340 N Oceanwalk Dr siding 2014 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
5- INSPECTION PHONE LINE 247-5814
Application Number . . . . . 14-00000555 Date 4/10/14
Property Address . . . . . . 340 N OCEANWALK DR
Application type description SIDING PERMIT
Property zoning . . . . . . . RES SF DISTRICT
Application valuation . . . . 6000 --------------
-------------------------------------------------------------
Application desc
siding -------- --------------
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Owner Contractor
------------------------
------------------------
MITCHELSON, THEO OWNER
340 OCEANWALK DRIVE
ATLANTIC BEACH FL 32233
-- -------------------------------------------------------------------------
Permit . . . . . . SIDING PERMIT
Additional desc - -
Permit Fee . . . . 80 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 6000
Expiration Date . . 10/07/14 -----------------------
----------------------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 80 . 00 80 . 00 . 00 . 00
Plan Check Total . 00 * 00 . 00 . 00
Other Fee Total 4 . 00 4 ' 00 . 00 . 00
Grand Total 84 . 00 84 . 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 13EACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
J JobAddress: ZkO 0Ce_Q-tawPL-w.-'ADQL P-1. Permit Number:
o rl
g
CLegal Description Parcel
s
Floor Area of Sq Ft. Sq.Ft
V lu tio
aluation of Work$ Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of ep�ting/pro osed structureQ) (�ircle oirie): Commercial Residential
If an existing strucrure,is a fire sprinkler system installed9 (Circle one): Yes No N/A
(Florida Product Approval# -"15ILy
ka _�
or multiple products use product approval for
Describe in detail the type of work to be performed: At4v%pvran CA4.^, S-4'
Propertv Owner Information:
Name—T�,. VVN-_�v ekl65ayd Address: .0 0 C_e-4q--:,, sL tJ
city f* State jFLZip I'L%-11 Phone (4904t
ILC.S,
E-Mail or Fax#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: Qualifying Agent:
Address: ty Z)'_ State Zip
Office Phone Job Site/Con er Jax#
State Certification/Registration# r
Architect Name&Phone# Ij 1 1
Engineer's Name&Phone# 0 W
Fee Simple Title Holder Name and Addre
Bonding Company Name and Address
Mortgage Lender Name and Addre
A A
i p a ato obtai ermit to do the work and installations as indicated I certify that no work or installation has commenced prior to the
t all w,
pp'icatio is ereby made to
by made to
App'icatio is ereby made to
by made to
ereby made to i
A P'ic c'io is reiby madh
c
c
isspainceio is ernnbtyand t attoall yi be pe?-formed to meet the standards of all laws regulating construction in thisjurisdiction. This permit becomes null
P
ssuance o
, 'o
and void i work is not commenced within six(6)months, or if construction or work is suspended or abandonedfor a
Wperiod ofsix(6)months at any time after
work is commenced I understand that separate permits must be securedfor Electrical—Work,Plumbing,Signs, ells,Pools,Furnaces,Boilers,Heaters,
Tanks andAir Conditioners,eta
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.
bta p
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I herelb certify that I have read and examined th' application and know the same to be true and correct. Allprovisions of laws and ordinances governing this
work will be omplied with whether eci/led herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provi.si.ons of any oth r ederal, ata. or localsfaw regulating construction or the pe�formance ofconstruction.
Signature of Owner Signature of Contractor
Print Name —.X I
�A Print Name
................................................... ........................................................................................................................................
Befor e Before me
ay 20 1 this Day of 20
Notary Public State 0& loridaN ry Public
Notwy-PubTiq— f JN Shirley L Graham
mY commission FF 086990
Expires 02/1412018 Revised 01.26.10
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 A ONE-OR
TWO FANH ALSO BUILD OR
EvIPROVE A THE BUILDING
MUST BE F SALE OR LEASE.
IF YOU S ONE YEAR
AFTER THE THAT Y0_U BUILT
IT FOR SALE OR LEASE.WFUCH IS IN VIOLATION OF THIS EXEMPTION- YOU MAY NOT
MRE AN UNLICENSED PERSON S 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 LICENSINQ
ORDINANCES.
III. 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(1). AN-OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE UF 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.
3SO C���A%-w- is C.
IOQN�E�NU M�BE
ADDRESS
__&_
- �40
PRINT M
SIG ATURE -6-A—TE
day of 1 20 4inthecountyof
Before me this
Duval,State of Florida,has pers+onalla—ppeared herin by himself I herself and affirms that
d I
all statements and declarations are ru n accurate.
Notary Public at Large,State of County of D4 c5�2
0 p lly Known
�=u.ed Iden' on-
Rc, NotatY Public state of Florida
Notary Signa e: % Shirley L Graham
my commission FF 086990
Expites 02114120`18
F-A3LDG/O��-BuildwAffadavit;RF-VIS D: 4/16/2009 of
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit NO. Tax Folio No.
St, If h)�_'i.c�l Countyof__
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: 0
General description of improvements: C�
Ow7-er
Address %k"jCA I– Ile
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor --Z,
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 d ate 4is ne(1)year from t�..7-late of recording unless a
ye"" "u'"
different date is specified):
OWN
ER'S USE ONLY 0
1 SPACE FOR RECORDI
DATE 5 Co
Signe:d: -in the
in s
�k ay of
Before m Is do, E u.co
County of Duval,State of Florida,has personoly appeared a M LL
herein by v;
himself/jmrsetil affirms that all statements a,d declarations herein 6,0 V
are iy-,r.-..d .c�rate� 5_j C14
0. - a
to
0
0
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Doc#20140795971,OR BK 16746 Page'1553, at Larg State of County of
Number Pages: I my commission expi S:
"7- A
—or
Recorded 040 1112014 at 08:05 AM, Personally Known
c
IRCUIT COURT DUVAL Produ ad Idenfifica on
Ronnie Fusse4l CLERK C
COUNTY
RECORDING$10 00