153 Belvedere St 2014 roof CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 14-00000400 Date 3/17/14
Property Address . . . . . . 1S3 BELVEDERE ST
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 3000 --------------
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Application desc
REROOF
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Owner Contractor
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JONES, JASON W & WHITNEY OWNER
153 BELVEDERE ST
ATLANTIC BEACH FL 32233
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Permit . . . . . . ROOF PERMIT
Additional desc - -
Permit Fee . . . . 65 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 3000
Expiration Date 9/13/14 -----------------------
2 . 00
Other Fees . . . . . . . . . STATE DCA SURCHARGE
STATE DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 65 . 00 6S . 00 . 00 . 00
Plan Check Total . 00 * 00 . 00 . 00
Other Fee Total 4 . 00 4 ' 00 . 00 . 00
Grand Total 69 . 00 69 . 00 . 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: 15—% Permit Number:
Legal Description 4S �2 wts. Parcel 4
Floor Area of Sq.Ft. Sq'Ft
Valuation of Work 3 000 Proposed Work heated/cooled non-heated/cooled 13
Class of Work(circle one): CSD Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) circle one): Commercial (R:e-sidentia
0
If an existing structure,is A fire sprin=system installed? (Circle one). �� N/A
Florida Product Approval# 114 51 . 14 ?—I
For multiple products use product approval lorm
Describe in detail the type of work to be performed: C�tii 4 V-0A
Property Owner Information:
Name: �Cq So-A L,3 Address: 152, (3CjVjC*C 5-f
City State E�Zip_J22S I Phone 'qOL4—a[9ti-T 55�2
E-Mail or Fax#(Optional) Cl 5 e?W"U:Ci rn 0— cpvvii C Ct 3-r.'U'A
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: S a L,r— 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
4pplication is hereby made to obtain a permit to do the work and installations as indicated I certify that no work or installation has commencedprior to the
issuance ofa permit and that all work will be per
formed to meet the standards of all laws regulating construction in thisjurisdiction. This permit becomes null
and void ffwbrk is not commenced within six(6)months, or ifconstruction or work is suspended or abandonedfor a period ofsix�months at any time after
work is commenced I understand that separate permits must be securedfor Electricar Work,Plumbing,Signs, Wells,Pdols, I urnaces,Boilers,Heaters,
Tanks andAir 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 FINANCING9 CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I herelb 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
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 otherfederal,state, or local law regulating construction or the pe�formance of construction.
Signature of O<ear � Signature of Contractor
PrintName Print Name ......................................................................................................................................
............................................... . ................
....................................................................
...... . .. .. .. .......... ...
Before in ore me
this !Xn v of Public State of Fjorricia tl Day of 20
- I i ey raham
Y commission FF 086990
I-im OF Expires 02114nPol a
54, tary Public
Notai77ublic
Revised 01.26.10
A07
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 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
RvWROVE A COMIVIERCLkL 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 TEE CONSTRUCTION IS COMPLETE, THE LAW WELL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF TT11S 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 EWLOYED 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.
Ill. 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(l). 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.
15 3 PHONE NUMB
ADDRESS
j 6 5orl ot S
_--PfUNT NAME
SIGNA RE
e this day of 2J�in the county of
Before m elf and affirms that
Duval,State of Florida,has personally appeared herin imself I hers
all statements and declarations are t d rate
Notary Public at Large,State of- X7.uoun'tyo
.J0 Wrsonally Known
kbroduced Ident ffir-afton
blic State of F
Notary Pu 4GZ:1orida
Notary Signature: yL raham
MY Commission FF 086990
Expires 02114/2018
FlBLDG/Ownu-BuilduAffadavit;REVISED: 16/2009
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. o � o Tax Folio No.
State of 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:
1 '� 3 ge�\jj4rt 'Sj Af I(,,yri.C BC c,(_I,, F L �)D
Address of property being improved:_ I Is�) 9-C 14 CIA
Altilwi .,_ flx,, �, FL 2)lazk 2)
General description of improvements: Ivi!� 0�
Owner EL 3;A:�'3
Address
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor
Address
Phone No. Fax No-
surety(if any)
Address —Amount of bond
Phone 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
Phone 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 Statutes.(Fill in at Owner's option).
Name
Address
Phone 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):
THIS SPACE FOR RECORDEW5 USE ONLY OWNER
'BWned: DATE
d
B for -4et Istjday f
ft�foere 0__ in the
,of
Co �y of at, ate of Fl rida,has personalty appeared
herein by
Doc#2014058507,OR BK 16719 Page 2261, himselft herself and affirms that all staternent��and declarations herein
are true and accurate
Number Pages:I
Recorded 03/17/2014 at 01:27 PM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL LY
COUNTY
RECORDING$10.00 ic rge, Of County of
n ly n or
ient
_Ten
PRO& hirley L Graham
my Commission FF 086990
of'O'd Expires 02/14/2018