500 CLIPPER SHIP LN - DWAY21-0001 Building Permit Application Updated 10/9/18
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City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
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Job Address: c 'C' Cr p S'1,113 Lowe, Permit Number: V(A) L 2. ( - 000 ,
Legal Description 3.5.--e W / /7- 2-S-2.9) SeAsPON tbT t.3 gz-r- # Cio.7o-?—U 2/Z-(
Valuation of Work(Replacement Cost)$ //S—O 6 Heated/Cooled SF Non-Heated/Cooled .0
• Class of Work: ❑New pddition DAlteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial pResidential
• If an existing structure, is a fire sprinkler system installed?: DYes pNo
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) $no o
Describe int{it the typeof work to be performed: v,` Aid, Lid.i y pas- -iiN 0 A
`.(3,E-- emUS , J
Florida Product Approval# for multiple products use product approval form
Property Owner Information
C'
Name .IA�`ISk�Qi ls
X erCt-w Address S-00 CA)ifff S I 1.-",1€1,
City �1-10,A+1C.. 8eat., ) State F L Zip 3223 ' Phone C1'()(t /72.._- Cli$"63
E-Mail CAN(`IS oittc4,4-i yevloo.COM
Owner or Agent(If Aggent, Power of Attorney or Agency Letter Required)
Contractor Information --< --- 7--' 1",
Name of Company Qualifying Agent �� ] 1 i-
Address City State Zip
Office Phone Job Site Contact Number
State Certification/Registration# E-Mail JAN - 6 2021
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt D 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 r• ',
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 OBTAI►• F ' ANCING, r • NSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORD! e •UR NOT ' OF COMMENCEMENT.
W(Signatcwner or Agent) (Signature of Contractor)
Signed and sworn to(or of 1:P, ed)befor• me this ay of i Signed and sworn to(or affirmed)before me this day of
C)tr1 ,7oZ ( ,b 0 1--15 wil C-41 -: ` ,by
),
( ;i:natu .Not. (Signature of Notary)
.'I `'as.?t"••., — TON DLESPER Perso allyKnown OR
[ ]Personally Known OR ;�,.. ?fit,,; ��
[ ]Produced Identification14.:1'.
,t r•� :,, MY COMMISSION#GG 3,52,tihdured Identification
. n;; EXPIRES:October 6, of lc entification:
Type of Identification:__ .• .• i.-_N
!‘ ‘'s corded Thru Notary Public Underwriters
Owner Builder Affidavit **ALL INFORMATION
eriAHIGHLIGHTED
' IN
0City of Atlantic Beach Building Department GRAY IS REQUIRED.
■� 800 Seminole Rd, Atlantic Beach, FL 32233
`art ~ 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO.455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEE THE COUNTY"CERTIFICATE OF COMPETENCY"OR THE FLORIDA"CONTRACTORS
CERTIFICATE"TO ASCERTAIN IF A PERSON ISA LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.US) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I
COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
Job Address: ��SOO C IhLAW.SiLAW. 1 ,4F/a- rti-iC. Ret c l-t C _ 32233
Owner Name: run ris toe herr' C +z) Phone Number: 9041- to z_-ti t"63
Mailing Address: 'It. 0 'er . .LCAAe., City: A „ _ ,,'_I,. State: P-1.— Zip: a 2..2-3
Notarized Signature of Owner G / ^
•
The
efo goingin$trument was acknow -•g• • before me t ,is (Z./ day of Qr\ , 20 2(in the State of Florida, County
T
Signature of Notary Public v
es..-----Th
[ ] Personally Known OR [ ] Produced Identification
Type of Identification: '
:.---I.:71'4' Updated 10/24/18
: ;'� ;,•. TONI GINDLESPERGER
MY COMMISSION#GG 353178
• r; k.,,1
. ';, EXPIRES:October 6,2023
`,°.' Bonded Thru Notary Public Underwriters
Closing Disclosure
Closing Information Transaction Information
Date Issued 11/11/20 Borrower Cadyn Marie Filler and Christopher Geraty
Closing Date 11/13/20 500 Cipher Ship Lane
Atlantic Beads,FL 32233
Disbursement Date 11/13/20
Settlement Agent Amerio's Choice Tide Company Seller Leonard T.Trosdter and Amy C.Tioscher
File# 20-930-CD 1907 Oak Circle
Property 500 flipper Ship Lane Atlantic Beads,FL 32233
Atlantic Beach,FL 32233
Sale Price $450.000
Summaries of Transactions Contact Information
SELLER'S TRANSAC TON KE
REAL ESTATE BROKER(B)
Pt Due to Seller at Closing $450,747.77 Name Fluid Remy
02 Cale Price of Prrperty $_450,000.130 Address
04 Bruer Rehete frvrl/DP $100.00
05 FL License ID
06
07 Contact Brett O'Reilly
08 Contact FL License ID
Q9 Email txettoreify@fluidreafty.com
-walustinents-for-Ibe id-bySeller-in-Advance Phone (904)608-3317
10 (Dl/Asmeots __________ — — — —
11 • r r i r •:7.73REAL ESTATE BROKER(S)
12 Nne❑ae Name Surf Shads Realty
13
14 Address
15
16
F1 License ID
Contact Anry Troscher
Fl1 Due from Seller at Closing $375.635.73 Contact FL License ID
02 Errpcs rrprgt
03Emailsurfshadcrealty@gmall.com oa at loyp¢(,y) $17,591.2404
Email sufshadcreaRy@grriail.com
.t.oan(c)acurprinrTaken 5rtbjertto Phone - (904)669-393505
$-352,258.61SETTLEMENT AGENT
_ ff re
0 Payof Semd M rtg r r nail S 1,RT1?R
07 Name America's Choice Title Company
08 170 AlA North
Address
09CLAP,'Paid C�Ing C st Pante Vectra Beads,-FE 32082
10
11 FL License ID B)48695
12 $-1,91290 Contact Christine Nidell
13
Contact FL License ID A053397
-11Ijustments-for-Items-UnpaidbySefer Email dxistine@adloicetille.mm
15 CDrVAscecsnerts Phone ((904)280-3535
16 Curdy Taxes
17 .,•. ,.
18
19 Questions? If you have questions about the
loan terms or costs on this form,use the contact
information above.To get more information
CALCULATION or make a complaint,contact the Consumer
Total Due to Seller at Closing(M) S 490.747.77 Fulandal Protection Bureau at
www.consumerfinance.goy/ tgage-dosing
Total Due from Seller at Closing(N) - $375,635.73
Cash [J From QX To Seller $75,112.04
CLOSING DISCLOSURE PAGE 1 OF2
MAP SHOWING SURVEY OF
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