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68 17TH ST - FENCE ,,:,!....A.,„,. r .4., �� 'ii.ss31 CITY OF ATLANTIC BEACH . ,.-` 0 800 SEMINOLE ROAD 7.4 ATLANTIC BEACH, FL 32233 "<<;; s-) INSPECTION PHONE LINE 247-5814 FENCE WALL OR BARRIER - FENCE MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: FNCE17-0092 Description: 6' FENCE Estimated Value: 7004 Issue Date: 1/5/2018 Expiration Date: 7/4/2018 PROPERTY ADDRESS: Address: 68 17TH ST A RE Number: 169585 0000 PROPERTY OWNER: Name: PARISH WAYNE A Address: 68 17TH ST ATLANTIC BEACH, FL 32233-5810 GENERAL CONTRACTOR INFORMATION: Name: Address: , Phone: Name: SUPERIOR FENCE AND RAIL OF NFL Address: 5470 HIGHWAY AVE JACKSONVILLE, FL 32217 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. r,r '`°. s CITY OF ATLANTIC BEACH t 800 Seminole Road ,' �„r,._, Atlantic Beach,Florida 32233 REVISION REQUEST/CORRECTIONS TO PLAN REVIEW COMMENTS Date /Z 2 / 7 Revision to Issued Permit Corrections to Comments Permit# 'Ne E/7- Project Address 6 (f /7 i j% Contractor/Contact Name 1;1A 7,-cik jsfi( Phone 9.-'(>9-977, ,S-?O Email P/9/0ayi .0C1,,,i ¢l, / Cf,/1Y\-- Description of Proposed Revision/Corrections: Permit Fee Due $ d D ' s f 7-73,A c'/-‹ SA/c a.i ti Additional Increase in :uilding Value $ Pi Additional S.F. By signi below,I A g i /L) -E: 7j£J5 j./ affirm the Revision is inclusive of the proposed changes. (printed name) .4:j 0, ---. /r): i &A ( / /7 ignature of Contrac or/Agent(Contractor must sign if increase in valuation) Date (Office Use Only) Approved ,/ Denied Not Applicable to Department Revision/Plan Review Comments Department Review Required: , Building arming & ZoningReviewed By Tree A ministrator� Public Works ( Public Utilities 1 1— — /et — ( 7 Public Safety Date Fire Services 0 oav rt ,j,"�� City tlantic Beach �'l' APPLICATION NUMBER f � Building Department Q./-- (To be assigned by the Building Department.) y-a, s .800 Seminole Road '�( ' ,, Atlantic Beach, Florida 32233-5445 tiPhone (904)247-5826 • Fax(904) 247-5845 c. '!r�;��g! . E-mail: building-dept@coab.us Date routed: Z l J City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: I-1-1 -ST Department review required Yes No Applicant: S U pe( JOR, PL_ 3C F `� i),CL _p nning &Zoning Tree Administrator Project: P- . D� blic Works .. tfb is Utilities 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 /� N1/41- 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 i(�V cedi 1 C:04-f 5-e`l1 - C44.k PLANNING &ZONING Reviewed by Date: ( L- ( f i 7 TREE ADMIN. Second Review: Approved as revised. Denied. pp ❑ I INot 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 ID r-----Q- Lilt iil iket 9 DEC CITY OF ATLANTIC BEACH LO2Ol --`� 800 Seminole Road ; Atlantic Beach,Florida 32233 "%, . y REVISION REQUEST / CORRECTIONS TO PLAN REVIEW COMMENTS Date ;„�A0 �`7 Revision to Issued Permit Corrections to Comments_ Permit# Sp Project Address Z. I "It' S I Contractor/Contact Name 1{ ?zit) is/s' Phone �O /- 4/7 7-9,j, .3S Email 7f?/€1SI1 Z .3 0 6'i t A c / w r,•, Description of Proposed Revision/Corrections: Permit Fee Due $ ,f)/)D,A-Oil 4 F �f vOCA /34-1. C/J9 C/,H /n£ti 7i ;/ Additional Increase in Building Value $ , Additional S.F. By signing below,I �0n ix., P2A/2.4ShI affirm the Revision is inclusive of the proposed changes. (printed name) t— i2 ' /2/2//7 Signature of Contractor/Agent(Contractor must sign if increase in valuation) Date (Office Use Only) Approved r Denied Not Applicable to Department Revision/Plan Review Comments Department Review Required: Building Planning & Zoning Reviewe y Z Tr-e Administrator - __ Public Wor Pub is 1 i i ies DEC 2 0 2017 /. -'o2it% / Public Safety Date Fire Services r /;. J n "-- s REVOCABLE ENCROACHMENT PERMIT '7111Li! REVOCABLE ENCROACHMENT PERMIT by the City of Atlantic Beach,Florida,a municipal corporation organized and existing under the laws of the State of Florida,hereinafter referred to as"CITY"and M9 4 2 ?iYk/SN of Atlantic Beach,Florida,hereinafter referred to as"USER". WITNESSETH: That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon the property for the purpose as described in the City of Atlantic Beach. This work is generally described as d ' FL/c.c_{__. . Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to relocation or removal on thirty(30)days' notice by CITY to USER, said notice to USER shall be given by certified mail, return receipt requested,to the following address 6e- f 7 t4 ST A ri Q)t n/C BG//,Fl 3 22-33 • In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter upon the above described property of the CITY, the USER shall replace at the USER's sole expense, any and all material necessarily displaced during the action of maintaining, repairing, operating, replacing or adding to of the utilities and facilities of the CITY or franchise utility provider. • The facilities allowed by the permit shall meet the current requirements of the City Code, Building Codes,Land Development Code and all other land use and code requirements of the CITY,including City Code Section 19-7(h) which states"Driveways that cross sidewalks: City sidewalks may not be replaced with other materials,but must be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks." • The USER,prior to making any changes from the approved plans and/or method,must obtain written approval from the City of Atlantic Beach Public Works Department,for said change within 30 days after the day of completion. • This permit shall inure to the benefit of,and be binding upon,the USER and their respective successors and assigns. • USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or specifications,to include utilities locate requirements and use limitations/requirements of public right-of-ways and other public land. USER further agrees that the CITY and its officers and employees shall be saved harmless by the USER from any of the work herein under the terms of this permit and that all of said liabilities are hereby as med by the USER. e �ljj Ldp Date % / Property YOwner/Agent(signed in presence of NotaryPublic) STATE OF FLORIDA,COUNTY OF DUVAL The foregoing instrument was acknowledged this ' D day of OQLt ' ,20 0- , by O.A Q.(\ C t.i.1A 0.-W1 QO-( ( \ ,who personally appeared before me and (printed name of Signer) acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. NI1 , / ,o, Signat:if- of Notar r bl I'tate of Florida Approved/Public Works Department: Personally Known Produced Identification(Type) `L i(1 J(ii S <Le-1)S ----/ / / 9 •trsYP''s, JENNIFER tam s, K�Drector 2 , . . : Scott ilhams,Pu lic orks Director re� MY COMMISSION#GG 042984 `* ,, ,t_ EXPIRES:October 27,2020 so, , ,fr. Bonded Thru Notary Public Underwriters 4 'S '„ RIGHT-OF-WAY /EASEMENT PERMIT yPermit#Issued b the Ci of Atlantic Beach ` ._woo— y tY / PCL 17 OIJ F A PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES Job Address �j / 9'4 i . Phone 7O V– 977-95 3P Permittee /►,4 —' 7, ,a/S/-I Email ��q/ZeS,v 6 306),(A,/.Co/0^ Requesting Permission to Construct lj i L rli,,E... Location(Reference to Cross-Street) • Permittee declares that prior to filing this application they have ascertained the location of all existing utilities, both aerial and underground and the accurate locations are shown on the sketches. • Whenever necessary for the construction,repair,improvement,maintenance,safe and efficient operation, alteration or relocation of all,or any portion of said street or easement as determined by the Director of Public Works,any or all said poles,wires,pipes,cables or other facilities and appurtenances authorized hereunder, shall be immediately removed from said street or easement or reset or relocated hereon as required by the Director of Public Works and at the expense of the Permittee unless reimbursement is authorized. • All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the supervision of /)9Ui 7 P 10 S&H rn,rtr (Project Superintendent) with Company Name 5'u PcRa"A S�x.C( 4:-... f4 t I Phone 9O5' dg3-6399 • All materials and equipment shall be subject to inspection by the Director of Public Works. • All city property shall be restored to its original condition as far as practical,in keeping with City specifications and the manner satisfactory to the City. • A sketch of plans covering details of this installation,as well as a copy of a recent survey shall be made a part of this permit. Calculations showing any increase in impervious area on owner's lot or in the City right-of-way are to be included with this application. • The permittee shall commence actual construction in good faith within days. If the beginning date is more than 60 days from date of permit approval then permittee must review the permit with the Director of Public Works to make sure no changes have occurred in the area that would affect the permitted construction. • It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right,title and interest in the land to be entered upon and used by the holder,and the holder will,at all times, assume all risk of and indemnify,defend and save harmless the City of Atlantic Beach from and against any and all loss,damage and cost of expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges. • The irector of Public Works shall be notified twenty-four(24)hours prior to starting work and again i ediately upon c 14:12�y.� Cfjl Date %Z o7�7 Permittee(signed in presence of Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL 0-,h Q('(1�d�-f�^ / The foregoing instrument was acknowledged this day of OQL ,20 I - by K Gl.0 2 n -acttu btkl Q&1.5V\ ,who personally appeared before me and (printed name of Permittee) acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. \ `' PersonallyKnown r1.. ��/���.r� Signa e of Not.irTV State of Florida Produced Identification(Type) Fl. Of.0 04'S k.tLC A._ • i,... JENNIFER JOHNSTON ,�, _ MY COMMISSION#GG 042984 11• W- : EXPIRES:October 27,2020 '%';F•op Bonded Thru Notary Public Underwriters r Lvf N City of Atlantic Beach APPLICATION NUMBER JS r • Building Department (To be assigned by the Building Department.) 800 Seminole Road Fi GE I l _ 009 2 , Atlantic Beach, Florida 32233-5445 {— l Phone(904)247-5826 • Fax(904)247-58450EC 1 5 2017 ,;tt!? E-mail: building-dept@coab.us Date routed: Z _ S City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 6 - -PILL -ST Department review required Yes No D (-Bui din Applicant: S L.) pE(`. DR. PE_-_-/\_De_E_ . 1NN(C_ nning &Zoning Tree Administrator Project: ��:\__D C ( • iblic Works lic Utilities 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 _4 P`d- 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 b . ^ Date: /A•Ye-'17 TREE ADMIN. Second Review: Approved as revised. ❑Denied. ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed b, : ,0,1 % �;SyUv;,�� City of Atlantic Beach j APPLICATION NUMBER :l Building Department (To be assigned by the Building Department.) iii r . . v , 1.800 Seminole Road 7'•_ 00 C e) 1 7 ST j , Atlantic Beach, Florida 32233-5445 Phone (904)247-5826 • Fax(904)247-5845'E-mail: t " 9'''i Olt � building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM 111— c Property Address: 5 I l 2 ( Department review required Yes No din 1 Applicant: .S (, PE RA OP--, PEACE -9, . ,CL. nning &Zoning � / Tree Adminis ra or Project: (4 I--E )e_t__ ublic Works lic 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 ./( P.--t- 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 1) - Reviewed by: � Date: /2 / 6 '<D TREE ADMIN. Second Review: Approved as revised. ['Denied. I INot 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 Updated5/5/17 �r Y OFFICE COPY '= Cit of Atlantic Beach 800 Seminole Road,Atlantic Beach,FL 32233 "`It v Phone:(904)247-5826 Fax:(904)247-5845 Job Address: 6g" % '> S.7- Permit Number: EN CE( 7- 0 4) Z. Legal Description FEK-C i 7cpJczc_c ,x 11^-j RE# Valuation of Work(Replacement Cost)$ 7 0 0171. C0 Q Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): ID Addition Alteration Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial Residential • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No CP • 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: Rt-4w oc. / of £ XiS /ih ' CCrt. CCAAry%) - -/ F S7 //a-7i0in p hJ '' ELifrv/ Florida Product Approval# for multiple products use product approtal form Property Owner Information Name: Jo4AFyV "/FJ/Z/S/1 Address: /i g" i 7144 S r City /,1 L e4/77-/C i(ACr1 State F/ Zip .3 22-33 Phone 90y-4/77- 95-3k, E-Mail PA02&946 3 Cv Gmdei i! <'-0t,& I Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) Contractor Information Name of Company:_�(� /Z�02 I£A-e-S c/KA+ � _Tile'. Qualifying Agent: --)00,) Fk/S,-/lit4),--7 Address `Z;y'7t7 614/)7..,L Ai E City 3/a01SOv�u,/jt I State $ / Zip .372 c ' Office Phone 9D4/- ,53—6.S 9? Job Site/Contact Number S'DV (53 6 3 99 State Certification/Registration# /7/A E-Mail /9,A Architect Name&Phone# /)/'Q Engineer's Name&Phone# ti// Workers Compensation tl/A 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. I 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 MAS( 1 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 G YOUR N.1,4_,4›..._- e ,,,, tc:2,4 OT OF COMMENCEMENT. (Signature of Owner or Agent) (Signature of C.• ractor) (includ' ontractor) e. ned and sworn to(or affi )befo - e this l day of ISigned and sworn to(or affir• ed)before me this d�@y of 20 (7 ,by at... r, lS� Aiii0 (Signat - . No ary) (Signature of Notary) i'ONI G DLES'FR MY C 10FC-C 1 i E1 PES Octoo ::319 [ j Personally Known ORF ` ' r °''r""' `' I' [ 1 Personally Knew OR [ j Produced Identification ..... & O S � ( _/ [ Produced Identification Type of Identification: tJ -5 y e j2.0 dentification: NOTICE OF COMMENCEMENT OFFICE C0PY State of FI. County of IA U w) Tax Folio No. I (O 1 S F S -00 0 C) To Whom It May Concern: The undersigned hereby informs you that improvements will be made to certain real property,and in accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT. Legal Description of property being improved: i 5- &Z O"t Z S•-2.9. QC:_e_0r>C; t ove b6.c"4 I • S/c PT Lo-jc. 7 , Address of property being improved: • ; 1 tk. 6 i A L Ac ,--1 2, General description of improvements: �j ,i p i G e t. w L T Op- E)(J$ T t- t (2 0 7)ii v. c f Y` w 1'44 A lit y j c'-F.k.c L / Owner: OA A tit A i- kA R f G A PAS'N Address: 6 g I sr Arm h Tl C QC W G1 n / Owner's interestin site of the improvement: f/ k„),,t>,,r7- ©J DL/ Y'f c_L. Fee Simple Titleholder(if other than owner): / Name: . Contractor: Sp-le.,�K pfl Yt-ci 91- fr?A/ / / / Address: ,5 9�i�0 dG �y2 �// L�. , -5¢�C/'�.SOj'1 Ur !1i/ C l 3 Z 5` Telephone No.: /0% , 0 3 C�3 7 5' Fax No: Surety(if any) Address: Amount of Bond$ Telephone No: Fax No: Name and address of any person making a loan for the construction of the improvements Name: Address: Phone No: Fax No: Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other documents may be served: Name: Address: Telephone No: Fax No: In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.06(2)(b),Florida Statues. (Fill in at Owner's option) Name: Address: Telephone No: Fax No: Expiration date of Notice of Commencement(the expiration date is one (1)year from the date of recording unless a different date is specified): THIS SPACE FOR RECORDER'S USE ONLY OWNER r Signed: ate— e:-.) /2- -C- ,. Date: 12- 4- 117ofin the Coun of DState Doc#2017285829,OR BK 18219 Page 2031, Before methis I 4- day �o�? val, Number Pages:1 ,Of Florida,has personally appeared ZC-,i 1 Recorded 12/14/2017 12:44 PM, Personally Known: or RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Produced Identification: P Z C?- C, 1 - 6 02.--C) COUNTY i Notary Public: C RECORDING $10.00 My commission expires: _ OF- I i.O E S'E E:: 1/ \` _ t V I Chir 11��:: lot4 t;rf S,24. 1 ; } j EXPIRES:October 6,2019 0 U.:rf'd Thr i ftny Pu?Iic tinder?I ilal i ;;;11. 1-%,:.;; OFFICE COPY r* ."( -:IA'. , 's/1 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 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. IL 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. 7/a's �S ! I / j,c Lc�r/3221 PHONE NUMBER ER/ 77-5:52 E 4.‘ f/v G : ? ,si- PRINTNME /2 r w /�-/`/ Irl IGNATURE DATE Before me this )4 day of ,2Jj in the county of Duval,State of Florida,has persona I�ed herin by himself/herself and affirms that all statements and declarations a true and accurate. Notary Public at Large,State of \ County of V Vcv.4 • ..,-... ..._._ - f_ 7 , PE r? Slvfd'1 F c .I ❑Personally Known �j�7T�y /J , 2roduced Identification- v ` � '--ter ' — CO� ^� Y I ,} 'f F D19 t� . ;,. l Notary Signature: , F:/BLDG/Owner-Builder Affadavit;REVISED:4/16/2009 Cf:U�i _ City of Atlantic Beach APPLICATION NUMBER *' '" Building Department (To be assigned by the Building Department.) -r� .800 Seminole Road ^, `' Atlantic Beach, Florida 32233-5445 F I v C E r 7 - 009-2- -a O9 2 Vr Phone(904)247-5826• Fax(904)247-5845 r E-mail: buildin de t coab.us DEC 15 2017 Date routed: Z _ 5 /i7 ,31�' 9 p City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM `11Property Address: 7 a ,, ST Department review required Yes No DD Bui din Applicant: S L) PES-lc(_. p[v Q g , ,„___(_P ening &Zoning 'Tree Administrator Project: 6 (:----e_.,/UC— blic Work lic Utilitie Public Safety Fire Services Review fee $ 1 2/ Dept Signature 1Z Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept.of Environmental Protection Florida Dept.of Transportation 4 p,,:F 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. I 'Denied. Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: l -.\-------- Date: 2 T /7 TREE ADMIN. Second Review: Approved as revised. Denied. pp ❑ ❑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 977H STTEET V RY1 • 17' ASPHALT EDGE OF PAVEMENT 889`58trE 50.00'(P81 • ———95.38 (M) '-3 A 3'KF ��`_ �9_ 95.00 (P) S.IJR.Q. 5/8" END. 4' X .4' ;� 4 DQBBfj�61 CST F.LP. 1/2' o= N CONCRETE N =O (v)) (�(�� NO ID NO IDta ORIVE� z°� ( r~ -)-'"- BLOCK CORNER -t . 28.3' • 1.l� NI LOT 3 I v = ,,IM00p BLOCK 8/ o "�-*- 0 G //"LOT O� M�ORCH / ,� , $ m BLOCK B 1-, 'd 1i 11 Q f68 i', c o LOT 4 � i_u j v. .4 BLOCK 8 U W /O Q. t , o lo /2B.3 o u. Za OFFICE Copy 28.2' X 13'� *,..... .2' EAST COVERED W000 -' .2' NORTH o PATIO STAIRS T;°::.:; FENCE TIES 2 STOATS T 2' NEST CONCRETE' '—t 2' NTHPATIO s-`•' FENCE TIES 5' EASEMENT FOR DRAINAGE 5' EASEMENT FOR DRAINAGE F.I.P. 1/2" I N891258111�00►(1 1 NO ID 1�� F.I.P. 1/2" 49.83' (M) I NO ID LOT 19I LOT 18 1 LOT 17 BLOCK 8 BLOCK B I BLOCK 8 COMMUNITY DEVELOPM N'i° SURVEY NOTES: AP P R V " f1 BEARINGS ARE BASED ON THE PLATS WEST LINE OF LOT 3 IN BLOCK 8 BEING N DO. 00' 00"E (ASSUMED) CERTIFIED TO AND FOR THE • f2 UNDERGROUND UTILITIES, FOUNDATIONS OR OTHER EXCLUSIVE BENEFIT OF: aMPROVEMENTS WERE NOT LOCATED BY THIS SURVEY. NOWNERS ASSURANCE TITLE AGENCY. LLC 6 FIRST AMERICAN TITLE INSURANCE COMPANY -. f3 ACCORDING TO THE FEDERAL EMERGENCY MANAGEMENT AGENCY VYSTAR CREDIT UNION co FIRM MAP PANEL NO. 120075 0001 0, EFFECTIVE 04-17-89, WAYNE A. PARISH & KAREN E. PARISH i THE PROPERTY DESCRIBED HEREON APPEARS TO LIE IN ZONE "X". o ii ADDRESS: 68 17TH STREET 0o f4 THIS SURVEY PERFORMED WITHOUT BENEFIT OF AN ABSTRACT, ATLANTIC BEACH. FLORIDA ,., TITLE SEARCH, TITLE OPINION OR TITLE INSURANCE. Cti.qt 8 05 DIMENSIONS ARE SHOWN IN FEET AND DECIMALS THEREOF SCALE: 1 = 30 M o AND ARE PLAT AND MEASURED UNLESS SHOWN OTHERWISE. ti m f6 ALL EASEMENTS ARE PER PLAT UNLESS SHOWN OTHERWISE. ` rell o NOTICE OF LIABILITY: THIS SURVEY IS CERTIFIED TO THOSE INDIVIDUALS SHOWN ON CLY O. VAN KLEECK m THE FACE THEREOF. ANY OTHER USE. BENEFIT OR RELIANCE BY ANY OTHER PARTY IS FLORIDA REGISTERED-SURVEYOR AND MAPPER NO. 2546 a STRICTLY PROHIBITED AND RESTRICTED. SURVEYOR IS RESPONSIBLE ONLY TO THOSEANTHONY"P._O'N,EIL CERTIFIED AND HEREBY DISCLAIMS ANY OTHER LIABILITY AND HEREBY RESTRICTS THE FLORIDA REGISTEREDSURVEYOR`ANIYNAPPER NO.5684 RIGHTS OF ANY OTHER INDIVIDUAL OR FIRM TO USE THIS SURVEY. WITHOUT EXPRESS ., NOT VALID WITHOUT THE SIGNATURE G THE ORIGINAL RAISED '` NRITTEN CONSENT OF THE SURVEYOR. SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. 0 \ L F.C.M. -FOUND CONCRETE MONUMENT C.M. - CONCRETE MONUMENT SEC- SECTION FEN - FENCE DHE -OVERHEAD ELECTRIC L F.I.R.C. -FOUND IRON ROO AND CAP P.T. -POINT OF TANGENCY TNP- TOWNSHIP CLR - CLEAR =C.L.F-CHAIN LINK FENCE g F.I.R. - FOUND IRON ROD P.C. -POINT OF CURVATURE RGE- RANGE FND - FOUND WFWOOD. . FENCE .- F.I.P. - FOUND IRON PIPE U.E. - UTITLITY EASEMENT P.I. - POINT OF INTERSECTION (P) -PLAT CB -CBEARING L. S.I.R.C. - SET IRON ROD AND CAP D.E. - DRAINAGE EASEMENT A/C - AIR CONDITIONING UNIT EL -ELEVATION M.M.-WATER METER F.NBD - FOUND NAIL AND DISK C 6 G - CURBS GUTTER NTS - NOT TO SCALE CONC.- CONCRETE M.P.-MOOD POLE N (M) - FIELD MEASUREMENT RIM - RIGHT OF MAY (PR) - PROPOSED ESMT -EASEMENT P&M-PLATS MEASURE() w (C) - CALCULATED MEASUREMENT C/L - CENTERLINE (E) -EXISTING COR - CORNER M/H-MANHOLE FIELD SURVEY DATE PROJECT INFORMATION w PLOT PLAN FIRST COAST LAND I RDER NO: 9615 z BOUNDARY • 06-15-06 SURVEYING, INC. RAWN BY: APO w FORMBOARDEVIEWED BY: TNP 4FAO-R 1 MJF AVFNIIF I111TH .1ArKS/1NVTI 1 F Fl 1,2111