925 AMBERJACK LN RESO20-0034 revision 3-23-21 Revision Request/Correction to Comments **ALL INFORMATION
+'1t! HIGHLIGHTED IN
+, n City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 y�r- /�
no- Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: 1`G ZV>CX�34
SD
❑ Revision to Issued Permit OR I "1 Corrections to Comments Date: y20' /
Project Address: 7 ZS/441 earj fir E !..4✓✓e
Contractor/Contact Name: w-14,4•41 EP+s1e,-..c-bo Ess
Contact Phone: 909773- Ms Email: G ibtue9li!/yt6®'b'Py ® fri4/1, &i'i
Description of Proposed Revision/Corrections:
ihicS St> 1-e(ich U ro✓ Aheire 7— Goo4/04_14
I kc~// 414-1 4PI'ji 'u gii, affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
• W. proposed revision/corrections add additional square footage to original submittal?
No ❑ Yes (additional s.f.to be added: )
• Wil roposed revision/corrections add additional increase in building value to original submittal?
No ❑*Yes (additional increase in building valu-• ' --..-- ) (Contractor must sign if increase in valuation)
giir,e*Signature of Contractor/A.4 . . ;,rtt//�
/'
(Office Use Only)
❑ Approved ❑ Denied ❑ Not Applicable to Department Permit Fee Due$
Revision/Plan Review Comments
Department Review Required:
Building
Planning&Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities
Public Safety Date
Fire Services Updated10/17/18
#411`7", Building Permit Application Updated 10/9/18
a, _ 61 City of Atlantic Beach Building Department **ALL INFORMATION
L•` s/
' " 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
low., _aVI IS REQUIRED.
Phone:
f(-904))-247-15826 Email: Building-Dept@coab.us
Job Address: gc�(S A yn.be GZC� I r� Permit Number: IN l„�z0— �f�3'
Legal Description i,o-t- p I oCk-4t Qi. GL\ P,6,,\( Ul,n�'� I RE#
Valuation of Work(Replacement Cost)$ 1(960, o t7' Heated/Cooled SF Non-Heated/Cooled X.'.
• Class of Work: ONew ❑Addition OAlteration Repair OMove ODemo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): OCommercial ($Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes 1:2No
• Will tree(s)be removed in association with paposed protect? OYes(must submit separate Tree Remov I Permit) No
D scribe in detail the type of work to be performed: Kept C..€'W\e vC& Oc e cl- -h"4 Co ver ,ti'"
Clue 1 .
-o s106- • Da .yr. - 1= -(S) co luin-,n5, aryCij2o -1a 9 Q +els ailed
Florida Product Approval# for multiple products use product approval form
Proper] Owner Information 1 n
Name lA1 t` East(OT Address (p;S Aiydoer
City 'c, act State r[, Zip 3DB 3 Phone J - k.\
-37i
3 3
E-Mail t Crf birJ;yf p lr►19 144a i I ,C n,.".
Owner or Agent(If Agent, Power of AjkorneYOr Agency Letter Required) (iA--)/1 P/'
Contractor Information
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❑ 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 OBTAINSINANCING, CONSULT WITH YOUR LENDER OR ;:l L' 'TTORNEY BEFORE
REC OUR NOTICE OF COMMENCEMENT. `i-
49.________,
(Signature of Owner or Ag: (Signature of Contractor)
1
ne and sworn to(o affirm:. ,fore - i day of Si ned and sworn to(or affi r e. •ef. e S day of
Si�r ,and
IC . •y •. Coibt2cdk•-s O,by 1 -to.ill a. beCi)4--
(Signature of Notary) (Signature of Notary)
NVPj'
WILLIAM C.MEDI.If' ��� ( ]personally Known OR �;- WILLIAM C.MEDLIN
[ ]Personally Known OR ..", "'. - - _ . . _ �,;,r 'h _ Commission#GG 91791
� �. ,: Commission#GG 9179 i
?, Expires November 4,2023 I:k P` Expires November 4.2023
4.`,F`O' donded Thru Troy Fain;n,urance WO-395-7019
` ,F : donded Tin Troy Fain Insurance 600-365 1019 j _,_ -- _ -�_m _
Owner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
f_ City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: ! /��(�
�Ildlr�=��p�l�CQ��i,r�,• PERMIT#:��Ll�✓ .-00- 4-
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 ) 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: 90/5 4J12LQr- ciCE 1 n
Owner Name: W II op lI`([rv•- b(��C-� 1 / / Phone Number: 9z)r-�i-7 3 " 3 cP
Mailing Address: /0(-) -MLPr 4. i c City: _ 4ka..4/�i(- ,L,ac tate: h Zip: , ,)-,).-1/43--
Notarized Signature of Owne /1,0 / `
j
I
The foregoing instrument was acknowledged before me this S day of re/rd I ` , in the State of Florida, County
of ,, . ,
Signature of Notary Public -
u -- • °f a IP'
[ 1 Personally Known ORI[ oduced Identification
Typef entificatio : SL ";71,___
-
c _ - i''+•o'
'c, i\AYTCOor NMI MGIISNSDILOENS#PEGRGE4'1P
d8a
tet 10/24/18
'° i��c� EXPIRES:October 6,2023
f ,F''°
Bonded Thru Notary Public Underwriters '
MAP SHOWING BOUNDARY SURVEY OF
LOT 22 BLOCK 4 ACCORDING p TO THE PLAT OF
JNII
ROYAL PALMS ONE
AS RECORDED IN PLAT BOOK 30 , PAGE(S) 60 AND 60A OF THE CURRENT
PUBLIC RECORDS CF DUVAL COUNTY, FLORIDA.
CERTIFED TO:
WILLIAM M. EASTEPBROOKS, ,
PRIMELENDINC, A PLAINSCAPITAL COMPANY,
THE LAW OFFICES OF ROD SCHLOTH, P.A., AND OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY.
o ;-.'2
+ LOT 12 14.
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BLOCK LOT 134 I WN 2377.33'E 63.00'(M) BLOCK 4
i I
I -i N 23'37'33" E 83.00' (R)
CONCRETE g <
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IN
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OBAINAGE&UTiLTIES 1 y 1 x-2_0' -'-2.;' N 1 '
- 1 X r_f -LX=X—X= X---x—xv,' —
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(2)1/2• 0.9--I
REF OR AR I 'x LOT 22 .
LB 5488 BLOCK 4
3.00' I
OFFSETS ,
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8 �'3
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a 3 I b =xg I 19.4' + �- _ r, BLOCK 4
T0' l, 10.0'
Y_ o °' 1 STORY N N
NCV I I 't' BLOCK & STUCCO W (, zo
T", RESIDENCE ZF ( CV N M
^ ,,z_•. NO. 925- ga 1 Zo
''oI 8'. COVERED M o.r
JJJ CONCRETE BB
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CONCRETLO
0 T 79.4' I 24.2. PORCH -WALL 02• (/1
Z I '' —•X t7...—_
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► WAIH0.7' BLOCK WALL
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PLANTER
BLOCK
IWALL cl
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1/Y . `• BEARING REFERWM LINE ®
••' °1 S 23°37'33" W 1/2- S 23'37'33'W R21.78'(R)
'.
83.00' (R) S 24'00.24•W
••o •. ,. S 2377'33'w 8296'(m) 21.72'(M)
1.5'CURB&GUTTER
—V–= VINYL FENCE
AMBERJACK LANE 60' R/Y1
.-
FLOOD ZONE"X"=AREAS DETFFSONED TO EC OUTSIDE THE 0.:R ATM&CHAT:.^E FLOOD FLAN/P_000 ZONE-X(SHADED)"a G. M
AREAS OF 0MORAL CHANM FLOOD: EAS OF 1X ANNUAL
CHANCE WIN AVERAGE DEPTHS OF LESS THAN 1 FOOT OR WIN DRAINAGE MEAS LESS TNM t SQUARE MME;AND AREAS PROMOTED BY LEVEES FROM/X ANNUAL CHANCE FLOOD.
R J E y O'!'.5'
1.BEARINGS ARE BASED ON CzEE]E6td1 �yOg�a�
1PLAT BOOK PAGE 60A
6J 2.STRUCTURE N0. 925 SHOWN HEREON LIES INTO FLOOD ZONE X AS
INC. 7.i TINNED FROM F.EN.A FLOOD MAPS PANEL NO�ATFR04-17-1989
ASSOCIATED SURVEYORS NC3.THIS ISA SURFACE SURVEY ONLY.THE EXTENT OF UNDERGROUND FOOTINGS,
LAND & ENGINEERING SURVEYS PIPES AND U1IUTIES, IF ANY, NOT DETERMINED....:
ETERMINED.
1...1 4.,1,URISDICTIONAL AND/OR ENVIRONMENTALLY SENSITIVE AREAS IF ANY, NOT
38=6 B ANC:"rG BOULEVARD LOCATID EY THIS SURVEY.
32–%10 1
Q � Jlu:KSONVILLE, FLORIDA S.THIS SURVEY BASED ON LEGAL DESCRIPTIONS FURNISHED. THE PUBLIC
J j = 904-771-6468 RECORDS WERE NOT SEARCHED BY THIS SURVEYOR FOR EASEMENTS, TAIL,
7 COVENANTS, B.R.L'S RESTRICTIONS, CLOSURES, TAKINGS OR ORDINANCES,ETC.
0S S V CERTIFICATE OF AUTHORIZATION NO. LB 0005438 THERE COULD BE OTHER MATTERS OF RECORD THAT AFFECT THIS PARCEL.
6.UNLESS OTHERWISE STATED ALL IRON PIPES FOUND HAVE NO IDENTIFICATION.
I HEREBY CERTIFY THIS SURVEY WAS DONE UNDER MY LEG /AMRENIATIOIMB
DIRECT SUPERVISION AND MEETS THE MINIMUM TECHNICAL o sET IRON PIPE OR REBAR P.C. -POINT OF CURVE CII =CHORD
STANDARDS FOR LAND SURVEYING PURSUANT TO CHAPTER 5J-17.050 O ASSOC.IRON PI OR P P4E88 P.T.-POINT HEAD UIRIIESCY ((V.-COMPUTED
M) ® ECCASURED
THROUGH 17 052 FLORIDA
A AADDMINISTRRIATIVE CODE CHAPTER 472, F.S. • FOUND CONCRETE MONUMENT(ELM.) V a FIRE HYDRANT (C)=C01pUTEB DATA
L���J// /N c7" tiJ X= CROSS CUT OR DRILL HOLE CONC. =CONCRETE L a RADIUS
i (/gyp &-i .O.R.B. OFFICIAL RECORD BOOK A\C AIR CONDITIONER L.- ARC LENGTH
BY: ® =WATER METER
CHARLES B. HATCHER FLORIDA C .FICATE NO.3771 O.R.V.a OFFICIAL RECORD VOLUME PEO POOL EQUIPMENT =PHONE RISER
CHARLES L STARLING FLORIDA CERTIFICATE NO.4579 P,R,L v PERMANENT
REQ STRIC E MONLIMaIT X-X CHAIN UNK FENCE R/W=How OF WAY
RAYMOND J. SCHAEFER FLORIDA CERTIFICATE NO.6132 E.T. =ELECTRIC TRANSFORMER&PAD W-W vaRE FENC B.T= nureNG EE
l]—Q wooD FENCE �+=GUY
AN HOR
J.EA JACOVN ANT ELECTRIC AUTHORITY I I IRON FENCE =GUY ANCHOR
JOB NO. 59809 DATE 11-29-2012 •C&R- COVENANTS&RESTRICTIONS I- conCo -COVERED
P.C.C.=POINT OF COMPOUND CURVE E.g:ELECTRIC BOX
SCALE: 1" = 20• DRAFTER CLS P.R.C. POINT REVERSE CURVE (ET.)=FAVE TIE
NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER