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418 SKATE RD - FENCE �j 8.%1.7YJn $, CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 FENCE WALL OR BARRIER - FENCE MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: 17-FNCE-3743 Description: Estimated Value: 2000 Issue Date: 5/24/2017 Expiration Date: 11/20/2017 PROPERTY ADDRESS: Address: 418 SKATE RD RE Number: 171558 0000 PROPERTY OWNER: Name: JAKE AND JENNA THOMASON Address: 418 SKATE RD ATLANTIC BEACH, FL 32233 GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Name: Address: Phone: PERMIT INFORMATION: Please see attached conditions of approval 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 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. * A notice of Commencement is only required for work exceeding an estimated value of $2,500.For HVAC work, a Notice of Commencement is only required when HVAC work exceeds and estimated value of$7,500. Building Permit Application Updated 5/5/17 City of Atlantic Beach 800 Seminole Road,Atlantic Beach,FL 32233 Phone:(904)247-5826 Fax:(904)247-5845 Job Address: —fIK SkIrE kPAO Permit Number: ad I=Ajce-34-43 REN Legal Description Valuation of Work(Replacement Cost) " d Heated/Cooled SF Non.Heated/Cooled Class of Work(Circle one): a Addition Alteration Repair Mov em Pool Window/Door • Use of existing/proposed str ure(s)(Circle one): Commercial esldenti • If an existing structure,is a fire sprinkler system installed?(Circle one . e• s N/A Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal Describe 1.detail thetypeof work to be performed: Q &"D �'Go .G Y��F FE2 P&Zwn I Z 2-O 0"ASIL- Florida Product Approval N for multiple products use product approval form Pro ert Owner Information �I y SI. r,,,� O _q Name: LµA. Ad O City Ikk( H { l;7 State Zip Phone E-Mail Rb. . koh. a ,4Ma (•N I L' Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) Contractor Information Name of Company: Qualifying t: Address City State_Zip Office Phone Job Site/ act Number State certification/RegistrationIf E-Ma Architect Name&PhoneN Engineer's Name&Phone N Workers Compensation EvemDt/insurer/tease Employees/Expladon Data Application is hereby made to obtain a per ' to do the work and installations as indicated.l certify that no work or installation has commenced prior to the issuance of a p it and that all work will be performed to meet the standards of all the laws regulationg construction in this jurisdiction.l un rstand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOIL ,HEATERS,TANKS,and AIR CONDITIONERS,etc. OWNER'S AFFIDAVIT:I certi hat 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 RECORDING YOUR NOTICE OF COMMENCEMENT. (Signature of owner AgenU (Signature of Contra r) (ind in contractor) Si ned and sworn ntto((or a Irm )before m thi ay of Signed and sworn to(or affirmed)be re me this_day of b by aryl (Signature of Notary) tip'ITONT GINDIESPERGER {pkq pry ccsNISSION*FF92Q51 a'.�`r.�ei EXPIRES:Ccicosts 2019 I .... Q eo•mf mNN":ary PUEk WdenMm ( )personally Known Per. Produced Identification ,t _ ( 1 Producetl ldentifi flan Type of ldentiNcation: ( SZS — 'IzrJ'�gj Typeafldemifcan: Z¢7 —d . YIVbYijr:. CITY OF ATLANTIC BEACH OWNER/ BUILDER MITIDAM I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 'CONSTRUCTION CONTRACTING' REQUIRES OWNER I BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.101 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 MIPROVE 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 FOR ORYOU,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 PERSONAS 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 COLRaTY OR MUNICIPAL LICENSING ORDINANCES. IL INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. 111. 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. ADDRESS PHONENUMBER PRINT NAME I/ I SIGNAT Safa Nis yoR/ .20` la dle count,of Duval, tale of Florida,hi pe souni...aad hedn M M1lasaVl M1 Mf lana eflirms Nal an alatamema and declarationsa accurate. Noi Public at]i State of Count,of ❑FeRonmvl(nwm Z5 -58 _z TO NI GNDIEBPEI GER ❑Pmeicea laenli!Im- 'R` .,, M, GOMMISSICNtFF924951 EXPIRES'.Ocl0dGr6,2D19 �2 mmaama N+'vn peeucuoaer.ann Nafary SiOnature: F9B1➢Gg—Builau AMdualAEV ..i/IQR009 AGREEMENT TO ACCEPT TRANSFER OF UNCOMPLETED BUILDING PERMIT This agreement and a new Permit Application are required to transfer an uncompleted building permit. j`n71oyv Phone 9 ° y 03 -OP Address� �� Sy` � (L 'AD NIkhO• C��aA Sw/ Mkl � rd` Email 5p<k�2•�iD /' �`'(� State Certification/Registration # understand that Building Permit 1'7-P:-_t-)CE -37 was started by another contractor and is currently uncompleted. I agree to, after reviewing the approved plans and the unfinished as-built construction, to submitting a Revision Form and revised construction drawings to the Building Department to correct any deviation between the approved plans and as-built construction, where found. I understand that, based on the current inspection record, I am responsible for the Code compliance of the finished project. Details (Optional) Signature of Contractor/Owner Builder =Br ate u r/� fyy7Before me this20aSignature of NoSPERGERSSICN YFF929 1'.Ocbber 6,2019ow,P �UNerwihr MAP SHOWING BOUNDARY SURVEY OF LOT 15 r 19 _AS SHOWN ON MAP OF wr REPLAT OF PART OF ROYAL PALms UNDP TWO A AS RECCRDEO W PLAT BOp( x _PAf Id IW q� Opc 2 rC RECCIPOS O�UJVA( CIX/N1Y, 1Q%DA CER77F7ED FOR:ALLISON W FLl45YM' NR MAWAY&REYNOTD P ❑!M DARE A`✓S CO. 54'R/W uR DRAWAC£& UALT u� akin Nome'02 F' 80.66 rrAw r w xo w � ' .. . revxxx rNu (elm L.J 220' CL_ R O q' I r-S.'ORY sRH.Cb Lu co 220• ..j WF ry 0 ...� • .909'1808$ .B5' SKATE ROAD (60',R149 scorn EO: W.O. mm-B7, 2-9-15 ECQ'MEO: WO /89-2559; 5-29-59 AN'PRO>E SHOW)HEREON APPEARS M L WMW RoW HAZARD ZONE_BL AS SC FRGIE ROOD NSLARANCE RATE NAPS_ FDR WVAL COUNTY. ROWA, DATED 6-J-13 . ANO f5 SNOMN AS A CWRIESY QYLY ANp DCE5 NOT CONSAAJIE A fFRAF^..AADN C'F SANE. TRI-STATE' LAND SURVEYORS, INC. 5875 MlMNG TERRACE 8209, JACKSONWLE; FLORIDA 32257 (904) 880-2535 �y &ARWGS BASED W RVW [Mg AS SHOWJ. w A[BeR MTS SJRYFY ODES NOT REFLECT W CETERNINF OWVDt,w ALM NtnFV-NNY NOT V. l WNW, ME 9GVATURE AND WE 0.4IGA✓AL RAISED g,LL N y OF A ROWDA UaM"SVRWE AND NAPPER. rov vwen yaE ^T5 S Wy BASED UPW DESCIT'PADN AS RWM'A ,, AMC Wwwr E ¢eAw.Mz (gNEETT OF A AAE NAWFR ABSTRACT OF RRE AND DEED RISE' 4L AN c4MrwsM.nio m mm Y 1fY_ LL BROW 39J tPr, FA4F2VT mss mraw uneerrme �Y Mg9R DATE SSD-4f a Pawl cr Hent �(kS>EA£D SW2�'Y�4 N preo•<-g TAMdFI ARMS DA R:' a-1-91 STAtE CT RgRIDA (LB fl92t) a cm: DRDEB NQ S f=111-1' CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 &WI c.) INSPECTION PHONE LINE 247-5814 FENCE WALL OR BARRIER - FENCE MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: 17-FNCE-3743 Description: Estimated Value: 2000 Issue Date: 5/24/2017 Expiration Date: 11/20/2017 PROPERTY ADDRESS: Address: 418 SKATE RD RE Number: 171558 0000 PROPERTY OWNER: Name: ALLISON V FORSYTH Address: GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Name: Address: Phone: PERMIT INFORMATION: Please see attached conditions of approval. 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 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. * A notice of Commencement is only required for work exceeding an estimated value of $2,500. For HVAC work, a Notice of Commencement is only required when HVAC work exceeds and estimated value of$7,500. I City of Atlantic Beach APPLICATION NUMBER Js • • Building Department (To be assigned by the Building Department.) ,I 800 Seminole Road I - rN j.. _ M Atlantic Beach, Florida 32233-5445 ..'„ 111,— Phone(904)247-5826 • Fax(904)247-5845 Date routed: CJ� �? E-mail: building-dept@coab.us City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: Li S t-cut_ Dena�rtm1ent review required Yes` No uildi V Applicant: Dt,k LZoni�� �' Tree Administrator Project: '� nl cca__ �}� �k u006)..0.1\ ,P_ works e-i?uhlic Utilities Public Safety Fire Services Review fee $ Dept Signature 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 by: ill Date: 171'i 217 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 05/14/09 s==vir City of Atlantic Beach APPLICATION NUMBER S jr ''- Building Department (To be assigned by the Building Department.) -- `` 800 Seminole Road Atlantic Beach, Florida 32233-5445 1 F N cc- - 3--1 L( Phone(904)247-5826 • Fax(904)247-5845 LJ—��>r E-mail: building-dept@coab.us Date routed: OLt l<< I City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 0 S kclkL (4a . Department review required Yes No uildin ' Applicant: DUJ y1124 nq & Zoning, Tree Administrator Project: `LI \C.QL-e- (}'2k 1,)00n P_ bli ` orks� c Utilities Public Safety Fire Services Review fee $ Dept Signature • 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 by: d,,..•.,/ l-----it-----" Date: SPA 7 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. I (Denied. Comments: Reviewed by: Date: Revised 05/14/09 ;;s .1- ` ,�, City of Atlantic Beach APPLICATION NUMBER .; Building Department �• (To be assigned by the Building Department.) J =- ;% 800 Seminole Road E!Ni. y �� �� Atlantic Beach, Florida 32233-5445 I 1 FN C.(_." -1-1q 3 Phone(904)247-5826 • Fax(904) 585 '�-artis) E-mail: building-dept@coab.us A R 1 3 2017 Date routed: OL{ E l i I City web-site: http://www.coab.us BY: APPLICATION REVIEW AND TRACKING FORM Property Address: Li t 1 S-C(.V L 2._a . D rtment review required Yes No uildi Applicant: 1A)y'1; ---fng &Zoning �' Tree Administrator Project: '( L nl`C---Q- k*D * 1.300,0A J Qbli_Works c'-P-ubbc Utilities Public Safety Fire Services Review fee $ Dept Signature • 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: IVApproved. ['Denied. 6y147 (Circle one.) Comments: iee /#44/44 44fma BUILDING /p�/ ` PLANNING & ZONING yyff � Reviewed b i�'2�6 f!j4�/ 2224-4__ �e,i,,,7 Date: TREE ADMIN. Second Review: A roved as revised. ❑ pp ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: I 'Approved as revised. I (Denied. Comments: Reviewed by: Date: Revised 05/14/09 City of Atlantic Beach APPLICATION NUMBER (1-.51.AV: t. � Building Department c� (To be assigned by the Building Department.) ;, (j - 8tla SeminolecRoad E C E 1� I --- N (4-..-.- 3-1q3 j - Atlantic Beach, Florida 32233-5445 �1r y _•. Phone(904)247-5826 • Fax(904) 247- 5 3 I x r'� V E-mail: building-dept@coab.us APR 13 2017 Date routed: OLf 1<1 I I"4- City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: L[ D S -c k- Q_Ul . D,rtment review required Yes No :uilditlg:--- Applicant: DU-3 0-Q--( ' -inn. &Zonin• Tree Administrator Project: Lp\(.ct_L 6D * W000UA Wilki2ii Works • . Utilities Public Safety Fire Services Review fee $ pz Dept Signature • 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: V . ['Denied. (Circle one.) Comments: 1 BUILDING N PLANNING &ZONING yt/ A" Date:__±_*_LZ_Reviewed by: TREE ADMIN. Second Review: A roved as revised. ❑ pp ❑Denied. WORKS Comments: yUe BL UTILITIES PU LIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 I FILE COPY „ .,„„iv-y.4, BUILDING PERMIT APPLICATION J \`1\ CITY OF ATLANTIC BEACH DATE ' J r 800 Seminole Road,Atlantic Beach FL 32233 l'71,01119 Office:(904)247-5826 • Fax:(904)247-5845 Job Address: 1"//S S/f L° Rd Permit Number: I t- r-N(L-39- 3 Legal Description i-D /S- E)o c<< / 9 RE#_ / X155 Valuation of Work(Replacement Cost)$ 4 i'.96' Heated/Cooled SF If 74 Non-Heated/Cooled • Class of Work(Circle one): • Addition Alteration epair Move 11emo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial 'estdential • If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No dal • Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal Describe in detail the type of work to be performed: ^/ 6 plaeuz all -ref\c.e_ - add ��t:v ��.rc e - �0,�%t Florida Product Approval# for multiple products use product approval form Property Owner Information Name: n) li 3 ciV\ I-v15(PikAddress: ! -4 3 8 SN(Val` fr j o' . City ( State F( Zip 3g,1‘3:5 Phone 9 D LtI- 4 I/Q - 3 7.9 -7- E-Mail ( -7- E-Mail a,-(o t`s 19 Co 0 Cd. C_Jo.( , c curl Owner or Agent (If Agent,Power of Attorney or Agency Letter Required) 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. Contractor Information: Name of Company: Qualifying Agent: _ c- Address: at -�3e City Office Phone Job Site/Contact Number State Certification/Registration # E-Mail Architect Name&Phone # Engineer's Name &Phone# Worker's Compensation Exempt / Insurer / Lease Employees / 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 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 a period of six(6J months at any time after work is commenced. l understand that separate permits must be secured for Electrical Work,Plu ing, Signs, Wells,Pools,Furnaces,Boilers,Heaters, Tanks and Air Con '' ne • Signature of Property Owner: U etJUA)o A 2,..21--- ignature of Contractor: Before me this tt Day of kpf t . 16 U 1 Before me this Day of Notary Public: Notary Public: I hereby c .t. e J tt� have MdFeRclot ivroptc l th 1 application and know the same to be true and correct. All provisions of laws and ordinance r.,..t ; limy egtu tls$imvIliGtli64,4c emplied with whether specified herein or not. The granting of a permit does not presume h , ,„1, trite mess,°( Zq;r�pd'!th"'provisions of any other federal, state, or local law regulating construction or the petformat*cs 30' :, lrnpj(d d7h Notary Public Undermiters . '„+ . , II --r . ID Rev. 5/2/16 MAP SHOD GARY SURVEYOP — LOT._____If____BLOCK— 19 AS SHOWN ON MAP — REPL4d OF PART OF ROYAL PALMS UNIT TWO AOS AS RECORDED W PIAT BOOK 31 PAGES 16-160 OF THE PUBLIC RECORDS OF DUVAL COUNTY, CERTIFIED FOR:ALLISON W. FORSYA'• HATHAWAY& REYNOLDS PA• CHICAGO 77TLE INS ca CERTIFIED irmir� 54'R/#FOR DRAJNAGE& UTILITIES 1 1 C 0-I'k`c4- •-e-'c-- i N0r18'02"I 80.65' J NO!G171.1N2 1/2 - ------u- _-_-- _ - i v. ._ elft ..-`'7 •. CORNER t'AUS k1 70"Om" INEE dd ,,,.?s ill, -,, 1 4 J -1220• 36.0 2 1-STORY STUCCO 018 e . r4wco z 1G, 16 4041k,C13:I I IiiCO lo I \y ...o• Ik2ZO' 03 - - . ..� .� � . . _j 1 •e I res cO+c s/w • ' . . 9.1?C. _ 1 `Q I N ? • SFr yr 1r _ 1 . L$df921„.0 - I I _ •F&URD 1/2'IP �J ' 19.- - sOr16'g2 i 60.65' , -— - t f t . . -- _7 i SKATE ROAD (60'D/W) RI1FIED: W.O. #2015-67,• 2-9-15 E:.� ECR 1F1£I2: W.O. #99-2569,- 5-29-99 THE'PROPERTY SHOWHERRN APPEARS TO LIE WNW ROOD HAZARD ZONE A INSURANCE RATE"MAP 408 FOR DUVAL COUNTY, FLORIDA, DATED 6-3-13 AS SCALED FROM ROOD IS SHOWN AS A COURTESY CWLY AND DOES NOT CONSTITUTE A CERTIFCATION OF SAA/E. AND TRI--STATE LAND SURVgYORS, INC. 5875 MINING TERRACE #209, JACKSONVILLE, FLORIDA 32257 (904) 880_2535 :£GJ.D BEARINGS BASED ON RAI/ �'' CONC.` LINE AS SHOW.. 1 !ROY R8 APJA THIS SURLY LOGES NO;REFLECT OR DEIERMINE OWVERSHIP• RA +T--OF xaY s7x uq;l NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL DAV DRtEtyAr OF A FLORIDA LICENSED SURLEYOR AND MAPPEA.. OM COWRED AREA THIS SURVEY BASED UPON DESCRIPTION AS FURNISHED, AND .WITHOUT I zYT 4u BENCr1T OF A iln,.,E BINDER/ABSTRACT OF TITLE AND/OR DEED RESEARCH4 A/C Air COAD!^act6 PAD (R) RADIAL DISTANCE cava cogcrt:E CALE: 1`= 20' GLENN M. BROA mrr EA.aAt'aT .SM. O. a8! 8 RL 81.11:04Y3 RESIRIC710N UNE PC •E7-D WORK DATE 5-3D-9r Pc POW a a REGISTERED SG7ZLYOR AND MAPPER, PTPO1N Or TANGENCY 1GNATURE DATE- B_1-81 STATE OF FLORIDA (LB#4927) PG cin S1-r149 ORDER NO. ' - •• FAR/FQfL( Idgfla0 QUIZ of Qaa 9ESl-QB8:xe3 A3MJ1S OM 31d1S-181 i 1.40%-i., J 1r' _r CITY OF ATLANTIC BEACH 'J%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 REOUIRED 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN"OCCUPATIONAL LICENSE"IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826)IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE - STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. i-II6 SLiotp td q'oy- d-4l- cfq , ADDRESSI e , PHONE NUMBER 716, J iJ� PR NT NAE - V..- ( __-L4011/1 //(--J,- /-"zit z_Ai "Id- /7" SIGNURRT E DATE Before me this 1 day of I ' ` 20t'q in the county of Duval,State of Florida,has personally appeared herin by himself I herself and affirms that all statements and declarations are true and accurate. liNotary Public at Large.State of F L— ,County of b LA.4(t ❑Personally Known ,eroduced Identification- t-�l-'-I S `I L��, r±_r�,..,„ ER,oINS?ON "Y 1`"4's MY COMM ISSION$ �2 964 i t ` '.? EXPIRE--October n. 2020 Notary Signature: �V" h 1 ,7: Bon '(htu Merl vrffbls Ft/BLDG/Omer-Builder AIM 't;REVISED.4/16/2009