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199 Sylvan Dr alteration permit CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 Tv RESIDENTIAL ALT/OTHER MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 ]OB INFORMATION: Job ID: 16-RAAR-2079 Job Type: RESIDENTIAL ALTERATION Description: replace damaged concrete patio with pavers Estimated Value: $4,600.00 Issue Date: 9/30/2016 Expiration Date: 3/29/2017 PROPERTY ADDRESS: Address: 199 Sylvan Drive RE Number: None PERMIT INFORMATION: FEES: PLAN CHECK FEES $36.50 BUILDING PERMIT FEE $73.00 STATE DCA SURCHARGE $2.00 STATE DBPR SURCHARGE $2.00 BUILDING PERMIT FEE $73.00 Total Payments: $186.50 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CRY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. Building DepartmentrV � ,4PPLiEATION-NUMSER BOO Seminole Road ',/�7,+7 (To be assigned by the B(u)ilding Depaidment.) Atlangc Beach, Florida 3223354456 Phone(904)247-5826 Fax(804Eilbuilding-depnooabustyeb-site: http:/Mrwru.ceabu APPLICATION REVIEW AND TRACKING FORM Property Address: `l�( Sy Wa A De artment review required Yes No Buildin Applicant: WtPlannin onin Tree Administrator Project: f LQ� (,L �A,tY�(L p(/� h(�� @ublic orks P"'D 1,4^ POLY" ublic Utilities Public Safety wB(fi/e /,'� Fire Services Review fee $ W DeF(T/['Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B Florida Dept.of Environmental Protection Florida Dept.of Transportation St.Johns River Water Management District Army Caps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: SCL{pproved. Eenied. 9✓��/"�� (Circe one.) Comments: 4i r,,'p��/ BUILDING V L �� / PLANNING&ZONING Reviewed y: Date: TREEADMIN. 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: Revleed 07127110 .r ✓ Q Ilii v r 4 +J � J / V III I 40 449 r i Wo(1[ — GIOi,Ib�Q —BliitbW6 PERMIT APPLICATi CITY OF ATLANTIC BE SEP 5 2016 800 Seminole Road,Atlantic Beach Fl,32233 Office:(904)247-5826 • Fax:(904)247-5845 Job Address: j l t-Al / Pe umber: Legal Description tr RE# Valuation of Work(Replacement Cost)$ [L v Heated/Cooled Sit Non-Heated/Cooled • Class of Work(Circle one): New Addition Alteration (j!95110 Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial si • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes 5Q:) 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: +esy/9ef oA .49zr1 moo, ecE�a � e c ;�y ��R✓see S Florida Product Approval# for multiple products use product approval form Property Owner Information Name: �% /-� W' {6k¢N J`/.J,Ci✓ y ,J/�i �� Aadresa: /9�i s State!/Zig X20Phone —2_ dee E-Mail Owneror AgentntAgmtpowerofAaoomyotAgeocyl.8terayuuW7 WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY STNFINTFOR TNTS ERUORAEYEUBRETOOBAIIANCG CONSULT WH YO LENDRNATTORNYEFORE RECORDING YOUR NOTICrE OF COMMENCEMENT. Contractor Information: NameofC any: /VOu{�Qualifyin Agent: Address: 2 d7 City soti`!//t= a Zip zzr/ Office Phone O — 3d SO Job Site/Coutact Number State Certification/Re ' tion# E-Mail Architect Name& one# Engineer's N &Phone# Worker's pensation empt n e oyeea pvanov We Application is hereby made to obtain a permit to do the work and imta(lations as indicated I certify that no work or installation has rommenced enor to the issuance ofa permit arW that all work will be performed too the standards ofall laws rcgu/acing construction in this jurudicnon. lno permit beco mes mall and void if urork is rzot mmmenred wfthin six(6 months, or iJronsuvcHan or uark is suspended or abartdaned ror a period o(six(6)manthsatanytlme ajler work is commenced. /rmdersmthat sepamtepermits must be securedfor6[ectrirai Work,Plumbing, Signs,Wells,Poole,Furnaces Boil Xeate Tanks and 44 Cood/t/one ,ate Signature of Property Owner: c Signature ofContiactor. Before thisay of Before me this Day of Notary Public: Notary Public: 'hereby his application and know the same to be true and correct. All provisions a laws and mdinanc gpver"ni this tppp ppldr wi/1 complred with whether spec, ,=b, herein or not. The granting of a permN does not +resume �t 6yt 0"*p ft" I he provisions of any other ferlerol, state, or local law regulating construction or the terform d0 ii. +'<rcN�issioulFF 916115 MYMM.eXpu%Sap.],2919 Rev.3/14/16 CITY OF ATLANTIC BEACH ®"ER/BUILDER AFFIDAVIT I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW DISCLOSURE STATEMENTFOR SECTTON 489.103(7),FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER qN BXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE O WNIM OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR BVEN THOUGH YOU DO NOT HAVE A LICENSE. YO MUST SUPERVISE THE CONSTR CTIpi. TWO FAMILY RESIDENCE ORrt—�-q FAR YOU MAY BUILD OR IMPROVE A ONE-OR IMPROVE A COMMERCIAL BUILD UTBUILDING' YOU MAY ALSO BUILD OR MUSTBE FOR YOUR 1 c ING AT A COST OF$25,000.00 OR LESS. B U DRJG ��AI�DILDING OU ITMAYNOTBEB SELFOR SALE pR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILP YOURSELF WTT AL ONE YEAR AFTER THE CONSTRUCTIONLLBSE, VaIS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF BED N ACCO C r^RN PD PERSON Ac COA'IR THIS E�MPTTON. YO MA V ninI BE DONE ACCORDING TO THB BUILDING CODES YOUR CONSTRUCTION MUST YOUR ES REQSIEX Y TO MAKES AND ZONING REGULATIONS. IT IS LTGENSPS RFp TgrF THAT PEOPLE EM_ptnw ri ND AY OLIN'ly OR MIY C �-� NSTNr 11. 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 CIRCNOT 13E UMSTANCES OWNERS BEING SUB CT TO $5,000NPENALTY UNDER FEMPLOYED STATUTE NO. 455-228(1). AN"OCCUPATIONAL LICENSE• UNDER ANY SEE THE COUNTY CERTIFICATE It THE OWNERSHOULD PHYSICALLY CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED ENCr R CONTRACTOR.THE TELEPHONE"CONTRACTOHS BUILDING DEPARTMENT(247-58 6)IF IN DOUBT. V.ACKNOWLEDGEMENT;1 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. /9G 5v ve%;� L L I /T V / y( PHONE NUMBER PRI AME dd BA G Bekrema tM1la tlaY cr 5 20l6jn Ourel Ste[e of F orltle,Ilea parsonaly eppevetl flarip by M1lmae,Ylllenentyo Raed�Iflmu Nat ell slakmentsaM Jegeretlonsaretme enaa7aureb. p Nohry pybllc et Large,Smle W lµ(,Savntyaf IAV r7)_{ PP16O"'ry K"^"" r CL NA DA' VMIS Notary Palic,StatsRaiEs Commissbp;FF 916115 Mymmm.expires Sept 7,2019 NatarySigrval0ra F✓B>DG9wr+Hwltiv ABMaviSHHV6Hb mm, - k s.. WAEV" -'7-- 0= 0= LOT 7 :dr ;tAe. a4' O!t. - 735 u u10 RES;c"CE it 23.T �� o am POSTED 199' o y n i 90"022'36§ f' 0`O L - 96 n 3 T _ 102'4 F E e FOUND 1/2- D, /2 ('I p w IRON PIPE `N wtN 6' 11W0 PENCE O 0.1' FQMD 1/Y MON RPE 79]095' 46.80' 46.75' (FIELD) I LOT 719 i I 1A 20 40 SCALE: 1 a 20' ES -NE PER PLAT. THIS SURVEY WAS MADE FOR THE BENEFIT OF y w-- - -_ - LAT C. LEIGH WILHITE 1 -- - - -- -- -fEREON APPEARS VIRTUAL BANK, A DIVISION OF LYDIAN PRIVATE BANK =SNE 'X" AS WELL AS STEWART TITLE GUARANTY COMPANY PROM THE FLOOD BUSCHMAN, AHERN, PERSONS & BANKSTON COMMUNITY PANEL- - - - - - - - REVISED APRIL 17, °TLANTIC BEACH, C,-A-%- A LISA OWN W. BO TWRI P.S.M. ■�6;'�'_ ^_sE� FLA. LIC. SURVEYOR AND MAPPER No. LS 3295 !./Lo rnR7 FLA. LIC. SURVEYING & MAPPING BUSINESS No. LB 3672 IF0 6Y- '41— BOATWRIOHT LAND SURVEYORSL INC. pq 7E; 0070BER-26-2005 III W. CRT - 1500 ROBERTS DRIVE `' 2905-1580 JACKSONVILLE BEACH, FLORIDA 241-8550 SHEET�OF >_ ty_nP Atlantic --- Bull dingDepartment ECEIVE (To be assigned by the Building Department.) 800 Seninole He 2 '.� Phone l904) Beach, Florida 3223 CGp t6 2��6 D lb--O k��a�T � Phone(904)247 .vv E-mail: buildingdept(a?coab.us Date routed: -21�u ( b City website: htlp://www.coab.uBY• APPLICATION REVIEW AND TRACKING FORM Property Address: 1 `lq. ; I tU& 1 �,� De artment review re wired Yes No Q Buildin Applicant: I.Q.IIh W t I h I f Plannin onin Tree Administrator Project: (LQ� LL mau(A 'A LfI tQ. ublic orks V*617 Wt'" pt N ublic Utilities 1_ Public Safety Fire Services Review fee $ _Dept Signature_ ✓� -- Other Agency Review or Permit Required Review or Receipt Date Florida Dept.of Environmental protection of Permit Verified B Flonda Dept.of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaumnts Division of Alcoholic Beverages and Tobacco Other. APPLICATION STATUS Reviewing Department First Review: Approved. []Denied. (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by: Date: � 1L 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 07/27/10 City-"tlantic Beact! — ——__. - f(To - -APPLIC-ATION NUMBEf�Building Department be assigned by the Building Department.) 800 Seminole Roadp 1yn iAtlantic Beach, Florida 32233-5445 IV hA TIL—a01C, Phone(904)247-5626 - Fax(904)247-5846E-mail: building-dept@coab.us ate routed: 9l 1lA l 16 -- Cityweb-site'. http'.//w wab.us APPLICATION REVIEW AND TRACKING FORM Property Address: I 'LCI S1tuan Department review required Yes No Buildm Applicant: Plannm Onln A,, Tree Administrator Project: ifLgkitLL AAMiL tPALU IL 'Public orks PA:l1 l.p w i" a N ubfic Utilities P Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B 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: oApproved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING&ZONING "� Reviewa.gv7smed by: ��/ Date: 1 TREEADMIN. 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: RevisaE 07/27/10