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1226 HIBISCUS ST DWAY22-0059 <'_ ,'-,, Building Permit Application,/ Updated 10/9/18 f , i , City of Atlantic Beach Building Department **ALL INFORMATION 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY j3 7r IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: 1216Sen. /5c V S .5'TgE 6T Permit Number: ' 1A-) �tLy Z Z--©©SC� / Legal Description en. H k-\--(_a,eo ci Lc,'k (/O St K ZSI..IFE# .17 1 0 7 - d 0 6 0 Valuation of Work(Replacement Cost)$ $7 Heated/Cooled SF Non-Heated/Cooled • Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial ❑Residential • If an existing structure, is a fire sprinkler system installed?: ❑Yes ❑No • Will trees) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ❑No Describe in detail the type of work to be performed: ( i Oi l VQ 1&u ( Florida Product Approval# for multiple products use product approval form Property Owner Information Name TV f1 Al Co_ J A k1 Address /226 kit Q i S L. U..s Q sT - E 1 City rk-1-1;ft-01- i L ( }-f State ft Zip?2 7 3 Phone af4-,) 88 I-63 / E-Mail JUt{Y1aharl1111 's Rout;I. Co,--1 Owner or Agent(If Agent, Power of Alto ciey or Agency Letter Required) Contractor Information Name of Company Qualifying Agent Address City State Zip Office Phone Job Site Contact Nu der 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 wor. .nd 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 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 OBTAIN FINANCING, • ► SULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR N• •F COMMENCEMENT. (Signator . / o Agent) (Signature - Contractor) Signed and sworn to(or a '11.P•)before me isZ Bay of igned and sw+rn to(or . •irmed)before me this day of ti by r..ture •1 (Signature of Notary) i'"r' TONI GINDLESPERGER gtr ',!; :. MY COMMISSION#GG 353178 '-..5-':...Z .:7 EXPIRE •p�.�o. Y3 IB .) x', ,. [ ]Personally Known OR - X4 :1: ers [ ]Produced Identification Type of Identification: ' 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 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT (904- 247-5826 OR BUILDING-DEPT@COAB.US ) IF IN DOUBT. V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. Job Address: i 2-. u3 ' 7 C 6C N FL 77233 Owner Name: JJ j4-I6 Ig13/1-Ai Phone Number: (y0'/) e61-- C65/ Mailing Address: (?..1 , /ZEE city: fTLftiUT/L 17C14 State: /CL, Zip: 22 `33 Notarized Signature of Owner f The fzning instru ent was acknowle•:-d'.- ire me this 2- 'day o 0✓ ,20 the State of Florida, County of L.) qi� S4--"p Signature of Notary Public_- [ ] Personally Known OR [ ] Produced Identification Type of Identification: ( L. TONI GINDLESPERGER as •,: MY COMMISSION#GG 353178 Updated 10/24/18 ..s7 EXPIRES:October 6,2023 •' BondedThru Notary Pu61ic Undenvr+ters BOUNDAR Y SURVEY k-T(BLOCIC CORNER) UNIZOIRM1 PPE ;` 1 1. °30 E. J J I ±11 1 LOT 4 LOT 4 I BLOCK 229 BLOCK 230 1 1 FTC 1/2IRON PIPE I-25.0' NO NUMBER 102.46'(M) N_W. CORNER OF FND 1/2"IRON PIPE FND 1/2- IRON PIPE LOT 5,FI.00( 229 /i NO NUMBER 102.00�(P) NO NUMBER �� 101.62' M 04b,,, ....._...),10.;\ Io i i-- 40. - i$ 102.00'(P) ` ,aJ �o n ° 0 1 ILLI �yJ �, J t W W 25.0' 30.0' 4s.� f' 1 C1 LOT 5 I�o�— cn I— LOT 5 BLOCK 230 — Z CO r BLOCK 229 N N .•-._ a a , w in no v z U -Iw 0 Cr)o co 0 M Z = _ Z --Mgt' i ____` . �.� O)O ItM000 ( W 3. �P O N 1 m 0)O IQ_ STEPS OC 0 0 = i O I OO 30.0' O O I— AL1 ;I[) a I J ON Q a LOT 6 LOT 6 , Q M- BLOCK 229 BLOCK 230 R 01 Z � li____ g DL I Z I � LOT 1 ,S SET Cie+IRONN Ft0D 102.00'(PdcM) 5.IRON ROO LB#7504 BLOCK 197 1 LOT 1 BLOCK 196 C PJD.}-PARCEL UFI1FICATION NUMBER I r WOOD I . I -ASPHALT I°0',N. =BRICK(PA VFR?ILF I /ROPER TY ADDRESS: 1226 HIBISCUS STREET-ATLANTIC BEACH, FLORIDA 3223 PSC -POLVTOFLDATATETIR]HENT LEGEND Legal Description: Lots 5 and 6, Block 230, of P.QT4 =POINT OF BEGINNING DIT = SURF :1 =POINT 0FMTFFSE[-TIAV C...;\ C PLAT °, rpt ATLANTIC BEACH, SECTION'Tr, according to the plat € -CENTER LINE C. .... thereof as recorded in Plat Book 18,Page(s)34, of the .&D -NAIL AND DISK CL -RTGNTOI LINK � - Public Records of Duval County,Florida- . w -RIGHTalAN OF WA) .7.. -WOOD FENCE PCP -PE.QAIANENT CONTROL POINT 'C -�TTOFFCURVNVA� CERTIFIED TO: CLIENT NO: 17-206614 =DESCRIPTION 9 N IE - JUANGABRIEL ARANCHIMAL JOB NO: 24724 -RADIUS ! F7ELDDATF._ 06/14/17 _. .„„, C?MTCFTTTAw PT .............. ..... g11q11N 1 � 1 1111111111111.11111111111111.1111111111111 1111.1111111 EIMAIIMI111111111 . MINI MEM ammummiEmnidammioN ' 111111111111111111mEIMMIENNI . • . : you ••••••iii••••••••••• .•••••••••••••••_. ,, Ti � W •••••r•••••••••••••• glIIIIIIIIIIII a