287 NAUTICAL BLVD - PATIO SLAB rLy.
S� CITY OF ATLANTIC BEACH
s) 800 SEMINOLE ROAD
j Via- ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ADDITION
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-RADD-3607
Job Type: RESIDENTIAL ADDITION
Description: adding concrete slab in rear of home for patio
Estimated Value: $2,000.00
Issue Date: 4/5/2017
Expiration Date: 10/2/2017
PROPERTY ADDRESS:
Address: 287 S NAUTICAL BLVD
RE Number: 170703-0371
PROPERTY OWNER:
Name: Vogel, Lane
Address:
PERMIT INFORMATION: PUBLIC WORKS:
Full erosion control measures must be installed and approved prior to beginning any earth disturbing
activities. Contact the Inspection Line (247-5814) to request an inspection from Public Works 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(Advanced Disposal, Realco Recycling,
Shapell's Inc.). Container cannot be placed on City right-of-way.
Full right-of-way restoration, including sod, is required.
Any plan change must be submitted as a Revision to the Building Department.
FEES:
ENG REV RESIDENTIAL BLD $100.00
UTIL REV RESIDENTIAL BLDG $50.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WI'I'II :U,I. CI 111 OF Al I.VNrIC Bt;ACII ORDINANCES AND TUE FLORIDA
RI/I CODES.
CITY OF ATLANTIC BEACH
f
�Sf� 800 SEMINOLE ROAD
r ;}
J ATLANTIC BEACH,FL 32233
/ INSPECTION PHONE LINE 247-5814
SIAI E. U131'I-Z SURCHARGE $2.00
STATE DCA SURCHARGE $2.00
Total Payments: $154.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
r
01./11./:r el City of Atlantic Beach
$51 -# �� Building Department � ��*�, ,� � �� APPLICATION NUMBER
a to ' (To be assigned by the Building Department.)
800 Seminole Road _ n A
•r._ Atlantic Beach, Florida 32233-5445 , , ``-A 0 n (00�
Phone(904)247-5826 • Fax(904) 17-56rr5� s 2017
..1.71)...V E-mail: building-dept@coab.us Date routed: 0 13
City web-site: http://www.coab.us BY:
APPLICATION REVIEW AND TRACKING FORM
Property Address: W -4- 1"CtLIA C Ct . Department review required Yes No
Building
Applicant: Q.A)1\.Q-( Planning &Zoning
� Tree Administrator
Project: C l�(lU Sly�O �1.)f P Alb Public Works")
'-Pubic Utilities
Public S7r6fr.
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. ❑Denied. Q q-f-77
(Circle one.) Comments: fa /Wait( 111 _2j
BUILDING
PLANNING &ZONING
Date:/ //?
Reviewed by: • . C//r l
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
MAP SHOWING BOUNDARY SURVEY OF:
LOT 2, BLOCK 4, SEASPRAY, AS RECORDED IN PLAT BOOK 35, PAGES 64 AND
64A OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA, LESS AND
EXCEPT THE SOUTH 5.00 FEET OF SAID LOT 2
SEASPRAY AVENUE
60' RIGHT–OF–WAY
A
FOUND 1/2" IRON PIPE
vi NO IDENTIFICATION
Z
LOT 1 10.0' LOT 443
mI a i
O m
N �S67'28'II" 100.00' —
•o' D..• FOUND 1/2" REBAR
2 '' \ 02 -NO IDENTIFICATION 'a
O 2 %n . w
o \ Lt \:;
o 2 .e a• -S
O \� 22.8' 7 I - 3.
E.
O zo " o gi 1 O
I^ CQ4CRETE DRIVE .� M 3
`C) o o - , �s i<0 LOT 444
f� z . To Z 500 r.4 �. Iru"Q
_ . h r . I coo z 1
�`� e N �W
w
zo .N E°o n5 1
o 7,,,W i t,,,\
1e'1(---'
I O
O u 2\ . O S.2•I C;?
W \ 11 j
N 20 0� \ .--6
In am i. v \ _ -0 �] :_.] 7 Q
z e,, N F-
Z m N 6.0 (N H
xi
s 1 f� Q
a ww
Q \z Zi.O' 40.0' 4; Eo I 0
I THE SOUTH 5.00 FEET OF o. ' 6.0' . a
I� 0LDT 2 NOT INCLUDED IN THIS t• SET 1/2" IRON PIPE
h m SURVEY "b. 1,• DURDEN LB. #6696 T p
2 �. h.
0
—I I- w LOT 2 I_N67.28'00'W 100.00' N. LOT 12 i c LOT 445 0
CD a LOT 3 n: LOT 3 FOUND 1/2" REBAR Z
o
O I/ PAD 11EL PSP I x NO IDENTIFICATION CO
z z 20.8' I O lig 20.8' v v—
oO N^ I ` , 0L44.1¢TEI I ol'� _-.O. O Q.
J O 2.0' I I O t 1
< o 4
0000 ' '' ; 1 I" °° w
U � z z^ 9a
. o(�zi
W ;.U -0SED
1 OO J.D' V 14.1' o o SUN ROO x
0 1l O WO ` /1N „.5' ../9.4c.., I n O
D ^ 1112222FFFFffff(Fs / %
0 0 Lu N SUN ROOM ENCLOSED c _. I 0
ZN a 3.0 1s.2'\ isr) LOT 446
•Npco . P I N
pCN c,_.0 A• 0 9y I. N
Z .goNe-RE T olvE 1 H $}f 1,,L;,.'400
Ti.
Jl oc V)
'•=! 20. J //
O O _ concriErr rt,' .
Q —�-' —,,--__a
LAVE „--L-,51-- FOUND 1/2" REBAR
NOTESI "N NO IDENTIFICATION
THIS PROPERTY UES IN FLOOD ZONE 'X"BY FLOOD N6 7°28' 0"W 100.00' o
MAP RENSED AUGUST 17, 1989, COMMUNITY PANEL
NO. 120075 0001 0
BEARINGS BASED ON THE EAST RIGHT-OF-WAY LINE OF m LOT 4 il
LOT 447
NAUTICAL BOULEVARD SOUTH AS BONG N 2732'00'E I 10 0
20'BUILDING RESTRICTION LINE(B.1?.14 BY PLAT
N.T.S. DENOTES NOT 7D SCALE I IP'
ALL LOTS SHOWN HEREON UE WITHIN BLOCK 4
—X— DENOTES 4'CHAIN UNK FENCE I CERTIFIED TO:
--//— DENOTES 6' WOOD FENCE
—W— DENOTES 5' WIRE FENCE OLIVE H. & TOM BRUGGEMAN
THERE MAY BE ADDITIONAL RESTRICTIONS THAT ARE NOT
SHOWN ON THIS SURVEY THAT ANY BE FOUND IN THE
PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
I hereby certify that this survey meets the
' minimum technical standards cs set forth by
the Florida Board of Land Surve,ors, pursuant to
A DURDEN Section 472.027 Florida Statutes and Chapter
I I61817 Flo( A stratior e
SURVEYING AND MAPPING, INC.
8150 Lone Star Rood, Suite 3
Jacksonville, Florida 32211
I 1 (904) 724-5588 Fax 724-9154 FLORIDA REGISTERED SURVEYOR No. 470
LICENSED BUSINESS NO. 6696 H. BRUCE DURDEN,Jr
SIGNED JANUARY 11. 2010
SCALE: 1" = 20'
WORK ORDER NUMBER: 210005 B R
THIS SURVEY NOT VAUD UNLESS THIS PRINT IS EMBOSSED WITH THE SEAL OF THE ABOVE SIGNED. — 7 8 7Q
e-i-twr,, City of Atlantic Beach
FE' EIVE APPLICATION NUMBER
is , Building Department
-,- 800 Seminole Road (To be assigned by the Building Department.)
r Atlantic Beach, Florida 32233-5445 MAR 3 1 2017
_� Phone(904)247-5826 • Fax(904)247- 5 1 , ���� O
\oitiO E-mail: building-dept@coab.us
gy;_ Date routed: D 3 I l
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ca%q' I"uLt LGtr l IAA_ S . Department review required Yes No
Building
Applicant: DO(VQ-,( Planning &Zoning
1 Tree Administrator
Project: __0(1L-1__0(1L-11__0(1L-11-V- Sa-b ( tO4 Nab Pubtic Works
-P> ic Utilities
Public Safety
Fire Services
Review fee $ Dept Signature #1r\
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: -pproved. ❑Denied.
(Circle one.) Comments:
BUILDING 40"
PLANNING & ZONING �y
Reviewed by: / - Date:4/ 7
TREE ADMIN. l
Second Review: [Approved as revised. ❑Denied.
WORKS Comments:
PUBLI TILITIES
-3-1
PUB IC SAFETYReviewed by:
Date:
FIRE SERVICES Third Review: []Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
avised 05/14/09
610-.1‘0
I/9a o23 ,Z04—.460tLvele Po
j tip2 Y /!2_ /fib
04/1/41-'
f;kak x
II X 10 o
�. "di ,.3 x 3 9 121
, ;"= Building Permit Application
1'
City of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
oj96,' v Phone: (904)247-5826 Fax: (904)247-5845
Job Address: r .?. ,4ILLiJ .4 ,13/vd S AA /- 127 Number:
Legal Description RE#
Valuation of Work(Replacement Cost)$ 20000 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): aAddition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Residen 'a()
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No al
• 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:
Corker-a siu 6 .Fat- IGIC,triJ i h bc,.ck yw,r4
I Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: ✓1c Ijd tI Address: Ail �ta,t,i t4 O/v. S
City ,'T 100%-GC '-<4" State F'' Zip 3224 33 Phone if., ?V ;3 i 14eJr-
E-Mail /0.416,Va,r./ C 50"•44-/. t G.•,,- .
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information ii;i
Name of Company: r-
' tot 4•INir' .'.w ' Qualify'•: igent: � 1Ute; ,Gi__.i
Address 1113 t•fi v2 t '•• -x-" • 1 City •..c{< ,iffil�� 1z1i�
Office Phone/ `l'c/ ''4y '' ' Job Site/C.- tact Number Ci 4"/ . • 64q z,
State Certification/Registration# '41 W tnIfit E-Mail
Architect Name&Phone#
Engineer's Name&Phone# (', {,�_,
Workers Compensation • f ;, L►� ,��
Exempt/Insurer/Lease Em 1y ace ,
ra
the work and installatl its indicated.I certify that no work or; installation has
Application is hereby made to obtain a permit to do �
III commenced prior to the issuance of a permit and that all work will be performed to r> nthlsi n of all the laws regulationg
construction in this jurisdiction. I understand that a separate permit must be secured LECT IC L WORD,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES, BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc.
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
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
RECORD! G YOUR OTICE OF COMMENCEMENT.
„._,_ Y
Si
(Signature of Owner or Agent including Contractor) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this teday of Signed and sworn to(or affirmed)before me this day of
4 I. • - _. LU�v,i , by
JENNIFER JOHNSTON -
''•A:,,,, MY COMMISSION#60 0429•
, :'- EXPIRES:October 27,2020 ' (Sign lure•A otary) (Signature of Notary)
:•:.: 7 Bonded Thru Notary Public Underwri-
[ ]Personally Known OR [ ]Personally Known OR
[,Produced Identification \ [ i Produced Identification
Type of Identification: 0--11\19-i'.' `l(��.f1S� Type of Identification:
•SLAV
- �i`'`; CITY OF ATLANTIC BEACH
'a- OWNER / BUILDER AFFIDAVIT
\:,;t V .
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 525,000.00 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, 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. ii
- -i'/1 NCL 17 11/4) / lcl s' a,-c,c,dek re- 37-13; �e 332, 7- Zt-
ADDRESS , PHONE NUMBER
Jj� f
PRINT NAME /
V 4 I �' - Z�
SIGNATURE,' 0� O IML(�\79tAd
t(�J DATE
Before me thisv2/ day of .44/Lit ,20 Tin 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 B- .County of d C�
❑PersonallyrodKnown p 0�\S1 fi
.Produced Identification- OL \ L- 'r oy4,, JENNIFER JOHNSTON
,,, :,�: MY COMMISSION*GG 042984
I;•: " EXPIRES:Ocbber 2T,2020
Notary Signature: TxuINotary Public Undat l►
ars
, t?
F:/131.13G/Owner—Builder Affadavit;REVISED:4/16/2009