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Permit 14 Forrestal Cir N I f%'j I�r VIJ I CITY OF ATLANTIC BEACH 800 SENHNOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 06-00034271 Date 11/21/06 Property Address . . . . . . 14 FORRESTAL CIR Application type description RESIDENTIAL ADD/RENOVATE/ALTER Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 1000 ---------------------------------------------------------------------------- Application desc UTILITY ROOM/REPAIR ONLY ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ 0 CCUPANT OWNER 14 FORRESTAL CIRCLE ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit . . . . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 35 . 00 Plan Check Fee 17 . 50 Issue Date . . . . Valuation . . . . 1000 Expiration Date . . 5/20/07 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 35 . 00 35 . 00 . 00 . 00 Plan Check Total 17 . 50 17 . 50 . 00 . 00 Grand Total 52 . 50 52 . 50 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CITY OF ATLANTIC.BEACH PLAN REVEEW SHEET Rotded tD: e-D- -Effiff R-) Mu e Building Department Public Worim&PWWlic Ufflities D%wtMeaft Load 1200 Sandpiper Law Ca Wo Seminole P Atlantic Beach,Florida 32233 Aflantic Beach,Florida 32233 D.Kaluzniak ON)247-5800 (904)247-5934 Pubk Safety (904)247-5845 Fax (904)247-5843 Fax PLAN REVIEW COAUKENTS Pernift Application# - �qaw Property Addrew 14 ppusa- u r<, - Applicant: _V_ZVA/18 Al- i '�b� E 436 Project: UlLdk6f =IeLVI PAUL *7pplicati"has bee proved as noted b Y thue;Z�_nm*l -Department. rMal application"proval most cow_�ftvm the Buibling Depaftment. Reviewed and the following items need attention: Please re-submit 2-copies of all revisions. Please re-submit your revisions to the Department,requesting them. Building Dept, Public Works and 'Utility information at top of page, failure to notify the correct department may delay your permit from 1-being issued. Y. ./7 Date. Dit 016tMttor Notified: AMP SHOWAWG BOUNDARY- SURVEY OF LOT If- -BLOCK z- - AS SHOWN ONAMP Of. . /V-7'1 q.4.1�-IC VIZ-I-,Q UA�117- All� AS RECORDED IN PLA T BOOK PAGES OF- ME PUBLICAECORDS OF DUVAL COUNfY, FLORIDA CER 77FED FOR. AIAJOe,--� OQ Vl_r e 1<'4 7M�e 0WIJ-1 A14 Vr 717'129' 16-1r. CO. 1: B1A7'_CaA-1 s-13 0Aek,-g7 e,ecc, r 7 UP I- ,4-10AZ 7A/ o CA tn Q IZ '37.4' 13L I' sr'y 37.d' AAZCr AA/ NOT VAW UNLESS EMBOSSED W7H SFAL OF THE UNUMSMED, HEARINGS BASED ON UNE AS ShOli ME PROPERrY SVONN HEREON APPEARS TO UE W7HfiV FLOOD HA2ARD ZONE X -AS SCALED FROM FLOW IAJCV IOAAIfV' VA 7r IWAp FM 7HEaTy OF AV 74.V"7,�r& , FLONDA, DA M_ -/15 -0 c ^4r.94ze" �> . AND CN 4 -41 11 IL ly f 11 fill IA Kil New, 11 '4r (p Lp WN 6,W -- ----------------- CITY OF ATLANTIC.BEACH PLAN REVIEW SHEET Routed to, r Building Department Public Works&Public Utilities Departments 8M Seminole Road 1200 Sandpiper Lane a Atlantic Beach,Florida 32233 Atlantic Beach,Florida 32233 D.Kaluzniak VN)247-5800 (904)247-5834 Public Safety (904)247-5845 Fax (904)247-5843 Fax PLAN REVIEW CONMENTS Permit Application# 3YO-1 Property Address N re Applicant: Project: E&L a-nllzzz &tAk- T �t applicadi on has been: Approved as noted by the Department. Final application approval must come from the Building Department. wed and the following items iiiention: 6WV &,Ct 46 ........... Please re-submit 2-copies of all revisions. Please re-submit your revisions to the Department.requesting_them. Building Dept, Public Works and Ultility information at top of page, failure to notify the correct department may delay your permit from being_issued. ' / Reviewed By: Date: - 7 Date Contractor Notified: Aht-a-,� CITY OF ATLANTIC BEACH BUILDING PERMIT APPLICATION �4q� (Alterations&Additions) Date: Job Address: Owner of Property: Ot5�1)4/ Address: j��, jy�c e-1. At, Telephone: 33 7 7 Legal Description: Block Number: .7— Lot Number: I Zoning District: Contractor: N�4� State License Number: Contractor Address: Telephone: �Ly Describe proposed use and work to be done: Present use of land or building(s): 4- 1 Valuation of proposed construction: 0 Dimensions of the added space: feet X feet Will this project involve: a Heating&Air- 13 Plumbing Li Electrical u Fireplace Conditioning Is approval of Homeowner's Association or other private entity required? J,40 If yes, please submit with this application. Will this project involve changes in elevation, site grade or any use of rill material, or the addition of 5% or more to the original impervious area or the removal of any trees? JE92L Applicant certifies that no change in site grade, impervious area or fill material will be used on this project. El YES. See Step 2 below. Approval of the Public Works Department is required prior to issuance of a Building Permit. El NO. Applicant certifies that no trees will be removed for this project. YES. Removal of Trees will be required for this project. 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 appropriate Incomplete applications may result in delay in issuance of permit STEP 1. Verify zoning designation and proper setbacks for the proposed construction. If you are unsure of this information, please contact the Planning and Zoning Department at 904-247-5826. In order to correctly verify zoning designation,please have Property Appraiser's Real Estate Number available. STEP 2. Contact the City of Atlantic Beach Department of Public Works to determine if a pre-construction or post-construction topographical survey or grading plan is required. (If not required, written verification must be provided with this application.) The Department of Public Works is located at: 1200 Sandpiper Lane,Atlantic Beach,FL 32233 Telephone: (904)247-5834 STEP 3. Submit Tree Removal Application if trees are to be removed or relocated. 800 Seminole Road -Atlantic Beach,Florida 32233-5445 Page 2 Telephone: (904)247-5800 Fax: (904)247-5845 -http://www.ci.attantic-beach.fl.us Revised 8/04 Special Information for Owner/Builders DISCLOSURE STATEMENT for Section 489.103(7),Florida Statutes: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERAUT UNDER AN EXENWTION TO THE LAW. The exemption allows you as the owner ofyour property,to act as your own contractor even through you do not have a license. You must sgpervise the construction ygurself. You may build or improve a one-family or two-farnily residence or a farm outbuilding, You may also build or improve a commercial building at a cost of$25,000 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease more than one building you have built yourselfwithin one(1)year after the construction is complete,the law will presume that you built it for sale or lease,which is a violation of this exemption. You may not hire an un-licensed person as your contractor. Your construction must be done according to building codes and zoning regulations. It is your responsibility to make sure that the people employed by you have licenses reguired by state law and by coMpty or municipal licensing ordinances. In addition,the owner must supervise construction and becomes liable and responsible for the employees he/she hires. This responsibility includes,but may not be limited to: 1. Workers Compensation,for workers injured on the job. 2. Social Security Tax must be deducted from employee's wages and matched with owner's funds. 3. Federal Withholding. Since owners must be liable for injuries to workers they hire,the Building Division suggests Workers Compensation Insumnce be purchased unless the homeowners insurance policy clearly protects the owner. Owners hiring workers become employers and should also observe IRS withholding tax Form 1099 requirements on the workers they employ on their improvement work. Un-licensed contractors cannot be qMloyed under gLny circumstances. Owners are subject to a$5,000 penalty under Florida Statute#455.288(l)instigated via Building Division citations. An OcMational License is not adequate. The owner should physically see the county Certificate of Competency or the Florida Contractors Certificate to ascertain a person is a licensed contractor. Telephone the building Division(247-5826�f in doubt. I hereby acknowledge that I have read and understand all the above on this / 5 Dayof,__Odr�-t�--�, 12r" al, A r--.0-Z-S4-..( C/. Owner Builder Signature Address 0 r-'a,? "-5 4,,, 2 3 3 C( Print Name Telephone Number STATE OF FLORIDA: COUNTY OF DUVAL to me well known to be the individual and Before me personally appeared I owner bui I der d e s cribe d in an d w4he)xe Leut—ted thi s inst rument an(/s everallY acknow I edged the executio n thereof to b e,hi s o wn free act and deed as such owner builder hereunto authorized. WITNESS my hand and official seal this of, 4V n 0 -ttF46 af resaid. and S 'foresai, NOTXP-��- ST)TE 0 OWA PrintName: J SMLEY k.MAHM Nota a ry PUM-Sft of Fbft MY CONMISSION EXPIRES: - iMy Commission Expires Feb 14,2010 o Personally Known 1,7 322- Commission #DO 518533 "entification: Bonripri Rv National Notary Asson. STEP 4. Please submit Building Permit Application, Energy Code Forms, Notice of Commencement, Owner/Contractor Affidavit if owner is contractor, and four (4) complete sets of construction plans to the Building Department, which is located at the Atlantic Beach City Hall, 800 Seminole Road,Atlantic Beach, FL 32233 Telephone: (904)247-5826 In addition to construction and engineering detail, plans must contain the following information as appropriate for the type of work being performed. Scale of drawings should be sufficient to depict all required information in a clear and legible manner. 1. Current survey showing the property boundary with bearings and distances and the legal description. 2. Location of all structures, temporary and permanent, including setbacks, building height, number of stories and square footage. Identify any existing structures and uses. 3. If required by the Department of Public Works, a pre-construction topographical survey. 4. Any significant environmental features, including any jurisdictional wetlands, CCCL, natural water bodies. 5. Impervious Surface area calculations: include driveways, sidewalks, patios and other Impervious Surfaces. Swimming pools may be excluded from total Impervious Surface. 6. Product Approvals for all exterior windows,doors shutters etc..(FBC 2004) Address and contact information of person to receive all correspondence regarding this application(please print). Name: Oewoq 6'.5 A& -5 A (-- X , MailingAddress: 6k . (�h el Telephone: 2,9 7_2 Fax: E-Mail: I hereby certify that I have read and examined this application and attached documentation and know the same to be true and correct. All provisions of the laws and ordinances governing this type of work will be complied with, whether specified herein or not. ne granting of a permit does not presume to give authority to violate or cancel the provisions of any federal,state or local rules,regulations,ordinances,or laws in any manner,including the governing of construction or the performance of construction of the property. I understand that the issuance of this permit is contingent upon the above information being true and correct and that the plans and supporting data have been or shall be provided as required. Signature of Owner: 4A Date: 0 - 15-- 4� AS TO OWNER: Sworn to and subscribed before me this day of 520 State of Florida,County of Duval Notary's Signature: F1 Personally known Fj Produced identification Type of identification produced Signature of Contractor: Date: 800 Seminole Road -Atlantic Beach,Florida 32233-5445 Page 3 Telephone: (904)247-5800 -Fax: (904)247-5845 -http://www.ci.atiantic-beach.fl.us Revised 8/04 035 37.4' /-17' V) V) S 7-'X' j e,0AlC. 13 4 0 c,< 13-d' NOT VALID UNLESS EA48OSSED W7H SEAL OF THE UNDERSIGNED. BEARINGS BASED ON LINE AS SHOR4 W PROPERT'Y SqOW HEREON APPEARS TO LIE WHIN FLOOD HAZARD ZONE X AS SCALED FROM f-1-00D 476A9A�171& IN-WRANCE RATE MAP-2-- F-OR THE CITY OF 13,f-9cev , FLORIDA, DA 7E-D 3-/-5 -8 AND IS SHOW AS A COURTESY ONLY AND DOL'S NOT CONSTHUTE A CER77FCA77ON OF SAME. 11-1 L"D SURVEYORS, INC. Mr-STA rpL,, 8411 BAYMEADOWS WAY SUITE #2, JACKSOWLLE, FLORIDA J2256 (904)� 7JI-72J5 LEGEND I HEREBY CER77F-Y THAT THE ABOVE LANDS RERE SURVE)ED UNDER MY * Cow- mw RE-SPON9,91LE SUPER WSWON AND DIRECTION, THAT THERE ARE NO * ow Car. ENCR OA CHMEN'TS EXCEP T A S SHO*N A NO THA T THE SUR VE Y SH 0 W (SU WIN a4P if LS 414#) HEREON MEETS THE MINIMUM 7ECHNICAL STANDARDS SET FORTH By THE Fv" FLORIDA STATE BOARD OF PROFESSIONAL SURVEYORS AND MAPPERS 0 RON CON.(Fouw) PURSUANT TO SEC77ON 472.027, FLOMDA STATUTES. S CROSS CUT am.1- BuLlmw KSMICTM L*c aw'r &csagxr LARRY G, EDDY, R .S. No. 4 144 ft1W ffWr-0--W4Y Nq COV. COHM ANEA SCALE: f CiNmuw Alt AIR caw77aww PAD GlSTE-MRPVEYQR AND. 0 (R) RAOM OISTANCr �TAI TE VRIDA DA TE. oavatm ORDER NO. 22-41L, CITY OF ATLANTIC BEACH SS 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 -5826 INSPECTION PHONE LINE 247 INSPECTION EMAIL REQUEST: Building-deptCa coab.us Application Number . . . . . 07-00001473 Date 10/25/07 Property Address . . . . . . 14 FORRESTAL CIR Application type description RESIDENTIAL ADDITION/ALTERATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 5000 ---------------------------------------------------------------------------- Application desc ENCLOSE CARPORT ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ SELBY, DENNIS OWNER 14 FORRESTAL CIRCLE ATLANTIC BEACH FL 32233 --------------------- Structure Information 000 000 ---------------------- Construction Type . . . . . TYPE 5-A Occupancy Type . . . . . . RESIDENTIAL Flood Zone . . . . . . . . ZONE X ---------------------------------------------------------------------------- Permit . . . . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 55 . 00 Plan Check Fee 27 . 50 Issue Date . . . . Valuation . . . . 5000 Expiration Date . . 4/22/08 ---------------------------------------------------------------------------- Special Notes and Comments *2004 FLROIDA BUILDING CODE W/ 105- 106 SUPPLEMENTS. 2004 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. ----------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 55 . 00 5S . 00 . 00 . 00 Plan Check Total 27 . 50 27 . 50 . 00 . 00 Grand Total 82 . 50 82 . 50 . 00 . 00 PERMIT-IS "PROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CITY OF ATLANTIC BEACH PERMIT APPLICATION # BUILDING / ZONING DEPARTMENT 900 Seminole Road Atlantic Beach,Florida 32233 (904)247-5-00 (904)247-5845 Fax www.coab.us copy APPLICATION TRACKING FORM ARRED DEPT� PLANNING N y BUILDING Property Address: z PUBLIC WORKS y Applicant: hLon y UBLIC UTILITIES J y A) FIRE DEPT. Project: LKLA CMDD(4— PUBLIC SAFET Y Py AN �J U) APPROVAL REQUIRED AGENCY: RECEIVED BY: INITIAL: DATE: Z LCUI UJ )y N D.E.P HUFSTETLER a 2-� ')' D y S.J.R.W.M. CARPER LU LU N �ARMY CORPS of ENG CARPER H 0 Y N OTELS R HUFSTETLER T APPLICATION STATUS CIRCLE ONE: SITE BUILDING DA ,AP EVIEWED BY: INkTIAL: PATE: 1 ST REV ETI 0 1 PLANNING 2ND RE BUILDING PUBLIC WORKS PUBLIC UTILITIES FIRE DEPT. PUBLIC SAFETY 3RD REV Retu rn this form to the Building Department once you have entered your comments into the AS400. CITY OF ATLANTIC BEACH - -V 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 07-1 OFFICE:(904)247-5826 0 FAX NO.:(904)247-5845 BUILDING-DEPT@COAB.US BUILDING PERMIT APPLICATION DUVAL COUNTY N � - M K- RPM 1- "M 2 M"' �M 9,1 ntic Beach, FL �223 3 M"IF -7 7 RA ;Ii Wo 0 W qlr"A 77 11 N�V BUILDING 0 DEMOLITION EMESIDENTIAL LOTIjC;�BLOCKCR SUB DIVISIONI 'DITION El CONVERTING USE 0 COMMERCIAL V I Irl Q'rD 13 ALTERATION 11 ACCESSORY BLDG. 0 REPAIR 13 POOL/SPA 11 0 N/A en= car r4- 0 MOVE J I 2'O'THER �NO 0111M ftltlt' 777F 9.NAME: 22 COMPANY NAME- rcl K A-4 fit 4r- I _J ZnQ 24.LICENSEE NAMEi_) El"";1' 10.ADDRESS: 17.STATE OF FLORIDA LICE- N 0-: STATE QF fLORIDA LICENSE NO.: .2 r,,?L4(P Ll ffe!I5�Cd C('(M 18.ADDRESS: 26.ADDRESS: f\V(*' , A+Ionbc P'leact) FAX NO.i 728.FAX NO.: I-OFFICE PHONE: 12.FAX NO.: 19.OFFICE PHONE� 27.OFFICE PHONE: I C PHONE: 21.CELL PHONE: 29.CELL PHONE: '�;M-.,�cn-7 14.EMAIL ADDRESS: 22.EMAIL ADDRESS: L DRESS: Ogg i 0#i �0"0-ft-, 0 0 05''p 0''ftl ........... SO"49 Pw lop "I n W-1 I "','w ., ,"" 4, M 01"A"M Eff" M NO,W W"1 'N' 31.NAME: 33.NAME: 35. I 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,Wells,Furnaces,Boilers,Heaters,Tanks, Air Conditioners,etc. OWNEII 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. 222 WARNING TO OWNER: 222 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. R" 1,11 rh Signed: Date: Signed: Date:- Before me thisQ!9��day of..C)30�0&r ,2007 in the county of Before me this day of 2007 in the county of Duval,State of Florida,has personally appeared Duval,State of Florida,has personally appeared ])ejo r)i 5 Sc I W herin by himself/herself and affirms that io 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 f7l, County of J)UVC1_4 Notary Public at Large,State of County of 0 Personally Known 0 Personally Known CWMduced Identification- 13 Produced Identification- Notary Signature: Notary Sig ture: K.CM0111111"AM mowy PAk-ftb of FII CawnWw ExplIN F&X.201110 coffffAlw#00 52=1 COAB FORM BLDG01:REVISED:110/5/2007 '21M., gaGIMM py Nef"No"AM. d;I CITY OF ATLANTIC BEACH OWNER / BUILDER AFFIDAVIT r n19�, 1. 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: CP 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. 11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED UNDER THE HOMEOWNERS INSURANCE POLICY TO CLEARLY PROTECT THE OWNER. Ill. 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. 455-22B(l). 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. I Q ffib aX33 - ADDRESS PHONE NUMBER D_�Pnnit) PRINT NAME Ica MINIATURE 1000000 DATE Before me thiz;:9__4-yof_0C&r1_'e� 2007 in the county of Duval,State of Florida,has ersonally appeared herin by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of FL_ 'Countvof K CUWSWHAM Sw of FWN8 13 Personally Known mowy Pubic 11,200 Q,w6uced Identification- CcffwN9*n E*m Fab 215�1 is too S DD 523M gor"91 NOWY W- Notary Signatur 7 COAB FORM BLDG:,07;RF ED: 8/1 CITY OF ATLANTIC BEkCH PERMIT BUILDING/ZONING DEPARTWNT APPLICATION 800 Seminole Road Allantic B=14 Florida 32233 (904)247-5800 (904)247-5845 Fax www.coab.us APPLICATION TRACKING FORM RF,CMRED DEPT: (_Y,) N PLANNING Property Address: Z (y) k BUILDING I-- PUBLICWORKS Applicant: 0 Y T?d "PUBLIC UTILITIES Y FIRE DEPT. Project: Y�;N PUBLIC SAFETY APPROVAL t1i 0 REQUIRED AGENCY: RECEIVED BY: INITIAL- DATE. z WCI W CC Y N D.E.P HUFSTETLER Y N S.J.R.W.M. CARPER w w Y N ARMY CORPS of ENG 0 y N HOTELS&RESAURANTS HUFSTETLER APPLICATION STATUS CIRCLE ONE- SITE BUILDING DA AP RP116WED BY: INITIAL- DATE. 0 0 1STREV 0 of Zp NING 0 1 0 12NDREV 10 1 UILDI)N T PUBLIC WORKS PUBLIC UTILITIES FIRE DEPT. PUBLIC SAFETY 1 0 13RDREV 10 10 1 Retarn,this form to the BWkilng Department once you have eutet�your comments mte the AS400 1-1-j-.1 CITY OF ATLANTIC WACH SW SEMINOLE ROAD�ATLANM BE"Fl.3= 07-. O"ICE:(W4)247-5=0 FAX NO.:(W4)247,rM5 BUILDING�DEPTOCOAILUS BUILDING PERMIT APPLICATION DUVAL COUNW ZVALUATM OF WORK JASO.FT,UNDERROOF� &l.ntic Beach, FL 32233 4,E6QALA�89C1PnjOW G.USE LOT11C2;SLOCKC2 SW DIVISMejj-� =0 =DW, 0 DEMOLITION SIDENTIAL tPESCROPITIONOFWORK CA 1 0 CONVERTING USE 0 CMIAL 0 ALTERATION 0 ACCESSORY BLDG S.FIRES101"Nidi5t 0 REPAIR 0 POOL I SPA 0 INA CO� 0 MOVE 0 OTHER 9-y14P0- 1PROPERTY0111111111ft UONTRACTOR. ARCHITECUENGROMR: 9.NAME: !§,COMPANY NAME. 4 COMPANY HAW J_St _i _jC _ -n I,,. G_A 11, "1.� Ofnn�e--) Vk'I Se I ulf�trt 24�LW*NSEE NAME:_) 10.ADDRESS: 07.5TATE OF FLORIDA LICENSE NO.: T6LAjjLVr:,. 25.STATE QF FLORIDA LICENSE NO.: ,L-� fbYre5+Cd Cly-Cte .26?L4(s '18.ADDRESS: 26.ADDRESS: 1Z FAX NO�: 19.OFFICE PHONE. FAX NO.: 27.OFFICE PHONE: 28.FAX NO.. -1 1 r- —W(P -.1"X40 1.;t L PHONE: 21.CELL PHONE: 29.CELL PHONE: -.,-?Cn--� 14.EMAIL ADDRES& 22-EMAIL ADDRESS: 33, 7:,, 31.NAME: 33.NAME: 35�PAME: 11-1 in-rrusf Ro n 32.ADDRESS: 34.ADDRESS: 36.ADDRES& Appkabon a hereby made to obtain a permit to do the work and Installations as Indicated. I carWy that no work or Installation commenced prior to the issuance of a permit and that all work will be performed to~the standards of&N tam regulatiogi 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 fbr a period of sk(6) months at any*ne after work Is oornmenced. I understand that sepanne permils must be secured for Electrical WoM�wnbkv&"Us,Furnaces,Dollem,"MUM,Tanks, Air 4ft. OWNEWS AFFIDAVIT-I certify that all dw foregoliv irtbrination is accurate and thal:all work will be done m compliance with all applicable law regulaft construction and zonkV.I will not occupy or use the referenced budft or any part therof,until sit inspection are finaled and pnor to obtakft a cerfificale of occupancy or completion issued by-the buddkV Official,as required by law. 222 WARNING TO OWNER: 222 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. INT-RAC MMIMtWAGENT Date: 2007intheMuntyof Before me#ft day of —2007 in ft CMNAy of Duval,Stale d Florida,h"personally appmW Mtval,Stele of Florida,has personally appeared ]�Cnffi=z se-liu — herin by hirnself/herself and affirm that a�slalerrierft and declarations we herin by hknsW/herself and aftm fiat all stalarrIervis and declarations are true and accurate. true aw accurate. of_ Notary Public at LaW,Stag 1�'. cm*or ITAkya'� l Notary Public at L&W State of lc�of 13 Pwsonauy Known 0 Posmft Known 7 CW"*joed Idw0kabon- 0 Produood Wwffkafion- L No�y SWo K CUNW**IAM No"pum-Bob of FMft cammw Eon Fib 21L 2M c4mmitillion#W COAS FORM BLDG01:REVIsEMD.-1OWFU20=07 mled By Nall"Nobtry AwL 'ss CITY OF ATL.AJMC BEACH OWNER BUILDER AMDAVWY-:J�'li-, 1 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTE.9, PART I �06N�6CTION CONTRACTING'REQUIRES OWNER I BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA Si 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 RAVE A LICENSE. YOU MUST SU F M)M nM- CONSTRUCTI(M YOUMEX. 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 BUILI) 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 WELL PRESUME THAT YOU BUILT -a MA rrFoR SALE OR LEASE,WHICHIS IN VIOLATION OF Tiffs EXEMPTION. Y U -YNOT HIRE AN I TNI ICENSED PERSON AS YOUR CONTRACIO—IL YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOY BDI BY YOU HAVE LIC&SES REOUMM By STATE LAW AND By COUNTY OR MUN IPAL LICENSING ORDINANCES. It. 114JURY LIABILITY; SINCE OWNER� MAY BE L"LE FOR INJURIES,TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKERS COMPENSATION INSURANCE BE PURCHASED UNDER THE HOMEOWNERS INSURANCE POLICY TO CLEARLY PROTECT THE OWNER. Hl. IRS W"HOL.DiNG; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX ANDIOR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE -EMPLOYED . UNQM- ANY CIRCUMSTANCES. OWNERS BEING SUBJECT To$6,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(j). AN-OCCUPATIONAL LIC NSg:Ip 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. 9c sn,l ILI ff--A�je7 _*W f- rY.14 1-1 ADDRESS PHONE NUMWR rk,--nni�) PRINT iVWE-- WMATURE DATE Betove me t., Vn , ,, 2D(Yl in the courity of Duval,State of Florida, a"y herm Wmseff I hemelf em aftm ftiat ag statements m-od dedarshom we true and accurate. Notary Public at Large,State of County of 0 pwwnamy wvvn cwm"me*wF4bX2010 COWWWO#W 523M B WWAj Nfty AWL E OrMW N NotarySigns D COAB FORM BLOW; CITY OF ATLANTIC BEACH, FLORIDA Appmed by APPLICATION FOR ILICTRICAL PIRMIT TO THE CHIEF ELECTRICAL INSPECTOR: DATE: IMPORTANT NOTICE: IN CONSIDERATION OF PERMIT GIVEN FOR DOING THE WORK AS DESCRIBED IN THE FOLLOWING, WE HEREBY AGREE TO PERFORM SAID WORK IN ACCORDANCE WITH THE ATTACHED PLANS AND SPECIFICATIONS, WHICH ARE A PART HEREOF, AND IN-ACCORDANCE WITH-THE ELECTRICAL REGULATIONS, CODES AND CITY OF ATLANTIC BEACH ORDINANCES. A\r\,u�'j it v--- �;kc - ELECTRICAL FIRM: MMWELECTRICIAN SIGN&J1,4fd JOURNEYMAN /I v NAME ADDRESS: c"k-F RFD____WX_ BLDG.SIZE BETWEEN: RES.0, APTA COMIMA PUBLIC( I INDUS. NEW OLD REW. I ADDITION( TRAILER ( TEMP. SIGNS $0.FT. SERVICE: NEW INCREASE -REPAIR FEE CONDUCTOR SIZE AMPS COPPER f ALUM.I SWITCH OR BREAKER AMPS PH w VOLT RAGEWAY EXIST.SERV.SIZE 5_0 AMPS PH -3 W Z3oVOLT Se-v/ RACEWAY FEEDERS NO. size NO. SIZE NO. SIZE LIGHTING OUTLETS CONCIEALIED OPEN TOTAL RECEPTACLES CONCEALED OPEN TOTAL 1 0.80 AMPS�_i Amili SWITCHES INCANDESCENT FLUORESCENT&M.V. FIXED 0-100 AMP*. OVER APPLIANCES BELL TRANSF4 AIR H.P.RATING H.P.RATING CONDITIONING COMIP.MOTOR OTHER MOTORS AMPS C91L HEAT: KW-HEAT OVER MOTORS H.P. VOLTAGE PH$ NO. I H.P. VOLTAGE PHS MISC��ANEORS (o Q---vvtj' 1js f?c�xl a 0-0 DATE: PRE-SERVICE DIVISION JACKSONVILLE ELECTRIC AUTHORITY 2,�j WEST DUVAL STREET JACKSONVILLE, FLORIDA 32202 THE FOLLOWING FINAL INSPECTION(S) HAVE BEEN MADE AND ARE SATISFACTORY : ------ ------------------j-------------------------------- -------------------------------------------------- --------------------------------------------------- ------------------------------------------------- ------------------------------------------------- -- Enclosed are the blue copies of the permits. SINCERELY, 7 BUILDING INSPECTION DIVISION cc : FILE DEPARTMENT OF BUILDING. CITY OF ATLANTIC BEACH,FLORIDA PERMIT NO6737 PERMIT TO BUILD THIS PERMIT MUST BE POSTED ON JOB Date Yuw 21, 1 o 85 Valuation$ RE-"F Fee$ 7.50 7 50 T 7:50CKT This permit not valid until above fee has been paid to City Treasurer,and is A 5/21/8 subject to revocation for violation of applicable provisions of law. 6737 *00cac ARLX4=–BK4CMS FK)F][�� This is to certify that psery Terrace JAMR96MIre- i 866 R09023962 has permission to NAd – Re–ROOf S Classification residelitial Zone Owned by Lester Jordm Lot Block S/D House No. 14 Forrestal Circle North According to approved plans which are part of this permit NOTICE—ALL CONCRETE FORMS AND FOOTINGS MUST BE IN- SPECTED BEFORE POURING. PERMIT VOID SIX MONTHS T AFTER DATE OF ISSUE ;D 0 Building material, rubbish and debris zi from this work must not be placed in public space, and must be cleared tip and hauled away by either con- ri�e–o;or owner. 4, Building Official. FOR OFFICE PERMIT DATE CONTRACTOR USE ONLY NUMBER PLUMBING =Lr�]RICAL SEWER WATER AMW CITY OF ATLANTIC BEACH APPLICATION FOR BUILDING PERMIT Owne'z'-/"0 Address c4a—LO U"one Architect Address Phone Contractox Addres Phone Da e License Number�Keda? Expiration Da e 4/69 Lot # Block # Subdivision _Z�oning Sireet Between and side Valuation $ 'urpose of Buildinz//� ,42Z,1-7Z' Type Const. Dimensions : Building Lot Sz.Footings Sz.Piers Sz. Sills Greatest Span Sills Sz. Ceiling Joists Distance on Centers Greatest Span Sz.Floor Joists Distance on Centers Greatest Span Sz.Rafters Distance on Centers Greatest Span Heating Solid-Filled Ground Roof Flood Zone If located within a FLOOD HAZARD ZONE fill out reverse of this application. Inspections Required: 1. When steel is in place and ready to pour footing. 2. When steel is in place and ready to pour columns/lintel. 3. When steel is in place and ready to pour beam. 4. When framing, mechanical , rough plumbing and fire place is completed and ready to cover up. 5 . Rough electrical. 6. Final inspection. In case of rejection, reinspection MUST be called SETBACKS for after corrections are made. In consideration of permit given for doing Rear Lot Line the work as described in the above statement, we hereby agree to perform said work in accordance with the attached plans and specifications , which are a part hereof, and CL p. in accordance with the building regulations M M of the City of Atlantic Beach. t-4 r_1 0 0 rt rt Signature OWNER Signature BUILDE Front Lot Line CITY OF 800 SEMINOLE ROAD ATLANTIC BEACH,FLORIDA 32233-5445 TELEPHONE(904)247-5800 jlv� FAX(904)247-5805 '-W-WPW, gcc'�� SUNCOM 852-5800 October 23, 1997 Kathi Davis 14 Forrestal Circle Atlantic Beach,Fl 32233 Dear Ms. Davis: Our records indicate that you are the owner of the following described property in the City of Atlantic Beach: Re: 14 Forrestal Circle It has come to our attention that the assigned house street numbers art not permanently attached to your buffding. This is required by Chapter 6,section 108 of the Code of Ordinances of the City of Atlantic Beach and Jacksonvitte Electric Authority Rules and Regulations section 2.19 The absence of these numbers affixed to your budding and visible from the street is a determent to your safL-ty should you require police,fire or medical emergency services. I urge you to install a nfinimum of four inch high numbers in addition to any numbers presently displayed on a mail box. Failure to property display the numbers.can result in thisviolation being brought before the code enforcement board. Under Fl . S.S. 162 you can be fined$250-00 per day fbr a first violation and$500-00 dollars per day for a repeat violation. r it -OW.- C e'eew�ald Code Enforcement O&o KWG/ph cc: Public Safety Director CITY OF 800 SEMINOLE ROAD ATLANTIC BEACH,FLORIDA 32233-5445 TELEPHONE(904)247-5W FAX(904)247-5805 SUNCOM 852-5800 October 23, 1997 Jack Mitchell 22 Forrestal Circle Atlantic Beach,F1 32233 Dear Mr, Mitchell: Our records indicate that you are the owner of the following described property in the City of Atlantic Beach: Re: 22 Fonv9d Circle It has come to our attention that the assigned house street numbers are not permanently attached to your bu"ag. This is required by Chapter 6,section 108 of the Code of Ordinances of the City of Atlantic Beach and Jacksonville Electric Authority Rules and Regulations section 2.19 The absence of these numbers affixed to your building and visible from the street is a determent to your safety should you require police, fire or medical emergency services. I urge you to install a minimum of four inch high numbers in addition to any numbers presently displayed on a mail box. Failure to property display the numbers can result in this violation being brought before the code enforcement board. Under F1 . S.S. 162 you can be fined$250.00 per day for a first violation and $500.00 dollars per day for a repeat violation. S' IY.% -Z Karl W. GruneWald Code Enfbreement Officer KWG/gah cc: Public Safety Director MAP MrOl WMG BOLMDARY- SURVEY, OF LOT /Z —"CK AS SffOWN - ON-.-JW- OF:– AS RaXIMW IN PLAT BOOK 30 PAGES OFIW-.PUMJCII�E&*D,�"i7,O� DL*AL,"'COUAfT..YAMDA- . ,-R77RED FOR.--A7A-"0A--fW OQ VIT, I-AdAr-4 ze- 7_'r47AV 4e OV�13 X- 4�1 4- 95- 6: 715.CO' r '4 45.4Ce_- CAW. ILI ;n �j a Los U lk f- fee /4' C#y Of At antic Be j=A zoor"A" I . 13.do.9 . FA al regulations, but d M Cons"laft (I%14or> u74e-.v ap fdr No Issuance of ps Y� je ad" with FWde BuMng Code mW w0appillcow local, State and Federal pwm mqukonm* must be vadW aig tur*of Cky Of A#W& sesch 8 Ming pw to alls, am"" IL C A? C Co,Q.oV&-A AACCJ* tA.1 ESIDENC-F- plq*r*x,pl(lx IIA040WEL" PROW BY! 4 PGA laotlL DTpV4W MUW a6OSSED WN&AL OF,ME MDOMMM MMMS BASED OV LNE AS 9M: WE PROMMY MOM HIMEM APPEARS TO LIE WNW FLOW HAZARD 20W X AS SWID FROW FLOOD -4 7'4-VA--T,& B-/5 -BS2 AND IMIMJVAAfrr VA7F ALALP FVR ME aTY OF- Ak FLOMA. DMED