1542 PARK TERR W - WINDOWS •j yV��.
f ts� CITY OF ATLANTIC BEACH
;-- . o800 SEMINOLE ROAD
Jv
ATLANTIC BEACH, FL 32233
"!WI > INSPECTION PHONE LINE 247-5814
RESIDENTIAL - ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES17-0222
Description: new windows
Estimated Value: 5000
Issue Date: 11/1/2017
Expiration Date: 4/30/2018
PROPERTY ADDRESS:
Address: 1542 W PARK TER
RE Number: 171940 0000
PROPERTY OWNER:
Name: COLEMAN CYNTHIA
Address: 1542 PARK TER W
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.
,‘:S�ic J;,+,, City of Atlantic Beach APPLICATION NUMBER
S
is Building Department (To be assigned by the Building Department.)
i (2.-ES 800 Seminole Road i 9- ---0 a-a-,4
I - - 0 Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845 (O l I
Agitir " E-mail: building-dept@coab.us Date routed: 1 Ll l kl-
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 4 SL( �— \ . PGV1L 11-.,(et ' - • • - ut review required Ye No
Building
Applicant: 0 il.L1( Planning &Zoning
Tree Administrator
Project: r\Qt I r LO S Public Works
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:
APPLI ATION STATUS
Reviewing Department First Review: Approved. ❑Denied. ❑Not applicable
(Circle one.) Comments: o /
BUILDING IV (—
PLANNING &ZONING Reviewed by: ,71 r Date: /0 -(4-7-0
TREE ADMIN. Second Review: A roved as revised. Denied. Notapplicable
n pP ❑ ❑
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
xra►r-
�j Building Permit Application Updated 5/5/17
y of
lantic Bech
5 p Ay•� OFFICE C o 800°Sem i t e Road,tAtlant c Bead h, FL 32233 OCT 2 4 ?
¢�' Rgir
Phone: (904) 247-5826 Fax: (904) 247-5845
Job Address: y1542 "Pa rr1 P,►'!'QC�1 tAJ?-5+ Permit Number: ES -
Legal Description 36�� 5-4 An41/ ( ()AZT 2, RE#
Valuation of Work(Replacement Cost)$ roce. DD Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repain Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial'esidenf j
• 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:
W ,DCGIJ5
Florida Product Approval# /11 9/( • t - 'MO kid( for multiple products use product approval form
Property Owner Information
Name: _ ,/)t'h,G. • eta it Address: /5i/cA ?ar 7 rr-aee fill•
City " A / G G'fief-) State FL_ Zip 3ao�,3� Phone qD40 1/ lo- 0L/(o7
E-Mail C' I e4'ra-)71 �U _//,CDM
Owner or Ag�fit(If Agent, Power of Attorrdy or Agency Letter Required) /TihI CZ b Ie� n
Q
Contractor Information _ /
Name of Company: Qualifying Agent:
Address City State Zip
Office Phone Job Site/Contact Number
State Certification/Registration# E-Mail
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 FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
+IAA,dieeht-ez44-
(Signature of Owner or Agent) (Signature of Contractor)
(including contractor)
Si ned and sworn to(or affirmed before me this day of Signed and sworn to(or affirmed)before me this day of
O( , / by ,& Y frt' 4w. = - ,by
laff
•' i PETELOFTIS#GG 121;861
1— .ignature of Nota ) (Signature of Notary)
« • MY COMMISSION
►•�MN„o�,. IRES:qBonded_ uest 15,2021
I nru Notary Public under
[ ]Personally Known OR [ ] Personally Known OR
[ }Produced Identification4-1 _ [ 1 Produced Identification
Type of Identification: Type of Identification:
,ILA/J"--7.r
��'' CITY OF ATLANTIC BEACH
IZ'WNER/ BUILDER AFFIDAVIT OFFICE co
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.
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SIG/ URE DATE
1.
Before me this - day of L' 201A 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. d I
Notary Public at Large,State of 1 `� ,County of D� J�
;;+`Pl.;•. JENNIFER JOHNSTON
❑Personally Known s �•;�,� H S -6 L 1.••s 2`` ��`•-•' MY COMMISSION#GG 042984
Producedldentca6on- (J ja ''' ''" EXPIRES:October 27,2020
' *f.f o Bonded Thru Notary Public Underwriters
Notary Signature: N_ ‘ 04Illilliban
%.,
AI 4—
F:/BLDG/Owner-Builder Affed ill..•VISED:4/16/2009 •
I
Permit Number Tax Folio Number
NOTICE OF COMMENCEMENT
STATE OF FLORIDA
COUNTY OF DUVAL
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property,and in
accordance with Chapter 713,Florida Statutes,the following information is provided in this Notice of
Commencement.
�/ 11 -/c�.rrl-�c&itch
1. Description of property(Street address): ,A/51/- Par /- , e 1,�/ , _ FL 32266
Legal Description: 011 )-g < L A liAp TA!. u
2. General description of improvement: /ice 4 �1_:L �
3. Owner information:
a. Name and Address: ( /1777i'1et,(o/einail , /5'V 12arf I r? , W., A.B.; FG 3,30153
b. Interest in property: D her
c. Name and address of fee simple titleholder(other than owner):
4. a. Contactor's name and address: " C n-1 c - c - )
b. Phone number: r- . Fax number:
5. Surety Information:
a. Name and address:
b. Phone Number: — Fax Number: _
c. Amount of Bond: •
—
6. a. Lender's name and address:
b. Phone Number:
7. Person within the State of Florida designated by Owner upon whom notices or other documents may
be served as provided by 713.12(1)(a)7.Florida Statutes.
a. Name and address:
b. Phone numbers of designated persons:
8. a. In addition to himself/herself,Owner designates ---------- of
to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes.
b. Phone number of person or entity designated by owner:
9. Expiration date of notice of commencement(the expiratio date is one(1)year from the date of recording
unless a different date is specified) )11.0600K
WARNING TO OWNER:ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION
OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER
CHAPTER 713,PART I,SECTION 713.13,FLORIDA STATUTES,AND CAN RESULT IN YOUR
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 COMMENCING WORK OR RECORDING YOUR NOTICE OF
COMMENCEMENT.
Siature of Owner(Owner's Authorized Officer/Director/Partner/Manager:
(ift,94ziii, 22./...axat,C-
4-atory's Title/Office)
Tc.
The foregoing instrument was acknowledged before me this day of CC , 20 /
•
by "O"'as a w i- for m .
-;-
Notary: £ A.
Personally Known or Produced Identification `/Type of identification Produced: C.. -f
My commission expires: g//c a-(
Under penalties of perjury,I declare that I have_read the foregoing and that the factsstated in it are true
Doc#2017243802,OR BK 18161 Page 2386,
Number Pages:1 PETELOFfIS 128861
Recorded 10/24/20170428 PM, ` .*\
-4‘.� MY COMMISSION#GG 2021
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL j�=`Qp►RES:Aug�s61�U�enrtite�
i.
COUNTY
RECORDING $10.00 "x,;07 Bonded lhruNotarY