2016 SELVA MADERA CT RES23-0059 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
GREENWALD JOHN R JR 2016 SELVA MADERA CT ATLANTIC BEACH FL 32233-4531
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
169506 1636 SELVA NORTE UNIT 02
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
2016 SELVA MADERA CT RESIDENTIAL ALTERATION
RESIDENTIAL Interior remodel $20000.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $155.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $77.50
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.49
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.33
TOTAL: $238.32
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property
that may be found in the public records of this county, and there may be additional permits required from other
governmental entities such as water management districts, state agencies, or federal agencies.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
1 of 1Issued Date: 3/28/2023
PERMIT NUMBER
RES23-0059
ISSUED: 3/28/2023
EXPIRES: 9/24/2023
RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
4'- BuildingPermit Application Updated 10/9/18Af. , PP
A City of Atlantic Beach Building Department ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
I 9
IS REQUIRED.Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 2016 Selva Madera Ct.,Atlantic Beach,FL 32233 Permit Number: F S Z 0059
Legal Description 40-37-09-2s-29e Selva Norte Unit 2 Lot 73 RE# 169506-1636
Valuation of Work(Replacement Cost)$ 20,000 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 NIResidential
If an existing structure,is a fire sprinkler system installed?: ®Yes No
Will tree(s)be removed in association with proposed proiect? Yes(must submit separate Tree Removal Permit) No
Describe in detail the type of work to be performed:
Remove existing tile,replace. Replace shower. Remove and replace existing tub. Install new cabinets. No structural changes.
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name John R Greenwald Address 2016 Selva Madera Ct.
City Atlantic Beach State FL Zip 32233 Phone (904)887-4803
E-Mail jgrnwldl@gmail.com
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company N/A 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
RECORD! ;G YO R'N'l TICE OF COMMENCEMENT.
ft•!"NILre of•\. ner o ArorSignatureofContractor)
Signed and sworn to(or affirmed)before me this 21 day of Signed and sworn to(or affirmed)before me this day of
IVIGtrCA , i,011 ,by St.l1n (-ore LU(i.(d: by
ture of Notary) Signature of Notary)
rsonally Known OR Personally Known OR
Produced Identification Produced Identification
Type of Identification:FL.ID 1. a(091-47b-5511-3Nq-0 Type of Identification:
I:`` v;*
VANESSA ANGERS
I `-' MY COMMISSION#HH 244118
oF gQ EXPIRES:March 23,2026
By Mike Jones at 9:49 am, Mar 23, 2023
REVIEWED FOR CODE COMPLIANCE
Owner Builder Affidavit ALL INFORMATION
HIGHLIGHTED INr
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#: rtS23 -0051
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES
OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
pDISCLO5URE 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
I 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: 2016 Selva Madera Ct.,Atlantic Beach, FL 32233
Owner Name:John R Greenwald Phone Number: (904)887-4803
Mailing Address: 2016 Selva Madera Ct. City: Atlantic Beach State: FL Zip: 32233
J
Notarized Signature of 0 er '` C.--,
The foregoing instrument was acknowledg:d before me this Z I day of MCtYCh , 2o2-3, in the State of Florida, County
of Di,tt
Signature of Notary Public
it •,VANESSA ANGERS Personally Known OR ["Produced Identification
MY COMMISSION#HH 244118
EXPIRES:March 23,2026 7 fI6°F; t° Type of Identification: L. b t e=i la 5u- 7 -59 -399-0 SUhr E1(ee11(,>J4d
Updated 10/24/18
NOTICE OF COMMENCEMENT
State of d Det -(la Tax Folio No.
County of DV V.4 L-
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:
46-31- D q - 2 5 -2.4 Q Setiva NO cjio 'T 2 COT -73
Address of property being improved: 20( 5>LVA 1/Vl d Dej2.4 Cr 14 I LC'
n
Q L N23),
General description of improvements: kekktr1 'PcOLA T LE Ai4 0'lD f NI,1STE a 4T4
2 o'
LvE
q`-_- ?EpLA 11,4ti ES
Owner: NJ (.(2(n aLD Address:
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor: Taw (P(L. JJoA£271
Address: '2-0(,(47 P \Jtd4 ?v JQ Ct, 4tkvt-ELn DeCC'i) f iL 3Z2 3
Telephone No.: 4' j 1 IVO3 Fax No:
Surety(if any)
Address: Amount of Bond$moL- zizom00mco
Telephone No: Fax No: c o; Q coz -<a m
Name and address of any person making a loan for the construction of the improvements o
nwo
Name: a N "
EA 01
o n o
Address: g m Ni
0
o
mPhoneNo:Fax No: N
Name of person within the State of Florida,other than himself, designated by owner upon whom notices or other documen• 0 Ni_
c
be served: Name:0 v
o (n
Address: G,
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided it
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 / /'d ' ,it
li''
Signe.. 1` , Date:
I2
Before me-this. I day of MarCiA 20-3.3 in th County of Duval,State
Of Florida,has personally appeared (TTill .e.znwea of
Notary Public at Large,State of Florida,County of Duval.
ti P My commission expires:
VANESSA ANGERS•
ith Personally Known: o or
MY COMMISSION#HH 244118 fL Di. el 1/294-1-1-7 - -3qg-c,Produced Identification:
fqF no:EXPIRES:March 23,2028
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