941 PARADISE CIR RFNC22-0057 x `''''''' Building Permit Application Updated 10/9/18
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,; City of Atlantic Beach Building Department **ALL INFORMATION
�� HIGHLIGHTED IN GRAY
___)'..,\
, 800 Seminole Road, Atlantic Beach, FL 32233
','2.11.- IS REQUIRED.
Phone: (904/') 247-5826 Email: Building-Dept@coab.us
Job Address: i /47 l4�rd ss 0,-di Permit Number: RE NCZZ - CO S..-7
/
, #6541-144.,
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S Legal Description /</Ja:rc/i$c /r te( RE# /12-3747 -00:0&S—
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Valuation of Work(Replacement Cost)$ SSV. Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration BRepHe�air ❑Move ❑Demo ❑Pool OWindow/Door
• Use of existing/proposed structure(s): ❑Commercial ®Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes JWI‘
• Will tree(s) be removed in association with proposed protect? ❑Yes(must submit separate Tree Removal Permit) [a'No
Describe in detail the type of work to be performed: /
/- l(/ ‘,51./e ,k7/ q-'7lerkoli'i/ s1C.0 ;4 /40/ y cc/
Florida Product Approval# for multiple products use product approval form
Property Owner Information /
Name g8Akm- 6i(E Address JL// A/4...e (Iiir_e_
E-Mail /l t` (%/i/b 4 1( �o State 12. Zip ,3^_2 3,7 Phone 99�/- ?/'-t- 72-72
Owner or Agent(If Agent, PoweVof Attorney or Agency Letter Required)
Contractor Information
Name of Company /)Ci S r'tISF GAG• Quali ring Age 1�eurr? 7di17pYi
Address /..2-6/40 '07t /P& 1? Gyp City/ 'r ,/(t State rt._ Zip ,�.)�.
Office Phone 9Cy`J.
= ,•.'97 Job Site Contac umber
State Certification/Registration# ;72-g liZe;v1. E-Mail e,1e/r(Q�{1 .9`YIt1L+/. f't
Architect Name&Phone# (/ �J
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt o Expiration Date
Application is hereby made to obtain a permit to do the 'ork and installations as indicated.I certify that no work or installation has
commenced prior to the issuance of a permit and tha :II work will be performed to meet the standards of all the laws regulating
construction in this jurisdiction.I understand that a --parate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TAN' ,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-Y9UR NOTIC co. COMMENCEMENT.
Si ure ner or A nt) (Signature of Contractor)
ed and sworn to(or a 'r y d)before • e thi- y of I Signed and sworn to(or affirmed)before •• is day of
7c27. `y.6 Q i14 �• c- , by
_mar
(S i? ature o ''ot-7, (Signature of Notary)
,,,i!; ,, TONI GINDLESPERGER
'k` *t ItiNKSAfIHNl6l5fOI 0035317: [ ]Personally Known•'
a "" i (L [ ]Produced Identification
4A,1;4 ]P rOP R1 tt1603,4023
" f?Q Tlip�ecf1d�rNifitgaglitt e.-..iilu. _ Type of Identification:
-�firOwner Builder Affidavit **ALL INFORMATION
'' HIGHLIGHTED IN
7, \' City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
•Ot
-,PPhone: (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: qy/ f r�i e._ Kjelm
Owner Name: 6/Leff i Cbz Phone Number: 909–7fy_7/Z2--
Mailing Address: 9y/ / 47d5 _ .%-c--14' City: /T/%I i L &4I, State: fL Zip: 5/t.33
Notarized Signature of Owner
Th` o oin instr ment was acknow edged before me t 'sl .day . /M• , ,WZ_in the State of Florida, County
of A...--r' ,
\L„......_
Signature of Notary Public — Q
taYPG ,. TONI GINDLESPERGER
�° '' '° MY COMMISSION#GG 353178 [ ] Personally Known OR [ ] Produced Identification
: i . :.:
,�,. A .y." EXPIRES:October 6,2023
''," l Bonded Thru Notary Public Underwriters
TOFFType of Identification:
Updated 10/24/18
/ Fence Addendum Updatedl/14/2021
1 .
1: .� Cityof Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233
PERMIT#
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
'S// A/4°6-e li' i, 5-3/-2-Z
Property Type: Lot pe/ Features:
Z ResidentialOne Street frontage (interior lot)
❑ Commercial ❑ More than one street frontage (corner lot,through lot,
etc.)
❑ Swimming Pool
Fence Material: Fence Height (select all that apply):
❑ Wood ❑ Four Foot (4ft)
❑ CI,n Link ❑ Six Foot (6ft)
LT Vinyl 1270ther _g
❑ 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?
❑ Yds(must submit separate Revocable Encroachment Agreement)
No
Will tree(s) be removed in association with proposed project?
7❑ Y (must submit separate Tree Removal Permit)
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.
MIIIIt7rctara"1 his.
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I Gibraltar Title Services
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DEBBIE LtPOLE AND LYNNE L POLE
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REALTOR' REALTOR*
DATE 3/10/20012
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BUYER RYAN S.AND trtNGER N.hi ALKMON triffilUPOLICOM -
0f081ElUPOLE®PR EET.COMSELLER.KERI COAND MELISSA CARR „y
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CERTIFIED TO GINGER
GIBRALTAR / Ai„.00: .sippA
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COMPANY;FIRST FEDERAL 1 RAL RANK OF FLORIDA AND BANK€R %” f`
HOME MORTGAGEr wwwserveystars.coro
a.r, M., . . , Land Surveyors, Inc. 556-73519151 Fe.8 rae'38Af
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