2107 S FAIRWAY VILLAS RFNC21-0008 Building Permit Application Updated 10/9/18
J
r City of Atlantic Beach Building Department **ALL INFORMATION
; Y 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
tt! IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us f
Job Address:?07 f-,Ir L
di VA 11 tA- Lv}t- S _ Permit Number: RFN C2_1 - OOOB
Legal Description 2 F-PI)r1,(J V I P� Lo.1 J RE# ' /(O 7 3?& - /0%
Valuation of Work(Replacement Cost 1C0 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: 'ew ❑Addition DAlteration ❑Repair ❑Move ❑Demo ElPool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s) be removed in association with propoled proiect? EYes(must submit separate Tree Removal Permit) tNo
Describe in detail the type of work to be performed: L. �'` ,. •-1)\
Florida Product Approval# for multiple products use product approval form
Prosert Owner Information / , I
Name e r }'
b , �^-15te1c\ Address . W
f\-IcIA� V I L- f J.
City -t C. I _ - G C� State FL Zip Phone d s I S
E-Mail 24, Ir.S ]rV
OQAAircoM
Owner or Agent(I Agent, Power o ttorney or Agency Letter Required)
Contractor Information
Name of Company -c Q,c‘c e tl.1v-%� \\ Qualifying Agent ,�,,r�j•� S,\JQ "'ICA.r‘
Address 3-%al s ci„\ flCx 1 RQ,.\ (.� `t L' City c,cCJOZW- ‘\' State `E' Zip 3.a p-1
Office Phone (N,.. -1- 53S- ob'a 1 Job Site Contact Number CACM-- -'c - 5C1-1 ci
State Certification/Registration# aQ-314G1y'30-A E-Mail . — N. •.. III. - -�- 2.
Architect Name& Phone# _
Engineer's Name&Phone# est _iv( s Y --
Workers Compensation Insurer "'[,vJ(.,3 i\o`-S 1\ OR Exempt❑ Expiration Date L{ -\- Z 1
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 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 OBTAIN Fl ANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RE R NC i UR NOTICE OF COMMENCEMENT
(Signature of Owner or Agent) (Signature of Contractor)
igned and sworn to(or affil m:d)bef-r• m• this I , da of Signed and sworn to(or affirmed)before me this,1fIr\day of
nl
, • b A. .' ,t ...d il . ' % \Jiiin , , bY1 ,i nYV 51 1 Oeg
rillill IL .1
(Signa I o Nota Hendry
;ot ,c% AlTONI GINDL 0 RGER -r !n Notary Public
c f.,1 : , MY COMMISSION#GG 353178 State of Florida
[ ]Personally Known ,zEXPIRES:October 6,2023 [)ersonally Known OR ;, ''1� My Commission Expires 11/30/2021
-Y"" �' Produced Identification
[ ]Produced Identificaori•..p,lb,° bonded Thru Notary Public Underwriters ] �/ � commission W0.GG 155172
Type of Identification: Type of Identification: �`-''
NOTICE OF COMMENCEMENT C
State of F-1or\(/l a Tax Folio N9., ,' T3 & /v
County of 1,)(k tA1
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• :ted in this NODE COMMENC•MENT
Legal Description of property being improved: . I(rev' 1 (
Address of property being improved: a 101 1--A IRA)tel-1 (1 I(A` Lon({ S S. %au.,
rt...
General description of improvements: Vyn6 I 4ne Crec4ecA ovk + 1�� k a h"l SOCJ k.
?irkeAki j
Owner: 7-c-c L/ rlAddr
Owner's interest in site of the improvement:JiS\-c� Jt'IUaC
I Titleholder(if other than owner):
Fee Simple
Name: �'�� ✓� J �)� r' .. S
Contractor: -ce r (J r
Address: 3-1a-1 k - a
Telephone No.:C\ S 3 - 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 fro " ._. - __•_ _•__-_ - -• sate is
specified): .. •°`6 > TONI GiNDLESPER GER —
r�A %,": MY COMMISSION fi GG 353178
•.� o? EXPIRES: G,2023
THIS SPACE FOR RECORDER'S USE ONLY OWNER \ �rFOFc��.' Bon EXP•
IRES:
eb uFJuta OcbberPub%U der •.rs 7
Signed: J Date: `�(
Before n' -h)s V' day o h in he Coy n of Duva
Doc#2021013914,OR BK 19542 Page 715, Of Florida,has personally app ai ;J - `
Number Pages: 1
01/1
Recorded 01/19/2021 12:03 PM, Notary Public at Large,Sta - o •nda,Cou s ial.
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL My commission expires:
COUNTY Personally Known: Ck_ I41
or
RECORDING $10.00 Produced Identification: {`(pZ3 -42-4 _ (- r V
(---
-- ',r,,, Fence Addendum Updated 1/7/2021
City of Atlantic Beach Building Department
v 800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Property Type:
jesidential
El Commercial
Lot Type/ Features:
ne Street frontage (interior lot)
❑ More than one street frontage (corner lot, through lot, etc.)
❑ Swimming Pool
Fence Material:
❑ Wood
❑ Chain Link
inyl
❑ Block/Stone (Plan details required for footings and/or retaining walls)
❑ Other
Fence Height:
[11 / 1
�
Four Foot(4ft) - PA fir rA4—
❑ Six Foot(6ft) 6.0. i1/4,, h ►4 C(6.-
❑ Other
Fence Location:
Please submit an accurate boundary survey required showing all existing improvements(including building footprint,
driveway, swimming pool, etc.) and location of fence/wall and any gates. Plan details required for block wall footings and/or
retaining walls and any portion or fencing above 6ft in height.
Will the fence be built in an easement?
❑ Yes (must submit separate Revocable Encroachment Agreement)
ErNo
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
No
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.
U V '` MAP SHOWING IjUUNUAKY SUKV.Y UI-:
P.T. "-
IRON PIPE NOID
FOUND 1i/2"/FICA110 LOT 18, FAIRWAY VILLAS, AS RECORDED IN PLAT
IRON PIPE BOOK 39, PAGES 22 AND 22A OF THE CURRENT
NO IDEN IIFICA710So 1n PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA •
O k:J FOUND 1/2"
O IRON PIPE 0 CURVE RADIUS ARC LENGTH CHORD LENGTH CHORD BEARING DELTA ANGLE
NO IDENTIFICATION Cl 25.00' 16.09' 15.81' N 19'49'21" W 36'52'00"
�J J C2 50.00' 23.72' 23.50' N 19'58'44" W 2711'01" _
C3 50.00' 27.69' 27.34' N 19'40'37" E 31'43'47"
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NOTES k
THIS PROPERTY UES IN FLOOD ZONE X"PER FLOOD INSURANCE
RATE MAP(FIRM), DUVAL COUNTY, COMMUNITY No. 120077,
MAP/PANEL No. 1203IC-0000-J, REVISED NOVEMBER 2, 2018 • I SET 1/2" IRON
BEARINGS BASED ON THE SOUTHWEST PROPERTY UNE OF LOT PIPE DURDEN
18 AS BEING N 48'56'57"W L.B. #6696
NO BUILDING RtS/KICTION LINE BY PLAT
N.T.S. DENOTES NOT TO SCALE
ONE DENOTES OVERHEAD ELECTRIC
ALL LOTS SHOWN HEREON LIE WITHIN BLOCK- EXCEPT AS NOTED
-X- DENOTES 4' CHAIN LINK FENCE EXCEPT AS NOTED
-1/- DENOTES 6' WOOD FENCE EXCEPT AS NOTED CERTIFIED TO:
THERE MAY BE ADDmONAL RESTRICTIONS THAT ARE NOT SHOWN JEFFREY D. KRISTEN
ON THIS SURVEY THAT MAY BE FOUND IN THE PUBLIC RECORDS
OF DUVAL COUNTY, FLORIDA.
I hereby certify that this survey meets the
Ilii minimum technical standards as set forth by
DURDEN I the Florida Board of Land Surveyors, pursuant to
Section 472.027 Florida Statutes and Chapter
SURVEYING AND MAPPING, INC. I 5J17 Florida Administrative Co e
985 11TH AVENUE SOUTH
' I ,JACKSONVILLE BEACH, FLORIDA 32250
(904) 853-6822 FAX 853-6825 1 )/17/1Ze.
LICENSED BUSINESS NO. 6696
FLORIDA REGISTERED SURVEYOR Na. 470
H. BRUCE DURDEN,Jr.
SURVEYOR'S NOTE?
THE SURVEY HEREON WAS MADE WITHOUT THE BENEFIT OF ABSTRACT OR SEARCH OF TITLE AND SIGNED OCTOBER 12. 2020
THEREFORE THE UNDERSIGNED AND DURDEN SURVEYING AND MAPPING, INC., MAKE NO CERTIFICATIONS
REGARDING INFORMATION SHOWN OR NOT SHOWN HEREON PERTAINING TO EASEMENTS, CLAIMS OF SCALE: 1" = 20'
EASEMENTS, RIGHTS-OF-WAY, SETBACK UNES, OVERLAPS, BOUNDARY LINE DISPUTES,AGREEMENTS,
RESERVATIONS OR OTHER SIMILAR MATTERS WHICH MAY APPEAR IN THE ABSTRACT OR SEARCH OF TITLE. WORK ORDER NUMBER: 20445 _ _ B- 9 7 5 7
THIS SURVEY NOT VALID UNLESS THIS PRINT IS EMBOSSED WITH THE SEAL OF THE ABOVE SIGNED.