1390 BEGONIA ST - DECK s- `:? .City of Atlantic Beach
js'. '" APPLICATION NUMBER
a , • ;'+�� Building Department
(To be assigned by the Building Department.)
`-','Vi p 800 Seminole Road
s, / d� - � 7
�� ,.. - �r Atlantic Beach, Florida 32233 5445
Phone(904)247-5826 • Fax(904)247-5845 Q
�6;; I.P. E-mail: building-dept@coab.us Date routed: 2- /(//!' •
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
•
Property Address: /c? / el , ,tl,9€M/a... Jr D_._ment review required Yes No
Applicant: �Planning &Zonin•, _-
I sec AnIffirnsirator
Project: Public Works
Public Utilities
Public Safety
Fire Services
;Review fee $ Dept Signature
•
Other Agency Review or Permit Required Review or Receipt
of Permit Verified By Date
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: Approved. ['Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by:Ai:NI..1/�i- Date:171t-17/;
TREE ADMIN.
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:
ised 07/27/10 i
I
;;s�=L`lr,�, City of Atlantic Beach APPLICATION NUMBER
�s Building Department
, ,`i 800 Seminole Road (To be assigned by the Building Department.)
... ,_s, /l -/J - z 7
s Atlantic Beach, Florida Fax 5445
Phone(904)247-5826 • Fax(904)247-5845 Q
'`� �;;;>%' Email: building dept @coab.us Date routed: 2- �(/
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: /ci / a , , e D/viet. cz D- • . ment review required YeyNo
Applicant: Uit)77 64- Planning &Zonino
1 ie�AZSPPf tnthrator
Project: re L1 L 2 E C R.- 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: •
APPLICATION STATUS
Reviewing Department First Review: Ilil'Approved. ❑Denied.
(Circle one.) Comments:
BUILDING L) (-1- 7
PLANNING & ZONING
Reviewed by: i Date: (91/9//6
TREE ADMIN. Second Review: ❑Approved as revised. ['Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: DApproved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
I
INSPECTIONS REQUIRED FOR PERMITS
To verify compliance with building codes,inspection of the work authorized at various points of the construction are required.The following
inspections are typically for residential projects.
Date: Initial: Date: Initial:
Power Pole Swimming Pool Steel
Swimming Pool Safety
Piers Electrical Grounding&Bonding
Underground Plumbing When the pool and deck steel is in place but before it is covered.
Underground Electric
Swimming Pool Final
Foundation/Footing
Slab Additional Inspections may apply to your project,if your project
Retaining Wall Footing contains these elements.
Formed Columns/Beams
Rough Electric
When forms and reinforcing steel, anchor bolts, sleeves, and inserts, and all
Rough Plumbing/Top Out electrical,plumbing,and mechanical work is in place,but before concrete is placed.
Rough Mechanical
1
When all rough electric,plumbing,mechanical are complete but before any work is Structural Steel -
covered up. 'When all structural steel members are in place and all connections are complete.but
before such work is covered or concealed.
House Wrap
Tie-down Framing Connections Z .... 1::::::EneyS
Wall Sheathing ,em,it l;pe
Rough Framing
Roof Sheathing , 'rS.1--UP.,
Roofing In Progress Js '�
Window Installation-Door ;'� �r
, rte
Insulation Ceiling tij("319`�
Insulation Wall l 4
27
Peru No.
Exterior Lath
Scratch Coat
13`)D 13EGOttik
,toe Address
Drywall/Tile Backer Board ow t �..
'When all wallboard is in place but before joints are taped and finished. Contractor
Early Power
POST THIS CARD WITH PERMITS
Gas Rough IN FRONT OF BUILDING
Gas Final Inspection Line:904-247-5814
'When all gas piping is complete and wallboard is installed but before gas is attached to Must Call By 4PM Previous Day
any appliance.All outlets must be capped and pipe pressurized at a minimum of 15 lbs.
Building Department Fire Department
Phone:904-247-5826 Phone:904-630-4789
Final Plumbing Fax:904-247-5845 Fax:904-630-4203
Final Electrical
Final HVAC Public Works/Public Utilities
Phone:904-247-5834
Final Building Fax:904-247-5843
CC Final Construction Hours per City Code
When all construction work including electrical,plumbing,and mechanical,exterior finish 7 am-7 pm Weekdays
grading,required paving,and landscaping are complete and the building is ready for 9 am-7 pm Weekends
occupancy but before being occupied.
1 ti
ti ik, _,,; -ti CITY OF ATLANTIC BEACH
5''' ' �r I�%WNER / BUILDER AFFIDAVIT
ua sf
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. TIE 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 Lti.
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING rr�
MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. �1 E
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR a c
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT y
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT = L•�•+
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS 0.,
YOUR RESPONSIBILITY TO MAKE SURE TIIAT PEOPLE EMPLOYED BY YOU HAVE 0 Z ( )
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING tliI 7
ORDINANCES. a Z Illo
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIR E,0 Cl)
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE d
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. W
0
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE Z
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN J V Q ,,
OWNER-BUILDER PERMIT. z
139 O gegon i o� r e 8 u�
ADDRESS J S� �° + 904.251'-ZS°� ( o m o . Q
I PHONE NUMBER W U QQ O
or ck S 00 00 z o
PRINT E
2 Vg �
SIGNATURE DATE ^' _I Q
cc Q l"
Before me this f(/ day of �LZ 20 i the county of 0 O a Q
ILI m
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that W UI ( W
all statements and declarations are true and accurate.
Notary Public at Large,State of ,County of
W V N W W
; Q ELI
Personally Known W 5
W
roduced Identificalion / _Is=�/ 2 - 4 9 g - 6 Q .
Notary Signature:_
trAlliffir, Po Notary=p ,. Public State of Florida
Shirley L Graham
•
F:BLDG/Owner-BuilderAf-adavitREVISED:4/16/200'
411■ y'- y Commission
/2018 086990
Hof Aoa Expires 02/14/2018
40•dY"h
•
MAP SHOWING SURVEY OF
LOT 1, BLOCK 220, ALTANTIC BEACH SECTION "H", ACCORDING TO THE PLAT THEREOF
RECORDED IN PLAT BOOK 18 PAGE 34, OF THE CURRENT PUBLIC RECORDS OF DUVAL
COUNTY, FLORIDA.
CERTIFIED TO: DALE A. THORLAKSON, JACQUELINE L. THORLAKSON
EVERBANK ISAOA/ATIMA
GUARDIAN TITLE &. TRUST, INC.
CHICAGO TITLE INSURANCE COMPANY r
1 U- oc Z
k p ®
FND. CONC MOM MITERED Qa
--x x (NO I.D.) W r '
.'8't DITCH 1— Ili
O N �
Rev' wad and Appreved Rev,rewed and Anrnved
077- /y i
x sUt-6 a.„---J-Arzzet,.—Acv--.
WEST 14 h -STREET I C.)
(50.0 FOOT RIGHT–OF–WAY) I < r Z Q
(NOT PAVED) ` - O
o W
E—A=
FD. 1/2'IRON +`
o (LB 5231)(RISET) 102.00' &.. J
B.s~ Sr-> 3' CONC WALK o d aye N f
�'�' 26` � T' , ` 13' 20.2' �v
' � /13 : 21.9'
.�
Cr) '1 tV 1V w n . 4'4' 4 .4 d
`1 ® "i . r
15.6 m - �h•
N '` n a 13.5' 1 ID s CONCRETE..' , ♦• - 'V..I � E-,r
6.2'
"' EE; 'a DRIVEWAY 4 a • :i ti W 3
a
..'
J p 0
07 f\ 2.5' rn M < U)
• C cp p
H E
F– \ >- a AD n o
O 6 N z O
$G 13.0' F Z!n 0 1<
o o
3' W o
ao `\
NZh N ;r n o ale ih N CON 21.8'
- 112 I
W
22.7' 20.5' a
J �u74..: ,�01 a ,)
90.19' 0ry
i N , . n? 4.
9 FD. 1/2" IRON 1.51.\1 X x x— 102.00'—x x x
(LB 5231)
l'i n I 1.1 19.0' FD. 1/2' IRON
(RLS 3129)
AMENDED: DECEMBER 15, 2015.
FOR REFERENCE SEE SURVEYS BY: ECK LAND SURVEYORS, INC
W.O.#13-214; DATED 12/4/13 AND W.O.#15-194-2; DATED 9/23/15.
LEGEND; '
❑ CONCRETE MONUMENT ECK LAND SURVEYORS, INC.
o IRON PIPE OR ROD
1660 EMERSON STREET
0/E OVERHEAD ELECTRIC JACKSONVILLE, FLORIDA 32207
(904) 396-6334
Oft OVERHEAD TELEPHONE FAX (904) 396-9997
X CROSS–CUT IN CONCRETE
FENCE
GENERAL NOTES; C.Trklf:.#,/el
As best determined from an 1. This is a: Boundary survey. e r-�
inspection of Flood Insurance Rate 2. Noi abstract of Title furnished. LOUIS J. EVERETT
Map: 120075 0408 H 3. Not abstracted for easements. Not valid unless Surveyor's Certiilccio No. 4099
doted 6-3-13, the lands/house 4. Basis of Bearings: N/A Officio! Seal is embossed Professional Sirvayors&Mappers
surveyed lie in Zone 'X' do 'AE". hereon. State of Florida
SCALE: 1"=20' DATA 12-4-15 FIELD BOOK L.L. PAGE DRAFTSMAN; J A B ORDER # 15-276 — A
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904) 247-5845
Job Address: /390 • 6 n a- 512- Permit Number:
Leg al Description 4 I I 1a e.,-/e-/e Z? ..Se.e Ile Al Parcel#
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$ 3/(/Z. 0 a Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition CAlteratio) Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial ,-- '• , '.
i
If an existing structure, is a fire sprinkler system installed? (Circle one): ' - o
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed: ., ,./L. ,i9 c/r./L.1.%J' /}-0-7A G
11/al/,:y er, .ti'il- - ._,. ..W__,_, d4 ir711-- r✓eo
Property Owner Information:
Name: et//4 - l , /5 � A Address: /3 > s•' r►� 5/.
City /a n A z.. / 4./ -- State Zip ,327 3 3 Phone -o ' - Zr 9 751
E-Mail or Fax#(Optional) /Aar/4A-50,. J I7 (2 q/rt At/ • e e)v1-•-
Contractor Information: `l
Company Name:Alt I. f A • Qual.' in Age
: •A • • A I
Address: . � ������—_ u ity .Nc ci W— MarE 3
•lL
Office Phone ' O T' J e, 'rte/Co Tr Numb- MIIMMORIV Fax
State Certification/Regi'ation# V V r UMW •
Architect Name&Phone#
Engineer's Name&Phone# /
Fee Simple Title Holder Name and Address A ��rA_____
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 if 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 ElectricalPWork,Plumbing,Signs, Wells, Pools, Furnaces, 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.
(hereb certify that I have read and examined this a placation and know the same to be true and correct. All provisions of laws and ordinances governing this
!ype of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
,rovisions of any other federal,state, or local law regulating construction or the performance of construction.
signature of Owner Signature of Contractor _ A, —....a
?rant Name _ el.
ov 10,-k O n Print Name N,ey\ l'kol ne
;worn to and subsc 'bed before me Sworn to and subscribed before me
lass M(Q Day of m..i '.0 V ,20110 this/( , Day of, - re.i .4 ,20/4
Mt"' ag
ary Public "% notary Public soaeiatFie. i t. Public Jackie Ttodakson•• Air • CA:056a Dwane IMF 953809 ,. : D‘ My Canmission FF 927215
w Expine02l232020 Sei at►114019
CITY OF ATLANTIC BEACH
800 SEMINOLE RD
ATLANTIC BEAC,FL 32233
CITY OF ATLANTIC BEACH 03,02;2016 14:58:31
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233 CREDIT CARD
PHONE (904) 247-5855 VISA SALE
Cashier Id: aspcust\atlbbia Card u XX)00000 0(XX4040
Receipt Date: 3/2/2016 2:58:44 PM 8
Receipt Number: 05-64337 SEQ#:
Batch R: 76
Job ID: 16-DECK-427 - PORCH DECK PC - PLAN INVOICE 8
CHECK FEES $32.91
Approval Code: 035834
Job ID: 16-DECK-427 - PORCH DECK BLDGFEE - Entry Method: Mil
BUILDING PERMIT FEE $65.81 ghlrhe
Mode:
Job ID: 16-DECK-427 - PORCH DECK DC - STAT Card Code: M
E DCA SURCHARGE $2.00
Job ID: 16-DECK-427 - PORCH DECK SS - STAT SALE AMOUNT $102.72
E DBPR SURCHARGE $2.00
Amount Due: $102.72
Tender Information: Cash $102.72
Tender Type: CC CUSTOMER COPY
Tender Amount: $102.72
Change Due: $0.00