452 Osprey Key Patio Submittal r Building Permit Application Updated 10/9/18
iClty of Atlantic Beach Building Department **ALL INFORMATION
4'` im
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
,�P/hCone: (904) 247-5826 Email:
builijing-oept@coab.us
lg-oept@coab.us IS REQUIRED.
Job Address: 7 T✓v . 6s 13 P.,a,67 !f,/J Permit Number:
Legal Description / / •c - — �d �t�� // RE# /7q �� 7- i??)-
Valuation of Work(Replacement Cost)$ o mov/v o Heated/Cooled SF , "-- Non-Hea. •
fo
• Class of Work: 113 ew ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Wind• DoPR 0 8 2021
� II
• Use of existing/proposed structure(s): ❑Commercial L17fCesidential °
_
• If an existing structure, is a fire sprinkler system installed?: ❑Yes I b/it BV:
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) C3No /°'
Describe in detail the type of work to be performed: p-ii --
:1-1-1141.4.i(Jilatj----irl41 ' ------ ---- -_ -------- ---- ------ - ---------' ---- -,
U 7)
Florida Product Approval# f 't/o /--4 for multiple products use product approval form
Pro•ert Owner Infor ation
Name / i 7///.//Y--) Address e �J /2 ////
City /C . / 1 State±-.-/,-,..__ ( L1G f�? � (��' ..5. S�
/ Zip � Phone J
E-Mail ' I/2UfL ?////JO// i..�v5 � (9U6/2Z- '
• Lly1'j
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 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 OB) IN FINANCING, Cs SUL WITH YOUR LENDER OR AN ATTORNEY BEFORE
REC• ' A IV/ R NOTI •f; G1ENCEMENT.
/ 7: Z '( gnature of i ( er or Agent)
[Signature of Contractor)
recj and sworn to (or a irmed) befgte me this Z�day of Signed and sworn to(or affirmed) before me this day of
« ( � 1I _Jy x' 11+C_�ll leo by
�; 1;i4,; TONI GINDLESPEN�ER , '" a't+rree o G /�
:`',.• ;• (Signature of Notary)
4: a•I _,,, MY COMMISSION#G
� :'-'7 EXPIRES:October 6,2023 J
,. r�'Pt fjrl(l ogi PIJpkc t�fldeiWriters
— [ ] Personally Known OR
Produced Identification [ ] Produced Identification
Type of Identification: I., , t _ Type of Identification:
Owner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
-01: 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: Vf/2r! / / 77 C /. .L /( z2--33
Owner Name: 1 11 Ldi tL. JI Phone Number: a al—DS3,/—
Mailing Address: Sv2 S/ ' ' , 4 I City: i/ / • / State: ,F/ Zip: 2233
Notarized Signature of Owner 7 i /ft
/ _
The oing instr ent was ackn.• ledged before me this 2- day of '� , 20 21, in the State of Florida, County
of.4 V'oc_
Signature of Notary Public C&
[ ] Personally Known OR [ ] Produced Identification
Type of Identification: < L
TONI GINDLESPERGER Updated 10/24/18
wk- MY COMMISSION II GG 353178
'••
'' EXPIRES:October 6 20
23
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•;!FOP fV�•• Bonded"(btu Notary__--_._
e gym'
MAP SHOWING BOUNDARY SURVEY OF
LOT 45, ACCORDING TO THE PLAT OF
SEL A. LAVES
AS RECORDED IN PLAT BOOK 41 , PAGES 55 AND 55A, OF THE CURRENT
PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO:
DEBORAH C. HUTCHINSON,
STEWART TITLE GUARANTY COMPANY,
WATSON & OSBORNE TITLE SERVICES, INC.
AND EVERBANK.
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Ft\JE Y 0 R 1.6EARINGS ASS USED OK �����PLAT�BOOK 441, PAGE 55A
3' X AS 8EST
�`� 2-STRUCTURE NO. 452 SHOWN HEREON UES WITHIN FLOOD ZONEN04-17-1989
A — — .— —. . -- ■.......�..... ... DETERMINED FROM F.E_M.A. FLOOD MAPS PANEL N0.
NOTICE OF COMMENCEMENT
State of /a rda Tax Folio No. /CJS i /7e.q(2a 7-5v9
County of (/ v
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713
of the Florida Statutes,the following information is stated in this NOTICE OF /COMMENCEMENT. � �/�
Legal Description of property being improved: 'X/ 'S S /7-S - �, A4 / 7"�ve/ra^ ic-e.r
,�/ IV----
JPlafBa,ot (t'atcc ssiss,
Address of property being improved: "i � ,5�� I / /P4 frG At'a a/ F/
General description of improvements: Gni {' a/4"u !
p P �Q /y�'f�(rt
Owner: 3h 0 �7(Nf � Cl Address: g if r%;
Owner's interest in site of the improvement: / /
Fee Simple Titleholder(if other than owner):
Name: ,,,, ,p /'r n��/
Contractor: �a e t s OU//€%
Address:
Telephone No.: Fax No:
Surety(if any)
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name:
Address:
Phone No: Fax No:
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may
be served: Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b), Florida Statues. (Fill in at Owner's option)
Name: _
Address:
Telephone No: Fax No: r >�'�,, TONT GINDLESPERGER
Expiration date of Notice of Commencement(the expiration date is one (1)year from the •At•�-,• oMk'liGQIdMIPI1ll$la is
specified): 1", t-•:`1 EXPIRES:October 6,2023
`'4;r,rGd'1 Bonded Toru Notary Public Underwriters
r 11 i
THIS SPACE FOR RECORDER'S USE ONLY OWNER
ORiiir
BK 19603 Page 1841, Signed: -AL
Dater �� tT /
Doc#2021050455, -
Number Pages:1 Before •,?i. �ra� of M4• in the Co ty of D val,State
Recorded 02125/2021 03:25 PM, Of FIq da,has personally apgiod e.*or-• C 1-4 a .h -1So(\
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL Notary Public at Large,St. - • lorid. Co of Duv31. I
COUNTY My commission expires: _/
RECORDING $10.00 Personally Known: w or
Produced Identification: T ._