893 Amberjack Ln DEMO25-0003 PermitOWNER:ADDRESS:CITY:STATE:ZIP:
LUNDGREN CHARLES 893 AMBERJACK LN ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171178 0000 ROYAL PALMS UNIT 01
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
893 AMBERJACK LN DEMO COMPLETE DEMO HOUSE $250000.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 PUBLIC UTILITIES UNDERGROUND WATER SEWER UTILITIES INFORMATIONAL
Notes:
Avoid damage to underground water and sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is
needed, call 247-5878. State Law requires calling Sunshine 811 to have ALL public utilities located BEFORE beginning the work.
2 PUBLIC UTILITIES DISCONNECT AND CAP INFORMATIONAL
Notes:
* REQUIRED Disconnect and cap water and sewer lines. Capped sewer line must be located at property line and standpipe must be visible above
ground level.
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.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY 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 RECORDING YOUR NOTICE OF COMMENCEMENT.
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.
1 of 3Issued Date: 4/10/2025
PERMIT NUMBER
DEMO25-0003
ISSUED: 4/10/2025
EXPIRES: 10/7/2025
DEMO PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BLDG 2ND PLAN REVIEW FEE 455-0000-322-1006 0 $50.00
3 PUBLIC UTILITIES INSPECTION PRIOR TO DEMOLITION INFORMATIONAL
Notes:
** REQUIRED
MUST CALL 247-5814 FOR A PRE-DEMO INSPECTION OF THE DISCONNECTED AND CAPPED WATER AND SEWER LINES PRIOR TO DEMOLITION.
4 PUBLIC WORKS EROSION CONTROL INSTALLATION INFORMATIONAL
Notes:
Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line (904-247-
5814) to request an Erosion and Sediment Control Inspection prior to start of construction.
5 PUBLIC WORKS DUMPSTERS/ROLL-OFF CONTAINERS INFORMATIONAL
Notes:
Dumpsters and roll-off containers must be used in compliance with Section 16-8 and must comply with all standards, per City code.
6 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration, including sod, is required. Full site to be grassed.
7 PUBLIC WORKS CONSTRUCTION SITE MANAGEMENT INFORMATIONAL
Notes:
Provide construction site management plan, including location of silt fence, dumpster, portable toilet. Right-of-Way Permit is required if using right-of-
way for construction parking.
8 PUBLIC WORKS SLAB DRIVEWAY REMOVAL INFORMATIONAL
Notes:
Slab and driveway to be fully removed.
9 PUBLIC WORKS REVISION INFORMATIONAL
Notes:
Any plan change must be submitted as a Revision to the Building Department.
10 PUBLIC WORKS DEBRIS REMOVED INFORMATIONAL
Notes:
All construction debris must be removed from job site by Contractor.
11 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Contractor.
12 PUBLIC WORKS DEBRIS INFORMATIONAL
Notes:
Roadway must be kept free of debris, mud, dirt, etc. during and after project by Contractor. All holes that have been dug and any property that has
been disturbed must have barriers and flags placed during project by Contractor.
2 of 3Issued Date: 4/10/2025
PERMIT NUMBER
DEMO25-0003
ISSUED: 4/10/2025
EXPIRES: 10/7/2025
DEMO PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DEMOLITION 455-0000-322-1000 0 $100.00
PU REVIEW BUILDING MOD OR ROW 001-0000-329-1007 0 $25.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.25
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $204.25
3 of 3Issued Date: 4/10/2025
PERMIT NUMBER
DEMO25-0003
ISSUED: 4/10/2025
EXPIRES: 10/7/2025
DEMO PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
t
Revision Request/Correction to Comments ALL INFORMATION
3p
HIGHLIGHTED IN
ri) City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
tt Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: 1-3EMO -O0c3
ALL REVISION SUBMITTALS MUST BE EMAILED AS A PDF ATTACHMENT ONLY**
Revision to Issued Permit OR Corrections to Comments Date:3 13115
Project Address:S`"1'S
Contractor/Contact Name: `--V \ ar l'p.r\
Contact Phone: 04—9(0-1- 79 5 Email: ace_b('P @ ho-(incti- 1 ,Q-0 in
Description of Proposed Revision/Corrections:
re,e
n s , I(V\c Ao.S Coq
QWne1` e ot,tcPC—
affirm the revision/correction to comments is inclusive of the proposed changes.
Printed name)
Will proposed revision/corrections add additional square footage to original submittal?
No 1 Yes (additional s.f.to be added:
Will proposed revision/corrections add additional increase in building value to original submittal?
INo C*yes (additional increase in building value: $ Contractor must sign if increase in valuation)
Signature of Contractor/Agent:
Office Use Only)
Approved Denied Not Applicable to Department Permit Fee Due$
Revision/Plan Review Comments
Department Review Required:
Building
Planning&Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities
Public Safety Date
Fire Services
Public Works Approved
03/07/2025
Zoning Approved
03/10/2025
rj_:
JJ), TREE & VEGETATION AFFIDAVIT FOR INTERNAL OFFICE USE ONLY
7 'f , City of Atlantic Beach PERMIT#
Community Development Department
800 Seminole Road Atlantic Beach, FL 32233 Please submit form in person
01i>9%' (P)904-247-5800 or to buildng-dept@coab.us
SITE INFORMATION
ADDRESS ;
737 ,
i4a AL_
SUBDIVISION a/ jy BLOCK ¢ LOT 2
RE# / 7// -7y/ -,mem IX RESIDENTIAL El COMMERCIAL D OTHER
APPLICANT INFORMATION
NAME (xir/e-f Ui-7 ref PHONE# 9, 7y6 29 s
V
ADDRESS 0 93 dek Qc Zkif2. CELL#
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CITY /Iri je.„ r ' ,e.STATE ZIP CODE 372-73
EMAIL c e£6/1e e z_O d LAT,(/61,
144 OWNER LEGAL AUTHORIZED AGENT
I affirm that I have reviewed the provisions of Chapter 23, "Protection of
Trees and Native Vegetation", of the Municipal Code of Ordinances for the
City of Atlantic Beach Florida and/or I have participated in a pre-
application meeting with the Administrator of those regulations.
Subsequently, I affirm that no regulated trees and no regulated vegetation
will be damaged, destroyed and/or removed from the above-described
property and/or adjacent properties including right-of-way.
In lieu of signed, sworn and notarized signatures of the property owner, agent and/or contractor, and under penalties of
perjury, I declare that I have read and examined the foregoing application and that the facts stated in it are true and correct."
1"
arIe A-- S Ph r 3 3-2-d 25
s( NE OF APPLI , T PRI OR PE NAME OF APPLICANT DATE
TREE AND VEGETATION AFFIDAVIT 11.26.2024
Public Works Approved
03/07/2025
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JOB COPY
Public Works Approved
03/07/2025
0!.. .Ir,,, OWNER BUILDER AFFIDAVIT
City of Atlantic Beach Building Department JOB ADDRESS:
800 Seminole Road, Atlantic Beach, FL 32233 f,93 mie/Q / An&0109'?
v
Phone: (904) 247-5826 Email: Building-Dept@coab.us
cl
OWNERS MUST PERSONALLY APPEAR AT THE BUILDING DEPARTMENT TO SIGN THIS DOCUMENT**
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES OWNER/ BUILDER
TO ACKNOWLEDGE THE LAW:
To qualify for exemption under this subsection, an owner must personally appear and sign the building permit application and must
satisfy local permitting agency requirements, if any, proving that the owner has a complete understanding of the owner's obligations
under the law as specified in the disclosure statement in this section. However, for purposes of implementing a "United States
Department of Energy SunShot Initiative: Rooftop Solar Challenge" grant and the participation of county and municipal governments,
including local permitting agencies under the jurisdiction of such county and municipal governments, an owner's notarized signature
or personal appearance to sign the permit application is not required for a solar project, as described in subparagraph (a)3., if the
building permit application is submitted electronically to the permitting agency and the owner certifies the application and disclosure
statement using the permitting agency's electronic confirmation system. If any person violates the requirements of this subsection,
the local permitting agency shall withhold final approval, revoke the permit, or pursue any action or remedy for unlicensed activity
against the owner and any person performing work that requires licensure under the permit issued.The local permitting agency shall
provide the person with a disclosure statement in substantially the following form:
DISCLOSURE STATEMENT- Please initial Items 1 - 13
1. 1 I understand that state law requires construction to be done by a licensed contractor and have applied for an owner-
builder permit under an exemption from the law.The exemption specifies that I, as the owner of the property listed, may act as
my own contractor with certain restrictions even though I do not have a license.
2. I understand that building permits are not required to be signed by a property owner unless he or she is responsible for
the construction and is not hiring a licensed contractor to assume responsibility.
3. I understand that, as an owner-builder, I am the responsible party of record on a permit. I understand that I may protect
myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my
own name. I also understand that a contractor is required by law to be licensed in Florida and to list his or her license numbers
on permits and contracts.
4. R I understand that I may build or improve a one-family or two-family residence or a farm outbuilding. I may also build or
improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my own use or
occupancy. It may not be built or substantially improved for sale or lease, unless I am completing the requirements of a building
permit where the contractor listed on the permit substantially completed the project. If a building or residence that I have built
or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I
built or substantially improved it for sale or lease,which violates the exemption.
5. 4Z_I understand that,as the owner-builder, I must provide direct,onsite supervision of the construction.
6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my
building or residence. It is my responsibility to ensure that the persons whom I employ have the licenses required by law and by
county or municipal ordinance.
7. I understand that it is a frequent practice of unlicensed persons to have the property owner obtain an owner-builder
ermit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner-builder,
may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or her
employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am
willfully acting as an owner-builder and am aware of the limits of my insurance coverage for injuries to workers on my property.
8. LO I understand that I may not delegate the responsibility for supervising work to a licensed contractor who is not licensed to
perform the work being done. Any person working on my building who is not licensed must work under my direct supervision
and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and
social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers' compensation for
the employee. I understand that my failure to follow these laws may subject me to serious financial risk.
Owner Builder Affidavit 11.12.2024
JOB COPY
Public Works Approved
03/07/2025
9. (/ I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern owner-builders as well as employers. I also understand that the construction must
comply with all applicable laws,ordinances, building codes,and zoning regulations.
10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue
Service, the United States Small Business Administration, the Florida Department of Financial Services, and the Florida
Department of Revenue. I also understand that I may contact the Florida Construction Industry Licensing Board at (850)
4 7-1395 or the DBPR for more information about licensed contractors.
11.I am aware of, and consent to, an owner-builder building permit applied for in my name and understand that I am the party
legally and financially responsible for the proposed construction activity at job address listed on this document.
12.I agree to notify the Atlantic Beach Building Department immediately of any additions, deletions, or changes to any of the
information that I have provided on this disclosure.
13.Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have
a license, the Construction Industry Licensing Board and Department of Business and Professional Regulation may be unable to
assist you with any financial loss that you sustain as a result of a complaint. Your only remedy against an unlicensed contractor
may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or
firm is injured while working on your property, you may be held liable for damages. If you obtain an owner-builder permit and
wish to hire a licensed contractor,you will be responsible for verifying whether the contractor is properly licensed and the status
of the contractor's workers' compensation coverage.
Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and
returned to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the
notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required
when the permit is issued.
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: e(3 //,44.71y,LI1G RE# I2ES 2 02,6U—
Owner Name: e f (/1 /y Phone Number: y)01 95-75-
Mailing Address: 0/3 , 1 ejptc rl City: exy G gede..64 State: ft— Zip: 7 7.2-3Y
I GINDLESPERGER
J
MY COMMISSION#HH 407122
ignature o 0, -r or ent) Date)
EXPIRES:October 6,2027
Signed before me this day of Vat 2.0 25
in the County of Duval,State of Florida, has personally appeared
Ad/4: C(f n
Personally Known OR [ ] Produced Identification
n
My commission expire •
Owner Builder Affidavit 11.12.2024 Notary Signature: 0 /
OF
Public Works Approved
03/07/2025
Received by Building
01/28/2025
DEMO25-0003
Public Works Denied
02/04/2025
Received by Building
01/28/2025
DEMO25-0003
OFFICE COPY
Zoning Approved
02/03/2025
DEMO25-0003
Public Works Denied
01/24/2025