1985 MAYPORT RD CFNC22-0004 y�s-'L`'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
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 19 1" i✓l p_,,, g as d i\-k l;r Be u c J-Permit Number:C r`V c.,�Z_ 0004
Legal Description 1 9 - 1(e ►7 -2S ' 2 if .2 3 D o^•ttr. 5 iel p /T Fjl oc4. 2 E# O/R I'1 i oG - 118$
Valuation of Work(Replacement Cost)$A4 00 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): €ommercial ❑Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ONo
• 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: i
t<,J 00� t<e � �- �_ x;� c l `1 X ( 0
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name AVttco- er- e I Address 13\ SS L.ec„t-ivtr(Pei E' U( S
City j O C.-I 5 p,.,,;\Le State Zip 3 Phone c‘O's-1
E-Mail is\cK" 4 /' (pa_..) .
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company 0/6 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❑ 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
RECORDING YOpR NOTIC OF COMMENCEMENT.
(Signature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this.1day of Signed and sworn to(or affirmed)before me this day of
e 7422 ,by A e—.-c1 A-e_I ,by
c�--
(Signature of otary) (Signature of Notary)
COLETTE J POORE
y
Personal) Known OR ' Notary Public•State of Florida [ ]Personally Known OR
I `
[ ]Produced Identification Commission r HH [ ]Produced Identification
` or My Comm.Expires Nov056368 t 2,2024
Type of Identification: 4 BA+d•d tbrough-Atationsi-Notaq assn. Type of Identification:
Owner Builder Affidavit **ALL INFORMATION
--" HIGHLIGHTED IN
; 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.US ) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I
COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
Job Address: !CI t6.
1y i0 rk (Z) 0( A�-`,„4 c-' ,,1,,, tit- 322?3_
Owner Name: \' k- r E r-' -r' Phone Number: '0 ti Li— 57 I
Mailing Address: ) �� M �eh r-\-- ed City: A \�„4-`� e c State: re‘--- Zip: 322'3T3
Notarized Signature of Owner _ 1 1-_.
1.V
Ti,
The fgrregoing instrument was acknowledged before me thisp17 day of If.t-e , 20.E in the State of Florida, County
of 1)v v o--\
/1
Signature of Notary Public L _G-1.-,,- _. tv
--"Personally Known OR [ ] Produced Identification
Type of Identification:
�oe�., COLETTE J POORE
A'$/ %. Notary Public-State of Florida Updated 10/24/18
p`; Commission IN 056368
o ` My Comm.Expires Nov t 2,2024
Bonded through National Nctary Assr.1
r1' Fence Addendum Updated 1/14/2021
1 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: S2 Date:
Property Type: Lot Type/ Features:
❑ Residential ❑ One Street frontage (interior lot)
JCommercial More than one street frontage (corner lot, through lot,
etc.)
❑ Swimming Pool
Fence Material: Fence Height (select all that apply):
.IWood ❑ Four Foot (4ft)
❑ Chain Link 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)
XNo
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
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.
MAP SHOWING A SURVEY OF
THE NORTH 100 FEET EXCEPT THE EAST 40 FEET AND ANY PORTION IN THE
RIGHT-OF-WAY OF STATE ROAD 560, OF BLOCK 23, DONNER'S REPLAT, AS RECORDED IN
PLAT BOOK 19, PAGES 16 AND 16A OF THE CURRENT PUBLIC RECORDS OF DUVAL
COUNTY, FLORIDA.
DUTTON ISLAND ROAD EAST
a (50. RIGHT OF WAY)
(FORMERLY CHURCH ROAD WOOD POWER POLE
QFOUND 1/2" IRON
O
PIPE (NO CAP)
.^_ 93.45' SET 1/2" FOUND 1
! IRON PIPE /2" IRON
/'�/3 Q r . 4 SIDE ALK -= (L8 3672) PIPE (NO CAP)
1.� Q N
1"—o 0 93'41'56"°ANGLE TO CHORD C,' 40.00' 12' C
a "90'02'33' 9.0'
XL-12
y;�o I ; 2J.7' 52.6'
�.L 17.8'
O o' I • rONCRETE, - ONE STORY
/� o •
DRIVE N MASONRY
LL BUILDING
�.. v co POSTED "1985" VI
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219' Mal 18.8'
G • , 0.6' O
RADIUS=2914.79' °' 1 o
LENGTH=1 00.21' TV CONTROL RISER V
N O a 1
DELTA=01'58'12" �' � 24.1' 21FRAME .4' ' —
100.21' „BUILDINGI 3
o
csi
(CHORD) v
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86'18)04" `�
24.1' •
ANG B1� CHORD / w
`/ i ! 9''" - /L6. wooD F49'57,27' 1
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• -._... •X ------/ 0.1�... CS 1 N
1/2" 99.99' U..I.HWN 111th LNC. 1� SET 1/2"
I ON PIPE rJ.2'IRON PIPE
CONCRETE POWER POLE (LB 3672) (LB 3672)
IOFFICIAL RECORDS B001< I
��ll /, 1 612, PAGE 65
L _ o =-\--' - -
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LOT 2
LOT3 LOT4
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NOTES:
I
1)THIS IS A BOUNDARY SURVEY.
2)ANGLES AS PER FIELD SURVEY.
3)NO BUILDING RESTRICTION LINE PER PLAT.
4)NORTH PROTRACTED FROM PLAT.
5)BOUNDARY LINES DISTANCES SHOWN HEREON ARE
MEASURED PER FIELD MONUMENT. THIS SURVEY WAS MADE FOR THE BENEFIT OF
1985 MAYPORT, LLC.;
THE PROPERTY SHOWN HEREON APPEARS STEWART TITLE GUARANTY COMPANY;
TO LIE IN FLOOD ZONE "X" AS WELL AS BUSCHMAN, AHERN, PERSONS & BANKSTON.
CAN BE DETERMINED FROM THE FLOOD
INSURANCE RATE MAP COMMUNITY PANEL
NUMBER 120075 0001 D, REVISED APRIL 17,
1989 FOR THE CITY OF ATLANTIC BEACH,
DUVAL COUNTY, FLORIDA.
DONN . BOATWRIGHT, P.S.M.
"NOT VAUD WITHOUT THE SIGNATURE AND THE FLA. LIC. SURVEYOR AND MAPPER No. LS 3295
ORIGINAL RAISED SEAL OF A FLORIDA LICENSED FLA. LIC. SURVEYING & MAPPING BUSINESS No. LB 3672
SURVEYOR AND MAPPER.'
CHECKED BY: 6*--- BOATWRIGHT LAND SURVEYORS, INC. DATE: JULY-17-2007
DRAWN BY: CRT 1500 ROBERTS DRIVE
FILE #: 2007-826 JACKSONVILLE BEACH, FLORIDA 241-8550 SHEETI_OF L_