5880 SHERRY DR RFNC22-0073 •
7I. Building Permit Application - . �r,,d 7,. ,f,
i Oak,
V47.1 u City of Atlantic Beach Building Department ' ••AfNFORMATION
+ _ 800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
4tl.i IS REQUIRED-
. 0Phone: (904) 247-5826 Email: Building;-Dept@)coab.us \
lob Address I• IP .IIL L. % 1 to Ill _ r a Permit Number RF 'v-nva�_.c)0
legal Description i'' ,� 1 Lel .71D PE• l�V1p(' VSJt1c�
Valuation of Work(Replacement Cost f S 3tiO.Q Heated/Cooled Sf Non-Heated/Cooled
• Class of Work)(New LlAddstion ❑Alteration ;;Repast ❑Move i.l0emo ❑Pool DWindow/Door
• Use of existing/proposed structure(s) °Commercial' Residential
• If an existing structure,is a Me sprinkler system mstatkd7 Dies ENo
• Will tree(s)be removed in association with proposed protect'r yes(must submit separate Tree Removal Permit) ONO
« Describe in detail the type of work to be performed
iirn5-Q4iAhs`/'/�J IA -tali b wird 040oalro! ht d ice
Florida Product Approv o for molt ple products use product approv3t form
Propert Owner Information
Name / 1' ,LI HOMED, Address fAro O sit s t -i
tii City a r. Zenon State PL Zip 32233 Phone 0040 ie-I COli
E Mail ((c t "iC k t1A(t I rftt C6 Vl
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company I`rl•...4.. crey,b, Qualifyin Agent `
Address 2r 2_SQfl ,IC v!• • s C--J caTh >�llr�l� State_a_z u 32t�R2
Office Phone 4014-5 - V1g lob Site Contact Num
State Certification/Registration a PIS Qtpini2'1/21T E-Mail 'luta)r"•• A • ' • COWLArchitect Name&Phone a �J/_
Engineer's Name&Phone a
Workers Compensation Insurer OR Eaemp Expiration Date 01rz-1 20023
Application is hereby made to obtain a permit to do the wor .nd installations as indicated I certify that no work 6br ins allation has
commenced prior to the issuance of a permit and that all r.k wilt be performed to meet the standards of all the laws regulating
construction in this jurisdiction I understand that a se.•rate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TAN ,and AIR CONDItIONERS,etc NO1ICE•In addition to the requirements of this
permit,there may be additional restrictions appli ,• to this property that may be found in the public records of this county,and
there may be additional permits required from• er governmental entities such as water management districts,state agencies,or
# federal agencies
i. 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
4 RE-CORDING YOUR NOTICE OF TMMENCEMENT.
(Signature o14,6
wner or Agent) (Signature of Contra rl
i
s, Si ned and sworn to(or affrrme,before me thin •fkday of Si ne and sw n�� to(or affirmed 0 g,e thi • d i of
! Oo ,by ►/ t r ( 1771f1X�jL[1 .by 4i,,,. . / /r. - i�
Agrrsprtrw
i (S,gnature of Notary)
1�of Not).,; IWKAHALY
!,(:7,,,,;....: Notary Pub is-State of Florida
� F Commission k 00 924046 I Notary Publle SW.01 Ftor as
.'?e M Comm.Expires Oct 20,2� Meduon Wilson
Y rsonally known OR 1
OPersonally Known OR Mr Commission
p�Produced identihcaUo dorC?d through Satioral Notary Asst).• oduced Identification 1111 nil 2110200
• ' p of identification 1 Exp 5/2/2020
Type of Identification r PI: — —
. .. ._ ., .,. .- • ....-++r.,..,.• 4e ' " *' . ,. 's "Hu in ..,... ' —"Ai.. wet;is 4 i
Owner Builder Affidavit **ALL INFORMATION
.,„0-44-9-6-,, HIGHLIGHTED IN
,S ° City of Atlantic Beach Building Department GRAY IS REQUIRED.
s
800 Seminole Rd, Atlantic Beach, FL 32233
ti 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: Sao 3 m c r v) Of ( v-e -
Owner Name: �'L c c ci V\1-)L,,--' � Phone Number: 9 p - (--s ) (o - 1 0 6--1
Mailing Address: S2() c�V1C.,j L�v� �f ( J-L City: Atka,-14-;( Eec<<LState: (L_ Zip:z�
Notarized Signature of Owner ►� 1 _,G,- ( , )V‹.�
The fdr ing instrument was acknowledged before me this Z Oday . - `' , 2077in the State of Florida, County
of j 'Jo Va� ,
/ n
Signature of Notary Public --, i `- c_- ilk
i
[ ] Personally Known OR [ ] Produced Identification
Type of Identification: L,---iii , L_
I t�<�ar'�BL• TONT GINDLESPERGER
z tiMY COMMISSION#GG 353178 Updated 10/14/18
;�. .;7.- EXPIRES:October 6,2023
f rS Bonded Thru Notary Public Underwriters
' , Fence Addendum Updated 1/14/2021E:f----
.......'i City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233 I
PERMIT# RFNCZZ-oo7`
Phone: (904) 247-5826 Email: Building-Dept@coab.us I
Job Address: Date:
3o Sherri Dri j e ,012q I 2022
Property Type: Lot Type/ Features:
Residential i ❑ One 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):
hO Wood ❑ Four Foot(4ft)
U chain Link i,Six Foot(6ft)
❑ Viny! I n Other
❑ Block/Stone (Plan details required for footings and/or
retaining walls) I
❑ Other i
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
III Will tree(s) be removed in association with proposed project?
❑ Yes(must submit separate Tree Removal Permit)
El 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.
j • 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.
s/GP-�h 'ON 2/30210 0/ Jd c� 8d
; D
ro�21074 + LS s6 L a /I v0 MINVI MOW r�
a13ddv)f • , d .j'e SID • OVd aMPINuKIwo ew air
;MrA1LP 3
37WOS IOW moca+aO >�°°
AM-JO-DON WY
**1* .0 S'71d'�A003 ,12/�1Y7 leanar3 1.1163
3 u Haeaius3or game rets
iiwza
)• spc
.1‘
t (arm) aao Hoer o
3orcLd -
OiasrldrnHIM Las)
"H3dddlti ONVV 80A3AHOS 03SN3017 V012/073 V 30 WOO AD •
7V3S 03SI V8 7V N101210 3141 ONV 3,101V NDIS 3141 1110 HI Al 017VA ION tion woo ■
'dIHS213NM0 3N/W213130 Y0 10373381 ION S300 ,(3i12/fS S/HI CW3937
Sf ZL-l£'L (006) 9SZZf vaie'o 7, '37701 NOSNO dr 'Zig` 31 N7S AVM SM OOV3P(A VS l 11,1?
'OM1 'SZ1oA3i1nS INV7 3 L VOLS-Th L
3?WS 3) MOL/V ilL2130 V 31l1LLLSN00 ION 5300 ONY A7N0 AS3L21000 Y SY N410/5 SI
ONY • �g-z-I-I, 03L YO .V01.9014 " 413W7Ivti 30 .1110 314L ?110.3 / dVPI 31Y21 3ONY?ll1SNI
00073 IM021.1 037YOS SY ><i V 3NOZ 02IVZVH 00073 N/HLiM 317 01 SYY3ddY N031314 NNOHS A14113d)d!d 3141
'03NOISd30N11 3HL JO 7Y3S HIM 035SO81Y3 S537Nn OI7Yn ION
J-4-37 '� - :bg0 'd�s - 27 ' 7a - S/ • d/ 1 / Z
20 "0.z - 7/ 'An
S I2/ --po 'PO -S7- ad l//`' .L?1- zy
dP(.4/ra 'lo//- So-o pi /0.1'b -L O / /L2' 2
to
y g •sciaF)liFY
'P�
N M
h" •
,co.ao/ �d I'o
S 1'2 I -jr/ IA . 0 ' ,
w os. �0 -
S
� N� �42� 0
O oo� • W
J1 (5 "b ' -5d ) ,,4
\►1 /j X - 'Q
(20 _S 'g ' r.
.1 obs
G GSE
N 0 01%. .-.'::' -).8
N
et
U 0
V
PI j
°9"12 ?°)1 i 1 . S� •
vu
0.1
N
"'c,4
Zo
N � v-vt�5 / ; ,
I X06
0
co .0o/
("'/a,,o
54V &/7 ,c::;/
.dd ' raoC/so
r
3 ropi s..c • -.2p7 327/400s2/,21, Q >'71 LL .l2 b/7 1 . < T101- 1
1 S/71.1 r ii iv1i (7 .� )id _I& . rQ 7/2i 7j? -r b z b.. . !2203 03/3/1230
VO/2/014 Al Nnoo 7Y1170 30 S0210.0321 O/78nd 3141 -40 0) S30Yd O x008 I Y7d NI 0302100321 SY
a,'!C/17d'S •0/Y r ','i ?3 S XC L6'7d
10 d Ar NO ALILOHS SY oPg L07 ,(2--) L'Lzroi"57zz G,r “ .L07
10 A24&J1S AMPII1Off Oft OHS dWr