Permit Fence 420 W Dutton Island 2012 CITY OF ATLANTIC BEACH.
•M 800 SEMINOLE ROAD
`' ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000410 Date 5/03/12
Property Address 420 W DUTTON ISLAND RD
Application type description FENCE PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
4 and 6 ft fence
Owner Contractor
WIGLEY HIROMI OWNER
420 W DUTTON ISLAND RD
ATLANTIC BEACH FL 32233
Permit FENCE PERMIT
Additional desc . NEW FENCE
Permit Fee . . . 35.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 1800
Expiration Date . 10/30/12
Special Notes and Comments
Fence must not block retention area flow.
Fee summary Charged Paid Credited Due
Permit Fee Total 35.00 35.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 35.00 35.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Doc # 2012059862, OR BK 15884 Page 690, Number Pages: 3, Recorded 03/20/2012
at 09:27 AM, JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $27.00 DEED
DOC ST $805.00
This instrument was prepared by:
HAYWOOD M. BALL, ESQUIRE
HAYWOOD M. BALL, P.A.
341 West Forsyth Street
Jacksonville, Florida 32202
(904) 354-2232
R.E. Tax ID No.: 172374 -1015
WARRANTY DEED
THIS DEED made this 16` day of March, 2012, by BEACHES HABITAT FOR
HUMANITY, INC., a not for profit Florida corporation (the "Grantor "), whose mailing
address is 1671 Francis Avenue, Atlantic Beach, Florida 32233, to HIROMI WIGLEY,
unmarried, whose mailing address is 420 Dutton Island Road West, Atlantic Beach, Florida
32233 (the "Grantee ").
WITNESSETH:
That Grantor, for and in consideration of the sum of TEN DOLLARS ($10.00) and other
good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged,
has granted, bargained and sold to Grantee the real property located in Duval County, Florida,
described as follows (the "Property"):
East 'h of Lot 3, STEWART SUBDIVISON SECOND REPLAT,
according to the Plat thereof as recorded in Plat Book 46, Page
11, of the public records of Duval County, Florida.
TO HAVE AND TO HOLD the same unto the Grantee, her heirs and assigns, in fee
simple forever.
THIS CONVEYANCE IS SUBJECT TO: (1) taxes and assessments for 2012 and
subsequent years, (2) the provisions of the Maintenance Agreement in favor of the City of
Atlantic Beach; (3) covenants, conditions, restrictions, reservations, easements and other matters
of record; and (4) the following covenant running with the land, to wit:
OR BK 15884 PAGE 691
The Grantee understands that the Grantor is a non - profit, charitable organization that
works with low income people who need simple, decent housing. Grantor accepts contributions
which are used to build new homes and has a responsibility to the contributors to put the money
to its best possible use.
In the event Grantee desires to sell the Property at any time prior to twenty -five (25) years
from the date hereof, Grantee must first offer to sell the Property to Grantor. The offer shall be
made in writing at least sixty (60) days before Grantee accepts an offer to purchase from any
third party. Grantor shall have sixty (60) days from the date of receipt of the offer to accept or
reject said offer. This right of first refusal shall automatically terminate twenty -five (25) years
from the date hereof or upon the recording of a satisfaction of the purchase money mortgage
dated of even date herewith from Grantee to Grantor.
Any conveyance of the Property contrary to this covenant shall be null and void. In the
event of such a conveyance, Grantor shall have the option, at anytime within three (3) years of
actual notice of such a conveyance, to purchase the Property from the title holder of record
pursuant to the terms and conditions of this covenant.
And Grantor does hereby fully warrant the title to the Property, and will defend the same
against the lawful claims of all persons whomsoever.
IN WITNESS WHEREOF, the Grantor has executed these presents as of the day and year
first above written.
Signed and delivered in the BEACHES HABITAT FOR HUMANITY,
presence of: INC., a not for profit Florida corporation
M •.7 - itrAe"--712r*--4-4—•
ess
1 HAYWO D M. BALL
' "CS ] Vice President– Real Estate a
'riot name below signature
le,r
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Zbailitida.1/474— ).....
Witness [Affix Corpo,T d�'! �•
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Print name below signature � ' ��� », ,+ r .
2
OR BK 15884 PAGE 692
STATE OF FLORIDA
COUNTY OF DUVAL
The foregoing instrument was acknowledged before me this 16 day of March, 2012, by
HAYWOOD M. BALL, as Vice President -Real Estate of BEACHES HABITAT FOR
HUMANITY, INC., a not for profit Florida corporation, on behalf of the corporation, the
Grantor named therein, who [X] is personally known to me or [ ] has produced a Florida drivers
license as identification [check one].
N . Publ
S . - of Fl • ' da at Large
` 1 JENNIFER
Y COMMISSION 4 EE 036607
= S: November 11, 2014
O '14,, ndad lb Thru Notary Public Underwriters
Print nam elow signature
[Affix Notary Stamp] My Commission Expires:
My Commission No.:
3
-s » City of Atlantic Beach RECEIVED APPLICATION NUMBER
f 4,y, Building Department (To be assigned by the Building Department.)
4 800 Seminole Road APR 1 2 2012 - 6
Atlantic Beach, Florida 32233 -5445
Phone (904) 247 -5826 • Fax (904) 2%08,45
E -mail: building- dept @coab.us .� Date routed: //
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 7 Z ttJ D tt j/ a ,- 1 C± Department review required Yes No
Applicant: elow i
Planning 8 Zoning
,` rnstiator
Project: � e `1 re r)-1-- PubI!c W dss%
ublic Utilities
61-7- Public Safety
Fire Services
• 4
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed brD Date: �- l -12
TREE ADMIN. Second Review: Approved as revised. ❑Denied.
P"WO omments:
• -I
PU = LIC SAFE Reviewed by: Date:
FIRE SERVICES Third Review: Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
-s- » City of Atlantic Beach RE►C ' IV�..i APPLICATION NUMBER
irjelp,,4..k Building Department (To be assigned by the Building Department.)
• 800 Seminole Road APR 12 2012 - e
�, Atlantic Beach, Florida 32233 -5445
Phone (904) 247 -5826 Fax (904) • 7 -5845 ,/////' �
• "._DA , E -mail: building- dept @coab.us BY: Date routed:
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 7 Z U altz /rni' ej Department review required Yes No
�uiidir�g--- -----
t Planning & Zoning g
Applicant: ��Gl.�/� Imo- - • • •nstra
Project: j e - 77e C• plan' Publi q
"ublic Utilities
611 Public Safety
�� Fire Services
N
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: [Approved. ❑Denied.
(Circle one.) Comments:
BUILDING AfC- 1 nAIAN r il/reA 2-vk A
PLANNING & ZONING Reviewed by: Date:
TREE ADMIN. Second Review: ['Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10 (�
; p.m- City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
-r Atlantic Beach, Florida 32233 -5445
Phone (904) 247 -5826 Fax (904) 247 -5845
-U,3 , E -mail: building- dept @coab.us Date routed: 1 fI w
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: .12. U W7 all 6 n / �/m►j ei Department review required Yes No
Applicant: fv/ v/`. Planning & Zonis
pp e 'stator
Project: % T I n Publi
ublic Utilities
lY r 4E/14 Public Safety
Fire Services
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: proved. ❑Denied.
(Circle one.) Comments:
B
• •NNING &ZOO. - t/'t
Reviewed by: Date: /1
120
TREE ADMIN. Second Review: ['Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: Z/21) 4 ', Miami- Permit Number:
Legal Description Parcel #
//
c") Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $� Proposed Work heated /cooled non- heated /cooled
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool /spa window /door
Use of existing/proposed structure(s) (circle one): Commercial Residential
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /A
Florida Product Approval #
For multiple products use product approval form
�r r
Describe in detail the type of wor to be performed:
Property Owner Informa ion: ' �r2 (/L - / - )ti-r-6•-
Name: j t 1 lento i w Address: �1 ' 1'. �• -�
ri mf�a %
Ci t� 1e State7L Zi Phone _ G
E -Mail or Fax # (Optional) Hi-#n, w . /.e j na, . Lan/
Contractor Information:
Company Name: Qualifying Agent:
Address: City State Zip
Office Phone Job Site/ Contact Number Fax #
State Certification/Registration
Architect Name & Phone #
Engineer's Name & Phone #
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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 laws regulating construction in this jurisdiction. This permit becomes null
and void if work is not commenced within six (6) months, or if construction or work is suspended or abandoned for aperrod of six (6) months at any time after
work is commenced. 1 understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, F urnaces, Boilers, Healers.
Tanks and Air Conditioners, etc.
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.
l hereby certify that 1 have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal. state, or local law regulating construction or the performance of construction.
Signature of Owner V Signature of Contractor
Print Name 51ey Print Name
Sworn ' and su . s rib�• be �. j'� Sworn to and subscribed before me
th's ', Day • _.v ; it tylltyr _ RAHAm this Day of 20
P
h f ' ,: ' : *E MY COMMISSION 1 DD 957760
"� ,, irr�, - • ES: February 14, 2014
—At NO " IC p'h:' ante, ru'aary •u•lc'nrenwnters Notary Public
Revised 01. ..10
CITY OF ATLANTIC BEACH
WNER / 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. 7 7) " /C4- g eC
t 5'/ v /O
ADDRESS PHONE NUMBER
rorvi, WI, ' �7
PRINT NAME /
9/i, 1
SIGNATURE DATE
Before me this day of 1. _ 20! Lin the county of DEBORN{ AMANDAW
Duval, State of Florida, has personally J. eared herin by himself / herself and affirms that MV COMMISSION # E E 057e15
348
all statements and declarations - - tr / - nd accurate. *: EXPIRES I�ubil� : May 21 , 20
rwriters
Notary Public at Large, State of , County of _ _.___m - -
Personally Known /) •/� (J � 4
BOOded 1 htu N
"Ni Identification - (" — ( - ����•// 31.:i
t
Notary Signature: /1 -��_ --
F:BLDG /Owner - Builder Affadavit REVISED: 4/16/2009
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