1690 Jordan St RESA19-0012 COAB Permit Form with Conditions - RenewedOWNER:ADDRESS:CITY:STATE:ZIP:
SAM BARBARA 1690 JORDAN ST ATLANTIC BEACH FL 32233-4336
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
172285 0000 ED SMITH S/D
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
1690 JORDAN ST
RESIDENTIAL OTHER SINGLE OR
TWO FAMILY RESIDENTIAL
OTHER
PATIO COVER OVER
EXISTING CONCRETE -
Renewed
$200.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $55.00
BUILDING PERMIT RENEWAL 455-0000-322-1000 0 $13.65
BUILDING PLAN CHECK 455-0000-322-1001 0 $27.50
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 $50.00
TOTAL: $150.15
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
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.
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.
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.
1 of 2Issued Date: 6/24/2019
PERMIT NUMBER
RESA19-0012
ISSUED: 6/24/2019
EXPIRES: 4/10/2024
RESIDENTIAL OTHER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
2 of 2Issued Date: 6/24/2019
PERMIT NUMBER
RESA19-0012
ISSUED: 6/24/2019
EXPIRES: 4/10/2024
RESIDENTIAL OTHER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
City of Atlantic Beach APPLICATION NUMBER
Building Department To be assigned by the Building Department.)
800 Seminole Road ZzAtlanticBeach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us L Date routed: !>
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1699 D 0 7- Department review required Yes No
ui din -
Applicant: 0 Co 0 ning &7o_n_Tnr--,
Tre-e_7Vd—m-1ffM-ra-For
Pro'ect: Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required
Review or Receipt
Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other.-
APPLICATION STATUS
Reviewing Department First Review: []Approved. ee nied. E]Not applicable
Circle one.) Comments:
PBUILDING
LA 8,ZONING
Reviewed by:Date:
TREE ADMIN.
Second Review: ElApproved as revised. [:]Denied. F]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:Date:
FIRE SERVICES Third Review: ElApproved as revised. E]Denied. F]Not applicable
Comments:
Reviewed by:Date:
Revised 05/19/2017
Building Permit Application Updated 1019118
City of Atlantic Beach Building Department ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us
IS REQUIRED.
q* /,OA z,Job Address: Permit Number: Rc— sA n -oo i
Legal Description RE#
Valuation of Work(Replacement Cost)$ Heated/Cooled SF No 7-_.O.at-ed/c_0qled
P_VVin_-dow_/D__o,6__r_ClassofWork: ONew MAddition DAlteration EIRepair DMove DDemo Elpoo)t,
J
Use of existi ng/pro posed structure(s): LICommercial EIResidential
MAY 2 3 2019
If an existing structure,is a fire sprinkler system installed?: DYes ao i,
Will tree(s) be removed in association with proposed proiect? F]Yes(must submit separate Tree Removal Permit) E1No
Describe in detail the type of work to be performed:
Florida Product Approval# for multiple products use product approval form
PropertV Owner Information
Name 'bogj?)Address
City S!.0A Vi State zip .
41)—gZa L Phone PICI-i
E-Mail UJ
Owner or Agent(if Agent,Power of Attorney or Agency Letter Required) U
Contractor Informat,on LL
Name of Company Qualifying Agent LJL
Address City State Zip
Office Phone
r or t
Job Site Contact Number
State Certification/Registration# E-Mail
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt 11 Expiration Date LILI
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or install0on has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws reg ing 0
ST -A Zconstructioninthisjurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING Sl -_ 4 0it
WELLS, POOLS, FURNACES,BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE:In addition to the reiquiremerfto,hg i=
permit,there may be additional restrictions applicable to this property that may be found in the public records of this coun!W Aw— 0
Z
W
there may be additional permits required from other governmental entities such as water management districts,state ager&AZ 0 4
federal agencies.0 H L) a
UJI II.- < g
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance"Vita);Z Ic Z
0
applicable laws regulating construction and zoning. U. W
co
14
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT M46 4 t: 6LL2
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INI%ND 05
CIL Cr co
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE W LU M a
3: W C3 LU
RECORDING, YO E 0 ENCEMENT. Ca LU 3:9"O!Tjfi E 0 F C 7 I= uJ
21A
Signa 94 of Owner or AgentF Signature of Contractor)
MT6T"r 1 T-- --fo,e me this day of Signed and sworn to(or affirmed)before me this day of
JENNTEF"WJO Nj 4Ltv,%ZrN W L &rAS by
EXPIRES:October 27-2020
ublic Underwriters Signature of Notary)Bonded Thru Notary P i atWof 14o ta )
I Personally Known OR Personally Known OR
jv Kroclucecl Identification I Produced Identification
Type of Identification: Type of Identification:
ALL INFORMATIONRevisionRequest/Correction to Comments
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
1,(
Vill
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: C)
Revision to Issued Permit OR Corrections to Comments Date:
Project Address:C) 0 rl
Contractor/Contact Name:
Contact Phone: Email:
Description of Proposed Revision/Corrections:
d r-
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?
VN o El Yes (additional s.f.to be added:
Will proposed revision/corrections add additional increase in building value to original submittal?
146 []*Yes (additional increase in building value: $ Contractor must sign if increase in valuation)
Signature of Contra cto r/Agent:
Office Use Only)
Approved Denied Not Applicable to Department Permit Fee Due$
Revision/Plan Review Comments
Department Review Required:
Building
Planning o n i n g Rev'iewed By
Tree A 5mls :torrtorinisra
Public Works
Public Utilities
Public Safety Date
Fire Services Updated 10/17118
ALL INFORMATIONOwnerBuilderAffidavit
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY 15 REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: R&S0417-6V12-
1. 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. YOUHAVEAPPLIED
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 Lj_
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS.
IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES C)
REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES.
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENT
SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. .
Ill. 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(l). 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.
JobAddress:JO(CtM. SA
Owner Name: Phone Number:
Mailing Address: City:State: Zip:
Notarized Signature of Owner
The foreffing instrument was acknowled/g/ed before me this eaK day of A-CAXJ 20 in the State of Florida, County
of
Signature of Notary Public
V V
JENNIFER JOHNSTON Personally Known OR [aProduced Identification
Type of Identification: FLI RIVIJ113
MY COMMISSION#GG 042984
EXP I RES:October 27,2020
Bonded Tivu Notary Public Undervv ters
Updated 10124118
M4P SHDWING BDUNDARY SURVEY DF;
THE NORTH 47.50 FEET OF LOT 8, BLOCK 1, ED SMITH SUBDIVISION, AS RECORDED IN
PLAT BOOK 26, PAGE 50 OF THE PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA, TOGETHER
WITH THE SOUTH 2.50 FEET OF THE 20 FOOT ALLEY AS PLATTED BY SAID ED SMITH
SUBDIVISION, SAID 2.50 FEET OF THE 20 FOOT ALLEY LYING BETWEEN THE NORTHERLY
PROJECTION OF THE EAST AND WEST LINES OF SAID LOT 8.
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NOTES:
BEAMNGS ARE BA SED CN THE wrs r RIGHT-OF-WA Y LINE OF
XRDANsrREErASBEINGS.00*15'00"E.
NOBULDINGRE$7'RICTIONLINEBYPLA7',Bur THEREwYaE
RESTRICTION LINES a9 EAS&RENTS THA r AFFECT THIS PROPERTY
BY ZONING OR RECORDED IN THE PUBLIC RECORDS OF 7'HIS COUN TY
THAT ARE NOT SHOWN ON T415 SURVEY
THISPROPERTY LIES IN FLOOD ZONE-X"OY FLOOD MAPS 4117189,
COMMUMI rY PANEL NO.120075 000/D.
City of Atlantic
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