1860 SEA OATS DR RFNC22-0103 $fl BuildingPermit Application Updated 10/9/18
-- •_ City of Atlantic Beach Building Department **ALL INFORMATION
�, � HIGHLIGHTED IN GRAY
if
,�,';Ji3 9 800 Seminole Road, Atlantic Beach, FL 32233
Phone: +(904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 1SGI a OdS D✓ Afiaet '
cc.- rraci, Permit Number: Rzz- (51 C.)3
Legal Description (�➢ �! / duc' 1"l(kt,AA L iVQ _I RE# J 7 2/02.0—OS 3t
Valuation of Work(Replacement Cost)$ 40C).00 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: lew ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial liiisidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes B'No
• Will tree(s)be removed in association with proposed proiect? ❑Yes(must submit separate Tree Removal Permit) 124
Describe in detail the type of work to be performed:
11413()& 0_4(iS ft K:1/4,5 ( /rte. „ws"Nv( gri_Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name ' MQ VV Amos - :Address q l SCA Oaks 1:11/ _
City OAA.41C., teciL.L.,. . 'StateIRL Zipl 52233 Phone 904—37.6-oz%
E-Mail GAMY lOkCkI' �M tAa k•COIN
Owner or Agent(If Agent, E,er of Attbfney or Agency Letter Required) O��/ -
Contractor Information ^ .
Name of Company O W W�.✓ Sv L J.Li v Qualifying Agent'
Address ,City / State! Zip'
Office Phone; Job Site Contact umber•
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone# V
Workers Compensation Insurer! 7 OR Exempt❑ Expiration Date. '
Application is hereby made to obtain a permit to do 9 a work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit an 2ISat 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
, HEATERSTANKS,tand AIR CONDITIONERS,etc NO C�theaudbon `tierquemtints ofth
g
Ie'*'*t5*4peni9 temr badditionl reic'tionPppcabfeo hproetythat maybeop .34°-:1-0,9,17-±, ouraid
here may be addlt aiiiek ermits required from other governmental entities such as water;management districts;state-agencies,oil
ederalage.cut”
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
RECORD2G YOUR NO ICE OF COMMENCEMENT. /
s
(Signature o Owner or Agent) (Signature of Contractor 7
Signed an. sworn to(or a irm befor- e th'sZY day of Signed and sworn to(or affirmed)be .re me this day of
w •„ if �` ff: <I +•I , . is—
E_,..
,by
,o.,;...,:�: CI'v!(d!ND.LE0' -GER
*: MY CG?r;,';;iSSiGi; r,C ^3($t• u -ejf (Signature of Notary)
9� `�ej EXPIRES:r h 1Ad
Bonded ihru;dc �
---.---.4,-i,-,---,.7,-,,- '`T,:...:.,_-_ -er.writers
[ ]Personally Known OR [ ] Personally Known OR
[ ]Produced Identification [ ]Produced Identification
Type of Identification: .- Type of Identification:
.0,11r Owner Builder Affidavit **ALL INFORMATION
."":" F° • HIGHLIGHTED IN
g,x,,._. :s City of Atlantic Beach Building Department •GRAY IS REQUIRED. •
' - 2 800 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 STAVE 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��ISSUAN++CE OF AN OWNER-BUILDER PERMIT.
Job Address:IT lVOCt Otr ei+t9LkriC L2-233
Owner Name: 7-Mk t.& 41 .Phone Number:,Q®4 r3gG—o ,
Mailing Address: OS c bOv� City:I State:I Zip:
Notarized Signature of Owner Akilla 14 7, 9,7
The p?e ing in,trum nt was acknowledged before me this Z(Iday of + , 20 Z in the State of Florida, -County
Signature of Notary Public ______Q— ' 411111116.`
[ ] Personally Known OR [ ] Produced Identification
Type of Identification: '- __._
•
Updated 10/24/18
'.*V.is(;., TONI GINDLESPERGER
c MY COMMISSION#GG 353173
i•. '>`':' EXPIRES:October 6,2023
2,f-° ' Bonded Thru Notary Public Underwriters ,
n
, r
;i sFence Addendum . Updated 1/14/2021
s City of Atlantic Beach Building Department
;, 800 Seminole Road, Atlantic Beach, FL 32233
,t PERMIT#
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
X1869-Sea:0a1s"Dr:Atlaritic BGadh-FL 32233 . ) [Oct"17;;2022 _W
Property Type: Lot Type/ Features:
171 Residential f One Street frontage (interior lot)
❑ Commercial ❑ More than one street frontage(corner lot,through lot,
etc.)
0 Swimming Pool
Fence Material: Fence Height (select all that apply):
❑ Wood 0 Four Foot(4ft)
❑ Chain Link 0 Six Foot(6ft)
Vinyl 0 Other.
O 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?
O Yes(must submit separate Revocable Encroachment Agreement)
CZf No
Will tree(s) be removed in association with proposed project?
❑ Yes(must submit separate Tree Removal Permit)
O 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.
•
: .
•.t...
•••
•
' .
• .
•.
. .
.-..
. .
•
•
. .
•
• .
•
...
•
. ?
•
•
•
• . '
. ' •
. .
• .
•
. .
•
• .
. .
•
•
it
• . . , .
. .. . . .. • ...... . . .. • . . •.
• • ....,
• .
. .
• . .
°
. . . .
. .
. : . '.. 0..... ... ..
•....
. . ,
• . •
lit
. . •
•
•
. . •
' . 0. 0 i.7 . . • • ..
• 4
• •
vi
..; • .
• —
• • •- . • :
• `Ic • "' .41
. CJ
,..
.
• •• • • •
. .
Z:5 0
•
_,.... . .
•
0
•' • • :.;.., .' . . • • . .
•CI) Tr. . 7 ....1 •
" • . " 4 .
•
. r . . .
•
. .
• . • . 04 ___,_....
_ f .
. . . . .
••• • .
•
. _
• , J .
• ... .... . . . .. .
. . . ..
, :'..1 I d .....- , . . ,. . • . . • r --a , • ,4
• .
n
c9 _
1. ...... . . . .
: t. •• ....: :.•••:....•••:.::::li f!•'•:::••:•......::i...i*7:::::.....:;.)::. ..•::••• •• ••..•••• •• • • ••. •• -...ri11111:•
. •
2 7 19
.. .. . . .. ..,. .. • : .•..•. .. • •
•
A. V • • t)
A - . . • .. . :. . ' ';',..I
L'.'. . ') * . • :: .. :1•......:1:::::.:::::7::::1::::::::;::;;;•:•-..'.,....''.1.:::.;1.:.:!;.!#;:•::•.:::•;11.....;::—.1.: ..1:•,;...::::::;.,:•:.1:1.':........;.:.:1::.:::.;:::.. •. . .. :-:' "... : . . ' 'a.. i
.. .. ....- •.:.-..: , •-• •• •• • • i
,•• -.
- -
• (1. (.1./
•
•
..
• .
. .... ... .. .... ....•
. . ,
• • .. .
.. . . .. . .• .. . ,
. •
. .:
.
• • • •: •: • • •
.
17-. d .... .
. .
. . .. . ...•. . •
. . . .
0 ...
. .
• ,.._ .. • •
•
. . • • . . -. • ,
>
c). 4 • ' •
...1...-,...
c..._ t--••
r.,..._tu ••••"'
• US I'' Cr)
\
„0„.i7
, .
•
.- •f.3-• _s ui •
I id . • • • 'I 4! ef6S .CD
• ,/ • .trint
i•-• • .
tII
,....41.• .
. • ' •
•-• t
' •
. • 2
. •
. ' . . c.•'4. .
—I. 4)
•
.. ,
• "Z.. 0- 0)
• • •• .) 0 i :
•
- • • . .
.
, .
I;.
...
. kf . kft .
• I
,,
'
0
.
•
„
• .
” .
. . . .
• •
e... r"-
.
• •
•
•
. . .
. .
•
• . • . .
•
•
. .
. .
•
•
. .
. .
(
.-.., .
/fr,,-.-;-._,... •
•
(
''-.r...,-..e•li-'
-
. .