940 & 950 ORCHID ST RES22-0119 iL,
rs`= Building Permit Application Updated 10/9/18
J ;jP
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
J33 9r IS REQUIRED.
Phone: (904) 247-5826' Email: Building-Dept@coab.us
Job Address: Zr c/b 0 rA UYl d U 5h Permit Number:R ZZ 'U t L Cl
Legal Description J CG1OIl f ,A-
, 4- 6h l,
I 'c '1GG� / t0'T i Ito- ��l 'KE# 1-vf q7- o
Valuation of Work (Replacement Cost)$ I J/ OOb,t. /�Heated/Cooled SF q� Non-Heated/Cooled 0
• Class of Work: ❑New ❑Addition DAlteration I/?Repair DMove ❑Demo ❑Pool indow/Door
• Use of existing/proposed structure(s): DCommercial [BResidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes VC
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) eNo
Describe in detail the type of work to be performed: /) ,iS°
UP4Ni� c,:�-4.�€tt '-ft.t-"o dukItcs'vu r./2Ice -rWr,14f,� iepf, ,‘Atd� w, /r.
Florida Product Approval# for multiple products use product approval form
Property Owner Information 1 GC '
Name i--f- -4- /4- Se455i'd /9 )? Io/l•34�Gt%l— Address I-2/� P�i6l*aii a`
City 1' /�& i.. /I State FL___ zip - L5O Phone 9441-35? -7P73
E-Mail .-g eGQy 6) (GIOuJ . co/Y)
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information /�
Name of Company Fe r VS,�vi Boy'IC(€�'s i Qualifyin_Agent C CC �e/
Address /-7 C oGe�i e) d hv(J City ( ✓1 I C-- : /.'ell Zip 3a"1-.3
Office Phone 12N 41.3 1 fL. Job Site Contact Num r
t� e
State Certification/Registration# ' b)I)13 E-Mail C 9 � , 9 f 4.%/, &O di
Architect Name&Phone# ye
/
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt o 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
RECORDIN XOUR p C OF COMMENCEMEN , .
+IA.& Y----- -,FCe(1(- -C9-A3
(Signature of Owner or Agent) (Signature of Contractor)
���7
Si ed and sworn to(or affirmed),before me this I T) d y o Signed and sworn to(or affirmed,)before me this. day of
�, 241 1,by iii kl/1 /�L�'��P�ile� C,/ c70,1�.,by /4 �, � . ,v13
(Signature of Notary)
Notary Public S -— - - -
EgisagaragLigtain
Ryyan Gary WetNotary Puttilaa Z of FWIDmi4y�
. , My Commissiersonall Known OR R'an Gary ydat rRn y
ersonally Known ORIIIb,;,, HH 182983 [ y Ivy Commission
[ ]Produced Identificatio Exp. 10/7/2 [ ]Produced Identification IIII _ NH 182987
— Exp. 10/7/2025
Type of Identification: — — Type of Identification:
NOTICE OF COMMENCEMENT
State of r'b t,a, Tax Folio No. , -7 061 Li Os'oc,
County of ,,J d w`
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713
of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: u
Seed+on � ' kloo4t-� b�k(J� Loo -1 '�/Alori&, 114114 1,4151 ,/ueA /51
Address of property being improved: ,,1I LID 0 rciVl i�I ST/ 14±14(n +k— 6 eGC_kt )'6 /1-t
General description of improvements: K E ,I kdc1�.i 11'11) i� ii F�� tiill �' aorMAs / P y/4 e� I Ike",
Ct.VG a1n �1- (tNA 52 I L/� -1 q�1 t Lu �u r S c}� it) de we �J,� ✓
Owner: I-1''�N $CAS;CI� /Jf�eIO �-�-� Address: /713 km.4it t K.(.►1 j-cdX1e c4 P 3)-)-SD
Owner's interest in site of the improvement: 11240I-C, ,5-4(0C.:(1)(42—
Fee
1('cC(1)(e—Fee Simple Titleholder(if other than owner):
Name: A
Contractor: re,f(�O O .1),-,
050A 5, 'YIL tts , -OA iI
Address: (�J a-\6 0 c€c B�� , i4+14�►4,�..$er�l� i L 3
Telephone No.: (� 010iG3`t3 IS Fax No:
Surety(if any)
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of anyperson makinga loan for the construction of tl Nuc Number Pages:
1 OR BK 20228 Page 517,
Pages: 1
Recorded 04/18/2022 01:24 PM,
Name: JODY PHILLIPS CLERK CIRCUIT COURT DUVAL
Address: COUNTY
RECORDING $10.00
Phone No: Fax No:
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may
be served:Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b),Florida Statues. (Fill in at Owner's option)
Name: _
Address:
Telephone No: Fax No:
Expiration date of N tice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is
specified): -7 3( 2(W ' —
THIS SPACE FOR RECORDER'S USE ONLY OWNER - 4„,v ��
Notary Public State of Florida Signed: �'C�7 " 1 Date: //e.fo)J_.
Ryan Gary WeMefiold Before me this /B" .ay of 1-F n; ?No/ in the County f Duval,State
Hitt ~� y Commission !
tfll HH 182987 Of Florida,has personally appeared vb h R.l1_ Old rt
Exp.10/7/2025 Y
o., Notary Public at Large,State of floric�a,County of Duval.
My commission expires:/ !U 1 ).02S
Personally Known: // or
Produced Identification:
NOTICE OF COMMENCEMENT /� /,
State of Piot it6( V
Tax Folio No. I ,q /– O sc
County of Id Ullul
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713
of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved:
see IDA 14-1 A-V-14kA-,c, g.t40411, ,1 q 4- 441A 1441 eir63 f. 5 (p/,Fiz /5
1! ; ,
Address of property being improved: `fSb 0 t G5-1/ 4+1 tuff i'C� 6eyc 4 ?L 31).23
General description of improvements: 1eiMo(it/Ai j '-1C L ‘(7 rf--4 S/J/Cr9/ ce // V/tbl✓}7
r p .A4 iivi3m e -F00-1, 0 ew 4,„"r c W,Gi dvufs /
Owner: H`-14 SAdfigf!'( A✓c/ Ll 13/3 A7 /70 i4ii' c4Y
Owner's interest in site of the improvement: 4 ..ii C_ 5f`�‹... FL
Fee Simple Titleholder(if other than owner): 3 ,52
Name:
Contractor: Pa/ USA..//k Z e ( /�� 11i 3 / _
Address: � 7'Li:Meiji
,U fit a i 1?/ d A4-Ie.A ik, 46&C 4 p(� sJU 3j
Telephone No.: d y ] V93-11/5- Fax No:
Surety(if any) /
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the im Doc#2022096782,OR BK 20228 Page 516,
Number Pages:1
Name: Recorded 04/18/2022 01:24 PM,
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL
Address: COUNTY
RECORDING $10.00
Phone No: Fax No:
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may
be served: Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b),Florida Statues. (Fill in at Owner's option)
Name: —
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one (1)year from the,Jate of recording unless a different date is
specified): � (�'
THIS SPACE FOR RECORDER'S USE ONLY OWNER CJ,-�t �
_ _ __ _ _— 4
Notary Public State of Florida I Signed: 644iiDate: L/7402)
I Mk Roym Gary Wetherhold I Before met da of )-1— in the Counal,State
11 biy Commission y
1111 Exp,/G 981 Of Florida,has personally appeared
Notary Public at Large,State of Flor'da,County of Duval.
My commission expires: -7/a01
Personally Known: 11 or
Produced Identification:
BOUNDARY SURVEY ti
1
1 LOT3
BLOCK 156
sate
SET//Z"�1.5'OFF — 3,5'OFF1 N 90° 0'00 W 170�� F AQ \...
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(NOT INCLUDED) En
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CORNER-
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SURVEY NOTES
PAVER DRIIVETROSSING INTO RiW ON
EASTERLY SIDE OF LOT
THERE ARE FENCES LOCATED NEAR
THE BOUNDARY OF THE PROPERTY.
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0 1 1 r 1 C S O rr`
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1 o No 5415 e _ SURVEYORS CERTIFICATE
W I HEREBY CERTIFY THAT THIS BOUNDARY SURVEY SURVEYING,
IS A TRUE AND CORRECT REPRESENTATION OF A
SURVEY PREPARED UNDER MY DIRECTION.
�¢ NOT VALID WITHOUT AN AUTHENTICATED ELECTRONIC
STATE OF SIGNATURE AND AUTHENTICATED ELECTRONIC SEAL, - LB#7893
.r o4F( o A i o °p> OR A RAISED EMBOSSED SEAL AND SIGNATURE. SERVING FLORIDA
` S U"V E r
KKKenneth Digitally signed by
Kenneth Osborne 6250 N.MILITARY TRAIL,SUITE 102
bate:2022.03.24 WEST PALM BEACH,FL 33407
�z,,� Osborne 16:50:51-04'00' PHONE(561)640-0)22
STATEWIDE PHONE 600 2264807
(SIGNED) - 4800 .
( )
KENNETH J OSBORNE PACE 7OF 2 PACFS STATEWIDE FACSIMILE (800)741-0576
PROFESSIONAL SURVEYOR AND MAPPER#6415 (N OhaPI. ITxb ACE I, WEBSITE: http://targetsurveying.net
vol
l BOUNDARY SURVEY
I LO•1 .3
BLOCK I5(1
,rr, RFM\INI)E R OF _.�_ COVERED .i.;--?5•0',4:...'-'i'%;
LOT 4 (— .,� LT
wx BLOCK i56 ENTRY ",ti, 4 "".
f J h f 1.„4,4,9k.'•'..•�. .4.V .
of 1 NOT IncLUDI D; •
!1��N ...IC BUILDING : ::' ; 13;,
CO ,-1 I Z PORTION OF #950 ,. '0 K,ET . ' .;,,-. ck;
as LOT 4 ; =M.,.,.
BLOCK 156 ��
IRON ROD h (INCLUDED) N 89°00'33"E 156.36' :. .s
LB#7893' 1 > 55.8' 37.0'PARTYWALL 63.5' R;..,, d$3
J..'
- 'e ,
W
vovI PORTION
0F BUILDING 4
-, LOT 5 o #940
tr,- rI BLOCK 156 .CONCRETE -
• �r .a ° M (INCLUDED) 33.0' COVERED DRIVE ^ ; „ : J-,�-' O 56.2' ENTRY `d;e' Q 4,, ti
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Q.
rnd..
M ,-0.70N �' CJ;�Q
SET 1/2"esf o.6'OFF O/r i ".'0 00'00 IN-1-0.2 141.35' P 0.8-(PARCEL 1)- • • ::O,
/RON
#7893 ,ir , /FRO
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RE;•9AINDER OF IRONROD •!'?Y:;a. .1-;.i,-7!..+1\,i-
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LOT 5 LB#7281 7,0,s,- 4:41;
:41a;
BLOCK 156 (1.0N) 4 ''''`=uv'• '
(NOT INCLUDED
OD
o /
WEST 9TH STREET BLOCK
CORNER- /
FOUND 1/2"
IRON PIPE /
SURVEY NOTES
PAVER URIVE CROSSING INTO RIW ON
EASTERLY SIDE OF LOT
THERE ARE FENCES LOCATED NEAR
THE BOUNDARY OF THE PROPERTY,
., N � °s
.r fc ., 1 F 1 e 8 0 �`
= �P 4r " TARGET
W ° No 6415 m SURVEYORS CERTIFICATE
I HEREBY CERTIFY THAT THIS BOUNDARY SURVEY
° IS A TRUE AND CORRECT REPRESENTATION OF A SURVEYING,
TRS TT1Z ING,
- SURVEY PREPARED UNDER MY DIRECTION. V IL�/rJ].jjr
NOT VALID WITHOUT AN AUTHENTICATED ELECTRONIC
.° STATE OF a SIGNATURE AND AUTHENTICATED ELECTRONIC SEAL, r,,.r LB#7893
°a:
e P` ORA RAISED EMBOSSED SEAL AND SIGNATURE
y .
• ` n 1 ° SERVING FLORIDA
I + Kenneth Digitally signed by
Kenneth Osborne 6250 N.MILITARY TRAIL,SUITE 102
/ ....e...out.i.
Date:2022.03.24 16:44:47 WEST PALM BEACH,FL 33407
Osborne -04'00' PHONE (561)640-4800
(SIGNED) STATEWIDE PHONE (800)226-4807
KENNtIH J O bUHNt PACE2OF 2 PACES STATEWIDE FACSIMILE (800)741-0576
PROFESSIONAL SURVEYOR AND MAPPER 66415 (N ot. L FRt I At I WEBSITE: http://targetsurveying.net
I