The URL can be used to link to this page

1148 LINKSIDE CT RFNC22-0102 �,� 1,lFfj s Building Permit--.Application Updated 10/9/18 r1 City of Atlantic Beach Building Department **ALL INFORMATION wuw. 800 Seminole Road, Atlantic Beach, FL 32233 I. HIGHLIGHTED IN GRAY k f,� I IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: /Pt k5,do cr. X 4-51 R.1 . `vQ2— CD 02 -- Legal .,(P_erm/int Number: C Legal Description;t e:�li^0. -1 ,ksc C�e V 'l L e 1 4 0 RE#' .I '737// 5Z© `6 Valuation of Work(Replacement// Cost)$' 9 '0 v Heated/Cooled'SF Non-Heated/Cooled • Class of Work: II�1Vew DAddition DAlteration ❑Repairer�❑Move ❑Demo ❑Pool ❑Window/Door •. Use of existing/proposed structure(s): DCommercial [fa'Residential • If an existing structure,is a fire sprinkler system installed?: ❑YesNo • : Will tree(s)be removed in association with proposed project? DYes(mustsubmit separate Tree Removal Permit) o Describe in detail the type of work to be performed: c �ec'/ac e.;4') Florida Product Approval# for multiple products use product approval form Property Owner Information Name l > � -nti� V Li • 6,-)e-St)e-St i ;Address! l/`f L• �-- C� W--- - City ft— 7t-/cw• / ‘c i s ' . State;FL • 'Zip 13 2-2.3 3 PhoneJot/ Zct./ •-2 Y95 E-Mail I /3 5 0..,,71---on=- ✓A 4—Cz, Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company+ •c c•--s faux e L�e-c-K 'Qualifying Agent,Jo�+�®Z.Cs2.v Address`. 2'H ,l'\c j ts+,c C /+re 5 S ]), {\)or3-L City' 04K State I PL • ;Zip' 32.2-3 3 Office Phone I /O - 38 ' 7-577 Job Site Contact Number State Certification/Registration#i E-Mail RJC.'tf•E S p V Architect Name&Phone# / Engineer's Name&Phone# ``�� Workers Compensation Insurer, /T'-Tr/ZL, OR Exempt o Expiration Date l(//Z Application is hereby made to obtain a permit to do the •rk and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and tha : I work will be performed to meet the standards of all the laws regulating construction in this jurisdiction.I understand that a eparate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS, WELLS,POOLS,FURNACES, BOILERS, HEATERS,Tr KS,and:AIR CONDITIONERS,etc OTICE: additiomTAp requirements 2this pgracsaggmalb e addrtional res t oz`s app ble toFthts property th;My ye,ifS,Lin,d1101kG public records(i ftp eel here n ,l 3addittonal'•ermtts rete utred froa'other governmental entities such;as water management districts,state agencies,_C ederal.agenci6: 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 BEFO• RECOR = e _ - - ! MENCEMENT. 7 Signature o • Aral"-, - g (Signature..Contractor) iSigQed a d sworn to(or affir- ed) ,oefore m;F hisZcay of Signed and sworn to(or a''armed)before me this day of 2027,by .Or\V1 b ['as_ by 4,.s!i,ifc' . TONI GINDLESPERGER t ign.;f111r-of eta 1 (Signature of Notary) tutMY COMMISSION#GG 333178 y .9;r!!$7 •EXPIRES:October 6,2023 ;� eO ,,, se!.-;.F,t yir&ilildrinderwriters [ ]Personally Known OR [ ]Produced Identi icatiori " ...j_ [ ]Produced Identification Type of Identification: 1, 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 ` 0 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 ATA 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:PERSONAS 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$5,000 PENALTY UNDER FLORIDA STATUTE NO.455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY"CERTIFICATE OF COMPETENCY"OR THE FLORIDA"CONTRACTORS CERTIFICATE"TO IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904- 247-5826 OR BUILDING-DEPTa@COAB.US) IF.IN DOUBT. V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT:. . Job Address:i //N/8 LLn k 5;cJc- C7--• �-5 f-- /2 -./1- r31,_ /$L •• Owner Name:_ %.3p-c_cf Se-:,,,' t,r-c— 'Phone Number:I '7014 - ?--til - 2-g95— ' Mailing Address:' //4-/ "L.„ls, 0-. L.-r-sf" City:E , Jam i-f /3J• State:,I r%G - Zip: 3 2 3.3 IP- ri I PIIP I 1 Notarized Signature of Owner Tri . Y~� Theng instru ent was acknowledged before me thisZZ(day of ,2e , th- State of Florida, County of );,'")Vs . "- t, of Notary Public 400_,,k. SPER��cR [ ] Personally Known OR [ ] Produced Identification ��3 �1 Glilpl-�� S0� � GG353178 M ,caw Posh ,.: ,hY COA^Id1aSOctober 8,2 aaryPu p23 1ers Type of Identification: h�1R S Unde tE*i Gni C E , blit � '-'''''?/—,-�^`!� Updated 10/24/18 n.SL`.-IyJ�r' Fence Addendum Updated 1/14/2021 '413" - : City of Atlantic Beach Building Department 64, 800 Seminole Road, Atlantic Beach, FL 32233 PERMIT# Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: Date: . Pro•:erty Type: Lot.Type/ Features: ResidentialLG%One Street frontage (interior lot) ❑ Commercial 0 More than one street frontage(corner lot,through lot, etc.) ❑ Swimming Pool Fence Material: Fence Height (select all that apply): tt(Wood 0 Four Foot(4ft) O Chain Link 'eSix Foot(6ft) ❑'Vinyl 0 Other ❑ Block/Stone(Plan details required for footings and/or retaining walls) O Otherl 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 blockwall footings and/or retaining walls and any portion or fencing above Eft in height. Will the fence be built in an easement? O Yes (must submit separate Revocable Encroachment Agreement) P1//No: Will tree(s) be removed in association with proposed project? ❑ Yes(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.