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94 13th Street West Shed Submittal Building Permit Application Updated10/9/18 ri, City of Atlantic Beach Building Department **ALL INFORMATION 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: CT (/i ,6'( � c2-,E. !" I � e �n7 A -Permit Number: C Legal Description 5 1 V - ( q VjY(7s RT1` Ac RE# /70g0J�`0v 70 Valuation of Work(Replacement Cost)$ '2-7000 Heated/Cooled SF Non-Heated/C E • Class of Work: ©New ❑Addition EAlteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Do APR 1 2 2021x•_ • Use of existing/proposed structure(s): ❑Commercial (residential// • If an existing structure,is a fire sprinkler system installed?: ❑Yes IJNo CY: • Will tree(s)be removed in association with proposed project? DYes(must submit separate Tree Removal Permit) No Describe in detail the type of work to be performed: Con54-cc-tuft-0 r\ O I541‘Aci SciTtAChtfe. Florida Product Approval# for multiple products use product approval form Property Owner Information FF� Name `k-7" -.-0Y-e--e- ( Address C 4 W4 /341 S.f re+ City Lr Gt,✓t1 ' • State f--L, Zip 3 .l-3 Phone QO L- 4Sl -�`' t 5 E-Mail PP+e411 1Yyu.( •UJ M Owner or Agent(If Agent, Power d#'Attorney or Agency Letter Required) Contractor Information Name of Company se, t -Cil3; cA C=+ r Qualifying Agent \ _ • 7 Address `IL-f' Li ('-- ` t" City / 1c3..4-Cc. State t Zip 37-2-3 3 Office Phone cl'O {`6F,S( ' ' ".A5 Job Site Contact Number 'O4'- State Certification/Registration# E-Mail c7 -'X b(r<c�,t/efi .- C3 rVl& { , CO Architect Name&Phone# t �J Engineer's Name&Phone# Workers Compensation Insurer OR Exempt r'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 RECO5DING YO R NOTICE OF COMMENCEMENT. (Signature of Owner or Agent) (Signature of Contractor) Signed and sworn to(or affirme before me this 8 day of Signed and sworn to(or affirmeddbefore me this R day of F26 , ac»-1 ,by e+e✓ 1-1-oiL'evs F , �ba1 by eke✓ \gv€k,s . .t e.f►o .1 (Signature of Notary) SMITH >:ctar.7u:,ic-State c'7Icrida �'jr�� KARLA SMITH [ ersonally Known OR `C$r4 Commission=HH°IEEE [ ]Personally Known OR .� `: Notary Public•State of Florida rti; +ny C^.mm.cx.ires Jai C.20.24 ®`' Commission K HH 018840 Produced Identificati� [ ]Produced Identification ,. My Comm.Expires Jul 8,2024 [ ] Bort:EC tirraugk►aticca Notary rssr. Type of Identification: Type of Identification: Bonded through National Notary Assn. ALL Owner Builder Affidavit **HIGHLI HIED I ON ' HIGHLIGHTED IN City of Atlantic Beach Building Department GRAY IS REQUIRED. 800 Seminole Rd, Atlantic Beach, FL 32233 y`D 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: cm- GJe.64" )3�11 5tr e&f Owner Name: ye,f rQ�// e,4L5 �+� _ L Phone Number: (04-—451— $4.S Mailing Address: 1 tie ,4 ( 3 J XRT City: /�4.v.�'L 1;/kirAG,h State: FL... Zip: 31233 Notarized Signature of Owner ,: ::--c--44---' The fore oing inn�sstrument was acknowledged before me this 1 day of V.bf ill� , 20�‘, in the State of Florida, County of O,„,,dct Signature of Notary Public ,i,t, ..! :-S.:.=::s---- 1 _e"" JENNIFER JOHNSTON 1 [ ] Personally Known OR [f roducIdentification I • = 14YCOAM93SI0N 81.40575791 c .'•" .•s` EXPIRE&°ci ben27.2°21 I Type of Identification: F L (t 4 Q\ J `:Lt O 4..„�.'... Banded Tins Notary Palk UnduwMn 1 Updated 10/24/18 MAP SHOWING BOUNDARY SURVEY OF F, LOT ti, ULOCK 58, E:XCEP1 THE. NORTH 52.70 FELT TALI.([( TOGETHER WITH THE WESTERLY 10 FEET OF LOT 5, BLOCK 58, EXCEPT THE NORTH 52 70 FEET THERE.OF SECTION "H" ATLANTIC BEACH ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 18, PAGE 34 OF TI-4E CURRENT PUBLIC RECORDS OF DUVAL COUNTY. FLORIDA. CERTIFIED T0: ROBERT J. FEGAN, STEWART TITLE GUARANTY COMPANY, WATSON & OSBORNE TITLE SERVICES, INC. AND RANK OF AMERICA, N.A. ORCHID STREET (50' AVW) .19.3(' (RI °I 49._10•(U9 1OC, SLAV. ' `4 • ! DEc CVE 3/a' T/2. LB. 4803 LB. 6085 LB. 2772 LB. 5485 . . • . • -- 10- "' --le p T J ...... _.__52.70•(R) 201.53(R) • . « � � 52,72-(U) 4 � ,GOND IA.- 12.v a.9• 16.7' i FL I Q i.0. ,•!,.1:4.e IO.R'v; VI 1 i 23. b I. i-STORY FRAME 2.5,Y 1 Y'•- cDu�.} 0 A COOUINA i2; `` p 'n 1ul ti LOT 6 RE9! MCF.. iu '.<,. 2 O x � A ti ' -, w/t3'EAVES ^ o :.,.. 1, y o_Jtr 1 o q m• O BLOCS( 56 v N0. 94 j ¢,,,rd Of- a m o" CDNC.--~ 7.7,Z•". • u co h ITS A/C RPO 4.3' , ; • x44, j ^41 W i COV•D.,� , CONC. 4 3 t6 263 -4'..?pp-,....j I! • ()c'� ____ M r _ —", — --NOR TM 52.70' _ 1 11VV// e~ it 111 4 J t 2. 9� g.n .-sail q a7 EXCEPTION Or— 0 1 J LB. 4003` , - ' 1 1.3/1 DEC LIVE . 1-Li 18. 460! a.-.Gout. C d, • . 49 28' (A/ L WAU( I I .F ' 49.30' (R) i Clien1.6.4) LOT 5 BLOCK 58 1— ROVER*ENt3AL ROVER* p N , ,.' ''' , I.ANGLES ARE SHOOT ON MS STOW), y .. 2.SIFAICIU2f NO _.4i_.1T00YN fAFIIN UE5 O .N IICLOW,'.CNC_.i AS HIST "� `�•�� fKtrRuit4:1)/RUN fEM.A.fUXTO 9..k5 PANEL.n_ '.. CA1E6W-,T-16I* A SSOCIATED SURVEYORS INC. 3.149 IS A St1RfAcr MRVEY Okty THE ExRNT Of IrCERCROMC FE101KEGS, • ;.,',,,,..-x/ LAND A CNGi$EERING SURVEYS Pt'ES AND IITL1TES,IF ANL,NOT OE1FQUNf.Ci 4...ORIS0tCII(NAL AND/Ofi UTHR(7WFJ'IALLY :ENSIT!',E AREAS 8 ANT',NOT 4J3646 BLANDING OOULCVARO LACA11D Rt hG:044.4.4 -4,'7.> 04 w�.I. JACKSON�Huf, FLORIDA 32210 5.ns SURVEY BASED ON LEGAL DESCR!PTlONS PJRM44ED THE PUBLIC J V ? 9O4--t7I-6468 RECORDS HERE NOT SEARCHED BY 1H15 99JRVEYOR FOR EASEMENTS. v1 TtnLi. co'.OIANTS.IEsrRic 10N5. QHS. TAKINGS OR cRONANCES ETC. _CJS g Y CERTIFlCATE OF MJTNORI/ATION 00. LB 0005485 MIRE COJIO BE O1HER MATTERS OF RECORD THAT AFFECT MS PARCEL 6.UNL.ESS ORERMS(STATED Au KION MKS FOUR HALE NO UENTIFICATlOE T I#_RI ESY CERTIFY Ti-IIS `SURVEY WAS GONE UNDER MY UEORND/AYpEVIA110116 O,RCCT SUPERVISION ART) UEET5 THE MINIMUM TECHNICAL 0 STT mot( 44.E CO Kiwi I-. -,' .,i of CLVr•E 0:1) - OM.�.L ''TANDAFNDS Fop (Ahoy S JRVGI1!G PURC'JANT TO CHAPTER "AS X:-A:RAI.Y" OR i 0 WO PT -PONT CA lWGt!CY C B-tilLIRK;*i 6'C1') t, I'IRiDA Ai)Mt':t05RAtl roof.. Ci R 4722, F.S. • FeTuNO RAW CSN DAT AWE (P) �P,c.c -AUNT OT REVERSE CLEM )!!/V1,, l/4. {/ 9 10,940 D:NC1911 TOONTAEXi (C M.) PL G i)NT a CrAN+cA*O C'.AE L .!'1.SJ.4.�E v lr-CfKSS Cu! AR mai HRF IL rt7i►N,rin CAu 641.IE)41 Or 6• PV l!1 .. ._..._/_�_ ------- , (R) -IMCCO O (LT)- HE/SJRIJ),CCN ::C1MZRETE 9 r - 84 1.T.N; E i.riARl f1 i B. HAT'IICR 1 t(OLU C1J 'KATE NO 1 R.-MOWS4. 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