834 Cavalla Rd Fence Submittal ,';'-.-./,.. Building Permit Application, Updated 10/9/18
j City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
'uttilr IS REQUIRED.
Phone: (904)//247-5826 Email: Building-Dept@coab.us
Job Address: V �jl'"'�' C A-V A-1_(.,• - �..D Permit Number:
Legal Description 3 - (b 3 c' S - z ( F . 0:3 girop PT' OC FO`,4L RE# Li LI I -i G 2 -7-0
10 G( l,lN lT /- vJ 1L, t{c�l`1 c'-' `�'i 71 J j LO( , 61,K, 267
Valuation of Work(Replacement Cost)$ IIS 00 Heated/Cooled F i Non-Heated/Cooled
• Class of Work: 6New DAddition ❑Alteration ❑Repair ❑Move ❑Demo DPool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial 13ffesidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes 1334o
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) Levo
Describe in detail the type of work to be performed: Li STILL- t-{ Fr (10b01)-6-i.-ArT-, F c,p.Y i y.k-2-D
PEN�.0
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name tV'Af CLt3 P IC-K El-2_1 IQ`.) Address '63(.4_ C.AV ALL.A 12.0
cityATL/kt c • EPC State F L. Zip 32 Z 3 3 Phone 9014 • 4' *7 1-
E-Mail 013?ic_KPkktccl sObP ciffl(r,( . C.iim
Owner or Agent(If Agent, Pow r of Attor y or Agency Letter Required)
Contractor Information RECEIVE'Name of Company Ualifying AgentAdress • City State t i., , ! _
Office Phone Job Site Contact Number ' • j '
State Certification/Registration# E-Mail 8Y
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
RECORDING YOUR NOTICE OF COMMENCEMENT.
Le&�17d_ . ( )7_/;1.f/�
gnature of Owner or Agent) (Signature of Contractor)
Signed and_sworn to(or affirmed)before me this day of Signed and sworn to(or affirmed)before me this day of
MUNE , 2021 ,by MIgRCVS PICKJNG ,by
1��� ��
(Signa ure of Notary) (Signature of Notary)
,...;1;. ;;.'k,, CHRISTIAN GILES
E,)piMrysc I0S -#d*1 117153 [ ]Personally Known OR
*- 'n'' ro _
-,•EORio,�',� �A#�fllc�i�0�25 [ ]Produced Identification
TviP8`004k 1l''11ti�c underwrliers (f)L. Type of Identification:
tjL r Owner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
' City of Atlantic Beach Building Department GRAY IS REQUIRED.
Viir Seminole Rd, Atlantic Beach, FL 32233
on 9, 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. ,i
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.v
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. 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEE THE COUNTY"CERTIFICATE OF COMPETENCY"OR THE FLORIDA"CONTRACTORS
CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.US) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE S/ATEMENT AND THAT I
COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
Job Address: (0`k CAVA-Li-4 'RD
Owner Name: Mlk12Gud PIC-KEI11 (1l-1 Phone Number: goq-t c{C35 0$ Z.-
Mailing Address: 9 3 L\ C v A-ILA- RD - City:Al il-Nr 4 BEAC.1-1 State: L Zip: 3Z.2_33
Notarized Signature of Owner11L4AIJ4_16 <_24Ji
The foregoinginstrument was acknowledged before me this day of cj U N 6 , 20 21, in the State of Florida, County
of bUV -
Signature of Notary Public C /�C/t
:; 11/14/7c(c.72---
:�"�'! ;; CHRISTIAN GILES [ ) Personally Known OR [ 4roduced Identification
e►; ."` ;, MY COMMISSION#HH 11713
EXPIR5S:April 13,2025 Type of Identification: rt_.- !J�
?g;i o• Notary Public Underwlers
Updated 10/24/18
-'—`ii- Fence Addendum Updatedl/7/2021
_ City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233
---�J3C1 Jr
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Property Type:
RResidential
❑ Commercial
Lot Type/ Features:
One Street frontage (interior lot)
❑ More than one street frontage (corner lot,through lot, etc.)
❑ Swimming Pool
Fence/ Material:
IV Wood
El Chain Link
❑ Vinyl
E l Block/Stone (Plan details required for footings and/or retaining walls)
❑ Other
Fence Height:
Four Foot(4ft)
❑ Six Foot(6ft)
❑ Other
Fence Location:
Please submit an accurate boundary survey required 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)
❑ No
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
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.
ttL 1J JUnly ril,G. PIILL GKN Y.A.
CAVALLA ROAD
60' R/W
EDGE OF PAVEMENT t
S 853215' E 16.41' (11) ..f-4' CONCRETE
S 85'37'27" E WALK
1/2' 16.40' (R) NAIL
427.35' (Raft)
REBAR
LB 6702 I.. LB 5488 48.19' (M)
� � SEARING LME v33
25.31' (R) 22.94' (R)
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DISK
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t s
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REBAR N N 85'37'27" W N ASSOC v
LB 5488 16.40' (R) LB 5488
N 85.35'28' W 16.34' (M)
OPEN DITCH
FLOOD ZONE X -AREAS DETERMINED TO BE OUTSIDE THE 0.211 ANNUAL CHIME anon PLAN/EXEC DONE-N(s4OEDy - AREAS OF 0.2%ANNUAL CHANCE FLOOD; AREAS OF 1%ANNUAL
CHANCE tlRI AVERAGE OEPlHS OF LESS MAIN 1 FOOT OR EV ORAINACE AREAS LESS RWI I SQUARE IKE; ANO AREAS PR01EC1ED BY LES FROM 111 ANNUAL CHANCE FLOOD.
v E Y O 1
J R j IS' 1. BEARINGS ARE BASED ON PLAT B GENERAL A3=
2.
SHORN HEREON UES IITHIN FLOOD ZONE x „As
A SSOCIATED SURVEYORS INC. 3.THIS BEST OETFRIIBIED FROM FLOOD YAPS ND 1 DMr)04-17-1989
IS A SURFACE SURVEY ONLY. THE EXTENT OF LINUERGROUND FOOTINGS,
i LAND & ENGINEERING SURVEYS PIPES AND U11UTIES, IF ANY, NOT DETERMINED.
Li j 4.JURISDICTIONAL AND/OR ENVIRONMENTALLY SENSITIVE AREAS IF ANY, NOT
I-- j 3846 BLANDING BOULEVARD LOCATED BY THIS SURVEY.
4. JACKSONVII I F, FLORIDA 32210 5.THIS SURVEY BASED ON LEGAL DESCRIPTIONS FURNISHED. THE PUBLIC
j 2 904-771-6468 RECORDS WERE NOT SEARCHED BY THIS SURVEYOR FOR EASEMENTS, TITLE,
J j 0 COVENANTS, B.R.L'S RESTRICTIONS, CLOSURES, TAKINGS OR ORDINANCES, ETC.
O S S V CERTIFICATE OF AUTHORIZATION NO. LB 0005488 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 i.EGIENDOA YIATIONS
DIRECT SUPERVISION AND mitts THE MINIMUM TECHNICAL o SET!Rai P6,E 0R REBAR P.C. - POINT OF CURVE CH = CHORD
STANDARD FOR LAND U NG PURSUANT TO CHAPTER "ASSOC-SURVEY" OR L.8.5488 P.T. = POF TANGENCY (R) = RECORD
61G17- FLORIDA I THE C C 472, F.S. • FOUND IRON PIN OR PIPE (IP)-0.0ONT.-= 01E3t HEAD Ull11Es (M) = MEASURED
• FOUND CONCRETE MONUMENT(CJI.) s FIRE HYDRANT (C)- COIEUIED DATA
X= CROSS CUT OR DRILL HOLE CONC• s R =RADIUS
BY: -ASO.R.B.=OFFICIAL RECORD BOOK A\C = AIR CONDITIONER L = ARC LENGTH
C B. HATC . FLORIDA C FICATE N0. 3771 O.R.V.=OFFICIAL RECORD VOLUME ® =NATER METER = RISER
PRJJ.=PERTINENT Krum(mamma P.EQ. =POOL EQUIPMENT
tau 1 cc I CTA DI MAI n nolne r nnnere ��n A��n ________ _., cr.v.c RAI=RANT CF DAY