197 Pine St Driveway Submittal Solid Foundation 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
un}' IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: ('t 1 eIlWtr - Permit Number:
Legal Description 16.-/ He 25 Z°IE Sii-ft AA-tL Sct 3 /fit (� Z3 RE# 110G35--60 (0
Valuation of Work(Replacement Cost)$ —(401-Zoo Heated/Cooled SF Non-Heat E
• Class of Work: III-New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo [Wool ❑Windo o OCT 1 9 2021
• Use of existing/proposed structure(s): ❑Commercial Eliktesidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes 11No
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) LLI
Describe in detail the type of work to be performed:
letlet.,� ova 0 Id 01I�t=�3 p'�}1(+ 0 , -)41 J1)611? e_O kiLY e-frr 1 kl I/1,--to 4
Florida Product Approval# for multiple products use product app4roval form
Property Owner Information /
Name 1 l/t'l' A T'l - Lek Address 6l 7 LIP%tn./ •"(
City 1444k 1 )1, �J State ( Zip 32233 Phone 4164-gto -
E-Mail .3. .1,1Sr I.Y1 C10A-lit Co ti
Owner or Agent(If Ag nt, Power of Attorney or Agency Letter Required)
Contractor Information l rr
Name of Company C,a41(f4 -c ;salifying Agent �C tG ,/� @DU1J" S
Address C 32,q ,n Df 1'.>`e City `5_0,4c State . C- Zip 32.2 ('J
Office Phone of Oy-So S3 --(a 4 7 8 Job Site Contact Number
State Certification/Registration# C( c' '' y 12e, 2-E-Mail be.1(ar• 2 r3 e
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt) Expiration Date 67-Z 2-
Application is hereby made to obtain a permit to do the work and installations as indicated.)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 WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
(Signature
Owne Agent) ignature of Contractor)
Signed and sworn to(or affirm )before me this /q day of ne
d and sworn to(or affirmed)before me th's lq day of
OCT , 2021 , byi‘c�1 � 11 , S 1, SidCT , 20Z1 ,
by g ( c- A1
G 41 0114444:26-t--
(Signature
(Signature of Notary) (Signature of Notary)
........
CHRISTIAN G $ersonal Known OR �' HRISTUW GILES
[ ]Personally Known OR �� a9""
MY COMMISSION# :.; '' MY COMMISSION#t HH 117153
[►�}'l'roduced Identification -�: y��� = �7aKi�ce�' Identification _
Type of Identification:f�- �-L- ••'.'Fp PIR6S:April1� �fIde •fication: .'�!�'O EXPIRES: 1 41
r Bonded The Nol2y Public ndeivi tern ..
�NOfery PubNc U1Me,rgly�
.-coo RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION
A\m City of Atlantic Beach HIGHLIGHTED IN GRAY IS
-111,24' 800 Seminole Road,Atlantic Beach, FL 32233 REQUIRED.
`4011
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address `� `] P;.� S�4 f- — Permit Number D w y 21 -0o 2 �,
Contractor Information
r L
Company S 4 l� �� �UuLA.cL4-ut 'i' C r)r 4c-orS Qualifying Agent d rt.(v. '&UT-)-S
Address a 3 0 A-1�,,` 1t rt',urt City State tz t Zip 3.22(6
Phone 6 "6`i )Q Email FSC‘c.Ael e;..22 e ."0"v---
State Certification/Registration# L 1 5 O boo c( I 2 a =Z
Architect Phone Email
Engineer Phone Email
Workers Compensation Insurer OR Exempt 5tc Expiration Date UD 2 2
• 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 °DC (Project Superintendent)
with(Company Name) 5t1 p-a vh.„c a ko,n Cr_,"hcrr 4 r r La-Rhone 41-by—c 03—G'/7 c,
• 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 I C 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 shall be notified 24 hours prior to starting work and again immediately upon completion.
Letz,4 MA • c�� Date /o '1? IL/
Permittee(signed in presence of tary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this '0 1 1) day of OCTOBER. ,20 24. ,
by P3r)Astt-d I9_ S /CK ,who p
(printed name of Permittee) r `':icir ,. CHRISTIAN GILES
. ,A, :, MY COMMISSION#HU 117153
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. `. EXPIRSS:April13,2025
'••••.mf;;.... Bonded'Mu Notary Pubic Undentr1ete
[ ] P sonally Known
Signature of Notary Public,State of Florida [.Produced Identification(Type) FL- v• (r'
H:\Applications&Forms\Word&Excel Document originals\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18
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AGREEMENT TO ACCEPT TRANSFER
\J
OF UNCOMPLETED BUILDING PERMIT
This agreement and a new Permit Application are required
to transfer an uncompleted building permit.
� c ckv, N\ ��f , Phone qo - s `Z-1 Cj ,
Address b f 01--Q
Email D.1_ LI GUrvb c Cc
State Certification/Registration # L, ( S 0c on L ► 2. , understand that Building
Permit D ` v was started by another contractor and is currently
uncompleted.
I agree to, after reviewing the approved plans and the unfinished as-built construction, to
submitting a Revision Form and revised construction drawings to the Building Department to
correct any deviation between the approved plans and as-built construction, where found.
I understand that, based on the current inspection record, I am responsible for the Code
compliance of the finished project.
Details (Optional)
State of Florida
County of Duval
The foregoing instrument was acknowledged before me this day of ,
by ,who personally appeared before me
and acknowledged that he/she/they signed the instrument voluntarily for the purpose expressed in it.
Signature of Notary Public
[ ] Personally Known OR
[ ] Produced Identification
Type of Identification:
N � �
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NOTICE OF COMMENCEMENT
State of El�.. Tax Folio No. 1. I'sL 0(.Q3 S 00 1 0
County of ID UV A-(
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713
of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT. I ‘
Legal Description of property being improved: cj I d d I- t,`t>'" iJ Pt----0MA — A) rt) C7 I�'-i J0� —
111)441( ci (baa) it.eE ) idi,vi=k_-- /6-- l(e /4 - Vi E_
A N
Address of property being improved: i'q'7 i 1 !VL - SA 1f#1 t .5- -e--3 i_. 't 1
Gen al description of im rovements:
►acl- I � ��
V 14--1 111z'Zv'i L-0-0C-�i4E:
Owner: [ ; C•.�/11} e_s:.I H .L zit/4-i Address: t' Val )1)e, -
Owner's interest in site of the improvement: 014e Cu) in_
Fee Simple Titleholder(if other than owner):
Name: C .i." f ,,i el-r 1
Contractor: c&II•c1 �Mx^.Aa A- i' r C0 r h(-cc.,1e.tsI 14-6-
Address: 6 3`3n 41c:„ . �i1:t& ________—
—
Telephone No.:
(1611--sdc7 (, y70 Fax No:
Surety(if any)
Address: -Amount of Bond$
Telephone No: OtO`'i— C O S3`"-c K7o 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,designated by owner upon whom notices or other documents may
be served: Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b), Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is
specified): —
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Doc#2021274497,OR BK 19965 Page 1219, Signed: Date: (0 Ilcilz, i
Before me thisdayof ,CJ .1 in the County of Duval,State
Number Pages:1 i�'f{^i �
Recorded 10/19/2021 11:16 AM, Of Florida,has personally appeared L.n. L-
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL Notary Public at Large,State of Florida,County of Duval.
COUNTY My commission expires: v
RECORDING $10.00 per • or
Proauc�¢i '' kjfication:CHRISTIAN GILES
? '.;, MY COMMISSION#HH 117153
"a-r--.. EXPIRES:April 13,2025
%ter � e`,�
'4..OF, p'' Bonded T ruNotary Public Underwriters