768 Aquatic Dr res20-0280 `so'-""'`, Building Permit Application Updated 10/9/18
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j City of Atlantic Beach Building Department **ALL INFORMATION
HIGHLIGHTED IN GRAY
;, „ �;, 800 Seminole Road, Atlantic Beach, FL 32233
J'.i IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: �6O /47-ca R,, dr, Permit Number: (�fps ZO C.YZ-
Legal Description 38` 11 1 2.5 vie-OA-Tit h � lot- lei-PRE# j1I) 1Q2 —525(0
Valuation of Work(Replacement Cost)$ •`i J eated/Cooled SF Non-Heated/Cooled
• Class of Work: ONew ❑Addition ❑AlterationRepair ❑Move ❑Demo ❑Pool jNindow/Door
• Use of existing/proposed structure(s): ❑Commeerccial ,esidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s) be removed in association with pro/ oos�edJprojeect�? ❑Yes(must ssuu mit separate Tree Remov I Permit)Ago
Describe in detail th type of work to be performed: (:�u/ Cu'lr eL ;S�Lf,, 48i/ weal
F)9/1/ ter ��) ��
Florida Product Approval# for multiple products use product approval form
Property Owner Inform.do
Name 6/,,�'f/ /# �� i I Address XS" 114' `',
City (� ( �„i/. / it i State___EA,_Zip _g��33 Phone —_5—j/-/ 6/
E-Mail ,#42 ' Q,f ,, .4,7
Owner or Ag nt(If Agent, P.,,er4of 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 n 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
RECO' 4 ► YO ' NO E 0 COMMENCEMENT.
a•• it/% _ -v
i
(Signature of Owner or Agen _ (Signature of Contractor)
Signed and sworn to(or affirmed) before me this (---P day of Signed and sworn to(or affirmed) before me this day of
0c, 3-( rz;2L C,by C.o(e�[`; A Lit by Wer , , by
(,,_P cr --,1—(ret .��-C
•a r-of Notary) (Signature of Notary)
+ot.Fr^o ERII(ASLAWSON
NoCommubhon State of Florida PersonallyKnown OR
[]'Personally Known OR crti�. M GG 286725 [ ]
y Comm.Expires Dec 25,2022 [ I Produced Identification
[ ] Produced Identificatio Bonded through National Notary Assn.
Type of Identification: _ Type of Identification:
-•L'-',.•,,
r i,
, Owner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
'j\ j / 800 Seminole Rd, Atlantic Beach, FL 32233
--- Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT it
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 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 REQUIR MENTS/Jr.
FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
Job Address: 1pk �Gt /e4 //d// ( b. �'i f c� ,�3
Owner Name: Ci12°9or y 7C-Ly/or yy�� Art' S 9(.7-7--673 —/.5 Phone Number: 5 /
Mailing Address: 765- 4,/,Mf
L i. City: 4/1/'.t ,&'I State: Fi1. Zip: 3.)33
Notarized Signature of Owner /a ,/
The foregoing instrument was acknowl ged before me this day of L C LiL , 20 l, in the State of Florida, County
of '. v V Ct 1
Signature of Notary Public /. . ... ' 0 71/4--------
,'i►�Y°�'. ERIKA SLAWS of I ` 'Personall Known OR Produced Identification
1 V:`: Notary Public-State of Florida Y , )
' `.� a jf Commission#GG 286725 ' _
`• of:' My Comm.Expires Dec 25, 2022 F
Bonded through National Notary Assn. Type of Identification: ( 1 v L ‘Cr-iii S-{
Updated 10/24/18
ler PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FLORIDA (*REQUIRED)
U4)-
*Project Address: 768 Aquatic Drive Atlantic Beach, FL 32233 Permit#:
*Owner/Project Name: Gregory Taylor and Summer Morris
As required by Florida Statute 553.842 and Florida Administrative Code Rule 9B-72, please provide the information and product approval number(s)for
the building components listed below as applicable to the building construction project for the permit number listed above. You should contact your
product supplier if you do not know the product approval number for any of the applicable listed products. Information regarding statewide product
approval may be obtained at:www.floridabuilding.org.
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
A. EXTERIOR DOORS
1.Swinging Plastpro 3RF3cG Pre Hung FL-28093
2.Sliding
3. Sectional
4.Garage Roll-Up
5.Automatic
6. Other
B.WINDOWS
1.Single hung
2. Horizontal slider Wincore 8400 Vinyl Horizontal Sliding Non Impact FL-16092.1
3. Casement
4. Double hung
5. Fixed
6.Awning
7. Pass-through
8. Projected
9. Mullion
10. Wind breaker
11. Dual action
12. Other
Page 1 of 4 Updated 10/17/18
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
C. PANEL WALL
1.Siding Nichiha Fiber Cement Products Panel Walls/Siding FL12098-R6
2.Soffits
3. EIFS
4. Storefronts
5. Curtain walls
6.Wall louvers
7.Glass block
8. Membrane
9.Greenhouse
10.Synthetic stucco
11. Other
D. ROOFING PRODUCTS
1.Asphalt shingles
2. Underlayments
3. Roofing fasteners
4. Nonstructural metal
roof
5. Built-up roofing
6. Modified bitumen
7. Single ply roofing
8. Roofing tiles
9. Roofing insulation
10.Waterproofing
11.Wood shingles/shakes
12. Roofing slate
13. Liquid applied roofing
14. Cement-adhesive
coats
15. Roof tile adhesive
16. Spray applied
polyurethane roof
17. Other
Page 2 of 4 Updated 10/17/18
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
E. SHUTTERS
1.Accordion
2. Bahama
3.Storm panels
4. Colonial
5. Roll-up
6. Equipment
7. Other
F.STRUCTURAL
COMPONENTS
1. Wood
connector/anchor
2.Truss plates
3. Engineered lumber
4. Railing
5. Coolers-freezers
6.Concrete admixtures
7. Material
8. Insulation forms
9. Plastics
10. Deck-roof
11. Wall
12. Sheds
13. Other
G.SKYLIGHTS
1. Skylight
2. Other
H. NEW EXTERIOR
ENVELOPE PRODUCTS
1.
2.
Page 3 of 4 Updated 10/17/18
In addition to completing the above list of manufacturers, product description and State approval number for the products used on this project, the
Contractor shall maintain on the job site and available to the Inspector, a legible copy of each manufacturer's printed specifications and installation
instructions along with this Product Approval Sheet.
I certify that this product approval list is true and correct to the best of my knowledge. I further certify that use of different components other than the
ones listed in this document must be approved by the Building Official.
*Contractor / i\A-01'45 &....-----------':
Name (Print Name):(1,v el)✓ti 1(,thi ✓ . Contractor Signatur-. ' at wit ; _
*Company Name: J 1 ii \,..„.
JJ 11
*Mailing Address: ql, --6, J-e'
I
*City: tcuZ 1 6tr,li., *State: *Zip Code: : 2 Z ) "3
*Telephone Number: 6)10 8(e) S 8 *E-mail Address: ' (,t VW., ' i (01) Th 00 • e l. DI'�
1 � n
Cell Phone Number: " ` Fax Number:
Page 4 of 4 Updated 10/17/18