379 AHERN RFNC22-0077 Building Permit Application Updated 10/9/18
a li City of Atlantic Beach Building Department **ALL INFORMATION
Var~ 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
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Phone: (904)�p247-5826 Email: Building-Dept@coab.us IS REQUIRED., i
Job Address: .. --19 A }� t0 Permit Number: RpNic,z_z_ - v0 7 7
Legal Description S`(‘) I l I -25-age"kT(4,fT''C. (3C4Cr W 1/'1 o r i 'S U ET RE# /(,9 7 55'1 - L(0-0-6
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Valuation of Work (Replacement Cost) $ Z y 95' Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ❑Residential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s) be removed in association with proposed project? ❑Yes (must submitse arate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed: ZE/"'v7/eCit, t G��G,-= 1 S`7-74°(--c-- NCI-✓ (. r.,-•-/
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Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name J C F- .y MPJ,✓✓,( / s 141/7/1 Address
City State Zip Phone
E-Mail
Owner or Agent (If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company 7;EACH-E3FE'''Gze--cAt f e6-02.itualifying Agent JO 1..) ''T (7Z-&(--1 iS
Address iy 4 AlAkreS i l c_ C VP Cc-ss D e bi City .J4ClGspNviLGL- State l' Zip 3ZZ 33
Office Phone gag 761f 7'755 5 Job Site Contact Number
State Certification/Registration# E-Mail act)c,L c` Pn P 6.0.1.411.. . G ,--1--,
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurer An/7-4).5-7' OR Exempt ❑ Expiration Date di J Z
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 YOUR NO ICE OF COMMENCEMENT. ,Q,___.i..._:61._„7
(Sigh of Owner or Agent) (Signature of Contractor)
XI
even S6, ffirel rvi C
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ned and sworn to(or affirmed)before me this day of Signed and sworn to(or armed) efsrime this d- day of
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"`i-'"'4 Si:nature of No ar
40Notary Public State of Floi i,' '
Jessica A Dolquist c Notary Public State of Flori: ;
my Commission HH 142; a Jessica A olqu st
[ ] Personally Known OR dr Expires 08/14/2025 Personally Known OR S Myr mission HH 142217 y
Of w Ex 051 :noes
}+.4 Produced Identification ,�,, _ . ] Produced Identification wR C,
Type of Identification: .it/ .of Identification: • .�✓.f '.4
5/23/22,9:33 AM Duval Property Map
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f '-iFence Addendum Updated 1/14/2021
r City of Atlantic Beach Building Department
.)'.,r J��; �, 800 Seminole Road, Atlantic Beach, FL 32233 PERMIT #
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
&70 -R,A 24 '2 lz,412z
Property Type: Lot Type/ Features:
/Residential /One Street frontage (interior lot)
❑ Commercial ❑ More than one street frontage (corner lot,through lot,
etc.)
Swimming Pool
Fence Material: Fence Height (select all that apply):
❑ Wood ❑ Four Foot(4ft)
❑ Chain Linkix Foot (6ft)
/Vinyl ❑ Other
❑ Block/Stone (Plan details required for footings and/or
retaining walls)
O Other
Fence Location:
Please submit an accurate and current boundary survey showing all existing improvements (including building footprint,
driveway, swimming pool, etc.) and location of fence/wall and any gates. Plan details required for block wall footings and/or
retaining walls and any portion or fencing above 6ft in height.
Will the fence be built in an easement?
O Yes(must submit separate Revocable Encroachment Agreement)
12t-No
Will tree(s) be removed in association with proposed project?
O Yes (must submit separate Tree Removal Permit)
JE'N o
Conditions of Approval:
• Roll off container company must be on City approved list. Roll off container cannot be placed on City right-of-way.
• All old fencing and debris must be removed from job site by contractor or homeowner.
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 YOUR NOTICE OF COMMENCEMENT.
Revision Request/Correction to Comments *ALL INFORMATION
fi:j., HIGHLIGHTED IN
rCity 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#: RENC_ZZ-067 7
❑ Revision to Issued Permit OR Corrections to Comments Date: 21/1/2-Z.—
Project
Project Address: 3 7' 4
Contractor/Contact Name: '--- 6,1e.46-S V&---Ni(-E- 1(;,06 f --sz-6-62-A
Contact Phone: QUZ 7 O --77s-5-- Email: 136:4 cl-f-C P QM1A/ d .Cf71-4-1
Description of Proposed Revision/Corrections:
i'V)‘ CAT LUc -1-14-1-1OPL ‘r - A.. I-4=i -/I-S 0a-1
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I ..Jc^-i -- 1.d-r-r_g LA s i affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
• Will proposed revision/corrections add additional square footage to original submittal?
❑No ❑ Yes (additional s.f.to be added: )
• Will proposed revision/corrections add additional increase in building value to original submittal?
CI No ❑*yes (additional increase in building value: $ ) (Contractor must sign if increase in valuation)
*Signature of Contractor/Agent:
(Office Use Only)
❑ Approved ❑ Denied ❑ Not Applicable to Department Permit Fee Due$
Revision/Plan Review Comments
Department Review Required:
Building
Planning&Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities
Public Safety Date
Fire Services Updated 10/17/18
5/23/22,9:33 AM Duval Property Map
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