315 11th St. RES17-0162 garage door RESIDENTIAL PERMIT PERMIT NUMBER
IC' tt
g CITY OF ATLANTIC BEACH
RES17-0162
800 SEMINOLE ROAD ISSUED: 4/8/2019
ATLANTIC BEACH, FL 32233 EXPIRES: 10/5/2019
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:
RESIDENTIAL ALTERATION
315 11TH ST RESIDENTIAL install new garage door $5558.95
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170099 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
VERGARA OSCAR J 315 11TH ST ATLANTIC BEACH FL 32233-5531
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.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455 0000 322-1000 0 $80.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $40.00
STATE DBPR SURCHARGE 455-0000 208 0600 0 $2.00
STATE DCA SURCHARGE 45500002080700 0 $2.00
TOTAL:$124.00
Issued Date:4/8/2019 1 of 1
C:L��fi City of Atlantic Beach APPLICATION NUMBER
�� Building Department (To be assigned by the Building Department.)
800 Seminole Road n t 1 ,_O L/„ e
� Atlantic Beach, Florida 32233-5445 �t�,J TYlPhone(904)247-5826 • Fax(904)247-5845I' f��,i iia E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 3I, S I ( ST . Department review required YeNo
uilding J/
Applicant: OW nQ..( Planning &Zoning
Tree Administrator
Project: t n S\-Ct a Q,,..,) 6 u ffrawr Public Works
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: proved. ❑Denied. ❑Not applicable
(Circle one.) Comments: /{)
oc....._
BUILDING
PLANNING &ZONING Reviewed by: r
r I Date: 7-/z7(./ 7
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
. '�► Building Permit Application D Lup5/5/17
1 FFICE COPY City of Atlantic Beach 1 2017
800 Seminole Road,Atlantic Beach, FL 32233
"�' Phone: (904) 247-5826 Fax: (904) 247-5845 - �,
Job Address: u�hL k { Permit Number:
Legal Description RE#
a5
Valuation of Work(Replacement Cost)$ 'STS`d ----- Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Additionterati'n Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial _sicltaia•OaI
• 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:
►cc'-c,.k (New or«,--v ac;cs"
Florida Product Approval# -c1J_-_ T i 2C)(Q5 for multiple products use product approval form
Proper Owner Information '3.
Name: c h t(ib . Vr cm-exC Address: SNS- t 0" �� -t ,
City itj( cOPC.( State IL Zip 32.2h'5 Phone 911 .53c1 -3 11\
E-Mail (?k)STISNSTI- FNiNC'�?CtilAYwt1- CALTI1
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
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
Exempt/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.
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 NOTICE OF COMMENCEMENT.
---.tel;
(Stgriature of Owner or Agent) (Signature of Contractor)
(including contractor)
Signed and sworn to(or affirmed) before me this 31 day of Signed and sworn to(or affirmed)before me this day of
AlltSIASSr , a01', by 5i141:.SSt t aQ.1-\1Q{1 G(CI ,by
(Signa re otary) (Signature of Notary)
�,.,A7> JENNIFER JOHNSTON
``:� ai V:. JENNIFER
MY COMMISSION#GG 042984
`*. 'n" ;� EXPIRES:October 27,2020
[ ]Personally Known OR ;��-o rsonally Known OR
-;eoF"o?. Bonded Thru Notary Public Underwriters. I
[/.Produced Identification 2 . I oduced Identification
Type of Identification: # A,)Iffigoadiourve Type of Identification:
l �1 CITY OF ATLANTIC BEACH OFFICE COPY
OWNER / BUILDER AFFIDAVIT
JJ��ttF
•
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 TI-IOUGH 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.
X315 11}" 5� \ q1 . 53ct. 3t 111
ADDRESS PHONE NUMBER
' • 'CL ♦ c
• "ME
2 ,'cate DATE
Before me this J, day of �— 20 Iffin 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 L. ,County of 1JNIVk •
❑Personally Known P'•., JENNIFER JOHNSTON
Produced Identification- C l 11.** • °
��t.> �.�AS Q '�•= MY COMMISSION#GG 042984
?i EXPIRES:October 27,2020
•
Bonded 7hm Notary Public Underwriters
Notary Signature:
F:BLDG/Owner-Builder Af a avil;REVISED:4/16/2009