1761 OCEAN GROVE DR RESO21-0074 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
DERR STACY B 1761 OCEAN GROVE DR ATLANTIC BEACH FL 32233-5844
COMPANY:ADDRESS:CITY:STATE:ZIP:
BOSCO BUILDING
CONTRACTORS 2158 MAYPORT RD ATLANTIC BEACH FL 32233
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
169604 1000 OCEAN GROVE UNIT 02
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
1761 OCEAN GROVE DR
RESIDENTIAL OTHER SINGLE OR
TWO FAMILY RESIDENTIAL
OTHER
PAVER DRIVEWAY, PATIO
AND WALKWAY $8500.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 PUBLIC WORKS EROSION CONTROL INSTALLATION INFORMATIONAL
Notes:
Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line (904-247-
5814) to request an Erosion and Sediment Control Inspection prior to start of construction.
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.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY 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 WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
1 of 2Issued Date: 10/8/2021
PERMIT NUMBER
RESO21-0074
ISSUED: 10/8/2021
EXPIRES: 4/6/2022
RESIDENTIAL OTHER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BLDG 2ND PLAN REVIEW FEE 455-0000-322-1006 0 $50.00
BLDG 3RD PLAN REVIEW FEE 455-0000-322-1006 0 $75.00
BUILDING PERMIT 455-0000-322-1000 0 $95.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $47.50
STATE DBPR SURCHARGE 455-0000-208-0700 0 $8.59
STATE DCA SURCHARGE 455-0000-208-0600 0 $5.73
WORK WITHOUT PERMIT 455-0000-322-1000 0 $205.00
TOTAL: $486.82
2 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
3 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL
Notes:
Roll off container company must be on City approved list. Approved list can be obtained at the Building Department at City Hall. Roll off container
cannot be placed on City right-of-way.
4 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration, including sod, is required.
5 PUBLIC WORKS RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site. Cannot raise lot elevation.
6 PUBLIC WORKS MAXIMUM DRIVEWAY INFORMATIONAL
Notes:
Maximum driveway width within the City right-of-way is 20 feet.
7 PUBLIC WORKS DECKING REMOVED INFORMATIONAL
Notes:
All old decking and debris must be removed from job site by Contractor.
8 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Contractor.
9 PUBLIC WORKS OTHER PUBLIC WORKS CONDITION INFORMATIONAL
Notes:
No additional impervious area can be added to this property. Property is maxed out.
2 of 2Issued Date: 10/8/2021
PERMIT NUMBER
RESO21-0074
ISSUED: 10/8/2021
EXPIRES: 4/6/2022
RESIDENTIAL OTHER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
Du!ming rermit Application Updatedl0/9/18
City of Atlantic Beach Building Department ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address:I , / C C ( iVY' JJ/ Permit Number:
Legal Description O -10 G 9 AS 3- 9 % • 1e 3 RE# J L y 6c, — fd'e
Valuation of Work(Replacement Cost)$ iSoO• Heated/Cooled SF Non-He
Class of Work: New Addition—NAlteration Repair DMove Demo OPool Win /D r
Use of existing/proposed structure(s): Commercial Residential G 2 5 2021
If an existing structure,is a fire sprinkler system installed?: Yes No BY,.
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: it /hGc" exj7' G u 4 U'G . 1) ,r giv 4-
Mi" EY4f7)",4 /2004_ ,0a-lc w114 "I Vg-le--1
rf/jA ,V .' patio X411 ice'P•'cal4
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name 1 C J A l_)z7 R Address > 7`/ C Cg nn 6',4 Pn — Ai; 3 ;? J)
City 97L. j3c i' State 1 1-- Zip 3 9-i 3 5 Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company /:.:30 CO /3)-0 G-., T2z4cTGWs hre Qualifying Agent IC,'ISD /9 l
Address S /"1/g,/e:t TAP City T./../)( State f %- Zip 3 -1,1- 3 3OfficePhone 9'/ -c' .3 > o Job Site Contact Number Ye.< — 3 / a 4
State Certification/Registration# G GG E-Mail T',')i7 5 e-6 (-BG- c r/1
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurer A01';4'/X p'Ye .SQ 4.99c'? OR Exempt Expiration Date 16/3-7'
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, andtheremaybeadditionalpermitsrequiredfromother governmental entities such as water management districts, state agencies, orfederalagencies.
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 Fl 'AN'I c.-, CONSULT WITH YOUR LENDER OR AN ATTORN Y BEFORE
RECORDING YO i OF COMMENCEMENT. 6 -
Sig'.ure of Owner or Agent) Signature of Contractor)
rkh/3/Cia hL `/ /'e J r 1 )'/c,544 yriee}eJ 1Signedandswol/n to(or affirmed)befort me this2.. A day of Signed and sworn to(or affirmed)before me this "_day of
4,;11.47- > 1/ , by 4cL7e2f'ie 9 N;ST, ids/ ,by To v0
t/gid-" Prx
ISit?nature of otarvl
k'.?'••.WILLIAM L.POPE t."° WILLIAM L.POPE
ii 1.1 MY COMMISSION#GG 348645 MY COMMISSION#GG 348845NPersonallyKnownOFmJ^ po EXPIRES:October 19,2023 Personally Known OR =';;
47'747,5;:gEXPIRES:October 19,2023ProducedIdentificatignForFOBondedThruNotaPublic_Underwriters OF"p Bonded Public UnderwritersNotaryProducedIdentificationN
Type of Identification:Type of Identification:
RESO21-0074
01.11/ RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION ALL INFORMATION
irk City of Atlantic Beach HIGHLIGHTED IN GRAY IS4 "`
800 Seminole Road,Atlantic Beach, FL 32233 REQUIRED.
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address CYLA -`f'il-e DR, Permit Number
Contractor Information
Company / SCi 4 6 'n/i 'LAC iu ,r` Qualifying Agent l0100 %°ll L'
Address 0-1 /'9A//eh t Rte City J Ak State ft. Zip 3.9-2-3s.
Phone 9i - J-4 - V 7>o Email 'T&Ov LO.% ON" cac • Cell
State Certification/Registration# G BC -
Architect Phone Email
Engineer Phone Email
Workers Compensation Insurer1 I /1.'27A I X ..4'l d cff ce OR Exempt®Expiration Date 1
Permittee declares that prior to filing this application they have ascertained the location of all existing utilities, both aerial
and underground and the accurate locations are shown on the sketches.
Whenever necessary for the construction, repair, improvement, maintenance,safe and efficient operation,alteration or
relocation of all,or any portion of said street or easement as determined by the Public Works Director, any or all said poles,
wires, pipes,cables or other facilities and appurtenances authorized hereunder,shall be immediately removed from said
street or easement or reset or relocated hereon as required by the Public Works Director and at the expense of the
Permittee unless reimbursement is authorized.
All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the
supervision of Te 0 goJce Project Superintendent)
with (Company Name) ,e95 CaVir fC ;0,itS :Th/C, Phone 701
All materials and equipment shall be subject to inspection by the Public Works Director.
All city property shall be restored to its original condition as far as practical,in keeping with City specifications and the
manner satisfactory to the City.
A sketch of plans covering details of this installation,as well as a copy of a recent survey shall be made a part of this permit.
Calculations showing any increase in impervious area on owner's lot or in the City right-of-way are to be included with
this application.
The permittee shall commence actual construction in good faith within days. If the beginning date is more than 60
days from date of permit approval then permittee must review the permit with the Public Works Director to make sure no
changes have occurred in the area that would affect the permitted construction.
It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right,
title and interest in the land to be entered upon and used by the holder,and the holder will, at all times,assume all risk of
and indemnify,defend and save harmless the City of Atlantic Beach from and against any and all loss,damage and cost of
expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges.
The Public Works Director al t ie 24 ••r,rs prior to starting work and again immediately upon completion.
Date
Permittee(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument wasrmacknowledged this .7Cl i day of , NJIY/ 20 .J ,
by j2 C9- e''SC C who personally appeared before me and
printed name of Permittee)P(-0)/G41-C % /`'ee1erl r WILLIAM L.POPE
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. MY COMMISSION#GO 348645
i•8: EXPIRES:October 19,2023
P" Bonded Thru Notary Public Underwriters
J'!%- 4 . >4 Personally Known
Signature of Notary Public,State of Florida Produced Identification(Type)
RESO21-0074
NOTICE OF COMMENCEMENT
PREPARE IN DUPLICATE)
Permit No.
Tax Folio No.State of County of
To whom It may concern:
The undersigned hereby Informs you that Improvements will be made to certain real property,and inaccordancewithSection713oftheFloridaStatutes, the following Information Is stated in this NOTICE OFCOMMENCEMENT.
2o -09 7 C-29 IC 3LegaldescriptionofpropertybeingIproved:
EZEi4U Gi UU (1(ST O O,2
60 751- coi
Addr ss of property being improved: 1 7 61 o C e wt 6-'O 1/e 6r, 1-1-/Wt `Ceac.k . FZZ 33
General description of improvements: P ' -r Nenc e L q.,ld SccJ,j,154' 3G F-c-€ 11: s'
Owner S-f"ct-c y 93 err
Address (-76( OCC rove Dr, A4-/(z..4'It C 1S 4C 4, {L ,?22- 7J
Owner's interest in site of the improvement f,M PrOvMM(c -{- i 0 v
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor 8C, SC 6 d,Jy COA+rc 6-fur c_ (Todd- igoSgS
Address Zr /S''Q .i t xPar-4- (d, J4cYrdn.v.'(ie -6 z23
Phone No. 46`j_ Zy( —G T 40 Fax No.
Surety(if any)
Address
Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name
Address
Phone No. Fax No.
Name of person within the State of Florida, other than himself or herself,designated by owner upon whom
notices or other documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself or herself,owner designates the following person to receive a copy of the Lienors Notice as
provided in Section 713.06(2)( b),Florida Statutes.(Fill in at Owner's option).
Name
Address
Phone No.Fax No.
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless adifferentdateisspecified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
SDATEigu P/h kot' 1 7':
5itf
Beforeno r t I Ilk day of_34-AL i '_ in theCountyofDuvalSttofFbrlda,hasperson a T
tareiWgcUAMI„POPEDoc#2021220154,OR BK 19877 Page 1845,himself/herself and affirmsthatallstatements gd la;,. - •saretrueandaccurattrr--• pm°OMMISSIQN#GG 348645NumberPages:1 71Z7 J/ EXPIRES;October 19,2023Recorded08/24/2021 02:17 PM, FOr,rgt.' Bonded TinNotary Public UnderwritersJODY PHILLIPS CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING $10.00 Scat arge.stateo +— . County of_adtry - ion expires: /O –
LPSfsanagy Known`r orProducedIdentification
RESO21-0074
EXISTING FLOOR AND WALL
FRAMING
2)2X8 LEDGER. FASTEN TO
EXISTING WITH TLOK6 AT 24"O.C.
I 2X8 RAFTER AT 12"O.C.NOTCH
AROUND END CAP. FASTEN TO
FLOOR SYSTEM WITH (2)TLOK10.
IVAI 11
2X8 END CAP. FASTEN AT ENDS
WITH TLOK10
EXISTING WALL FRAMING
TRELLIS CANTILEVER
3/4"=1.-0"
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4 .., q t 1"...THIS ITEM HAS BEEN ELECTRONICALLY SIGNED AND SEALED BY GEOFF GARTNER,PE,USING A DIGITAL SIGNATURE.PRINTED COPIES OFTHIS DOCUMENT ARE NOT CONSIDERED SIGNED AND SEALED WITHOUT THIS STATEMENT.(FAC BIG15-23.085(0)&81G1-18.805}
Z. w ; G m — Sheet No. Draw
0 : NO.59328 7 ' BOSCO BUILDING CONTRACTORS `
SIGNS N 21-0108
C} Tft.EVER SECTION Check Ey: N. DATE DESCRIPTION BY APPD
GWG DERR RESIDENCE 1 08- 27-21 ISSUED FOR COMMENT AND REVIEW GWG GWG
o STATE OF : AI OOr.
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FL PE 59328 08-27-21
TLANTIC BEACH, FL
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NOTVALID WITHOUT AN AUTHENTICATED ELECTRONIC
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ORARAISED EMBOSSED SEALANDSIGNATURE
LB#7893
Digitally igned SERVING FLORIDA
Kenneth by Kenneth 6250 N.MILITARY TRAIL 02
WEST PALM BEACH,FLL 3340733407
Osborne PHONE(561)640-4800
SIGNED) STATEWIDE (600)PHONE (800)226-4807
KENNETH J OSBORNE O s T f 2020.06.09 STATEWIDE FACSIMILE (800) 741-0576
PROFESSIONAL SURVEYORAND MAPPER05415 1) WEBSITE:httpJ/targetsurveyUg.net
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