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1622 E Park Terr concrete parking area permit r is1 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 Yvan 9 INSPECTION PHONE LINE 247-5814 RESIDENTIAL OTHER - SINGLE OR TWO FAMILY RESIDENTIAL OTHER MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: RES017-0038 Description: CONCRETE PARKING AREA Estimated Value: 4800 Issue Date: Expiration Date: PROPERTY ADDRESS: Address: 1622 E PARK TER RE Number: 172020 0304 PROPERTY OWNER: Name: ALLEN JOSHUA D Address: 1622 PARK TER E ATLANTIC BEACH, FL 32233-5824 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. •t�rLy f 'S`r 'n• Conditions l City of Permit Number: RES017-0038 Description: CONCRETE PARKING AREA Applied: 10/6/2017 Approved: 10/20/2017 Site Address: 1622 E PARK TER Issued: Finaled: City,State Zip Code:Atlantic Beach, FI 32233 Status:APPROVED Applicant: <NONE> Parent Permit: Owner:ALLEN JOSHUA D Parent Project: Contractor:<NONE> Details: OWNER BUILDER LIST OF • • SEQ NO ADDED DATE REQUIRED DATE SATISFY DATE TYPE STATUS DEPARTMENT CONTACT REMARKS 1 10/20/2017 EROSION CONTROL INSTALLATION 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. 2 10/20/2017 ON SITE RUNOFF INFORMATIONAL PUBLIC WORKS Scott Williams Notes: All runoff must remain on-site during construction. 3 10/20/2017 RIGHT OF WAY RESTORATION INFORMATIONAL PUBLIC WORKS Scott Williams Notes: Full right-of-way restoration,including sod,is required. 4 10/20/2017 RUNOFF INFORMATIONAL PUBLIC WORKS Scott Williams Notes: All runoff must remain on-site. Cannot raise lot elevation. S 10/20/2017 ADDITIONAL COMMENTS PUBLIC INFORMATIONAL WORKS PUBLIC WORKS Scott Williams Notes: This permit is for concrete parking pad on private property ONLY. It is not for City right-of-way. 00, Printed: Wednesday,2S October, 2017 1 of 1 21 1110/', City of Atlantic Beach APPLICATION NUMBER JS Y SBuilding Department (To be assigned by the Building Department.) 800 Seminole Road O _ O3 d �r Atlantic Beach, Florida 32233-5445 \ S 0 Phone(904)247-5826 • Fax(904)247-5845 OCT u HH 9 2017 E-mail: building-dept@coab.us Date routed: /(O ' City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM f Property Address: Department review required Yes No ! � �.� �2K � L2 � q uildin Applicant: ND annin &Zoning 0 Project: CC) Q 't -- u lic Work u is 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: BUILDING PLANNING &ZONING Reviewed by: 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: ❑Approved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 Pt'"LyfJ� City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) i 800 Seminole Roadj� DDS '7 Atlantic Beach, Florida 32233-5445 r \ SO / 0 Phone(904)247-5826 • Fax(904)247-5845 oil �:' E-mail: building-dept@coab.us Date routed: ) C) City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: Department review required Yes No uildin Applicant: N WL Project: Chi ►� 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: BUILDING PLANNING &ZONING Reviewed by' ���� 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: ❑Approved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 City of Atlantic Beach APPLICATION NUMBER J3 �� Building Department (To be assigned by the Building Department.) r 800 Seminole Road OCT U 9 201r c—)Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845 moil E-mail: building-dept@coab.us Date routed: /' 7 City web-site: http://vmw.coab.us APPLICATION REVIEW AND TRACKING FORM f Property Address: Pp�21t L iL( rtment review required Yes No ` � �� � Department uildin Applicant: N ,-Panning &Zoning 0 Project: L 0 K-) u lic Work u is Utilitie ��— Public Safety Fire Services Review fee $_ _°' Dept Signature 'zt^ 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: BUILDING ��ff�� PLANNING &ZONING kv?' 'Reviewed by: Y��ZL'�ifDate.. TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. ❑Not applicable P _ WO KS 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 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) r i 800 Seminole Road �- I _ O� �r Atlantic Beach, Florida 32233-5445 Esc) 1 Phone(904)247-5826 • Fax(904)247-5845 / E-mail: building-dept@coab.us L Date routed: City web-site: http://vmw.coab.us APPLICATION REVIEW AND TRACKING FORM ff Property Address: Department review required Yes o 4 � �Z i4(LK � C�2 uildin ' Applicant: annin &Zoning o Project: C� P� _ - _C. - u lic Work .!TuTlic 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: roved. ❑Denied. ❑Not applicable (Circle one.) Comments: �l ILDIN / r' D� PLANNING &ZONING Reviewed by: Date:l�" l 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 Building Permit Application OFFICE COPY J City of Atlantic Beach 800 Seminole Road,Atlantic Beach, FL 32233 Phone: (904) 247-5826 Fax: (904) 247-5845 Job Address: «Zz ,t� ��� �. Permit Number: �SD( -7 - 0 03 Legal Description 39-52- 09-' 2S--2_Rg RE# I^72020- d3`n I Valuation of Work(Replacement Cost)$ �(� Heated/Cooled SF til- Non-Heated/Cooled • Class of Work(Circle one): New AdditionIteration Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial Resi"esti • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No 1A • 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: C• ccAcre�e ecCW%n5 arec,, -Lf A_c_( tAlc( oesi� B�fS fij yeoU�s;' ceNcre�e w� ��loer, S4+ �,sti j neI 'iw�Pe:��e�s ctru. L�L%W�e _UD S=+2- rYv�o�ec( r�ct L,.,lkways c,,� ()OL140 ffeV,CLte,(y Florida Product Approval# for multiple products use product approval form Property Owner Information Name: Ci,,VwtA A,-LLC--N Address: \622- City A(TL N-rxc P>Grlcf( State FL_ Zip 32233 Phone c(D`{ 63S S9'a7 E-Mail 1ri5�-4[[�n Q c �,�c,.c,�y�•, Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) Contractor Information Name of Company: ;ALLAO-0 Qualifying Agent: Address City State Zip 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 AY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF Y]© INTEND r TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BE RE RECORDING YOUR NOTICE OF COMMENCEMENT. ( ' ature of Owner or Agent including Contractor) /OR of Contractor) Signed and sworn to(or affirmed)before me this Lot day of Signed and sed)before me this day of C0 ,byTtir�t,ucc C�c��fCI �I1) "� � •. GRACE MACKEY tav i°:••....e s MY COMMISSION#GG 042989 (Signature of Notary) (Signature of Notary) :; EXPIRES:October 27,2020 Bonded rh.Notary Public Underwriters [ j Personally Known OR [ ]PersonallyProduced Identification ) [ ]Produced Ty p of Identification: rL AV�f'S L1U,(',V- Te of Ident Vis, ,y TREE & VEGETATION AFFIDAVIT City of Atlantic Beach s) Department of Community Development "~ Planning&Zoning Division 800 Seminole Road Atlantic Beach,FL 32233 v r'il> (P)904 247-5800 (F)904 247-5845 PERMIT# SECTION I-APPLICANT INFORMATION Owner(s) r Legal Authorized Agent* NAME OF APPLICANT —154U,4 4LL&t4 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 � LcZ' Pack?- If ackZIf an address has not been assigned to this property,contact the AB Building Department at(904)247-5826 to request an address. LEGAL DESCRIPTION 2s`21 E 5(LV A MArZ:T:►4A Lt KT LOT BLOCK Z SUBDIVISION REAL ESTATE NUMBER 2 DW ' "�p 40T OR PARCEL SIZE: 12I to SQ FT AC RESIDENTIAL _� COMMERCIAL OTHER(SPECIFY) 1 affirm that 1 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 1 have participated in a pre-application meeting with the Administrator of those regulations. Subsequently,1 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. SIGNATU OF OWNER SIGNATURE OF OWNER Signed andswornbefore me ii on this(0%Jv1"clay of ( � d by State of Uri ao1 ��c�►>k .Lr.C) ),r, 1 �{�PXI County of DuLVA I Identification verified: Oath sworn:moi' Yes r No GRACE MACKEY Notary nature ,F *, MY COMMISSION#GG 042989 I_ ^� ec EXPIRES:October 27,2020 My Commission expires: 6C jv�j`a / 'd u 14 onded Thru Notary Public Underwriters r CITY OF ATLANTIC BEACH j OWNER / 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 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. �-- � �22 Pc,(-\L ADDRESS PHONE NUMBER Jo S*,kA Aut- PRINT NAME / SIGNA E r DATE Before me this t ih day of 20_ 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 eG CiJA County of a,k)a ' Yi• ❑Personally Known <I ;,; :^'`.'is'•., GRACE MACKEY 1 oduced Identification- ��r� L MY COMMISSION x GG 042939�r � (��-r� _ ; ,��, i :ar= EXPIRES:October 27,X20 •;G Bonded Thru Notary Public Underwriter Notary Signature: L J1tejit4 F:BLDG/Omer-Builder Affadavit REVISED: 4/16/2009 MAP SHOWING BOUNDARY SURVEY OF LOT 1, "BLOCK 12, ACCORDING TO THE PLAT OF SELVA MARNA UNET NO. 7 AS RECORDED IN PLAT BOOK 34, PAGE 52, OF THE CURRENT CERTIFIED T0: PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. JOSHUA DANIEL ALLEN, COMMONWEALTH LAND TITLE INSURANCE COMPANY, REGIONS MORTGAGE AND OBERDORFER & BARRY, P.A. It 57 A'Z PA19/�C 03 2oZ.s Fez S 06•,04'50" E 50.00' (R) `Nei +�n�ervo+5; ,27q S S 06'24'50" E 50.00' (M) tf� BEARING REFERENCE UNE I/2- 5. P.C. `C.M� � �� j ld TELEPHONE RISER A,70.x. :,.CONI:. a DRIVE -10 Ln. e�\ 30' B.R.L --------------- •y�_ + " A'� ���o fes+ (pd' F<<2 1 ------ J CONIC. WALK R ►Cq�310 ��D CONIC. A/C ,� \ WALK UNIT 5'n NAIL k DISK LB 5488 p w\uJ� O I IN MAG. TREE o, as Q I i O P.R.C. COV'D CONIC. �+ J rt %P41 I p ' -ol': o m y►,9 r ill LOT 1 26 ul a tp a \d rC-4: — 1/2- N 06'2954" W 1J2.68' (M) 21 vtowl I/2 Vice- N 06024'50" IF 132.56' (R) 3O' PA RA' � = MAP SHOWING BOUN11ARY SURVEY OF LOT 1, BLOCK 12, ACCORDING 'TO THE PLAT OF SELVA MARNA UNCT NO.. 7 AS RECORDED IN PLAT BOOK 34, PAGE 52, OF THE CURRENT CERTIFIED T0: PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. JOSHUA DANIEL ALLEN, COMMONWEALTH LAND TITLE INSURANCE COMPANY, REGIONS MORTGAGE AND OBERDORFER & BARRY, P.A. r�ro,I SIGvJ PARK S 06"24'50" E 50.00' (R) /� `Nei M�edv cus; 27q .e S 06'2450" E 50.00' (M) tS� BEARING REFERENCE LINE 1/2" . .. P.C. C.M.^ 'j, � TELEPHONE ..` ��. 'cP_ ��ZI DaZ RISER ti�,�,'. �Va��,�' �a'o-� o: a ' DRIVE �\ Lo: ------------- -- -30_B.R.L;_ CONC. Sbccj WALK u, 1 (D CONC. AIC Z WALK -. UNIT 5'n NAIL k DISK LB 5488O IN AG. TREE N ~ do��.090 P.R.C. -' COVD I- 0 c+��2�� S.y CONC. N ar,c�c�`� I ° Olo o,Cp a �` I .. o LOT Z� "N �` a 13% tp cn: \� _ — 1/2- N 06'2954" W 1J2.68" (M) ZI �fa„1 PrDPer 1/2' N 06'24'50" w 132.56' (R) 1 = 30' P A R IC j Mo N `! DEQ E� Ap P