128 Camelia Street - PermitPREPARED 7/14/10, 9:34:32 PAYMENTS DUE RECEIPT
CITY OF ATLANTIC BEACH PROGRAM BP820L
---------------------------------------------------------------------------
APPLICATION NUMBER: 10-00000519 128 CAMELIA ST
FEE DESCRIPTION AMOUNT DUE
---------------------------------------------------------------------------
FENCE PERMIT
35.00
TOTAL DUE 35.00
Please present this receipt to the cashier with full payment.
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PREPARED 5/03/10, 15:27:49 PAYMENTS DUE RECEIPT
CITY OF ATLANTIC BEACH PROGRAM BP820L
---------------------------------------------------------------------------
APPLICATION NUMBER: 10-00000519 128 CAMELIA ST
FEE DESCRIPTION AMOUNT DUE
---------------------------------------------------------------------------
FENCE PERMIT 35.00
TOTAL DUE 35.00
Please present this receipt to the cashier with full payment.
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n M:AP SHOWING BOUNDARY SURVEY ~F
LOT 4, BLOCK 87 ACCORDING TO THE PLAT OF
~Ec~~°a®~a ~~~ ~~~~e~~°a~ ~E~~~
AS RECORDED IN PLAT BOOK 18 PAGE(S) 34 OF THE CURRENT
PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED T0:
GARY D. JAMES AND CABBIE L. JAMES
LOT 5
_ BLOCK 88
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LOT 3
BLOCK 88
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LOT 4 I
' BLOCK 87 ;~
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470.00' (R) 5/8'
469.48' (M) REBAR
r
~i'"'''~''1,~ City of Atlantic Beach
~1 _ ~~~ Building Department
_ ` ~ 800 Seminole Road
-~ Atlantic Beach, Florida 32233-5445
Phone (904) 247-5826 Fax (904) 247-5845
'~~J;3 ~~ E-mail: building-dept@coab.us
City web-site: http://www.coab.us
APPLICATION NUMBER
(To be assigned/by the Building Department.)
/~"
Date routed: ~" Z~-~o
APPLICATION REVIEW AND TRACKING FORM
Property Address: l Z S C~cinetl ~{, c~T
Applicant:
Project:
~f
Department review re uired Yes No
Building ~/
Planning 8~ Zoning
Tree Administrator
Public Works
Public Utilities ~/
Public Safety
Fire Services
Review fee $
Dept Signature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified B 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
Cppy
Reviewing Department First Review: ^Approved. ^Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed by: Date:
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 05/14/09
'"s~~j'`~~'' BUILDING PERMIT APPLICATION
\SS
_w
r
-- ~ ~~ CITY OF ATLANTIC BEACH
.., .., ~ ~ r 800 Seminole Road, Atlantic Beach FL 32233
Office: (904)247-5826 • Fax: (904) 247-5845 /i .~-
Job Address: ~ ~~ ~~rir~~~ ~ G J~ . ,) C~ ~ 3~ Permit Number:
Legal Description ( ~~1 _~~nc ~ ~~r ~(-'~'`~.l(' ~(`1 ~~ak cfiK ~ Q~ ~ J,~
Valuation of Work (Replacement Cost) $ lfY~6 .°-~~"'- Z
^ Class of Work ((Circle one): New rtion Alteration Repair e
^ Use of existing/proposed structure(s) ((C~ircle one : Commercial esi
^ If an existing structure, is a fire sprinkler system mstalled? (Circle one : es N /A
^ Is approval of homeowner's association or other private entity required)? (Circle on~~"Y~ No ~~~
Describe in detail the type of work to be performed and Total Square Footage of construction:
1 ~J~r-,', ~ Q -~- ~ nC~ -~o ~~~m ~ ~.( CSC C~ . ~( ~lGl~-F~
Prouerty Owner Information
Name
City _
Contractor Information:
State ~ \ Zip 3 ~ a.~Phone
~,
Name of Company: (,,~ Qualifying Agent:
Address: ~ City State
Office Phone Job Site/Contact Number
State Certification/Registration # Office Fax #
Architect Name 8c Phone #
Engineer's Name &~hone #
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 erformed to meet the standards ofall
laws regulating construction m this jurisdiction. This permit becomes Hutt and void work is not commenced within six (6)
months, or if construction or work is suspended or abandoned for a period of six_ f6) months at a~ time Ater work is
commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, igns, Wells, Pools,
Furnaces, Boilers, Heaters, Tanks and Air Conditioners, etG
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF CONIlVIENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU
INTENT? TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
1 hereb certify that I have read and examined this application and know the same to be true and correct. All rovisions o
laws and ordinances governan~ this type of work wall be complied with whether specified herein or not. The wanting of a
permit does not presume to give authority to violate or cancel the provisions of any other federal, state; or local Iarv
regulating construction or the performance of c
Signature of Property Owner:
Swo and subscri d before a '" ~--
tlii~ Day of ~ L/ ~~
Notary Public: ~~~~~-°'~~~~
REVISED 07/26/07
~~
~~
~ /j
~
~A
Y
Signature of Contractor: h~
i+
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-~ ~ ~ d
n ro 3 7d Sworn to and subscn`bed before me ~
~ this Day of
g Z
~...P ~ N
~~ Notary Public:
~ s c~i
a
Zip
-:~ ,
%~ -~>.,
,., _
fl
~: /~ ~ ~'' CTT~ Off' ATLANTIC BEACH
`~ ,..
I. FL®I~IDA 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 IIvII'ROVE A ONE - OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IlVIPROVE 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 BUII,T YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT
TT 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. 1T IS
YOUR RESPONSIBLLTTY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
ll. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
I11. IRS 10191THH®LDII~G; 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.
1'if. P'EhIALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-728(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.
0/. ACKI`I(3194dLEDGEIMENT; THEREBY 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.
A DHSS--~~ ° PFiTNE NUMB R
SIGNATURE
Before me this ~'-' day of , 20~ in the county of
Duval, State of Florida, has person appeared herin by himself /herself and affirms that
all statements and declarations ar and accurate. ! ~~,~,,~
Notary Public at Large, State of ~ County of ~uG~~" ^'~ "
ld
DAT
^ Personalty Known ~~ /~ ~ ~ !~ /~ ~ ~J / ~/ /
~rnduced Identificafion - f Cf / (rJ ~ (~ (0
///,.~~ ~
Notary Sionatura: ~/C.~
co
~,~ .,••;~~r.~~••.
~~ ~"-
(~ ~:
F ~ ~ ~ } ~~-
,:r._ DEB A.WNITE
MY COMMISSION ~ DD 634126
EXPIRES: May 21, 2011
Y ~ :~ uy°,°' Bonded Thru Notary Publfc Underwmers
F:/SLDG/Owner-Euilder Affadxvit; RH' 1VI51rD: 4/16!2009
' MAP SHOWING BOUNDARY SURVEY OF
~pnLOT 4, BLOCK 87 AC~CpORDING T+O~pTnHE PLAT OF
SE~ If l1®~ ~ A If ~A~ {!1 {<l~ ~EA~~
AS RECORDED fN PLAT BOOK 18 PAGE(S) 34 OF THE CURRENT
PUBL{C RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED T0:
GARY D. JAMES AND CABBIE L. JAMES
LOT 4
BLOCK 88
.~
LOT 3
BLOCK 88
~ ~ ---
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470.00' (R) 5/8'
469.48' (M) REBAR
Y
S 00'18 05" W 49.93' (M)
S OO°18'05" A' 50. DO' ~RJ '~
CA~ifEL/A STREET ~®
50 ~ GY ~`'~
~ R/ ~
FERAL NOTla+
S - - L ANQES ARE- SHOYNV_QN THIS SURVEY
rj+..ay;.1J~ City of Atlantic Beach
:it ~~ ~~ Building Department
%' v 800 Seminole Road
j -~~~~ Atlantic Beach, Florida 32233-5445
Phone (904) 247-5826 Fax (904)
"~~;s ~%• E-mail: building-dept@coab.us
City web-site: http://www.coab.us
-u~,,,,~r,~ ~~.~ D APPLICATION NUMBER
A Pp ~ ~ 2010 (To be assigned by the Building Department.)
~~ ' Date routed: ~ ~' ~-moo,
APPLICATION REVIEW AND TRACKING FORM
Property Address: l2-~ ~,iy~~ ~ ~,~`.
Applicant: IJ ~i~,~s/k-ti
~~
Project:
De artment review re uired Yes No
Building v~
Planning & Zoning
Tree Administrator
is W /
ublic Utilities j/
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified B 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; [Approved. ^Denied.
(Circle one.) Comments: C ~ 1 ~ /Z~
//YS ~~' L ~ ~ ~ 61f ~A-
BUILDING ~ "~ ~~~ / ~~ ~ ,q-y~'f~yl.Fjv~' F..~ G ~. l~l~k
PLANNING & ZONING ~~~J~e MNS T ~~ QU ~y6~ e,! ~ a ~~
Reviewed b : Date:
TREE ADMIN. Second Review: QApproved as revised. ^Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: QApproved as revised. ^Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
-i is-1+`!
1,,
rj `~
-J
.-v. J Fi 1 %~ `~
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach FL 32233 ~`,
Office: (904)247-5826 • Fax: (904) 247-5845 V .~
Job Address:
Permit Number:
.,
Legal Description ~~~~~ CSC cb ~, ~(~r \ ~`~,r-~ ~`~~_~ ~_!~k K ~ `~6 ~ ~~,~ 1
Valuation of Work (Replacement Cost) $ !(YX5 J' Z
^ Class of Work ((Circle one): New rtion Alteration Repair e
^ Use of existinglproposed structure(s) ((Circle one : Commercial esi
^ If an existing structure, is a fire sprinkler system installed? (Circle one): es o N /A
^ Is approval of homeowner's association or other private entity required? (Circle on~~ No fJ~~
Describe in detail the type of work to be performed and Total Square Footage of construction:
Contractor Information:
Name of Company: ~ ~ ~ ~ _Qualifying Agent:
Address: City
Office Phone Job Site/Contact Number
State Certification/Registration # Office Fax #
Architect Name & Phone
Engineer's Name &PPhone #
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 rior to the issuance o~ f a ermit and that all work will be erformed to meet the standards of all
laws regulating construction in this jurisdiction. This permit betimes nuZZ and void work is not commenced within six (6)
months, or f construction or work rs suspended or abandoned for a period of six ((6) months at arty time after wark rs
commenced. I understand that separate permits must be secured for Electrical Work, PlumBing, Signs, Wells, Pools,
Furnaces, &nilers, Heaters, Tanks and Air Conditioners, etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMl~~NCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU
INTEND TO OBTAIN FINANCING, CONSUL'T' WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF CONIMENCEMENT.
thereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing this type of work wtll be complied with whether specified herein or not. The granting o ffa
permit does not presume to gtve authority to violate or cancel the provisions of any other federal, state, or local Zativ
regulating construction or the performance of c
Signature of Property Owner:
Sworn to and subscribed before,me
this ~ Day of ~' ~'' C _
Notary Public:
J ~.,
REVISED 07/26/07 ~" ~'`
~~~ ~
s
t
,~
e
~ ~°+
~ '~
+.
b
Signature of Contractor:
~~~
~ ~
~
~" ~ Sworn to and subscribed before me
`~ a this I)ay of
~; ~ ~,;
~ ~ r;
`
G~ ~ ~ r
, t
L~---' ~ ~
Notary PuUl~ci:
m o
~
~o
sc
i
a
State Zip
Property Owner Information
/ r ~ 1i'e~'~ ~~;r ~
. '.' CITY C~ ATLAN7[`IC BEACH
:~~~~/
I. FL®RI®A STATUTES; GRAPIER 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. TIC 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 ]1VII'ROVE A ONE - OR
TWO FAIv1)I,Y RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IIvIPROVE 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 BUIZ,T YOURSELF WITHII~I ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT
TT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEIVII'TION. YOU MAY NOT
HIRE AN UNLICENSED PERSON A5 YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILI"I'Y TO MADE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUMCIPAL 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 WITHH®L®I~IG; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
08SERVE IRS WITHHOLDING TAX ANDlOR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
!'~. P'EFdALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228{1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON 15 A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT (247-5826) IF IN DOUBT.
V/. ACICIPI®aP07LEH~C9EIdIEIrIT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
ADD SS 4 PH17NE NUMB R
SIGNA'
r c~ `
DAT
Before me this ~"' day of , 20~ in the county of
Duvat, State of Florida, has person appeared herin by himself /herself and afFrms that
all statements and declarations ar and accurate. `'~y,/,,,~
Notary Public at Large, State of`~' County of ~GL%v" "_
~,~C7 PPersonally Known J~ ~' ~ y ~ ~ J ~ ~, ~ ~~ `-~ V! W
~~Produced Identifcatian-
~_ ~ ~, r
,r!~, ~, ,,,,` / ~ , ,
iv ry °,i.-~ pure: _ % ` t:'~{ -~ ~ ,, `~,. ~ t~.. ~'~s ~.___ -~'-
~i' `'?~`
; ;..,,
. DEBOAAN A. WHITE
~' ~! :-
<= MY COMMISSION # DD 634126
21 2011
EXPIRES: Ma
>~~,n
~;': ~; r' y
Aoudad Thru Notary Public Underwrltors
r_/bLi)G/O game;-°uilder .4.`fadavi=2~ViSEB~ =/la/s(7;:J
MAP SHOWING BOUNDARY SURVEY AF
•~pnLOT 4, BLOCK 87 /A~C~CpORDING TO~pTHE PLAT OF
~E~ Il ~1~~ ~~~ X11 ~1 ~~~ ~1 ~~ ~~~~~
AS RECORDED IN PLAT BOOK 18 PAGE(S) 34 OF THE CURRENT
PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED T0:
GARY D. JAMES AND CABBIE L. JAMES
LOT 5
BLOCK 88
LOT 3
BLOCK 8$
1 /2' 0.5'
-~-
-a- .
0.4' ~ 0.7' .2'
~` i t s'
~~
• ~ 15.0'
c .CONC..
' P,14i10
. a~ • • '. 7.2'
35.1'
J
~ ~ `-
~ ~ O ~n
O~~ ~
~m4 ~
~S ~
o.t'. 11/2.
LOT 4
BLOCK 88
50.00' (R~~
49.78' (M)
got o.o'_
p~~ h
~28~ METAL SHED
W/ DIRT FLOOR
7.5'
NORTfi
,~ C /C .
A
PAD
t-STORY FRAME
aD do COQUINA
~ RESIDENCE ~ •~
W/1.5' EAVES '~
NO. 128
4
0.2 N ~ ~ V
~ ~~ ~
C01rD iO
7.5' 17.0' N CONC. N o~ O m
6~ IW
~ W
LOT 4 ( y
BLOCK 87 e, ~ 0.2'
~: CONC. I ~~~
WALK e
~~ 72.1' 7.3'
• n
,p ( `~
• .~ .O
.N
p.
90~, .." "` a DRIVE ':"sso;'
d '.
1/2' ~ ~ 1/2" 470.00` (R) 5/8'
' 469.48' (M} REBAR
S 00' 18'05" W 49.93' (M)
S DO°IB'05" Ar 50. DO' (R1
~~~~~~~ ~~~r~~:
_ - - 1. ANGLES ARE_SHOWN ON THiS SURVEY
_ ---
~i.a~~~;.jJ~ City of Atlantic Beach
1 ~ > Building Department
r ` 800 Seminole Road
- • ~ ~w~ Atlantic Beach, Florida 32233-5445
Phone (904) 247-5826 Fax (904) 247-5845
'~~U;i ~' E-mail: building-dept@coab.us
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: l2 g ~i~~ ~{. ~f `.
Applicant: CJ ~~;~M-ti
~(
Project:
Revievv fee $ ,~ Depfi Signature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified B 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
APPLICATION NUMBER
(To be assigned by the Building Department.).
~U - ,~
Date routed: ~' ~~-"~~
De artment review required Yes No
Buildi ~/
Ian ing & Zoning
Tree A minis ra or
Public Works
Public Utilities ~/
Public Safety
Fire Services
Reviewing Department First Review: pproved. ^Denied.
(Circle one.) Comments:
BUILDI
NNING & ING
TREE ADMIN.
Reviewed b : `-,/ ~~~
Y
fat ~Z ~l~
PUBLIC WORKS
PUBLIC UTILITIES
PUBLIC SAFETY
FIRE SERVICES
Second Review: ^Approved as revised. ^Denied.
Comments:
Reviewed by:
Third Review: ^Approved as revised. ^Denied.
Comments:
Reviev~ed by:
Date:
Date:
Revised 05/14/09
-S L="~3~~ f~„
• r JJ,~
~~
J~
r
,, - v~
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach FL 32233
Office: (904)247-5826 • Fax: (904) 247-5845 1/~ .~-- ~~
Job Address:
Permit Number:
Legal Description ~°,~` ~j\(~(' ~f rb~~ ~(~~~C~ ~` ~~~k ~2(~, ~ ~ ~~,~J 1
i
Valuation of Work (Replacement Cost) $Z
^ Class of Work ((Circle one): New ition Alteration Repair e
^ Use of existinglproposed structure(s) Circle one : Commercial esi
^ If an existing structure, is a fire spn~er system installed? (Circle one}: es N /A
^ Is approval of homeowner's association or other private entity required? (Circle on~ e No IJ~~
Describe in detail the type of work to be performed and Total Square Footage of construction:
Property Owner Information ~
f_
Name: Address: ~ , C -~
City State ~ ~ Zip =~ L- ?, 3 3Phone C~ - ~
Contractor Information:
Name of Company: I~ ~ Qualifying Agent:
Address: ~ City
Office Phone Job Site/Contact Number
State Certification/Registration # Office Fax #
Architect Name & Phone #
Engineer's Name &`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 o ffa permit and that all work will be erfarmed to meet the standards of a1Z
laws regulating construction an this jurisdiction. This permit becomes null and void work is not commenced within six (~)
months, or a construction or work is suspended or abandoned far a period of six (6) months at airy time after work is
commenced. I understand that separate permits must be secured for Electrical Work, PlumBing, Signs, Wells, Pools,
Furnaces, &oilers, Heaters, Tanks and Air Conditioners, etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COI~~IlVIENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS. TO YOUR PROPERTY. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR. LENDER OR A1V ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMIV~NCEMENT.
1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing this type of work wall be complied with whether specified herein or not. The grantingg o~ fa
permit does not presume to give authority to violate or cancel the provisions of any other federal, state; or ZocaL Immv
regulating construction or the performance of calfi5'tPltC
,yau ~,
5~~~
Signature of Property Owner:
;~ ~
Swax~.t~ and subscribed before me~ _ ~~- ~ ; ~, !~ ~ ~
this.- I3ay of f j'~ °' l 'ri~ t ' ~:.
^'
Signature of Contractor: __ ~ ! ~'
l
Sworn to and subscribed before me
this F3ay of
f m'
Notary Public: '' ~ ~ _ ~.... ' ~ ,:,, ~ ~ ~
r, ~ ~ ~, 9 Notary Public:
_d p
C po pA~
~ N 4,
REVISED 07/26/07 ~`~ ~' °'
Zip
State
-~~-~'~~
i r ~ Jr'
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-:--
I. FL09:1I]A 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 REQUIl2ES 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 IIvIPROVE A ONE - OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IlVIPROVE 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 WI'I'FIIN 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. 1T I5
YOUR RESPONSLBILFTY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUMCIPAL LICENSING
ORDINANCES.
II. LNJURY LIAl31LITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURGHASED.
819. IRS 1POPITFIHt~L®99~G; 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.
I'1E. P'Et`~ALTY; UNLICENSED GONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCLfMSTANCES. 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 "GERTIFICATE 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.
0/. AC9^~9®1POFLE®GEIi#E9VT; 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.
~ ~4~ ~~a~ `~ c., ~ _ ~Cl~ ~- ~ ~S- Sir ~ '~
ADD SS PHONE NUMBER
GNATURE
r ~ `~
DAT
Before me this `"' day of , 20~ in the county of
Duval, State of Florida, has person appeared herin by himself /herself and affirms that
all statements and declarations ar and accurate. `'~~,/,~~
Notary Public at Large, State of`~' County of f GG%'„r "'"
^ PPersonally Knoum J~' (/r/~/~ ~,~ ~ /, ~ ~~ ~ lY Y~
,r~r'roduced Idertification-
_ ~ ~ ~.
~ ~ ~ e,
~~=';,:~ ° „ DEBORAH A. WHITE
_' 2_ ~;: R4Y COMMISSION # DD 634126
~~. _~ ,~ - EXPIRES: May 21 2011
~, ~ ~':iG~' ~ ~ondad Thru Notary Public UnderWdters
_aHLDG/O ~em~-Builder P..`iadavi: x.EVLS3D: ?/'o/2La9
MAP SHOWING B4UN:DARY SURVEY A~
LOT 4, BLOCK 87 ACCORDI//N~~G TO THE PLAT OF
~~~~~®~ ~~~ ~~~RJ"~1~~~~ ~~~~~
AS RECORDED IN PLAT BOOK 18 PAGE(S) 34 OF THE CURRENT
PUBLIC RECORDS OF DUYAL COUNTY, FLORIDA.
CERTIFIED T0:
GARY D . JAMES AND CARRI E L . JAME S
LOT 5
BLOCK 88
0.1'. ~ 1 /2.
LOT 4
BLOCK 88
49.78' (M)
~p10.0'_
A~~ n
~26' METAL SHED
W/ GIRT FLOOR
7.5'
1/2"
0.4- ~ 'r ~0
ti~ i 1.6'
9°'
• • 1~.U
b .CONC..
PAi10
35.1'
~~~~..
U Q ~
~ O ~ °o
JmO O
~'1
~~~~.
CONC.
A/C
PAD
1-STORY FRAME
~0 do COQUINA
~ RESIDENCE • ••
W/1.5' EAVES
NO. 128
0.2
COV'D `O•
7.5' 17.0' ;a CONC. n
... N 6
ti
• LOT 4
BLOCK 87 e, .n
~;
~: CONC.
~ . WALK e
~'; 121' 7 3'
a°
• n
•y .O
.N
O'
o~,_,, ,r, _. N ~ CONC. ~~.
~-pp "' a DRIVE .,"*p D
d '.
LOT 3
BLOCK 88
NORTH
~- M ah0
4
wn ~ Y
O ' ~! O m
O I W
~~
_ y\
Q74h
~1, ..
470.00' (R) 5/8"
4fi9.48' (M) REBAR
~;5!.:ayffJ~ City of Atlantic Beach ~~~~~:~~~~
\~s ~~ Building Department
-~ ~ 800 Seminole Road At~R °~ $ ~~~~
~, ~~~~ Atlantic Beach, Florida 32233-544
Phone (904) 247-5826 Fax (904 5845
^., ~ ;~ v~ E-mail: building-dept@coab.us g Z
City web-site: http://www.coab.us
APPLICATION NUMBER
(To be assigned by the Building Departmenf.)
~U
Date routed: (' ~~-"~L7
APPLICATION REVIEW AND TRACKING FORM
Property Address: ~2-S Gdcinell ~. ~f.
Applicant: Cl
~~
Project:
Review fee $
Department review required Yes No
Building ~/
Planning & Zoning
Tree Administrator
Public Works
is tilities ~/
u is Safety
Fire Services
_ Dept Signature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified B 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 I First Review:
(Circle one.) Comments:
BUILDING
PLANNING & ZONING
TREE ADMIN.
P WORK
C TI
2Q /0
PU ICS ETY
FIRE SERVICES
Reviewed by:
Second Review: ^Approved as revised. ^Denied.
Comments:
Reviewed by:
Third Review: ^Approved as revised. ^Denied.
Comments:
Reviewed by:
Date: ~3v'~~/
Date:
Date:
Approved. ^Denied.
Revised 05/14/09
~ 1ry f
~f. 1
~' ~~~\
'~
r .~
~. % JF il~r
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
$00 Seminole Road, Atlantic Beach FL 32233
Office: (904)247-5826 • Fax: (904) 247-5845 //i , ~~
Job Address:
Permit Number:
Legal Description ~{,~L`~ C , cb~~ Cjc~r,~C,.~ ~, ~~ ~} (~k ~C~,, ~ ~ ~ ~~,~ I
Valuation of'Work (Replacement Cost) $ t(Y56.°--c Z
4
^ Class of Work ((Circle one): New ition Alteration Repair e
^ Use of existinglproposed structure(Circle one : Commercial esi
^ If an existing structure, is a fire sp, er system installed? (Circle one): es o N /A
^ Is approval of homeowner's association or other private entity required? (Circle on~~Y`~- No ~`~
---r
Describe in detail the type of work to be performed and Total Square Footage of construction:
Property Owner Information ~
r
Name: Address:
City State F \ Zip 3~~Phone
Contractor Information:
Name of Company:__I~,~ Qualifying Agent:
Ad~xess: ~ City State
Office Phone Sob Site/Contact Number
State Certification/Registration # Office Fax #
Architect Name & Phone #
Engineer's Name &~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 o~ ffa permit and that all work will be erformed to meet the standards ofall
laws regulating construction zn this jurisdiction. This permit becomes null andvoid work is not commenced within six (6)
months, or if construction or work is suspended or abandoned for a period of szx (6) months at agcy time after work is
commenced. I understand that separate permits must be secured for Electrical Work, PlumBing, Signs, Wells, Pools,
Furnaces, Boilers, Heaters, Tanks and Air Conditioners, etc,
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COIVIlViENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IlVIPROVEMENTS TO YOUR PROPERTY. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMI~~NCEMENT.
Thereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting off a
permit does not presume to gtve authority to violate or cancel the provisions of any other federal, state, or local l~
regulating construction or the performance of ca~ts~t~
~~~ ~
~~~
°~~
Signature of Property Owner: _
Sworn t and subscribed before ~ ~~~ ty ~
this ~R Day of ,. ,-, ,u2e _ ~ ~y
~.,•
5
Notary Pubiic: ~ ~, ~ ~
~; o:, ° ~~
0
~~~G~
REVISED 07/26/07 ~'~ ~'`~ ~ °'
f~. ,
Signature of Contractor: f' ~ l
5vvorn to and subscribed before me
this Day of
Nat~ry Public:
Zip
% r^~:~~~
,.:
f
T l ~; CYT~' ®I+' ATLANTIC I~EAC~
-J~+~
I. FL®9TVIfl~A 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 REQUIlES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMTT UNDER AN EXEMPTION TO THAT
LAVJ. 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 BUII D OR IMPROVE A ONE - OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL, BUILDIhTG 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 I5 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 MAIEE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDQ~IANCES.
II, 1NEJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION [NSURANGE BE
PURCHASED.
199. 9RS V0o01TFIH®L®II~G; 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.
!'\f. P'EhIALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUhtISTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228{1). AN "OCCUPATIONAL LICENSE" tS 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, ACI^Ln9®V90irLE®GE9i~ENT; 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 PERM9T. \
ADD S~_~~~~.~~ - ~l )"1 ".~ ~~' S~C~'11C~•
PHONE NUMBER
S l C~
SIGNATURE ~~},',~~q~-C~ DAT
Before me this ~'"' day of , 20~ in the county of
Duval, State of Florida, has person appeared herin by himself /herself and affirms that
all statements and declarations ar and accurate. ~j/~..f
Notary Public at Large, State of`~' County of ~~i~"" "'" ,
_ ATM. ~;: •" DF.BORAF! A. WHITE
^ Personally Known ~~ •;~<t ~~~ ;'
~.~ J~ ~"~~Cr CJ J 2'~ (~ ~ ~~ ~1 CO f~ ~~ °' • ,,~ •:_ MY COMMISSION # DD 634126
~o~Producetl ldenti5cation - ~ + EXPIRES: May 21 20t i
l_ P ~. I":r +~ ~ ~ Bondad Thru Notary Public UnderWrliers
,~
grSign_ii~ ;~
-1P.LDi!Ov+n~-Bcilder-.:nda~i5 R V1S i~D: ^-, .cQ009