163 BELVEDERE ST DEMO23-0027 �S` �`ik„ BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
ms's v = City of Atlantic Beach Building Department PERMIT# ;�t�mpZ3� �OZ7
s,
'\ 800 Seminole Road, Atlantic Beach, FL 32233 **ALL information required to process
-M-°'' v Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address (23 36) ,v6.-pee- -e _‘- A/t nc 404 t 3L RE# 1-703-1b3 _DOOo
Legal Description I b_8 i 7 -vS 'PM __ 1(.,-TA IIC St1( f £()( S Q 7 ..S-9 1
1
Valuation of Work(Replacement Cost) t.5-00,C) Heated/Cooled SF Non-Heated/Cooled SF
- 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 submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed:
VG'o S1 i,c,i 0 k4,6t / 7 / t;S/9al) 6.6 1 6-1,cr--17- 1 C 4-45t120-1.
- 1,✓�t/d6)-3tai I-.5i h r r
Florida Product Approval# (For multiple products use Product Approval Information Sheet)
Property Owner Information. Name - > c„.. I JV6ST-n-,a(jTS Phone qj v t(--`e&t•5ii`ie
Address 9 15 ()Q Gg., s----; City iVe 2p j( (),,-1,(tj State qL- Zip 7 ZZtot„
Email Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
• Contractor Information Name of Company f tLU (ices jt iy ` �'
pvC Phone qPt /f - 't, s
/
Address ID- (;o/a ti/�� /n City 1/47/pe. 0,644 State r'�- Zip ?'Z��-S
Qualifying Agent )Ct,,\f l W �uv j/-L.1 . . • State Certification/Registration# C4 'C( Z5 h j---7,c
Email , )(/-j-c, yl S f'I/( -/p,,,Np al-f;ii /- Job Site Contact Number qo �--g �— 0�lj i�
Worker's Compensation Insurer V OR Exempt Expiration Date 7//5-1/4..„1/
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Architect's Name Email Phone/ //
Engineer's Name Email • Phone
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 maybe 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 YOU 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.
- ,-- A. �
(Signature of Owner or Agent) c� (Signature of ractor)
Signee/d��and
��sworn to(or afffiir��med)before me this � day of Signed anii'sworn to(or affirmed)before me this /1) day of
AV-4, , 2D2 by /" V , Zirk; by 4svl,.W (444�4
Signature of Notary _ �v R Y /J�s3ipnat a of Notary � QV ys . •. . /,�
.� Expires- .- , '�
1Thsonally Known OR [ ] Produced Id cat 312 p� 6�` Personally Known OR [ ] Proctued Id of; ;,+.� .0'�
Type of Identification: =CO TrenB Ra T9f Identification: _��' �P�a� 0?j 03:----
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MAP SHOWING BOUNDARY SURVEY OF:
LOTS 593 & 594, SECTION NO. 1 SALTAIR, ACCORDING TO THE PLAT THEREOF,
AS RECORDED IN PLAT BOOK 10, PAGE 8, OF THE CURRENT PUBLIC RECORDS OF
DUVAL COUNTY, FLORIDA, IN SECTION 17, TOWNSHIP 2 SOUTH,
RANGE 29 EAST, OF SAID COUNTY.
CERTIFIED TO: JWB REAL ESTATE CAPTITAL
LEGEND:
BRL BUILDING IP IRON PIPE ((�� PROPERTY LINE I ELEc 1 ELECTRIC METER
RESTRICTION LINE IRC IRON ROD & CAP ITE ID.REAL ESTATE
CLF CHAIN LINK FENCE N&D NAIL&DISK IDENTIFICATION MATE�d WATER METER
CONC.CONCRETE OHE OVERHEAD NUMBER SET 1f2"REBAR
FL FLORIDA L ON ORB OEFFICIAL AL ECTRIC UNE SRFW SQUARE°FEET Y my Az CAP STAMPED
INV. 6.07' FND FOUND RECORDS BOOK TELE. TELEPHONE GAI LB 3604"
GYA GUY ANCHOR p PLATTED DATA WSHP WOOD SHARED
BENCHMARK: I ID IDENTIFICATION P,B. PLAT BOOK UTILITY POLE \ PROPERTY
SET PK N&D / INV. INVERT ELEVATION PG. PAGE OWNERSHIP HOOK
GAI TRAV."
EL. 9.00' I
DAVID STREET
p5 a9` Li' a�6 (50' R/W BY PLAT) 654 EPBENCHMARK: $1,g
10 GAI TRAV.
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CATCH BASIN 10"WSHP
GRATE EL. 8.51' I 1 ''1. EDGE OF PAVEMENT :.�
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[[ 0 I- •94 CYNTHIA HAGIST ET AL �w
T � rj' j" o I N �0 716 DAVID STREET ,, INC.)
ATLANTIC BEACH FL 32233 0 N
w 18"PALM RE ID. 170585-0000 , o^N
10"WSHP I ORB 18497, PG. 1900 0 -N
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TELE.RISER Se' RE ID. 170584-0000 �Ot `'9 -IRE ID. 170593-0000 r^� o'\
TIE:0.1'SE I ORB 10777, PG. 1593 \ ORB 18942, PG. 425 f al' .0C
NOTES: -k , .....•_,A.�s
1. BEARINGS SHOWN HEREON BASED ON STATE PLANE COORDINATES (1983/2011) WITH THE BEARING ON THE EASTERLY RIGHT-OF-WAY
LINE OF BELVEDERE STREET BEING NORTH 22'04'01" EAST.
2. ELEVATIONS SHOWN HEREON BASED ON NORTH AMERICAN VERTICAL DATUM OF 1988 PER TRIMBLE VRS NETWORK WITH AN ORIGINATING
BENCHMARK BEING A SET NAIL AND DISK STAMPED 'GAI TRAY.", WITH AN ELEVATION OF 9.00 FEET(SHOWN HEREON).
3. THIS PROPERTY APPEARS TO LIE IN FLOOD ZONE "X" WHICH IS AN AREA DETERMINED TO BE OUTSIDTHE 0.2% ANNUAL CHANCE
FLOODPLAIN, ACCORDING TO COMMUNITY PANEL 120075-0409-J OF THE FLOOD INSURANCE RATE MAPS FOR THE CITY OF ATLANTIC
BEACH, DUVAL COUNTY, FL, DATED NOVEMBER 2, 2018 AS PUBLISHED BY THE FEDERAL EMERGENCY MANAGEMENT AGENCY.
4. THIS SURVEY WAS PERFORMED WITHOUT THE BENEFIT OF A TITLE COMMITMENT. THERE MAY BE EASEMENTS AND/OR RESTRICTIONS
RECORDED IN THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FL AND NOT SHOWN HEREON.
5. ALL LIVE OAKS AND LONGLEAF PINES ARE MARKED. ALL OTHER OAKS ARE SCRUB, WATER, OR LAUREL. ALL OTHER PINES ARE SLASH
OR POND.
6. THIS PROPERTY IS ZONED RESIDENTIAL SINGLE-FAMILY(ARS-2). d.l) MINIMUM LOT AREA: 7,500 S.F.; d.2) MINIMUM LOT WIDTH: 75
FEET; d.3) MINIMUM LOT DEPTH: 100 FEET; e) MINIMUM YARD: 1)FRONT: 20 FEET, 2) REAR: 20 FEET, 3) SIDE: COMBINED 15 TOTAL
FEET AND 5 MINIMUM FEET ON EITHER SIDE; f) BUILDING RESTRICTIONS: 1) MAXIMUM IMPERVIOUS SURFACE: 45%, 2) MAXIMUM BUILDING
HEIGHT: 35 FEET ALL PER THE LAND DEVELOPMENT CODE FOR THE CITY OF ATLANTIC BEACH, FLORIDA.
. LEGEND: SCALE 1"=20' I HEREBY CRRTIOY THAT THIS SURVEY MEETS THE STANDARDS OF
gai consultants PRAE GCE AS SST FOR 114 EY THE FLORIDA BOARD OF SURVEYORS
1301 Ri verp�laco Boulevard,Suite 900 MAPPERS PUNSUANT TO CHAPTER•>2.02)OF THE FLORIDA
lackaoovilfe Florida 3220' STATUTES AND 51-1r of THE FLORIDA ADMINISTRATIVE CODE.
www.gaiconsultauts.com
www.gaicoRSultaata.com ]OB No
iiLB 3604 ENGINEERING•PLANNING•SURVEYING•CEI SERVICES B160030 DATE NOV.23,2020 JOSEPH K.LEK FLA.P.S.M.CERT.NO.LS 6016
NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED PROFESSIONAL SURVEYOR AND MAPPER
m000 c o1
O c o o 3 c" Permit Number Tax Folio Number 765 83-
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0
0 -C10- -0N
E F (-0 NOTICE OF COMMENCEMENT
7NN cD
cvs cnN
Om co O STATE OF FLORIDA
o x o xi COUNTY OF DUVAL
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n IV THE UNDERSIGNED herebygives notice that improvement will be made to certain real property,and in
� -u N P
c K 9 accordance with Chapter 713,Florida Statutes,the following information is provided in this Notice of
=i N Commencement.
o -o /� p
Oc 2 1. Description ofproperty(Streetaddress): )L3 Btkie pie ¶ 4Tt.raflr' ecn CA.377,73
2. Legal Description: lb—' g7— ?. c 2,1 1d t"-t r S Lt
Oc 9.13. General description of improvement: lIeA^ib St t Ltryt 1 Ly (1"S t esti
D
r 4. Owner information: LLC a. Name and Address: .a Si�ry e.S r rr.t�. LLC
b. Interest in property: Oyp ,p
c. Name and address of fee simple titleholder(other than owner):
5.a.Contactor's name and address:_KLT Construction Inc.-Kevin Hensley 15 Fairway Rd.Jax Beach FL 32250
b. Phone number: 904-813-8613 Fax number:
5. Surety Information:
a. Name and address:
b. Phone Number: I Fax Number:
c. Amount of Bond: /
6.a.Lender's name and address:
b. Phone Number:
7.a.Person within the State of Florida designated by Owner upon whom notices or other documents may be
served as provided by 713.12(1)(a)7.Florida Statutes.
a. Name and address:
b. Phone numbers of designated person •
8.a.In addition to himself/herself,Owner designs of
to receive a copy of the Lienor's Notice as p vided in Section 713.13(1)(b),Florida Statutes.
b. Phone number of person or entity designated by owner:
9. Expiration date of notice of commencement(the expiration date is one(1)year from the date of recording
unless a different date is specified)
WARNING TO OWNER:ANY PAYMENTS MADE BY THE OWNERAFTER THE EXPIRATION
OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER
CHAPTER 713,PART I,SECTION 713.13,FLORIDA STATUTES,AND CAN 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 COMMENCING WORK OR RECORDING YOUR
NOTICE OF COMMENCEMENT.
Signa of Owner wner's Authorized Officer/Director/Partner/Manager:
(Signatory's Title/ ffice)
The foregoing instrument was acknowledged before me this Z 3 day of 202.3
b} 0 pjS[0pas rJt,,/p/e1/L for LS dlit1s$ '/'c 00t1iiuii„,,
Notary: �.Zl.l' `�\Q�PR pe20P2ig5ne:.--::35res �4`
0/31 Personally Known Or Produced Indentification` entification Produced:�� _ TrenaRa
My commission expires: Q
My Commission
HH 192509 *.••Z
•Under
r penalties
best of
perjury,
I dand belief. `
declare
chave read the foregoing and that the facts stated in it are 'ii�` /O �Q
true the �\\`�``
i,nut�