343 PLAZA RESO22-0036Building Permit Application
City of Atlantic Beach Building Department
// 800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: I-WHO:TR-- LoaLLus
Job Address: 343 Plaza, Atlantic Beach, FL 32233
Updated 10/9/18
**ALL INFORMATION
HIGHLIGHTED IN GRAY
IS REQUIRED.
Permit Number: Z, 9, -
Legal Description Lot 20 and the East 1/2 Lot 22, Block 11 Subdivision A RE# 170003-0000
Valuation of Work (Replacement Cost) $ 13000 Heated/Cooled SF Non- Heated/Cooled 392sf
• Class of Work: ONew DAddition 6Alteration ORepair LIMove ODemo ElPool OWindow/Door
• Use of existing/proposed structure(s): LICommercial aftesidential
• If an existing structure, is a fire sprinkler system installed?: []Yes N No
• Will tree(s) be removed in association with proposed project? [Nes (must submit separate Tree Removal Permit)
(4-9'
Describe in detail the type of work to be performed:
Finish detached garage with hvac, plumbing, walls, flooring etc. per attached floor plan
Florida Product Approval # for multiple products use product approval form
Property Owner Information
Name Nancy Love
City Atlantic: Reach
E -Mail
Address 343 Plaza
state FL Zip 32233 Phone 904-553-6266
nancy@coastaladvantagerealty.com
Owner or Agent (If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Qualifying Agent
Address City State Zip
Office Phone Job Site Contact Number
State Certification/Registration #
Architect Name & Phone #
E -Mail
Engineer's Name & Phone #
Workers Compensation Insurer OR Exempt 0 Expiration Date
Application is hereby made to obtain a permit to do the work and 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, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORpIpIG YOUR TI E OF,COMMENCEMENT.
/1/1.4"
(Sigiature ofwfier or Agent)
gned and sworn to (or atf
9 2 C
1 Personally Known OR
1 Produced identification
Type of Identification:
(Signature of Contractor)
9/
d) before me t day of Signed and sworn to (or affirmed) before me this day of
u .of Natary)
....efteenzelm_
TONI GiNDLESPERGER
MY COMM [E,S1ON
EXP NES Octio f6 if TO ,9^r ed
Bonded "(Ma Natary PUnalefatident
,by
(Signature of Notary)
nown OR
entification
cation:
systems and
storage
,m
X
/X/M111104 101,114010 IV V,
356 ft2
IIISMONVAMMIMrr
JAMIffir
MErm arr tmMa, 412,======1"4
0010111i11µ1 111
II 11011 00101 V1,11M1011101 1,011,11 10 1,111 111111,11
1 6141011
twauvammo
10111001110. II PH V/1
Owner Builder Affidavit
City of Atlantic Beach Building Department
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904)247-5826 Email: RuiI li ng:. -Dept@)
**ALL INFORMATION
HIGHLIGHTED IN
GRAY IS REQUIRED.
PERMIT #:
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
RE • UIRED 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(4 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 ISA LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT (904-
247-5826 OR BUIN.I::')IIN( DI° I? V (2)( OAIe IJ ) 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:
Owner Name:
Mailing Address:
Notarized Signature of Owner
The f i w;oing instru( lent was acknow -dged befo
of
.,-in the State of Florida, County
Signature of Notary Public
[ ] Personally Known OR [ ] Produced Identification
Type of Identification:
OMM5SSIONa`G 55317
I'JfF"5 e^ ii
lr� of
PuNic lFnderw {4e
Updated 10/24/18
LEGEND:
R ‘x RADIUS
L= LENGTH
NOTES:
LOT 24
BLOCK 11
CERTIFIED TO:
NANCY J. LOVE
CTX MORTGAGE CORPORATION
ATTORNEYS' TITLE INSURANCE FUND, INC.
PATTERSON, BOND & LATSHAW, P, A.
LOT 21
BLOCK 11
SCT 172- REBAR
STAMPED 'ACM LB 6702'
LOT 19
BLOCK 11
75.00' (DEED)
S 8952'13" E
74.78' (MEASURED)
0.3
FOUNO 1/2" IRON RIPE
NO IDENTIFICATION
0.00'
25 00'
0.0'
WEST 1/2
LOT 22
BLOCK 11
MEASURED)
COvERE
19.o'
MASONRY AND lo
FRAME GARAGE T.L4
1' 29 2'
LJ
4
EAST 1/2 1,
LOT 22
BLOCK 11
u.1
NI- 0.2 '7
0
—
CD u j
0
4.
LOT 20
E3LOCK 11
X
FOUND I/2" IRON PIPE
NO IOENTiFiCATION
0.7'
X
ONE STORY
MAONRy & FRAME
POSTED // 343
12.2" o 1b
P L"
z
25.00'
FouND 5/6' ROAR
NO IGEN TiFiCA DON
FENCE
CONCRETE
NOTES:
26 4'
25.00 50.00'
S 8952'27" W
74.78' (MEASURED)
75.00' (DEED)
x
4.0'
PLAZA
(50.0' RIGHT OF WAY)
'4.9'
SVSS XXssss et X,. Ss MAX
• 'AA
tkoi Le;
ftPf?
r!LY Atlantic Bcacti
..-1g and .L.,ning
0.0'
2'
X
6
LtJ
0)
uJ
ro
S 00'00100" W
LOT 18
BLOCK 11
0
c.)
d
ff)
FOUND 5/8" REBAR
NO IDENTIFICATION
79'51`4 •
im 0 W
457 „; CASUR[0)
(Pt 41)
A-0
FOUND I/2- IRON PIPE
NO IDENTIFICATION
SOUTHWEST 8LOCK CORNER
ACCEPTED BY:
1.
AssumED s oor BEARINGS ARE BASED ON THE GEARING OF :oo'fxw ALONG THE
EASTERLY BOUNDARY LINE OF 5U13JECTPAfiCEL.
2. BY GRAPHIC PLOT TING ONLY THE CAPTIONED LANDS LIE WITHIN FLOOD ZONE x_ AS SHOWN ON INC
NATIONAL FLOoD INSURANCE MAP DATED APRIL 17, 1989, COMMUNITY NUMBER 1206757,—P—A'NEL .,,_QP!!_Q,,,
_
THIS SURVEY REFLECTS ALL EASEMENTS Zic RIGH TS OE WAY AS PER RECORDED PLAT &/OR TITLE COMMITMENT
II SUPPLIED, UNLESS OTHERwiSC S TA TED, NO OTHER TI TLE VERIFIGA 'ION HAS BEEN PERFORMED BY THE UNDERSIGNED.
4, 11115 SURVEY NO) VALID WITHOUT THE ORIGINAL SIGNATURE AND EMBOSSED SEAL OF THE CERTIFYING SuRVEYOR,
JOB # 14342 1 DATE OF FIELD SURVEY: 04-28-01 DATE OF ISSUE: 04-
3 01
AJacksonville, Florida 32204
2522 Ook Street CERTIFICATE
REVISIONS
D SCRIPTION
NEREBy CERTiFy DIAT THIS SURVEY WAS MADE UNDER 1.47 RESPONSIBLE CHARGE
AND MEETS THE MINIMUM TECHNICAL STANDARD'S 65 SET FORTH BY DtE 110640A