412 Ocean Blvd RERF21-0006 Shingle r JrS''''''ri REROOF SHINGLE PERMIT PERMIT NUMBER
t jr:' r
RERF21-0006
�� CITY OF ATLANTIC BEACH ISSUED: 1/12/2021
800 SEMINOLE ROAD
' it»" ATLANTIC BEACH. FL 32233 EXPIRES: 7/11/2021
.1-`'
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.
JOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property
hat may be found in the public records of this county, and there may be additional permits required from other
:overnmental entities such as water management districts, state agencies, or federal agencies.
,. , JOB ADDRESS: PERMIT TYPE: I DESCRIPTION: VALUE OF WORK
412 OCEAN BLVD REROOF SHINGLE SHINGLE ROOF $8500.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: ! NUMBER: GROUP:
170169 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
CASTRO ROBERT R 412 OCEAN BLVD ATLANTIC BEACH FL 32233-5338
NARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT If'
'OUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
OUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU
NTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
ECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF CONDITIONS
toll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $95.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$99.00
Issued Date: 1/12/2021 1 of 1
rt,.u,r, R aRF z ( -000(c,
• , Building Permit Application Updated 10/9/18
r s City of Atlantic Beach Building Department **ALL INFORMATION
u
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
-•01tIV'' IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
'T
Job Address: VI, 10 4-0=X •4 r-4104Permit Number: 17O 1 6,9-0000
Legal Description L rAo f.,:t2c ,..'3 ��L 4-i:`1 i4LRE#
Valuation of Work(Replacement Cost)$ S Z pc) ,,"7 Heated/Cooled SF Non- eate /Cooled
• Class of Work: ['New Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door V''L gii 6G
• Use of existing/proposed structure(s): ❑Commercial Residential .5171SQ
• If an existing structure,is a fire sprinkler system installed?: ❑Yes [Jo
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) 1No
Describe in c\.
tail the type of work `ibe erfo ed•
P.C,C>13 ,
Florida Product Approval# EL 46 12.'i'- " R•2c ,- for multiple products use product approval form
Pro er Owner Inform tion [ C 5-' p7 IJ— 216 n_ .
Name 1 ,ktV , .. 34cii 1 4. . Address q /2- O 44-4 .-lam tat
City .. t` , ,: - State `.�Zip 32.2,z-m. Phone Cj�ti .- 2-46-- 1 ..C:,
E-Mail 2e-i? ( STV�L, -1 ,4-(( .a 472)4,R
Owner or Agent( Agent, Power of Attorney or Agency uired)
Contractor Informati r Cd(eT Oa aie�
NOVA, 5 14
Name of Company NOV 6 i' Zualif is Agent., `
Address ('). L'.('_`ADi Va LA.94. City rt.pfei((cr. . ,State:�t 4 Zip �:2�
Office Phone Job Site Co tact umber tc
State Certification/Registration# E-Mail ad <-4 -111f, IA B Ei Q.� 4i I
Architect Name& Phone# �J 40
Ler
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt❑ Expiration Date
Application is hereby made to obtain a permit to do the work and installati s as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be rformed to meet the standards of all the laws regulating
construction in this jurisdiction. I understand that a separate per must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,an 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
REST IN Y UR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TOO AIN F ANCING, CONSULT WITH YO LENDER OR AN ATTORNEY BEFORE
RECO D G R ICE OF C NCEMENT.
ti• (Signature of ner or Agent) (Signature of C• tractor)
igned and sworn to(or a' it es) b fore m- thi d :.y of Signed and sworn to(or affir' ed)before me this day of
=h...nat* 171,,ar ) (Signature of Notary)
[ ]Personally Known OR ' ;=..!$19.?y c; TON It�t�iL.ESPa��2 R 0
[ ]Produced Identification _„: blr ;,_ MYCO re Iii ica> >n
�� L— =-"T ��.. / EXPI y�:ag Al
Type of Identification: "''''••••'•Q•` „ ,-,Thru o� �E1 41+%-t
• irk,, Owner Builder Affidavit **ALL INFORMATION
s HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
'' V 800 Seminole Rd, Atlantic Beach, FL 32233
`r Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
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. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.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: X12 ., a L.Ot3C.)
Owner Name: %Lc/A- dor it.,10,(E ,�A Oft) Phone Number: 9 "I 2...cietz e
6,6
Mailing Address: q(7., r"= t. ity: L t,4tK t� State: q 14. Zip: '.2.2._"35:3.
t\ 1/4_
Notarized Signature of Owner . . ) -
The,fore oing instrument was acknowledged before me this 17 day of Q ,(2.-kin the State of Florida, County
of ` 0 fn
Signature of Notary Public ®� Q` ��
110
[ ] Personally Known OR [ ] Produced Identification
Type of Identification: (—
"PavP' ,, TONI GINDLESPERGER
20 ,�. ' MY COMMISSION#GG 353178 Updated 10/24/18
,t ,,._. '•_
cj.0 e EXPIRES:October 6,2023
,'
'sf.bWg° Bonded Thru Notary Public Underwriters
NOTICE OF COMMENCEMENT
Permit No. Tax Folio No. ( 7 016-•.4— 'Ob OD
State of Florida, County of Duval
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. D•scr'j.ti on of. o.erty(legal descri.tion ofpro.e and as dr s if.v.it ble):
� -2 i.
IC c A'
2. General Description of improvements. AP"'oo
3. Owner Information:
a)Name and Address: t ed 'T� /95-47(2 aeg j7J Lodi/Jar L14,3Z733
b)Interest �
in property: nee, /Pcr ,.,,,p1 t
c)Name and address of simple titleholder(if other than owner):
4. Contractor Informatio ' i a
a)Name and Address: 0 '��l f 11 i ! - CO/7611/ . I#"�' 1
b)Phone Number: ov- ,/3 — - 7-
5. Surety Information: ///ifa)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, Flori -atutes:
a)Name and Address:
• b)Phone Numbers of Designated erson:
8. 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.
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
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 SI1'b
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.
der penal of perjury, I declare that I have read the foregoing notice of commencement and that the facts stated
t ein are t to the best of my knowledge and belief.
ignature of Owner or Owner's Authorized Officer/Director/Partner/Manager Signatory's Printed Name&Title/Office
The foregoing instrument was acknowledged before me erans o i i .. sical presence orDonline notarization,
this day of 0^ , 20 , by d3(2 4 0.s1O ,who isersonall known to
p Y
(Name of Person)
me or produced L--• as id; ication, as
Typ f Authority,e.g..officer,attorney in fact,etc.)
for
(Name of P Instrummerlt�
„a'�Pvay + TONI GINDLESPERGER
'F:-"t MY COMMISSION#GG 353178 NO 11'Y9aBLIC SIG AT —STATE OF FLORIDA
EXPIRES:October 6,2023 Commissioned Notary Name:
�•F°F,F;°a'••Bonded Thru Notary Public Underwriters y
Doc#2021010459,OR BK 19536 Page 2009,
Number Pages:1 .
Recorded 01/13/2021 10:08 AM,
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL
COUNTY Revised 1/1/2020
RECORDING $10.00