610 OCEAN INTERIOR REMODEL 2016 T 'jy \1
j '''� `S� CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
j 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: 16 -RAAR -879
Job Type: RESIDENTIAL ALTERATION
Description: interior remodel
Estimated Value: $25,000.00
Issue Date: 4/14/2016
Expiration Date: 10/11/2016
PROPERTY ADDRESS:
Address: 610 OCEAN BLVD
RE Number: 170133 -0000
PROPERTY OWNER:
Name: SKINNER JR, C B
Address: 78 SAN JUAN DR
PERMIT INFORMATION:
FEES:
STATE DCA SURCHARGE $2.63
STATE DBPR SURCHARGE $2.63
BUILDING PERMIT FEE $175.00
Total Payments: $180.26
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
s ue.
BUILDING PERMIT APPLICATION
7.5 .4, ' CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach FL 32233
� >r Office: (904)247 -5826 • Fax: (904) 247 -5845
Job Address: Co 1 b Permit Number:
Legal Description RE#
Valuation of Work (Replacement Cost) eated /Cooled SF 1 00 0 Non- Heated /Cooled 1 50
• Class of Work (Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing /proposed structure(s) (Circle one): Commercial Residential
• If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No 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:
E � L..; 5 1 d r'y hxiL+ -) - i e_Go i h.
Florida Product Approval # for multiple products use product approval form
Property Owner Information
Name: C- T 6 Ste_ I h r•, •Q r" -- • Address: 1 1,,;" Rw\IDA
City=Vor+ Ve ro StatecL ' %I
-Phone 32.0 G 0 Li -G( C� 3 - L./ L./J/-1f
E -Mail 0- C3 S IT l CEO L. C,O r•,
Owner or Agent (If Agent, Power of Attomey 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 : ► ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
Contractor Information:
Name of Company: Qualifying Agent:
Address: City State Zip
Office Phone J. . ite /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 o obtain a permit to do the work and installations as indicated. 1 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 aba oned for a
period of six (6 months at any time after work is commenced. 1 understand that separate permits must be secured for Electrical W� , Plumbing,
Signs, Wells, Fools, Furnaces, Boilers, Heaters, Tanks and Air Conditioners, etc.
Signatur of Property wner�i Signature of Contractor:
Befo a • ..— •
this 7 Da ��_•; / / Before me this D. of
Nota ' • '� Notary Public:
I hereby certt& that I hav• •a.. n ' ami • t ... at on i d know the same to u e true and correct. A11 provisions of laws and
ordinances governing this t;o }' . ° . .' 'I r Mth hether specified herein or not. The granting of a permit does not
presume to give authority . v te- or'Vlftl• "g i ' , n y other federal, state, or local law regulating construction or the
performance of constructi r, 94_ M ommiss o
of M1" Expires 02/1412018
Rev. 3/14/16
,' " � CITY OF ATLANTIC BEACH
OWNER / BUILDER AFFIDAVIT
_r Jl:l9'
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.
10 Oc)ec VI id . 9 °`1-- cp - `-i 4LP-)
ADDRESS PHONE NUMBER
0.„1-55 --In1,-,,e r r .
PRINT NAME 4 i 16
SIGNATURE L //// DATE
Before me this 8 day of I L , 2(`S the county of
Duval, State of Florida, has personally peared herin by hi self / herself an. affirms that
all statements and declarations are true and accurate.
Notary Public at Large, State of F County of —.—, at
a Y po Notary Public State of Flor d
d
❑ l ovally Known : 1 Shirley L Graham roduced Identificati. _ . ` c4 My Commission FF 086990
'�/ QF FLJ4 'Expires 02 /14/2018
Notary Signal
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.c7 2 ,6
F:BLDG /Owner - Builder Affadavit; REVISED: 4/16/2009
NOTICE OF COMMENCEMENT
State of fi L County of 4D V6 L _. 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: 5-( j (p - 2 ' 2,ci E. alp
A +r w fmac. &ecAch to - /I z- B/ k-
/ 19-
Address of property being improved: 1 t Z e.. h She . AkL rj C 1
- lam
General description of improvements:
aV e5 ,
Owner: L V /�0" • Address: I 1 L-
Owner's interest in site of the improvement: 01, 'jl r l 1 j 2- ri Is 2
Fee Simple Titleholder (if other than owner):
Name:
Contractor: ivH
Address:
Telephone No.: Fax No:
Surety (if any)
Address: Amount of Bond $
Telephone 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:
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:
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):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Date:
nnQQ \Ii--1(10
Signed: l� ✓.—
Before me this j day o �r�rigtal in the County of Duval, State
Of Florida, has personally appeare.
Personally Known: Amok 4 or
��
Doc # 2016084343, OR BK 17527 Page 1516, Produced Identifi _
Notary Publi•:
Number Pages: 1 My commissi • - I i 2�T _� V
Recorded 04/14/2016 at 02:42 PM, �,�
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY 4 Notary -ublic - of Florida
RECORDING $10.00 ^ Shirley L Graham
if My Commission FF 036990
ro OF fue Expires 02/14 /2018
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