2021 SELVA MADERA CT DWAY21-0012 3;- . Building Permit Application Updated 10/9/18
r City of Atlantic Beach Building Department **ALL INFORMATION
+ittagg - 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 2,00212,0021 ,el✓OA WlaAev� C¢-, A? 3„20233 Permit Number: UW -7
Z 1 — OD I C�
Legal Description 9Q -37 Oq-25-A elE Se)va/Oort-e Un,4- Two Lo+ $O REH 14q 506,-'LSO
Valuation of Work(Replacement Cost)$ II Cob.-- Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New DAddition ❑Alteration ,Repair ❑Move ❑Demo DPool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercialtesidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ›(No
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) J$'No
Describe in detail the type of work to be erformed:
x'Re piciCc' aIA(vd '-.1 ✓L 1
Florida Product Approval# _for multiple products use product approval form
Property OwnerInformation / / c�
Name ?/ C/i&i //ovt Buk-j•''�!'t 9e Address 202/ S va. alG -e C,-
city A4-6s4 F' 5eactl / State_PL.__Zip 3,z,233 Phone q04-,q 5(a-1.35:2
E-Mail /lab 3av4. 0 y,nasI . Coon _
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information t1H6LN4'1-G
Name of company t � �'o _ e
QGv� Qualifying Agent i4-1/1 (,J�l,�o vN
Address/,26 /1ja. :IAA, I.
� vcC— City eAState F-(__ Zip ,32.2.50
Office Phone Sky- 6.0g -Y 553 Job Site Contact Number 4O-/- 605 - qS.c'
State Certification/Registration# E-Mail i 4 - t• f a - .� �PPM i.I.COOrk
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 COMMENCEME AY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PRO RTY. I 'OU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATT EY : FORE
RECO DI YOUR NOTICE OF COMMENCEMENT.
...,.. ..././ ignat re owner or Agents (Si: ature • CAP or)
ed and worn to(or
affir :•)before me this 3day of Signed an`�i sv�prn t or afifirm�l) before me this day of
J),20?1 , • ,, L/ `. , 44 - ; -- ,! \�, ,/ ,Y
:tu ary / (Signature of Notary)
�, "wi sTONIGINDLESPE GER
[ I Personally Known OR '�., ‘. MY COMMISSION#[G P` • ;all nown OR
':w�`.'''..:Y' .puce. •entification
[ ]Produced Identification ,r': EXPIRES:Octobe(r�,r
Type of Identification: - -l„........433.,!;;°'' BondedThruNst�(yPubI ':• •anI ication:
S%jLr Owner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach,
FL 32233
rs '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(WCOAB.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: o? 7 ( SeJVot lMac gve" C�' -�-�)a t t4-iC BeaCA , PL-- 32233
Owner Name: i1 CA4-oK 31,srb -iJAFe Phone Number: 4104-v2 - 43.c
Mailing Address:20.2j 5e(Vex evs. C4- City: A+IA►4.:c Rezak State: 7L Zip:3,2,233
Notarized Signature of Owner
Th egoing i_nstr ment was acfcn wl-::-• •e • - m- hie _ day of aw, , 20 �,(in the State of Florida, County
of 0VQa
Signature of Notary Public _ C2e
[ ] Personally Known OR [ ] Produced Identification (�
Type of Identification: [Th L
*?• •• TONI GINOLESPERGER Updated 10/24/18
,. :,' MY COMMISSION#GG 353178
• EXPIRES:October 6,2023
j• FOF FL�✓'�, Bonded Thru Notary Public Underwriters
1rs1r,� RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION
( , City of Atlantic Beach HIGHLIGHTED IN GRAY IS
i'%' 800 Seminole Road,Atlantic Beach, FL 32233 REQUIRED.
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address...20Z 5e.((Ja' &a- e- Permit Number
At+la 14:1—k- 9 ea‘dA i "L. 3202 33
Contractor Information
Company A+(avt{-►C CAS nn C tArilef e Qualifying Agent Ke-,141. Wis 1,so v,
Address /..Z.6:, JvG�ind;o(i, ,1. ttC,le- CityDov 4e. V�✓o e,StaState FL Zip 3125-0
Phone Q0q— 6 og-(4 553 Email of ictvt'k c.CLAS f ro% CoCtie ' . 9 •( .Cowl
State Certification/Registration#
Architect Phone Email
Engineer Phone Email
Workers Compensation Insurer OR Exempt ❑ Expiration Date
• Permittee declares that prior to filing this application they have ascertained the location of all existing utilities,both aerial
and underground and the accurate locations are shown on the sketches.
• 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 Public Works Director,any or all 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 Public Works Director and at the expense of the
Permittee unless reimbursement is authorized.
• All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the
supervision of ea;4-41. (A.)f Sot^ (Project Superintendent)
with (Company Name) A+l 4-►C Gas k . autcr 4-e. Phone qat-661$' - It 553
• All materials and equipment shall be subject to inspection by the Public Works Director.
• 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.
• 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.
• The permittee shall commence actual construction in good faith within days. If the beginning date is more than 60
days from date of permit approval then permittee must review the permit with the Public Works Director to make sure no
changes have occurred in the area that would affect the permitted construction.
• 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.
• T Public Works Director shall be notified 24 hours Lor to starting work and again immediately upon completion.
•
�_ Date
Perm tee(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
s. z(____,
The foregoing instrument was acknowledged this______S___day of 20
by 1/. c/i1, O,-t BC-4# v 7P -X' ,who .ersonall ...-. -• •- - - --- -•
(printed name of Permittee) k�' CONI GINDLESPERGER
if ,.. •`• MY COMMISSION#GG 353178
ackn. :aged that she signed the in trument voluntarily for the purpose expressed :jf. ;..
r,�-:,,c4.• EXPIRES:October 6,2023
%'f.Mil°• Bonded Thru Notary Public Underwriters
• [ ] Personally Known y�
Signature of Notary Public,State of Florid ---c....____ [ ] Produced Identification (Type) U c_
H:\Applications&Forms\Word&Excel Document Originals\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18
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Ordered By:
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The Law Offices of Rod Schioth :L-
2187 S Third St f'''' S41/4:11.
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Jacksonville Bch, FL 32250 :ham j 3 y, i
904-372-9351 3
BriSIR De
beach@rod-taw.com li
PROPERTY ADDRESS: 2021 SELVA MADERA COURT ATLANTIC BEACH,Florida 32233 SURVEY NUMBER: FL1211.1036
FIELD WORK DATE: 11/14/2012 REVISION DATE(S):(rev.1 11/18/2012)
FL1211.1036
BOUNDARY SURVEY
DUVAL COUNTY
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I hereby certify that thi eA of u eY oo e-.n described property has
been made under my.i don,/ .f79ie•-st of knowledge and belief,it is
a true and accurate repre -'r o •• - - rvey thatmeets the minimum technical NOTES:
standards set forth b e. /xi,% ' •e al Land Surveyors as LOT APPEARS TO BE SERVICED BY CITY WATER AND SEWER.
described in Chapter{O 17 of ,•aa
STATE OF••minis r- e Code. FENCE OWNERSHIP NOT DETERMINED.
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Wesley B.Haas GRAPHIC SCALE \\,
State of Florida Profeuional Surveyor and Mapper I inch = 40 feet frO
Lieanse No.3708
Use of This Survey for Purposes other than Intended Without Written Verification,will be at the User's Sole Risk and Without Liability to the Surveyor. 1,
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2020 NOTICE OF PROPOSED PROPERTY TAXES DO NOT PAY
Duval County, Florida
THIS IS NOT A BILL
Legal Description:
= H1111111 IHII I IE1I11I IIS I III 40-37 09-2S-29E
11+'IIIII1 11111111111111111111111111011111.1111111111111 I SELVA
OT 80 NORTE UNIT TWO
129873***P10 T405***********AUTO**5-DIG!f 32224
a: BURBRIDGE H CLINTON
BURBRIDGE MISCHELLE D
2021 SELVA MADERA CT
ATLANTIC BEACH FL 32233-4531
RE No: 1695061650R Use: 0100 Dist: USD3 Prop. Address: 2021 SELVA MADERA CT
Taxing Authority Tax Information
Your Final Tax Rate Current Your Tax Rate and Taxes Your Tax Rate and Ta"
Prior and Taxes (2020)
Taxing Authority 1 r This Year if NO Budget This Year if PROPOSE:
Taxable Value Last •Year Taxable d-iue 9
(2019) Change i3 Made P r,.., Gang:, .
COLUMN 1 COLUMN 2 COLUMN 3_ �C. :_t.,M!:!4 COLUIV1N 5 E COLUMN 6 l .,L-!9N 7 ! COLUMN 8
rWTE TAXES RATE { TAS RATE I TAXES
County 273,016 8.1512 2,225.41 280,445 7.7392 I 2,170.42 6.15`.2� 2,285.96
Public Schools:
By State Law 298,016 3.9020 1,162.86 305,445 3.7625 1,149.24 3.6570 1,117.01 ,
By Local Board 298,016 2.2480 669.94 305,445 2.1676 662.08 2.2480 686.64
FL Inland Navigation Dist. 273,016 0.0320 8.74 - 280,445 0.0306 8.58 0.0320 8.97
Atlantic Beach 273,016 3.2285 881.43 280,445 3.0588 857.83 3.2285 905.42 I
Water Mgmt Dist. 273,016 0.2414 65.91 280,445 0.2287 64.14 0.2287 64.14 ,
SJRWMD ,
I
•
1
. .°... / • 5,014.294,912.29 5,068.14!
IMO
Property Appraiser Value Information.
I ASSESSED VALUE ASSESSED VALUE l•
MARKET(JUST)VALUE I :c:Fxcnp=c_s; ae �cx xn oen„
I Applies to School Millage ..• Applies to Non}School Millage _
PRIOR`YEAR(2019) 45',,781 323,016 323,016
CURRENT YE (2020) 497,438 1 330,445 X30744-5 I
I AppiiedAssessmentReductionM.,• �,i :ttr- .. 1c+ °:`.;•;. °,C .t If you feel the market value of t r-
property is inaccurate or does n,),
Save Our Homes or Portability Benefit All Taxes 128,765 I 166,993 reflect fair market value as of Januar',
Agricultural Classification Al Taxes 0 0 1, 2020, or if you are entitled to al
exemption or classification that is n...
Non-Homestead 10%Cap Benefit Non-School Taxes 0 0 reflected, please visit the Duval Coun,
Property Appraiser's Office at 231 E.
:,4 t . Forsyth Street, Jacksonville, Florid.
Charitable&Institutional All Taxes 0 32202, call (904) 630-2011 or one u"
the numbers on the back of this notice.
First Homestead or TPP All Taxes 25,000 25,000 i If the Property Appraiser's Office
Additional Homestead Non-School Taxes 25,000 25,000 unable to valresue, the smsific ioas to t.
market value, classification r
Disability All Taxes 0 0 exemption, you may file a petition fo,
adjustment with the Duval Count,.
Limited-Income Senior 1 County/Municipal Taxes 0 0 Value Adjustment Board. Petitin.
forms are available at the addres.
Limited-Income Senior 2(25 Yrs) County/Municipal Taxes 0 0 above or online at www.duvalpa.com.
Widow/Widower All Taxes 0 0 Petitions must be filed on or before
Historic Preservation County Operating Taxes 0 0 September 8, 2020
Deployed Service Member Exemption All Taxes , 0 0
SEE REVERSE SIDE FOR EXPLANATIONS OF THE COLUMNS AND SECTIONS ABOVE.