885 SEMINOLE RD - KITCHEN REMODEL (2) ,S r fr, ,ly,..
�' ' ''s CITY OF ATLANTIC BEACH
Ss,
� � ' 800 SEMINOLE ROAD
yr ATLANTIC BEACH, FL 32233
/..1.Olt !P INSPECTION PHONE LINE 247-5814
RESIDENTIAL -ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES18-0003
Description: KITCHEN REMODEL
Estimated Value: 12000
Issue Date: 1/5/2018
Expiration Date: 7/4/2018
PROPERTY ADDRESS:
Address: 885 SEMINOLE RD
RE Number: 170026 0000
PROPERTY OWNER:
Name: HENRY PLANT OCBORNE
Address: 1632 BEACH AVE
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$7,500.
r Building Permit Application Updated 12/8/17
�,�• "" '` City of Atlantic Beach
%P 800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)(2247-5826 Fax:(904)247-5845
Job Address: �c'� 5-evo i In 0�`e T ` C a ct Permit Number:
Legal Description RE#
Valuation of Work(Replacement Cost)$ 1 2-) 00 U Heated/Cooled SF 0 S/ 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 be performed: !
,NQt,-• .-..1 0 0 r / epIacivG/ kITcita' V1
Florida Product Approval# (/ for multiple products use product approval form
Property Owner Information
Name: Hcvir/ r - Cis bowie Address: g£5 5eviiel0f c pogo(
City J1-/ ate cL Zip 3 2237 Phone ero4 —,34 -14 ZS
E-Mail O380RA/E-... Na vi it GV►'►at ( . C ' W.
Owner or Agent(If Agent, Power of Attorney or gency Letter Required)
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
Ex pt/Insurer/Lease Employees/Expiration Date
Application is hereby made to obtain a permit to he work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit d that all work will be performed to meet the standards of all the laws regulationg
construction in this jurisdiction. I underst d that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HE TERS,TANKS,and AIR CONDITIONERS, etc. NOTICE: In addition to the requirements of this
permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and
there may be additional permits required from other governmental entities such as water management districts,state agencies,or
federal agencies.
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 , ,Y
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF Y• 4 INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEF%RE
RECO DING YO R NOTICE OF COMMENCEMENT.
1 Ga—______
/ (Signature of Owner orAgent) -/ (Signature , Contractor)
/ (including •• tractor)
igned and sworn to( r affirm-• befor A hi •a of Sid and sworn to(or affir ed)before me this day of
1 ,affirm
►., W44 .? ne11j. , , •
(Signature of Notary) AMP (Signature of Notary)
[ ]Personally Known OR [ ]Personally Known OR
[ ]Produced Identification c o, ,Th[ ]Produced Identification
Type of Identification: �, SSS Z ca`L./Type of Identification:
';57 :::
j t..%1iJY.,
�'�� CITY OF ATLANTIC BEACH
s>
"' I3'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 $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826) IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNERR-Q-BUILDER PERMIT. (�
v5- S( irwo0le Roo 0( cloy 5341 1412
ADDRESS, PHONE NUMBER
1 -/ev)ry
n, Cs o r vI-e
PRINT NAE
:2 Urie ------ I /-5-/ IF
SIATU E ca DATE
Before me this ---._Th day oft_'A, 2OL in the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affi ms that
all statements and declarations are true and accurate. / 'V11
Notary Public at Large,Stat-of — ,County of `� V/Q_
❑Personally Known r ; r lr J _S C — L.
�e
❑Produced Identification- G-
Notary Signature:
F:BLDG/Owner-Builder Affadavit,REVISED. 4/16/20091111.
NOTICE OF COMMENCEMENT
State of oy i�c c County of DA v Tax Folio No. 1 7 0 az(v -- V oo
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of
the Florida Statutes,the following information is stated in thisciOTIqE 9F QQ1WVIENCEMENT.
Legal Description of property being improved: Cv " (a—Z. g
La-t- t.
Address of property being improved: g g5— Selo,-IA o )e. Rock ci
General description of improvements: R c>M o cQ e l rt:+ I A e v. / it e cL Ca i K e t S
Owner: ,--1e4-ry p. 0silo r>ne./Renc. ff . CQck5kdre s:
Owner's interest in site of the improvement: F e e S i vin p
Fee Simple Titleholder(if other than owner): <3 ekv 4 '&
Name: A
Contractor: i f A Cc S C)u 1,1 `e v-
Address:
Telephone No.: Fax No:
Surety(if any) AfA
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name: — 1V J
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: /U l
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) �r
Name: I v .�•
• 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: )[ {J " Date: i (//
5 J g
Before r this day ofv Gk_ in the County of Duval,State
�n�Rn�zs„ OR BK 18242 Pagel235, bf Florida,has personally as eared X7(0
Doc# personally Known:
Number Pages.1 Produced Identification: 1111ZA 4.9 S g or
Recorded 01105(2018 11:33 AM,
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL votary Public:
COUNTY �Iy commission expires:
RECORDING $10.00