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369 3rd St RES20-0046 Win/Door -51. ,v---„,, '`'r�' RESIDENTIAL PERMIT OC;.,\ uiPERMIT NUMBER CITY OF ATLANTIC BEACH RES20-0046 - Jr) 800 SEMINOLE ROAD ISSUED: 2/27/2020 -�D';.j..% ATLANTIC BEACH. FL 32233 EXPIRES: 8/25/2020 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: 369 3RD ST RESIDENTIAL WINDOWS/DOORS WINDOWS AND DOORS $1800.00 TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION: CONSTRUCTION: NUMBER: GROUP: 169824 0000 ATLANTIC BEACH COMPANY: ADDRESS: CITY: STATE: ZIP: OWNER: ADDRESS: CITY: STATE: ZIP: EILERS ELIZABETH T ESTATE C 0 LYNN T EILERS ATLANTIC BEACH FL 32233 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 $60.00 BUILDING PLAN CHECK 455-0000-322-1001 0 $30.00 STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.90 STATE DCA SURCHARGE 455-0000-208-0600 0 $2.60 WORK WITHOUT PERMIT 455-0000-322-1000 0 $170.00 TOTAL: $266.50 Issued Date: 2/27/2020 1 of 1 fir City of Atlantic Beach APPLICATION NUMBER A Building Department (To be assigned by the Building Department.) A l 800 Seminole Road c 7 /�y j Atlantic Beach, Florida 32233-5445 R ES l�f. ` O—w 1 E-mail:(904)41, Phone bud ng�d pt@coab.us04)247-5845 s Date routed: z/ I q /2-0 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 3 (D 9 3 Y S ( D• • - • fient review required Yes No Buildin• Applicant: 1 C - - ing : oning Tree Administrator Project: W f DOOZ-S 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 \V`V 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: RApproved. Denied. ❑Not applicable (Circle one.) Comments: 4dhfr pea. BUILDING PLANNING &ZONING Reviewed by: Date:4290 W TREE ADMIN. Second Review: Approved as revised. ❑Denie . !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 '!,P'1,*,., TREE & VEGETATION AFFIDAVIT FOR INTERNAL OFFICE USE ONLY ` A,, City of Atlantic Beach '' Community Development Department PERMIT# J 800 Seminole Road Atlantic Beach, FL 32233 ",!91,,o)'f' (P) 904-247-5800 OFFICE COPY SITE INFORMATION ADDRESS 3 6 el 3 p,A SUBDIVISION Q 3 0 ( BLOCK S LOT V/a22� (j,s/ c Pt RE# /6d1 S d L/ - poopgi RESIDENTIAL ❑ COMMERCIAL ❑ OTHERHER APPLICANT INFORMATION NAME ///0/3 6 La 5 PHONE# ADDRESS 3 9 3 lidS� CELL# Ci lC — 3146- r"7O9 CITY pjl/1,)Tie_ 8 t A6 I STATE L ZIP CODE t:54 3 3 EMAIL /511 re l Ifis cD mai I- 0-YY'/\ r-sz OWNER ❑ LEGAL AUTHORIZED AGENT I affirm that I have reviewed the provisions of Chapter 23, "Protection of Trees and Native Vegetation", of the Municipal Code of Ordinances for the City of Atlantic Beach Florida and/or I have participated in a pre- application meeting with the Administrator of those regulations. Subsequently, I affirm that no regulated trees and no regulated vegetation will be damaged, destroyed and/or removed from the above-described property and/or adjacent properties including right-of-way. I HE EBY ERTIFY THAT ALL INFORMATION PROVIDED IS CORRECT:Signature of Property Owner(s)or Ar ori ed Agent \--/Tr,-) -:.-2.4 616., p 1 r) [- i i(icS (27 /h6i) C4 SIGNATURE OF APPLICANT PRIOR TYPE NAME DATE SIGNATURE OF APPLICANT(2) PRINT OR TYPE NAME DATE Signed and sworn before me on this 3k' day of ©C \o.e.•t , '2.4\el by State of L. '^'k V\Vm \-e-Nr S County of NA 0 a Identification verified: S olna 111 \GA.o w Vl /1 0 Oath Sworn: Yes E No ti A'1 �/' ."'"'to o P Notary Sig atve ll((// "`z MARY L.CRAWLEY �4161 _' MY COMMISSION#GG 111174 9 — �0 -a a ,-,1 (.....) '`,0,,,ee, EXPIRES-September 06,2020 My Commission expires 04 TREE AND VEGETATION AFFIDAVIT 03.01.2018 . rf'''r,., Building Permit Application OFFICE COPY Updated 10/9/18 v. L A, ,j City of Atlantic Beach Building Department **ALL INFORMATION _. :li800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY , 'ii p- IS REQUIRED. Phone: (904) 247-5826LEmail: Building-Dept@coab.us /��/' //- Job Address: 3 661 3 ad 6 c I2c=t I Permit Number: RESZO- Oc410 Legal Description 5 -69'/er` 5— 'olgi-• /a`1 f /A'Jiu./3 i}Cti W//ZJci ?g./ 6- RE# /6'1802`"x — 000O Valuation of Work(Replacement cos()$ /b'I:,C•', • 00 Heated/Cooled SF //0 fi Non-Heated/Cooled /`'e • Class of Work: ❑New ❑Addition DAlteration ❑Repair ❑Move ❑Demo ❑Pool (XWindow/Door • Use of existing/proposed structure(s): ❑Commercial XResidential • If an existing structure, is a fire sprinkler system installed?: ❑Yes IidNo • Will tree(s)be removed in association with proposed proiect? ❑Yes(must submit separate Tree Removal Permit) ONo Describe in detail the type of work to be performed: R�- /,,c c EA-5,if K 4(aHco ,u ,n„i,y:J , S c:--' �,1/Js .) c L ,,u cto%v n :A., ; i ti c ,c..0-;c,.) 5` ? -wk Ste, ,h �j L=LI'rLi.>.v� il�, ,✓c/Ui.�1 5�M , 2i• KJ tn.l(,UkJEj .. 5 I� ,Ur+m / r (-rZ pL U j 0P 55- Florida Product Appro I# 6_ /' _for multiple products use product apprtlal formCt Property Owner Informa ion c a = cn Name / A)�J i//tii5 Address j 1 3 N 5;ar-cr 1 a O City 1 1lAU�i i c. 8,7c L State , L•- Zip .3).9-33 Phone c(/G 3 `/G 5 IOce c g E E-Mail L./N,J F I L A S 62(01,4 L 4 Gn�C• n < LU Ci ii.l Owner or Agent(If Age , Power of Attorney or Agency Letter Required) I.-.j )v i`( tI '. K-5 �(�_c_Z_O O Contractor Information I LL i3O Q�pU Name of Company L y,�Jo !r-n5 Oa);vc� Qualifying Agent ZZ 0 cc Q Address City State Zip U J `Ni cA Office Phone Job Site Contact Number CC Q f- Z la State Certification/Registration# E-Mail O ti. fit Architect Name&Phone# a }0 Uci. � m Engineer's Name&Phone# LIJ F— III .. a tu Workers Compensation Insurer OR Exempt❑ Expiration Date w %.,iN W Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or instal&ion has Z la commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regting CC construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,S NS, WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS, and AIR CONDITIONERS, etc. OTICE:,]t 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. F EB 1 8 2020 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. BIJi1C �I i r,rt f''"I''' ''A'-.'n nt , . 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 RE DING YOUR_NIVICE OF COMMENCEMENT. / (Signature o Owner or Agent) (Signature of Contractor) Signed and sworn to(or affirmed) before me-this i Oday of Signed and sworn to(or affirmed) before me this day of F(LkY___An„ Z19).02_143 k ; 2 , , by i - , c 1. —Or (Signature of Notary) ... "''•'. CLAUDIA A.ESTES _* • , MY COMMISSION#GG 179523 IYN ersonall Known OR ` `'Q EXPIRES:January 25,2022 • [ ]Personally Known OR [ ]Produced Identification •'?`ef;:? Bonded Tin'Notary Public Underwriters ' [ ]Produced Identification Type of Identification: Type of Identification: cOwner Builder Affidavit FFICE COPD **ALL INFORMATION -�F����� HIGHLIGHTED IN City of Atlantic Beach Building Departmen GRAY IS REQUIRED. J800 Seminole Rd, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: QESc20 oU`/I 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. . 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: 369 3rd Street Owner Name:Lynn Eilers Phone Number: (904)346-5709 Mailing Address: 369 3rd Street City: Atlantic Beach State: FL Zip: 32233 57 'ks NotaAzedSignature ofOw ie )1 Y �_/j y , The fry oipg,,Sn ment was acknowledged before me this t 1 day of fib(U , 2020, in the State of Florida, County T MAY llil 121 ;;<a� CLAUDIA A.ESTES Signature of Notary Public ��'�� �—� *. :e' :t_ MY COMMISSION#GG 179523 �.���.�a: EXPIRES:January 25,2022 [ ersonally Known OR [ 1 Produced Identification '•.For n.°•• Bonded Thru Notary Public Underwntet. t _ /. .: Type of Identification: Updated 10/24/18