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Permit Folder 175 15th St City Of Atlantic Beach Building Department APPLICATIO 800 Seminole Road N7Department.) " F3 Atlantic Beach,Florida 32233-5445 Crc be assigned by the BPhone(9(4}247-5826 . Fax(904)247-5845 /VIBI, E-mail: building-dept(gcoab.usCity web-site: httpJAwww.coab.us Date routed: 2 / APPLICATION REVIEW AND TRACKING FORM Property Address- /7� /P '' �Trf t review wired Yes No Applicant: 4 'n Plannin & Project: _ 1&4 e e or Utilities u afety Fine Services t�e _,WS nature r t } �.�9 Other Agency Review or Permit Required Review or Receipt of Permit Verified B ©ate Ftorida Dept,of Environmental Protection Florida Dept.of Transportation St Johns River'Water Management District Army Corps of Engineers Division of Hotels and Restaurants Dnrtsion of Alcoholic Beverages and Tobacco Other. ------------ APPLICATION STATUS Reviewing DepartmenFFIrRe w: pproved. (Circle one.) ❑Denied. : BUILD P �&ZONI Reviewed by S�.� -'�-- Date: o 2 2 x id TREE ADMIN. view: []Approved as revised. []Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: []Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05114109 City of Atlantic,Beach Building Department APPLICAT[tJN NUMBER . 800 Seminole Road E' ° `-!_ e.�� (To be assigned by the Buildin Department.) t� Atlantic Beach,Florida 32233-5445 F�` '91 O Phone(904)247-5826 - Fax(904) 47-5W 9 * / V1,01 E-mail: building-deptawab.us � Z f� Z �9 City web-site: httPJAwww.coab.us �� Date routed: 64 APPLICATION REVIEW AND CKIN G FARM Property Address; 'n #review u' tract Yes No Applicant: Planning& Project: _ ;r /Q de r Utilifies Fin=Services - F�:::�.g 4' Other Agency Review or Permit Required Review or Receipt Date Florida Dept of Environmerrta!Protection of Permit Verified 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: APPmved. [:]Denied.(Circle one.) Comments.- / BUILDING V` &A PLANNING&ZONING 99/ Reviewed by: Date:a";4 /d TREE ADMIN. Second Review: ❑Approved as revised [Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date.- ----------------------------------- ------------- FIRE ate:FIRE SERVICES Third Review: QApproved as revised. []Denied. Comments: Reviewed by: Date: Revised 05/14/09 -t l City of Atlantic Beach Building Department FDate LICATION NUMBER .. 800 Seminole Road nee!by the Buitdn Department.) Atlantic Beach,Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-5845 /O + �'R), E-mail: building-deptQroab.us City website: httpJ/www.coab.us : APPLICATION REVIEW AND TRACKING FORM Property Address: �7� 13'x' � Z� t review aired Yes No Applicant: �/V�4 in Planning& Project: _ ;r C/—/ Utilities u afety FIn3 S@tViceS 4.. Other Agency Review or Permit Required Review or Receipt of Permit Verified Date Florida Dept of Emrironmertai 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. (Circle one.) Comments: Tc ❑Denied. BUILDING PLANNING&ZONING Reviewed by: Date:- PUBLIC TREE ADMIN_ Second Review: [Approved as revised. []Denied. PUBLIC W Comments: LIC UTILI PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: [,Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 Public Works Plan Review Comments Date: Z/2,24 Initials.-, Projeet'Name/A.ddress. ) -7S /5:7)4 ST Application Permit AiI Ca 7071 �°a L*k1D olriffieIIts , . .. b�lllVlll'f�,IIr� - Provide impervious surface calculations. N Provide.erosion and sediment control plans with installation details and maintenance schedule.. Provide drainage plans showing site topography(flow arrows, etc.) ❑ Provide construction site management-plan, including Right-of-Way Permit ifusing � rigbt-of-way for construction parking. Provide a pre-construction topographic survey prepared by a Florida Licensed Professional-Land Surveyor, showing l' contours. Section 24-66(b) of the Land Development Regulations requires on-site storage for increased runoff. Provide Delta volume calculations and on-site retention required ❑ per Section 24-66(b). (See attached info. Sheet) If on-site storage is required, a_post construction topographic survey documenting ❑ proper construction will be required. A Right-of-Way Permit must be obtained for use A Revocable Encroachment Permit must be obtained_ ❑ Pool—Wellpoint(if used)must discharge into vegetated area 1.0minimum from ❑ street or drainage feature (swale, structure or 1 oon). All concrete driveway aprons must be 5 inches thick,4000 psi,with fibermesh from the'edge of the pavement to the property linea Reinforcing rods or mesh are not ❑ allowed in the ROW(Commercial driveways—6"thick). Any utility cuts in the road must be repaired using COJ Standard Detail Case X and must be overlaid 10 feet in each direction from the center of-the cut...Repair must be ❑ shown on the plans. . P -Roll off container company must be on City approved list and cannot be placed on City right-of-way. CITY OF ATLANTIC BEACH r3 ay OWNER / BUILDER AFFIDAVIT 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 Il PROVE A ONE-OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR DaROVE 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. )LOU 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 If. 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. /7r A-Y7'7267- a�.z - Ga ADDRESS PHONE NUMBER �!1'Stlso�Al 4PRINTNA E L Q" DATE Before me this Fjc day of 201/4 in the county of Duval,State of Florida,has personally appeared rin by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of County of �� �❑Personally Known ��� /� ,,` ,,,, roduced Identification- J ' 3 v?p��j � v �' p ^ EXPIRESS1()N#00�q, 126 Notary Signature• (if nr Bonded7hruNotgp�bl210n011"V^ 1 F.BLDG/Ovm Builder Affadwit,REVISED: 4/16/2009 i City of Atlantic Beach Building Department APPLICATION NUMBER 800 Seminole Road (To be assignee!by the BDepartment.) r� Atlantic Beach,Florida 32233-5445 Phone(904)247-5828 - Fax(904)247-5845 /D - 0/7 on'19" E-mail: building-dept@coab.us City web-site: http:t w.coab.us Date routed: Z �q ww APPLICATION REVIEW AND TRACKING FORM Properly Address: /7� ,� �7r f review uired Q Yes No Applicant: m PlannifnVg& Project: J _ j� / j,qG L Utilities Fire services Review fee -4epSlgnature' Other Agency Review or Pennit Required Review or R'pt Date Florida Dept of Envirorunerrial Protection of Permit Verified 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. APP (CATION STATUS Reviewing Department First Review: Approved. (Circle one.) ❑Denied' Comments: BUILDING "e P J. PLANNING&ZONING Reviewed by Date: -� "'1C� TREE ADMIN. Second Review: ❑Approved as revised. []Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: []Approved as revised ❑Denied. Comments: Reviewed by: Date: Revised 05114M t CITY OF ATLANTIC BEACH OWNER / BUILDER AFFIDAVIT 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. 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. ADDRESS PHONE NUMBER �oIso al PRINT NA E / IGNA Q f' DATE Before me this day of20 O in the county of Duval,State of Florida,has personally appeared rin by himself/herself and affirms that all statements and declarations are true and accurate. cf'��,,� �� Notary Public at Large,State of IL,County of Gltx / ❑Personally Known ^''� educed Identification- �J� (J 6 �S' /,.f 31 M A ES. 634126 d 21 ��DD �201 d�• m 1 9 � OF ATLANTIC B g - TH I E DNS. ON rREVWI?EWEDBY:� DATE:a� IU EACH IN p►E CTION F CITY OF ATLANTIC BEACH s) 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 10-00000163 Date 2/16/10 Property Address . . . . . . 175 15TH ST Application type description MECHANICAL HVAC ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ------------------------------------------------------ Application desc 1 cu 1 ahu ------------------------------------ Owner Contractor ------------------------ ------------------------ JOHNSON _ _ _ ___JOHNSON DONOVAN HEATING & AIR 175 15TH STREET 315 SIXTH AVENUE SOUTH ATLANTIC BEACH FL 32233 JAX BEACH FL 32250 ------------------------------------------- (904) - ------------------------- 241-3785 Permit . . . . MECHANICAL HVAC PERMIT Additional desc . . Permit Fee . . . . 99 . 00 Plan Check Fee 00 Issue Date Valuation 0 Expiration Date . . 8/15/10 -------------------------- ------------------------ Fee summary Charged Paid Credited Due ------ ---------- ---------- ------- Permit Fee Total 99 . 00 99 . 00 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 99 . 00 99 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. MY OF ATLAKM BEACH no r r.a OFRcE 7-5=0 FAX x+04901 7-5110 asn"NiEpr000mus MECHANICAL PERMIT APPLICATION DUVAL COUNTY i.•OB ADDRESS t M THS A SM PELT: A DATE: 1�N0 OYES PERWr8t PROPERTY OANIBt !.MANIC ADDRESSWO rrFROM.lOaAOORES& PYiOIIIE: all Tb�jajbll lECItANICIIL CONTRACTaft 7_WAIE OF COWWff MADORESSL U'n Ct L"l- S I STATE OFFLORIDA Lr331SEWO: W CBLPNO de ll-FAX NO. Gt C.a )(o l —"'-11-3-7LlJ- lZB"KADDRESS: 1M OFFICE PHONE Z —2 AppiraGon xy- is hendry made to ablair a perms to do the work and inafalteGorrs as buk--led_ 1 ON*that all wart WE be per6mred to meet the standards of all haws mgubft aorrslawlion o tlrs jAri ftftL TW pa"N o ms MA and void 9 work is nd aammerroed wiAir Sk morins,or g coons nwdon or work is suspended or abandoned fora period of sor(%nlorr2rs at any*w sftrvjwk is oorrinrenoed Am* 3.2S- VO COKIIIACTORS 516rNTlilE.�• /�/ll1i�� iL CLASS OF WDRIt eaLntNs> ct mmuTcove O NEW INSTALLATION 13 NEW TwL RLORK)A BUILDING CODE- )(REPLACEkBw OF EXISTING srs fEt/ oklmum 13 CONNERCIAL IECHAN ICAL 11 ALTERATION/A001T10N TO EXIST SYSTEM 17 REAR D OTHER �CfiAHGIt.B lENT7011ESISTALLEIk 19.HEAT: D SPACE 13 RECESSED CENTRAL 13 FLOOR 21L AR 17 Root XCEKTRAL 21.DUCT SYSTEM: MATERIAL- THS MAX CAPACITY- cfm 22.FJ9 3MATION: MAX CAPACITY: chn 23.COOLING TOWT3t CAPACITY: gpm 24.FRE SPRI NIG.E - NUMBER OF HEAM. 2L LIFT SYSTEMA: 8 MATM: MAIiIET: ESCAI.ATOIR: AUTOLET: 2L f1 r.1l RCIAL WOOD NUMBER: 27.FIREPLACE-- PREFABRICATED: MASONRY: 2L IRRI('�ATX t T]PUMP E3 WELL 17 PIPING 2L GAS PUMIM, OF OUTLETS: O GAS AHO: D GAS MUM HEATM 31L OTHER-SPECIFY: soLARWAWW.,lIOILEtS,Uri PRESSUREVESS9,11EATOWIM GM OR COI.M DUCTS ETC. ALOE FOR OTHER nEM& M CCI ttMs EauMNEWr AR commnomwa.fa FRowm7mm MAISER APPROVIC'tG OF UNnS Dt nM MODEL s WAtR)FACTURat TONS AGENCY 1 It A4 we - Etc TL WATMG EHllPIVIE1fr tis OF UNrTS OESCRWTM MODELS MANUFACTUNIUM r$TU AGENCY jh It ale ,e �v� Lh (,f Zvi cEl IL TANIM XWMING Nl9R f GALLONS CONTAINED WANUFACTU RM SERIALS ABY BLDG04 Permit Applicaton P oe:h:REVISED:1211842W8 I f CITY OF ATLANTIC BEACH s) 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . 10-00000187 Date 3/01/10 Property Address . . . . . . 175 15TH ST Application type description FENCE PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 --------------------------------------------------- Application desc 6ft 4ft block wall ------------------------------------------- Owner Contractor ------------------------ ------------------------ JOHNSON R MARK & TERESE M OWNER 175 15TH STREET ATLANTIC BEACH FL 32233 ------------------------------------------------ Permit . . . . . . FENCE PERMIT Additional desc . . Permit Fee . . . . 35 . 00 Plan Check Fee . 00 Issue Date Valuation 0 Expiration Date . . 8/28/10 ----------------------------------------------- Special Notes and Comments *2007 FLORIDA BUILDING CODE W/ 105- 106 SUPPLEMENTS . 2007 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. *ALL FENCES OR ENCLOSURES OF LAND SHALL BE SUBSTANTIALLY CONSTRUCTED. *SCHEDULE FINAL INSPECTION ONCE FENCE HAS BEEN COMPLETED. PERMIT AND APPROVED SURVEY MUST BE AVAILABLE FOR FINAL INSPECTION. Avoid damage to underground water/sewew utilities . Verify vertical and horizontal location of utilities . Hand dig if necessary. If field coordination is needed, call 247-5834 . The sewer service appears to connect at the east side of the property. Recommend the owner or contractor locate the customers sewer service prior to start of construction. Roll off container company must be on City approved list and cannot be placed on City right-of-way. ----------------------------- ------------------ Fee summary Charged Paid Credited Due -- ---------- ---------- ------- Permit Fee Total 35 . 00 35 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 35 . 00 35 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. LOT g �KIs�/V�j BLOCK 63 0.3' . , &__LSC. 47.89 (M) 2" I • 0 21 96.00 (R) 95.88' ( ) M 0.3 CONC.'•�'' i ,.29.5.E 15 � G 7�•�-�' S�'c 7 •.w 16°•' 4' POOL I L6 L A 0.6' ALL CK WOOD a '' R 9.1' w� OP P ANT s WOOD d v 'STEPS" N COV'D , WOOD DECK 12.5' �4,,, t" � 24:3' N to _ p + • 00 F— U C1 c� V 00 A 01 a �pr TA'�G tm © � 4.7,' ' 1. 2 do 3 STORY M FRAME t(�! Sz' 1 or, l 8.00 RESIDENCE NO. 175 COV'D 9' C-4 CONC. ,'Jw I + CS .• (tea v ' :0.*' a 23.1' 4.7 • /\ N .'CONC.,e N ' -FT 'M L,(- QRIN ; LOTa� f( SC-C-1.7 tA./' 1/2• :' ',�4,�:. BLOCK 63 o.s 96.00' (R) •49, p.6'. 95.86' (M) • d ._.CbNC. WALK BEARING REFERENCE1' UNE City of Atlantic Beach Planning and Zoning Depa�� 48, 14' /�/ M 1D This approval verifies compliance with applicable 4d•00 (/li zoning, subdivision and other local land COdevelopment regulations, but does not constitute fILE approval for the issuance of permits. Compliance �t�r� ilding Code and all other applicable a and Federal permitting requirements 40 / rifled by signature of the City of Atlantic R �/ Beach Euilding Official prior to the issuance of a Building Permit. I C PIApproved By: � ��...----.._.....-. _._._ ...• ommu ty Deve opment Date: 1. ANGLES ARE SHOWN ONTHIS �"RAL NOTES' 1 A an �.. : 2_ SIM Irn icc un ,,7e �-IS.-- CITY OF ATLANTIC BEACH ti 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 I I I I I OFFICE:(904)247-5826•FAX NO.:(904)247-5845 BUILDING-DEPTCCOAB.US BUILDING PERMIT APPLICATION 1.JOB ADDRESS: DUVAL COUNTY 2.VALUATION OF WORK, r 3.SQ FT UNDER ROOF 4.LEGAL DESCRIPTION: 5.CLASS OF WORK! 6.USE OF STRUCTURE: ' LOT 3 BLOCK(0-1SUBDIVISION r 1�/w �`TL� ❑NEW BUILDING ❑DEMOLITION StRESIDENTLAL 7,DESCRIPTION OF WORK: ❑ADDITION ❑CONVERTING USE ❑COMMERCIAL Ct' / ❑ALTERATION ❑ACCESSORY BLDG. 8.FIRE SPRINKLER: � C- (5/VGLc�S� I���G�l(�� ) ❑REPAIR ❑POOL/SPA ❑YES ❑WA PROPERTY OWNER: }� rV ❑MOVE THER 13 NO CONTRACTOR: ARCHITECT/ENGINEER: 9.NA/yM�yE:}�}�� 15.COMPANY NAME: 23.COMPANY NAME: 16.NAME 24.LICENSEE NAME: 10.ADDRESS: 17.STATE OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.: /7IT /sem ST'. 18.ADDRESS: 26.ADDRESS: 11.OFFICE PHONE, 12�FUy p, O 19.OFFICE PHONE: 20.FAX NO.: 27.OFFICE PHONE: 28.FAX NO.: lay&IQ 08 301 13.CELL PHONE: Y 21.CELL PHONE: 29.CELL PHONE: 14.Er�aILADDRESS' 1^ �� 22.EMAIL ADDRESS: 30.EMAIL ADDRESS: Vh)O Yl(1-50A FEE SIMPLE TITLE OL ER: (F on6t THAN owNerQ.., COMPANY:BONDING COMPANY MORTGAGE LENDER: 31.NAME: 33.NAME 35.NAME: 32.ADDRESS: 34.ADDRESS: 36.ADDRESS: 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 laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6) months, or if construction or work is suspended or abandoned for a period of six (6) months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks, Air Conditioners,etc. 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. I will not occupy or use the referenced building or any part therof,until all inspections are finaled and prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law. ** 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. OWNER orAGENT CONTRACTOR Uf Agent,Power of ey o' gency Letter Required) u (Qualifier Only) Signed rt„ : ���d A ,,pp �� Signed: Date: Before me this J*-day o in the county of Before me this day of 2009 in the county of Duval,State of Florida,has personally appeared Duval,State of Florida,has personally appeared ✓�C�1� A"-4 414 s. n herin by himself/herself and affirms that all statements and declarations are herin by himself/herself and affirms that all statements and declarations are true and accurate. 4andcurate.Notary Public at Large,State ofCounty of ' Large,State of❑Personally Known �-/ e �Produced Identificatio " ( do Notary Signature: oa DEBORAH A. DD 634126 O ► �► E ,: 'fi•� MY WIRES: may #1, 634126 r O EXPIo g:May at,rwel J VcITE FOR BLDG01 Perm' g:/lEtlflBEida ryI➢Ig0lllggl!IMl Urlderwrttars .,,.., EACH INSPECTIO CITY OF ATLANTIC BEACH (OWNER / BUILDER AFFIDAVIT 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 WITFIIN ONE YEAR TT AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT 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 YOUVE HA LICENSES 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. 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$5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN"OCCUPATIONAL LICENSE"IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826)IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. ADDRESS PHONE NUMBER 4�P-RINTE q� DATE IGNA Before me this / day of 201/4 in the county of Duval,State of Florida,has personally appeared rin by himself/herself and affirms that all statements and declarations are true and accurate. rn Notary Public at Large,State of County of 17tit.t'/ ❑Personally Known '''�� ( ''7 T „� I produced Identification ;y pEB p,,,'�'� g MYO EXPIRES;Ma 00 634126 P1 Nota ?0 11 , Y21 i Notary Signature F:BLDG/0wner-Buil der Affadavit;REVISED: 4/16/2009 -- -- I I CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 I I I I I OFFICE:(904)247-5826•FAX NO.:(904)247-5845 J BUILDING-DEPTGCOAB.US BUILDING PERMIT APPLICATION DUVAL COUNTY 1:JOBAODRE$S 2',VALUATION OF,WORK 3.SO:FT-'UNDER 7..� l S� rn S-r2T L 3oJ ir4i LEGAL DESCRIPTIQN,. .'' � 'i „ ^' 5.CLASS"OF WORIG;,", -.,..i. r. 13 ADDITION 11 CONVERTING USE ❑USE, IDENTIAL STRt1CTU RE- . ❑NEW BUILDING ❑DEMOLITION ESIDR LOT BLOCKt SUBDIVISION '1°" L� COMMERCIAL trt7,DESCRIPTION OF;WORK ., ❑ALTERATION ❑ACCESSORY BLDG. 8;FIRE SPRINKLER.SGC t/VGt.0s eb. 07�� 11 REPAIR ❑POOL/SPA ❑YES 11 NIA A�s�2f ❑MOVE i&DTHER ❑NO s "PROPERTY OWNEW-7,7-7; " CONTRACTOR: , ;'ARCHITECT/"ENGINEER. .NAME: `��y �} S 15.COMPANY NAME: 23.COMPANY NAME E r "`A� :-+V tI Ar ,0� 16.NAME: 24.LICENSEE NAME: 10.ADDRESS: 17.STATE OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.: /7S7 /5 fV '51' 4-� 18.ADDRESS: 26.ADDRESS: 11.OFFICE PHONE: 112;,W p o 19.OFFICE PHONE: 20.FAX NO.: 27.OFFICE PHONE: 28.FAX NO.: 13.CELL PHONE `f 21.CELL PHONE: 29.CELL PHONE 14.EMAIL ASinS- r 22.EMAIL ADDRESS: 30.EMAIL ADDRESS: •' I s rK�'c.ovti FEE SIMPLE TITLE• OL ER (IF OTHER THAN OuyNet�. BONDING COMPANY MORTGAGE LENDER h 31.NAME: 33.NAME: 35.NAME: 32.ADDRESS: 34.ADDRESS: 36.ADDRESS: 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 laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six(6) months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks, Air Conditioners,etc. 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.I will not occupy or use the referenced building or any part therof,until all inspections are finaled and prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law. * 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. jj OWNER olr AGENT_. : CONTRACTOR : " f Agent,Power of mey o' gency Letter Required) (Qualifier Only) . 9ath: Signed: Date: e�Q 2-(YM a Signed>1�' ,p LV- Before me this��f�-Tiay o in the county of Before me this day of 2009 in the county of Duval,State of Florida,has personally appeared/ Duval,State of Florida,has personally appeared ✓��C 1�� M�t '�lnsrn herin by himself/herself and affirms that all statements and declarations are herin by himself/herself and affirms that all statements and declarations are true and accurate. true and accurate. Notary Public at Large,State of�- County of Notary Public at Large,State of ,County of ❑Personally Known1. �� /1 11 Personally Known Produced Identiricatio V V ❑Produced Identification- Notary Signsture: ^��Lee � Notary Signature: P DEBORAH A.WHITE MY COMMISSION#DD 634126 €XpIRE&May 21,2011 BLDG01 Perm dg:Mlydafft Najpiaftd UrSderwdters CITY OF ATLANTIC BEACH ' FENCE PERMIT APPLICATION Date: Job Address: �'� p; 5 1� et Owner's Name: Address: 75- s t-yr.re+� 1-/ -� (f(4 1 L Phone: 2 y a, �ci d Legal Description: Block Number:�� n Lot Number: Zoning District: M A IW l�4 L Fence Contractor: uwN��Z Address:—/'75 15 S'tr y City: fT U"L h Phone: Q t L re (� c State: r L �.�3"Z� Zip: Fax: Type of fence and materials to be used: a y , ��10&L wa Valuation Of Fence: ►'/n 0 Interior Lot ❑ Corner Lot ❑ Dumpster or storage tank enclosure Is approval of Homeowner's Association or other private entity required? Ivo If yes, please submit with this application. Tree Protection: M NO. Applicant certifies that no trees will be removed for the installation of this fence. ❑ YES. Removal of Protected Trees will be required for this fence. TREE REMOVAL PERMIT IS REQUIRED. Tree Removal Permits to be reviewed by the Tree Conservation Board,which meets two times each month. Procedure: In order to expedite issuance of permits, please follow all steps and provide all information as an Incomplete applications may result in delay in issuance of permit. I. Attach copy of property survey showing location, height and all distances from property lines of the proposed fence. (Fences shall not be placed within any utility or drainage easements without written permission from the Utility and/or Public Works Departments. Fences shall not restrict any private easement.) Address and contact information of person to receive all correspondence regarding this application(please print). Name: M'�-(4L ,T©p f IVSo/V Mailing Address: 1 -75- Phone: 7JPhone: � ��(�� ,A 1 C/ 22 Fax: E-Mail: yJu �V1.s0r) /a u. sj)r�/ nef, cow 800 Seminole Road Atlantic Phone: (904)247-5800 • Fax (904)2475845 - http:://wworida w 3-5445 Page 1 ei.at antic-beach.fl.us Revised 3/04/04 r DESCRIPTION OF PROPOSED BLOCK FENCE: The total length of the block wall will be 94' feet, and will be constructed along the right property line (east side of property). There will be a 4 foot tall column (12"X 12") at the front right corner of the property(SE corner). There will be a 4 foot tall section of wall which will be connected to the column, and will run 19 feet north, along the right property line (toward the rear of the property). The wall will connect with a 6' tall column(12"X 12"). The wall will step up to 6 feet in height, and continue an additional 67 feet in length north from the column, along the east property line, and will connect with another 6 foot tall column (12' X 12"). This section of wall will teinate at the length, which will tie into an existing block wall at the right column. There will be a separate wall section which will be 6 feet in height and 5 feet in corner of the property. line.) rm rear (The wall stops and starts due to several palm trees which are located along the property WALL SECTION: TOP .0.9 WALL • MF.NwL . }. CELLS. / /Cmc ;' GRADE .3jt-4-.'.YCONT. i V /1 w cz5 (4 115 NO r f"'