410 SKATE RD - FENCE sA CITY OF ATLANTIC BEACH
L'ott.;
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
'-=•ostisw INSPECTION PHONE LINE 247-5814
FENCE WALL OR BARRIER — FENCE
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: FNCE17-0084
Description: FENCE
Estimated Value: 1500
Issue Date: 12/8/2017
Expiration Date: 6/6/2018
PROPERTY ADDRESS:
Address: 410 SKATE RD
RE Number: 171557 0000
PROPERTY OWNER:
Name: ARCHIPELAGO IMMOBILIEN LLC
Address: 1140 20TH ST N
JACKSONVILLE BEACH, FL 32250
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.
„,,senivw City of Atlantic Beach APPLICATION NUMBER
' Building Department �- (To be assigned by the Building Department.)
.s `' 800 Seminole Road s l
r Atlantic Beach, Florida 32233-5445 ;
E-mail: building-dept@coab.us; ~ I��-C—. 7 C)(. )ca
Phone(904)247-5826 • Fax(904)24a 45J i
” 20gDate routed: I Z l I ( t 7
fl
City web-site: http://www.coab:'usd
APPLICATION REVIEW AND TRACKING FORM
Property Address: `1 1 lJ S k(*TC R_D Department review required Yes No
( uildinq�
Applicant: l ) (Q ;Planning &Zoning
Tree Administrator
Project: FGK) CG ub1icUUo0k
Public Uti i ie
`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: 14Proved. [Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by Date: g—c%/i7
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
� �+ ��`r., City of Atlantic Beach APPLICATION NUMBER
��s'fi BuildingDepartment ,
� � p (To be assigned by the Building Department.)
_ I
,-, 800 Seminole Road I^ N. 1E �� )�
'`' . Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
"04' y�`.. . E-mail:. building-dept@coab.us .. Date routed: 9 I ( �
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address:' 4 1 CD S k -TE RDepartment review required Yes No
(elildinti._ :.
Applicant: n Lu lU J ranl g;&'=Zo.ning:
Tree=Administfator'
Project: FGK) C_ _ ublic Works
ublic Uti I i
`ublic Safety
Fire Services
jReview fee $$ Dept Signature . - 7.:
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: 1Approved. ['Denied. ['Not applicable
(Circle one.) Comments:
BUILDING
-� -i4,1:..,,,L:-
r;
r=
CPANINGZONG;
.Reviewed by: Date: (2 v-
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. I (Denied. ❑Not applicable
Comments:
Reviewed by:. Date:
Revised 05/19/2017
.r.Y0,0ys City of Atlantic Beach APPLICATION NUMBER
? 4_ Building Department (To be`assigned by the Building Department.)
1� 800 Seminole Road
NS Atlantic Beach, Florida 32233-5445
( ice, l 7 '_�-�c)84
Phone(904)247-5826 • Fax(904)247-5845
4-7.:4;i:,;4, E-mail: building-dept@coab.us Date routed
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 4 ( d S kccTe Rc Department review required ' Yes/ No
� uiIdinq 1/
Applicant: (D LAD/ E�(2 __J ,Planning &Zoning
Tree Administrator
Project: r '�� ublic Works
ublic i i ie
u lic Safety
Fire Services
'Review fee $ ? De®t 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:
BUILDIN.e
PLANNING &ZONINGReviewed by: Date: /2 S'' (7
TREE ADMIN. Second Review: ['Approved as revised. ['Denied. TiNot 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
r pyi. ,, Building Permit Application Updated 5/5/17
�r'r, .'',''y-'i City of Atlantic Beach OFFICE COPY
ov_. _ r 800 Seminole Road,Atlantic Beach, FL 32233
`o�;'�r Phone: (904) 247-5826 Fax: (904) 247-5845
(� ` I I J �j,Ad t 3 33 `l Q
Job Address: 1 O J k Li e �� / ia4f�L v---'1 Permit Number: INCE 1 `V 0`
Legal Description RE#
Valuation of Work(Replacement Cost $ Vs Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one)• New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed str ture(s)(Circle one): Commercial Residential
• ' If an existing structure,is a fire 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
Des ribg In etail he type of work t be performedr3L,L, (eQ r koCc` 4 -ee_..tc.e., I+,f/`i s
`C`eAde w- LI a� le -Pee-4- IA hei5lid-�n- kae-W ince W;; �; a e /°� el
A' �t� .,a �U I
T of Vh-C� , 1T P9 c -&;/l,•4 Q CA s+ , , 15 Da. fq L l 24f 7)1 saU;i sal ,J rF 2fl OSP_
I
Florida Product Approval# Vfor multiple products use product approval form
Property Owner Information q
Name: O�'Ir(+ ft6Aril e" Address: 1 v c
k-0-4- i' d--,) ,
City '1 p,ttl c 2a G State FL Zip 6Z3 33 Phone G� 0—10 ,(2---CA-73-C24/
E-Mai cberberim7 co01(44 n� ,----
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information r-ck I P e l Q-.3 c, 1 c)bi`I l er L L C_
Name of Company: Qualifyin: a gent:
Address City State _ Zip
Office Phone Job Site/ tact Number
State Certification/Registration# E-M.'
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation
Exempt/Insurer/Lease Employees/Expiration Date
Application is hereby made to obtain a permit • do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a perm' and that all work will be performed to meet the standards of all the laws regulationg
construction in this jurisdiction. I underst• d that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HE,TERS,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, CONSU -T ITH YOUR LENDER OR AN ATTORNEY BEFORE
RE RDING • R NOTIC Or Ce MENCEMENT. ,/'' -
. ki k
(Signature of Owner or Agent) (Signature of ontractor)
(including contractor)
Signed and ssw rn to(or affir •e• •-f r me thi,„ pa of Signed and sworn to(or affir ed)before me this day of
.3 „,„....,,„,... .,,--.7.,21)1,3by _•. I 511 -C-4JQ ___y
b
...
TONI GINDLESPE?G:- I G1�1�
!,1:• F.; MY COMUISSION - �� ��,;
= of Or (Signature of Notary)
? EXPIRES:October 6,2019 e rY
+ :;e o-,Fro;` Bonded Thru Notary Public Underwriters
_.•__. , y P�,, iESPERGER
.=Q. :?:
_.,, ,u ,,*._ �,- N for 6 2019 [ ]Personally Known OR
4951
[ ]Personally Known OR ,.m: he • - f" � :"er 6,2089
; �;:ilv
[ ]Produced Identification „p; �,• B; ..:u;.dervrtters [ I Produced Identification
Type of Identification: .= .....--1-.5.------,--,,, _ Type of Identification:
•
•
•
i Lai/y-4..
.:01; CITY OF ATLANTIC BEACH •
'' "� !1 WNER / BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, . PART 1 ."CONSTRUCTION •
- CONTRACTING"REQUIRES OWNER I BUILDER TO ACKNOWLEDGE THE LAW:
• 'DISCLOSURE STATEMENT FOR SECTION 489.103(71 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 MA\'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 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 1S
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 $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR: THE FLORIDA "CONTRACTORS
CERTIFICATE' TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826)IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE •
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
• OWNER-BUILDER PERMIT.
•
MO S`�-`te i � c� c coy, q6
• ADDRESS J PHONE NUMBER
PRINT NAME CIOLQ1
't- 1I
URE � !^�) DATE
Before me thi..6 day of_ O' 20_f 7n the county of
M
Duval,State of Florida,has personally appeared berin by msc'If/herself and affirrps that
•
all statements and declarations are true and accurate.
/T
Notary Public at Large,State of Pt. County of Cts J
❑�eaana!ly Known /' fl _ c5'_S . 09'7
09`7
D.oodoced Identification- 1111.1
�C /
mea src .
�r s;1 i Li SPEPGER
Notary Signature;T., .- — IR :'C;�` iJ,rFF924951
E:K RES:3 tob�-r 6,2019
}:tDLDG'O,,,.-}3uitddi lmlmu REVISED. 4!1612005 •`' - Bcr:ded-!iN Plotay Public Undenm;ters4
\s+YS�yL�j,ar City ofAtlantic'Beach 'APPLICATIONNUMBER
a Building Department. — (To be assigned by the Building Department)
800 Seminole Road II /
Atlantic Beach, Florida 32233-5445 I'(�C�•( '7 c 7�
v 440„.21 Phone(904).247-5826•:Fax•(904)247=5845D1:-L (I- 1017: •
t (E-mail: building-dept@coab.us Date routed: I (
z
: :. City web-site: http://www.coab.us:.
APPLICATION REVIEW AND TRACKING FORM
Property Address: 4 l 0 S:lore . Department review required Yes No
uildi
rn
J:. Pla � Zonin :.
Applicant: (�i`� � ? nnin9 &
Tree Administrator.
: . . . Project: Fe :C.--� �I bl.ic.Works
.„("Public Uti i ie _
:Vidalia Safety :
Fire Services
Review fee$ !i. Dept'Signatures •
Review or Receipt
Other Agency.Review or Permit Required • 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. of applicable
(Circle one.) ..Comments:
BUILDING 1 .
PLANNING&ZONING /
Reviewed.by: Date:.'
TREE ADMIN.: .
Second Review: . Approved as revised.. . ❑Denied. . : . ❑Not applicable
P.. r , WORKS :Comments:
'tJBLI'C ILITIES
PUBLIC_SAFETY .: .: Reviewed by: Date: -
FIRE SERVICES. : Third:Review: . ['Approved as revised. :❑Denied: : - :['Not applicable .
.Comments.:
. Reviewed by: Date::
Revised 05/19/2017
BOUNDARY SURVEY
UVJ
t / ? t E!.,
r.- \ FOUND 1/2"
LOT. 15 IRON ROD '
•:\.
BLOCK .19 NOID. 1 ,,: ."3: .4
ZG :: fir •
FOUND 1/2"! N.82°43'58 E' g3 3o.a .-r 1 .
IRON ROD —. •— •—j 1 '.` �::"::..
NO I.D. \\1 0-5' _ 1.5' i i
0.5'NW 1 = CE l N Vii:-'``. 1 .-1-u
.FEN (J7 C::.. . o
• 24.7' ;:1.. :�:.-t;:.ki QM
'� 0.T 0 •... 1 L;v �I
23.9' -i `'T :". '
0 LOT 14 c D 0 CD �1 ; ,-.
BLOCK 19 'o,— o n r? 1.'. -:.,
0 0 0 f
t ):,,- \ 11.:...:CY• :>*:":"s.1.-1 .
40'2:---N 4, 11.6' {t 24.7`...__� X0 '.., o,.v:�,''1:
t 'f 7.3'q �:.R� •CONCRETE ....';': '1.1..:'-- ;t:`_ 1::.: _1;1
CO \ • o s.--,:(...- :.1:,;-,-:;•'•-- -------\V 7'•:,:l k•,....-:14
O
CP w 30.0. #`i
0.5' NCE „i.,
1.8' FE 0.1' (n• il. 3.1 .
/00 9 3.00' ------1 \:F.-:.::',.:.'.,:,-..,..,..-:.0
•:
SET 5/8" I S.82°43 58 V\1.-
LOT
V FOUND 1/2" , .;�_ ;=::t
IRON ROD . ,1..,. ...:.':,'':, ,,..1
IRON ROD LO I' 13 NOl.D. ! Q 0 tr., ,,.,,r.;. ::."> '
LB#7893 I 0)...1 :::.,:- • ;:'
• BLOCK 19 1
. BLOCK
CORNER
•
SURVEY NOTES UNITY DEVELOPMENT
-CONCRETE DRIVE CROSSING PROPERTY LINE COMM
ON EASTERLY SIDE OF LOT. V
-BUILDING CROSSING OVER THE PLATTED BUILDING AP P P�
ED
SETBACK LINE ON EAST SIDE OF LOT.
-THERE ARE FENCES NEAR THE BOUNDARY
OF THE PROPERTY. •
•
-A J_08.
l F 1 B . ...
?�P� �Al?R .
.gym 4, No.6415 ' 4" SURVEYORS.CERTIFICATE "y +:•a'' TARGET r'
'� I HEREBY CERTIFY THAT THIS BOUNDARY SURVEY
'' IS A TRUE AND CORRECT REPRESENTATION OF A Ca RTT�.j YING LLC L C
SURVEY PREPARED UNDER MY DIRECTION. -•
!.J L!SAC .LCt S.dl�9 9 ,R
NOT VALID WITHOUT AN AUTHENTICATED ELECTRONIC
STATE OF SIGNATURE AND AUTHENTICATED ELECTRONIC SEAL, (6LB#7893
s'ory:`� o a o/o Q.° ORARAISED EMBOSSED SEAL AND SIGNATURE. CGR\/Ir rr FI (1RIrlA
--�S_."E,- Kenneth J`,.Kenn ally siJ.
Osborne
rn •
6250 N.MILITARY TRAIL,SUITE 102
Kenneth J.Osborne
Date:201 7.11.07 WEST PALM BEACH,FL 33407
Osborne 12:21:37 05'00' PHONE (561)640-4800-
(SIGNED) ------ - ""_.._._ -.. ..__. STATEWIDE PHONE (800)226-4807 . i
KENNETH J OSBORNE IPP T9IPAr9Frc ) STATEWIDE FACSIMILE (800)741-0576
PROFESSIONAL SURVEYOR AND MAPPER 56415
WEBSITE: httpJ/targelsurveying.net