s3 Job Address: _/�© i r1l� r f 7, Legal Description �j( I k01-1 —16 "247E pD iALALAL l 172ALctI J Num,-:to 4 i 720 --(zoo Valuation of Work(Replacement Cost)$ �70 , '° 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): Commercial Residential a 43 • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A • Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal Describe in detail the type of work to be performed: U v Florida Product Approval# for multiple products use product aoWl irrp. Property OwnererInformationI '/ ,�, `� m E Z Name: ��1,3 ✓'l/Lj Address: 7745 ilik 1 r���`a.L TMl? %.10 L3 p 0 Q City -l. State FL Zip X22(7 7 h e g04 46'3 Z E-Mail �Ipe L� Z CC Owner or Agent(If Ag�nPower of Attorney� or Agency Letter Required) V J � 0 Con ra : Information CC Q z Name of Compa • .1t: &c-'f 4 (�P �E Qualifying Agent: U. LI_ a n Address City State Zip 0 O w w 5 Office Phone Job Site/Contact Number > 4 5 m W F Lill j p State Certification/Registration# E-Mail WF- L wLU Architect Name&Phone# j rr W Engineer's Name&Phone# W W Workers Compensation cc Exe /Insurer/Lease Employees/Expiration Date 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 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 FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE REC• "DING YOU '- NOT OF COMMENCEMENT. I0 �e.t . 4 / 'gnatuof Avner or Agent) (Signature of Contractor) (including contractor) Si ned and sworn to(o affirme. before mem�.�++l�--i day of Signed and sworn to(or affirmed)before me this day of 0 C , Al I _ by , (u• , ,by , -, 11WAM dr (Signature of Notary) (Signature of Notary) [ ]Per onally Known OR r-------[ ]PPAvalb: e. jeKti 7�NrfF�roduced Identification/, . / , I._F MY�O4 1l Type of Identification: /r LCI ( [4 . [ * WORM topteigai sp2022 4 .,Fs`• Bonded Nu Notary Pubic -Underwrite `ini CITY OF ATLANTIC BEACH LI V C rr us 9/ 4S%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. .7e '5.A-P2 ca-, /04- 40'3 043 0 ADDRESS PHONE NUMBER LL i cv A 73C ' NAME / �;� -., 14' % . URE tX_k'" DATE IIBefore me this iS day of�i 20a in the county of Duval,State of Florida,has personally appeared herin by himself/herself and affirms that all statements and declarations are true V and accurate. ` Notary Public at Large,State of Ft..... ,County of](i(, e- ( 2 Pe duce y Known �f t 1 k ` roduced Identscation- 4 Il \f j�y "�� srp"^ ;, t- ill JAMIE D.SMITH r „/ j�. L•-: ; MY COMMISSION 0 GG 255331 Notary Signatur . , �. %?'-�..�8,: EXPIRES:September 5,2022 .'%`.F.reti�'° Bonded flxu Notary Public Underwriters F:BLDO/O er-Build. Affadavit;REVISED:4/16/2009