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' -4,1) APPROVED 0 CITY OF ATLANTIC BEACH BUILDING OFFICE 1 .„:„, ( CIT .„--/ ' 4 ( 11 -- --- titil ...-• i DEC 1 5 1989 , / D (14 •e%'0.!.....410-)07 • s!VL r'l s Ls )4 0 ?Zfr*)vi -)A. - ''' `IT',-,-; '-' \ \ l N CITY OF ATLANTIC BEACH -� _ V BUILDING PERMIT APPLICATION (Alterations & Additions) Date: Job Address: Owner of Property: Address: Telephone: Legal Description: Block Number: Lot Number: Zoning District: Contractor: State License Number: Contractor Address: Telephone: Describe proposed use am Present use of land or buil 3 6 2. 3 g(_7_-_____------ _ . .,_..rv... - (o o _ ___._ -__ __.__ Valuation of proposed con R - X�� "� `� -- --° - Dimensions of the added sl_^..__.__. / / Will this project involve: .-- ❑ Heating &Air- A ❑ Fireplace Conditioning V Is approval of Homeowner" ,�/ -, please submit with this application. Will this project involve cha; dition of 5% or 51101'e ,' ❑ NO. Applicant cep ----- - rial will be used on this project. ❑ YES. See Step 2 bet_ 1., issuance of a Building Permit. ti ❑ NO. Applicant cert- * , ❑ YES. Removal of Tr As IS REQUIRED. Tree Removal Perm__„.. o times each month. Procedure: In order to expedn " ___ mation as appropriate. Incomplete applications may re; ___ _ STEP 1. Verify zoning designs - -- - -- -°'""` )f this information, please contact the Planning a ; designation, please have Property Appraiser's R‘. _.._,.- .... -__ ..r._._.. ------- - _ _ STEP 2. Contact the City of A . __.,..�...._. -.. lion or post - construction topographical survey or __led with this application.) The Department of Publ tone: (904) 247 -5834 STEP 3. Submit Tree Removal A; "" _ _- .. «moves or relocated. 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 800 Seminole Road • Atlantic Beach, Florida 32233 -5445 Telephone: (904) 247 -5800 • Fax: (904) 247 -5845 • http : / /www.ci.atlantic- beach.fl.us Page 2 Revised 8/04 • 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. Other information as may be appropriate for individual applications. Address and contact information of person to receive all correspondence regarding this application (please print). Name: Mailing Address: Telephone: 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. The 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: Date: AS TO OWNER: Sworn to and subscribed before me this day of , 20 State of Florida, County of Duval Notary's Signature: ❑ Personally known ❑ Produced identification Type of identification produced Signature of Contractor: Date: AS TO CONTRACTOR: Sworn to and subscribed before me this day of , 20 State of Florida, County of Duval Notary's Signature: ❑ Personally known ❑ Produced identification Type of identification produced 800 Seminole Road • Atlantic Beach, Florida 32233 -5445 Telephone: (904) 247 -5800 • Fax: (904) 247 -5845 • http : / /www.ci.atlantic- beach.fl.us Page 3 Revised 8/04 J.,11 CITY OF ATLANTIC BEACH OWNER/I3UILDER AFFIDAVIT Date: Job Address: 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. ORDINANCES ALSO ALLOW AN. OWNER TO IMPROVE THEIR OWN PROPERTY WHEN IT IS FOR PERSONAL OR FAMILY USE, AND LIKEWISE REQUIRE ALL WORK (EXCEPT MAINTENANCE UNDER $2,000) BE UNDER A BUILDING PERMIT AND PASS ALL NORMAL INSPECTIONS. THE ORDINANCE STATES OWNERS MAY PHYSICALLY DO .YORK THEMSELVES; OR MAY HIRE UNLICENSED WORKERS PROVIDED SUCH WcIs:KERS BE UNDER "DIRECT : UPERVISION OF THE OWNER, WHO MUST BE ON THE JOB AT ALL TIMES WHILE •.r ORK IS IN PROGRESS BY TJ `LICENSED TRADES PEOPLE." THIS DOES NOT ALLOW USE OF UNLICENSED CONTRACTORS. 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. OWNERS HI1W G WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND /OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMM1 ON THEIR IMPROVEMENT TRADES. 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. 1 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. PROPERTY OWNER/BUILDER SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY OF 20 . NOTARY PUBLIC ,•�� r.- ........ ,r.,. MY COMMISSION EXPIRES: • NOTICE OF COMMENCEMENT State of County of Tax Folio No. To Whom It May Concern: The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of the Florida Statutes, the following information is stated in this NOTICE OF COMMENCEMENT. Legal description of property being improved: Address of property being improved: General description of improvements: Owner: Address: Owner's interest in site of the improvement: Fee Simple Titleholder (if other than owner): Name: Address: Contractor: Address: Phone No: Fax No: Surety (if any): Address: Phone No: Amount of Bond S Fax No: Name and address of any person making a loan for the construction of the improvements. Name: A .' Tress: P - ,)ne No: Fax No: Nam of person within the State of Florida, other than himself, designated by owner upon notices or other docu,r eats may be served: Name: Address: Phone No: Fax No: In addition to himself owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.06(2)(b), Florida Statues. (Fill in at Owner's option). Name: Address: Phone No: Fax No: Expiration date ofNotice of Commencement (the expiration date is one (1) year from the date of recording unless a different date is specified): THIS SPACE FOR RECORDER'S USE ONLY OWNER Signed: Date: Before me this day of in the County of Duval, State of Florida, has personally appeared Notary Public at Large, State of Florida, County of Duval. My commission expires: Personalty Known: or Produced Identification: DEPARTMENT OF BUILDING PERMIT NO. " o CITY OF ATLANTIC BEACH, FLORIDA PERMIT TO BUILD THIS PERMIT MUST BE POSTED ON JOB Date OCTOBER 7 19 82 Valuation $ 7,$00.00 Fee$ L2.00 This permit ect not valid until above fee has been paid to City iTreasurerof l , and is subj to revocation for violation of applicable provisons aw. This MYERS CONSTRUCTION COMP his is to certify that 3310 BOWEN LANE, JACKSONVILLE= FLORIDA has permission to build REHAB AS PER PLANS SUBMITTED. CDBG CASE NO. $1 -02 Classification SINGLE FAMILY Zone RG`"1 Owned by WILLIE 14ILLEY DOER'S REP ' T Lot 12 Block? - -S/D House No. 1990 PARK STREET According to approved plans which are part of this permit NOTICE —ALL CONCRETE FORMS t AND FOOTINGS MUST BE IN- SPECTED BEFORE POURING. PERMIT VOID SIX MONTHS AFTER DATE OF I r 7 �--- -♦ t i 4,1.. � O Bu ilding material, rubbish �p� /� .1 from this wp3l5 �ust %o d mu be in public spape « .j c i up an • h au , r ay by 4 e i l I rr . o �UOO 1' Building Official. CONTRACTOR I FOR OFFICE USE ONLY Date 19 Permit # Fee $ CITY OF ATLANTIC BEACH Valuation $ FLORIDA House # APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure described. This application is made in compliance and conformity with the Building Ordinance of the City of Atlantic Beach, Florida, and all provisions of the Laws of the State of Florida, all ordinances of the City of Atlantic Beach and all rules and regulations of the Building Department of the City of Atlantic Beach, shall be complied with, whether herein specified or not. The Contractor or Owner - Builder who has been issued a Building Permit is automatically responsible to ascertain that all sub- contractors engaged by him are duly licensed in the City of Atlantic Beach, Florida. To prevent delay or embarrasment regard- ing intermediate or final inspections it is suggested that a list of sub - contractors be submitted to this office so that licenses can be verified. /y y q 4 Date - l /..,26 1a 2� 19- 2.Zr.-. Owner.._ 21/ib A i* //e Address / l / V - K 2'16 Telephone No. "' e)6215 Architect / Address Telephone No Contractor Builder.. if CI S... C.... /../.!..)l._ Address.... /e4 1✓a -ti Telephone No... ?A? /"mil Lot No l 2-- Block No. 1 --- Sub Division... ) .e.-Z,• Zone Street Side Between and / p Sts. Valuation $_..76OO For what purpose will building be used . ario +/e�'.' rype of construction if it h U Dimensions of Building Dimensions of Lot Size of Footings Size of Piers Size of Sills Greatest Sill Span in ft Type Roof How will Building be Heated? Will Building be on Solid or Filled Ground? Size of Ceiling Joists , Distance on Centers , Greatest Span a Size of Floor Joists , Distance on Centers.. __.. , Greatest Span Or Size of Rafters , Distance on Centers , Greatest Span A P P R O V E D This rectangle is to represent the lot. CITY OF Ail %.NTIC BEACH Locate the building or buildings in the E U I L D I N G O F ICE right position. Give distance in feet from all lot -lines and existing buildings. _ 7 1 982 REAR LOT LINE Two copies of plans and specifications shall • s be submitted with application. Inspections required. ii t y 1. When steel is in place and ready to pour footing. W 2. When steel is in place and ready to pour colrlm : and /or lintel. z x 3. When steel is in place and ready to pour bea . a 1 4. When framing is completed. 0 5. When rough plumbing is completed, and ready to cover up. •7 6. When septic tank drain field or sewer is laid but before it is covered. W W A q 7. Electrical inspection by City of Jacksor.ville. rn 7 8. Final inspection. Note: In case of any rejection, re- inspection MUST be called for after corrections are made. FRONT OF LOT In consideration of permit given for doing 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 in accordance with the building regulations of the City f AAtttla• ntic Beach. / /� Signature of Builder. C''�.�,.s.L, Address. 23/ v A-14 A dl& e:,,t, Signature of Owner _ _- Address / 7 7 6 tt1t 6 1 f � `1r I 1\ • ..- ZA 1.3 - 1 ' Th s II JW 1 Prcr-c:rt} Address _ _. _ 1990 PARK STREET C..ner WILLIE F. MILLEY Teler,hone 246 - 0629 _ - _ Case */ 81 -02 SLJ'.',!.'.ARY OF WORK Exterior work includes repairing of roof. Replacing damaged fascia boards. Forming & pouring front porch. Installing new columns on porch. Paint exterior of house. In- stall new 4" sewer line from house to city sewer. Fill septic tank with dirt. Haul off all trash & clean yard at completion of job. Extend house to the rear 6'10" x 24'3 ". See attached plan. Build new back porch 3'0" x 6'0" with one step. Extend roof over back door to protect from rain. Interior work includes removing all drywall on walls and replacing. Install insul- ation in ceiling 6" and 31/2" in' outside walls. Replace all interior doors & trim. See plans for sizes. Tape & texture all drywall to receive two coats interior laytex paint. Woodwork to receive two coats stain. All new hardware throughout house. Back door to be replaced with steel door. See plan for Mfg. Number & size. Repair water & sewer lines and extend to relocate appliances. Electrical service to be checked out and extended to relocated appliances. Install green board in bath walls to receive thin set ceramic tile - replace kitchen & bath floors with vinyl sheet goods over underlayment 1 ". Install new carpet in new bedroom over pad. Install 5 new light fixtures. Furnish & install O. (1) new screen doors, F scR i;&' ,_! 0Nr Install vent hood over stove, duct to extend thru roof. az'R L [ illa ll ---"- \ Ili ti ti 01 0 r ;- \i u L 111 e e 4:00 PM AUGUST 31, 1982 CITY HALL CITY OF ATLANTIC BEACH, FLORIDA 9 Specification Sections Included: Work completed must adhere to applicable General Specifications, - -- - - - -- -- unless otherwise noted in the work description (includes materials'& workmanship). All material quantities are approximate and each bidder must visit job site and estimate quantities for his bid. The terms approximate and approximately, for the purpose of this job, shall mean + - 10% of the amounts and quantities listed for each item in the work description. Scope of work includes labor, materials, equipment, drawings (if necessary) and services for the proper completion of the rehabilitation of the above identified property. 1 t CASE I/ 81 -02 ADDRESS 1990 PARK STREET PEC Y AREA WORK DESCRIPTION COST 7 -B ROOF Replace all deteriorated roof rafters and fascias, aprox. 135 ,J lin. At. Repair roof shingles for leak as needed. 13 -3 FRONT Remove front porch wood floor and clean up all material, use PORCH this wood framing to form 4" concrete slab with 6 x 6 x 10 / wire mesh. Note detail on Sheet 411 for outside edge of slab. / lb 21 cu. yds. concrete and 50 lin. ft. wire mesh needed plus labor to finish. 11" fall. 8 -B COLUMNS Replace deteriorated columns (2) on front porch. See Sheet 41 1 for size & design. 8 -B ADDITION Build 6'10" x 24'3" addition across back of house. See floor plan 411 and Sheet 413 for layout & design. Install 1 concrete step as needed at back door. 8 -F WINDOWS Furnish and install 14 alum. single hung windows. See sheet / v #1 for size & location. 8 -B PORCH Build wood porch 3'0" x 6'0" using treated materials as shown .- 1 , v (REAR) on Sheet #3. 9 -G PAINTING Clean, sand and caulk all wood work on exterior of house. Apply two (2) coats vinyl laytex exterior paint on all wood 71t, work. Owner to select color. • 15 -A SEWER Plumber contractor is to run 4" PVC from septic tank to city sewer. 'IISC. Sr= wi.RT-4 / .v The contractor is to leave sm.../ER crina. out of his base bid. The grant will pay this fee. 2 -B SEPTIC TANK Pump out septic tank, put lids down in tank and fill with dirt. '2c-k/ v � 15 -A TERMITES Treat permises for termites (subterranean). Provide renew- able certification or bond, B -8 EXT. Front door is to remain as is. Apply weatherstripping and DOORS new lock set keyed same as back door. Furnish new alum.(]) 11 screen doorON 4- �? F � 4 / ; ,P� 1�.RESCREE/1/'� wit�i closers. Furnish new back door Scotty's 1/ EE -EU -44 Crossbuck, steel 2'8" x 6'8" x 1'3/4 ". 9 -B FRAMING Remove all drywall on outside walls and insulate with 3 bats. Replace with new 1" drywall. Tape, sand and finish. Partitions are to be done in the same manner. Ceilings are // J/�/0' to be repaired where necessary and stippled. Insulation in ceiling to be 6" bats or blown -in. In bathroom use green board around tub area. 9 -D CERAMIC Install 44" x 44" thin set ceramic tile around tub. Color by 1� TILE owner. Furnish 4 bathroom fixtures. CASE P 81 -02 ADDRESS ___19 PA ItK_ STREET_ PEC # AREA WORK DESCRIPTION COST 8 -C FRAMING Reframe back bedroom and kitchen area of addition on back of �i ) house. See floor plan Sheet 4/1 for design. Install 5/8 under � layment in kitchen and bedroom over subflooring. pre-hung 8 -B DOORS & All interior doors to be new 3/8" trim, TRIM to match door trim, all closet doors tto metal 8 bi- fold. {c, / stall shelving as shown on floor plan with cloth rod. ' 8-B KITCHEN Kitchen cabinets are to be replaced as shown on Sheet ll2 CABINETS detail. 15 -A PLUMBING Plumbing contractor is to check out all plumbing for leaks and run new lines to water heater and washing machine. Run PVC LI �} J drain to washing machine. Install new sink trim on kitchen sink. 16 -A ELECTRICAL Rewire kitchen, as shown on plans. Furnish 5 light fixtures, 3 rV $10.00 each. i►csrau. V yr yoop eqh2R s - cv1 9 -C - CARPET & Bath & kitchen to have vinyl tile over underlayment. Back 1- VINYL TILE bedroom to have carpet not to exceed $9.00 per sq. yd. 6 installed. � - G PAINTING Paint interior of house 2 coats laytex wall paint and 2 coats stain on all woodwork. - E HARDWARE Furnish all new hardware on interior doors. Profit & overhead _ f/ • WILLIE F miLLEy •..," / PARK ST. .=):‘),70 ez r-1F 241, - 0629 - 244- Fo 2x8 4 --4 '' L iZ)R /%., 2 x 4- --- 1 ! SE:E SHEET 3 F 0 R poPcn be TAIL !4 - - - / RDe.0 A t? r: 4 ---. A - te e 1 c:2 ‘2,t's /r, 4. A 1 13611-15 x.t‘ PlisSt4Gr: I 1 tvEnrhy."-IR S / Ow Sef — ■ ...- rhRusitoi-L) 1-3`/1-3'L Rti-i: ' i v _..... r 3.R, . I loorr To 4.3/)cic, ---L----`1) k • '.. NO ea ,5 , 3 ,c. z.e• b cF4iVEZ -fr WIR:FinEF „/ — Lb r C L 0 I' • , I ... , mmion. D R Fr DcR szEs to Le. - --) t.)1 ,-- • Ct/-71-4 II n, . - FRo Iv I- 3b' 6 `gb LJ !3i1CI . , . 3c!,' Doc p ! - 1 . L R . , BR ST er_-_L 1 L ...---- Nri oR aoas 1 . I 1 - 1 Y o - c.41 .t. kx USE OLD vvOOD F& - 7 - j F up p 4,- CONcRETC c \- 1 0 , '77," x c• 1 1/ 5 . ,, I, 63, j . ......_ ___4 . elsA 0 N - PORCH. / Q 4 4- co 1 2 " ^ •::) F LoITH r);&7: ft i t t riff 1E31 Y I .- 1 fixio i-E 1 1 •t- --..,____ i RF pi. A c _ - g'0" AC " Vc7".. fiL / 'Thi•s s 7 I3 SHEET Z e'-- 7 " _________________ CT 6/ Z 1- eAB)/yE7,3 7 Z3E /vf/L.L. Av:4 Di= w 17 f o repvicA 70 p..5 , ____,-,_ 11. SEE House Po R .c.x A rz-s, l'z I L1_, 0" h .- - ------------.----■ e , _ 6 7 I t o , gi -1 32 X. .2/ ZWVA . I ■ -- I ' r ,t3tH _ __ , ____ 4...: 0 1 12LS" , , 3 . 0 0 , , ■ I • I/ f i ___, .. _______ ?• it 1 1 . 111 j / 1 - I I Q1 I I 1 ----. - 7 -----1 r . , ti I I . .. - ' 0 OUT-SE a Pt ook PI '-'"( gii 7 2 cp 3 r . . • AbD1TioN To - REAR OF I-!ouS',n ■ ,2, AND ►2 � r OS 101\6 ,/� ic,h4 Fk /�Cr /L /NG G �G 1 k r , , /.3.4 s /NS !-t l AT 1 b� i 40004 AHD eyw,a L L- r - X T J ND '4 "? ALL EXTERlo/? WALLS To ,yHvr HDUSE To HAVE ALL nE 3.1.2." LSAT /NSv.c A rioN, v wiNDowS- CHI- f' p G h' NGUS E FCR /ZeS. 4 N n 4 .. si /v G I. r HUA.-c X 5 Douai- � i1fc.l_. - l �t Z Q to • / S /D //Y G• / 0 Pub' PA ACA/ aARD ovER MATCH » ousE I C.D>c, /ALL BED K oor� I/D I II . I 2,s 4 T/tr-A'f-FD F,CooR To�.sr 2`Xg "zL yp J 1 ? ( A712- 7 4 _ 4 //r/s e-74 C'�A4p� BLx1 I 1 SCAJE Y2 1 = /= Sh'ir'= T 3 of 3 ;zlG CITY OF /111cottic /S - ,� Office of Building Official I _ av(y -(....2., REQUEST FOR INSPECTION Date ` Permit No. Time A.M. �DlstrlCt No. Received P. M. Job Address Locality Owner's i r �r /./1 Name Contractor BUILDING CONCRETE ELECTRICAL PLUMBING MECHANICAL Framing ❑ Footing ❑ Rough Wiring ❑ Rough ❑ Air. Cond. & ❑ Re Roofing ❑ Slab ❑ Temp Pole ❑ Top Out ❑ Fire Re Place ❑ Lintel ❑ Pre Fab FOR INSPECTION M Mon. Tues. Y �10 Thurs. Friday r' A.M. Inspection Made P.M. Inspector Final Inspection ❑ /7? D rtificate of Occupancy Date i," ,, . , y� CITY OF ATLANTIC BEACH 8� SENIINOLE ROAD . 4u• - r , ...*; _ ATLANTIC BEACH, FL 32233 ij INSPECTION PHONE LINE 247 -5826 Application Number . . . . . 06- 00033229 Date 6/16/06 Property Address 1990 PARK ST Tenant nbr, name ADD ROOM /ENCLOSE PORCH Application description . . RESIDENTIAL ADD /RENOVATE /ALTER Property Zoning TO BE UPDATED Application valuation . . . • 0 Owner Contractor MILEY, WILLIE F. COALSON CONTRACTORS, INC. 1990 PARK STREET 1825 -A NORTH 3RD STREET ATLANTIC BEACH FL 32233 JAX BEACH FL 32250 (904) 249 -3470 Permit BUILDING PERMIT Additional desc . Permit Fee . . . • 105.00 Plan Check Fee . . 52.50 Issue Date . . . • Valuation . . . . 15000 Fee summary Charged Paid Credited Due Permit Fee Total 105.00 105.00 .00 .00 Plan Check Total 52.50 52.50 Grand Total 157.50 157.50 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CITY OF ATLANTIC BEACH BUILDING PERMIT APPLICATION (Alterations & Additions) Date: O / ii /e. d 4 Job Address: l a '7 e) ��� �� %L ` Owner of Property: 6(}4/Z '7 /fr', , r Address: / fD s _ Telephone: 9D V •- L 9 2q I tuv OF LO 1 5 6' DoN - A.•S amp(-A-7 No, Legal Description: // Block Number: Lot Number: Zoning District: /�� Contractor: W�%u° A� (ow h(' State License Number: lit 7 l l Contractor Address: 4,44 o f", � ` el -.. - - /be) n Telephone: Fax: Describe proposed use and work to be done: 3,1 0 6 D 1V R, bDVn l' to pp cc i4 r- E , r 1 r �- - Present use of land or building(s): tYl. ki horn C P Cc-I4 — 1 1(04. 1 4.1- Valuation of proposed construction: (' 5 , CXDO Dimensions of the added space: 3-7 feet x 6 feet Will this project involve: a Heating & Air- ❑ Plumbing ❑ Electrical ❑ Fireplace Conditioning Is approval of Homeowner's Association or other private entity required? Iv 9 If yes, please submit with this application. Will this project involve changes in elevation, site grade or any use of fill material, or the addition of 5% or more or the removal of any trees? ® NO. Applicant certifies thattt in site grade, impet' ous area or fill material will be used on this project. ❑ YES. See Step 2 below. Approval of the Public Works Department is required prior to issuance of a Building Permit. E 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. 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 800 Seminole Road • Atlantic Beach, Florida 32233 -5445 Telephone: (904) 247 -5800 • Fax: (904) 247 -5845 • http : / /www.ci.atlantic- beach.fl.us Page 2 Revised 8/04 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. Other information as may be appropriate for individual applications. Address and contact information of person to receive all correspondence regarding this application (please print). Name: ' P 1-g2A C4011, L- Sot'J Mailing Address: it IBS — A 143It1Z L'i 1 k kW & . / 4 Telephone: 24-4 1 - 3 4 - /0 Fax: ZL - ' 1 et 1 E -Mail: C S J e_6 s„,/ 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. The 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. I/ r 643/:(5 K _ Signature of Owner: r � � Date: LP 6 AS TO OWNER: (-'46 h Sworn to and subscribed before me this J day of ./ /l.. , 20 d l // 0. State of Florida, County of Duval /,/� • . EB J. L Notary's Signature:{, Ilvi�ik ",'^+,^ . ' '" ' ° • '' Notary Public . Stag of Florida 1 :My Commission Was App 71.2010 El Personally known 1 ' -1 Damn # DO 545441 Produced identification r � ■ � ° ' �^ Type of identification produced r D L .rA Signature of Contractor: e 7(../211 ‘ ' . pfri,"„( �/ Date: DLZ / 6 AS TO CONTRACTOR: 6 Sworn to and subscribed before me this day of lii� , 20 0 6 State of Florida, County of Duval . �� `� • — — — — — ■ — — — — — — • Notary's Signature /9ti c' f 0, b4 z..) ■ `,� II p 1 i. ?EBPA J WILLIAMS o` S Notary Public - State of Florida 1. (; �• x = • ❑ Personally known • arty Commission Expires App 26, 2010 t 1 =; .-'. Commission A DD 545441 F [I Produced identification �J / 1 '''4 `' , Bonded By National Notary Assn. 1 /` Type of identification produced i _ ]) L.... 800 Seminole Road • Atlantic Beach, Florida 32233 -5445 Telephone: (904) 247 -5800 • Fax: (904) 247 -5845. http : / /www.ci.atlantic- beach.fl.us Page 3 Revised 8/04 ' j " ` l ' CITY OF ATLANTIC BEACH r _ .. . OWNER/BUILDER AFFIDAVIT Date: Job Address: CO eA r K 5T1 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 S25,000.00 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 CONSTRUC:1ION 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. ORDINANCES ALSO ALLOW AN. OWNER TO IMPROVE THEIR OWN PROPERTY WHEN IT IS FOR PERSONAL OR FAMILY USE, AND LIKEWISE REQUIRE ALL WORK (EXCEPT MAINTENANCE UNDER $2,000) BE UNDER A BUILDING PERMIT AND PASS ALL NORMAL INSPECTIONS. THE ORDINANCE STATES OWNERS MAY PHYSICALLY DO' °u WORK THEMSELVES; OR MAY HIRE UNLICENSED WORKERS PROVIDED SUCH W BE UNDER "DIRECT ;UPERVISION OF THE OWNER, WHO MUST BE_ON THE JOB AT ALL TIMES WHILE wY ORK IS IN PROGRESS BY U ?LICENSED TRADES PEOPLE." THIS DOES NOT ALLOW USE OF UNLICENSED CONTRACTORS. 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. OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND /OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMI`LOY ON THEIR IMPROVEMENT TRADES. 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. 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. PROPERTY OWNERJB I a •,• EB� � �My r : Notary Pub1 c - State 01 Ronda • bV + . ..t :: r 4 0 BEFORE ME THIS b DAY OF■U n 0 , 20 0(P Commission 1 D6545441 , /� . , 'Ar Bonded a! NMIOnel Notify Ann. �` t 1 NOTARY P LIC MY COMMI SION EXPIRES: rrnvr -c. DT-7D A CVO 1TKTr D1 T T T s.w NOTICE OF COMMENCEMENT State of £Lt DJPr Tax Folio No. County of QL. To Whom It May Concern: The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of the Florida Statutes, the following information is stated in this NOTICE OF COMMENCEMENT. Legal description of property being improved: Z$1 100 [3 h1fl S 43-t Z 1ThuN i. QE Qt.47 NQ, Z Address of property being improved: f el q0 PM 5 VA.6,54- too toFuis 8 °L2 tit.&E I QrP( Z Z General description of improvements: C.1„Co ~ �W &- 4 IL) .24i2.& PP.l re_ 1 Owner: ' 2 ► t, t mi 4 %1 Address. Owner's interest in site of the improvement: Fee Simple Titleholder (if other than owner): eyN Name: Address: Contractor: e ).TF1t_ it '1Gc4.1.,a£(t Address: Phone No: Fax No: Surety (if any): Address: Amount of Bond $ Phone No: Fax No: Name and address of any ( \_, er R on making a loan for the construction of the improvements. Name: 6 A .' & ne No: Fax No: Nam := of person within the State of Florida, other than himself, designated by owner upon notices or other docu:nents may be servcd - Name: ll�� Address: Phone No: Fax No: In addition to himself owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.06(2 (b), Flgrida Statues. (Fill in at Owner's option). — Nam e: Address: Phone No: Fax No: Expiration date of Notice of Commencement (the expiration date is one (1) year from the date of recording unless a different date is specified): THIS SPACE FOR RECORDER'S USE ONLY , ,T - l6r -- W.(/ � to OW'{ER /- Signed: C.Z. Date: (a - O S 0 Before me this 5 day of Ili in the County ���,,,,,, of Duval, State of Florida, has personally appeared .\ No Y Public - b'rb of Floods • Comrwbn aphis** . Notary Public Large, State of Florida, County of Duval. Ca iiiielon E DO 54 1 — "'IVi commission expires: q-7...&-/0 Seeded fly *Monte Moiety Assn. Personally Known: or Produced Identification: FL 0 1-- Duval County Property Appraiser - Parcel Information Page 1 of 1 Owner's Name: MILEY WILLIE F ET AL Real Estate Number: 172278 0000 Property Address: 1990 PARK AV Mailing Address:1990 PARK AVE City: ATLANTIC BEACH ATLANTIC BEACH , FL Zip: 32233 Zip: Unit Number: 32233 -1952 2006 Exempt Value: $25,000.00 PARCEL DESCRIPTION Property Use: 0100 SINGLE FAMILY (Transaction Date: 11/21/1994 Transaction price displayed is based on the actual amount of Legal Description: 25 -68 17- 2S -29E documentary stamps DONNERS R/P NO 2 E 100FT LOTS 8 TO 12 Transaction Price: $100.00 paid at the time of BLK 2 - recording. The current rate is 70 cents per $100. Neighborhood: 941702 DONNER NBHD (Section /Township /Range: 17 -2S -29E (No. Buildings: 1 Official Record Book and Page: Heated Area: 1262 079810458 Map Panel: 'Exterior Wall: Single Siding /No Sh VALUES AND TAXES FROM 2005 CERTIFIED TAX ROLL Land Value: $116,590.00 Taxing Authority: USD3 Class Value: $0.00 'County Tax: $188.55 Improvements: $38,848.00 School Tax: $237.31 Market Value: $155,438.00 'District Tax: $88.87 Assessed Value: $54,649.00 'Other Tax: $14.84 Exempt Value: $25,000.00 'Voted Tax: $12.48 Taxable Value: $29,649.00 Sr. Exempt: $0.00 Sr. Taxable: $0.00 Total Tax: $542.05 http:/ /apps2.coj.net/pao /printver.asp ?ReNum = 172278 +0000 6/13/2006 f , ! f'ilt l,,: , �= °\ CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD y ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5826 4 Application Number 06- 00034004 Date 9/29/06 Property Address 1990 PARK ST Application type description ELECTRIC ONLY Property Zoning TO BE UPDATED Application valuation . . . 0 Application desc 240 VOLT ADDITION Owner Contractor MILEY, WILLIE F. E -4 ELECTRIC, INC. 1990 PARK STREET 1247 BOCA GRANDE AVE ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233 Permit ELECTRICAL PERMIT Additional desc . Permit Fee . . . 70.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 3/28/07 Fee summary Charged Paid Credited Due Permit Fee Total 70.00 70.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 70.00 70.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. Sep 29 06 10:20a james 19042463936 p. • • -- - Sep 29 06 .:0'•02a Information i SYstet'ns 1 ` '..m -- - "�'a. ; CITY OF ATLANTIC BEACH z- ELECTRICAL PERMIT APPLICATION 't Date: f q OL Property Address: t O 1 C (0 Park SY- Owner: LU i 1 �� erL 4 4 ;le y Telephone#: 2 Y, .2 8 Contractor: - `( (ems (f , Telephone #: Contractor Address: t...)0 < rvi se i Fax #: 3 9 3 � - Contractor Signature: 1 '� � ` ,- said work in In consideration of permit given do ing the work as described in the above statement. we hereby agree to P accordance with the artacaed p and specifications which are a part hereof and in accordance with the City_ of Atlantic Beach ordinance and standards o go od price listed therein..__ If other consnnlctioa is Building: BalWing Taper O New ❑ Trager Services ti done m tb;s building O Temp. O New Or c6e � Old - • a Commercial O Signs 0 tix reaSe Permit auwbec 0 Re -win -la- Addition Sq. Ft. 0 Repair 3 3 �› �! Conductor Size: . AMpS: COPPER 0 ALUMINUM ❑ Switch or RACE Breaker AMPS ' PR W VOLT WAY Existing Service ' RACE Sire AMPS PH W . VOLT , WAY Meter Number Feeders: NO. SIZE NO SIZE NO SIZE Lighting Outlets CONCEALED OPEN Receptacles , OPEN + � Up ALMS 31 MO AMPS Switches ft C Incandesocnt - Fluorescent & - - M.V. Fixed 1 0.100,4MPS OVER BELL . Appliances TRANSFER Air H.P. ATING H .P. RATING CEILING - KW-HEAT Conditioning COMP. MOTOR. OTHER MOTORS AMPS Oh HEAT 2 Motors 0-1 H.P. VOLTAGE ' PH I NO. OVER 1 H.P. PAS IINDle{400V 9VER600v 1 Transformers NO. KVA NO. KVA No.Neon Transf. Ea. Sign • Miscellaneous 800 Seminole Road • Atlantic Beach, Florida 32233 -5445 Phone: (304) 247 -5800 • Fax: (904) 247 -3845. http : / /www,ci.attantic- beacb.[l. Revised 1/04 Sep 29 06 10:02a Information Systems _ _ _ _ 904-247-5845 P 1 J �n CITY OF ATLANTIC BEACH ' - �= ELECTRICAL PERMIT APPLICATION • Date: 7 - C,C, Property Address: I t" C+ o Pc , f 51- 9 ;� Owner: Lt?, i l i a , 44 ley Telephone #: -2 y 9 .297 g Contractor: E - c( le c tf , ' c - Telephone #: Contractor Address: 5)-3 r ; v , s e ' Fax #: q 3 F3 Contractor Si, nature: oe In consideration of permit given • doing the work as described in the above statement, vee hereby agree to perform said work in accordance with the attached p.: .s and specifications which are a part hereof and in accordance with the City of Atlantic Beach ordinance and standards of good practice listed therein.___ Building: Building Type: D Trailer Service: tf ocher construction is O New Residence 0 Temp. ❑ N being done on this building Old ❑ Commercial O Signs 0 Increase a site, list the building Or 0 Re wire - Addition Sq. Ft. Repair 0 Re p ew number: p C^(, 33.. 9 Conductor Size: AMPS: COPPER ALUMINUM • Switch or Breaker AMPS pg W ' RACE Existing Service VOLT WAY Size AMPS PH W RACE Meter VOLT ;WAy Number Feeders: NO. SIZE NO SIZE NO SIZE Lighting Outlets CONCEALED OPEN Receptacles CONCEALED OPEN a In empg 31 inn Amps Switches p f I - Incandescent I Fluorescent & M.V. Fixed 0.100 AMPS OVER Appliances BELL Air H-I' RAT[I•,'G H P. RATING TRANSFER Conditioning f COMP. MOTOR OTHER MOTORS AMPS D G /,� , CEILING Rw -HEAT HEAT `7ctc)✓ f Motors 0 -1 H.P. VOLTAGE PH I NO. OVER 1 H.P. P118 UNDER600V OVERboov l Transformers NO. KVA NO. KVA No.Neon Transf Ea. Sign Miscellaneous • '7 f J 800 Seminole Road • Atlantic Beach, Florida 32233 -5445 Phone: (904) 247 -5800 • Fax: (904) 247- 5845 • http : / /www.ci.atlantic beach.fl.us R,vised 1 104 HP Officejet 7410 Log for Personal Printer /Fax/Copier /Scanner Information Systems 904 - 247 -5845 Oct 03 2006 12:46PM Last Transaction Date Time Type Identification Duration Pages Result Oct 3 12:46PM Fax Sent 96654470 0:59 2 OK 3419 DEPARTMENT OF BUILDING CITY OF ATLANTIC BEACH PERMIT IL LOCAIION itif.URMAIION --------- rmit Number: 41 idress: 1990 PARK STREET Permit Type: RE-ROOF ATLANTIC BEACH, FLORIDA 32233 'ass of Work: NEW ---------- LEGAL DESCRIPTION --- onstr. Type: WOOD FRAME Block: 2 Section: -roposed Use: SINGLE FAMILY Township: RNG: 0 wellings: 1 Code: 0 lbdivision: Aimated Value: $0.00 Improv. Cost: $0.00 Total Fees: $22.50 Amount Paid; $22.50 Date P ' 2/20/91 Work L 'PLACE 27SQUA ROOFING MATERIALS OWNR iNT0ixMA1iON ---- APPLICATION FEES ----- Name: WILLIE F. MILEY PERMIT $22.50 ;Actress: 1990 PARK STREET WATER IMPACT FEE $0.00 ATLANTIC BEACH, FLORIDA 322' SEWER IMPACT FEE $0.00 Phone: .90 5700 WATER METER $11 RADON GAS-H.R.S. CONTRACTOR INFORMATION - RADON GAS - 5/ $0.00 Name: SEARS -GANY M. GRAVER WATER TAP $0.00 idress: 3333 NORTH CANAL STREE SEWER TAP $0.00 JACKSONVILLE, FL. 32203 HYDRAULIC SHARE $0.00 icense: CCCO35634 Type: 1 RE-INSPECT FEE $0.00 SEC.H IMPACT FEE $0.00 OTHER $0.00 NOTES: NOTICE - ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE, AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER "FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS." ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW NTIC BEACH BUILDING DEPARTMENT CITY OF ATLANTIC BEACH APPLICATION FOR ROOFING PERMIT j BUILbING OWNER W II1iQ' / ` /Pier PHONE a'?y(c • JOB ADDRESS I 990 fArJ� " . r c Ai. gad 3 3, „ LOT# j -/ ) BLOCK OR UNIT # gi SUBDIVISION nn 1 CONTRACTOR .3-€46- G4t 64+ LeCl PHONE 35j Sl av ADDRESS 33 /✓ CA,4 4I Strr LICENSE NUMBER C o 3) 63 V EXPIRATION JOB VALUATION $ 3 9 g9' MATERIALS: (O * Ate/Ace.- a 7 59 /Qoope43 �A - • SIGNATURE OWNER • DATE SIGNATURE CONTRACTOeilli%ar�,� (, DATE a\ aO\�I cz. A P P L I C A T I O H F O R B U I L D I N G P E R M I T CITY OF /*gala& Vead - 96neda REQUIRED SUBMITTALS 716 OCEAN BOULEVARD Each application for building P. O. BOX 25 permit will be accompanied by ATLANTIC BEACH, FLORIDA 32233 two complete sets of plans, including TELEPHONE(904)249 - 2395 a detailed site plan indicating location of utilities, parking, size of yards and other pertinent data; one set of Florida Energy Efficiency Code sheets; recent survey (on new construction) SCHEDULE OF INSPECTION Requests for inspections will be accepted from 8:00 AM until 4:30 PM. All inspections will be made the following working day. 1. Footing 2. Rough Plumbing /Sewer CALL IN WITH PERMIT 3. Slab NUMBER FOR EACH TRADE 4. Framing, Rough Electric, Mechanical, Top Out Plumbing 5. Insulation 6. Final Inspection /Issuance of Certificate of Occupancy BUILDING CARD MUST BE POSTED OR HO INSPECTION WILL BE MADE Pour no concrete or cover any work until building card is SIGNED by the inspector. You will be required to uncover any work that has not 1 been inspected. ( $10 fee is required for all re- inspections. • 1 1.1 1 1 U1' PROPERTY DESCRIPTION 4(€4 is gead - 6Preeia W� 716OCEAN BOULEVARD Lot #y /� Block 41 1 Section #_�, _ P.O. BOX25 ATLANTIC BEACH, FLORIDA 32233 TELEPHONE 1904) 249 -2395 Subdivision:__ __ _ � Street Name Q _ e �_ / DESCRIPTION OF WORK or Address:_f.�f ��/�- If in a FLOOD HAZARD 7442001-LL) Flood Zone: X R area complete page 3. Brief Description: _ _ _ Class of Work: (Hew /Remodel /Addition) __ _ ZONING INFORMATION Type of Construction: Zoning / Proposed District: _'" Use : __ Estimated Value $ Exceptions or Materials: Variances Granted: �'`y ,/� Solid or Filled Ground: Roof: OWNER INFORMATION Method of Meeting, • / Property Owner: _ _, __ Phone: Mailing a '� Address . 9 Y _ _ / � ' . X 2 33 Zip :3.3 CONTRACTOR INFORMATION Ay " d 4 -9 Contractor: Phone: Mailing Address: Zip: Expiration License Number: Date: • 1 HEREBY CERTIFY THAT I HAVE READ AHD EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF THE LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE 1,144* COMPLIED WITH, WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO i1 ' GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY FEDERAL, STATE OR LOCAL RULES, i �� „�., REGULATIONS, ORDINANCES, OR LAWS IN ANY MANNER, INCLUDING THE GOVERNING OF CONSTRUCTION OR THE r ' ; . ( ,,r - �' ? PERFORMANCE OF CONSTRUCTION OF THE PROJECT. I UNDERSTAND THAT THE ISSUANCE OF THIS PERMIT IS y y,� v... f ,7; CONTINGENT UPON THE ABOVE INFORMATION BEING TRUE AND CORRECT AND THAT THE PLANS AND SUPPORTING $ 'j ,s�� DATA HAVE BEEN OR SHALL BE PROVIDED AS REQUIRED. If �` �7 1w ' f Pl i q Owner Signature Date _�;4 a1 Contractor Signature Date 4 1 t. FLOODPLAIN DEVELOPMENT INFORMATION Type of Development:__ Flood Zone: Required Lowest Floor Elevation: If building is located within a flood hazard zone, a survey must be made AFTER THE SLAB HAS BEEN POURED, certifying that the LOWEST FLOOR ELEVATION is equal to or above the base flood elevation established for that zone. No final inspection will be made and no certificate of occupancy will be issued until the survey is on file with the Building Department. COMMENTS: Applicant Acknowledgement: I understand that the issuance of this permit is contingent upon the above information being correct and that the plans and supporting data have been or shall be provided as required. I agree to comply with all applicable provisions of Ordinance Ho. 25 -7 -11 and all other laws or ordinances affecting the proposed development. Date Applicant's Signature Department Use Required Lowest Floor Elevation As Built Lowest Floor Elevation Survey Filed with Building Department Building Department Representative page 3 001817 DEPARTMENT OF BUILDING CITY OF ATLANTIC BEACH PERMIT INFORMATION - - LOCATION INFORMATION rt Nutobel 1817 Address: 1990 PARK STREET Perna I. Type; BUILDING ATLANTIC BEACH, FLORIDA J.:. Claes of Work; ADDITION - - LEt3AL DESCRIPTION Cons r Type WOOD FRAME Lot.: Block ; Sectiarb Proposed Use: SINGLE FAMILY Townsilip: RNG; 0 Dwetlingst 0 Code; 0 '.3*.tbdivis ion DORMERS REPLAT 2 Est irrast.ed Value $3550.05 mpr ov Cost t 10.00 To t I Fees; $24.00 Amokt** $0.00 T PORCH PEP PLAte3 - Vot4 ORMATION - APPLICATION FEES flme W. F. L PERMIT $24. 00 /990 PARK STREET WATER IMPACT FEE *0. Of.' ATLANTIC BEACH, FLORIDA 3 SEWER IMPACT FEE *Q0 0t Phone (904 )241-4807 WATER METER 4 SO. ocrh. RADON GAS-H. R. S. $0.06- CONTRACTOR INFORMATION RADON GAS - .5% 74',;1.3 so. bitt 12/1 r pripupTy nWNFR WATER TAP $0.00 SEWER TAP 74E42 $0. b HYDRAULIC SHARE *0. 00 Type t RE- INSPECT FEE $0.00 •0. Cit so. fl NOTES NOTICE — ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE, AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER. "FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS." ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. ATLANTIC BEACH BUILDING DEPARTMENT By �`" %� CITY OF ATLANTIC BEACH A PLAN REVIEW SHEET Routed to: Ma Buildin De art ment Public Works & Public Utilities Departments S.. Higgi j ''' 4 050 91- ` J ' ; },r 800 Seminole Roa 1200 Sandpiper Lane L Atlantic Beach, Florida 32233 Atlantic Beach, Florida 32233 R. Carper (904) 247-5800 (904) 247-5834 P. Kaluzniak (904) 247 -5845 Fax (904) 247 -5843 Fax Public Safety PLAN REVIEW COMMENTS Permit Application # (IQ — )5 i vv Property Address: 6 q t b p of K C 6 Q .\ -? v r l C rA--f a C'1 h vi. Project: R ,tiom_ artd.)-b RI I 6 This permit application has been: u Approved as noted by the Kin) Department. Final application approval must come from the Building Department. E Reviewed and the following items need attention: Please re- submit your application when these items have been completed. Reviewed By: ( Date: 10 �� Date Contractor Notified: t m CITY OF ATLANTIC BEACH BUILDING DEPARTMENT INSPECTION REPORT JOB LOCATION PERMIT # SUBDIVISION OWNER NAME PHONE LEGAL DESC: LOT 1 PARK .gpriFAT PERMIT TYPE 1317 w ATLANTIC BEACH, FLORIDA 32233 CLASS OF WORK DONNERS REPLAT 0 cr • CONTRACTOR PROPOSED USE co W. F. MILEY ( 904 )241 -4807 z « . w WORK DESCRIPTION BUILDING ADDITION z ,w INSPECTION REQUIRED PROPERTY OWNER INSPECTOR SINGLE FAMI' Y O ry P f 0 - DATE INSPECTED/ J. ..2 . 3 i B T PORCH PER PLANS APPROVED i REJECTED n z 5 FRAMING AM COMMENTS CITY OF ATLANTIC BEACH i� BUILDING DEPARTMENT INSPECTION REPORT JOB LOCATION PERMIT # SUBDIVISION tn uu OWNER NAME PHONE z 1990 PARK STREET z LEGAL DESC: LOT A7>31.J�WJ IC BEA F IO 1809 W o ►IG'LORIDA 32233 PERMIT TYPE lewis CLASS OF WORK CONTRACTOR WILLIE F. MILEY PROPOSED US f 1 241 -4807 z f z O P W ORK DESCRIPTION ELECTRICAL JOHN M. KOELLING REPAIR c i INSPECTION REQUIRED INSPECTOR .. SINGLE FAMILY ex#i Oamps 1ph 3w 120/240 volt r acewa DATE INSPECTED /64- -- ,4 2 -e1 ,4 BY (e, - APPROVED y REJECTED n 6 ROUGH ELECTRICAL AM COMMENTS E. ,L L -'-L'1 j fro ' f CITY OF ATLANTIC BEACH s 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5826 ' Application Number 06- 00033229 Date 6/16/06 Property Address 1990 PARK ST Tenant nbr, name ADD ROOM /ENCLOSE PORCH Application description . . RESIDENTIAL ADD /RENOVATE /ALTER Property Zoning TO BE UPDATED Application valuation . . . 0 Owner Contractor MILEY, WILLIE F. COALSON CONTRACTORS, INC. 1990 PARK STREET 1825 -A NORTH 3RD STREET ATLANTIC BEACH FL 32233 JAX BEACH FL 32250 (904) 249 -3470 Permit BUILDING PERMIT Additional desc . Permit Fee . . . 105.00 Plan Check Fee . . 52.50 Issue Date . . . Valuation . . . . 15000 Fee summary Charged Paid Credited Due Permit Fee Total 105.00 105.00 .00 .00 Plan Check Total 52.50 52.50 .00 .00 Grand Total 157.50 157.50 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. 0 `4 �o„ N.) / vJ `N -----6-----_______________ ----- 1 i _I 1 11 11: 1 1 ... 11 is 7? N. z / 4 di mss/ ---- . / g - u'rc- e eX/Sr;".. if --y , , ,4--- '4ocP,S' T 0 - 0 11-2" Vcst' • u." "---1.-- . // - ' 4. 4 • r li• - 1 i ' , .7 1 C y ,I rtfr 05 4 1 : Ril I i 4k '1 / ' • ,. 1 .• ,,..,' .. . , / ■ , , I ,,..-- ... 0- - ,* II t• , 0-- .0 II -, cl .S C (NI .3 C4 C ■ 4 ,-- •>i) ■ es- Z ''t-- ./,,, . 'I . ' , • 1 r'" rt '•(.‘ ii t 14 ' ;-; ,.. •• - ....• r- -- - 7..:;'•'. , ' 1 k •i l A -. L ....- .....".„/ --) -"" ..../. . ,-- .• 1 1 I ,..% (1 , .. --i ( ,-- c q\l. %• t, /,'-' .' .,, . r .1 ,...._ ,, /- ,,, ''... '''' , 1 , • ''' --'• 1 ( i g ' ' •-• cl, j ''' ■ r 8 '.4.• K % 1 ' \ \ .1) ' V) ..' % — -. i 1 , • r' \ .. ,„ i. s ..,. I - - , "I ■. ..., ,.% \ \ \ \ \, 4l 1 .., i 1...., ci As (1 (1. I IA ! 1 ... . , , . \ - ..- \ . 't) I • C :,:t2 k t f l . \ • , ::-... 1 A ..4. QA . , ! V, C , . . -A- ..,i ; 1 - i -..,... Sk it, - ., \ , \ s \ •„ \ \ gsgawIED APPROVED I • s 1 CITY OF ATLANTIC BEACH DEC 1 4 98 9 BUILDING OFFICE 1 1 ,...- \\„:',,,, , i V.. • ! DEC 1 5 1989 , Building and Zoning c , 1 D . : \ 1 ...., ... . . - ... /211.44,4 /7.7"),,4,1';`el .41 f L 1 S %`/ ' 6 i,14 il?�G /C ' p Qr • - .4S f I I"' . . . .� rt.- ._ _S e (4,, s g - fJ ..r �.v v-d o .r qtr_ k r I a To bi: - 4 iI . ' 1 • 4 I r i _ � i ;• _ 17- _._._ I dG I ._._, •. J © [, V !Pc' r H, . , • ' f in i,, t t /1 . 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N I ( : �_ ..T iii: ice= ='-ice® -, - r I \ r ' _ _Oil _ _ [_.1._ ..ri 4 Nn — a b to th t L' o v to 73 Ni a . \o N Z v C1 l,\ v \/� r s „ g/ : 9/ 9 » �9 'i ,t- 0- ita r (--- Mi L, 1 4 19 89 L •x L',4 ,'l and Zoning OWNER BUILDER PERMIT AFFIDAVIT State of Florida City of Atlantic Beach ) X , 9g 'ORN, the undersigned authority, personally appeared who upon first being duly sworn, deposes and says:: 1, ('�� " " . and the legal owner of the following property: s Acz_e Subdivision Block jr. Y L. 11 [ : / AKA - I am applying for a building permit pursuant to the Owner Builder exemption set forth in Florida Statute, Section 485.103. Florida law requires that I have been provided with the following DISCLOSURE STATEMENT: DISCLOSURE STATEMENT 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 025, 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 more than one 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 a violation of this exemption. Your construction must be done according to 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. 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. Further, affiant sayeth not. t2/, 4% , Property Owner Sworn to and subscribed before this _ / day STATE OF FLORIDA !Department Of Prt1fes91nllral 31■Catllattomi, (JD ELECTRICAL CONTRACTORS LICENSING BOARD 1 KOELLING. JOHN M (INDIVIDUAL MUST MEET ALL LOCAL COMPETENCY REQUIREMENTS PRIOR TO 1 ` CONTRACTING IN ANY AREA) HAS PAID TII FEE REQUIRED BY CIIAPT'IL_489 '. F11It Ill„ H F 1 • . NE 1 1999 1 i „ l .,,,, T „ ___ k;J1 RY . ttl A L E i , 6 9kiii; 6_ G OVERNOR 4 ►''�e + a'IC' g § f r � f y A �+•'Qee IONAI � . z ION r , CITY OF JACKSONVILLE, FLORIDA CONSTRUCTION TRADES e � � �. : / QUALIFYING BOARD , A josh j KOELLING JOHN M has met all the requirements of law and Is licensed as a craftsman as indicated until the 1st day of October following the date hereon.1 MASTER ELECTRICIAN No.: LIE -331 Date: 10 A, L. E. Taytox . t CHAIRMAN * W i ..��"!'r.1FJr nr A.k 0 ,6--ciP6 i tjt ,-- i .... e ... II ...).) - • • • ,.. ' . .,•\,) , . NS tz •—• ' 4 1 i4 z, . ."' 0,4 . ■ , x , ■ / 7 - --•7 0 !J. 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A 1 1 �► J ' tH ,111,4 ►`i,1 IA -Li __ _ . _ . pr._ r- - t, - .1 ..,,, ,, WiY#'1 , - '1%\ri 1- -- - )$$$$## __ _...) ____ V . • ... - t #4 l .,,. . i tat III ' { ,,... } A # 4 %44 . 4 iv � fir 1._ _-, , `, ,'�'1 ■ u _k k .' _ 0+ +■1`04' 1/ i S a o I I I ,,, 4. r I i , l' , ' 1 , 11 1 . Y I .. I t ... I T TTr ii CITY OF ATLANTIC BEACH, FLORIDA I Approved by I APPLICATION FOR ELECTRICAL PERMIT (0 TO THE CHIEF ELECTRICAL INSPECTOR: DATE: 1 /7 19 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. ELECTRICAL FIRM: //A IX ELECTRICIAN SIGNATURE JOURNEYMAN �if NAME /i' /, e i/AIX f / ADDRESS: /?72 'iC / S/ RFD BOX BLDG. SIZE / BETWEEN: RES.10 APT. ( ► COMM. ( ) PUBLIC ( ► INDUS. ( ) NEW ( ) OLD ( ) REW. ( ) ADDITION TRAILER ( ) TEMP. ( ) SIGNS ( ) SO. FT. SERVICE: NEW ( ) INCREASE ( ► REPAIR ( ► FEE CONDUCTOR SIZE AMPS COPPER ( 1 ALUM. ( ) SWITCH OR BREAKER AMPS PH W VOLT RACEWAY EXIST. SERV. SIZE /1d AMPS / PH 3 w A YO VOLT (', / RACEWAY FEEDERS NO. SIZE NO. SIZE NO. SIZE LIGHTING OUTLETS CONCEALED OPEN TOTAL RECEPTACLES / CONCEALED OPEN TOTAL 0 -30 AMPS. 31 -100 AMPS SWITCHES INCANDESCENT 2 erC X19 S / B/ cA /, '& A FLUORESCENT & M. V. FIXED 0 -100 AMPS. ' OVER APPLIANCES BELL TRANSF. AIR H.P. RATING H.P. RATING CONDITIONING COMP. MOTOR OTHER MOTORS AMPS CEIL HEAT: KW -HEAT 0 -1 I OVER MOTORS H.P. } VOLTAGE PHS NO. 1 H.P. VOLTAGE PHS � _ MISCELLANEOUS TRANSFORMERS: UNDER 600 V. OVER 600 V. g2S CITY OF l'•' 14elltitie Eead etvtedet ~ \3� 800 SEMINOLE ROAD ATLANTIC BEACH, FLORIDA 32233 -5445 TELEPHONE (904) 247 -5800 FAX (904) 247 -5805 February 28, 1996 Willie F. Miley, et al 1990 Park Street Atlantic Beach, FL 32233 Dear Mr. Miley: Our records indicate that you are the owner of the following property in the City of Atlantic Beach, Florida: 1990 Park Street a /k/a Lot 8, Block 2, Donner Replat #2 RE #172278 -0000 Investigation of this property discloses that I have found and determined that you are in violation of City of Atlantic Beach Ordinance Chapter 12, Section 12 - 1 Abandoned motor vehicle stored on south side of property. You are hereby notified that unless the condition above described is remedied within ten (10) days from the date of your receipt hereof, this case will be turned over to the Code Enforcement Board. Under Florida Statute 162.09, the Code Enforcement Board may impose fines of up to $250.00 per day for a first violation and $500.00 per day for a repeat violation. Sincerely, Karl W. Grunewald Code Enforcement Officer KWG /pah cc: Public Safety Director CERTIFIED MAIL RETURN RECEIPT REQUESTED cr) co C P1 111 m m. 0, a ii c h a •� �v �� v p , p n a � 6' _ r c c66l on • t ¢ r m g rQJ E E w uo9t Who j S , d rt ( a .N complete items 1 and/or 2 for additional services. Complete items 3, ;II Print your name and addr ss y card to you, on the reverse of this form so that we can return this I also wish to receive the ' this form to the front of the following services (for an permit. mailpiece, or on the back if s extra fee): 0 ■write Receipt Req Pace does not 1. Addressee' ;� •The Return Receipt uested'on the mailpiece below the di . delivered. pt will show to whom the article was delivered and the date S Address u number o 0 3. Article Addressed to: 2. ❑ Restricted Delivery r 0 Ii2 o n 4b. Service Type 0 Consult postmaster for tee. a cc � � 4a. Article Numb al / e cc 9 Q s /— 3 2_ -3 ❑ Registered a p ❑Express Mail ertified o ❑ Return Receipt for Merchandi -- ❑Insured .E Z cc 7. Date of Delivery ❑ 5. R ceived Pfint /Name L� Gt 8. Addressee's Addre 5 6. Sin / >. o o X 9 Signature: (Addre see or Agent) and fee is paid) iY t "requested N tt cc PS Form 3 _` CO t " 811, December 1994 Domestic Return Receipt Address /3_10 X2tA_____... Heated Square Footage @ $ ___ - Garage /Shed per sq ft = $ .__ _ @ $ per sq ft = $ Carport /Porch �" ------ @ $ $;OS per sgft =$ 5 .--s-- 0 , . Deck — @$ per sgft =$ Patio @ $ per sq ft = $ TOTAL VALUATION: $ 3, 5'V). et' Total Valuation $ /0. o— 1st $ �0,6. —5—a 6 Re r � nder Valuation $ �� 3,COper thousand or portion thereof Total Building Fee $ l6 'a ADDITIONAL PERMITS and /or FEES REQUIRED + 2 Filing Fee $ P,'). Mechanical Fireplaces @ 15.00 $ P1 ing BUTI_,DING PERMIT TEE $ 7 66 Electric /Nea Electric /Tam ^ Septic Tank BUILDING PERMIT $ 014/ °d Well WATER METER CHARGE $ S�aimning Pool SEWER IMPACT IJEE $ Sign WATER IMPACT FEE $ Water Connection MISCELLANEOUS $ Sewer Connection _ $ Water Meter $__ Elevation Certificate __ GRAND TOTAL DUE $ c p2 1 7.1 mi CALCULATIONS and /or NOTES PLANS REVIEW CHECK LIST Address ? ?e) � Owner 4 = Ow . / Legal Description / - 7-/� • 40: 1 = Contractor _ _ :�. °, .4 RAC_ 1cense Number_ - -- License on File (7S 3 NO Section 24 -101 * Zoning Regulations 4-i- Zoning Dis trict___,G _L____ Proposed Use - �//4//) Required Lot Size__ 5 Actual Lot Size Setbacks Required Prov ed Section 24 -17 front L'eP/ il CORNER LOT INTERIOR LOT rear _27/ _ Cf.) side -1 _ -271 Flood Zone ' 'f �" 1 � Required Elevation side -2 1 5 &J it Max. Height Allowed jS -0 Proposed Height_j Section 24 -82 * Minimum Lot C verage Required Heated Area __ 4P'___ Proposed Area 1. Section 24 -161 * Offstreet Parking Number Spaces Required____ Spaces Provided Section 24 -82 * Duplicate Buildings Is there a similar building within 500' of proposed building ?YES NO Utilities Water and sewer service is to be provided by: __ __ Buccaneer Utilities ___ _ City of Atlantic Beach Utilities ___ _ Private Source SEPTIC TANK WELL Plan Reviewed by: Date Build ng Permit # - ISSUED DENIED WORKERS' COt1PENSATION AFFFIDAVIT Contractor, Subcontractor - Certification of No Employment PERMITTING OFFICE: City of Atlantic Beach, Florida 716 Ocean Boulevard, Post Office Drawer 25 Atlantic Beach, Florida 32233 (904) 249 -2395 Project Location: 419C) az,...e 5.7/„c.1 1, - j j ) - _ - -4 ji___..7.eizt G D /B /A 44/4_ i12%li C■ (Name of Applicant) (Name of Business) R Q.t_e_o _ /v .d2. 22-2 _ . /4 3. -2 33 (Street Address) (City) ' t2ip> hereby certify or affirm that the entity named herein has no employees and will have no employees during the project for which this permit authorizes. Siqne _ g6i Tit ' /� Any employer required to secure the payment of compensation under Chapter 440 Florida Statutes who fails to secure such compensation shall be guilty of a misdemeanor and, upon conviction thereof, shall be punished by a fine of not more than five hundred dollars, and /or by imprisonment for not more than sixty days. Such employer may be enjoined from employing individuals and from conducting business until such payment for compensation has been secured; provided, however, that the employer, upon notice from the Workers' Compensation Division, shall have seventy -two (72) hours to secure such compensation prior to the filing of the complaint by the division. This section shall not affect any other liability of the employer under this chapter. (Chapter 440.43, Florida Statutes) MY'Corn Public State of Florida Swo n to and subscribed before me this mission Expires , Feb. 21, 1993 _ 1 - Day of k 1, , A. D. , 19_e7. Ge l -ate- ir ik., / -.1 , L�� 0a- 62 � Feruit::ing 0 41L 7 Official 4_ ms . . ,e , _ 1r2 1 "'.it1e .. _. ,.... u:J*''.J � Zon