Permit Siding 154/156 Pine St 2012 x CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000140 Date 2/03/12
Property Address 154 PINE ST
Tenant nbr, name 154 AND 156 PINE ST
Application type description SIDING PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 3000
Application desc
REPLACE ROTTED T -111 SIDING
Owner Contractor
LINK JEANNE OWNER
154 PINE STREET
ATLANTIC BEACH FL 32233
Permit SIDING PERMIT
Additional desc . REPLACE ROTTEN SIDING
Permit Fee . . . 65.00 Plan Check Fee . . 32.50
Issue Date . . . Valuation . . . . 3000
Expiration Date . 8/01/12
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.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: / /S f o i 1--�� - Permit Number: , l 7
Legal Description Parcel #
i d Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ (20, Proposed Work heated /cooled non - heated /cooled
Class of Work (circle one): New Addition Alteration (Rep Move Demolition pool /spa window /door
Use of existing /proposed structure(s) (circle one): Commercial Residential
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /A
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to be performed: / e S57D l /0 C"
O
17 — ///2 '
Property Owner Information: �
Name: c /�'�}- x1,.16— li<it1lf— Address: tS r j r <J cis
T.
City State _Zip , Phone 2-- V3
E -Mail or Fax # (Optional) 1
i
Contractor Information:
Company Name: Qualifying Agent:
Address: City State Zip
Office Phone Job Site/ Contact Number Fax #
State Certification/Registration #
Architect Name & Phone #
Engineer's Name & Phone #
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. 1 certify that no work or installation has commenced prior to the
issuance of a pernzit 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 is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, F urnaces, Boilers, 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.
I 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 Owne /1'1 .i . d ir.. Signature of Coii actor
Print Name , Nc...... 1---A. 1.1 Print Name
Swaat,nd subscribe. •re me Z Sworn to and subs 'lied be ► e me
this '7 l ay of ...a. _ 20( / this Da : 20
Notary Publi•' 4i! I °:'• - AMANDAWNUTE Notary '' blic
lit* ', . s MY COMMISSION M EE 067349
1 4, tk, Bonded Thni NN�Pu�c 21, 2015 Revise. 11.26.10
Doc # 2012023780, OR BK 15840 Page 1005, Number Pages: 1, Recorded
02/03/2012 at 11:07 AM, JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY RECORDING
$10.00
• � 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.
1. Description of property (legal description of property and address if available):
for 66 1 Ac-7g- a S'EZ3
2. General Description of improvements:
R- e•, 4-c- S /aid4.-
3. Owner Information: '�j
4
a) Name and Address: JO v "?9 - ,v
e--"-) i �, / � /�t - ST.
b) Interest in property: Ow r�Gr .4-2 . ���
c) Name and address of simple titleholder (if other than owner): 3-L2_33
4. Contractor Information:
a) Name and Address: ...5_,Z •0 - 2eLL)
b) Phone Number: QTIM�7�y // A
5. Surety Information: A? 3 co ' a" C 6 / • E.
a) Name and Address: �p� K s, * . `3 ao� tt�
b) Phone Number:
c) Amount of Bond: $
6. Lender Information:
a) Name and Address:
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 (1)(a) 7, Florida Statutes:
a) Name and Address:
b) Phone Numbers of Designated Person:
8. In addition to himself /herself, Owner designates of to receive
a copy of the Lienor'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
1, 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 ,..a day of Feh . , 20 / 't^
142e4G.1 t ( 70-Z4_,
NOTARY PUBLIC, STATE F
Print Name: C(f
❑ Personally Known L G.. S A C S2 73206
Identification/Type: �6„
Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I have read the
foregoing and that the facts stated in it are true to the best of my knowle e and belief.
pEBOFWtAM a1*WHTE ignat of pr operty Owner
NI CZ # EE 057918
E May 21,2018
BmbA7hu NdvrPuENC UbMw�IKs
Revised 10/1/2009
FIRST COAST PAINTING -
� \ & REPAIR INC.
a ,4
C.
PAINTING • RESTORATION • CARPENTRY • WDO WOR C • TILE
OFFICE/FAX 1236 Jamaica Rd. East • Jacksonville, Florida, 32216 I CELL PHONE
(904) 745 -1316
(904) 463 -1177
DATE: (- (6 - ZC, 7
Customer: ., N
Address: g 'I / 1SL '—"
City /State /Zip Pt l i C� ("� \
Phone:
FREE ESTIMATES
JOB:
(
DUE UPON RECEIPT
2% LATE CHARGE PER MONTH ON PAST DUE ACCOUNTS:
r' ; r
CITY OF ATLANTIC BEACH
-'�' .� 0 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.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
I11. 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.
/S1- / 72 - c ',
ADDRESS PHONE NUMBER
F it; C AJ le---
PRINT �E , �� 2/6// �
F/. , / A� DATE
IerRE ^ ��
Before me this 3 day of 20 "Tithe the county of
Duval, State of Florida, has perso ally appeared erin by himself / herself and affirms that
all statements and declarations are tru nd accurate.
Notary Public at Large, State of , County of
❑Personally Known ' i �L L 3 e2"0- ,4::?... ? 3' 2p li d , `'" " ! '�•, DEBORAH AMANDA WITE ;
Produced (dent cation - l ` � : *; "•� * EE 05 349 t
MY COMMISSION # 7 1
/! c 1 ., 4 •;: EXPIRES: May 21, 2015
Bonded Thni Notary Public Underw I ..
• Notary Signat
F: /BLDG/Owner-Builder Affadavit REVISED: 4/16/2009