302 MAGNOLIA ST RFNC22-0071 Building Permit Application Updated 10/9/18
1 ._,.__ City of Atlantic Beach Building Department0,_____,
**ALL INFORMATION
\rBeach,800 Seminole Road, Atlantic FL 32233 HIGHLIGHTED IN GRAY
��';���� IS REQUIRED.
Phone: (904)
247-5826 Email: Building-Dept@coab.us
Job Address307 MayOlia a., a4-1AA.1-iL Permit Number: p FNC Z.2 / C>7
/
Legal Description Lbf 2q4, S(t i VO
. 2_ Sal+u r RE# 11 0 W - 001 0
Valuation of Work(Replacement Cost)Sol )OO 0.°—`) Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition XAlteration XRepair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial >illesidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes XJo
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) o
Describe in detail the type of work to be performed: MOVI ng •Pevi.c a Sj. On +a pro FIR4-h) 1,yl,( , \\\\\ I
Y'n C.1�r. b def 541. Wl?oa( FGytce., ((Dr) .NO POO( or cl"oS��J � .p See- DYl04001/41-1I
Florida Product Approval# for multiple products use product approval fo§Tt' '
Property Owner Information
Name l a u rey\ Address 80 2 M n I G
City -r_[(L1/1-"i'c_ a�.c,l ) State FL- Zip 322 Ph ne �Q�.1 7. —/ S5
E-Mails LA,Uri v-leictinay 1 r'1 I O►S • Ctr1'x'1
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) LA urEvz. I Q Dna4
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❑ Expiration Date
Application is hereby made to obtain a permit to do the work and' stallations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all wor. ill be performed to meet the standards of all the laws regulating
construction in this jurisdiction. I understand that a separa - permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS, FURNACES, BOILERS,HEATERS,TANKS,a d 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 O:TAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
REC
ry�DI G YOUR N ICE OF COM ENCEMENT.
AX.A�-
(Signature of Owner or Agent) (Signature of Contra or)
c)
__tor and swatn.tor affi -• before me his I ••ay of Signed and sworn to(or affirmed efore me this day of
` v l --/-,6-CJ by P v ....4/1 , a 1 i , , by
smillek
Nal. at"". No (Signature of Notary)
' ti�tirau' TONI GINDLESPERGER
[ 1 Personally Known OR MY COMMISSION dig ill flown OR
[ ]Produced Identification ,S.`:....#4)... ..', '= ]�r�gplsrced entification
�= FJ(PIRES:Octo r
Type of Identification: -�r' P ryp, yff�,6zftilckrst cation:
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#: 1 ( Nez_Z--bOL
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 ISA 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 REQUIREMENTS1FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
Job Address: 307 Ma6nQ[IA 5+. P4+10.1,lilt BeAG- 32233
Owner Name: LqI)C'-p -y-1 Leznayd Phone Number: god`Li i1`1 p Ss
Mailing Address: SCwv,� City: )` . I CJ'\State: ` I, Zip:
I
Notarized Signature of Owner ,LAA��.- ,�Q{ // I
The foregoing instr ment was acknowledged before me this I C�iay A c) - ,202(,;_in the State of Florida, County
of �v VC--� I
Signature of Notary Public -9-- _ k-
[ ] Personally Known OR [ ] Produced Identification
,..':•.. TONI GINDLESPERGER Type of Identification:
IE. ' MY COMMISSION#GG 353178
I ..i i ;,
:`!c, EXPIRES:October 6,2023
L';':°::-:' • :;ed Thru Notary Public Underwriters Updated 10/24/18
C%'S''"�''r". Fence Addendum Updated 1/14/2021
City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233 PERMIT# RFric_zZ-( 71
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
vol Mafinbl i et-' .
Property Type: Lot Type/ Features:
XResidential 0 One Street frontage (interior lot)
❑ Commercial f "More than one street frontage (corner lot,through lot,
etc.)
0 Swimming Pool
Fence Material: Fence Height (select all that apply):
XWood 0 Four Foot(4ft)
❑ Chain Link ›'Six Foot(6ft)
❑ Vinyl 0 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)
)(No
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
XNo
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 BOUNDARY SURVEY OF
LOT 294, SALTAIR SECTION NO. 2, AS RECORDED IN PLAT BOOK 10, PAGE 15,
OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
FIED TO:
RESOURCE BANCSHARES MORTGAGE GROUP, INC.
JONATHAN TOKE AND LESLEY A. BOOTHMAN TOKE
STEWART TITLE GUARANTY COMPANY
BUSCHMAN, AHERN, PERSONS AND BANKSTON
LOT 282
1 liK
N 09'58'48" E
11 50.00' (PLAT)
ll N 09'58'48' E K
fOUND 1�r Erz t o.r 49.96' (MEASURED) 'FOUND 1/2•RON ,E
f ......" NO UI NI1NCATON 7 ,,,11.9.96'
V 0.3, NO 14�N11FICATION
X0.7'
LOT 294
K
475 3rCONDOD FLOOR
16.5' rjl/1/ 7.S
^ 26.2'
W . ES-
41
a < CC lz•
Qa
CO n b x xm
'CSS' F.
o Torn r+ TWO STORY M o
y C � . FRAME
1 W POSTED # 302 '"��{ oi
01 LOT 293
Z <J
> ; "— 3PR
°x W W
Q ,, 3 3
o V o
0
¢l op :qo
Q .. 0 0 N
Nv 0 0 14.9' 26. 2' 7. UP
Q Z ;;COW 00R,
. `0.3' x
WZ •,,. , /
in
gi r
•
FOUND 1/2'IRON PIPE NO 1/2•IRON PIPE
NO IDENTIFICATION .S X0'15'27' w NO IDENTIFICATION
49.70' (MEASURED)
S 09'58'48" W
50.00' (PLAT)
MAGNOLIA STREET
(50.0' RICHT OF WAY)
NOTES ACCEPTED BN
LEGEND:
R = RADIUS —X—X'- FENCE
L = LENGTH O = CONCRETE
NOTES:
1. BEARINGS ARE BASED ON THE ASSUMED BEARING OF N 80700'00• W ALONG THE REVISIONS
SOUTHERLY BOUNDARY UNE OF SUBJECT PARCEL. DATE DESCRIPTION
2.BY GRAPHIC PLOTTING ONLY THE CAPTIONED LANDS UE WITHIN FLOOD ZONE X AS SHOWN ON THE
NATIONAL FLOOD INSURANCE MAP DATED APRIL 15, 1989, COMMUNITY NUMBER-120078,12PANEL 0001 0.
.3. 71-115 SURVEY REFLECTS ALL EASEMENTS&RIGHTS OF WAY AS PER RECORDED PLAT&/OR TITLE COMMITMENT
IF SUPPLIED. UNLESS OTHERWISE STATED, NO OTHER 1111E VERIFICATION HAS BEEN PERFORMED BY THE UNDERSIGNED.
4. THIS SURVEY NOT VALID WITHOUT THE EMBOSSED SEAL OF THE CERTIFYING SURVEYOR.
JOB # 23241 1 DATE OF FIELD SURVEY: 02-04-04 ISSUE DATE: 02-04-04 [ -SCALE: 1" = 20'
CERTIFICA
'ASP. 2522 Oak Street I HEREBY• 'S SURVEY WAS LIAOE UNDER NY RESPONSIBLE CHARGE
MIs I Jacksonville, Florida 32204 WARD'. r«. TECHNICALITTSTANDARDSD APA9 SET FORTHORB 1517-B FLORIDAFLORIDA
*SST' (Phone) 904-389-5989 -.7✓, IN
(For) 904-389-6175 ADMIN-PRA/i PURSUANT TO SE ON 2.0 FL TATUTE6.
SURVEJI
C1G Inc
UCENSED BU "635 #6707 RE STEREO SURVEYOR AND PER #4879 STA IE OF FLORIDA
LAND 5 :VEYS 0 CONSTRUCTION SURVEYS 0 SUBDIVISIONS