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240 Seminole Rd Fence Permit Submittal 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 -o't} IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: 240 Yy18.1 C KC - ALA ), (11141.-lite,C. - µ Permit Number: Legal Description i c - F) k LO —2- -VI t )(.r A-j (, 14 412- RE# 170 715 - Ooclo Valuation of Work(Replacement/ Cost)$5j Heated/Cooled SF l48(o Non-Heated/Cooled • Class of Work: Ef ew ❑Addition RAlteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial R'Residential , • If an existing structure, is a fire sprinkler system installed?: ❑Yes EQ'IVo • Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) B'IVo . Describe in detail the type of work to be performed: 1 Et7L 4 ..E Q©"iTi.J ' L.L.D ccJQ c U Cr ice t 4 t--i� i (a= 1 TULA- , 0 -1 G>✓ A4- cam" (Dlkt`TAL4.4-E0 '`J'-.2 `'► - Florida Product Approval# for multiple products use product approval form Property Owner Information Name J Aix\ (Yl, OP-Q.�Cgc�l Address 2L ,s -:(1,1t -(c .,E, et/44, City I�rL-A.•.lt'1 C ( State F(._ Zip 3223'72 Phone cio-I--- (c-f1•-(- - S�v E-Mail CJ a. c=>be—actor, & c s-* I cc _-. LcC ' Owner ox.15,gent (If Agent, Power of At rney or Agency Letter Required) Gu,).-1. Contractor Information E C E 9�, „� Name of Company ? tY1c (Ds.......J 6Q-- Qualifying Agent / Address City State p MAR 0 5 2021 Office Phone Job Site Contact Number State Certification/Registration# 4 E-Mail BY, Architect Name& Phone# (--1 A Engineer's Name& Phone# 1.•1 IL 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 RESUL _IJ-YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND • OBTAIN FINAN k ING, Co ULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING OUR i 5 I i' OP ' • MENCEMENT. - - 441. (Signature of Owne or Agen. (Signature of Contractor) Signed and sworn to(or affirmed) be . - e this 5 day of Signed and sworn to(or affirmed)before me this day of ( i. ILL.( „02 b ( CC - , by 4 ppY a F(ATHY 8 G 1ristt. alli • • �• NotaryPuState of(. ;:•Hre of Notary) (Signature of Notary) �• ,d 9, r Commissionblic ,S,GG 281708 11 Mi Comm.Expires Dec 4,2022 [ ILerxmdW9l 9U/UT-UT--——— 4 I I Personally Known OR (7q Produced Identification [ ] Produced Identification Type of Identification: (-Ls)L...- Type of Identification: - L,���h Owner Builder Affidavit **ALL INFORMATION 's '1-" HIGHLIGHTED IN .� City of Atlantic Beach Building Department GRAY IS REQUIRED. y, ti f 800 Seminole Rd, Atlantic Beach, FL 32233 °';"� 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: 240 Seminole Road, Atlantic Beach, FL, 32233 Owner Name:James M. Obregon and Alessandra M. Obregon Phone Number: 904-654-3550 Mailing Address: 3033 Brettungar-DriveC : Jacksonville State: FL Zip: 32246 -------t7 40, , Notarized Signature o •wner The foregoing instrument was acknowledged before m: this J i ay of May , 20,;A i, in the State of Florida, County of ,Dvvcl. Signature of Notary Public Com----C ( ,•� ...."' KATHY B GRANFORS \, _�' n���i Notary Public-State of Florida �° Commission GG 2 Ho [ ) Personally Known OR [Produced Identification I °F,F`'' My Comm.Expires Dec 4,2022 Type of Identification: �- L � .._„ Updated 10/24/18 Fence Addendum Updated 1/14/2021 City of Atlantic Beach Building Department 800 Seminole Road, Atlantic Beach, FL 32233 PERMIT# Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: VOAPi Date: 21r0 `-fYli Oi-nAlliC Ca (r)/10,1-1 S , 202 Pro rty Type: LotfType/ Features: Residential OOne Street frontage (interior lot) El Commercial ❑ More than one street frontage (corner lot,through lot, etc.) ❑ Swimming Pool FFene Material: Fence Height (select all that apply): P/Wood ❑ Four Foot(4ft) ❑ Chain Link Six Foot (6ft) ❑ Vinyl ❑ Other ❑ Block/Stone (Plan details required for footings and/or retaining walls) ❑ Other Fence Location: Please submit an accurate and current boundary survey 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) /o Will tree(s) be removed in association with proposed project? ❑ Yes(must submit separate Tree Removal Permit)es Conditions of Approval: • Roll off container company must be on City approved list. Roll off container cannot be placed on City right-of-way. • All 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. • liil LtDEOC' •Ft5m-t,CC ... 3 i . . . . • I:1:>1 Mester Badvoom 4 Mester Bedroom 'IT 11.450415 3 • ' : .LI 14 Laundry 0 0 Ettratr I . ...., Master Closet 0 Bedroom ICIIINIOICC t Closet AVAC LA)0CD 0 Bedroom .v.'Tr 5131,37. 1r15,10155 Dinning Room 11.6xf410. i t rtl., . - - 1 , in • , Mare Room 115,15s1715 Nerd Kitchen 'PTA 1C1105 0 W /cop Cr:ylis 4,6 /, s___ J \ 1 . , SEMINOE ROAD • list: caul Fidelity National Title111 �, it Al of Florida Inc. ' PROPERTY ADDRESS:240 SEMINOLE ROAD, ATLANTIC BEACH,FLORIDA 32233 SURVEY NUMBER:FL2012.1169 FL2012 1169 BOUNDARY SURVEY DUVAL COUNTY m v 0 e .. a o 2 LAD (n/ore '� ^ '.D'O / AO 0 LP, LA-5C)L7 P j lo OT4� l( '00,,rM) r l3 -♦ ifs N•FiP 3sa ilra'O' p/D •O4'•. \2 Q�!/ D 91* 2 1- F pO p Mk 40.(.F CSS.•, �, 1 Al cpN`DW v •�., �1 6 0 J N6j3/,94w /finn^6 , I., ., l� 6 J 0 TABLE: `,cit. l frit, rtNryN LI 5 22°29'566 W 50.00'(P) RC q l SFTktFj. v1 'iz I L2 N22°29'566E50.00'(P)) NIF(P� �>, ®e°P �.O ,��� N 23°28'36'E 50.51'(M) `•7) _M,� SURVEYORS NOTE5' AGI^,Ti LOT APPEAR5 TO DE SERVICED DY'Cl iv WATER AND 5EWFP FENCE OWNERSHIP NOT DETERMINED 30 0 75 30 GRAPHIC SCALE (In Feet) N 1 inch = 30' ft. 1 SURVEYORS CERTIFICATION: POINTS OF INTEREST: NONL VISIBLE ��O�SSelft I hereby certify that this Survey of the lands EI x1g� described hereon was made under my direct / �N CRs.\ supervision,and to the best of my knowledge 6132 and belief is a true and accurate representation 1 of said lands and meets the Standards of 1 1 1 Practice set forth in Chapter 5J-15.050 through I /.2 5J-15.053,Florida Administrative Code, 's.: Florida Land AFFILIATE ,• a pursuant to section 472.027,Florida Statutes. pO y This survey is not valid without the signature and .I Title ASSOCIaLIon MEMBERS A STATE OF original raised seal of a Florida licensed surveyor�FLTA n 4 'rp> FLORIDA ti, and mapper,except when the electronic ".-4L S URi%6..0I;' signature and seal of a Florida licensed surveyor and mapper is affixed hereto. . RAYMOND J.SCHAEFER •EXACTA Stale o/Florida Probational Surveyor and Mapper License Number 6132 . LB#8291 Office 866.73519161 Fax:866744 2882 11940 Fairway Lakes Drive.suite 11 Fort Myers,FL 33913 DATE OF SURVEY: 1 2/11/20 FIELD WORK DATE:12/10/2020 SEE PAGE 2 OF 2 FOR LEGAL DESCRIPTION PAGE 1 OF 2-NOT VALID WITHOUT ALL PAGES REVISION DATE(S):(REV,O 12/11/2020)