299 Atlantic Blvd 1 DEMO18-0037 City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
V I tit E-mail: building-dept@coab.us Date routed: 12-
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Z91 Department review required Yes
R:(-Uer CJU ( Buildin--q3
Applicant: —Pla—nning &Zoning
Tree Administrator
Project: gi- eii-1*0 0 �cWorks
,..Public Utilities��
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection C ev
Florida Dept. of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants ;'k
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: [JApproved. [:]Not appiicabie
(Circle one.) Comments: i�lqi 7/-,/?23
BUILDING R-epz
PLANNING &ZONING Reviewed
TREE ADMIN. Second Review: F]Approved as rev')p
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviev,
FIRE SERVICES Third Review: FlApproved as able
Comments:
Reviewed by:
Revised 05119/2017
Building Permit Application Updated 12/8/17
I Di
City of Atlantic Beach iCE COF� i
800 Seminole Road,Atlantic Beach,FL 32233 Z (n
Phone:(904)247-5826 Fax:(904)247-5845 _J Z
rX 0
JobAddress: 2P(ct AILAWnc- %W6 PAIM Permit Number: 16P -3--2-
e
Legal Description JA lT_Pt5F*2& OE
Valuation of Work(Replacement Cost)$2-0 003 Heated/Cooled SIF Non-Heated/Cooled
LJ cc
0
0 Class of Work(Circle one): New Addition Alteration �e�love Pool Window/Door 0 L
_J
Use of existing/proposed structure(s)(Cir Co rn m�Derci a Residential I.- cn
0 -cle one) 0 1 CC Z
?JCirc
If an existing structure,is a fire sprinkler s nstaCI;e ?(Circle one): Yes (n) N/A 0 :E
a ystem I ista; LL U.
0 Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal 0 o I W
0 Pr
LU -_ -
Describe in detail the type of work to be performed: Lu =D)
til C33
SlEe_ ATTA42A+IED LU tun) UWJ
Florida Product Approval# for multiple products use product aWroval form J
ric
Property Owner Information t5�� A�T-LA_,Sr%C_ INLV 0 gv I M —I—.
Name:So%Al"Vt C-OASr —Address:
city "C-PTI"le '!�IIFACA+ State V-_' Z i P'S 2-1-L JC —Phone '40 � -4.o 5 VO
E-Mail KJt11TJe4_P LOVE-TrMLLA.*_e CA5 r-1
Owner or Agent(if Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: V�jftr CAJI!i (�bn±1AjC;tD f-& (VkC. Qualifying Agent:
Address ISJO tAOMWAOL 0dt-<AAk" City �d_C.(r-6()MV11(-6 State F:11, Zip Z42D*
Office Phonec(lo 4-,3 4�01 - 7 va 1. Job Site/Contact Number
State CertificationjRegistration# 0110OS-1 I- E-Mail Wain(3kiveir6t!4-g&��a .cnm
Architect Name& Phone#
Engineer's Name&Phone#
Workers CompensationRLILI 01210't "LLI bl-,, 1 31
Exempt/rnsurer 'ease EAploye'es/Expiration Date
ir
Application is hereby made to obtain a permit to do the w D-frTTMinstallations 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 regulationg
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 VOYR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, NSULT V
,�ITH YOUR LEN 0 ATTORNEY BEFORE
RE C1 ENCEMEN
C ;31
'bture o
(Sign f dw-Ffier or Agent) (Signature of Contractor)
(including contractor)
signed and sworn to(or affirme efo e e this day of igned and sworn to(or affirmed)before me&his Xrclay of
IN y Atw
by 4N b
00 rif r\Iat;UW1_
ASHLEY AWN Ddtd
.0 IFF 25 690 -londa
84
0
9 ID2
ROSIN KAY BARNES
s"o xp,
mmission Ai IFF 925690
Notary Public-State of Florida
[/Personally Known OR
_OR Co A Zf�
My Commission Expires Commissior 9 GG 170984
0 . 01 9
Produc I tion October 08, 2=0 19 Produced Identification my Comm Expires Jan 22.2022
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9
,i PROTECT E)IJSTINr
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21 f4lhS*L*tA7ION: RLSI(JRL�f4lS�4LS04�-PA'C�&L)ARLAS.
22 REAXNL LX.!i TING SHLLVINU AND CABINETS NY'KIYUHLN*AREA
23 qfWYF SuSpFhr)F n CjEik W.AN)GR 0
24 �*16"ISH ANO RFMOW EXISTING RESTROOMS
25 4LAALWL LX S I ING.KJi,1,;L BAR AND SHELVING
------ A MAP SHOWING A BOUNDARY SURVEY OF
THOSE LANDS OF SOUTHYOAST CAPITAL f�ARTNERSHIP,_LTD., A FLORIDA CORPORATION
—--—-- LYING IN ATLANTIC'BEACH AND NEPTUNE BEACH,-DUVAL COUNTY, FLORIDA
FOR: SOUTHCOAST'CAPITAL PARTNERSHIP. LTD., A FLORIDA CORP6RATION
AHE)--"E'
u_ (57.RjCH,,_0E-WAr)
DESCRIPTION
ATLANTIC BEAE,,.PAC�.
-PMCn I-AS IN.-1.DMIRT'A'AS
No
LP� THOSE LANDS OSSCRIBED AS
—--—-- RECORDED IN OMCIAL RESOIDS WS.PAGE 2W.DWAL SO—FLORDk
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UNNU...ED T% P �NC OXD-.U.LOT a B EN
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ATLANTIC BEACH.TERRACE,AS RECORDED IN PIT OOK I'.PAGE U.OF
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ME SOUTH UNE OF LET 5 AND 5 AND ON
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'A4 t BOOK 5.PAGE 159
LA.=8E.I&H TEMCr -------
T DKI
L. �.!Dipoc I.S.PW U_%.
------------;&ipj
x
% ME`OUOMNG SURVEYS REaE USED AS REFERENCES IN PREP.ERXMN OF THIS SURVEY.
--------- 1)SUMR� H�0 RE"ll �OCATES.FRE No.112..GATEO,-SEPT.21.1178
u
2)SUR�GY ELUS.WnS A KOOKER,IRE No.F2,.-3.-
.i 3)SURVEY W EU-IS.CURSIS&KOMER. GO 16122.DATED:�.12,1931
FILE No 5-1"F�2-114.DATEE:MAR.1.1973
_�7 4)SLIP-W ELU�,WRITS&KOOKER,FRLE No.00-M-9,DATED:2-�2001)
5)SJR�IN R.WELLINGTON.DATED:29 SEPT.1931
6)SUR-
7)STAM 0 FLORIM STATE ROAD DEPAMM
I EUJS.CLW,TS&KOOKER.FILE No.DN65fL4 F155-14S..MTED:OCT.16,1924
F
7 . ..... -(RORRA L'EPAPI&AJ;W't)F.TONSPOWAMN),-�HT����.
.M'. SECTION 12/11/56
a No.72--.DATED!
SUR�RY HA�RDE DATED:OCT 27.1-
9)
N D)W= FILE No.0-2672.DATED AUG.8.1997
-KM.DATED: 1.13
oFX` III EXPLAMAWN W-DU ROSH&ASSOCIATES.�PLAINING RIGHT-OF-WAY PROSLE�. 197,
om$
2)ATLANTIC REACH.FLAT BOOK S.PAGE 69
3)NEPTUNE 9�MRACE SECTION 2.PILAT 60OX 15.PACE
14)NEPTUNE.FLAT�C PACE 46
Mo I
o -r E
15)ATU`N"C BEACH MRACE PLAT BOOK 15.PACE 34
3
T
F
lr�
1 OD.7
S a
a
ME FOU-ING DIU,REPORTS PREPARED W OLD
REPUBLIC TITLE(ORT)INSURAH E COMPAMY WERE USED IN
PREPARATION OF THIS SUR_C
Off No.111111�1 2:2
-X_ ORT No.031031,I.A"'. 32
..T No.-.31o.M 2:
09T No.031031 23 3
ORT No.031.03
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,M ':2 gg�3
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ORT No.W103198 DATM.OCT.23.2003
ORT No 03 03 80 DATED'OCT.2.2003
No:-039,18 DATED:OCT-23.2003
W.
NOTES,
1)BEARINGS SHO-HEREON ARE BASED ON ME WST Rl�ff-OFUW OF OCEAN 8OLUA;,..
SOUTH-'10'EAST.AND REFER To SUR�W HA DURDEN�ASSOCIATES. IN ATLANTIC OEACH.BEiNG
FRLE�MSER 7624.DATED:SEPT.21.19711,
2)UNDERGROUND �l NOT LO-TED I,M,�S,,R.
3)FOR A LIST OF ITTI-E REPORTS USED IN ME PREPERAT)ON OF THIS SUWEY SEE ME TA"LE AS SHO-HEREON.
N wz 20i.tl'
7, 4)THE PARCELS SHOW HEREON UE IN ZONE N'AS SHOWN ON FLOOD INSURANCE RATE MAPS 120079 0001 D(NEPTUNE REACH)
ANKI 120075 0001 D(ATLANTIC O�N).DATED APRIL 17,1959.
SHEET I OF 2
SEE SHEET
5773 NORAMDv BOUMARD,
BUY JACKSONvILLL rLoRiDA 32205
us Rmons -(904)79"400 FAX(904)78,1479
UIDDsEE,amNERs- Am
TLORCA PRIYES� -0-10 1113�S./�18/2- DRAFTED�-.-N
D MAPPER CHECKED BY,P.FERRARI I CAD FILE:03635.DWO
Pe"M 0o 3 7
NOTICE OF COMMENCEMENT
Stateof Tax Folio No.
County of
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713
of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: C—WV1A-i2A-LAJkt- ZoWeo Ac-U —
V5-34 -2 t-2S-2-1%e.35
Address of property being improved:2-q0t A;rL"-nC- St-\/0 S" ITI�- 5- A-T14N-KT-1C- BEAL%X,FL- 32,7-33
General description of improvements:'WT0KM,. - �R tQ
got C)C-Mr) po(L jtJT)E:kt(.*- ?,C-McOEIL- AEObVA 0
Owner:�01ATA6*%T-CP-?tTAt-TAWaS*1 2 1 Address:-2-4A kT1PojTV-9,-VO I%,A%VE U% F:k-
owner's interest in site of the improvement: 4�5*Jltjm
Fee Simple Titleholder(if other than owner):
Name:
Contractor:
Address:
Telephone No.: Fax No:
Surety(if any)
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name:
Address:
Phone No: Fax No:
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may
be served:Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b),Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNE
Signed%z-oaqcA Date:
ASHLEY ANN DODD Before me this gjjCjA .day of the County of Duval,State
Of Florida,has personally appeared V'rwil
Commission#FF 925690
Notary Public at Large,State of Florida,County of Duval.
�67 My Commission Expires
October 08, 2019 My commission expires:
-- -I PPr.-;onnllv Known- 0 or
COPY
LN Legal Description
1 15-34 21-2S-29E .35
2 ATLANTIC BEACH TERR S/D
3 LOTS 1 TO 4,PT CLOSED ALLEY,
4 5-69 ATLANTIC BEACH
5 S 15FT LOT 7,LOT 8,LOT S OF LOT 8
6 BLK 35
CITY OF ATLANTIC BEACH
�_Aj
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 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, WI-RCH 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.
11. 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(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(24775826) 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.
2,'-Pi—I A-r-L,&o n L-vo �A,,-TLx ri -L %4 . Vv(j%-
ADDRESS PHONE NUMBER
P_
RIN N
SIGNYFURE DATE
Before me this day of 20t in the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of DOOM—County of VUVA
114ersonally Known
Produced Identification-
000M,,,
ASHLEY ANN DODD
commission N FF 925690
*s
My Commission Expir�
Notary Signature: 000bef 08, 2019
F/111-1)(3/0—r-Builder Affadavit;REVISED:4/16/2009
Building Permit Application Updated 12/8/17
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845
Job Address: 2P(Of A-V L4kWnC_ tLVtj SIAIM :1 A.D_ PermitNumbeir: 'Mo 100-0o-57
j;5_-3Lj -
Legal Description jA _35-
Valuation of Work(Replacement Cost)$2-0 i W3 Heated/Cooled SF Non-Heated/Cooled
e Class of Work(Circle one): New Addition Alteration RLeQajL_Move <� Pool Window/Door
Use of existing/proposed structure(s) (Circle one)'_Corripmercia Residential
If an existing structure,is a fire sprinkler system in'sta'le . (Circle one): Yes (:� N/A
Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
See-
Florida Product Approval# for multiple products use product approval form
PropertV Owner Information
Name:S*%Al-�ilr C-OASI- C-^F%-rA%_ ?AATJ"-&W1f Address: '1+1 tTl� A-TLA-,SnC_ INLVO rtkim
City WQT"19 J�EA4_4+ State Zip'37_1_4JC Phone `t`40 � -ko 1
E-Mail 141t11T,e_e LQV*_7rM&t_Lt�Z .00 r" cn
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Z
Contractor Information
Name of Company: 9-iyex- CA.L.. M (VkC. Qualifying Agent: *tA.*N cultriti C LM
-)
Address IS(0 tAQA�-aAAO;t; jNjt!<Afty,4L1 City State F(- Zip
Office Phone C1104 SC19 - Y19-wo Job Site/Contact Number 0
State Certification/Registration# 011005-11- E-Mail 0j a-n GO h y ejr-6j:!4- L.126
Architect Name& Phone# V
cc
Engineer's Name&Phone#
LL
Workers Compensation I�XAAIIAA "LL161, 1 0
Exempt It�(`nns_urer ease ErAployees I Expiration Date
st a
Application is hereby made to obtain a permit to do the wor installations as indicated. I certify that no work or iniliWlKfti��h
_9s
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the law3e'Vatipr(9 Lu
S C
construction in this uriscliction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBIN14!S GO,'a
i . > W uj
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE: In addition to the requireffints of this 5
LU
permit,there may be additional restrictions applicable to this property that may be found in the public records of this t4unty,and cc
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 T9,Y0YR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, PINSYLT WITH YOUR LENqE40 ATTORNEY BEFORE
REC ENCEMEN .
V (Signature of Co
(Sign'i t) ntractor)
(including contractor)
Signed and sworn to(or affirmed) f this 5-f"'day of gned and sworn to(or affirmed)k7fore me&his dayof
1710W 'byA� M" by 7-7'0-4
o
ASHLEY'A N
Q ROBIN KAY BARNES
.".4, ida
_1or
commission FF 925690 Notar�Public-State of Florida
[/Personally Known OR J, K.
4
14 Person I R My Commission Expires Co�rnissior 9 GG 170984
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A MAP 'SHOWING A BOUNDARY SURVEY OF
THOSE LANDS OF SOUTHebAST CAPITAL PARTNERSHIP, LTD.. A FLORIDA CORPORATION
LYING IN ATLANTIC BEACH AND NEPTUNE BEACH, DUVAL COUNTY. FLORIDA
FOR: SOUTHCOAST'CAPITAL PARTNERSHIP. LTD., A FLORIDA CORPORATION
07 m5`r-",-ANr)
DESCINFIFoH
ATLANTIC BE�.PARCEL
'PARCEL A.AS SHIONIN IN UHIW'A'AS
'�D THOSE LANDS DES-MBED AS
RECORDED IN OFI WCORDS 6671.'AGE 2W.DUIA&COUNTY FLON.,
'GODO, HONG THE SOUTHERLY 15'OF LOT 7.ALL OF LOT S.AND THAT CERTNN
""'12 UNNUVRIERE'LOT.OR STRWI OF LANG.L�SOUTH M LOT a BMIEEN
SAID LOT 8 AND ATLANTIC BOULEVAREp A�RECORDED IN pLAT 90M S.
PAGE fig OF SAID PUCUI RECORDS.T&C��LOTS I�3 CS AND 6.
ATLANTIC BEACH TERRACE.AS RECORDED IN PLAT BOOK 15-- -
TOGETHER PATH�T CERTAm Ij PAGE X OF
BY THE SOUTH
5 SAID�Ic
ROUNDEED ONt UK OF LOT 5 AN NO ALLEY
THE SOUTH RY THE NCRTN UK,Lon I THROUDH A
cGAFAA.ING ACKS.NDIIE ON LESS
II&&CH
PLAY
ATLANTIC REACH TERRACE ROON 1.PA.IS
PILAT 1100K 151.PAGE 34
G I I
V,
THE FOUDIVING SLRYM IrFRE USED AS KFEREN�IN Mo",DD,OF THIS SURVEY.
A06 2-11----------- 1)SURVEY ITT—DUROE?l&AS�AFF.FILE W.7624.DATED:SEPT.21,1978
2)SURVEY BY ELLM—&—ER.
3)SURVEY W ELLIS.GUNTS FILE F2.5-14-013'1652.GATED:SE,,Y.12.1931
, &KDONER.
4)SURVEY By ELUS.CUIM, &KOONER.TRUE NIA8 F432-74.2MM:NAR,1.1913
5)WRIVEY IN R.KLUNGYGAL GATED:NFICE GO-"-9.DATED:2-200D
4 6)SURVEY ITT ELUS.CUICTS&KOONER.FS"Ift"'IL 5"F155-1�.DATED OCT. 16.1221
7 7)VAX OF FU(NGDk STATE ROAD"ARPNENT(FLOINDIA UEPARYNENT'CT Toh�A,,I RIGHT-OF-.
E -lill.DATEE,.
SECTIGH—7210
S`P`V"W HA DLQOE.GATED:OCT 27.1-
----------i 'GO SURVEY DUNDEN LAND SURVEYDRS.FILE—0-2672.MTED AUG.a.I..,
%$T21-W E 110)�BY ELLIS.t—&K""P,DATED�l 1.1113
-n
2 ATLANTIC 9ENON. ,,AT S&
) .PACE 69
�3)NEPTUNE REACH TERRACE SECTION 2.ILAT 15.PAGE 1.
AGE
A) ,FUNK PLAY�A.
IS)ATLANTIC TERRACE.PVT R-I 15.PACE 34
2
-STORY a
I (CONKRCT) c
FW
b
THE FOUCANING TITLE RIONORTS PKPAqED R,OLD
RVUKC YTTLE(ORT)INSURANCE CONPANT VIERE USED IN
PREPARATION OF 71�SURVEY:
ORT NN,.03103150 DATED:MT.222 2003
CRY -GO'
N' WlO3;3 DAR 99 2�2:Z
OS 003
O�3;OWI;I I DA ITT.23,200�
DA%!0
ONT N� 03;oalG OC
97�7&OCT 2.2003
2
m W. 03, DAFED,.OCT,23
M ARD 2r
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W 0"18 OATM.OCT.2k 2003
AN
NOTES,
1)`N"`"GS HENDON'K"SEG ON THE WEST`NGH`-OF--LINE OF OCEAN 0MI-EVARD.IN An�BEACH.KING
SOUTH TS".10-EAST-AND REFER TO SURVEY BY HA DURDEN&ASOI FILE IIU.MR 762..DAM:�.21.t978,
2)UNDERGROUND IMPROVEME1117S/lENCIN)mCNIVIENTS,F ANY.IVENE NOT LOCATED OT THIS
—2 Ml- 201.11' 3)FOR A U�OF TITLE REIONTS USED IN THE pREpEpATGN OF THIS SURVEY SEE THE T� HEREON
AS SNDNN 0.FLOW MU,"M RATE MAPS 120on GOD,0
AWI 120075 0001 0(AFLAFTC REACH).DATED APRIL IT.19,9. (�W BEACH)
4)THE——NERE-LIE IN ZONE
-------- ------ -
SEE SHEE 2 SHELF I OF 2
Ow
P UcDIIIIEiIo Kwmn NN,=a
ABLO TERJII,%R�
`U`NG,ANGFC�ANK,aA"ImPm Sao,
ED ITT A W.LU.
I,—...By:P.ff"Am CAD FILE:03635-OM (TO 475 PS,46'14
-D
NOTICE OF COMMENCEMENT
Stateof k 0A Tax Folio No.
County of
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713
of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: C—16-P-0LA-AA-*-- Zoluje* Ac—&D
6-34 -2-1—zS-2-C% e.35
Address of property being improved:2-q'i A.TLApk*�-tc- b4EAuA , FL- 32,7-33
General description of improvements:A14T94Cr� 4k* — oc-Mvu poa_ jo-ce7Atua-
owner:�OUT�460N&T-C"11-A-,-TARAWLS*1 Pt Address:2jdr-I
Owner's interest in site of the improvement: C>WP01— 3
Fee Simple Titleholder(if other than owner):
Name:
Contractor:
Address:
Telephone No.: Fax No:
Surety(if any)
Address: Amount of Bond
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name:
Address:
Phone No: Fax No:
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may
be served: Name:
Address:
Telephone No: Fax No:
in addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b), Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNE
Signed: Date:
Y AN.IN DODD Beforemethis &C4 day of De(gM20G�Wthe County of Duval,State
ASHLE Of Florida,has personally appeared �N ROOM LO VeH-11
Commission # FF 925690
Notary Public at Large,State of Duval.
MyComrnission Expires 11ohda,County of
�I LOH
My commission expires:
Octobet 08, 2019
I Pprnn;illv Knnwn:�;4— nr
LN Legal Description
1 15-34 21-2S-29E .35
2 ATLANTIC BEACH TERR S/D
3 LOTS 1 TO 4,PT CLOSED ALLEY,
4 5-69 ATLANTIC BEACH
5 S 15FT LOT 7,LOT 8,LOT S OF LOT 8
6 BLK 35
zl�
CITY OF ATLANTIC BEACH
OWNER / BUILDER AFFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAVV-
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 THAI'
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
ORDINANCFS.
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
111. 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(l), AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OVVNER 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
OVVNER-BUILDER PERMIT.
Ton— Al-L.&o n c, e)Lv o 9 AiT- L,,bt1-nC— q&l 4, ��4 1-%-(j V
ADDRESS V--L— -S-2--X—�� —5 PHONE NUMBER
-N .
R
IN I N <k
SIGNYrURE \—o
Before me this dayof 201& in the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of flOV14A County of IXAVA
WPersonally Known
11 Produced Identification- ODD
ASHLEY ANN D
Commission # FF 925690
My Commission Expires
Notary Signature: 000bef 08, 2019
IF,
R/BLDG(Owrier-BuilderAffadavit;REVISED:4/16/2009