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267 JASMINE ST RFNC24-0056 l•-c'-''% Building Permit Application Updated 10/9/18 BuildingDepartment **ALL INFORMATION ,� City of Atlantic Beach k'”Ilinr 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY -p%t t' IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: a4,7 .TF\SNS\NE' ��. Permit Number: !R E=(U C Z - O 05 6' Legal Description Sec-kjoti K S ,O F--1- Lo c a, N 0FT 1-0k- 3 :A.1'< `f9 RE# \-7Ot5C,t - O \OO Valuation of Work(Replacement Cost)$ 7no,Q0 Heated/Cooled SF Non-Heated/Cooled • Class of Work: Efew ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial 1 J1 esidential • If an existing structure, is a fire sprinkler system installed?: DYes ilo • Will tree(s)be removed in association with proposed project? DYes(must submit separate Tree Removal Permit) QNo Describe in detail the type of work to be performed: ‘, --` LF= bc\ (o F' 'o\- Fet ice bek' 't e B c.),,;‘di i r.LS., s-k-etopit. cccwL)►..t ko 3,4_ F ©;N L--\ Foot fpm c-e. -- -crt Al SH ‘.-F Florida Product Approval# for multiple products use product approval form Property Owner Information Name TAC'A Uri'\ 1(AS Address a-f7 SRSIt t e. ST City F --k- IN V'k- 1c_ .eft-c-h State FL. Zip 3 --4,3 Phone n4 ,Sfrt-n tiC) or E-Mail .' - - • o . C a. . • - Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information IN\c,..1.;kR\-\u N f i4 yr-`` 1...c-Fmiri I: • J C p ryl Name of Company jam,/ 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 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 R 'RDIN YOUR NOTICE OF COMMENCEMENT. _, .f, r _ rill (Signature of Owner or Agent) (Signature of Contractor) Signed and sworn to(or affirmed)before me this 1 b+1 day of Signed and sworn to(or affirmed) before me this day of cy.\ ,'a,ba Lk ,by jL A NC\U S , by ...0■Vor,- (Signature of Notary) - =.. ..f 1e:. MOHAMED ALSHARA Notary Public-State of Florida PI Commission#HH 393842 [ ]personally Known OR [ ] Personally Known OR '"of F.,°o- My Comm.Expires May 3,2027 (}Produced Identificatio ' - [ ]Produced Identification •Type of Identification: - rei.l, 4 "4 Type of Identification: i ' 11 ,rowl, ' '',,l7 .1 ..t.•,..i noits311qt4Atitni9q .ciritbitu4:1 .. , . te191-rt--;;ls(1 !?,r7,7',71tuEi ellirtt-.13iInsItA to,y113 ' .. 7 .V r11E.,: l'...tils-11-A ,i:Jcei 91.oilirn92 008 - .,ciLi.... .. . • - -, . :ritirnii 8'e-Ct.S, `,401.?) :qrtr.,',11 ... - - .._ . . .. : , .. - • . ' 1- . 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' -..1.-;•'' to.31r,' )it-Ju. /In. -. .!...‘i,..,,, -,,..-•' '''', ei.‘.... ,..• . , 4 o.: i .4.s74,,,o,ipt -n'- .-14,,. ..-',..r • -.,„ *7 - - ' -. ,' 17-,•......-;.1 :•,-,:;,..,-.. -rt ,,'". j ni:,1;; .T:,i1.-" ' i: ••••: ' •4"111°•""*.'"`''''-r.'—'=•' 4.'' '..••• 44,',A *****1• ':. ' . ',. 't...--.',:.':ill'.,.!:'t,'"'•-c,. S%'''Alir7, Fence Addendum Updated1/14/2021 City of Atlantic Beach Building Department ro... \� J;��; 800 Seminole Road, Atlantic Beach, FL 32233 PERMIT# Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: Date: - 7 SresN tnLe -4-. Property� Type: Lot Type/ Features: 6d" Residential 2"One Street frontage (interior lot) El Commercial ❑ More than one street frontage (corner lot,through lot, etc.) ❑ Swimming Pool Fence Material: Fence Height (select all that apply): V Wood i—/our Foot(4ft) ❑ Chain Link [Aix Foot(6ft) O Vinyl 0 Other ❑ Block/Stone (Plan details required for footings and/or retaining walls) O 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) tiNo Will tree(s) be removed in association with proposed project? 0 Yes (must submit separate Tree Removal Permit) /o 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. • ft!',bite i.littA4 9:34191 • Ir. :".,ilrii;Uf A to y, stb ;PE ci!onifTt9?, 008 • • . . „ . :a291bbA dot . . _ tri 1CJ .;•.. i•••••!..•;!••'ii:1 ii; •It", •1 ; I . • •ei r*.f t St3f1s1 - boolq 1-1 • , • _ rwoc,i ..4)013 C• • 16/0.1 911191 r; • . -;. ;i; , . • `.! /I N.,!F• .; r•t..; f .2,1` 2•)q 1 (1, 1. rr;:, ?1v 9r,4119'! r;1) 7! o 7; tiolci '1 ;1/11 71stionlqqA • : • : . . 47;•-..1 'Jo )!:1 Oflt! rid 7;4 -..1"."..iTt-10 t.1.1023:- J7 .;;IQ ' OT , ;: •• • • RCA :;4.1,-!OV !. fiL;OY 1- rt ' YJUievICID ,CP1014 'A i'•;';,73r10,010:) '10 3—AID-I ft y i. A CITY OF ATLANTIC BEACH , _ / OWNER / BUILDER AFFIDAVIT 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. TELEPHONE THE BUILDING DEPARTMENT(247-5826) 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. X67 aliv<oNe 5\ 904 4 -o5io ADDRESS PHONE NUMBER ' : rte L l VS PRI,te/ AME a kft. /.4. 271/2 1,/; / i SIG ATURE DATE Before me this (0 F day of P Q;_1 ,20c7�Hin the county of Duval,State of Honda,has personally appeared herin by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of cLoO t i \ ,County of OU\./Ct\ D Personally Known 1 ( �) C / I .4. -i+p MOHAMED ALSHARA I Produced Identacation-Ci U1— k1 2-2' C::1\---"St -6p ZS -b =o• l¢.'' 1 ���. Notary Public-State 9 Florida .,�, o+Q: Commission#HH 393842 ° r'` My Comm.Expires May 3,2027 Notary Signature: F./BLDG/Owner-Builder Affadavit;REVISED: 4/16/2009 MAP SHOWING BOUNDARY SURVEY OF HE SOUTH 30 FEET OF LOT 2 AND THE NORTH 10 FEET OF LOT 3, BLOCK 99, SECTION "H" ATLANTIC BEACH, AS RECORDED IN PLAT BOOK 18, PAGE 34, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. CERTIFIED TO: - LOT 2 LOT 1 BLOCK 100 LOT 3 LOT 4 BLOCK 100BLOCK 100 BLOCK 100 S 00'18'00" E 40.00' (PLAT) S 00'18141" E 1.6' 40.14' (MEASURED) MASONRY LB 5050 - _ _ WALLIli -- 20.00' (PLAT) 30.00' (PLAT) 7 0.214 40.00' (PLAT) .T •-1.7 2.11 3' " 1.51 iv 10.00'(PLAT2.4.1. � r+ +FRAME • SHED yll 18' LOT 3 LOT 2 ' BLOCK 99 8. BLOCK 99 o.i� •• a .' x. I ({P• �A�D ° • 4 �•J ^ • •. ° 0 28.1' a 0.5-v'• ��I i Ct 4.6 D • o J^ ONE STORY Cl') iz`°1Y/ FRAME LOT 1 5 Q M a.a l����POSTED # 265 '' LOT 4 BLOCK 99 BLOCK 99 a o ONE STORY i:� a o M FRAME / S o POSTED #267 N 0 }' o • 24 LF09' , Foe 3- NI o woad FcascQ La I- 0 �� to N 0.T � 14.0' q •4- p d W ~'b L- IN 14.2' ah In O.'– a 0.8' 0 3 w W tmOWo , u • 00 o(no O , . LFo'F �4r-OOLZ ., •4•0.00 (PUT),\\\: .00'( 40.00' (PLAT) 20.00' (PLAT) 1 1 PLS 4470• " LB 5050 'V 510.00' (PLAT) CORNER N 00.20'22 W 40.01' (MEASURED) N 00'18'00" W 40.00' (PLAT) JASMINE STREET LEGEND: (50' RIGHT OF WAY) —X— = FENCE O = CONCRETE O = SET 1/2"REBAR STAMPED PSM/6146 • = FOUND 1/2'IRON PIPE NO IDENTIFICATION (UNLESS OTHERWISE NOTED) • = 4"x4'CONCRETE MONUMENT PC = POINT OF CURVATURE PRC = POINT OF REVERSE CURVATURE A/C = AIR CONDITIONER PT = POINT OF TANGENCY PCC = POINT OF COMPOUND CURVATURE NOTBS: REVISIONS PLAT BEARING OF _N 90'00'00" E ALONG THE 1. BEARINGS ARE BASED ON THE NORTHERLY BOUNDARY LINE OF SUBJECT PARCEL. DATE DESCRIPTION 2. BY GRAPHIC PLOTTING ONLY THE CAPTIONED LANDS LIE WITHIN FLOOD ZONE __= -.._, AS SHOWN ON THE NATIONAL FLOOD INSURANCE MAP DATED NOVEMBER 2, 2018, COMMUNITY NUMBER 120075, PANEL _94.08 J _. 3. THIS SURVEY REFLECTS ALL EASEMENTS & RIGHTS OF WAY AS PER RECORDED PLAT &/OR TITLE COMMITMENT OR OTHER DOCUMENTS PROVIDED BY CLIENT, IF SUPPLIED. UNLESS OTHERWISE STATED, NO OTHER TITLE VERIFICATION HAS BEEN PERFORMED BY THE UNDERSIGNED. 4. THIS SURVEY IS NOT VALID WITHOUT AN AUTHENTICATED ELECTRONIC SIGNATURE AND AUTHENTICATED ELECTRONIC SEAL. JOB # 44627 I DATE OF FIELD SURVEY: 03-28-23_ SCALE: 1" 20' RaytlFiThompson CERTIFICATE 1F7 I HEREBY CERTIFY THAT �` •"OF ggggY nnr�rr NDER MY RESPONSIBLE CHARGE SURVEYING, Inc. OF PROFESSIONAL SAND MEETS THE LUR A� ''S ANd'1�1C1PPCR5 S IN's°y1�OR R 5J-17. FE LORIDA A BOARD Going U DISTANCE YOUI ADMINISTRATIVE C•' 'SUANT TO SECTION 472 T�.� ORIDA STATUTES. 1825 University Boulevard West ‘AL / • !,'1�i�Jacksonville, Florida 32217 ONooM••(Phone)904-448 5125REGISTER .aR•y• APPER # 6146 l (Fax) 904 448 5178 STATE OF FLO4.•� 1.. .":USINESS No. 7469 LAND SURVEYS 0 CONSTRUCTION SURVEYS 0 SUBDIVISIONS T I