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1918 Oak Circle 16-SCRN-2602 s-up,..'' City of Atlantic Beach thS APPLICATION NUMBER ' S Building Department i (To be assigned by the Building Department.) 800 Seminole Road �'Y- ° -r Atlantic Beach, Florida 32233-5445 Se --26V Phone(904)247-5826 • Fax(904)247-5845 NOV 2 1 2016 !o;ils.)r E-mail: building-dept@coab.us Date routed: 1 (. / Ij// C City web-site: http://www.coab.us ((( APPLICATION REVIEW AND TRACKING FORM Property Address: 19 t ej C f\fcC l CLE Department review required Yes No CuildApplicant: \/U L) nning &Zonin• Tree Administrator Project: C REE DJ Ekjew_so,s c, 2_c. ry ublic Wo! (f'ublic Utilities) Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt of Permit Verified By Date 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: VApproved. I 'Denied. i !/''•?, /k (Circle one.) Comments: BUILDING Z. PLANNING &ZONING Reviewed by: `/ Date: 7/� //6 TREE ADMIN. Second Review: I 'Approved as revised. nDenied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: [Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 s�t�Usi ry I � BUILDING PERMIT APPLICATION ' CITY OF ATLANTIC BEACH 'J a 1 ;�;t 800 Seminole Road,Atlantic Beach FL 32233 Office:(904)247-5826 • Fax:(904)247-5845 1 G _e YEN - 260 z Job Address: I 9 i (3 On,k CI f G le_ Permit Number: Legal Description Lot l 0 SQi l 110.- Pi G,n n Ct, RE# unit P-.- A Valuation of Work(Replacement Cost)$ e ri L) eated/Cooled SF Non-Heated/Cooled .Fe 0 CN 'I r Ac,, • Class of Work(Circle one): New Ai i[tion teration Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial Residentia • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes ED N/A • Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal Describe in detail the type of work to be performed: I n a,1 cl.. c) 111 V f . n fp S ore Ove(' 300 44 of e xi s i n5rat a0/St4 . Florida Product Approval # for multiple products use product approval form Property Owner Information Name: f k 1'e (n Address: /9/8 °ale_ Circ le City n t C a•.ett-CState ELZip 327_..3 3 Phone 3©y- -2. 9 8 I - E-Mail k 32 :3 2, q ��oo,corn wne or Agent (if Agent,Power of Atfomey or Agency Letter Required) 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. Contractor Information: Name of Company: Qualifying Agent: Address: City State Zip _ Office Phone Job a/Contact Number State Certification/Registration# E-Mail Architect Name&Phone# Engineer's Name& Phone# Worker's Compensation Exempt / Insurer / Lease Employees / Expiration Date Application is hereby made to obtain a permit to do the work and installations as indicated I certify that no work or installation has con menced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this j •sdiction. This permit becomes null and void if work is not commenced within six(6)months, or if construction or work is suspended or ab, ,oned Ikr a period ofsix(6 months at any time a ter rk is ,mnence/. I understandthat separate permits must be secured for Electrical , ,rk,Plumbing.Signs, Wells,Pools,Furnaces,Boilers, I,,l'r• auks and Air Conditioners,etc. Signature of Property Owner: Signature of Contractor. Before me this I 1 Day of I\-C'' 1 ii• .=_A,2._ 2 011r Before me this r ay of Notary Public:(..) bilkA U^cki jr-- Notary Public: I hereby certify that I have read and cvamined this application and know the same to be trite and correct. .411 provisions of/ ys and ordinances governing this ripe of work will be complied with whether specified herein or not. The granting of a permit docs not presume to give authority to violate or cancel the provisions of any other federal, .state, or local law regulating consult,11w?Or the petfonntrnce of construction z Y►u ,-CRYSTALBRADDOCK Rev.3/14/16 €�� Commission#GG 005409 uu tr: rill.., .off Exoires June 23.2020 LAN n TREE & VEGETATION AFFIDAVIT s r r \s, City of Atlantic Beach A� it Department of Community Development Planning&Zoning Division - ,<4.?, 800 Seminole Road Atlantic Beach,FL 32233 r�J;ilg� (P)904 247-5800 (F)904 247-5845 PERMIT# SECTION I-APPLICANT INFORMATION .P Owners) r Legal Authorized Agent* NAME OF APPLICANTdr( //e,/72 NAME OF COMPANY ADDRESS OF COMPANY PHONE CELL EMAIL CONTRACTOR CERTIFICATION NUMBER ATLBCH BUSINESS TAX RECEIPT NUMBER SECTION II-SITE INFORMATI/4/ N STREET ADDRESS OF PROPERTY g az ;r-le),9:77 ` 24 Fi_ Z23lam` 3 If an address has not been assigned to this property,contact the AB Building Department at(904)247-5826 to request an address. LEGAL DESCRIPTION 1,41 /v Selrr� (/o rf,-1,, , i /` n 2 LOT / b BLOCK / i SUBDIVISION REAL ESTATE NUMBER LOT OR PARCEL SIZE: SQ FT / AC RESIDENTIAL i'''''--- COMMERCIAL OTHER(SPECIFY) 1MM 1 affirm that 1 have reviewed the provisions of chapter 23, Protection of Trees and Native Vegetation"of the Municipal Code of Ordinances for the City o 'tlantic Beach,FL and/or i have participated in a pre-application meeting with the Administrator of those regulations. . que• I,I affirm that no regulated trees and no regulated vegetation will be damaged,destroyed and/or removed from the aba s b•a or\adjacent properties in conjunction with this project. " SIG A URC 2 OWNER SIGNATURE OF OWNER Signed and sworn before me on this l?day of /J c / ,'ZO/&byState of 1— �Ck_ County of V l)V', ( Identification verified: p I' c ) Oath sworn: r, Yes `� ` r- No • , r= • 7 ,,,*:''i4. TONI GINDLESPERGCR 1 Notary Signature '' ":� pry 1;_. MY COMMISSION#FF 924951 REV- ., vc� EXPIRES:October 6,2019 MY Commission expires: '?„iiF t Bonded Thru Notary Public Underwriters :r(Ir%1iyr�n CITY OF ATLANTIC BEACH ...)VJ%V V ' WNER / BUILDER AFFIDAVIT - ; t,r I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I "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. TELEPHONE THE BUILDING DEPARTMENT(247-5826) 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. ]) 196 01 Cii-6,1e, hf lan`bc 64 Fb 4 33 4)64-2 - 98 d ADDRE S ePHONE NUMBER iin PRIN NAM 110, , ' , 0/Z0/4 SIGNATURE DATE Before me this I(4 day of &)0V2yr 19.e.-t2. ,20 hp in the county of Duval,State of Florida,has personally appeared herin by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of RNA DR ,County of L.. 0\I A L 0 Personally Known . LJ Produced Identification- J' (.1, 1 11'--.C)1?..V 1123 ��„�� 1 Z►: CRYSTAL BRADDOCK • I Commission#GG 005409 1 Ni P!iL P.E.. S/ ;,���P Expires June 23,2020 Notary Signature: a.." ntA (Ci �I�e:F oP' Bonded ThruTroy Fain Insurance 800.3857019 F:BLDG/Owner-Builder Affadavit;REVISED:4/16/2009 \\\, r_ .It 1--,) ti.1.45 0 ) n '.. -- . l' /A ,/ , /c?) ;. ,„ • • 7 - ,--- joocf \ , i-s- ›ravoIN , 0 _z4-1- ot.c-i z 7 _I , , -7,— , . _ LI I : ! AI1 i : -• I 1 ; / • • ii - ; 0 lil .-11, ,rglt-5- ir si — . - • — :k.,ii- t-.17-ib.cro_if, • (A��.. J w , i ' T:',;-... .-4 ,r J1 ' ,ly'•• "A'/ W/ �r •+• ,1~ '7"."'• ,�F i Yh'7,17F Y vc. a • • ' I- • - T' 1L 1 1 • �I• J 4i ��e7s - • _ ti � ,i•k t 1 • CL:.•":„.. p Sia ` • .3--)1•1'.., • ^ ', r•• t `1 • •L' •1.1; rt 41' 4 4• • .....;-'s.� ,s�a. l '1.t.1'a' '1'1 r J .Jr I, c� . r % •ri:tv -'1 • �{+ �•- • ••/ _ •:'• ✓�t,� el?,--.P ( lFlFlFj...�rr+' • • r • - I , 1 J 1,::r 1 i.I { L. art r 4, t C•. 4. 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SELVA MAelrtA UNIT tJp.1Z-A 1918 OAK_ GIR..CLE aocordi}y to plat recorded In Plot Book 3C.P , Page ( 4 of the current-publc records lot DuvaL County,Fl,-Jo. Examination of Flood Hazard Boundary Map, Community No. 'Izooms , ponos Or,-4 D , dated 9-1-1.89 , Indicates. that the property shown ono described hereon lies within a Zone_...Z.- area. i LLc u T Lar z •SIEC y 7.2 Q•ZrI•E Fuo , !z I P P ' .0 /•( W ei) <2 0 8V ti' J0r 0° LOT I I , N c 9 N . r, owe. 'OSA •K O.t• 4oL..,"i..e'o/ I/o' +'T o-r V".11 11.Aq' ' ea SEC.9 T 2.5�R Z9-E FLuce°..�. �.. Tea' (T1s) j �ti a NeOBA4 Pt' / r1A .Pr 10.9• o0 D3 Lea••• h0 J , 3 r t�Fa,Lo.0 P Q 1P' wore� . \''',.. '� •.•• . ".2.47•( F,'AF.E PLAT DIMENSIONS ALANG. _ - _ __ �,f C THIS LINE APP INco¢LECT, Ofi+E t 191D •5141,..,1J ACE NEN COMPUTED " F.F.OL6V DIST'A NC Es "N • • .... 'le ` *.• PO w 4.1.3 r,,,,, !S �, Iwo 40'- q,0 r Q O oc Y.CuT.- ' 'e '- 54 7 . 4 •'s 3s.: ' e.a-/Q 25.1 (TIES ©R.� clfc'cL€ C (T.e 2, 1 ,j 1 .,W . SIB I` Il I.t \ `q .., O I.... OF -z� ze sur. / \ �1a �5.1_04 m` G N•42.4. --'--- _ t .. E Anh,IF..I 1' U .4.1au 5 O• j4 ".5 E: I IS.Z2 u ..x. 'ru.a n ,. /�FUV 1, Yw... .r N.NT . ii• 1 e l 3 ' J L L-.._-,T 9 . N8: N r� EEFE[ENGE eENGLIMAE Li, 30 5. .. -,-,4, OF INTEESE4TI ON OF t. Fire 5T. AND 4_ SENINOLE ED B!. ELEV.(I 0.40 WE•/I5EO FLoop LECTIFICATIOIJ a-10-5q I Ct DAVID CLARK & ASSOCIATES LAND SURVEYORS 2711-2 ST. JOHNS BLUFF RD.-JACKSONVILLE,FLORIDA-(904)841-8700 A LEGEND KALL IAANLY JL.!pOLOTI•4i 5. CLEWN, LMICAGO TITLE I J- MC5 COa.,pANV+ • OONrJIC1Z IJlE11f THIS IS TO CERTIFY touA"Y FEoeL*L 4e"IT "I''''' • METAL SLUM eLT• ' this map Is a taus rspre.4ntallon of on actual tom.,oAc. surysy under IMO O YC01.e'Auu►a04o supervision In accordance with the minimum technical-standards.ae out• 0 tAO3uCUr lined In Chapter 2IHH-6, F.A.C. pursuant to Section 472,027, Ktt,t That `RX—MCI thers ore no encroachments except as may be shown harsont and that,to the best of my knowledge and belief, told survey Is correct. WL JOY NO, Basle of booting.' PB.3m P6 (04 5-9 B9 5-Ba IZ *Mb ►t►1L U.las '30 32 3(. Signed NAY 12 19.11. •- • 48. AL Irri ONIYt 1 motto iv 1 ea.1 nee ,orr.y 1, e,t weal tales: it t, FL negistsred-Surveyor Mt-44Z4 ` E.I-r T.B.L.. wb,../with t1. .YFYq/fV mt. TNU2NAN B. LIN[, „$)-Llifr, City of Atlantic Beach Js APPLICATION NUMBER � , Building Department ;4 ” 800 Seminole Road ' (To be assigned by the Building Department.) ,_) 8 ICQ –SaR-2 OL Phones (04)24715826 32Fax(04)247_584 47 5845NOV 2 � 2016 ,1110 E-mail: building-dept@coab.us Date routed: l I /( l ' City web-site: http://www.coab.us •- APPLICATION REVIEW AND TRACKING FORM Property Address: 19 t e) (p < @ , k.CL Department review required Yes No uildi _ Applicant: CD • l) E--(7 anning &Zoning' ) C E---: Tree Administrator S ���Project: k j CLO,S C/ 2c. cublic Work ) ublic Utilitie.V Public Safety Fire Services Review fee $ /9.------ 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: I✓Approved. I Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING S V I I `Z' Reviewed by: ,�,r V►� ` Date: • TREE •DMIN. Second Review: riApproved as revised. I (Denied. , P 4¢ WORKS Comments: PUBLIC TILITIES PUBLI —LT—/ SAFETY Reviewed by: Date: FIRE SERVICES Third Review: I !Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 r..i ,-ice•, ' L 't Z 5E . . 9 , -T-z-s a-z9-E _ --- -- _ ,F14D Y2 I P• 1 •o� a 10 .o 7,Q po r w 41 a • I 0v Ad. a 9 Is . N OI.- . LT l I -5 n 5 { t^ N,Q% fir, 64000�9 },4a / �nlct• oa \ wool" i j -j V 0.'I-❑ 16.8 .47ur `„•,\ c_,,,,,,--rc_,,,,,,--r LoT (i woo FE IV.tD.• 39.5 • - ;c..,�� 5EG a1 ,T•2-•5, R•Z9-E . P , o 0 -02 � � ., v 5 '-'r ` FNue.rxu NOTE: \ 3 °� GONG • 't . Z-ST'( FRAME '''';74.. Pl AT /DIM E1l- lOt�fS ALO + ,/ce vE EES. T1%5 LINE APE INcoe2EGT U^ 5Ho,..w AQE f4E.J Go4-1 PUT EC, • # 1918 J ( ^'� / F.F. zLEv . ,441/4...1.1\) DISTAIIGES GONG. n M CpK Z. os ti N 41'9 ,.%�'� c3 t. CO VC FUp . 11,3.08 X40 ' ' 61.o -r K-cuT--- 5.4 i a . 38.z `CO "' 9 I ri5y\0.4'/0 25.E (T1e.) ''