18 5th St (vault) (2) CITY OF ATLANTIC BEACH
DEPARTMENT OF BUILDING
-5877
800 SEMINOLE ROAD-A71 LANTIC BEACH,FL 32233-TEL: 247-5826-FAX: 247
C
LQ_i
PERMIT INFORMATON— ATION I
Address:— 81 - !�flr-r�f 8TMEET
2_0-f0_4 233
PermitType: SIDING ATLANTIC BEACH, FLORIDA 32
Township: 0 Range: 0 Book:
Class of Work: NEW Lot(s): Block: Section:0
Proposed Use: Subdivision: ATLANTIC BEACH
Square Feet:
Parcel Number:
Est.Value: 0-W-N I ER INF ATIO
Improv. Cost: 8,000.00 Najjjj:___j6H_N HOLMES
Date Issued: 9/28/2000
Address: 81 FIFTH STREET
Total Fees: 50-00
ATLANTIC BEACH, FLORIDA 32233
50-00
Amount Paid: Phone: (904)246-2315
9/28/2000
Date Paid:
- '______kEPLACE 810 NG
-'Work DWc: IC
CONTR-ACTQ90-t-
--j PERMIT
�ER—-----
1"s
S MUST BE REQUESTED AT LEAST 24 HOURS PRIOR TO INSPECTION
NOTICE-INSPECTION
ED IN PUBLIC SPACE,AND
BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLAC
MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER
SULT IN THE PROPERTY
"FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RE
UILDING IMPROVEMENTS"
R PAYING TWICE FOR B
OWNE
APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION
ISSUED ACCORDING TO OvISIONS OF LAW.
FOR VIOLATION OF APPLICABLE PR
$58.N 14
Date: 10/83/08 81 Receid. IM356
CHECKS 427i
�T_�LAVIC Bt 6H
C:r2,r Or ATLANTIC BEACH
ATOlq REMODELf ADDITIONSf . OR I ALTERATIONS
PIMMIT APPLIC
MOVING., IT I
owner(s) :
Phone;
Job Address:it
subdivision:
Lot # Block or Unit
state License
contractor:��
phone NO:
Address: Zip Code
State
city
Describe work to be done:
CD
present use of 'buildingt
Valuation of Proposed Construction:
Proposed use:
if yesp what are. the dimensions of the added
is this an addition? ft. Will the added area be heated and
sp�ace:--.ft. X
cooled?__ New electrical (or increase) ?_
New fireplace?New Heat/AC?--
New plumbing fixtures?_
XMWXAZ,) COWLS= SSTS OF PL&NS' zXCZUD-124G
SUBMIT THP" (COMM=IAL) TWO MES WS NOTICE or CO26MCEMENT, AND
SUARVEY, ZM= COIN F01 0,
SXTR PLAN, "TIDAVIT, ly OWMM IS coNMRACTOR-
OWNSR/CONTRACTOR
Date':
Signature OWNER: Date:
signature CONTR OR:
AS TO OWNER: f 2�10 0 0-
i dayy 0
sworn to and subscribed before me th
9AM P LIC
NOT PUBLIC
Pat
'Vskg, ricia Amonette
RES
ON# CC947012 EXPI
MYCOMMISS1
AS TO CONTRAGTOR:
Aligust 27,2004 '0000.
sworn to and subscribed before me this___ day
NOTARY PUBLIC
CITY OF
800 SEMINOLE ROAD
ATLANTIC BEACH,FLORIDA 32233-5445
TELEPHONE(904)247-5800
FAX(904)247-5805
SUNCOM 852-5800
CHAPTER 489, FLORIDA STATUTES, PART I "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 APPU ED FOR A PERMIT
UNDER AN exempTION TO THAT LAW. THE EXEMPTION ALLOWS YOU, AS THE OWNER OF YOUR PROPERTY, To ACT AS YOUR
oH YOU 00 NOT HAVE A LICENSE.. Y U ST SUPERVISE THE CONSTRUC-TIONYOURSELF.
OWN CONTRACTOR EVEN THOU IDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
You MAY BUILD OR IMPROVE A ONE - OR TWO FAMILY RES THE 5 JILDING MUST BE FO t YOUR USE AND
IMPROVE A COMME:RcIAL BUILDING AT A COST OF $25,000-00 OR LESS.
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
NUc SED P R ON AS YO JR CONT-RACTOR.
LEASE, WHICH IS IN VIOLATION OF THIS EXEMr`rION- DES AND ZONING REGULATIONS- IT IS YOUR
YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CO I NS S R UIRED By STATE OkW AND By
RESPONSIBILITY TO MAKE SURE THAT PEOPLE
COUNTY OR MUN CIPAL jCENSING ORDINANCES.
ORDINANCES ALSO ALLOW AN OWNER TO IMPROVE THEIR OWN PROPERTY WHEN IT IS FOR PERSONAL OR FAMILY
USE, AND LIKIEWSE REQUIRE ALL WORK (EXCEPT MAJNTENANCE UNDER $a,000) BE UNDER A BUILDING PERMIT AND PASS
ALL NORMAL INSPECTIONS. THE ORDINANCE STATES OWNERS MAY PHYSICALLY Do WORK THEMSELVES; OR_MAY HIRE
UNLICENSED WORKERS PROVIDED SUCH WORKERS 19E UNDER "DIRECT SUPERVISION OF THE OWNER, H MUST 183 ON
THE JOB AT AL T1 ES WHILE WORK IS IN PROGRESS BY UNLICENSED TRADES PEOPLE." THIS DOES NOT ALLOW USE OF
L�
UNLICENSED CONTRACTORS.
SINCE __Lj��uRj TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS
OWNERS MAY ISE LIABLE FOR INJI NERS INSURANCE POLICY CLEARLY PROTECTS
WORKER'S COMPENSATION INSURANCE BE PURCHASED UNDER THE HOMEOW
THE OWNER. 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.
UNLICENSED CONTRACTORS CANNOT B EMPLOYED UNDER AN_y CIgCUtdSTANCE:S. OWNERS BEING SUBJECT
To $5,000 PENALTY UNDER FLORIDA STATUTE: No. 455-228(1). AN-- i NOT ADEQUATE.
THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF comPE:-rFNcY" OR THE FLORIDA "CONTRACTORS
CE:RnFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT (247-
5826) IF IN DOUBT.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL
THE REOUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. 001,
ew,0�;1v
PR ERTY OWNER/BUILDER
ADDRESS TELEPHONE
SWORN TO AND SUBSCRIBED BEFORE METHISA DAY OF
NOTARY PUBLIC
PHRASES UNDERLINED ABOVE My COMMISSION EXPI. D�+,;-:_A monette
N OTE: Pi MYCOMMISSION# CC947012 EXPIRES
ARE EMPHASIZED BY THE BUILDING
V August 27,2004
DEPARTMENT. BONDED TH�U TROY FAIN INSURANCE,lNr-
CITY OF
4&,&, Be4c4-0;&U'k
J"
office of Building official
REQUEST FOR INSP Permit No.
Date
A.M.
Time PM.
Received
Job Add ss
owner's "jCon4tract�or
Name MECHANICAL
11 �CONCRETE ELECTRICAL PLUMBING D Air Cond. &
BUILDING 1-1 Rough Wiring F! Rough [I Heating
'ng L1 Footing F1 Temp Pole 0 Top Out F] Fire Place
Re Roofing Ej Slab 0 Final Li Sewer Pre Fab
Insulation Lintel READY FOR INSPECTION
2 es Wed. Thurs. Friday
Mon. es. A.M.
P.M.
inspection Mad Final Inspection EJ
-cuPancy 0
71nspector Certificate of Or
Date
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
-5826
ION PHONE LINE 247
INSPECT
Application Number . . . . . 08-o0001192 Date 9/02/08
Property Address . . . . . . 81 5TH ST
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation - - - - -------6000-------------- ---------------
-- -------------------------------- ----
Application desc
reroof -----------------------
---------------------------
Contractor
Owner ------------------------
----- ------------------ HARRISON CONSTRUCTION
C . HOLMES, ELIZABETH REMODELING1 INC.
81 5TH STREET
ATLANTIC BEACH FL 32233 917 1ST AVE .
NEW SMYRNA BEACH FL 32169
(386) 689-0689
------------------ ---------------------------------------------------------
Permit . . . . . . ROOF PERMIT
Additional desc . - 60 . 00 Plan Check Fee . 00
Permit Fee . . . . Valuation . . . . 6000
Issue Date . . . .
Expiration Date - - 3/01/09 --------------------------------
------------------------------------------- Credited Due
Fee summary Charged Paid ------ ----------
----------------- ---------- ---------- ---
Permit Fee Total 60 . 00 60 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 60 . 00 60 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
,-,,T COMMENCEMENT
NOTICE %J-u
Tax Folio NO.
stau. of
county of
concern: and in ac
_XM�e with Secti
T(5 Whom It May you that improvements wiU be made to certain real property,
OMMENCEMENT
The undet signed hereby informs nation is stated in this NOTICE OF C
the Florida Statutes,the following infor, A,.�-11�
Legal Description of property being improved:
16 0 -rf
Address of property being improved: 411112
General description of improvement,:
01
Address:
Owner:
the unprovement:
Owner
.)—.,Fee Simple Titleholder(if Other than owner)'
Name: -----------
C6ntractor:
1 1 �- / 1/1 r- �-n
Address: 0I - Fax NO:
Telephone
Surety(if any) Amo-unt of Bond$-------
Address: Fax No:
Telephone No: ------- cuts
Name and address of any person making a loan for the construction of the iniprovern
Name:
Address: Fax No: ----- documents may be
Phone No: -------- notices or other
Name of person within the State of Florida, other than himself, designated by owner upon whom
served: Name:
Address: Fax NO: -----
Telephone No: s Notice as provided in Section
In addition to himself, owner designates the following person to receive a copy of the Lienor'
- (Fill in at owner's option)
713.06(2)(b),Florida Statues
Name:
Address: Fax No:
Telephone No: ----------- of recording unless a different date is
Expiration date of Notice Of Commencement(the expiration date is one(1)year from the date
specified):
ONLY OWNER q, e,7 "A
THIS SPACE FOR RECORDEW S USE Date:
Signed: d I ay.of in e County of Duval,State
Befor is an eare Al
Of da,has personally apPeare of Duv
Doc#20082 3266,G,R 8 KI 46.3 rage-166, ary Public at Large,State of Flo Cou
22 ssion exp. e - or
NUmber Pagesi I my comini
Recorded 09/02i2008 at 10:31 AM, T DUVAL Personally Known'
JIM FULLER CLERK CIRCUIT COUR
Produced Identification:
F
COUNTY ow XpIRES-April 11,—
RECORDING$10-00 I-840-,T-1VOTARY Fl.Notary Discount-Assoc- o
. ........�J,p. CITY OF ATLANTIC BEACH 08-
800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233
E:(904)247-5826 0 FAX NO.:(904)247-5845
OFFIC
BUILDING-DEPT@COAB.US
ICATION COUNTY
RI, is u
fil BUILDING PERMIT"IIA,,P,, PL - - 1 4- SWIEFU
0
0 .
ALUATICKOF, P,' P.
77-
32233
L c SEOF STRU
Atlantic Beach, F S X,
`AK '60,
TI [3 RESIDENTIAL
I DEMOLITI N
[I NEW BUILDING J
0 CONVERTING USE [3 COMMERCIAL
114KILE
[3 ADDITION 'F IRE SPR =Rj"'.
LOT I BLOCK,?—,6 SUB DIVISION [I ACCESSORY BLDG. 1 11
V 0 YES NIA
ALTERATION
CRIPTIOI.......... 0 POOL/SPA
REPAIR E]OTHER Q.N.0
MOVE R�*- �,
..I �$,:,; , Cli;TF-CT j_ENGINEE
,.1N
�,,CON, TOR:W,,,
23,COMPANY NAME:
15. pANY NAME'
9.NAME: 16.NAME, 24,LICENSEE NAME:
t, 17.STATE OF FLORIDA LlUtN=1-- Zb.61AI= NO.:
10.ADORE S:
C. 4 26.ADDRESS:
I B.ADDRESS:
r 19.OFFICE PHONE: 20.FAX NO.: 27.OFFIS 2&FAX NO.:
11.OFFICE PHONE: 12.FAX NO.:
21.C PHONE, 29.CELL ONE:
13.CELL PHONE: 30.EMAIL ADDRESS:
22.EMAIL ADD SS:
77-
14.. MAIL ADDRESS' 717r!.:,,!,7,-777:7 777`777=77='
LDEP41
ER� 33.NAME: 35.NAME:
31.NAME:
36.ADDRESS:
34.ADDRESS:
32.ADDRESS: certify that no work or nstallation has
ain a permit to do the work and installations as indicated. tr ct�tion
Application is hereby made to obt all laws regulating consiru ion in thi:
the issuance of a permit and that all work will be performed to meet the standards of ork is suspended or
commenced prior to enced within six(6)months, or if construction or w
s null and void if work is not Comm
jurisdiction. This permit become nths at any time after work is commenced. I understand that separate permits must be secured for
abandoned for a period of six (6) mo AIr Conditioners,etc.
Electrical Work,Plumbing,Signs,Wells,pools,Furnaces,Boilers,Heaters,Tanks, 11 be done in compliance with all applicable
OWNEWS AFFIDAVIT-I certify that all the foregoing information is accurate and that all wor W
laws regulating construction and zoning. I will not occupy or use the referenced building or any part therof,until all inspections are finaled and
prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law.
WARNING TO OWNER:
YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF ORETHE
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEF
END TO OBTAIN FINANCING9 CONSULT WITH YOUR
FIRST INSPIECTION. IF YOU INT CORDING YOUR NOTICE OF COMMENCEMENT.
RNEY BEFORE RE
Of
LENDER )R AN ATTIC
iRW CONT 1�1
U
6 red),
�T
NA
vi�� Letter
lt&rlibi, ,1;:!::�Date:
Signe
Signed:/ day of 204n the county Of
Before this day of 20CSin the county of Before me thii 11 peared
Duval of Florid as p�erso
Duv , tate of hal pers ppeare
herin b i self/herself and affirms that all statements and dFeclaratons Ire, herin by himself I herself and affirms that all statements and declaration
true and accurate. County of V V,
true and accurate. County of Notary Public at Large,State of
(Sot ry Public at Large'State of 11 Personally Known
ersonally Known 0 Produced Identification-
piduced Identification- G Notary Signature:
Notary Signature: R 0
xNN N DD536S35
0 C vs.Nvo 111 2010
M.�COMMISSIO ,
EXPJRES�Nprl CO
.��nt A5sc--
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OF!�,,JPXN
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COAB FORM BLDG01:REVISED:1116/2007