1952 Beachside Ct RES21-0001 Bathroom Remodel RESIDENTIAL PERMIT PERMIT NUMBER
' _' RES21-0001
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 1/4/2021
., 0,:1sr ATLANTIC BEACH. FL 32233 EXPIRES: 7/3/2021
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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.
JOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property
hat may be found in the public records of this county, and there may be additional permits required from other
:overnmental entities such as water management districts, state agencies, or federal agencies.
JOB ADDRESS:a "_ PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
1952 BEACHSIDE CT RESIDENTIAL ALTERATION BATHROOM REMODEL $100.00
RESIDENTIAL
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169542 0590 BEACHSIDE
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
BELL RICHARD A 1952 BEACHSIDE CT ATLANTIC BEACH FL 32233-5955
YARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT If\
'OUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
✓IUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU
NTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
ECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF CONDITIONS
toll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $55.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $27.50
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$86.50
Issued Date: 1/4/2021 1 of 1
lf ,
''=L'''',, Building Permit Application Updated 10/9/18
N f City of Atlantic Beach Building Department **ALL INFORMATION
v 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
� IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: /f 2— t e.4 S e et Permit Number: RES2- I -0 001 q
Legal Description C�.{'�C C8 e Loi L B - I k I) RE# I67 � t Z
Valuation of Work(Replacement Cost)$
� 00 Bated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition BA teration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial Iential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes Gado
• 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: Ato/a,..@ k -44 jr ;,)f In -. y3cc' k
,V?
Florida Product Approval# for multiple products use product approval form
Property Owner Information } �/ 2
Name A/C./4---4--- /D cc-
_ Address / 4 2_ /be- � �i l cO CT
City Al. ,_ AO :- State_a_Zip -3 2.2.- --)7 Phone 9/m 4- 704_ to ti S
E-Mail b /j,-i c Q t // Save a ndal-
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 per 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' I i G •U ' ► 0 ,O F • ' MENCEMENT. /
(Signature ojf ner or A.ent) (Signature of Contractor)
signed and sworn to(or affir, •pbefor- .-4,his day of Signed and sworn to(or affirmed)before me this day of
l , , by
IrMI� -� , by .. . �_WAINI
�/ .'
Z�Z 1� Jr!J>< ,I . .�fIR A CrSignature of Notary)
=o;A+;?u c; TONI GINDLE 1` R
��. = MY COMMISSION#GG 353178
Personally Known OR ;i Lou' ' EXPIRES:^ciober 6,2023 ]Personally Known OR
-rte/�\�:o:
[ 1 Produced Identification ?,4' °cc Bonded Thru Notary Public Underwriters ]Produced Identification
--
Type of Identification: - ype of Identification:
Owner Builder Affidavit **ALL INFORMATION
pig HIGHLIGHTED IN
City 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.
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: j7 ? /,e4 (
Owner Name: 22C4 a.,- 1Phone Number: `764' 7o fb_C
Mailing Address: /14,2 /X•,, et City: 1-c-y17L &J-7 State: Zip: `32Z-27-?-,
Notarized Signature of Owner / 4
/
The fonn3 in�tru nt was ac owledged before m=1s day of /A , 2CL, in the State of Florida, County
of V VPr
Signature of Notary Public r fry,
[ ] Personally Known OR [ ] Produced Identification 6
Type of Identification:
TONI GINDLESPERGER Updated 10/24/18
!.! _ MY COMMISSION#GG 353178
r-Z:;;;, EXPIRES:October%,2.23
'•*OF F q°' Bonded Thru Notary Public Underwriters