260 6th ST RESO20-0006 signed app. 2-9-21 ' `-. Building Permit Application Updated 10/9/18
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t, ! 1V City of Atlantic Beach Building Department )i' 9R;Rr1'1�IQN
'800 Seminole Road, Atlantic Beach, FL 32233 f:410100.14:.,'. 51004)`:::'
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Phone (904) 247-5826 Email: Building-Dept@coab.us , y
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2Job Address: y � it t :. tv . .: kg . ± r / g.s Permit Number: .- 0��"boo
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Legal Description. M
Valuation of Work(Replacement Cost)$ `>1 '1 fa,.r ' Heated/Cooled SF_ Non-Heated/Cooled
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• Class of Work: ❑New DAddition DAlteration kepair DMove Dbemo ❑Pool Window/Door
• Use of existing/proposed structure(s): ❑Commercial JkResidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes )(No
• Will
treg � 9 rejgoy n issociatjorwith pro•osed4prol%t? ❑Yes(must submit separate
Tree Removal Permit)
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Florida Product Approval# PTt /ilC&?S bu/—SY6o
W8 for multiple products use product approval form
Property Owner Information
Name f e; f � 2.9• T4.�- W ggelr 4FAddress l /F
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Owner or Agent(If Ag ,
Power of Attorney or Agency Letter Required)
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f04 h1 1l AIXK z¶ k j.fName of Company y $h �RIpY pi pM4Qualifying Aent w a: IcA zAa4>'ir xGigi i
Addres '.zaL C 6 K ti 2 -gRkS Cit ui t c it State k Zipi3 • t
Office Phone''„ a .;AA L„ rrs.i''*�, . s` ;`tY `
,vim. . z:�,Sx, Job Site Contact Number
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State Certification/Registration#IVASVIMPINSVag E-MailE4v .. f a ^iV
Architect Name&Phone#
Engineer's Name&Phone#
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Workers Compensation Insurer a t 44 ” ; Y *w : . H OR Exempt Expiration Date l .x;z
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. NjOTJCE. Irl ad t1oh to the requirements oIthis
ti=;
rrx# ,[<`h temay be;additional restrictions,ap fab � ' t"_(�{+_i(''y. o y, -X4 'i1( ( 1�* olOt ts'cciun y,#rad
t.r� .1Z�:yyti �ti: ." � ,. r. ,.'. . -.._t_ ...�y3cg'�'""`��t .'n"".t,=�r •• :�i�•l"ii�'iY �ar y:=r7t,��.•�i-..�ti w•':::t'i,;i.�y,�,.
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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. I
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
4 TO OBTAIN ; i, NCIH %, CONSU T ITH YOUR LENDER OR AN ATTORNEY BEFORE
REC i ; t IN% i R ;`%TI % `f MENCEMENT a�N�a:�> x z �r i �; .
f w0.-"-'‘.:74/'"!",'•• a>W "7a. x. 2 )` .., u )'sirn �'X�M £"R g1klx Th1r )r >S=?1SSR-4
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Signature of Owner or .,ent) (Signature of Contractor)
Signed and sworn to(or aff m-d)befo•- • e is day of igned and sworn to(or affirmed) before me this day of
b f # A44 /''Y, , by
Ciiigna ' .f N. . (Signature of Notary)
4r r,'ii: ++j I GWDLESPERGER
' �.T.` SSION# 353178
[ )Personally Known OR .; i*: P nail nown OR
;i;','"-It's' EXPIRES:Octob•,r -
[ )Produced Identification ;?FaPo:: BondedThruNo4vyPubodt�r �•entification
Type of Identification: •- cation:
Owner Builder Affidavit pak fi {
City of Atlantic Beach Building Department r: "VA" r ' E:::}
' Imo" 800 Seminole Rd, Atlantic Beach, FL 32233
�P xi i np 94 z47-5826 Email: Building-Dert@coab.us
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;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
RE•UIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES.
14-we. IJ IINIJURYLIABILITY;SINCE;OWNERS MAY BE LIABLE FOR INJURIES TO WORKERSTHEY.>HIRE THEIBUILDft?I.0 DE1?#I TMi: 1 .
SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. .
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRSUITHHOLDING
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.
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)caner Name w<r q> , �� N ~�r�q� <k n� Phone Number•40:f4409"57.53
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Votarized Signature of Owner h ': •
h, ;,:, t n1.w-s;ac rtowle ed befog me this da •
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Signature of Notary PubliE— (�
[ ] Personally Known OR [ ] Produced Identification
Type of Identification: II
Updated 10/24/18
:'•" TONI GINDLESPERGER
rte' •
.` MY COMMISSION#GG 353178
"••`;',..W...j.4? October 6,2023
%EBonded Thru Notary Public Undeiwrftets
RECEIVED
By Toni Gindlesperger at 8:34 am, Dec 31, 2020
Building Permit Application
Brinkley A. Harrell
904-899-3753
260 Sixth Street,Atlantic Beach,FL 32233 .
Lot 40, Atlantic Beach Terrace
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Description of Work to be Performed revised 12-21-2020
•
1. Remove all existing, deteriorated and rotten T1-11 wood siding on entire second story.
Specifically across entire 30 foot width of front of house-north wall, along 50 foot length of
west wall, along 30 foot width of rear of house-south wall, and along 50 foot length of east
wall.
2. Install 7/16"Zip System OSB-sheathing with built-in vapor permeable water resistive barrier
over all second story walls. Specifically on all walls listed in#1 (above) where T1-11 is
removed.
3. Remove all existing single-pane aluminum windows on entire second story.
4. Install new PGT Brand white vinyl-clad, double-pane insulated, single-hung windows.
SH-5400 Florida Product Approval Code 1435
5. Install new HardiePanel 48-in x 96-in HZ10 type smooth Fiber Cement Vertical Siding
atrels.,on•seeond.story east and west walls. •" i,,aim°` '° " :`'xz' "```+a :
'6. Install new HardieShingle 15.25-in x 48-in HZ10 Straight Edge Woodgrain Fiber Cement.. •
Shingle Siding on front and rear walls and on roof gables.
Florida Product Approval Code FL13192.3 and FL13192.4
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