259 AHERN ST - 2ND STORY DECK 4 r' Jr,'
�' I \S, CITY OF ATLANTIC BEACH
"" J 800 SEMINOLE ROAD
.-!) ____t" " ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
_____j
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-DECK-2726
Job Type: DECK/PATIO
Description: New 2nd story deck in rear
Estimated Value: $5,000.00
Issue Date: 12/12/2016
Expiration Date: 6/10/2017
PROPERTY ADDRESS:
Address: 259 AHERN ST
RE Number: 172534-0000
PROPERTY OWNER:
Name: GUIN JR, ORVILLE WAYNE
Address: 259 AHERN ST
PERMIT INFORMATION:
FEES: -- - ----
PLAN CHECK FEES $37.50
BUILDING PERMIT FEE $75.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
WORK W/O PERMIT BUILDING $110.00
Total Payments: $226.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITII ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
City of Atlantic Beach APPLICATION NUMBER
t'APAllit, Building Department (To be assigned by the Building Department.)
-7N-A7CP 800 Seminole Road
�� r Atlantic Beach, Florida 32233-5445 t� OECK Q-1-3 6
Phone(904)247-5826 • Fax(904)247-5845 `
oV E-mail: building-dept@coab.us Date routed: �� l luo
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Stt S' , 4 nt review required Yes/No
Building t/
Applicant: 0 uo(\k11- planning &Zoning
ata_ Tree Administrator
Project: d L (LiQ a J ( Public Works
1 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: [pproved. ❑Denied.
(Circle one.) Comments: D
UILDING C�
PLANNING &ZONING , ��6
Reviewed by: Date:A„�
21
TREE ADMIN. Second Review: A roved as revised.
❑ pp ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
NOTICE OF COMMENCEMENT
State of 1"1 Pc County of --NAV a` Tax Folio No. 15 y LI y SS ' C C)O0
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: VS y-311 ). �� S - r {O - l�,,,�;c, (3e li
`Te r r Le, 5 f Q P c�S t—,1- 1
Address of property being improved: AS 1) 1 .a41 ),L'J AC ( A,w r•i 5 1,/ h-t-Ln 4;c_ f c'a 4 1n f
General description of improvements: kr q:es
Owner: Oft •1\n "f' Address: a 51 AL, er,A)
Owner's interest in site of the improvement: k„.0 P vi rs 0 F )Cr
Fee Simple Titleholder(if other than owner):
Name:
Contractor: N I C szk5 C ..)3
Address:
Telephone No.: Fax No:
Surety(if any) b`) `(Nt--
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name: t► I $\...
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: f. /11 -
•
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: N 1>n
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
Signed: Cr,..).diL a_) A Date: i I-30�3,O1�
Before me this S n day of a ' ' i .SI in the County of Duval,State
Doc#2016279996,OR BK 17803 Page 768. Of Florida,has personally appeared v \ l� �� . �j,t,,t n
Number Pages: 1 Personally Known: 1 or
Recorded 12/08/2016 at 11.17 AM, Produced Identificatio : f \ �e
Ronnie Fussell CLERK CIRCUIT COURT DUVAL , • —
COUNTY Notary Public: .��l 0 4d atl.1/,!'•uy.Z2=
RECORDING$10.00 My commission expires: l i ( e<rr��7,%, a ,
e 1 tion•FF 245645
I , •' My Comm.Expires Oct 23,201
OocM5Ni0uptSMta dNotary
qaa+ r ;lgi3OAP" #
k
ECEOVE
rt��ly'" BUILDING PERMIT APPLICATION
a s� 1
CITY OF ATLANTIC BEACH DEC - 2 2016
�. 800 Seminole Road,Atlantic Beach FL 32233 — 1 .
=u';fur Office: (904)247-5826 • Fax: (904)247-5845
1_.
Job Address: .,5� �c r r) S r Permit Number: 1 0 0— K `o0
: 1--4(e
Legal Description 15-3 i Ai 5 -),49 E AA-lar‘un S�&rt��LQ RE# I '1 ,r)39 "CC>64
Valuation of Work(Replacement Cost)$ 5.cob- Hhfed/oaeSF /,lion-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Rep; Move Demo Pool Window/Door
• Use of existing/proposed structure(s) (Circle one): Commercial Residentia
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes o
• 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: :oducts
/2724-C--
Florida Product Approval # for multiple use product a proval forn�
Property Owner Information
Name: ON),IN c. 1/3 G-A%r\e\ Address: 0).S.9 AINe.en1 5i-.
City A1-)Gt,1;c., 13c-anti Stat-- Zip_3 _Phone 96 LI- ).(-102, -�f98Z
E-Mail LA;,-,in t,Jc..“t�•,2 Q > I 1 Sr:�-0_ •
. Nc_A--
Owner or Ageit (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: Qualifying Agent: f------
_
Address: City -Stafe Zip
Office Phone Job Site/Contact Number
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name & Phone#
Worker's Comae. _. .•
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: ` a `r .ignature of Contractor:
Before me Daydi
3 C) Day of �v�Y u V-b 20l Y'
this of Before me this
CA{\Notary Public: Notary Public:
•, wars Nelie•Stats of Florida
I hereby cert that I have read and examined this application an ow the same to be tru ARl1NA41b'�. � t
ordinances governing this type of work will be complied with whether specified herein o ;\,..:____/�'Air, to �ttiD ''
presume to give authority to violate or cancel the provisions of any other federal, state, o o1'1 • re .
performance of construction. `
Rev. 3/14/16
i
5 ,,,,� OFFICE COPY
' is
Js �� CITY OF ATLANTIC BEACH ;j:'` 1.;:-.-s„ - '
r
•
'r 1i%WNER / BUILDER AFFIDAVIT
�slvr DEC - 2 2016
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1±.."CONSTRUCTION -_.1""-'fir
CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
A NW
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.
a511 Reef- a S4^ , PO-LYNA1(... l dr R (400(1. atla-95,e),
ADDRESS I PHONE NUMBER
II
W`\tb...4/`t, r irhN
PRINT NAME`
l.J 6+y—-- *--) . I X-a•2vk.
SIGNATURE DATE
Before me this day of °t-L�.Cr1C,20 Ito in the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of V' L-- ,County of D��C-
ENNNSTON 1
0 Personally Known !\ ?�:•e MY COMMISSION
IFERJOHat GG 04291,4
Produced Identification- U fir'
4 EXPIRES:October 27,2920
1 1 'r ""."�� Banded Thu Notary Public Undsn titers i
Notary Signature: Q� ��
c
F:BLDG/Owncr-Builder Affidavit;REVISED:4/16!2009