631 SHERRY DR REFNC21-0091 KFK)ezt -vogl
;tom Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
/ 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
--e n 9`- IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.ustf� �s�
Job Address: ( 1 S 1c rYf1 ff lVe- Mkt n7ic &4O){�,3�P�mtt Numppber:� 0 1��d1� `v` I ^
Legal Description c/ 2 �. 14" "? --. , -r----1-6: �s�'�,f-sc✓t.�S R.` P 7>RE# 1.. ,(-0300 ls(��' �� �(
Valuation of Work(Replacement Cost)$ 1 OOD Heated/Cooled SFS Non-Heated/Cooled (i tot-a
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door itebuirreird
• Use of existing/proposed structure(s): ❑Commercial VResidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes ❑No nJo,
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit)( No
Describe in detail t e type of work to be performed:
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name6)tsGllvja{i1 16• QOM SGlAddress ('31 SVYYrvi 171 Ive .
City E4-1't0„vtf-1G e(Gt&tel tate Zip 3223., Phone 0) OL(. 5-7y9). 3 I ocl
E-Mail loro wrIr-i09 r--ck iry,Stitt 1h-cti I • ( 49-nn
-------- ---------
Owner or Agent(If Agent, Pow'r of Attorney oragency Le ter Required)
Contractor Information
Name of Company N- Qualifying Agent
Address City State Zip
Office Phone Job Site Contact Number
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone It
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 WIT : uR LENDER OR AN ATTORNEY BEFORE
RECO 1_NG YO�J T-1 E OF COM �, ENCEMENT.
G (Signature of Owner or Agent) (Signature of Contractor)
ned nd sworn to(or affi ")...beforA,, • e t . day of/{ Signed and sworn to(or affirmed)before me this day of
� �) 0 •y 1 )5 a fad 1 • # r.t..E� , by
4 ‘:IMA _ —
—11": .tu -of Notary) 4 (Signature of Notary)
•'' ".• TONI GINDLESPERGER
[ ]Personally Known OR =,: i• :,: MY COMM Sopey P8'0I
[ ]Produced Identification ->!"..•P. EXPIF(E$ft'dotfbeed, etifical/on
. ..... .
Type of Identification: 1--� •.:=!r,;,.`°` Bonded ThsTyphroputi 'hlsas:
Fence Addendum
Updated 1/14/2021
City of Atlantic Beach Building Department
9' 800 Seminole Road, Atlantic Beach, FL 32233
PERMIT#
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
&3( 41-- -' v e, 1/ L z I
Property Type: Lot Type/ Features:
Residential 0 One Street frontage(interior lot)
O Commercial 0 More than one street frontage(corner lot,through lot,
etc.)
0 Swimming Pool
Fence Material: Fence Height (select all that apply):
❑ Wood Four Foot (4ft)
❑ Chain Link 0 Six Foot (6ft)
O Vinyl ❑ Other
❑ Block/Stone (Plan details required for footings and/or
retainingwalls)
Other P'I6l.mi nut.M
Fence 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?
`❑0 Yes (must submit separate Revocable Encroachment Agreement)
XNoo
Will tree(s) be removed in association with proposed project?
❑(Yes (must submit separate Tree Removal Permit)
PINo
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
RECORDING YOUR NOTICE OF COMMENCEMENT.
Owner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
Z' City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
`i Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: RINcZ I -OU°(
I. FLORIDA STATUTES;CHAPTER 489, FLORIDA STATUTES, PART 1"CONSTRUCTION CONTRACTING" REQUIRES
OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
lDISCLOSURE 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: (031 SiAcieni r'I YQ. A-1-tairvi'i c ac.atn f 3 a.a. '3 /� / ,,q
Owner Name: 6)I�j0.h'-j-Y-• 0. (LA"v i .( Phone Number: gO`I • • 310
Mailing Address: (03 1 She `t'1�1 Ai" City: •A4-10."._1-;c ' ie State: Zip: 8.3d 33
1�
Notarized Signature of Owner � .S1 ,�C
ii. &/ir ?5- --,
The�oing instr ment was acknowledged before me this �)day9 _ , , .OZ ,(in the State of Florida, County
of # J1.) vs ,_
Nil
MI ,�
Signature of Notary Publi
L
[ ] Personally Known OR [ ] Produced Identification
Type of Identification: `—�
s-,34: (';•, TONI GINDLESPERGER
'•g. '`�*: MY COMMISSION#GG avaa d /24/18
:.' ,A. , EXPIRES:October 6,2023
'."..?&,,,,,, Bonded Thru Notary Public Underv�riters
MAP SHOWING BOUNDARY SURVEY OF
Lot 1, Except the Easterly 50 feet and all of Lot 2, Bowery's Replat,
according to prat thereof as recorded in Plat Book 20, Page 22 of the
Current Public Records of Duval County, Florida.
Certified To: Travis Gibbon
Commonwealth Title Insurance Company
R:c'ard G. Hathaway, PA/Porte Vedro Title, LLC
3 (See Drtatl of the area bottom right)
Lot
Wood Fd. o v1\2.
la,IP, N
Pt. "EI'
, Ret) bD.tX)' (C) ;b,
a $;— ..-g-,:,..
. (C} ry 83'•42'C4• M+
Fd 1\7":P, •�Ze __. — r'L' _.__, 13-1„;.(' -1X(Il
No,d. R,Chalet Lin. rh,',.
flat. P1 'A' 0,5'(Ft)-_ with wood 7o'Ta'e QO w ' 4.
\,,,,..
4 ` lea Shed
' '. Lot2
\ a` ^ a -..
1 15 a 1,1
l II,.e Gado t.lo,Faac
21.2 s I
•
sus0. 3 4
• p ',A
'goo ' D N a m ea, Tile. Eostert
c�,,s1 ▪ a�,,s,,` - 'a " 1 50, of Lot
1-14 Lt
0. it___,,,,: U% Z,1' S ti-.� --
(�$1, p 1• , to. J 1 G 011 e
pf'....• (fit 1. \*,),,,,sie4 VOk\
1,4
./ '4.0'
n
..\\.
al
con I
tis ,Ti.•
Ij 4 o0" W �'D
fl 2
g
I J13.74'(o s 8 ----"
s 53.42'00" w 68.76' (C)• Detail
tr Smote of Detail -`-----.
-.
to ea:
property earner
Wood under shod
Lot 3 st,ad
D 4'(BI)
Elamite line isetwaar. Peleronae Points pJ��W (TY(DO 0,75•FTI e
rtn!srence Point 'A' to Reference Pont "0" N 48' (C) { re""".�t N g3'4t E S€
N &1'13'00' E 83.48' Of) v< Fd i\4' P,"'(:)83.42:°1).
?, 50'N. (0)
--%- No id,
13.74'(0 y t _ _,Y C' t.l,(lo) 1' Rat. pt. 'ti' Th F4alor'
r15'{tli)� yq' of Lot
1 9
AtLw
mlrn 1. �_
Shah S Oe15 OO E
115.00' C
u ^tALGl-i;''R hQDreYLt7tign
1, iF.N iso FA aha+r7n Rtyrdcr A/c - Denotes A.r C°ndltlywar
Pop g 9 SM=La.Y, (yl)- Denotes Meting Una Inside of subject property tele
2. ecertnge ore booed on the Northerly R\W line of Sieth F'traet, timPs the A.osumed Loafing of S 83' B.ttL -Concha 8•utdloe Reatriottan Line
. 42' 00' W, as par Reoo'd ?tot. ;O) - Denotes Ca eutoted par Plot
1. There may be Peatrietlar.e or Foam:ante that ore not oho.m orr We moo that may be fund in the ,-b _Denotes Oicrd B oMQ
Phone Recuse of thin County or evident-ed by Toile ararrtnot err, :h -Donates Chord Dletcnee
4, Me oursiy wee performed wlthoui the benefit of a'title Comm0mant. Cana -- Denotes Cancrate
5. The Property shown hereon anbrocad by heavy!nee 1 based on a Leos:Description pro>4ded by0) -Denotes Deed Dtme'cetm regarded 'o Pubt1c Recnrde
Went, rr). -Donotte found
a. MI. Survey dogs not relit or dalwx-mint Ownership. 'FS) -Denote. Fonda Una inside of aubyet property flee
1. Thle Sunray shown arty the Above Crcnoi l:aRaa, No Unberpround Utilities. Footer's, Structures, a
) )•- Denoted Fer,ae floe a,la'do of eub)Qat property line
improvements are shown on tall mop. 'fCt. --Denotes Fence Una on t'tla t tine
S. Unload a:herwlae notny any patten of the parcel that rnoy be deemed m 'Fa UOnds by Slots to , ) Tea property
Gauerament Aganciee,hot not been detrmtned and any t:at;tty resulting tharctrorn le net the ,FIA) - Denotes Measured Dlmensicn mach is field
responsibility of the undersigned, or embstentiated by Field TrouNte cMculallors end mcaeunomcnts
'C+i) - Noche Coy Y4re!noldo of re.-bpot property lino
Ft40d Certification a- De otore Idultl9aat)m
J' -Denotes Iron Pips
R -Denotes tPin or Rates
By, th
Ely Graphic hotting only, properly ween harem alas within 2011C x J.E.A.E. - Canate%Jackson MBe Vectic Authority Easement .
OR 101000 01 the Potato' Emapanay incnag emert Agency(F.E.M.A.)National Flood lona-arms Program, _B -Corotes Uccny d Bushels
Flood Ineuronee Rote Mop (r.t.R.N.)Community Portal Number. 2;,-a0Dttj, :M0•)- Oo otas Slop Book
Bop reAsec date: Apri;..1O.10.9. NO -Denotes Nail 0,OhM(
— Denotes Overhead Electric Lane
Legend A Roll or noted
V. -0ertotes Official Re rde Valvme
• Fs, IP giro nosed - No 10 U.O.N. 0 id. flo6'o04 5pDco • Apt--Cenci Rot ^ ot, n shown On retarded Plat
rs ^ Donetee Plot Book
Uo rd, IP stem noted -No I0 U.D.N. °C. - Donates Point of Curve:
---�� -Darotoa Line not to acola
o Set 5/8'Pebor Cc eddy U3 y 7080 - - --Oonotee B.R.L °000_. Denotes PPo pea
an Fd. OM s;2e note - No ID 0.014. -' -- —Dn'.o tea Easement tiny " 11 - Denotes Prohf am4anat Surveyor end'Jigsaw
Denotes Ferree ilea
PL - Denotes Point
T. Noe and Orae an noted feet. -Oanotet Polaranca
ate-__.7-7:/a
aa' Fe. %--Out I. 4'4 e,,• 4 t5_e Denotoa Comoro-Oa Alen 'R/Yin - Dana ttc %/-t of 140;
:to. -- Denote,, Jaiaae Otherwteo Noted
I hereby certify that thio manly roe mode to the beat of my 4221 BBosyrer...iodises Rood, Stilts 8
kna.teoge a-d nonfat cad moats the Mlnwmum Toalolooi Slanderdt as flaw pate R--20nR Jori.eanvTJe,Road's 3.2217
cot forth try ton Florida Poard of Prefoms:or:ai Lard turveyoro M ti Phones (80.4)717--8870
Chapter •1017- .0(Forrnsny Chapter 21hh--eA). fltYiAAiiLyyyyyy000000 Job Number. azas Fal: (F04)737-8571
Admtnie L•o A p..-'suont to Boohoo 472.027, Fl do Statatea Ucenaed Ouslnasa Na: %AC
/ /�, { Ftetd Bods LTJ ELtAit' fersurveyeb N`so:tN.net
ay. f 'R.:�. -) 1� ' �11i'Lu_t% Pop: i8 _...0<.... JW Cannady
W. Cainady Professional Surveyor & •spa,, Scale L"_ •
Iileeu No. 5388, Sloth of Florida S iJ R V£Y 1 NJ t3 I rd c e
t 96'.; 8-30--2019 I.
-
Unites it borne Dad Slromre and Lha CrSlind Raised seal of o Florid, Lkenaed Surreys( anti Manor, this Crewing, Sketch, Piet (�
or Lap Is lea Informs:IMs to
7l purpoaae only,and It; ocila Page i of 1 File No, A'-9A1