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680 MAYPORT RD FNCE19-0133 ic,,,,APP? City of Atlantic Beach APPLICATION NUMBER 3ilding Department (To be assigned by the Building Department.) jAl;Fp; l800 Seminole Road e, J / r -i' --v l 33 ., Atlantic Beach, Florida 32233-5445 r �" t�t� q� Phone(904)247-5826 • Fax(904)247-5845 10 1 3 I ' � E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: V1 SO Rti-ktport a• D ment review required Ye 1 No Bu li ding Applicant: 0Ln)((( ming &Zoning \ dministrator Project: \(�S�LI 1 S — +(`,,�( . p\ h-ti Y n `'(/< it�f mrm� n� CPublic Utilities '�I I Public Sate y Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department I • ' MA.'roved. Pkfenied. ❑Not -•• •.- - - (Circle one.) Comments: ftqll'S--if BUILDING PLANNING &ZONING Reviewed by: Date: //- 5-^/ 9 TREE ADMIN. Second Review: ®Approved as revised. ❑Denied. ❑Not applicable PUBLIC WORKS Comments: Af ill/,I /b Sperj.041 D -P P4,'Svov 4i oi9 -eirt 4 16T PUBLIC UTILITIES het/ ivil O n A`I /_ P ce5 a rQ i n 64/ /- PUBLIC SAFETY Reviewed by: f Date://_ s-' / FIRE SERVICES Third Review: Approved as revised. (Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 r'''. Building Permit Application Updated 10/9/18 rr 4- S ;� City of Atlantic Beach Building Department **ALL INFORMATION +� 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY cm 1.0' IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: Co '3 MG \/ poi+ 12 8 ' Permit Number: — Legal Description RE# Valuation of Work(Replacement Cost)$ t OCA e OC Heated/Cooled SF Roif H tell moo ed • Class of Work: INew Addition ❑Alteration ❑Repair ❑Move ❑Demo [Wool ❑Window/Door • Use of existing/proposed structure(s): riicommercial ❑Residential OCT 3 O 1019 • If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No • Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Rem�o�vall�Permi,' Ito Describe in detail the type of work to be performed: I(' S :C\\\ a -Fe r c- I u3k-c \ kiZy IT E`171. , p-� �' X11 i , . r, r' [" t._ �r.��plmen-fi �' mul � -�' �'�c�. City afi/�:i;::��; ��.,:�_..fE, Florida Product Approval# for multiple products use product approval form Property Owner Information Name �t-tar)t1GtbcocXlk3embiy occ 0d Address 00 Mea/ port- Rd . City A.,Elm -� nd i � r°© U�e•C e o n e` — a E-Mail •iS. • •>- WWII: e 4 Owner or Agent(If Agent, Power of Attorney or Agency Letter Requireill Contractor Information Name of Company Qualifying Agent Address City State Zip Office Phone Job Site Contact Number State Certification/Registration# E-Mail Architect Name&Phone# Engineer's Name&Phone# Workers Compensation Insurer - OR Exempt❑ Expiration Date 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 YO �aif► e �'1 COMMENCEMENT. r (Signature of Owner or Agent) (Signature of Contractor) Signed and sworn to(or affirmed)before me thiscV '�{�day of Signed and sworn to(or affirmed) before me this day of 0ck0beir , t. ,OI , byGreeoyD.Huii0 , ,by L Q01,0/ �?a�t ) (Si nature of Notary) (Signature of Notary) [Personally Known OR ""N, NANCY L. MASTEN [ ]Personally Known OR [ ]Produced Identification * MY COMMISSION 1GG364II3 [ ]Produced Identification Type of Identification: \,,.,.d EXPIRES:August 08,2023 Type of Identification: -0-An, Owner Builder Affidavit **ALL INFORMATION AL i HIGHLIGHTED IN k "' City of Atlantic Beach Building Department GRAY IS REQUIRED. 800 Seminole Rd, Atlantic Beach, FL 32233 �-+ /-� Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: 1- n' 1 /q —CV Y3 I. FLORIDA STATUTES;CHAPTER 489, FLORIDA STATUTES, PART 1"CONSTRUCTION CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. . III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO$5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY"CERTIFICATE OF COMPETENCY" OR THE FLORIDA"CONTRACTORS CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904- 247-5826 OR BUILDING-DEPT@COAB.US) IF IN DOUBT. V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. Job Address: 6gO May por+ Rd • tard-1 G beach , FU • Owner Name: Lisgh+hOu3e-, 0,11 q 4 ris+ian PreschcbI Phone Number: ( ) ► 12 - Mailing Address: (,80 Maypor+ Rd. City: A+Iarti-1ceeQei)State: FL) Zip: 3110,83 Notarized Signature of Owner I � The foregoing instrument was ackno ed ed before me this ca 'day of 0d1)be.r , 20 I q, in the State of Florida, County of D uN ci Signature of Notary Public (-/'20.-/XV-% `K ?"//'J "�P°&� NANCY L. MASTEN • [ }ersonally Known OR [ ] Produced Identification 460 MY COMMISSION 4 GG364113 EXPIRES.August 08,2023 Type of Identification: Updated 10/24/18 City of Atlantic Beach APPLICATION NUMBER Y Building Department a (To be assigned by the Building Department.) '� 800 Seminole Road / �/l� w [ 33 5–penr Atlantic Beach, Florida 32233-5445 r FA) Phone(904)247-5826 • Fax(904)247-j8 5 NOV u 209 `D ` 3 i i 1e) 71711!7' E-mail: building-dept@coab.us ! Date routed: City web-site: http://www.coab.us BY: APPLICATION REVIEW AND TRACKING FORM Property Address: (.0 UO ka_ipui Se.paTtment review required Yes No (Building Applicant: 01,\AI-4 fanning &Zonin T -- Administrator Project: ns\a O S— Seni_Q._4- - '1 ` • VA r,t_n t ( Public Utilities (/� I'1' 'LI' TPublic Sate y Fire Services Review fee $ Dept Signature Review or Receipt Other Agency Review or Permit Required of Permit Verified By Date Florida Dept. of Environmental Protection Florida Dept. of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: Vpproved. ❑Denied. fNot applicable (Circle one.) Comments: BUILDING PLANNING &ZONING yg-/j��� ' ./2, 6 —1 f Reviewed b r Date:/l TREE ADMIN. Second Review: ['Approved as revised. Denied. Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES • PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: I 'Approved as revised. Denied. F INot applicable Comments: Reviewed by: Date: Revised 05/19/2017 PUBLIC WORKS PLAN REVIEW COMMENTS n/ Date: // / / , Application#: f�V /9� � 3 3 Project Address: % o Q fir l)r W CONDITIONS OF APPROVAL TO PRINT ON PERMIT Check Box to Select All concrete driveway aprons must be 5" thick,4000 psi, with fibermesh from edge of pavement Driveway to the property line. Reinforcing rods or mesh are not allowed in the right-of-way. 0 Apron (Commercial driveways—6"thick). Erosion Full erosion control measures must be installed and approved prior to beginning any earth Control disturbing activities. Contact the Inspection Line (247-5814) to request an Erosion and Sediment 0 Control Inspection prior to start of construction. Onsite Runoff All runoff must remain on-site during construction. Post Const. If on-site storage is required, a post construction topographic survey documenting proper TOPO construction will be required. All water runoff must go to retention area and retention overflow 0 Survey must run to street. Pool Pool—Wellpoint (if used) must discharge into vegetated area 10' minimum from street or drainage ❑ Wellpoint feature (swale, structure or lagoon). Roll off container company must be on City approved list(Advanced Disposal, Realco Recycling, Roll off Shapells, Inc., Republic Services, Donovan Dumpsters, Phillips Containers,JDog/Dennis Junk Container Removal,All American Roll Off,WCA Waste Corporation). Container cannot be placed on City ROW. ROW Restoration Full right-of-way restoration, including sod, is required. Utility Any utility cuts in the road must be repaired using COJ Standard Detail Case X and must be overlaid ❑ Road Cut 10' in each direction from the center of the cut. Repair must be shown on the plans. Construction Provide construction site management plan, including location of silt fence, dumpster, portable ❑ Site Mgmt. toilet. Right-of-Way Permit is required if using right-of-way for construction parking. Runoff All runoff must remain on-site. Cannot raise lot elevation. Document Strongly suggest thorough documentation of impervious areas be recorded. 0 Impervious Slab Slab and driveway to be fully removed. 0 Driveway Maximum Maximum driveway width within the City right-of-way is 20'. 0 Driveway Circular Maximum circular driveway width within the City right-of-way is 12'. 0 Driveway Grass Full site to be grassed. ❑ 10P0 Must provide a topographic(TOPO) survey with water retention for final CO Inspection. 0 Survey Revision Any plan change must be submitted as a Revision to the Building Department. 0 Fencing All old fencing and debris must be removed from job site by Contractor. Removed Decking All old decking and debris must be removed from job site by Contractor. 0 Removed Infra- Any damage done to infrastructure must be repaired by Contractor. 0 structure Revised 2/26/19 rS�s4y City of Atlantic Beach APPLICATION NUMBER cis �, Bue. ilding Department (To be assigned by the Building Department.) w 800 Seminole Road �� / /ii� ' O 13� -5 vanny f' Atlantic Beach, Florida 32233-5445 (.,�L lJ l r Phone(904)247-5826 Fax(904)247-5845 1 0 I ` 1 �/„ -�;s gr E-mail: building-dept@coab.us Date routed: ! !! J City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: (0 UO 4A ( l fa, D tment review required Yes No BGi ding Applicant: 014)(11.4 arming &Zonin 1 (`,, T dministrator Project: \ t 1 S- +J1 t4- Q\ 1 Yl) 1' n m n 1 C Public Utilities L�l QQ'�I'l'r "�I' T Public Sate y V (� Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept.of Environmental Protection Florida Dept. of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: ❑Approved. Denied. ❑Not applicable (Circle one.) Comments: BUILDING I� Y3(' ' 61 5.-&-h 4$_6(c frvzedema fe�c PLANNING &ZONING Reviewed by:_,". Date: I 1— 6- I F TREE ADMIN. Second Review: A roved as revised. Denied. ❑ pp Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: I /Approved as revised. Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 ri�:vprf, City of Atlantic Beach APPLICATION NUMBER pis t1b�,r , Building Department (To be assigned by the Building Department.) A'"1'•,- 800 Seminole Road Fit) 1 / �ii/�/ -b 133 r0 Atlantic Beach, Florida 32233-5445 /� (�(�r(e 6 l ,� v Phone(904)247-5826 - Fax(904)247-5845 1 �'!J;31a�'r E-mail: building-dept@coab.us Date routed: l ! 3iile) City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: (0 vD RilAtOott a D ment review required Yes No Bing Applicant: C )N(( arming &Zonin 1 (`,, __Eae.-1dministrator Project: \nS 1 S— . Se_nu2 A- Q` �l1 Y n `' £�;nm n + 2Uilities 1 f/` r 'LI' Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept.of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: (Approved. ❑Denied. Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: . ` �`�`— Date:_//-17/--"/4 TREE ADMIN. Second Review: A roved as revised. Denied. ❑ pp ❑ I Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. Denied. I INot applicable Comments: Reviewed by: Date: Revised 05/19/2017 MAP SHOWING BOUNDARY SURVEY OF LOTS I THROUGH 7, EXCEPT THAT P..1 1'1 TNF RIC,' OF WAY. BLOCK 35. ATLANIN;BEAU,. 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