860 Bonita Rd RES19-0316 Replace Siding rs` cif RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH
RES19-0316
800 SEMINOLE ROAD ISSUED: 2/4/2020
ATLANTIC BEACH. FL 32233 EXPIRES: 8/2/2020
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:
860 BONITA RD RESIDENTIAL ALTERATION REPLACE LAP SIDING $2000.00
RESIDENTIAL
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171105 0000 ROYAL PALMS UNIT 01
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
KNIERIEMEN DANIEL J JR 860 BONITA RD ATLANTIC BEACH FL 32233-4229
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 $65.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $32.50
STATE DBPR SURCHARGE 455-0000-208-0700 0 $4.09
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.73
WORK WITHOUT PERMIT 455-0000-322-1000 0 $175.00
TOTAL: $279.32
Issued Date: 2/4/2020 1 of 2
rs1...„ ,0M`%� RESIDENTIAL PERMIT PERMIT NUMBER
J `� RES19-0316
CITY OF ATLANTIC BEACH
'� 7
800 SEMINOLE ROAD ISSUED: 2/4/2020
`o's >( ATLANTIC BEACH. FL 32233 EXPIRES: 8/2/2020
I
Issued Date:2/4/2020 2 of 2
s,,y:Ly ,� City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road R r si 9 _ /1 1 /
,� Atlantic Beach, Florida 32233-5445 G �J 1 \O
Phone(904)247-5826 - Fax(904)247-5845
�o;; E-mail: building-dept@coab.us Date routed: ) 0 /1 s I t 9
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ' ,(p c O N l j A R-- Department review required Yes No
Building j
Applicant: CD K;C Planning Zoning
Tree Administrator
Project: LAP ( o 1 N.D G Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date SV1v
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: [✓A(pproved. ❑Denied. ❑Not applicable
(Circle one.) Comments: Dov�� . s Cti O
BUILDING
PLANNING &ZONING
Reviewed by: rri Date: /4-2./. /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
„ ,:o-Ah-4,..,,, BuildingPermit Application
OFFICE COPY Updated P ��
_~ City of Atlantic Beach Building Department **ALL INFORMATION
j�� V 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: ur1 o�i'11 aD Permit Number: IRE 1 1 -031(.6,
Legal Description 3 0- (9 0 r ( ' - Z`, ))�2qf RE# / r7 1 10
Valuation of Work(Replacement Cost)$ 2, v vv— Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ONew Addition ❑Alteration. tepair ❑Move :Memo ❑Pool ❑Window/Door ri-
• Use of existing/proposed structure(s): Commercial Fesidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes -kNo
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail thet pe of work to be performed:
eQLAU. iiv5—4 /-(__ MQ Srorn.-
Florida Product Approval# tin roi).e. Pt44 La p ' di 4...s for multiple products use product approval form
Property Owner Information - /_ �p
A
Name VA0 \f yii• -1 one,-/' Address 2-400D E'N(f So 1 �/�n
City f”_3 L St to '�\ Zip 32233 Phone 5J '�[i(a"�
E-Mail d,K jV 1115 z: (Prouttj
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Qualifying Agent
Address City
Office Phone Job Site Contact Number
State Certification/Registration# E-Mail
Architect Name&Phone# OCT 1 4 2019 c.
Engineer's Name&Phone#
rt
Workers Compensation Insurer OR Exempt❑ Expiration Date W
Application is hereby made to obtain a permit to do the work and installations as indicated.I catatIiisingi laepararna has
commenced prior to the issuance of a permit and that all work will be performed to meet tettlendlryrktlyitte Beadql,a44,5 Q 0
construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGI , d ZH
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE: In addition to the requirementsa ttus 2 p
permit,there may be additional restrictions applicable to this property that may be found in the public records of this count 4130 6 G
there may be additional permits required from other governmental entities such as water management districts,state agenc ,6.1) c o a
federal agencies. C3 Pcc.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with Q LLO C
applicable laws regulating construction and zoning. I— F-0I-
-o Q Z
WAR 1 • TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MA'2 u- ct
111
RES T IN OUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTV,I0. a t m
TO •BTAIN ' INANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE 1-- LJ a w
RE' OR' NG OUR NOTICE OF COMMENCEMENT. w U w y
5 oc w
w
X CC
_`��ignature of Owner or Agent)
(Signature of Contractor)
Signed and sworn to(or affirmed) before me this ID day of Signed and sworn to(or affirmed) before me this day of
0 Lt )a.t(, a0( by, b0.11i Lk K-n\0-( 1P(f1L , , by
yr44.t> JENNIFER JOHN a . At��_
==4�,�, ie= MY COMMISSION t}GO 042984 t' '°ture of Notary) (Signature of Notary)
"0` ..:Ti- EXPIRES:October 27,2020 '
•:;oc,..?:V Bonded Tru Notary Public Underwriters
r- -•• .--• . - [ ]Personally Known OR
[l].Pf duced Identification [ ]Produced Identification
Type of Identification: °1- OLI i1/4/0-4 S ek±&150 Type of Identification:
OFFICE COPY
rs�L��,, Owner Builder Affidavit **ALL INFORMATION
s HIGHLIGHTED IN
J " City of Atlantic Beach Building Department GRAY IS REQUIRED.
n
" 800 Seminole Rd, Atlantic Beach, FL 32233
-cm Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: Iigi9'-'0316.
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 ATA 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 ISA 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.
Job Address: sub ,v(ki1Ti)m '`N p
Owner Name: N K'n , f 1 QC- Phone Number: se)V -g
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Mailing Address: 6/1'nikCity: i1.6State: pt Zip: 32233
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Notarized Signature of Owner
The foregoingin trument was acknowledged before me this ID day of D(,' bbl'(,20 11 in the State of Florida, County
of INA. `'l.
Signature of Notary Public IP _Or _
?x; 042984PersonallyKnown OR
y`'-"; JENMFERJGH�S�GN Produced Identification
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:. `'�. 4p COV�MISSION#GG 2020 [ ) l�
: ` EXPIRES:Graber
PublctJnd fere J
'�' oundedThruNotary envn Type of Identification: F W , do d f t f,.i1 <C1ir
Updated 10/24/18