1841 Ocean Grove Dr RES19-0184 Win Replacement RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH
RES19-0184
800 SEMINOLE ROAD ISSUED: 6/13/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 12/10/2019
MUST CALL INSPECTION • • • 1 i i BY 4 PM FOR • •
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • '
CODE, ' OF • 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:
1841 OCEAN GROVE DR RESIDENTIAL ALTERATION WINDOW REPLACEMENT $880.00
RESIDENTIAL
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
• • GROUP:
169598 0300 OCEAN GROVE UNIT 02
COMPANY: ADDRESS:
• ADDRESS:
SMITH KRISTIN LYNN 1841 OCEAN GROVE DR ATLANTIC BEACH FL 32233-5842
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 • •
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
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $59.00
Issued Date: 6/13/2019 1 of 1
rt`�L Building Permit Application Updated 10/9/18
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.
Job Address: l Vczuy / Permit Number: ' `ES I J `-' 4—
Legal Description dAt\)s l 21 - Wt
Ab� i� Ab �I(i(jl x'111;.tet' YF #` W
y
Valuation of Work(Replacement Cost)$ SZ Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ^epair ❑Move ❑Demo ❑Pool f�-Vindow/Door
• Use of existing/proposed structure(s): ❑Commercial &esiclential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes P No
• Will trees be removed in association with proposedproject? ❑Yes must submit separate Tree Removal Permit No
Describe in detail the type of work to be performed: --T—
V 1 t r\ (2)A _ 0/e&k(0—" ( kt /� _S/
Florida Product Approval# _for multiple products use product approval form
Property Owner Information
Name k, Address 4 �+r-�V'� 17T�� •
City State zip Phone lO — `10a
7
E-Mail Cft,
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) T'
Contractor Information
Name of Company a Quali ging Agent cS G= 0(✓�V-\ e �
Address city State zip
Office Phone — Job Site Contact Number; 3
State Certification/Registration# E-Mail m
Architect Name&Phone# ►n a\ V _
Engineer's Name&Phone# sAze, L W, C-J S
Workers Compensation Insurer OR Exempt Y Expiration Date
Application is hereby made to obtain a rermit 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 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
RECQR,DING YOUR NOTICE OF COMMENCEMENT.
- �1- — -
(Signa ure of Owner or Ag6t) (Signature of C ractor)
Signed and sworn itKN�*AGI
before e thi day o Signed and sworn to(or affir ed)before me this day of
lbr\ ey 1__�:A - ti
�/
i ure (Signature of Notary)
,tippy Py.; TONI GIRDLESPERGER
Personally Known OR ,i�• My COMMISSION#FF 92495 Personally Known OR
]Produced Identification '*i EXpIRES:October 6,2019 roduced Identification
F A
E ": BondodT,ru :otayPublicUndewnter
Type of Identification: e of Identification:
Owner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
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. .
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. 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. 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
/O�-F,'AN OWNER-BUILDER PERMIT.
Job Address: A P-"- /�'f zwr keo_c� n tl�
Owner Name: C4 1II TIP Sf1N�'�1�1 Phone Number: q6L, —�6 �6
Mailing Address: l QA/� City: Pat State: — Zip:
Notarized Signature of Owne i
The foe ing instrument was acknowledged before me this t ay �1 ,2 in the St to of Florida, County
of
Signatur of Notary Public !/
' TUNI GINDLFSPERGER
rhYCOti1MISSION#FF92`'y5t [ ersonally Known OR [ ] Produced Identification
EXPIRES:October U 2019
Bonded Thru Notary
Public Underwriters
Type of Identification:
Updated 10124118