770 Sailfish Dr 2013 Shed CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00002703 Date 5/30/13
Property Address . . . . . . 770 SAILFISH DR
Application type description SHED PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 200
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Application desc
10 X 10 SHED
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Owner Contractor
------------------------ ------------------------
ATTELL, HOWARD D OWNER
770 SAILFISH DR
ATLANTIC BEACH FL 32233
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Permit . . . . . . ACCESSORY STRUCTURE NEW RES
Additional desc . .
Permit Fee . . . . 55 . 00 Plan Check Fee 27 . 50
Issue Date . . . . Valuation . . . . 200
Expiration Date . . 11/26/13
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Special Notes and Comments
2010 FLORIDA BUILDING CODE, 2008 NATIONA1 ELECTRIC CODE
*CALL FOR FINAL INSPECTION WHEN SHED COMPLETE AND ANCHORED
TO MEET 120MPH WIND LOAD.
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
ENG REV BLDG MOD OR ROW 25 . 00
STATE DBPR SURCHARGE 2 . 00
UTIL REV MODIF OR ROW 25 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 5S . 00 55 . 00 . 00 . 00
Plan Check Total 27 . 50 27 . SO . 00 . 00
other Fee Total 54 . 00 54 . 00 . 00 . 00
Grand Total 136 . 50 136 . 50 . 00 . 00
PERMIT IS APPROVED ONLi' IN ACCORDANCE WITH ALL CITV OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH E COPY
800 Seminole Road, Atlantic Beach, Fl, 3223
Office (904) 247-5826 Fax (904) 247-584
- - rr n
urn e.21 2qf3
JobAddress: 77;' C) <��aZC�t� K- Per hy e3
V�Y \0S, & F\",
Legal Description Parci--;�Lq L11
1 1,loor Area ol Sq.Ft.
Valuation of Work$ r9C)0 Proposed Work heated/cooled nr.-h;:--e--a t�e d SrC4
Class of Work(circle one): CZ4—e Dw Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial Jvs—identl;�
If an existing structure,is a fire sprinkler system installed? (Circle.one): —es No /A
Florida Product Approval 4
For multiple products use product approvaTUorm
Describe in detail the type of work to be performed: �o\
Property Owner Information:
N =res*
:3 P
Sta��tea Z��i hone c)
C - 4 4"� p
E-Mai#orFax 0(�Option�al)��
Contractor Information:
Company Name: Qualifying Agent:
Address: city State Zip
Office Phone Job Site/Contact Number Fax 4
State Certification/Registration
Architect Name&Phone#
Engineer's Name&Phone
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
s here ade ana e do he work nd in a q n nd d ,ertify that no work or installation has commencedprior to the
a'
a I'a rntgif tns uction in this jurisdiction. Thispermit becomes null
A c t '� 0 s s 'ca 'ce y
i bt rmit to s ti d all u ti co tr f six(6)months at any time after
a 0 he an a
to
t r f
i "o Y"d ha k e per 0 ed to m t t s,
i, rm ru , r 0 k d or abndonedfor a period o
P'i a b st
p
Per, an m t s, or st ct 0 0, or s' Plumbing,Signs, Wells,Pools, Fkirnaces,Boilers,Heaters,
's""'0 0, is t ot om t 11 wo w win (6 on h n n
and d f k n ed t at s s 0 f I t
"""i'o "",- I, T's' t h ep"'t,Permit,", t be secured or E fe,'Ica ork
k is d nde tand
Tanks andAir Conditioners,e1c.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING9 CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
Ihere certify that I have read and exam i.ned th' plication and know the same to be true and correct. All provisions of laws and ordinances governing this
11s a
work will be coMpli d 'th whether ecirfiped herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisi.ons of any otherfederl'al,YIM, or localsp, eg ating construction or thepe�fbrmance of construction.
type.I/V
Signature of Owne Signature of Contractor
PrintName Print Name ............................................ ..........................................................................................
.. .. ..........
..... .....
..... . ..
Before Before me
this 20 this _Day of 20
AM
Notary Publ
ES: arY 14,2014
N Onde Thiu N "blic Underwrfters Revised 10.24.12
.�p
rem
CITY OF ATLANTIC BEACH
(OWNER / BUILDER AFFIDAVI ILE Cop
11E =
r
FILE COPY
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART
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. TEE EXEMP'1ION ALLOWS YOU,AS TBE 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 TFIE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMP'nON. 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.
[L INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
111. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(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 ACKINOWLEDGE THAT! HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
C)q
ADDRESS PHONE NUMBER
Pft'r E
7C
SIGINKTORE
Before me th'. 2L3 in the county of
Duval,Statefq�oU 14syrZfr�6411yZe ppl�ed herin by himself f herself and affirms that
afl statements and declarations are true 2n.0 k�ccurate_
Notary Public at Large,State of K1_ County of
OP natiy Known
rodumd 11pdenb6n M__
N4,)n 57760]
OM
EXPIRES.R-b",ry,4 2014
r p bl
y Un e"t,.r"
URAHAM
COMMISSION 4 9D 957760
EXPIRES:R-b 14 2
1 014
aded I .1111�1,r,il U n�ewrite
Notary Sig 44491ery rs
F/131,E)GIO—Buillder Affadavitl; ED: 4/165/200
MAP SHOWING BOUNDARY SURVEY OF
LOT 18, BLOCK 5, ROYAL PALMS UNIT ONE I AS RECORDED IN PLAT BOOK 30,
PAGES 60 & 60-A, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY. FLORIDA.
CERTIFIED TO:
HOWARD P
FIFTH THIRD MOOGA GE C P -01DF COMPLUNCE
RICHARD T. MOREHEAD M2 & Foit 1"j, CE
OLD REPUBLIC 11 CM OT, kfLMxnc6FACH
SEE PERMITS ROk "IDDiTIONAL
RMUIREME
T1
A
Y. D�
RVABM BY:
SAILFIS
(W RIGHT OF WAY)
S 85'20'02" E 80.65' (PLAT)
BLOO( S 85'18',30" E 80.67- (WEASAW)
CORNER
17QW1I`(PLAT)
Li
Z9
<
_j
0j *.. .'9 1-1 1, COMD
0.
W
C=
UNE
W -15.4'-
<
a.
0.7'
C�
ONE STORY
C1 MASONRY
4M 'A POSTED #770
LOT 19
LOT 17 BLOCK 5
BLOCK 5
211'-
31;
0
z z
LOT 18
IV EASEMENT FOR BLOCK 5
ORAWAGE UT1UTXS
N S5'26*11' W 80.82' (MEASURED) "Of
N 85*20'02" W 80.65' (PLAT)
LOT 14 LOT 13 LOT 12
BLOCK 5 BLOCK 5 BLOCK 5
LEGEND:
0 -=I REPAR. PC POINT OF 13JAVA7LM
PSM061 Pt P014T OF TANGIDICY
FOUND 1/r OM ME
NO AXTW2tn PRC PONT OF W4RSE
LrSS 0 E%W) CLAWATURE
4'"'CONCAM M&� PCC POW 4y COMPOUND
A/C - AM CURVATURE
CON"I"I", CONCAM
__ - FENCE
I LI I I Ray Thompson REVISIONS
I AM I I DATE DESCRIPTION
SURVEYING, Inc.
Going the DISTANCE fbr Yot4 NdIr xvb IlEs(graw, 3%tr
4613 Philips Highway,Suite 210 1309 ST.JOHNS BLUFF ROAD NORTH,W
Jacksonville,Florida 32207 JACKSONVILLIE, FLORIDA, 32225
(Phone)904446-5125 (904)-555-2777-FAX(904)-555-2797
(Fax). 904448-5178
JOB # 20507 1 DATE OF FIELD SURVEY. 2-21-2012 SCALE: 1" 20'
CEPTIFICATZ
NOTES: I HEREBY CERTIFY THAI my RE906GLE CHARGE
1: BEAW=ARE BASED ON THE -PLAT BEARING OF --- AND MEETS THE MIk"M TH or A
ALOKO THE WESMRLY BOUNDARY UNE OF SUBXCT PARCEL BOARD OF
2: BY CAAP"C PLOrTING ONILY THE CAPTI061ED LANDS LJE WITHIN FLOOD ZONE AD=MtM4MTMRATk%0E A.T STA`rUr.--
. ,. -AS SHOWN ON THE NATIONAL FLOOD INSURMCE MAP.
DATED:WL-77.-F9-89,COMMUNITY NUMBS: 120075 PANEL DAM n .
3., THIS qjRUEY REFLECTS ALL EASEMENTS&RIGHT OF WAY AS PER RECOROLD
PLAT&/0R MLE COMBA`Tbr.NT IF SUPPLIED.L*AESS OTHERWISE STATED.NO
OTHER TITLE VE,*ICATION HAS BEEN PERFOFIMED BY THE UNDERSIGNM AYMWW W
4: Tits SUFNEY rS NOT VAL;D W714WT AN AUTHENTICATED ELECTRONIC SIG"rURE REGISTERED SUR MAP 146 STATE OF FLORIDA
AND AUTH04TWATM ELECTRONIC SEAL LICE I .7469
LAND SURVEYS 0 CONSTRUCTION SURVEYS 0-SUBDIMSAONS
10/16/2006 03:43 9049643330 HANDI HOUSES PAGE 81/8
NOM-INSTAU
Datatb for Coricrete Imtollatiom if OW27=12 1
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-L 2
3. HELICAL AMOHM rOK I Wph%vMD ZONC5 WUST MEr,A MINMV.WVMmG LCIA,�OF 3484 C.Ir Iw-r 11-V 6 a 1 3 3
ft.AND AN ULTMATIE LOAD OF 5 M", 11,41 Wv- 71-r a 3 3 3 3
4. ANCHORS MUST BE MTALLEP TO W.NUMM)RER5 RECOMMEMOATK"-ANY EfMOrNG OR IIr-w 1QW 114, 4 2 2 2 2
MAMAU CAU5W UPON 1115TALLAITION MLL VOID ANCHOR.AND MVJT OE DIXARDW. W-tr Ir-v r4P I� 1 2 V. �21
CONTRACTOR 3HALL VISIT THE 511C AND TMOROUGMLY FAWLIARIZIE THEWEV WITH tXv5TjNr, I IVW 194r r4r -L
CONDITIONS.CONTRACT Olt 6 n`SP�MR MEMN6"L WOWCATION rOK SIZING 1 tro itz r-r 3 3 3 3
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6, ONE AN040K 5MALL OE FLA=AS EACM OUR0414r.COM4r.9t wn,im 12*or OoRmp�, lv�r W-W r-r 10 —4 —1 —. -4 v
7. ANY R-EQUIREO INTEWXDtAlt ANCHORS 5MAU ae 11�0 COUAL WA'ACES,APART J`RCW E4,Cd MW 3C1-T t2 —5 a—7—6
Crim.- It%W 12%W
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DMOIX6 WOULD W 2X"NtAeM JJSTW IN 7M SCMWtA-n Ir-r Wr v-r u 5 a 5 5
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BUqDING CODE zolo IT-Ir 4rc &W 24 S 6 6 4
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P.O.bw"o
Hangy Associates Inc.
GA 30401
Engineering&coustmcdon Plan-Ing
PmEcr f4maeR. P.(L 6-34%ft 94&C 29M-?I.—It"446-Ma A%&"4-04-I-qu
DA T C MmA 27na.20 12
MAP SHOWNG BOUNDARY SURVEY OF
LOT 18, BLOCK 5, ROYAL PALMS UNIT ONE, AS RECORDED IN PLAT BOOK 30,
PAGES 60 & 60-A, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY. FLORI[DA.
HOMPAPiLL
FFTH THIRD MORTGAGE COMPANY
RICHARD T. MOREHEAD TITLE & ESCROW, INC
OLD REPUBLIC TITLE
SAWLS,H DRIVE
T cr myl
S 8520*02" 1- 80.65' (PLAT)
mum S WOW E 80.6r (16WAMAW)
W
zi
81
tar—
aw
17 ONE STORY
001 MASONRY
co POSTED FM
LOT 12
LOT 17 BLOCK 5
w
is so
too
LOT 18
BLOCK 5
'S
all%
-pwlzl -w —_ _qMW SMEAVATM)-
N 55='02* W 80.65- (PLAT)
LOT 14 LOT 13 LOT 12
BLOCK 5 BLOCK 5 BLOCK 5
LEGEND:
0 xl=1=0 ft POW or DAVAllm
PMOPM PT POW W TAPNEWr
%NSAMM POC POW 4F OMM
"am cowww""M oAvwrjm
ZIN 4w 000"UMPAwn PW
;. G). a0licom
u— 0010E REVISIONS
A L I I Ftey Thompson
Ili= I SURVEYING. Inc-
AIIIIIIIIELL-1-i Me natb waamw, 3ur
=W2" 13M ST JD"NAff AM"MIK lla
-AWTA I JAMCSONVUL FLOND&32M
(PhM)W"4"125 (904)-30-V"-fAX(W)-5$5-XW
N (W 044484179 1
ice_U 20507 1 DATE OF FIELD SUMY: 2-21-2012 SCALE: 1- 20-
CERTWICATE
NOTES: I"Way WWI NAT ur rAwmalft"OVAK
1, SE"OS X LOW am Va 1W KMW OF IMWFMI�z Pam
me low I be UT M IM FLOW
ALDO Joe moumwm:= fwr-�L ON"
2:GY ata"c g OLM am soon co
Ob""awl, ftm"Mma". ADMOMM
%=WANO UWn PM& BAM n -
I XL EkleaM a OW Of WAY AS PUT
PIAT AM WMft=r No low
=My=0"IM STAML
1w UN00tiv"M
WT at.Wa9t AUVOWAM=TROM 90"r'M 446 STAIE OF FLOOMA
AM my"OrWAM
LAW SURVIM 0 CONS71RICRION SLOR'*V S 0 stiel)POSIM
Showman, Lisa
From: Walker, Jennifer
Sent: Thursday, May 23, 2013 2:09 PM
To: Showman, Lisa
Attachments: 770 SAILFISH DRIVE.tif
Lisa,
I went ahead and called this gentlemen because I was sure he didn't mean to put the shed in the front yard. He meant
to put it in the back. Here is the corrected survey. It should have been caught at the front desk so I apologize,
Tx,
jeI&V-U WaLlur
Administrative Assistant
Building Department
City of Atlantic Beach
904-247-5826
PUBLIC WORKS PLAN REVIEW COMMENTS
Initials: PN ML�__
Date: 5-23-13
Project Name/Address: 770 Sailfish Drive. Application Permit#: 13-2703
Check Box Check
Application Tracking Comments to Add Box to
Comment "Print"
IMPS Provide table of impervious surface calculations for entire lot(existing and post 0 0
construction).
ESCP Provide erosion and sediment control plans with installation details and maintenance 0 0
schedule.
DPLN Provide drainage plans showing site topography(flow arrows, etc.) 0 0
CSMP Provide construction site management plan, including Right-of-Way Permit if using 0 0
right-of-way for construction parking.
TSUR Provide a pre-construction topographic survey prepared by a Florida Licensed Professional 11 0
Land Surveyor, showing 1' contours.
LDCS Section 24-66(b)of the Land Development Regulations requires on-site storage for
increased run-off if adding 400 SF or more impervious surface. Provide Delta volume 1:1 0
calculations and on-site retention required per Section 24-66(b). (See attached information
sheet.)
PCTS If on-site storage is required, a post construction topographic survey documenting proper 0 0
construction will be required.
RWPM A Right-of-Way Permit must be obtained for use 0 0
REPM A Revocable Encroachment Permit must be obtained. 0 13
PLWP Pool—Wellpoint(if used) must discharge into vegetated area 10' minimum from street or 0 0
drainage feature (swale, structure or lagoon).
DAPR All concrete driveway aprons must be 5"thick,4000 psi, with fibermesh from edge of
pavement to the property line. Reinforcing rods or mesh are not allowed in the right-of- 0 0
way. (Commercial driveways—6"thick).
U RCT Any utility cuts in the road must be repaired using COJ Standard Detail Case X and must be
overlaid 10 feet in each direction from the center of the cut. Repair must be shown on the 0 0
plans.
RWRS Full right-of-way restoration, including sod, is required. 0 0
ROFF Roll off container company must be on City approved list and container cannot be placed on
City right-of-way. (Approved:Advanced Disposal, Realco,Shappelle's and Waste 11 11
Management)
ECIN 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 0 13
Inspection prior to start of construction.
MEET Recommend Owner/Contractor meet with Public Works Director to discuss proposed 0 11
construction. Call 247-5834 to make an appointment.
Accessory structures not allowed in front yard per Land Development Regulations 11
LDR 24-151(b)(2)ii.
0
PUBLIC WORKS PLAN REVIEW COMMENTS
Date: S- J a — f- 3 lnitials�: PN IV M
Project Name/Address: T20 Application Permit#:
Check Box Check
Application Tracking Comments to Add Box to
Comment "Print"
IMPS Provide table of impervious surface calculations for entire lot (existing and post
construction). 13 0
ESCP Provide erosion and sediment control plans with installation details and maintenance
schedule. C3 0
DPLN Provide drainage plans showing site topography(flow arrows, etc.) 0 0
CSMP Provide construction site management plan, including Right-of-Way Permit if using 13 0
right-of-way for construction parking.
TSUR Provide a pre-construction topographic survey prepared by a Florida Licensed Professional
Land Surveyor, showing V contours. 0 0
LDCS Section 24-66(b) of the Land Development Regulations requires on-site storage for
increased run-off if adding 400 SF or more impervious surface. Provide Delta volume
calculations and on-site retention required per Section 24-66(b). (See attached information
sheet.)
PCTS If on-site storage is required, a post construction topographic survey documenting proper
construction will be required. 13
RWPM A Right-of-Way Permit must be obtained for use
REPM A Revocable Encroachment Permit must be obtained.
PLWP Pool—Wellpoint (if used) must discharge into vegetated area 10' minimum from street or
drainage feature (swale, structure or lagoon).
DAPR All concrete driveway aprons must be 5" thick, 4000 psi, with fibermesh from edge of
pavement to the property line. Reinforcing rods or mesh are not allowed in the right-of- 0 E3
way. (Commercial driveways—6" thick).
U RCT Any utility cuts in the road must be repaired using COJ Standard Detail Case X and must be
overlaid 10 feet in each direction from the center of the cut. Repair must be shown on the 0 13
plans.
RWRS Full right-of-way restoration, including sod, is required. 0 0
ROFF Roll off container company must be on City approved list and container cannot be placed on
City right-of-way. (Approved: Advanced Disposal, Realco, Shappelle's and Waste 13 111
Management)
ECIN 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 0 0
Inspection prior to start of construction.
MEET Recommend Owner/Contractor meet with Public Works Director to discuss proposed
construction. Call 247-5834 to make an appointment.
13
YC4(I- ee
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 3223
Office (904) 247-5826 Fax (904) 247-58
-720 MA- Ygj
Job Address: Per be
Legal Description \Q), Parcf,.-.-�
I Floor Area ot- �;q.Ft.
Proposed Work heated/cooled '�d
Valuation of Work$ c-942)0 %n4n-h e a t e
Class of Work(circle one): (Zew) Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Xt-sl-de-n-t-131 -1,
If an existing structure,is a fire sprinkler system installed? (Circle.one):`Ye—s No /A)
Florida Product Approval 4
For multiple products use product app—ro-7a-Morm
Describe in detail the type of work to be performed: 1'wc (>- C-,
Property Owner Information:
Name: \4mk k Address:f]2 20 !�.cr Or. 011-14
�State�RZip
city StateR-Zip_92.�3 Phone -9ri-�'k 9 Poe E6 2�/
E-Mai AorFax�#:�((Optional)
Contractor Information:
Company Name: Qualifying Agent:
Address: city State Zip
Office Phone Job Site/Contact Number Fax#
State Certification/Registration#
Architect Name&Phone 4
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address_
Mortgage Lender Name and Address
A ca here ad i a e , d e work and ins i�n nd�,c or installation h as commencedprior to the
0 0 th 'a" ' s as I w thisjurisdiction. This permit becomes null
mi e ormed to m t the stan r al f six f
0 k ss aWeriod o months at any time a ter
f �s Z nstruct n r Od r ells,Pools,ou'rnaces,Boilers,Heaters,
ix m t , or c
s (6 on
ep
ra Per its mu t scu, f
0, ctnc
0 is m 0 b
e 0 'ta p
P' by d 11 k
p
'su"c'o a permit a, t a or
and oid o'k is not co me"ced w thin
w', is c me", I u, rsta, t t s P
k d de d e a te b ed E e
Tanks and Air Conditioners,e1c.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOVIi NOTICE OF
COMMENCEMENT.
I herelb certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
i work will be co�nplied ithwhether eci(led herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any otherfederal, tate, or loca re ating construction or the pe�rormance ofconstruction.
Signature of Owner Signature of Contractor
Print Name Print Name
..........U............. ....... ............................................ ..........................................................................................
ST W�eatin
r
e ..........
g
Before I Before me
this 20 this —Day of 20
M
z
Ll
ES: Notary Publi
14,2014
No ndm Thru Und
7- Revised 10.24.12
2,64 -0
CITY OF ATLANTIC BEACH
(OWNER / BUILDER AFFIDAVIT
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:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO TTIAT
LAW. THE EXEMPTION ALLOWS YOU,AS TBE OVrNER.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 B-LTILD OR RSAPROVE 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 RAVEEBUILT YOURSELF W117HIN ONE YEAR
AFTER TBE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUTLT
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 TI-M BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILIT-Y To MAKE SURE THAT PEOPLE EMPLOYED BY YOU RAVE
LICENSES REQUIRED BY STATE LA-W—AND BY COUNTY OR—MUNICIPAL LICENSING
ORDINANC S.
If. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
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.
rV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(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.
q C)q
-)n Lc,'� � t �-
ADDRESS PHONE NUMBER
PMN'r E
7C
SIGh&MI,_ DATE
Before me this day of 2L3 in the county of
Duval,State nd_a�,has personally app ed herin by himself/herself and affirms that
ar.'t ccura�
all statements and declarations are true and
,pno ccurate.
Notary Public at Large,State of KL County of
El P ally Known
uced Iden' tibn
L_U'RAHAM
HycomwSSION400957760
EXPIRES:Fpbr
Notary Sig ......... R,nnj,d T Wry 14,2014
rVpljbIjCtjndeWtp
rS
F/BTDG/0Buildu Affad&avit; ED� 4116/20
MAP SHOWING BOUNDARY SURVEY OF
LOT 18, BLOCK 5, ROYAL PALMS UNIT ONE, AS RECORDED IN PLAT BOOK 30,
PAGES 60 & 60-A, OF THE CURRENT PuBL'C RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO:
HOWARD D. ATTEIL
FIFTH THIRD MORTGAGE COMPANY
RICHARD T. MOREHEAD TITLE & ESCROW, INC
OLD REPUBLIC TITLE
SAILFISH DRIVE
(W RIGHT OF INAY)
S 85'20'02" E 80.65- (PLAT)
BL= S 8518'30" E 80.67- (MEASURED)
CORNER
a 2-
LIJ
Z
01. 0
LAI
IAJ
RESTRICTIONhUSNE V)
ENTRY
< Ll <
W —15.4' 39.0, low 2 -1
b
ONE STORY C�
"i F� C-4
a, MASONRY
A/C X
PAD POSTED #770
LOT 19
LOT 17 BLOCK 5
BLOCK 5
Uj
I.Aj I
Go
17�0)
z z
LOT 18
BLOCK 5
10'EASEMENT FOR
DRAINAGE 0-i.LJTIES
0
0.1'0 5 1�7,- , 9
N 85"26'11" W 80.82�
_()4EA§UFjEDj_
N 85'20'02' W 80.65' (PLAT)
L07 14 LOT 3 LOT 12
BLOCK 5 BLOCK 5 BLOCK 5
LEGEND:
C) -�"1/2'ROAR46 PC . POINT OF CURVATLAE
PSM051
FOUNO 1/2-IRON PIK PT - PONT Of rAHGDtCr
NO IDENTIMATION PRC - POINT OF RE��
0-LESS OTHONSE NOTEM) CLWYATUM
-4',4*CONCRETE MONUMENT KC - POINT OF COMPOUND
A/C - AIR CONDITIONER CURVATURE
— . FENCE 0 . CONCRETE
I L I I I I Ray Thompson REVISIONS
SURVEYING, Inc. DATE DESCRIPTION
jr, ing the DISTANCE7�r�Yo Mitle nab fs(Irvtv, 3itr
46113 Philips Highway.Suite 210 1W9 ST. JOHNS BLUFF ROAD NORTH, #A3
A— JacksonAlle.Florida 32207 JACKSONMU-F- FLORIDA, 32225
(Phone)904-446-6125 (904)-565-2777- FAX (904)-565-2797
(Fax) 9N-448-5178
JOB # 20507 DA�E OF FIELD SURVEY: 2-21-2012--F SCALE: 1" - 20-
NOTES: CERTIFICATE MY RESPO.NSULE CHARGE
i KARwas ARE BASED oN THE PLAT BEARNG OF--X-q1731:5d'-Z--- STAND FORTH BY THE FLORIDA
ALONG THE WESTERLY BOUNDARY LINE OF SUSWECT PARCEL I -.FLORIDA
2: BY GRAPHIC PLOrnNG ONLY THE CAPTIONED LANDS LIE#ATHIN FLOOD ZONE ANT M 710%4 ORIOA STATUrES.
-- . X'---AS SHOWN ON 114E NATIONAL FLOOD iNSURANCE MAP,
DATED: APRIL 17,1989.COMMU1117Y NUMBS: 120075 PANEL 0081 D .
3: THIS SURVEY REFLECTS ALL EASEMENTS&RIGHT OF WAY AS PER RECORDED
PLAT&/OR nTLE CO&MAITMENT IF SUPPUED,UNLESS GTRMWSZ STATED,NO
OTHER TITLE VERJFICATION HAS BEEN PERFORMED BY THE UNDERSIGNED. AYWAN474M
1: THIS SURVEY IS NOT VALID WITHOUT AN AUTHENTICATED ELECTRONIC SIGNATURE REGISTEREID SUR D M 46 STATE OF FLORIDA
AND AUTI-IENTCATED ELECTRONIC SEAL. I Lic 1 9
LAND SURVEYS 0 CONSTRUIC110N SURVEYS —0— \ASIONS
City of Atlantic Beach RECEIVED APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
MAY 2 2 2013'
800 Seminole Road
Atlantic Beach, Florida 32233-5445 7el ,�
Phone (904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed:
City web-site: http://Www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: -7-740 cs�� gapartment review required Yes No
uildin
,M—anning &Zonin
Applicant: 0 6) � e
istrator
Project: & �ic W o ris-�:) I
<'qnnc-Utiliti�� I
Public Safety
Fire Services
Review fee $ Dept Signature r_/
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: F]Approved. XDenied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Date:
I Reviewed by: A<
TREE ADMIN. Second Review: ;Approved as revised. FlDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: [:]Approved as revised. FIDenied.
Comments:
Reviewed by: Date:
Revised 05/14109
IN 7
City of Atlantic Beach APPLICATION NUMBER
Building Department MAY 2 2 Z013 (To be assigned by the Building Department.)
800 Seminole Road
2 7el 7�
-5445
Atlantic Beach, Florida 32233 1-3
Phone (904)247-5826 - Fax(904)2"4. 5
E-mail: build ing-dept@coab.us Date routed:
City web-site: http-./Ivmw.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: -7-76 cs��1A,S-A :Z� l4apadment review required Yes No
Buildin
Applicant: :��nning &Z(
Administrator
Project: Y & orks-
42 1 2cw
<'FnTEC-Utilit§L�
Public Safety
Fire SepmT�
Review fee Dept Signature
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. []Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed b Date:
TREE ADMIN. Second Review: DApproved as revised. 17Denied.
IC W RKS Comments:
C IC UTILITIE
PULIC SAFE Reviewed by: Date:
FIRE SERVICES Third Review: DApproved as revised. []Denied.
Comments:
Reviewed by: Date:
Revised 05/14109
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us I
APPLICATION REVIEW AND TRACKING FORM
Property Address: -7-76 cs�� Depadment review required Ye5K No
ui in
Applicant: �ning &Zoni�n��
-Tree Administrator
Project: J110�lc Works
ir Utilitie—s
Public Safety
Fire Services
Review fee $ Dept Signature
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: MA'pproved. E]Denied.
(Circle one.) Comments:
CE��
PLANNING &ZONING Reviewed by: Date:
Of
TREE ADMIN. Second Review: []Approved as revised. F-]DenieF
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: E]Approved as revised. E]Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445 1 1-3 2 7� ,�
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed:
City web-site: hftp://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: _7_�6 cS�� Qgpadiment review required Yes No
QLuildin
Applicant: ell
7-re-e-T-d-ministrator
Project: ?Vy-1cworks�-j
Public Safety
Fire Services
6-
Review fee $ Dept Signatu re
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: E]Approved. <Denied.
(Circle one.) Comments: q1/1
(26A 00� k1e oa-eez-1 -i o r-( "'o_-- d
BUILDING C1
tia*4 SCCk-P� �;�4_t
1::zJ_
LANNING &ZONING z Reviewed by: Date:
TREE ADMIN. Second Review: EVpproved as revised. Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:_ Date:
FIRE SERVICES Third Review: [-]Approved as revised. [-]Denied.
Comments:
Reviewed by: Date:
Revised 05/14109