523 SELVA LAKES CIR - PAVER PATIO 41 .. • , CITY OF ATLANTIC BEACH
y 800 SEMINOLE ROAD
N
�
t¢ ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-DECK-1845
Job Type: DECK/PATIO
Description: Paver Patios
Estimated Value: $2,000.00
Issue Date: 8/30/2016
Expiration Date: 2/26/2017
PROPERTY ADDRESS:
Address: 523 SELVA LAKES CIR
RE Number: 172027-5504
PROPERTY OWNER:
Name: Dewalt, Marcy
Address: 523 Selva Lakes CIR
PERMIT INFORMATION: UTILITY DEPT.: PUBLIC WORKS:
Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible.
A sewer cleanout must be installed at the property line.Cleanout must be covered with an RT1
concrete box with metal lid. Cleanout to be set to grade and visible.
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 runoff 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 Recycling, Republic Services,Shapell's, Sunshine
Recycling and Waste Pro).
Full right-of-way restoration, including sod, is required.
Any plan change must be submitted as a Revision to the Building Department.
14
PERMIT IS APPROVED ONLY IN ACCORDANCE WI III AL1, (.I I Y OF A I LAN I It. ULA(.II ORDINANCES AND THE FLORIDA
BUILDING CODES.
J\J riil .
CITY OF ATLANTIC BEACH
.f 800 SEMINOLE ROAD
- r ATLANTIC BEACH,FL 32233
u INSPECTION PHONE LINE 247-5814
FEES:
PLAN CHECK FEES $30.00
BUILDING PERMIT FEE $60.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ri Jy;, City of Atlantic Beach APPLICATION NUMBER
e' ; :�5� Building Department (To be assigned by the Building Department.)
1 800 Seminole Road. E C E I i C` D e [[JJ
�r . _, Atlantic Beach, Florda 32233-5445 -�"�: (� ` l e
Phone(904)247-5826 • Fax(904) 5 5
�1G 15 2016
______ � E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
Li
BY:
APPLICATION REVIEW-AND TRACKING FORM
Property Address: 523 SEC_VA LP K aa, Department review required Yes No
Building
Applicant: �1-)/��g.._ Ianninq &Zoni
Tree Administrator
Project: AVE 2c ( csublic Wor
Public Utilitie ) •
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
f Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department I First Review: 'Approved.�J ❑Denied. �. ��-�6
(Circle one.) Comments: Joe '4 c4 & ,,d
BUILDING
PLANNING &ZONING Reviewed by: �/ Date: ��Ar
r
TREE ADMIN. Second Review: ❑Approved as revised. ❑De,.-d.
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
,,,:o—��! ,. City of Atlantic Beach APPLICATION NUMBER
' ! \) Building Department (To be assigned by the Building Department.)
-. `i 800 Seminole Road I C` D G � CC
T� '"� Atlantic Beach, Florida 32233-5445 Cts �`'t�
~ Phone(904)247-5826 • Fax(904) 247-5845
j;31�� E-mail: building-dept@coab.us Date routed: 7/t 3/
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 523 SELVA LAKE(7/ Department review required .Yes No
Building
Applicant: Ca0i\Dje_,... tannin &Zoning
Tree Administrator
Project: AVE "Public Wor s
(-Public Utili ie
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.
I Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed by: 4/7/...--___- Date: S ir-O6
TREE ADMIN. Second Review: A roved as revised.
❑ pp ❑Denied.
PUBLIC WORKS ' Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: nApproved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
;;rfa,�F�, City of Atlantic Beach APPLICATION NUMBER
�s r Building Department (To be assigned by the Building Department.)
• 800SeminoleRoad.5.,;0,. ._,,y„,,,. Atlantic Beach, Florida 32233-544
Phone(904)247-5826 • Fax(9fiECIVE
47- 1 5
c+
JR gr E-mail: building-dept@coab.us 2016 Date routed: a)/t S/I cc::,
City web-site: http://www.coab.us
BY:____ ___—
APPLICATION REVIEW AND TRACKING FORM
Property Address: 5 3 SCLVA LJ\K&CR_ Department review required Yes No
p
Building
Applicant: � »� .._ Plannin1c &Zoni g j
Tree Administrator
Project: AVE2ublic Worcs
C.ILiblic UtilitieS -
Public a e y
Fire Services
Review fee $ igr Dept SigrinallallpillIM
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: pproved. ❑Denied.
(Circle one.) Comments:
BUILDING /u7//6
PLANNING &ZONING Reviewed by: h! �� Date:
TREE ADMIN. Second Review: ❑Approved as revised. ['Denied.Co ments:
i2
PUsRL UTILITIES
/ %
PU LIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. DDenied.
Comments:
Reviewed by: Date:
Revised 05/14/09
,;1‘....A.,,./.,-,;.;\
BUILDING PERMIT APPLICATION
:J• -S 1
- ' CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
<I-` i'! " Office: (904)247-5826 • Fax: (904)247-5845 ' 6_0 Eco -1 845
Job Address: SZS S 'oL CO' j414,,E};`i t,t ci_ 322 3 Permit Number:
Legal Description L{3-I` 11 -2S-29E Silva Lam\ O,A 2 RE# 1710 V7 5 D y
Valuation of Work(Replacement Cost)$ ZO000-- �+ Sy
( p Heated/Cooled SF Non-heated/Cooled
• Class of Work(Circle one): New Additio Alteration Repair Move P- 1,p• Pool Window/Door
• Use of existing/proposed structure(s) (Circle one): Commercial 'esidentia
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes 6. N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
A-00 iL C RA,o 1,— V co,r ✓k.r c)
Florida Product Approval # for multiple products use product approval form
Property Owner Information
Name: ��r ./ �,Uo.1 ��Xsoi Address: Q-3 Se4e- LLes ar
City �4(o.w k�er.,z_.1 State t-Zip 3Zz33 Phone q6q-2-uu-C.7?S
E-Mail (- S7 57 e. (Aoo_ ems,.-.
Owner or Agent (If Agent,Power of Attorney or Agency Letter Required)
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.
Contractor Information:
Name of Company: Quali '•: ' gent:
Address: . , State Zip
Office Phone Job Site/ • tact Number
State Certification/Registration # E-Mail
Architect Name& Phone#
Engineer's Name &Phone#
Worker's Compensation
Exempt / Insurer / Lease Employees / Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certib that no work or installation has commenced
Thirior 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.
s 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 1 understand that separate permits must be secured for Electrical Work,Plumbing,
Signs, Wells,Pools,Furnaces,Boilers eaters, Tanks and Air Con, :loners,e .
Signature of Prop- er: .dii ii %f /�/ `J ., i" r ,�p�?pp��l ��llll ppE__RGER
Before me ._ ¢it.-tu �i Y cmilmibbluN '
this lZ�`Da of KS ga • / y;=>. ` ,„ 5:October 6,2019
- •" F ' "l� P;o!aryPubliicUndeMay•
Notary Public: Q- ' - '� Notary Public:
I
'hereby cert that I have read and examined this appli on and know the same to be true and correct. All provisions of laws and
ordinances governing this type ofwork will be complie with whether specified herein or not. The grantin, of a permit does not
lresume to give authority to violate or cancel the provisions of any other federal, state, or local law regulating construction or the
'erformance of construction.
Rev.3/14/16
.ems.
CITY OF ATLANTIC BEACH
•
'_' 11 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 DIVE 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 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.
ADDRESZ3 lV4 Ita.IL€S0,f-,CilKt 1G -"Sta4i, IYL Tot/ Z3e- G7 75
,� W' I �� 32233 PHONE NUMBER
G 90.'\
P I T%•ME n Pb(/
g/4/ZOIC61T �
DATE
Before me this (Z , day of /31"1"-\ 20 D. 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.
Notary Public at Large,State of FI— ,County of l VG.
❑Personally Known Aitibl
'30 7 z D
prProduced Identification-=Ir
0�?Y TONI GINOLESPERGER
MY COMMISSION#FF 924951
Notary Signature: lairee '•-'� EXPIRES:October 6,20
19
,,, `,.` Bended Thru Notary Publiic Underwnlers
F:/BLDG/Owner-Builder Affadavit;REVISED:4/16/2009
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523 Selva Lakes Circle Paver Application
Sq Ft
Lot size 4340
Impervious Calculation
House footprint and Patio 1511
Drive 323
Sidewalk 84
AC Pad 9
Impervious Subtotal 1927
75
Impervious Subtotal 1852
New Pavers
Replace existing sidewalk w/pavers No impact to Impervious Clac
New Rear Patio 12'x16' 120
Walk to new Patio 3'x10' 30
New Front Patio 5'x12' 60
Impervious Total 2062
Impervious as Percentage 47.50%
Pervious as Percentage 52.50%
Property Appraiser- Property Details Page 1 of 2
DEWALT MARCY Primary Site Address Official Record Book/Page Tile#
523 SELVA LAKES CIR 523 SELVA LAKES CIR 17308-00668 9417
ATLANTIC BEACH, FL 32233 Atlantic Beach FL 32233
523 SELVA LAKES CIR
Property Detail Value Summary
i RE# 172027-5504 2111.1.Cattitleil2016 In Proaress
Tax District USD3 Value Method CAMA CAMA
Proaerty Use 0100 Single Family Total Building Value $120,699.00 $134,937.00
#of Buildings 1 Extra Feature Value $2,295.00 $2,060.00
For full legal description see Land Value(Market) $75,000.00 $75,000.00
Legal Dem. Land&Legal section below Land Value(Aaric.) $0.00 $0.00
Subdivision 04274 SELVA LAKES UNIT 02 lust(Market)Value $197,994.00 $211,997.00
Totienme 4340- Assessed Value $197,994.00 $211,997.00
The sale of this property may result in higher property taxes.For more information go Cap DIff/Portabllity Amt $0.00/$0.00 $0.00/$0.00
to Save Our Homes and our Property Tax Estimator.'In Progress'property values, IMMO. #0.00 See below
exemptions and other supporting information on this page are part of the working tax
roll and are subject to change.Certified values listed in the Value Summary are those Taxable Value $197,994.00 See below
certified in October,but may include any official changes made after certification
Learn how the Property Appraiser's Office values orooerty.
Extra Features 4 `
pt g ;Length al
LPI Feature Code Feature Description Bldg. Width �Total Units Value
1 FPPR7 Fireplace Prefab 1 0 0 1 1.00 $832.00
2 1 SCPR2 Screen Porch I 1 118 10 180.00 $1,228.00
Land&Legal
Land Legal
LN I Qglg I Use Description Zoning Front Depth Category Land clang Land LN Legal Description
Units Dike Value 1 43-11 17-2S-29E
i 1 10100 iRES LD 3-7 UNITS PER APUD 38.00 115.00 Common 1.00 Lot $75,000.00 2 SELVA LAKES UNIT 2
3 LOT 54
Buildings
Building 1
Building 1 Site Address Element Cale Detail [_ " L11
523 SELVA LAKES CIR Unit rAtlantic Beach FL 32233 Exterior Wall 16 16 Frame Stucco
Roof Struct 3 3 Gable or Hip rJ
--Building Type 0105-TOWNHOUSE Roofing Cover 3 3 Asph/Comp Shng In L
Year Bulk 1987 Interior Wall 5 5 Drywall l• 1
Building Value $134,937.00 Int Flooring 12 12 Hardwood L - '-,
Int Flooring 14 14 Carpet -J
Gross Heated Effective Heating Fuel 4 4 Electric
Tt.—...---1
Type Area Area Area
___ Heating Type 4 4 Forced-Ducted
Base Area 812 i 812 1 812 Air Cond 13 3 Central
Finished Open 89 I 0 27
Porch
Element Code
Finished 378 0 189
Garage Stories 1.000
Finished upper 774 774 735 Bedrooms 3.000
story 1 Baths 2.500
Total 2053 1586 1763 Rooms/Units 1.000
Property Record Card(PRC)
The PRC accessed below reflects property details and values at the time of Tax Roll Certification in October of the year listed.
2015,
2014
http://apps.coj.net/pao_propertySearch/Basic/Detail.aspx?RE=1720275504 8/11/2016
SLVA LAKES HOMfQWNERS ASSOCIATION
JLLOUEST FOR ARCHITEC'T'URAL APPROVAL
• Ilix eyue$t thrum k to be completed by the Homeowner and submitted to the(ARC)prior to the commencement of work.
DATERECEIVED BY ARC:
/., , THIS SECTION TO BE COMPLETED BY HOMEOWNER
Derr- 71L��f Lo 111:3
Haw _ 0_ ' I ► IN Lot N l
Address: _ Z3 Stl.t.WasC;c. .AiltvAlc ,rt V2L33
Horne ,e: o- 64.6- Zo' 7 Other Ph --
Contractor l bat h it. _t7 v ,Mt lL_ W.--
Deatrtbe the Mwk to be door (i.e.ststesn room.addition.fence,prase door,siding,outdoor lights, exterior painting.
roof nepeirs'r epl1acement.gutters.�� � etc.)
- .i MItL , I 1 r,5c i tb.\ C y Slee---`
- xr‘skil Nva <,xx
l- ille.,A L `.) t�GJss\s :n 4CO'�� yOSLA
Ne tI..pte.A3 , .a, \f'(...e)
411 -. ' ''''PaCN1 iNtte 40 Vet r?tN.c(A,N.
c.4 et,s4 ha.n�i y 1 (caste W� �,
Cep- a,�.ri.r y t N. SN ,1t. ,coo, ,c.ri.1 k\ri_.c10-
Lo con: Attach a copy of ror survey,indicating the location of the work to be done.
Describe Location: .Ct r* ink.A(a.4a __-
Specifications: Attach a copy of the plans,drawing,picture.specifications(material,color,etc.) All exterior paint must meet SLA
specifications.. Pun lase at Duvalnt rid Hardware,3'J St.South.Jacksonville Beach. Reference Selva Lakes stnadard.
Egimateai date of c mpletion: q I 1 .'--7_
♦OlFE: Owners are responsible for the conduct of the contractor. You are required to supervise the work being done. You are
personall) responsible and liable kir any damage done to common property or adjacent property. When required by the City of
Atlantic Beach you are roqdired to provide the AR 'wf
� a copy of the building permit.
1 /' I i ! •
Date: � /�
A
Homeowners Signature -�
- Dane Approval IS.'S.'L Date Denied - --
[tet \
_ - ARC SiSAartltl(sl: -- _
0)-Ay� TREE & VEGETATION AFFIDAVIT
ri a* � City of Atlantic Beach
"' Department of Community Development
-,'iiPlanning&Zoning Division
C—..71-01119>':
� 800 Seminole Road Atlantic Beach,FL 32233
J'tl>>' (P)904 247-5800 (F)904 247-5845 PERMIT#
SECTION I-APPLICANT INFORMATION r Owner(s) r Legal Authorized Agent*
NAME OF APPLICANT Marcy DeWalt Nelson
NAME OF COMPANY
ADDRESS OF COMPANY 523 Selva Lakes Circle,Atlantic Beach,FL 32233
PHONE • 2386775 CELL EMAIL gn5757@yahoo.com
CONTRACTOR CERTIFICATION NUMBER
ATLBCH BUSINESS TAX RECEIPT NUMBER
SECTION II-SITE INFORMATION
STREET ADDRESS OF PROPERTY 523 Selva Lakes Circle,Atlantic Beach,FL 32233
If an address has not been assigned to this property,contact the AB Building Department at(904)247-5826 to request an address.
LEGAL DESCRIPTION 43-11 17-2S-29E
LOT 54 BLOCK SUBDIVISION Selva Lakes
REAL ESTATE NUMBER 172027-5504 LOT OR PARCEL SIZE: 4340 SQ FT AC
RESIDENTIAL X 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 a e-descri ed or adjac rop ies in co/junction with this project.
fi
SIGNA R OF OWNER SIGNATURE OF OWNER
Signed and sworn before me on thiiS day of ,2_0((ej,by State of I— (
County of 1::)(.7 ✓a\
Identification verified: I- 4 3a-54 7 z-9(a 0
Oath sworn: r Yes r No - 4 /
„„
„�.yie
. 70NI GINDLESPERGER
4i k;. MY COMMISSION Y FF 924951 Notary Signature Air
w: EXPIRES:October 6,2019
-'.?y Bonded ThruNotary Put*Unde^"rten My Commission expires:
REV g,. •••