337 Plaza RESA17-0007 Re-Instated Laundry Room Addition fr
7'1i,-,. RESIDENTIAL ADDITION PERMIT PERMIT NUMBER
41 tf RESA17-0007
.-• si CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 7/27/2017
``'i;l�" ATLANTIC BEACH, FL 32233 EXPIRES: 8/24/2020
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:
RESIDENTIAL ADDITION SINGLE REINSTATED 1/21/2020
337 PLAZA OR TWO FAMILY RESIDENTIAL $20000.00
ADDITION laundry room addition
TYPE OF : REAL ESTATE ZONING: i BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170001 0000 ATLANTIC BEACH
COMPANY: I ADDRESS: I CITY: STATE: ZIP:
OWNER: I ADDRESS: CITY: STATE: , ZIP:
MATCHETT DAVID B 337 Plaza ATLANTIC BEACH FL 32233-5345
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.
1 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
2 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL
Notes:
Roll off container company must be on City approved list(Advanced Disposal,Realco Recycling,Shapell's,Inc.). Container cannot be placed on City
right-of-way.
Issued Date: 7/27/2017 1 of 2
_
at
�s~S'r�'-, RESIDENTIAL ADDITION PERMIT PERMIT NUMBER
•
CITY OF ATLANTIC BEACH
____)
RESA17-0007
J 800 SEMINOLE ROAD ISSUED: 7/27/2017
—eft yr ATLANTIC BEACH. FL 32233 EXPIRES: 8/24/2020
3 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration,including sod,is required.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $59.00
BUILDING PERMIT 455-0000-322-1000 0 $155.00
BUILDING PERMIT RENEWAL 455-0000-322-1000 0 $44.10
BUILDING PLAN CHECK 455-0000-322-1001 0 $77.50
BUILDING PLAN REVIEW RESUBMITTAL SECOND 45500003221006 0 $50.00
PW REVIEW RESIDENTIAL BLDG 001-0000-329-1004 0 $100.00
STATE DBPR SURCHARGE 455-0000-208-0600 0 $4.24
STATE DCA SURCHARGE 455-0000-208-0700 0 $4.24
ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 $50.00
TOTAL:$544.08
Issued Date:7/27/2017 2 of 2
Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
-un 0'" IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 7 ,b44-41- Permit Number: RLS A U t 0001-
Legal Description RE#
Valuation of Work(Replacement Cost)$ /00 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move [Memo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ❑Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed:
/;A., L421A)J),y 490/)
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name 2.9 "> �1 I e99 Address ?37 I1/47City 4}J'/1/9tA ,&4C#— State /- Zip 3Zzf Phone 90'/. �3/ - Zgz-7
E-Mail 0/94,24" -ale/ l'<t/jzo✓}lf-/VT--
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 Insurer OR Exempt❑ 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 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
RECORDING YOUR NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) �{ (Signature of Contractor)
e
Si:n-d and sworn to(or affirmed) befo me his 1 day of Signed and sworn to(or affirmed)before me this day of
•
• 7--:_ ,a Olk(Vt.ttr , by
JEN IFER JOHNSTONVI• 1,�� .
MY COMMISSION#Ge r• Si nature of Notar
EXPIRES:October 27,2020 ,'ig .ture of Notary) ( g Y)
op' Bonded Thru Notary Public Underwriters
[ ]Personally Known OR [ ]Personally Known OR
[jroduced Identification [ ]Produced Identification
Type of Identification: fU- ��kvJ-4 vi_LAS Type of Identification:
!Arlr,, Owner Builder Affidavit **ALL INFORMATION
r. ' Wd HIGHLIGHTED IN
r,
City of Atlantic Beach Building Department GRAY IS REQUIRED.
"Mir 800 Seminole Rd, Atlantic Beach, FL 32233 /�
-on I.)- Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: /eg-C //`197
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 THECONSTRUCTION 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. 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: 339 NA-Z/ -
Owner Name: lJiei..oi,® /7/4 /fe.ri— Phone Number: fr� (j.3( -212-7
Mailing Address: 337 a%}z.9- City: "9/1,11Y4C £'e4trif- State: � Zip: 3Zz-J_Y
Notarized Signature of Owner zc, - 1-, II
The foregoinginstrument was acknowledged before me
this \-'\ day of Ft.t4 , 20b in the State of Florida, County
of £&V ci
Signature of Notary Public
[ ] Personally Known OR [ duced I ntification
s>v4• ;•• JENNIFER JOHNSTON I�
r.'�� t '`�`= MY COMMISSION#GG 042984 Type of Identification: F\-0r�0.� V I,U Y—i \1L A,
r�.�.: = EXPIRES:October 27,2020
V:,
•<*c.;P•' Bonded Thru Notary Public Underwriters
Updated 10/24/18
SELF-PROVING AFFIDAVIT
State of Florida }
County of Duval
City of Atlantic Beach }
I, David Matchett , whose name is signed to the foregoing instrument, being first duly
sworn, wish to purchase the property located at 337 Plaza Atlantic Beach, FL. I
understand the property has an Owner/Builder permit #RESA-0007 that was obtained
for repairs to the property by the current owner Paul Malzahn. I further understand the
permit status is "open" and that I am assuming all responsibility and liability to finish
repairs and close the permit.
Individual's Signature Date 71/Y(4-4)
Witness Signature !4A � 11
,��iLI� . gate /i V/02-6d-6
414
Witness Signatur_ a/ qk Date Z ( ( ifZ0Z-O
A notary public or other officer completing this certificate verifies only the identity of the
individual who signed the document to which this certificate is attached, and not the
truthfulness, accuracy, or validity of that document.
NOTARY ACKNOWLEDGMENT
-th
On this ly of Fa(L1. , 20 a-l) personally appeared the above-named
64,i, d ttk WAQ, and acknowledged the foregoing to be
(his/her) free act and deed, before me.
My Commission Expires: 101 -113-01-6 Notary Public
(Seal) Print I-Q.RnI ��� tlS
*??<o'•. JENNIFER JOHNSTON
MY COMMISSION#GG 042984
EXPIRES:October 27,2020
" oP Bonded Thru Notary Public Underwriters
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