Permit Siding 405 Garden 2011 c �. Ssl CITY OF ATLANTIC BEACH
: 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
`� , v INSPECTION PHONE LINE 247 -5826
M1K
.r4 ,0.131
11- 00001746 Date 3/08/11
Application Number 405 GARDEN LN
Property Address
Application type description SIDING PERMIT
TO BE UPDATED
Property Zoning 7000
Application valuation . . •
Application desc
REPLACE WOOD SIDING WITH HARDIE BOARD
Contractor
Owner
OWNER
HAMMONS
405 GARDEN LANE FL 32233
ATLANTIC BEACH
Permit BUILDING PERMIT
Additional desc . Plan Check Fee 42.50
Permit Fee 85.00 7000
Valuation
Issue Date 9/04/11
Expiration Date .
Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONALELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE
Fee summary Charged
Paid Credited Due
.00 .00
Permit Fee Total 85.00 85.00 . .00
42.50 42.50 .00
Plan Check Total 4.00 4.00 .00
Other Fee Total 131.50 .00 .00
Grand Total 131.50
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: r--\ U` Cyi>rei1e LA Permit Number: 1/ — / 7 9 6
Legal Description LIZ NVVIiZc.. " �� 11040,&41 11040,&41 Parcel #
Floor oor Area of Sq.Ft. Sq.Ft
Valuation of Work $ 6O6 Proposed Work heated /cooled non - heated /cooled
Class of Work (circle one): New Addition Alteration ' epair Move .. molition pool/spa window/door
Use of existing /pro osed structure(s) (circle one): Commercial `�.. • Reside •
If an existing structure, is a fire s r mkler s Stem in all d? (Circle one): es No N /A
Florida Product Approval # — 1 ,n 1 A ( (D5 1
For multiple products use product approva or ��--
Describe in detail the type of work to be performed: J/ t / A/6—
Property Owner Information:
Nam& - {Z{ Y� � vie N > Address: "O ��� LAS
City GA\ow k c 1� to c� Stat Zip Phone rL-\
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: Qualifying Agent:
Address: __ __ .. _- State Zip
Office Phone I RIMEWEft #
State Certification/Registration #
Architect Name & Phone # 1 i s ��� (T i n: i �A,i S►:��1; �1:' - -- •
Engineer's Name & Phone # ( -
g p an
• .:. • :;: i ii 1 1
Fee Simple Title Holder Name and Ade
Bonding Name and Address �� ,� /L r
Y
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 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. 1 understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Bo Heaters,
Tanks and Air Conditioners, etc.
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 YOUR NOTICE OF
COMMENCEMENT.
1 hereby certify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal, state, or local law regulating construction or the performance of construction.
Signature of Owner \ �,� (4-'� �` Signature of Contractor
Print Name � {fit \� L� -\ C{- 01 \ 6 Y\ S Print Name
Sworn subscribed efore me Sworn to and subscribed before me
this' Da of ice- % . , 20 / / this Day of , 20
•, TT
Notary Public ' .: MY COMMISSION # EE004846 Notary Public
', , EXP IRES August 23, 2014
$• ; ; Revised 01.26.10
(407) 998 -0153 FlorideNotar}rServke.corn
y ,/
I I ,
� CITY OF ATLANTIC BEACH
' .-., - ` ( J :
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 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.
11. 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. STATEMENT L AND E T THAT I COMPLY WITH ALL ACKNOWLEDGE
L T THE REQUIREMENTS ABOVE S FOR THE ISSUANCE OF AN
OWNER- BUILDER PERMIT.
ADDRESS
PHONE NUMBER
`
�1, A. i'� 4 \".. V•A 0 IN C M
PRINT NAME
Noh.01,....-4.—.4.—do-404•4■--Ili d5/03/foll
S 1ATURE DATE
Before me this w d day of ,491 201 in the county of
Duval, State of Florida, has personally appeared herin by himself / herself and affirms that
all statements and declarations are trr�ue nd accurate.
Notary Public at Large, State of f l / , County of /71l tl.1 // ,,, ,, KAREN F DEVITT
I
'' *- MY COMMISSION # EE004848
rsonally Known :;9.• �� -per 2014 / 0 Produced Identification - •� ',. ,„, d'.` EXPIRES August 23r
(407) 398 -0153 ftoridaNOta - •�
Notary Signature: 1. P/N 7
F: BLDG / Owner - Builder Affadavit; REVISED: 4/16/2009
. MAR-3-2011 11:47 FROM:CLERK OF COURTS 904 270 1512 TO:92475845 _ — P:1 /1 — —
/ _ f 7 NOTICE OF COMMENCEMENT
Permit No. Tax Folio No.
State of Florida, County of Duval
THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
I. Description of property (legal description of property and address if available):
Lci. A.,�c \mat . , "F,," 5e( ✓A MarriflA t1a C _RI 1 Z&acl,,.
2. General Description of improvements:
•
3. Owner Information: -
a) Namc and Address: 1.,c u . 4,. _ .t_ a 'Ln i4. _.. 1 ,De\, - 4 \
b) Interest in property:_ n e {t _
c) Name and address of simple titleholder (if other than owner):
4. Contractor Information:
a) Narnc and Address: �V, n a.-nti 6.0....,S L ty C rew. \...4..)
b) Phone Number: qt,, �- \- s.'a.'a. - 't.s.„‘_\" -.1,
5. Surety Information:
a) Name and Address: fA
b) Phone Number:
e) Amount of Bond: $
6. Lender Information:
a) Name and Address: I�t ,�
b) Phone Number:
7. Person within the State of Florida designated by owner upon whom notices or other documents may be served as
provided by 713.13 (1Xa) 7, Florida Statutes:
a) Name and Address: -
b) Phone Numbers of Designated Person:
8, In addition to himself/hcrself, Owner designates of to receive
a copy of the I.ienor's Notice as provided in Section 713.13 (1) (b), Florida Statutes.
a) Name and Address:
b) Phone Number of person or entity designated by owner:
9 Expiration date of Notice of Commencement (The expiration date is one (1) year from the date of Recording unless a
different date is specified:
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART
I, SECTION 713.13. FLORIDA STATUTES, AND CAN 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 COMMENCING WORK OR RECORDING
YOUR NOTICE OF COMMENCEMENT.
The foregoing instrument was acknowledged before me this day of „/ pK2P , 20
7 ....-'
KAREN F DEVITT s
= MY COMMI531ON M EEEmma ,y�
N TARP PUBLIC TA T OF O
_
EXPIRES August 23.20i4 Print Name: zT a,01«, ,- w '
(407) 3.0152 PbddareeMeiwma . en
,.personally Known
fl Identification/Type:
Verification pursuant to Section 92.525, Florida Statutes. Undcr penalties of perjury, I declare that 1.havc read the
foregoing and that the facts stated in it are true to the best of my knowledge and belief:
____ P-CNI--1-1.--4C--------‘
uo. Lu 11 (Add 59, urt 8K 1 im4'I F dye tea, Signature of Property Owner
Number Pagec 1
Recorded 031012011 at 10 55 AM,
JIM FULLER CLERK CIRCUIT COURT DUVAL
COUNTY .
RECORDING 510.00
Revised 10/1/2009
s0 City of Atlantic Beach APPLICATION NUMBER
i5 Buildin Department
r ss1 Building p (To be assigned by the Building Department.)
v 800 Seminole Road
j , Atlantic Beach, Florida 32233 -5445 / f F2
Phone (904) 247 -5826 • Fax (904) 247 -5845
„Hl�'" E -mail: building- dept @coab.us Date routed: 3 //
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Address: � '7J J � �'i"1
Property t review required Yes 7 No
Y ���1� q
Buildin
Applicant: Planning & Zoning
�" ' // Tree Administrator
.J
Project: /D /�./ (t -- Public Works
Public Utilities
Public Safety
Fire Services
Other Agency Review or Permit Required Review Receipt
of Permit or Verified By
Date t ,
Florida Dept. of Environmental Protection / N O
Florida Dept. of Transportation U y
St. Johns River Water Management District AR 03 2011
Army Corps of Engineers B
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING
Reviewed by: Date: Y ----- //
TREE ADMIN. Second Review: ❑Approved as revised. ❑D ied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09