760 REDFIN DR ACC22-0022 application - Duffie guest house_1/i ~!U\, · • it! Building Permit Application
·~ · ' 2 City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email : Building-Dept@coab.us
Updated 10/9/18
**AU. INFORMATION
HIGHLIGHTED IN GRAY
IS-~QUIRED.
Job Address: 760. Rd+/"I l)rr,I~ , t1ft~rlb-8e,::;,ct, 1Fe, ~~;~/rmit Number: _________ _
legal Description 3o-q q. 11-' i s -z,¥/e ~t(td PvrlHf5 !lvfrl-Z, ufl~ 8 1/!. q RE# /7/3/tJ -(){Jt)(J
Valuation of Work (Replacement cost)$'' ·9 /J{)() Heated/Cooled SF ~'/ Non-Heated/Cooled._8"::;__S __ _
•
•
Class of Work: l)dNew
Use of existing/proposed structure(s):
• If an existing structure, is a fire sprinkler system installed?:
• Will tree s be remove in association with ro osed o·ect? must submit se arate Tree Removal ermit o
Describe lndetallthetypeofworkto be performed: 17 'x /2," 6,,rtt-J-1-h()vff~ t--J/ 17 ' K 5 1 ee,v~p()~
1 S lu.6 /Jf/f '71'"'a/4 /,zunt,{~fr'P11
Florida Product Approval# __________________ for multiple products use product approval form
Property Owner Information
Name Be /¼@; e,, · ·· · . Address 7~/J f!«-1: iH /jy ;
City A-t!a11 fi,e, • State rk ~ip ?zz,:13 Phone 3Z-I-Z--zR-~t.¥z.,
E-Mail .. bduf/i~ 7/"Gk 4'1(114-i /, C-<JiJn~~-~-,. , .
Owner or Agent (If Agent, PowYrot Attorney or Agency Letter Required) __________________ _
Contractor Information
Name of Company. ___ S_e.,;../,_,_'/-_--'---------'-_;:__--,-Qualifying Agent ______________ _
Address · · · · City..c•'..;.' ______ State ___ Zip _____ _
Office Phone f · ---· - · · · ' Job Site Contact Number--,.,--------------
State Certification/Registration#.._.,-_______ , E-Mail. __ ..;__......_"--_______________ _
Architect Name & Phone# ________________________________ _
Engineer's Name & Phone#----------------,---,------..------------,---
Workers Compensation Insurer . · . -,: ; "_ OR Exempt q 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 i.n the·publlc records of this county, and
there may be additional permits required from other governmental entities such as water management districts, state agencies, or
federi:11 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
RECOR R NOTICE OF COMMENCEMENT.
(Signature of Contractor)
Signed and sworn to (or affi · day of
4orrl . ?o?-1-. . I
Signed and sworn to (or affirmed) before me this __ day of
___ ___, __ ___, by __________ _
(Signature of Notary)
-[ ) Personally Known OR · State of Florida [ ) Personally Known OR
~roduced Identification II HH 239255 [ ) Produced Identification
Type of Identification: -f~..J..loill ...... ~.,.~~ir""~.,M .. ar.,13•· 11111
20
111
26,..rype of ldentlflcatlon: ____________ _
ACC22-0022
By Mike Jones at 1:59 pm, May 04, 2022
REVIEWED FOR CODE COMPLIANCE
NOTICE OF COMMENCEMENT
State of F(tJritltft Tax Folio No. ____________ _
County of {),,, V~/
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.
LegalDescriptionofpropertybeingimproved: ~o-,::Ptj 17 -Z,>-zqE f!.,n1.:Pt:./(1,1 S tlJti it i hf /5 8/tt 'I
Address of property being improved: 7 pl} /2.d.f!-lht Jh:i fl(, AI-/AA f g4d Ft,, 3 vv?:?
General description of improvements: _....,,Guo<.l<-'-'e"""'S,Lf!..__,.&'1....<.,<~,L..5C'""----------------------
Owner: .8r?r/d /)u#¼., Address: "16Q ~h, fk. A/-/w;,fi? 8 <6d, &,,, -3vz,-1;,
Owner's interest in site of the improvement: _.,_/>.~rL....,i-"IM~,_,,c,_'f-~-'-ra--""><....::!ide,,i"""'ac.,'""e('...~'------------------
Fee Simple Titleholder (if other than owner): _____________________________ _
Name: _______________________________________ _
Contractor: __ ~----"'~-'-/,...._ ________________________________ _
Address: J't?ime tli ! t!fclto~
Telephone No.: ?'V/-Z,:pf-.:Jvtfz 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 the date of recording unless a different date is
specified): _______________________________________ _
THIS SPACE FOR RECORDER'S USE ONLY
(if;iff;:.\ N>JIB NAKHEL I\_~;) Notary Public · State of Florida \~o, ,._i/ Commission I HH 239255
..... ........ My Comm. Expires Mar 13, 2026
OWNER 2~
Signed: ~Fl=.~!'.1:D___ Date: cj/! ( / 2--t; Z-2.-
Before mfthis-----i..;<.L~ day of /9pd l Zo:Z.:Z.. in the County of Duval, State
Of Florida, has personally appeared R, o 'f d \) 11, Y e., e..
Notary Public at Large, State of Florida, County of Duval.
My commission expires: IYJorc ) 3 7o ? 6
Personally Known: ____________________ or
Produced Identification: \> y-) v e« I i c t'44 $ e
/lt)-tO\v'\.') 51 0jvto,{1,v~
ACC22-0022NOT FILED
Owner Builder Affidavit
City of Atlantic Beach Building Department
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: {904) 247-5826 Email: Building-Dept@coab.us
**AU. INFORMATION
HIGHLIGHTED IN
GRAY IS REQUIRED.
PERMIT#: ______ _
I. OFLWORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES
NER / 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
RE UIRED 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 ..
Ill. 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.
ob Address: . . 16/l R..t-1//in "/Jv.i:v< Al:~C? Bud, f? /~~'3
)wner Name: IJo' 'bufl, i.o Phone Number: 32'/ -Zt,,( -?11,<,l:J,,
"1ailing Address: Ji,o gdj:~ City: ,4/-/,mf:ic,,,&«ft State: ?z,, Zip: 12,,Z,/::i
r-Jotarized Signature of Owner _i~at:~~'lZl.:.:B5:=====:.._--------------------
·he foregoing instrument was acknowledged before me this li!b_day of A pti l • 2011.., in the State of Florida, County
,f o, .. yo.A,
-~~y NA.JIB NAKHEL
'
~-.ii Notary Public · Stat• of Florida ~di::/ CClmmission I HH 239255 cu-. ... •· . ......... My Comm. ExpamMar 13, 2026
s;gnature of Notary PubHc
[ ] Personally Known OR ~Produced Identification
Type of Identification: Dr\ 1/ e,y LI C-t,v\. c, e,.
Updated 10/24/18
ACC22-0022
PRODUCT APPR~VAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FLORIDA (•REQUIRED) •ProjectAddress: 7~o R..-tfl?iv? '/)v,jve. Allwtu:CU?t,,, h ~zz.-33, Permit#: ________ _ •owner/Project Name: Bo ~£/ie / 6ue.ff &(.{>~ I As required by Florida Statute 553.842 and Florida Administrative Code Rule 61G20-3, please provide the information and product approval number(s) for the building components listed below as applicable to the building construction project for the permit number listed above. You should contact your product supplier if you do not know the product approval number for any of the applicable listed products. Information regarding statewide product approval may be obtained at: www.floridabuilding.org. Category/Subcategory Manufacturer Product Description Limitation of Use State# Local# A. EXTERIOR DOORS 1. Swinging 2. Sliding A11h.$a,, s-~1.e,s Shi~ rt-lift./ ~-q 3. Sectional ./ 4. Garage Roll-Up 5. Automatic 6.0ther B.WINDOWS 1. Single hung 2. Horizontal slider To+c,,o 3'~s~ies Ft,,. -u "! ti-7, 3. Casement 4. Double hung 5. Fixed Mr t-J'rHd1A1s ~?H Se,v-~ Pl--I ftt/tf 6. Awning 7. Pass-through 8. Projected 9. Mullion 10. Wind breaker 11. Dual action 12.0ther Page 1 of 4 Updated 06/21/21 ACC22-0022By Mike Jones at 2:07 pm, May 04, 2022
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local# C. PANELWAU 1. Siding J1,1~e1 ~;,,,_ ~i · Pvwtvf Fl, -I VZ--3 2. Soffrt:s 3. EIFS 4. Storefronts 5. Curtain walls 6. Wall louvers 7. Glass block 8. Membrane 9. Greenhouse 10. Synthetic stucco 11. Other D. ROOFING PRODUCTS 1. Asphalt shingles ~A-F A-< oJ..4 .f Fv!t?tz,4 2. Underlayments 3. Roofing fasteners 4. Nonstructural metal G/ ~rvi f-1-t:tv-5V u--!M,.p PA.vie;{ roof y-l,-11175 5. Built-up roofing 6. Modified bitumen 7. Single ply roofing 8. Roofing tiles 9. Roofing insulation 10. Waterproofing 11. Wood shingles/shakes 12. Roofing slate 13. Liquid applied roofing 14. Cement-adhesive coats 15. Roof tile adhesive 16. Spray applied polyurethane roof 17. Other Page 2 of 4 Updated 06/21/21
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local# E.SHUTTERS 1. Accordion 2. Bahama 3. Storm panels 4. Colonial 5. Roll-up 6. Equipment 7.0ther F. STRUCTURAL COMPONENTS 1. Wood connector/anchor 2. Truss plates 3. Engineered lumber 4. Railing 5. Coolers-freezers 6. Concrete admixtures 7. Material 8. Insulation forms 9. Plastics 10. Deck-roof 11.Wall 12.Sheds 13. Other G.SKYUGHTS 1.Skylight 2.0ther H. NEW EXTERIOR ENVELOPE PRODUCTS 1. 2. Page 3 of 4 Updated 06/21/21
In addition to completing the above list of manufacturers, product description and State approval number for the products used on this project, the Contractor shall maintain on the job site and available to the Inspector, a legible copy of each manufacturer's printed specifications and installation instructions along with this Product Approval Sheet. I certify that this product approval list is true and correct to the best of my knowledge. I further certify that use of different components other than the ones listed in this document must be approved by the Building Official. *Contractor Name (Print Name): Sp /)u k;-<:--*Contractor Signature: -+-&----11~~1'::?" ........ ""'--------------*Company Name: Al '.-4 ----'-=-t-'"-'-------------------------------------* Ma iii n g Address: 1fRtJ gd /,;vt Uv-i f/~ *City: ft-f.-lv?f/11-iv B.eAt,?1 *State: Pc-*Zip Code: _?_'2-_Z--__ ?"---'3.__ _____ _ *Telephone Number: ,3'2,1, 1,,,v{,,.. %4 z._.., *E-mail Address: 6duf£i~ 7 / ;1~111 ;;, UUi Cell Phone Number: _________________ Fax Number: _________________________ _ Page 4 of 4 Updated 06/21/21