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150 2nd St 2014 Demo (interior) CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 14-00000429 Date 3/20/14 Property Address . . . . . . JSo 2ND ST Application type description DEMOLITION Property Zoning . . . . . . . RES SF DISTRICT Application valuation . . . . 0 -------------- ------------------------------------------------------------- Application desc interior demo ----------------------------------------------------- Owner Contractor ------------------------ ------------------------ WOOLVERTON DERICK R OWNER 3761 log AVE NW PONTE VEDRA BEACH FL 32004 ---------------------------------------------------------------------------- Permit . . . . . . DEMOLITION PERMIT Additional desc . - 100 . 00 Plan Check Fee . 00 Permit Fee . . . . Valuation . . . . 0 Issue Date . . . . Expiration Date 9/16/14 ----------------------- 2 . 00 Other Fees . . . . . . . . . STATE DCA SURCHARGE STATE DBPR SURCHARGE 2 . 00 - -------- ----------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 100 . 00 100 . 00 . 00 . 00 Plan Check Total . 00 * 00 . 00 . 00 Other Fee Total 4 . 00 4 * 00 . 00 . 00 Grand Total 104 . 00 104 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax(904) 247-5845 nd Job Address: 150 2 street Atlantic Beach,Florida 32233 Permit Number: Legal Description Lot 6, Block 3 1, Plat No.1,Sub"A"Atlantic Bch, Fl. Parcel 4 170211-0000 Floor Area of Sq.Ft. Sq.Ft Valuation of Work$ Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): New Addition Alteration Repair Move Demolition pooUspa window/door Use of existing/pro osed structure(s)(circle one): Commercial Residential If an existing strucrure,is a fire sprinkler system installed? (Circle one): Yes No N/A Florida Product Approval#--- For multiple products use prod-u-c-t approval Form Describe in detail the type of work to be performed: Demolition on as needed basis tokitchen and bathroom-w- ly "OCTOkMIVE P,6P*14LS Property Owner Information: Name: Derick Woolverton Address: 1502 nd street City Atlantic Bch, State_EI_Zip 32233 —Phone 904 509 9963 E-Mail or Fax#(optional, Contractor Information: Company Name: Qualifying Agent: Address: city State Zip Office Phone Job Site/Contact Number Fax# State Certification/Registration Architect Name&Phone# Engineer's Name&Phone Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and Address A 1* t* 's hereby made to obtain a permit to do the work and installations as indicated. I certify that all work will be pei:(�rmed to meet the standards oJ Spiralcw's 1roeng ullati�j construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6)months, or i(construction or workissuspende or abandonedfor aper,iod ofsix(6)months at anytime after work is commenced I understand that separate permits must be securedfor Eledi1cal Work Plumbing,Signs, Wells,Pools,Furnaces,Boilers,Heaters, Tanks and Air Condidoners,eta 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 FINANCING9 CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. t. nd know the same to be true and correct. All provisions of laws and ordinances governing this I hereb certify that I have read and examined this,a ica ion a y to violate or cancel the ec, type p.work will be complied with whether le herein or not. The granting of a permit does not presume to give authorit 17, sf, ance of construction. provisions of any otherfederal,state, or local aw regulating construction or the peifom Signature of Owne Signature of Contractor Print N C - ..........." Print Name ........................................................................................................................................ 0 Orn to ore me r e Notary Public Stated iorida S and subscribed bef S ornt , subscribed b t, 0ey L Graham t Day of - 20 this D of on FF 086990 Expires 02/14/2018 � F - q64 -6 Notary Pu ic Revised 01.26.10 V, CITY OF ATLANTIC BEACH (OWNER / BUILDER AFFIDAVIT 1. 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 PERM[IT 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 StTERyLS ONE-OR EjW"qQNSjWQTIWyQVRSELF. YOU MAY BUILD OR IMPROVEA TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMNERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDIN 9U$T.PE.FOR-YQVRU$K.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 TIES EXEM[PTION. YQU—MAY NOT HERE N Uq4jCENaED pERSp�LAS yoTaCoNTRACTOR, YOUR CONSTRUCTION MUST ____A_ ___ __ BE DONE ACCORDING TO THE BUILDING CODES AND zONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE FINIT.Lo�,Y�ED�.�.��BY..��Y�.OlU HAVE LICENSEs uQUIREI)....BYSTATE LAW-AND DY&Q hunZ MQ SING 11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. Ill. 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 CIRCUMSTANCES, OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(l). 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. TELEPHONE THE BUILDING DEPARTMENT(247-5826)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. (SV 2-r4 o S7g&L---7-.47zA6fj7c &4&IQ- -2;L2 33 ADDRESS PHONE NUMBER bMIC4- Woo P DATt SIGNATURE Before methI1l:2?-0—c13y 5001��4'1111 20,jt�the county of Duval,State of Florida,has personally appearefherin by himself I herself and affirms that all statements and declarations are true and accurate — Notary Public at Large,State of rzn .C o unty of ,qKrsonallt Known 0 i duced Identific Notary Public State of Flo a NoSa.l.,it" Shirley L Graham my commission FF 086990 F./BLI)GfO�,B�iklerAffada�t;RFVISED:: 16f2009 OF Expires 02/14/2018