2021 Selva Madera Ct addition permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ADDITION
MUST CALL BY 4PIA FOR NEXT DAY INSPECTION: 247-5814
30BINFORMATION:
Job ID: 16-RADD-2206
Job Type: RESIDENTIAL ADDITION
Description: demo existing deck, add covered porch, enclose space
under overhang, renovate kitchen
Estimated Value: $45,000.00
Issue Date: 11/17/2016
Expiration Date: 5/16/2017
PROPERTY ADDRESS:
Address: 2021 SELVA MADERA CT
RE Number: 169506-1650
PROPERTY OWNER:
Name: BURBRIDGE, H CLINTON
Address: 2021 SELVA MADERA CT
GENERAL CONTRACTOR INFORMATION:
Name: CORNELIUS CONSTRUCTION CO.
,CBC048967
Address: 7119THST CIA MARGARET S. CORNELIUS
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 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).
All runoff must remain on-site. Cannot raise lot elevation.
Any plan change must be submitted as a Revision to the Building Department.
Section 24-66(b)of the Land Development Regulations requires on-site storage for increased run-off if
adding 4DO SF or more impervious surface. Provide Delta volume calculations and on-site retention
required per Section 24-66(b).
AT�IC BEACH OIWFN�CES � THE FLOWDA
RUILWNG COM.
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
FEES:
ENG REV RESIDENTIAL BLD $100.00
PLAN CHECK FEES $137.50
UTIL REV RESIDENTIAL BLDG $50.00
BUILDING PERMIT FEE $275.00
STATE DCA SURCHARGE $4.13
STATE DBPR SURCHARGE $4.13
Total Payments: $570.76
PERMIT IS APPROWD ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC REACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
City of Atlantic Beach APPLICATION NUMBER
Building Department
800 Seminole Road if Si�p 3 (To,be assigned by the Building Department.)
Atlantic Beach,Florida 32233-5445 zkap(o
Phone(904)247-5826 Fax(904)247
E-mail: building-dept@mab.us Date routed: -PCA) lao I 1(p
Cityvreb-site: littpJA�,coab,us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ;k0a i Sdva AkttAug C4 . De a���"entrewew_re uired Yes No]
u, r:
C PBuildinct -..,)
Applicant: t0tAL140S, tDA:!ftftU"A1 lanning&Zoni�)i
I me Administra
Project: ALM-() cifirl, 12 r%Ar' k. u lie Wo
I I Public Utilieties
tr% "u- Lit, ()V Lumn
JI Public Safety
(LAO akct�talb) Fire Services
Dept Signature
Other Agency Review or Permit Required Review
Of PehmIt=PBY Date
Flonda Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Managementbistdcl
Amy Corps of Engineers
Division of Hotels and Restaurants
Di�visian of Alcoholic Beverages andiobacoo
Other:
APPLI ATION STATUS
4
Reviewing Department First Review: V�Approved. E]Denied.
(Circle one.) Comments:
Via BUILDING
w
(C
I n
BU
rc
'L
D
0
D
n
p
Na
a
G
ment
PLANNING&ZONING Reviewed by: Data
TREEADMIN.
P Second Review: DApproved as revised. ODenied.
=WORK I Comments:
.r_ �
IL
B U T
JILITIE;$
PUBLIC SAFEf_Y Reviewed by: Date
I . "'C .
FIRE SERVICES Third Review: ElApproved as revised. [:]Denied.
Comments:
Reviewed by: Date
Revised 06114/09
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC REACH FILE COPY
900 Seminole Road,Atlantic Beach,FL 32233
Offiche(904)247-5826 Fax(904)247-5845
Job vftl, vrrA 6r. —PermitNumber: ief-APA- A,\016
A&<O�� 'IT parcel#
Legal 0 1 ELVA Nor, 014
Valuati of $ 1`1 oco,9-0 Ig' ;OA; Ot sq
On INcoolled 150 -,F som-'heitted/coo ��1414
of 15 ed Work M't led
Class of Work(circle one): New 46� Alteration Repair Mo Demolition poolspa window/door
Use of existing/pror.o,-d'stracture(s)(circle one): Commercial Residen
i (Curcle om)��
if an existing struc u re,is a fire sprinkler 1: Nr
t)jj,
Florida Product Approval# a 2_OZ27:70- Z CFA 6
n�For m u Itiple prod nets use ivroilact—Appre 0
Describe in detail the type of work to be performed,D F-Mo E)t jSpH6 'Dely//ADD COVERED VQWld
rlr)SF- SPACL 0i,lbEIZ &JER-HAW6 / RF=IJ0VXTE- V17<44EA
Peonerly,Owner 1111ohnnuttion:
Nam n IZ- Address: EO?-1 SF-I-,4A MADEvI
city P!VrI>r _StdeELZip3ZZ3_3__PhonhS -F u 7- 15p_
E-Mail orFax#(Optional) hcb pz lne,c— eDrA
Contractor Information: rvAo�ck,� eo�qote�l@
CmnpanyNameCDI2haF-6IL)z (on-n-l-Rochrihoo QualifyingAgent: kAR6AkE:r 6-�,Rjri.W-S
Address:?-IA i3Ay city VIEMpy- stm State FL- Zip S22&l.
OfficePtume 904 29AJ 117DIP Job Slid Contact Number qb4 2q4- 4170(o Fax#
State Certificatidnitilegistration# f Re n kLAQ (07!
Architect Name&Phone#—
Engineer's Name&Phone#
Ehk6 18 E-�I IJ 62 ?
��Wl�- ATL. Oc�l- Fl,
Fee Simple Title Holder Name and Address jft4 Mr 12,t ffi�PWQ51 E L-5 MAM�- rf.j
Bonding Company Name and Address
Mortgage Lender Name and Address—
Applicatiothe the hereby made to obtain ainemit to do Me work and isrosilations as indimind. Icertifythwmwot*�L�tallationhw�wnced
issuanceofapethnitandthattailwarkwiltbe e
is not connethenced within dxP(60)*=id to m7cfc��wl of all laws reguhatwgcons�ctiohnt in thisjunisdiction. 7hispernutbf.—talw6m,
and- '7-or' Is ae w.,k..p�hdd�.bad..df.,aWeriodofs�P6)�nt&wa"tima r
21
wa�k,=men�d lundsenandthatsepaeateperouts trust be se�umdjbrElrvoicd Work Phimbing,Sign, eftpd, ussacetBoders,7=
Tanks sadAhr Candautem da
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. �q , t,
I heh?7�Certify then lhave readand�amioed thisifl7l,cation and kthoiv the natne to be i�and eterect.
=qcw at be conspi ed h h h d
ted hemin or�not. The runfing of a Wmit does that pressene to gnee atahwzy ns wolate or eaneel the
'71=11"Zianng coar�uon or the Mrf�ahce of coas�doa.
whha,f.heeal.
Signal=of Owner Signature of Contractor 411AJY PA7j,to,AY.Jh
Print Nor
Print Name d. artv, ne
SWOM tD)md subscribed before me: Swom to and schslIsibed befq
y of
r me
this �114 Day of 'e. 20 1(� this 2j
NI Gfq�t"
Notatj�"ftc Z,-j j,jyC0WIS90N#FF2IMI 01WHE
EXPIRES Mpst7 M19 Sed.d Th.
In
L yim�j�2610
ReanT.WeYP'bko�.
A ryn7 / �t /6-- kA,0D- DJOG
NOTICE OF CONaIENCEMENT FILE COPY-
Stateof Fl-,nRIDA TIDLIFolioNo.
Countyof QjA/AL–
To Whom It May Comm:
The undersigned hereby informs you that improvements will be made to certain real property,and in accordance with Section 713 of
the Florida Statutes,the following information is stated in this NOTICE OF COhEMENCEMENT.
I,egad Description of property bemg improved: l,,0T go ZFLVA HDIZX VWT TWO
I
Addressofproperty being improved: 20?_1 �SF—WA 14ADERA C-T-
General description of improvementr. enk);5T-R IJLT CQVr:-20AQ POIR.If tj FF-14CLOSE
t-Wr=z plkw(3
O—m,- Ci,'lMT 15uggRiper— Address: 2 o 21 sEwA hAADF-RA cT, ATi
Owner's interest in site of the improvennent: olj)jjf�—P
F S' I Titich Ider(if other than ow=)-
Surety(if my)—
Address: AmouutofBmdS
Telephone No: FamNo:—
Name and address of any person making a Into for the construction of the improvements
Name:—
Address: —
Phone,No�-- Fax No:
Name of person within the State of Florida,other than himselt designated by owner upon whom notices or other documents may be
served: Name:�
Address:
Telephone No: F%rNo:.—
In addition to himself owner designates the following person to receive a copy of the Lionear's Notion as provided in Section
713.06(2)(b),Florida Statuas. (Fill in a Owner's option)
Name: —
Address:—
Telephone No.— Feet Nor—
EVindion deft of Notice of Commencemeat(tbo expiration date is one(1)year from the date of recording unless a different date is
speciffed):
TEIIS SPACE FOR RECORDEWS USE ONLY 0 7R �/7 fees:
Si: i
DW#2016226257.OR SK 17727 Page 148, Sclurc,L thi deyo se 1?�_in the County ofUmal,Noun
Number Pages I CAFIrida,has personally appeared 'ItMP MKIzagoIc :M_
Notary Public a Lame,State offlori&6 Cotus,
Recu�09/2W2016 W 11:46 AM. yofDumL
Ronnie Fussell CLERK CIRCUIT COURT DUVAL Mly ammesoon expires: —----------
COUNTY ccd ldentifi:—�=-
RECORDING$10.W 110. ==n�Er
C�'r
RE"
a =
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach,Florida 32233-5445 dwiLkm-_aaC6
Phone(904)247-5826 - Fax(904)247-6845
E-mail: building-dept@wab.us Date routed: blbw
Citywela-site: hftp:#�.coalbus
APPLICATION REVIEW AND TRACKING FORM
Property Address: ;kOa I Sdft jIk(L&JA 61 ��quired Yes No
q-Building _J
Applicant: Come'as tpnslhu4ibi� nning&Zonino
Project: dtm d i r a di bom jA Tree Adm—inistrator
T-55RIC wo izi___
-Eublic Utilities
tlNdos'L "LL ac" ovur,"J) Public Safety
Rre Services
IELept Signature ...411111kRismieffiss
Other Agency Review or Permit Required Review or Receipt
of Permit Verified B Date
Florida Dept.of Environmental Protwdon
-Ronda Dept.of Transportation
St.Johns River Water ManagernentDistrict
_;�m_y Corps of Engineers
Division of Hotels and Restmamts
Div—ision of Alcoholic Beverages and Tobacco 7M
Other.
APPLICATION STATUS
Reviewing Department First Review'. E]Approv d enied.
(Circle one.) Comments: f" ��X'4d
BUILDING
P p NN NG Z NING Date:
LANNING &ZONING Reviewed by,49:,'— L
TREEADMIN. Second Review: )ZApproved as revised. ElDenied.
PUBLICWORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by_,de::.�-e '�--�000_�Date: Ivic5ta
FIRE SERVICES Third Review: DApproved as revised. ODenied.
Comments:
Reviewed by: Date:
Revised 05/14109
ZONING REVIEW COMMENTS
City of Atlantic Beach
Community Development Department
800 Seminole Road Atlantic Beach,Florida 32233-5445
Phone: (904)247-5826 Fax: (904)247-5845 Email: dreeves@coob.us
Date: 10/3/16
Permit: 16-RADD-2206 Applicant: Cornelius Construction
Review: 19 Address: 218 Bay St,Neptune Beach,FL 32266
Site Address: 2021 Selva Madrea Phone: (904)249-9706
RE#: 169506-1650 Email: Not Provided
Correction Comments
1. Tree Removal: Section 23-21 requires a Tree Removal Permit for any trees removed within 2 years of
this project. Please submit a Tree Removal Permit Application if any trees are to be removed or were
removed in the last 2 years. If no trees are to be removed or were removed, then please fill out an
Affidavit of No Tree Removal. Both forms me available on the city website order "Plarming and
Zoning"and at City Hall.
Derek W. Reeves
Planner
dreeves@coab.us
L4
_-TREE &L VEGETATION AFFlD"T_____
aty of Atlantic Beach
Department of Community Development
Planning&Zoning Division
BOOSeminoleRoad Atlantic Beach,FL 32233
(P)904 247-5800 (F)904 247-5845 PERMIT#
SECTION I-APPLICANT INFOPJVIATION F- Onmer(s) r- Legal Authorized Agent-
NAME OF APPLICANT
NAMEOFCOMPANY
ADDRESSOFCOMPANY -Zia Ony .Tr . MjW-1o;jF_r
PHONE ;? t CELL MAIL
E "Ti;
CONTRACTOR CERTIFICAlION NUMBER
ATUICH BUSINESS TAX RECEIPT NUMBER
SECTION 11-SITE INFORMA71ON NOV 10 2016
STREET ADDRESS OF PROPERTY 7-Q 7- _-V)4A Mocha
LEGAL DESCRIPTION
LOT BLOCK ---M"A AJOW'�UBDIVSWT
REAL ESTATE NUMBER LOT OR PARCEL SIZE: SO FT AC
RESIDENTIAL COMMERCIAL OTHER(SPECIFY)
I Offirra that I how mieftd the provisions of Chapter 23, "Protection of Tirees and Nothv Vegetartlan"of the Municipal Code of
Ordinances for the City ofAtIantic Beach,FL andlor I how participated In a pre-opplication meeting with the Administrator of those
regulations. Subsequently,I affirm that an regulated mms and no regulated wiletation will be damaged,destroyed and1hr removed
fromtheabove,desc"toradyjacentpropetfies mconjunction with thisprcloct,
zffww-'� . -
SIGN
'�)IIRE OF OWNER SIGNATURE OF OWNER
Signed and svrom before mean this/Oday of �'�0/6by State of F I
Countyof Zuvo_�
Identificationverified:
Oath swom: r7 Yes r- No
TON
I------- c_�� 0
,�Yoo Signature
y(%G,:11I1�lF11MI ota,
E'XP" Ta
El
XPIRE Geloto,6,Mg
_U._.� Yr
pFV.WA,jaj,L,�X So,&,1,1�Puwu,4ewwm yConamisslonexpires:
_j_
City of Atlantic Beach APPLICATION 19UMBER
Building Department (To,be assigned by the Bui
800 Seminole Road j7 vjt��
Atlantic Beach,Florida 32233-5445 SEP $
Phone(904)247-5826 Fax(904) 247-5845
Date routed:
E-mail: building-dept@wab.us
Cityweb-site: Inffix/A�.coatims
APPLICATION REVIEW AND TRACKING FORM
Property Address: ZLC);k I '50a Ma&4(( low uIred Yes No
Applicant: C&II1114U, tDASkhtd;DJ) lanning&Zonin
Tree minis rator
Project: 64 n dift. ad'd u lic Works
Public bities
ti%(A(XL LMUX Public Safety
Fire Services
Review fee Pgpt
N Other Agency Review or permit Required Review or Receipt
of Pertnit Verified B Date
Florida Dept.of Environmental P ion
Florida Dept.of Transportation
St.Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverag and Tobacco
Other:
M
APPLICATION STATUS
Reviewing Department First Review: [OApproved. E]Denied.;110�1#K"lk
(Circle one.) Comments: -(to Awud4w�
BUILDING
PLANNING&ZONING Reviewed by: Date: /0 A"I
_Zb�
TREEADMIN. Second Review: OAPProved as revised.tE]Ejed.
PUBLICWORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ElApproved as revised. E]Denled.
Comments:
Reviewed by: Date
Revised 05/14/09
2zo
Ll.
VP-0
ZI/
to /
vr
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IV
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Read
Atlantic Beach, Flonda 32233—IA45
Phone(904)247-5826 Fax(904)247-5B45 it—
D`1 L1142
E-mail: building-dept@mab.us Date routed:
City web-site: http:/twww.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: _10a I De a I'm t lewrequired Yes 'No
:B: in
Applicant: comilia-s' togsk A[4;w� I fRanning &Zonino
Tree AU—m—inistrator
Project: ti1.M-t) dtfL4ad� b0M1JPD1Lh, t
I I I
I'AUC&L "LLLL-C" ulu""'n, Public Safety
Fire Services
EZeview fee
Other Agency Review or Permit Required Review=lBy Date
of Permit
Flodda Dept.of Environmental Protection
Floncla 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�6TICIN STATUS
Reviewing Department First Review: M14proved. ElDemed.
(Circle one.) Comments:
PLA��BUILDING NIN Date://-2—/6
N NING Reviewed by: 500�
TREE ADMIN. Second Review: —ID,rWd.
]Approved as revised.
PUBLICWORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date
FIRE SERVICES Third Review: ElApproved as revised. E]Denied.
Comments:
Reviewed by: Date*—
Revised 06/14/09
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
OFFICE COPY (904)247-5800
BUILDING DEPARTMENT REVIEW COMMENTS
Date: 10.03.2016
FP-eM-i-t#-:---F16--RADD-2206 Site Ad4n��ptune Beach
I Site Address: 1 3021 Selv a Madera Ct., AB Phone: 904-249-9706
�Review: 1 Email: PcorneHm3@gmafl.com
Homeowner: I Clint Burbridget 242-9352
Email: hcb3@clintburbTidge.com
Applicant: Cornelius Construction
Wi�
Correction Comments: These comments are from 1 of 5 Departments that are
reviewing this application.
Application is disapproved for the following issues:
1 Submit the FLORIDA PRODUCT APPROVAL FORMS that are supplied at the
Building Department for all components and cladding materials.This project would
involve roof covering materials,windows and doors,siding material,etc. There are 13
windows made by the company that is using the product approval for the fixed windows.
Choose the exact one that will be used at this job. There are 4 different doors made be the
sliding glass door company,choose the exact one. In both situations it comes down to a
decimal point added to the end of the Fl,#to identify the product.The suppliers should
be able to supply this information. Looks like there might be a mullion device needed also
for the fixed window system.An FL#will need to be submitted for that as well.The form
ust be filled out completely. 2 copies.
2. Submit COVER F-4JUE-fm:2Lkns that were submitted, to include the following
information in the title block area, 1. Adar-e-si-otprolei;L,�Qccu Index o
u'd
re 13
W. i'dows
C! de be t e
sl'
it(
b(
fo
2,
all drawings and attachments and ail pagegWd-m-15—er,5. Printcd-�ont,ct info,date
0
It,
qnd
V� 4
. . . -11 Changearom-e�ffn-14opies- 04'.10-1q.16
,,=��al person responsible for the design of the structure. 2 copies.
3. to �41;Aw M
nt- headers on exterior walls. 2 copies.
-T
Submit wall sectional de alt-uf4he-perimetcrwalls,showing the-tiezilown-gysfina from
foundation. Structural e
rafter to foundation. Structural ��s din't reference the
as ourgm—k-bghtmg n
Submit an ele 11. .....It would be a good idea to disco
t c it�
inside�hadd ion or
fro�
a
n, controlla
Lthe .�aditio ble from inside the addition,as well as a new GFCI exte 'or
, al
receptical.
4 r io If
CITY OF ATLANTIC BEACH
F.0 LE 9 V E 800 Seminole Road
Atlantic Beach,Florida 32233
�,D Telephone(904)247-5800
FAX(904)247-5845
OR
�T EET OR
CORRECTIONS TO REVIEW COMMENT OFFICECOPY
Date: jb -(7-1� Received by: Resubmitted:-
PermitNumber: tV-f-AC�0-aAQ6
Origirtal Plans Examiner: Project Name:_;Fes
Project Address: .2 3� P.4- -
Contractor: ContactName: F�!.r!y "�ektd;"S!
ContactPhone : Z41- 9706 w-te-mail:
.,,eohT
Revision/Plan CheX/Permit Fee(s)Du6: $ -r -5U.00
Description of Proposed Revision to Existing Permit:
J='JacI2 PIAA
- fi(o 11 f_ /M-a�.,.a44OL4 a,S V�--f,4 eS
AJO(-
Additional Increase in Building Value: $ Additional S.F.
Site Plan Revisc& Public W/U Approval:-
-10�.I //L K- 2 - -
By signing be (print nam.) affirm that the above revision
is inclusive of the proposea coanges.
Signature of Contractor/Agent(cmunctu,must sip if mcmase in valuation) Date
offi.U.0.1,
D..:A' G Apprusd: X Rq.md' Notiflud by
Plan Review Comments:
P�rjj P37,-P/ -Fro� Cr i 5 ;Aa I Plf,-\ QIPW-e� ca" 6A-
Department review re -ulred Yin-No
Building
Planning &Zoning
Tree Administrator
Public Works /0 G
Public Utilities
Public Safety Date
Fim Services
Ordered By: Dr.
The Law Offices of Rod Schloth
2187 S Third St
t5o
JacksonviRe Bch, FL 32250 n
904-372-9351
beach@rod-law.com
PROPERTY ADDRESS 2M1 SELVA MADEFA<CX*��BEAq&jk)k'le*, SURVEY NUMBEEIL FL1211.1036
FIELD WORK DATE:11M�2 RIEVISIONO (S)
FI1211.1036 OFFICE COPY
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Ordered By
The Law Offices of Rod Schloth
2187 S Third St
Jacksonville Bch, FL 32250 rend
904-372-9351
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PROPERTY ADDRESS:2021 SELVA�MADEMiOURT�ATLANTIC 6f1r;'H,)r
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