2009 Selva Madera Ct RFNC21-0141 Fence Submittal / Building Permit Application Updated 10/9/18
/i ;, City of Atlantic Beach Building Department **ALL INFORMATION
_ / 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
\-i� IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 2-009 cai/Pr MVO* (."'( Permit Number:
R.1- , Zl - 014
Legal Description 110-17 Of —ZS-Z7 C: SE/144 not—TE ovirZ tor BZ RE# 10 506 - (bS4
Valuation of Work(Replacement Cost)$ ila'3 Heated/Cooled SF N f ft Non-Heated/Cooled N/11k
• Class of Work: ❑New E? ddition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑CommercialResidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes CINo //
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) C�iVo
Describe in detail the type of work to be performed:
i NS nf.L- AV6w ref<E - 0_0 col c i-c-t Mr WblG N 1%( 1!kk FeNCE
Florida Product Approval U for multiple products use product approval form
Property Owner Information
Name PAOC crEkitri--Te Address 2004 SEL✓f} /1^IPEek Cr
City ferleK1L t3E1tf.Q1 State ft- Zip 72233 Phone 170 -272 - 15'2l
E-Mail sirxt, -/Fe coltw-L. co--o
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company et ST f^12-1 Qualif ing Agent
Address 2.00i SEW / 'Qeti-A' Cr- City 1C j?Ektittate 1 L Zip 223 3
Office Phone 770 4:71,- 7c2? Job Site Contact Number
State Certification/Registration# E-Mail 4 ^'Iu.'it�L L-• co-A--
Architect
o-A -Architect Name&Phone#
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
RECO;•ING YOB NOTICE 0= NCEMENT.
(Signature of Owner or Agent) (Signature of Contractor)
Si ned and sworn to(or aff:d)before m this i 1day o Signed and sworn to(or affirmed)before me this day of
v4 ZO. . . n e-coQ4 , ,by
--411% w (Signature of Notary)
[ ]Personally Known OR 'l = �FiH; TONI GINDL€ji Wally Kr wn OR
'I .. I:+ ., MYCOMMISSICgN]f dertification
[ ]Produced Identification 7: r,,lr
Type of Identification: 41:.:-r.`,"`"yr`'` EXPIRES:0 �-itificfzion:
--b Notary Public Underwriters
Owner Builder Affidavit **ALL INFORMATION
t�—L'Jr�„ HIGHLIGHTED IN
\�s `° City of Atlantic Beach Building Department GRAY IS REQUIRED.
"Wir 800 Seminole Rd, Atlantic Beach, FL 32233
---cmgfePhone: (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: ZC O' ra.v4 M4PE.' C
Owner Name: hrt,Gt MAXI-1C Phone Number: 710 478 —7SZ.7
Mailing Address: 2005 SELV't "'Valk'k' Cr City: ,4' C- 3 State: Ft Zip: 3221?
Notarized Signature of Owner Ate....-- kr...".
TheMing instru ent was acknowledged before me this l 7 day of 0 f 200 r n the State of Florida, County
of v f ,
(4ii/'
Signature of Notary Public` 0,--
[ ] Personally Known OR [ ] Produced Identification
Type of Identification: L
, ,..,. Updated 10/24/18
h
11 ..0'.PU � TONI GINDLESPERGER
'�i t MY COMMISSION#GG 353178
:;; a�' EXPIRES:October 6,2023
1 :°�F,,O•' Bonded Thru Notary Public Underwriters
i Vin;,, Fence Addendum Updated 1/14/2021
f1 ,., 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:
'i x`i SeiVA- ' - 2,v cr II/le/Li
Property Type: Lot Type/ Features:
"Residential D One Street frontage (interior lot)
❑ Commercial I/More than one street frontage(corner lot,through lot,
etc.)
Kf Swimming Pool
Fence Material: Fence Height (select all that apply):
E'Wood ❑ Four Foot(4ft)
❑ Chain Link H/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)
1N o
Will tree(s) be removed in association with proposed project?
❑ Yes(must submit separate Tree Removal Permit)
I/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.
t, .
----- - _3 .()UNDARY SURVEY ,...‘
/ SURVEY NOTES r c.P
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CONCRETE DRIVE AND WALK CROSS THE PROPERTY BOUNDARY 7 1'IS;0' LINES ON THE SOUTHERLY AND WESTERLY SIDES OF THE LOT
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LINE TABLE
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4 OR 1 °40* UNDERANAUTMYHENDITRICEACTICELECTRONIC /
STATE OF
SIGNATURE AND AUTHENTICATED ELECTRONIC SEAL, LB#7893
OR A RAISED EMBOSSED SEAL AND SIGNATURE,
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SERVING FLORIDA A........, p. 6*
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KennethDigitally signed by
Kenneth Osborne 6250 N.MILITARY TRAIL,SUITE 102
WEST PALM BEACH,FL 33407 1
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sDate:2021.08.23 PHONE (561)6404800Iore(SIGNED) 1452:38-0400' STATEWIDE PHONE (800)2264807
c KENNETH J OSBORNE micAcifetlig r?IttiNg 0 STATEWIDE FACSIMILE(800)741-0576
PROFESSIONAL SURVEYOR AND MAPPER 06415 WEBSITE: http://targetsurveying.net
NOTICE OF COMMENCEMENT
State of FLOtat DA Tax Folio No. (69 5.06- 16S It
County of DUVAL—
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 stated in this NOTICE OF COMMENCEMENT. T nJNCC Tom,
Legal Description of property being improved: 110 V.09—2S— Z?E CEL-VA' /44/2.1t—
Lor
2 —
LorgL -
Address of property being improved: 2001 StC✓R "APER q C r
General description of improvements: FENLE 1 Nr(fLL
Owner: P(WK ST11"112 1 Address: 70' SaVA ,p01,14 LS
Owner's interest in site of the improvement: (OO
Fee Simple Titleholder(if other than owner):
Name:
Contractor: I4Lex S 40-T
Address: Seto 4 �� ci —
Telephone No.: 110 —27R— 7517 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):
THIS SPACE FOR RECORDER'S USE ONLY OWNER i
.40
Doc#2021307158,OR BK 20020 Pae 486, Signed: _ Date:
�
Number Pages1 Before me this � ay of Q
Page - in the Count o State
:
Recorded 11/17/2021 04:12 PM, Of Florida,has personally appeared , FL-h L
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL Notary Public at Large,State of Florida,County of Duval.
COUNTY My commission expires:
RECORDING $10.00 Personally Known: i or
Produced Identification:
s+� EXPIRES:ApdI 13,2025
''.,RR °`A Banded Thu Why Public Uninffikeri