Permit 736 Selva Lakes Cir -, , CITY OF ATLANTIC BEACH
IS
j 800 SEMINOLE ROAD
+} ". ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 09-00000636 Date 2/05/10
Property Address . . . . . . 736 SELVA LAKES CIR
Application type description SIDING PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 3700
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Application desc
REPLACE T1-11
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Owner Contractor
------------------------ ------------------------
PARRY OWNER
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
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Permit . . . . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 50 . 00 Plan Check Fee 25 . 00
Issue Date . . . . Valuation . . . . 3700
Expiration Date . . 8/04/10
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Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/ 105- 106 SUPPLEMENTS .
2007 FLORIDA BUILDING CODE - RESIDENTIAL.
2005 NATIONAL ELECTRICAL CODE.
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 50 . 00 50 . 00 . 00 . 00
Plan Check Total 25 . 00 25 . 00 . 00 . 00
Grand Total 75 . 00 75 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Y
r CITY OF ATLANTIC BEACH
09- I I I I
800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233
I. � OFFICE:(904)247-5826•FAX NO.:(904)247-5845
BUILDING-DEPT@COAB.US
BUILDING PERMIT APPLICATION DUVAL COUNTY
1.JOB ADDRESS: 2.VALUATION OF MURK 3.SO.FT.UNDER ROOF
r13 to :5 3 1 (10(o".'
4.LEGAL DESCRIPTION: 5.CLASS OF WORK: 6.USE OF STRUCTURE:
❑NEW BUILDING ❑DEMOLITION GKESIDENTIAL
LOT13-qBLOCK-SUBDIVISION .St LX) ✓}- LVA-ltl S 11 ADDITION 11 CONVERTING USE 11 COMMERCIAL
I� 7.DESCRIPTION OF WORK: IIQALTERATION ❑ACCESSORY BLDG. 8.FIRE SPRINKLER:
❑REPAIR ❑POOL/SPA C1 YES 11 N/A
❑MOVE ❑OTHER
PROPERTY OWNER: CONTRACTOR: ARCHITECT I ENGINEER:
9.NAME: 15.COMPA Y NAME: 23.COMPANY NAME:
y =)ACL ZI
16.NAME: 24.LICENSEE NAME:
10.ADDRESS: 17.STATE O FLORIVN . 25.STATE OF FLORIDA LICENSE NO.:
SrLv A- Lrrw-t 5 12 C
18.ADDRESS: 26.ADDRESS:
r3 a 3 ri�� Ila- v�
11.OFFICE PHONE: 12.FAX NO.: 19.OFFIC 20.FAX NO.: 27.OFFICE PHONE: 28.FAX NO.:
13.CELL PHONE: 21.CELL PHON : 'Y 29.CELL PHONE:
W
14.EMAIL ADDRESS: 22.EMAIL ADD S: // 30.EMAIL ADDRESS:
(IF onfR THAN ovuNM>
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.
r 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 INSPECT N. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER ORAWATTORNEYj3EFORE RECORDING YOUR NOTIC OF COMMENCEMENT.
OWNER A T NTRACTOR
(If Letter Required) (Oualilwr Only) 2
Signed:I e: 7/� Q� Signed: Date: 3 D
Before me this-2L3-day 2009 in the county of Before me this day of 4114 2009 in the county of
Duval,State of Florida,hasperson Iiy appeA aced Duval,State of Florida,has personally appeared
!,;(It' Pal Scams So�cv►5C�
Kenn by himself/he elf 2�W' s g d declaratio s are herin by himself/hers el bti nI +-f-on, + dedarations are
true and axurate. 1.... DD 788236 true and accurate. :i? �!Ig' JAMES H.MILLER
Notary Public at Lar oo`; IrBS JW3pnnnr12 Notary�Ublic at Large :*= Ofi1R111 y4A 788236
13+Personally Kn n 1 'R int` `j. 19 ersonally Known %+..F.ao-�O,= Aires Q 1, 2
❑Produced Ide tification- ❑Produced Identific ion lh."�'� TroyF' n 385-7019
Notary Signature. Notary Signature:
D FOR CODE COMPLIANCE
CITY OF ATLANTIC BEACH
BLDG01 Permit Application Bldg:REVISED: "TILE
/2 SEE PERMITS FOR ADDITIONAL
� i L E COPY REQUIREMENTS AND CONDITIONS.
I+..... .. r;. . .:. ::, REVIEWBD BY: DATE: 5 O
S
y .
] TH
s
NOTICE OF COMMENCEMENT
State of f=I n r,'c) Tax Folio No. 1 7 - 6-g 5-0
County of 'Q U V a L
To Whom It May Concern:
The undersigned hereby informs you that improvements wilt 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: L o-t- 1 a. fl�t_I-V VA [ ►9-14,1=s l)A k-
Address of property being improved: (,, S Lvvq L qKL-S C l►2 f4-T LYi 0-t Ig- !J GA-"-j-4 FZ-1-
3 3
General description of improvements: ..4 to S 1 c, lyl�e uJ e4 r-.to t- ( a e,r d S t i V\,Q e-
Owner: P h i l l iyJ Address: 9_�j(0 5 c L V W i v41�t-� L� t►2(' L t
Owner's interest in site of the improvement: WV16 t2
Fee Simple Titleholder(if other than owner):
Name:
Contractor: _ -:S(i&-rT So S&--m
Address: 3X04; S vvc) v IL, 134, V\, IM LL) r Q , Ft— 3 a,0lo<;�, _
Telephone No.: q O L4 L4 to l- 9 1 IC Fax No: !3 p L( J q 1 v)(o 1
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:
t
City of Atlantic Beach APPLICATION NUMBER
f ,, Building Department 1 ,l (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445
1 Phone(904)247-5826 • Fax(904)24 -5845
IT E-mail: building-dept@coab.us Date routed: (0
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
QsjartErLent review required YeV No
Property Address: 3 ✓� L,�iC ,s �;� - wilding
P �Y � anning &Zoning
Tree Administrator
Applicant: L Public Works
Project: /
ProjV&) Anv-. +�&a�b �i rn Public Utilities
1 Public Safety
Se-il 66 -,f-,--h7l Fire Services
To— Review or Receipt
Other Agency Review or Permit Required Date
of Permit Verified i3
AT'' fi Florida Dept.of Environmental Protection
j 0�OR1'I Florida Dept.of Transportation
_ St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other.
APPLI TION STATUS
Reviewing Department First Review: Approved. [—]Denied.
(Circle one.) Comments:
�DIN
PLANNING&ZONING
TREE ADMIN. Reviewed by: Ar Date:09/091
PUBLIC WORKS Second Review: QApproved as revised. ❑Denied.
Comments:
PUBLIC UTILITIES
PUBLIC SAFETY
FIRE SERVICES Reviewed by: Date:
Third Review: FlApproved as revised. ❑Denied.
COG'nLu encs:
�-av s,�•
PREPARED 5/08/09, 14 : 00 : 46 PAYMENTS DUE RECEIPT
CITY OF ATLANTIC BEACH PROGRAM BP820L
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APPLICATION NUMBER: 09-00000636 736 SELVA LAKES CIR
FEE DESCRIPTION AMOUNT DUE
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PLAN CHECK FEES 25 . 00
BUILDING PERMIT 50 . 00
TOTAL DUE 75 . 00
4
Please present this receipt to the cashier with full payment
/31
3
Il � 2-2)
CITY OF ATLANTIC BEACH
(OWNER / 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 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 TIES 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. 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
OWNER-BUILDER PERMIT.
-736 LV,4 LA��S �'.%� 2,qr - 2y3�
ADDRESS PHONE NUMBER
PRINT NAME ^
SIGNATURE ,`!'_►'A DATE
Before me this J day of 20LCin the county of
Duval,State of Florida,has persdinally appearedrin by himself/herself and affirms that
all statements and declarations are true and accu te. ��• f�
Notary Public at Large,State of ,County of
❑Personally Kno
uced Idents ion-w 06 a a 66 3 Wo --.-.........
Prodr�
EBOW k WHITE
D
;*; MY COMMISSION#DD 634126
Notary Signature i •" EXPIRE
MRY 21,2011
„ Bonded T IN Notary Public UndenviitA44era
F:BLDG/Ow u-Builder Affadavit;REVISED: 4/16/2009