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1717 SELVA MARINA DR DWAY21-0041 0nr,,, Building Permit Application Updated 10/9/18 ; City of Atlantic Beach Building Department **ALL INFORMATION ifs..• 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY ls* Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED. Se1Wto, *.iriv.o. v n;+ 6 Lo A- 2. 5lk o Fob I .1 Akj b Address: VI 1 � )-e l j kwr i Vi D r Permit Number: L ) .Z( - O04 X Legal Description I . __ �' _.r.._._:.....�.� - - - �'!..w `:' 41eir AtE# 17;.o t:z{ — OOo Valuation of Work(Replacement Cost)Co $ I,O0(') ,OC) Heated/Co• e• SF Non-Heated/Cooled • Class of Work: ❑New IJAddition ❑Alteration ❑Repair ElMove ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial L'Residential • If an existing structure, is a fire sprinkler system installed?: ❑Yes 1410 • Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) 121No Describe inhe type of work to be performed: b-I vt voay El(ithS1On Pod - Sift WALK o."c& ?C.HC in Cop,o- Florida Product Approval# for multiple products use product approval form Property Owner Information nn Name I'1u[i.1Yfl�. lA Ci(VU 11 Address 1-117 5c\vc'.Mcu, '✓ 4tic�1Df City - ( 'gene} State FL Zip 32233 Phone 015)-2'11- 3561 E-Mail o.0 ObeA+S ae ►ve • GAM Owner or Agent(If Atent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company V_(15kst(l a C0nccck PAL Qualifying Agent t rinij-ltIO Roc:11,-i SU t2. Address 131() Rl(tc1Chriu_A(Trl W City 3 r-vi)1t. State FL Zip 32_225 Office Phone 1 i) 851- 2 123 Job Site Contact Number State Certification/Registration# Qnitocong 3 E-Mail EciM-Sidt... Corirtrft D ldCa-a)•(OM Architect Name& Phone# ' Engineer's Name&Phone# Workers Compensation Insurer 5ejr &e. Prnexi(.ar, 1haLynn i (OM? • ` Exempt❑ Expiration Date 1- 11-2022 Application is hereby made to obtain a permit to do the work and install- ons as indicated.I certify that no work or installation has commenced prior to the issuance of a permit and that all work will .• performed to meet the standards of all the laws regulating construction in this jurisdiction. I understand that a separate p- it must be secured for ELECTRICAL WORK, PLUMBING,SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and • • CONDITIONERS,etc. NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable . this property that may be found in the public records of this county,and there may be additional permits required from othe :overnmental 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 RECORD.: . •UR N @TICE OF COMMENCEMENT. • (Signature of•wner or Agent) (Signature of Contractor) Si ned and swor to(or f• i.ed) before me this day of Signed and sworn to(or affirmed) b re me this day of , (� �b ai C .v'Ce , by ►'•na*aha. . (Signature of Notary) 7bU TONT G ESPEfjGER [ I Personally Known OR �pt!S` h n. ly Known OR [ ]Produced Identification ,r � 1 MY COMMISSION G� ducl• Identification Type of Identification: 9.^�.Qo; EXPIRES:October T� tification: Yp ^ublic UM& f°�d a. Owner Builder Affidavit **ALL INFORMATION '"`�'�'�. HIGHLIGHTED IN 'f Afik City of Atlantic Beach Building Department GRAY IS REQUIRED. r 800 Seminole Rd, Atlantic Beach, FL 32233 v 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: 11 11 5e,W o.. Off\wC c ro. %ft - Owner Name: NdJCLCOh pAct6VGILY1 Phone Number: -I 1 5-lo 1 Mailing Address: \-1 i 5 till& MILYiv‘a,INC City: itke State: fL Zip: 32-1-33 Notarized Signature of Owner The`#er.e.,,g oing inst(ument was acknowledged before me this v day of aj- , 2. (in the State of Florida, County of , Jv,l'aA Signature of Notary Public 4 [ ] Personally Known OR [ ] Produced Identification Type of Identification: Updated 10/24/18 TONI• GWDLESPERGER i.' •;,`: MY COMMISSION#GG 353178 ;t`,. EXPIRES:October 6,2023 Bonded Thru Notary Public Underwriters „tor,v4,,, RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION 'S $ City of Atlantic Beach HIGHLIGHTED IN GRAY IS �,-,y 4 800 Seminole Road, Atlantic Beach, FL 32233 REQUIRED. PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES Job Address \ ]\1 'AVO, Os)r�Cs Permit Number Contractor Information Company EC1Siz,irk Canc,re1-e lr-c Qualifying Agent Irrwzr)Ck' Ra--)ri9uc2- Address \3\(( NarK)-rural( 1r1 ( 0 City �jc<ony I I le State FL Zip 32225 Phone 60-11 S5() 2(123 Email lS�Sfr�e_Crnrxr�e e 9rth00 c 0 rn State Certification/RegistrationJ # Pt"}CjCie2853 (SuAlbiz) Architect Phone Email Engineer Phone Email Workers Compensation Insurer_,z',Fxvice Arrrr rtnrm lade - n; nn5.OR Exempt ❑ Expiration Date 2-I1-2O2 • Permittee declares that prior to filing this application they have ascertained the location of all existing utilities,both aerial and underground and the accurate locations are shown on the sketches. • Whenever necessary for the construction, repair,improvement,maintenance,safe and efficient operation,alteration or relocation of all,or any portion of said street or easement as determined by the Public Works Director,any or all said poles, wires, pipes,cables or other facilities and appurtenances authorized hereunder,shall be immediately removed from said street or easement or reset or relocated hereon as required by the Public Works Director and at the expense of the Permittee unless reimbursement is authorized. • All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the supervision of Ptf mn.r,60 (Zodr)Sue z (Project Superintendent) with(Company Name) F1,S ide I;rjnrxet_ Ir-t Phone OM) R,Sq'2c12 3 • All materials and equipment shall be subject to inspection by the Public Works Director. • All city property shall be restored to its original condition as far as practical,in keeping with City specifications and the manner satisfactory to the City. • A sketch of plans covering details of this installation,as well as a copy of a recent survey shall be made a part of this permit. Calculations showing any increase in impervious area on owner's lot or in the City right-of-way are to be included with this application. • The permittee shall commence actual construction in good faith within days. If the beginning date is more than 60 days from date of permit approval then permittee must review the permit with the Public Works Director to make sure no changes have occurred in the area that would affect the permitted construction. • It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right, title and interest in the land to be entered upon and used by the holder,and the holder will,at all times,assume all risk of and indemnify, defend and save harmless the City of Atlantic Beach from and against any and all loss,damage and cost of expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges. • Th- •.. 'c orks Director shall be notified 24 hours prior to starting work and again immediately upon completion. A f/ Date t0 (ear 1 a- l Permittee(signed in presence of Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL The foregoing instrument"- was acknowledged this day of O02 ,20 , Pc'- iby R,�nted�,e -,�;:_,,_.:. :::�., r;;.0. (printed name of Permittee) ;o 'b ,„ TONI GINDLESPLRGER �' rid '°* MY COMMISSION#GG 353178 ack wedged that • - si:--d the instrument voluntarily for the purpose expressed in i'' 6 • �� EXPIRES:October B,2023 I o ;;°':''' Bonded Thru Notary Public i Jnderv+rtters All• [ j Personally Known . re f Notary Public,State of da [ ]Produced Identification(Type) H:\Applications&Forms\Word&Excel Document Originals\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18 MAP SHOWING BOUNDARY SURVEY OF LD1 2, BLOCK 10. SOLVA MARINA UNIT NO. 5, AS RECORDED IN PLAT BOOK 30, PAGES 29 AND 29"-A, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. I' "s) CERTIFIED TO: (\V�'�y' AUDREY ROBERTS MCGOVERN AND JOHN LEON MCCOVERN CALIBER HOME LOANS, INC. r\ 7' i", RICHARD T. MOREHEAD TITLE AND ESCROW, INC. OLD REPUBLIC NATIONAL TITLE INSURANCE COMAPNY /1L \ �' `IAF Y0,0 t.1 �, �� -rte 10' 3056 • �•• Q• 15 A0.E •..'x 76 • a: 4 ii • w1 mot` ., .,., 5 ,r t�' \ mi .- TOT 3 „ � ,y tr- N BLOCK 10 �. Jt ^ • s. \ oKc1°ERY Illr•. `rZ tV ^� sP Po,'') A• • •, + - _' RA/In.3.MIME at.a,A m 6I-6 31. LD1.• yG J,d • 14-5. \ * » �.., T .opo r � ii ` , '.-x.n ) LOT IN C-t �,. BLOCK ID S 29'1 t'48•W • _ j' 1 `, ,C: 15:r- NAT; 28.10•,(MEASURED) • —. � VI/ �.J1r W .�28.28 (PLAT) (� /j e� NE35°2 yl ; a..a,m V p V EW 1� DiOCK,D 'T Ray Thompson '��� I �q� SURVEYING, I.xe. Eirharb E. •arrhrnb °L`°R'PT"w —T �,j Ling Me DISTANCE/or TOeS Bills cob Euiam, 2nr. 1�J /"� �� 1825 University Boulevard West E O CH. STREET V 1 — Jacksonville Florida4432217 NEPNNE BEACH,FLORIDA,32266 (11U`. © I (Phone)904-4485125 (004}247-8147-FAX(504)-N7-6067 (Few) B04 448-5176 0013 N 4149/ DA It 01 I IFD SURVEY ___j CAI r• 1 T p- LEGEND: —OM: NGS'ARC BASO CH ML_.eLAL MAIM U ---,-W-1'4.1,0:1--- ...LUNG 5-)�+f1+SD-- CIA I t ICA T, C ENT EASTERLY BOUNDARY LINE or SUB.Cet PARCEL. f�,e. 11E 0,1011X, 0 SET 1/2:REBAR PC o POINI q"CURVATURE 2'B]GRAPHIC )(T IL4 MTV R£CAREENED LANDS UE WITHIN FL000 ZONE (� SIANPED PSN�'8146 K,_S6.e74914 AS SMOWN aN THE 844;120075AL FLAW INSUR P7 Li °' �r vc v as DA �`' •a FOUND 1/2'IRON PIPE PT POINT Of TANGENCY DAM,0 NOVEMBER 2,2016,COMMUNITY NUMBER; PANTE W r NO IpENTiT CAtiON PRC = POINT OF REVERS '1'THIS SURK REFLECTS AL EASEMENTS k RIGHTS OF WAY AS PEA RECIXIaFL` y/ (UNLESS OTHERWSF NOTED) CURVATURE PUT k/W R IJ:COMMITMENT OR OTHER DOC4I.ENTS FRONDED BY CUFNT /6q '� SURF 744 UNtf 55 OTHERWISE STATED.NO Ol11Eli TPF VERIFICATION HAS RI A �- Na eite CONCRETE MONIINENT 700 - POINT 10 COMPd1Np PLPI SV EU BY 11E UNINASICNEO, CURVATURE 4 TM S%RVt 6 NOT YALE/*ABM AN AUl11LN11CATE0 ELEGIRONIC SIONARI14 REGIS-ERTL A-FLORIDA A/C AIR COND1110NER Cf-1)- CONCRETE AN ..'NF=A I.SFM. :^ o, LAND SURVEYS 0 CONSTRUCTION SURVEYS ',UBDIVISIONS ejy ` ;' CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD + ATLANTIC BEACH,FL 32233 (904)247-5800 \JI31 fir' SURVEY AGREEMENT NOTICE All new projects creating more than 250 Square Feet of impervious surface or requiring on-site storm water retention, including swimming pools, will require pre-construction and post-construction topographic surveys, as required by COAB, Section 24-66 and described in Bulletin 2-18, Surveys. The surveys must be new original documents, from a licensed surveyor, signed, sealed, and dated. Other small projects, such as fences and construction less than 250 SF,will not require a new topographical survey,but a current original-size survey with all relevant details is still needed. These surveys,when included as part of a building permit application,must be complete, up-to-date,and original size and scale, as produced by the surveyor. Copies of old surveys lacking details or copies not of original size cannot be accepted. Building permit applications with unacceptable surveys cannot be reviewed and the application will be returned to the applicant. Thank you for your cooperation in this matter. AGREEMENT I have read and understand the Notice above and affirm that the outdated survey I am submitting is still accurate and complete, and all structures and impervious surfaces on the property are shown on the survey. I further understand that, if the survey is found to be inaccurate or incomplete, a $50.00 Plan Resubmittal Fee will be charged; or if the permit has been issued, a Stop Work Order will be posted with the associated $110.00 Fee. JOB ADDRESS 1 1 selosi Y wu i 1'►at 'Take. OWNER or CONTRACTOR(Print) A.j 11X, 'Wit)ifi\. Signature Aa Date 1°14 1