345 1st St (vault) \Js )) �S, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
j ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
ri r 19 INSPECTION EMAIL REQUEST:
Building-dept(a,coab.us
Application Number . . . . . 07-00001353 Date 9/28/07
Property Address . . . . . . 345 1ST ST
Application type description ELECTRIC ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
----------------------------- ------------------------------ -----------------
Application desc
rewire house 200 amps
------------ ----------------------------------------------------------------
Owner Contractor
------------------------ ---------------- -- ------
ARENS, MARK BROOKS & LIMBAUGH ELECTRIC CO
345 1ST ST Q/A BROOKS, CHRISTY
ATLANTIC BEACH FL 32233 42 WEST 8TH ST.
(904) 246-5570 ATLANTIC BEACH FL 32233
(904) 241-9051
---------------- ----- -------------------------------------------------------
Permit . . . . . . ELECTRICAL PERMIT
Additional desc . .
Permit Fee . . . . 70 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 3/26/08
-- -------------- ----- ------------------------------------------------- ------
Fee summary Charged Paid Credited Due
----------------- ---------- ---- ------ ---------- --------- -
Permit Fee Total 70 . 00 70 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 70 . 00 70 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
CITY OF ATLANTIC BEACH
n ELECTRICAL, PERMIT APPLICATION
Date-
Property Address: � IS� St r� ,
Owner: Mari(
Telephone
Contractor: !/ � � -
Telephone tow!qo s t
Contractor Address: L 12 \ ��h
�t Fax A:
Contractor Si attu•e•
In consideration of
Permit given or doing the work In the above
accordance with the p
attached Inns and specificxtio �vh tro a statement, we hereby agree to perform said work in
ordinance and standards of ood ractice listed therein. pan heroof and in accordance with the City of Atlantic Beach
Building: Building
O New rn'O' ❑ hailer Service:
❑ Residence other �+cziW is
C�OId ❑ Commercial p S�' ❑ New being done on�p��
O Re-wire O Addition � ❑ Increase Or site,ust the building
Sq.Ft ❑ Repair Permit number.
Conductor Size: �•;��7_ 3
AMPS: COPPER ALUMINUM
Switch or
Breaker AMPS
Existing Service PH W VOLT W,,Y
Size
PH
Meter j �y , RACE
VOLT�J WAY S L�
Number
Feeders: N0. SIZE NO SIZE
Lighting Outlets NO SIZE
CONCEALED
OPEN
Receptacles CONCEALED
OPEN
Switches
incandescent
Fluorescent &
M.V.
Fixed 0.100 AMn OVERAhances BE
Air H.P.RATINGTRANSFER.
Conditionin COMP. MOTOR H.P.RATING CEILING
OTHER MOTORS AMpS KW-HEAT
HEAT
Motors VOLTAGE
PH NO. OVER 1 H.P. PHS
Transformers NO. KVA
No-Neon_Traasf NO. KVA
Ea S'
Miscellaneous /
800 Seminole Road.Atlantic Beach,Florida 32233-5445
Phone: (944)247-5800. Fax: (9o4)247-5845. 6ttp //www ci atlantic beach tl us
Revised 1/04
CITY OF ATLANTIC BEACH
~V SI 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
jty}r INSPECTION EMAIL REQUEST:
Building-dept(a�coab.us
Application Number . . . . . 07-00000320 Date 9/18/07
Property Address . . . . . . 345 1ST ST
Application type description RESIDENTIAL ADDITION/ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 50000
----------------------------------------------------------------------------
Application desc
interior remodel/add patio and covered porch
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
ARENS, MARK OWNER
345 1ST ST
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 246-5570
--------------------- Structure Information 000 000 ----------------------
Construction Type . . . . . TYPE 5-A
Occupancy Type . . . . . . RESIDENTIAL
Flood Zone . . . . . . . . ZONE X
----------------------------------------------------------------------------
Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Sub Contractor . . STEEG PLUMBING CO. , INC.
Permit Fee . . . . 126 . 00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 3/16/08
--------------------------------------------------------------
Special Notes and Comments
*2004 FLROIDA BUILDING CODE W/ 105- 106 SUPPLEMENTS.
2004 FLORIDA BUILDING CODE - RESIDENTIAL.
2005 NATIONAL ELECTRICAL CODE.
*EMAIL INSPECTION REQUESTS TO: BUILDING-DEPT@COAB.US
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 126 . 00 126 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 126 . 00 126 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES:
•
CITY OF ATLANTIC BEACH
[t�
PLUMBING PERMIT APPLICATION
Date: d
Property Address: J�i' /
Owner: ,1'I/dcy�S Telephone#:
Contractor: _t�'ftc4' M4 (',0 t Telephone
r
Contractor Address: f�Q/ �.�Ir 'S f Fax#:
Contractor Signature:
In consideration of permit given for doing work as described in the above statement,we hereby agree to perform said work in
accordance with the attached plans and specifications which are a part hereof and in accordance with the City of Atlantic Beach
ordinance and standards of good practice listed therein.
Installation of plumbing and fixtures must be in accordance with the most recent edition of the Southern Standard Plumbing
Code.
Plumbing Type: If other construction is being done on this building or site,
❑ New list the building permit number:
❑ Re-Pipe
Number of Fixtures:
Bath Tubs Showers
Closets Shower Pans
Dishwashers Sinks
Disposals Urinals
Floor Drains �_ Washing Machine
--j Lavatory Water
Sewer T Water Heaters
Sprinkler System Other *See attached sheet see
For Backflow and Irrigation procedures
Fees
Permit Issuing Fee: $35.00
Total Fixtures: X$7.00 + $35.00=
800 Seminole Road a Atlantic Beach, Florida 32233-5445
Phone: (904) 247-5800 . Fax: (904) 247-5845• http://Www.cl.atiantic-beach.fl.us
Revised 9/06
CITY OF ATLANTIC BEACH
:r g1
} 800 SEMINOLE ROAD
j ,k ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
i ,JJ3I>c ? INSPECTION EMAIL REQUEST:
�
Buildingdept@coab.us
Application Number . . . . . 07-00001315 Date 9/24/07
Property Address . . . . . . 345 1ST ST
Application type description MECHANICAL ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
------------ ------------------------- ------ ------- -------------- - -----------
Application desc
1 hp 1 ahu
------------------------------------------------------ ------- ------- -- ------
Owner Contractor
------------------------ ------------------------
ARENS, MARK DONOVAN HEATING & AIR
345 1ST ST 315 SIXTH AVENUE SOUTH
ATLANTIC BEACH FL 32233 JAX BEACH FL 32250
(904) 246-5570 (904) 241-3785
----------------- ----------------- ------ ------ ------ ---------- - -------------
Permit . . . . . . MECHANICAL PERMIT
Additional desc . .
Permit Fee . . . . 87 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 3/22/08
--- -------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ------- ---
Permit Fee Total 87 . 00 87 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 87 . 00 87 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
F7Lf�i. CITY OF ATLANTIC BEACH 7_
to ` O■
"' 2�a'��''•� 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233
it OFFICE:(9G4)247-5826 0 FAX NO.:(904)247-5845
BUILDING-DEPT@COAB.US
�P MECHANICAL PERMIT APPLICATION DUVAL COUNTY
1.JOB ADDRESS: 12.IS THIS A SUB PERMIT: 13.DATE
3 YT / S 1 -r ❑NO
Atlantic Beach, FL 32233 ❑YES PERMIT#:
PROPERTY OWNER:
s NAME �! q 5.ADDRESS IF DIFFERENT FROM JOB ADDRESS 6 PHONE.
MECHANICAL CONTRACTOR:
7.NAME OF COMPANY: 8.ADDRESS.:
15- co �e
� � s-
9.STATE OF FLORIDA LICENSE NO: 2/ 10.CELL PHONE: 11.FAX NO.:
C a(_o5c( 2 DqS - -1 ) s q 1;)-f I -37 VS
12.EMAIL ADDRESS: 13.OFFICE PHONE: 14.
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify 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.
CONTRACTORS SIGNATURE::
15.CLASS OF WORK: 16.BUILDING: 17.SER 18.CURRENT CODE:
❑ NEW INSTALLATION ❑ NEW ARESIDENTIAL -['06 FLORIDA BUILDING CODE-
,,,VREPLACEMENT OF EXISTING SYSTEM EXISTING ❑COMMERCIAL MECHANICAL
❑ALTERATION/ADDITION TO EXIST SYSTEM
❑REPAIR ❑OTHER
MECHANICAL EQUIPMENT TO BE INSTALLED:
19. HEAT: ❑ SPACE ❑ RECESSED kCENTRAL ❑ FLOOR BURNERS:
20.AIR CONDITIONING: ❑ ROOM CENTRAL
21. DUCT SYSTEM: MATERIAL: T-ie-f, Lkc 1 THICKNESS:_JL(, MAX CAPACITY: fJG cfm
22. REFRIGERATION: MAX CAPACITY: Cfm
23.COOLING TOWER: CAPACITY: Spm
24. FIRE SPRINKLER: NUMBER OF HEADS:
25. LIFT SYSTEM: ELEVATOR: MANLIFT: ESCALATOR: AUTOLIFT:
26.COMMERCIAL HOOD NUMBER:
27. FIREPLACE: PREFABRICATED: MASONRY:
28. IRRIGATION: ❑ PUMP ❑WELL ❑ PIPING
29. GAS PIPING: #OF OUTLETS: ❑GAS AHU: ❑GAS WATER HEATER:
30.OTHER-SPECIFY:
SOLAR HEATING, BOILERS,UNFIRED
PRESSURE VESSEL,HEAT EXCHANGER
OR COIL IN DUCTS ETC. IVALUE FOR OTHER ITEMS:
31.COOLING EQUIPMENT:
AIR CONDITIONING REFRIGERATION EQUIPMENT CONDENSORS ETC.
NUMBER APPROVING
OF UNITS DESCRIPTION MODEL#_ MANUFACTURER TONS AGENCY
2c,f LMP Z-3t4e-
u C
32.HEATING EQUIPMENT:
FURNACES BOILERS FIREPLACES AIR HANDLERS ETC.
NUMBER APPROVING
OF UNITS DESCRIPTION MODEL# MANUFACTURER BTU AGENCY
33.TANKS:
TYPE LI UI AFYROVING
NUMBER GALLONS CONTAINED MANUFACTURER SERIAL# AGENCY
COAB FORM BLDG03:REVISED:8/13/2007
CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
±) ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
4Jiil� INSPECTION EMAIL REQUEST:
Building-dept2coab.us
Application Number . . . . . 07-00000320 Date 7/03/07
Property Address . . . . . . 345 1ST ST
Application type description RESIDENTIAL ADDITION/ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 50000
-----------------------------------------------------------------
Application desc
interior remodel/add patio and covered porch
-----------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
ARENS, MARK OWNER
345 1ST ST
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 246-5570
-------------------------- Structure Information 000 000 -----------------
Construction Type . . . . . TYPE 5-A
Occupancy Type . . . . . . RESIDENTIAL 2
Flood Zone . . . . . . . . ZONE X
------------------------------------------------------------
Permit . . . . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 280 . 00 Plan Check Fee 140 . 00
Issue Date . . . . Valuation . . . . 50000
Expiration Date . . 12/30/07
-----------------------------------------------------------
Special Notes and Comments
*2004 FLROIDA BUILDING CODE W/ 105- 106 SUPPLEMENTS .
2004 FLORIDA BUILDING CODE - RESIDENTIAL.
2005 NATIONAL ELECTRICAL CODE .
*EMAIL INSPECTION REQUESTS TO: BUILDING-DEPT@COAB.US
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
---------------------------------------------------------
Fee summary Charged Paid Credited Due
---------- ---------- ---------- ---------- ----------
Permit Fee Total 280 . 00 280 . 00 . 00 . 00
Plan Check Total 140 . 00 140 . 00 . 00 . 00
Grand Total 420 . 00 420 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BP250U01 CITY OF ATLANTIC BEACH 7/03/07
Application Tracking Step Selection by Revision 10: 08 : 40
Application number . . . . : 07 00000320
Address . . . . . . . . . . . 345 1ST ST
RE number . . . . . . . . . . 169766-0000- -
Application type . . . . . : RESIDENTIAL ADDITION/ALTERATION
NCR OLD ACCOUNT NUMBERS . . : AB09046
Tenant name, number . . . . .
Type options, press Enter.
2=Change 4=Delete 5=View 6=Fast log 8=Action log maintenance
9=In/out maint
Path ---- Rey Dates --- - Action Summary -
Opt Agency description Rev Step Req In Est Cmpl Last Type By
_ BUILDING DEPT. A 01 Y 07/03/07 03/23/07 07/03/07 AP DH
_ PLANNING & ZONING A 01 Y 03/22/07 03/23/07 03/22/07 AP SD
PUBLIC WORKS A 01 N 03/21/07 03/23/07 06/29/07 AP LS
Bottom
F3=Exit F5=Land inquiry F6=Add F7=Revisions F8=Misc info inquiry
F10=View 3 F11=Sort by agency F12=Cancel F14 Action log inq F24 More keys
f!.'blp
CITY OF ATLANTIC BEACH
PLAN REVIEW SHEET Route
Building Department Public Works&Public Utilities Departments
800 Seminole Road 1200 Sandpiper Lane
Atlantic Beach,Florida 32233 Atlantic Beach,Florida 32233 D. Kaluzniak
(904)247-5800 (904)247-5834 Public Safety
(904)247-5845 Fax (904)247-5843 Fax Jax Fire dept.
PLAN REVIEW COMMENTS
Permit Application# Q 1• e o3 2 0
Property Address J�� 1.51- S- w T
Applicant: 4 Vi-n
Project: gZ_ CP09V-*rrS
f�nD evz2ED Peck
This permit application has been:
❑ Approved as noted by the Department.
Final application approval must come from the Building Department.
Reviewed and the following items need attention:
45i1S7ie-cry M/v DJr70ics' Co 4WCir
IN 4.1C,,ry G 7-a S/ o S� i�7idG C4zCS
W 40�9 r fe 7o f 4Aft-6 I.v
/
Please re-submit 2-copies of all revisions. Please re-submit your
revisions to the Department requesting them.
Building Dept, Public Works and Utility information at top of page,
failure to notify the correct department may delay your permit from
bein issued.
Reviewed By: Date: Z D
Date Contractor Notified: 2, 2-3. ,o -7
BUILDING PERMIT APPLICATION
ISI
CITY OF ATLANTIC BEACH �pD
J;ior 800 Seminole Road,Atlantic Beach FL 32233
Office: (904)247-5826 • Fax: (904)247-5845
Address: 3VCY- /IS,/- SfiQ p f Permit Number:
Legal Description
Valuation of Work(Replacement Cost) $ no
■ Class of Work(Circle one): New Addition Alteration Repair -Move
■ Use of existing/proposed structures) (Circle one): Commercial en is
esi
■ If an existing structure, is a fire sprinkler system installed? (Circle one): es o
■ Is approval of homeowner's association or other private entity required? (Circle one): Ye—s o
Describe in detail the type of work to be performed: 1--nTex1*e4 eEma alB
vt�ejQ ;Doee H
Property Owner Information
Address: 1-i?e- S'`
City State/2 Zip ?z3 Phone
Contractor Information:
Name of Company: t Qualifying Agent:
Address: City State Zip
Office Phone Job Site/Contact Number
State Certification/Registration# Office Fax#
Architect Name & Phone#
Engineer's Name& Phone#
4pplication 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 o/'all laws regulating construction in this1�urisdiction. This permit becomes null one
void if work �s 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
ommeneed. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks andAh
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.
there certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type
�f work tivill be complied with whether specified herein or not. The granting of a ermit does not presume to give authority to violate or cancel the provisions o any
ether federal,state, or local law regulating construction or the performance ojconstruction.
Signature of Property Owner: Z?Yi52� /--21. Signature of Contractor:
Swoy�yQ aid sub eSworn to and subscribed before me
his Day of '00 -7 this Day of
Votary Public: Notary Public:
Nowy Pubk-Sto of F1016
• Ay Commission Expires Feb 14,2010
Commission N DO 518533
OF fl
Bonded By National Notary Assn.
14 2 ffvce 72 3�3 - b
DO NOT WRITE BELOW THIS LINE: OFFICE USE ONLY
Special Information for Owner/Builders
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 THE LAW.
The exemption allows you as the owner of your property,to act as your own contractor even through you do not have
a license. You must s>ervise the construction yourself. You may build or improve a one-family or two-family
residence or a farm outbuilding. You may also build or improve a commercial building at a cost of$25,000 or less.
The building must be for your own use and occupancy. It may not be built for sale or lease. Ifyou sell or lease more
than one building you have built yourself within one(1)year after the construction is complete,the law will presume
that you built it for sale or lease,which is a violation of this exemption. You may not hire an un-licensed person as
your contractor. Your construction must be done according to building codes and zoning regulations. It is your
responsibility to make sure that the people employed by you have licenses required by state law and b county ounty or
municipal licensing ordinances.
In addition, the owner must supervise construction and becomes liable and responsible for the employees he/she hires. This
responsibility includes,but may not be limited to:
1. Workers Compensation, for workers injured on the job.
2. Social Security Tax must be deducted from employee's wages and matched with owner's funds.
3. Federal Withholding.
Since owners must be liable for injuries to workers they hire,the Building Division suggests Workers Compensation
Insurance be purchased unless the homeowners insurance policy clearly protects the owner. Owners hiring workers
become employers and should also observe IRS withholding tax Form 1099 requirements on the workers they employ
on their improvement work.
Un-licensed contractors cannot be employed under any circumstances. Owners are subject to a$5,000 penalty under
Florida Statute#455.288(1)instigated via Building Division citations. An Occupational License is not adequate. The
owner should physically see the county Certificate of Competency or the Florida Contractors Certificate to ascertain a
person is a licensed contractor. Telephone the building Division (:247-5826 yf in doubt.
I hereby acknowledge that I have read and understand all the above on this c:7�O Day of,i-�'� -Ch
Owner Builder Signature Address
Print Name Telephone Number
STATE OF FLORIDA:
COUNTY OF DUVAL
Before me personally appeared to me well known to be the individual and
owner builder described in and who executed this instrument and severally acknowledged the execution thereof to be his own free
act and deed as such owner builder hereunto authorized.
WITNESS my hand and official seal thi�day of�, tl n B ach. o an State aforesaid.
NOT P S TE RM
SW1Ftl.EY L.GRAHAM Print Name:
Notary Pubk,-state of Florida
€Mr Commission Expires Feb 14,2010 MY COMMISSION EXPIRES:
Commission#DD 518533 ❑personally Known
Bonded By Natrona Nota y Assn ❑Identification:
NOTICE OF COMMENCEMENT
State of /---/o r,`ad a Tax Folio No.
County of /
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of
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 /S¢ Sf- ��/grf�C ��Q eh -3:20,52 -
General description of improvements: ��r�r✓d�'C iia., /� �� r'��
lam/
Owner: ./�nq/� ` ,Q� Z,21e .4,ivr — Address:
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor:
Address:
TelephoneNo.: Fax No:
Surety(if any)
Address: Amount of Bond S
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name:
Address: 0CL
Phone No:- �,/., —S 5 70 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 g�d �
unless a different date is
specified): MISSIO. BY
EXPIRES: N t DD 314806
HIl
TS SPACE FOR RECORDER'S USE ONLY OWNER B� �
drnNNota Publc 2�8
ry Public(/q�
Signed: Arwtf
5
Doc#2007092717,OR BK 13876 Page 145, Before me this day of p the Cou o arm l,S e
Number Pages: 1 Of Florida,has personally
Filed&Recorded 03;20/2007 st 01:49 PM, No Public at Large tate of Flori County of Duval
JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY o commission Public a expir s:
RECORDING$10.00 r
Personally Known:
Produced Identification:
Special Information for Owner/Builders
DISCLOSURE STATER "' 1030,Florida Statutes.-
STATE
tatutes:STATE LAW RF `'BE DONE BY LICENSED CONTRACTORS.
You HAv, i(// '? AN EXEMPTION TO THE LAW.
The exemption alio 1� -i contractor even through you do not have
a license. You m• A or improve a one-family or two-family
residence or a far C -tercial building at a cost of$25,000 or less. .
The building miG I lilt for sale or lease. Ifyou sell or lease more
than one build/ D l ;onstruction is complete,the law will presume
that you built - in. You may not hire an un-licensed person as
your contras Ming codes and zoning regulations. It is your
responsibil licenses required by state Iaw and by county or
municipal
In addition, the owner _ ible and responsible for the employees he/she hires. This
responsibility includes,but L
1. Workers Compensau- l 3� i on the job.
2. Social Security Tax must J 1 employee's wages and matched with owner's funds.
3. Federal Withholding.
Since owners must be liable for injuries to workers they hire,the Building Division suggests Workers Compensation
Insurance be purchased unless the homeowners insurance policy clearly protects the owner. Owners hiring workers
become employers and should also observe IRS withholding tax Form 1099 requirements on the workers they employ
on their improvement work.
Un-licensed contractors cannot be employed under any circumstances. Owners are subject to a$5,000 penalty under
Florida Statute#455.288(1)instigated via Building Division citations. An Occupational License is not adequate. The
owner should physically see the county Certificate of Competency or the Florida Contractors Certificate to ascertain a
person is a licensed contractor. Telephone the building Division (247-5826}f in doubt.
I hereby acknowledge that I have read and understand all the above on this c7;�Q Day of, SCh
IX
Owner Builder Signature Address
Print Name Telephone Number
STATE OF FLORIDA:
COUNTY OF DIIVAL
Before me personally appeared to me well known to be the individual and
owner builder described in and who executed this instrument and severally acknowledged the execution thereof to be his own free
act and deed as such owner builder hereunto authorized.
WI'T'NESS my hand and official seal thi�day of� aX�dt tl n c B ach- Co an State aforesaid.
NOT P S TE10
IR+Y+GRAHAM Print Name:
lnpY P�je i�
=o �� Notary Public,-State of Florida ,!
_My Commission Expires Feb 14,2010 MY COMMISSIONEXPIRES:
.f f
" Commission #DD 5.18533
. o Personally Known
Bonded By. National Notary Assn' ❑Identification:
BUILDING PERMIT APPLICATION
is1
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
Office: (904)247-5826 • Fax: (904)247-5845
Address: 1_:?z/S_ /S-/- ls�"C f Permit Number:
Legal Description
Valuation of Work(Replacement Cost) $ DDD .
■ Class of Work(Circle one): New Addition Alteration Repair0eito
ve
■ Use of existing/proposed structures) Circle one): Commercial en to■ If an existing structure, is a fire sprml�er system installed? (Circle one): o
■ Is approval of homeowner's association or other private entity required?(Circle one): es o
Describe in detail the type of work to be performed: ��T�� �,e ,��a d�L ,4 D d ?,V'TiO ��A✓�GS�
Property Owner Information
Dame: r Address:
City A-; State tZ Zip 3 Phone
Contractor Information:
Name of Company: Qualifying Agent:
Address: City State Zip
Office Phone Job Site/Contact Number
State-.Certification/Registration# Office Fax#
=Architect Name &Phone#
Engineer's Name &Phone#
4pplication is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has conznzenced prior to the
ssuance of a permit and that all work will be performed to meet the standards o/all laws regulating construction in tl2is1'urisdiction, This permit becomes null ana
void if work zs not commenced within six(6)months, or if construction or wort ds suspended or abandoned for a�eriod ofsix(6)months at any time after work is
ommenced. I understand that separate permits must be secured forElectncal Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks andAii
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.
There certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type
'f workwill e complied with whether specified herein or not. The granting of a ernzit does not presume to give authority to violate or cancel the provisions o arty
,ther federal,state, or local law regulating construction or the performance of�onstruction.
Signature of Property Owner: z2�Y�-ti�� Signature of Contractor:
Swoy�yp amid sub je k! �oo Sworn to and subscribed before me
his Day of K-(:�11� this Day of
Votary Public: Notary Public:
SHIKLEY t.OF 1
Notary Public-State CA Fbrida
_my Commission Expires Feb 14,1010
Commission#DO 518533
OF FL�P�` Bonded By National Notary As
,,,,, sn.
72 343 - 6
DO NOT WRITE BELOW THIS LINE: OFFICE USE ONLY
�S rL`1:rJ J�
CITY OF ATLANTIC BEACH
,, yr
PLAN REVIEW SHEET Routed o:
Building Department Public Works&Public Utilities Departments
800 Seminole Road 1200 Sandpiper Lane
Atlantic Beach,Florida 32233 Atlantic Beach,Florida 32233 D. Kaluzniak
(904)247-5800 (904)247-5834 Public Safety
(904)247-5845 Fax (904)247-5843 Fax Jax Fire dept.
=BY:
PLAN REVIEW COMMENTS
Permit Application # 47- e032-0
Property Address ��� �� S i o T
Applicant: Jwn. - Q alm
Project: f 1- 460 PWr20 (Al✓�r�
/1VP eD ,e2C/L
This permit application has been:
❑ Approved as noted by the b IG 2Qh!_S Department.
Final application approval must come from the Building Department.
71
Reviewed and the following items need attention:
Provide survey of lot with existing improvements.
Provide erosion and sediment control plans with details and
maintenance schedule.
Provide impervious surface area calculations . If adding
>5o impervious, on-site storage of excess runoff is
required.
Please re-submit 2-copies of all revisions. Please re-submit your
revisions to the Department requesting them.
Building Dept, Public Works and Utility information at top of page,
failure to notify the correct department may delay your permit from
being issued.
Reviewed By: D Date:
Date Contractor Notified: v!
�J t CITY OF ATLANTIC BEACH SHEET Route
_ PLAN REVIEW
J s� ..
<= Building Department Public Works&Public Utilities Departments
800 Seminole Road 1200 Sandpiper Lane
Atlantic Beach,Florida 32233 Atlantic Beach,Florida 32233 D. Kaluzniak
(904)247-5800 (904)247-5834 Public Safety
(904)247-5845 Fax (904)247-5843 Fax RECEIVED Jax Fire dept.
PLAN REVIEW COMMENTS 1% A ' 2 1 2007
Permit Application # 41- 403 2 D By:
Property Address r s ei� /
Applicant: Vit-n Q W n
� ,;,
Protect: ��7�,e;D,� .�C� �� �6 D TAno� CSD Y_04EQeC h.
This permit application has been:
Approved as noted by the b IG _Department.
from the Building Department.
Final application approval must come
67
Reviewed and the following items need attention: - rT� �r-
j JUNI - ;
Provide survey of lot with existing improvements.
Provide erosion and sediment control plans with details and
maintenance schedule.
Provide impervious surface area calculations. If adding
e of excess runoff is
>5% impervious, on-site storag
required.
A g R SE D
Please re-submit 2-copies of all revisions. Please re-submit your
revisions to the Department re uestin them.
Building Dept, Public Works and Utility information at top of page,
failure to notify the correct department may delay your permit from
being issued.
Date:
Reviewed By:
Date Contractor Notified: K
BP250UO2 CITY OF ATLANTIC BEACH 4/09/07
Application Tracking Individual Step Review 13: 48 : 48
Application number . . . . : 07 00000320
Application type . . . . . : RESIDENTIAL ADD/RENOVATE/ALTER
Revision number . . . . . . .
Agency/path/step/seq . . . : PUBLIC WORKS A 01 00
Date submitted, resulted . . 32107
Approval code . . . . . . . .
Reviewed by . . . . . . . . .
Revised est cpl date . . . . 32307
Copies of plans . . . . . . .
Seq Comments Prt Date
1 . 00 Provide survey of lot with existing improvements . 32207
2 . 00 Provide erosion and sediment control plans with details and 32207
maintenance schedule.
3 . 00 Provide impervious surface area calculations . If adding 32207
>5o impervious, on-site storage of excess runoff is
required.
More. . .
F3=Exit F12=Cancel
V(J
CITY OF ATLANTIC BEACH
PLAN REVIEW SHEET Route o:
Building Department Public Works&Public Utilities Departments
800 Seminole Road 1200 Sandpiper Lane
Atlantic Beach,Florida 32233 Atlantic Beach,Florida 32233 D. Kaluzniak
(904)247-5800 (904)247-5834 Public Safety
(904)247-5845 Fax (904)247-5843 Fax Jax Fire dept.
PLAN REVIEW COMMENTS
Permit Application # Q 7 e 03 Z D
Property Address J�4�'
Applicant: 14 Vi 7'I - Q al7l
Project: El- .�46 D PATIO (?,#✓6rs
lfnD e0✓DEQ PP-C/.
This permit ication has been:
0
Approved as noted by th Department.
Final application approval must coV from the Building Department.
`Reviewed and the following items need attention:
22 .0 -7 -
Please re-submit 2-copies of all revisions. Please re-submit your
revisions to the Department requesting them.
Building Dept, Public Works and Utility information at top of page,
failure to notify the correct department may delay your permit from
being issute:ed.
Reviewed By: /�`—` Da -
Date Contractor Notified: L� YoftkA,# 3. 21' 0-7/r0/ M a 3/z Z
BUILDING PERMIT APPLICATION
S11
xN s CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
Office: (904)247-5826 • Fax: (904)247-5845
Address: 3_/XY_ 1574 Permit Number:
Legal Description
Valuation of Work(Replacement Cost) $ no .
■ Class of Work(Circle one): New Addition Alteration Repair �esiiocVeen_
e
■ Use of existing/proposed structures) (Circle one): Commercial is
■ If an existing structure, is a fire sprinkler system installed? (Circle one): o
■ Is approval of homeowner's association or other private entity required? (Circle one): o
Describe in detail the type of work to be performed: I-n 7_f e t p,e ,e lno dE L ,a D d ��r�0 `�q✓FLS
Property Owner Information
Dame: -4Ze/-. r7Address:
City e,24 -/,.;c e4 State f=L Zip X 223 Phone �a2 z/-c;-2 y(o
Contractor Information:
Name of Company: Qualifying Agent:
Address: City State Zip
.Office Phone Job Site/Contact Number
State=Certification/Registration# Office Fax#
Architect Name&Phone#
Engineer's Name &Phone#
4pplicati0
n is he made to
obtain a ermit to do the work and installa'o' asts indicated. I certify that no work or nstallation has commencedprior to the
ssuance of a permit and thatallworkwilbeperformed to meetthe standads o/all laws regulating construction in this 'urisdiction. Thpermit becomes null ana
void ifwok isnotomenced within six(6)nsonths, or if construction or ork is suspended or abandoned for a perioofsix(ti)months at any time after work is
:ommenced. I understand tlsat separate permits must be secured forElectncal Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks mtdAh
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 application and know the same to be true and correct. All provisions of laws and ordinances governing this pe
�f wor tivill e complied with whether specified herein or not. The granting of a ermit does not presume to gcve aa�thority to violate or cancel the provisions ony
9ther federal,state, or local law regulating construction or the performance of construction.
Signature of Property Owner: -L � Signature of Contractor:
Swo amid sub je kp _ r� Sworn to and subscribed before me
hisp Day of KK((::��h o<d this Day of
votary Public: Notary Public:
OWLEY t.%vj7fm%Ann AM
Notary Public•State of Florida
:My Commission Expires Feb 14,2010
Commission#DO 518533
Bonded By National Notary Assn.
72 N-3--_6
DO NOT WRITE BELOW THIS LINE: OFFICE USE ONLY
Special Information for Owner/BuRders
DISCLOSURE STATEMENT for Section 489.1030=Florida Statutes: _
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS.
YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THE LAW.
The exemption allows you as the owner of your property,to act as your own contractor even through you do not have
a license. You must supervise the construction yourself. You may build or improve a one-family or two-family
residence or a farm outbuilding. You may also build or improve a commercial building at a cost of$25,000 or less.
The building must be for your own use and occupancy. It may not be built for sale or lease. Ifyou sell or lease more
than one building you have built yourself within one(1)year after the construction is complete,the law will presume
that you built it for sale or lease,which is a violation of this exemption. You may not hire an un-licensed person as
your contractor. Your construction must be done according to building codes and zoning regulations. It is your
responsibility to make sure that the people employed by-you have licenses required by state Iaw and by county or
municipal licensing ordinances.
In addition, the owner must supervise construction and becomes liable and responsible for the employees he./she hires. This
responsibility includes,but may not be limited to:
1. Workers Compensation,for workers injured on the job.
2. Social Security Tax must be deducted from employee's wages and matched with owner's funds.
3. Federal Withholding.
Since owners must be liable for injuries to workers they hire,the Building Division suggests Workers Compensation
Insurance be purchased unless the homeowners insurance policy clearly protects the owner. Owners hiring workers
become employers and should also observe IRS withholding tax Form 1099 requirements on the workers they employ
on their improvement work.
Un-licensed contractors cannot be employed under any circumstances. Owners are subject to a$5,000 penalty under
Florida Statute#455.288(1)instigated via Building Division citations. An OcMational License is not adequate. The
owner should physically see the county Certificate of Competency or the Florida Contractors Certificate to ascertain a
person is a licensed contractor. Telephone the building Division (247_5826�f in doubt.
I hereby acknowledge that I have read and understand all the above on this c;;�Q Day of, SCh
Owner Builder Builder Signature Address
-eff
Pri tNam�e f� S Telephone Number
STATE OF FLORIDA:
COUNTY OF DUVAL
Before me personally appeared to me well known to be the individual and
owner builder described in and who executed this instrument and severally acknowledged the execution thereof to be his own free
act and deed as such owner builder hereunto authorized.
WITNESS my hand and official seal thi-azday ojf X, tl n c B ach_ Co an State aforesaid-
NOT P S TE
SHIRLEY L.IRAHAM Print Name:
9 i
jo ��;,
Notary Public,-Stets of Florida
My Commission Expires Feb 14,2010 MY COMMISSION EXPIRES: �T l
F e
Commission#DD 5.18533 ❑personally I{nOWn
°`. Bonded By National Notar`v Assn
❑Identification: