371 8TH ST - DETACHED GARAGE \S\ CITY OF ATLANTIC BEACH
j• 800 SEMINOLE ROAD
J v" ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ADDITION
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-DGAR-2039
Job Type: DETACHED GARAGE
Description: Finishing upstairs room of garage. Owner is now owner-
builder. See Permit 15-DGAR-424. NOC already turned in for this new permit.
Estimated Value: $10,000.00
Issue Date: 9/15/2016
Expiration Date: 3/14/2017
PROPERTY ADDRESS: -- - ------ ------ -
Address: 371 8TH ST
RE Number: 169975-0000
PROPERTY OWNER:
Name: WOOD, JEREMY B
Address: 371 8TH ST
PERMIT INFORMATION:
FEES: - ----------
BUILDING PERMIT FEE $100.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $104.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACII ORDINANCES AND THE FLORID.
BUILDING CODES.
,•S::Lyr
--- �, {� BUILDING PERMIT APPLICATION
s CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
�.4orti9r Office: (904)247-5826 • Fax: (904)247-5845
' Job Address: S1 ' F3\--N s ¼QQs Permit Number: 1 b -06-0.2
06- - a c9
Legal Description RE#,
Valuation of Work(Replacement Cost)$\(:),M(\,ObHeated/Cooled SF ✓ Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteratio Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s) (Circle one : Commercial --- esidentiai
• If an existing structure, is a fire sprinkler system installed?(Circle one): Cli; No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
^n‘1\i \- 1 4 \AeCk'dS. Ot.V\A, \,\)I \cLQ k-NC\a4\ ‘.
Florida Product Appr v 1# for multiple products use p d t approval form
Property Owner Informatio
��1c 'S^l l (Lfi r• Q
Name. 1�Sz� •� . al1,Ul, Address:
City t. A State Zip , aa13 Phone l O� -9.2-u - e6 c 8
E-Mail <rya I. l -3 e „q�, COMM
Wj or Agent (If Agent,Power of Att mey 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: • • ' ' ing Agent:
Address: City State Zip
Office Phone to/Contact Number
State Certification/Registration# / E-Mail
Architect Name & Phone
Engineer's Name : ' one#
Worker's : pensation
xempt nsurer ease mp oyees xpiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that n. 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 .fte work is commenced. um derstand th separate permits must be secured for Electrical Work,Plumbing,
Signs, Wells,Pools,Furnaces,Bol : s, eaters, T,nks a id Al 1�,nditiopers,etc.
Signature of Property Owner % .k. _idgnature of Contractor:
Before me n 4. / ��
thig (L Day of v4- 1119. Before me this c (0-(11 Day of LOT
Notary Public:4:40./A- ' l- - - — -------- `1 Notary Public:
%" 0 MY COAM�IISSION 1 FF 217841
I hereby certify that I ave read a , •...i:v£d t' . •fltel ;7t:.'41. -u v the same to be true and correct. All provisions of laws and
ordinances governing this type of ''1',: ! ''si rr}�[Ll .t*ftl6ti'i A. specified herein or not. The grantiv of a permit does not
presume to give authority to violat - i •• i.ions o any other federal, state, or local law regulating construction or the
performance of construction.
Rev. 3/14/16
)• CITY OF ATLANTIC BEACH
'J=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 OUTBUILDNG. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDNG
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.
0101— kci - scg
ADD'ESS PHONE NUMBER
PRIG i
µy . DATE
-m
. e this L74 '
Altfday of 1► (.(,S� 20 'Gin the county of
Duval,State of Florida,has personally apeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of I L ,County of .t CWA-1
WDAYNA H.WIWA�MS
❑Personally Known cati ` •bL =+: P'! .+ MY COMMISSION y FF 217841
Produced Identifion- 1 L 1,03w ct,32 r1 I (Up�p EXPIRES:August 7,2019
'Or 1\d Bonded Thru Notary Public Underwriters
Notary Signature: - � .-.
F:BLDG/Owner-Builder Abad 't;REVISED:4/16/2009
NOTICE OF COMMENCEMENT
State of County of 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 st ted i thi NOTICE OF COMMENCEM 0 Fsioa
Legal Description of property being improved: „ii40_10 r� C
t/J /(0, .74 t_6+ r39- /art A E/19 .1 W Th ELK /0
Address of property being improved: L>� l 1 a--4-9.41v O c>� j.L [3 9.9� 'J�
General description of improvements: V ' ���,tCL. �� 3 G� \O /O \►s 1 lY
QV , \Thi ( cqk a\(‘ c?\
V
Owner ► t I. ! t ,&A A t k_, ii.1. v Address:�� 1` it .
Owner's interest in it,of the improvement: Js Pt / R4
Fee Simple Titleholder(if other than owner):
Na \-: a
I
A Contractor. \ 1 • O.I
Address: 37 l b
p • `6'
/ \M�� -&26 \ t
Telephone No.:,�` 27to- Fax
8 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 OWNE V v \, ``
Signed: Date: ti',�[: 1�Q
Before e s ,2671” day of t in the County of Duval,State
'If.Flori h personally appeared v vt n i Lift t^ Wool'
Doc#2016199457,OR BK 17688 Page 2164, ••. or
Number Pages:1C�duced Identi;fication•T G i 2. Is 10
Recorded 08/26/2016 at 12:50 PM, 'otary Puittc.• „, • (,1ht14.1.--^-
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY ly commission expires:
RECORDING$10.00 ,i'".'y't, DAYNA H.WIWAMS
tat MY COMMISSION I FF 217841
`'' EXPIRES:August 7,2019
o,�� '. Bonded Thtu Notary Public Urderwiters
Phillips Builders
1250 Selva Marina Circle
Atlantic Beach, Fl 32233
phillipsbuilders@comcast.net
To Whom It May Concern;
I, Michael Phillips of Phillips Builders, hereby relinquish permit I O6Ae
on
371 8th Street, Atlantic Beach, Fl.
7/ '
4/
'chael Ph' lips