1847 OCEAN GROVE DR RFNC21-0058 Building Permit Application Updated 10/9/18
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City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233
HIGHLIGHTED IN GRAY
-416P`4 IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Db Address: t9, �{'� t c_eo.rn f61` �f Permit Number: R1-NGZ( 1 00S5
Legal Description RE#
Valuation of Work(Replacement Cost)$ '�.'1 OG �— Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration gRepair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial 'Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes �No
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ,'No
Describe in detail the type of work to be performed:
(ce-p lace, ..X,s-fi,n c.,m1 S61 -A 51cie of kt'Se- -
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name gyp,n =i I i Address /gel 7 CCeari
City AI I an j>c. Ric State F1. Zip 3 z.2.5 3 Phone 94 cc,it/ "(i33
E-Mail v ckr cLJl); L/.t C c •nc*aI•CCovi
Owner or Agent(If Agent, Power of Atto?ney or Agency Letter Required)
Contractor Information
Name of Company Qualifying Agent
Address City State Zip
Office Phone,,;:,, Job Site Contact Number
tate Certification/Registration# E-Mail
r,rchitect 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 OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
f,;v
(Signature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed) beforeme this day of Signed and sworn to(or affirmed)before me this day of
Y. I , Z-1)71 , by -1'ecir 4_ S✓1) van , by
A-il,
(Signature of Notary) (Signature of Notary)
CHRISTIAN GILES
7 c*, MY COMMISSION#HH 117153
[ ]Personally Known OR It '[ ]Personally Known OR
-���`• EXPIRGS:April 13,2025
[ oduced Identification .'F,�;;,qa':' Bonded ThnjNotaypuetictMde ers [ ]Produced Identification
Type of Identification: i - — Type of Identification:
Fence Addendum Updated 1/14/2021
lit*,* City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233 PERMIT#1 ivCZ(- 00,
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
is ` tic. 4J( g*5r .!
Property Type: Lot Type/ Features:
TX/Residential CiCOne Street frontage (interior lot)
❑ Commercial El More than one street frontage (corner lot,through lot,
etc.)
❑ Swimming Pool
Fence Material: Fence Height (select all that apply):
WWood ❑ Four Foot(4ft)
❑ Chain Link N"Six Foot(6ft)
❑ Vinyl I=1 Other Z ' `�/%/%///i%'' `
❑ Block/Stone (Plan details required for footings and/or
retaining walls)
y „ 77/%//%0
❑ Other } �
nce 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)
›t/No
Will tree(s) be removed in association with proposed project?
El Yes(must submit separate Tree Removal Permit)
(o
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
;ECORDING YOUR NOTICE OF COMMENCEMENT.
-1= Owner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
', City of Atlantic Beach Building Department GRAY IS REQUIRED.
40r1
800 Seminole Rd, Atlantic Beach, FL 32233 7
°�`'" Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:R 'NCZ( -OOs�
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: /V 7 cmc earl C51-6 Ve. ):)(-.
Owner Name: _A eft►\ Si: I I, v411 Phone Number: '' S/-4/0 93 SS
Mailing Address:/O/S-4*k ti -i)`C 6/1/4 SJVLZ7C3 City: A4/4n fi.c .4rA1 State: FL- Zip: 3ZZ 3.3
Notarized Signature of Owner rt-4----4 ,04lc 4-vt,
The foregoing
V A ipstrument was ack n ledged before me this day of A?n / , 20 Z‘, in the State of Florida, County
•Signature of Notary Public C/dl [r� ,1 ��
4r CHRISTIAN GILES
l'. 1,1 MYCOMMISSION#HH111153 [ ] Personally Known OR [Joduced Identification
+ Y+`.? EXPIRES:April 13,2025
4R,�,
wBondsd Thu Noisy Public VIWYflNh os �) I J L
Type of Identification: L y�
Updated 10/24/18
MAP SHOWING BOUNDARY SURVEY OF
THE SOUTHERLY 30 FEET OF LOT 1, ACCORDING TO THE PLAT BOOK OF "OCEAN GROVE UNIT NO. 2",
AS RECORDED IN PLAT BOOK 20, PAGE 20 OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO:
STEPHEN J. SULLIVAN, JEAN F. SULLIVAN,
OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY,
GIBRALTAR TITLE SERVICES AND
BANK OF AMERICA, N.A.
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GENERAL MOTES=
J r R S 1. BEARINGS ARE BASED ON PL.a-r B.,....<-- 26, P4 GF 2C7,
2.STRUCTURE NO. /8.47 SHOWN HEREON UES WITHIN FLOOD ZONE X AS BEST
ASSOCIATED SURVEYORS INC.0 FROM
3. THIS RISI"ADSURFACEESURVEY MAPS
EXTENT OF UNDERGROUNANEL NO. / D FOOTINGS,
A LAND & ENGINEERING SURVEYS PIPES AND UTILITIES, IF ANY, NOT DETERMINED.
w 4.JURISDICTIONAL AND/OR ENVIRONMENTALLY SENSITIVE AREAS IF ANY, NOT
F / 3846 BLANDING BOULEVARD LOCATED BY THIS SURVEY.
/ JACKSONVILLE, FLORIDA 32210 5.THIS SURVEY BASED ON LEGAL DESCRIPTIONS FURNISHED. THE PUBLIC
904-771-6468 RECORDS WERE NOT SEARCHED BY THIS SURVEYOR FOR EASEMENTS,
J % 0 TI
O - CERTIFICATE OF AUTHORIZATION NO. LB 0005488 TITLE, COVENANTS, RESTRICTIONS, CLOSURES, TAKINGS OR ORDINANCES, ETC.
S S yTHERE 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
LEGEND/ABBREVIATIONS
DIRECT SUPERVISION AND MEETS THE MINIMUM TECHNICAL ® SET IRON PIPE OR REBAR P.C. = POINT OF CURVE BTN. = BETWEEN
STANDARDS FOR LAND SURV I PIJRSUA T TO C APTER ••ASSOC.SURVEY" OR L.B.5488 P.T. = POINT OF TANGENCY (CHD) = CHORD
61G17- LORIDA ADMINIST II CQaE, C PTER 2, F.S. • FOUND IRON PIN OR PIPE (IP) P.R.C. = POINT OF REVERSE CURVE
.�XJJ
• FOUND CONCRETE MONUMENT (C.M.) P.C.C. = POINT OF COMPOUND CURVE
f
BY: CROSS CUT OR DRILL HOLE C/L = CENTER LINE R/W= RIGHT OF WAY
CH LE B. HATCHER LORIDA CERTIFIC N0. 3771 (R) = RECORD L = ARC LENGTH CONC. = CONCRETE B.T.= BUILDING TIE
R =RADIUS (M) = MEASURED A\C =AIR CONDITIONER (E.T.) = EAVE TIE
CH RLES L. STARLING FLORIDA CERTIFI" TE NO. 4579 C & R =COVENANTS & RESTRECTIONS WM =WATER METER UP= UTILITY POLE
RAYMOND J. SCHAEFER FLORIDA CERTIFICATE NO. 6132 O.R.V. =OFFICIAL RECORD VOLUME P.EQ. =POOL EQUIPMENT )= GUY ANCHOR
P.R.M.=PERMANENT REFERENCE MONUMENT -O.U.- =OVER HEAD UTILITIES
JOB NO. 49364 DATE 20 dea./ Zoo 4. B.R.L. =BUILDING RESTRICTION LINE X—X FENCE N & 0= NAIL & DISK
SCALE: / 0.0. DRAFTER �/d�f E.T. =ELECTRIC TRANSFORMER & PAD W—W WIRE FENCE E.B.= ELECTRIC BOX
J.E.A. =JACKSONVILLE ELECTRIC AUTHORITY REF.COR.= REFERENCE CORNER
NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER