769 JASMINE ST RFNC22-0037 ''"-A:ti Building Permit Application Updated 10/9/18
,
l) City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
n°r IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 769 Jasmine Street, Atlantic Beach FL 32233 Permit Number: CR r m QZZ-Dci 3 7
Legal Description 18-34 38-2S-29E .117 Atlantic Beach Sec H Lot 5 BIk 147 RE# 170930-0000
Valuation of Work(Replacement Cost)$ $4099 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: $1New ❑Addition DAlteration DRepair DMove ❑Demo ❑Pool DWindow/Door
• Use of existing/proposed structure(s): ❑Commercial IXResidential
• If an existing structure, is a fire sprinkler system installed?: DYes ❑No
• Will tree(s)be removed in association with proposed proiect? ❑Yes(must submit separate Tree Removal Permit) ONo
Describe in detail the type of work to be performed: Replacement of existing wooden privacy fence with new
6'Tall Stockade style PT Pine privacy fencing with 2 gates.
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name Richard Ghiotto Address 769 Jasmine Street
City Atlantic Beach State FL Zip 32233 Phone 904-525-0202
E-Mail rghiotto1990@qmail.com
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Daniel L. Darmata, Inc. Qualifying Agent
Address 449 Arthur Moore Drive CityGreen Cove Springsstate FL Zip 32043
Office Phone (904) 333-0981 Job Site Contact Number (904) 422-5887
State Certification/Registration# 24517 E-Mail annahel@darmatafence.com
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer Utica First Insurance OR Exempt o Expiration Date 5/1/22
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
RECORD Y R rJ IC OF COMMENCEMENT.
(Signatu a of Owner or Agent) (Signature of Contractor)
iied and worn to(or aff ..)bef• e • this ./Pday of Signed and sworn to(or affirmed)before me this day of
ie; .•.,veti 202L,b 4ii10l Mai rifi
, by
ATrc -( sP- ‘.'•,FS7r�l�A�R (Signature of Notary)
m:, . fir,<,a ,., TONI GINDLE • RG
•':. . - MY COMMISSION#GG 353178
ersonall Known OR -,- .` [ 1 Personally Known OR
�t`�� EXPIRES:October 6,2023
I )Produced Identification °.?,`'s\' Bonded ThruNotary Public Undenvriters [ 1 Produced Identification
Type of Identification: -'17 -" Type of Identification:
(„<fiiA Owner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
)I
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 OF AN OWNER-BUILDER PERMIT.
Job Address: 7 L��SISI�' S e�f' 1f 1w h c tcli/ FGA 3� 3
F,d(104-J.Owner Name: V k Ip Phone Number: 10
Mailing Address: 74Lct crCCSiv7i4g City: it G f7\C. Bek State: FL Zip: 3-2:2,..3,-s"
(/
Notarized Signature of Owner 1
Thejcrezoing instru ent was acknowledged before me this 6,day of 1.110001,- , '0 nthe State of Florida, County
of 1 r(2 V 0� i
P
Signature of Notary Public � _.
,-1'15ersonally Known OR [ ] Produced Identification
Type of Identification:
TONI GINDLE_;"iRGER
MY COMMISSIOi.i#GG 353178 Updated 10/24/18
=
rj•���o EXPIRES:Oc;�her 6,2023
. r..nneleA Tru Notary FanUnderwriters
(-40.4-1"Al )'i.4, 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: ,t-KU c_ Ceocti Date:
766( Oa snam e S tfee f- 3-2a33 04 706 r?-6?-2)--
Property Type: Lot Type/ Features:
Residential X-One Street frontage (interior lot)
(❑ Commercial ❑ More than one street frontage (corner lot, through lot,
etc.)
D Swimming Pool
Fence Material: Fence Height (select all that apply):
Nfg(Wood ❑ Four Foot (4ft)
Chain Link 'Six Foot (6ft)
❑ Vinyl D Other
❑ Block/Stone (Plan details required for footings and/or
retaining walls)
O 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?
0 Yes (must submit separate Revocable Encroachment Agreement)
No
Will tree(s) be removed in association with proposed project?
0 Yes (must submit separate Tree Removal Permit)
)4No
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.
769 JASMINE STREET, ATLANTIC BEACH, FL. 32233
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-ALL ANGLES AND DISTANCES SHOWN HEREON ARE BOTH RECORD AND MEASURED UNLESS OTHERWISE NOTED
The survey map & report or the copies thereof are not valid without the digital signature
and seal of a Florida licensed surveyor and mapper
Date of Field Work : 06-12-2020 ,00,0N"'�"+yr,�
Drawn By: Oleg
girl
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Order #: 91764 �`,
Last Revision Date: 06-12-2020 �`:s;i•:. ��-r• 3ilssuawxrn1.05 a+naso«u�il.Boundary Survey prepared by: LB8111 Ex6E_LN
�A.. .g.:4111:.,,..
ii`:{o,' * nvaE�.wn�u .*NexGen Surveying, LLC 7•:�i�•f.+'�► 0110066) 05601 Corporate Way, Suite #103o Yo4 q c�oaio�
West Palm Beach, FL 33407 SURVEYING LLC. �g'a. ../.•
561-508-6272 i �'g•'°'j0,
NOTICE OF COMMENCEMENT
State of I/`U`tciCA Tax Folio No. 1 70 C/30 — OOod
County of 0 Ju
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 st`gedh'n this NOTICE^OFC COMMENCEMENT A-4-kg Legal Description of property being improved: x I b ' Jf( 3' -0� '�� (( I , +ic Q24 Ci Sec f{
Lof 5 (3Ik 147 r, e J
Address of property being improved: 76G1 0-c6 vtW' Sr1 A1�n4t c 1�di, f L_1 3-)_)-3 3
General description of improvements: {"seelQGeYY1e'11woo urD�'i✓icy Tice
(A)"1 r e ( 6 k i(I Sttk,�Gc e s f-1e .ne < P2% s c�J/r�1 t f-C_5
Owner: ( (C C'lC.. CL 6t'ito C( OCt
o Address: 76Sri fvle 4 Ct• iC 1Je(C c 1/
Owner's interest in site of the improvement: 353
Fee Simple Titleholder(if other than owner):
Name:
Contractor: (l U_U) e 1 1-- Do ryvkt,FA irlc -
Address: 1.44q Arftl a! j)(.00 br;sie ? ( ce, (ode- )finds Fr 3')--6 q 3
Telephone No.:Coq -Y33 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:
I UNI GINDLESPERGER
Expiration date of Notice of Commencement(the expiration date is one (1)year from ate is
specified): EXPIRES:October 6,2023
- �%���`�=
• or,! Bonded Thru Notary Public unoerwrtters
• a 14.
THIS SPACE FOR RECORDER'S USE ONLY OWNER / , _
jr. Z�Signed: I � Date.
Doc#2022085699,OR BK 20210 Page 2412, Before me this 4 day of ' )t c 20 •lin the Coun y of D al,State
Number Pages: 1 Of Florida,has personally appeared '1' _LI G C ( t41 o
Recorded 04/06/2022 11:50 AM, Notary Public at Large,State of Fl. !County•uval.
JODY PHILLIPS CLERK CIRCUIT COURT DUVALMy commission expires: •
COUNTY Personally Known: V / or
RECORDING $10.00 Produced Identification: