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210 POINSETTIA ST RFNC21-0130 Building Permit Application Updated 10/9/18 City of Atlantic Beach Building Department **ALL INFORMATION My 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY it u`" IS REQUIRED. Phone: (904)p247-5826 Email: Building-Dept@coab.us Job Address: 2 I 0 Po i h Sc1-ha. St ,p Gf Permit Number: I- NCS bO Legal Description t�ii 'j ��� ,�i i, 'rs' a; • ��tSLIPC\R Sa,3 N1/2 Wt54c6 RE# 11 05741-06°Q Valuation of Work(Replacement ost)$ 4-2.00 Heated/Cooled SF Non-Heated/Cooled • Class of Work: ❑New Addition ❑Alteration ❑Repair ❑Move /Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial f tesidential • If an existing structure,is a fire sprinkler system installed?: ❑Yes • Will tree(s)be removed in association with proposed protect? ❑Yes(must submit separate Tree Removal Permit) ©No Describe in detail the type of work to be performed: T Il Z fen(,Q, I S d ctrYa Jed .co 1-rc1 I i vtl dowit) tiv?Yv1- 4,1 wl 0 i v y I fth Florida Product Approval# for multiple products use product approval form Property Owner Information Name LitclG A/ P k(yy � Address 2-ID PO ► V11C4-h City Ac city tIG g(�ilC/''7 State IL Zip 2�S 3 Phone col- 6' S3a2 E-Mail /I'✓1dSGyj pc+-ry13e fJmck i I • C-0 on Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) 1_I YVA I92'X�'� Contractor Information / Name of Company 5IY1ttk Rice COmPaviy tVX_QualifyingAgent Address (4-1 MOvacc�5f. City JacKsortJi t)(_ State FL Zip 22-Lf Office Phone (101.\- 7 431 t Job Site Contac ' . ber State Certification/Registration# E-Mail ' nth C.41 cz-co 0-4Th O • c 0 M Architect Name&Phone# ‘onm�ausc4' i - ' 04 - ' 3 - L 2 Engineer's Name&Phone# Workers Compensation Insurer OR Exempt❑ 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 REO ING YOUR NOTI�OF COMMENCEMENT. (Sign e of Owner or Agent) (Signature of Contr tor) ed an sw to or affi bef re me thi iia of Signed and sworn to(or affirmed) efore me this day of ,'2dZ (by�t f y , by jr (S',1 at c' •t )%hi (Signature of Notary) 4.11 ': . f rNI GINDLES?ERGER [ ]Personally Known OR ,:0..•`., �=_ MY OMMIHIBRf5 AX3Ww OR [ ]Produced Identification �'•. ' ' EXPIRES:arRgt.i6pAyientif ation :;..:....•oma; n Type of Identification: ,�FF�,`, Bonded Th,u NaMPc'fitfli gl 0o Owner Builder Affidavit **ALL INFORMATION �L'lr�,. HIGHLIGHTED IN ,, City of Atlantic Beach Building Department GRAY IS REQUIRED. a f) rI ) 800 Seminole Rd, Atlantic Beach, FL 32233 ` -t'j''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: 2..i) PO\11€Jt1 O1 sk (��,(� Owner Name: L:\1 (:1 Spe y C t,Y rl y� y1 Phone Number: 6104-Z�Q--9)302- Mailing UW 2. Mailing Address: Z1 O [ O InCitit St City: h"� IGn 11c @c State: f L- Zip: 32-.' � Notarized Signature of Own A4,--ke3214,44_-1f) The foregoing instrument was acknowledged before .this 1 S day of .r `e 6cr, 20 2,1, in the State of Florida, County (..4.,........___v of uvo_ t OP of Notary Public , (\. .__ t ] Personally Known OProduced Identification * ype of Identification: �✓ =`��ii<:,;c; TONI GINDLESPERGER =� i._%..%''': MY COMMISSION#GG 353178 'i"i EXPIRES:October 6,2023 Updated 10/24/18 .FpF F°; Bonded Thru Notary Public Underwriters SSS\, Fence Addendum Updated1/14/2021 'IMCity of Atlantic Beach Building Department 800 Seminole Road, Atlantic Beach, FL 32233 PERMIT# Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: Date: 210 thInce„-i-ri G St. Property Type: Lot Type/ Features: /Residential 'One Street frontage (interior lot) ❑ Commercial ❑ More than one street frontage(corner lot,through lot, etc.) ❑ Swimming Pool Fence Material: Fence Height (select all that apply): ❑ Wood 0 Four Foot (4ft) ❑ Chain Link /Six Foot (6ft) Z v0Cinyl ❑ Other LI Block/Stone(Plan details required for footings and/or retaining walls) ❑ Other Fence Location: Please submit an accurate and current boundary survey showing all existing improvements(including building footprint, driveway,swimming pool, etc.) and location of fence/wall and any gates. Plan details required for block wall footings and/or retaining walls and any portion or fencing above 6ft in height. Will the fence be built in an easement? ❑ Yes (must submit separate Revocable Encroachment Agreement) 1Q No Will tree(s) be removed in association with proposed project? ❑ Yes (must submit separate Tree Removal Permit) Colo Conditions of Approval: • Roll off container company must be on City approved list. Roll off container cannot be placed on City right-of-way. • All old fencing and debris must be removed from job site by contractor or homeowner. 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 NOTICE OF COMMENCEMENT. ORDERED BY - I ISLAND - 2 TITLE E r + +1 „, .,. ()P 9T AL'1:1:RTINI:I.1.4 / ��:>��`q ,s' \-'ds rf tL '+ p WV"V iSlwdtidCkLUVn " ca • Phone 9114 4717272 Fax 904.471 4242 °' PROPERTY ADDRESS.210 POINSETTIA STREET ATLANTIC BEACH,FLORIDA 37233 SURVEY NUMBER:ISOB 0556 FIRD WORK DATE:worms REVISION°ATE(S}:gKVO V'MOM 1508.0556 TA1511 BOUNDARY SURVEY DUVAL COUNTY L I 75.00'(P) N 0'0127'W 75.01 (M) 1irS d L2 25.00(01 may, N 20'14 i 9'E 24.96'(BA) RBA=D & 1P NOT DertRMINC0 (3 100.00(P) ' 5 69'4806`C 00 08'(Ml ',4 5)7.00 Cr') N 20. 136•E 49.68 fM) Z 4, ' 1°7-525 CBT' 9:Fi P' L, s ? a � C',4.? 1s•• J.Tt� cw, Mr.) 69.E 3q, 6, A y 6�T •c1017 p. P LD.7377 ." if �.,. - :. j Of ! 7-r nP IR'N ( ./2 ran, 4. N0�9V •t. % 077 Oh ; 1��+/ r: F_` Y�*1/ / ,;, ,:-,- k 6y.�Ob�. /0 4 •r 1,420,--, TH, ` rlfyrs � A 40,1 ... n,.43°1(4i61. w "V•0!'�j t•�1�—�:r•k'7-:iv>` � �0�1 , � y r s :, 2 �a' �„_;;00 1” �� 'ram. 1 4,3 c Ir>.. ! '�* s or �. �i/ ....gee 0j's� 20is _ k 3 0 5 (4o NA, 4tt,,, P rapyc.* ` 1AmrbelitSt • AnIwomdr,+crbao ;ropey Au•.;made ander mydisecL i bbbed ofmy I t Army SW Sendit • ..7 e''bS• , &As' Bard8.•• . , , Il.i,;, CAacor -17o' o 10 o IS so .,. 1114% uatA�a,keno, GRAPHIC SCALE (In Feet) s,..aruoPn mbri .,aIF.FP. iikoa..... 1 inch 30' ft _,* ne U..M,v 5,,,.4 fe,wtwr.urw tr...,mlaa.4 wino.r.., Sere W..ndWLwJ uteh a e1.forma. Imetn;Poem+ens;b.0 m.emGirtunuytu.rr H.ekrnone03teuwme..C.nrra FLOOD INFORMATION: POINTS OF INTEREST BY PERFORMING A SEARCH WITH THE.00AL GOVERNING NONE VIS'ELF MUN CIPAUTY OR WWW FEMAGOV,THE PROPERTY APPEARS TO BE LOCATED IN ZONE X TH S PROPERTY WAS FOUND IN THE CITY OF ATLANTIC BEACH,COMMUNITY NUMBER 120075,DATED 06/133/13 li. Florida Land AFFILIATE CLIENT NUMBER: ,DATE:8!17/2015 ; Title Association BUYER: KNa..d.,T. I..e,e,.B..•H.IoHoodun,Tntt43Nb.cgrnmm �;:�'�' MEMBERS SELLER: ikE CERTIFIED TO:BRUCE H. :AS TRUSTEE OF THE BRUCE H.HOWARD E=...±.=_Ac T A LIVING TRUSTST DATED APRIL 2(2000:ISLAND I LE OF ST AUGUSTINE LLC CLO REPUBLIC NATIONAL TITLE INSURANCE COMPANY Land Surveyors Inc. �,. This b e 1 of 2 and is not valid without aR es. PaE671S I.FL W9 pages. it 1�9.OIrv.7 Wet Dew,SJIe 1•fL 4pIt FL 11}11 NOTICE OF COMMENCEMENT State of 'F L Tax Folio No. � 170c)71--0060 County of O'\c 1 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 statedpp ?..1in this NOTICE OF COMMENCEMENT.IT. Legal Description of property being improved: SPc1 f'k �� ' N 1/2—2— LO151f2 — Address of property being improved: 2_I 0 Po 1 1 cr-eAr 1 Gl, General description of improvements: R•4PIC1 cA VV) 'L_,X1 cLi r1C CQ/ Owner: Li►'\dyoj Pi Y 1uj Address: 2-I 0 Pu Ilei a S I • a9afi i L eck Owner's interest in site of the improvement: FL_3z Fee Simple Titleholder(if other than owner): Name: Contractor: ,, f n I h Ffi{l C.( rOJ (_orr)r6tArIL, , �h L _ Address: 13 9 MO1rCi'VSi- • J C --SOr1 v1 I(, , ft- 3 2—I I Telephone No.: —I 04_7L ? 7( (�75 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): • ah ?g• ; •aye TONIGINDLESPERGER THIS SPACE FOR RECORDER'S USE ONLY OWNER MJeciCTO,hMruMlf. SION#GG 353178 ,,: XPIRECctob� dOF F. lSine, �.?utllir e_Doc#2021271256,OR BK 19960 Page 528, g � �. Number Pages: 1 Before me is ea d.9of • `� in the my o 'uv. , tate Recorded 10/15/2021 10:56 AM, Of Florida,has personally appeare. l•1 a Se Li , - c e r ry JODY PHILLIPS CLERK CIRCUIT COURT DUVAL Notary Public at Large,State o Fl. '..,Co a of i uval. COUNTY My commission expires: RECORDING $10.00 Personally Known: QV or Produced Identification: L..