1270 OCEAN BLVD RESO23-0047 S-"1/2-. Building Permit Application Updated 10/9/18
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rr City of Atlantic Beach Building Department **ALL INFORMATION
-K-frif800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
rst�~ IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us QEa 7
Job Address: 0 '1 O Q(JLJJI\ Permit Number: ` \ SO3 0047
Legal Description 10''I 1 lD ' S ._ 4 E RE# 11 I` ' a3 60ttO
Valuation of Work(Replacement Cost)$ Iy( 000
Heated/Cooled SF Non-Heated/Cooled
• Class of Work: IKNew ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial E tesidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ONo
• Will tree(s)be removed in association with proposed project? OYes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed: . -'
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Florida Product Approval# for multiple products use product approval form
Property Owner Information` (�I
Name ( S�YW �.. 5 �.. t 1 D < U l�j,,
L.hr _ Address -�� :,)- ,
City J jp/1f'i., )74 (n State rL Zip 12)33 Phone 'jU{- ',.-5--3(4) • (13O
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company 0 I , f ,011,iii Qualifying A ent /hi,i, F.0 "tet
Address I9�r ',j4lfpp'r /4 City �Ln-' Gk/State r( Zip 3?2 3
Office Phone Job Site Contact Number
State Certification/Registration# E-Mail a'(,aL e F/cr/JL Tu,t C9M(r r C 4
Architect Name&Phone# `l
Engineer's Name&Phone#
Workers Compensation Insurer (3!u( p1/4- //1 , /tic OR Exempt❑ Expiration Date
Application is hereby made to obtain a permit to o 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 FINAN f , CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDIN YOU' •T CE OF COMMENCEMENT. ..., i - it r . 0 -- ,--�r `'
(Signa .e o Owner or (Signature of Contractor)
• ned and sworn to(or a ;.) efore - th' ,ay ofw4C ' n d and sworn to(or aff' ;)pefor= tis day of
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/ \o- Rs .t -fid , _�i: at Prof �
1 �t"•"Y"-"t••; TONI GINDLESP.
[ ]Personally Known OR ,,, •°: s; Known O
,: MY COMMISSION#
[ ]Produced Identification ""' _ q9: 'PYd3ce Identificat r1: tr.v.'Y • TONI GINDLESPERGER
Type of Identification: ;b J 'ti^? EXPIRES:OctoberTyp f Ide f`ification: - ' MY COMMISSION#GG
yp { • • ...... They H✓y pubs; ti -.,-;;.,,,,,.:-.....;:s7 EXPIRES October 6,2023
',,P_ ;, Bonded Thru Notary Public Underwriters
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N 89°59'55"E 124.99'
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STONE RESIDENCE Ic...c -� .� PROPOSED:
EXFILTRATIC
1270 OCEAN BLVD x 30%=60 C
ATLANTIC BEACH,FLORIDA
OCC()F000ACy rtc$S. ccol `3 TOTAL STOF
POST DEVELOPMENT AREAS:
PRE DEVELOPM NT AREAS:
LOT 7,844 S F.
LOT 7,844 S.F.
IMPERVIOUS INCLUDES:
IMPERVIOUS INCLUDES. EXPANDED HOME,DRIVEWAY,WALKWAYS,
EXISTING HOME,DRIVE,WALKS. 3,866 S.F POOL. 3,866 S F.
TOTAL IMPERVIOUS 3,866 S.F. =.49% TOTAL IMPERVIOUS 3,866 S.F. =.49% DELTA VOLUME=3,587-3,,