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2135 Seminole Rd 2012 siding CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 12-00001044 Date 8/13/12 Property Address . . . . . . 2135 SEMINOLE RD Application type description SIDING PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 11000 ---------------------------------------- ------------------------------------ Application desc siding ---------------------------------------- ------------------------------------ Owner Contractor ------------------------ ------------------------ COURTNEY, JOHN C OWNER 2135 SEMINOLE ROAD ATLANTIC BEACH FL 32233 ---------------------------------------- ------------------------------------ Permit . . . . . . SIDING PERMIT Additional desc . . Permit Fee . . . . 105 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 11000 Expiration Date . . 2/09/13 ---------------------------------------- ------------------------------------ Special Notes and Comments need noc ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Faid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 105 . 00 105 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 109 . 00 109 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDING PERMITAPPLICATION CITY OF ATLANTic BEACH 800 Seminole Road,Atlanfic Beach, FL 32233 Office(904)247-5826 fax(904) 247-5845 Z� Job Address: -5r-V41M9kZ- 12"�) PFQAVk'_i I CINE AC�)Permit Number: Legal Description aw M 146 km 0 Yloor_7Ee_a51___ sq.Ft. Parcel# Sq.Ft Valuation of Work$41,0,00 —Proposed Work heatefl/cooled /70n non-heatedVcooled I Class of Work(circle one): New Addition Alteration (:�e:13�ai:r) Move Demolition pool/spa window/door Use of existing/proposed structureQ)(circle one): Commercial �ZR�eside ' S ;.:� - If an existing structure,is a fire sprinkler system installed? (Circle one es C-9/A7) Florida P�oduct Approval# For multiple products use product approval I-orin Describe in detail the type of work to be performed: I M-S Ig L-- RZ 5zc-,eKs �fcyl Gz :7u' i Property Owner Information: Name: Address:_,Q.35 Sr p city 10�=MIAVLJ -Up Phond 96 ^ 1 1�4 E-M0aior Fax;#(Optional) !7gi AID /qn- Contractor Information: Company Name: Qual ifying Agent: Address: — City State Zip Office Phone- Job Site/Contact Number Fax 9 State Certification/Registration 4 Architect Name&Phone# Engineer's Name&Phone# Fee Simple Title Holder Name and A-ddress Bonding Company Name and Address Mortgage Lender Name and Address a e e y mode 0 0 o'n a ermit to do the work and installations as indicated I certify that no work or installation has commencedpriorlothe f b ormed a mZt the stan�a ds alial vs regulating construction in thisjurisdiction. This permit b�comes null 0 k is.ruspended or abandoned for a period ofsLr�6)monthsat OnVtime after us n isp'er r 'and th a,'t 'rk pi r O� 'Pplic io u ce a 'w v n i m I ',or, construction or (6 on h a , 0_0, mi'01 c a 0 w ep d 0-d f k i ced th n, " is m_,�c 'sto, t t sp rate Pri s u t be secure or Cjr_ T rk co ed de d a a df Ele "Wr Work,Plumbing,Siins, Wells, Pools, turnaces, Boileis, Heaters. C a ks nd.4, on 'One's,'ta WARNING TO OWNER: YOUR FAIL TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR P YING TWICE FOR IMPROVEMENTS 'y TO YOUR PROPERTY. IF YOU INTEND TO 0 TAIN FINANCING CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFO r RECORDING YOUk NOTICE OF COMMENCE)�TENT. I hereby certify that I have read and examined this application and know the same to be true and correct. Allprovisionso ws and ordinances governinZ this 5 ope of work W11 be complied with whether eci fla fied herein or not. The granting oj'a permit does not presume to give authority to violate or canc�l the provisions ofany otherfederal,state, or local aw regulating construction or the peFfbn nance of construction. Signature of Owner Si�pature of Contractor Print Name 01 V 1'. - .........................0 j ? 4 ...... ...... ..... .......... Pri tit Name ...........................I............................................................................................................. Swo , toa subsci b '16 r Sworn to and subscribed before me this ay of 20 f,-2_ this —Day of Not U lic - SHIRLEY L,GRAHAM Maury Public COMFAISSION 9 DO 9,57760 PIRES: C &3��4 February 14,2014 Revised 0 1.26.10 ed Thra Notary Public Uriderwrits 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 CONSTMRUCTI TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERN IT UNDER AN ENEMPTION TO THAT LAW. TBE ENEMPTION ALLOWS YOU,AS THE OWI MR OF YOUR PROPERTY,TO ACT As YOUR OWN CONTRACTOR EVEN THOUGH YOU DC NOT FIAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU I 4AY BUILD OR IMPROVE A ONE—OR TWO FA�AILY RESIDENCE OR A FARM OUTBUIL�)ING- YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE B MUST BE FOR YOUR USE AND OCCUPANCY. IT MAYNOT BE BUILT FOR SALEOR 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 VIOLATTON C F THIS EXENIPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CON _-TOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT FEOPLE EMTLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY OUNTY R MUNICIPAL LICENSING ORDINANCES. 11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLEJ-OR INJURIES TO WORKERS THEY HIRF— THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. III. IRS WITHHOLDING;-OWNERS HIRING WORKERS B COME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. M. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,0012 PENAL TY-UNDER FLORIDA STATUTE NO. 455-228(l). AN"OCCUPATIONAL LICENSE"IS NOT ADE UATE. 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. � k3.1; ((i( ADDRESS PHONE NUMBER 3cM" -Q-two :D E--4 6INT NAME E` S �T 1V W l AT RE DATE fore me this dayof —20 Zinthecountycl' _L Duval,State of Florida,has personally appeared herin by himself I herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of County of El Personally Known q,p�d led Identifi SHIRLEY L.G RAHAI� .6, *.*s MY MMI 10N#DD9�7760 NotarySig ttui-e, EXPIRES: February 14,2014 0)nded Thru Notary Public Underwriters FIBLDG/0—�-Buil der Afi�adavi�REVISED. 4/16/2009 ........PGW NOTICE OF CO NCEMENT Stateof V—L=Q-Vz2V� Tax Folio No. county Of�)�� To whom it may concern, th ection 713 of ents will be made to certain real Property,and in accordance w' S The undersigned hereby informs you that unprovem the Florida Statutes,the following information is stated in this NOTICE C F COMMENCEMENT. Legal Description of property being improved: ing improved: 1 3J5---i —%U�k ZL Address of property be "Detm EELS- General description Of improvements: S Dh&i� k'r r Owner:A(2AAtQ Address:- ,2 ',,Owner's interest in site of the Vem Fee Simple Titleholder(if other than owner)' Name: Contractor: Address: Telephone No.: Fax No: Surety(if any) Amount of Bond Address: Telephone No: Fax No: Name and address of any person making a loan for the construction of tb e improvements Name: Address: Phone No: Fax No: If gng wn ti es oth Name of person within the State of Florida, other than himse ,desi ted by o er upon whom no c or er 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 or e(1)year from the date of recording unless a different date is specified): noc#2012'171040,ORBK!6'31 Page949- OWNIM \iuriber Pages�', Recorded 08�13:2012 at 11:05 AM, Si ed-� Date: UIT COURT DUVAL JiM 9JILI-ER CLERK CIRC me this day of in the�oYnty o Duval,Stalc I c-��IJN7! 05f ipErida)l hasp i�'n--ally appeared RECORDINIG�-10-00 li Notary Pdblic at ge,State of Florida,County of Duval. -------- -My commission ex pires- S LEY L HIP -MV commiSsION EXPIRES:February 14,,2014 Bonded ThrU Notary P70161c:Urolerw6tm , ,Or