364 2nd St ACC22-0001 Paver Walkway Nr'ec ACCESSORY PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH ACC22-0001
800 SEMINOLE ROAD
ISSUED: 1/20/2022
9`' ATLANTIC BEACH. FL 32233 EXPIRES: 7/19/2022
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
364 2ND ST ACCESSORY SINGLE OR TWO PAVER WALKWAY $2500.00
FAMILY ACCESSORY
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169771 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
PHILLIPS PHYLLIS S 364 2ND ST ATLANTIC BEACH FL 32233-5230
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT II\
YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 PUBLIC WORKS EROSION CONTROL INSTALLATION INFORMATIONAL
Notes:
Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line(904-247-
5814)to request an Erosion and Sediment Control Inspection prior to start of construction.
2 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
Issued Date:1/20/2022 1 of 2
0"Al' ACCESSORY PERMITPERMIT NUMBER
f CITY OF ATLANTIC BEACH ACC22-0001
-Mr 800 SEMINOLE ROAD ISSUED: 1/20/2022
i3!•)� ATLANTIC BEACH. FL 32233 EXPIRES: 7/19/2022
3 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL
Notes:
Roll off container company must be on City approved list. Approved list can be obtained at the Building Department at City Hall. Roll off container
cannot be placed on City right-of-way.
4 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration,including sod,is required.
5 PUBLIC WORKS RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site. Cannot raise lot elevation.
6 PUBLIC WORKS MAXIMUM DRIVEWAY INFORMATIONAL
Notes:
Maximum driveway width within the City right-of-way is 20 feet.
PUBLIC WORKS I- DECKING REMOVED INFORMATIONAL
Notes:
All old decking and debris must be removed from job site by Owner.
87 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Owner.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
WORK WITHOUT PERMIT 455-0000-322-1000 0 $110.00
ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 $100.00
TOTAL:$239.00
Issued Date:1/20/2022 2 of 2
Building Permit Application Updated 10/9/18
f. . _ City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 3 L `� ati S\ct \ , N\\,„,-,--\,( c \-, Permit Number: \C C Z Z— OC i C I
Legal Description t ,,\ 0 \ l\C,c\<;,_ 3 Q\\c,,c.\\c rW,r,c i1 vv; R Lc\ REtt
Valuation of Work (Replacement Cost)$' U'CC Heated/Cooled SF Non-Heated/Cooled -
• Class of Work: `❑New [-)Addition iteration JARepair ❑Move [❑Demo [ Pool I Window/Door
• Use of existing/proposed structure(s): ❑Commercial Residential
• If an existing structure, is a fire sprinkler system installed?: EYes FNo
• Will tree(s)be removed in association with proposed project? EYes(must submit separate Tree Removal Permit) fO-
Describe in detail the type of work to be performed:
"1,^s- c,.\\J"1,^s- c,.\\ ycxsier\pcaS(' �C %, l cc C � \\ l
`E�v X]�f
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name ('c‘‘k\\` \'\n,\\cv s Address , 1/4,:,•-\ 1`lam (fie
City :lk":c\c.,,;,Vr R•li'�� \ State Zip j' Phone qpy- \ -
E-Mail Q\n \RCA. c,,,,;(.. „-,:,::.\ Cc KY. -
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) _
Contractor Information
Name of Company t=l,a.c\cs( \,tv,t- Qualifying Agent
Address City / State Zip_
Office Phone Job Site Contact N.f/ber
State Certification/Registration# E-Mail ,
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurer 7 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 Y R NOTICE OF COMMENCEMENT.
r
(Signature of Owner or Agent) (Signature of Contractor) //
igned and sworn to(or affi -d)before me this day of Signed and sworn to(or affirmed)before me this day of
<---- C4-f\ ,ZO'2 by ( ' — -, ,by irill, —
MIIINIMahVI
❑.Lure ant • 4 & _ ' (Signature of Notary)
.ti'pY Dt
SPERGER
[ I Personally Known OR `,: (1 lsersonally own OR
[ ]Produced Identification -� 15-61, - [ J Produced I ntification
Type of Identification: '--i, Type ofiderkffi ation:
Owner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
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#: ACCZZ"`UOD(
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
1 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: 3[4A 31/4`� a5rtA-k\c,.,\N ,LTher.N, , V\-- ,n,--)-A-?,
Owner Name: -h-\\\\\.` �,l,\Vcic. Phone Number: ctotk• .cSR-3',-:
Mailing Address: ,ljld-k j `--1--- SAce r\ City: A-\\c;v.-\,c ttcState: c-\_ Zip: TZ'
3
Notarized Signature of Owner _, --).._
The or ing instru ent was acknowledged before me this / day of - , 20Z 4in the State of Florida, County
Signature of Notary Public
[ ] Personally Known OR [ ] Produced Identification
Type of Identification: _ , (____
Updated 10/24/18
TONI GiNDLESPERGER
,[.....;;;;: ::i.....
.1 a. MY COMMISSION#GG 353178
i --:. >>, EXPIRES:Cc ober6,2023
f�'- ,^ra tL.ary Pi Vic Urderwtiters
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BRUNT. 3 78774 FORM 1 1330
,- , /50 • ,2'3
MF' SHOWING BOUNDARY SURVEY OF LOT 21, BLOCK 3, SUBDIVISION "A" ATLANTIC BEACH, AS RECORDED
IP PLAT BOOK 5, PAGE 69 OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO
PHYLLIS S. PHILLIPS
R. LEE SMITH, P.A.
CHICAGO TITLE INSURANCE COMPANY
BARCLAYSAMERICAN/MORTGAGE COMPANY
SECOND STREET
(A 40-FOOT R/W)
50' (PLAT)
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I HI 2EBY CERTIFY THE INFORMATION DEPICTED HEREON AS MEETING LEGEND
THE MINIMUM TECHNICAL STANDARDS FOR LAND SURVEYING, CHAPTER
21H -6, FLORIDA ADMINI ATI / OD AND/OR, CHAPTER 180-7, BEARINGS BASED ON 'Al/A -
GEC :GIA STATUTES.
BY: �rO� PROPERTY SHOWN HEREON UES WITHIN FLOOD
ZONE "c" AS SHOWN ON FEMA FLOOD
CARL S. COURSON, P.LS. FLORIDA CERTIFICATE NO. 3129 INSURANCE RATE MAP. COMMUNITY NO. /20075
GEORGIA CERTIFICATE NO. 2272 PANEL NO. 000i c
COI:TRSON & ASSOCIATES, INC. O - SET 1/2" IRON PIPE
PROFESSIONAL LAND SURVEYORS • FOUND IRON PIPE OR ROD
PROF
_ --. -_—_--- 0 - SET CONCRETE MONUMENT
• — FOUND CONCRETE MONUMENT
is ONE SAN JOSE PLACE —X—X— FENCE
//',� SUITE 24
\ DATE OF SURVEY 545- / JOB NO. /6'7G
.'ACKSONVILLE. FL 32257 DATE SIGNED 5-Z./-9/
DRAWN BY c
PHONE (904) 260-4233 SCALE 1• � 20'
NOT VALID UNLESS SURVEYOR'S OFFICIAL SEAL IS EMBOSSED HEREON