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157 BELVEDERE ST - SCREEN ROOM !_ ,'S CITY OF ATLANTIC BEACH A s) 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 -f-0111S) RESIDENTIAL ADDITION MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 16-SCRN-935 Job Type: SCREENED ENCLOSURE Description: SCREENED ROOM - 10' x 12' Estimated Value: $10,000.00 Issue Date: 5/20/2016 Expiration Date: 11/16/2016 PROPERTY ADDRESS: Address: 157 BELVEDERE ST RE Number: 170584-0000 PROPERTY OWNER: Name: BURCH, ROBERT & LESLEE ANN, * Address: 157 BELVEDERE ST GENERAL CONTRACTOR INFORMATION: Name: JEP CONTRACTORS INC Address: 1416 FOREST AVE QA JOHN EWEL PEARSON, Ill Phone: - - PERMIT INFORMATION: PUBLIC WORKS: 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 Inspection prior to start of construction. All silt must remain on-site during construction. Roll off container company must be on City approved list and container cannot be placed on City Right- of-Way. (Approved: Advanced Disposal, Realco, Republic Services, Shapell's,Sunshine Recycling and Waste Pro.) Full right-of-way restoration, including sod, is required. FEES: ENG REV RESIDENTIAL BLD $100.00 PLAN CHECK FEES $50.00 BUILDING PERMIT FEE $100.00 I'ERNII'I' IS APPROVED ONLY IN ACCORDANCE WFFII AI.1. CITY OF A II,ANI'IC BEACH ORDINANCES AND 'I FLORIDA BUILDING CODES. 1-r '-; CITY OF ATLANTIC BEACH 0 800 SEMINOLE ROAD J _..};". ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 .<. -0.1-11.9:Y STATE DCA SURCHARGE $2.00 STATE DBPR SURCHARGE $2.00 Total Payments: $254.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. :Syay;.e, City of Atlantic Beach APPLICATION NUMBER � Building Department (To be assigned by the Building Department.) A - 800 Seminole Road4. CD 'r Rv -935 Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 •• Fax(904)247-5845 jV E-mail: building-dept@coab.us Date routed: Atar(7-31 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 157 i E LVE'DERE D- • . ment review required Yes No Buildin• Applicant: EP C., Plannin• &Zoning Tree-77""° Project: C RE.EliED E,K)C_LoS V aE (P ,blit Works ublic U ilities 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: ['Approved. 1ZDenied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: �G Date: l TREE ADMIN. Second Review: VlApproved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 - �"''�% ZONING REVIEW COMMENTS \J "IV .;� City of Atlantic Beach Building and Zoning Department 800 Seminole Road Atlantic Beach, Florida 32233-5445 i 0111}91'' Phone: (904)247-5826 Fax: (904) 247-5845 Email: dreeves@coab.us Date: 5/2/16 Permit: 16-SCRN-935 Applicant: JEP Contractors Review: ls` Address: 1416 Forest Ave,Neptune Beach, FL 32266 Site Address: 157 Belvedere St Phone: (904) 247-9525 RE#: 170584-0000 Email: N/A Correction Comments 0 Setbacks: Please show the distances between the proposed structure and all property lines. Tree Removal: Please submit a Tree Removal Permit Application if any trees are to be removed. If no trees are to be removed,then please fill out an Affidavit of No Tree Removal. Both forms are available U, ;,the city website under"Planning and Zoning"and at City Hall. Derek W. Reeves v.) Planner dreeves@coab.usQ" i\ ej Ad— c17 e/0 OJ c)C ©� -iya,��r City of Atlantic Beach APPLICATION NUMBER \js rt \ Building Department (To be assigned by the Building Department.) r, 800 Seminole Road 1/ —Se-R -9- ..S C R� _� si 15 V -, Atlantic Beach, Florida 32233-5445 IlD Phone(904)247-5826 • Fax(904)247-5845 a Js3 ga E-mail: building-dept@coab.us Date routed: Aiatii0 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 157 i- E LVE DERE c,_ 7 . D- . - ment review required Yes o I Buildin• n' Applicant: A EP C.,. C�t TR�\L-j O R-S ill Planning &Zoning liE , 4:: .. :. 111111=Ell Project: C RE,Ek.SED E )CL0S v 2.__S 411—P • • a •rks 4l'ublic 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: [ pproved. ❑Denied. (Circle one.) Comments: 1VO:UILDINI• PLANNING &ZONING Reviewed by: /71 f Date: 5--/6/13 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: Revised 05/14/09 -S,%,,,:,„ City of Atlantic Beach Cl'�j� APPLICATION NUMBER JS r f. `` Building Department 4PR pt.__(To be assigned by the Building Department.) ,- Si 800 Seminole Road 22 ,0/6, Sc p\` `p- ,� ,, Atlantic Beach, Florida 32233-5445 1 L(j �J Phone(904)247-5826 • Fax(904)247-5845 `:-� '��o,t >r E-mail: building-dept@coab.us ;/I Date routed: 4/Z.1 Cityweb-site: http://www.coab.us -,..2„..,/ APPLICATION REVIEW AND TRACKING FORM Property Address: 157 i ELVEt ERE, F ---r. D- • - ment review required Yes No Buildin• Applicant: A EP C,. C,1j-T�j1C j O« Planning&Zoning Tree Aim • : . Project: C c € J3ED EK)cLos v 2 C hlic:Works ublic U ilities 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 Y ��AReviewed b : � Yv✓, Date: TREE ADMIN. Second Review: ❑Approved as revised. ElDenied. j O WOR$S Comments: ' :L ' UTILTIE' P :LIC SAFE i Y Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 • BUILDING PERMIT APPLICATION • FILE COPY CITY OF ATLANTIC BEACH • r � ` C 800 Seminole Road, Atlantic Beach, FL 32233 I C-0 -SIv� -935 Office (904) 247-5826 Fax (904247- :,(6-� �•. -- h Job Address: �eYe Y � --ermit Num- xis e--e- - r Sq� S n���� er: �. Legal Description fit''h !` .s'`�c.r'�b►R Floor Area of Sq.Ft. Parcel # Valuation of Work$ t'-0170 Proposed Work heated/cooled t non-heated/cooled lz-b Class of Work(circle one): New Add 10> Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structures (circle one): Commercial esidentia'� If an existing structure,is a fire sprinler system installed? (Circle one): c✓ N/A Florida Product Approval # F4 2 Z11. I ' 1Oo/3, For multiple products use product approval-f' f orm Describe in detail the type of work to be performed:AD /d'x /a' / a� 1 �crN�v1n►y r4`L�t�s2vin Sfrt.e 7% re. it re"rn 'or�.J' _:e , ;-, AreeoLE Property Owner Information: `, Name: Rbhc'r * POUf c.L Address: 1 5 7 P e( IJ ed e_,^ e SA--- City 6 t lc.n{ : c i_ e.. .c_L Stater[ Zip 2-.133 Phone i 0 4- 5 3 - (064, 2- E-Mail or Fax#(Optional) ( f. L_ -- . t.,,l c' c-� . N, 7 Contractor Information: CONTRACTOR EMAIL ADDRESS: Company Name:)6P C c,tnt-ra e*"� , /11 Co Qualifying Agent: �/yA q r� Address: ! 1 Fc,r,-S7' Av G Office Phone Z� City/W.f. vr� )�4�4L State � Zip��‘6 T- gS2S Job Site/Contact Number,ro All Z211.- 4g32Fax# State Certification/Registration# CC‹ .0551f4..? Architect Name&Phone# Engineer's Name&Phone# HO-rt.)d WI'//i,6-r C, Fee Simple Title Holder Name and Address L � /o! g'� _3 3 3 v5 Bonding Company Name and Address � � � � �� Mortgage Lender Name and Address A issuance Application is hereby made to obtain a permit to do the work and installations as indicated. I certiAi that no work or installation has commenced prior to the and void iffwork istnot commenced withinat all work l be six performed6) onths,oo r1if construction or ofeet the standards all is suspended or abandoned for a�construction in hppt e iod of six n((6)mon hs at abecomes ctime after work is commenced. I understand that separate permits must be secured for Electrical !Fork,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. f T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions type of work will be complied with whether specs ied herein or not. The granting of a permit does not presumetogivel authority to violategorvcancel this the vrovisions of any other federal,state, or local law regulating construction or the performance of construction. 3ignatute of Owner /\ �� 4.A....-4_7(._ R. Signature of Contractor 'Tint Name U ..fir + .Uk i'Cwt �Print Name o � E ��''QrSot't� 3efore me � his -2-1- Day of & , 20 I Be ' .gip ii;';t�OIFSPERGER _ this IWOay •#�iy,; tr- „tlia�'GNaFF924951 C ES.21b Z G.�cvn ri�'�. V RTER I ohm J 1 t rotary Public e° �; = �� Notary Public-State 01 Florida Notai ublic tAtIrMy Comm.Expires Mar 30.2018 ,; r Commission 0 FF 107821 Rev,.ed 0 .26.10 Slay;.,„ City of Atlantic Beach 1:1 ---ApCI- -Pf? APPLICATION NUMBER os r ,a� Building Department ���, (To be assigned by the Building Department.) ji . v 800 Seminole Road Co��� �� Atlantic Beach, Florida 32233-544 ' - 2-; 20 'lSC R1�l` 1 Phone(904)247-5826 Fax(90 ;5845 /� • , _____ E-mail: building-dept@coab.us Date routed: 4 /Z.1 P.16—, City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 157 'i- C LVE 1-. .ERE 7 D- . - ment review required Yes No Buildin. Applicant: A EP C,. c N[R\C_T o R.S Planning&Zoning EtQc_Los Tree . . - . Project: C: REEFED V�� �,„ hlir.Works LII.. -5- 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: I tpproved. ❑Denied. (Circle one.) Comments: J4 A4 dd 40 j:irN'.( BUILDING PLANNING &ZONING Reviewed by:j44, ` 2 Date: "1,2 TREE ADMIN. Second Review: A roved as revised. ❑ pp ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 'Y1 3c1 itate /6---reief.ffr ko .f- loo X (-r1) (coot) ,elm 3©,. _z 2O,.2 C V." a _ 02- k 7? yep 11 / X 7 ` ..r'6 ivy x7/ 1---- iii,;(7t0-6.701621 f er 7 � cwoay-4 X If 01 9/7 60./kiek) a r !`f iil C-V/: _ City of Atlantic Beach AFR 2 ��� � APPLICATION NUMBER ��?, Building Department _., 0 ��16 (To be assigned by the BuildingDega��n :; ; 800 Seminole Road �' (/� Y z; Atlantic Beach, Florida 32233-5445 - Phone(904)247 5826 Fax(904)2:1;--58145171716C1_1): 47-5845 �� E-mail: building-dept@coab.us Date routed: --- 14/7)91////‘ City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: / Z itcliL Department review required Yes ? No Building Applicant: Q 1(J•)) Planning &Zoning Tree Administrator Project: Cd,ie,4 rAz:, -spy}lie c Public Works lic Utilities -{ + f i w Ayublic Sat Fire Services Review fee $ 5 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: APPL • ATION STATUS Reviewing Department First Review: Approved. ❑Denied. (Circle one.) Comments: BUILDING ) 17€‘11 PLANNING &ZONING Reviewed by: "/ Date: y(2-1-i(fr TREE ADMIN. Second Review: ❑Approved as revised. ['Denied. PJ i Q WOR S Co 1 ments: Aliw PUBLI TILITIES IN—/k PU LIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 li t CITY OF ATLANTIC BEACH CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS 1 800 Seminole Road 904-247-5800 cut Atlantic Beach,Florida 32233-5445 Fax 904-247-5845 PLEASE SUBMIT(2)COMPLETE SETS OF PLANS WITH APPLICATION. PERMIT# Date /9 /9 24)/c ISSUES BY THE CITY Job Address $73/ Qq c4 44e E-mail G/Lc-)/7`71/'7 -40_,C4-1"9-200- -1,74 Permitee: Telephone# Permitee Address: Requesting Permission to Construct: ( 1Crcj7E T E S Location: (Reference to Cross-Street) 1. Applicant declares that prior to filing this application he has ascertained the location of all existing utilities, both aerial and underground and the accurate locations are shown on the sketches. A Letter of Notification was mailed to the following Utilities/ Municipalities: Jacksonville Electric Authority Yes ( ) No ( ) Date: // Bell South Telephone Company Yes ( ) No Date: Ferrell Gas Yes( ) of ) Date: Comcast Yes ( ) No ( ) Date: 2. Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation, alteration or relocation of all, or any portion of said street or easement as determined by the Director of Public Works, any or all of said poles, wires, pipes, cables or other facilities and appurtenances authorized hereunder, shall be immediately removed from said street or easement or reset or relocated hereon as required by the Director of Public Works, and at the expense of the Permitee unless reimbursement is authorized. 3. All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the supervision of (Contractor's Project Superintendent) located at Telephone#: 4. All materials and equipment shall be subject to inspection by the Director of Public Works or his designee. 5. All city property shall be restored to its original condition as far as practical, in keeping with city specifications and the manner satisfactory to the city. 6. A sketch of plans covering details of this installation, as well as, a copy of a recent survey shall be made a part of this permit. Calculations showing any increase in impervious area on owner's lot or in the city Right of Way are to be included with this application. 7. This permittee shall commence actual construction in good faith with days. If the beginning date is more than 60 days from date of permit approval, then permittee must review the permit with the Director of Public Works to make sure no changes have occurred in the area that would affect the permitted construction. 8. It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right, title and interest in the land to be entered upon and used by the holder, and the Holder will, at all times, assume all risk of and indemnify, defend, and save harmless the City of Atlantic Beach from and against any and all loss, damage, and cost of expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges. 9. The Director of Public Works shall be notified twenty-four(24) hours prior to starting work and again immediately upon completion. Adirl ro VNt Notary Public State•f aritElpir •./-`�a� 1.�/� . Shirley zaigfl- • Date(' Before me this gj0--" day *`. personally M''Commtff'on Fie^ the County of Duval, State Of Florida, has appeared '�arr`o4 expires 021470.11 p y pp Notary Public at Large, State of Florida, County of Duval. My co ••>>ir sires: V . Personally Known: /44 Produced Identification: ( _ Revised 7/29/15 Permit Attachment of for Permit# issued ,20_Atlantic Beach,FL 32233 Owner's Name: Property Address: R.E.#: Subdivision: Lot#/Block#: REVOCABLE ENCROACHMENT PERMIT THIS REVOCABLE ENCROACHMENT PERMIT,issued on this /, day of 424.4..0 ,204 by Atlantic Beach, Florida, a municipal corporation organized and existing under the laws of the State of Florida, hereinafter referred to as "CITY" and of Atlantic Beach, Florida, hereinafter referred to as"USER". • WITNESSETH: That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon the property of the City of Atlantic Beach for the purpose as described in the City of Atlantic Beach Right-of-Way/Easement permit numbers noted above(copies attached). This work is generally described as: e 'ze' r_6a�cc r�,� � S Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to relocation or removal on thirty(30)days notice by CITY to the USER, said notice to USER shall be given by certified mail, return receipt requested, to the following address: The depositing of said notice of cancellation in the United States mail shall constitute the notice of cancellation and the burden is upon USER to keep the CITY informed of USER's proper address. The USER shall promptly make any and all necessary repairs to any facility erected or maintained in the exercise of the privilege herein granted and shall at all times maintain said facility in good and safe condition. In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter upon the above-described property of the CITY, the USER shall replace at the USER's sole expense, any and all material necessarily displaced during the action of maintaining, repairing, operating,replacing, or adding to of the utilities and facilities of the CITY or franchise utility provider. The facilities allowed by the permit shall meet the current requirements of the City Code, Building Codes, Land Development Code,and all other land use and code requirements of the CITY, including City Code Section 19-7(h)which states"Driveways that cross sidewalks: City sidewalks may not be replaced with other materials, but must be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks." Page 1 of 2 1 The USER, prior to making any changes from the approved plans and/or method, must obtain written approval from the City of Atlantic Beach,Public Works Department,for said change. The USER shall,at the discretion of the CITY, be requested to submit as-built drawings showing the change within thirty(30) days after the day of completion. This permit shall insure to the benefit of, and be binding upon, the USER and their respective successors and assigns. USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or specifications, to include utilities locate requirements and use limitations/requirements of public rights-of-way and other public land. USER further agrees that the CITY and its officers and employees shall be saved harmless by the USER from any of the work herein under the terms of this permit and that all of said liabilities are hereby assumed by the USER. ' DATED and SIGNED this / day of 29:i0-4-c-,0 ,20/4' By:(elf-46e-Z-71, /X/ajlarf‘r Property Owner (to be signed in presence of the Notary) STATE OF FLORIDA COUNTY OF DUVAL On this / I day of r' , 20Jpersonally appeared before me, a Notary Public in and for said County d State, the property owner of ,Atlantic Beach,Florida,known to me to be the person(s)described in and .o e. - .. -a the foregoing instrument; who acknowledged to me that he or she executed the same freely v. tarily an. for the . - std purposes therein mentioned. 00,Nit Notary Public State of Flonda I� L '� � Shirley L Graham oto Public in f. said C b. ` l�' My Commission FF 086990 rY ;„i� and State '�or.„.oP Expires 02/1412018 CITY OF ATLANTIC BEA, FLORIDA, a municipal corporation: Approved: Kayle Moore,Public Works Director For Permits where city sidewalk is impacted, City Manager approval required: Nelson Van Liere,City Manager Page 2 of 2 J `";, CITY OF ATLANTIC BEACH I4' WNER / BUILDER AFFIDAVIT 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 WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE, 'HIE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICI-I 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 RESPONSIBII,ITY 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. , a �--/ ADDRESS3' a a; /l�L -L•t1L- L PHONE-/ 4RE /3 e/`'-A/ie[rj7- -/d ,I�4'7 lz4--i�_ PRIN NAME ,,/ I,�/ J mac^ /K I"1 --cv PLr - /9' I�Q�C.,2...-0/(.. SIGNATURE 1// DATE ( Before me this L.CA day of PYI-L ( 2U(-.dirt the county of Duval,State of Florida,has personally appeared herin by himself/herself and affirms that all statements and declarations are true tr`uee and accurate. ` Notary Public at Large,State of r" 1., /,County of 0 U �/�� 44❑Personally Known : ..---.5:7? JZSioduced Identif .. ' 1 c. Notary Sign- ` f • a Notary Public State of Florida �� Shirley L Graham I'/BLDG'Owner-Builder Alradavir REVISED .1iI @009 '5 j 0.01- Expires 02/14/2018 086990 MAP SHOWING BOUNDARY SURVEY OF LOT 595, SECTION NO. i, SALTAIR. AS RECORDED IN PLAT BOOK 10, PAGE 8. OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. CERTIFIED TO: ROBERT LEE BURGJj AND LESLEE A. BURCH GOVERNMENT EMPLOYEES CREDIT UNION OF FLORIDA ��� i PONTE VEDRA 11TLE, LLC / RICHARD G. HATHAWAY, P.A. COMMONWEALTH LAND AMERICA /9 N. BELVEDERE STREET (50.0• RIGHT OF WAY) FOUND 1/2- IRON PIPE 52.= ,'y- -_•:3 CROWS FCDT NO IDENTIFICATION N 4518'26` E 50.26':::-_ ,s6. -.ELEPPO'E RISER 0.2,0- - i Cofi)'14-- 0 0.2' �12 100.00 (PLAT) x x I— I. _m w CCx Ir II , 0—/� O 8.5' I. • v .. I, ------ ` 12.2 I-1 COAD Q Q DECK 4 >`^ 5.- o W A.4 o 8.0'.. Q � rt CI Q ' 10.0. 1.4. Os: ;T W \ K Q �� - LU .... -,,, x Q a �xo o gi, I ONE & TWO STORY n n o FRAME ori o t POSTED # 157 K 3 r_ Li G > B.0' 30.2' _ .c p `tn \� In LOT 596 Z t IO '��\� �\ ur LOT 594 LOT 595 > /rty7os2S1 vs, Luivt/-Gr .EYE I7ar�k 4 0 / O.S�;N x x x x x 1 0.0' 2. 5 ' r Y FOUND 1/2 IRON PIPE"'';2 45'15'22' W 49.85' (MEASURED) FOUND 1/2�IRON PIPE IDENTIFICATION UNDER WATER>e NO IDENTIFICATION 50.00' (PLAT) x LOT 611 NOTES: ACCEPTED BY: LEGEND: R = RADIUS —x— = FENCE L = LENGTH O = CONCRETE • NOTES: 1. BEARINGS ARE BASED ON THE ASSUMED BEARING OF N 45'00'00" W ALONG THE REVISIONS SOUTHWESTERLY BOUNDARY LINE OF SUBJECT PARCEL. DATE 1 DESCRIPTION 2. BY GRAPHIC PLOTTING ONLY THE CAPTIONED LANDS LIE WITHIN FLOOD ZONE x , AS SHOWN ON THE NATIONAL FLOOD INSURANCE MAP DATED APRIL 17, 1989, COMMUNITY NUMBER 120075, PANEL 0001 D 3. 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V1 3 J VI J V1 3 J 5 • p a w CO tD Cf 00 N n 01 .-i w CO 01 .i V1 n N M N N w CO CI' tO M V •-1 n ' VI •Op• '� • 0 n Ct n N .i m In Co ? 0 .i O N 01 0) .i to O 3 0 N O ri m N ••1 Ct CO p • i m O Ln m O 01 CO LC) Cr N O N LIi rl O Oi 01 CO CO m O N .-i Co to M .i .-i O 01 i., •• )O0 J _ ri r-I N N J .-1 rI ri J .-i N ri .i ri .i 1-1 0,.,f 000 X Q J Q J Q J g IN Cr Ifl Co:°01:4 00 Al`I Rb X cc1-1 X n R CO N n •V ri CO o3 rt1 X X 01 O U1• O) 0) ri to O X CO (Ni O .i M •~ •ti Ct CO lit ▪ G .�•/ m O 0) tb n tD tD N tri .Ni O Ol 01 W W N 2 0 W to m .Ni .-i O Ol 500t '" PiE ‘1110 O ` •ri ri 0 ....... .-/ .i 0 . r•/ rl .i .i ri et 3d O O O °Q X 01 V, X- -0 V, X 0 V, M m o 0 0 0 0 o o o IT me-- o 0 0 o 0 0 o 0 tD 'o d o 0 0 0 0 0 0 0 3 -0 .i N en v Ln to n co 3 -O - N M Ct to tD N CO 3 'o .i N en Cf In to N co ,•t .�[.:a Q o Q , Q o ---- ,\� TREE & VEGETATION AFFIDAVIT r ;ti City of Atlantic Beach ';,3r1 .. ; Department of Community Development \, Planning&Zoning Division r` / 800 Seminole Road Atlantic Beach,FL 32233 � -- !u;;lv' PERMIT# (P)904 247-5800 (F)904 247-5845 SECTION I-APPLICANT INFORMATION 7 Owner(s) 7 Legal Authorized Agent* NAME OF R 4eaQ r' 4.-- 4---,---- '5 V r C-A. NAME OF COMPANY j— p C v n Ira-Gt©r, ,/, G ADDRESS OF COMPANY /Ty// �O Ind$t A '1 Aon t-v,, g-�a k.-2_ ?ZZ6G PHONE Z`147-q5 2 5 CELL Z.Z.c 6 g132_. EMAIL ,T6pC0ntrac-tor@4"0,mct5r,tet" CONTRACTOR CERTIFICATION NUMBER G C : d 43 w r ttlIVA ATLBCH BUSINESS TAX RECEIPT NUMBER Iniiiinimi lnl SECTION II-SITE INFORMATION STREET ADDRESS OF PROPERTY /5 Bim/ %a rSZL— 11 iliLj•MMMLUIll I If an address has not been assigned to this property,contact the AB Building Department at(904)247-5826 to request an a..ress. LEGAL DESCRIPTION 17- 2.5" -29 E _5t-c.f/ol A/4. I, -544-- A /,. LOT 59� BLOCK SUBDIVISION o 3(((a,.silie1'9.fR sE4. a( REAL ESTATE NUMBER /7051N N- o o,t,o LOT OR PARCEL SIZE: SQ FT /y3 AC RESIDENTIAL g COMMERCIAL OTHER(SPECIFY) I 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-application meeting with the Administrator of those regulations. Subsequently, I affirm that no regulated trees and no regulated vegetation will be damaged, destroyed and/or removed from the above-described o djacent properties in conjunction with this project. /',/ / 13„-,-------- SIGNATURE OF OWNER SI6NATURE OF OWNER Signed and sworn before me on this rj day of M A , Z Ott, ,by State of 'jf/L, 4/\._ ,,1 L.:-/:71,1 cN(JO (GSL, LZ Ct 4 County of U 1 A-i, Identification verified: V, u Oath sworn: Yes FlAslo - - - - - - --- - - - - 1�V -- 4 :o�;"""14sZs JENNIFER L.BENDETTI I � ignature Alin I P. Notary Public-State of Florida o., Commission*FF 904388 My Commission expires: U (Ai LO ( C-1 "•1, d��'' MyComm.Expires Aug ,2019 I 1 '•�•ou��,,r D � FOUND 1/2 IRON PIPE 50.00' (PLAT) NO IDENTIFICATION N 4578'26' E 50.26' (MEASURED) OFOUND CROWS N TELEPHONE RISER 0.7-* 0.2' •r 1..... 100.00' (PLAT) • x m -Q!` I N W M W } �•� x a 13 �85' ' I -----PS. 12.2' . COVERED = Iii DECK a LC d' I.4 — o 8.O'_ tat Q fr Q l y 10.0' 11.4' 0.9' a a d\ In �� fr 11 I Q a W ` o ^ �a 9 0 o ONE 8c TWO STORY I o FRAME of g POSTED # 157 I °f - 3 13e(Y7,-c{-v� I I Li I Oi 0 8.0' V30.2• G ,• ( ,WOOD DECK I Ii PN LOT 596 Z l-__.__ �����. 2.7, 2 LOT 594 LOT 595 *' 1 ! ` I lecEIlvef O5' x 0.0 1 _ � x x�_x 1.0• O.z' i , 111 IDENTIFICATIONUNDERUNDER IRON PWA TER .S 4J75.22` W �' - V �,',l,; - ,'-� 49.85' (MEASURED)FOUND 1/2-IRON PIP I I ��? I50.00' (PLAT) NO IDENTIFICATION LOT 611 • NOTES: enritiminiiiiiiiACCEPTED BY: memomm.... iii nil LEGEND: R = RADIUS --X— = FENCE L = LENGTH O — CONCRETE NOTES: ASSUMED 1. BEARINGS ARE BASED ON THE SOUTHWESTERLY BOUNDARY LINE OF SUBJECT PARCELBEARINC OF _ N 4500'O0" W --- -- REVISIONS THE REVISIONS NG 2. BY NATIONALHIC FL000 INISURANCE MAP DATEONAPR LANDS 17, 1989 COMMUNITWITHIN OYD X AS SHOWN ON THE NUMBER 120075. PANEL __0001 o- DATE DESCRIPTION 3. THIS SURVEY REFLECTS ALL EASEMENTS & RIGHTS OF WAY AS PER RECORDED PLAT &/OR TITLE COMMITMENT IF SUPPLIED. UNLESS OTHERWISE STATED. NO OTHER TITLE VERIFICATION HAS BEEN PERFORMED BY THE UNDERSIGNED IMEMINIMIIIIII IIIIIIIIIIIIIIIM 4. THIS SURVEY NOT VALID WITHOUT THE ORIGINAL SIGNAT• URE AND EMBOSSED SEAL OF THE CERTIFYING SURVEYOR. JOB # 18731 DATE OF FIELD SURVEY: 09-25-02 DATE OF ISSUE: 09-26-02 —IIMIIIIIIIIIIII— SCALE: 1" = 20' i!��\ 2522 Oak Street CERTIFICATE �� ~, Jacksonville, reefFlorida 32204 I HEREBY CERTIFY TITAT THIS SURVEY WAS MADE. •' Phone 904-389-5989TES, �- UNDER MY RESPONSIBLE ( ) AND MEETS THE WNDAUTA TEC, STANDARDS AS gi FORTH BTHE FLORIDA E �_'�� BOARD OF PROFES SURVEYORS AND MLFPERS IN CHAPTER 61G17-6, FLORIDA (Fo%) 904-389-6175 ADMINISTRATIVE E. Pl4SUA.VT CT1,�r(/N'472.0,2. FLORIDA STATUTES. suRVEuinuInc ___________ LICENSED BUSINESS # 6702 CHARLES K. Mr INTOSH REGISTERED SURVEYOR AND MAPPER y 5502 STATE OF FLORIDA LAND SURVEYS 0 CONSTRUCTION SURVEYS 0 SUBDIVISIONS �„ --- f ...... _ ,,fir..,••. _ .. � !' 1\ .., c. �� r 1 _. CONTROL LINE___. , -7„c0 / CONCRETE BULKtIEAD -. ��_{----- .. ___ w _ ---- / �O! :•.. � __-. 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