893 Amberjack Ln patio permit Jay.
CITY OF ATLANTIC BEACH
i 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ADDITION - SINGLE OR TWO FAMILY RESIDENTIAL ADDITION
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RESA17-0012
Description: 8 x 15 feet concrete patio
Estimated value: 350
Issue Date: 7/12/2017
Expiration Date: 1/8/2018
PROPERTY ADDRESS:
Address: 893 AMBERJACK LN
RE Number: 171178 0000
PROPERTY OW NER:
Name: LUNDGREN CHARLES
Address: 893 AMBERJACK LN
ATLANTIC BEACH, FL 32233
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.
i
r Permit Conditions
City Atlantic Beach
Permit Number: RESA17-0012 Description:8 x 1S feet concrete patio
Applied:6/26/2017 Approved:7/12/2017 Site Address:893 AMBERIACK LN
Issued:7/12/2017 Finaled: City,State Zip Code:Atlantic Beach,F132233
Status:ISSUED Applicant:<NONE,
Parent Permit: Owner:LUNDGREN CHARLES
Parent Project: Contractor:<NOI
Details:
LIST OF CONDITIONS
SEQ NO ADDED DATE REQUIRED DATE SATISFY DATE TYPE STATUS
DEPARTMENT CONTACT REMARKS
1 ]/6/201] 1 EROSION CONTROL NSTALIATION INFORMATIONAL
PUBLIC WORKS Scott Williams
Notes:
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 Erosion and Sediment Control Inspection prior to start of construction. . , u.. ,
2 1 ]/6/201] 1 1 ON SITE RUNOFF INFORMATIONAL
PUBLIC WORKS Scott Williams
Notes:
All runoff must remain on-site during construction. '
3 1 7/6/2017 ROLL OFF CONTAINER INFORMATIONAL
PUBLIC WORKS Scott Williams
Notes:
Roll off container company must be on City approved list(Advanced Disposal,Recite Recycling,Shapell's,Inc.,Republic Services). Container cannot be
placed on City right-of-way.
4 7/6/2017 RIGHT OF WAY RESTORATION INFORMATIONAL
PUBUCWORKS Scott Williams
Notes
M1
Full right-of-way,restoration,lac siding sod Bi-squired.
5 7/6/2017 RUNOFF INFORMATIONAL
PUBUCWORKS Scott Williams
Tamonom
Printed:Wednesday,12 July,2017 1 of 2
T
'a"
Permit Conditions
City of Atlantic Beach
op
6 )/6/20ll REVISION INFORMATIONAL
PUBLIC WORKS Scott Williams
Nates:
Any plan change must be submitted as a Revision to the Building Department.
Printed:Wednesday,12 July,2017 2 of 2
Ytr City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
600 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 Fax(904)247-5845 L
E-mail: buildingAept@coab.us Date routed:
-- City website: hhpU/www.coab.us
APPLICATION REVIEW AND
dA TRACKING FORM
Property Address: °%3M �a.(.�I�,IC.. Deartmentreview required Yes No
mldir
Applicant: w mng &Zoning
T
f(�� Lstmtor
Project:
_LIS TQ[, Public Works
Public Utilihe
u Ic Safely
Fire Services
Review f
Other Agency Review or Permit Required Review of PermitVerified or Receipt B Date
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
Sl.Johns River Water Management Dishict
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobaac
Other:
APPLICATION STATUS
Reviewing Department First Review: VrApproved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date: Z ��
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY
Reviewed by: Dale:
FIRE SERVICES Third Review: []Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 06119/2017
�1sry City of Atlantic Beach APPLICATION NUMBER
r3r n Building Department (To be assigned by the Building Department.)
d 800 Seminole Road g&CJ A- I� -^O' `
Atlantic Beach,Florida 32233-5445 t/ O'
Phone(904)247-5828 Fax(904)247-5845
E-mail: building-dept@wab.us Date routed:
City web-site: hftp://www.wab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: U 3 Amba ,aLIL_LAO 2 Departmentreviewrequired Yes No
tuing
Applicant: mg &Zoning
11 II rT stra or
Project: A ( bo— a�l l7 _ X I Tet Public Works
Public U""',a
Ic Safety
u
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
Florida Dept.of Transportation
St.Johns River Water Management Distdct
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: ❑ (((Approved. Denied. [-]Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Dater Z�
TREE ADMIN. Second Review: Approved as revised. ❑Denied.
[]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by� � _ Date: 7lialp
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
ZONING REVIEW COMMENTS
fd City of Atlantic Beach
it s Community Development Department
800 Seminole Road Atlantic Beach,Florida 32233-5445
Date: 6/28/2017
Permit: RESA17-0012 Applicant: Charles Lundgren
Review: ZONING Address: 893 Ambedack Lane,Atlantic Beach
Site Address: 893 AMBERJACK Phone: 322-2603
LN
REM 171178 0000 Email: ceebreez@hotmail.com
Correction Comments
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 are available on the city website under "Planning and
Zoning" and at City Hall.
Informational Comments
Brian Broedell
Planner
CITY OF ATLANTIC BEACH
J3 800 Seminole Road
ld Atlantic Beach,Florida 32233
j Telephone(904)247-5800
=" FAX(904)247-5845
yoil S) REVISION REQUEST SHEET OR
CORRECTIONS TO REVIEW COMMENT
Date: (� Z Received by: Resubmitted:
Permit NurnbczAI f z
Original Plans Examiner: Project Name:
Project Address:
Contractor: Contact Name:
Contact Phone : Contact e-mail:
Revision/Plan Check/Permit Fee(s)Due: $
Description of Proposed Revision to Existing Permit:
n p A s fr e
Additional Increase in Building Value: $ Additional S.F.
Site Plan Revised: Public W/U Approval:
By signing below.I(print name> affum that the above revision
is inclusive of the proposed changes.
Signature of Contractor/Agent(Contractor must sip if increase in valuation) Date
ogee Use only
Ease: Approved: Rejected: Notified by:
Plan Review Comments: T�
De ariment review required Yes No
Building
nnmg &Zon— Plans Examiner
Tree Admims ra or
Public Works / 7
Public Utilities
Public Safety Date c>m.eaunn n«.n
Fire Services
City of Atlantic Beach APPLICATION NUMBER
�s Building Department (To be assigned by the Building Department.)
800 Seminole Road S \
O IO
Y Atlantic Beach,Florida 32233-5445 ~�� '
Phone(904)247-5826 Fax(904)2471 45 JUN i
E-mail: building-dept@wab.us 20�] Date routed: 'Q (Q ( I�
City web4te: hhp://vw .coab.us
APPLICATION IR,�EVIEW A- -ND TRACKING FORM
Q
Property Address: n q 3 AM ULf I C (l De a tment review re uired Yes No
'I 11 m ding
Applicant: �W�� ning&Zoning
lr� gFireSewices stra or
Project: ot'� X I T� rks
ibe
ety
Review fee $ Dept Signature
Other Agency Review or Permit Required Reviewor 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: [ Approved. ❑Denied. -]Not applicable
(Circle one.) Comments: Jct hw(�UGgI/
BUILDING
PLANNING &ZONING Reviewed by: Date: '
TREE ADMIN. Second Review: A roved as revised.
❑ pp [_]Denied. ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/79/2017
City of Atlantic Beach APPLICATION NUMBER
m
Building Department �+ ('ro be assigned by the Building�Department.)
�
800 Seminole Road .~".' ( 0 I P`
Atlantic Beach, Florida 32233-5445
Phone(904)247-5828 Fax(904)247-5841 JUN
;tlpr E-mail: building-dept@wab.us / Date routed: h I�
Citywel -site: hap://w .coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ° 3 AM bUi aLLstn 2 Department review r aired Yes No
ui ding
Applicant: nlnl n•L✓ I Ing&Zoning
T stra or
Project: ( ol�J X1 T2C Public Works
Public Ublibe
u Ic 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: ❑Approved. ❑Denied. of applicable
(Circle one.) Comments:
BUILDING
PLANNING&ZONING //
Reviewed by: �/ �G11 Date � r7
TREEADMIN. Second Review:
❑Approved as revised. ❑Denied. ❑Not applicable
rBL_G1C7US_
ORKS ) Comments:
FETY Reviewed by: pate:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
Updated55/1]
o Building Permit Application
6 City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
A Phone:(904) 247-5826 Fax: (904)247-5845
XR3 /74Ltf/e C6� Rhe- _Permit Number.
Job Address: / .1�(Qt//f ,,I y .y�j [l
Legal Description 3040 17'.x. —/,9 G RMQ I FAW3 Un I�-[ �1"2�BOK RE# / 11 /17 `00d e
Valuation of Work(Replacement Cost)$35'0 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New dditm Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Residential
• If an existing structure,is afire sprinkler system installed?(Circle one): Yes No 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:
C0r%CrC-�E r0t+0 $'4mt.x/5',iN-
Florida Product Approval# for multiple products use product approval form
Pro art ne Information ¢'Y L
Nam Address:
N.a State_Zip
E-Mail
Owner ar Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information , JUN 23 2017
Name of Company: Ooalifying
Address City
Office Phone Job Site/Contact Number
State Certification/Registration# E-Mall
Architect Name&Phone If
Engineer's Name&Phone#
Workers Compensation
Exempt/Insurer/Lease Employees/Explmtion Date
Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or Installation has
commenced prior to the issuance of a 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
RECORD OUR NOT F COMMENCEMENT.
(S' a of Owner r Agent) (Signature of Contractor)
including contractor)
Signed and orn to(or affirmed)before me this��day of Signed and sworn to(or affirmed)before me this_day of
Sun 'arO by C Wl by
(Signature of Notary)
...... JENNIFER) NSTDN
tr 4 WCOMWss;oN#Wru2BN
EXPIRES:Oc 127.2020
Y' Gudkar�mnNn
[ ]Personally Known OR
'M>+,i aenaeaTNU No:aiy I Personally Known OR
IV Produced Identification [ ] Produced Identification
Type of Identification: AM&d & I /n1_ Type of Identification:
gR3 Amberjq�k LGth�
Legal Description
30-60 17-2S-29E
ROYAL PALMS UNIT 1
LOT 24 BLK 4
....................................................................................................................:
/6
15 �
3
B
BAS
x® UCP 17
L6
3
e 7i
MAP SHOWING BOUNDARY SURVEY OF .�
LOT 24 BLOCK 4, ROYAL PALMS UNIT ONE,
AS RECORDED IN PLAT BOOK 30 PAGES 60 THROUGH 60A OF ✓
THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY,FLORIDA
CERTIFIED TO:
COMMUNM FIRST CREDIT UNION OF FLORIDA,
FIRST AMERICAN TITLE,MACAU LUNDGREN
J- Lar ZS
wJ
n h Ur 2� a bh . . fy 17�J 0 4l1
,
o
'•o Cv) \ \ s. 44• /s'40••E //8.97 C J
LEGEND
LOT Z3 X--X-X=FENCE
OINT OF CURVATURE BRL= BUILDING RESTRICTION LINE A=DELTA ': =CONCRETI
DINT OFTANGENCY CL.CENTER LINE An ARC LENGTH \\�\=WOOD
POINT OF REVERSE CURVE IP?IRON PIPE C.CHORD
POINT OF COMPOUND CURVE F6-FOUND Co.CHORD BEARING O =FOUND IP
POINT 014 CURVE Ra RADIUS __ : A/C=AJRCONDMoNER + • =SET IP
CITY OF ATLANTIC BEACH
OWNER/ BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 'CONSTRUCTION
CONTRACTING' REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STAT'EMENTFORSECTION 489.1070,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 CONSTEUCITON 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'
MUSTBE 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 TIES E)MMPTION. 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 REOUIRED BY TATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES
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 CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN-OCCUPATIONAL LICENSE"ISNOTADEQUATE. 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.
A893 s Lu �o�a//e HOM .N ;Z a
P E _ / -23 -20
IGM TURE �(� DATE
eamre mem �daya 111!1 _ 2-17
In mawuntyor
Duval.Stale m Florida,hes Pem allyaPPeamd hadn MNmxM limmeMandaffirms Net
all atntemenm and declatsdons are ime and a rau .
Notary Pubfiat Large Smteof FL--- Gomnryd
JEANIFER
❑Poaonary Nnoxn L l+. A MYCON{LLGS
j{QrWuredldenlR eon. �r luLi �
. — Y DfPIREb.O t
CC ( i
Nomry SlgnaWra:_�` ..
JENNIFER JOHNSTON
rreioonm.+-a.11a.artw. t:asvu® ul roe MY COMMISSIONRGG W3334
E%PIRES:Ocbber P,ZSZO
iAv Nolvy Putle IM W txrimn
TREE & VEGETATION AFFIDAVIT
City of Atlantic Beach
i Department of Community Development
Planning&Zoning Division
`<onIS), 800 Seminole Road Atlantic Beach,FL 32233 %
(P)904247-5800 (F)904247-5845 PERMIT% /7 N
SECTION I-APPLICANTIIN/FORMATION / V;5�rer(s) r Legal Authorized Agent"
NAMEOFAPPLICANT I /�A�1e �/La VPM
NAMEOFCOMPANY l-yYYY ffl4 uu(f
ADDRESS OF COMPANY
PHONE CELL EMAIL
CONTRACTOR CERTIFICATION NUMBER
ATLBCH BUSINESS TAX RECEIPT NUMBER
SECTION 11-SITE INFORMATION
STREET ADDRESS OF PROPERTY �+q3 X /,fal/ Z�fxw
Nanaddress has not been assigned to thtspropagv,,contacttheMBUMM9 nepaammi at(M)247-5U6 toreguestan address.
LEGAL DESCRIPTION
LOT BLOCK SUBDI%ASIDN
REAL ESTATE NUMBER / � OU00 LOT OR PARCEL SIZE: SOFT AC
RESIDENTIAL _t,"' COMMERCIAL OTHER(SPECIFY)
I affirm that 1 have reviewed the provisions of Chapter 23, "Protection of i reel 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. Subse r�Ttly,I affirm th t no regulated frees and no regulated vegetation will be damaged,destroyed and/or removed
from the abov cr' dor ad%ac p pertles in co
with this pro%ecl.
5 RE OF C SIGNATURE OF OWNER tom-
Signed and sworn before me on thio y of � , 017,by State of (�� cn,
County of
Identification verified:
Oath sworn: I—. yes F- No
r TONI GINGtESPEPGER
My conu+IssloNU FF 9M51 Notary Signature
^# EXPIflES',October s,2m5
r�f, e:.naearnn wwyPueKua.�men
REV-
My Commission expires: