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2291 OCEANSIDE CT - PERMIT r 0.. �S, CITY OF ATLANTIC BEACH . f 800 SEMINOLE ROAD �j .,. `) ATLANTIC BEACH, FL 32233 / INSPECTION PHONE LINE 247-5814 ELE RICAL PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 15-RADD-1870 Job Type: RESIDENTIAL ADDITION Description: Addition. enlarge 1/2 bath, interior remodel Estimated Value: $165.000.00 Issue Date: 1/7/2016 Expiration Date: 7/5/2016 PROPERTY ADDRESS: Address: 2291 OCEANSIDE CT RE Number: 168846-5140 GENERAL CONTRACTOR INFORMATION: Name: Kassel Construction Address: 3830 Sa Williamsburg Park BLVD Phone: 904-610-3726 FEES: PLAN CHECK FEES $337.50 BUILDING PERMIT FEE $675.00 STATE DCA SURCHARGE $10.13 STATE DBPR SURCHARGE $10.13 Total Payments: $1,032.76 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. L6x6x%6"STEEL ANGLE L 6 x 6 x%6"STEEL ANGLE y"x 2 Y4"MASONRY SCREWS @ 16"O.C. = • ow ALONG STEEL ANGLE ow m M = (2) %"x5'TITENHD �, --. ' M • .:, •C ANCHORS AT EACH END ;.=-- •- - •NM /� SECTION-END OF ANGLE B SECTION-MIDDLE OF ANGLE CO J (2) Y'x 5"TITEN HD f L 6 x 6 x%6"STEEL ANGLE. , ANCHORS AT EACH END �EXISTIN TIE BEAM..mi ./r (SINGLE co URSE) �'-Y"x 2Y4"MASONRY SCREWS @ 16"O.C. ALONG STEEL ANGLE r 8" ROUT SOLID ----1 Ell . J 1 I ME 111 iii -_Mil . - iii-I. ii- LI CF�.I��-,, ELEVATION-OPENING �*• No S�""N,' = CCVNTL STEEL ANGL T, VWC O(? ING DUVAL ANTHONY HIC X29 ■ , IDECOIJRT '�"°w`R "' !� , 14-0609 ,,,„4/4,..... ..,, ,,„,..,,c$ LEULSBERG'',„,„,, 1111 11011 ENGINEERING, INC. ( 1 11481 OLD ST.AUGUSTINE RD.,SUITE#202,JACKSONVILLE,FL.32258 LOYD S.SIMPII,PE P:904.886.2401 F:904.260.4367 Email: jhulseng@bellsouth.net SCALE:1 r 2”=V-0" FL PE No.50791 (FL.CERT.#:25846) l RELEASE DATE:07-01-15 I DRAWN BY:CMF 0lai,Ii,y�; City of Atlantic Beach APPLICATION NUMBER f' Building Department (To be assigned by the!Tiling Department.) v�i c Atlantic tic Seminole Beach, Florida ri � � � �� Atlantic Beach, F 32233-5445 \' , Phone(904)247-5826 • Fax(904)247-5845 5 ?c��si;• E-mail: building-dept @coab.us Date routed: VI City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM • Property Address: 2. $ oce,o1 151 d c+ De•artment review required Yes No �Applicant: n� 4 P anning&Zoning Project: Addl.-lion, �1IAr `,/ Public Works - or == /2. �4 h• '��'� re e( 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: ❑Approved. ['Denied. (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by: Date: TREE ADMIN. Second Review: ['Approved as revised. ['Denied. 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 BUILDING PERMIT APPLICATION D ii C11 CITY OF ATLANTIC BEACH F I L E COI Y 800 Seminole Road,Atlantic Beach,FL 32233 JUL 3 0 Office(904)247-5826 Fax(904)247-5845 uy_ Job Address: a aci I ()c-ec-, f CI 44(c- - 5d IL 32133 Permit Number: Legal Description lig - 3/ 37 ..5 ---29 E CCeoki slCl e Parcel# 1(D S g`t( -51'4 L Floor Area of Sq.Ft. o 6 Valuation of Work S I 651 a 00 Proposed Work heated/cooled 3(0 15 non-heated/cooled Class of Work(circle one): New (Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s)(circle one): Commercial esidenti If an existing structure,is a fire sprinkler system installed?(Circle one): .N/A Florida Product Approval# For multiple products use product approval form Describe in detail the type of work to be performed: TA- a&I+ cry is of er l c. "z. a t-el Femo(ert 420 r+ e1 e c c ►!_-j 11 4u5....- - G(4-t'(6,Lozf t6._ fig �"� Vc_'6`A-eer U / _b rd � h Property Owner Information:, ,, Name:_4.41,.•.� 7. ,c/J/ KaLL V 144 Address: )25/ 3cec"Je°le U. City j4-4-ic-,L /5rc,4 State rc.Zip 3.2-M Phone (y 3`+) q 5y- 1,233- — E-Mail or Fax#(Optional). G 1,e.cl i 3 a..,,Pr,'<a e f/��M — Contractor Information: bl�as�'el C ` U�a •c0{N‘ Company Name: K SSe( CL_o S eto" Quali y ng Agent D r to r, S e p Y Z• �7 Address: X930-5/4-:14)1/1/ m .- a Ef vd City vox State E _. Zip -- Office Phone a-1'(a/o -3?A Job Site/Contact Number ?0V--(9/0-3_12 6 Fax# State Certification/Registration# C C /.9-5-7 a37 nt y. 8-7 7-I Architect Name&Phone# I 1 /71 b I coin =# - --- Engineer's Name&Phone# u s vim" et91 nseri Fee Simple Title Holder Name and Ad #"i-ie Ky Cr, -/i .K5' -22°1 I CCU/15 e G/�t. ___ Bonding Company Name and Address_7 / Mortgage Lender Name arid'Address -- — -- Application is hereby made to obtain a permit to do the work and installations as indicated. I certi that no work or installation has commenced prior to the issuance of a permit and that all work will he performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes nul and void tf 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 afte, work is commenced. I understand that separate permit must be secured for Electrical-Work,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 hereby certify that I have read and examined this and know the same to be true and.cor ect. All provisions . laws a . ordi governing thi type a/work will be complied with whether specified herein or not. The granting of a permit does not presu • give •ut .rity t. • ate,or cancel th, provisions of any other federal state or local law regulating construction or the performance of construction- Signature of Owner 41.i Signature of Contractor Print Name A/IL - ga Print Na ne (-IC C-CC, Sworn to and subscribed before me Sworn to and subscribed •-fore me this :21 � 21 Day offZ-v// ,2015 this t Day of 4 Is .20 t S Notary Public 'q off', jail -vtse� r ��� � JORGE MORENO ppY py�� .a -___..._. ....--- - .../M_...�:..�.._...m-srz:ru�_�:eec:ac�e*r.::xss \'Z,,,,,,,,, EXPIRES September 11,2018 (407)399.0153 FloridallotaryServlce.com DO NOT WRITE BELOW- OFFICE USE ONLY Applicable Codes: 2010 FLORIDA BUILDING CODE Review Result (circle one): Approved Disapproved Approved w/ Conditions Review Initials/Date: -/D-!7 Development Size Habitable Space 6Y s, r' Non-Habitable 0 Impervious area Miscellaneous Information Occupancy Group _;-R-3 Type of Construction . /3 Number of Stories 4; no 1 CI. pf Ivxa C k S Zoning District (2- Cr- Max. Occupancy Load Fire Sprinklers Required Flood Zone ,X Conditions/Comments: (1,0 .[ t p r, i s kans,� al C-vrdc don w ,4i, x s= , S "Acd et, vt+ CASSrcit, Cg:r-L--1-... 2:2:-9 t o \d.� C.- -- �, rte_ I1.,.., . 1 1 .-•-mom-. �.rs;.:,, ,, City of Atlantic Beach APPLICATION NUMBER • '�, Building Department (To be assigned by the Building Department) " 800 Seminole Road 1 Atlantic Beach, Florida 32233-5445 ! ~ �� " '�� ', I Phone(904)247-5826 • Fax(904)247-5845 f,- 151 E-mail: building-dept @coab.us Date routed: , City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: $ oceo Cli" De•artment review required Yes No Applicant: hcr.,5e \ ' arming— &Zoning -. _ or —� Project: Ad a i•h.Chl L -ell IA r4 G Public Works _- VI, `/ i h !rkrfar renVOt( Public Utilities _- Public Safety Fire Services _ - Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt of Permit Verified By Date 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: ❑Approved. ,'Denied. (Circle one.) Comments: .5.•-c., 01A, c.-L',) ////`""'" BUILDING PLANNING &ZONING Reviewed by:...." N►e/(4.-/ pate: V201. TREE ADMIN. Second Review: ['Approved as revised. Xpenied. PUBLIC WORKS Comments: $ , t_ , / _ 0 J" PUBLIC UTILITIES �%�L{J PUBLIC SAFETY Reviewed by_//...-u✓, Date: Gy �'��,5' FIRE SERVICES Third Review: Approved as revised. ['Denied. Comments: Reviewed by:7.�-+,-.i,[/ ----Date: ti,/2 3 Lr Revised 07/27/10 "ern erVil LLS__ �'s ,, ZONING REVIEW COMMENTS . `SJ City of Atlantic Beach '' Building and Zoning Department ,, '. �r 800 Seminole Road Atlantic Beach,Florida 32233-5445 0.219f' Phone: (904) 270-1605 Fax: (904)247-5845 Email: dreeves @coab.us Date: 8/26/15 Permit: 15-RADD-1870 Applicant: Kassel Construction Review: 1st Address: 3830 Williamsburg Park Blvd,Jacksonville,FL 32257 Site Address: 2291 Oceanside Ct Phone: (904) 610-3726 RE#: 168846-5140 Email: bkassel @hotmail.com Correction Comments 1. Survey: Please provide a legal survey showing the calculated average grade. I have included the definition of calculated average grade below for reference. This was a topic discussed in March of this year when preliminary plans were submitted for review, but a clear resolution did not occur. The new plans appear to be an improvement over preliminary plans; however, there may still be issues with changes made above 35 feet from the calculated average grade. More comments are expected once the calculated average grade is determined and shown on plans as required. Grade, calculated average shall mean the average elevation of a site, calculated prior to development or redevelopment of a site or any future topographic alteration of a site. The calculated average grade shall be used for determination of the maximum allowable height of building on parcels that have topographical variation of more than two (2) feet as demonstrated by a certified topographical survey and for all oceanfront parcels. This average elevation shall be determined by the mathematical average of elevation points dispersed at approximately ten-foot equidistant intervals across the buildable area of a parcel. For sites where natural topography has been previously altered or where existing structures remain,the same method shall be used excluding areas where existing structures remain. Where required,the certified Calculated Average Grade Survey shall be submitted with Construction Plans,and the Calculated Average Grade shall be depicted on all exterior elevation sheets of the Construction Plans. See definition of Certified Survey for requirements. Derek W. Reeves Planner dreeves @coab.us BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 S e m i n o l e Road,A t l a n t i c B e a c h,FL 32233 i Li! 3 0 Office(904)247-5826 Fax(904)247-5845 (C 32x33 Permit Number: ._-.. Job Address: a a�j c)(•Panf,�lr (� 44L-1,_ A.4_t Legal Description�� 3 V :37 -)-S -_2q-e-- t�G e o h std e Parcel# 1(0 8S-t 6--Sl 4f O Floor Area of Sq..Ft. Sq•.Ff Valuation of Work S I 67 i 0 00 Proposed Work heated/cooled 5675 non-heated/cooled 6 '1 C) Class of Work(circle one): New (Addito-....) Alteration Repair Move Demolition pool/spa window/door Use of existing/pro structure(s (circle one): Commercial 'esidenti• • If an existing structure,is a fire sprinkler system installed?(Circle one): • 4,. on N/A Florida Product Approval# For multiple products use product approval form _ , r Describe in detail the type of work to be performed: The- udd i+lobe cns es'( o' 8r,(4 rG ; CA. Z. &4k ci r--me e�t�S ' Ir�s J --e,. ex154► �+�i , . - u(+ea.. },)i_bf� t �S+e vc,-Fm -ec(i›...e+,i, Property Owner Information: Name:_A2- L . _) . 4/(i/cf/ tL11 Vii- ./1 Address: ).2'/ OPc,,.feb U- City 1441,-.,4'. Are;.4. State ci_Zip 32-).72_Phone (f0'1 1 9 CV- 1•2 3>- E-Mail or Fax#(Optional)_a_1.L ci i 3 c.,,,pr,ct:.re f/.c-JM Contractor Information: brets.Sel �` orka-k, co. Company Name: ' S's'�1 C—'eyh-5-{-n,c 41,x►, Qual inng Agent r'IA IN KISS e Address: 5230- i1- );//t tar b ? u vd City 414xx State EL Zip 2_051 Office Phone'6 d-ta -3.74 _-Job site Contact Number.spy-6/0-- .z6 Fax#-- —i State Certification/Registration# -- Architect Name&Phone# kc- i n M u i/i can --#Engineer's Name&Phone#ll iii.,h t , _r�i n e'ert } �` Fee Simple Title Holder Name and Add�ss >Wjr r:`Ky .0- 3-1te.:."-S -2�'1 I C'XecZ sic s Grf _� _ Bonding Company Name and Addreess A / — Mortgage Lender Name and'Address __ — Application is hereby made to obtain a permit to do the work and installations as indicated.. I cent 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 perndt becomes nul and void tf work is not commenced within six(6)months]or if construction or work is suspended or abandoned for a penod of six(6)months at any time afle, work is commenced. I understand that separate permits,must be secured for Electrical-Work,Plumbing,Signs, Wells,Pools,Furnaces,Boilers,Heaters Tanks and Air Conditioners,etc 1 ' 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 RECORDING YO JR NOTICE OF I hereby cert`ly that I have read and examined this and know the same to be true and.correct. All provisions laws a • or•' governin thi type of work will be complied with whether.specified herein or not. The granting of a permit does not presurneTo give ut . ity t• vi ate or cancel th. provisions of any other federal. state.or local law regulating construction or the performance of construction. Signature of Owner ' Signature of Contractor Print Name ,4- gL t ., Print Name '''`! : '.. .!b( >> Sworn to and subscribed before me. Sworn to and subscribed fore me this .2 t Day of 5v/ ,2015 this0, .. Day of 4 l ,20 1'S f % v %),,o,5 IIMIL! 1, _Alaillr. . Notary Public "otay, 'V .,• Y._.. , Nisei i i _ , P .�4.\ JORGE MORENO ENO i+_ • 1 '.?a;,, ' EXPIRES September 11,2018 (4071 913.0153 FlorldeNoteryServlce.com 'S );'si- ‘ ZONING REVIEW COMMENTS City of Atlantic Beach °' J' Building and Zoning Department 6 - 800 Seminole Road Atlantic Beach, Florida 32233-5445 c r Phone: (904) 270-1605 Fax: (904)247-5845 Email: dreeves @coab.us �JFiI� Date: 11/6/15 Permit: 15-RADD-1870 Applicant: Kassel Construction Review: 2nd Address: 3830 Williamsburg Park Blvd,Jacksonville, FL 32257 Site Address: 2291 Oceanside Ct Phone: (904) 610-3726 RE#: 168846-5140 Email: bkassel @hotmail.com Correction Comments 1. Height: The elevation provided with the average calculated grade survey would appear to put the overall height of the structure above 35 feet from the average calculated grade. Please show in plans height measurements from the average calculated grade. Derek W. Reeves Planner dreeves @coab.us 29 ? .f-1111tr f ' ,�\ CITY OF ATLANTIC BEACH I7;WNER / BUILDER AFFIDAVIT WI)r 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 S IAIUIES: SIATE 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 MU$T 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 TEE RUTLT)INCr 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 AT'TER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME IHAT 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 ('ODE=S AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SUR LICENSES REQUIRED BY STATE LAW 1 ---71 2 Q ORDINANCES. IL INJURY LIABILITY; SINCE OWNERS MAY B Y-) 4- vm 'etcl . THE BUILDING DEPARTMENT SUGGESTS �✓ v� _ PURCHASED. Cj� i A\ I+— III. IRS WITHHOLDING; OWNERS HIRING WC fl 1 -}-ea jlcL v V I OBSERVE IRS WITHHOLDING TAX AND/OR FC L Y EMPLOY ON THEIR IMPROVEMENT TRADES O r T IV. PENALTY; UNLICENSED CONTRACT ?' CIRCUMSTANCES. OWNERS BEING SUBJECT 6k YY\ • 3. rli 455-228(1) AN"OCCUPATIONAL LICENSE"IS! c I Y SEE THE COUNTY "CERTIFICATE OF CC ry\,) S 5)/" ef>(l S CERTIFICATE" TO ASCERTAIN IF A PERSON C+,/ ` I E BUILDING DEPARTMENT(247-5826)IF IN DOUI ''r c. y n� V.ACKNOWLEDGEMENT;I HEREBY ACKNOV1 .'(j,/ j _ E STATEMENT AND THAT I COMPLY WITH ALI P1 v/!%%` r N OWNER-BUILDER PERMIT. 11l __II )) / OcPw-0,, //e C71 411,A, 6,-,,1 �C_ 72)2) Ivy -ci y v- s"-.2 3 5- ADDRESS r PHONE NUMBER / f I ��,�J. I TI<k I. PRINT SIGNATURE .. - DATE m Before e this 1 Z.I day of -,U/V ,20_Li In the county of Duval,State of Florida,has personally appeared herin by himself I herself and affirms that all statements and declarations are true and accurate Notary Public at Large Stale of F�Oti�t ,County of I)v V4 1 __ {7 Porsoruty Known O Produced rdenlrnwnon- : : FATIMA V SIMONS 1/ '° MY COMMISSION#EE125508 I a 1I mdj 4 Cjjyy�hs r EXPIRES P• dust 28,2015 • Notary Signature: _ (407/'4413-‘0153 Fiorldanivarys^•ice.torn r eu)i/Owncr•uuaacr A,Yu,Lvn-,:S:vistiu.4/16/2009 2014-2015 BUSINESS TAX RECEIPT oia c �o, 4W� MICHAEL CORRIGAN, DUVAL COUNTY TAX COLLECTOR >v t: l s;��P:A 231 E.FORSYTH STREET,SUITE130,JACKSONVILLE,FL 32202-3370 ' � Phone: (904)630-1916,option 3; Fax: (904)630-1432 :'= Website:www.coj.net/tc; Email:taxcolledor @coj.net Note—A penalty is imposed for failure to keep this receipt exhibited conspicuously at your place of business. This business tax receipt is furnished pursuant to Municipal Ordinance Code, Chapters 770-772, for the period October 1, 2014 through September 30, 2015. S. KASSEL CONSTRUCTION COMPANY S. KASSEL CONSTRUCTION COMPANY 3830 WILLIAMSBURG PARK BLVD STE 5A JACKSONVILLE, FL 32257-5585 ACCOUNT NUMBER: 4947 LOCATION ADDRESS: 3830 WILLIAMSBURG PARK BLVD STE 5A JACKSONVILLE, FL 32257-5585 DESCRIPTION: CONTRACTOR-ALL TYPES COUNTY RECEIPT DESC: CONTRACTOR-ALL TYPES COUNTY TAX: 14.06 MUNICIPAL RECEIPT DESC: MC 772.309 MUNICIPAL TAX: 39.06 TOTAL TAX PAID: 53.12 VALID UNTIL September 30, 2015 ***ATTENTION*** THIS RECEIPT IS FOR BUSINESS TAX RECEIPT ONLY. CERTAIN BUSINESSES MAY REQUIRE ADDITIONAL STATE LICENSING. This is a business tax receipt only. It does not permit the receipt holder to violate any existing regulatory or zoning laws of the County or City. It does not exempt the receipt holder from any other license or permit required by law. This is not a certification of the receipt holder's qualifications. TAX COLLECTOR THIS BECOMES A RECEIPT AFTER VALIDATION. PAID-39421 . 0002-0002 I14 01 /16/2015 53 . 12 2014-2015'3USINESS TAX RECEIPT 141.;9` MICHAEL CORRIGAN, DUVAL COUNTY TAX COLLECTOR 231 E.FORSYTH STREET,SUITE130,JACKSONVILLE,FL 32202-3370 5.• •,` .1^: `yw Phone:(904)630-1916,option 3; Fax (904)630-1432 - iP-S%:-z V;, - Website:www.coj.net/tc; Email:taxcollector@coj.net Note—A penalty is imposed for failure to keep this receipt exhibited conspicuously at your place of business. This business tax receipt is furnished pursuant to Municipal Ordinance Code, Chapters 770-772, for the period October 1, 2014 through September 30, 2015. KASSEL, BRIAN SCOTT S. KASSEL CONSTRUCTION COMPANY 3830-5A WILLIAMSBURG PARK BLVD JACKSONVILLE, FL 32257 ACCOUNT NUMBER: 194813 LOCATION ADDRESS: 7379 SAN JOSE BLVD JACKSONVILLE, FL 32257 DESCRIPTION: QUALIFYING AGENT, CONTRACTORS COUNTY RECEIPT DESC: QUALIFYING AGENT, CONTRACTORS COUNTY TAX: 0.00 MUNICIPAL RECEIPT DESC: MC 772.325 MUNICIPAL TAX: 125.00 TOTAL TAX PAID: 125.00 VALID UNTIL September 30, 2015 ***ATTENTION*** THIS RECEIPT IS FOR BUSINESS TAX RECEIPT ONLY. CERTAIN BUSINESSES MAY REQUIRE ADDITIONAL STATE LICENSING. This is a business tax receipt only. It does not permit the receipt holder to violate any existing regulatory or zoning laws of the County or City. It does not exempt the receipt holder from any other license or permit required by law. This is not a certification of the receipt holder's qualifications. • TAX COLLECTOR THIS BECOMES A RECEIPT AFTER VALIDATION. PAID-39421 . 0001-0001 I14 01 /16/2015 125 . 00 STATE OF FLORIDA (Arti-j'217— D EPARTMENT OF BUSINESS AND'PROFESSIONAL REGULATION ,_ l_c. rt. • I CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 el'-- 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 KASSEL, BRIAN SCOTT S KASSEL CONSTRUCTION COMPANY 3830 5A WILLIAMSBURG PARK BLVD JACKSONVILLE FL 32257 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, 44f DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFESSIONAL REGULATION Every day we work to improve the way we do business in order to CBC1257237 ISSUED: 08/28/2014 serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information CERTIFIED BUILDING CONTRACTOR about our divisions and the regulations that impact you, subscribe KASSEL, BRIAN SCOTT to department newsletters and learn more about the Department's S KASSEL CONSTRUCTION COMPANY initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, is CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! Expiration date AUG 31.2016 11408280002023 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER CBC1257237 y "^1'1' The BUILDING CONTRACTOR • •Named below IS CERTIFIED 'ti�Y, , Under the provisions of Chapter 489 FS. w` Expiration date: AUG 31, 2016 0 i:,-17141 • CI KASSEL, BRIAN SCOTT -F 1 - • S KASSEL CONSTRUCTION COMPANY +Li1�;j 1 K. 3830 5A WILLIAMSBURG PARK BLVD • JACKSONVILLE FL 32257 Zt ;, ❑ z1. CI%• ISSUED: 08/28/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408280002023 • 4 JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW** CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 11/6/2013 EXPIRATION DATE: 11/6/2015 PERSON: KASSEL. BRIAN S FEIN: 591724752 BUSINESS NAME AND ADDRESS: S KASSEL CONSTRUCTION C 3830-5A WILLIAMSBURG PARI JACKSONVILLE FL 32257 SCOPES OF BUSINESS OR TRADE: LICENSED BUILDING CONTRACTOR Pursuant to Chapter 440.05(14),F.S..an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under the chapter.Pursuant to Chapter 440.05(12).F.S.,Certificates of election to be exempt..apply only withal the scope of the business or trade listed on the notice of election to be exempt Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shaH be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate,the person named on the notice or * to a n - 'o � a ro b -- O :o Pc' v 9\ to W N Q1 Ch W N -- irJ r ' S 7?) 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