2291 N FAIRWAY VILLAS LN - SIDING & WINDOWS j
r CITY OF ATLANTIC BEACH
� r 800 SEMINOLE ROAD
KATLANTIC BEACH, FL 32233
0.iw INSPECTION PHONE LINE 247-5814
RESIDENTIAL -ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES18-0122
Description: 5 WINDOWS AND HARDIE BOARD SIDING
Estimated Value: 8000
Issue Date: 3/30/2018
Expiration Date: 9/26/2018
PROPERTY ADDRESS:
Address: 2281 N FAIRWAY VILLAS LN
RE Number: 169398 1094
PROPERTY OWNER:
Name: MOULTON PAUL DOUGLAS
Address: 2281 FAIRWAY VILLAS LA N
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.
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.
* 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.
„: 1,J-1/`Jj City of Atlantic Beach APPLICATION NUMBER
s�� Building Department (To be assigned by the Building Department.)
j., 800 Seminole Road O
.511 - Atlantic Beach, Florida 32233-5445 REs(�”- U 12-Z
44Phone(904)247-5826 • Fax(904)247-5845Q
sJ;;i,%' E-mail: building-dept@coab.us Date routed: --Si Zg/I (.
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
LK) NJ
Property Address: Z Z PRRLOL(� 0l LAS De Tent review required Ye No
uil
Applicant: OU1/43 N ef2-- Planning &Zoning
' 1 Tree Administrator
Project: l Q D o(A). < S ( �( �C� 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:
APPLICATION STATUS
Reviewing Department First Review: [oved. Denied. ❑Not applicable
(Circle one.) Comments:
UILDING
PLANNING &ZONING Reviewed by: `' / l Date:Y191204"
TREE ADMIN. Second Review:
'Approved as revised. ❑Denie . ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: I 'Approved as revised. ['Denied. Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
OFFICE CORY i• din Permit Application Updated 12/8/17
'7111/,l City of Atlantic Beach
\,_`,„yr 800 Seminole Road,Atlantic Beach,FL 32233 _
U�
Phone:(904)247-5826 Fax:(904)247-5845
RESIS-
i a V ZZ-
Job Job Address: `1( rvJON4. J Ol((Cis_(c Permit Number:
Legal Description ��, I _RE# � I a — i cgq
Valuation of Work(Replacement Cost)$ 8O0 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: s` ( 3 Q
` C�Q-
( ,�(DO c 5 ( Cc 7 �1.�\
Florida Product Approval# for multiple products use product approval form
Property Owner Inform
ation
Name: �W ( Address: I t rte` V i1 Cid �%City 147,31k.,(.. -1
-�.rrl sr :�cJ� State( Zip --c-Z03 Phone 7 —6?j; -�A5-- 6
E-Mail ()Gt_,L,L1 Z7 irnc»
Owner or Ageht(If Agent,Power of Attorney or Agency 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
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. 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 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 NOT CE OF Co MMEKCEMENT.
i
fir
(S': ature of Owner or :ent) (Signature of Contractor)
(includi'; • tractor) ao
i ned an sworn to��jjo;r affir' . before a e thi• •ay of Signed and sworn to(or affirmed)befor: me this day of
r!�J ,by :cam �41 , by
I a la lel la
Signatur= . ota ) , ignature of Notary)
[ ]Personally Known OR f Personally Known OR
[ ]Produced Identification f STA
TONIGINDL�SPE'•ci • e tification
Type of Identification: .. ' ' " u tiff tion:
Yp _a si Y CrWMISSINREFP In
A EXPIRES:October 6,2019
'1 0:0' Bonded Thru Notary Public Underwriters
fedmy PE3Jk-- G/2Z-
NOTICE OF COMMENCEMENT
State of �`lfi �/�,OrTax Folio No. /GIS `g I/
0 7 q-'
County of ThiJC,t 1 OFFICE COPY
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 state this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: i r-I AJCL,1 v t I s' � ��
Address of property being improved: 71e ) o ,
" (4-Aiite,,I)L
General description of improvements: V` I Cj S .. i<PMeOIG:C.11L
/ _.!
Owner: A _ LI. , _ . .4 Address: 1.7r-Q.) U1 I(Citc (II
JAOwner's interest in site of the improvement: W i -r 0‘..05. ((c} lFee Simple Titleholder(if other than owner):
Name:
Contractor: ca. ,t.&e S Oi tajfe-T
Address:
Telephone No.: Fax No:
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: d /� Date: 3 I f 2
Before me — d- . A A & , in the Coun of D val,State
Doc#2018071625,OR BK 18329 Page 918, Of Florida,has person• ly ap Vd - , — 7.1.
Number Pages:1 Notary Public at Lar•e,Stat- lorida,C•Viiiirli /
Recorded 03/28/2018 09:04 AM, My commission expires: m imp, .
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL PersopA v --"'n'.--. ..P:111'. rdre
COUNTY Prod ' ed,l' 'tRtjficatic ONI GI 1 ;, I ', ; - i! � MINE:.� -
RECORDING $10.00 ` '` = MY COMM •` '
.: "p 'a EXPIRES:October 6,2019
`I '', :‘,S' Bonded Thru Notary Public Underwriters
rI tr.glik
�� CITY OF ATLANTIC BEACH
OFFICE COPY
'v V II WNER / BUILDER AFFIDAVIT
'Lull 9%
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.
--Z 1 ',--‘`t(-wort,/ bit((5 tO 9D(( `(>>C-C ()
ADDRESS PHONE NUMBER
lea &L ILAC u()/1
PRINT NAME
.c(E07'i c?
SIGNATURE DATE
Before me this_l ay of \c 'c .f Jp,\,20 I! e county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations aretrueand accurate.
Notary Public at Large,State of l-� ( ,County of
❑Personally Knowniii �-rj
El Produced Identification-Nhl "P .
Ili Al2i -4
�.— ..Z4
: ',® 10141 GINDLESPEFGER
1:�.^ !MISSION 9201
9-51
Notary Signature:_ yp.• wf COMM tuber 6,2019
IR 'trio :+= EXPIFIES:cater
6ndern9„,_
P:/BLDG/Owner-Builder Affadavit,REVISED: 4/16/2009 "i Bonded'Nu NOW/.tea