828 CAVALLA RD - DOOR & WINDOW RESIDENTIAL PERMIT PERMIT NUMBER
RES18-0379
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH. FL 32233 ISSUED: 11/27/2018
EXPIRES: 5/26/2019
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: VALUE OF WORK:
828 CAVALLA RD RESIDENTIAL ALTERATION Siding, Door& Window $1800.00
RESIDENTIAL
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171717 0200 ROYAL PALMS UNIT
02A3.00
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
Blake Ehler 2142 Cypress Landing Dr Jacksonville FL 32233
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.
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 $60.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $30.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $94.00
Issued Date: 11/27/2018 1 of 2
-0.J-Vi-i-,,. City of Atlantic Beach APPLICATION NUMBER
J Building Department (To be as igned by the Building Department.)
rjAtlantic Seminole Road ) (jam O3 B
Beach, Florida 32233-5445 (QPhone(904)247-5826 • Fax(904)247-5845
7
f /� E-mail: building-dept@coab.us Date routed: t i f ` / ,
City web-site: http://www.coab.us 111 111
APPLICATION REVIEW AND TRACKING FORM
Property Address: V IC. k.UQ Department review required Y177- No
cuiIdincp
Applicant: ObrYle- D W flfir Planning &Zoning
n
c Tree Administrator
Project: J j t n V v i nd Ow k Public Works
j ) 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: Approved. ❑Denied. ❑Not applicable
(Circle one.) Comments: S ToP VI UP k .c, r ole Y F--e-t Shat 1 ka--e_
BUILD( . CIP) iPd 4 4-A P *-; c--c 0 . 4-1)(--5. P-rYwn(`4-.
PLANNING &ZONINGM a0-is,
Reviewed by: Date:
TREE ADMIN. Second Review: ❑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
4;rt "`f`,'a'25)
Building Permit Application Updated l0/9/18
'1
City of Atlantic Beach Building Department **ALL INFORMATION
�r 800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
�`Dii1r" Phone: (904) 247-5826 Fax: (904) 247-5845 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: Z8 Cf v0".UC cl\.G M04-(C g�� cor �'Permit�ZNumbZ'�1 j er: I 6311
( i
Legal Description . ',1`" 2-3'- 2 9 E Pi*. T v RE# tlI7 17 - 0I-GO
l
Valuation of Work(Replacement Cost)$ , ICO Heated/Cooled SF Non-Heated/Cooled
• Class of Work: [Mew ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool Window/Door
• Use of existing/proposed structure(s): [Commercial ❑Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No oN/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: (4A__ U 5• �,,�y ` w,^ili a, 4dr ��
t% .
OP;hdo'.- 5)dtoo� 7 �,
Florida Product Approval# /y9�/,/ j r—f /3 2z--3�' �2 363/ for multiple products use producigparov4larrr�
Property Owner Information 0. d z h
Name �$�.O.-\C.tt... ��+.\R Address el\L4 Ly rGr�, L��\V� LJ z ui
Cit 50� �,I'Q�V E��Z, State F-
y C� �— Zip `✓'22,�J Phone �(jy - x7(- �� O Q
E-Mail blv. e., e1.,.\,-tr Q 31-N-0: cut,,
LU Q o 0
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) 0 2 tr Z
Contractor Inform. 'in U J L.O cn
Name of Company Qualifying Agent CC el Fes- Z
Address City State Zip LL U- ix 2
LU
Office Phone Job Site Contact Number p 0 LH w
State Certification/Registration# E-Mail W N ,n, "1, 0
Architect Name& Phone# W U cLn to
Engineer's Name&Phone# 5 cc w
Workers Compensation Insurer OR Exempt❑ Expiration Date IJ W
rt
Application is hereby made to obtain a permit to do the wo and installations as indicated. I certify that no work or insinstallation has
commenced prior to the issuance of a permit and that all work I be performed to meet the standards of all the laws regulating
construction in this jurisdiction. I understand that a separate permit 'ust be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS, and AIR CONDITIb' ERS,etc. NOTICE:In addition to the requirements of this
permit,there may be additional restrictions applicable to this property that m. be found in the public records of this county,and
there may be additional permits required from other governmental entities such a ater management districts,state agencies,or
federal agencies.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work wil .- 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
RECORD YOUR NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) (Signature of Contractor)
Signed and sworn to or affirm `befor: - his L C dpy of Signed and sworn to(or affirmed)before me this day of
KU`VQm�i. , er.o.. by 1/'� 'Q_ lei►' r ,by
�I4A, ' _ r_I'M
;�;Y nature 0 ..1 .�q (Signature of Notary)
t... ; 5 , i.SMITH �
*: 4 MY COMMISSION#GG 255331
[ ]Personally Known OR .F2 °c',BO d 'September5,2Q22 [ ]personally Known OR
--• Notary Pubac Underwriters
Educed Identification]L _ [ ]Produced Identification
Type of Identification: (— �.—' Type of Identification:
rj-fr COPY
r� - �� OFFICE
y CITY OF ATLANTIC BEACH
WNER / BUILDER AFFIDAVIT
If 9r
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.
e—atC aU� � Q e 7o-1- ?7(- s o
ADDRESS PHONE NUMBER
PRINT NAME
t 46 /ce,
SIGNATURE n Qt- ( (/� DATE
Before me this t� day of *ye- `D� ,20 V' in the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of FulaAunty of TI/LA..Vim-I
oPersonally� Known
,.., �'a
oduced Identification- P "- L•
:, JAMIE 0,SMITH
;.; MY COMMISSION#GG 255331
lig +:-' EXPIRES:
Notary Signature:„�J• ON s,,f ,�e, SePlembet5r2rv22
EXPIRES:
17xu Notary Pubic Undervortters
F:BLDG/Owner udder r adavo;REVISED' 4/16/2009