1830 SEMINOLE RD RES22-0286 OWNER BUILDER rI.Jv\
frRESIDENTIAL PERMIT PERMIT NUMBER
£)3 ,J
,
CITY OF ATLANTIC BEACH RES22-0286
V 800 SEMINOLE ROAD ISSUED: 10/28/2022
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tJ,ls9ATLANTIC BEACH. FL 32233 EXPIRES: 7/17/2023
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.
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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
1830 SEMINOLE RD RESIDENTIAL ALTERATION INTERIOR REMODEL, DOORS $66500.00
RESIDENTIAL AND WINDOWS
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172020 0510 SELVA MARINA UNIT 09
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ' ZIP:
ANDREW BRYANT 1830 SEMINOLE RD ATLANTIC BEACH FL 32233
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $59.00
BUILDING PERMIT 455-0000-322-1000 0 $348.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $174.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $7.83
STATE DCA SURCHARGE 455-0000-208-0600 0 $5.22
TOTAL:$594.05
Issued Date: 10/28/2022 1 of 2
� Building Permit Application Updated 10/9/18
�,' City of Atlantic Beach Building Department **ALL INFORMATION
�
� 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
;i
�r IS REQUIRED.
Phone: (904) 247-5826 Email:i,Building-Dept@coab.us
Job Address: b 30 S fti C �L (,) tt(Ah C ECA•1 Permit Number: 'CJ2 Z- OZO
Legal Description 367 v . ac S?kI Ma(ouk Uv.f.4-et RE# I ap®O,U
�"/� g tc-'L
Valuation of Work(Replacement Cost)$ ( t -00 • Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition VAIteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ❑Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes
• Will tree(s)be removed in association with proposed project?❑Yes(must submit separate Tree Removal Permit) MN()
Describe in detail the type of work to be performed: /
(v\.ae'ry(u- -vi,{t' . U*7A— �, k a u'v C J, yr„..)"- : 4 (1) -4044. ozAc5
Florida Product Approval# V)'NQS for multiple products use product approval form
Property Owner Information
Name At' dAcc_k, Y CA tA- Address i
City »'k k vl �C- k_E,Gti State Zip 3'2 5 Phone ((et/ — -3 44_5""
E-Mail pkv16.f aC t Li vt•-1 3 C 7W1 t 4' I • C
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 ser
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt o Expiration Date
Application is hereby made to obtain a permit to d• e work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit a • that all work will be performed to meet the standards of all the laws regulating
construction in this jurisdiction. I understan. at a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS,POOLS, FURNACES, BOILERS,HEAT'RS,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 DING OUR NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) (Signature of Con '.ctor)
• ned and sworn to(or affi :•)bef. e me is 7 d. of Signed and sworn to(or affirm-: before me this day of
3 b • 111 _ /. ,by
�l♦�: a gAMTSP DAI . (Signature of Notary)
7-. TO. 'DLESPERGL
'' '• aa. `` ? MYC .SION#GG3:i31i3
[ ]Personally Known OR ,:. ^Pq•` EXPIRES.Octobe(6j persona Known OR
[ ]Produced Identification " , ''O°F°' Bonded 7hruNo'aryPubl' pY 75 Identification
Type of Identification: , Type of Identification:
Owner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
P--,.'ifse)!
' 800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: VE-Sr)3 -C -") 'j(1.'
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: Ig30 ckvwvtoCR, k_41. - 4C, V\cALAI,i pc -d- S
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Owner Name: 1- V c3 NAA; Z fL S± Phone Number: �'�QLt-
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Mailing Address: 1Z7O wit✓\c(Q e . City: ak-kink &,11 State: 'FL. Zip: 0,%'1 - S
Notarized Signature of Owner
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The for-' going instrument was acknowledged before me this / day o 20� the State of Florida, County
of I , \iiCz
/ CZSignature of Notary Public - C
11. 4�`°"��`;, TOPE GiNDLESPERGER
[ ] Personally Known OR [ ] Produced Identificati
1•.; .; MY COMMISSION#GG 353178
EXPIRES:October 6,2023
� 'NF:..r:•.• Bonded ThruNotary Public Underwriters Type of Identification:
Updated 10/24/18
NOTICE OF COMMENCEMENT
State of F [OY l(.0 Gk. Tax Folio No.
County of W Ute,`
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. II
Legal Description of property being improved: • f�� 6 Cl' -9-r aft 54/..l Uz: (.r i rtG'. ll n,4 c
Address of property being improved: ( 36 c 114i►tctg- MAO,tA"\-i , Ev/1" , it L -?
General description of improvements: kik ItP C .4 "OI- VkcS Yvk.os.(er 132 el rtcYvk► l( (Uy ,
u+ tc t'14-- ► ictus- (-kJ demo31�`',s . /' --
Owner: I k'Vk. AUL) b!1 ✓ Address: k%36. c.Pk i v,1� J - ,A1 O
t 1CAV 1t CPA. C1-33'?
Owner's interest in site of the improvement:
Fee Simple Titleholder(it other than owner):
Name:
Contractor: d
Address: V SPA"p.1-`0 �CJ I\CAv
Telephone No.:gQ�`(_Ogp"--1-�1,/S Fax No:
Surety(if any) m o o m Z 8
Address: o z ° 3
Amount of Bond$ C
1'a
Telephone No: Fax No: _F
"0 0 U) (ll
Name and address of any person making a loan for the construction of the improvements o coi o
12)
o mW O
Name: A O
X Co
..
Address: =w
.Au-0 N
Phone No: Fax No: - -13
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other docur
be served:Name: o
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as providE
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 OWNER
Signed: �� I1., _ Date: 7
Before me this day of "n the`Coounty of val,State
1-•;.b� TONT GINDLESPERGER Of Florida,has personally app:. -�
t 4, 2\ MY COMMISSION#GO353178 Notary Public at Large,State o • ida,Co my. s oval.
EXPIRES:October 6;20 M commission expires:
Bonded
l" ` 'Nu Notary Public Underwriters Y
Personally Known: • or
Produced Identification: