177 Pine St Driveway 2012 'S% A 1.
CITYOF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
C,
Application Number . . . . . 12-00000923 Date 7/26/12
Property Address . . . . . . 177 PINE ST
Application type description DRI) EWAY
Property Zoning . . . . . . . TO IE UPDATED
Application valuation . . . . 0
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Application desc
REMOVE/ADD CONCRETE IN DRIVEWAY OILY
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Owner Contractor
------------------------ ------------------------
DUTTER WILLIAM M. & ELSIE OWNER
1742 OCEAN GROVE DRIVE
ATLANTIC BEACH FL 322335845
--------------------------------------- -------------------------------------
Permit * * * * * * DRIVEWAY PERM T
Additional desc . .
Permit Fee . . . . 35 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 1/22/13
--------------------------------------- ------------------------------------
Special Notes and Comments
Avoid damage to underground water/sewer utilities . Verify
vertical and horizontal location Df utilities . Hand dig if
necessary. If field coordination is needed, call 247-5834 .
A sewer cleanout must be installel at the property line.
Cleanout must be covered with an ZT1 concrete box with
metal lid. Cleanout to be set to grade and visible.
Ensure all meter boxes, sewer cleinouts and valve covers
are set to grade and visible.
Roll off container company, if usad, must be on City
approved list and container cannot be placed on City
right-of-way. (Approved: Advancel Disposal, Realco,
Shappelle ' s and Waste Management)
Full erosion control measures must be installed and
approved prior to beginning any earth disturbing
activities . Contact Public Works (247-5834) for Erosion
and Sediment Control Inspection prior to start of
construction.
--------------------------------------- -------------------------------------
Other Fees . . . . . . . . . STA E DCA SURCHARGE 2 . 00
STArE DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
PERMIT ISP,01W"D Ift9V WPAWaORDANCE WIT115Aft()CITY OF vrt,154iQ(hEACH ORDINANCWAND THE FLORIDQ 0
BUILDING CODES.
Page 2
Application Number . . . . 12-CO000923 Date 7/26/12
Plan Check Total . 00 - 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 39 . 00 39 . 00 . 00 . 00
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fa:. (904) 247-5845
Job Address: Permit Number:
Legal Description F1oorA_re_a_oT___9_qT. t_-_ Parcel# Sq.rt
Valuation of Work Proposed Work heatedi cooled non-heated/cooled
Class of Work(circle one): New Addition Repair Move Demolition pool/spa window/door
Lteration
Use of existing/proposed structure(s) (circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed? (Circle me): Yes No N /A
Florida Product Approval#---U—
For multiple products use pro uct approval Form
Describe in detail the type of work to be performed: AC 07 6 rf rg; FV I
Al W
�Dri V, * 44-1,
PAV
Property Owner Information:
N am /1.4.e 15' .—Address:
h Statqo�LZip J.,�23 Phon(
city
E-Mail or Fax#(optional)
Contractor Information:
Company Name: Qua ifying Agent: State Zip
Address: _Ci
Office Phone JobSite ontactNumb Fax 9
Job Site o
LC7-A �9
ntact Numb
State Certification/Registration
Architect Name&Phone 4
Engineer's Name &Phone#
Fee Simple Title Holder Name and dress—
Bonding Company Name and A ess W11,
Mortgage Lender Name and A dress
that no work or installation has commenced prior to the
A a here ade b a n a d he ork and a ns s in,, icated. I certify
to t w '"stal t'ods , ws regulating construction in thisjurisdiction. This permit becomes null
in 0 r a' , eriod of sixP6)months at any time after
0 a er it 0 dtom tthe stan a 010rk suspended or abandonedfor aW
p be e rme
s 0,�c 's ct, n or
c s "d th to 11 w rk ill f It f I
r
)in t
(6 n eiis, Pools, urnaces, Boile s, Heaters,
io by p
pp nce a em t an t 0 w ,
s , !' k s not co need thin s 'i cur 0 cl
"a 0 0 P i x 0 obe tsre' ed r E e at Work, Plumbing, Signs,
and d t t, p , p rm s m, t
'o 'tandwha e a ate e
k i f 'encd nde'
or s coin
Tanks and Air Conditioner"etc.
WARNING TO OWNER: YOUR F)AIL RE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR AYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO BTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEF RE RECORDING YOUR NOTICE OF
COMMENC MENT.
I here rtify that I have read and examined this application and know the same t( be true and correct. All provisions of laws and ordinances governing this
type .0�wcoe rk will be in lied with whether specified herein or not. The grantin� of a permit does not presume to give authority to violate or cancel the
provisi.ons of any oth r e eral,state, or local I regulati constructiol or the pet(ormance of construction.
Signature of Ow 4LUre of Contractor
JJIF— Name .................................................................................................................................
Print Name ........... ........ .....
......................... ............. .................. .... ...
Sworn to and subscribed before me
Sw 0 sc ed b
th V Da 0 qfdM 7e 220 this Day of - 20
Notary Public
Not=ublic 6N [)D 957760
DD 9577
My Go 20 14
'iy
fXp RT�February 14,2014
P
Notary u
U Bonde�d bru Notary Public underwriters Revised 01.26.10
CITY OF ATLANTIC BEACH
OWNER / BUILDER kFFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA 3TATUTES, PART 1 "CONSTRUCTION
CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNC VVLEDGE THE LAW.
FDISCLOSURE STATEMENT FOR SECTION 489.103(7)�F IORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTIOT TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERM IT UNDER AN EXEMPTION TO THAT
�� I
LAW. THE EXEMPTION ALLOWS YOU,AS THE OW�ER OF YOUR PROPERTY.TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST
SUPERVISE THE CONSTRUCTION YOURSELF. YOU�JAY BUILD OR IMPROVE A ONE-OR
TWO FAMILY RESIDENCE OR A FARM OUTBUIL ING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST 0 ?$25,000.00 OR LESS. THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT MA'"NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE I UILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE,THE LjA W WELL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION THIS EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRA JOR- 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 �OUNT OR MUNICIPAL—LICENSING
ORDINANCES.
11. INJURY LIABILITY; SINCE OWNERS M f BE LIABLE FOR IN_JURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
Ill. IRS WITHHOLDING;'OWNERS HIRING WORKERS B COME 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 C NNOT BE. EMPLOYED. UNDER ANY
CIRCUMSTANCE OWNERS BEING SUBJECI TO $5,00 ) PENALTY UNDER FLUKIDASTAIUIL NO.
455-228(l). AN-OCCUPATIONAL LICENSE" IS NOT ADE )UAT THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LKENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826)IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE T1 IAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
7 -z Z!__7_'
ADD 9HON�NUMBER
.!�E�S
-4
PV E
DATE
SIGNATURE
Before me this 7"o day of the county of
Duval,State of-F-Ito—dda,has personally appear d herin'4 h?,.----If herself ar d affirms that
all statements and declarations are tr nd ccurate.
p�i -
county of_
7Notary, lic at Large,State of
I.�
r
Per.s.na!l,Known
0 Produced Identifi
A, S�:RLEY L.GRAHAM
My CC OMISSION 4 DD 9577CO
_QZF�S:February 14,2014
Notary S atu
on e u Notary Public Underwriters
R/BLDG/0��-BuildarAffada�it;REVISED: 6/200
F"-I
UST 8
BAS 32 FUA
I-A
177 PINE ST Atlantic Beach FL 32233
Building Type 0105 -TOWNHOUSE SOH
Year Built 1981
Type Gross Area Heat& Area Effective Area
Finished upper story 1 560 560 532
Finished Open Porch 24 0 7
Base Area 540 540 540
Finished Open Porch 10 0 3
Unfinished Storage 64 0 26
Total 1198 1100 1108
Front 25.00
Depth 100.00
ur DUVAL cUUNTY, FLORIDA.
CERTIFI.ED TO: WILLIAM X. DUTIER, USIE D. HARRIS,
STEWART TITLE CF JACKSONVILLE, INC. ,
WATSON & OSBOK E TITLE SERVICES, INC. ,
AND WELLS FARGCHO'ME MORTGAGE, INC.
7-
/00. 0 'L'e-)
1,1ox-rll 11z- Z 07- 677
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P
q E 0 GIERNERAL NOTES,
1. BEARI GS ARE BASED ON &49:-
2.STRU RE NO./77 SHOW HEREON WES VATHIN FLOOD ZONE X AS BEST
s"
E Y
o
kRI GS
RU JU�
SS
;j DE ED FROM F.E.M.A. FLOOD MAPS PANEL NO. g' DATED 4-/7-el� .
ASSOCIATED SURVEYORS INC. 3-THIS A SURFACE SURVEY ONLY. THE;EXTENT OF UNDERGROUND FOOTINGS.
E A�
I IC
LAND & ENGINEERING SURVEYS PI f 0 UTILITIES, IF ANY, NOT DETERMINED.
PE AN
4.JURI ICTIONAL AND R ENVIRONMENTALLY SENSITIVE AREAS IF ANY. NO7
3846 BLANDING BOULEVARD LOCA D BY THIS SURVO
JACKSONVILLE. FLORIDA 32210
s 5.THIS SURVEY BASED ON LEGAL DESCRIPTIONS FURNISHED. THE PUBLIC
0 904-771-6468 RECORDS WERE NOT SEARCVED BY THIS SURVEYOR FOR EASEMENTS.
0 0 TITLE COVENANTS. RESTRICTIONS. CLOSURES. TAKINGS OR ORDINANCES. E-�.
'T CERTIFICATE OF AUTHORIZATION NO. L13 0005488 -rt4AT
S v THER COULD BE OTHER MATTERS OF RECORD
City of Atlantic Beach APPLICATION NUMBER
- -F- B lding Department (ro be assil;ned by the Building Deparhrmw.)
MA ul
J64
800 Seminole Road
/ Z - 992- 5
Atlantic Beach, Flonda 32233-5445 101?
Phone(904)247-5826 - Fax(904)2 5
E-rnall: bulkiing-dept@mab.us Date routed: /Z d Zz Z,
City we"ite: h1fpJA~.coab.ua
APPLICATION REVIEW AN TRACKING FORM
Prop"Address: 17 -7 J-r Department revkm required Yes No
Building
Applicant: '0 Planning&Zoning
Tree AdministreAor
Project: 7?�fidy Aonerf7l -DYW610,WV �ru-b I ic—W-67j�
I c UTJ1n!g5>
OP NO rl�b7- 01 PJAI ;Pftuoblic Safety
Fire Services
R view or Receipt
of
Date
Other Agency Review or Permit Required
Of I ormit Verffied By
Florida Dept.of Environmental Proteclion
Florida Dept.of Transportation
St.Johns River Water Management District
"C;o"of Enginem
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
00W.
APPLICATION ST TUS
Reviowing Department First Review: pproved. E]Denied.
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Y: Date:
TREE ADMIN. Reviewed
Second Review: ElApproved as revii ed. ElDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES I
PUBLIC SAFETY Reviewed Y: Date:
FIRE SERVICES Third Review: ElApproved as revi.-ed. F]Denied.
Comments:
Reviewed Y: Date:
Reviso 07127110
City of Atlantic Beach APPLICATION NUMBER
Building Department
800 Seminole Road (To be assiWwd by the Building Del)aftent.)
Atlantic Beach,Florida 32233-�,, /z -
x 47-5845
Phone(D04)247-5826 - Fax
E-mail: building-dept@coab.us Date routed: 7
Cifyweb-siie: hffp:/A~co9b-ua
APPLICATION REVIEW AN D RACKING FORM
Property Address: / 7 -7 J7_ Department review required Yes No
Building
Applicant: -Planning&Zoning
Tree Adminisb-ator
Project: PlaoifA P012(r� ublic Wo-iB>
#)&V e15
C
tl INO r/ PJ Ay Public Safety
Fire SeryJ9mk\
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other
APPLICATION STATUS
Reviewing Department First Review: pproved. E]Denied.
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed by: Date:
TREE ADMIN. Second Review: ElApproved as revised. E]Denied. 4
P Comments:
I IL I S
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: F�Approved as revised. [:]Denied.
Comments:
Reviewed by: Date:
Revised 07127110