Mayport Road 1480 (3) BUI]LDING PERmff APPLicATION
CffY OF ATLANTic BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845
Job Address: M lbea-c� Me/ Permit Number. /A,--
Legal Description 1(0-2-5--49 E 01P, P 1(03 Parcel# %j 0- 10 0'?-
q
q
ilk S '
Valuation of Work$-2-2-1 000 70roornsreeda Wo'ork Sh d/cooled n(�n-heated/coole
Class of Work(circle one): Now Addition Alteration (E) Move Demolition pool/spa window/door
Use of e?Lkting(prof:,ed structu=(drcle one): Commercial 112� N/A
If an esisting struc e,is a fire spir kler system installed?(Circle one)- Is
Florida Product Approval#... .NIA.
For multiple products use pro u—ct approval form
Descp'be'm detail t4e type of work to be performed:Reqlace 62c� 6arAsarJ tutlln% on
2P-" a h j 3 Ud f 100 0-f # A
Property Owner Inforumflon:
Name:shocecrd coido kssoc. Address: 1%21, GeW, Ave,
City 1k*t0LhTtG beac-h -statcE&zijp 3ZL3-3 Phone—Li4q x 59!9
E-Maif or Fax#(Optional
Contractor Informadow.
Company Name: vk%Ta' Quali ingA t- sco*Lam rfo&I
Address:S. city Tta)L 94cK -Styte FL Zip -37-7-SO
Office Phone 1�� 1!9 t4(3 Job Site/Contact Number Fax# ICA to
State Cerfification/Regis tion# C-!e?C- !25194W- 1
Architect Nawmne&Phon # ki0memyl patrt�es 9(97--CP3kPR
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 apermit to do the work and instaRations as in&cated I certb5,that no work or installation Aax commencedprior to the
issuance of apermil and that all work W11 be e edto meet the standar,*ofafl laws regulating construction in zhisjurisikedon. Thispermabicomes null
'd d� abandonedfor weriodorshvi,6)monda at any time afier
'�- if*,brk mewed wthin six(6 months,or if consirswiton or"iork:' naft or
's no'— "w
ark a
nced I understand that separate permits must be securedfor Eke PhmbW Signs dU Pbafs wwaces Boders Hea&rs
Tamb andA&ConMoners,ete-
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 YOM NOTICE OF
COMMENCEMENT.
I ha�y cer161 re acamined this a"ficafton the same to be true and corred.Allpromons
to 84k=jV-f7 n this
t
y
"pe ZI rs- I in or ru. .2�g tin aArm4=not pres e I C=5 the
ru h;�e�
P. - ary -98, a 00 c (t coon. um
Signature of Owner Signature of Contractor
Print Name ('54 int Name
-� &
Sworn to and subscti ed afol-e me Sworn to and subscriked before me
this Day of e---o 12&--.— 20 tO this --?,Day of z2lr� 20 to
D
N N�ot�aryy
_Revised 01.26.10
0 JASON DRACH
t y P Lj4 JASON DRACH
state of Florida Notarypublic.$let#a,
Notary�fublic
My Comm. Expires Aug 0,1014
my Comm Expires Aug 9,2014
1"OF FLCR
Commission # EE 14543 now" Commission#EE 14643
R]EVIEWED FOR CODE COMPLIANCE
CITY OF ATLANTIC BEACH
SEE PERMITS FOR ADDITIONAL
REQUIREMENTS AND CONDITIONS. FILE COPY
LREVIE BY:
_f�D 5z DATE:
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road /.2
Atlantic Beach, Florida 32233-5445
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: -Department review required Y No
Buildi
Applicant: Planning &Zoning
Tree Administrator
Project: �yj,0/_b'4 11&0Lf9&F- -5�; el Public Works
—Public Utilities
Public Safety
Fire Services
-'a """A
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 rApproved. E:]Denied.
(Circle one.) Comments:
q��)
PLANNING &ZONING Reviewed by: Date:_Lo—k—o
TREE ADMIN. Second Review: FlApproved as revised. F—IDenvied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: DApproved as revised. FIDenied.
Comments:
Reviewed by: Date:
Revised 05/14/09
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
'F4 ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 04-00029373 Date 12/14/04
Property Address . . . . . . 330 COUNTRY CLUB LN
Tenant nbr, name . . . . . . BLK ALUMINUM PRIVACY FNCE
Application description . . . FENCE PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 7000
Owner Contractor
------------------------ ------------------------
DRAYTON, CHARLES F. DUVAL FENCE
330 COUNTRY CLUB LANE 11556-2 PHILLIPS HWY.
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32256
(904) 318-5176 (904) 260-4747
----------------------------------------------------------------------------
Permit . . . . . . FENCE PERMIT
Additional desc . .
Permit Fee . . . . 35 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 35 . 00 35 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 35 . 00 35 . 00 . 00 . 00
PERmrr Ls APPRovED oNLY iN AccoRDANcE wnu m.L CM OF ATLANnC BFACH ORDINANcEs AND Dm FLORMA
BUILDINY,QODES.
9 IL A%
BURMING OFFICLAL
CITY OF ATLANTIC BEACH
0ff,
FENCE PERMIT APPLICATION,
A� Date, 0 L4
Job Address: Ck kt� L-',�
Owner'sName:_ CIL)J-11�, �a rl_
Address: CIL-S e— 0 -_� Phone:
Legal Description: Block Number: Lot Number: Zoning Distrimse(vr,
Fence Contractor: C
Address: J>S R" LAJ �_j Phone: C�,
city: State: Z* 3 a7iro Fax: 426 0 4aS-�6
Type of fence and materials to be used: C_tc 0
Vek c
Valuation Of Fence: otgo F_�_terior Lot Comer Lot El Dumpster or storage tank enclosure
Is approval of Homeowner's Association or other private entity required? /\) 0 If yes,please submit with this application.
Tree Protection: 2'_N�0 Applicant certifies that no trees will be removed for the installation of this fence.
F�YES. Removal of Protected Trees will be required for this fence. TREE REMOVAL PER-MIT 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 movide all information as appropriate
Incomplete applications may result in delay in issuance of permit.
1. Attach copy of property survey showing location, height and all distances from property tines of the proposed
fence. (Fences shall not be placed within any utility or drainage easements without written permission from the
Utility and/or Public Works Departments. Fences shall not restrict any private easement.)
Address and contact information of person to receive all lcorrespondence re arding this application(please print).
Name: Ck�_� (cs nce r
Mailing Address: ca)
Phone: tFax: _� '—�_3(0) E-Mail:
800 Seminole Road -Atlantic Beach,Florida 32233-5445
Page 1 Phone: (904)247-5800 - Fax: (904)247-5845 - http://www.ci.atlantic-beach.fl.us Revised 3/04/04
LOT 4
1b
FOUND 3/4' IRON
PIPE (NO CAP)
City of Atlantic Beach
pwv am Zoning Dowknd
rAb --fm 9 somplava vft appomme
LOT 3 zoning, lvist" OW otlw local land
bd does#W constituto
bt of owinits. Conviianos
Iwo flofts&Aftv Code am ON cow applic"
local. suft ww i4ftw—menrAft fewroments
w4M be m by sionshn Of ow city of mantle
efteoch Du�k�**.=ww Is m"Of 0
911111WAV
Appwad 9r.
j V
-H
DEC 0 7 2004
BY�
THIS SURVEY WAS MADE FOR THE BENEFIT OF
CHARLES F. DRAYTON; AMSOUTH BANK; OLD
REPUBLIC NATIONAL TITLE INSURANCE
COMPANY; AND FISHER, TOUSEY, LEAS &
BALL, P.A.
DOR-W. BOATWRIGHT, P.S.M.
FLORIDA LIC. SURVEYOR and MAPPER No. LS 3295
MMOINA I 11� a- .. — ----
FENCE POST 0.7'
ON CORNER
0.6'
ol
Jb A:)
0 A
LOT 9
FOUND 3/4- IRON
PIPE (NO CAP)
NOTES:
1. THIS IS A BOUNDARY SURVEY.
2. BEARINGS BASED ON NORTHERLY LINE OF LOT 6 BEING
N89*20'10*E PER PLAT.
3. THERE IS A 30' BUILDING RESTRIC11ON LINE AS SHOWN
PER PLAT.
THE PROPERTY SHOWN HEREON LIES IN FLOOD
ZONE 'Y' (AREA OUTSIDE 500 YEAR FLOOD
PLAIN) AS DETERMINED FROM THE FLOOD
INSURANCE RATE MAP, COMMUNITY PANEL
NUMBER 120075 0001 D, REVISED APRIL 17,
1989 FOR ATLANTIC BEACH, FLORIDA.
IOT VALID WITHOUT THE SIGNATURE AND THE
�IGINAL RAISED SEAL OF A FLORIDA LICENSED
JRVEYOR AND MAPPER.-
ECKM BY: LE-2004-1258�LDR A YMM4 8 Y-. i C i BOATWRIGHT LAND SURVEYORS, Inc. 1500 ROBE
i'AJ �4
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
''r
Application Number . . . . . 04-00029394 Date 12/14/04
Property Address . . . . . . 330 COUNTRY CLUB LN
Tenant nbr, name . . . . . . IRRIGATION SYSTEM
Application description . . . IRRIGATION/SPRINKLER
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . . 0
Owner Contractor
------------------------ ------------------------
DRAYTON, CHUCK HULIHAN TERRITORY
330 COUNTRY CLUB LANE P.O. BOX 331268
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 318-5176 (904) 285-8505
----------------------------------------------------------------------------
Permit PLUMBING PERMIT
Additional desc . .
Permit Fee . . . . 50 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 50 . 00 50 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 50 . 00 50 . 00 . 00 . 00
PERMrF IS APPROVED ONLY IN ACCORDANCE WrM ALL MY OF ATLANIIC AND FLORIDA
BUILDIN4NES.
It It
400%.-
BUILDING OFFICIAL