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982 OCEAN BLVD - INTERIOR DEMO r d Ms `s CITY OF ATLANTIC BEACH , A ) 800 SEMINOLE ROAD j r — ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 0;319? DEMOLITION PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 16-DEMO-848 Job Type: DEMOLITION Description: INTERIOR DEMO Estimated Value: $400.00 Issue Date: 4/12/2016 Expiration Date: 10/9/2016 PROPERTY ADDRESS: Address: 982 OCEAN BLVD RE Number: 170342-0000 PROPERTY OWNER: Name: Woessner, Brian J Address: 982 Ocean BLVD PERMIT INFORMATION: FEES: STATE DCA SURCHARGE $2.00 Demolition Fee $100.00 STATE DBPR SURCHARGE $2.00 Total Payments: $104.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. American Land Title Association ALTA Settlement Statement-Combined Adopted 05-01-2015 FileNo./Escrow No.: 16B1819 Richard T. Morehead Title&Escrow,Inc. Print Date&Time:4/6/2016 @ 4:56 PM Officer/Escrow Officer: Beth Murphy 444 Third Street Settlement Location: Neptune Beach,Florida 32266 444 Third Street Neptune Beach,Florida 32266 Property Address:982 Ocean Boulevard,Atlantic Beach,Florida 32233 Buyer: Brian J.Woessner Seller: Mark Louis Rouleau,a married person conveying non-homestead property Brenda Rouleau Kerekes,a married person conveying non-homestead property Lender:JP Morgan Chase Bank, N.A. Settlement Date:4/8/2016 Disbursement Date:4/8/2016 Additional dates per state requirements: Seller Description Borrower/Buyer Debit Credit Debit Credit Financial $465,000.00 Sales Price of Property $465,000.00 Deposit including earnest money $5,000.00 Loan Amount $372,000.00 Lender Credit $750.00 Title-Insurance Seller Credit $2,400.00 Title-Search Fee Seller Credit $125.00 $2,400.00 Title-Insurance Seller Credit $125.00 Title-Search Fee Seller Credit Prorations/Adjustments $2,046.81 County Taxes from 1/1/2016 to 4/7/2016 $2,046.81 Loan Charges to JP Morgan Chase Bank,N.A. Process/Underwriting Fee to JP Morgan Chase Bank, N.A.(POC $505.00 by Borrower:$90.00) Tax Service Fee to JP Morgan Chase Bank,N.A. $87.00 Prepaid Interest($35.67 per day from 4/8/2016 to 5/1/2016) $820.41 to JP Morgan Chase Bank, N.A. Other Loan Charges Appraisal Fee to Solidifi National Appraisal Services(POC by Borrower: $410.00) Flood Cert. Fee to CoreLogic Flood Services $11.00 $9.00 E-Filing to Old Republic National Title Insurance Company $9.00 Copyright 2015 American Land Title Association. Page 1 of 3 File#:16B1819 All rights reserved. Printed on 4/6/2016 @ 4:56 PM 4 1 � Ja.tfl,`. BUILDING PERMIT APPLICATION JS' �. .J J.' CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach FL 32233 �(I tl>r Office: (904)247-5826 • Fax: (904)247-5845 Job Address: q 32._ 0 C-- -A- ki LU 1). Permit Number: Legal Description RE# Valuation of Work(Replacement Cost) $4 Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s) (Circle one): Commercial 'esidential • If an existing structure, is a fire sprinkler system installed?(Circle one): Yes o N/A • Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal Describe in detail the type of work to be performed: b i M 0 (. (T7DI J O F 1 ti? .l G1Z Ll .-S A- O C El L /A/l-s _I Aili4-T7d tit Florida Product Approval# E5!ESN- pp _ _ for multiple products use product approval onn Property Owner Information Name: 31?-4/N Li D S Al.E-/l-_ Address: q8 Z 0 C.&1--k.1 b (,V 1J . City F TL_Prn!1-1 C_ ileetCH State. ip 3223 3 Phone q o y-5-71-3&O E-Mail b r t an w dr°ssvl+c r,1014 i 1.-nil Owner or Agent (If Agent,Power of Attorney or Agency Letter Required) 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. Contractor Information: Name of Company: • , ying Agent: Address: City State Zip Office Phone Job e/Contact Number State Certification/Registration# E-Mail Architect Name & Phone# Engineer's Name & Phone# Worker's Compensation Exempt / Insurer / Lease Employees / Expiration Date Application is hereby made to obtain a permit to do the work and installations as indicated. I certify 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 if 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 Electrical Work,Plumbing, Signs, Wells,Pools,Furnaces,Boilers,Heaters, Tanks and Air Conditioners,etc. Signature of Property Owner:- --g- �?�/lr . signature of Contractor: Befc ,me this 4C. Day of I` ,a, ©1 Before me this Day of MINIMI11014111.11‘ • /�----- c 2I�Not., ■. Notary Public: g' EXPIRES:October 6,2019 I hereb' cei if}fihda' htlYTr�ir .1--.-•n d this app'cation and know the same to be true and correct. All provisions of laws and ordina .----_: pe o work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to vio ate or cancel the provisions of any other federal, state, or local law regulating construction or the performance of construction. Rev.3/14/16 1 . 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: Development Size Habitable Space Non-Habitable Impervious area Miscellaneous Information Occupancy Group Type of Construction Number of Stories Zoning District Max. Occupancy Load Fire Sprinklers Required Flood Zone Conditions/Comments: i ,;-�J�J i. r, f . J J',' J 1 A 800 Seminole Road '' Atlantic Beach,Florida 32233 '-' c) Telephone(904)247-5800 j FAX(904)247-5805 J� \J.N 19 r Construction Site Management Plan Compliance A construction site management plan conforming to Atlantic Beach City Code Sec 6-18 has been approved as a part of this building permit. The Construction site management plan was approved based upon the following information. 1. Parking plan—parking plan showing how site will be accessed and all onsite and abutting street parking areas. 2. Location of construction trailers, loading/unloading area and material storage area. 3. Location of chemical toilet area.(chemical toilets must be kept out of City right-of-way and not further than 15 feet from structure under construction) 4. Location of dumpster. Dumpster must be from an approved waste company (in accordance with Chapter 16 City Code) as of 2009 the permitted dumpsters are Advanced Disposal,Realco Recycling, Republic Services, Sunshine Recycling and Shappells. Dumpsters will have tarp covers or rigid covers on windy days. Dumpsters must be removed prior to issuance of Certificate of Occupancy. 5. Traffic control plan, showing access with dimensions, area to be stabilized, narrative on phasing of construction with adequate parking and delivery of materials. 6. Site cleanliness. Contractor must have the entire construction site cleaned by Friday of each week. This means removal of scrap lumber, concrete remnants and other such construction debris including cans, metal,plastic and paper. 7. Erosion and Sediment Control. Contractor must maintain all elements of the approved Erosion& Sediment Control Plan (silt fence, catch basin filters, etc.) until sod or other stabilization has been placed and approved by Public Works. 8. Other activities,where special conditions are identified by the Building Official. Failure to comply with the Construction Site Management Ordinance may result in a Stop Work Order being issued in accordance with City Code Sec. 6-17 (3) Revised 3/2016 ` jLMj ii CITY OF ATLANTIC BEACH '' WNER / BUILDER AFFIDAVIT «J;f 3r 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 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. 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. 9g2. oceytki um, 40L-f-571-, 809 ADDRESS PHONE NUMBER - A - 6NElt- PRINT NAME IG DATE c / Before me this ay of r t t 20L the county of Duval,State of Florida,has personally a eared herin by himself/herself and affir s that all statements and declarations are true and accurate. Notary Public at Large,State of I C ,County of V VOL.' ❑,,,��/Personally Known Z, -070-7G-4 1 7- 0 7c�roduced Identification- J / ��JJ __ ;; ;:y,, TONI GINDLESFERGER MV COMMISSION#FF 924951 EXPIRES:October 6,2019 Notary Signature: ';•�►`[OC pub FcUndelwdters Bonded Thru Notary F:/BLDG/Owner-Builder Affadavit;REVISED: 4/16/2009