885 AMBERJACK LN ACC21-0032 ":„r City of Atlantic Beach Building Department **ALL INFORMATION
\ v 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 605 ixtvk ig5f1 J AL k ��<V Permit Number: t�
Q.C2_I —00
Legal Description 2E 1.i)FNC.I_ RE#
Valuation of Work(Replacement Cost)$ ,2f Ln-4 r}OO Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New C3Addition DAlteration DRepair ❑Move DDemo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial I3Residential
• If an existing structure,is a fire sprinkler system installed?: DYes ❑No
• Will tree(s)be removed in association with proposed project? DYes(must submit separate Tree Removal Permit) Elko
Describe in detail the type of work to be performed:
06-> CaNke-4
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name `(-0M '4--Via) G.�r' -4.-- Address - A-Pn I ,)Ac f< Lam -
City A ,K'- State iF 1.-- Zip -- ,)-a 3 3 Phone Qi:(--t S 5—(1'-i c.-.5.
E-Mail )GT Jk),.c..sc',ST i-V( C,ma 1 ( - Ccv-r
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information JAC
Name of Company 'A S[J(L44teri' �`l"'P'eJl 9055 Qualifying Agent
Address I r G fYle Qu.,*,,,, Pat City rOti-4_TP t— State 674- Zip (O`4-K
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 OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECRD
OING YOUR NOTICE OF COMMENCEMENT.
J
(Signature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this(rte day of Signed and sworn to(or affirmed)before me this day of
Y° `-=' _ - . - • 44th I (, !C , ,by
:�,I yp,„;., MARISSA LORDA -, 7p
f--,..A.''',..'•:,---,. Ms/COMMISSION,G�z. 4 (Signature of Notary)
=�; uo= EXPIRES:June 12,2022 [ gnature of Notary)
v./ '•,,P,f„„°'� Bonded Thru NOiay Pubiic Underwriters (
[ I Person Ily Know"'i�OR , [ ]Personally Known OR
t tt Vt IYVI t t LV■ti
-111C 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 RESPONSIBIUTY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE UCENSES
REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL UCENSING ORDINANCES.
i
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: 4j 55 AN & 'Trire c W A • 5. //
Owner Name: I O'TA 4 �—�-1 rh '�,v . ( Phone Number: C3 L( ( 'Rc- 01-03-
Mailing
IMailing Address: 41"m r AS 66)(4 City: A . l?- State: -F.V Zip: -3} ??
Notarized Signature of Owner (41/1„-
1/1- t
The foregoing instrument was acknowledged before me this (;.°' day of 4-1912( L- ,20f'I1 , in the State of Florida, County
of Du 0:41_.
Signature of Notary Public;'�
[ ] Personally Known OR [ roduced Identification
:•t:.af . MARISSALORDA I
:arcA ',,: MY COMMISSION# 1r:GG 228145Type of Identification: )1}V(6 \;, c l'V S
EXPIRES:June 12,2022 x,
i' ",*:!';°,' Bonded Thru Noiary Public Underwriters I
Updated 10/24/18
' � Purchase Order
( 1086 Gene McQueen Rd. ..
CSS Moultrie, GA 10768 / d _/i , '
23.1.1161./419:61 Dealer Name:
ac. Office (229) 890-0858 Fax (229) 890-0861
Dealer Phone: %TAXAni Z
Email:southertisteelbuildings@windstream.net Order Date: Air
Name: 1 1/e 11 Install Address: `�6— A 74II V e L1( L.A.
City: 4V17 State: -Cr —Code:Zip 32 Z'S'County: O./Wit- Inside City Limits?L ,'( ❑N
Day Phone: Akt -- 1,<-
- < -)--27S- 7.] Evening Phone: Email:
> f') �� ROOF STYLE
' X 2;I',, X Certification:
WIDTH LENGTH HEIGHT P1 Vertical Roof ❑Boxed Eve i3R'e ular Style g `7 Braces required for certification:MHA required for ground certification.
o Roof: Sides/Ends: + Framing Gauge 10.14 Ga. Included
0o Pt)/-1 It -Li ✓i i"e lj 0I a rhA('-1-,Pn 12 Ga Upgrade*
Special Notes: LOT MUST BE LEVEL OR UNIT WILL BE INSTALLED AS IS ON LOT
Customer may incur extra labor fees if additional labor is required
to install because of un-level surfaces,or for building over obstacles.
Installation Surface
Electric:11y Available
NOTE:FRAME IS 1 FT.SHORTER Ready for Installation: ®, 11I N 43 Ai
THAN ROOF LENGTH ONLY CHECK IF SITE IS READY FOR INSTALLATION Ex. ,Concrete,eetc. Y ❑N
Is your install Surface Level?: l ❑N NO YORE THAN 3"UN-LEVEL&CLEAR OF OBSTACLES Lot not level? Customer Initial Installer Initial___ ___
Qty. Features Description Building Type: Price
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PURCHASE AGREEMENT&TERMS V.4.0 Subtotal, --1 ' O
GA Southern Steel Buildings,Inc.reserves the right to correct any balance/pricing errors.GA Southern Steel Buildings,
Inc.holds the right to repossess any buildings not paid in full upon installation.The customer is responsible to any alterations rTax /
//o r i4
ioor modifications done to CarporUCarport Building.A labor charge will be added for any additional labor such as cutting �� �J � I �
posts to level carports,building over objects such as RV's&moving materials to remote locations,etc.Customer is m Total
responsible for pulling permits.Customer understands that all building frames are 1'shorter than roof lengths.By signing m
this agreement,customer understands and agrees with all terms and conditions found on both the front and back of this p 18%Deposit Cho<t/ 56O. T
document.No refunds. J �� 0 ,/4/ -
iii 1 ^����)(1".
Exira LaborFL �-fCu.LIC r g7170natu i` �� 1 %, mCustomer Signature: 1 Equipment Rental
Date: o' n
W r
Balance Due `7 j , _ J
With customer present at time of installation,customer will sign below to signify acceptance of unit as installed. o
Card Fee 5%
Customer Signature Date Installer Signature Date Card Balance Due
❑Credit Card CI Money Order No card fees in ALL ORDERS COD
CO,CT,KS,MA
Office Use: Li Cashier's Check ❑Other NY,OK,TX ❑No Ll Yes
GA Southern Steel Buildings
GA Southern Steel Building gives you the peace
of mind that many Steel Company's don't with
our top of the line Warranty. We have a Three
Month warranty on our craftsmanship (except
for the act of God) and Our steel panels have a
40 year limited warranty from the
Manufacturer and our Tubular steel frame work
has a 20 year limited warranty. This should give
you the confidence in the carport or building
that you have purchased will be around for
many years to come.
Thanks
GA Southern Steel Buildings
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MAP SHOWING SURVEY OF
LOT 25, BLOCK 4, ROYAL PALMS UNIT ONE AS RECORDED IN PLAT BOOK
30, PAGES 60 AND 60A OF THE CURRENT PUBLIC RECORDS OF
DUVAL COUNTY, FLORIDA. \1111\
I
I I I
I I
LOT 7 LOT 6 I I Q 10 20 40
FOUND 1/2"IRON I I I I LOT 5 SCALE: 1" = 20'
PIPE, NO CAP _ _ S85'26'35"E 99.93'�FlELD) J. L
_ 6'WOOD FENCE S85�20.02-E 100.00'6' WOOD FENCE - 1O' EASEMENT
-_-k0_ , 1 4'CHAIN LINK FENCE, FOUND 1/2"REBAR, PER PLAT
----D1 0 �0 �.'CAPr 7261
w
0, •. LOT 25 I Z I I
= FRAME 1
O Z ` SHED A4 z w 1
I ` o Io
�y24.6'
IW
d, m 1
0 -
S1__-.,"'"STORAGE o•
?o, �• �I. 1—STORY PI I .
Orn 1 ii1�D� FRAME I
D- m RESIDENCE " 10' EASEMENT
iO Ci f 0 1O.5' No. 885 1PER PLAT
e
I 3
g' o
LOT 24 ,g CARPORT ONCC8 .`n I c;
x�x� ---1 M 1
o N z4.7
iiiiii
4B. �h l
29.2' I 0 1�
aR..1 0.1'
,•FAX
CONCRETE WALK I r I 25' BUILDING RESTRICTION UNE
T _
..— I z I LOT 26 LOT 27
ill
�,.
i s ,0 x
913t T
�• y Z� Ii m •
G
S. I
N85'20'02"W N85'20'02"W
•
I I
/ FOUND 1/2" IRON 80.66' (FIELD) 80.48' (FIELD)
Z PIPE, NO CAP
d.9,1 1
,
FOUND 1/2"IRON \ '? N85'20'02"W SET 1/2"IRON FOUND 1/2" ON FOUND NAG NAIL&
PIPE, NO CAP SB6.02�18"WPIPE, CAP L83672 PIPE,CAP RLS4144 DISK,CAP 155488
/- 36.00'" 36.84' (36.93'' (FIELL
D)
//
585'56'50 W
36.07' (FIELD)
//
r_-_ ____,-4_..-. i:f; .
NOTES
1. THIS IS A BOUNDARY SURVEY.
2. BEARINGS ARE BASED ON THE SOUTH
RIGHT OF WAY UNE OF AMBERJACK LANE
BEING NORTH 85'20'02" WEST, AS PER PLAT.
3. BUILDING RESTRICTION UNES PER PLAT.
THE PROPERTY SHOWN HEREON APPEARS
TO LIE IN FLOOD ZONES "AE" (EL4),
"X"(AREA OUTSIDE THE 0.2% ANNUAL
CHANCE FLOODPLAIN) AND "X"(SHADED)
AS WELL AS CAN BE DETERMINED FROM THIS SURVEY WAS MADE FOR THE BENEFIT OF
THE FLOOD INSURANCE RATE MAP No. DAVID & AMELIA PHILLIPS.
120077418H, REVISED JUNE 3, 2013 FOR
THE CITY OF JACKSONVILLE, FLORIDA.
"NOT VALID WITHOUT THE SIGNATURE AND DONN W. BOATWRIGHT, P.S.M.
THE ORIGINAL RAISED SEAL OF A FLORIDA FLORIDA UC. SURVEYOR and MAPPER No. LS 3295
LICENSED SURVEYOR AND MAPPER." FLORIDA LIC. SURVEYING & MAPPING BUSINESS No. LB 3672
CHECKED BY: BOATWRIGHT LAND SURVEYORS, INC. DATE:
DRAWN BY: KLW MARCH 11, 2015
FILE: 2015-0274 1500 ROBERTS DRIVE, JACKSONVILLE BEACH, FLORIDA 241-8550 SHEET 1 OF 1