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Permit 1670 Beach Avenue TIC BEACH CITY OF ATLAN SS 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 10-00000731 Date 6/08/10 Property Address . . . . . . 1670 BEACH AVE Application type description WINDOW AND/OR DOOR Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 5000 ---------------------------------------------------------------------------- Application desc window replacment ---------------- ------------------------------------------------------------ Owner Contractor ------------------------ ------------------------ OLMSTED, JR, CHARLES T OWNER 1670 BEACH AVENUE ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit . . . . . . WINDOW AND/OR DOOR PERMIT Additional desc - - Plan Check Fee 37 . 50 Permit Fee . . . . 75 . 00 Valuation . . . . 5000 Issue Date . . . . Expiration Date . . 12/05/10 -------------------------------------------------------------------- ------- Special Notes and Comments need noc b-4 first inspection *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. WINDOW AND DOOR INSPECTION: *INSTALLATION INSTUCTIONS REQUIRED *ALL STICKERS ARE TO REMAIN ON THE WINDOWS *PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 75 . 00 75 . 00 . 00 . 00 Plan Check Total 37 . 50 37 . 50 . 00 . 00 Grand Total 112 . 50 112 . 50 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: I(v 70 a 9AC 14 A-VE 44 —Permit Number- grgwcre :Z P ircel Legal Description 1 15 >19 2- Oct- F�Po-'q'o-r�"ea 0 Sq-Ft. non-heated/cooled bJ/,4 Valuation of Work$ 54e)00, Proposed Work heated/cooled-r- 0 Class of Work(circle one): New Addition Alteration Repair Move Demolition Np�P dX6 Use of existing/proposed structureQ) (circle one):. Commercial Residential N JU -0 7 lo If an existing structure,is a fire sprinkler system m0alleV (Circ�p one): Yes No Florida Product Approval 4 LEB3yj For multiple products use proTu—ct app-Foval Torm Describe in detail the type of work to be performed: SE Property owner Information: N CZ E-Mal Contractor Information: Company Name: Qualifying Agent: State zip Address: city Fax# office Phone Job Site/Contact Number Ze Certification/Registration.if 6e "ame&Phone# �Dt-j �Z:5-j C Engineer's Name&Phone 9 Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and 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 ofa permit and that all work will be perjbrmed to meet the standards of all laws regulating construction in thisjurisdiction. This permit becomes null or aWeriod of sixg)months at any time after and void if-vpork is not commenced within six(6)months, or if construction or work is suspended or abandonedf j workiscommenced I understand that separate permits must be securedfor Electricar Work,Phtmbing,Qns, wspools, urnaces,Boilers,Heaters, Tanks and Air Conifidoners,eta 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 RECORDING YOIffi NOTICE OF COMMENCEMENT. Ihereb d �d this a f laws and ordinances governing this cerofy that I have r, a e pplication and know the same to be true and correct. Allprovisions o thority to violate or cancel the F19 zot. The granting of a permit does not presume to give au type o work will be comDfie 14 inth=r specijTed herein or F 17, e pe�fbrmance ofconstruction. provisions ofany otherfetral, t I e, or local law HgOatin g construction or th X _L�� Signature of C actor Signature of Owner Print Name C�w ............ ............... ...... ......................................................................................................... Print Name ................................ swomtoandsu scribedb reme S1 orau LLO allu bu this D f 20 ti 3 a- ubli RMWTS FOR A # (0) ES: 4,2013 REQUIMMEWS AND t evised 01.26.10 OF sowm FILE COPY1111 REVIEWEDBY: DATE: 6-Y-10 -------vow—_, CITY OF ATLANTIC BEACH (OWNER / BUILDER AFFIDAVIT 1. 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 14AVE 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 YOU�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,WMCH 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 T14AT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIP LICENSING ORDINANC S. 11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. Ill. 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(l). 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. ADDRESS PHONE NUMBER CRASLI�5 PRINT ZEJ4 DATE Before me this--i—day of in the county of Duval,State of Florida,has per afilyappeared herin by himself herself d affirms that ccu all statements and declarations ire true and accurate. Notary'Public at Large,State Of r.,County of gepersonally Known 0 Produced Identification- �OAY P& 0WEC.STEVEf" My MISSON#DD WOO Notary Signature� EXPIRES:NoVember 14,2013 BMW Tft&.* IF BLDG 0�-Builder Affadavit.REVISED 416/2009 CITY OF ATLANTIC BEACH PRODUCT APPROVAL SPECIFICATION SHEET (short form) As required by Florida Statute 553.842 and Florida Administrative Code 9B-72, please provide the information and approval numbers on the building components listed to be utilized on the construction project for which you are applying. We recommend you contact your local product supplier should you not know the product approval number for any of the applicable listed products. Statewide approved products are listed online @ www.floridabuiidinp,.org Category/Subcategory Manufacturer Product Description FL Approval#(s) EXTERIOR DOORS a. Swinging b. Sliding c. Sectional/Roll Up d. Other WINDOWS a. Single/Double Hung 51(Y10^)To&( 07-0967beffiWFZVFAPL"5 )JL 12.7�53 b. Horizontal Slider c. Casement d. Fixed e. Mullion f. Skylights 9 oPet AVV 9/,VC- PAN&WALL a. Siding b. Soffits c. Storefronts d. Glass Block e. Other ROOFING PRODUCTS a. Asphalt Shingles b. Non-Structural Metal c. RoofingTiles d. Single Ply Roof e. Othe STRUCTURAL COMPONENTS a. Wood Connectors b. Wood Anchors c. Truss Plates d. Insulation Forms e. Lintels f. Others NEW EXTERIOR ENVELOPE I understand that,at the time of inspection,the following information must be available to the inspector on the jobsite: /1. A copy of the product approval. /2. The list of performance characteristics which the product was tested and certified to comply with. V3. A copy of the applicable manufacturers'installation requirements. Further,1-wor5tand a product may have to be removed if approval cannot be demonstrated during inspection. Applicant Signature Date H:/Product approval spec sheet short form.xlsx CL/ U,-slia- Property Appraiser-Property Details Pagel of2 rile# OLMSTED CHARLES T JR&CAPRICE P Primary Site Address Official Recordbo olk/Page 1610 BEACH AVE 1670 BEACH AVE 07293-01401 9409 ATLANTIC BEACH, FL 32233-5841 Abantic Beach FL 32233 1670 BEACH AVE Value Summary PrODertv Detail I . 1 2009 Certified 2010 In Progress RE# 169570-0000 Value Method CAMA CAMA Tax District USD3 Building Value $207,941.00 $183,389.00 Property use 0100 SINGLE FAMILY Extra Feature V I alue $0.00 $0.00 #of Buildings 1 Land Value(Market) $310,500.00 $310,500.00 15-082 09-2S-29E 0.136 i Legal Desc. OCEAN GROVE UNIT NO 1 S/D Land Value(Agric.) $0.00 $0.00 $493,889.00 Subdivision 03096 OCEAN GROVE UNIT 01 Just(Market)Value $518,441-00 $211,474.00 The sale of this property may result in higher property taxes.For more information go to Saw Our Assessed Value(A10) $205,915.00 Homes and our Pro s Exemptions $50,000-00 perty Tax,Estirnator.Property values,exemptions and other information listed a See below I ___ x roll and will not In Progress'are subject to change.These numbers are part of the 2010 working ta Taxable Value $155,915.00 See below be certified until October.Liaarnhow the Property A_WraiSeft Office vakms�Propeft Taxable Values and Exemptions—In Progress If there are no exemptions applicable to a taxing authority,the Taxable Value is the same as the Assessed Value listed above in the Value Summary box. County/Municipal Taxable Value S3RWMD/FIND Taxable Value School Taxable Value Assessed Value ............................................$211,474.00 Assessed Value...................................................................$211,474.00 Assessed Value.......................................I........................$211,474.00 Homestead Exemption(HX)....................................I 1-$25,000.00 Homestead Exemption(HX)............................................$25,000.00 Homestead Exemption(HX)......................... -$25,000.00 Amend 1 Homestead(HB).................... .................$25,000.00 Amend I Homestead(HB)..............................................$25,000.00 Taxable Value $186,474.00 Taxable Value $161,474.00 Taxable Value $161,474.00 Sales Sale Date Sale Price Deed Instrument Type Code Qualified/Unquallfied Vacant/Improved WD-Warranty Deed Unknown Vacant 07293-01401 3/18/1992 $53,500.00 Unknown Vacant 0687"1840 3/15/1990 $100.00 QC-Quit Claim i 4/12/1988 $100.00 QC-Quit CJaim Unknown Vacant 06508-M14A QC-Quit Claim Unknown Vacant 9 4/12/1988 $100.00 Unknown Vacant 06508-01499 4/12/1988 $100.00 QC-Quit Claim $100.00 QC-Quit CJaim Unknown Vacant 06508-01497 4/12/1988 ------------- Extra Features No data found for this section Land&Legal Land —----- I Lii_ _._U�611is� I LN Legal Description ripi, Depth Category Land Units Land Value Common 57.50 $310,5 1 15-082 09-2S-29E 0.136 1 0100 RES LD 3-7 UNITS PER AC ARG-2 57.50 103.00 2 OCEAN GROVE UNIT NO 1 S/D 13 N1/2 LOTS 4&5 BUK 6 Buildings Building 1 Building 1 Site Address Element- 1670 BEACH AVE 1"Exterior Wall 16 16 Tile/Frame Stucco Atlantic Beach FL 32233 f Exterior Wall 8 8 Horizontal Lap F T_ __T 0102-SFR 2 STORY SOH Roofing Structure 3 3 Gable or Hip i i BAS:FUA L J S—T--L, Building Type I rigle Year Built 1992 Roofing Cover 3 3 Asph/Comp Shii I --------_--------- Interior Wall 5 5 Drywall L ------- Int Flooring 14 14 Carpet 1 Type Gross Area Heated Area [-.-r 7 Heating Fuel 4 4 Electric IFOP j Base Area 848 848 1 Finished upper story 1 848 848 Heating Type 4 4 Forced-Ducted Finished Open Porch 105 0 Air Conditioning 3 3 Central -------------------------- Finished upper story 1 105 105 Element Code Base Area 105 105 Stories 2.000 105 0 Finished Open Porch Base Area 30 30 Bedrooms 4.000 Finished Open Porch 87 0 Baths 2.000 1 Finished upper story 1 44 44 1 Rooms Units Finished Garage 400 0 Finished Storage 72 0 Total 2749 1980 http://apps.coj.net/pao_propertySearch/Basic/Detail.aspx?RE=1695700000 6/3/2010 Building Foot Print Ami L 66 6L 7`1 I LI a rq Mae OL low Mai 4-J R4t 0 z C fy) N z U b s a p 0 peag oiweliv 4s je-joD oLqT 0 juawa:)ejda�j mopulm Pa4swjo 0901 -0 L) CD -4 ad C) Uj �b City of Atlantic Beach APPLICATION NUMBER (To be assigned by the Building Department.) Building Department 800 Seminole Road ach, Florida 32233-5445 Atlantic Be Fax(904)247-5845 Phone(904)247-5826 V va E-mail: building-dept@,c6ab.us it Cityweb-site: http://Www.coab.us CA APPLI ATION REVIEW AND TRACKING FORM Droperty Address: uildin ent review required Ye kpplicant: Planning &Zoning Tree Administrator Project: Public Works Public Utilities Public Safety Fire Services Other Agency Review or.Permit Required Review or Receipt Dat of Permit Verified By Florida Dept. of Environmental Protection 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: APPLP<TION STATUS Reviewing DepartmentTFirst Revi.-w. Approved. []Denied. - e (Circle one.) Comments: 4,; =BUILDING PLANNING &ZONING Reviewed by:_ �:M Date: 6 �q7�� TREE ADMIN. -]Denied. Second Review:: OlApproved as revised. F PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: 7Approved as revised. DDenied. Comments: Reviewed by: Date: Revised 05/14/09 CITY OF ATLANTIC BEACH 7 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 08-00000944 Date 7/21/08 Property Address . . . . . . 1670 BEACH AVE Application type description FENCE PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 2400 ---------------------------------------------------------------------------- Application desc INSTALL FENCE ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ OLMSTED, JR, CHARLES T OWNER 1670 BEACH AVENUE ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit . . . . . . FENCE PERMIT Additional desc . . Permit Fee . . . . 35 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 1/17/09 ---------------------------------------------------------------------------- Special Notes and Comments *2004 FLROIDA 13UILDING CODE W/ 105- 106 SUPPLEMENTS . 2004 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. *ALL FENCES OR ENCLOSURES OF LAND SHALL BE SUBSTANTIALLY CONSTRUCTED. *SCHEDULE FINAL INSPECTION ONCE FENCE HAS BEEN COMPLETED. PERMIT AND APPROVED SURVEY MUST BE AVAILABLE FOR FINAL INSPECTION. *EMAIL INSPECTION REQUESTS TO BUILDING-DEPT@COAB.US Roll off container company must be on City approved list and cannot be placed on City right-of-way. ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 35 . 00 35 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 35 . 00 35 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. ukcL .S!-Aj1j?-;. City of Atlantic Beach 'the Building Department riment.) PP "Oo--y - ..'��D 800 Seminole Road Atlantic Beach.Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-5M E-mail: building-dept@ooab.us City we"Ite: http*www.coab.us APPLICATION REVIEW AND TRACKING FORM Depa-rtment review required No roperty Address: 162rO &J-CAjQV(-) Bumng PlanniM&Zoning pplicant PublicWorks ublic Safety 6 tFir ServiceS r M Other Agency Review or Permit Required Rovkrw or Recelpt Date of Penult Verifled BY Florida Dept.of Environmental Protection Florida Dept of Transportation St.Johns River Water Management DisWct Army Corps of Engineers Division of H-t--Is and Restaurants Division of Alcoholic Beverages and Tobacoo Other APPLICATION STATUS leviewing Department First Review: []Approved. nied. (Circle one.) Comments* f Ve Y, (:BU�I�LiNG�- ILANNING&ZONING Reviewed by,121 Date� 7-1 PUBLIC WORKS PUBLIC UTILITIES Second Review: ffApproved as revised. 013enied. Comments" PUBLIC SAFETY FIRE SERVICES Reviewed by. Date: 7 Third Review: F�Approved as revised. Odenied. Comments: Reviewed by. Date: 1670 Beach Ave Fence Application Fence Details We have attached copies of the survey with our proposed fence drawn in. As you can see, on one corner we propose a slight variance outside our property line. This was done to make it more aesthetically pleasing to us and our neighborhood, by having the fence parallel both 14each Avenue and our house. If we were to run it down our property line the whole way on the Beach Ave side, it would not look very good, being at a very severe angle and drastically limit our fenced area available to our new puppy. After looking up and down Beach Ave, we see many other instances of fences being quite close to the road, some of them solid structures. The fence we propose will be low profile (42") of black aluminum, so it will blend in well and not affect any lines of site on our comer lot. It would still be well off the Beach Avenue asphalt itself. It will be professionally installed to insure it's long term good looks. We hope you appreciate the spirit of our request. Th k You, y a6L�, Chuck and Cappie Olmsted P.MMT,D FOR COME COMPLUNCE �Tli CITY OF AXL/��ITJ.0 BEACH SEE PERMIT'#FOR ADDHIONAL REQUIREMENTS AND CONDITIONS. FILE CONf REVIEWED BY: DXrE: AUA lb:06 PAA YU4 TeICO hiOrtgage 444 Wt"KO beaches MAP SHOWI 1VG BOUNDA R Y SUP VEY OF 'e-y Vw j7x- Z-40-r 4 -Al e-y AS SHOWN ON MAP OF Z-0 S7 B C.f< 9:2, C4VI7�- AS RECORDED IN PLA r i3ooK-.4-sv .*A 0.2 7-HE-,PUBLro RE'CORDS OF DUVAL CO. FLA. CER'r.TFIED To , &, '�577-R,:57 ,r 7- C -4,0 > ir 00 '. G-7 .d)o f f L C-, 0 %U 94 Z, ...IT" N -7 CD Y.I'm 4' k 70 zdp. 40 F. 0 4 14 -o/ e.S ; &S, -02 1!CIP sT?'. ff.X- 'o, ox 0 14 k) V L IL a 0 1 k' g /V 0 7- J t,jt, 50-t wt-y oor r,?Ajro*C-' W.4. '51=- C4V'34 tO l%C T"d J�J-reptwcnopj OF: DCAC44 AV46. C.04^1- Sil. THF49 MAY BE AWMONAt MSEMENrS ANCIOR WOP WAIL IM IZ- ML-M RESMICrIMS NA TARE NOT SHOWN ON THIS SURVEY ewlyfiyor-olo,46 rNArm.4y8EFoUNoiN THEpu&ir,REL,,OqosoF b4iscouNry 16-00' x t-cReo y cE.9 rxFy TNA r rW-A SWW WLREON 15 IN THE SPWAL FLOW HAZAAaD ZOW AS 50YOW ON F1.000 J'#V$L4Q4A0Ctr MA r4f A(AP_E-c-" rM rW CXTY &P JACOMONVILL& FLMrDA, DA rLl*0 A CP�-? loy 'A SiVOASAU"S V..fo . 4 X ZA, -A AC V971 V'..001 lip~a v z p 17 "If Jw I p C7 400AP-9 1010 ev!p o i is sp tf Old if N S. r 9 v N., .,-or ��4 &4# V IL 4L 36 -4 '411 47,01V O�6 Ld I T L)I-A I LAN I I., Dr-M1,1711 Ut$- d. 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 OFFICE (904)247-5826 0 FAX NO.:(904)247-5845 L I BUILDING-DEPT@COAB.US BUILDING PERMIT APPLICATION DUVAL COUNTY 1.JOB ADDRESS- 2.VALUATION OF V40RK: 3,SO,FT.UNDER ROOF �10 r3ed�C,4 " E e F214-00 — 4.LEGAL DESCRIPTION: 5.CLASS OF V40RK 6.UU OF STRUCTURE �EWBU1�LDING 0 DEMOLITION t3;mLFJIDENTIA1- ILOT_BLOCK_SUB DIVISION *0 ADDITION 11 CONVERTING USE -0 COMMERCIAL 7.DESCRIPTION OF WORK: I C3 ALTERATION 11 ACCESSORY BLDG 8,FIRE SPRINKLER 11 REPAIR EIPOOL/SPA 11 YES 11 N/A rff�V C6 YAP JIJ�-)4 0 MOVE OTHER V:ZOO&?� 11 NO PROPERTY OWNER: CONTRACTOR: ARCHITECT/ENGINEER: NAME: 15.COMPANY NAME: 23.COMPANY NAME C N Y IVo I a N C"a 16 NAbF%\ 24.LICENSEE NAME: Q ok, 10.ADDRESS: 17.STATE ON IDA LICENSE NO.: 25,STATE OF FLORIDA LICENSE NO.: ea I-A A-v�, 18.ADDRESS: 26.ADDRES& FAX NO.: FAX NO.: 2-q)- &0,1q 2 - 1� -P 11.OFFICE PHONE: 12.FAX 27.OFFICE PHONE: NO 19.OFFICE PHONE: 13.CELI-PHONE: 9 '33 to 06 21.CELL PHONE: 29.CELL PHONE 14.EMAIL ADDREfS: 5�t'k � 22.EMAIL ADDRESS: 30.EMAIL ADDRESS: +'aa - - li Co wof�/)C-1, FEE SIMPLE TITLE HOLDER: BONDING COMPANY: MORTGAGE LENDER- 31,NAME: OF OTHER THAN OYMER) 33.NAME: 35.NAME 32.ADDRESS* 34.ADDRESS 36.ADDRES& 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 /(If A�t,,Pow gVMwney_V AAericy Lii Required) (Qualifier Only) Signed:_ (-�� / 41(;ll Signed: Date: Before me this I &#) I ' day of JQ 2004'the' county of Before me this_day of 2007 in the county of Duvg�,State of Florida,has personally apo4ared Duval,State of Florida,has personally appeared ( N=Jt6t Jr— herin by himself/herself and affirms that all statements and declarations are herin by himself/herself and affirms that all statements and declarations are true and accurate. IV* true and accurate. Notary Public at Large,State of 7 L, county of va Notary Public at Large,State of County of 11 Personally Known El Personally Known L Yroduced Identification- El Produced Identification- .tary Signatur Notary Signature: K. CUNNINGHAM "'Ity Notary Public-State of Florida COAB FORM BLDG01:REVISED:1110/2008 M* A-My Commission Expires Feb 28,2010 Commission#DD 523638 Bonded By National Notary Assn. — — — — — I CITY OF ATLANTIC BEACH j OWNER / BUILDER AFFIDAVIT 1. 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 PERNUT UNDER AN EXENTTION TO THAT LAW. THE EXEM[PTION 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 IM[PROVE A COMAdERCIAL 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 COM[PLETE,THE LAW WELL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF TFUS EXEM[PTION. 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 MAXE SURE THAT PEOPLE ENTLOYED BY YOU RAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANC S. 11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED UNDER THE HOMEOWNERS INSURANCE POLICY TO CLEARLY PROTECT THE OWNER. Ill. 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(l). 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. tk?o &e- - qG y- 2 Y f -_6�_C_y Lf ADDRES,%-, PHONE NUMBER N PRINT NAME( -2 T)v SIGNATURE DATE Beforemethis/ I dayof jufq 20kAhe county of Duval State of Florida,has persoria(iy appealed �by himself/herself and affirms that all staiements and declarations are true and accurate. PK. CUNNINGHAM _�'rp% Notary Public-State of Florida Notary Public at Large,State of 700L countyof JDU V _:My Commission Expires Feb 28,2010 OF Commission#DD 523638 n lly Known �erso a roduced Identification Bonded By National Notary Assn. Notary Signature:"I COAB FORM BLOW;REVIS .4 IP-7 -4 co-7 f-76,ft/ -y-tdvy ie 5.01 aA SA tl 11.0 iN x A0, ZA, 7L "Wet 'Als F.T. OW a Y,S '7 1,TA / am I'' J16 0(a. lop lift P ATIQ City of Atlantic Beach APPLIC Q14 N ER Building Department (To�ba iiisljOb dby t I he B Ing- BW Seminole Road Atlantic Beach,Florida 32233-6445 Phone(904)247-W26 - Fwc(904)247-5845 E-mail: buItdInq-fttC0coab.us Date City web-Me: http:/ANww.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: r�) &x1h J V() Department review required Yes No Building Applicant Chovk�t olmatka) Planning &Zoning Public Works ro'"j-i;ci':' j C2CMA,1 Public Safety Fire Services Other Agency Review or Pe.rmit Required Review or Receipt Date of Permit Verified By Florida Dept of Environmental Protection 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 APPLICAMN STATUS Reviewing Department First Review: B�Proved. nDenied. (Cirde one.) Comments: BUILDING SeCIL�- 167CO-) 0k (4Z11) PLANNING&ZONING e24- 1,67(0) ()V- C 4211) PUBLIC WORKS Reviewed by: ak'4) i4v ) PUBLIC UTILITIES Second Review-. ElApproved as revised. []Denied. PUBLIC SAFETY Comments: FIRE SERVICES Reviewed by: Date: Third Review: ElApproved as revised. ElDenied. Comments: Reviewed by: Date: CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 08- OFFICE:(1104)241-5826 0 FAX NO.:(W4)247-5W BUILDING-DEPT*COA8.US BUILDING PERMIT APPLICATION DUVAL COUNTY 1.JOB ADDRESS: 2.VALUATION OF MRK -13.SQ.FT.UNDERROOF -70 Reacll+ 4-�j E, 4.LEGAL DESCRIPTION: 6,CIASS�)F WORK 6.USE OF STRUCTURE. ANEwautwiNG 0 DEMOLITION 45;%UIDENTLAL LOT_BLOCK_SUB DIVISION 13 ADDITION 0 CONVERTING USE -0 COMMERCIAL 7.DESCRIPTION OF WORK ALTERATION 0 ACCESSORY BLDG. 8.FIRE SPRINKLER: 13 REPAIR 13 POOL/SPA 13 YES 0 N/A e)fe r-CWCe, YSU' 14J�-' 4 0 MOVE OTHER IV:& _ I El NO PROPERTY OWNER: CONTRACTOR: ARCHITECT I ENGINEER: NAME: Is.COMPANY NAME: 23.COMPANY NAME: _Z( N""IVO r e*1-'a(t1-e& --4 ' 1AVV-6+j' L." C14psoj Yle C- S.HAbF-. 24.LICENSEE NAME: W.ADDRESS: 17.STATE 0 DA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.: -7 o 18.ADDRESS: 26.ADDRESS: a In c' 9 1 r—(— & Z' I i.OFFICE PHONE: 12.FAX NO 19.OFFICE PHONE: FAX NO.: 27.OFFICE PHONE: 28.FAX NO.: 13.CELL PHONE: 21.CELL PHONE: 29.CELL PHONE: 9 13 3 - 0i-S 14.EMAIL ADDREPS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS: Co FEE BIMPLE TITLE HOLDER: BONDING COMPANY: MORTGAGE LENDER: 31.NAME: 3&NAME: 3&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 firne 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. OWNERorAGENT CONTRACTOR /(ff AjtP--9V*e—yff 49--y L9IW Required) (Qualifier Only) Signed: 04lba- Signed: Date: Before me this J*yl day of Liki 2004 the county of Before me this day of 2007 in the county Of Duvqj�state of Florkla,has personally apodared Duval,State of Florida,has personally appeared Oinvii-cd, Jr- herin by himself/herself and affirms that all statements and declarations are herin by himself/herself and affirms that all statements and declarations are true and accurate. 9::-1 true and accurate. Notary Public at Large,State of 7 U ,County of 1DUVOk Notary Public at Large,State of_County of E3 Personally Known 13 Personally Known Zrh'f oduced kkaft ation- 13 Pmduced identirmation- y Signature., Notary Signature: A .4 V-7 'A A IM0 trA 4L VIP low op a 0. a. 66 4L �14 ,- #I S. . Vpf.W J* t -4 J;t C6 6 YIV r ("A Vv TAW ? ^41e 1�7 * -7 Atlantic Beach C City of AP -1 4T!Qb!NI _PQ_ Building Departinent (ro, b 'to Buildin Departrrlent� y 800 Serninole Road -2 Atlantic Beach,Florida 32233-6445 Phone(904)247-5826 - Fax(904)247-5845 a. E-malt buiklng-dept@coab.us DaW, City web-edw. httpJANww.coab.us APPLICATION REVIEW AND TRACKING FORM Department review required Yes No Property Address: Building 'hO [L 427� Planning&Zoning Applicant PubkWoft r0iia..': Public Safety Fire Services Other Agency Review or Permit Required Review or Rocelpt Date of Permit Vo~By Florida Dept of Environmental Protection Florida Dept of Transportatim St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other APPUCATION STATUS Reviewing Department First Review: [�]`Pproved. E]Denied. (Circle one.) Comments* BUILDING PLANNING&ZONING PUBLIC WORKS Reviewed by: z Date*2� PUBLIC UTILITIES Second Review: FlApproved as revised. []Denied. Comments-. PUBLIC SAFETY FIRE SERVICES Reviewed by. Date: Third Review: OApproved as revised. ElDenied. Comments: Reviewed by: Date: Publie Works Plan Review Comments Date: L9 Initials: L kelicle Project Name/Address: (a 2 Aeqe� Akfe plication Permit 67 c/4f 'Box AC A�pp ca on h Tra6kinirComments loAdd fomment Provide impervious surface calculations. 0 Provide erosion and sediment control plans with installation details and maintenance schedule. 13 Provide drainage plans showing site topography (flow arrows, etc.) 0 Provide construction site management plan, including Right-of-Way Permit if using right-of-way for construction parking. 0 Provide a pre-construction topographic survey prepared b_y a Florida Licensed 0 Professional Land Surveyor, showing 1' contours. Section 24-66(b) of the Land Development Regulations requires on-site storage for increased runoff. Provide Delta volume calculations and on-site retention required ri per Section 24-66(b). (See attached info. Sheet) If on-site storage is required, a post construction topographic survey documenting proper construction will be required. 13 •Right-of-Way Permit must be obtained for use •Revocable Encroachment Permit must be obtained. Pool—Well oint(if used)must discharge into vegetated area 10' minimum 1�o_m p street or drainage feature (swale, structure or lagoon). El All driveway aprons must be concrete, 5 inches thick, 4000 psi, with fibermesh from the edge of the pavement to the property line. Reinforcing rods or mesh are not allowed in the ROW(Commercial driveways—611 thick). Any utility cuts in the road must be repaired using COJ Standard Detail Case X and must be overlaid 10 feet in each direction from the center of the cut. Repair must be shown on the plans. Roll off container company must be on City approved list and cannot be placed on City right-of-way. 0 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD,ATLANTIC SEACH.FL 32233 08-1 F7 OFFICE:(904)241-5826 0 FAX NO.:(904)247-5845 8UILDING-OEPT@COA8.US BUILDING PERMIT APPLICATION DUVAL COUNTY 1.JOB ADDRESS: 2.VALUATION OF WORK: 3.SO.FT.UNDER ROOF 4.LEGAL DESCRIPTION. 5.CJMS OF WORK 6,USf OF STRUCTURE, X�EW BUILDtNG 0 DEMOLITION b4RQIDENTIAL LOT_BLOCK_SUBOMSION U ADDITION 13 CONVERTING USE 0 COMMERCIAL 7.DESCRIPTION OF 104ORK 13 ALTERATION 0 ACCESSORY BLDG. a.FIRE SPRINKLER 13 REPAIR 0 POOL/SPA 0 YES 13 NIA YOU' OJ�-4 0 MOVE OTHER RVI(XI?- 13 NO PROPERTY OWNER: kCTOR: ARCHITECT I ENGINEER: 1.NAME: is.COMPANY NAME: 23.COMPANY NAME: IN all, N/Vor C14,0soroy'ail- 16 NAb\ 24.LICENSEE NAME: 77.STATE DA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.: 10.ADDRESS: ol:,r IV70 12,e4A �k t 18.ADD;TESS: 26.ADDRESS: FAX NO.; 11,OFFICE PHON 12.FAX NO 19.OFFICE PHONE: FAX NO.: 27.OFFICE PHONE: 13.CELLPRONE: 21.CELL PHONE: 29.CELL PHONE: M -13 14 EMAIE-'KDDREPS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS: FEE SIMPLE TITLE HOLDER: BONDING COMPANY: MORTGA43E LENDER: (IF Cytift THAN OW14M 31.NAME: 31 NAME: v 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,Fumaces,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 III,ALP-W gl�"—yo ft—cy LeW Required) (Oualifier Only) Signed: Signed: Date: Before me this day of the ,tv of 200V county of Before me this_day of 2007 in the county Of Duv3l�iState of Florida,has personaily apolred Duval,State of F"a,has personally appeared ( yof/1�?- 0-1 d, Jr- herin by himself/herself and affirm 3nd declarations are herin by himself/herself and affirms that all statements and declarations are true and accurate. true and accurate. Notary Public at Large,State of 7 L, County of, V Notary Public at Large,State of_,County of 13 Personally Known 0 Personally Known Yroduced Identification- 13 Produced Identification- .tary Sig-natura,:::�� iNotarY Signature: el�11MIMA!H AM '-577-RC&—:- 7- 4 W. k. N,In Ito IK v 0 le.f, Ic 0.-lu Om IV ab 4�1. Vftm-e de crc/ FEE Cl T'Y. S rucea I N ,q.g!v,or.Aj CS WX 6.4,C!P Cb Or d OW t"4,- Z cf.CIO' f VX 45, W -W 'I's, 4! 4.z z 7 It-140 c C> NI CAI'Sll AOgg_or OJr VIP T City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach,Florida 32233-5445 -T 71� Phone(904)247-5826 - Fax(904)247-5845 E-mail: building-dept@coab.us .Date routed: City web-site: hftpJAuww.coab.us 11 1 1 APPLICATION REVIEW AND TRACKING FORM Property Address: yr) Department review required Yes No Building Planning &Zoning Applicant: (-'h 0,r k 0_2-�-7 Public Works Oroje'et'i. � :" L." 'a Public Utilities ... . .. Public Safety Fire Services Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept.of Environmental Protection 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: APPLICATION STATUS Reviewing Department First Review: VApproved. FjDenied. (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by: Date: PUB WO KS PUB IC IL IES Second Review: E]Approved as revised. RDenied. PU�VSALFETY Comments: FIRE SERVICES Reviewed by: Date: Third Review: RApproved as revised. RDenied. Comments: Reviewed by: Date: CITY OF ATLANTIC BEACH OW SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 08-1 OFFICE:(904)247-5826 0 FAX NO.:(9D4)247-5M5 BUILDING-DEPTOCOWUS BUILDING PERMIT APPLICATION DUVAL COUNTY I J013 ADDRESS: 2.VALUATION OF WORK. 13,SO.FT.UNDER ROOF rg eac/4 A-\) E 4,LEGAL DESCRIPTION: CAMS OF MRK' S.UA OF STRUCTURE: GEW BUI�LDING 13 DEMOLIT19N ZJ;tQIDENTIAL LOT_BLOCK_SUB DIVISION V ADDITION 0 CONVERTING USE 13 COMMERCIAL T.DESCRIPTION[OF VMAK 13 ALTERATION 13 ACCESSORY SLOG. 8.FIRE SPRINKLER: 0 REPAIR 13 POOL I SPA 13 YES 0 N/A L r—651V C e Y19! 14J�-44 13 MOVE OTHER V&0&?-. 0 NQ PROPERTY OWNER- CONTRACTOR: ARCHITECT I ENGINEER: NAME: IS-COMPANY NAME: 23.COMPANY NAME: 0'-64"� --,�Nol- 04ProrJYa-;- 7- 16.NAbF�.\ 24.LICENSEE NAME: W.ADDRESS: 17.STATE 01'r,�DA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.: 18.ADDRESS: 26.ADDRESS: 11.OFFICE PHONE: 112 FAX NO 19.OFFICE PHONE: FAX NO.: 27.OFFICE PHONE: T28-FAX NO,: 13.CELL PHONE: 3 21.CELL PHONE: 29.CELL PHONE: 14 EMAIL ADDREFS: 22-EMAIL ADDRESS: 30.EMAIL ADDRESS: VAL) I M i5�t co MC43-t-/le-�r FEE SIMPLE TITLE HOLDER: (W 07HM THAN 0%hwam BONDING COMPANY: MORTGAGE LENDER: 31.NAME: 3&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 pernnit 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,Fumaces,Boilers,Heaters,Tanks, Air Conditioners,etc. OWMER'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 OJR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. OWNER or AGENT CONTRACTOR /(If AL),& gtA%—y_gr 4"ney Left Reqti*d) (Oualifisr Only) Signed: W4e: Signed: Date: Before me this 1-ft,day of .2004the' county of Before me this day of 2007 in the county of W Duv,3L,State of Florida,has personally ap Duval,State of Florida,has personally appeared C Mr/e;;l- 0 1 amn� Jr- herin by himself/herself and affirms that all statements and declarations are herin by himself/herself and affirms that all statements and decJarations are true and accurate. true and accurate. Notary Public at Large,State of County of -%.-I V Notary Public at Large,State of County of Personally Known 0 Personally Known h6roduced man"rtion- 0 Produced Iderriftation- Zotary Signatu lNotary Signature: � ,-,),C) G-U�q C, its). A 4 .vt oi .."400"pj c 4w�4.00iv 4p, 9,5, .—-, z Cove ly 4&Ajc , a ruceo i 4, ~49.�PO :5 N-lA-1 4-4-C 15 f 4 va-ro 4-at r Pundamiera, Robin Subject: INSPECTION: 1707 Beach Avenue, 04-29116, Roof Final, Romano Roofing Services 246- 5649, (Owner: C. Grant) Start" Tue 11/9/2004 3:30 PM End: Tue 11/9/2004 4:00 PM Recurrence: (none) CHECK FOR SHEATHING INSPECTION. IF NOT, HAVE CONTRACTOR SEND A LETTER. SEE ME. LJH 11/9/04