1879 GEORGE ST RFNC22-0120 Building Permit Application Updated 10/9/18
(.1 City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
'! IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
01
Job Address: /6771 6-e - S' Permit Number: RAVC Z2_ ` z
*S j,L71-tb /k.�
Legal Description M/(v /7-25—29E Ke'r� 12/1' ?7 L0r3 LSTRE# 1722_3 ' -
Valuation of Work(Replacement Cost)$ /000- �� Heated/Cooled SF Non-Heated/Cooled tO
• Class of Work: ❑New EAddition ❑Alteration ptepair ❑Move ❑Demo EPool ❑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 pro osed project? ❑Yes(must submit separate Tree Removal Permit) )iie.No
Describe in detail the type of work to be performed: g&et-t di/', ' a % fQ C e rt, `FertC ez�.
n
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name /9(z,, &X//,'' Address /677Y Sf
City /47Z-L,riec State iC—e- Zip 3a2_33 Phone 9/? -6,31- 5-306
E-Mail eaL,i X (,% cc.,•ti`
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company �tcc's 11�',-- Qualifying Agent
Address City State Zip
`
Office Phone Sk �c G 4-S �/
E� L �= Job Site Contact Number
State Certification/Registration# /t1�/4- E-Mail
Architect Name&Phone#
Engineer's Name& Phone#
Workers Compensation Insurer /1/A- 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 YOUR NOTI OF COMMENCEMENT.
,a
(Signature of Owner or Agent)
(Signature of Contractor)
Signed and sworn to(or affirmed) before me this ) day of Signed and sworn to(or affirmed) before me this day of
N-0JrIA.,e'4 , (,_ by 614.1 I X Ltd , by
r' - ' (Signature of Notary)
e�'., JENNIFER L.BENDETTI
_•:• 1 al Notary Public-State of Florida
[ ]Qersonally Known OR P .
Commission a GG 367988 [ ] Personally Known OR
My Comm.Expires Aug 20,2023
[ Produced Identification "" [ ] Produced Identification
Type of Identification: - - w - 10 • Type of Identification:
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#:
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: ,454 7'/ ‘rcrr-y ,S7'
Owner Name: Ala 1,--1 ,r�f pier Phone Number: 7/3 63‘1,5-342(
Mailing Address:j(.1:39'7Sf city:M-64 .e. 4 State: ;CL Zip: ?2233
Notarized Signature of Owner �_ 41111111114.‘'
The fgre`goin instrument was acknowledged before me this day of N( J A Y-t..., 20 21, in the State of Florida, County
1�
of
;oi►sYO�gf.. JENNIFER L.BENDETTI Signature of Notary Public V -
( _: '�'�`
• � Notary Public-State of Florici �\
°i Commission if GG 367988
•.'�°F Fd! My comm.Expires Aug 20.2023 [ ] Personally Known OR [' Produced Identification
Type of Identification: r�r`)_ 61q(a- (J )9
Updated 10/24/18
s-Lar„ Fence Addendum Updated1/14/2021
r
City of Atlantic Beach Building Department
�,, iii
�,t�; `y 800 Seminole Road, Atlantic Beach, FL 32233 PERMIT #
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
/971 6- 07y-e- S-E— r i//6"/Zc2 2 Z
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 Link Six Foot(6ft)
❑ Vinyl ❑ Other
❑ Block/Stone (Plan details required for footings and/or
retaining walls) I
❑ 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?
❑ Yes (must submit separate Revocable Encroachment Agreement)
15(No
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
k 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.
MAP SHOWING BOUNDARY SURVEY OF:
LOT 18 TOGETHER WITH THE SOUTH 1/2 OF LOT 16, BLOCK 3, DONNER'S REPLAT AS RECORDED IN
PLAT BOOK 19, PAGE 16 OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA
N
/13
LEWIS STREET
30' RIGHT-OF-WAY
_ _ ]OED _ _ -w.m' _ _ - - _ - - - _
1
I
I
8 I NORTH 1/2 OF
LOT 17 X LOT 16
8 NOT INCLUDED IN a
vi
.8 THIS SURVEY
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I
5 FOUND 1/2'
IRON PIPE FOUND 1/2'
.r.,NO IOENTIFlCATON N90'00r00NW 120.00' IRON TAPE
naa STAT)• (DUE NdNM) OOHUYT L.B.4238
50.00'
o n,l — 7a.mi- nn�, HAST,__ Ran.,--
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LOT 18 J
LL,I > ryn4 ran rad 044 .043_
N QI STORY
I..L 3 o MASONRv/FRAME =I SOUTH 1/2 OF Inas .
• I ' S RESIDENCE I LOT 16 qn JI
(/V •. LST - /1879 •S - 0
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I "---rain.-7--"
IRON PIPE
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IRON PIPE
7093 nNl oK •� x oti _...0,
- - - - - _
LB 7893 0.04' MOO. tari'"'v!.../..,......
_�J0.m'(P) SD.00'(P)
14'1 1447 rila}iIr NW13rnI 7
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(DUE EAST),.
IRON
I = o n "Aa -� NO DETRKA TION
I r.? Pn n'." a 6.4•1
7T SOUTH
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.Lan ROBERT STREET wan R .0t n.p
i 30' RIGHT–OF–WAYOrEST
Of WDaDm'w Fn LFACE
1_1 ¢01 311)BBB 82
1
I
IMPERVIOUS CALCULATIONS
LOT AREA- 13.8002 SOUARE FEET
NOTES. DESCRIPTION SOU4RE FEET
THIS PROPERTY UES IN FLOOD ZONE'X'PER FLOOD INSURANCE BUILDING AREA 78082
RATE MAP(FIRM),CITY OF ATLANTIC BEACH,DUVAL COUNTY,
COMMUNITY No. 120075,MAP/PANEL Na 12031C-0408-4REVSED METAL BUILDING 3303
NOVEMBER 2,2018
BEARINGS BASED ON THE EAST RIGHT-OF-WAY UNE OF GEORGE PORCH/LANAI 1303
STREET AS BEING N 00'00'00'W(DUE NORTH) FLATWORK 1,1972
ELEVATIONS SHOWN AS THUS(10.23)AND ARE BASED ON THE A/C PADS) 93
NORTH AMERICAN VERTICAL DATUM(NAV.O.)OF 1988 TOTAL 9WER%OUS AREA=3,4742
TREES HAVE BEEN LOCATED AS ACCURATELY AS POSSIBLE UNDER TOTAL DENSITY=25.22
CURRENT CONDITIONS.TREE SIZE AND LOCATION ARE MEASURED BY DBH
(DIAMETER BREAST HEIGHT)APPROXIMATELY 48 INCHES ABOVE GROUND
NO BUILDING RESTRICTION UNE BY PLAT
N.T S.DENOTES NOT TO SCALE
(M)DENOTES FIELD MEASURED
(P)DENOTES PUT
F FE. DENOTES FINISH FLOOR ELEVATION
�4--DENOTES EXISTING DRAINAGE FLOW
CERTSIED TO:
ONE DENOTES OVERHEAD ELECTRIC
WPP DENOTES WOOD POWER POLE ALAN&DENISE BI%LER
F.F.E.DENOTES FINISHED FLOOR ELEVATION
GRATE DENOTES STORM DRAINAGE GRATE /
TRB DENOTES TELEPHONE RISER BOX
1'R8 DENOTES TELEVISION RISER BOX
WN DENOTES WATER METER \
OHE DENOTES OVERHEAD ELECTRIC I H ERM CERTIFY THAT TITS SURVEY 111
YFETS E
STADAROS OF PRACTICE AS SET FCRM BY I
INV DENOTES INVERT M FLORIDA BOARD CFAA ND STATU
AP,FR
SAWYERS.PURSUANT
EL DENOTES ELEVATION SII�INON 4)ipU!CP,/% ST
RCP DENOTES REINFORCED CONCRETE PPE E U R D E N 00
ALL LOTS SHOWN HEREON LIE WITHIN BLOCK 3 EXCEPT AS NOTED 'AND VAPPING '
gas 1111(Aa0NuE SOUTH
-/N- DENOTES 6'WOOD FENCE EXCEPT AS NOTED JAIXON
SNLIE BEACH.FLORDA 32250 n
THERE ALLY BE ADDITIONAL RESTRICTIONS THAT ARE NOT SHOWN (9UCDISED BUSINESS No.85.3-6922 FAR 6699
ON M5 SURVEY THAT AMY BE FOUND IN THE PUBLIC RECORDS 1!]R SEPTAMII H 1007
OF DUVAL COUNTY,FLORIDA ac±L
W IITL NO.,-11.9 mil I-a a-t,ATM 60Ra snow
110 SURVEY NOT VAD LAMS MS PRET D OMOSS93 DIN ME SEALIOF ITR!MOLE SWm.
Pri
to IRON PIPE
ci
NO IDENTIFICATION o > >? )
x (101) N90 °00 00 W 120 . 00
(to., (99)x
70.00' (DUE NORTH) x(10.6)
x r1 p 4 3' CHAIN LINK FENCE5.5' TIE-,
I:1
x A x
�o (�.9) ..5' 7' i r" o'm 0.5' t? w _. x z 1 p' __-----X�1
2" OAK �J.4 _„ , _. 3• C
`'72) �, -f 15.0'
I Remove replace o
J fence and gates In ;•0 : 7
X57x \ /
_ \ / J _ K!'10.4)
a.a cow S*lu,r.. ^ COVERED \ /x (10.89) ti ^�
C1, Q Will�nolude2 1� M . CONCRETE / \ • til _j
m O gates that wen out / N.N.
a
0. fews co
carport One 1 / / ►-� . \ \
Z : walk thcv44410 a / Ni \
0 w I house 10.70) .,. 'S Q'
x x
m ;70.94)
3 (193) ' 006) (iD.3) (r1
m rn x (9 9) X (tO.J) 30.5' (?O.6;� A/C PAD x
u- ., (1 C 7) 24.0'
N 0 iv 5' WOOD
N 0 --', o FENCE
ru I (10.4)x N•) �,-y
o u J 1
co
1U1
LOT 1 3 7.8'
C
w 6.0' 106) (60.6) (10.4) 1
STORY
a SOUTH 1 /2
o a ti o .`, e _,
MASONRY/FRAME
----- DO " n.' RESIDENCE `° LOT 1 6
10. 7 (9.94)0 d
CONCRETE < •
A #1 X79
,
L .,DRIVE JF.F.E. x(10.8) (1Px6) (
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to 6 O •
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QCONCRETE '-/
h PORCH & STEPS X
710.7)
(10.2) 30.5
30.1'
x (94,Z ' 10.4) (10 .7r
/ COVERED
I PORCH
2.3' x (10.8)