1865 HICKORY LN DWAY21-0049 Building Permit Application Updated 10/9/18
J�
.,,._ City of Atlantic Beach Building Department **ALL INFORMATION
_ / 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
uxlv`, IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: f cc(. S 4.-1 t G(4-0/L'1 L-L/i✓'- Permit Number: DW RCI z ( w`rt el
Legal Description Lac" /571 S44vf n11-44../.4- c..w1 i 12^C QhPG,,it r RE# l`7tc, 2-0 --7.F3 2-
Valuation of Work(Replacement Cost)$ U, gg ap Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New DAddition L?JAlteration DRepair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial Lesidential
• If an existing structure,is a fire sprinkler system installed?: DYes K I o
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ONo
Describe in detail the type of work to be performed: ,2.i_rt o vi Q>"i5 i",,,et C 'Z' 7X P.a./"k'"-4-y/
Cc/�P '2.4,•r'P sf/NS i if-I., Gon/G,,t 6.i 7 Psi.✓.62$.
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name ti,d -f154 ( /-g-, ,4 //1/fi- C4/7Pb�GL Address /Q,GS E/ic-1 ,1eti L-4-/vi.
City 4-r A/7-[ G 131AG4-{ State FL Zip 3ti233 Phone ''o4 - qeo - Ov 7`t
E-Mail GYcIeCO{ rrp COtitrast -•? .-i-
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company iCGah✓ j I lip. Qualifying Agent 41/e/4.7,4,--) ic,"„- ,r"ti
Address .09' 3y74-c/ �i City :A". /3cL State min- Zip j Z Lr
Office Phone Id y-YZ'- toy/ Job Site Contact Number
State Certification/Registration# E-Mail Lt/rir�ic., Go A fr. Nit
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt i- Expiration Date ZO i 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
-'RDING YO ' NOTICE OF COMMENCEMENT.
Via' - —
(Signature of Owner or Agent) (Signature of Contractor)
0
i F •d and sworn o(or affirmed)b fore me this I''4tay of Si ned and sworn to(or affirmed)before me this C.. day of
" .i' :At k , Y UIf`,l�JAM'V Cfi`1Y��0e,\k 'Lib „by C\.;t•-ycv..-ei +W`,-c .c\.c�_ !.'
O c ,=
0 0 c.- , (Signature of Notary) (Signature of Notary)
Wy Q t
-L N 1-
E
-J v w Personally ,',).'''.'"••‘°%1....'"••. COLLEtNA KEELING
�P rsonally Known OR [ ] ersonall Known a•41 - Commis #GG 165631
' J Produced Identifica •t4 '•'
P educed Identification [ "
�r,/� '•:';',7 "+•1.1:� � �:.: ber 7,2021
� : : N 0\,CC "'C"`C t ^ ,,�
•.'�f ,!�.e.f Identification: � � lQ�� L " Type of Identification: ... ,��'i`k,•.,._ _ •. ,
St
MAP SHOWING BOUNDARY SURVEY OF
LOT 15, SELVA MARINA UNIT NO. 12-C REPLAT, AS RECORDED IN
PLAT 900K 37, PAGE 29, OF THE CURRENT PUBLIC RECORDS OF' DUVAL COUNTY. FLORIDA.
CERTIFIED TO:
WALTER W. CAMPBELL AND LEA ANNE CAMPBELL
TICOR TITLE INSURANCE COMPANY
JAX NAVY FEDERAL CREDIT UNION
BUSCHMAN, AI-HERN. PERSONS AND BANKSTON
a )
1 LOT 10
S 00-24'53" E 86.00• (PLAT)
rouND 1/2" IRON PIPE S 00'08'03- E 86.34' (MEASURED) F007700142"IRON PIPE
SIARPED •LH 6645
Q O NOT1FICATON
Ldp-
LOT 15
X
. % Q +
W 2a.T•
74.•' La-
1
v
d'S LI
W N 164 W
p - '� • 6.6' O
p `i a ..,-..CO
C, -CTI - TWO STORY ,t .--.o
-- CF) MASONRY & FRAME
rn 7_, POSTED Jf.1865 rn
rnCS)
\ ,-
LO': 14 66 LOT 16
_ W
l...l L 16.3- x A 3....
n 6.6' 10_0' 1.n h
o O i
n 0
In Ls,
;-� r7 • ._ / u,
d-h
2 c0
g Ai CM Ao
.:;::
C___,.........)33 CO
1n
IIB' X
: ..
,....._
.:. • .....7 •.- ....... ,..._
G7 4
I '•• .: , • - O 70.3T PLAY PONT of CURVATURE
F :.urED LnJ.7o�- N 00'11'07". W 86.04' (MEASURED) sSTT.AN1tDPED'WS E
N 00'24'53" W 86.00' (PLAT)
HICKORY LANE
(60_17 RICHT OF WAY)
NDTES: r A CERt IOFIED TO HF
A TRUE AND
LEG_ND: CORREC PY O Ti IE C7RtGInts�L.
N •• RADIUS -•-Y--X.= FENCE /J
L - LENGTH CD - CONCRETE i'C!J .
NOTES:� • REv1510NS -
I. A1:_:CS ARE BASED ON 1HE PLAT BEARING OF N 89 '07' E ALONG THE
NOR"::ZRLY eC'JNOARY LINE OF SUBJECT PARCEL
DATE DESCRIPTION
2. DY L.,/.PHIC PLOTTING ONLY THE CAPTIONED LANDS LII: WITHIN FLOOD ZONE T AS 340,0.: ON THE
NAT1.:IAL FLOOD INSURANCE MAP DATED APRIL 17. 1080. COMMUNITY NUMBER 120075. PANEL OCIDL JL
3. THIS :,URVEY REFLECTS A:,. EASEMENTS & RIGHTS CF WAY AS PER RECORDED PLAT &/OR TITLE COMMITMENT
IF SL;•PLJED. UNLESS OTHERWISE STATED, NO OTHER TITLE VERIFICATION HAS BEEN PERFORMED BY THE UNDERS1CNED.
4. THIS. :.UR VEY NOT VALID WITHOUT THE EMBOSSED SEAL OF THE CERTIFYING SURVEYOR.
JOB' if 10655 J GATE OF FIELD SURVEY: 02-28-00 1 DISK /t • CD-3 I SCALE: 1" = 20'
y:, i•'r'4: 'er/. ERTIFICATE
.f. 4%,.A.._.:-....T. : j.• 'jr•1: 2.522 Oak SEr<el . HEREBY CERTIFY/RAT PAS DIA VEY WAS JASC UNDER UY RESPONSPLLE CN ARcE
.7 61��M' r. �i •' 'o CYSPnvi1lc, Florioo 32204 AND MEETS TIE NWIUUv IICNN.AL STANDARDS 'S :ET FOP TN Uv TIE FLORIDA
r.•I.': 'Y1� g,rr '� IOARD OF PROs AL SURVEY AMO MA:'PF.RS IN CHAPTER 61017-6. FLORIDA
F; 4 (F.6.) 401-3 0- 175 '
X(t. •��,4 � C)/: ;i !� i� ( ) ADLIHLSTRA S RSt3wt1Y 70 :ECP' 4;2oTj, •1DA STATUTES.
Fo• 904-30'5-6175 '
)•i11C; : j: rig' -
34'• .. t.:7,"%:•J. rL• .A MICHAEL J. AIG'.0
r LICENSED BUSINESS N 6702 RCCISTERED SURVEYOR AND MAPY': -07e STArT or F,oa10.,
LAND SURVEYS 0 CONS I}-'UCTION SURVEYS 0 SUBDIVISIONS
86.34'
Lot Area 8,509sf
Impervious Lot
House Area 1 ,850sf 8509sf
Driveway 376sf
Ramp 228sf q
New side 56sf Wood Deck
Total 2,510sf
29.5%
� 0 House
1 ,850sf
a' a;
a' Q,
Wood Deck
New
Pavers/Ramp
Side / ///////� l�r (remove
I
pavers � Pavers j - �j wood ramp) I
56sfDriveway 228sf
376sf c i) A
_ , j� 86.04'
1865 Hickory Lone