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72 W 14th ST FNCE20-0002 rci , 1,, City of Atlantic BeachAPPLICATION NUMBER i\ Building Department (To be assigned by the Building Department.) r' 2 800 Seminole Road r l • -' Atlantic Beach, Florida 32233-5445 NCC Zv r CO�z Phone(904)247-5826 • Fax(904)247-5845 j! 9P. E-mail: building-dept@coab.us Date routed: I / 1 z Q City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM '7 Z. ,& 14-11 �`— De artment review required Yes No Property Address: 1 uildinq) Applicant: C) GOO PO Fj ung &Zing F---- Tree Admisinra or Project: EKD c..E Public Wor Public Utilities Public Safety 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: ['Approved. Denied. ['Not applicable (Circle one.) Comments: BUILDING CG r tY A / I �.� I �--t f, e et-fftc-Lied PLANNING &ZONING Reviewed by: � - Date: � — Z�ZG TREE ADMIN. Second Review: A roved as revised. ❑ pp ❑Denied. ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. ❑Denied. Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 ,s r LAJ Building Permit Application Updated l0/9/18 75 J t, i!! City of Atlantic Beach Building Department **ALL INFORMATION 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY `,F; �r IS REQUIRED. Phone: (904) � QE j247-5826 Email: Building-Dept@coab.us ,��7 ` Job Address: �1?_ U-) i -- S' - Permit Number: F 0 " 6✓0Da Legal Description So m N P l ey;c i � e-Z 6(z rt_�a�t 3 RE# i C)E (X - O00D 3 L.K S(o Valuation of Work(Replacement Cost)$ 30.) Heated/Cooled SF Non- Heated/Cooled • Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ECommercial ❑Residential • If an existing structure,is a fire sprinkler system installed?: ❑Yes :No • Will tree(s)be removed in association with proposed project? DYes(must submit separate Tree Removal Permit) ❑No Describe in detail the type of work to be performed: r nK-I,v el ij Fr Tom- Uhl LA'f tcC ox To," "Fv 12,0 F - 34c-IL f O A ? er--2t--1 Live_ Ti--1V k-Lc- 0 op Tv („,r r (3,44...o o Q Goaso F64CiN�� Florida Product Approval# for multiple products use product approval form Property Owner Information Name l ' t)L J j JAMA) —ZOCAC(v Address 72- L4) lL 4} 5t City 'f1c:., F}}c,41_ State CL_ Zip 312-.3 3 Phone COLI- S T 0080 E-Mail FC Vl D O0 1 Q 1vWP tL. conn Owner or Agent (If Agent, Power of Attorney or Agency Letter Required) 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 0 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 MAV- 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 N TICE OF COMME'JC ENT. f- ,.U� y v vIc_- /: (Signature of Owner or Agent) (Signature of,CQntractor). _ , City r f 1.4.I^r,+i f', [qtr"a.'„h Fl!,.. Signed and sworn to(or affirmed)before me this,.7fih ay of Signed and sworn to(or affirmed) ef`ore me this clay of 1.LCervl b,e-723(4 ,by •Dei "i In tlAcA , by .:a. e. „ . . (Signature of Notary) .49.1."'‘ r�olary PubWic Staor Florida Michelle L Guthrieb Personally Known O' .40.#' tiN,comma04/03l202�aion GG 309727 [ ]Personally Known OR • Exgrea [ ]Produced Identificati.n °'^ [ 1 Produced Identification Type of Identification: Type of Identification: Owner Builder Affidavit HIGHLFORMAIN r� **ALL INFORMATION City of Atlantic Beach Building Department GRAY IS REQUIRED. t"' 800 Seminole Rd, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: 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. IEIS YOUR QU RED BY STATE ILLAW AND BY COUNTY ORMUNICIPAL EMPLOYEDBILITY TO MAKE SURE THAT PEOPLE LICENSES LICENSING ORDINANCES R II. INJURY LIABILITY; SINCE OWNERS MAINSURANCE LIABLE FOR E INJURIESPUUTO ORKERS THEY HIRE,THE BUILDING DEPARTMENT SUGGESTS WORKER'S COM III. IRS WITHHOLDING;OWNERS HIRING REQUIREMERKERS BECOME NTS ON THE WORKERS THOEYERS AND EMPLOY ON THpALSO OBSERVE IRS EIR IMPROVEMENT TRADES.TAX AND/OR FORM 1099 REQ IV. PENALTY; EMPLOYED CIRCUMSTANCES. SUBJECT TO$5,000 PENALTY UNDER FLORIDA STATUTE NO.4528(1) AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE D PHYSICALLY SEE THE NTY"CERTIFICATE OF R THE FLORIDA"CONTRACTORS OWNER SHOULCER AIN IF A PERSONIIS A LICENSED CONTRACTOR.OO CERTIFICATE"TOO ASCERTAIN SAS CONTACT THE BUILDING DEPARTMENT(904- CE 247-5826 OR BUILDING-DEPT@COAB.US) IF IN DOUBT. V. ACKNOWLEDGEMENT; I HEREBYACKNOWLEDGE THE ISSUANCE OF AN OWNERBBUILDERCP RMT LOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS Job Address: -72- (Lfl fr1-L4/si lC- C +c-1. 3z�-33 q��- Sq /-(���C� 1 ��Q4R- 2��� Phone Number: Owner Name: ---�-Gl �2z33 Mailing Address: 2 44+44- City: 0 IC 66.44- State: pi__ Zip: Notarized Signature of Owner a72Qi64'VL ��'"" The oregof g instrument was acknowledged before me this Ulday of (-2fr`trd,( ,20 11, in the State of Florida, County ofl�U Signature of Notary Public s U LW- ' \ • [)6 Personally Known OR[ 1 Produced Identification Type of Identification: r Notary Pudic Stale d FRaids�c Michelle L Guthrie Updated 10/24/18 Expires° sno2Gs 309727 i)-eVi:r City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) •.ji• - 800 Seminole Road w CD 0O OZ- ..:410 : Atlantic Beach, Florida 32233-5445 1 ��� Phone(904)247-5826 • Fax(904)247-5845 p E-mail: building-dept@coab.us Date routed: I / lrJ" / z City web-site: http://www.coab.us �1 APPLICATION REVIEW AND TRACKING FORM Property Address: Wc,4-11:- ) Department review required Yes No uildingj) V Applicant: (,D PO PFning &Zoning—s> (� Tree Administrator Project: 1` (= lU( E Cublic work Public Utilities 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. I (Denied. Not applicable (Circle one.) Comments: / rn - PP►�Ot O Kira r 4 7 gritivair BUILDING PLANNING &ZONING Reviewed by: Date: – �" 2v TREE ADMIN. Second Review: I 'Approved as revised. I 'Denied. Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. I lDenied. Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 ter City of Atlantic Beach APPLICATION NUMBER js - Building Department (To be assigned by the Building Department.) ` i 800 Seminole Road :, ��ce Zo- C o oz Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845 r� -an �' E-mail: building-dept@coab.us Date routed: � / l� IZC) City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: / Z. `!V i 4-11= J De_artment review required Yes No uilding� Applicant: anniJng &Zoning Tree Admmis rrafor Project: 1 �,1� � Public Public Utilities Utilities 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. I ]Denied. Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by �� ✓Date: l TREE ADMIN. Second Review: I 'Approved as revised. ❑Denied. 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 Wiatse4..... 'ammo iVII ""E YS>.A,yr City of Atlantic Beach JAN 07 2023 APPLICATION NUMBER 4 i oo Building Department (To be assigned by the Building Department.) A . 800 Seminole Road py f j—ay/4f Atlantic Beach, Florida 32233-54z 1 tCG Z.c+ GG oz' Phone(904)247-5826 • Fax(904)247-5845 f r,; 9 E-mail: building-dept@coab.us Date routed: I G z c) City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: / Z A 14-11= .STDe artment review required Yes No uilding) Applicant: C, CO ND�ZWinning &Zoning Tree Administrator Project: 1- E,j .DQj Public Wor Public Utilities ) 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. I 'Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING ~ Reviewed byj`iJ%a/y „�tate: /"7";�4l© TREE ADMIN. Second Review: nApproved as revised. I Denied. nNot applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: Approved as revised. ❑Denied. Not applicable Comments: Reviewed by: Date:_ Revised 05/19/2017 (7 MAP OF SURVEY " BOUNDARY " DESCRIPTION: THE EAST 25 ' OF LOT 3 AND THE WEST 6. 25 ' OF LOT 2 IN BLOCK 56 OF " SECTION "H" ATLANTIC BEACH" ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 18 PAGE 34 OF THE PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. .50•LB 7261 _"�ay�' k0„ LB ' �:..�'/, y'. I 2- N N ' :;'e': r .. W 4/3 41 S. '.C. _...fr. . \ . ��m J 261 (J../ / --- •-.....„ ��� . :+: 0 au� �o �, o / N • � � � ` 8 1/,1� / 2j P..) srI / FFEf /t / CONC. PATI / S.I.R.C.L87261 414feft / 416if /`��:4,., CONC. PATIO/ ?evil' SI 31 / K/ �j . :I�. IDT / S.I.R.C. LB 7261 CERTIFIED TO AND FOR THE EXCLUSIVE BENEFIT OF: DEVON IMMAN SUNSHINE TITLE CORPORATION FIRST AMERICAN TITLE INSURANCE COMPANY ADDRESS: 72 WEST 14TH STREET N I HEREBY CERTIFY THAT THE MAP OF SURVEY SHOWN SURVEY NOTES: HEREON IS IN ACCORDANCE WITH THE TECHNICAL STANDARDS AS SET FORTH BY THE BOARD OF o BEARINGS ARE BASED ON THE NEST LINE OF LOT 2, BLOCK 56 PROFESSIONAL LAND SURVEYORS IN CHAPTER 61G17-6, L BEING N 20' 13 00 E ( ASSUMED ) FLORIDA ADMINISTRATIVE CODE, PURSUANT TO SECTION v UNDERGROUND UTILITIES, FOUNDATIONS OR OTHER SCALE: 1 = 3O 472.027, FLORIDA STATUTES. ' v STRUCTURES WERE NOT LOCATED BY THIS SURVEY. --e/��_ w ACCORDING TO THE FEDERAL EMERGENY MANAGEMENT AN---4441"--:-1,-.--4-44,9r ON, 0' IL J 568 /!/ n AGENCY FIRM MAP PANEL NO. 120075 0001 0, EFFECTIVE 8/15/89, FLORIDA REGISTERED LAND SURVEYOR AND MAPPER. NOT E THE PROPERTY DESCRIBED HEREON LIES IN ZONE X . VALID WITHOUT THE SIGNATURE 6 THE ORIGINAL RAISED L▪\ SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. ai FCM - FOLND CONCRETE MONUMENT C.M. - CONCRETE MONUMENT 0 - DELTA OR CENTRAL ANGLE FEN - FENCE OHE `OVERHEAD ELECTRIC F.I.R.C. - FOUND IRON ROD AND CAP P.T. - POINT OF TANGENCY P.I. - POINT OF INTERSECTION CLR - CLEAR C.L.F.-CHAIN LINK FENCE L., F.I.R. - FOUND IRON ROD P.C. - POINT OF CURVATURE A/C - AIR CONDITIONING UNIT FND - FOUND W F. -MOOD FENCE F.I.P. - FOUND IRON PIPE U.E. - UTITLITY EASEMENT R - RADIUS (P) - PLAT E S.I.R.C. - SET IRON ROD AND CAP D.E. - DRAINAGE EASEMENT L - ARC LENGTH EL - ELEVATION C.B.- CHORD BEARING m F N&D - FOUND NAIL AND DISK C 6 G - CURB & GUTTER NTS - NOT TO SCALE CONC.- CONCRETE CO- CHORD DISTANCE p , (M) - FIELD MEASUREMENT P/N - RIGHT OF MAY - PROPOSED ESMT - EASEMENT o� (P)(C) - CALCULATED MEASUREMENT C/L - CENTERLINE (E) - EXISTING COR - CORNER L a. PREPARATION DATE \ " FIRST COAST LAND \ ORDER PROJNO.T 4440 INFORMATION PLOT PLAN a BOUNDARY 3-2-05 SURVEYING, INC. DRAWN BY: tnp -i REVIEWED BY: TPO FORMBOARD 1660-8 LANE AVEUE SOUTH, JACKSONVILLE, FL. 32210 u. FOUNDATION PHONE (904) 779-2062 FAX (904) 779-7784 �INAL CERTIFICATE NO. LB 7261 J