36 DUDLEY ST RESO21-0021 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
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: .5 b U v J I Cy j-1' Permit Number: i \��0� I ` 002- (
�....•
2e (C1
Legal Description ' - ("Nile N ti �� 1 �.-v'{' 7 6t . RE# 17 7 �rj - U Q C
Valuation of Work(Replacement Cost)$ 55D Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ' Addition ❑Alteration DRepair ❑Move ❑Demo ❑Pool DWindow/Door
• Use of existing/proposed structure(s): ❑Commercial Residential
• If an existing structure, is a fire sprinkler system installed?: DYes CiNo
• Will tree(s)be removed in association with proposed protect? DYes(must submit separate Tree Removal Permit) -No
Describe in detail the11type of work to(bee performed: Sc,--„,,,‘`) ,r ForG►\ , /1,c S-1-‘,„c cl . 11Mo.5 3fr"�lV
�V-re . -D J v,t T - St c f6.-r J , . ii),/, e x,s AA.) fur-64., Q.c.tr.or (-
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name IV,4--1-kVi.c-k,.I (")?.,, a-to,kC-( Address 34. LvJ ICV 5'4-
City
-I City /46,,,ki4. (4C._,,i. State c L Zip 32 z.33 Phone 939-9`1 t • Jy s L
E-Mail tM+t^n SP I g 9 3 93.E I, c ,
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Qualifying Agent
Address City State Zip
Office Phone Job Site Contact Nu r
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
RECORDING OUR NOTI OMMENCEMENT.
2y ���
(Signature o wner or Agent) (Signatur Contractor)
ned anld sworn to(or :ffirmp )bef•re me this day of Signed and sworn to(orfirmed)before me this day of
r ,I I, Z_CILL,b I 1 a • 'o • ic4er ,by
t ignatu T '`ota (Signature of Notary)
[ I Personally Known OR [ ]Personally Known OR
[ ]Produced Identification ( [ ]Produced Identification
Type of Identification: . l..r— ;;
• . TONI GINDLESPERGEr;
i:,,,,{`''4 WY COMMISSION#GG 353178
Y - --fi'ic� -- tt,P;'ES:October6, 023
f I'r :•* '%?op'dc Ea.'!otary Public Underwriters
iters
Owner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
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. 1
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: 36 9,J I cid S-1 A-LLn-),c. c3cd_ck\ 3Z 7 3 3 (L
Owner Name: Yn .i"�1,',(n..1 @o 04,1-zi Phone Number: L/3 U . 9 9C - O(i 3 Z
Mailing Address: 4. [)v,) I t\I S� City: 1.)o-h c Vic„u,(,. State:1' 3 Zip: 3 LZ3
•40/// 9 �'
4/Notarized Signature of Owner , � a %'��,
TheUng_insyum nt was acknowledged before me this 5 day QjO'h.20 . ,6n the State of Florida, County
of (k�
I •
Signature of Notary Public� , gbh.
[ I Personally Known OR [ 1 Produced Identificatio
Type of Identification:
" 4'.1.: �- - Updated 10/14/18
,:.,:g,':'44,,,, TONI GINDLESPERGER
. ,' 'ii' MY COMMISSION#GG 353178
i '"•41;', ?'''
7 r�� EXPIRES:October 6,2023 d
6"a ?''' Bonded Thru Notary Public Underwriters
1 '�; Screened Enclosure & Sunroom Affidavit **ALL INFORMATION
HIGHLIGHTED IN
.',.\ City of Atlantic Beach Building Department GRAY IS REQUIRED.
ItI800 Seminole Rd, Atlantic Beach, FL 32233
x,._ / Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
The purpose of this document is to make you aware of any limitations in the enclosure that is being permitted at your residence.
The table below, Screened Enclosure and Sunroom Requirements provides a brief description of the various sunroom category
requirements. There may be restrictions on the use of your present home depending on the category of sunroom you are
installing.
The property owner is hereby notified that should any form of temperature control system be added to a Category I, II, or III
Sunroom or the removal of the doors separating any Category I thru IV Sunroom from the host structure occur, the room shall
become non-compliant and must comply fully with all of the requirements for habitable/conditioned spaces as mandated by the
Florida Building Code,The Florida Model Energy Code,and State Statutes.
Screened Room,Sunroom and Screened Enclosure Requirements
Category I II III IV V
Habitable Space No No No Yes Yes
Foundation Walls<200plf can Walls<200plf can Walls<200plf can Walls<200plf can have Walls<200plf can have
have 8"Wx12"D ftg have 8"Wx12"D ftg or have 8"Wx12"D ftg or 3"Wx12"D ftg 8"Wx12"D ftg
or 3-1/2"slab if no 3-1/2"slab if no 3-1/2"slab if no
concentrated load concentrated load concentrated load
>7501b >750Ib >750Ib
Exit Lighting Not Required Required Required Required Required
Interior Electric Not Required Not Required Not Required Required Required
Outlets
Emergency Escape Egress from exist. gress and Exit must Egress and Exit must Egress and Exit must Egress and Exit must meet
Openings structure allowed if eet code meet code. Other meet code. Other code. Other resistance
open to atmosphere resistance eesistance requirementsrequirements for forced
or considered screen requirements for 'or forced entry,air entry,air leakage and water
enclosure and has forced entry,air eakage and water penetration also apply.
screen door leading leakage and water penetration also apply.
away from residence. penetration also
apply.
Misc.Window and Host structure 'emovable windows Removable windows Host structure windows Host structure windows&
Door Requirements windows/doors shall -'lowed in sunroom. 'allowed in sunroom. &doors shall not be doors may be removed.
not be removed. ost structure Host structure removed.
indows/doors shall pnrindows/doors shall
of be removed. not be removed.
Wind Borne Debris Not Required Not Required Not Required Not Required Not Required
Opening Protection
Energy Sheets Not Required I Not Required Not Required Required Required
1 .
Notarized Signature of Owner or Agent: 7. ,/,,,, %r,,
The foregoirig-iQstrument as acknowledged before me this_5 day of (1\Ai"'ti 02`in the State of Florida,
County of ` )_5 ‘('c
• i
Signature of Notary Public: __,S2.— 421116y __,., 1?5 --..
[ ] Personally Known OR [ 1 Produced entification
Type of Identification: ,
"g Updated 10/17/18
.t':e . .. TONI GINDLE`-,PEi .;'R
.�,'. MY COMMISSION#GG 353178
i`,-.,f.-4•.,:;,.--:
•..'. 1, ,, EXPIRES:October 0,2023
',{p'r F,c.• $endCd ThN Notary FuWic Ur envriters
s
AFFIDAVIT FOR ATTACHING A NEW STRUCTURE TO AN EXISTING STRUCTURE
TO: Building Inspection Department,City of Atlantic Beach,800 Seminole Road
Home Owner: , ..----'v'V'' I n, g
ame
N 36 Dv(1lc S-1
StrewAddress
-113ol L Rt )—ZK I)
City. State and Zip Code
Contractor: se I 'C
Permit Number -
As the Contractor for the proposed new structure located at the above address,I have personally viewed
with the above named home owner those portions of the existing structure on which portions of the
proposed new structure are to be attached for structural support. I am confident that the drawings and
details included with this permit application depict the existing conditions of the host structure,and the
members of the existing structure upon which the new structure are to be attached are sound with no rot
or deterioration. The home owner has been advised by me that, in my best judgment based on experience
and knowledge of structural adequacy,the members of the existing structure upon which the new
structure are to be attached are sound with no rot or deterioration and will support all structural loads and
forces imposed on them. By signing below, I hereby declare that I will hold the City of Atlantic Beach
harmless and release it from any responsibility and liability for any adverse consequences or failures
resulting from this work,and further that I will not initiate,execute or enjoin any legal action against the
City of Atlantic Beach for such consequences or failures.
A copy of this document will be recorded as an official record with the Building Inspection
Department permit history so that any and all future buyers/owners of this property may be made
aware of the status of work performed on this structure.
1// ,
Signed / /'�%� /j/,% Date 3 / 5l 2-1
Before me this day of MJF-1--kil 1ni ,ei ONACr-
In the County of Duval,State of Florida, has personally appeared
herein by himself/herself and
Affr
2t--.
11 stateiii declarations herein are true and accurate.
ill
•
Notary Public at Large, State 1- Ma ,County of Ni u
Personally K own or Produced Identification
ID Type ---C-
4�YP TC.i;GiNDLESPERGER
4: a `- MY C messiON#GG 353178
F:building/affidavit for attaching a new structure to an existing structure. Scat. „,wEY.PRRES:October 6,2023 7/21/09
••••};O%F�? Banded Thai Notary Pubfc Underynfters
BOUNDARY SURVEY
DUDLEY STREET
50'R/W (IMPROVED)
..pz.'i-=Y'a^:)r^1 <q:3.T'.':'t.�._. -;.--..:r:^s`'s :!-a'S;::.a,t,;.;-.::.fs•.�, r.'..... :'.�r'f. w•-
• �
Cj • : w� r. .e"t�:`• • r`�)y:�..• y'Y•:���.Lr� �r'�'• IZ,L.L•1P-�
..• y
y
:
P , ,:„• •'~-� ;4:f?r7,•-,:„.7%..7-i-'4%-.—C•t)).'.w J•` Sf.7Iw.1. �•w..))'•:•::s:ii� 37-
..4.:7-..,:..14......:,-:•17-7."----,,
-". -- :Y` . „ • . l_ ..4 •-. ,
V615/ .y.. .. ;.L:‘,:••.• w._._.�a'.'i.e:4 `..X., :\i..:.t•':.• .-.-C ..1• �.tt.. y.nr
O �!4"Va -,'�
i
k 43(1 V•�l�- •
frfsr .; =..:.'. 50.00' 256.10'(P)
D 1/2•4771".....%•••_••••,...., FOUND 1!2' V BLOCK
S:LII
IRON- '• •":;-;• AD° IRON PIPE CORNER tv• r. OO• U��` 1Na,S A\ru')\/ 6\ g_ ..ww,- -; 0O,
c' • o
/ o-FS"1'h"I 1 /- 5.2'
�,�{ h�ca. C�nLfL'� e 26.0' T
'-c•, COVERED •
1`,4.. • W
::.-o :': LOT 6
BL.O�CK2 _
k .s BLOCK 2
co cid— '—
�THENI OF
��++ /�Lm'VP) -a-
g-0« WIC . .• LOT Io
-t'os�'`n i BLOCK 2
(INCLUDED) 1
•5 r7,44\ o• �) ' 0 'A- BUI#DI6 G
I
26.0' I 5�,
� nc ti.
ID"15 r I NC- I
SC �1 Pa-) 1a IT I I
1 1
6c c/ t(a r`s4' S o.1' _ ,— ,_ ,— -— •°'
90°00'00" 90°00'007 '6‘1
SET 1/2" 50.00' FOUND 1/2"
IRON ROD I IRON PIPE
LB#7893
TIiLOT 7IP 0F
SURVEY NOTES BLOCK 2
CONCRE I E DRIVE CROSSES THE PROPERTY (NOT INCLUDED)
LINE ON NORTHERLY SIDE OF LOT. IIII
M
E` H , O S B it
1 o a TARGET `;
No.6415 yF SURVEYORS CERTIFICATE r p
t i
v : I HEREBY CERTIFY THAT THIS BOUNDARY SURVEY _..6,-, , ,,_, ,,,, T1
A - � �.�
'o '" IS A TRUE AND CORRECT REPRESENTATION OF A a SURVEYING,LLC
SURVEY PREPARED UNDER MY DIRECTION. ��`
NOT VALID WITHOUT AN AUTHENTICATED ELECTRONIC
STATE OF SIGNATURE AND AUTHENTICATED ELECTRONIC SEAL, - LB#759311]
o L u o-�! ORA RAISED EMBOSSED SEAL AND SIGNATURE.
''4 4 ! ! E'G Digitally signed by SERVING FLORIDA I
Kenneth Kenneth Osborne 6250 N. RARY TRAIL,SUITE 102
Date:2020.03.18 WESTMILPALM BEACH,FL 334D7
,•
: OSbOCnet90738 04'00' PHONE (561)6C04800ii
(SIGNED) ( STATEWIDE PHONE (600)226.480,C H