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655 SELVA LAKES CIR RESO23-0016 Building Permit Application Updated 10/9/18 City of Atlantic Beach Building Department **ALL INFORMATION \ HIGHLIGHTED IN GRAY 800 Seminole Road, Atlantic Beach, FL 32233 --on yr IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: 6 5 5 I_[AI4 LA K a-5 C-I 12 Permit Number: NEC) - z3OO t Legal Description y / O /4 -Z-5 — Z1 SkLVA LAKES01Ni j RE# Valuation of Work(Replacement Cost)$ �� Heated/Cooled Non-Heated/Cooled • Class of Work: ❑New ❑Addition [Alteration ❑Repair ❑Move j•Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ['Commercial J .Residential • If an existing structure, is a fire sprinkler system installed?: ❑Yes -�No • Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) L .No Describe in detaillthe type of work to be performed: De. rlD/� & C cc ©r= _ # -e- YA I 2ZS vti Florida Product Approval# for multiple products use product approval form Property Owner Information Name --1-1 MO —►-y 1l SOLOD y N IF41N' Address 6 _.V4 5 S�lL KES Nrt._ r l rZ City AT LA1t 1�' !CAA State �(_Zi 3LZ3 Zj Phone SZ.) j , 7 .3, 5-5-6 E-Mail JF 17YNN1Git. C- MALI (QiI Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) C"1__ 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 obtgifi a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuan of a permit and that all work will be performed to meet the standards of all the laws regulating construction in this jurisdicti . I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS, WELLS, POOLS, FURNACES, OILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE: In addition to the requirements of this permit,there may be add tional 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, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDIN9170• NOTICE OF COMMENCEMENT. . e of Owner or Agent) (Signature of Contractor) , 7 e and sworn to(or affir -.)before me this I day of Signed and sworn to(or affirmed)bef. e me this day of e O , 7023b 1,-(pc - .. y, a aL.) , ,by Y _ !i ' ' (Signature of Notary) . :°64; 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(WCOAB.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: 6j53 ��LL)/4 LI4K 5 Ci ii- Owner Name: NOrJY I/ SO/..-,047YAlJ/G)/- Phone Number: 5ZYt . 7Z3. a3-3'y. Mailing Address: j'— �� j_VA- LAKff, Cj 14Wz,a State: f Zip: 3 Zz.3 5 Notarized Signature of Owner The twegoing inst(ument was acknowledged-before me this 17 day of – , 20 2-3in the State of Florida, County ofk)de� Signature of Notary Public - Q � P•f" TONI GINDLESPERGER '?' " [ ] Personally Known OR [ ] Produced Identification I tj MY COMMISSION#GG 353178 .- ' �' EXPIRES:October 6,2023 F9.F,�:°c Bonded Thru Notary Public Underwriters Type of Identification: t _ L Updated 10/24/18 ,;y-/_ RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION City of Atlantic Beach HIGHLIGHTED IN GRAY IS /" 800 Seminole Road,Atlantic Beach, FL 32233 REQUIRED. lH1i v PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES Job Address (p S5 �--{L()A LAKE-, 6.4Z_ Permit Number Contractor Information Company cDu3 N 17-SZ Qualifying Agent Address ��55 5- A- LACJa5 Cj Cityct(State ft Zip 3ZZ53 Phone 'I rZ5• ,S-S-gy Email 'Tirib E.y50(.!)DY4NIGiA.€c,11.}1(r,Cpt`-( State Certification/Registration# /4 0 ' Architect Phone Email Engineer Phone Email Workers Compensation Insurer OR ExemptfExpiration Date • Permittee declares that prior to filing this application they have ascertained the location of all existing utilities, both aerial and underground and the accurate locations are shown on the sketches. • Whenever necessary for the construction,repair,improvement,maintenance,safe and efficient operation,alteration or relocation of all,or any portion of said street or easement as determined by the Public Works Director,any or all said poles, wires, pipes,cables or other facilities and appurtenances authorized hereunder,shall be immediately removed from said street or easement or reset or relocated hereon as required by the Public Works Director and at the expense of the Permittee unless reimbursement is authorized. • All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the supervision of • • i r`(o Fir/ S OL13 /at•itG\('- (Project Superintendent) with(Company Name) Phone 501 . 723 .55 4i • All materials and equipment shall be subject to inspection by the Public Works Director. • All city property shall be restored to its original condition as far as practical, in keeping with City specifications and the manner satisfactory to the City. • A sketch of plans covering details of this installation,as well as a copy of a recent survey shall be made a part of this permit. Calculations showing any increase in impervious area on owner's lot or in the City right-of-way are to be included with this application. • The permittee shall commence actual construction in good faith within days. If the beginning date is more than 60 days from date of permit approval then permittee must Peview the permit with the Public Works Director to make sure no changes have occurred in the area that would affect the permitted construction. • It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right, title and interest in the land to be entered upon and used by the holder,and the holder will,at all times,assume all risk of and indemnify,defend and save harmless the City of Atlantic Beach from and against any and all loss,damage and cost of expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges. • The Pub irks Director shall be notified 24 hours prior to starting work and again immediately upon completion. Date ,- 17 2OZ-5 Permittee(s•:: . in . esence of Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL �/ The foregoing instrument was acknowledged this ( T day of .P" -1-Z_O N _.y ,20 Z.-- , by l l r-tQF' Y V . SCS L0b'yh1J 1L‘i--) ,who personally appeared before me and (p inted name of Permittee) ,.41.�''•. TONI GINDLESPERGER ackno le ed that h • - -d the instrument voluntarily for the purpose expressed in : ,., MY COMMISSION#GG 353178 .•o: EXPIRES:October 6,2023 A 1'''`,�-''' Bonded Thru Notary Public Underwriters r [ ]Personally Known Signature of Notary Public,State of4 a [ ]Produced Identification(Type) H:\Applications&Forms\Word Documents\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18 179 f-fr-7,7 0 I . I •.- •• 0 !VP W atom Tide Services of N.FL,Inc.. 'n v • ! ::,�� • 11226 Sint Jose Blvd.,Ste.2 _ v ,' Jacksonville,FL 32223 . ' '" 904-461-3220 - : ""° t `•w oce@wfi atsoititle.iet r - ---_...- - PROPERTY ADDRESS:655 SELVA LAKES CIRCLE, ATLANTIC BEACH,FLORIDA 32233 SURVEY NUMBER: 2209 5088 2209.5088 BOUNDARY SURVEY DUVAL COUNTY __. /ar .,.„,,,,,,...J 1),0 ,. 0 eri- ,7,- 0's r— 7,-; ...., . : 4„ 421, -... .4,4 4/7, .. • .. :1,.• - \,,b p ;1:x. . :4 ,,, I I 1R"fr,-••', q� • Ia.f1P 112'ftec ILL, ^,k ••' 14°1D IziW LES ° gIRC ', -In PS. [:}• ; 114.19'( P 'Pn ill N ,.5 f,e'.::E 11,3.x.E 114.33'( ) ' N81 4005 E N N-.. �pu%:LAN ICNICI LOT 152__.= L. ' 0.080 Ac. ON LI • r Li o d p� LOT 151 g O 1 o LOT 153 a m ;_,..e , CD ....3 \ V3PN1�11G 1, /T r 1c, QAC —YAZ, OffA trtr 1 A0�-'� Ty �//� 03'OF r ND �� ` 1 `1{D�� ` � e' ic, ONLINE - - .- _3/4 c C �L —- Edi 1 �pL�M• 1 vs, INf 'Tri N N`�?!4-U-- .. .f6 '1 III O ID LBtf i 048 R. 170.00'(P8M) (� _ _S) A= 2°01'42'(P)2°01'41"(M) eAv< o N 82°38'52"E 6.02'(P) d N82°42'14"E 6.02'(M) THE PLAZA A LINE TABLE: (80'RAV) -----qL1 N 81°38'01'E 28.47'(M) - N 81°2542"E 28.47'(M) ------1 - -- - SECTION 2 L2 S 83°42'00"W 34.50'(P) SALTAIR S 83°54'17'W 34.44'(M) p•8.10,PG.15 3o 0 15 30 siiviin SURVEYOR'S NOTES: FENCE OWNERSHIP NOT DETERMINED. GRAPHIC SCALE(In Feet) J.E.A.-E.-JACKSONVILLE ELECTRICAL AUTHORITY EASEMENT 1 inch=30'ft. SURVEYORS CERTIFICATION: POINTS OF INTEREST: 0;14 E- 1.CONCRETE DRIVEWAY OVER 7.5'JACKSONVILLE qy I hereby certify that this Survey of the lands ELECTRICAL AUTHORITY EASEMENT SNE•KROQ9y'4,i4 described hereon was made under my direct •3O nse Nt ');5, 1.1. supervision,and to the best of my knowledge , LS 7386°" and belief is a true and accurate representation y �l of said lands and meets the Standards of K,t.:L1_. 7.-4 Practice set forth in Chapter 5J-15.050 through A 1-1; = 5J-15.053,Florida Administrative Code, ,EXACTA S` 1 STATE OF 4s pursuant to section 472.027,Florida Statutes. Exacta Land sur..yon Llc V Q ,,,41-.. This survey is not valid without the signature and Lend Surveyors.LLC 18/8197 '�. Vs FLORIDA � - . / y .�� original raised seal of a Florida licensed surveyor o:866.735.19161 f:866.744.2882 ,��0�.1 SUM/V.'- p�`���` and mapper,except when the electronic y 3E46Blanding Boulevard,Jacksonville,fL31210 /,1/4 �yyhnionitiiiiii ptl���` signature and seal of a Florida licensed surveyor JOHN E.KROBATH and mapper is affixed hereto. Florida Land State of Florida Professional Surveyor and Mapper AFFILIATE License Number 7388 �L ` Title Association N e Exacta Land Surveyors,LLC I L291 . L:TA' .•.MEMINPOT,e_. MEMBERS DATE SIGNED: 10/07/22 FIELD WORK DATE: 10/6/2022 SEE PAGE 2 OF 2 FOR LEGAL DESCRIPTION REVISION DATE(S):(RENO 10/7/2022) PAGE 1 OF 2-NOT VALID WITHOUT ALL PAGES