407 SARGO RD - RFNC21-0019 'Ali .' Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
.1111rv 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
--.011!)".
ojt!)r IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: �b`7 S/t-/26/p e rcH Permit Number. FICZ ( - C0 (9
Legal Description ��v�5 / DWS•M-16 RE#
Valuation of Work(Replacement Cost)$ l 49 t /Cooled SF Non-Heated/Cooled
• Class of Work: N'IVew ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial fafresidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes i Tlo
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) to
Describe in detail the type of work to be performed: f(" 1,10(,)6 ell e e-,L 4C-E ,v.. �� 7/
( ' -�y Sy,6 ,3
op c`-.f-fafr:0 �-C•C re '/v G'w 6d4-7 i 1-c o f
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name f 41 ' t • � As/ Address /107 g gofii9
City / 2 77 C [i. tate F/ Zip �2 2.33 Phone f—67 0 .—c2951-- "le? C7
E-Mail --
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information ,tib EM,i:t <--
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 0 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 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 FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RERR � R NO ' E COM , ENCEMENT.
(
(Signature of Owner or Agent) (Signature of Contractor)
�igned and sworn to(or aff ••d)before me this /day of Signed and sworn to(or affirmed)before me this day of
C �Z� 'b �61@O,n �.O.��c , ,by
A.Y.if�"'' TONI GiNDLESPERGER nat T=.f .tar 1 (Signature of Notary)
*. j .*.' MYCOMMIISSION#GG
1-r-;;;,..". ..i:;*; EXPIRES:October 6,2023
'" f:°••'• 1.;y.,,,1,,:).wNi derwriters [ ]Personally Known OR
[ ]Produced l.enti ication [ ]Produced Identification
Type of Identification: Type of Identification:
C,,,,.S'y
-- Fence Addendum Updated 1/7/2021
City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Property Type:
Residential
❑ Commercial
Lot Type/ Features:
❑ One Street frontage (interior lot)
More than one street frontage (corner lot, through lot, etc.)
❑ Swimming Pool
Fence Material:
❑ Woodo
L9'Chain Link
❑ Vinyl
❑ Block/Stone (Plan details required for footings and/or retaining walls)
❑ Other
Fen a Height:
Four Foot (4ft)
❑ Six Foot(6ft)
❑ 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?
❑ Ye ust submit separate Revocable Encroachment Agreement)
No
Will tree(s) be removed in association with proposed project?
❑ Ye 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.
Owner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
• riCit of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 ����((11
..'s 'r Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:RFn t -60
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: 407 S'Gf O 4w) 1-rt1 /ter/C' Pet/ .3 2-.2-3 2
Owner Name: PAS-°t-- tOw' �1 Phone Number: (— 91:1 5 —;-9F4'11230
Mailing Address: 7c"`7 seW6t7 0 City: A-TL4i-77C ,Berm State: f-L. Zip: 22-2-33
Notarized Signature of Owner Cye2f4—e•e92"1 / -
The', IIP oi ng instfiment was acknowledged before me this 7..Q/day Qt.\i0 tin the State of Florida, County
f
Signature of Notary Pu '
[ ] Personally Known OR [ ] Produced Identification
__.. +f Identification: L,
;.2oS�Fv;ayo; TONI G!NDLESPEkGER
.; ra :,_ MY COMMISSION#GG 353178
::8 EXPIRES: ct,ber 6,2023 Updated 10/24/18
•,odFe�P. Bonded Thru Notary Foh c Underwriters
atirof.,,a ....W
A
IEXACTA y. . .. .
. Land °urwey'urs,Ll_c
www.exactaland.com I office:866735.1916 1 fax:866.744.2882 ."f' ..
PROPERTY ADDRESS: 407 SARGO ROAD , ATLANTIC BEACH,FLORIDA 32233 SURVEY NUMBER:2011.1913
20111913
BOUNDARY SURVEY
DUVAL COUNTY /z FIP
• NO ID LOT I o BLK 17 .
TABLE:
Lor COR. LOT 1 1 BLK 17 LI N 7°I6'O2'W 80.65'(P)
N 7°10'54'W 80.77'(M)
O
_ LOT I I
�1 BLK 17 ° 02 oN
2sa 30a_ E93.55'(P)
I
` � -- N :112.
N:2°44'57% 00' ) �� uz•FIP LOT 14
._. :..4,4,.
L FIPN2°43'58 E 93. NOIDBLK 17
I .p°" NO 10
.UR 4'C.L.F.(tYP.I
I J
0.6 ON 1 5 .6°"
41
I Cis 4.0 OFF
.9'_
i 27.6' \/
\k\' l • Z . . r-_.-- �o 28.1'
J
O ZJ 25.6 NI s
LOT I1;1 11
'r"' 0 0 •
DI O O a1 > RES ST'.
1 rn LOT 1 3
:N cl w �O BM 17
QI �� I 6L
17
CD C.D
Op I
61N-
-t-9
N .
la in
q0.1' i 'O
0 Q Q L 240 26.6'
-I t-'9 5'5.5 L.
I • METAL
S 1/2' PIP m, fig
NO 10 N I
UTILITY POOLE I B.C. 6
I 0.5'ON N 0.6 ON _
719'''."---...-•:,
.p_ I/2' FIR
\'``_ N 85°3727^W 94.95'(P) No Io .
. N 85°37'27'W 94.84'(M)
CATCH 8.(PR PLAT) ,5 °uR
— ._
I , ., —_ ,... ____, any ,
.,.,._
— TNcT r
cuTLA55 oR��E�6a r � -_°
m
NI
---�._
J/lSURVEYOR5 NOTES: _2___L,
SETBACK INFORMATION SHOWN ON PLAT.NOT VERIFIED .�
FENCE OWNERSHIP NOT DETERMINED.
D.U.E -DRAINAGE AND UTILITY EASEMENT
30 0 15 JO
=M iiii
IMMI
fill
MINIM=GRAPHIC SCALE (In Feet)
1 inch = 30' ft. 7
SURVEYORS CERTIFICATION: POINTS OF INTEREST: ,
1.4'CHAIN LINK FENCE OVER 5'DRAINAGE AND UTILITY
r j- --
/---(.4%-i--5—
I hereby certify that this Survey of the lands EASEMENT 2.RESIDENCE OVER 25'SETBACK LINE
;Si - described hereon was made
my
��G 5 rect
M N4,--, supervision,and to he best of myrknowledge
%'/ 6132 k \ \\ and belief is a true and accurate representation
1of said lands and meets the Standards of
� I. Practice set forth in Chapter 5J-15.050 through
','CjF,._.di..2 SJ-15.053,Florida Administrative Code, As''''y; Florida Land AFFILIATE
y1 /a, pursuant to section 472.027,Florida Statutes.
tA'
/4;,/ This survey is not valid without the signature and Title Association
\4 STATE OF original raised seal of a Florida licensed surveyor—FLT'A- MEMBERS
:\.� FLORIDA v" and mapper,except when the electronic
NY,1C'8 signature and seal of a Florida licensed surveyor
and mapper is affixed hereto. .
RAYMOND J.SCHAEFER •EXACTA
Slate of Florida Professional Surveyor and Mapper
License Number 6132 . - - - Leu 8291
Office:866.73519161 Fax:866744.2882
11940 Fairway Lakes Drive.Suite 11 Fort Myers.FL 33913
DATE OF SURVEY: 11/19/20
FIELD WORK DATE:11/17/2020 SEE PAGE 2 OF 2 FOR LEGAL DESCRIPTION
PAGE 1 OF 2-NOT VALID WITHOUT ALL PAGES
REVISION DATE(5):(REV.O 11/19/2020)