1480 JASMINE ST - PERGOLA 1 ��'� CITY OF ATLANTIC BEACH
S�
9f 800 SEMINOLE ROAD
k " ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
�F31�r
RESIDENTIAL ADDITION
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-RADD-2406
Job Type: RESIDENTIAL ADDITION
Description: PERGOLA
Estimated Value: $650.00
Issue Date: 10/26/2015
Expiration Date: 4/23/2016
PROPERTY ADDRESS:
Address: 1480 JASMINE ST
RE Number: 171081-0000
PROPERTY OWNER:
Name: DEMEO, JENNIFER
Address: 1480 JASMINE ST
PERMIT INFORMATION:
FEES:
BUILDING PERMIT FEE $55.00
PLAN CHECK FEES $27.50
STATE DBPR SURCHARGE $2.00
STATE DCA SURCHARGE $2.00
Total Payments: $86.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
•
•
•
•
NORTHWEST CORNER (L&
OF BLOCK 250
SCALE: 1" = 20' o
B L O C K 2 5 1
1 1,-;
LOT 1 0
LOT 4 lOT 3 LOT 2 to
0
vi
N.01 17'06"W. 49.85' N.01'13'39"W. 50.24' N.0117'11.'141. (NO I.D.),
(LB.(1674) (50' PER PLA )�z (LB. X674) (50' PER PLAT) (NO I.D.) 27.36'
w
11.0' —4 l e="` e.S
*Po IS wloc :�.� o�z
1 1.0' J O E 10,0, 16.9 a___e
DEEP f our Fz :ail ' coa1C.• 3.5'
v
j 5.5 FRuM 22.3'
BACK FENCE •
I INE. Nu}cekctie In .
W co
hcUSc. U
Z 11 N ^
O > > � n J p >
N 0 CC I Li I ' 0_ Cpl th -�-�
O w p
p ¢ i- wQ ¢ ccc.i N p
_l o.• --' O a3 M I- Z
CL `t• ZO O CV O Z
09 c5 O I- Lr.l J
o N w o . o vi �. O -� o•
-J N C- 00 o 3' L 7 J
CO CC
IN 2 0� L2 vi
tl(. ao W
c0
((n 1041 10 ' Z
O
10.5 N
f.9. 3' 3111
kc1Ot
.. . .
I •
, cox.. .
3 12.8' . • colic.••' .
o NORTHEAST CORNER
-4 • • oRi✓E
92.,c- � c, n iiiiiiri� W of�N�Stc H OF BLOCK 250 ." /
(50' 'ER- AT •: .. i . o
• 0 . 6'45"E. 5 .00; uco�TA1 )
V__ ----- 1/0"— ---- i
?r0_Med a
in Extsttvl5
i. JASMINE ST ._ ( 50 ' R / W ) � _
0 5 10 20 40 60 8(
G R A P H I C S C A L E
,-i"\:�ice; City of Atlantic Beach APPLICATION NUMBER
' s ; Building Department (To be assigned by the Building Depart ent.)
w-- 2 800 Seminole Road n
91';-M r� Atlantic Beach, Florida 32233-5445 /� ���� - d a�
\� Phone(904)247-5826 . Fax(904) 247-5845
,;; 4/51/..c t�:- E-mail: building-dept @coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1'/to JArlY)èf) E. Department review required I Yes o_
: . ..
Applicant: 0 tv -4 tie- -lanning &Zoning
ree ' •mi - '-
Project: ig.9 d Li Public Works
/ Public Utilities
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:
APPLI ATION STATUS
Reviewing Department First Review: Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed by: Date: /0 wI 3 •1,,c-
TREE A . Second Review: ['Approved 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 07/27/10
7 S i cc;,i,fn
-' ' ` ' CITY OF ATLANTIC BEACH
\ OWNER / BUILDER AFFIDAVIT
j
I. FLORIDA STATUTES; 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 'DIKE
LAW. THE EXEMPTION ALLOWS YOU, AS THE OWNER OF YOUR PROPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN TI-IOUGI-I 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 NOW
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 LICENSES
ORDINANCES.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
III. 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(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.
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.
.111R20 Uasm;ne Sffeel A‘ tc 3,1;33 90 ./ - yid- ?,QV U
ADDRESS PHONE NUMBER
n / /,{
PINT NAME
l ^ 44 ' A 0 / .,� [0 - t3 - 1_5
.1-NATURE , DATE
13'efore me this/2. day of 0&r - ,206 in the county of
Duval,State of ida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of ,County of Y W
❑Pe�rsonally d Known �/ /�
L�Prouced Identification- _ (� �(�
• zci , 6
• Notary Signature: 61 ^ V
649RYPPt. Notary Public State of Florida
Shirley Graham
I'/n LDC✓OswmrDuild:,Affidavit;REVISED:0/IriP_009 �' y
�t C: , My Commission FF 086990
(op A41" ClyuvS02/14rzu I
csra -�fo RE Put�Pc sro - RAGS o� ��
°FrE2s 3 -�- = AT �ilcK �x�
�a■cKz of 4�tcrccQETE
is 2ti' �i : "Co A �YcK c icQEYE PRESS�'1LE iV.€j P
/ ,f.(E29
H tom post-.
23w W ..
22" /1 .1 a i,
�' X Ib XlZ
1 / 1�
•3 edvAs oc iO4g5 y 6 t ,.F t pY:R 3k Icic tP`car
CF QuiC�CCQE'fE � ,--v Co is i d:Z VI=.. D
� S�,SCK ;:,,,D 320 ua fR cTEi. ^�k
1. co i:ErE 6,6
�1 t+ c,,y c2ETE fArlo
At-IEtiNa1v4" pA
f S U t-T iN1., 1 tS -
con-1.042 9c6r. L u......,
IN CkSo _7 �,.+ ,—ett/S
of' cnx-Xi.* rL rf±/s
�\ ter'
ami beIc
s,c!.4,T;?, City of Atlantic Beach APPLICATION NUMBER
`at : O • � Building Department (To be assigned by the Building Department.)
;-:,• 800 Seminole Road iglial) ��d�
r Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
„�; 9.- E-mail: building-dept @coab.us Date routed: 4/4-7/5-
(l/�/f5-
City web-site: http://www.coab.us J /
APPLICATION REVIEW AND TRACKING FORM
Property Address: Jtö Ji D- • - r ment review required Yes No
: • .•.._
Applicant: 0 & '7) £� 'tanning &Zoning
ree ' •mi -
Project: E.g.7 B L q Public Works
P • '
Review fee $ Dept Signature ' I\, 4 . ; CSC
Other Agency Review or Permit Required Review of
of Permit V \IN S
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: nApproved. Denied.
(Circle one.) Comments: fee, A.1444GZ.A1
BUILDING
PLANNING &ZONING /L /~'
Reviewed by: , �/'�'` / Date: O
TREE ADMIN.
Second Review: gApproved as revised. nDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:d/...,,,���_/ Date:
FIRE SERVICES Third Review: nApproved as revised. nDenied.
Comments:
Reviewed by: Date:
Revised 07/27/10
r •
BUILDING PERMIT APPLICATION OFFICE COPY
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904)247-5845
Job Address: i eiv) sitcov/ie st,it X9.3 ft 34133 Permit Number: /S 'R O
Legal Description 7 DLO • Parcel #
Floor Area of Sq.F . t
Valuation of Work$ &5p-- Proposed Work heated/cooled / non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A
Florida Product Approval#
For multiple products use product a pprova form
Describe in detail the type of work to be performed: tWe� a 10-f A- by 1/ u,f. �/' o k ,eje 1lail
/loci se Pa+ 4FIc-,� -iv hoe i .ft s1 - reti evr/frr 5./ ..2rvre� 4)144 y.a /�tdf o4 C-f cfek c."41,)
rlcb.s
Property Owner Information:
,
Cc Name: S-e n n,Cr, ke.rlig v f Address: Pied 6) .ctSvh 4 a -
City 44-1-t PA-le .t7PaS Statea,Zip Z 3> Phone 7d4/ • 'AZ -gQ r/c/
E-Mail or Fax#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: Qualifying Agent:
Address: City ate Zip
Office Phone Job Site/Contact Number #
State Certification/Registration# ,�/1
Architect Name&Phone# a '`Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations as indicated I certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void f work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a_period of six(6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools, urnaces,Boilers,Heaters,
Tanks and Air Conditioners,etc.
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 YOUR NOTICE OF
COMMENCEMENT.
I hereby cert fy that I have read and examined this placation and know the same to be true and correct. All provisions laws and ordinances governing this
type ofYwork will be complied with whether specified herein or not. The granti of ng of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,state, or local law regulating construction or the performance of construction.
.
L/Sig re of Owner .Jti� � � J J ; Signature of Contractor
Print Name ,/' 1 ' %�
6 1 Print Name
Befo : `' Before me
:hi d/t 4 f Q 4re ,20 this Day of ,20
b / _ . . ,
\r o a- ' bl is • °�i� Notary Public State of Florida 41 otary Public
Shirley L Graham
My Commission FF 086990 Revised 01.26.10
Na Hxpine 02/14/2018
, ,;S 1..vpr r,
'co CITY OF ATLANTIC BEACH OFFICE COPY
®WNER / BUILDER AFFIDAVIT
r IS)Y
I. FLORIDA STATUTES; 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 WITI IIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME TTIAT 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.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
III. 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(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.
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.
III
/(4270 lasm;ne 64fee-t 4‘ t� �'.a33 Qo�-1 - 4/a-89c�(
ADDRESS // PHONE NUMBER
��Y1A1 S r 'kV
P-INTNAME / /
l0 1.3 - l�
NATURE / DATE
fore me this ��day of V`�� 20/�in the county of
Duval,State of Florida,has personally appeared herin by himself!herself and affirms that
all statements and declarations are true and accurate. ^ ,/y�,
Ilij Notary Public at Large,State of ` i/,County of �[J 24-Va
❑��P��onally Known c/ �/`
La,Produced Identification- !!! (/ i{,,,)
f 2 41 -. 6
Notary Signature: (P ... i
a95°(,4 Notary Public State of Florida
F:/BLDG'Owner-Builder A6adavil,REVISED:4/16/2009 • . Shirley L Graham
'�j f My Commission FF 086990
? �J CxNnnstT2rtwr�uta
Department of Health•Vital Statue
STATE OF FLORIDA (STATE FILE NUMBER)
Recorded in Public Records
MARRIAGE RECORD 0710512012 at 03:03 PM CR
TYPE IN UPPER CASE Book 15991 Page 1383.
USE BLACK INK OFFICE COP
Clip license or not valid Court.unless seas or thereon. !nstrument#2012140350.
Circuit or County Coun.appears thereon.
Jim Fuller Clerk of the Circuit
;ourt
2012 ML 2079759 Duval County. FL
;APPLICATION NUMBER)
APPLICATION TO MARRY 2.DATE OF BIRTH(Month.Day,Year)
1. GROOM'S NAME(First.Middle,Last) 03/17/1970
ROBERT JOSEPH SCHEILDING
3b.COUNTY 13c.STATE 14.BIRTHPLACE(State or Foreign Country)
ATLANTIC BEACH H
3a.RESIDENCE-CITY,TOWN. LOCATION ; DUVAL FLORIDA NEW YORK
5b.'MAIDEN SURNAME(If different) 6.DATE OF BIRTH(Month,Day,Year)
Sa. BRIDES NAME(First Middle.Last) �
JENNIFER ANN DEMEO 1 GABLICK 09-09-1961
7b.COUNTY 7c.STATE 8.BIRTHPLACE(State or Foreign Country)
7a. RESIDENCE-CRY,TOWN,H LOCATION n (VA ! FLORIDA, PENNSYLVANIA
ATLANTIC BEACH L JAL
WE THE APPLICANTS NAMED IN THIS CERTIFICATE.EACH FOR.HIMSELF OR HERSELF.STATE THAT THE INFORMATION PROVIDED
ON THIS RECORD IS CORRECT TO THE BEST OF OUR KNOWLEDGE AND BELIEF.THAT NO LEGAL OBJECTION TO THE MARRIAGE
NOR THE ISSUANCE OF A LICENSE TO AUTHORIZE THE SAME IS KNOWN TO US ANO HEREBY APPLY FOR LICENSE TO MARRY.
0.SUBSCRIBED AND SWORN TO BEFORE ME ON(DATE) •
9.SIGNATURE OF GROOM(Sign full name usi ajofedr ink) 06/07/2012
�� ^�
SNE.cwc �1 > ),,,A.fon Ctb2
�-•oF,:..•••••/4.,,,.'><,'''s, 72.SIG ATU 0 FF,ICIAL;USSO ink/
= o }t 1. TITLE OF OFF?CIA > / //
•. •' CLERK �.� ,. u"e///
'try ;�
C-2' DEPUTY CLE � ,�
•i iv. ..:•,,, ' t4. SUBSCRIBED N ORN TD BEFORE ME ON(DATE)
,..1'.,, _,,'• 13. SIGNATURE OF BRIDE( ton/ens°Mg°tap`nk)
• > 06/07/2012
`'•r..v.. ��_�����'%u-F•i/) � � i i6.SIGN RE F FI IAL iUse !
D5. LE OF Cb FICIAL /,
UTY CLERK V\ ', An� IMteC ' �,_.,�y/ '�� ",/
• AUTHORIZATION AND UCENSE IS HEREBY GIVEN TO NYC E SON DULY AUTHORIZED BY THE LAWS OFSTATE OF FLORIDA TO PERFORM
A MARRIAGE CEREMONY WITHIN THE STATE OF FLORIDA ANO TO SOLEMNIZE THE MARRIAGE OF THE ABOVE NAMED PERSONS.THIS LICENSE MUST
BE USED ON OR AFTER THE EFFECTIVE DATE AND ON OR BEFORE THE EXPIRATION DATE IN THE STATE OF FLORIDA IN ORDER TO BE RECORDED AND VAUD.
17.COUNTY ISSUING LICENSE 18.DATE LICENSE ISSUED 18a.DATE LICENSE EFFECTIVE 19.EXPIRATION DATE
„a`p'R�o�'v 06/07/2012 06!1012012 08/09/2012 .
1 - d`S��ti c)iio��.?�P > DUVAL I � 20c.BY D.C.
1' .•.: "i 20b.TITLE
t x.1: •• 20a.SIGNATURE F COURT RK R DGE JIM FULLER CLERK OF CIRCUIT COURT kI
`:: / �-._
>BY
'< ;' CERTIFICATE OF MARRIAGE
HEREBY CERTIFY THAT THE ABOVE NAMED GROOM AND BRIDE WERE.DINED By ME IN MARRIAGE IN ACCORDANCE WITH THE LAWS OF THE STATE OF FLORIDA.
21.DATE OF MARRIAGE(Maren y ''earl ' 22.CITY,TOWN,OR LOCATION OF MARRIAGE
�E C I A r U JUL i 701 I B e a c h, 3 2 2 6 6 Neptune l� 23c.ADDRESS(Of Gerson performing ceremony)
OY\u bli%pi)� C 1J V L. v "
,7 °jJ tzar ':� 23a.''IGNA R F PERSON PE ORMING CEREMONY(UseWapc ink) I' 1543 At1 tprf B1Vd.
4
g 24.SIG TURF OF WITNESS TO CERE. QNY(use WxkrYc)
23b.NAME N T L OF SON PERFORMING CEREMONY +
.ti �q,� JEWELL �'
O/ (Or notary i �j`j et W LL ! > vrsi i. .� o
•(_QUN1y� CLERK 25.SI NATURE OF WITNESS TO CEREMONY(use Neck ink)DEPUTY
,: �.W tINE.03.111L iI.P1 E.M YfARRAWSW3 S1 A:'1I5T .AKINMAN.QAT0?BEz!?g..CORPgD ✓✓K ilea <
28.WERE YOU EVER !F ANSWER IS'YES'TO ITEM 28, HEN COMPLETE ITEMS 29a.29b and 29c
26.SOCIAL SECURITY NUMBER 27.RACE PREVIOUSLY 29a.NO OF THIS ' 29b.LAST MARRIAGE ENDED BY 29c.DATE LAST MARRIAGE ENDED
MARRIED? MARRIAGE ! (DEATH,DIVORCE OR ANNULMENT) (Mo.,Day,Year)
GROOM 215-96-8942 WHITE ' NO xYES 2 DIVORCE 04/27/2011
I
30.SOCIAL SECURITY NUMBER 31.RACE 32.WERE YOU EVER IF ANSWER IS'YES'TO ITEM 32,THEN COMPLETE ITEMS 33a,3b DATE 3:AST MARRIAGE ENDED
PREVIOUSLY 33a.NO.OF THIS 1 338.LAST MARRIAGE ENDED BY Mo..Day,Year/ `
MARRIED? MARRIAGE ;DEATH,DIVORCE OR ANNULMENT)
BRIDE WHITE NO x YES 2 DIVORCE 08/03/2005
178-58-0591 •
DH Form 743April 98(Replaces Feb.91 eo!llonl
.
1!.=Lyr)f, ZONING REVIEW COMMENTS
s ill9
J...
'' ��
City of Atlantic tlantic Beach
Building and Zoning Department
800 Seminole Road Atlantic Beach, Florida 32233-5445
4J;31�� Phone: (904) 270-1605 Fax: (904) 247-5845 Email: dreeves @coab.us
Date: 10/20/15
Permit: 15-RADD-2406 Applicant: Jennifer Scheilding, Owner
Review: 1st Address: 1480 Jasmine St,Atlantic Beach, FL 32233
Site Address: 1480 Jasmine St Phone: (904)412-8944
RE#: 171081-0000 Email: N/A
Correction Comments fill d GL/4-a-S h 0 ythe 0 de"YI
1. Site Plan: Please provide a site plan showing the location of the pergola and the distances between the
pergola and all property lines and the house.
Derek W. Reeves
Planner
dreeves @coab.us
►Ltlb
1 a 121
6.. of
Ib
Ream to:(enclose sel/addressed smm*enndope)
Noon:
Mldnm.
This lmmrnnot 1'N/wed'p: OFFICE COPY
Mark Franzoni
Xpress, Inc.
1511-B Penman Rd.
Jacksonville Beach, FL 32250
Property Appraiser's Parcel Identification (Folio) Number(s) : 171081-0000
THIS QUITCLAIM DEED, Executed on October 12, 2015, by
JENNIFER DEMEO
first party, to JENNIFER SCHEILDING
whose post office addresses are 1480 JASMINE ST.
ATLANTIC BEACH, FL 32233
second party (Wherever used herein the terms "first party" and "second party" shall include
singular and plural, heirs, legal representatives, and assigns of individuals, and
the successors and assigns of corporations, wherever the context so admits or
requires.)
WITNESSETH,That the said first party,for and in consideration the sum of$ 10 in hand paid by the second party, the
receipt whereof is hereby acknowledged, does hereby remise,release and quit-claim unto the said second party forever,all right,
title, interest, claim and demand which the said first party has in and to the following described lot, piece or parcel of land,
situate, lying and being in the County of DUVAL, State of FLORIDA, to-wit:
LOT 3, BLOCK 250, SECTION H, ATLANTIC BEACH A SUBDIVISION
ACCORDING TO THE PLAT THEREOF RECORDED AT PLAT BOOK 18, PAGE
34, IN THE PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
SUBJECT TO COVENANTS, EASEMENTS AND RESTRICTIONS OF RECORD.
To Have and to Hold The same together with all and singular the appurtenances thereunto belonging or in anywise appertaining,
and all the estate,right, title, interest, lien,equity and claim whatsoever of the said first party,either in law or equity, to the only proper
use, benefit and behoof of the said second party forever.
In Witness Whereof The said first party has signed and sealed these presents the day and year first above written.
Signed,sealed and delivered in the presence ofi _
Si,0., a,,, 0 .4.4 / L. _
urs s .
Witness Si sure(as to First Grantor) , �� !/1
- aa� i i nrFFr che�� I L ---
edNane ` Prime! 60 V U !it �f_ �f ire C�
IF
1(,)t.A...i.
(i/ 4l 1 "T
Witness unsure(as to First Gran n) Post^1s e Address / J l ?�
u.r01. re. 11r/�Yll�;C P_C{G� C, ORd�3
Printed Name OD,State and Zip Code
STATE OF FLORIDA
COUNTY OF DUVAL
I hereby certify that on this day, before me, an officer duly
authorized to administer oaths and take acknowledgements, personally appeared JENNIFER SCHEILDING,
known to me to be the person described in and who executed the foregoing instrument, who acknowledged before me
that she executed the same, that I relied upon the following form of identification of the above named persons:
V L)L. and that an oath was not taken.
NOTARY RUBBER STAN SEAL Witness my hand and official seal in the County and State last
aforesaid on October 12, 2015.
•rzn4.„UAN ITA LOFTIN / — iNotary Public-State of Florida• My Comm.Expires Oct 30,201e ary Signature
-.,,,�, P�= Commission 0 FF 173201 ✓
•',,o,,,,, Banded through National Notary Ann.
Doc#2015233698,OR BK 17332 Page 533,
Number Pages:1
Recorded 10/12/2015 at 09:33 AM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING$10.00
DEED DOC ST $0.70