28 N Forrestal Cir Fence Submittal J r
'''�' Building Permit Application Updated l0/9/18
} City of Atlantic Beach Building Department **ALL INFORMATION
�' 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
�``''�``/�/ IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 2Y Fb I CIL C__ilk LE MOP T)t Permit Number: j
Legal Description( .&L,�k 1%, I (a, ),'11--t ' L L;-C C�1 P--,11.e. RE# _ ( t 7 LJ — 0 00 0
Valuation of Work(Replacement Cost)$—7D0C Heated/Cooled SF Non-Heated
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/ r NOV 2 3 2021
• Use of existing/proposed structure(s): ❑Commercial Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes OrNo BY:
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) No
Describe in detail the type of work to be performed: Re,f kce f e v cc,, `
Florida Product Approval# for multiple products use product approval form
Property Owner Information{ _ �}n 1 _ p ,
Name MPi)r�j 1Sk{'U j \ ` _ Address 7S YOKKe,TI-1L �.,. 1 N0/� 7
City A t I Cjit T lc { $2Oi CAA State t' L Zip '32i.-1 -; Phone �J L L - 2.`�J'''74`7
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Qualifying Agent
Address City ,- State Zip
Office Phone Job Site Contact Number
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt D Expiration Date
Application is hereby made to obtain a permit to do th ork and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and th 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 YOU ' OTICE OF COMMENCEMENT. `'
ly
/Signature of Owner or Agent) (Signature of ontractor)
Signe and sworn tolor aff -.)before •e this day of Signed and sworn to(or affir• ed)before me this ZYday of
0V , '- L', • 4. _ .. CL__ •Y
ammo
e .r,�1A (Signature of Notary)
;a�` �P4 's TONI GINDLESPERGER i'"�
_� i' ;; MY COMMISSION#GG 353178 I r
YPig,w�nhg, �i, [ ] Personall nown OR
,, � r,jr]FPer rY
t...-la , ,i. •rs [ ] Produ -d Identification
Type of Identification: 0 ,� Type• Identification:
Fence Addendum Updated 1/14/2021
f--
..,.,. 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:
ZS' 'f1)((f��-A 1 C;' l e /VV, ( 1 i//2-5/2- z/
Property Type: Lot Type/ Features:
Residential ❑ One Street frontage (interior lot)
O Commercial Kilore than one street frontagenerBrough lot,
etc.)
❑ Swimming Pool
Fence Material: Fence Height (select all that apply):
❑ Wood Four Foot(4ft) 51 do
❑ Chain Link ASix Foot(6ft) 6 C k
1
.k Vinyl )(Other A l U 1"'1 I - 1D )n
❑ Block/Stone (Plan details required for footings and/or
retaining walls)
4Other Allit VII 10
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)
,XN o
Will tree(s) be removed in association with proposed project?
❑ Yes(must submit separate Tree Removal Permit)
kNo
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.
Owner Builder Affidavit **ALL INFORMATION
rs'--�`�r,,, HIGHLIGHTED IN
f 5 f "' City of Atlantic Beach Building Department GRAY IS REQUIRED.
r�
.� 800 Seminole Rd, Atlantic Beach, FL 32233
M_1 � 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-BUILDERlPERMIT.
Job Address: Z,� pFO/PR�S 1fz L C�-AC'LE NOI r17
Owner Name: MA I�I HU Yfi. Phone Number: 9'01- Z9/-74 y 7
Mailing Address: Zs' d PR E 5Th L CrI /ity: A i�t"SCC 9f-imitate: FL Zip: 32.133
Notarized Signature of Owner 1/1/17,,542' ry
The ` r goipg instrument was acknowledged before me this 48 day of N? 1./ , 20 C � in the State of Florida, County
of .0b VA-L
Signature of Notary Public
[ ] Personally Known OR [ ] Produced Identification
Type of Identification:
Updated 10/24/18
MAP SHOWING SURVEY OF
Lot 9 , Block 2 , Atlantic Beach Villa Unit No. 1 , according to the plat
thereof recorded in Plat Book 30 , Page 56 of the Current Public Records
of Duval County , Florida .
Certified To: Mary Elizabeth Shuda, In _ (r�"
Title Insurance Company of Minnesota ��
and Florida Homeloan Corporation . t�
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3 I!WE HEREBY ACKNOWLEDGE AND
oZ ACCEPI THfS REP,
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ELUS,CUR71S&KOOKER,INC. Ihereby unify Slat tothe best of ENERALNCTES:
Land Surveyors and Planners myknowle je ndl t,the intormaUon 1)TI*tea:
NOTICE OF COMMENCEMENT
--7 ( 7 C 0
_
State of F i 0 Y'�", Tax Folio No. I ! �
County of b it\(r I
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. ^( 1 / f
Legal Description of property being improved: r' P r\ ' t., iSeQ�=�-�l Y , l 0.l i Pl L
C
Lc,+ g , ill k Z.
Address of property being improved: -a Fo r(e 5 kJ Ct 1rc I e North
General description of improvements: a I (Ct C ( rN cj i C'
Owner: SI K d`=1 Address: 2 q rD ((e S �`1 I C
ur^ 1 (-C l< IVO r 4"6)
Owner's interest in site of the improvement: re f kc i v'C 'c-vC (-
Fee Simple Titleholder(if other than1ow r): '--�p __ t ry, p ` -e .
Name: Cie 5 Yt )4, C
Contractor: CD ('\ F f —
Address:
Telephone No.: 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 t)e},i a •c recor t ( NIUg%p.s = 5e : to is
}} * MYCOMMISSIO ;
specified): `I='•. rRr I-,,,,.;..,... 0., ,: EXPIRES:October 6,2023
THIS SPACE FOR RECORDER'S USE ONLY OWNER °F P` F3onded Thru Notary public Underwriters
--.-- -_
Doc#2021311366,OR BK 20026 Page 1295, ned: X �' L Date: 1 ( /Z-3 Z
Number Pages: 1 `ore me this day of C,J 7 OZ ( in the County of Duva,State
Recorded 11/23/2021 09:41 AM, Florida,has personally appeared 1\A,133-- g..- %h.d
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL
COUNTY tary Public at Large,State of Florida,County uval. /
RECORDING $10.00 commission expires: 0--sonally Known: ( or
..,duced Identification: