920 Sailfish Dr RESO23-0110 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
STEVENS LISA 920 SAILFISH DR ATLANTIC BEACH FL 32233-4219
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171164 0000 ROYAL PALMS UNIT 01
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
920 SAILFISH DR
RESIDENTIAL OTHER SINGLE OR
TWO FAMILY RESIDENTIAL
OTHER
SYNTHETIC TURF $4436.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 PUBLIC UTILITIES UNDERGROUND WATER SEWER UTILITIES INFORMATIONAL
Notes:
Avoid damage to underground water and sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is
needed, call 247-5878. State Law requires calling Sunshine 811 to have ALL public utilities located BEFORE beginning the work.
2 PUBLIC UTILITIES METER BOX SEWER CLEAN OUT INFORMATIONAL
Notes:
Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible.
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 3Issued Date: 12/8/2023
PERMIT NUMBER
RESO23-0110
ISSUED: 12/8/2023
EXPIRES: 6/5/2024
RESIDENTIAL OTHER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 $100.00
3 PUBLIC UTILITIES ADDITIONAL COMMENTS PUBLIC UTILITIES INFORMATIONAL
Notes:
See Revocable Encroachment Agreement regarding driveways/pavers and public utilities in the ROW
4 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.
5 PUBLIC WORKS DUMPSTERS/ROLL-OFF CONTAINERS INFORMATIONAL
Notes:
Dumpsters and roll-off containers must be used in compliance with Section 16-8 and must comply with all standards, per City code.
6 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration, including sod, is required.
7 PUBLIC WORKS CONSTRUCTION SITE MANAGEMENT INFORMATIONAL
Notes:
Provide construction site management plan, including location of silt fence, dumpster, portable toilet. Right-of-Way Permit is required if using right-of-
way for construction parking.
8 PUBLIC WORKS GRASS INFORMATIONAL
Notes:
Full site to be grassed.
9 PUBLIC WORKS REVISION INFORMATIONAL
Notes:
Any plan change must be submitted as a Revision to the Building Department.
10 PUBLIC WORKS DEBRIS REMOVED INFORMATIONAL
Notes:
All construction debris must be removed from job site by Contractor.
11 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Contractor.
12 PUBLIC WORKS OTHER PUBLIC WORKS CONDITION INFORMATIONAL
Notes:
Use base material with <10% fines only. Inspection of base material is needed prior to artificial turf placement. Must submit receipt of artificial turf
material being used at final inspection.
2 of 3Issued Date: 12/8/2023
PERMIT NUMBER
RESO23-0110
ISSUED: 12/8/2023
EXPIRES: 6/5/2024
RESIDENTIAL OTHER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
TOTAL: $125.00
3 of 3Issued Date: 12/8/2023
PERMIT NUMBER
RESO23-0110
ISSUED: 12/8/2023
EXPIRES: 6/5/2024
RESIDENTIAL OTHER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
0
3 :
I Ll)1 BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE?USE ONLY
City of Atlantic Beach Building Department PERMIT# R,ESbZJ-01 (0S
V 800 Seminole Road, Atlantic Beach, FL 32233
ALL information required to process
Jf3 u'' Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address -L,, SAIL-(114 t'*2-- LST kI''>%1 c- .B-L,61/4 L 1-t %L 3-:,33 RE#
Legal Description NJ-- N tl"IETiC. "fU c1= "r) K L%i'LL+C- G-ic.:-'}S5 -- CP 3C /—
Valuation of Work(Replacement Cost) (4456.00 Heated/Cooled SF Non-Heated/Cooled SF
Class of Work: gNew E 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?: DYes No NI Pk
Will tree(s)be removed in association with proposed project? EYes(Must submit separate Tree Removal Permit) [to
Describe in detail the type of work to be performed:
P71J y `„` ,k,rit i r ',k'i' e. mit,x1-6-s c'P:Jot_ it . k(_t' yA44J -171 i' .el_ ...rr-5 "IAA;
707q e i(/kr /CSD
I
Florida Product Approval# For multiple products use Product Approval Information Sheet)
Property Owner Information Name LI 5fr c 1-w 1.-15 Phone g(a0 -9c4 -312 c.:"-
AddressAddress °IZ G "ilk'Li 1 F I ')l -- City A T t,A Lsi)( ( c fti I,} State( L Zip •32L
Email L.Pe.;ij_VL t"=-) 6 A.pI_.;sfkOwner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information Name of Company Pv<tKal LA VJk•- I'A&lb LAN OSCAPE- Phone 6)0.1'117 0-0 1.1 ?.)q
Address I:,Il .Y kg/Ler:l 44t City A/ t'. let, ' State Imo(_
Zip ' 22 r0
Qualifying Agent iJ I LL.I Ak& PO SCI State Certification/Registration# A
Email PCS 1k12C- i LONJP.J e I-kyiptA L. CCAs. Job Site Contact Number 4 196 O 1-1
Worker's Compensation Insurer OR Exempt 'Expiration Date
Architect's Name t•/13C Email Phone
Engineer's Name 111 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 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 YOU PAYING TWICE
FOR IMPROV ENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER • ' AN
ATTO7...
EY E RECORDING YOUR NOTICE OF COMMENCEMENT.
Signature • Owner or Agent) ,..
s,•`
Signature of Contra •r)
Signed and sworn to(or affi •)before his - day of Signed and sworn to(or affirmed)bef• e me this day of
6 rib 142- by its." S
Signature of Notary Signature of Notary
Personally Known OR Produced Iden tion Personally Known OR [ ] Produced Identification
Type of Id- - '••• __.--___ ____,...--1 Type of Identification:
il:!'Y•; •. TONI GINDLESPERGER
mss MY COMMISSION#HH 407122hnu
p` EXPIRES:October 6,2027
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: 2b 5A1(..i=cst r>?-- A-7.".-11 >`ct -
Owner Name: L-LSA Phone Number: '( )3 1 ZS
Mailing Address: x'17.4; A-1 l N ki 'City: 1.1-11.4.117(- t'J l`FC. 14 State: f'(_Zip:_322 2,
Notarized Signature of Owner
The
for eg0--ipg instrument was acknowledged before me this a6 qday of 1 tbt , 20 n, in the State of Florida, County
J V
Signature of Notary Public A
Personally Known OR [ ] Produced Identification
Type of Identification:
Updated 10/24/18
vP`
B•.' TONI GINDLESPERGER
MY COMMISSION#HH 407122
A• P's EXPIRES:October 6,2027
a
vi,;;, REVOCABLE ENCROACHMENT AGREEMENT
t
City of Atlantic Beach
ALL INFORMATION
HIGHLIGHTED IN GRAY
800 Seminole Road,Atlantic Beach,FL 32233
IS REQUIRED.
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation organized and
existing under the laws of the State of Florida, hereinafter referred to as"CITY" and
L[Sn S'rVeNS of Atlantic Beach, Florida, hereinafter
referred to as "USER".
WITNESSETH:
That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon the
property for the purpose as described in the City of Atlantic Beach.
This work is generally described as t eL ftCA N(7 &gASS W/ TUQF i OSo C)93p L
Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to
relocation or removal on thirty(30)days'notice by CITY to USER,said notice to USER shall be given by certified mail,return
receipt requested,to the following address 92,0 S Pc 1 CC tSt-( DP- /-r. iN-1 C 3Fpco-k ,(i32z3.5
In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter
upon the above described easement or property of the CITY, the USER shall replace at the USER's sole expense,
any and all material necessarily displaced during the action of maintaining,repairing,operating,replacing or adding
to of the utilities and facilities of the CITY or franchise utility provider.
The facilities allowed by the permit shall meet the current requirements of the City Code, Building Codes, Land
Development Code and all other land use and code requirements of the CITY, including City Code Section 19-7(h)
which states "Driveways that cross sidewalks: City sidewalks may not be replaced with other materials, but must
be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks."
The USER, prior to making any changes from the approved plans and/or method, must obtain written approval
from the City of Atlantic Beach Public Works Department, for said change within 30 days after the day of
completion.
This permit shall inure to the benefit of,and be binding upon,the USER and their respective successors and assigns.
USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or
specifications,to include utilities locate requirements and use limitations/requirements of easements,public right-
of-ways and other public land. USER further agrees that the CITY and its officers and employees shall be saved
harmless by the USER fro any of the work herein under the terms of this permit and that all of said liabilities are
hereby assume by the SER.
Date
l6 (z f 25
Property Owner/Agent(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this 024,
frie\
day of 0C'b-t r 20
22->
by SSA- 51V L N S printed name of Signer),who personally appeared
before me and acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
TONI GINDLESPERGER
iun MY COMMISSION#HH 407122
di
e= EXPIRES:October 6,2027
fZ, F;.• ;.`
Department Approval:
Signature of Notary Public,State of Flor •a
I Personally Known
1Produced Identification(Type) ` , Public Works Department Date
Revision Date:05/09/2023
MAP SHOWING BOUNDARY SURVEY OF
LOT 10, BLOCK 4, ROYAL PALMS UNIT ONE, ACCORDING TO THE PLAT
THEREOF, AS RECORDED IN PLAT BOOK 30, PAGES 60 & 60—A,
OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO:
SAILFISH DRIVE
60' RIOIIT OF WAY)
N 23'37'33" E
104.55' (PLAT)
N 23'34'44" E
104.58' (MEASURED)
Cir
0.2'
11") m•
5••\
Srlb
cve,
P
ev,l'.• rO 0J
25' BUILDING 7
RESTRICTION LINE
I7.1 .,
y..'- .–.._.._..___
O --16'e
39.0 COVERED 10.0' '
iLi ENTRY PT
3 2 .. ONE STORY o 0 3,
I\ aN Q n MASONRY N '6"
LOT 11 N IN 1 POSTED #920 In 0
om
BLOCK 4 N o N` 4,
co p LO CA
o.Y
o CN
CN .'
0.6' 4`0 ,.r n a 01. A(4,
Q- .1
Z O P
O m W3'L
r A/
DG
r
A? ti^O LOT 9
O' c, O• BLOCK 4
1-67,..:3161____
T.--
77,
OT 10I /A, / .^)
LOCK 41
C-1
0.3 Ds
S 34'23'41" W
10' EASEMENT FOR
c____.
o •,,,
DRAINAGE do UTILITIES tri 1' 22.58 (CHORD)
L-2
y0' 1.3'
MEASURED)
S 34'31'54" W
LOT 23
OT 24 \BLOCK 4
LOCK 4
22.68' (CHORD)(PLAT)
L-1
S 5913'28" W
10.00' (MEASURED)
S 59'08'20" W
10.00' (PLAT)
10ca 7 Z1-f 5 L-2
k.)^S Ql) ,7/S 2310'33" W
37.10' (MEASURED)
S 23'37'33" W
LEGEND: 37.00' (PLAT)
X— - FENCE
0 - CONCRETE
Q - SET 1/2' REDAR STAMPED PSM/6146
0 - FOUND 1/2* IRON PIPE NO IDENTIFICATION
UNLESS OTHERWISE NOTED)
4'x4" CONCRETE MONUMENT PC = POINT Of CURVATURE PRC = POINT OF REVERSE CURVATURE
A/C = AIR CONDITIONER PT = POINT OF TANGENCY PCC = POINT OF COMPOUND CURVATURE
I DC\ACl/IAIC
I: „ Revision Request/Correction to Comments ALL INFORMATION
HIGHLIGHTED IN
r City of Atlantic Beach Building Department GRAY IS REQUIRED.
r
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:'RESO23 .0 I I V
Revision to Issued Permit OR Corrections to Comments Date: // /20Z 3
Project Address: I20 SA Dg_ a-TLMJTIC 6E ct2( FC_ 322-3 j
Contractor/Contact Name: L ISA 5-i-G.\/GN5
Contact Phone: .60 glp I 3125 Email: LAPS1tVei\-1S & a- _ C 0 ,
Description of Proposed Revision/Corrections:
op 3 p L 5 y>Jroci1c -1L) e-650vAccs /-tam AGF.) AP-P2OV 6L
W 2 v S g IN IN Pi o,_ yAeD 1t/ PPP4o /A( - 61-/ 2 Ei Eic _ .
Pgekliou3 (N S iiosc_t,_ vv/k, coot P L Gui (.-(../f}44 toa L6
L-)5A STEN-1 S affirm the revision/correction to comments is inclusive of the proposed changes.
Printed name)
W' I proposed revision/corrections add additional square footage to original submittal?
o Yes(additional s.f.to be added:
Will proposed revision/corrections add additional increase in building value to original submittal?
10No *
yes(additional increase in building value: $ Contractor must sign if increase in valuation)
Signature of Contractor/Agent: ((Ca
Office Use Only)
Approved Denied Not Applicable to Department Permit Fee Due $
Revision/Plan Review Comments
Department Review Required:
Building
Planning&Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities
Public Safety Date
Fire Services Updated 10/17/18