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1885 Sea Oats Dr paver patio permit CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 RESIDENTIAL OTHER - SINGLE OR TWO FAMILY RESIDENTIAL OTHER MUST CALL BY 4PM FOR NE)(T DAY INSPECTION: 247-SS14 PERMIT INFORMATION: PERMIT NO: RES017-0021 Description: PAVER PATIO Estimated Value: 0 Issue Date: 7/11/2017 Expiration Date: 1[7/2018 PROPERTY ADDRESS: Addre : 1885 SEA OATS DR RE Number: 1720200534 PROPERTY OWNER: Name: FULTZ GARY L Address: 1885 SEA OATS DR ATLANTIC BEACH, FL 322334511 GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Name: Address: Phone: PERMIT INFORMATION: Please see attached conditions of approval. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. * A notice of Commencement is only required for work exceeding an estimated value of $2,500. For HVAC work, a Notice of Commencement is only required when HVAC work exceeds and estimated value of$7,500. City of Atlantic Beach APPLICATION NUMBER Building Department 800 Seminole Road (To be assigned by the Building Department.) Atlantic Beach, Florida 32233-5 If o0z 4A5 so t7 Phone(904)247-5826 Fax(904)247 5845 E-mail: building-dept@coab.us Date routed- Cdy"Ic-site: httPIN�.cowlt.us :&::�, APPLICATION REVIEW AND TRACKING FORM Property Address: r--kC)PT& E) D, IrtM,nt ,,Is,r, uddin Applicant: CDWOe4;-�1- . & ree Administrator Project: Pp,\(-C—,P— P&-cco Public Utilitie Pu ic Safety Fire Services A Ot ER T110 MB pa' y T [f7 y �A LIC �L� P PP P T 0 be ."ined b the E lcfft�o o at.mu D led ReVre7w fee Dept Signatur4 Other Agency Review or Permit Required Review or Receipt of Permit Verified B Date Florida Dept of Environmental Protection Florida Dept.of Transportation Tt Johns Rher��erManajemenFJD�istnct Any Corps of Engineers Division of Hotels and Restaum�— DiVision of Alcoholic Beverages and Tobacco im Other: APPLICATION STATUS Reviewing Department First Review: [DApip.d. DDenied. [6Nt applicable (Cincle one.) Comments: BUILDING PLANNING&ZONING Reviewed by: gngt'/4' Date 4 2"? ( 7 TREE ADMIN. Second Review: DAPProved as revised. []Denied. ONot applicable P I ORKS/ Comn P _)ants: ��BLI&C UTILITIES PUBLIC SAFETY Reviewed by: Date:— FIRE SERVICES Third Review: [DAPproved as revised. DDenied. DWI applicable Comments: Reviewed by: Date: Revised OW1912017 City of Atlantic Beach Building Department 800 Seminole Road Atlantic Beach, Florida 32233,5445 Phone(904)247-5826 Fax(904)24,55A5 E-mail: building-dept@wab.us Cityweb-site: m(pJA�,mab.us APPLICATION REVIEW AND TRACKING FORM 7�0, Property Address: e—KC T& E)12 D partment review requi7!J!!]:n Applicant: Administrator Project: P():\rC_9_ ublic Utilitie Pu c Safety Fire Services RevieWTWL_ be lghatdfg�IIINIIIIIIIII Other Agency Review or Pe !tRequirw Review or Receipt of Permit Verified B Date Florida Dept of Environmentaa Protection Florida Dept.of Transportation St.Johns River Water Management District Amy Corps of Engineers Division of Hotels and Restauran Division of Alcoholic Beverages and Tobacco Other. APPLICATION STATUS rReviewing Department First Review: VApproved. ElDenied. E]Not applicable (Circle one.) Comments: J6710- U D BUILDING I IL I ZO PLA'TNNING &ZONMING Dat�"- 8 M Reviewed by,_� a: TREE ADMIN. Second Review: E]Approved as revised. ElDemed. E]Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ElApproved as revised. ElDenied. ONot applicable Comments: Reviewed by: Date Revi5ed OW19/2017 All 000 V PZ f7 i x I rz 44 44ahwi jv� k I I-V nv g o 1-1 e 4r- V, Zd �o 7?Z wmmmmmmm� City of Atlantic Beach Building Department 800 Seminole Road Atlantic Beach,Flonda 32233-5445 Phone(904)247-5826 Fax(904)247-5845 E�mail: building-dept@mab.us Citywelb-site: hftp:/Avwmcoab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 16185 's ENC_A:�& P_ De artment review re uired Yes No Applicant: etl� uildin & Pse Administrator Project: PaVC-Iz- palco Public UtIlite Pu ic Safety Fire Services WM ease -mbell3t9ignature Other Agency Review or Permit Required Review or.Rece'pt rmuV nt'Z a of pe =Pat Date Flonda Dept.of Envimnmental Protection rmit d By Florida Dept.of Transportation St.Johns River Water Management District Any Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco WOther. [l APPLICATION STATUS FReviewingDepartment First Review: Approved. ElDemed. E]Not applicable V' W' 9 Dep rmne '(Circle one.) Comments: C rcl.on I B U UILDING IL I PL ,ZO PLANNING &ZONING IG8 Reviewed b T r : M TREEADMiN. Second Review: ElApproved as revised. ODenied. E]Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date- FIRE SERVICES Third Review: DAPproved as revised. ElDenled. E]Not applicable Comments: Reviewed by: Date: Revised 051912017 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 [REIS01-7- OOZ Phone(904)247-5826 Fu(904)247-5845 E-mail: building-dept@wab.us City web-sits: Imp 1/www coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: CA OPT& bli? Department review required Yes No uildina Applicant: efa— 1 Tres Administrator Project: PRVC-(.?- Pft'ccc) -1 4�.-Public UtlIftlR:> Pubric,Safety Fire Services Re—vim or Receipt Other Agency Review or permit Required of permit Verified By Date Florida Dept of Envinowental Protection Flonda Dept of Transportation St.Johns River Water Management District Army Corps of Engineers; Division of Hotels and Restaurants Division ofAlcoholic Beverages and Tobacco Other. APPLICATION STATUS Reviewing Department Firat Review: 24'proved. DIDenied. E]Nat applicable (Circle one.) Comments: -��BUILDING PLANNING &ZONING Reviewed by: Date: 6-IEV TREE ADMIN. Second Review: F]Approved as revised. ODenieV. E]Nat applicable PUBLIC WORKS Comments; PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: E]Approved as revised. E]Denied. F]Not applicable Comments: Reviewed by: Date: Revised 0511912017 -Ad CITY OF ATLANTIC BEACH OWNER/ BUILDER AFFIDAVIT 1. FLORIDA STATUTES,- CHAPTER 489, FLORIDA STATUTES, PART I '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 RAYE APPLIED FOR A PERMIT UNDER AN 100IMPTION TO THAT LAW. THE 13XENVTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN TIKOUGH YOU DO NOT HAVE A LICENSE. YOU MUS SMME THE CONSTRUCTION YOURSELF, YOUMAYBUILDORE,4PROVEAONE—OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF S25,000.00 OR LESS. luLaU&Mg: MUSTBE FOR YOUR USE AND OCCUPANCY. ITMAY NOTBEBUILTFORSALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHEN ONE YEAR AMR THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF MS EXEMPTION. YOU MAY NOT JERE AN IEUCENSFn 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 EQWM BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING 11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. Ill. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX ANDIOR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANrEC�WNERS BEING SUBJECT TO $5.000 PENALTY LINDER FLORIDA STATUTE No. 455-228(l). AN-OCCUPATIONAL LICENSE-IS NOT ADEQUATE, THE OWNER SHOULD PHYSICALLY SEE THE COUNTY NEUFTA�ATE 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. �DRE I. Sed PHOKEN UMBER TIGMIT-6 R DATE B-famm'N. ya 20 lnthm�urtyof Bh., . m Du�l. he&Hvida has peasonally appeonad hadn by him aff/herself and affirassfad 00 _2 Z -4 6-e�05 Noba,Sf,nabma�_ EXPIRES.O=Ear 6,2019 Ma. CITY OF ATLANTIC BEACH 800 Seminole Road Atlantic Beach,Florida 32233 OFFICE COPY Telephone(904)247-5800 FAX(904)247-5845 Dills) HE VISION REQUEST SHEET OR CORRECTIONS TO REVIEW COMMENT Date: 6- - tq- 1-2 Received by:_ Resubmitted: Permit Number: R ESP 17-On 7— Original Plans Exammer:— . Project Name: PGNtae— PAT,(� Project Address: �,Ll�r :�e, n�f� a)r_ Crmtmctorl�.l Bepai V-Name:- ��l 193dA) Contact Phone tact e-mal Revision/Plan Check/Pen�t Fee�(�s)One: i1b Description of Proposed Revision to Existin2 Permit: tQ�,V,-e- al E &1�, P U Additional Increase in Building Value: $ Additional S.F. Site Plan Revised: —Public W U Approval: By signing below.I(print nme) affirm that the above revision is inclusive of the proposed changes. Signature of Contractor/Agent(C--imtnr—9�ipn ifinc...in�a[..tu,.) Date offi.U.()n], D.tc Apprrv,ni: Notifirlb, Plan Review Comments: _PspartuiQnt review re uIred Yes 0 Building ) 7" Jarring &Zoning r— Tree Administrator Plans Examiner Public Works P PPublic Utilities 45 -7 Public Safety Fire Servit;es Date Building Permit Application Updated 5/5/17 City of Atlantic Beach OFFICE COPY 80OSeminole Road,Atlantic Beach, FL32233 0 Phone: (904)247-5826 Fax: (904)247-5845 Job Address: 0.0h Permit Number: R GS(N_7- OOZ( L L g�l 1 -7 - lVca- ("0 -1 oet� *(j.RE# 1-7-7 0Z 0 -0 S3'+ egal Description L�oi I EiK I S(E_ _t V.l..j Heated/Cooled Valuation at Work(Replacement cost)$ Heated/Cooled SIP_Non Iterati Repair Move Demo Pool WindOW/Door Class of Work(Circle one): New Addition eig� Use of existing/proposed structure(s)(Circle one): Commercial If an existing structure,is afire sprinkler system installed?(Circle one): Yes No GD Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal e�n -IZ6�,,gr [Descrilay in detail the type of A�jk t�be perfokped '.�L , c- vS6 e9L 1v iz�P14,e q/- e� /3er -J 0/. Florida Product Approval# for multiple products use product approval form property Owner Information Name: Address Xj,.,l .,4 . 4 .4 City tate zip FZZ3�) '0 Phone E-Mail Owner or Agent(if Agent,Power of Attorney or ency Letter Requ Contractor Information Name of Company: 7%4�� &;� !tying Agent: Addle V4 .2 Lfe—,,wr State /I zip_z�� Office Phone 70z/-2 3-/- rrs-0 v 1pr�i!e/co itact Number ;Plq-.2 f'/-8,5'a e Mail State Certification/RegIstration If Architect Name&Phone IF Engineer's Name&Phone#_ 7 Workers Compensation 4— Exempt/insurer/Lease Employees/Expiration Date Application is hereby made to obtain a ermit to do the work and installations as indicated.I certify that no work or installation has It commenced prior to the issuance o /permit and that all work will be performed to meet the standards of all the laws regulationg construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,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 RECO�DING YOUR NOTICE OF COMMENCEMENT. nerorAgent) (Signature of Conlanicto (including ntractor) to(or affir )before me this A day of �Signecl�andsworn to(or affirmed) ore me this day of YA A 20 n ,by ghr,� tz_ by Tally Kyo is litur ry) (Sign r of Notary) (Signature of Notary) No.FF SM I Personally Known OR I I Personally Known OR JUArraduced Identific!Ilk 040e6 L,,- I Produced Identification Type of Identification Type of Identification: R: CITY OF ATLANTIC BEACH OWNER/BUILDER AFFIDAVIT 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 'CONSTRUCTION CONTRACTING'REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW. DISCLOSURE STATEMENT FOR SECTION 490.103(7),FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO 13E DONE BY LICENSED. CONTRACTORS. YOU HAVE APPLIED FOR A PEFIHT 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 14AVE A LICENSE. YOU MUST LD OR 11,2ROVF A ONE-OR DO MAY ALSO BUILD OR .00 OR LESS. nffiBUILDINO BUILTFORSALE ORLEASE. SELF WITHIN ONE YEAR PRESUME THAT YOU BUILT OM YOU MAY NOT CONSTRUCTION MUST G REGULATIONS. IT IS LQ By YOU HAVE OR 'AL LICENSING > IL If. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. LLJ Ill. 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 0 CIRCUMSTANCES, NERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(l). AN-OCCUPATIONAL LICENSE-IS NOT ADEQUATE THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTFFiCATE 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 I OWNER-BUILDER PERMIT. z z 0 L ADDRE�. PHONEtl& 5 Lu — a 0 to != z 00 C3 w P: 4 SiGNATUR z z DATE 0 0 4 cc Du�l,S. RoHda, hedn by hl.71f 0 LL IL w W W C�nly n 0 , % I W >. 3: t: w m Lu L) ww m TONI GIN)LE5PERGEt MYWMMISSON#H`92�1 cc B j 0 0 Z 0 0 //.107 Of .107 &Od J z _Y31LIS PSI AMA _ _L __ __ .0,00/ ;N /4P.667's -------- ------------- 4 LL 19W 0 m 0 zz u N > J V 00 cj) Z > 0 0 -70E 0 m '. ol 2 Ox x -00/ 3.61,2g.sew 'o Qi z J3-761JS q,61 MAP SHOWING SURVEY OF LOT 17, BLOCK 1 SELVA MARINA UNIT NO." 9 AS RECORDED IN PLAT BOOK 36 PAGE 20 OF THE CURREN� PUBLIC RECORDS OF DUVA COUNTY, FLORIDA. z-7 OFFICE COPY LOT /3 LOT 12 IND.ll� 'E... 0"' S.00002'41"E. 9/1 0' TV- Lor16 I-, 60.7' 151 Q I OtvE STORY BRICK RESIDENCE No.1885 ob ai Z5.6 I 7W w OR jk� 15.3, /J.7' CONC,WALe it R�25' L rNo.J14 P� N, 00002'41"W 9ZO' 'w. NOTE BEARINGS AS PER. PL47' BRt AS PER PLA7. 60"91w PAVED DRIVE SEA OA T I HEREBY CERTIFY THAT THE PROPERTY SHOWN *,11PON IS IN FLOOD ZONE, "S" AS SHOWN DN THE FLOOD HAZARD BOUNDARY MAP ':)R THr CIT'I! OF ATLANTIC BEACH, FLORIDA. I HEREBY CERTIFY TO GARY & MARCELLA DARLENE FULTZ AND ATLANTIC MORTGAGE & INVESTMENT CORPORATION THAT I HAVE SORVEYED THE LANDS AS SHOWN IN TRE ABOVE APTION AND THAT THIS MAP IS A TRUE AND CORRECT REPRESENTATION OF THAT SURVEY ND THAT THE SURVEY REPRESENTED HEREON MEETS THE MINIMUM STANDARD REQUIREMENTS DOPTED BY THE FLORIDA STATE BOARD OF PROFESSIONAL LAND SURVEYORS I CHAPTER I-HH AND THE FLORIDA LAND TITLE ASSOCIATION. 1� -,am\it, DONN W. BOATWRIGHT, L.S. _'--k FLORIDA REG. LAND SURVEYOR No. 3296 SCALE: 1",201 BOATWRIGHT LAND SURVEYORS, INC. DAT DRAWN BY: 1301 PENMAN ROAD SUITE D SHEET—/ OF F.B. *: AIZE JACKSONVILLE BEACH, FLORIDA 241-8550