462 Aquatic Dr RES20-0234 Kitchen RemodelOWNER:ADDRESS:CITY:STATE:ZIP:
BURDITT CLIFFORD C JR 462 AQUATIC DR ATLANTIC BEACH FL 32233-3834
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171818 5154 AQUATIC GARDENS
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
462 AQUATIC DR RESIDENTIAL ALTERATION
RESIDENTIAL KITCHEN REMODEL $1500.00
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 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $94.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
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.
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.
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.
1 of 1Issued Date: 9/9/2020
PERMIT NUMBER
RES20-0234
ISSUED: 9/9/2020
EXPIRES: 3/8/2021
RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $94.00
RES20-0234 Address: 462 AQUATIC DR APN: 171818 5154 $94.00
BUILDING $60.00
BUILDING PERMIT 455-0000-322-1000 0 $60.00
BUILDING PLAN REVIEW $30.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $30.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R13158 $94.00
Printed: Wednesday, September 09, 2020 4:20 PM
Date Paid: Wednesday, September 09, 2020
Paid By: BURDITT CLIFFORD C JR
Pay Method: CREDIT CARD 360499866
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R13158
1Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department ALL INFORMATIONg
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
1,°`''J'" IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: qee Z 41-Aiv*/-1 C Dim I UC,,4, ' 7 L 3Z 13.i Permit Number:
Legal Description 7l RE# / 7 i —,S 6 t-/
Valuation of Work(Replacement Cost)$ /cad r f"t) Heated/Cooled SF Non-Heated/Cooled
Class of Work: New DAddition KAJteration DRepair Move Xpemo Pool DWindow/Door
Use of existing/proposed structure(s): Commercial xaesidential
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) )4Jo
Describe in detail the type of work to be performed: /04 O /1/c t7vc=j (.-d 2/L 4- E2d,.J17/r/jeLJ,„P.h7CZt-Z /I/ r fr.!tr,/ / IZE;-1v%Jdcl .
Florida Product Approval#for multiple products use product approval form
Property Owner Information
Name C L!6= (• f3 Jf r,I I i Address y f Z ( D(ti i
City /J TIC !&3-Cff 3 2-1StateFL- Zip3'3 Phone fD 2 SZ .0 4'Z 7
E-Mail -difif (INm.C1 I.,['Oret
Owner or Agent(If Agent, Plower of Attorney or Agency Letter Required)
Contractor Information
Name of Company Qualifyin: e: -
Address _ Cit State Zip
Office Phone Job Si • ontact Number
State Certification/Registration#I ail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt Expiration Date
Application is hereby made to obtain a pe it to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of- •ermit 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 •U INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY : ORE
RECORDING YOUR I F COMMENCEMENT.
410L/ / • /4
ignature of• ner or Agent)Signa .re of Contractor)
ned a..
Lnd
sworn to(or rmed) b/ re . e this day of Signed and sworn to(o .ffirmed)before me this day of
r l • _ . •y C L'(
1I C--L1 -- by
a.Q1
lr, • -, ••
SPERGER
Sig •1u: •,•, t•ftar .i,MISSION#GG 353178 Signature of Notary)
a' .IIIRES:Cctober 6,2023
F° oF ': Bonded Thai Notary Public Under*Titers
Personally Known OR rt....,.. - Known OR
Produced Identification, Produced Identification
1TypeofIdentification: (O 33-103-.,4•Zo c,_ O Type of Identification:
RES20-0234
Owner Builder Affidavit ALL INFORMATION
rit1i
HIGHLIGHTED IN
tCity 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.1
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:
I&1-- nti f?fl( a/2-tfZ/41l c- f t/f-/ F_ 51z )j
i!Owner Name: Cf-
1111
Y C. 6k//2.42/J Phone Number: 'dZ Z , 0y z )
41
Mailing Address: ,L 4/' City: /?7L?k47 &*/1 State: ft_ Zip: 32.2 33
Notarized Signature of Owner 7;/-1-7 C /
Therrying instr ment was acknowl dged before me this (. day .P 20Zc the State of Florida, County
of U V.
1111
Signature of Notary Publ.
Personally Known OR [ ] Produced Identification
Type of Identification:
Updated 10/24/18
TONI GINDLESPERGER
MY COMMISSION#GG 353178
EXPIRES:Cctober 6,2023
f.F;'r?0'• Bonded Thru Notary Public Underwriters '
RES20-0234