321 8th St RESO24-0023 A
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,/,';'Lf‘-'' ,ti Building Permit Application
Updated 10/9/18
City of Atlantic Beach Building Department •`ALLINFORMATION
an 0' 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 5 0+4, -t N'� f Permit Number: RSO Z4- Z
t VV
Legal Description —L: U /v'- ` ''& /If/ j f/I f --ri lr /`.•ik /CI REH_/ C�9 cr 20n/
Valuation of Work(Replacement Cost)S I C '7 __t)', Heated/cooled sr tilt Non-Heated/Cooled,' /n!!
• Class of Work: ❑New IlAddition `Alteration I !Repair I !Move I 'Demo LlPool CJWindow/Door fFt
• Use of existing/proposed structure(s): LCommercial TYt1<tesidential •
• If an existing structure,is a fire sprinkler system installed?: C1Yes (Ao p)it
• Will tree(s)be removed in association with proposed project? Lyes(must submit separate Tree Removal Permit) ONo
Describe in detail the type of work to be performed: <7/2/ �,:. 4:'/4----* Pr/7 pU c/y
A� � �lcj�, i,,1 /N517\11A ( .'- rrf-t_ Pr---I•-';t ay--
Florida Product Approval# for multiple products use product approval form
Property Owner Information
37l 0 'K- 51. '
Name 'Ge ( Address p��
City r L..'; State ��• Zip Z 73 Phone 4_,/1,, .Si)y rtL/47
E-Mail /17 / + , .r.,:-- .t" ' 7 .-'i` �� C D ;'' r / 1
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information _
Name of Company 5Ot e2 11,7 l2,t�'"" Qualifying Art _
Address I «..---- '�f f�t 3_,i.• City����' �' . , State ✓ • Zip 7 7_,—L-L,s
Office Phone L`-` i> " y
Job Site Contact Number �;f
l=!'. t
State Certification/Registration#Li fJ i E-Mail GG, ,-,L,,,,,,✓f?)-✓)2,A-, i,,,,--i
Architect Name& Phone# /,-!/J ,
Engineer's Name&Phone# ( t
Workers Compensation Insurer Vri)iiii.
'j OR Exempt o Expiration Date r---/— Z c';
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 PROP RTY. I' YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN 4 ' •RNEY B J •RE
RECORDING YOUR NOTICE OF COMMENCEMENT. - •
(Signature Owner or Agent) (Signator- • . ractor)
Signed rd sworn to(or affirmvd)_t�efore me thisZ�ay of
Si ed a sw rn to or ffir d) Before me this y of
ref ZU 4-by ("A-, 1 �,,- . _ Vv F, t \ eb, Z Y
natV o nature Not
6-------------.
[ ]Personally Known OR ersonally Known OR
[ )Produced Identification \ 1 )produced Identification
Type of Identification: U L. 'r'P type of ode .ihcation:_-._
'�'" TONI GINDLESPERGER
• an c MY COMMISSION#HH 407122 ',a••
L n .• .:. '•••:It,•: TON!GINDLESPERGER
: •. P EXPIRES:October 6,2027 yTm MY COMMISSION#HH 407122
°F ` ';',... ',F........
. EXPIRES:October 6,2027
.,of �,,
14.
3L-1 5 HI 'tit ' 4Rrific/fl,
MAP SHOWING BOUNDARY SURVEY OF
LOT 10, BLOCK 10, SUBDIVISION "A", ATLANTIC BEACH AS RECORDED IN PLAT BOOK 5, PACE 69.
OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO:
GINNI L.KLEIN
THE GORDON BANK
•
STEWART TITLE GUARANTY COMPANY
RICHARD T.MOREHEAD,P.A.
SET 1/2'ROW o ocK 910 S 89'59'57" E � SET 1�2 REBAR
STAMPED'ACM LB 6702 p ' 49,99' MEASURED __02.•
HUMPED ACM LB 6702'
D • 120. �• 0.1' ._
50.00' (P.AT)
GARAGE
:,8 I1 r
21
,
LCT 10 ; • •
BLOCK 10 •
o ! o
W I W
a to
V e n
In
W MR • Q
W
M CONOIT,ONER 1
u I STEPSPAO
1j
C v
<E N 29 B' ot'13 4' (V 1
ONE STORY cl of
LOT 12 O N MASONRY AND FRAME ul N
r
BLOCK 10 ''" o LOT A
n 3 I 321 ��� 6 BLOCK 10
Li rT
co V • Q
IV N v• cV
O f- O
•• !1
Z 9' 13.4' ''I (n I 0 a
'ill"APrill I I- ,,
• O2
7CPS ' V O
it A 01tiCill
/ J �U 2t(''� d
N/959'40'w I i W
. - . • 20005'(PEAT) /� .'
N0'I E S9 Tl 1y`
_ __ 20000'(uEAHUREO) W
•
SET 1/2'RCBAR HET 1/2'REBAR ��
HTAMPED-ACM lB 67pY_• N 90'00'00" W STARRED'ACM LB 61C2' FOJND 1/2'IRON PSE
78TH STREET 49.99' (MEASURED) ND IDChTICAEON
(00.0' RGHT OF WAY) 50.00' (PLAT) 'I
1
NQS: ACCEPTCD Br —__-_______ _-_-_
LEGEND: -
R = RAMS - x--- = FENCE
L = LENCTII (..') e CONCRETE — -.r.- _ _-._.._--.__--..
t,OTES.
1 BEARINGS ATE BASED ON TIlE ,.ASSUMED BEARING OF ., N 900000 W ,,,ALONG THE REVISIONS
NORTH RIGHT Of WAY LINE OF'8TH STREET.
DATE DESCRIPTION
2 BY GRAPHIC PLOTTING ONLY THE CAPTIONED LANDS LIE WITH'N FLOOD TONE x AS S•IOWN ON THE
ATONAL FLOOD INSURANCE MAO DATED APRIL 17, 1989, COMMUNITY NUMBER 120075.PANEL 0001 D,
3 111'5 SURVEY REFECTS ALL EASEMENTS&RIGHTS OF WAY AS PER RECORDED PLAT VOR TITLE COMMITMENT
IF SUPPLED. UNLESS OUiCRWISE STATED, NO OTHER TILE VERIFICATION HAS BEEN PERFORMED BY THE UNDERSIGNED
4 TNS SURVEY NOT VALID WITHOUT THE EMBOSSED SEAL OF T.E CERTFYING SURVEYOR
JOB y 12974 I DATE Off FIELD SURVEY: 10--31-00 DATE OF ISSUE: 11-02-00 I SCALE: 1" = 20'
CERTIFICATE
(A--tl 2522 COk Street I HEREBY CERRFY THAT 13115 SURVEY WAS HATE;/NDLR MY R(SPONS DJ CHARGE
moi. JOGAIOf v.I e,FIOTido 32204 AND MEETS 131E WNIMUM TECHNICAL DI�HOARDD AS SET YOHIR BY THC F.ORIDA
(Phone)904-369-5989 BOARD Of THE TIN VF.JRS ANO UAPPF RS'iN CHAP:ER 51011-6.FLON DA
(F0e) 904-389-6175 AONIH'STRATIV( '545141 TO Sr. 1OA 47/.0.12 FLDRDA NTA1,IES
suUv[iinc Inc '-- -f ` __: �01��
M1puEL ,I : LO
LICENSED BUSINESS /6702 REGISTERED SURVEYOR AND MAPPER 14079 STATE OF FLORIDA
LAND SURVEYS 0 CONSTRUCTION SURVEYS 0 SUBDIVISIONS
Mfil P/c,, t 1`v'( lliSto li YOS1' Rest d eiC. 321 Si4 sf.
,:'''°'``. Building Permit Application Updated 10/9/18
,-
e .... ) City of Atlantic Beach Building Department **ALL INFORMATION
Jr l) 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 314. i5 441 5"Cre lir ,/ Permit Number: /fin0
Legal Description 54 /�QP�.s" ( t` ,3
2. ! ATI 136ti &0t/O Blk !0 RE# / l�1 0
'?$ 0
'7'
Valuation of Work(Replacement Cost)$ 1 q $g-• " Heated/Cooled SF N J/Q Non-Heated/Cooled Al/fj
• Class of Work: ❑New ❑Addition Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial etesidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes Vlo 01,1
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) Ell No
Describe in detail the type of work to be performed: Y21_56:.(44)-c...- Pri pt.T 4/'/
Ai All FICA -1'vPJ- IhiS "it l/r T/t i.) nett r'cLf -f'U4f
Florida Product Approval# for multiple products use product approval form
Property Owner Information b C J t
�arca.< F Address 3 , 7..3 - `
CCity •
e I.1-° C -
• State 'it• Zip 3 Z Z 33 Phone 2119 - St)9_ 9' 9
E-Mail b i , Yos-1 ' yAci { --D D 1i c • [. D ''�
Owner or Agent(If Agent,Power of Attofney or Agency Letter Required)
Contractor Information
Name of Company Lceti,i' ? "(J R.C` Qualifying Agent
Address ? ', d ,
_ City, State ZipJ
Office Phone C Job Site Contact Number vfr/),
State Certification/Registration/I#�f i? E-Mail 1 i dt f/� e-17P fkil,,f Z F>
Architect Name& Phone# 1 /'i n c✓ J
Engineer's Name&Phone#
/ /
Workers Compensation Insurer ��o/(>� ✓� _OR Exempt 0 Expiration Date �! ! Z /y
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 AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this day of Signed and sworn to(or affirmed)before me this day of
• ,by ,by
(Signature of Notary) (Signature of Notary)
[ ]Personally Known OR [ ]Personally Known OR
[ ]Produced Identification [ ]Produced Identification
Type of Identification: Type of Identification: