122 6th ST RFNC21-0134 Building Permit Application Updated 10/9/18
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City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept • coab.us
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Job Address: 1p3 C
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Legal Description �/� Lt.l Ifeke Z. /9 / 41 ) 5 41)/ / 70)4/9- oec)
Valuation of Work(Replacement Cost)$SP1411
Heated/Cooled SF Non-Heated/Cooled ✓
• Class of Work: ❑New DAddition lIteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes izrfio
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) (txao
Describe in detail the type of work to be performed:
ET4tac4.3, 6- -- - 6 ouig ....(2.14,C ei„Miettet
Florida Product Approval# for multiple products use product approval form
Propert Owner Information
Name Address /4:73 444
City R ,/�'J :' State4e_Zip 3 Phone •-f/ 7> 1Qc ^ fr3 3 j
E-Mail OA/61 l 45v, I) 14ZauP I C'eYr)
Owner or Agent(If Agent, Power of Attorney Agency Letter Required)
Contractor Information //��}},,�''LL,,�� pip s
Name of Company , (UJ e t �b ID r/ ualifying Agent -9 (TX) (, �,{Address //�2 �3 m 5 , City cp.cmia.ttifeE State pc. Zip 3:4.-4(:.,3 0
Office Phone Vo 4 _a U/ - .2 4 4, Job Site Contact Number
State Certification/Registration# E-Mail 'ACNE C<..b
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt/Expiration Date 7////2
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,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 of Owner or Agent) (Signatu,' Contractor)
e d swc4-nn,to(or affirmed) before me this , day of Signed and sworn to(oar ffir 411)before me this day of
, --1 J �,by I IA/ / 1 I O1/ ,z�G by_ i.4/AT n) � /r
X r4/
dv ot-pigetzuf o ,te a .tur-of �
4 f'=v-_..: �:. it
f ':+'' TONI GINDLESPERGER
�' MY COMMISSION#GG 353178
[ ]Personal) �nuKv,,�,utt —I 1 Personally Known OR 4 :*
� ;o<, EXPIRES:October 6,2023
TONT GINDLESPERGER
[ ]Produced Jet"'a�f'" [ ]Produced Identificatiofa:eP,;
COMMISSION#GG 353178 Type of Identificatio F, - Bonded Thru Notary Public Underwriters
Type of Iden 'inti N�
�KES:October 6,2023
F'° aorided Thru Notary Public Underwriters
ri ''r2,, Fence Addendum Updated 1/14/2021
jCity 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:
t zZ c xri-J s 1 1 1 2,-/2 r
Property Type: Lot Type/ Features:
lrResidential ❑ One Street frontage (interior lot)
❑ Commercial J 'More than one street frontage (corner lot,through lot,
etc.)
El Swimming Pool
Fence Material: Fence Height (select all that apply):
,Z "Wood 0 Four Foot (4ft)
O Chain Link 'Six Foot(6ft)
❑ Vinyl 0 Other
❑ Block/Stone (Plan details required for footings and/or
retaining walls)
❑ 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?
❑ Yes (must submit separate Revocable Encroachment Agreement)
,12'No
Will tree(s) be removed in association with proposed project?
El Yes (must submit separate Tree Removal Permit)
/1Z 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.
MAP SHOWING SURVEY OF
STREET THE EAST 1/2 OF LOT 6, BLOCK 19, PLAT NO. 1,
WAY
PAVED BENCH MARX:SET MAa4A� SUBDIVISION A" ATLANTIC BEACH AS RECORDED
EIEVA1KIN"1121 M.A.V.D.1986
6th 40'RIGHT OF is IN PLAT BOOK 5, PAGE 69 OF THE CURRENT
12.68 OOO PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
12.74 -
12.3112.¢6.._-_.._ S� ��\ POMER
13.PALM _-.�(79.04' FIELD
10'PALO P4 1'9,....W coo' rTT7 Par
WINK;POMFR ecu• 79.00, T'' 7
II-PAW\ Wf•� t
QMD 1.•ROM , I9., �.
PIPE.No CAP PAIR D16vE zw 9.2 ,11.T r,2'''''
,a w, NOTES
d Y1111'ge. lY PAW , 2.9 3.5 ti.
/'1 7. THIS ISA BOUNDARY AND TOPOGRAPHIC
POUND 1/2'RON 79.00' _ 199 4l
,17 d1' i,z,5 _. 49 3 I SURVEY WITH TREE LOCATION.
No CAP paee' �) �� J = 2. NO BUILDING RESTRICTION LINES PER
1zs /.- -OR 14.6 0� (i,`'2*
PLAT.
\s-_^ 13.• s" 1."- 3. INTERIOR ANGLES SHOWN AS PER FIELD
O' - v SURVEY.
2 STORY FRAME 4. NORTH PROTRACTED FROM CITY MAP
n iD 20 •13.1 260
m rp \i, oa RESIDENCE No. 122 r i 5. BENCH MARK AS SHOWN HEREON WAS
�, THE WEST 1/2 '?O 13.06 TMISHED FLOOR"1136 IJ"PAIY j•\ < ESTABLISHED BY GPS OBSERVATIONS
Z o OF LOT 6 1,,m O 1x1 `12'1 °0Ei P •.! y.� RUNNING TRIMBLE USING SPECTRA PRECISION
SOFTWARE IN
Io / 6 P iz \ .. 7.p J 9 -0 N.A.V.D. 1988 DATUM.
38S 10.1' ;4• PALM > 6. THE AVERAGE GRADE OVER THE
coc 0 I I 10:11. 16.6' ��R. J(9 SI UNDEVELOPED PORTION OF THE LOT IS
4 112'4 1� . \ a�!8 •'7-, v mlp 12.9 N.A.V.D. 1988.
y if2 �:• 1.z' iligii s.a
r 0.. • J PAWIIA11 I D.J' 81261 C
m 76.33 b •6 .n N�H. 8.3 2 m
0.2 (76.76' FIELD )
XI PSE tra W36 ) LOT 5 _ 9 40
9 8 t, 1 Z DI � 9 1�°
SCALE: 1. 0 20'
1 IMPERVIOUS AREA:
THE PROPERTY DESCRIBED HEREON LIES IN
FLOOD ZONE "X" (AREA OF MINIMAL FLOOD LOT AREA - 3,933 SQUARE FEET THIS SUR WAS MADE FOR THE BENEFIT OF
HAZARD) AS WELL AS CAN BE DETERMINED CANDICE L .
HOUSE • 1,771 S.F.
FROM THE FLOOD INSURANCE RATE MAP No. ALL PAVERS&CONC. - 775 S.F.
12031C0409J, EFFECTIVE NOVEMBER 2, 2018 TOTAL IMPERVIOUS • 2,406 S.F.
FOR DUVAL COUNTY, FLORIDA. - 61.2% �_.,.
(NO WOOD DECKS INCLUDED) J
DONN W. BOATWRIGHT, P.S.M.
'NOT VALE e1114OUT 111E 9(68AlUiE AND 114E ORIGINAL FLA. IJC. SURVEYOR AND MAPPER No. LS 3295
SEAL CC A 1L(DOA UcONs.D 988KroR AND MAPPER.. FLA UC. SURVEYING&MAPPING BUSINESS No. LB 3672
CHECKED BY: --
DRAWN BY: KLw/swC BOATWRIGHT LAND SURVEYORS, INC. DATE: NOVEMBER 4, 2020
FILE *� 411 2020-1284 1500 ROBERTS DRIVE JACKSONVILLE BEACH, FLORIDA (904)241-8550 SHEET 1 OF i