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905 PLAZA - CONCRETE PATIO CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD JATLANTIC BEACH, FL 32233 x r 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: RESA17-0011 Description: remove back porch &add 16 x 12 foot concrete patio Estimated Value: 550 Issue Date: 9/25/2017 Expiration Date: 3/24/2018 PROPERTY ADDRESS: Address: 905 PLAZA RE Number: 171172 0000 PROPERTY OWNER: Name: LUNDGREN MAGALI C Address: 905 PLAZA ATLANTIC BEACH, FL 32233-3811 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�_�ri;i� City of Atlantic Beach APPLICATION NUMBER u r Building Department (To be assigned by the Building Department.) �� `� 800 Seminole Road �< _ • �� Atlantic Beach, Florida 32233-5445 e W A I'3 0�I I Phone (904)247-5826 Fax(904)247-5845 / ,;ttj%- E-mail: building-dept@coab.us Date routed: (0/0- City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 10 s P 1 et Department review required Yes No Applicant: � nnin &Zoning Tree Administrator Project: (LI \ 0Jk__ b&,Lu(�) , P-..corks C\AL1 (�.{c3 i b x aA -ublic Utilities W "' — r Public Safety 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: �:' a pproved. ❑Denied. Not applicable (Circle one.) Comments: BUILDING PLANNING & ZONING Reviewed by: 1 Date: 1 0 t TREE ADMIN. Second Review: Approved as revised. ❑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 05/19/2017 s�v,vr City of Atlantic Beach r '��• APPLICATION NUMBER :; t Building Department �`•2 800 Seminole Road (To be assigned by the Building Department.) ' r2 Atlantic Beach, Florida 32233-5445 e Es A ( 1- oo I I Phone(904)247-5826 • Fax(904)247-5845 I/ `'4011»r E-mail: building-dept@coab.us Date routed: b`a(pII" City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 10 S P(a3� Department review required Yes No Applicant: D (A.ef nnin &tonin Tree Administrator Project: fun uki,,L b&(1— o(ai Att4 P..irAV orks Unci a-bi b 'ublic Utilities ` X Public Safety 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: I 'Approved. Denied. nNot applicable (Circle one.) Comments: BUILDING '(c e Per-04,fi PLANNING &ZONING Reviewed �jg/� 2 by: �/� Date: TREE ADMIN. Second Review: /Approved as revised. ❑Denied. ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by. i �,/� Date Aa/I 7 FIRE SERVICES Third Review: Approved as revised. I !Denied. I !Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 ZONING REVIEW COMMENTS City of Atlantic Beach Community Development Department 800 Seminole Road Atlantic Beach,Florida 32233-5445 Jtl>'' Date: 6/28/2017 Permit: RESA 17-0011 Applicant: Magali C. Lundgren Review: ZONING Address: 905 Plaza, Atlantic Beach Site Address: 905 PLAZA Phone: 322-2603 RE#: 171172 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 -S j"��1✓ CITY OF ATLANTIC BEACH J� / \s 800 Seminole Road 1 Atlantic Beach,Florida 32233 r' '.: ' `' s) Telephone(904)247-5800 J . FAX(904)247-5845 ,�J l 1, ' REVISION REQUEST SHEET OR CORRECTIONS TO REVIEW COMMENT Date: 6& /1/1 7 Received by: Resubmitted: PermitN ber: RFSAl7 _boll _ Original Plans Examiner: _ Project Name: Project Address: 9 D s (Na Contractor: Contact Name: Contact Phone : Contact e-m ' : Revision/Plan Check/Permit Fee(s)Due: $ Description of Proposed Revision to Existing Permit: N r _+ Additional Increase in Building Value: $ . Additional S.F. Site Plan Revised: Public W/U Approval: By signing below.I(print name) affirm that the above revision is inclusive of the proposed changes. Signature of Contractor/Agent(Contractor must sign if increase in valuation) Date / Office Use Only Date: Approved: v Rejected: Notified by: Plan Review Comments: Department review required Yes No Tanning &Zonin Tree Administrator Plans Examiner Public Works // l/ / ( 7 Public Utilities -- Public Safety Fire Services Date Created 4/13/16 Rev.3 r0-tv1f,, City of Atlantic Beach APPLICATION NUMBER �, Building Department `� 800 Seminole Road (To be assigned by the Building Department.) \ .. "" ¢"' Atlantic Beach, Florida 32233-5445 e Es/ ` (3—OQ I I Phone(904)247-5826 • Fax(904)247-5845 1� 0.219%- E-mail: building-dept@coab.us Date routed: (p i City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 10 S AD(ti ) Department review required Yes No Applicant: O 11. nnin &Zonin� �� "11 Tree Administrator Project: 02(1 NI— b&(,L p((,� 140 P orks C.bacc t+c IbX ,ELL' ublic Utilitie� Public Safety 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. ❑Not applicable (Circle one.) Comments: � 1.��'`` "I�ef/,4 BUILDING j�/� � ' PLANNING & ZONING � 4:LL Reviewed by _ :�ha �a,j it_ Date: TREE ADMIN. Second Review: [Approved as revised. ❑Denied. [Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: I lApproved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 ei.J-1).1/2„ City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) • 800 Seminole Road .. r-77 S. . s Atlantic Beach, Florida 32233-5445 ' '�' ` • (�—�Q Phone(904)247-5826 • Fax(904)247-flJU 5 t•Kodr_oni!) E-mail: building-dept@coab.us 2 ,' 20(] Date routed:City web-site: http://www.coab.us i APPLICATION REVIEW AND TRACKING FORM Property Address: 10 5 )(el�G, Department review required Yes No Applicant: D nnin &Zonin Tree Administrator Project: {LIM OJT bicit,L ()((,(/) P orks_ until ublic Utilitie� X T`"`" ' Public Safety Fire Services Review fee $ RV Dept Signature SCw 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: DApproved. ❑Denied. Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: 7 Date: AD7 TREE ADMIN. Second Review: DApproved as revised. ODenied. [Not applicable ZeP WORKGS/ Comm ts: ✓ PUBLIC UTILITIES —2-7/ 7 PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: DApproved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 S •. „4 Building Permit Application s, City of Atlantic Beach 800 Seminole Road,Atlantic Beach, FL 32233 `on u'r Phone: (904))247-5826 Fax: (904) 247-5845 Job Address: 9o5 //c? 2- 7 441 end P rmit Number: i--SA I coil Legal Description 30-60 i7-15-rZe -,674f a {4'i n11- f8 01RE# 17 /72-VOOOO Valuation of Work(Replacement Cost)$ 55 Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): New •_ddition Alteration Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial Residenti. • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes CD 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: CoAR:re-f t, pc -f t° 1 F x (Eft e o l ga..SF keAm twe- 1�6vri Florida Product Approval# for multiple products use product approval form Proert Owner Information Name: . t', Address: 7�} 0 c Phi Lit t City .1711911111ANI. State_ Zip 3a33 .Phone ?0 E-Mail ccebtec d /wQ 1 re-mi '1� N6' Owner or Agent(If Agen ,Power of Attorney or Agency Letter Required) Contractor Information i!'J ': Name of Company: Qualifying Agent`I\ JUN 2 1 201 Address City i State Zip --'1 Office Phone Job Site/Contact Number --- - State Certification/Registration# E-Mail Architect Name&Phone# Engineer's Name&Phone# Workers Compensation Exempt/Insurer/Lease Employees/Expiration 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 RECORDING YOUR NOTICE OF COMMENCEMENT. (Signature of Owner or Agent including Contractor) (Signature of Contractor) USi ned and sworn to(or affirmed)before me this day of Signed and sworn to(or affirmed)before me this day of �.n� ��1� ,by lACt8Cilt I1.11 ,by nature of '.tary)!' (Signature of Notary) trr JENNIFER JOHNSTON MY COMMISSION#GG 042984 [ ]Personally Known OR ;;,- op;. EXPIRES:Octoberunderwnteis 'ersonally Known OR .°: .•o: ,,,o;rA Bonded Thu Notary Public PQProduced Identification - ?roduced Identification Type of Identification: rk (♦ ' Type of Identification: amt-; cat;9r\ cel it CITY OF ATLANTIC BEACH IJ%WNER / BUILDER AFFIDAVIT • 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$25,000.00 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 TI-IE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF TIIIS 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. qo5 f'/ 'o1J 322-6a3 Af4401 ESS PHONE NUMBER i Luiqre►,^'l PRINT Welt . . --2-I — 2O 1 .7 I NATURC /'" DATE Before me this d`1 day of 3-1A.A aL ,2011-in 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 �� ,County of Akliu ;;n+old•., JENNIFER JOHNSTON 0 Personae Known ' c ' MY COMMISSION#GG 042984 a. ,.Produced Identification- 1 V U' 1:(111S S... .V- EXPIRES:October 27,2020 c&.141CA•` ( %.f,C °s'. ' Bonded Tin Notary Public Underwriters ' Notary Signature: \r A. ►� �.� 1 — ' F:BLDG/Owner-BuilderAffadavit;/ SED: 4/16000; rs r,,,i TREE & VEGETATION AFFIDAVIT �' ,. City of Atlantic Beach 1 Department of Community Development '� ' Planning&Zoning Division c J,��r 800 Seminole Road Atlantic Beach,FL 32233 DD/� (P)904 247-5800 (F)304 247-5845 PERMIT# n 63W SECTION I-APPLICANT INFORMATION �Owner(s) f" Legal Authorized Agent* Y NAME OF APPLICANT /, ,.9_6_,.;17 LL(/A/pGk_E--A ii NAME OF COMPANY ADDRESS OF COMPANY PHONE CELL EMAIL CONTRACTOR CERTIFICATION NUMBER ATLBCH BUSINESS TAX RECEIPT NUMBER • SECTION II-SITE INFORMATION / STREET ADDRESS OF PROPERTY C /,L MZ/4 If an address has not been assigned to this property,contact the AB Building Department at(904)247-5826 to request an address. LEGAL DESCRIPTION LOT BLOCK SUBDIVISION REAL ESTATE NUMBER/7//77— 2O9 ft LOT OR PARCEL SIZE: SQ FT AC RESIDENTIALt./ COMMERCIAL OTHER(SPECIFY) • I affirm that I have reviewed the provisions of Chapter 23, "Protection of Trees 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. Subsequently,I affirm that no regulated trees and no regulated vegetation will be damaged, destroyed and/or removed from the above-described or adjacent properties in conjunction with this project. 1 , ,I C —c,c�t,teyFig✓ S GNAYTUiE OF OWNER (Ji'-Z SIGNATURE OF OWNER Signed and sworn before me on thiZ9 day of_____ J R , 2.01 7,by State of t County of Identification verified: L S 32 -S sr - 30--(2,32- 411 Oath 30-v32- Oath sworn: - . J No ' , kl;,a:`"i TONI GINDLESPERGER I ` MY COMMISSION#Fr 924951 •a EXPIRES:October 6,2019 Notary Signature %; % 46 '';pt n;F'� Bonded Thru Notary Public Unierxriters Ri=v 1VA v10.12 My Commission expires: go 5- iv k.7_4. Pro4(1,; 87/11 v age2of2 ,, ,, , y , , , 7 r i fi / */ r---.7t---i ,,, i i y �=� C P /0 1 i , r...,7,,,_,L. ,, LL. , . A. .nuilumnr „ U S T }� 7 , v i I • % ' OASA '% , ? ; a FGR •• , % 1 f_�__�_ v ,9,. . ... .... .., , —,2tn.,n - _„ ,moi t r..,..... ) 3 , y 1 4 4UdIU/Ir/rt/6.:.1../81//0/1//1/ r0//U/U/l.•.%I1/MIMe./qNI. ./4/ffl/tl/UtllplllU Urq//////011/L.r/MIIIMI/M/il:niunuUN/ngnUlq.:W. /11/),”/M/////..• r// Mai.e � Alg /0 _d/-0 - - - - -- 11 I 9 Ov' ,t‘tot-- Zio+ 1 1/1 1/ S C e :f' ge �� • KK (zr( `‘ f i./03 kfitiol. /6 Al /z = /9,2