1212 Jasmine St ROOF20-0063 Shingle/Mod `"' ROOF NON SHINGLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH ROOF20-0063
"�
01 -��
800 SEMINOLE ROAD ISSUED: 10/20/2020
...I.; ATLANTIC BEACH. FL 32233 EXPIRES: 4/18/2021
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
1212 JASMINE ST ROOF NON SHINGLE SHINGLE AND MOD. BIT $6000.00
ROOF
TYPE OF REAL ESTATE � ZONING: BUILDING USE j SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP: j
171020 0020 ATLANTIC BEACH SEC H
COMPANY: ADDRESS: CITY: I STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
ROBERT& SHERRI 2208 MARSH POINT RD JACKSONVILLE FL
EMAHISER
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT II`
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
RECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF CONDITIONS
i
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
I DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $85.00
l
I BUILDING PLAN CHECK 455-0000-322-1001 0 $42.50
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$131.50
Issued Date: 10/20/2020 1 of 2
.,:5'-. 1
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, ROOF NON SHINGLE PERMIT PERMIT NUMBER
s . ��� ROOF20-0063
�;� ,, CITY OF ATLANTIC BEACH
Kir,_. 800 SEMINOLE ROAD
ISSUED: 10/20/2020
.r ,i91! EXPIRES: 4/18/2021
ATLANTIC BEACH, FL 32233
Issued Date: 10/20/2020 2 of 2
JOB COPY REVIEWED FOR CODE COMPLIANCE 10.19.2020
Building Permit Application Updated 10/9/18
- City of Atlantic Beach Building Department N2 **ALL INFORMATION
UUU
___, , 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
P �/ IS REQUIRED.
Phone: (904)L 247-5826 Email: Building-Dept@caab.us
Job Address: j dr/l��f� CIA `//r Permit� Number:mbROOF200--,0063
Legal Description /Yi" 1 f -7J F reRc 11 « a E„�j-Kdi RE# iii(*)-{k 'a
Valuation of Work(Replacement Cost)$f,,,,CM Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration epair ❑Move ❑Demo OPool ❑Window/Door5 /•;d
• Use of existing/proposed structure(s): ❑Commercial (Residential /1 Li
• If an existing structure,is a fire sprinkler system installed?: ❑Yes 3No '�•t'
• Will tree(s)be removed in association with proposed proiect?l iYes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed: pol t` p J(hc_J ,y ! ft / S'
r'.. .drbinM rl,'r 14- LiLty 0�r i i:^,1 0, , 2'/Y't•r Ci/r=61 16, Af,
Florida Product Approval# ``-FL S v./Li ,QY J L f/e; `'' for multip e p u t r uFt�ppynva form/7
Property Owner Information pi_ T �ht �� l7 -
Name` f a ( '(�„r) 1l ✓� Address /0r) tJf1` f(�
City t't t�`f. l c e(:J-1'i _ State/- Zip 5??3 Phone Q( - 1 3 ---43-,%19 7
E-Mail -�'-{~9 rJ r(.1 ` lS(' Cr/-I ��
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) l I
Contractor Informa Ictn 4 Cor B'aCT
Name of Company ` Y i t &i:?C 1 1 Qualifying Agent
Address //21'. ;I-P.<-_,r4NJ jT - City State Zip
Office Phone Job Site Contact Number
State Certification/Registration# E-Mail
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt o 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 regulating
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 YOU NOTICE OF COMMENCEMENT.
L/� l'a(1 of Owner t--i
t (Sig ure of Owner or Agent) (Signature of Contractor)
1/\.
Signed and sworn to(or affirmed)before me this day of Signed and sworn to(or affirmed)before me this_day of
— ----- _:,- ` )� ,I I C A 1 .. '. ✓ ,by
�+.�•._.:y.TRACY WA , '/ /��
= MY COMMISSION#OG 2-1 `• (Signature of Notary)
"' • Si nature of Notary)
�-' EXPIRES:November 20,2022 g
or: Bonded rnti Notary Pubiic Underwriters
[ I Personally Known OR [ )Personally Known OR
id T Produced Identification - [ I Produced Identification
'type of Identification: D{,V,L✓S LL re_t4�-,a—C-- Type of Identification:
JOBCOPY '•ALL INFORMATION
19,,�1�r� Owner Builder Affidavit HIGHLIGHTED IN
1- • City of Atlantic Beach Building DepartmentGRAYISREQUIRED.�' 800 Seminole Rd, Atlantic Beach, FL 32233
ROOF20-0063
Phone: (904) 247-5826 Email: :3uiidin Ue�t@cc�abu, PERMIT f#:
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 STATELAW 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. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR,BUILDING-DEPT(ahCOAB.US) 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.
JOb Address: 1212 Jasmine St.Atlantic Beach,FL 32233
Owner Name:Sherri Emahiser Phone Number: (904)583-5297
1212 Jasmine St. City: Atlantic Beach State: FL Zip: 32233
Mailing Address: l �,���
[f. ��l t:� ..l A
Notarized Signature of Owner ()ALI (The foregoing instrument was acknowledged before me day of(0 C Ribe✓ ,20 V,in the State of Florida, County
of AMA U Ct-.
Signature of Notary Public ( /.--0--- -------/
r
TRACYWATERWW
;, : MYPIRES: oeNbGG27B22 i ) Personally Known OR i�))Produced Identification
���-a,•= EXPIRES:November 20,2022
`. r,M1'• 8(414°4T ruNaa/A,bucuna ws Type of Identification:- T V IV�v Z-I A 02,11_.6.,t_—
Updated 10/24/18
NOTICE OF COMMENCEMENT
ROOF20-0063 171020-0020
Permit No. Parcel ID/Tax Folio No.
State of Florida,County of Du'al JOB COPY
THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with
Chapter 713,Florida Statutes,the following information is provided in this Notice of Commencement.
1. Description of property(legal description of property and address if available):
18-34 17-2S-29E Sec H Atlantic Beach Lot 2 Blk 204 1212 Jasmine St,Atlantic Beach, FL 32233
2. General Description of improvements:
Roof replacement
3. Owner Information:
a)Name and Address: Sherri Emahiser 1212 Jasmine St.Atlantic Beach,FL 32233
b)Interest in property:homeowner
c)Name and address of simple titleholder(if other than owner):
4. Contractor Information: ) IA % i d (7-45/77-1•31:
a)Name and Address: o(1 . 11/1/0-11.139
b)Phone Number:- — — i - ,4/-f(llncCI`y0 r1.
5. Surety Information:
a)Name and Address:
b)Phone Number:
c)Amount of Bond:$
6. Lender Information:
a)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 713.13(1)(a)7,Florida Statutes:
a)Name and Address:
b)Phone Numbers of Designated Person:
8. En addition to himself/herself,Owner designates of to receive a
copy of the Licnor's Notice as provided in Section 713.13(I)(b),Florida Statutes.
a)Name and Address:
b)Phone Number of person or entity designated by owner:
9. Expiration date of Notice of Commencement(the expiration date may not be before the completion of construction
and final payment to the contractor,but will be one(1)year from the date of recording unless a different date is
specified:
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 71',.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
MPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
'OSTED 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
t'OUR NOTICE OF COMMENCEMENT.
jUnder penalty of perjury, I declare that I have read the foregoing notice of commencement and that the facts stated
the in true to the st cf my knowledge and belief.
`D Arr6-11.trA L/r t21 ern
o
o, U Signa f wrier o 0 er s Authorized Officer/Director/Partner/Manager ' story's Printed Name&Title/Office
a F_
A-
0- The foregoing instrument was acknowledged before me this )l� day of n C- 1))9-P....f ,20 2(?
Q t SC✓as
co o w by(Name of Person)� �� (Type of Authority,i.e.Officer/Attorey)fOr(Name of Party Instrument was Executed for)
O OU
ri_ `A NOTARY PURL ,ATE OF FLO IDA
N N t� :� TRACY WATERMAN
`\' °i" Print Name: Y't' 4/) l�UCl YYl4:''
No a"ti Z r�, :*; MY COMMISSION 1100 278296 1
oN `w-8 W 13 ~CX .%��;off: EXPIRES:November 20,2022
E 6 z Z o ." Bonded Thai Notary Underwriters ❑Personally Known
8 8 o o w +�Identificatior/Type: Y i V� V LI(;G�l�t�
�ZIr�UK
(Affix Notary Seal Above)
Revised 1/18/18