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1175 ATLANTIC BLVD - GREENHOUSE FOUNDATION PERMIT • I1Ly ! \ CITY OF ATLANTIC BEACH ss1 4 s 800 SEMINOLE ROAD J. , : v.: ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 FOUNDATION ONLY MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 15-FOUN-1889 Job Type: FOUNDATION ONLY Description: CONCRETE FOUNDATION FOR GREENHOUSE Estimated Value: $50,000.00 Issue Date: 8/25/2015 Expiration Date: 2/21/2016 PROPERTY ADDRESS: Address: 1175 ATLANTIC BLVD RE Number: 170709-0000 PROPERTY OWNER: Name: ROBBINS NEST FARMS LLC, * Address: 1560 SELVA MARINA DR GENERAL CONTRACTOR INFORMATION: Name: CISSEL & COMPANY Address: 2554 Philips HWY Phone: 904-759-4312 PERMIT INFORMATION: PUBLIC WORKS: UTILITY DEPT.: All concrete driveway aprons must be 5" thick, 4000 psi, with fibermesh from the edge of pavement to the property line. Reinforcing rods or mesh area not allowed in the right-of-way. Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact Public Works (247-5834) for Erosion and Sediment Control Inspection prior to start of construction. All silt must remain on-site during construction. If on-site storage is required, a post construction topographic survey documenting proper construction will be required. Roll off Container Company must be on City approved list and container cannot be placed on City Right-of-Way. (Approved: Advanced Disposal, Realco, Republic Services, Shappel's and Waste Pro.) Full right-of-way restoration, including sod, is required. PERMIT IS APPROVED) ONLY IN ACCORDANCE WITII ALL CITY OF A"ITLANTICBEACII ORDINANCES AND THE FLORIDA BUILDING-CODES: 0 LANyy f CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD j ..� ... J ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 c 111 9? Any utility cuts in the road must be repaired using COJ Standard Detail Case X and must be overlaid 10 feet in each direction from the center of the cut. Repair must be shown on the plans. Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible. A sewer cleanout must be installed at the property line. Cleanout must be covered with an RT1 concrete box with metal lid. Cleanout to be set to grade and visible. — FEES: ------ PLAN CHECK FEES $150.00 BUILDING PERMIT FEE $300.00 STATE DCA SURCHARGE $4.50 STATE DBPR SURCHARGE $4.50 ENG REV COMMERCIAL BLDG $150.00 UTIL REV COMMERCIAL BLDG $75.00 Total Payments: $684.00 PERMIT IS .APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC REACH ORDINANCES AND THE FLORIDA BIJILDINC CODES. 1 ,.—ii:irv,/ City of Atlantic Beach APPLICATION NUMBER Building Department r ' 800 Seminole Road (To be assigned by the Building Department.) ' Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 Fax(904)247-5845 ' rOt)1`) -(g e:,Q., ‘,,.,.-----1,1-_r ttE-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us �� - APPLICATION REVIEW AND TRACKING FORM Property Address: 1 (7 5 a TLfl )-Tt_Q. e)(._■fi. - Department review required Yes No Building Applicant: CA SS E L CO m Ppi Planning &Zoning �_ Y ree •. _ or Project: 201 .)cRe T (`— C�U 1...10471 e),J Public Works 'P(� _ Public Utilities O O r G RE r-+J l-lcovSG- Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt of Permit Verified By Date Florida Dept. of Environmental Protection Florida Dept. of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: - APPLICATION STATUS Reviewing Department First Review: 111;1<--)roved. ❑Denied. (Circle one.) Comments: FT.•-.)'VD ki—E c.)A c:).4,....;BUILDING Ook-c-L -T—ta'� (5�1 ` ,,. v s sA l,L, , ,y V.../wt 2a 5 VC. PLANNING &ZONING Reviewed by: --- Date: 8`Z 1 ti TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 07/27/10 • BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: !% 7S 4Tt4,j7%c 8--..6, 4704147+c. 06144 Permit Number: Legal Description dikK 1/, /z, 13 - "'AN./`;`.1"' AQ/8 "3 5( Parcel # /7 0709 – a 0 0 Valuation of Work S"°,O0o Floor Area of Sq.Ft. Sq.Ft Proposed Work heated/cooled non-heated/cooled Ste' •1-. Class of Work(circle one): 40 Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s)(circle one): ommercia Residential If an existing structure,is a fire sprinkler system insta e- . Ire e one): Yes QV N/A Florida Product Approval # For multiple products use product approval- orm— „N..vI4 Describe in detail the type of work to be performed: 60A/6,gL r� lect -/b4.7a,/ ■ Property Owner Information: Name: la 4iif► A eli E4i•-1.I Address: /S60 -re cv4 i4,�e�.,vq Air. �9 &*a, StateP{Ziprl 1/ 33 Phone E-Mail or Fax#(Optional) S74144 e ./s,Ls4 ,d-C✓a co".,. Contractor Information: CONTRACTOR EMAIL ADDRESS: $ ✓,,e ( „el rs-71S744rd-eV. co+-/ Company Name: C+/JSE.. 4 col—f,24/.4y Qualifying Agent: �it v e. c..JJi-t/ Address: 2-SS4 /oh,A& /4*AI o1, g g Office Phone 705/ - 7�.'1'3/2.- 1 Job Site/Contact Number o d—f� i4 State �3 Zip 3 vL v7 State Certification/Registration# CEe 0/a/7 63 9 y-y Y3�1" Fax# toff-;3 q. 9/$Y Architect Name&Phone# See4.4 frt4h 4 Soft- S'7/. 23 7,3 Engineer's Name&Phone# /}AA d/.t4 40/2,..e.✓4 /by, 6 oo. ‘74-.; Fee Simple Title Holder Name and Address Ai/4 Bonding Company Name and Address A.i4 Mortgage Lender Name and Address n1/4 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 laws regulating construction in this jurisdiction. This permit becomes null and void tf work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six(6)months at any time after work is commenced. I understand that separate permits must be secured for Electrical;York, Plumbing,Signs, Wells,Pools, Furnaces,Boilers, Heaters, Tanks and Air Conditioners,etc. 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. I hereby certibi that I have read and examined this a placation and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other federal,state, or 1- al law regulating construction or the performance of construction. — i Signature of Owner ' —+ . Signature of Contract•. Pit 3rint Name S. 2. G, .2L A-t-t 7 Print Name SR. , (S S c 6-C ...................... 3efore iale ��p his (D Day of _A„Sc,,s-t- , 20 (4 Bas&TN Day of ....4•,s y 20 l'. lotar y Public •: v. ANGELA MtYONS (='=` � iM S Notaiy Put' : MY COMMISSION 4 F 41 MY COMMISSION 4 FF241404 y 404 c;:. � _..._46 �. EXPIRES June 17,2019 • ','to„,t,: EXPIRES June 17,2019 1401;39E-4 53 Fn rYgevisp. 1.26 10 107139$-0'53 Fk„d& arySeMca oon• .t�.•ti•!r� • F J OWNER'S AUTHORIZATION FOR AGENT .54-4/04.4.4 2. e @$5. ./ is hereby authorized to act on behalf of ,ge4.c4 CI 4Ai ✓ t J, 1-4.4. /i o 4...s d rI,4,,,,0 the owner(s) of those lands described within the attached application .1 as described in the attached deed or other such proof of ownership as may be required, in applying to the aty of Atlantic Beach, Florida, for an application related to a Development Permit or other action pursuant ❑ Zoning '-ncc ❑ Comprehensive Plan Amendment Use-by-E; rtption ❑ Zoning Map Amendment Building r> .mit ❑ Plat, Replat or Lot Division ❑ Sign Pert::' ❑ Tree Permit ❑ Other_ — -- � BY: Sigrtat) e of Owncr W, • -6 hL Print Name Signature of Ownsr Print Name q9 /93( 'q) Telephone Num' I()F t ` State of F O(.3. ... County of -- 4h Signed and sworn before it n this ._ day of,201t{. o • �4par►uq Notary Public State of Florida Kimberly A Billingsley By t _ �I 1`t�..__ Al My Commission 6E194120 010or Expires 04/30/2016 Identification verified: Oath sworn: Yes X No —.Agar:11111...--r.4111111111111111. Notary Signature - My Commission expires: b LI VIC I at) �J z � CITY OF ATLANTIC BEACH OWNER / BUILDER AFFIDAVIT ''%_,,,;ttJi , 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 REOUIRED 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. TELEPHONE THE BUILDING DEPARTMENT(247-5826)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. //75' Ar-. -7- c 3L-VD 9'(3 - 7 .9- V317- ADDRESS PHONE NUMBER sT • e� - L PRINT T�� / (2 f'3 (-1.br�G SIGN' RE DATE Befor: e this day of Q comet,20 iY in the county of Duval, lorida,has personally appeared herin by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of Ft- ,County of 'b V.VALL Q Personalty Known ❑Produced Identification- .600'C%. Notary Public State of Florida Alek A Mach j My Commission EE 877614 Notary Signature: ��ri. 1C./ or ac Expires 02/24/2017 F:/BLDG/Owner-Builder Affidavit;REVISED:411&2009 PERMIT NUMBER: 1 NOTICE OF COMMENCEMENT The undersigned hereby gives notice that improvement will be made to certain real property,and in accordance with Chapter 713, Florida Statutes,the following information is provided in this Notice of Commencement. d' 1. DESCRIPTION OF PROPERTY(Legal description of the property&street address,if available)TAX FOLIO NO.: 170709-0000 fa M SUBDIVISION Atlantic Beach BLOCK i1,i2,13 TRACT Section"H:LOT BLDG UNIT ..�� According to the Plat thereof, as recorded in Plat Book 18,Page 34 of the current public records of Duval County 3 2. GENERAL DESCRIPTION OF IMPROVEMENT: ti Construction of 8.000 square foot greenhouse and associated support facility. d 3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT: 73 a.Name and address: Robins Nest Farm LLC, 1560 Selva Marina Drive, Atlantic Beach, Florida 32233 b.Interest in property: fee simple c.Name and address of fee simple titleholder Of different from Owner listed above): Tracey Westbrook,1560 Selva Marina Dr.,Atlantic Beach,FL 32233 ` 4. a.CONTRACTOR'S NAME: Atlantic Beach Urban Farm LLC t." .1 r- Contractor'saddress: 850 6th Ave. South, Jacksonville Beach,FL 32250 b.Phone number: 904-868-6957 °0 H eA 5. SURETY(if applicable,a copy of the payment bond is attached): ( tt V a.Name and address: N/A o • b.Phone number: c.Amount of bond:S 7 6.a.LENDER'S NAME: N/A _-- } Lender's address: b.Phone number: — f 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7.,Florida Statutes: a.Name and address: SR Cissel, POB 1875, PVB.,FL 32004 b.Phone numbers of designated persons: 904-759-4312 cl I- v ~ rn fY 8.a.In addition to himself or herself,Owner designates Susan King of Atlantic Beach Urban Farms LLC a o to receive a copy of the Lienor's Notice as provided in Section 713.13(I)(b),Florida Statutes. ro ° 6 904-868-6957 2 U b.Phone number of person or entity designated by Owner: ro Y mfr 9. Expiration date of notice of commencement(the expiration date will be 1 year from the date of recording unless a different date is m 1O Y specified):June 1 ,20 15 0 "'r4 8 WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT In m J v> ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART L SECTION 713.13,FLORIDA STATUTES,AND CAN m o, 92 O RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE ,-CL° o RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT c'i k: v z 0 WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. 4k-g o c o 0 / / _ 8t8 Sow � , oZwO Uw �/_/_ _,... .• c, Tracey Westbrook Pew ;A- Aer_ (Signa e of Owner or •ssee,or Owner's or Lessee's (Print Name and Provide Signato s e/ ffice) Aut 1 rized Officer/Director/Partner/Manager) State of Florida County of Duval _ The foregoing instrument was acknowledged before me this .��S+ day of {{JJ by 'J'lt.te y W(S i wt.,o IL ,as M A.4 A•!ti •t t't 40-t . 1_ (name of person) (type of authority,...e.g.officer,trustee,attorney in fact) for 14 6.14 S 44 S•)'- P4 em LLB . (name of party on behalf of whom instrument was executed) Personally Known X or Produced Identification Type of Identification Produced goo Notary Public State of Florida ��I Kimberly A Billingsley �m�-.�-� - 1 617 . �; My Commission EE 194120 (Signature of ot�►,lie 0a wo expires 04/30/2016 (Print,Type,or Stamp Commissioned Name of Notary Public) City of AtIanttic Beech APPLICATION NUMt�EP, •• I a�ii�liru�t Depat�BTfleo � �r QED 9• 800 Seminole Road ;To be assigned by the Building Department.) DEC08 i '" � '• Atlantic Beach, Florida 32233-5445 2��4 �� /7 _ � �! - �j_ -'j Phone(904)247-5826 Fax(904) 47-5845 G (�/ City web-site: http:/lwww.coab.us BY g: • D / AIIINIMMI ate routed: ,� APPLICATOON REVIEW AND T 'rACK G FORM Property Address: //16:- In G' /✓C D,-*.,,if-talent review required Yes No Applicant: (]/'/3.�f/ c & iñ--n y /,cam Tre- e.�,� istratol �- Project: . er�" 9i -t /i a 3J--E 4 P • k •'I< d Public Utnit„s, MI e3mo5CC( /� Public Sarfetl Review fee $ ,;25-4° Dept Signature — ---g___-_-_________ CONTRACT. Er.'AYL ADDRESS d��1C�vi�@ CONTRACTOR CONTACT # • APPLICAT9•14 STATUS Reviewing Department First Review: Approved. — — — — —— (Circle one.) LJDenie�l Comments: i°` Sc-4.- ft"t'. ,-6 BUILDING PLANNING & ZONING Reviewed by: Date:/Z� TREE ADMIN. -----_— .— Second Review: DApproved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: _____ FIRE SERVICES Third Review: LJApproved as revised. DDenied. Comments: Reviewed by: _ Date: 'BED 09252014 . J TOSSI6 1 TZ, WEST 1ST STREET j„ 7.............1 _�:,. _ — - — — — 1 _at_ -- —— -___ _r +r• pAtr L'F NAT�RCRYC[-�. - y......,....1 l (•,kq" 1)JUSTED TO �1'f Avow TREF RM., �_�lG I / / �' POND GO / ...� ____–i / GD �� • cRUSIo 1 / Q • �� 5TONE } I / i ,`��,C�'�4,���`* TEMPORARY POWER _ I i�y�G� ?� WELL HEAD J il t■' Ir ( __./ %� a� PROPANE 8a TOILET �F wI�- ---- -.•- _:n - , of I _ W*j, r. 5T JETQJT —r - `6'--- - aI r !' 6� n 5 VI .N ", \ E . • • 1/.ter �i , r-_'r -a 1Q' R L OF t� ( s i. $ ,f DOOR t Ly 1� GATE YALYE /�4 ' Temporary Trailers NES° r 1 .� 6' R.EAHOUZ 1 I.- Construction t----- , a%2•' LOADING AREA . • c 1 — 3 Storage 8a Operations a I-'-=g.M ! r o CD 7' _ - .., .-.----- .._._- -'_- 4 r •' I • lU Li STUBOUT 4' /��' ► G .7. PVC FOP POSSIBLE.7---------1 "`"` ` �� Kr%ME CONNECnON i o a' - k w ,v _ # c� CRUS ILD r� 1 5' S�DEtoA�v •- --STONE='� SURc ACE I • # GREENHOUSE , • I • OFF' SITE PARKING • ' . CONSTRUCTION WORKERS 1 Cissel &Company __ a AMER. LEGION WEST LOT _ Certified General Contractor R # �� 904 759 4312 e .11 SECURITY ROLLING GAIL (M' R:) „ e TO 91 OPEN DURING BUSINESS I 1 FRO HOURS INSIDELOFF1 OPENED 24 1 f or DOUBLE . \ L YELLOW CEhTER:RNE ... MIN— — — — -_ _MMIII• 111=5 -- 7 STUBDrJT -, _P9 4 �._ • , SNiNv^ CAM Al SC){MALK ,k• I AND PLUG - T i V :'1 I o f \i/ • • I ( ri •�i , -. 1,1kA 1175 Atlantic Blvd ; 1,"\J`171-.4 ,c' ; : '4 CITY OF ATLANTIC BEACH J 800 SEMINOLE ROAD J "`"' „r ATLANTIC BEACH, FL 32233 INSPECTION PHONE: LINE 247-5814 I ./. ICOMMERICAL ALTERATION/OTHER MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 t30B INFORMATION: Job ID: 15-GOTH-611 I Sob Type: COMMERCIAL OTHER Description: CONSTRUCTION TRAILERS FOR URBAN FARMS Estimated Value: $5,000.00 Issue Date: 3/31/2015 IExpiration Date: 9/27/2015 PROPERTY ADDRESS: Address: 1175 ATLANTIC BLVD RE Number: 170709-0000 PROPERTY OWNER: Name: ROBBINS NEST FARMS LLC, * IAddress: 1560 SELVA MARINA DR GENERAL CONTRACTOR INFORMATION: lir Name: CISSEL & COMPANY Address: 2554 Philips HWY Phone: 904-759-4312 IPERMIT INFORMATION: I FEES: BUILDING PERMIT FEE $75.00 STATE DCA SURCHARGE $2.00 IPLAN CHECK FEES $37.50 ISTATE DBPR SURCHARGE $2.00 ITotal Payments: $116.50 I PERMIT IS APPROVED ONI.Y IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. N00 29'03"W 289. 76' 1 IP --,,.r -I .� r -� s' I --- `" o o oo D : z 0 ° c - c c _ A \- c� �� � —1 fi W y _ C - = Z o s — r I� ' 0� � � F. (° � . .. , p sT T Z I \ v _ I I <•1 � Om \J I-- • V V• m m a Z O W��.. 1 m rr i (C) C7 C7 N C ' I I *-• I - - -� 94 001rn XV) C Ord A °n I i 0 00 -+ � -110W zm _ I O i \I clmm Ill \C: j > I I \ w — • s 1 - • Sat ' t 92 • C 3dOH „Z I, dl 98 c < °3 4 i' L f r I lJ 1'� N t :T\ — 1 D rrci \m D .8 g () :g" 93 ( m •• .. D . ,• S I li at e p'rJx MAX. 'p'.dr .D p.' ► • p D 8 V p • a b I 4 ` l T I I im v ° � "' 7 j u 70 >_ I ` U Z ~- Z n oo o s o I K I . IN. I [ rJ 13 rnw Z r- m 6"PVC ti I N w r ' p ' ,I • ' r °' x = 11 o x _ • FBI! " z � � o `fl cn � C � Tm in ` ati Z + v O ' mJ Ta r mDp �� � 'I-- o c� C!1 V) 11 = ADZ mi z � o 101 1 a -ID ZO II m No c owl Elm - . 1 1 I �, _ .� _ _ X X a .......---.......•_.-.....--....... ,---".-ita: --11,1A • 1 r, . . -,; ' , X 4 pu24 t FUa24 - 1—rM/ - CITY OF ATLANTIC BEACH I �.� 11\ Department of Community Development • 800 Seminole Road Atlantic Beach, FL 32233 Phone:(911a)247-9 1M11 Fat:(900 24'•5545 Internet: t«<%c.coab.ux ~, �'�'` TREE REMOVAL PERMIT Kelly Ellmore lite: 1 175 Atlantic Blvd Tree Removal Permit: Not Required The tree application submitted seeks to remove a 559" of protected trees, while preserving 327". At a ratio of 1 tree inch preserved for every 2 inches removed. the applicants are preserving enough existing,trees on site. to not require any additional mitigation. The applicants will still he required to submit landscape plans prior to new construction on site. APPROVAL IS IN ACCORDANCE WITH THE CITY OF ATLANTIC BEACH COL• e'ORDINANCES IN EFFECT AT TIME OF ISSUANCE . (-C.0240 911474e_e_. Jeremy Hubsch.TPO ADMINISTRATOR '-i � CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD !J - f " ATLANTIC BEACH, FL 32233 \ INSPECTION PHONE LINE 247-5814 RIGHT OF WAY PERMIT JOB INFORMATION: Job ID: 14-ROW-128 Job Type: RIGHT-OF-WAY PERMIT Description: H20/SEWER CONNECT, PLACE PIPE FOR DWAY, OUT FALL Estimated Value: Issue Date: 10/10/2014 Expiration Date: 4/8/2015 PROPERTY ADDRESS: Address: 1175 ATLANTIC BLVD RE Number: 170709-0000 PROPERTY OWNER: Name: ROBBINS NEST FARMS LLC, * Address: 1560 SELVA MARINA DR PERMIT INFORMATION: UTILITY DEPT.: Avoid damage to underground water/sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is needed, call 247- 5834. Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible. A sewer cleanout must be installed at the property line. Cleanout must be covered with an RT1 concrete box with metal lid. Cleanout to be set to grade and visible. FEES: Fence/ROW $35.00 ENG REV BLDG MOD OR ROW $25.00 UTIL REV MODIF OR ROW $25.00 I Total Payments: $85.00 mion-1 Is APPROVED ONLY IN ACCORDANCE Wit All. CII OF ATLANTIC IWACII ORDINANCES AND "IIIF: FLORIDA BUILDING CODES. 4 f CITY OF ATLANTIC BEACH A 800 SEMINOLE ROAD 1517, ATLANTIC 13EACI I, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number 14-00100027 Date 7/08/14 Property Address 1175 ATLANTIC BLVD Application type description DEV REV TREES/VEGETATION Property Zoning TO BE UPDATED Application valuation . . . 0 Application desc TREE REMOVAL PERMIT Owner Contractor ROBBINS NEST FARMS LLC OWNER 1560 SELVA MARINA DR ATLANTIC BEACH FL 32233 Permit TREE PERMIT Additional desc . Permit Fee . . . .00 Plan Check Fee . . .00 Issue Date . 7/08/14 Valuation . . . . 0 Expiration Date . 1/05/15 Special Notes and Comments THE TREE APPLICATION SUBMITTED SEEKS TO REMOVE 559" OF PROTECTED TREES, WHILE PRESERVING 327" . AT A RATIO OF 1 TREE INCH PRESERVED FOR EVERY 2 INCHES REMOVED, THE APPLICANTS ARE PRESERVING ENOUGH EXISTING TREES ON SITE, TO NOT REQUIRE ANY ADDITIONAL MITIGATION. THE APPLICANTS WILL STILL BE REQUIRED TO SUBMIT LANDSCAPE PLANS PRIOR TO NEW CONSTRUCTION ON SITE. Other Fees TREE REMVL COMM/IND 250.00 Fee summary Charged Paid Credited Due Permit Fee Total .00 .00 . 00 .00 Plan Check Total . 00 .00 . 00 .00 Other Fee Total 250 .00 250.00 . 00 .00 Grand Total 250 . 00 250 .00 . 00 .00 rt:mrl Is .tPPUuvt:u u\I.1 IN .%((c►ICU.VS( I a n II .%I.i. c I I i OI .%I i.%%II( I11%(II (J UIIN •(T. %•u i nt: n min et It.WI(; COW. ,, City of Atlantic Beach / • Building Department APPLICATION NUMBER ' �' 800 Seminole Road (To be assigned by the Building Department) `; �� ' ' Atlantic Beach, Florida 32233-5445 I r Phone(904)247-5826 Fax(904)247-5845 \:�:,,;;; / E-mail: building-dept @coab.us City web-site: http://www.coab.us Date routed: J APPLICATION REVIEW AND TRACKING FORM Property Address: i1 !''LA�-T( Q C-f.1 rt rDe.ament review required Yes No 4 Buildin. Applicant: I SS F L �� N\ P j Planning&Zoning Project: c � l 0 0 is-)04-0(--)i,j 411 Public _� I O r C, P,,-C. t.- Public h i ies—` _- o(�S� Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt of Permit Verified By Date Florida Dept. of Environmental Protection Florida Dept.of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco IIIIIIIIIIIIIIiullMINNI Other: APPLICATION STATUS Reviewing Department First Review: AApproved. (Circle one.) ❑Denied. ) Comments: nr, 1.44 d��prt al IZ°CN Il a t�.f! Oh (r BUILDING JJa 4e -/c�tn'�f re •c�./� `7C'- *li,;t fe' :'�� PLANNING&ZONING y// Reviewed by: pate: 2 ,(f TREE ADMIN. Second Review: ❑Approved as revised. ['Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: []Approved as revised. ['Denied. Comments: Reviewed by: Date: used 07/27/10 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904)247-5826 Fax(904)247-5845 Job Address: /1 7S 4 7-4.4,,rie 8"4 037G4-#471c- Req-c4 Permit Number: Legal Description eeiK 11/ 17% 13 "411'4 b jy 0 "IM PFS Floor ' ea o Parcel# /7 . t - coo d Valuation of Work 1 -6".°,e"° �• t• q. r ------_. Proposed Work heated/cooled .6- non-heated/cooled g.-7-11- Class of Work(circle one): CO Addition Alteration Repair p Move Demolition pool/spa window/door Use of existing/proposed structures)(circle one): If an existing structure,is a fire sprinkler system insta 1 1. ire Residential Florida Product Approval# y ire e one): Yes IMO N/A For multiple products use product approva orm Describe in detail the type of work to be performed: G019/CAE r f d tits(Da71ae,/ Property Owner Information: Name: ,)d..vt A esi ,4iO4.t City . 4/ —r-c::c, a Address: !S60 J4cvq .'-i g�.t,,,,�,9 ,ate. A E-Mail or Fax#(Optional) S -r/,4 Stated Zip yy3 Phone Contractor Information: CONTRACTOR EMAIL ADDRESS: Company Name: d al•FL # coo-v/044 Address: Dh�/ a /�s.�alo, Qualifying Agent: 14 . g. &ti.ei Office Phone pay- ?s4•'�3t s Job Site/Contact Numbers o � sot�/� State /CC y- ,___z- Zip vL° State Certification/Registration# C&a 0/a/7 63 Fax#poif- 33 - 9/5 Y Architect Name&Phone# Sca404 F741j04- -Engineer's Name&Phone# ;..t d/•4 f Z o- 7/- .. 7- Fee Simple Title Holder Name and Address i ° 6 00_ ;� Bonding Company Name and Address Mortgage Lender Name and Address N/4 N1/4 Application is hereby made to obtain a permit to do the work and installations as indicated. I certi that no work or installation has commenced prior to the issuance ofa permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a�period of six(6)months at any time after work is commenced I understand that separate permits must be secured for ElectricalWork,Plumbing,Signs, Wells,Pools,Furnaces,Boilers,Heaters, Tanks and Air Conditioners,etc. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF 1 COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH h YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF H MMENCEMENT. hereby cert'that I have read and examined this plication and know the same to be true and correct. All provisions of laws and ordinances governing this pe of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate of any other federal,state, or - al law regulating construction or the performance of construction. tY tolate or cancel the ignature of Owner - 4- -.ow 41, 41.- Signature of Contract..- oLt. int Name 5. 2. G, .g� ,c .t,s7 Print Name SR. 4 t S S FA-- <6,-C. ;fore e :s re Day of Befor e Y �I,.s�,s-�- 20 this Co Day of_ L,. 54 20 � . y Public ;f.�^' ..i,;: ANGEtA-M LYONS 1 - _ a MY COMMISSION z:FF241404 l�Otary PU ;- ' MY COMMISSION tl F 41404 ' ry•,p •E FIRES June?7,2019 .7.,aR d. EXPIRES June 17,2019 � 14011 39P.-0.53 Fbrxiat�icxaySorvk:acnm �J01)39Ea-0!'�53 Flpriiyy�,� 01,26 10 aP- M .Sy1TIr\ U OWNER'S AUTHORIZATION FOR AGENT S4-.e04.¢,J a. et.ts-e/ is hereby authorized to act on behalf of 111442 jeet li (u, 1a -i -"44.1.1 Ge.e /god, , a,r� the owner(s) of those lands described within the attached application • t as described in the attached deed or other such proof of ownership as may be required, in applying to the .ity of Atlantic Beach, Florida, for an application related to a Development Permit or other action pursuant n Zoning V& '.nee ❑ Comprehensive Plan Amendment N. Use-by-E; option ❑ Zoning Map Amendment Building Y. .mit n Plat, Replat or Lot Division ❑ Sign Pert:;'. ❑ Tree Permit ❑ Other_ -- BY: �• Signal a of Owner l (mot �J t LL -1k— Print Name Signature of Owner Print Name ( 0t1) /,q9- Telephone Num* t State of t'Ll� 1 pGL ...__-- County ofIt V(* • Signed and sworn before tr,• n this -7 day of,20I. r- - w Notary Public State sl Florida _ ?° Kimberly li Billingsley va_By /lrl °< My Commission EE 194120 Expires 04/30/2016 Identification verified:____ -. Oath sworn: Yes X No Notary Signature - My Commission expires: OH 3elaj eo egr,.,,., ��� CITY OF ATLANTIC BEACH ,\' . / l�%WNER / BUILDER AFFIDAVIT 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. TELEPHONE THE BUILDING DEPARTMENT(247-5826)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. ADDRESS S ,47-1_,+,47--, G 3 L.ll U ‘?4:1Y-- ,s9- 7 3/L PHONE NUMBER .s7-6 , .,.1 e L. -PRINT�i�, APIr. d.■ (2,(3 /-2...4),%le SIGN' RE DATE Befor:me this day of Q Ec)thee,20 P(in the county of Duval, . - • Iorida,has personally appeared herin by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of FL" ,County of It v1/4YAL " Personatty Known ❑Produced Identification- 6 Notary Public State of Florida Alek A Albach 'r Ex Commission 877614 Notary Signature: ✓� W ft� Expires 02/24/2017 F:/BLDG/Owncr-Buildcr Affidavit;REVISED:4/16/2009 PERMIT NUMBER: 1 NOTICE OF COMMENCEMENT The undersigned hereby gives notice that improvement will be made to certain real property,and in accordance with Chapter 713, Florida Statutes,the following information is provided in this Notice of Commencement. d. 1. DESCRIPTION OF PROPERTY(Legal description of the property&street address,if available)TAX FOLIO NO.: 170709-0000 II el SUBDIVISION Atlantic Beach BLOCK 11,12 13 Section"H:LOT M r TRACT BLDG UNIT According to the Plat thereof,as recorded in Plat Book 18, Page 34 of the current public records of Duval County 2. GENERAL DESCRIPTION OF IMPROVEMENT: as tr. ti.t .f: sit . - .. . Mo 3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT: 73 a.Name and address: Robins Nest Farm LLC, 1560 Selva Marina Drive, Atlantic Beach, Florida 32233 Qv b.Interest in property: fee simple c.Name and address of fee simple titleholder(if different from Owner listed above): Tracey Westbrook,1560 Selva Marina Or.,Atlantic Beach,FL 32233 " 4. a.CONTRACTOR'S NAME: Atlantic Beach Urban Farm LLC r. Contractors address: 850 6th Ave. South, Jacksonville Beach,FL 32250 b.Phone number 904-868-6957 w 03 i 5. SURETY(if applicable,a copy of the A — py payment bond is attached): %4 a.Name and address: N/A i f b.Phone number: \ c; j c.Amount of bond:S 3 Id 1 6.a.LENDER'S NAME: N/A 2 Lender's address: --- I b.Phone number:, 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(I)(a)7.,Florida Statutes: a.Name and address: SR Cissel, POB 1875, PVB.,FL 32004 a b.Phone numbers of designated persons 904-759-4312 's a 8.a.In addition to himself or herself,Owner designates Susan King CD cr to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes. Beach Urban Farms LLC a b MU b.Phone number of person or entity designated by Owner: 904-868-6957 Q 9. Expiration date of notice of commencement(the expiration date will be 1 year from the date of recording unless a different date is Y N y specified):June 1 ,20 15 00 "U � �Y O Trcr 8 WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT N m J w ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713.PART I.SECTION 713.13,FLORIDA STATUTES.AND CAN ccoo iii ti% O RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE is RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT N a v _ tX WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. E o E 5-O or - o58' o0w -'i G Tracey Westbrook 1 € (Signa e of Owner or •ssee,or Owner's or Lessee's �)t ' ,71- n �,�1'�^ I Aut •rized Officer/Director/partner/Manager) (Print Name and Provide Signato' s •e/t ffice) State of Florida County of Duval _ i 1 The foregoing instrument was acknowledged before me this cI Sf day of ,20I 4 by T rtA.ce y Lv e sr 344,o lc., M Aw+A-4- a! ,as t'1tti bar, p_ (name of person) � for Po1)..-►5 142 S-1- pr«r+� LlL (type ofauthority,...e.g.officer,trustee,attorney in fact) (name of party on behalf of whom instrument was executed) Personally Known X or Produced Identification Type of Identification Produced 1 1 r•4X' Notary Public State of Florida , Kimberly A Billingsley �i ?7 " My Commission EE 194120 aM1o# Expires 04r30r2016 (Signature of ot�aar 1Ile �J (Print,Type,or Stamp Commissioned Name of Notary Public) i •cF •�!J, City of Atlantic Beach ?, Building Department 7L-,,_, T APPLICATION NUMBER .}--�' . 800 Seminole Road ( r ( o be assigned by the Building Department.) .:•,tom Atlantic Beach, Florida 32233-5445 ?015 r- Phone(904)247-5826 • Fax(904)247-5845 Imo E is` '- e 53, l :�`; E-mail: building-dept @coab.us •City web-site: http://www.coab.us `�—_ Date routed: –.5 APPLICATION REVIEW AND TRACKING FORM Property Address: 1 ( 5 1- ''CAN'T( C. cif i� _Department review required Yes No Applicant: i SS ` C C© ' 1 tannin -- Planning&Zoning -- `� ree '. _ or -- Project: �� • � .__._.. To ` c)o r�. I. i Public Works -� 1 r �1 l�E C.IJ -� Public lti ities ' - _- Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt of Permit Verified By Date Florida Dept. of Environmental Protection Imim...1.1111111A11._ MI_ 1111.111111 Florida Dept.of Transportation MMIIMIIIIIIIMIIIIIIIIIII St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: Approved. ❑Denied/.,',, (Circle one.) Comments: 'fee f4L/4G1 . 444f• ,,/ BUILDING 7Jf (y� PLANNING&ZONING Reviewed by: / �`_ d TREE ADMIN. —�i� '� Date: �� /� Second Review: QApproved as revised. •It ied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ['Denied. Comments: Reviewed by: Date: used 07/27/10 p PUBLIC WORKS PLAN REVIEW COMMENTS Date: 81 1 I I Application Permit#: / �-f`Ol1oL/ — 18 Project Name/Address : f � -1 5 Check Box to Application Tracking Comments Select CORRECTION ITEMS: CSMP Provide construction site management plan, including location of dumpster and portable toilet. Right- ❑ of-Way Permit is required if using right-of-way for construction parking. DPLN Provide drainage plans showing site topography (flow arrows, etc.) ❑ ESCP Provide erosion and sediment control plans with installation details. ❑ IMPS Provide impervious surface calculations for entire lot (existing and post construction). ❑ Section 24-66(b) of the Land Development Regulations requires on-site storage for increased run-off if LDCS adding 400 SF or more impervious surface. Provide Delta volume calculations and on-site retention ❑ required per Section 24-66(b). (See attached information sheet.) MEET Recommend Owner/Contractor meet with Public Works Director to discuss proposed construction. ❑ Call 247-5834 to make an appointment. REPM A Revocable Encroachment Permit must be obtained. ❑ RMRO All runoff must remain on-site. Cannot raise lot elevation without measures to retain runoff. ❑ RWPM A Right-of-Way Permit must be obtained for use ❑ TSUR Provide a pre-construction topographic survey prepared by a Florida Licensed Professional Land ❑ Surveyor, showing 1'contours. CONDITIONS OF APPROVAL TO PRI *N PERMIT: All concrete driveway aprons must b'°' ick, 4000 psi, wit fibermesh from edge of pavement to the DAPR property line. Reinforcing rods or mesh are not allowed in the right-of-way. (Commercial driveways— 6"thick.) Full erosion control measures must be installed and approved prior to beginning any earth disturbing ECIN activities. Contact Public Works (247-5834) for Erosion and Sediment Control Inspection prior to start t�9 of construction. OSRO All silt must remain on-site during construction. 21 PCTS If on-site storage is required, a post construction topographic survey documenting proper construction will be required. PLWP Pool—Wellpoint (if used) must discharge into vegetated area 10' minimum from street or drainage ❑ feature (swale, structure or lagoon). A separate pool permit is required. ROFF Roll off container company must be on City approved list and container cannot be placed on City right- of-way. (Approved: Advanced Disposal, Realco Recycling, Republic Services, Shappel's and Waste Pro). RWRS Full right-of-way restoration, including sod, is required. [H� URCT Any utility cuts in the road must be repaired using COJ Standard Detail Case X and must be overlaid 10 nry feet in each direction from the center of the cut. Repair must be shown on the plans. BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax(904)247-5845 Job Address: ! 7S 47-‘46•171-4 SL 14 47"1/71 Legal Description �4'e I!, /Z, II sE c7jo.,/�y�' � � Permit Number: ���� P48 V Parcel# /7 0 7a Valuation of Work S'' Work heated/cooled Floor ea o t. 9 — a o a d o t non-heated/cooled S -y 7, Class of Work(circle one): 410 Addition Alteration Repair Move Demolition of existing/proposed structures)(circle one): n pool/spa window/door If an existing structure,is a fire sprinkler system insta •° . irce one): Florida Product Approval# ) Yes ��. N/A For multiple products use pro uct approva orm Describe in detail the type of work to be performed: E. v,i p E.-r- fciti,Jf)a7oj/ ..� Prone_rty Owner Information Name: / L.i r Ales/ ,^'4/M,f City . 14/s,Jf„c Address: l S6a .fewq "S4,.t,,,1,g £4. E-Mail or Fax#(Optional) s- -1/4 Stated Zip 14-3 Phone v/s J - /,../K , Contractor Information: CONTRACTOR EMAIL ADDRESS: . ✓.c irs-/s714 rct'eV, Company Name: 6441. # t0M/04,4 y Address:_" Db,/,au /->�is,�arg,, Qualifying Agent:� p oXeev ie• ei f Office Phone ?eV• ,/, tit 2- City' ,A`^ ' State �L State Certification/Registration# cE oboSite/ Number fly.. �31 --_Zip vt.v Architect Name&Phone# Sc.* Fax#9°'�'33 4' 9/S Engineer's Name&Phone# f k 7�• Z. 7,3 Fee Simple Title Holder Name and Address `� q °y• 6 00 Bonding Company Name and Address ,/4 Ai Mortgage Lender Name and Address A1/4 Application is hereby made to obtain a permit to do the work and installations as indicated. I certifii that no work or installation has commenced prior to the issuance ofa permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null void:f work is not commenced within six(6)months, or if construction or work is suspended or abandoned for of six(6)months at any time a work is commenced. I understand that separate permits must be secured for Electrical.Work,Plumbing,Signs, Wells,Pools,Furnaces,Boilers Heaters, Tanks and Air Conditioners,etc. 1eull r rs, WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE WITH COMMENCEMENT. OF hereby certt&that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this of Ywork will be complied with whether sneci ged herein or not. The granting of a permit does not presume to give auth ' "ovisions of any other federal,state, or - ,al taw regulating construction or the performance of construction. g his g ortty to violate or cancel the ignature of Owner -AI' -.w 41, . ,4-7 Signature of Contract. • 0116.4, int Name 5.2. C► _ft_ A-et-t--17 ;fore gale Print Name Sti 4 .15 S FA- e 6-c_ :s Day of Aas, s+ 20 Beforrie this to Day of �l�,S,,s,, •Lary ' _ Public .. .. g .4 _.. ��+ + • `n MY COMMISSION tt FF241404 Notary Pu,1 ': *- MY COMMISSION u F 'a1 ,a•},��.:.' ..._t- d 404 ','t'o,y( ;:� EXPIRES June !7,2019 •%!an�; EXPIRES June 17.2019 140 11 °-0'53 FbrxinNorarySorvke.nar rio7139E-0'S3 FkxxiniVM� ', 'a .26 1 ;LS�.•LJj\ OWNER'S AUTHORIZATION FOR AGENT s-f /04.3./ f2. eISS.e/ is hereby authorized to act on behalf of Igiititc, Cscl? Gie i4.1 --"".4-1.11 GLG //�44,,,.;d.,/,Ai the owner(s) of those lands described within the attached application .• a as described in the attached deed or other such proof of ownership as may be required, in applying to the ' .ity of Atlantic Beach, Florida, for an application related to a Development Permit or other action pursuam ❑ Zoning VI, ,.nee ❑ Comprehensive Plan Amendment N. Use-by-E; eption ❑ Zoning Map Amendment Building P .niit ❑ Plat, Replat or Lot Division ❑ Sign Perm.. ❑ Tree Permit ❑ Other BY: 'f. ` %` Signat a of Owner I jl �' C_t... " . UN St�konF� Print Name Signature of Own"r Print Name ((-140 /Wr9- ., .x-93 Telephone Num' State of F Ll7 c S i .__..._ County of .__._... {;h Signed and swom before rr,-. a this __01-1 day of,20(1-{. -� r •, 1p9.r►u Notary Public State of Florida By r 1 j`-e ?° Kimberly A Billingsley °Y My Commission EE 194120 ‘0F op', Expires 04/30/2016 Identification verified:_� -. Oath sworn: Yes X No • Notary Signature My Commission expires: />1_7-11 34a1-(p ) " CITY OF ATLANTIC BEACH V / 'J%WNER / BUILDER AFFIDAVIT ,,..„,;,,18, I.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. TELEPHONE THE BUILDING DEPARTMENT(247-5826)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. ADDRESS 47-LA-,.4 7-; C 3 L VD / O t . �9- '/31_ PHONE NUMBER 7 PRINT NAM.. /`.lam — (2(3(1.-b,o SIGN' URE DATE Befor: e this day of QECtsee.,20 i in the county of Duval, . . . lorida,has personally appeared herin by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of FL. ,County of b%A VAIL- eO Personalty Known ❑Produced Identification- Ofet Notary Public State of Florida . . Alek A Albach Notary Signature: // / MY Commission EE 877614 W�� of a Expims 02/24/2017 F./BLDG/Owner-Builder AR'adavit;REVISED:4/16/2009 PERMIT NUMBER: NOTICE OF COMMENCEMENT The undersigned hereby gives notice that improvement will be made to certain real ro Florida Statutes,the following information is provided in this Notice of Commencemen and in accordance with Chapter 713, t t. DESCRIPTION OF PROPERTY(Legal description of the property&street address,if available)TAX FOLIO NO.: 170709-0000 el SUBDIVISION Atlantic Beach BLOCK 11,12,13 TRACT Section°H:LOT M According to the Plat thereof,as recorded in Plat Book 18, Page 34 of the current public records of Duval County 2. GENERAL DESCRIPTION OF IMPROVEMENT: C9rstruction of 8 000 a tar foot gre nho ana q a f ted s t port facility. 3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT: a.Name and address: Robins Nest Farm LLC, 1560 Selva Marina Drive, Atlantic Beach, Florida 32233 b.Interest in property: fee simile c.Name and address of fee simple titleholder(if different from Owner listed above): Tracey Westbrook, 1560 Selva Marina Dr.,Atlantic Beach,FL 32233 tel 4. a.CONTRACTOR'S NAME: Atlantic Beach Urban Farm LLC Contractors address: r 850 6th Ave. South, Jacksonville Beach,FL 32250 b.Phone number. 904-868-6957 .4103 5. SURETY(ifapplicable,a copy of the payment bond is attached): N a.Name and address: N/A 0. �I l� b.Phone number: • c.Amount of bond:S y 4- 6,a.LENDER'S NAME: N/A Lender's address: Z b.Phone number:` 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7.,Florida Statutes: a.Name and address: SR Cissel POB 1875, PVB. FL 32004 J a b.Phone numbers of desi atea 904-759-4312 gn persons: A 8.a.In addition to himself or herself,Owner designates Susan King a) ~ to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes.Atlantic Beach Urban Farms LLC a p ix m -U b.Phone number of person or entity designated by Owner: 904-868-6957 2 a 9. Expiration date of notice of commencement(the expiration date will be 1 year from the date of recording unless a different date is rT u,I y5 specified):June 1 ,20 15 Co � �Y o Tr.re 8 WARNING TO OWNE•: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT vii •N U e�•ARE CONSIDERED IMPROPER PAYM S UNDER CHAPTER 713 PART I SECTION 713.13 FL 6 RIDA STATUTE AND CAN a`�i (1 O RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING CONSULT cv `m a WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCIN WORK OR RECORDING YOUR NOTICE OF COMMENCEMEN . *_a LL O / oc� o = wo0w azorzUtE (Signa e of Owner or_ •ssee,or Owner's or Lessee's Tracey Westbrook /J1c1„t, ;;t ' ' Aut �rizedOtTicer/Director/Partner/Nianager) (Print Name and Provide Signato s ,e/tt tfiCe) At'T State of Florida • County of Duval sf t The foregoing instrument was acknowledged before me this day of 4 - 1 C. ,20±q by 'jVLa.c.Ey tvES i e4ok ,as MA,Adtial, (name of person) rl S.1-1 64 "� for F'ab•r►s ? d S4 p4,•-• LlL (type ofauthority,...e.g,officer,trustee,attorney in fact) (name of party on behalf of whom instrument was executed) Personally Known X or Produced Identification l Type of Identification Produced _�.►tNk Notary Public State of Florida t� Kimberly.A Billingsley ��,� ��_► —10„1.0*-�< Expires 04130!2016 194120 (Signature of Plpta ^,Ii-` 3 (Print,Type,or Stamp Commissioned Name of Notary Public)