1335 ROSE ST - ROOF %'?i i'Jr
j ' � CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
uv: ATLANTIC BEACH, FL 32233
~L o;; >%' INSPECTION PHONE LINE 247-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF17-0078
Description: RE ROOF SHINGLE
Estimated Value: 2000
Issue Date: 8/14/2017
Expiration Date: 2/10/2018
PROPERTY ADDRESS:
Address: 1335 ROSE ST
RE Number: 171064 0120
PROPERTY OWNER:
Name: BENNETT F RUEBEN JR
Address: 99 W 13TH ST
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name:
Address:
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB
SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500. For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
' Yt '`�-�� Building Permit Application updated 5/5/1.7
. ! City of Atlantic Beach
Li
800 Seminole Road,Atlantic Beach, FL 32233
`Jr Phone: (904) 247-5826 Fax: (904)247-5845
11 '' '-ERP" - 007e
Job Address: \2 35 Rose..., S-�Q,ee- po�ar4`1 --c &IIhPermit Num er:
1134 k �
Legal Description 1i-34 l i—2S -al F ; S (a,$-c-4- o) L.. + I ,(0 as o f 4+5 RE# ,'1 ( 0 (o y_ c5 l 20
ao, p
Valuation of Work(Replacement Cost)$ c2 0 O 0 Heated/Cooled SF 160 O 0, Non-Heated/Cooled 2 0 0 cis
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
1 • Use of existing/proposed structure(s)(Circle one): Commercial Residential
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes CI N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal /✓oy‘e_
Describe in detail the type of work to be performed:
ervloVG 4 Rep 1 a-te. SFli 1 es '-Poo- r.1 COde
Florida Product Approval# DO , S 1 4 01 ,for ultiiile products use product approval form
Property Owner Informatio KO Sy".;ti l.e, 3 ' . O %&l kaRl u-44
Name: R his ex\ 6enne'� "2. Address: \?35 1QdsL ST-c�ee"R"'
t' _
City t ,,,,,v-l-; C, �j&Q.� FL .� 2 3 4 - 9 S
E-Mail fA�pL
Owner or Agent(If Agbnt, Power of Attorney or AgencyState Letter Required)Zip (�\[f` Phone D —
Contractor Information
ll Name of Company: 42_ntJv ter_ Qualifying Agent: rn'‘s VeLLIDe.r\ 6Qy1 a2--S�
Address &olY64-,- a , esb City It - 13 , State -FL Zip 3 2.23 '2,
Office Phone q•o4. (4 c.l4 5 5'7 Job Site/Contact Number S Q qt.6._
State Certification/Registration# E-Mail
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation
ri-Xempt 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 the laws regulationg
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
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.
1::77/1 A zif_is,co
____ .._ . .,-,-- . 4.....__ /?...,_______
(Signature of Owner or Agent) (Signature of Contractor
1 (including contractor)
Signed and sworn to(or affirmed) before me this IA day of Signed and sworn to(or affirmed) before me this 14 day of
Al. _ ._ _- „u( ( vir AAA-51.A-SA , 2-0\� , by i V is p-e, &(a , cv,10 4" j-
)--,;;;;,‘ TONI GINDLESPERGER 1 -1 f J
_4 `s4 MY COMMISSION#FF 924951 ,♦,hr: /
1'7 �'e: EXPIRES:October 6,an0 �,,,uy��,,,,
I >:.;,.. odoomot Notary public urdewiters (Signature of Notary) •�" '. MORGAN SHAMI ( nature of Notary)
"" . . ,.1 ,'s_ Notary Public•State of Florida
/,� _ . �i i g Commission N GG 033972
�Z"`' . I14- r� '•-;Fo��o?•`' My Comm.Expires Sep 27,2020
( ) Personally Known 0}.
[ Produced Identif ation --.717===----
) roduced Identification
Type of Identification: �� Type of Identification:
NOTICE OF COMMENCEMENT
State of F/QJeICIGZ County of /,( V lq 1.. Tax Folio No. I I I b (o z4 ^ d 1 a o
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 CONCEMENT.
Legal Description of property being improved: t53 - 3%-) t I • .2 ,; 2.9 E I so u-1-1,NI -S 8/. 1.81-4 ,
0: 1A -. _ , 1 ' w C 2 5 1 _ ✓/
Address of property being improved: J...I 3,5- , OSP -e.R. C 33
General description of improvements: e--- p___iO 1 q Ce MeV>\' p kt ne, QOM b V•F. CIA'1 A_
GLe-G o�rkel 4 J) nn ll Rap I oct.e.
_r
in h/ e4 eA/rye f, ddress: `3, g,e J C'-.7, f"1iti ft JG
Owner's interest in site of the improvement: 14-1)rn�o El/ �e,(�, a�_ l3a 233
Fee Simple Titleholder(if other than owner): A` \0,4\A-.“.„ 0 O a, r e a 1n� I Nefri-U Ile, SIJ(�QAG1,
o� Name: 1oP �` 3u & L
,/"s C tractor: t-a � i(�C. �(�t
Address: 7Q � O S pt a� PaLd�!
Telephone No.: g D q. 111.14-925') Fax No: no n.e_
Surety(if any) C\1 Q`
Address: Amount of Bond S il
Telephone No: Fax No: fltr e_
Name and address of any person making a loan for th construction of the improvements
Name: n p 1 p a kl AJ 0,
Address:
Phone No: Fa)------"TR-67---------
Name
ax o:
Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other documents may be
served: ame: %( 1r\e, as 0 ut.S r.e
Mat dare : 9 ci 1,0eST I3+' £4 A-+I A.rLTt'G BCAA1 4-I , Z2.3.
Telephone No: -1 b 1 q 41-9 o? Fax No: 6 a c
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. (Fil)n at Owner's option)
Name:hhyy ,•r-1.'S I GLAps/ ,n i?P: , R.
Addiesscn. /. , , . A ' • .-6 ' Q, . •. . -6 5�r2ee_"� "1"�Q.K4H.c-
Telephone No: Q014- LI y4-q2 Fax Fax No: A/one_ , 3x233
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:�i�-'' Date: �-� l'i—( '1
�•�,,,�P Before me this 14 day of cia,st/ in the County of Duval,State
404,01„_i.s„014
MORGAN SHAMI Of Florida,has personally appeared Ti Ed i S Q�t .10L vt f3¢.vtvta_-ff 3
Notary Public•State of Florida Personally Known: Ni or
Si,�- ' Commission+«GG 033972 Produced Identification:
.,,,k,.. � Z1GtiVl,..$VIGtNV\:
�,,,a�1d.^.� My Comm.Expires Sep 27,2020 Notary Public: �U\,pr
i commission expire ,TGP• 2.1 , 2.6Z-0
Doc#2017190206,OR BK 18088 Page 1310,
Number Pages:1
Recorded 08/14/2017 at 03:16 PM.
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING$10.00
CITY OF ATLANTIC BEACH
•
r
^ fJ%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 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.
90 51W- 9.2 5-7
ADDRESS PHONE NUMBER
iv (eu.ge.✓ /5eA/4/e/7/
,_
•RINTNAME
_& - 1
SIG ATURE DAT
Before me this I`1 day of S'' 20 f1 in the county of fir. MORGAN SHAMS
Duval,State of Florida,has personall peared herin by himself!herself and affirms that �Ic ary Public-S1ate of Florida
all statements and declarations are true and accurate. Commission 9
GG 033972
I My Comm.Expires Sep 27,2020
Notary Public at Large,State of ,County of I) V&
Ikersonally Known
O Produced Identification MNyoCtCoaormymmMPmiuUsb.sE+hoCn aeSsStGa
StGeep0u3l 23F719:721 21
3f79u72i2'0
2.
0Itfit tis‘
Notary Signature:
F:/BLDG/Owner-Builder Affndavit;REVISED:4/16/2009