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610 BEGONIA ST RESO24-0029 ,3%': T,;, BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY Air, City of Atlantic Beach Building Department PERMIT# RES6Z�-boZ� ''� 800 Seminole Road, Atlantic Beach, FL 32233 **ALL information required to process �O; 25 Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address 41' CS 17.-,E (-_,--,c, NI"el T AILA J I c Trf}L1.1 pt_ 3L2.-- RE# Legal Description ,E x.le ncl.,,)5 LI C L,jC Valuation of Work(Replacement Cost) t, WO Heated/Cooled SF Non-Heated/Cooled SF 1` i •Class of Work: ❑ New 121Addition ❑Alteration ❑Repair EMove ❑Demo ❑Pool E Window/Door • Use of existing/proposed structure(s): E Commercial 4Residential • 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)"No Describelin detail the type of work to be performed: Ac .:,' i f} O� !r.,� h 'L Ct�.S*-,.-15 c e c. J ad a ecce ;- ?- r � � ,� dine 'f7) e X�th^5 -Peace. Florida Product Approval# (For multiple products use Product Approval Information Sheet) Property Owner Information Name M Act,/ ; N,4' { �� ,k Phone 7114 '-"!C-14, 77 L 3 Address V ID EG,O N14 ST City A-t/a.t-f;z. lgeaul, State V L Zip 3 Z2 33 Email xnu l l?yMa,), coni Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) DL jner Contractor Information Name of Company OW jl e ( Phone Address City State Zip Qualifying Agent State Ce.• cation/Registration# Email ,. 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 p- it to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of . .ermit and that all work will be performed to meet the standards of all the laws regulating construction in this jurisdiction. I derstand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS, WELLS, POOLS, FURNACES, B• ERS, HEATERS,TANKS, and AIR CONDITIONERS,etc. NOTICE:In addition to th• 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. /Z / 1/ (Signature of Owner or Agent) (Signature of Contractor) Signed and sworn to(or affirmed) before me this 12-1day of Signed and sworn to(or affirmed) before me this day of /AG(CAI , 20 1 by . • . all , by Signature of Notary ,- AlliSignature of Notary [ ] Personally Known OR [ ] Produced Id:* ication [ ] Personally Known OR o uced Identification Type of Identification: ,( Tf,i.�,�Rrif YP _ „�,no�o ,�.,,., ication: !'y'' TONI GINDLESPERGER ,,• t MY COMMISSION#HH 407122 • .a7 :' .,;F�<«o;: EXPIRES:October 6,2027 OWNER BUILDER AFFIDAVIT A, City of Atlantic Beach Building Department JOB ADDRESS: 800 Seminole Road, Atlantic Beach, n �� / FL 32233 g l0(d e pr iei S( A-16,1 c. 3Zz3 ji!A. Phone: (904) 247-5826 Email: Building-Dept@coab.us **OWNERS MUST PERSONALLY APPEAR AT THE BUILDING DEPARTMENT TO SIGN THIS DOCUMENT** I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES OWNER/ BUILDER TO ACKNOWLEDGE THE LAW: To qualify for exemption under this subsection, an owner must personally appear and sign the building permit application and must satisfy local permitting agency requirements, if any, proving that the owner has a complete understanding of the owner's obligations under the law as specified in the disclosure statement in this section. However, for purposes of implementing a "United States Department of Energy SunShot Initiative: Rooftop Solar Challenge" grant and the participation of county and municipal governments, including local permitting agencies under the jurisdiction of such county and municipal governments, an owner's notarized signature or personal appearance to sign the permit application is not required for a solar project, as described in subparagraph (a)3., if the building permit application is submitted electronically to the permitting agency and the owner certifies the application and disclosure statement using the permitting agency's electronic confirmation system. If any person violates the requirements of this subsection, the local permitting agency shall withhold final approval, revoke the permit, or pursue any action or remedy for unlicensed activity against the owner and any person performing work that requires licensure under the permit issued.The local permitting agency shall provide the person with a disclosure statement in substantially the following form: DISCLOSURE STATEMENT- Please initial Items 1 - 13 1.(fi .tlI understand that state law requires construction to be done by a licensed contractor and have applied for an owner- builder permit under an exemption from the law.The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. 2. if-601 I understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. 3. /flyiI understand that, as an owner-builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that a contractor is required by law to be licensed in Florida and to list his or her license numbers on permits and contracts. 4. fro?Y I understand that I may build or improve a one-family or two-family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my own use or occupancy. It may not be built or substantially improved for sale or lease, unless I am completing the requirements of a building permit where the contractor listed on the permit substantially completed the project. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or substantially improved it for sale or lease,which violates the exemption. 5. /�5!"I understand that,as the owner-builder, I must provide direct, onsite supervision of the construction. 6. /75.A✓ I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the licenses required by law and by county or municipal ordinance. 7. /4141 I understand that it is a frequent practice of unlicensed persons to have the property owner obtain an owner-builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner-builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner-builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 8. I understand that I may not delegate the responsibility for supervising work to a licensed contractor who is not licensed to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers' compensation for the employee. I understand that my failure to follow these laws may subject me to serious financial risk. Fence Addendum Updated1/14/2021 City of Atlantic Beach Building Department 800 Seminole Road, Atlantic Beach, FL 32233 PERMIT# Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: Date: U Be ori i c S+ ��i��� ti�!,/ FL 332, i y k1 A (Z 2''1 Property Type: Lot Type/ Features: Residential One Street frontage (interior lot) ❑ Commercial ❑ More than one street frontage (corner lot, through lot, etc.) ❑ Swimming Pool Fence Material: Fence Height (select all that apply): *Wood ❑ Four Foot (4ft) ❑ Chain Link XSix Foot (6ft) ❑ Vinyl ❑ Other ❑ Block/Stone (Plan details required for footings and/or retaining walls) ❑ Other Fence Location: Please submit an accurate and current boundary survey showing all existing improvements (including building footprint, driveway, swimming pool, etc.) and location of fence/wall and any gates. Plan details required for block wall footings and/or retaining walls and any portion or fencing above 6ft in height. Will the fence be built in an easement? ❑ Yes (must submit separate Revocable Encroachment Agreement) No Will tree(s) be removed in association with proposed project? ❑ Yes (must submit separate Tree Removal Permit) No Conditions of Approval: • Roll off container company must be on City approved list. Roll off container cannot be placed on City right-of-way. • All old fencing and debris must be removed from job site by contractor or homeowner. 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 RECORDING YOUR NOTICE OF COMMENCEMENT. BEARINGS SHOWN HEREON ARE TITLE AND BOUNDARY NOTES BASED ON PLAT BOOK 18, PAGE 34 1. DISTANCES SHOWN HEREON ARE GROUND DISTANCES UNLESS OTHERWISE NOTED AS GRID. I i 2. THERE MAY BE ADDITIONAL EASEMENTS AND/OR RESTRICTIONS THAT ARE NOT SHOWN ON THIS MAP THAT MAY BE FOUND IN PUBLIC RECORDS OF THIS COUNTY 3 UNDERGROUND FOOTINGS,FOUNDATIONS,UTILITIES,OR OTHER FEATURES WERE NOT LOCATED OR SHOWN. 4 FENCE OWNERSHIP IS NOT DETERMINED. 5 THE LOT SHOWN HEREON IS LOCATED IN FLOOD ZONE AE(AREA OF MINIMAL FLOOD HAZARD)AS SHOWN ON I I COMMUNITY PANEL NO.12031C0408J,EFFECTIVE DATE OF 11/02/2018. PVCI LOT 4 I 1.3'— I PVC LOT 4 12'1 FEN SYMBOL LEGEND __. 6' PVC FEN n 0/L—\ N89°06 X51'E 102.00' • MONUMENT FND • BOLLARD SET 6' PVCSET Q IPC FEN. 20.2' ,_IPC CULVERT r, O I.P. / I.B. END /C.P. A WETLAND FLAG Q 0/S BOG 60.3' BDG T • SET 5/8 RBR W/ORANGE A/C UNIT -,-12.0' 0 #4.7E 4,9'� N CAP STAMPED SCAUCE I[_ / 6 4 LAND SURVEY LB8534 ® ELECTRIC METER RAISED w Q Q STAKE —0-- PVC FENCE (PVC) M AS l• a s R VEWAY Q —o-- STOCKADE FENCE (STK) ® CROSS CUT cc cEN d A Ao3j5 SPOT ELEVATIONS —X— CHAIN LINK FENCE (CLF) LO 5 °� (2 WIRE FENCE 4 1 STORY ( LIGHT POLE r0 UTILITY POLE 1 5 "' FRAME BUILDING 6.0' SIGN >---- GUY WIRE i z \ #610 r, `-' 1 FIRE HYDRANT D.C. DEPRESSED CURB LOT 5 I J ^ � Q w Q) MANHOLE FNC FENCE _ Q CULVERT FA 'A"-INLETlo MAS. MASONRY 7.7' 6 0 as - "B"-INLET PLAT. PLATFORM pW00D N CO L.. 1--,1 Ei YARD INLET W.W. WINDOW WELL a0 DECK - V) Wo • YARD INLET B/W BAY WINDOW 7.6. 60.3' o Q o © GAS METER C.P. COMPUTED POINT ° ( I Q LU ® WATER METER 0/H OVERHANG CO w Q 0) I pd GAS VALVE R/0 ROOF OVER ',� 6' PVC FEN < (j' L„J006 Fe6FC v WATER VALVE CANT. CANTILEVER Digitally signed _ _ \ / ^_ -� 0 TEST HOLE G.O.L. GENERALLY ON LINE Daniel by Daniel R SET `PVC 2O S89°06'51"W 4'FND TREE 0/L ON LINE Jackson PVC 102.00 IPC FEN I RBRC IPC IRON PIN AND CAP Jackson Date:2023.09.22 FEN 0/S 0.2'1 SHRUB R.O.W. RIGHT OF WAY 16:32:46-04'00' LOT 6 —1.3' 12.0'_. 11.1' I LOT 6 GRAPHIC SCALE I SURVEYORS CERTIFICATE I 20 0 10 20 "I CERTIFY THAT THIS MAP WAS DRAWN UNDER MY SUPERVISION FROM AN ACTUAL SURVEY MADE UNDER MY SUPERVISION AND MEETS THE STANDARDS OF PRACTICE ESTABLISHED BY THE BOARD OF PROFESSIONAL SURVEYORS AND MAPPERS PURSUANT TOI 1WII LOT AREA r CHAPTER 472.027 FLORIDA STATUTES AND CHAPTER 61-17 OF THE FLORIDA ADMINISTRATIVE CODE,NOT VALID WITHOUT AN ± ORIGINALSIG • 'E OR AN • ••. 'TIC•' II ELECTRO IC SIGNATURE." 5,100.00 S.F. ■ i, ( IN FEET ) 0.12 AC. DANIEL 1.JACKSON- O' %• '-•FESSIONAL SURVEY••AND MAPPER NO.7447 SCAN ME 1 inch = 20 ft. \\VV��\11111111JJ// scALIcETAX NO. BOUNDARY SURVEY ?"to'z-E-74-,..krsJ• JAi� 170921-0025 610 BEGONIA STREET, ATLANTIC BEACH, FLORIDA 32233 1' /� LAOT 5 CCORD OG TO PLAT CK 138, ECTION "H"TEREOF, ASTLANTIC RECORDED CIN Q , 'C.1' O . Q 11Z =•_:: PLAT BOOK 18, PAGE 34, OF THE CURRENT PUBLIC - - •Z /� I/ -.41, _ JOB No.D23-3833 RECORDS OF DUVAL COUNTY, FLORIDA. I a n c s u ry ey n c PREPARED FOR AND CERTIFIED TO: -,�0p SFLORIDA \- �*". mjs andsurvey.com P:904-41 3-9355 DATE SURVEYED: 09/14/2023 MATTHEW NULK //,SURVEYOR PSS\\\ 205 Marketside Avenue, Suite 200, Ponte Vedra, FI 32081 1 I ATLANTIC OLD REPUBLIC TITLE Sc NATIONALTITLOWE /��/'1IIINIIIIItt�VV DR.:MC ICREW.:TJ SCALE: 1" = 20' ', UNAUTHORIZEDµTERA1gN OR ADD..TO nits NAP BEMNG A S SEµ5 A W (2)ON SURVEY NAPS THE SORMEYOA'S SEN.& GNAIURE.E CENURE TRUE ANDSURYEYTR'S ORIGINAL WORN KION.(J)WT.-IDAHO.ONArts SURVET..APACCORDANCE DARN THE CURRENT ExISTNC 'TM OF PRACTICE FOR LAND SLAVERS ADOPTED BY ITE STATE OF FORIE.THE CERTIFICATION R LOTTED TO PERSONS FOR ANON THE NWNOARV SURVEY NAP IS PREPARED.rO THE TLE COMPANY,TO ENE GOVERNMENTAL AGENCY,AND OTHE CORRECTLENDING EINSRRURRN USTED ON THIS BOUND.+SONE,MAP.(41 THE CERTIFICATIONS HENEN ARE NOT TRANSFERAEIE.(S)THE THATLOCATION OF UNDERGROUND RIPROVEMENTS OR ENCROACHMENTS ARE N FIRM L B 8 5 3 4 PTA NAyS ATIOS P NOW .D OFTEN MUST ESTWTEO,IF Amy UNOERGNDUND IER'AO.ELEEMS OR ENCROACHMENTSCOST OF ARE sHowN.WAD THE EVEMMEEN SS RWGHMENTS ROOF NOTSCOVER[TNETV TN4 SUMAC,'(S)ME OF"SER(OR DUENSLGES)W.HEREON FROM T U STRUCTURES TOLE TOE RNANTN TAT, ARE FDR A SPECIFIC PURPOSE AND USE Aho THEREFORE ARE NOT IATENDEE TO GUIDE THE ERECTION OF FENCES.RETANNG WALLS. TT NOTING AREAS,AoomoNSBETo BULDNGs,AND AHV OTHER TYPE OF CONSTRUCTION (T)THE EXISTENCERIGHTS PAND/ORT DOS HL RECORD IF ANT. NN ARE OT...TECO (e)SURVEY IS SUBJECT To ANY STATE OFF S R.N. TO-TATE x,w DISCLOSE.