95 DUDLEY ST - CONCRETE ADDITION BUILDING PERMIT APPLICATIONFMAY
CITY OF ATLANTIC BEACH D800 Seminole Road,Atlantic Beach,FL 322338
Office(904)247-5826 Fax(904)247-5845
Job Address:. By
M( cy Permit Number:
Legal Description 56t;i4f kl2 :i� LCSf 10�LO�� 1 Parcel#
22 Floor of Sy.Ft.�—Sq.Ft----
Valuation of Work S I S�l�Proposed Work heated/cooled—0-- non-heated/cooled NG SF
Class of Work(circle one): New Addition Alteration Repair Move Demolition Pool/spa window/door
Use of existing/proposed structures)(circle one): Commercial Residential
If an existing structtuure,is a fire sprinkler system installed?(Circle one): Yes No N/A
Florida Product Approval#
For multiple products use pro pc approve orm
Describe in detail the type of work to be performed: ADS__2Co Ue R t SLARS TO
CRC87r Atom VAP- Belfto � RP�D_�aIT [RldEtitA�
Property Owner Information•
Name%&(2 T`(�g1Lc�tz_ Address: .���.�0
Cita' State�/�Zip 22 Phone -to / 16!Vfi �� r
E-Mail or Fax#(Optional) 40/4a7 14 C, GY+z7
Contractor Information:
Company Name: Quali gAgent:
Address: CiState Zip
Office Phone Job Site/Contact Num Fax#
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
Application is hereby mode 10 obtain apermit to do the work and Instal/a tons m indicated. I rert)y that no work or installation las commencedprior to the
issuance ofa permit and that all work will be performed to meet the standards ofal!Jaws regulating construction in alub jurisdiction This permit becomes null
and void t work is not commencedwidds sts(6)months, or ifcomtrucilon or work u suspended or abandoned for a pe iod afsix 6)months at any time aper
work is cammenced I understand that separate permits must be secured for Electric. work,work,Plumbing,Signs, Wellr,Pooh, urnaces,Boi4n,Heafers,
Tanks and Air Condithmers,etc.
CENING TO
SUTOUR PATOOEFCOMMENMENT MAY RESULTIN FAILURE
TWICE OR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUi NOTICE OF
COMMENCEMENT.
'here cert that Ihave readand ettunmed this a p/icatian and know the same to be true and correct. A(l provisionr of laws and ordinoncesgoverning this
ype o work will be complied with whether sped red hereto or not. The granting of a permit does not presume to give authority to violate or cancel the
irovision,ojany other federal,state,or local taw regulating construction or the performance of construction.
40
Bell's Concrete
50 Dudley Street
Atlantic Beach,Fl. 32233
904-246-7758
Saturday,May 16, 2015
PROPOSAL SUBMITTED TO: Mr. or Mrs. Decker
CONTACT: 904-610-2743 Email: jasondecker@mac.com
PROJECT LOCATION: 95 Dudley Street,Atlantic Beach,Fla. 32233
Please take note to the following instructions to receive Bell's Concrete discount on
materials. SUPPLIER:GRISWALD CONCRETE 751.3796
Your total materials are 6min. yards of Concrete 3000psi w/Fiber Mesh. If any
additional materials needed, there will be an additional cost listed below.All material
must be purchased prior to delivery. Customer have the choice to pay Supplier's direct
with credit card or write check to Bell's Concrete prior to delivery.
TOTAL MATERIAL AMOUNT: $760.22
( TOP PORTIONS CUSTOMER OPTION )
6' x6' 8' x12'/3'x18' 111x16'
SCOPE OF WORK: Sidewalk& Driveway Addition w/Patio C.346 SF )
Bell's Concrete proposed to furnish the following Labor to complete your project as
follows:
Frame w/a Thicken Edge& Grade 4" / Tamp / Pour / Light Broom Finish /
Saw-cut or Tool Joint as needed every 5' -10' / Leave area clean of concrete debris.
PAYMENT PROCEDURE:
LABOR ONLYAMOUNT DUE: $ 800.00 Check# Date: / /2015.
Make All Checks Payable To Bell's Concrete on Completion
Total protect amount: $ 1,560.22
ACCEPTANCE:
The above Price,Project(s) or Specifications and Conditions are hereby accepted. You
are authorized to do work as specified above. All Payments will be made as outlined
above to Bell's Concrete.
Date Date
BELL'S CONCRETE CUSTOMERS AUTHORIZATION
Signature ofOwne m.of Contractor_
Print Name 422 Print Name
Swote a ld subre tom'Sworn to and subscribed before me
this._'/Vl. y o !� J 1 2 J this Day of .20
o[ary u c
Notary Public
Revised 01.26.10
RLOVI R6..l 3
w699OIjwI$SIww OAW i
epialll aIVIS a!19ndk WN d
laP
MAP SHOWING BOUNDARY SURVEY OF
THE SOUTH 1/2 OF LOT 10 BLOCK 1 ACCORDING
AAT�OpTHE PLAT OF
DOMMMpp
■S FUEMA U
AS RECORDED IN PLAT BOOK 19 , PAGE(S) 16 OF THE CURRENT
PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO: PETER J. DECKER, 3ANN W. DECKER,
STEWART TITLE GUARANTY COMPANY, WATSON S OSBORNE TITLE SERVICES, INC.
AND EVEREANK.
CHURCH ROAD
- - 50.00 (R) -__ T
�- NORTH 1/2
OF LOT 10 I
g BLOCK 1 � I2
o_
50.00' (R) I�-0.2
--0.2"
0.5' I 49.91' (M) CAP
UNREAD BLE 0.1'
45.21 I.P. i0 I.P. 1/2'
0.8' 0.8 °
1.4' 13'
5'
,Pq SOUTH 1/2 a
LOT 11 'a- OF LOT 10 WW LOT 9
BLOCK 1 BLOC o 0.7 BLOCK 1
1.° EAVE
E.T.1 UNE
yJ. 7.5' 14;11 6.5'I PADS
\ A/C °
I� PADS
�l I • � U
2 STORY 1 Nei
RESIDENCE c Y n m
l �a • I .6' + W/NNYL SIDING
^� a @10.95 S a' N¢�
0.1' WOOD N0.95 _tb
3, DECK \
YI000 2.1' /
STEPS 1
4 COYO.
'GONG. CONIC. 'I
28.3' 13.9' I
E1.27. 0.8 -
. .
aCORO. ° 2.1' 2.2' r
COVD C&C.
O o BY 2ND CTRIC 4
:O CONC.: Ox\ '2
1 j
20 (R")
al. }IJ, 2.0_
L .00' _ 0 299.91A(� _ _■
-1 12 /z
I/750.00' (M) AL.B5SSOCS RW AR RIS.
50.00' (R) 488
g LSDUDLEY srRsvr(5o, R/w)
a
OENINIAL NOTE81:
N E Y O I. ANGLES ARE SHOWN FOR MIS SURVEY
2.STRUCTURE NO. 95 SHOWN HEREON UES ■MIN FLOW ZONE x AS BEST
T@ py /� DETERMINED FROM E.E.M.A. ROOD MAPS PANEL NO I DATED04-17-1989
1 ED SURVE t ORS INC 3.THIS I5 A SURFACE SURVEY ONLY. THE E%TENT OF UNDERGROUND FODnNGS.
LAND k ENGINEERING SURVEYS PIPE4 JJURIIRSDI�ONTAL AND IORAENVIRONMENTALLYNOT ED.
SENSITIVE AREAS IF ANY, NOT
3846 BLANDING BOULEVARD LOCATED BY TMS Y.JACKSON\,A E FLORIDA 32210 5.THIS SURVEY BASED ON LEGAL DESCRIPTONS FURNISHED. THE PUBLIC
bP�71-6468 RECORDS WERE NOT SEARCHED BY MIS SURVEYOR FOR EASEMENTS.
TITLE, COVENANTS, RESTRICTIONS, CLOSURES, TAKINGS OR ORDINANCES. ETC.
TIFICATE OF AUTHORIZATION NO. LB 0005488 THERE COULD BE OTHER MATTERS OF RECORD THAT AFFECT THIS PARCEL.
6.UNLESS OTHERWISE STATED ALL IRON PIPES FOUND HAVE NO IDENTIFICATION.
.I HEREBY CERTIFY THIS SURVEY WAS DONE UNDER MY LINIENDOA■MEVIATIONO
DIRECT SUPERVISION AND MEETS THE.MINIMUM KCHNICAL 0 SET IRON PIPE OR REBAR P.C. - POINT OF CURVE COVD = COVERED
STANDARDS FOR LAND SrPRG PURSU IT TO HAPTER •ASSOC.SURVEY' OR LB.5488 P.T. = PONT OF TANGENCY E.B.-ELECTRIC Box
61G17- LORIDA ADMINI AT4� I G E. C APTE 72, F.S. ■ FOUND IRON PIN OR PIPE (IP)) P.R.C. = POINT OF RMRSE CURVE
■ FOUND CONCRETE YDNUYEM (C.M.) P.C.C. - POINT OF COMPOUND CUM
�,_ ® % = CRO55 CUT OR MILL HOLE (C) - COMPUTED DATA R/W- RIGHT OF WAY
C ESA . HATCHER LORIDA CERTIFl E N0. 3771 (R) •RECORD (M) - MEASURED WHO = CONCRETE BT - BUILDING TIE
R. =RADIUS L.- ARC LENGTH A\C •MR CONDITIONER (E T.) - EAVE LIE
C LES L STARLING FLORIDA CERTI AT
N0. 45J9 O.R.B.-OFFICIAL RECORD BOOK ® =WATER METER
0.= umnr POLE
RAYMOND J. SCHAEFER FLORIDA CERTIFICATE NO. 8132 O.R.V. •CRICIAL RECORD VOLUME P.EO. -POa EOUIHNENT - Cur ANCHOR
P.F.M._OFT' CM REFERENCE YONIWNI -O.U.--OYER HFAO UNLMES CH - CHORD
JOB N0. 44406 DATE 02-23-2005 B.R.L. =BUILDING RESTRICnON LINE X-X CHAIN UNK FENCE BTN. - BETWEEN
E.T. -ELECTRIC iAANSFgWER 6 PAD W-W WIRE FENCE -O�-WOOD FENCE
SCALE: 1" a 20' DRAFTER W. PADGETT J.EA -JACI601M1E BECIMC AURp■IY C k R = COVENANTS h RESTRICTIONS
NnT VAI ID WITHOUT THF SIGNATURE AND THE ORIGINAL RAISED SEAL Of A FLORIDA LICENSED SURVEYOR AND MAPPER
TREE SL VEGETATION AFFIDAVIT
+� City of Atlantic Beach
I Department of community Development
Planning&Zoning Division
i 800 Seminole Road Atlantic Beach,FL 32233
(P)904247-5800 (F)904247-5845 PERMIT Is
SECTION I-APPLICANT INFORMATION fx Owner(s) f— Legal Authorized Agent-
NAME OF APPLICANT Peter J.Don Decker
NAME OF COMPANY
N/A
iADDRESS OF COMPANY 1294th Ave S.Jacksonville Beach,FL 32250
PHONE CELL (904)610-043 EMAIL
Iesondecker®mec.cam
CONTRACTOR CERTIFICATION NUMBER
'
Ai LBCH BUSINESS TAX RECEIPT NUMBER
SECTION II-SITE INFORMATION
STREET ADDRESS OF PROPERTY 95 Dudley Street.AtleriHC Beach,FL 32250
IlanaMrefs hasnor5aan migrredfathaproptay,mnmR M4 ABBuiltlirg aepartmmf ar W115826 w,vestan addres,.
I LEGAL DESCRIPTION South 1/2 of Lot 10 Block 1 According to the Plat of Donner's Replat
LOT 10 BLOCK 1 SUBDIVISION
iREAL ESTATE NUMBER LOT OR PARCEL SIZE SOFT AC
RESIDENTIAL X COMMERCIAL OTHER(SPECIFY)
1 affirm that I have reviewed the provisions of Chapter 23, Protection of Trees and Native Vegetation'of the Municipal Code of
Ordinances for the City of Atlantic Beach,FL and/or I have participated in a pre-applicaHan meeting with the Administrator of those
i regulations. Subsequently,1 affirm that no regulated trees and no regulated vegetation will be damaged,destroyed and/or removed
from the above-de�edo centproperues In conjunction with this project.
SIGNATURE OF OWNER SIGNATURE OF OWNER
I Signed and sworn before meonthis /X day of �p � , ��py State of /L
FFFTf(L Counwofyq,
i
Identification verehd: ✓ _ `71 �7
Oath swum: r yes No
i
Notary Signature
rp Ndery L Granter,C SOW rkY
Y ExpOs LOraham My Commission expires:
g j My Comm"On FF DONN
APC Eywac 02t4Y1018
City of Atlantic Beach
Building Department APPLICATION NUMBER
800 Seminole Road (To be"sig ad by the WilingBDe a
"'^ 1 Atlantic Beach,Hands 32233-5445 T p Nnenf)
Phone(904)247-SM . Fax(904)7.47-5945
E-mail building-dept@ccabus (p
City web-site: hbv//www coati us Date routed: 8
Property Address: r
t De artment review re wired Yes
Applicant: /f j � g No
lf
.--r.�r Planning g Zo
Project: �A' J I `,' Tree Administrator
rT �'"iC ti f ublic Wo
u Public
Ufileies
W /�� Public Safety
f rAn&�j Fire Services
Review fee $ �N
-�Dept SignaturLTN
Other Agency Review or Permit Required Review or Receip
Florida Dept of Environmental protection °f Permit Verifietl B Date
Florida Dept.of Transportation
St Jahns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division ofAlcohdic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: rr��,,,,
(Circle ane.) J�I,APProved.
Comments: Denied.
BUILDING
'LANNING g ZONING I
TREE ADMIN. Reviewed by: / (�f
Second Review: �i Date:..t�
PUBLIC WORKS Comments: ❑proved as revised. QDenied.
PUBLIC UTILITIES
PUBLIC SAFETY
Reviewed by:
FIRE SERVICES third Review: Date:
Approved as revised
Denied.
Reviewed by:
Date:
tone/to ��
City of Atlantic Beach
tc�rvE
Building Department R4 2 U DIm
UMBER
800 Seminole Road {� ., ?QjJr ing Department.)
Atlantic Beach, Florida 32233-5445
Phone(904)217-6626 . Fax(904)247-584..5 E-mail: building-dept@coab.usCityweb-Site: http//w coab.us
APPUC ATION REVIEW AND TRACKING FORM
Propei%y Address: J" -` - Department review required yes No
Applicant: !, I-,Vl£00,
Planning&Zo "
project: Tee Administrator
ublic we
'V� I. ' u lic Utilities J A y Public Safety
/ rtn�r Fire Services
Review fee $ 2f Dept Signature f Z
Other Agency Review or permit Required Review or Receipt
Flonda Dept.of Environmental Protection of permit Verified By Date
Florida Dept.of Transportation
SL Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review:
(Circe one.) Comments: Approved. QDenied.
BUILDING
PLANNING&ZONING
TREE ADMIN.
Reviewed by: t♦�,r.�i
Date.
^
Second Review: QApproved as revised —
C WOR omments:
OUQDenied_
BBL�LIC L TILITIESS
p[TBLIC-2zi ETY'
Reviewed by:
FIRE SERVICES Third Review; Dafe:
QApprovetl as revised. --
Comments: QDenietl.
Reviewed by:
Date:
+sea mnnao
�_
City of Atlantic Beach �Wy1 " C`
By �1p�S APPLICATION NUMBER
\I 8uilding Department
00 Seminole Road (io be assigned by the Building Department.)
- "" -- ./ Atlantic 8each, Florida 32233-5445 Lt
j - Phone(g04)247-SSN> Fax(90q)247-Sg45 /�r N
E-mail: building-dept@coah.us Irr
City web-site: ht(o://www coah us bate routed:
APPUCATON REVIEW AND TRA
CK@NG FORM
Property Address:
�1., ,p V' T
en4 review required yes NoApyalicant: /�/�1 ��^ &ZoPPOjeCt: ? inistratoroI AlitiesW fetycesReview fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt
Florida Dept.of Environmental protection of Permit yenfied By Date
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:
APPI lC 4 PON STATUS
Reviewing Department First Review: Lr�5
(Circle one.) LJAPproved. .ODenied
Comments: � /j
BUILDING ,fee Aw .0
'LANNING&ZONING •�IIKKKK
TREE ADMIN. Reviewed by:
Second Review: ❑ADate:
PUBLIC WORKS Comments: pproved as revised. enied_
PUBLIC UTILITIES
PUBLIC SAFETY
Reviewed by:
FIRE SERVICES Third Review: Date:
Approved as revised.
Comments: Denied.
Reviewed by:
Date:
107/27/10 - �
I