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404 S OCEANWALK DR - DRIVEWAY ,, _____ ,,,„.,v, (._ CITY OF ATLANTIC BEACH ,, 800 SEMINOLE ROAD 7514, x ATLANTIC BEACH, FL 32233 at --rINSPECTION PHONE LINE 247-5814 DRIVEWAY - SINGLE OR TWO FAMILY DRIVEWAY MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: DWAY17-0008 Description: REPAIR DRIVEWAY ,CURB, REAPLY WALKWAY AND MOVE FENCE Estimated Value: 10000 Issue Date: 8/9/2017 Expiration Date: 2/5/2018 PROPERTY ADDRESS: Address: 404 S OCEANWALK DR RE Number: 169463 0524 PROPERTY OWNER: Name: FLANAGAN WILLIAM J JR Address: 404 OCEANWALK DR S ATLANTIC BEACH, FL 32233-4573 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. II II 0 0 0 `. , •: Permit Conditions .. City of Atlantic Beach 6 7/31/2017 UNDERGROUND WATER SEWER INFORMATIONAL UTILITIES PUBLIC UTILITIES Kayle Moore Notes: Avoid damage to underground water and sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is needed,call 247-5834. 7 7/31/2017 METER BOX SEWER CLEAN OUT INFORMATIONAL PUBLIC UTILITIES Kayle Moore Notes: Ensure all meter boxes,sewer cleanouts and valve covers are set to grade and visible. 8 7/31/2017 RT1 SEWER CLEANOUT INFORMATIONAL PUBLIC UTILITIES Kayle Moore Notes: A sewer cleanout must be installed at the property line. Cleanout must be covered with an RT1 concrete box with metal lid. Cleanout to be set to grade and visible. Printed:Wednesday,09 August, 2017 2 of 2 • r (Toiy�Vr��, City of Atlantic Beach APPLICATION NUMBER jt r1 Building Department be assigned by the Building Department.) 800 Seminole Road p _ j:: o Atlantic Beach, Florida 32233 5445 Lu t - 06 Phone(904)247 5826 Fax(93(-50444)5 04) 247- 47 5845 x.c i 0 E-mail: building-dept@coab.us Date routed: Z - City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 404 00-c aALvq,1 k Lf••3 De• . i la •nt review required Yes No ilding Applicant: nu.) LD Et ". ring &Zoning Tree A.ministraTor Project: D RAO C .,0A.�( f (. k_e, l E;&)C:C(�'ublic Work f / lic Utilities) Public Safety Fire Services Review fee $ Dept Signature 1 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: � oved. ❑Denied. ❑Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING • Reviewed by:/ •-•-'1, fX-1'"-- Date:7-.2:1- (7 TREE ADMIN. Second Review: A roved as revised. ❑ pp ❑Denied. ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ['Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 Cyvi-,.�, City of Atlantic Beach APPLICATION NUMBER A Building Department (To be assigned by the Building Department.) �, si 800 Seminole RoadflE•CEJV j� pp tt �r Atlantic Beach, Florida 32233-5445 '—�� 1� t 7` ? �o Phone(904)247-5826 • Fax(904)247-5 o;� �? E-mail: building-dept@coab.us J in- 1 R 2011 Date routed: 7/z 51i 7 City web-site: http://www.coab.us 111 BY: APPLICATION REVIEW AND TR KING FORM Property Address: 404 00,eQ\I.OQ k Nr-3 - Department review required Yes No r Buildin Applicant: C� CO k`)C ` annin &Zonin Tree Administrator Project: D c,�,J(�(,,J)Ac./ 0 k_6 / 1:-----6,,,ocr, ublic Works / is tilities ) 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: [Approved. ❑Denied. [Not applicable (Circle one.) Comments: 4 /f j��t: /_ 4 BUILDING ' /' �d/ 'HGam/ PLANNING &ZONING • Reviewed by: Date: 7.W/7 TREE ADMIN. Second Review: A roved as revised. ❑ pp ❑Denied. ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ['Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 -SiAvr , City of Atlantic Beach APPLICATION NUMBER Js 41 Building Department EC �----- (To be assigned by the Building Department.) A800 Seminole Road 15 Atlantic Beach, Florida 32233-5445 I .O8 — Phone(904)247-5826 • Fax(904)2 84'54) 2 17' -4-...cm cr E-mail: building-dept@coab.us Date routed: i City web-site: http://www.coab.us BY: APPLICATION REVIEW AND TRACKING FORM Property Address: 404 O cL,\Lc)sedk it..3 De.artment review re•uired Yes No - . • 'its Applicant: ¢,Dri(' _RNA-IT-ling nn nng &Zoni Tree Administrator Project: ��. Pm a„of�( - C3(� / �;(� ublic s V blic Utilities Public Safety Fire Services Review fee $ zr Dept Signature 1C-sv -. 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: APP CATION STATUS Reviewing Department First Review: reApproved. ['Denied. ❑Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING �/(� Reviewed by: "�^'` Date: ?/3//1 7 TREE ADMIN. Second Review: A roved as revised. ❑ pP ['Denied. ❑Not applicable P ,WO y Comments: BLIC UTILITIES ZG ---/ -7 PU LIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ['Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 ,,:o,i-vi-r4, City of Atlantic Beach APPLICATION NUMBER % Building Department (To be assigned by the Building Department.) 2 800 Seminole Road i ')11 ,� Atlantic Beach, Florida 32233-5445 1 ' A oo Phone (904) 247-5826 • Fax(904) 247-5845 ,;t1 • E-mail: building-dept@coab.us Date routed. Z City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM De Property Address: 404 O�C.L�Lt?R,l.k 6f partment review required Ye No Build Applicant: CD GO kDC lanning &Zonin) Tree Administrator RN tI R 1 0k_e), , ���� u is Norl �/ Public Utilities u-blic 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: roved. I 'Denied. I INot applicable (Circle one.) Comments: BUILD G PLANNING & ZONING Reviewed by: Date: • 3'! 7 TREE ADMIN. Second Review: Approved as revised. [Denied. IiNot applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: Approved as revised. I 'Denied. I 'Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 7. .7 Building Permit Application City of Atlantic Beach :i00 St+rninnle Road,Atlantic. Reach,11 32233 Phone (904)241.5826 Fax: (904)217 5845 .e/eL �GL�/yC.r4 &K /(�. 5 __- . _...__ 1-] - DeO Permit Number. D� .• .._ _- ...-.. . REa /.9 y63 - fls7-y. Valuat'on of Work ;,. ;: • ` / 6:/,1_ZC, Heated/Cooled SF Non-Heated/Cooled__-..._—.... _ _. ( • g - •s (Circle one) ';.•w Addition Alteration Repair Move Demo Pool Window/Door • a: ^. . ..ct,ae(.)(Circleone). Commercillil Residential • .;r„•r :•.a tat.,,pnnkler'y".ten)installed)(Circle one) Yes No N/A •— .... . ;,,! roil Application it any trees are to hi-removed or Affidavit of No Tree Removal ' n detail.... ,.:.- ......;•,?‘.to i (�„•'ormrrLc-A Y,rz X'' d f4 JTL_ P: W1,4,1 i C(tom r:-r'v-..J �- (J � ;•; for multiple products use product approval form Property Owner Information �� ' o Oe...----,...)..- (h- `'- • tate t–t- Zi 3 -z-_,-3 3 Phone /6..a.,.__2 -.�6-...►d' u' -- - o"----e- .1 ' l.”- - ------. •- or t,y- t:if ACPs; •er of Attornf r or Agency Letter Required) Contractor Information Nam.of Company..16_ 2`j-J .J L .L L 1 .; 1 A-e Qua ifying Agent: �C L. i 4. x /.5}1L' Address4.:Ib �..,'_(i_a.1__&T-Sl_f.;_V>i.'--_-. _____City-:?T-ALJ, .. __t State -L_ Zip. ?. ,?!..:;;/..40 . f �l l. Office Phone _ - 4:----`-.t–`j__'7�, Job Site/Contact Number 9 7_,� yjy '-/: v' State Cr rt:fication/R9gi;tration x(3L -4/.1,Jc - 1 E-Mail <-7 i,`tlL1C PFJ 4. C)/-1) 1:!.; .0 t6T Architect Name&Phone k ‹ s,%Lys4_•s_ -1- ,i Engineer's Name&Phone#___________ __--- ---- • --------- — --- WorYer;.Compen;at,on f xemp;/in•.urer/Lease mployee !txp,ratior+D,ite Appliratro,,is hereby made to obtain a permit to do the work and install tions as indicated.I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be p rformed to meet the standards of all the laws regulationg construction in this Jurisdiction I understand that a separate permit mut be secured for ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. OWNFR'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance with all .q)p!cable law,regulating construction and inning. 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 RECORDI SUR ► •TICE F COMMENCEMENT. .. ii: .... ._........... _._. _______ ,_(____., gr.,, . of Ownt or Agent) Si,r,.atur • CI) racior) ,ncludu; ..ntractor) Si lid and:worn to or alfir,S •] bef.-re is day of Signed and sworn to(or affirmed)before me this_L. day of • •(c ...............•by ! — ;� ,1c.1 7_.,by c---t-k1._4.__k. .sh_ a`- --. • OF . a\ks....., r i ,Signature of Notary) IS gnature of Notary) s ; HOWE CARTER TCN,GINDLESPERGER MY COMMISSION N FF 986064 I I P.'conaiiy xnn' ,,..,":':'4:1,",,,.►,`~i� nL I I PN. EXPt Ap6N �,y1MY COMMISSION#FF 92 951 isonallyKnown OR -• 51 RES 26.2020 11Pr,+du+odic"I+ tufr"1 .` C,ducodldentrfr(atnn = .° Tnn,JJotaryPL C Ivpe t rd,•nnf a ar.r = ;.:-;;°:' EXPIRES:October 6,2019 pe of Ident+ficat on i\(` 'f ••} � ••,;.;n.o••• -ftm:;cd Thruwary Public UnderwNers #J "`, fBuilding Permit Application OFFICE COPY S,:t ,. City of Atlantic Beach 800 Seminole Road,Atlantic Beach, FL 32233 '~''';:io'‘• Phone: (904)247-5826 Fax:(904)247-5845 Job Address: 404 Oceanwalk Drive S. Permit Number: 1 \4k)Ail 17"0 006 Legal Description c�T RE# 169463-0524 Valuation of Work(Replacement Cost)$ �v Heated/Cooled SF Non-Heated/Cooled / Som • 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: Adjust street curb, repair driveway paver edge, change walkway & porch to stone pads, adjust portion of fence. Florida Product Approval# for multiple products use product approval form Property Owner Information 404 Oceanwalk Drive S. Name: William J. Flanagan, ,Jr Address: City Atlanatic Beach State FL Zip 32233 Phone 857-498-0792 E-Mail williamjflanaganPcnmcast.net Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) Contractor Information Name of Company: �,y4.,...A._ e c •--sc- .r._ 1 '&•.)C- Quail Agent: Address bei Ce L)� y7- 3(o C' 5 �.�--C State t ` Zip 3 Z O7'S Office Phone go • rrS O `qq 7 ) Job Sit ontpct Nv` r 4-0 S1-- -' 257'/ 7 State Certification/Registration# 0 4 —143 Z E- it F S v,c'r-p (, Cc.--4--t�f • 4-�-�k Architect Name&Phone# •.3c k--S <<�.> -( \ Engineer's Name&Phone# Workers 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 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 FINANCIN , CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECO• !IA •UR ICE OF COMMENCEMENT. A,kr of 0 ner. :.nt including Contracto (Signature of Contra .r) ign:. - d sworn to(or affir u'Q.f befit"e is ay of Signed and sworn to(or affirmed)b- •re me this day of ', .(_ 7017 by ,by iNalla (Signature o Notary) of Notary) i..� >",t 'ik., TONI GINDLE SPEROEER yl, '._: MYCOMMISSION#FF924951 "l 7.31., {...,:v EXPIRES:October 6,2019 [ I Personally Known OR i �' �'P'. Bonded TAra Wary Pubk Underwr:,ers [personally Kn. nn�t];;5.••' [ ]Produced Iden i i a i. [ ]Produced Identification Type of Identification: Type of Identification: V f - ,' e r -1 W , a �'; tv. (D •iiiI ii,iA � • • ( ` M � , n. O :i73 < 1 j ! .' .' . i o 3 , JS ,i, . . D CD SD '2 cD ..\ ' it h :if; I tril4. u � '- ' i ;., 8I O is A, i• 0 (D • H H ,A., n C7 Z ),' , . Z . . • O1. Q. ,t i S� 4 .. • Q• � . (D • . . �_ . :..i -Ow 0 rD o D IV c . lcD < N 3 rt • — v, < 0 Q O 0 — O - Fri v o Q • n CU 0 — D n CM rr C o �. 3 �/' O0 nCD n r) rD n O us rD 3 E0 O -s C < CD v n rt - O 0'q v) Q fC. O Q rD 0 N C 1:3 aqN (D '--h < rD OO CI rD O m t3 n n ‹. ,- N O E N S 74.nu O' O 0_ (TO rD D- ,--,- R.O.W.Permit Attachment of for R.O.W.Permit# issued , 20 Atlantic Beach,FL 32233 MOwner's Name: "`i'— ` e )k Property Address: �/a fir. v .���._ /—• 471/6-s-�� 73, L Subdivision: Q�-N-- - /r l R.E. #: /6 q 46 - REVOCABLE ENCROACHMENT PERMIT THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of , 20 , by Atlantic Beach, Florida, a municipal corporation organized and existing under the laws of the State of Florida,hereinafter referred to as "CITY"and of Atlantic Beach, Florida,hereinafter referred to as"USER". WITNESSETH: That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon the property of the City of Atlantic Beach for the purpose as described in the City of Atlantic Beach Right-of-Way/Easement permit numbers noted above (copies attached). This work is generally described as: 17av e_ rS q n_Ct C v r 6 Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to relocation or removal on thirty(30)days notice by CITY to the USER, said notice to USER shall be given by certified mail, return receipt requested, to the following address: The depositing of said notice of cancellation in the United States mail shall constitute the notice of cancellation and the burden is upon USER to keep the CITY informed of USER's proper address. The USER shall promptly make any and all necessary repairs to any facility erected or maintained in the exercise of the privilege herein granted and shall at all times maintain said facility in good and safe condition. In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter upon the above-described property of the CITY, the USER shall replace at the USER's sole expense, any and all material necessarily displaced during the action of maintaining, repairing, operating,replacing, or adding to of the utilities and facilities of the CITY or franchise utility provider. The facilities allowed by the permit shall meet the current requirements of the City Code, Building - Codes,Land Development Code, and all other land use and code requirements of the CITY, including City Code Section 19-7 (h) which states "Driveways that cross sidewalks: City sidewalks may not be replaced with other materials, but must be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks." Page 1 of 2 The USER, prior to making any changes from the approved plans and/or method, must obtain written approval from the City of Atlantic Beach, Public Works Department, for said change. The USER shall, at the discretion of the CITY, be requested to submit as-built drawings showing the change within thirty(30)days after the day of completion. This permit shall inure to the benefit of, and be binding upon, the USER and their respective successors and assigns. USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or specifications, to include utilities locate requirements and use limitations/requirements of public rights-of-way and other public land. USER further agrees that the CITY and its officers and employees shall be saved harmless by the USER from any of the work herein under the terms of this permit and that all of said liabilities are hereby assumed by the USER. DATED and SIGNED this 2'5- day of .. ---o- V , 20 ' 7. 1,,,.- By: --, Pro•- Owner (to be signed in presence of the Notary) STATE OF FLORIDA COUNTY OF DUVAL On this 7,J day of 0 , 20 17, personally appeared before me, a Notary Public in and for said C. my d State, l cam_ , the property owner of 4 o4 ,, fa/ i& . Y_ , Atlantic Beach, Florida, known to me to be the person(s) descr''ed 'n and3 executed the foregoing instrument; who acknowledged to me that he or she execut,d samtil . d vo ntarily and for the uses and purposes therein mentioned. _o J, a Notary Public in for said County l - „,::'^i •• TONI GINDLESPERGER . .;,: .� ; ,a MY COMMISSION#FF 924951 1/4% :.a EXPIRES:October 6,2019 'X ii S4g•• Bonded Thru Notary Pubic Underwriters CITY OF ATLANTIC BEACH,FLORIDA, a municipal corporation: Approved: • s • Scott. 1 llliamS Interim Public Works Director File: 12/12/16 Page 2 of 2 • ss..Lp,i .. CITY OF ATLANTIC BEACH .- or:;,:41,1,. Y ��%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 TI-IOUGH 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. 14 t) 4. ti 04.-/ -4 ••, S g57- V18 - 079 z- . ADDRESS PHONE NUMBER /J-7 4_A-<->4.64 . (7/2 PRINT N• .1 1 SIGNAT.4 DATE Before me this ( . day of V f7 l�/ 2017in the county of Duval,State of Florida,has per • ally app red herin by himself/herself and affirms that ei all statements and declarationsitrue andd a te. Notary Public at Large,State of of t D'Personally Known ID Produced Identification - - TONI GINDLESPERGER 1 ,. MY COMMISSION#IT 924951 Notary Signature:• sy, xE,:a EXPIRES:October 6,2019 `'4.cc i1. ' Bonded Thru N:ay Public Uodery iters F:BLDG/Owner-Bui[der AfTadavit;REVISED:4/16/2009 f •�,',,,,. NOTICE OF COMMENCEMENT State of L' County of DJ J A.4-- Tax Folio No. /G q /t2 3 - D C Z 7 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. 2 Legal Description of property being improved: O Oc r,,,DcJk U A -k a Lot- t l 1 'JK 7OOS- l 875 Address of property being improved: / a Y oe Eq.-‘iCs- c {‹ it_ General description of improvements: '- - ---/-/A� e-7 r/ re }� 1f; e-�Ye-y Po- `ic,-1 / el, ci �- 4�G'/T< Lc.7G. fes' a.- -v �-fv:-c_ c o-v"s �"e_.Q Owner: (�cµ. Vie- 4,4d-k��U--g Address: 0=' 9/. ©ro_a.cc_ Lcio—/ .Dr- `�1/ t 42- i Owner's interest in site of the improvement: Fee Simple Titleholder(if other than owner): r-FE. SI .A-( ec : Name: / Contractor: 6 As_r £L�- e -. .,-.-• / ( `/ Address: v,1e___- ,/0 7 it, 1J' % 6 - r v �s ___Li t FC- 32 0` 6 Telephone No.: ga -en 6 -9 i 7 Fax No: 9a I" --3— - C7 y 7 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 . Signed: �I Am Date: 1 Before me is_ .S day of J _ + 7 he CountyLDu State Of Florida, . personally:. -:red L es 1'�U l'ayri , tan614n Personally Known: Li E3' or Doc#2017173545,OR BK 18064 Page 842. Produced Identificationt Number Pages:1 Notary Public: • Recorded 07/25/2017 at 12:56 PM. My commission expires: —* 1.1 diL br___________ Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY TONI GINOLESPERGER 's i';: MY COMMISSION t FF 924951 RECORDING$10.00 " _ .:31 EXPIRES:October 6,2019 %%?;or n°:.'' Bended Thru Notary Public Underwriters Building Permit Application r' l f ... '. City of Atlantic Beach 800 Seminole Road,Atlantic Beach,FL 32233 Phone: (904)247-5826 Fax:(904)247-5845 • Job Address: 404 Oceanwalk Drive S. Permit Number: D\,\.; 7--0 o Legal Description RE# 169463-0524 Valuation of Work(Replacement Cost)$ 10,L70c Heated/Cooled SF Non-Heated/Cooled • 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: Adjust street curb, repair driveway paver edge, change walkway & porch to stone pads, adjust portion of fence. Florida Product Approval# for multiple products use product approval form Property Owner Information Name: William J. Flanagan, Jr. Address: 404 Oceanwalk Drive S. City Atlanatic Beach State I-L Zip 32233 Phone 857-498-0792 E-Mail williamjflanagan( comcastnet Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) Contractor Information Name of Company: Quali g Agent. Address C' State Zip Office Phone Job Sit ontact Number State Certification/Registration# E- it Architect Name&Phone# Engineer's Name&Phone# Workers 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 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 FINANCIN , CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECO• !I •UR ICE OF COMMENCEMENT. ,4° •ignature of 0 ner o Ag.nt including Contra..ctoo[)_ (Signature of Contra..r) Ign:• . d sworn to(or affir e• bef• • e is_._ lay of Signed and sworn to(or affirmed)b- re me this day of L (•r --t-r✓by �� ,by WAIOM (Signature o Notary) (Signature of Notary) • t °@E TONI GINDLESPERGER t(' : A, 1,k1MY COMMISSION#FF 924951 ,��.�I,y: .o: EXPIRES:October 6,2019 [1ersonall Knok'vn' ,f.' 6ondedThrdNotarypublcUnderwritersPersonally Y [ ] Known OR [ )Produced Iden i ica i• _ . _ , [ 1 Produced Identification Type of Identification: Type of Identification: CU OD O .Q _Y (D4—, cn Q 0 O 12 .5 U U _0 QJ i 4-2 O Q.) U QJ (D > N QJ ti'sQ U -0 Q QJ O -Q +(?, Uate-+ (D D U Q) > C:1_ Z U U O m c 4J -� C O0 N O Q1 G.) ' W C �1J V L QJ _" O 0,0 N �O [D ro a) ,-1r,„2 l-i -o 4O 4 Q_ ate+ 0 oN v o L C a� M C i > QJ i N O as Q 'L CL: Q � c 70 Q (13 G o Ni c5 QJ O Q up a) 4— L. 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