174 Jackson Rd Fence Submittal (2) Building Permit Application Updated 10/9/18
(17 , ._ City of Atlantic Beach Building Department **ALL INFORMATION
� 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
`rT°,,,,,,/ IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address:114 �N 4. Alk.,Ak4 L IRA,R,4031?PermitfNumber:
Legal Description trAC"� `,DT I . c�� 4 �jAWk.51- v RE#
Valuation of Work(Replacement Cost)$Vett`p. 10 Heated/Cooled SF Non-He. ; , -1. . IVE
• Class of Work: "iaNew ❑Addition DAlteration ❑Repair ❑Move ❑Demo ❑Pool ❑Win. , "IDNOV 1 2 2021
• Use of existing/proposed structure(s): ❑Commercial BResidential '
• If an existing structure,is a fire sprinkler system installed?: ❑Yes No BY:
EY
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) �' io
Describe in detail the type of work to be performed:Ice WpRf-QSC1t'4 WA e9 ii-TW W ' t A
111" IANFAiR- 061- v4009pp 1-. iL .•'Me t.ic y \\ -
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name tyit 94441,‘,9,(*\,4I4 Address 114 z-kcii,-5Oet f9,
City R %eLlr State Zip 372`,`7, Phone &,s' I a - '.i0
E-Mail ooktt C �,etif1 DPOOlicico46zG MAIL• cc
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company C.45to IN.N. rcq S Qualif ing Agnne.n��t �' ^
Address 46tigo ► r-NAPIX4 City` tkiikNX State Zip -2_2A6
Office Phone i *A.- Job Site Contact Number
State Certificate n/ egistration# E-Mail lito.ves c,--kts. 40,, r k. emA
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer' r -a �j OR Exempt 0 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 Y UR TICE OF COMMENCEMENT " (......---
oka
(Signature of Owner or Agent) Sign ure of Contractor)
Signed and sworn to(or affirmed) beforenme this�Th day of Signed andts orn to(or affirmed)before me this y of
NMed a '' °s1
aD l affirmed) '. m h Ufa day of 14°Q44.141-
p-,�21 ,ID,..
:c'!,'
e� .._Ja��� .
�- A (Signature o otary) na i.�. . .
JUNECc�g � � ER-KONGQUEE
Commission#GG 279787
�w ire.". JOYCE MARIE FREEMAN
( -�:: :o;` Expires Februa 8,
Versonally Known( i• Notary Public-State of Florida [ ] Personally Known OR q ",;orq;;•• BorMaCThru T rY 2023
[ ]Produced Identifica+o ii Commission I HH 092628 royfainlnsurance800.3g5 7019
?or n. `� My Comm.Expires Jun 10,2025 `
[i]produced Identificatio
Type of Identification:' Bonded through National Notary qty, I Type of Identification: -R...:541211110.--"E, lr""`
'---- - - - - — — — — •
**ALL INFORMATION
ft'%L'�r,. Owner Builder Affidavit HIGHLIGHTED IN
j City of Atlantic Beach Building Department GRAY IS REQUIRED.
e. FL 32233
r800 Seminole Rd, Atlantic Beach,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 ISA 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: KA ,�,,4404 - � a - $4' VN__. 2233 p�� p
Owner Name: I'Y�' Y $% J v..., 9 -t\ Phone Numbe�r:l,�.',W,`" ) 6\ibAb3"�
Mailing Address: i7�-9C & �.9t City: t �t j f2e.“ State: DW ' Zip: 2.1_,)%
Notarized Signature of Owner d QfacA. 0• 134.12114,-
The
foregoing� instrument was acknowledged before me this l Z day of J'VO 1/6-413t7�o2/ , in the State of Florida, County
T �U
Signature of Notary Publicli w `/
[ ] Personally Known OR [11<roduced Identification
_ ""r'' , CHRISTIAN GILES � �r�
;.. MYCOMMISSION#ublHH117153 Type of Identification: ` L-- 0 . 1...._. -
+:,a o;;�' PIRGS :Apri113,2025
�YAare Updated 10/24/18
Fence Addendum Updated1/14/2021
City 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:
tr 4 -c. A—T'L . 522 i / I z / 2 i
Property Type: Lot Type/ Features:
1IResidential ®"One Street frontage (interior lot)
❑ Commercial 0 More than one street frontage(corner lot,through lot,
etc.)
❑ Swimming Pool
Fence Material: Fence Height (select all that apply):
VrWood ❑ Four Foot(4ft)
❑ Chain Link O'Six Foot (6ft)
❑ Vinyl ❑ Other
❑ 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)
• o
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
0-No
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.
(---
.....,..,,\\
MAP OF BOUNDARY SURVEY
DESCRIPTION AS PROVIDED BY CLIENT:
PART OF LOT 15, DONNER 'S SUBDIVISION, ACCORDING TO A PLAT RECORDED IN PLAT BOOK 8,
PAGE 4, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA, MORE PARTICULARLY
DESCRIBED AS FOLLOWS: BEGINNING AT A POINT IN THE NORTH LINE OF SAID LOT 15 AT A
POINT 140 FEET WEST OF THE NORTHEAST CORNER THEREOF, AND RUNNING THENCE WEST
70 FEET; THENCE SOUTH 109 FEET; THENCE EAST 70 FEET; THENCE NORTH 109 FEET TO THE
POINT OF BEGINNING.
DESCRIPTION AS SURVEYED:
PART OF LOT 15, DONNER 'S SUBDIVISION, ACCORDING TO A PLAT RECORDED IN PLAT BOOK 8,
PAGE 4, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA, MORE PARTICULARLY
DESCRIBED AS FOLLOWS: BEGINNING AT A POINT IN THE NORTH LINE OF SAID LOT 15 AT A
POINT 140 FEET WEST OF THE NORTHEAST CORNER THEREOF, AND RUNNING THENCE WEST
70 FEET; THENCE SOUTH 105. 5' FEET; THENCE EAST 70 FEET; THENCE NORTH 105. 5 ' FEET
TO THE POINT OF BEGINNING.
P.0.8.
S.N. 6 D.
JACKSON ROAD R/W VARIES LB 7261
RHONE FIRST COAST
_ _ _ F.IPI1 2"_BOX WEST 70_00' A 140.00'
M.P. `56 IT
a M.M.
N.E. CORNER
0�2`O ;a. X EXITING
(IT INGT NON T IN
15
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'04' o ••, . . :•..; .•... ,'•'X• RIGHT OF NAY)
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0.8' 09 _ 6' W-F `'. 5'
EAST 70.00'
SURVEY NOTES: F.I.P. 1/2" S.I.R.C. 5/8T '411 INTENTIONALLY LEFT BLANK. L6645 L87261
#2 UNDERGROUND UTILITIES. FOUNDATIONS OR OTHER
IMPROVEMENTS WERE NOT LOCATED BY THIS SURVEY.
#3 ACCORDING TO THE FEDERAL EMERGENCY MANAGEMENT AGENCY
FIRM MAP PANEL N0. 12031C 0408 H, EFFECTIVE 06/03/2013,
THE PROPERTY DESCRIBED HEREON APPEARS TO LIE IN ZONE X .
#4 THIS SURVEY PERFORMED WITHOUT BENEFIT OF AN ABSTRACT,
TITLE SEARCH, TITLE OPINION OR TITLE INSURANCE.
CERTIFIED TO AND FOR THE
/5 DIMENSIONS ARE SHOWN IN FEET AND DECIMALS THEREOF EXCLUSIVE BENEFIT OF:
AND ARE PLAT AND MEASURED UNLESS SHOWN OTHERWISE.
o HAYWOOD M. BALL, P.A.
a /6 ALL EASEMENTS ARE PER PLAT UNLESS SHOWN OTHERWISE. OLD REPUBLIC NATIONAL TITLE INSURANCE CO
in BEACHES HABITAT FOR HUMANITY, INC.
CD #7 THERE MAY BE ADDITIONAL RESTRICTIONS THAT APPLY WHICH ARE NOT SHOWN
in ON THIS SURVEY WHICH CAN BE FOUND IN PUBLIC RECORDS OF SAID COUNTY. ADDRESS:
co
al 08 THIS SURVEY DOES NOT GUARANTEE OWNERSHIP. 174 JACKSON ROAD
of ATLANTIC BEACH, FL.
in #9 TEMPORARY, NON-PERMANENT IMPROVEMENTS AND/OR MAN-MADE ITEMS
co /
SUCH AS, BUT NOT LIMITED TO THE FOLLOWING; BUILDING MATERIAL. IN
o STORAGE PODS, PAVER BLOCKS, RUBBERMAID OR PLASTIC UTILITY
o BUILDINGS NOT ON FOUNDATIONS, VEHICLES ON BLOCKS MAY BE ON /
N THIS PROPERTY BUT NOT LOCATED OR SHOWN. ' Vm /10LEGAL DESCRIPTION PROVIDED BY CLIENT. //*y*'
' �0o NOTICE OF LIABILITY: THIS SURVEY IS CERTIFIED TO THOSE INDIVIDUALS SHOWN ON ,/ /
a THE FACE THEREOF. ANY OTHER USE, BENEFIT OR RELIANCE BY ANY OTHER PARTY IS l;�G
n STRICTLY PROHIBITED AND RESTRICTED. SURVEYOR IS RESPONSIBLE ONLY TO THOSE CLYDE 0. AN KLEECK
CERTIFIED AND HEREBY DISCLAIMS ANY OTHER LIABILITY AND HEREBY RESTRICTS THE FLORIDA REGISTERED SURVEYOR AND MAPPER NO. 2546
RIGHTS OF ANY OTHER INDIVIDUAL OR FIRM TO USE THIS SURVEY, WITHOUT EXPRESS NOT VALID WITHOUT THE SIGNATURE 6 THE ORIGINAL RAISED
WRITTEN CONSENT OF THE SURVEYOR. SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER.
o
X
2(..C.M. - FOUND CONCRETE MONUMENT C.M. - CONCRETE MONUMENT SEC- SECTION FEN - FENCE: OHE -OVERHEAD ELECTRIC
L F.I.R.C. - FOUND IRON ROD AND CAP P.T. - POINT OF TANGENCY TNP- TOWNSHIP CLR - CLEAR C.L.F.-CHAIN LINK FENCE
°_ F.I.A. - FOUND IRON ROD P.C. - POINT OF CURVATURE RGE- RANGE FND - FOUND W.F. -WOOD FENCE
i F.I.P. - FOUND IRON PIPE U.E. - UTITLITY EASEMENT P.I. - POINT OF INTERSECTION (P) - PLAT C.B. -CHORD BEARING
L S.I.R.C. - SET IRON ROD AND CAP D.E. - DRAINAGE EASEMENT A/C - AIR CONDITIONING UNIT EL - ELEVATION N.M.- WATER METER
F.N60 - FOUND NAIL AND DISK C 6 G - CURB 6 GUTTER NTS - NOT TO SCALE CONC. - CONCRETE M.P.- MOOD POLE
w (M) - FIELD MEASUREMENT R/W - RIGHT OF WAY (PR) - PROPOSED ESMT - EASEMENT P 6 M- PLAT 6 MEASURED
w�C) - CALCULATED MEASUREMENT C/L - CENTERLINE (E) - EXISTING COR - CORNER M/H- MANHOLE \
T INFORMATION
PLOT PLAN
FIELD SURVEY DATE FIRST COAST LAND ` ORDER NO:C 9512/25067/25585
cii
z BOUNDARY 06/12/06 SURVEYING, INC. DRAWN BY: TNP
w UPDATED 08/10/2014 REVIEWED BY: VAN
_JUPDATED03/06/2015 840-222 EDGEW00D AVE S. JACKSONVILLE, FL. 32205
IL PHONE (904) 779-2062 FAX (904) 779-7784
\ .:INAL / CERTIFICATE N0. LB 7261 J