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224 S OCEANWALK DR RES22-0285 Building Permit Application Updated 10/9/18 City of Atlantic Beach Building Department **ALL INFORMATION �! -y 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: dR(71 OceQr1aln/Q IA aR/✓P S i7 1-iPermit Number: RZ/Z— U Z , Legal Description VV �/ — 0 / p? —oZ g ocem �«-IK q RE# /(Q(�7 €7'63 "©U7/2_ Valuation of Work(Replacement Cost)$ ...3( 00 0 Heated/Cooled SF Non-Heated/Cooled • Class of Work: ❑New ❑Addition Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial >i'l esidential • If an existing structure,is a fire sprinkler system installed?: ❑Yes 1VSNo • Will tree(s) be removed in association with proposed project? EYes(must submit separate Tree Removal Permit) Alo Describe in detail the type of work to be performed: /9a.e n f-1.45/ Tn f Pr=c0 et-to•ae/� kV 4,r//s 0-7j- Florida -7 -Florida Product Approval# for multiple products use product approval form Property Owner Information Name Lc,re/l u7L,Se7L Address 22 62C 420,1 w4 / Ofr,ve SUM/ City/9.-Ha n 1 f3c a cA State /l Zip 222_3 3 Phone (46)00 7 O(,9 F E-Mail Lc7R /LGT36-Ara./•(ar►7 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 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 REC D/ IN9 YOUR OT E OF COMMENCEMENT. �� # (Signature of Owner or Agent) (Signature of Contractor) Signed nd sworn to(or affir )before me this'9 day of Signed and sworn to(or affirmed)before me this day of ZO?Zip O Is P LJ-va+ ,by (Signature of Notary) � q°_` TC'NI GINDLESPERGLally [ ]Personally Known OR Pers Known OR [ ]Produced Identification w � MY COMMISSION#GG .frtPd ed Identification Type of Identification: 'sF P�•_ EXPIRES:Cctober 6,2�YPe of entification: P B° i n ru yc`zR,public Underwriters Owner Builder Affidavit **ALL INFORMATION 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: Z/ 2 V O (/ /./1 wa.." ,6,, v ' SOGCILG] . Owner Name: / Kc�iK ffe 11'S.e-7/— `` Phone N�umbeF q q) 7Z ^(��j 9 8 Mailing AddressZ2V Ort � wa,t°i(�gil/v-,SoCity: f r/air n L' AeaState: P/, Zip: 22.2_ 3 3 Notarized Signature of Owner ( 1 4 L i ThR foregoing instr ment was acknowledged before me this Iq day of 00A-- , 202+ the State of Florida, County ofJ /v-, City: , J------a„--- fof Notary Public [ ] Personally Known OR [ ] Produced Identification Type of Identification: T;;Ni GiNDLESPERGER Updated 10/24/18 ,i : '•` ;,: MY COMMISSION#GG 353178 T�ii' `y,.; �`. EXPIRES:October6,2023 °C"`"' Bonded Thru Notary Public Underwriters a' r NOTICE OF COMMENCEMENT State of r io e-i a G Tax Folio No. /6 /q, -2"06 '12- County v / 2- County of DLiVR--f 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. o Legal Description of property being improved: y��/� % -2s -29 e. aGQQI? WR2I<LLP / '/ L_o7 /9 Address of property being improved: 2 2 9 CC ea✓1 W / (er/v, ce ,c_ General description of improvements: 113& 17 r o v'IA vat PI r' / lQ,lac.e,ii e r._/,, 7toi (4. rec/ace r-x¢#77 pain/ S/ re 7L7 sv ,e rep /qc.e 74."/.c 67,-4,4, Owner: Ore He .S-ef Address: 22. l 64,/4...M.64,"/0co 64,/4...M.64,"/v",49v",49 % 41Lbut, Owner's interest in site of the improvement: /41 P/"-W,O i'Yt Pn Fee Simple Titleholder(if otherththan owner): � Name: C/O�C � ��C r) /,-. ei — Contractor: / Address: �� ()c.Qi O mieLe /fi V S u ' �"1 1 ia Telephone No.: Fax No: 322� 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 ' "'aa"-e p#r•ecoiing t : J` te is specified): • MY DOMINISSION#'CC 353178 — "� EXPIRES:October 6,2023 Doc#2022263052,OR BK 20470 Page 1019, OWNER • Q,"k4` Bonded i hru Notary Public Underwriters Number Pages: 1 g ck `/�/', ' /o // 2 2 Recorded 10/1/19/2022 11:54 AM, Si ne .( L Date: JODY PHILLIPS CLERK CIRCUIT COURT DUVAL Before me this 19 day of • O r•the County o Duval,State COUNTY RECORDING $10.00 Of Florida,has personally appeared r L 2 SC Notary Public at Large,State of Florida, I. ty of Duv My commission expires: Personally Known: Produced Identification: