1635 Richardson Ln Front Porch Submittal r,',:-- -, Building Permit Application Updated 10/9/18
•
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
•-paw, IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 1(113(•:3 RtcNARb N LANG-- M.-f(1 • Permit Number: ^ /`�
Legal Description Z- c� 1 7 - ZS-Z`ic-. i.50 f to,�c.ts �� u' RE# 17 Z CI —9 s 4 v
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Valuation of Work(Replacement Cost)$ co 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 ❑Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• 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:
SCS t•i►Nev tNi 94)N i ‘70 R.04 .'&05 ,00
Florida Product Approval# for multiple products use product approval form
Property Owner Information-� ` / tp
Name r.st�� J1, VA 01t I Address 414WITI C- Q-c City CO P I Ci-MA �� (JP State Zip Phone ctoci. i 2—(�O?
E-MailA-t--{,A►gati‘WO(2- \0YAH-00 -004"1
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 0 Expiration Date
Application is hereby made to obtain a permit to do the work d installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all rk will be performed to meet the standards of all the laws regulating
construction in this jurisdiction. I understand that a se rate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANK ,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
REC ID G YT _ NATICE OF COMMENCEMENT.
(Signature of Owner or Agent) (Signature of Contr or)
ned and sworn to(or of )ed)before Si is day of Signed and sworn to(or affir •ii)before me this day of
, Zo __ •A ,1 �L;i,! 01.6 ,
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(SKaigture of lo ary (Signature of Notary)
' 41: , TONI G '1'GER
:
[ ] Personally Known OR . MYCOMMISSION#GIG}3DStgOnak Known OR
[ ]Produced Identification tr :4-1•• .-Pic EXPIRES;October6, e2duce4 Identification
e•: ""•PO ification:of Identification: .„ Bonded Nu NotaryPublicD vrldlie
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Owner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
i ,
City of Atlantic Beach Building Department GRAY IS REQUIRED.
-
800 Seminole Rd, Atlantic Beach, FL 32233
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 O�F AN OWNER-BUILDER PERMIT.
Job Address: K03S R i C AP.QSnN LAW- A�[t ,
1 �) R__ ��a:�`�
Owner Name: P 1{ LA D.` JARik-VO(G�K9`� �` Phone Number: v`OL 4r1Z-0040
Mailing Address: L� Romwi )lam+ l� ��
City: 6C 1'1 State: FL- Zip: 322:33
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Notarized Signature of Owner
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Thegoing ins rument was acknowledged before me this,—.2)/ day of A 4 r\ , 20Z the State of Florida, County
of c��
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Signature of Notary Public -_
[ ] Personally Known OR [ ] Produced Identification
Type of Identification: L � (.
Updated 10/24/18
•s,''° TONI GWDLESPERGER
R. �•� ': , MY COMMISSION S GG 353178
` 'o`, EXPIRES:October 6,2023
;SOF FISP: Bonded Thru wry" Unde " en
MAP SHOWING BOUNDARY SURVEY OF
LOT 8, FRANCIS COVE REPLAT, ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 52, PAGES 49
AND 49A, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA, TOGETHER WITH A NON-EXCLUSIVE
EASEMENT FOR INGRESS, EGRESS TO RICHARD LANE OVER THE EASEMENT AREA LYING WESTERLY OF SAID LOT 8
AS RECORDED IN OFFICIAL RECORDS BOOK 9394, PAGE 1069 OF SAID PUBLIC RECORDS.
CERTIFIED TO:
PAMELA VANHORN, BANK OF ENGLAND,
JAMES C. PAYTON AND ALICIA M. PAYTON,
FIRST AMERICAN TITLE INSURANCE COMPANY BLOCK 15, E.H. DONNER'S SUBDIVISION PLAT BOOK 8, PAGE 4
AND OSBORNE & SHEFFIELD TITLE SERVICES, LLC. ALSO A PART OF LOT F, BLOCK 15 (AS SHOWN ON BUT NOT INCLUDED IN)
DONNER'S REPLAT, PLAT BOOK 19, PAGES 16 AND 16A
CMS S 89'36'00" E 95.54' (R)
S 89'36'00' E 4.55' (R) PLS 1624S 89'28'17" E 95.52' (M)
S 8815'45" E 4.38' M)� 1/2" SUBDIVISION BOUNDARY
IRON PIPE 1/2"
S 89'36'00' E 5.55' (R) LB 6645 I IRON PIPE
N 89'4°'11/1"2.E 5.60' (M) 0.3' 0.5' x (CNR) r0.6'
IROPIPE ��" aFI x-
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14 ro I TRACT "A" IS AN UNOBSTRUCTABLE
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`� 0 `' 0 U11UT1ES, WATER, SEWER, ELECTRIC,
z I o to GAS OR TELEVISION.
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t` N 89'36'00' W f
c 3.80' REVISED 11/28/2017 TO CORRECT LEGAL DESCRIPTION
FLOOD ZONE"X" - AREAS DETERMINED TO BE OUTSIDE THE 0.2%ANNUAL CHANCE FLOOD PLAIN /FLOOD ZONE "X(SHADED)" - AREAS OF 0.2% ANNUAL CHANCE FLOOD; AREAS OF 1X ANNUAL
CHANCE WATH AVERAGE DEPTHS OF LESS THAN 1 FOOT OR NTH DRAINAGE AREAS LESS THAN 1 SQUARE MILE; AND AREAS PROTECTED BY LEVEES FROM 1%ANNUAL CHANCE FLOOD.
444.
V E YGENERAL NOTES:
'p 1. BEARINGS ARE BASED ON PLAT BOOK 52, PAGE 49A.
J R % .' 2. STRUCTURE NO.1635 SHOWN HEREON UES MITH$N FLOOD ZONE ).__LAS BEST DETERMINED
CD FROM F.E.M.A. FLOOD MAPS PANEL NO.408 DATED 06-03-2013
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ASSOCIATED SURVEYORS INC■ 4. ,UAIRIU� NY, NOT DENNRONAIQRTALLY Sp s wUNODEEEGROUNµYO NOT Lx7ES ED SYDTHIS SURVEY
LAND & ENGINEERING SURVEYS 5. THIS SURVEY BASED ON LEGAL DESCRIPTIONS FURNISHED. THE PUBLIC RECORDS MERE
W NOT SEARCHED BY THIS SURVEYOR FOR EASEMENTS, TITLE, COVENANTS, B.R.L'S
RESTRICTIONS, CLOSURES, TAKINGS OR ORDINANCES, ETC.
I.- j3846 BLANDING BOULEVARD 6. THE HEAVY LINE SHOWN HEREON, MAY NOT INDICATE ACTUAL OWNERSHIP.
A. / JACKSONVILLE, FLORIDA 32210 7. UNLESS OTHERWISE STATED ALL IRON PIPES FOUND HAVE NO IDENTIFICATION.
904-771-6468 AC AIR CONDITIONER
0 .4poF.-
L BRL BUILDING RESTRICTION LINE PSN = PROFESSIONAL SURVEYOR a MAPPER
0 ' CERTIFICATE OF AUTHORIZATION NO. LB 0005488 E Br BUILDING TIE R = RADIUS
S s V G BTN BETWEEN CR) = RECORD
E <C) COMPUTED FROM RECORD RLS = REGISTERED LAND SURVEYOR
N CLR COVENANTS a RESTRICTIONS R/W = RIGHT OF WAY
I HEREBY CERTIFY THIS SURVEY WAS DONE UNDER MY D ,.0NR) CAANN NOT READ <TYP) = TYPICAL
DIRECT SUPERVISION AND MEETS THE MINIMUM TECHNICAL CONC CONCRETE 0 • • • • •SET IRON PIPE (IP) OR REBAR
STANDARDS FOR LAND SURVEYING PURSUANT TO CHAPTER 5J-17.050 1k EBVD ELECTRIC BOX • FOUND OIRON PIPE)LBR 5488 PIN
THROUGH 17.052, FLORIDA A MINI RATNE CODE, CHAPTER 472, F.S. BA EEA LENGTHET C OFRANSLFEO�RCLPAD APADORITY • • • ' FOUND CONCRETE MONUMENT(CM)
/ CROSS CUT OR DRILL HOLE
�/ B LB LICENSED BUSINESS NAIL& DISC
R LS LICENSED SURVEYOR _%i X=%X-I-X IX_CHAIN LINK FENCE
CM) MEASURED METAL FENCE
BY: C� - ��L E NLD NAIL & DISC -fin n r w000 FENWIRE S
CHA LES B. HATCH // FLORIDA CERTIF ATE NO. 3771 ORB OFFICIAL RECORDS BOOK o 0 0 , o 0 0 VINYL FENCE
(�/ I DRV OFFICIAL RECORDS VOLUME OVERHEAD UTILITY
CH LES L. STARLIN FLORIDA CER KATE N0. 4579 A PC = POINT OF CURVEFIRE HYDRANT
RAYMOND J. SCHAEFER FLORIDA CERTIFICATE NO. 6132 T PCC = POINT OF' COMPOUND CURVE l . PHONE RISER
1 PEG = POOL EQUIPMENT PAD ®. -WATER METER
PI = POINT OF INTERSECTION .UTILITY POLE
JOB NO. 70932 DATE 11-17-201 7 N PPRC = POINT OF REVERSE CURVE ,�0 . DIAMETER
RM = PERMANENT REFERENCE MONUMENT =(---•
GUY ANCHOR
SCALE: 1" = 30' DRAFTER MDC s PT = POINT OF TANGENCY
PLS = PROFESSIONAL LAND SURVEYOR L1
CENTRAL ANGLE
NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER
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