363 4th St RESO23-0030 cRESI- rSr�`'
DENTIAL OTHER PERMIT PERMIT NUMBER
�s - J f; RES023-0030
CITY OF ATLANTIC BEACH ISSUED: 4/6/2023
800 SEMINOLE ROAD
�`'';i�� ATLANTIC BEACH. FL 32233 EXPIRES: 10/3/2023
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: I VALUE OF WORK:
RESIDENTIAL OTHER SINGLE OR
363 4TH ST TWO FAMILY RESIDENTIAL Artificial Turf $7500.00
OTHER
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169843 0100 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
SOUTHERN TURF 102 PINE ST NEPTUNE BEACH FL 32266
OWNER: ADDRESS: CITY: STATE: ZIP:
PHILLIPS LONNIE R 391 AHERN ST ATLANTIC BEACH FL 32233
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN 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 BUILDING NOTICE OF COMMENCEMENT INFORMATIONAL
Notes:
No inspections may be scheduled until a copy a recorded Notice of Commencement has been submitted to the Building Department
2 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.
Issued Date:4/6/2023 1 of 2
r"''rRESIDENTIAL OTHER PERMIT PERMIT NUMBER
y
J RESO23-0030
CITY OF ATLANTIC BEACH ISSUED: 4/6/2023
800 SEMINOLE ROAD
li
X0:1»% v
ATLANTIC BEACH. FL 32233 EXPIRES: 10/3/2023
3 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
4 PUBLIC WORKS DUMPSTERS/ROLL-OFF CONTAINERS INFORMATIONAL
Notes:
j Dumpsters and roll-off containers must be used in compliance with Section 16-8 and must comply with all standards,per City code.
5 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
1
'Notes:
Full right-of-way restoration,including sod, is required.
6 PUBLIC WORKS GRASS INFORMATIONAL
Notes:
Full site to be grassed.
7 PUBLIC WORKS REVISION INFORMATIONAL
Notes:
Any plan change must be submitted as a Revision to the Building Department.
1 8 PUBLIC WORKS DEBRIS REMOVED INFORMATIONAL
Notes:
;All construction debris must be removed from job site by Contractor.
9 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Contractor.
j 10 PUBLIC WORKS OTHER PUBLIC WORKS CONDITION INFORMATIONAL
Notes:
Water retention area must not be bridged-will be verified at inspection.
11 PUBLIC WORKS OTHER PUBLIC WORKS CONDITION INFORMATIONAL
Notes:
Must submit receipt of artificial turf material being used at final inspection.
.11111.11"Aitiimairilifirt..
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $90.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $45.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.03
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 $100.00
TOTAL: $264.03
Issued Date:4/6/2023 2 of 2
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Building Permit Application
City of Atlantic Beach Building Department REVIEWED
t
D
i" 800 Seminole Road, Atlantic Beach, FL 3223 BY-41 ,„,
Mike Jones at 11:22 am, Mar 28, 2023
Phone: (904)CI(904)/24 (82r 247-5826 Email: Building-Dept@coab.us r r""`�"rnJ`�'
Job Address: 36-3 / f t- t Permit Number: g•ti-SCZ 3 --OCC`
Legal Description //14-211 111 CK l�, J(/JD/v'' 4' RE# 1(D / 0 1� 0U�
Valuation of Work (Replacement Cost)$ J'2IO UJ Heated/Cooled SF N//! Non-Heated/CooledA•11A
• Class of Work: CJNew [lAddition Alteration HRepair LiMove [iDemo OPooI LiWindow/Door
• Use of existing/proposed structure(s): []Commercial Residential
• If an existing structure, is a fire sprinkler system installed?: DYes X)No
• Will tree(s)be removed in association with proposed project? :'Yes(must submit separate Tree Removal Permit)\No
Describe in detail the type of work to be performed:
tUgr IM)t/ )IATinA)) 14,.30 Sail• (=6v/ lftl kr ,02
Florida Product Approval# f\ii' r- Avit to L1 c for multiple products use product approval form
Property Owner Information
Name L-0AiNi e- PA/NiPS Address 31, y-im _St, 4.8 1/ 32133
City /Adr( d t'itel-% _ State F) Zip 32-Z '- - Phone 35 2" 21/4 /33V
E-Mail t-t?/,c/%pJEArI4/'q/1c..) • L:vrr7
Owner or Agent (If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company joL/1- ')C v/" U&( Qualifying Agent
Address 1c,2 1//r/e cf. City Nejvr'C BeN• State Zip 3 2-2- 6 6,
Office Phone ie'r- Joe. •- 9 7,Y 1 Job Site Contact Number /i A-7-.24A/
State Certification/Registration# N/P E Mail PP/it/td `,";oil' "I) P--, D Y9
Architect Name& Phone# /(i /f
Engineer's Name& Phone# �
Workers Compensation Insurer R/el c" , OR Exempt o Expiration Date ..•.C--/-$ s '2 3
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 A ORNEY BEFORE
RECORDING YOU NOTICE OF COMMENCEMENT.
( ignat f Ow ent) (Signature f Contractor)
Signedand sworn to(or2affirmed)before me thisLi day of Signed and sworn to(or affirme 'befor•frte this<<day of
0/1,,Ys
L - ZOZJ , b L„ n„,C Pt,r+) +) Alp., i-i 2 ('13 by I'. , a. 1
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14'.f.: ,'i:'.. MY COMI�ISSIOtI#HH 203374 :` `� Notary Public S'r�.: - _-
t,.., ., .
�. EXPIRES:November 30,2025 ,/, =▪ `• 0:,. Commission ��_ •�
[ )P sonally Known OR ''''f. .17:4:'' p.rded Tbry Notary Pak 11,iderwriters NI Personally Known OR .� -,=:= Y Comm.Ex,:,,= : :::
Produced Identificati. - ( I Produced Identification Borcee through Natrona .1,i^
Type of Identification- IllairMIIMEAMIK, Type of Identification: �"'
nye WI 4
JOB COPY
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24JUNE113 14.0127
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MAP SHOWING SURVEY OF
111 LOT 24, BLOCK 6, SUBDIVISION -A" ATLANTIC BEACH AS RECORDED IN PLAT BOOK
5, PACE 69 OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA
JOB COPY
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EL DENOTES ELEVATIONI •. cm IT 1 I0 I 0
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NOTES. ----- ▪ (49.99' FIELD)
I THIS I5 A BOUNDARY SURVEY. eMtY Mj/'
2. NO BUILDING RESTRICTION UNES AS PER PLAT. b,_. 2
3 INTERIOR ANGLES PER FIELD SURVEY AS FOLLOWS wu 0.6e1
A - 89'31'27'
B ,e, 90'21'21-
4 L - 69352- OU (4Th) STREET
D - 901)7'20'
NORTH PROTRACTED FROM PLAT
FY PAVED PUBLIC ROAD
• RIGHT OI NA
THE PROPERTY SHOWN HEREON LIES IN FLOOD ZONE
'x' (AREAS OUTSIDE THE 0.2X CHANCE OF FLOOD)
AS WELL AS CAN BE DETERMINED FROM THE FLOOD THIS SURVEY WAS MADE FOR THE BENEFIT
INSURANCE RATE MAP 12031C0409H, REVISED JUNE OF LONNIE PHILLIPS AND MEGAN PHILLIPS.
3, 2013 FOR DUVAL COUNTY, FLORIDA.
1
•
FINAL SURVEY - JUNE 16, 2016 A. .4
-NOT VAUD Mr MOUT THE SIGNATURE AND THE ADOED BUILDING RESTRICTION DONN W. BOATWRIGHT, P.S.M.
MORAL RAISED SEAL Of A FLORIDA UCENSED LINES - OCTOBER 21. 2015
SURVEYOR AND MAPPER.' FOUNDATION LocAnoN - FLA. UC. SURVEYOR ANO MAPPER No. LS 3295
SEPTEMBER 18, 2015 FLA. LIC. SURVE YINC & MAPPING BUSINESS No. LB .3672
CHECKED BY: DATE:
DRAWN BY: PCP BOATWRIGHT LAND SURVEYORS, INC. JUNE 24. 2015
FlLE: 2016-0673 1500 ROBERTS DRIVE, JACKSONVILLE BEACH, FLORIDA 241-8550 SHEET'OF
111/ 2UlS-1131k 001/-Ill /
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i ,„..ash Register Receipt Receipt Number
91, City of Atlantic Beach R22851
_-:.--J i i__,
-- --!ESCRIP . t ..�. :
City of Atlantic Beach, Florida
ev,0 cardknox 800 Seminole Rd
A Fidelity Payments Company
Atlantic Beach FL 32233
904-247-5800
PROCESSING INFORMATION
Amount $264.03
Date: 4/6/2023 1:36:59 PM
Transaction type: Sale
Status: Approved
CARD INFORMATION
Card type: Amex Card expiration: 03/27
Card number **** 1013 Cardholder name:
BILLING INFORMATION
BUILDING-DEPT@COAB.US
ADDITIONAL INFORMATION
Entry method: Keyed Payment method: Credit
Reference Number: 847374839 Payment type: Credit Card
Authorization Code: 221532 AVS:
Address: No Match&5 Digit ZIP: No Match
Service Fee: $7.63
Description:
RESO23-0030
SIGNATURE
X
I Agree to pay above total amount according to card issuer agreement period.