2233 SEMINOLE MISC 1
a - CITY OF ATLANTIC BEACH
BUILDING /ZONING DEPARTMENT
800 Seminole Road
All . Atlantic Beach,Florida 32233 lir1,3,f v. (904)247-5800
(904)247-5.845 Fax
www.coab.us
PLAN REVIEW COMMENTS
Permit Application # — I 45
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Property Address: pC a,n ,-eir-v( 1 R.() If) 2_VIi t
Applicant: k t()(- f 4 I or l dcu C+'Q.G-k v
Project: p 1)Cf, lA)C C
s rmit application , been:
be CeuC-.. se:--t a ct er co vet
r AP-. 1 ved d E ctia e 02o• V66
Ea'" ' • . ed .d the following items need attention: 1U �ni
- / t iLk) Leser ► 1 loti) �},-L fill C" « r,_
<s ,1 e_SY IWIFO-G F ns. 4-- Y cod c Li.(,k,(LS�
1 '' REsu( iiiii) 11. Ll O 5 -27
CD(_ ) _(A) . f( tOz 5 x-( 4 --
P5 gO -760_54- 5 eCc-- -1-
C‘I ( pcdp61- IF Mort' 1)( e --76,65" oe
,..„ ip. ....--..„. ......• 1° 0 'Ereleeqfge44 .
4(41::: noINI4 tied 11 £n.
.. - _ . ' •,-+rr. cation when these items have been completed.
Reviewed By: � (. Date: 1 _.a:�iray�1► "�
Date Contractor Notified: LI `�`ort
yL`13,
' CITY OF ATLANTIC BEACH
BUILDING PERMIT APPLICATION
(Alterations&Additions)
j21 tri Date: q 2 2/05—
Job
Address: 2 2 .gS(fi►'1 I IUd1 L /g/) �1./�N,l '122 1 R Ft 3 ZZ 3.3
Owner of Property: 5 C5.5 i A bvn 4 S
Address: 22-33 S anwoe.c 44/9 Telephone: ,2`r9— 30 Flo
Legal Description: Block Number: 9 Lot Number: o?S Zoning District:^,�.79c
Contractor: A4f7t�►Sr 170,2,,3 4 COrV; CT/N ll State License Number: Che•
Contractor Address: /kV/ 6 4,1.7 3,,a Th,2, sAv rt 22.2S1'
Telephone: 70 ‘.7.1//— 7WS.5— Fax: ?O 4'— 2 >2
Describe proposed use and work to be done:____?sp teE PLit1L'cl' C /S�"/iV (7��� c,u /77f
A - 7) L2J4
Present use of land or building(s): 1) al(
Valuation of proposed construction: #11 000
Dimensions of the added space: / feet x 167 feet
Will this project involve:
❑ Heating&Air- a Plumbing a Electrical a Fireplace
Conditioning
Is approval of Homeowner's Association or other private entity required? Vo If yes, please submit with this
application.
Will this project involve changes in elevation, site grade or any use of fill material, or the addition of 5% or more to
the original impervious area or the removal of any trees?
,'NO. Applicant certifies that no change in site grade, impervious area or fill material will be used on this
project.
❑YES. See Step 2 below. Approval of the Public Works Department is required prior to issuance of a Building
Permit.
0. Applicant certifies that no trees will be removed for this project.
�?I't)wL YES. Removal of Trees will be required for this project. TREE REMOVAL PERMIT IS REQUIRED. Tree
v Removal Permits to be reviewed by the Tree Conservation Board,which meets two times each month.
l Procedure: In order to expedite issuance of permits, please follow all steps and provide all information as anarooriate.
Incomplete applications may result in delay in issuance of permit.
STEP 1. Verify zoning designation and proper setbacks for the proposed construction. If you are unsure of this information, please
contact the Planning and Zoning Department at 904-247-5826. In order to correctly verify zoning designation, please have
Property Appraiser's Real Estate Number available.
STEP 2. Contact the City of Atlantic Beach Department of Public Works to determine if a pre-construction or post-construction
topographical survey or grading plan is required. (If not required,written verification must be provided with this application.)
The Department of Public Works is located at: 1200 Sandpiper Lane,Atlantic Beach,FL 32233 Telephone:(904)247-5834
STEP 3. Submit Tree Removal Application if trees are to be removed or relocated.
STEP 4. Please submit Building Permit Application, Energy Code Forms, Notice of Commencement, Owner/Contractor Affidavit if
owner is contractor,and four(4)complete sets of construction plans to the Building Department,which is located at the Atlantic
Beach City Hall,800 Seminole Road,Atlantic Beach,FL 32233 Telephone:(904)247-5826
800 Seminole Road •Atlantic Beach,Florida 32233-5445
Telephone: (904)247-5800 •Fax: (904)247-5845 •http://www.ci.atlantic-beach.fl.us
Page 2 Revised 8/04
In addition to construction and engineering detail,plans must contain the following information as appropriate for the type of work being
performed. Scale of drawings should be sufficient to depict all required information in a clear and legible manner.
1. Current survey showing the property boundary with bearings and distances and the legal description.
2. Location of all structures,temporary and permanent,including setbacks,building height,number of stories and square footage. Identify
any existing structures and uses.
3. If required by the Department of Public Works,a pre-construction topographical survey.
4. Any significant environmental features,including any jurisdictional wetlands,CCCL,natural water bodies.
5. Impervious Surface area calculations: include driveways, sidewalks, patios and other Impervious Surfaces. Swimming pools
may be excluded from total Impervious Surface.
6. Other information as may be appropriate for individual applications.
Address and contact information of person to receive all correspondence regarding this application(please print).
Name: �I Ar') )rmC A AIL
Mailing Address: //,of eo/Ury/p/q .PK
Telephone: 9Q c/-r2L//- 7`'3 5 Fax: 90 V-2,0- 9,3Q E-Mail: )Ai,VFFCOrUC
11 0Oil/GK)'
ILjLT
I hereby certify that I have read and examined this application and attached documentation and know the same to be true and correct. All
provisions of the laws and ordinances governing this type of work will be complied with, whether specified herein or not. The granting of a
permit does not presume to give authority to violate or cancel the provisions of any federal,state or local rules,regulations,ordinances,or laws
in any manner,including the governing of construction or the performance of construction of the property. I understand that the issuance of this
permit is contingent upon the above information being true and correct and that the plans and supporting data have been or shall be provided as
required.
Signature of Owner: Date:7�,;� /( '/�` � Date: /vY �
/W 6s
AS TO OWNER:
Sworn to and subscribed before me this �? day of 0C- I2, ,20'5
State of Florida,County of Duval
Notary's Signature: tQ C1--
-,Y04,Y044.;
Anger.T(,,ogivim
El Personally known
My commission�D ?p .' Produced identification
or,ce Ext-Ps Oc';tor R.200e
Type of identification produced int OA!//3!1 2Q
Signature of Contractor: '-� Date: 9 J O'—0 S
AS TO CONTRACTOR:
Sworn to and subscribed before me this / 711 day of CC-40 b e ,20 6.57
State of Florida,County of Duval
Notary's Signature:
sirr4,• fintnx" m
[/Personally known
1,; ; . ., ❑ Produced identification
„wilt
Type of identification produced
800 Seminole Road •Atlantic Beach,Florida 32233-5445
Telephone: (904)247-5800 •Fax: (904)247-5845 •http://www.ci.atlantic-beach.fl.us
Page 3 Revised 8/04
b Y--
FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
4.
t Bureau of Beaches and Cns>sta]SysttmsRO \ 3900 Commonwealth Blvd-MS 300 PermitNai ii6M. -801()236 .- -.
Tallahassee,FL 32399-3000
vississaaat Phone:(850)487-4475 Na ofPagesAttached: [
FIELD PERMIT PURSUANT TO SECTION 161053 or 161.052,FLORIDA STATUTES
FINDINGS OF FACT AND CONCLUSIONS OF LAW: The request for a pant was considered by the staff designee of the Department of
Environment al Protection and found to be in compliance with the requirements of Chapter 62B-33,Florida Asa ninisostive Code(RAC.), is
specificalty limited to the activity in the dated location andthe ) Approval
condition stalled below by project description,approved pians(if any),attached standard conditions,and any special
pursuant to Paragraph 161.053(5),Florida Statutes. This permit may be suspended or revoked in accordance with Section 62-
4.100,F .C. )
PROJECT LOCATION: Ert ' cC' _s 6 �'< I r , ,/,C - �..L.
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.SR."1- C .r `s
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PROJECT DESCRIPTION: ff�!7•--I ✓P( ..f (/1 -7-' iL. , <-.)/ .=-I �.` i) I':;i- {-ti,
E f'!/f
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SPECIAL PERMIT CONDITIONS: This permit is valid only after all applicable federal,state,and local permits are obtained and does riot authorize
contravention of local outback requirements or zon.ing or building codes. This permit and public notice shall be posted oo the site hnamdiataly upon
issuance and shall remain posted aloes with local approval until the completion of any activity authorized by this permit: Other special condition of this
ermit incluele:
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STAI't'DAAD PE�RM7i1 C I NS 777�13sssccc ,C ! `�field ,co �'m . , t, ,r:� r„_:..
para she! �Y with the sttaehed sta�Sid permit conditions.
Tt.lyt, /�
x'77- ?/< —I j• >
APPLICANT INFORMATION: Is
hereby certify that I am either (1 a)the owner of subject property g (1 b)I have the owrser's concent to socwtc -
this permit on the owner's behalf,and that(2)1 tWll obtain any applicable heavies or permits which may be required by federal,state,
law prior 10 corumascanent of the authorized work; (3)I acknowledge that the authorized wort is what I u county,or municipal
compliance with all permit conditions. - reg and(4)I accept seaQoasrbiity for
Applicants Signature ...----...a...----,'
_ :M..'' (� �'/ Date , .. (i c.1 O l/ ' r
Applicant's Printed Nam r C Address f I ``T') / &,.:)/t,/ ...7...-4. '.', t "
If applicant is an agent ./ ,/,...<-1,7/. ti' / 2 - 3 SP:'1'.—', I-c: _ (m �`� y z7
��
' printed woes of-Property o?n 'r_s: i . J property ow�aerm add est 3 Avera'ovwer's teleplurn.,so. +
S, I'!-%.7 :1-'1 e t -�.
DEPARTMENT FINAL ACTION AND FLUNG AND A OWLEDGMBNYI•: This field permit is approved on behalf of the Deportment of
Envmroremenal Protection by the undersigned staff designee,and filed on this date,pursuant to section 120.52,F.S,with the
Deputy Clerk,receipt of which it hereby ad ncwledgcd. rxmdatysad deignated
a �
/ tytN � / ` f I C. C ,•N SW/ Clerk Priwhd Name ojDssigss+lDepnty Clerk- 1 .
_ Date
PUBLIC NOTICE IS ON THE BACK OF THIS PERMIT. EXPIRATION DATE: 2 ` J '
(Emergency permits issued pursuant to Section 62B-33.014,F.A.C.,are valid for no more than ninety doves and other field permits are ve&I far no more
than 12 months. The staff designee may specify a shorter time limit)
•
EMERGENCY PERMIT:0 YES 9NO Approved plans arc attached_ OYES 0 NO
AND PUBLIC NOTICE CONSPICUOUSLY ON THE SITE
DEP form 73-122(Updated 3105) i1rite Copy-Tallahaumt Office) (Yellow Copy-Applicant) (Pink Copy-SStie-Designee)
•d 6£86-89Z1706 ieneyoo> Ie ueC dl£:1r0 90 Ll 300