SIGN24-0003 at 1985 MAYPORT RDA Pik -I CQ,7GY1 Su am I rTEf ay I-oQ c,JoJso n yO H -3 4P(0 -a('1 .
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BUILDING PERMIT APPLICATION
l T,Sdnfb e3e 6 i. Cofl')
01-/-,-4 r FOR INTERNAL OFFICE USE ONLY
CiCty of Atlantic Beach Building Departmentr PERMIT# IC 24 --bo( 3
890 Seminole Road, Atlantic Beach, FL 32233
ALL information required to process
pli 9' Phone: (904) 247-582 mail: : ildin:-De.t ' coab.us
f
Job Address l g( C Free 1 gs Q p RE# ?a l J 6100
Legal Descripti W /7",095 We,, .7 11&.i R 7 / 2/ of need c/r? /97/Vao95
Valuation of Work(Replacement Cost) / OC, of-- Heated/Cooled SF Non-Heated/Cooled SF
Class of Work: New Addition Alteration Repair ID Move Demo Pool ['Window/Door
Use of existing/proposed structure(s):JKCommercial Residential • If 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)V No
Describe in detail the type of work to be performed:
A-lit{- 6f+ toy( b 14fi--u0,,Pe sic A) on FRoI r-of afx,p(i16 .
Rei) /Tion /9-t/-e- re Cp a., eA,'" Q.._ct
Florida Product Approval# For multiple products use Product Approval Information Sheet)
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71PropertyOwnerInformationName /9/0e I Phone q y/p29' 2 9V/
Address M3/ lea Aka"' 3 City —` e. State`s Zip L,y 1
Email/ 'y /4 d/ 74(c {el erk gent If Agent, Power of Attorney or Agency Letter Required)
Contractor Information //Name of Company Phone
Address City State Zip
Qualifying Agent State Certification/Registration#
Email Job Site 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 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 city/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. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE SITE OF THE IMPROVEMENT BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
Signature of Owner or Agent) 0.,_i
Signature of Contractor)
Signed and sworn to(or affirmed)before me this /
2
day of Signed and sworn to(or affirmed)before me this day of
f k0--7 , -
e zk.f by A Lr- / by
Signature of Notary £t Signature of Notary
Personally Known OR [ Produced Identification Personally Known OR [ ] Produced Identification
Ty l'!!1,l hi Ahedt
c011 evaoat - N\V `{ `\ n_O stir\ Type of Identification:
F/,• .r; Notary Public-State of Florida (
a `i Commission#1-04 056368
or..? . My Comm.Expires Nov 12,2024 I
Bonded through National Notary Assn.
mm..-- - /Ma. --4i
Owner Builder Affidavit ALLINFORMATI ON
v< —r,,
HIGHLIGHTED IN
5r".1
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
fi''
4111
r
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. j
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 $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEE THE COUNTY"CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT @COAB.US ) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I
COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
Job Address: /
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W %y,L 16• ,W/a, T/C _l l), C ( ; 3.,_
Owner Name:/7/i 64/
JJ/ //
Phone Number: 90e-/ 5/421"$/
k..)-26/./
Mailing Address: / 5/..7.5- ,L eav- J/ea Yrjcity: JLLX.. State: CZ Zip: , U
Notarized Signature of Owner % :/l Y 64
The foregoing instrument was acknowledged before me this I '- day of
i4,1r-,0..Y ,
20.2 1jin the State of Florida, County
of j)-^ ter` \
l'Signature of Notary Public 1,- d r
Personally Known OR [ ] Produced Identification
tY p i<'COLETTE.i POORE i
Type of Identification: fir: Notary Public•State o+=lorice
i% Commission g NN 056368
or,..c,1!-; My Comm.Expires Nov 12,2014 P
Bonded through National Notary Assn. 0 Updated 10/24/18
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OWNER:ADDRESS:CITY:STATE:ZIP:
1985 MAYPORT LLC 107 Tallwood Rd JACKSONVILLE Beach FL 32250
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
172194 0000 DONNERS R/P
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
1985 MAYPORT RD SIGN WALL PAINTED SIGN $100.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
ZONING WALL SIGN FEE 001-0000-329-1003 0 $30.00
TOTAL: $30.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
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.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
1 of 1Issued Date: 2/14/2024
PERMIT NUMBER
SIGN24-0003
ISSUED: 2/14/2024
EXPIRES: 8/12/2024
SIGN PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
MAP SHOWING SURVEY OF
THE NORTHERLY 100 FEET EXCEPT THE EASTERLY 40 FEET OF BLOCK 23, DONNER'S
REPLAT AS RECORDED IN PLAT BOOK 19, PAGES 16 is 16A OF THE CURRENT PUBLIC.
RECORDS OF DUVAL COUNTY, FLORIDA.
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NOV 131991
Z3LOG ZZ IBuildingandZonin •
I HEREBY CERTIFY THAT THE PROPERTY SHOWN HEREON IS IN FLOOD ZONE 'C' AS SHOWN
ON THE FLOOD HAZARD BOUNDARY MAP FOR THE CITY OF ATLANTIC BEACH, FLORIDA.
I HEREBY CERTIFY TO WILLIAM AND BERLF.TTA, URQUHART THAT I HAVE SURVEYED THE
LANDS AS SHOWN IN THE ABOVE CAPTION AND THAT THIS MAP IS A TRUE AND CORRECT,
REPRESENTATION OF THAT SURVEY AND THAT THE- SURVEY REPRESENTED HEREON MEETS
THE MINIMUM STANDARD REQUIREMENTS ADOPTED BY THE FLORIDA STATE BOARD OF PRO-
FESSIONAL LAND SURVEYORS CHAPTER 21-HH AND THE FLORIDA LAND TITLE ASSOCIATION.
VoTF:or s..v.k f...Awr oo.VE orr t•.,,
1/4. 1.,,...,,,,..\:-. 610....4. -...‘
DONN W. BOATWRIGHT. LS.
FLORIDA REQ LAND SURVEYOR No. 3200
SCALE: i,.= . BOATWRIGHT LAND SURVEYORS. MIC. D,5, 1$Ny%s
DRAWN Br s 1901 PENMAN ROAD SUITE0 8 ET_L__OF .
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $30.00
SIGN24-0003 Address: 1985 MAYPORT RD APN: 172194 0000 $30.00
ZONING PLAN REVIEW $30.00
ZONING WALL SIGN FEE 001-0000-329-1003 0 $30.00
TOTAL FEES PAID BY RECEIPT: R26245 $30.00
Printed: Wednesday, February 14, 2024 1:02 PM
Date Paid: Wednesday, February 14, 2024
Paid By: 1985 Coffee
Pay Method: CREDIT CARD 10141018629
1 of 1
Cashier: VA
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R26245