Permit Remodel 1956 W Sevilla 2011 - 1 1 ." - V- 17 1'
6 '�,', CITY OF ATLANTIC BEACH
k ;;, A , 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
. INSPECTION PHONE LINE 247 -5826
Application Number 11- 00001841 Date 3/31/11
Property Address 1956 W SEVILLA BLVD
Application type description RESIDENTIAL ALTERATION
Property Zoning TO BE UPDATED
Application valuation . . . 3000
Application desc
remodel bath /shower
Owner Contractor
STRAUB OWNER
ATLANTIC BEACH FL 32233
Permit . . . . . . RESIDETNIAL ALT /OTHER
Additional desc . .
Permit Fee . . 65.00 Plan Check Fee . . 32.50
Issue Date . . . . Valuation . . . . 3000
Expiration Date . . 9/27/11
Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONALELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
* Durra rock/ tile backer board inspection is required
before tile is set.*
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 65.00 65.00 .00 .00
Plan Check Total 32.50 32.50 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 101.50 101.50 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
NOTICE OF CO MENCE'li Mrr
uoc # Zv "^ U i . 75U, u U k 1 000d rage
Number Pages 1
State of /— L. C.) '`' ::),7 Recorded 03: 2011 at 0934 AM
JIM FULLER CLERK CIRCUIT COURT DUVAL
County of t "` COUNTY
RECORDING 51000
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certam real property, ana m accoraance witn secnon /1 s or
the Florida Statutes, the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved:
Address of property being improved: ' S i (r -- - t /44 t `� ` `_ a ,L
General description of improvements:
Owner: - Address: \_,\ Owner's interest in site of the improvement:
Fee Simple Titleholder (if other than owner):
Name:
Contractor: •- -- l
Address:
Telephone No.: Fax No:
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:
Phone No: Fax No:
Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other documents may be
served: Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
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): 4 '•ti
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Date: j t"\ f1 f.= L
Before me this 7/ day of 30// in the County of Duval, State
Of Florida, has personally appeared d _u' -r
Notary Public at Large, State of Florida, County of Duval.
.mmission expires: 4
2 ''
�. ;�:R� P�'••.,� Per ■nally Known:
l or
JASON DRACH
,1 ? Notary:;Public ro uced Idenfir hon: c °, 1 7 ✓ S
-State of Flori ti
�a �- � ""
, 4 or, My Comm. Expires Aug 9, 2014
�': ; FO�n Commission # EE 14543
r *' BUILDING PERNIIT APPLICATION ()OW 46 3TrNe B
CITY OF ATLANTIC BEACH
—1 800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: /954 /d .Jfy/ 1/ tU /✓Ql . Permit Number: /1 - /1
Legal Description Parcel #
Floor Area of Sq.Ft. Sq.l1't
Valuation of Work $ 5 64 . 00 Proposed Work heated /cooled non - heated/cooled
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool/spa window /door
Use of existing /proposed structure(s) (circle one): Commercial Residential 3-rbp
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /A (/
Florida Product Approval # liCQ
For multiple products use product approva orm 3-71 ( � Describe in detail the type of work to be performed: 17 / SA 014 - 0. 41 6 d f L
Property Owner Information:
Name: - - 5 4- r'°- u'b Address: t c'\ S L. S , z v„ t tc_. A i vG2 - 4)
City A -.- t C■..n, c :. ‹... A 4. c. k State i=t -Zip 3 z2- Phone 9 n '1 - Z'∎ a to '-1 o
E -Mail or Fax # (Optional) or //e3- 8 — ,A
Contractor Information:
Company Name: Qualifying Agent:
Andress: , -_ _ __i State Zip
Dffice Phone Job : i te , _ _ --Ty-;-1
- 1
State Certification/Registration # n � _ l 11 1 v' F I
Architect Name & Phone # MIN Y i ,.WW Y aim MITN ! .• _A.—, ._, ;. k.._ ,
Engineer's Name & Phone # SEE PERMITS FOR , O • 0.1 Nf j _
Fee Simple Title Holder Name and Address ' • UIREMENTS AND CONDITI • e ill PI 1 ■ gll V 1 PI '
3onding Company Name and Address it • •
t:�.'l'��N'. % Hit il' / /L�`�
Mortgage Lender Name and Address " aommo•7r1rarnar7M r . - i , ' - _
Ipplication 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
ssuance 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 f work is not commenced within six (6) months, or if construction or work is suspended or abandoned for aperiod of six (6) months at any time after
vork is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, ells, Pools, Furnaces, Bo Heaters,
ranks and Air Conditioners, etc
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IlVIPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
hereby certify that I have read and examined this plication and know the same to be true and correct. All provisions of laws and ordinances governing this
ype 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
■revisions of any other federal, state, or local law regulating construction or the performance o construction.
signature of Owner _ .Lr L� ■ Signature of Co I. • actor
'rint Name -"- 44...) - r d -. A . S 'f- t' a- b Print Name
;wom t2 and subscribed before me Sworn to and . scribed be • - me
his tt Day of /1�c h , 20 // this D . of 20
I
dota ' • • j P. ,�'= Notary Public State of Florida I Notai; Public
� �`: My Comm. Expires Aug 9, 2014 I 6.10
i '•.',, c ri oa;,s Commission # EE 14543 0 (1,.. ‘4.1e.jue....„.11
� M
CITY OF ATLANTIC BEACH
\ I _ � ®WNER / BUILDER AFFIDAVIT
j y `
'` J;i17
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.
H. 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455- 228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT (247 -5826) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT. &vJ 6? SE /ai 9: y_ Z (o — o 4. zr
ADDRESS PHONE NUMBER
.�w CL. �— A . s 4- ,-,vj
PRINT NAME
SIGNATURE D ATE
Before me this /yJ day of -' ' C 20 /1 in the county of Dv I4 L
Duval, State of Florida, has personally appeared herin by himself / herself and affirms that
all statements and declarations are true and accurate.
LC 7 ,VnCounty of 171/V4 L ( �
4pv ,��
I p�o�
i.: -
1 : < ;= Notar S ta A e of Florida
ID
Known F i 17 4 t VL' 2 S 1.11- ,
f$Z,Producedldentifiration - ( 'sue. _,..... li Q My Comm. Expir Aug 9,
Notary Public at Large, State of J 2014
,44 Boa;'' Commission # EE 14543
Notary .. - _ ■ '—/ � �(� 4
F:BLDG /Owner - Builder - SED 4/16/2009
rt:LV; City of Atlantic Beach APPLICATION NUMBER
jS r4•• Building Department (To be assigned by the Building Department.)
800 Seminole Road
•V Atlantic Beach, Florida 32233 -5445 f f
Phone (904) 247 -5826 • Fax (904) 247 -5845
sf E -mail: building- dept @coab.us Date routed:
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: /9c5 Ji;th II A In D ment review required Yes No
Buildin
Applicant: U (,V--27C Planning & Zoning
` J/ Tree Administrator
Project: - 5- Public Works
Public Utilities
Public Safety
Fire Services
k b^s fi .�,. sa.� 4 , b ""-' ""FS'"'�r Y'S'•n ''.^+ x !; e -W -u!' fi ti J
rc p ,1 J r � Dept� Slgnata .._ ...
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: DApproved. ❑Denied.
(Circle one.) Comments: yi 0 c -
BUILDING
PLANNING & ZONING Reviewed by: Date: J 9 A , 9
/ it
TREE ADMIN. Second Review: ['Approved as revised. ❑Den d.
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