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1555 Linkside Dr RESO23-0084 App_1r=-- 44>i, BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY a Cityof Atlantic Beach BuildingDepartment f i p PERMIT# (.- 1. 800 Seminole Road, Atlantic Beach, FL 32233 ALLALL information required to process os P- Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address 1555 Linkside Drive,Atlantic Beach, FL XRE# 1723' -61)75--- x 6075XLegalDescriptionSoleaLA4t( ,id e Myt1,i- 2. ) P+ (O-f qq- , 9- re id cJr ZO 373"/O1O Valuation of Work(Replacement Cost) 15,000 Heated/Cooled SF Non-Heated/Cooled SF Class of Work: New Addition Alteration DRepair ['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 tree(s)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: Replace old pavers and concrete around pool with Rosetta Stone linear flagstone. See attached survey. Florida Product Approval#For multiple products use Product Approval Information Sheet) Property Owner Information Name Robin&Thomas Heninger Phone 904-372-0122 Address 3948 3rd Street South#331 City Jacksonville Beach State FL Zip 32250 Email robinheninger@me.om Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company Phone Address City State Zip Qualifying Agent State Cert. ' ation/Registration# Email Job - e Contact Number Worker's Compensation Insurer OR Exempt Expiration Date Architect's Name Email Phone Engineer's Name Email Phone Application is hereby made to obtain a permit -. do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a per ' and that all work will be performed to meet the standards of all the laws regulating construction in this jurisdiction. I underst-nd 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 YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN ATTORNEY FORE RECORDI G YOUR NOTICE OF COMMENCEMENT. attu o wrier or ent) Signature of - tractor) Sig ed an sworn to(ora ed)befo - this _ day of ' Signed and sworn to(or affirme. before me this day ofJJ , it by 1`; 111b. ft O ( by Signature of Notary A. Signature of Notary Personally Known OR [ ]Produced Idhtification Personally own OR [ ] Produced Identification Type of Identification: h , L Type of Identific• ion: irsi'%;;,, TONI GINGLESPERGER r c„ MY COMMISSION#GG 353178 j'„—'4,....W EXPIRES:October 6,2023 9Bonded Thru Notary Public Underwriters 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.usPERMIT#: =E: > C, 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:1I55-5 l.iVlp f lavi(i c J"c c i , V (- Owner Name: V14 'r i44 t l y )141- Phone Number: 'o1-37.1-D 1- Mailing Address: City: ,p1.?( State: FL Zip: 3 7 S Notarized Signature of Owner kV The foie i`ginsttrruur ent was acknowledged before me this ( day 01_ ,20 in the State of Florida, County Signature of Notary Public Personally Known OR [ ] Produced Identification Type of Identification: l Updated 10/24/18 t'•`:%4''• TONI GINDLESPERGER MY COMMISSION#GG 353178 I r g EXPIRES:October 6,2023 Lorded Thru Notary Public Underwriters I 11 SJD CONSULTANTS, INC. am m \ Aws.eA lanae Naw:fM-)Io-gV 3.• 12..y ....... 0, MINIUM Awes.KIM p.h.l.NH,wena.mm e,•—IIIIMEi1'I,A EL.'N1- VI PROFILE 4 U'. or'-‘).- 1.,-, Kt g SCALE 1'_20' gT J l.. 0 T g 5 2^1 ,. 1 OD J y S L g z Q m y 2 p n-1 Iv', 1 CD C d 6''AC Z zZt FeEELB f ciA"m ireQ 112 G"11/4 IA ppEUHEAD uCwEN ,=y Lai‘ © p Z LL C2, _ PAVERS 22.01 1)p) W yNj 9 Z OONCRETE DRIVE i 4 11, NEW REDO-ROCK STACKED CQICREi[BLOCKGRAVITW4 Q IC 1411 1 WALLS LL E C NL MAK. Mi AME LaWNLSMALLBECONSTRUCTED )ME SAYEce E7 1 0 1 \LOCATON AS THE EMS1M3 WOODEN BUUMEAD Q 0 Q, N 22.0 1 1(a.) . MIMEO).SCFE PRICK. r) $f I Y BRICKEx15T W 1— STORY t,„ 1 e REMOVE v RESIDENCE No. 1555tir RrD 1. ypODEN DOCK GRACE TO DRAW TO EwseN3 O I I '4'1\e ARD weAx+TO INC NOON.n N aMVD. 112.21 VR fil m 1 11 1 1 `fit Z O x,2.)0 pm. s .2 \ x,2Y 1 .f '1C EDGE OF WATER YRA A COx 116 1 Y C iS. n' 5'IS.GII.. .. Z BENCH MARK: SET MAG S N pART OF LOT 94 Eu.2. POP x " x"[ LO4'BF NAIL&DISK,LB.3672 FIli WppDEN R TMA NG IN EDGE OF PAVEMENT 0 WALL't0 OESM&VW[NICKER SJC ELEVATION- 10.52 o i 1 RESIDENCE No' 1547MARC -- NEA[Mt VW NAND 1988 DATUM)WI' N a FOUND MAO NAIL! 1 p•......'•:tti"`\ DISK.PCP 0210 f "•••'- '• NOTESi. L 0 T 9 3 1. PROVIDE EROSION, TURBIDITY AND SEDIMENT *. , o CONTROL BARRIERS AROUND CONSTRUCTION 0.- sl n. AREAS. oc:'" 2. SOLID SOD ALL DISTURBED AREAS. PM.Na: 2233 OATS: ANAL 2023 SCAM ,'=20' u2c.SCA I a 1