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1835 HICKORY LANE DEMO INT PERM DEMO PERMIT PERMIT NUMBER DEM019-0005 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ISSUED: 2/11/2019 ATLANTIC BEACH. FIL 32233 EXPIRES: 8/10/2019 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 CODEA. 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: 1835 HICKORY LN DEMO INTERIOR ONLY EXTERIOR AND INTERIOR $0.00 DEMO TYPE OF REALESTATE BUILDING USE ZONING: SUBDIVISION: CONSTRUCTION: NUMBER: GROUP: SELVA MARINA UNIT 1720201438 12C R/P COMPANY: ADDRESS: CITY: STATE: ZIP: OWNER: ADDRESS: CITY: STATE: ZIP: STORY GRAHAM N 1835 HICKORY LN ATLANTIC BEACH FIL 32233-4547 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. w7m DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT BUILDING PERMIT 4SS-0000-322-1000 0 $S5.00 STATE DBPR SURCHARGE 45S-0000-208-0700 0 52.00 STATE DCA SURCHARGE 45S-0000-208-0600 0 $2.00 TOTAL: $59.00 Issued Date: 2/11/2019 1 of I .5-1 Is,"" Building Permit Application Updated 1019118 City of Atlantic Beach Building Department "ALL INFORMATION 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED. C-1 C- Job Address: Permit Number: 0ouL Legal Description -RE# Valuation of Work(Replacement Cost)$ U�-�VXW�J Heated/Cooled SF Non-Heated/Cooled • ClassofWork: [--]New ElAddition 0;�Iteraflon Ml�'e`pair ElMove 915�emo E]Pool E]Window/Door • Use of existing/proposed structure(s): OCommercial V<esidential • If an existing structure,is a fire sprinkler system installed?: E]Yes E��o • Will tree(s)be removed in association with proposed proffiect? E]Yes(must submit separate Tree Removal Permit) M-No cribe in detail the type of work to be performed: I I <�Lkk C, &M 0 oc:>O�5 Soy\ 6 0 cic(e Florida Product Approval# for multiple products use product approval form PropertV Owner Information Name slb_� Address City Ps S�i State FZ - Zip Phone C4 E-Mail I V,c:> _D 0 V\^ C�� 16-D Owner or Agent(If Agent, Ilower of Attorney or Agency Letter R�quirecl) c:x�,� Contractor Information Name of Company Qualifying Agent Address City State Zip Office Phone Job Site Contact Number State Certification/Registration# E-Mail Architect Name&Phone# Engineer's Name&Phone# Workers Compensation Insurer OR Exempt ci 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 regulating construction in this jurisdiction. I understand that a separaW.permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS, 06AIR CONDITIONERS,etc. NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicabW 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 OBTA Ir�ANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE 0 0;1 01 RECORDI NOTICE OF COMMENCEMENT. 154o�jatu e of Owner or Agent) (Signature of Contractor) S )to(Qr affirme ;/ djay of Signed and sworn to(or affirmed)before,me this _��qe worr d)before me thi! day of Z_ by �cJ\qCn\ Vuelr,� by n ure 4--<Ignature of Notary) TON!GiNDLESPERGER My COMMiSSION#FF 924951 eW3:kclober6,2019 N K, ywa Ofirwnters Personally Known OR 4,,0F, on— .001 Produced identification L)7 Type of identification: Type of Identification: zcs Owner Builder Affidavit "ALL INFORMATION HIGHLIGHTED IN City of Atlantic Beach Buildin Department GRAY IS REQUIRED. 9 800 Seminole Rd, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:b C-4,,"C, t9- 00&� 1. 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. YOUHAVEAPPLIED 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. 11. 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 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(l). 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. CONTACT THE BUILDING DEPARTMENT(904- 247-5826 OR BUILDING-DEPT@COAB.US) 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. JobAddress: Owner Name: Phone N umber: 7�Ai Mailing Address: V�� City: State: Zip: Notarized Signature of Owner f The or oing insttment was acknoyvl/edlge� before me this I': ,-)in the State of Florida, County _1�clay of Signature of Notary Public Personally Known OR Produced Identification Type of Identification: 3(00-- Z_Cj 7 C"*)C-_�i - -------- Updated 10124118 TON]GINDLESPERGER MY COMMISSION#FF 924951 EXPIRES:October 6,2019 Bondod Thru Notary Public Underwdters Graham Story 1835 Hickory Lane Atlantic Beach FL 32233 904-249-5730 February 11, 2019 City of Atlantic Beach Building Department To Whom It May Concern, I am the owner of the above referenced property and engaged Ferguson Builders Inc., to secure permits for renovation work I'd like to have done. It's my understanding from discussion with Building Department staff that Ferguson has pulled a demolition permit for me but I don't have a copy or a reference number. I've since decided that I would like to take over managing the permitting process from Ferguson,therefore I'm requesting release of Ferguson from the demolition permit and transfer of the permit to my name. I understand there will be a transfer permit fee. Thank yp!5�ery much. am Story A TONI GINDLESPERGER My C� Xp My COMMISSION#FF 924951 BLded�Thru Notary Pubfic Underwhters EXPIRES:October 6.2019 n -,x- C;; -,"�=16 E�