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120 Camelia St 16-ROOF-2009 is, CITY OF ATLANTIC BEACH f 800 SEMINOLE ROAD j , ATLANTIC BEACH, FL 32233 INSPECTIONPHONELINE247-5814-,,,,,,______________2 1. 0;319 ROOF PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 16-ROOF-2009 Job Type: ROOF PERMIT Description: RE-ROOF SHINGLES Estimated Value: $4,000.00 Issue Date: 9/7/2016 Expiration Date: 3/6/2017 PROPERTY ADDRESS: Address: 120 CAMELIA ST RE Number: 170848-0000 PROPERTY OWNER: Name: BULLOCK, NANCY L Address: 120 CAMELIA ST FEES: BUILDING PERMIT FEE $70.00 STATE DCA SURCHARGE $2.00 STATE DBPR SURCHARGE $2.00 Total Payments: $74.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITII ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. T='V':r;�:., BUILDING PERMIT APPLICATION jJ CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach FL 32233 �`,ROffice: (904)247-5826 • Fax: (904)247-5845 I (o -WOO R— z 00 Job Address: 1 a 0 C o y\&I l a. 5k AI- l 4.. Permit Number: Legal Description )g 3`t 3S -02 S"c,2 9 RE# (7 OK /f ' D DAD /R Valuation of Work(Replacement Cost) $ 110 OO Heated/Cooled SF Non-Heated/Cooled 'y DOM_ • Class of Work(Circle one): New Addition Alteration Repair ove 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 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: t Q^ ) asei,cdf-1r ; p O a r A Cc /Yle?Lt> -ei 4 s'1'l^c - { iaee, JD Florida Proddct Approval# Mk (W Pt' 7 0 (7 & I ) for multiple products use product approval uin r Property Owner Information ky7 L p� Name: C of P S/Aar)( Hie— k Address: ret 0 CQ, 1/tat. '51 City State F2Zip hone • 1 E-Mail S Lt.L cL € r �1 i (L�yy��j s C a yf'1 Owner or Agent (If gent,PowerolAttomey 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: Qualifyin: : :-nt: Address: City State Zip Office Phone Job Site/Cont. • umber 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 ol'six(6 months at any time after work is commenced. I understand that separate permits must be secured for Electrical Wor.,Plumbing, Signs, Wells,Pools,Furnaces,Boilers,Heaters, Tanks and Air Conditioners,etc. Signature of Property Owner: K) b Iiici Signature of Contractor: BeSore me Day of I V�' ' / r t.U- Before me this Da of _ 11,4 C 4i4%,, TONIGINDLESPERGER r _.: ra MY COMMISSION*FF 924951 Notary Public: I I 7// otary Pub ' b• Y .1•401:, Bonded Thru Notary Pubk Underwriters I hereby certifil that I have read and examined this application and know the same to be true and correct. All provisions o laws an ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not federal,to give authority to violate or cancel the provisions of any other state, or local law regulating construction or the performance of construction. Rev.3/14/16 NOTICE OF COMMENCEMENT State of—r---L---- County of ! U.- V a 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 t is NOTI E OF COMMENCEM T. S� Legal Description of property being improved: 40 -- , 5 L f _ ._ k OP A _ L C2—I,! �� Address of property being improved: - , t..l,1 _. a– hili•5I glian L • � 3 General description of improvements: •1 e ' IOwner: A • Y ' 4 1.I '. 'i Lt. / ddress: ' . 0 _!c. V 1.1 ► 1 .t. Owner's interest in site of the improvemen . Fee Simple Titleholder(if other than owner): Name: Contractor: Address: Telephone No.: Fax No: Surety(if any) Address: Amount of Bond$ Telephone No: Fax No:_ Doc#2016205984.OR BK 17698 Page 2056. Name and address of any person making a loan for the construction of th Number Pages: 1 Recorded 09,07/2016 at 09:1 7 AM. Name: Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY Address: RECORDING S10.00 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: 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 iiSigned: /6Date: Before this Nay o - • .. the County of vAl,State/ Y""' TONT GINDLESPERGER Of Flori a,has personally appeared to A� t t-�l©C� .I A'' v: PersonallyKnown: or �.� ,._ MY COMMISSION 0 FF 924951 . g :.r+�:•• EXPIRES:October 6,2019 Produced Identification: o_wh . . ... ' 0 3 V Bonded Thru Notary Pubic Underwriters Notary Public: =SIAri 1 My commission expires: WalfiRlnagm, le Vii,. _ JS i-' A. CITY OF ATLANTIC BEACH 911 V WNER / BUILDER AFFIDAVIT 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 1N 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. • i -0 C� ):3t-PIA Eifk S ADDRESS PHONE NUMBER f PRINT ME ( P0' A URE DATE Before me this day of S 9 Zile the countyof Duval,State oforida,has personally app red erin by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of F( ,County of fl w Qt ❑Personally Known di /,�1 `. CJ f oduced Identification- b. • ra r `-t . : g • ;�'�n+:iy... TONI GINDLESPERGER MY COMMISSION*FF 924951 Notary Signature: I �I _ �' • •• �a: EXPIRES:October 6,2019 1•1 •* ' Bonded Thm Notary Public Underwriters F:BLDG/Owner-Builder Affadavit;REVISED:4/162009 • Page 1 of 1 �,� .. 11111 wl y+ I111111111111111111111111111111111111111 -4,, Print Date: 9/7/2016 9:17:21 AM 4 ��•�IIIf'(�' Transaction#: 3099460 Receipt#: 3011271 Cashier Date: 9/7/2016 Ronnie Fussell 9.17.17 AM Clerk Circuit Court (MCARTER) Duval County 501 West Adams St RM 1051 Jacksonville, FL 32202 (904) 255-2000 Customer Information Transaction Information Payment Summary DateReceived: 09/07/2016 Source Code: BEACH ()NANCY BULLOCK Q Code: BEACH Return Code: Over the Total Fees $10.00 Counter Total Payments $10.00 Trans Type: Recording Agent Ref Num: 1 Payments $10.00 D.112d CASH 1 Recorded Items BK/PG: 17698/2056 CFN:2016205984 [R l (N/C) NOTICE COMMENCEMENT Date:9/7/2016 9:17:17AM From: BULLOCK CHARLES ETAL To: BULLOCK CHARLES ETAL INDEXING 4 $0.00 RECORDING 1 $10.00 0 Search Items 0 Miscellaneous Items file:///C:/Program%20Files/RecordingModule/default.htm 9/7/2016