395 12TH ST - DRIVEWAY rj"�'yv
43 ' CITY OF ATLANTIC BEACH
tt1
-,` sl 800 SEMINOLE ROAD
,� v ATLANTIC BEACH, FL 32233
'P O;3 ! INSPECTION PHONE LINE 247-5814
DRIVEWAY - SINGLE OR TWO FAMILY DRIVEWAY
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: DWAY17-0012
Description: semi-circular driveway
Estimated Value: 25000
Issue Date: 8/30/2017
Expiration Date: 2/26/2018
PROPERTY ADDRESS:
Address: 395 12TH ST
RE Number: 171922 0000
PROPERTY OWNER:
Name: SAUNDERS SAMUEL PALMER
Address: 395 12TH ST
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.
(--
Permit Conditions
0, City of Atlantic Beach
e
Permit Number: DWAY17-0012 De ription: semi-circular driveway
Applied:8/14/2017 Approved:8/28/2017 Site Address: 395 12TH ST
Issued: 8/30/2017 Finaled: City,State Zip Code:Atlantic Beach, Fl 32233
Status: ISSUED Applicant: <NONE>
Parent Permit: Owner:SAUNDERS SAMUEL PALMER
Parent Project: Contractor: <NONE>
Details:
LIST OF CONDITIONS
SEQ NO ADDED DATE REQUIRED DATE SATISFY DATE TYPE STATUS
DEPARTMENT CONTACT REMARKS
•
1 8/17/2017 EROSION CONTROL INSTALLATION INFORMATIONAL
PUBLIC WORKS Scott Williams
Notes:
Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line(247-
5814)to request an Erosion and Sediment Control Inspection prior to start of construction.
2 8/17/2017 ON SITE RUNOFF INFORMATIONAL
PUBLIC WORKS Scott Williams
Notes:
All runoff must remain on-site during construction.
3 8/17/2017 POST CONSTRUCTION TOPO INFORMATIONAL
SURVEY
PUBLIC WORKS Scott Williams
Notes:
If on-site storage is required,a post construction topographic survey documenting proper construction will be required. All water runoff must go to
retention area and retention overflow must run to street.
4 8/17/2017 ROLL OFF CONTAINER INFORMATIONAL
PUBLIC WORKS Scott Williams
Notes:
Roll off container company must be on City approved list(Advanced Disposal,Realco Recycling,Shapell's,Inc.,Republic Services). Container cannot
be placed on City right-of-way.
5 8/17/2017 RIGHT OF WAY RESTORATION INFORMATIONAL
PUBLIC WORKS Scott Williams
Notes:
Full right-of-way restoration,including sod,is required.
.11
Printed:Wednesday, 30 August, 2017 1 of 2 •
rj r11y f�J,
Permit Conditions
City of Atlantic Beach
6 8/17/2017 RUNOFF INFORMATIONAL
PUBLIC WORKS Scott Williams
Notes:
All runoff must remain on-site. Cannot raise lot elevation.
7 8/17/2017 CIRCULAR DRIVEWAY INFORMATIONAL
PUBLIC WORKS Scott Williams
Notes:
Maximum circular driveway width within the City right-of-way is 12'.
Printed:Wednesday,30 August, 2017 2 of 2
rs�_>>`\ City of Atlantic Beach Me-.-,,..` rii APPLICATION NUMBER
d' / Building Department ‘.1-5'20;711:
""
�,,� , . (To be assigned by the Building Department.)
m.
1-- J 800 Seminole Road A
'''" -:•i�� Atlantic Beach, Florida 32233-5445 ,,.11:4:".""A'4-47u6 1 5 OW A�t i - cola
Phone (904)247-5826 • Fax(904) 244845 f
`�y0;;1,r E-mail: building-dept@coab.us Date routed: 0t 11 . I I'I
City web-site: http://www.coab.us »—
APPLICATION REVIEW AND TRACKING FORM
Property Address: '_ ` ' ,S , S4 Department review required Yes No
Building
Applicant: D W 1 '--IPlannin&Zonin g
Tree Administrator
Project: 30.._m k " Li (( l.{I(1..( d..i !i k W ayublic Works j
Public 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: [Z/Approved. I 'Denied. I 'Not applicable
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed by..1/4 ' Date:
I' Arl
TREE ADMIN. Second Review: A roved as revised.
❑ pp ['Denied. Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: I 'Approved as revised. (Denied. I 'Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
6 1)0('
1iv
R.O.W.Permit Attachment of_ for
R.O.W. Permit# bvh) A`1 1 - `issued ,20 Atlantic Beach,FL 32233
Owner's Name: 50.W• fit,\ Sow r� S
Property Address: sots 1 Z"\- - Lz Z SS
Subdivision: R.E. #:
REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of
, 20 , by Atlantic Beach, Florida, a municipal corporation organized and existing
under the laws of the State of Florida,hereinafter referred to as "CITY"and
of Atlantic Beach,Florida,hereinafter referred to as"USER".
WITNESSETH:
That the CITY does hereby grant the USER permission on a revocable basis as described herein the
right to enter upon the property of the City of Atlantic Beach for the purpose as described in the City of
Atlantic Beach Right-of-Way/Easement permit numbers noted above(copies attached).
This work is generally described as: b r c sszAA .k CCC.
Any facility maintained, repaired, erected, and/dr installed in the exercise of the privilege granted
remains subject to relocation or removal on thirty(30) days notice by CITY to the USER, said notice to
USER shall be given by certified mail, return receipt requested, to the following address:
The depositing of said notice of cancellation in the United States mail shall constitute the notice of
cancellation and the burden is upon USER to keep the CITY informed of USER's proper address.
The USER shall promptly make any and all necessary repairs to any facility erected or maintained in
the exercise of the privilege herein granted and shall'at all times maintain said facility in good and safe
condition.
In the event it is necessary for the CITY or the pity's approved representative or other franchised
utility to enter upon the above-described property of the CITY, the USER shall replace at the USER's
sole expense, any and all material necessarily displaced during the action of maintaining, repairing,
operating,replacing, or adding to of the utilities and facilities of the CITY or franchise utility provider.
The facilities allowed by the permit shall meet the current requirements of the City Code, Building
Codes,Land Development Code,and all other land use and code requirements of the CITY,including •
City Code Section 19-7 (h) which states "Driveways that cross sidewalks: City sidewalks may not be
replaced with other materials, but must be replaced with smooth concrete left natural in color so that it
matches the existing and adjoining sidewalks."
Page 1 of 2
The USER, prior to making any changes from the approved plans and/or method, must obtain
written approval from the City of Atlantic Beach, Public Works Department, for said change. The
USER shall, at the discretion of the CITY, be reque ted to submit as-built drawings showing the change
within thirty(30)days after the day of completion.
This permit shall inure to the benefit of, and be binding upon, the USER and their respective
successors and assigns.
USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY
laws and/or specifications, to include utilities locate requirements and use limitations/requirements of
public rights-of-way and other public land. USER further agrees that the CITY and its officers and
employees shall be saved harmless by the USER from any of the work herein under the terms of this
permit and that all of said liabilities are hereby assumed by the USER.
DATED and SIGNED this 27 day of v CJ , 20 1 7
N •
By: • . _._. ,s._ -_A
Propertyll er
(to be si, in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this Z 7 day of ci J C f 20 ` 7, personally appeared before me, a Notary
Public in and� for said County I.
State, t C co-- , the property owner of
S I Z`L Sf , Atlantic Beach, Florida, known to me to be the person(s)
d .ed in 4o ex uted the foregoing instrument; who acknowledged to me that he or she
ei
ed the • ;ely d voluntarily and for the uses and purposes therein mentioned.
/
e III �
Notary Public in for sai ty and State -,-
.�'<q`•�"'Y°�, TONIGINfNus
PERGER
"i •= MY CCMMISY FF 924851
&nde FIRES: beri 2019�Thru Abablic UndenvrMrs
CITY OF ATLANTIC BEACH,FLORIDA,
a municipal corporation:
Approved:
,...zed 4i _ieit4......,..,_
Scott Williams
Interim Public Works Director
File: 12/12/16
Page 2 of 2
' 7
f 800 Se
•,'N, CITY OF ATLANTIC BEACH
} CONSminolTRe RoaUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
d
on nr Atlantic Beach,Florida 32233-5445 904-247-5800
Fax 904-247-5845
PLEASE SUBMIT(2)COMPLETE SETS OF PLANS WITH APPLICATION. PERMIT#
Date 1- Z"1 - 11 ISSUES BY THE CITY
Job Address 31C \?-'''^ 5 . E-mail ,s\rwolcS Vu:s-k-tnAck:,.k. (o,n,i
Permitee: Telephone# ,g03 -2_-ez - -tS
Permitee Address:
Requesting Permission to Construct:_ p. k - C'd CL dA 1�`---L.)(
Location: (Reference to Cross-Street) 1ZAU A' l\AA"
1. Applicant declares that prior to filing this application he has ascertained the location of all existing utilities, both
aerial and underground and the accurate locations are shown on the sketches.
A Letter of Notification was mailed to the following Utilities/Municipalities:
Jacksonville Electric Authority Yes ( ) No ( ) Date:
Bell South Telephone Company Yes ( ) No ( ) Date:
Ferrell Gas Yes( ) No( ) Date:
Comcast
Yes( ) No( ) Date:
2. Whenever necessary for the construction, repair, improvement, maintenance,safe and efficient operation,
alteration or relocation of all, or any portion of said street or easement as determined by the Director of Public
Works, any or all of said poles, wires, pipes, cables or other facilities and appurtenances authorized hereunder,
shall be immediately removed from said street or easement or reset or relocated hereon as required by the
Director of Public Works, and at the expense of the Permitee unless reimbursement is authorized.
3. All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed
under the supervision of (Contractor's Project Superintendent)
located at Telephone#:
4. All materials and equipment shall be subject to inspection by the Director of Public Works or his designee.
5. All city property shall be restored to its original condition as far as practical, in keeping with city specifications and
the manner satisfactory to the city.
6. A sketch of plans covering details of this installation, as well as, a copy of a recent survey shall be made a part of
this permit. Calculations showing any increase in impervious area on owner's lot or In the city Right of
Way are to be included with this application.
7. This permittee shall commence actual construction in good faith with days. If the beginning date is more
than 60 days from date of permit approval,then permittee must review the permit with the Director of Public
Works to make sure no changes have occurred in the area that would affect the permitted construction.
8. It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's
right, title and interest in the land to be entered upon and used by the holder, and the Holder will, at all times,
assume all risk of and indemnify, defend, and save harmless the City of Atlantic Beach from and against any and
all loss, damage, and cost of expenses arising in any manner of the exercise or attempted exercises by the holder
of the aforesaid rights and privileges.
9. The Director of Public Works shall be notified twenty-four(24) hours prior to starting work and again immediately
upon completion.
OWNER ` .,Z'.'?..�{. TONI GINDLESPERGER`
-t. rc MY COMMISSION#FF 924951
.''"- ,;a EX.PIR .,er6.2019
. ' .
Signed: _ ... ��1._.���ii. Datc�������Z"_`'.B�Ore�m: this � u. h day
of - . u in the t ou w of 11 St t . • .'speared
....
_ tary P iblic at Lar•-, State of Florida, County of My
commission expires: � my( Personally Known:
Produced Identification:
Revised 7/29/15
�1-1
jJ,
J: Comp. By: SRW
Date: 8/16/2017
' -u;119
Public Works Department
City of Atlantic Beach
Permit No: 16-SFR-1250
Address: 395 12th Street
Required Storage Volume
Criteria:
Section 24-66 of the City of Atlantic Beach's Zoning, Subdivsion, and Land Development Regulations
requires that the difference between the pre-and postdevelopment volume of stormwawter runoff be
stored on site. Volume of Runoff is defined as follows:
V=CAR/12
Where: V=Volume of Runoff
C= Coefficient of Runoff
A=Area of lot in square feet
R=25-yr/24-hr rainfall depth(9.3-inches for Atlantic Beach)
Predevelopment Runoff Volume:
Lot Area(A) = 15,360 ft2
Runoff Coefficient
Area Lot Area
Description (ft2) (ft2) "C" Wtd "C"
Impervious 2,867 15,360 1.00 0.19
Pervious 12,493 15,360 0.20 0.16
Runoff Coefficient(C)= 0.35
Runoff Volume
V= 0.35 x 15,360 x 9.3 / 12
V= 4,158 ft3
Postdevelopment Runoff Volume:
Lot Area(A) = 15,360 ft2
Runoff Coefficient
Area Lot Area
Description (ft2) (ft2) "C" Wtd "C"
Impervious 7,223 15,360 1.00 0.47 %ISA= 47.0%
Pervious 8,137 15,360 0.20 0.11
Runoff Coefficient(C)= 0.58
Runoff Volume
V= 0.58 x 15,360 x 9.3 / 12
V= 6,859 ft3
Required Storage Volume
DV= Postdevelopment Runoff Volume- Predevelopment Runoff Volume
DV= 6,859 - 4,158
DV= 2,701 ft3
Retention 12th Street 395 Revised for circular drive 8/16/2017
(----
,
r ��5; Comp. By: SRW
Date: 8/16/2017
'K,�//fir
__
Public Works Department
City of Atlantic Beach
Permit No: 16-SFR-1250
Address: 395 12th Street
Provided Storage:
Elevation Area Storage
(ft) (ft) (ft3)
7.5 450 0 BOTTOM Area 3 30 X 15
8.0 1,120 393 TOB 40 X 28
Elevation Area Storage
(ft) (ft) (ft3)
1 7.5 100 0 BOTTOM Area 2 20 X 5
8.0 450 138 TOB 30 X 15
Elevation Area Storage
(ft) (ft) (ft3) Area 1 20 X 5
7.5 100 0 BOTTOM 30 X 15
8.0 450 138 TOB
Inground storage=A"d"pf
A=Area= 2020.0
d=depth to ESHWT= 4.5
pf= pore factor= 0.3
Inground Storage= 2727.0 ft3
Required Treatment Volume= 2,701 ft3
Supplied Treatment Volume = 3,120 ft3
Retention 12th Street 395 Revised for circular drive 8/16/2017
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�Wrir'
Jf is ,�. � r nr��,; L I: �; CITY OF ATLANTIC BEACH
tS' , 800 Seminole Road
s Atlantic Beach, Florida 32233
AUG 232017
15140: t
REVISION REQUEST /CORRECTIONS TO PLAN REVIEW COMMENTS
Date ( Revision to Issued Permit Corrections to Comments ✓ Permit # PW A Y I?-O 0(2
Project Address —3`) S (2-k.. c1--
Contractor/Contact Name L;tm /4(0(( i-da.444 S cMC.S 7z4 .e-s /_
Phone (6 4 -C (q - 10S 3 Email J cs Ce? (•vta.I•t lq noc.).
Description of Proposed Revision/ Corrections:/ Permit Fee Due $
A IC :d.0, �' , iVo « rcr-‘• k e rr
Additional Increase in Building Value $ Additional S.F.
By signing below, I -�74 es5 affirm the Revision is inclusive of the proposed changes.
(printed name)
g -2� -11
Signature of Contractor/Agent(Contractor must sign if increase in valuation) Date
(Office Use Only)
Approved IDenied Not Applicable to Department
Revision/Plan Review Comments
Department Review Required: /0Z
Buildin
lannin t Zonin Reviewed By
Tree Administra or
Public Works
Public Utilities
Public Safety Date
Fire Services
TREE & VEGETATION AFFIDAVIT
�s rE2, City of Atlantic Beach
Department of Community Development
� Planning&Zoning Division
800 Seminole Road Atlantic Beach, FL 32233
(P) 904 247-5800 (F) 904 247-5845 PERMIT#
SECTION I -APPLICANT INFORMATION .(wner(s) Legal Authorized Agent*
NAME OF APPLICANT rr e—r-S
NAME OF COMPANY Low A ( s
ADDRESS OF COMPANY 22 Z {, P d, Z. 1 O CJc-S
PHONE To `t -l�( y-105 3CELL EMAIL \ GSA � v�q (^q�a� Gs
CONTRACTOR CERTIFICATION NUMBER
ATLBCH BUSINESS TAX RECEIPT NUMBER
SECTION II -SITE INFORMATION
STREET ADDRESS OF PROPERTY ` c�
If an address has not been assigned to this property,contact the AB Building Department at(904)247-5826 to request an address.
—'
LEGAL DESCRIPTION 2:3 �-- ( ? .c --2c <<.�. J n-n`v,hg LA r\- 4—
LOT (� O BLOCK ( SUBDIVISION O4
REAL ESTATE NUMBER LOT OR PARCEL SIZE: SQ FT AC
RESIDENTIAL COMMERCIAL OTHER(SPECIFY)
11
I affirm that 1 have reviewed the provisions of Chapter 23, "Protection of Trees and Native Vegetation" of the Municipal Code of
Ordinances for the City of Atlantic Beach, FL and/or I have participated in a pre-application meeting with the Administrator of those
regulations. Subsequently, I affirm that no regulated trees and no regulated vegetation will be damaged, destroyed and/or removed
from the above-describe djacent properties in conjunction with this project.
SIGNATURE OF OWNER SIGNATURE OF OWNER
Signed and sworn before me on this 1 day of 4s ,Zo(7 ,by State of
County of
Identification verified:
Oath sworn: [ Yes No
Notary Signature
REV-TVA-v10.12 My Commission expires:
01.AN:rf, City of Atlantic Beach APPLICATION NUMBER
Vis " Building Department (To be assigned by the Building Department.)
"k 800 Seminole Road
6vvnota
e Atlantic Beach, Florida 32233-5445 4
Phone(904)247-5826 • Fax(904)247-5845 Date routed: O 'J(� ( �
E-mail: building-dept@coab.us
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 3 -I S t 4 . 54 - Department review required Yes No
Building
Applicant: OW nL T (Planning &Zoning
l Jree Administrator
Project: t� - C. f t “\o L-( L'� +V w GL y C—Public Works
Public 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. ❑Not applicable
(Circle one.) Comments: ree f
BUILDING
PLANNING &ZONING Reviewed by' Datet 23—1 7
TREE ADMIN. Second Review: Approved as revised. ❑Denied. Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: Approved as revised. ❑Denied. Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
s0'`''''' Building Permit Application Updated 5/5/17
4
A City of Atlantic Beachti AUG 1 4 2011
WY800 Seminole Road,Atlantic Beach, FL 32233
1 9- �, _Phone: (904) 247-5826 Fax: (904) 247-5845 -... _. _
Job Address: -Th-.5)1C I2 \t" S - Permit Number: W 1k') 11--000
Legal Description RE#
Valuation of Work(Replacement Cost)$ ZS,000 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): leAddition Alteration Repair Move Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Residential
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yds--I�JJ
• Submit a Tree Removal Permit Application if any trees are to be removed or6ok_ffidavit of No Tree Removal
Describe in detail t e type work to be performed:
SQvw‘ C -CC ( cOvTh
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: -:)c k t(tL.\� Sc -'- S Address: �°1S \2-c'`
City p{.!t-I-1.,- cw,L. State C L Zip SZ Z SS Pho'a A03- aL(a-L-Q SLI%--.E-Mail Kaisl,..�� ,e 1vv.e.�\. [ov`..,
tri-,or Agent(If Agent, Power of Attorney or Agency Letter Required) 00-) '
Contractor Information
Name of Company: ()•- 1 Q 1 .o1r‘z (., ,ix Z Qualifying Agent: 3d w1/4-A-S ."T r'
Address ZZ 7 C (,) •-,-1 to' ?i wpSk- City St. Jati.nS State— ( Zip Z
Office Phone n�(-(o 1%-1. aCS 3 Job Site/Contact Number 9()Li- (Q_\1/4-4 - GDS 3
State Certification/Registration# E-Mail Jam'-SC k;l e_ct..1(.41�1 vw..r•-) . Co.-►.t
Architect Name&Phone# ��
Engineer's Name&Phone# i AF"_
Workers 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 the laws regulationg
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.
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
RECORDING Y s ' NOTICE OF COMMENCEMENT. _1
(Signature of Owner or Agent) (Signature Contractor)
(includin: - tractor)St'gned and sworn to(or affir • I efore • this _. day of Signed and sworn to(o .ffirmed)before me this day of
fi
t. ?[Ji7 , by - by
11.'95
t ,.. •` of Notary) (Signature of Notary)
'•°i'' TONiGINDLESPER
;= MY COMMISSION#FF 92=951 444
s. 'a EXPIRES:October 6,2019
;ps f;.•• Bonded Thor Notary Public Ur.der r,ters
[ J Personal y Known [ ]Personally Known OR
[ ]Produced Identification S S 3,-5044 ci 9sig [ 1 Produced Identification
Type of Identification: Type of Identification:
1
jCITY OF ATLANTIC BEACH
;- - OWNER / BZTILDER 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.
.-- 15. (2 ft. a 30-?-7 7 T' g''S(
ADDRESS PHONE NUMBER
PRINT NAME
SIGNATURE DATE
Before me this 14-day of 0 ,200in the county of
Duval,State of Florida,has personally app=la herin by himself/herself and affirrps that
all statements and declarations are true d a curate. l( C
Notary Public at Large,State of P.
. ,County of- U v
?ecodrsouncae,d,yrdKenown.ca., B +j 6, _�9 C, e) `7 c)- Mr(
JJ �jv -.^�;gY'Pye,, TONIGINDLESPERG:122
n�"�- '`4'= MYCOMMiSSICN#FF94951. Notary Signature: :, o; EXPIRES:October 6, 019- '•','i o f t°;' BondadThrONo:aryPublicllnerwr;e s
F:BLDG/Owner-Builder Affndavil;REVISED:4/16/2009
NOTICE OF COMMENCEMENT
State of Cr 1b(..• County of <D., '•) \ 1 Tax Folio No.
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of
the Florida Statutes,the following information is stated in this NOTICE DF COMMENCE T.
Legal Description of property being improved: 2. ' ti IC -Z S—L`' C�'vc, Ma-AL, (,tn.,'t
SO(----t- /
(- (
- 4 goy Go 4 i iLk 1
Address of property being improved: 3AS \2''6^ SA-• aNr\aw.{s;� '; .�\ I c L S ZZ
,
General description of improvements: 01,..„\-i, o.r, 0 SSW US'LLQ 8,4'LA.—,1:40
Owner: vv k M\` S ow ✓\- lddress: £95 12:50, S k— p.A\Z,„),=‘(.. t‘'1
Owner's interest in site of the improvement: Q�?'\—$1—S
Fee Simple Titleholder(if other than owner):
Name:
ii'llContractor: \,=.ve-- t. \vv`A- `,) ,r-.`5c a
Li
Address: ZZ Zo W, 3f, 7 Ic, w-,SSC
Telephone No.: C oy- 1 y 9 653 Fax No:
' Surety(if any)
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name:
Address:
Phone No: Fax No:
Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other documents may be
served: Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b),Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one (1)year from the date of recording unless a different date
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER S
Signed: r•fra Date: 7—Z 7" 1
Before me is day of c..... V in the County of Duval,State
Doc#2017189621,OR BK 18087 Page 1657, Of Florida,has person ly appeared Zr7 S
Number Pages:1 Personally Known: 2 q or
Recorded 08/14/2017 at 11:09 AM, Produced Identification: ' 3Cock')O4 ^ j - [ /
Ronnie Fussell CLERK CIRCUIT COURT DUVAL Notary Public:
COUNTY My commission e�Cpires: Ski
RECORDING$10.00
I Yo':< •%w; TONi GINDLESPEI;:GER
"F:., '1n :, MY COMMISSION 9 Fr 924951
1:•'!&,,,---',.-.:.6•5EXPiRES:October 6,2019
'ICA5BordedThruNotary Public Urdervrsrs
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