2359 SEMINOLE RD - REPLACE DECK C '' S CITY OF ATLANTIC BEACH
f 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-RAAR-2546
Job Type: RESIDENTIAL ALTERATION
Description: ALTERATION - REPLACE WOODEN DECK
Estimated Value: $2,000.00
Issue Date: 11/4/2015
Expiration Date: 5/2/2016
PROPERTY ADDRESS:
Address: 2359 SEMINOLE RD
RE Number: 168349-0000
PROPERTY OWNER:
Name: JACOBSON, SAMUEL S
Address: 2359 SEMINOLE RD
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $30.00
BUILDING PERMIT FEE $60.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION C CITY OF ATLANTIC B EACH 1 COPY
800 Seminole Road,Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904) 247-5845 t3 . R A a R zS
Job Address: 2.35Q frnc'Id4k Road Permit Number:
Legal Description t -7 ?_S-L` 1 - _ S Parcel# D;v •
oor A ea o q. t. 3oa t
Valuation of Work$ 2.00t5 Proposed Work heated/cooled non- heated/cooled V
Class of Work(circle one): New Addition Alteration Repai- Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial i esident *T
If an existing structure,is a fire sprinkler system installed?(Circle one): " YTS No c
Florida Product Approval#
For multiple products use product approve orm
Describe in detail the type of work to be performed: Rzete, cup nt.u-tz:_j wy_t c_k 62_4A
Iro 4e.A4 Wood O v. 's - t& oc*do tea,
Property Owner Information: t
Name: S C e U.cup1 S(i ii-k A. -T u c b b s C n Address: YV1(Ode(c ct,t
City At Vett h e 13 Pi c-ii StateF-L._Zip 2 2-2.83 Phone QD -'ot(4-b^6(bql
E-Mail or Fax#(Optional) J air ob-s ►.. 32.@r.OM Ca 4. n Q-{
Contractor Information: 144 CONTRACTOR EMAIL ADDRESS: ^a.lYu. et.,-; ERA)ne,r
Company Name: 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
Application is hereby made to obtain a permit to do the work and installations as indicated. I cert(that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void f 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. I understand that separate permits must be secured for ElectricalPWork,Plumbing,Signs, Wells,Pools,Furnaces,Boilers,Heaters,
Tanks and Air 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.
I hereb cert f that I have read and examined this placation and know the same to be true and correct. All provisions of laws and ordinances governing this
type ojYwork 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 other federal,state, or local law regulating construction or the performance of construction.
Signature of Owner`• �. Signature of Contractor
Print Name �v M.. TAO So Print Name
Befo e e Before me
:his ay of 6C4-d e ,20 IC this Day of ,20
k A4.
�
ary 'ublic =R.,,. - ONPO Notary ublic
MY COMMISSION a FF 897944 ry
`.%�.-a EXPIRES:July 12,2019
Revised 01.26.10
..... ' Bonded ThiuNotary pubacUndenrtilert
r:: CO?Y NOTICE OF COM M ENCEMENT -4/1/IIZ
State of County of ,11 6_1 Tax Folio No. _
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: fkG`•Z 1�. 3r1 "ZS -2./e.:(Dart) &Mit S/.) ( P} (_e*i
D1 Y 3 fPP2Crt R :��3.1/' I t Jtl
Address of property being improved: �.%.y� �efr)i Ir101 (Q C)&J_1 ( —6-1.(17 L �����( j =L_32-% 11
General description of improvements: (°C, p(c i. . Nein t ; iacke' c•1-Pb (-ken u.'d 011
Q40.lczt-t.LAM O�t.k a�ccOir cock. r ,a��r �,"-�[ ,,pp� `
Owner: 52rivels` iett •1 LO bn Address: 2 3 Gc( Sa MI�'lo�� % L7l&[(dic S�QC4
Owner's interest in site of the improvement: O CC_Le.p ant-
Fee Simple Titleholder(if other than owner): )`i
Name:
Contractor:4S:0 aft1,12_ cLS era,Yl,e r'
Address:
Telephone No.: Fax No:
Surety(if any) ts1A-
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of i Doc#2015247023,OR BK 17349 Page 450,
Number Pages:1
Name: .(A- Recorded 10/27/2015 at 02:14 PM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
Address: COUNTY
RECORDING$10.00
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: NA
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: IA A
Address:
Telephone 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): 6-.)c_l-oC9cvr 3 l,ZO( ,
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Signed: ,. LC• Date: ( O- :-i—6 6 lJ
Before m4 this day of ncko(,.enr QOI51n the County of Duval,State
Of Florida,has personally appeared •�� •E-6,` .. .C1 r-
Personally Known: or
Produced Identification: rip - • - •
Notary Public: Ar111Nf/l�
My commission e•sire . /,�//
�l I NM ALEX N.POWERS
lax MY COMMISSION A FF 897944
EXPIRES:July 12,2019
' p.hr' Bonded Thru Way Pubic UnderwMerc
-• ,, -,. s CITY OF ATLANTIC BEACH
Jv )1 I3%WNER / BUILDER AFFIDAVIT k 4 J �� s •
I. 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
IMPROVE A COMMERCIAL 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 THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS 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 EMPLOYED BY YOU HAVE
LICENSES REOUIRED 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.
III. 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 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.
2.4351 ;if‘ ¢ Ro01, M1&c 11(.63 c-ta+ a 4-6-6 i GI
ADDRESS PHONE NUMBER
i I- /
PRINT NAME
SIGN u(C �,��
Ra-9 /O CXn 4
.QR - , 2 b ( S.
DATE •
Before me this Z' / day of l JC4CJ.}/e ,20 I'in the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.tr
Notary Public at Large,State of r t- ,County of U L/E1
II ❑Personally Known �L 17L X21 _9.Z y - 3C, -509 -�
C�,Produced Identification-
,, :%i ALEX N.POWERS
Notary Signature: / :.: MY COMMISSION A FF 897944
V.7-4,,C
.k..= EXPIRES:July 12,2019
F:BLDGIOwner-Builder Afadavit;REVISED:4/16/2009
?Rf '• Bonded Thru Notary Public Undemdters
, ^„ Page l of 1
+ 1 111111 11111 11111 11111 11111 11111 11111 IIII IIII
tNE CYRCG,v
,tltl O4,t Syr
f ' - Print Date:
.. t �• 10/27/2015 2:14:51 PM
Transaction #: 2901686
Receipt#: 2821715
Cashier Ronnie Fussell
Date: 10/27/2015 Clerk Circuit Court
2:14:48 PM Duval County
(MCARTER) 501 West Adams St RM 1051
Jacksonville, FL 32202
(904) 255-2000
Customer Information Transaction Information Payment Summary
DateReceived: 10/27/2015
Source Code: BEACH
() SAMUEL S AND JUDITH A Q Code: BEACH
JACOBSON Return Code: Over the Total Fees $10.00
Counter Total Payments $10.00
Trans Type: Recording
Agent Ref
Num:
1 Payments
[P1 CASH $10.00
1 Recorded Items
BK/PG: 17349/450 CFN:2015247023
(N/C)NOTICE COMMENCEMENT Date:10/27/2015 2:14:48 PM
From: JACOBSON SAMUELS ETAL To: SAME AS
OWNER
INDEXING 2 $0.00
RECORDING 1_ $10.00
0 Search Items
0 Miscellaneous Items
file:///C:/Program%20Files/RecordingModule/default.htm 10/27/2015
City of Atlantic Beach
APPLICATION NUMBER
�t Building Department• ,o\ (To be assigned by the Building Department.)
800 Seminole Road
'� Atlantic Beach, Florida 32233-5445 1 5- R A-R-R_ 254G
Phone(904)247-5826 • Fax(904)247-5845 /
Apit 9:- E-mail: building-dept @coab.us Date routed: I O/Z2-7 / (S
City web-site: http:l/www.coab.us 6 •
APPLICATION REVIEW AND TRACKING FORM
Property Address: �--J—� EMI A3OL E 2D0 • - . - -nt review required Ye No
^i vW(\eC-
Buildin.
,
Applicant: � vl� 1 ` CLCOb50( — '. s. : ening
Tree Administrator
Project: C ECK_ REPC CE1'YVCQT Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature •
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: proved. I 'Denied.
(Circle one.) Comments:
BUILDIN
PLANNING & ZONING
Reviewed by: /'71 ; Date:/1-2-/S
TREE ADMIN. Second Review: A
❑ pproved as revised. ❑Deni
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10