1245 Jasmine RFNC21-0036 SWO Fence 3 t7f2, l
,; '`; Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
+ - 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
1 't IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 12_95-5 3GCIr'Y11 AL S'lY'CL,•\- A-00)1)1(... (kc .M,CL 3 Permit Number:
Legal Description )g- Pi 411.58- 25- 2762 O I)7 SEC H iiiiinAhc i&cQ•r/ Loi- lo , 1K? # ( -7-/0c0 0120
Valuation of Work(Replacement Cost)$ boo "- Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New DAddition Alteration ORepair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial )81Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s) be removed in association with proposed protect? ❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed:
wce - ct" ,
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name Kni1hroc. (1SY1 U--e Address J2_45 faimi1,E S4vte
City 4-)unhc Bcvch State FL- Zip 322:"{-3 Phone (32_I)- 29.29 ) to
E-Mail )11.9017(1,1e-& vi zy @t)rtihcv-Lu.N
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company 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 CONDITIONER etc. NOTICE: In addition to the requirements of this
permit,there may be additional restrictions applicable to this property that m y 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
RECORDING YOUR NOTICE OF COMMENCEMENT.
-�
(Signature of Owner or Agent) i (Signature of Contractor)
ed an swo�njtto�or ff .)before me his/ 7day of Signed and sworn to(or affirmed)bef me this day of
LCJZ.(s . YIS a_ 60✓l,a,,,- , by
f.•• . . e of i•. • (Signature of Notary)
?7 TONI GINDLESPERGER
[ ]Personally Known OR "
RR
t ,:,� =; : i MY COMMISt1*(30515'IIT"' R
[ ]Produced Identification ''. ` EXPIRE(;At9gemeibOsntifi tion
Type of Identification: ..';',°.,-I':-?..'‘ Bonded Thru IT0t1i4 Ptfbitlelndlifiimittio
Owner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
iiirriA •Cityof Atlantic Beach BuildingDepartment GRAY IS REQUIRED.
a p
V800 Seminole Rd, Atlantic Beach, FL 32233
``r Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
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. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.US) 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.
Job Address: 1245 77zcrnik, S <4_ 44-(61.1},'c 6eac h,
Owner Name: Kyi'_I)- ha_ Clen7-&,(.p k Phone Number: 321)-212-, 7-((e
Mailing Address: )2-4 A j',y n¢. S;ye.24- City: A-I-)an-Fit ii State: FL_ Zip: 3-27 3�
Notarized Signature of Owner
_.___74j5fr/-----"--
The ioreg.'n: instru ent was acknowledged before me this ' 7day •A .tf.t J 20 7(n the State of Florida, County
of 0.�
•
4 ________
Signature of Notary Publi
[ ] Personally Known OR [ ] Produced Identification
Type of Identification: L
Updated 10/24/18
+1I ''''" f,; TONT GINDLESPERGER
',: !a :+: MY COMMISSION#GG 353178
11'--`!;:•..4,o: EXPIRES:October 6,2023
'••, F'.'' Bonded Thru Notary Public Underwriters
Fence Addendum :,•,irtited=,'id,:,ri.,
` City of Atlantic Beach Building Department
fj - _.
840 Seminole Road, Atlantic Beach, FL 32233
PERMIT RFNC21-003
Phone: (904) 247-5826 Email: Building-DeptCcoab.0 s 1
___
Job Address: ' Date:
i z.�r 5 ,Rbypiin r Yet.E-
['ill-on-or:. Sez z -.-, .7?
� Property Type: -
l P Y yp Lot Type/ Features:
5/Residential 0 One Street frontage (interior Cat)
Commercial IJ More than one street frontage(corner lot,through jot.
etc.)
r7r -
.Sw rnming Poop
Fence Material: Fence Height (select all that apply):
Wood ❑ Four root(4ft)
G :hair .,r'k g'Six Foot(Gft)
El Viny: U Other
r] Block/ Stone(Plan details required for footings and/or
retaining walls)
❑ Othc- f
Fence Location:
L'It-asc suornit an accurate and current boundary survey showing all existing improvements (including building footprint,
r.riveway,swimming pool, etc.)and locat'on of fence/wall and any gates. Plan details required for block wall footings and/or
etain rg walls and any portion or fencing above 6ft in height,
Will the fence be built in an easement?
C Yes (must submit separate Revc•caoie Encroachment Agreement)
Will tree(s) be removed in association with proposed project?
7 Yes Imust submit separate Tree Removal Permit)
Conditions of Approval:
• Roll off container company must be on City approved list. Roll off container cannot be placed or City right-of-way.
• Ali 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.
MAP SHOWING BOUNDARY SURVEY OF
I-07 a. 81 OCR' 223. MLITOti --r ATIAN1/C A124. AS ff..LCUE:1 IN PI/7 3004( la,
'Art,
34. Or it cuF5iviT Ft;i3tIO fet•LXVDS Of DLNAL CD...N-Y, r.oRinA..
CERIVIED TO
IMST(A NAME .2.0.117
AkiERIrRIT FINANC3A1, INcalFoRATE)
ROIARD T. MORIENEAD ;ITU & EscRovi, INCORPCRATED
CIO RE-AtJAI.T INATIONAL 71-1Z 4:51...14ANo. CtIMPAN',
..•---OzwirWria -+
i
I LO- 6
kilDcic 224
, 5 Orzeocr L i
LOT 5 . ziv.;;C! PLM) WI I
N.00( n - ' moat( 2C-;^,
1 S 0r58.04- E i
_.....J..... , . 5c.15* MEASURED) r,"-,..
C'-
z-,....c
4 s.rn I
..---- • I - ..n7 c. t
- .---.-1=-,--
/—.--.7-.....
(a(Altli ("11 119
z-i3"3 ck- --
N
7 0 0 17..--ts i ONE STt3RY
FRMe g.i.
1,...--.- FORM! 0 124t.
4 Et •
r
,..
1 , a:, 0.7•Cr=
24'
1. t,,PV \Ili .•:; -'
- LDT I
Et...3L14: 2,3 1. RACK 203
:
,_. .i.,.1 i ..: : „ix • .
, iqI'1
i•-.•. . ...
. .
•
MACK N 0r.11.7.42- w
50.08 (MEASURED)
7.: 01"2,11v- IA
50.0V (RAT)
:FGF,ND.
....
-ar-1..7.••••,•1 t.ASK4!NE STREET
t
s - •51,C OF 13.110APAP
,.....46.1O....41,4 Cb.i..142 17:s
•_,,,,,.•„v.„.,,,,,,..
141,SIP4,1[1.111[114 Pal ... POW'-oncisc
:AMOS('4 Cilei.nr4.1..1 ••3 raw qtr
all•4.-pc-NOIXT ko..lvena r NC - 4,A.t Mi 0:11093.1r:
- *A
_ ..M•14.71..e
•..T. =vs-a.
—.- . 1G
---_,.
iiFOSICW.,
Kay rhornp.f.,:cpri
K. .yam b*URVEYING, L . E.irt arb Z. .21tDrr1lrub
Mr 11=11 poor,me DisrAtx:-E.A.-..r...1 Milts nab
IR , 1,....,1100110 1=-..:nvolaz,•Dooe62.,2 N.:v. i 444-3-sqn„slqa-r - .
IV 1 11101111I ' -or*--14:4Twte.Ficrzt3.r...::,7 " WPTskE aD04.FLOPEA_ 1:;166
kltot.,4,i.):4.d..,Lt-Illtb 0104]-2.47-n47 4.4 l'A1.(204)-147-6X7 ar............ .m...4111.1!
INA) W444.1-s-.71
KE ') Iti.i.) t_k:RvEY: LI:-I n-27 I ....if.:-.A.LE: 7. =
..-
. ;•_. '.:1-4::FICATE
74 • ar orov kk '.,.41_11-55::.2t 5_
.:an 144 wen--mg,IXV445417t JC ar SZ.T.Lel Paa.11. ...ipt.e.tgirrir,TA' ,.. .i• ...I,a,.^`,.s,--.4•-,t....eX
, n.rArrr...Mar.?, :W4-?mr c.^:,:)...tb i 44.4.4-A i 1 ors a404)4,:,,v,;4,"4.; .4•1 IALVS.1.6'caw ,,v• .. . if. ,,447,, -.e..-. ,..
uwaro OP • - • -.- AVOW 61..7.1.LLYR".9.a...r-el S. -e,r rm.
P.-"C5e.t5r4:71_4i.- 344`,.."''t. --1).'",. '''''''wk4,-.1?:. ..,......- ,-1" -r:Is r.le,4... „.-4.-
— o I
..r4.1...,,,..,4.1.11,,,/4-1-L.44.51511517!:a 23424TS CS MA',...A;CP 1 .7;0444,1
,14.“44.017, r tnaernes-v zq I7 OCCINEKTS PIOVCCD kr CI IN-, - __
' --,
--.• - -,
Li...Los orszaz STA TT 0, WC.OTKA 1171 E Ytyp KA,041.1 1:•=4 - -- 1. !,,..Uag7f,',. .. '
,DraliCI)II 7'I.:-.N.C.C126,424,12. C'
A..4c5=hire 4.:4.0 svt.15 ri.teal r An4 441.,.-,4t.),*1.:ATC,C.7.":',":/4:2,344ATISC .1.-V4!.-7.:.: WIN .1.,
=L..7 tnM
LND SU RVE7r'S 0 03NSTRUCTWAI aiRW-YS ' 07.17
'LI IVZ kI
-
A15#--- -SU)‘7-BC47:71.7S1-0N-S.--
--—.
ALTA Settlement Statement-Combined
American Land Title Association Adopted 05-01-2015
FileNo./Escrow No.:21B3329 Richard T.Morehead Title&Escrow,Inc.
Print Date&Time:2/18/2021 @ 3:14 PM
Officer/Escrow Officer: Beth Murphy 444 Third Street
Settlement Location: Neptune Beach,Florida 32266
444 Third Street
Neptune Beach,Florida 32266
Property Address: 1245 Jasmine Street,Atlantic Beach, Florida 32233
Buyer: Kristina Gonzalez,1245 Jasmine Street,Atlantic Beach,Florida 32233
Seller:Julia M.Rockwell,a married person conveying non-homestead property,54005 Turning Leaf Drive,Callahan,Florida 32011
Lender:Amerifirst Financial, Inc.,275 East Rivulon Blvd.#300,Gilbert,Arizona 85297
Loan Type:Conventional Settlement
Loan Number:2012EM338050
Settlement Date:2/19/2021
Disbursement Date:2/19/2021
Additional dates per state requirements:
Seller
Description Borrower/Buyer
Debit Credit
Debit Credit
Financial
$350,000.00 Sales Price of Property $350,000.00 $3,000.00
Deposit including earnest money
$320,000.00
Loan Amount
$495.00
Lender Credit
$850.00
$850.00 Seller Credit
Title-Insurance Seller Credit $1,825.00
$1,825.00 Title-Insurance Seller Credit
Prorations/Adjustments $455.65
$455.65 County Taxes from 1/1/2021 to 2/18/2021
Loan Charges to Amerifirst Financial,Inc.
Processing Fees $755.00
Underwriting Fees $740.00
Prepaid Interest($25.56 per day from 2/19/2021 to 3/1/2021)to $255.56
Amerifirst Financial,Inc.
Other Loan Charges
Appraisal Fee to Synergy Appraisal Services(POC by Borrower:
$495.00)
E-Filing Fee to Old Republic National Title Insurance Co. $9.00
Impounds
Homeowner's Insurance 3 months @$111.42 per month $334.26
Property Taxes 6 months @$282.84 per month
$1,697.04
3 File#:2183329
Copyright 2015 American Land Title Association. Page 1 ofPrinted on 2/18/2021 @ 3:143 29
All rights reserved.
e.,\J.,,,„„
/. .,. ;.. ,,,,
1 ' •- ':
) TOP WORK
,i.r.),„,,,
CITY OF ATLANTIC BEACH
BUILDING AND ZONING DEPARTMENT (904) 247-5826
NOTICE
This building has been inspected and work regarding:
_ General Construction _ Mechanical
- Concrete and Masonry - Electrical
— Plumbing _ I Gas Piping
IS NOT ACCEPTED AND MUST CEASE
CORRECT AS NOTED BELOW, BEFORE ANY FURTHER WORK:
FeY1ce ;ns-411I-el ct,,4h /lc) perm , -1-.
ADDRESS: l a`/S es-ni;/14-- S"6 A8
Please contact our department regarding this notice within 10 days. If you do
not, this violation being forwarded to the CODE ENFORCEMENT DEPARTMENT.
The posting of this placard by its contents shall serve as due notice.
DO NOT REMOVE THIS NOTICE
Inspector: (Y Date: / a- • _7 . 02p 2-0