1643 ATLANTIC BEACH DR - PERMIT ACC18-0033 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
wt S) INSPECTION PHONE LINE 247-5814
ACCESSORY- SINGLE OR TWO FAMILY ACCESSORY
MUST CALL BY 4PM FOR NE)IT DAY INSPEC17ION: 247-5814
PERMIT INFORMATION:
PERMIT NO: ACC1"033
Description: PAVERS AROUND POOL
Estimated Value: 1500
Issue Date: 6/11/2018
Expiration Date: 12/8/2018
PROPERTY ADDRESS:
Address; 1643 ATLANTIC BEACH DR
RE Number: 1695051095
PROPERTY OWNER:
Name: Pinhas Michael
Address: 1643 Atlantic Beach Drive
Atlantic Beach, Ft.32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name:
Address:
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU 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 WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In addition to the requirements of this permit,there may he 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.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500.For HVAC work,a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
City of Atlantic Beach APPLICATION NUMBER
-1 Building Department (To be assigned by the Building Department.)
800 Seminole Road A C30 t S_00�513
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 Fax(904)247-5846 Date routed:
City web-site: http:1Avww.coab.us
E-mail: building-dept@wab.us =:P�
APPLICATION REVIEW AND TRACKING FORM
Property Address: I (o 4 ippartment review required Yes No
anicing_-)
Applicant: C) arming&Zoning
?a Tree Administrator
Project: C4
-St �Izuulr_jqmt� -
Public Safety
POO Fire Services
Re, view fee $ Dept Signature
Other Agency Review or permit Required Review
of Pe nr,=lSX Data
Florida Dept.of Environmental Protection
Worlds 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 A�ggjA
Reviewing Department Firat Review: [JApproved. E]Denied. E]N I ot applicable
(Circle one.) Comments:
BUILDING
Date:
PLANNING &ZONING Reviewed
TREEADMIN. Second Review; ElApproved as revised. ElDenied. [-]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: E]Approved as revised. DDenied. E]Not applicable
Comments:
Reviewed by: Date:
Revised 06/19/2017
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road P&O ( 9-005-3
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 Fax(9D4)247-5845
E-mail: building-dept@wab.us Daterouted:
City web-site: hftp:/tvvv,.wab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I (o 4 ::5 P�� k��r�Ia,ew re YeV6
Applicant: N�tlanninq&Zoning
Tree Administrator
Project: P__(� Nn 4) IMM-0c WorMD
PubliQAA&�
Public Safety
Fire Services
Review'
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept.of Environmentil—Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Res�w_rants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
JNot applicable
Reviewing Department First Review: PApproved. DDemed.
(Circle one.) Comments:
(�E�
PLANNING&ZONING Reviewed by: k7l 3e:� Date: 6 -7—ow
TREEADMIN. Second Review: E]Approved as revised. E]Deni;r [-]Not applicable
PUBLICWORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date
FIRE SERVICES Third Review: E]Approved as revised. E]Denied. ONotapplicable
Comments:
Reviewed by: Date:—
Revised 05119/2017
19911� CoRpy.1012/8/17
Building Permit Application ICE
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845 &
Job Address: P�?C�cy\ D!:JX —Permit Number: C)
Legal Description cvoQv\c\ RE#
Valuation of Work(Replacement Cost) 570C) Heated/Cooled SIF—Non-Heated/Cooled_
• Class of Work(Circle one): New Cdd.jt,.:n)AIteratIon Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Connmerciac�
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
Florida Product Approval# —for multiple products use product approval form
Property Owner Information
Name&: �� k
-'Lk.
City (-4,0 C�Q_YN —State F I- ZIP
E-Mai 0-\4E X , Ca&)
Owner or Agent(if Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: Qualifying Agent:
Address
Office Phone Job Site ontact Num er
State Certificartion/Registration# E-M
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation
xempt/insurer/Lease Employms/Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated.", it. nstall tonhas
commenced prior to the issuance of a permit and that all work will be performed to me M� r o ationg
construction in this jurisdiction.I understand that a separate permit must be secured foTrIV 'OL pfts'
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. on be'
10D an" ox""nu..
]'rat,on#_; E-"
e
aanDI"insure,/Laee Ennolovec I E.P1.1on Date
OWNER'S AFFI DAVIT: I certify that all the foregoi ng information is accu rate and that all work will be done 1 n compliance with all
applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUI�kAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TW�E FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCIN9111500SULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING. U R OF COMMENCEMENT.
t
2:gOnature (owner or Agent) (Signature of Contractor)
(uncluch contractor)
.,a p
�gned and sworn to( ___ bef. . thi of rSigned and sworn to(or affirmed)before ethisdayof
ti\/fAtqiiE�j� I I Of by
Zry) of Notary)
TONI 01 G
I
Penonally Known OR I ink I n MY ISO otFF92435
bar 6,M19
I Produced Identification PUbkUxkxiwn
Type of identification: PSZO-_<S3 -OK14� li—ic
MAP SHOWING PLOT PLAN OF
LOT 8 AS SHOWV ON MAp OF
ATLANTIC BEACH COUNTRy CLUB UNITI,
AE RE�MDEV IN P"T V�67�GES �-54 OF Me �,, ,GM R,,,RW �A, Co�,
To. nxt awmEn, p,,.
SIGNED:
SQ.n NAM
Am SQ. DA
1%0
07
OSEL,
09017
C�.
PUBLIC Wo 8 ERMAI HEREM ME PER F�DA1104 PLAN
j 1)"MOVED T. mm.
)DENIeD WT sp� ..S. Q FT,
I N0Tj=,,TooWr 1 y y m R/w � sq. R.
WALI, I
RIEW-OF-WAY LEN..R
TETAL TWERMELS.A, 7,�
7REE SMEDULE
tLEVA� W
A PI-AN AM`IEQ 5.18�7W/IQNUS"A"MEN
'A
AlED AMS��ElUf .0 TREE INCHES
LEVATEM Mo �EREM �E RE IR
S'ER T.NARD QR. NUM%' �I-- E
70%
M. WOREE 1 M�,IDW�,M MALL BE CMWY�E,
1-0 m E U.E p ES.
....D.EN�M�RE,
ALL AAWERIC N
Ut- I' LORIDA, /wc�_
mw.—,
ED
2.1
CITY OF ATLANTIC BEACH
OWNER/ BUILDER AFFIDAVIT
1. 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 E)MMFTION ALLOWS YOU,AS TIE OWNER OF YOUR PROPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUS
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$25,01K.00 OR LESS. THE BUILDING
MJS�D 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
IHRE 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 SURF THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUMED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES,
L
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
Ill. 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 S5,000 PENALTY UNDER FLORIDA STATUTE No.
455-228(l). AN-OCCUPATIONAL LICENSE' IS NOT ADEQUATE, THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY 'CERTIFICATE OF COMPETENCY' OR THE FLORIDA 'CONTRACTORS
CERTIFICATED 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.
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TREE &VEGETATION AFFIDAVIT FORMITERNA11OFFICEUSE0111Y
City of Atlantic Beach PERMIT#
Community Development Department
800 Seminole Road Atlantic Beach,FL 32233
(P)904-247-5800
SITE INFORMATION
ADDRESS BeL�_h lbcwe,
SUBDIVISION BLOCK LOT
RE# KRESIDENTIAL [I COMMERCIAL D OTHER
APPLICANT INFORMATION
NAME JAQaUJ 'P*,,,XVLC�� — PHONE# 73Z-awQ-5�jt
ADDRESS (\4 -5- CELL#
CITY — STATE FL_ ZIPCODE
EMAIL E]OWNER n LEGAL AUTHORIZED AGENT
I affirm that I have reviewed the provisions of Chapter 23, "Protection of Trees and Native Vegetation",of
the Municipal Code of Ordinances for the City of Atlantic Beach Florida and/or I have participated in a pre-
application meeting with the Administrator of those regulations. Subsequently, I affirm that no regulated
trees and no regulated vegetation will be damaged,destroyed and/or removed from the above-described
property and/or adjacent properties including right-of-way.
I HEREBY CERTIFY ZTHA ALL INFORMATION PROVIDED IS CORRECT.Signature ofPropertyOwner(s)orAuthoeized Agent
MLLA- :,_, - -
5MINATURE OF
-PPLICANT DATE
SIGNATURE OF APPLICANT(2) PRINT OR TYPE NAME DATE
Signed and sworn before me on thiZa day Of T(P_LCC�by State of_V�IC� A
CnunWf� fl
Identification verified:
Oath Sworn: E] Yes ro-I No C_/
iximtlary gnalure
mylgm" tu
ISNON
EXPIRES 0=,.,Sgai us
EXPIRES 11� -
q ission expires
UP
04 TREEAND VEGETATIONAFFIDAVIT03.07.2018
