115 SEMINOLE RD RFNC21-0126 =P-, Building Permit Application Updated 10/9/18
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!w City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: ?g 5 5r= ,.41 1 ;sib Permit Number: REI(_a ( -0 1 ZC.,,,
Legal Description 10-'6 26 -g.S - tag . (tq 5f4-1-TAif S& 1 L-Q''f to ;Jo RE# i 1040 (i - d ICS
Valuation of Work(Replacement Cost)$ Ii0gZ. Heated/Cooled SF Non-Heated/Cooled
• Class of Work: 12Kew ❑Addition :Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial gthesidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes .KJNo
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed: /i-Ot/t;. 0-�4j i- ain> F-er-- uT /Z P C j G✓,Vf
t ( t,J 14 r TL "I/-k/ ce t-e .
Florida Product Approval# for multiple products use product approval form
Property Owner Informations _
Name K _ f%) E"; L-3-a-G 0 Address n " fr')8Z.
Ste-
i
City i_A/v 1 . (-46,2EielCAA State Fi Zip :32-03-2- Phone 9/.- 32 Oil 73
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information (�
Name of Company r',PSr Tv s j t� -J W Qualifying Agent r•fv-v-, ti% *Peyza 1'i -
Address 51`7/`1 n9,Q:5-Cy7'C-..C-"/t 2/ t' City -4 11C-456/,' r/'-Ler State C--- Zip 023
Office Phone (tell (7U`CS'1"7 5'5— Job Site Contact Number
State Certification/Registration# - E-Mail C.1tC c G.tiiGs, C .0-frIArt- •
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR ExemptpExpiration Date '1 /r fs�
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no wor ori stat lation 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 R AN ATTORNEY BEFORE
RECO' 5 ING Y9 I R 'TICE •F COMMENCEMENT.
6woh_ / -1;7./. A. — .-=i �"vt
(Sign re ofwner or Agen ) (Signature of Contractor)
�st-r >✓L 5•fren c.r n5+,se,
Signed and sworn to(or a firmed)before me this I day of Signed and sworn to(or affirmed)before me this I day of
.;� •.ry•u��c aeo .rid^ L
i' Jassica A Dotquist '4 . - • NI __ Notary Public State of F.i,.Imo!
vc . M Commission
osmissio 08/14/2025 142217 Signature of Notary) .'4"f* Jessica A uist
HH 142217ilk
(Signature of Notary) ir
1 M Fl . d 08/14/2025
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[ ]Personally Known OR ;1'41 .e sona y nown O•
kProduced Identification [ ]Produced Identification
Type of Identification: 1 L._ Type of Identification: _
/ .
VIP) ye...,
p / i' Ata
r.O1 OUND 1/1"
W O , IRON PIPE
c¢,co)N W � h LOT 635
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` i ,1 o)w/1' LOT 636 1.6� LB11019
. , o.o' o BUILDING o 0.6' o.r�
oa' #115
.-//FOUND 1/1" �" 1
r ,_ ._!if IRON PIPE .' Sz 11/ `�
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' jail,. LOT 650
LOT 637 &I` o.s
FOUND ff!'".'�
/RONPIPE
LB#1013
0.5'S
LOT 651
SURVEY NOTES
CON‘NE It DRIVE CROSSING THE PROPERTY LINE
• ON WESTERLY SIDE OF LOT
THERE ARE FENCES NEAR THE BOUNDARY
OF THE PROPERTY AND CROSS THE PROPERTY LINE ON SOUTHERLY,AND NORTHERLY SIDES OF LOT.
PROPERTY SUPPLIED BY CITY WATER AND SEWER.
•
� N J ;F14
v s409 .,No.6415 s'� SURVEYORS CERT1RCATE
'T'ARGE 'T'
1 HEREBY CERTFY THAT THIS BOItMRY SURVEY
ISA TRUE AND CORRECT REPRESEIITATKON OFA SURVEYING,LLC
i,i SURVEY PREPARED UNDER MY DIRECTION.
'. / NOT VAUD WITHOUT AN AUTHENTICATED ELECTRONIC
STAIEOF .€ SIGNATURE AND AUTHENTICATED ELECTRONIC SEM_ LB#7893
RAISED EMBOSH33 SEAL.'•�_°" 9":.,/ �A SIGNATURE
FLORIDA
ireVE,3
Kenneth D gitaIIy signed by 6250 N.MILITARY TRAIL,SUITE 102
Kenneth Osborne WEST PALM BEACH,FL 33407
Date 2017.04.18 PHONE(561)60.4800
Osborne,a,D,. STAB PHONE(800)226-4807
KENNETH J•.=.': PACF 2 PACES STATEWIDE FACSIW E(800)741-0576
PROFESSIONAL SURVEYOR AND MAPPER 56415 (NOT COMPi WI1 IOtJ1lf.{'P,E I7 WEBSRE:httpJRwfgetsurveying.net
Fence Addendum Updated 1/14/2021
City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233 PERMIT#
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
II L_)c- 1„I.n /0/6/2_1
Property Type: Lot Type/ Features:
Residential 'One Street frontage (interior lot)
❑ Commercial ❑ More than one street frontage (corner lot,through lot,
etc.)
0 Swimming Pool
Fence Material: Fence Height (select all that apply):
O Wood ❑ Four Foot (4ft)
O Chain Link x Foot (6ft)
Vinyl ❑ Other
❑ Block/Stone (Plan details required for footings and/or
retaining walls)
O Other
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?
O Yes (must submit separate Revocable Encroachment Agreement)
Ci No
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
iA No —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.