351 1st DEMO18-0030 DEMO PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH DEM018-0030
800 SEMINOLE ROAD ISSUED:
ATLANTIC BEACH. FL 32233 EXPIRES,
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
7�� 9Y&W4G.
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,orfederal agencies. -
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
351 1ST ST DEMO INTERIOR ONLY Interior Demo $80000
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1697670000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
LOVE WILLIAM 1 351 IST ST ATLANTIC BEACH FL 32233-5227
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 ORAN
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.
DLSLR11ATION LCEO;UNT QUANTITY PAIDAMOUNT
.E.. _ "S'C� �
UTICA 0
$2W
STATE DBPR SURCHARGE 12 '22 2LO-0 —0
STATE OCA SURCHARGE 0 $2.00
T TAL:$104.00
0
issued Date: 1 of 1
City of Atlantic Beach APPLICATION NUMBER
Building Department (ro be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach,Florida 32233-5445
Phone(904)247-5826 Fax(904)247-5845
E-mail: building-dept@coabms Date routed:
City we"ite: hftp:/hvvm.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: (351 ( 'S ST ant review required Y No
C BRuT d@,V --7—
Applicant: M D192�( L,6V E_ -Pra—nning&Zoning
Tree Administrator
Project: 6r D��m 0 rus
(=�,We
Public Safety
F—Fire services
Review
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Ftorida Dept.of Environmental Protection
Florida Dept.of Transportation
_SiAohns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other: — 1
APPLICATION STATUS
Reviewing Department First Review: OaApproved. E]Denied. ONotapplicable
(Circle one.) Comments:
CUIUD�l ;6
PLANNING&ZONING Reviewed by: rn)e-- —Date: /JP nd.9-00/i
TREE ADMIN. Second Review: ElApproved as revised. [-]Denied. E]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:—
FIRE SERVICES Third Review: []Approved as revised. []Denied. ONot applicable
Comments:
Reviewed by: Date:—
P�lsed 0611912D17
Building Permit Application Updated 12/g/17 >,
City of Atlantic Beach a_
NO Seminole Road,Atlantic Beach,FIL 32233 0
11one:(904)247-5826 Fax-(99A247-5845
-Dcm -0 Cj
Job Address: roUt Number-
Legal Description '41,A.L.,&-Q6 19-ol R C)i II!o k /9-' &:::7- RE#
0' EV
�MCT 33
Valuation of Work(Replacement Cost)$ H..td/Co.i.d SIP - Non-Heated/Coolled
• Class of Work(Circle one): New Addition Alteration Repair M em Pool Window/Door
• Use ofexisting/proposed structure(s)(Clircle one): Commercial �Qee!�d
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes (F2:>N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Afflidwit of No Tree Removal ...
Describe In d0ail the type of work to be performed: 0
Z
V'1'0 r t e rr)C5 0 _J ZO
Florida Product Approval A11V for multiple products use product ap v9i_
#_ I k.UU 0
Property Owner Information 0 ro 0 W l
Name: rG�q Address: 35k 0 L) 0
city Ste Zip Phone
E-Mail 0 rlr,,� ;I , Qa� 0
Owner or Agent(if Age t,Power of Attorney or ency Letter Required)
Contractor Information W t: Z
0
Name of Compari i-Leln Qualifying Agent:_ LL I:L
j3 W to GO
Addres City_State_ZlD
Office Phone Job Site/Contact Number C)
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineers Name&Phone It LU
Workers Compensation
Exempt I insurer/Lease Ernpoye.s/EpWatl.o Data
Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or instal lation 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.
OWNEWS AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliancewith 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.
11,�411!."'.'
al .
aA
I.gn.tAf�Agent) (Signature of�rtraclmr)
Uncludingoontractuar)
and sworn to(or affirmed)before me this day of Signed and sworn to(or affirmed)before me this day of
by V4q It 1-0 1-e by
(Signature of Notary)
(SIB re of Notary)
tfu
rally Known OR Personalty Known OR
I Produced Identification
uted Identification
Zypa Identification; f-wz- Z1SV�S-,V? ,6,0671X) Type of identification:
CITY OF ATLANTIC BEACH
OWNER/ BUILDER AFFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 'CONSTRUCTION
CONTRACTING' REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW.
DISCLOSURE STATEMENT FOR SECTION 499.103(7),FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTTION TO
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 MUS
SUPERVISE THE CONSTRUCTION YOURSELE. 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 FoRyDLJR USE AND OCCUPANCY. IT MAY NOT BE BUILTFOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE,WIRCH IS IN VIOLATION OF TIES EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MOST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
I ORDRIANCE& I
IL INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
111. 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.
ZS-228(l). AN-RCUPATIONAL 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 RAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
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ADDRESS PHONE NUMBER
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VGNATURE DATE
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