Permit 317 Seminole RdA
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
Application Number 10-00000059 Date 1/20/10
Property Address 317 SEMINOLE RD
Application type description RESIDENTIAL ADDITION/ALTERATION
Property Zoning TO BE UPDATED
Application valuation 4000
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Application desc
BATHROOM REMODEL
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Owner
Contractor
------------------------ ------------------------
KAEUPER OWNER
317 SEMINOLE ROAD
ATLANTIC BEACH FL 32233
--------------------- Structure Information 000 000 ----------------------
Construction Type TYPE 5-A
Occupancy Type RESIDENTIAL
Flood Zone ZONE X
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Permit BUILDING PERMIT
Additional desc .
Permit Fee 70.00 Plan Check Fee .00
Issue Date Valuation 4000
Expiration Date 7/19/10
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 70.00 70.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 70.00 70.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORH)A
BUILDING CODES.
~~,, _.._
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CITY OF ATLANTIC BEACH
B00 SEMINOLE ROAD, ATLANTIC BEACH, FL 32233
OFFICE: (904)247-5826 ~ FAX NO.:(904)247-5845
UNMN.COAB.US
BUILDING PERMIT APPLICATION
DUVAL COUNTY
1. JO
B ADDRESS 2. VALUATION
OF V~'ORK. 3. SO FT. UNDER ROOF
~j
,J~ J-I a /~
DO ~
4. LEGAL DESCRIPTION: 5. CLASS CF WORK 6
.
U
SE DF STRUCTURE:
^ NEW BUILDING ^ DEMOLITION ,
p
~
~O.RESIDENTIAL
LOT _ BLOCK SUB i .c:;l'".~~: ^ DDITION ^ CONVERTING USE ^ COMMERCIAL
'r. DESCRIPTION OF WURK 19 ALTERATION ^ ACCESSORY BLDG. 8: FIRE SPRINKLER:
^ REPAIR ^ POOL/SPA ^ YES ^ N/A
Y I ^ MOVE ^ OTHER ENO
PROP R OWNER: CONTRACTOR: ARCHITECT /ENGINEER:
9. NAME: 15. COMPANY NAME: 23. COMPANY NAME:
~Y/1
~QGU
~
~
16
NAME:
24
LICENSEE NAME:
. .
10. ADDRESS: 17. STATE OF FLORIDA LICENSE NO.: 25. STATE OF FLORIDA LICENSE NO.:
3 l `7 ~evnino~ ~a~zo~
18. ADDRESS: 26. ADDRESS:
11. OFFICE PHONE: 12. FAX NO.: 19. OFFICE PHONE: 20. FAX NO.: 27. OFFICE PHONE: 28. FAX NO.:
13. C LL HONE: 21. CELL PHONE: 29. CELL PHONE:
z -a
14. MAIL ADDRE S: ~
~~
r 22. EMAIL ADDRESS: 30. EMAIL ADDRESS:
~¢
r ~..eu ,
FEE SIMPL TITLE L ER:
tIK omen T~ owr~R1 BONDING COMPANY: MORTGAGE LENDER:
31. NAME: 33. NAME: 35. NAME:
32. ADDRESS: 34. ADDRESS: 36. ADDRESS:
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 laws regulating construction in this
jurisdiction. This permit becomes null and void if work is not commenced within six (6) months, or if construction or work is suspended or
abandoned for a period of six (6) months at any time after work is commenced. I understand that separate permits must be secured for
Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters, Tanks, Air Conditioners, etc.
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 will not occupy or use the referenced building or any part therof, until all inspections are finaled and
prior to obtaining a certificate of occupancy or completion issued by the building official, as required by law.
*** 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.
OWNER or AGENT CONTRACTOR
pr A t. Pw+er of Attorney or Agency Lever Required) (~ualfier only)
Signed: Date: ' GC"~ ` ~Q Signed: Date:
.~--
Before me this flay of , 2010 in the county of
Before me this day of , 2010 in the county of
Duval, Stat Florida, has pers Il
y
ap~eared Duval, State of Florida, has personally appeared
~
~
I~-~`1'`t~k ~
herin by h self /herself and affirms that all sta ments and declarations are herin by himself /herself and affirms that all statements and declarations are
true and accurate. true and accurate.
Notary Public e, St of County f Notary Public at Large, State of ,County of
^ Personall ^ Personally Known
^ Pr d Identi ^ Produced Identification -
Notary Sign Notary Signature:
I , o' e.~% ....„PLC i L.
~'~ • ~`~~= Notary Public- HAM
~ - • ., ; ~J x , = State of Florida
~ "; ., . x~, ,'~ MY Commission Expires Fzb 14, 2010
F "%:~"~" Com
,,,- .,,;:~' mtsston # DD 518533
Bldg Permit Application 2010 '~"'A""^~r.>~,~,ei1 Ey National Nota
ry Assn,
CITY OF ATLANTIC BEACH
,,
®WNER /BUILDER AFFIDAVIT
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 REQURES 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 THOL7GH YOU DO NOT HAVE A LICENSE. YOU MUST
SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE AONE - OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
Il~IPROVE A COMMERCIAL BUILDING AT A COST OF $25.000.00 OR LESS. THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. [T MAY NOT BE BUILT FUR SALE UR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIr] ONE YEAR
AFTER THE CONSTRUCTION I5 COMPLETE, THE LAW WILL PRESUME THAT YOU BiJTLT
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 SL!RE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY UR 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 9ITHHOLDING; 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT (247-5826) IF IN DOUBT.
V. ACKNOVII'LEDGEMENT; THEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
31'7 Sic i'~ a l~ ~~
ADDRESS
PRINT NAME
SIGNATURE
...~-
Before me this ~' day of .I 20 ~f7 in the county of
Duval, State of Florida, has personally appeared~by himself /herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large, State of ~~, County of
^ Personally Known~~ 1 *~"'~.":
^ Produced Identifi i I .~ !?;: ~~
notary
gam- ~3"~-oD~Z
PHONE NUMBER
-,20 - /D
DATE
E~RAHAM
to of Florida
~n Expires Feb 14, 2010
""'`'"' '=-~~Nota A
~,....~,~ '.w-..~...,-., .. rY ssn.
'~V,.
F:BLDG/Owner-Builder AfFadavit I2EVISEQi: 4/16/2009
JUN-3-2801 88:18 Ff~`t`: CLERK ~ COl>RTS 904 270 1512 Td: 92475845 P:1 ~ 1
~TO~ICE OF Ca~'~iE~tCEMENT
Pernit No. - ~ Tax Folio No.
State of'Plorida, County of:puval
THE UNDERSIGNED hereby give motlce that the improvement will be made to certain real prolxrly itt accordance with
Clsapter 713, Florida Statutes, the following inform3fiion is provided in this Notice of Comme~accme~oct.
1. Description of property (legal dcscripiion of propetty alnd ad/d~ress~if available):
Z. General Descripti of iaiprovcments•
~~.~.e-~i~r,
--•
3. Owner Information:,,
a) Name and Address: ~ 11.?~i/iy1 ~ix~ off' u 1-7 ~$~1,,11~~-~ ••~ 3
b) -nt+cttst in property:
c) Name and address of simple trtkhoider (if other than ownez):
4. Contractor information:
a) Narbc and Address:
b) Ptwnc Number: .. _ ..
S. Stuzty Information: coc a ~ are; Ewa. vn arc i s, s~ Pie sso.
Ncembec ?dQEg: 1
a) Name Gad Address: Recorded a~r2a~la~o ~ ~:5w ~,
b) I'homc Number: JiM fUIi.ER CLERK CIiCIEtT C0:1P,T DUYAi
c Amoum of Bond S couNTr
) P.cCORDiNG 110.00
6. itcnder Information:
a) Name a,~d Address:
b) Phone Number:,
7. Person within the State of Florida designated by owner upon whom notices or othac documeras xnay bo served ag
provided try 713.13 (X~a) ?, Florida Statutes:
a) Natnc and Address: .
b) Phoac Numbea:s ofi7esigo~aiod Person:
8, In addition to himself/hersel~ Owner designates of to receive
a copy of the Lienor's Notice as provided ~ Section 713.13 {1) {b), Florida Statutes.
a) Name and Address;
b) Phone tYumber of pcsson or entity designated by owner:
9 E~:pi rxtiotl date of Notice of Coanmcn~cemetrt f Tl>,e expization date is one { l) year from the date of Recoxdiug unless a
diffcrct+t date is spocil"ied: ~ ,
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF Tim
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,1'ART
1, SECTION 713.1 a, k'LORIDA STATUTES, AND CAN RfiSULT IN YOUR PAYLNG TWICE FOR
Ii~'ROVEMF.NTS 'PO YOUR PROI'ER.TY. A NOTICE OF COMMENCEMEN? MUST BE RECORDED ANI)
1'OSTIrD ON THE JOB SITE BEFORE TI•IE FIRST INSPECTION. lF YOU IlV7.'END TO OBTAIN FINANCING,
CONSULT WTIgI YOUR LENDT;R OR AN ATTOR.NFX BE>;ORE COMMETICING WORK OR RECORDING
YOUR NOTICE Ol: COMMENGP~IT. ~,,
5i aturd,,o,~ aer er/Manager S~t~'s,R~u~t~ Name & TitlolOffice
3n t'7~
M', ~dl~JlbSION ~ O 5
~ l;7C" ~RlS: M~eM ]1,701]
g in .~'`• ~ ~~ ~... a. re the thist~{~ day of. ~dl - , 20~ b
Y
' as for
(Ant rsiy Type, a. earfAtbomey) a>me of Party cnaoccxt was Face )