1915 SHERRY DR - FENCE ?�"a'�i'ie, City of Atlantic Beach
a' ' f BuildingDepartment
800 Seminole Road artmt APPLICATION NUMBER
• ? «� p (To be assigned by the Building Department.)
�. -e Atlantic Beach, Florida 32233-5445 11-F)CL- 3 aG) 0
Phone(904)247-5826 • Fax(904)247-5845
"=.40.70 '- E-mail: building-dept@coab.us Date routed: Ool Ieit,1 ri
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 19 IS Sh.tY1 p( • Department review required Yes No
Applicant: DLO (\L( ' annin. &Zonin.b.
Tree Administrator
Project: -‘1\ -\14‘‘ b`66 A- t a Qa it!,ilU__ (Public Works
ublic Uti i i
Public Safety
Fire Services
Review fee $ /7 Dept Signature .--4-,--- _
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:
APP CATION STATUS
Reviewing Department First Review: I Appro ed. I !Denied.
(Circle one.) Comments:
BUILDING , Ai-
PLANNING &ZONING
_,,YReviewed by: �' Date: ZZ l
TREE ADMIN. Second Review:
'Approved as revi (7 f
llippr
P WORKS / Comments: [�/gj i i 7
L✓ !!
UBLIC UTILITIES
2-z/- n ��
PUBLIC SAFETY Reviewed i/ lSc; ( ADC,
FIRE SERVICES Third Review: I 'Approved as revi ,
Comments: `�cs
is �- 130 l C—T/
Reviewed
Revised 05/14/09
1
'':11--
-:1,trJi
,, BUILDING PERMIT APPLICATION ,�� 1'�`
.) CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
,',..n;tt.
�r Office:(904)247-5826 • Fax:(904)247-5845
-, n , i I (rf4Fr- lit- /
Job Address: IY15 YiOr'i'J,SJr''� 1)j'( \J,if
Permit Number: ri - ivc.6.,- agb
Legal Description RE#
Valuation of Work(Replacement Cost)' 2 4_?q [ *-Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): ew Addition Alteration Repair Move Demo Pool Window/Door
■ Use of existing/proposed structure(s)(Circle one): Commercial elide 'a
• 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
Describe in detail the type of work to be performed: 6 rOof LA-)OD D 6g-14, I
F2nLe. 10 Re V.1-4 (wv-- SACK- Letrner 6-0Ced- 4 115 ; iPe 01 4twS)Z
Florida Product Approval# for multiple products use product approval form
Property Owner Information j
Name: ( rr, Zs 6 ce I I Add ess: I c l s ,u -)]. S�er1 '� A.
City I /c-t_ G L . StaR Zip 322 3) Phone 5' Y'G -5'V 5' k 6 7M
E-Mail ./f-S i1 9!7Yt-rcofr--
Owner or Agent (If Agent,Power of Attorney or Agency Letter Required)
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 WITI-1 YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
Contractor Information:
Name of Company: Qualifying Agent:
Address: City State Zip
Office Phone Job Site/Contact Number
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name& Phone#
Worker's 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 Me issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction.
This permit becomes null and void if work is not commenced within six(6 months. or if construction or work is suspended or abandoned for a
period o fsix(6)months at any time c f er work is commenced. I undeustand)that separate pe units must be secured for Electrical{fork, Plumbing,
Signs, { ells,Pools,Furnaces,Boilers Heat, Tanks and Air Conditioners,dc.
Signature of Property Owner: 1 Signature of Contractor:
Before me
this 1 Day of V't kg rl4(- ç at)V+ Before me this Day of
Notary Public: �...• ., ,-I. A_`,,,l nett% Notary Public:
/hereby certify that I irate -___ - -tow the same to be true and correct. .411 provisions allows and
orddnane•e's governing this ct:4rk nil irede 7 - i 1r i�•l ter spec-i/led herein or not. The granting of tt permit dues not
presume to giro authority t 3f,,,, 3t caw r �J}u,`{( `i�`in, niter eddernd, .state, or local hut•rtgtrdututg con truct:ni or the
pet in mance al convtrnciio LA ,,,,� 2* hilt; l$�' 042984 '
�,..•d: EXPIRES:October 27,2020
�` ' Bonded Tlw No Rev.3/14/16
�4 Notary Public Underwriters
l-tvif,,, City of Atlantic Beach APPLICATION NUMBER
acs . Building Department r--7.-.. r..., A o be assi ned b the Buildin De artment.sa , �►, , R 9 Y 9 p )
f -� 800 Seminole Road a � �`,,,;�
Atlantic Beach, Florida 32233 5445 —FA' ,� 3 a�
�J' ;r pp 1 v
, �� Phone(904)247-5826 • Fax(904)247-58D 2 1 2017
\01111.)r E-mail: building-dept@coab.us i Date routed: Oa lat.
111
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I q IS Sh Uy1 DC . Department review required Yes No
B q
Applicant: DIA) AL( PT"an`ninq &Zonin
Tree Administrator
Project: ‘i\ '‘Ct,1\ tor 66 A- t,b Qd . e-n CPub is Works
C.— u517Uti i i
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: [ proved. I IDeniegoe* 2-/
(Circle one.)) Comments: i—
ce
Je /Wtdd (0„„„, if
BUILDING
PLANNING &ZONING /
Reviewed by: Date:2/234�
TREE ADMIN. Second Review: I 'Approved as revised. I nied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: I 'Approved as revised. I (Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
01..i-v.ifif, City of Atlantic Beach APPLICATION NUMBER
rf t ,. .� Building Department (To be assigned by the Building Department.)
800 Seminole Road �/
my
c......-
�.. Atlantic Beach, Florida 32233-5445 —FIC L 3 aclPhone(904)247-5826 • Fax(904)247-5845
on 1.)r E-mail: building-dept@coab.us Date routed: Oa IQL1 II.
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 19 IS S ht y-1 QC • Department review required Yes,-No
B . 1/
Applicant: Ow hit Panning & Zonin
Tree Administrator
f\S'
Project: cctt\ Ip'66 Wod itfx.,L (Pubic Works
C--ublic ti i i
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: proved. Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONINGnn !
Reviewed by: "Y Date:2'2��,
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: Approved as revised. Denied.
Comments:
Reviewed by: Date:
i_
Revised 05/14/09
3
- a `� CITY OF ATLANTIC BEACH
4�s
I' V 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: ill ® (�� I
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSEL m' 1
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THA" I— LL
LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT M W
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUSS ® n L
SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE-OI
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OF
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDIN( Z 0
MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE Q ca Z ,
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAH U.1 ....I 0 MIN
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUIL' 0 a. •
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NO .3 ' 9
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUS'j
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT I$
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVII 0 w ,
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
N
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THU
EMPLOY ON THEIR IMPROVEMENT TRADES. 0 M
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER A► J Z N
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE N� V Q 0 csi
455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALItt Q F„.
OF=
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTOE w — p W
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE TI-0 m RZ <
BUILDING DEPARTMENT(247-5826) IF IN DOUBT. 0 V il O U n
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSUF Z Q 2
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF / 0 a
OWNER-BUILDER PERMIT. () DLL' N
0,4 F(_— " . FN.- Z
19 / 5 Nu—P, S ker,_, '(�l,>.�2-1 " '6,Y- S-6 s'., . L
ADDRE S PHONE NUMBER Q r w W $"
l{Prr� it Se it W 0 W
PRINT NAME W (.) (A W
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SIGNATURE DATE Q.
CIE
Before me this 1—day of Rio((1..Ci4-� ,20 in the county of
Duval,State of Florida,has personally appeared h rin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of FL ,County of kA/a I a;�ev ,, JENNIFER JOHNSTON
"P'•,., t MY COMMISSION N GG 042984
❑PersonallyKnown A • A^ e--?:4:::'"::k.
�� ""' EXPIRES:Octobe►27,2020
)(Prod ucedIdentification- U.I I 1'�,� U.Ct lS -'':;: o;:• gq>d.d TIW Notary Public Umbrvrtiters
Notary Signature:
F:/BLDG/Owner-Builder A1Y"+'
EVISED: 4/16/2009
1
�'i_.. •
MAP SHOWING ETOUNEY OF
LOT 10, SELVA MARINA UNIT NO. 10--C, AS RECORDED IN PLAT BOOK 31, PAGE 40,
OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO:
KERRY P. & LEAH M. RUSSELL
COMMONWEALTA LAND TITLE INSURANCE G . O COPY
GIBRALTAR TITLE SERVICES
PEOPLES FIRST COMMUNITY BANK
THIS PLAN MUST BE
ON JOB SITE FOR
EACH INSPECTION
SECTION 9. TOWNSHIP 2 SOUTH. RANGE 29 EAST
163.79' (PLAT) FOUND 1/2" 1140N PIPE 1.4'
N 89'08'46" E NO IDEN TFlCA PON
FOUND 1/2" IRON PIPE N 89'06'417.E 163.79' (MEASURED) - __
NO IDENTIFICATION, --- X
1.7'
C ! FOUND 1/2" REBAR
STTAMPED."A LB 6702"
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LOT IQ__— } 20.Ilesnrcna+ow -
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NO IDENRFICATION ` ��
R=500°.
ST/WPC IC,' DI ty8
34'98'6<MT?' (�
A, 6(C,y"YD)SVR�
35 0219.26"
?1g 26" '
'C11%)AT) NORTH SHERRY DRIVE
(VARIABLE WIDTH RIGHT OF WAY)
NOTES: ACCEPTED BY:
LEGEND:
R = RADIUS —X--X= FENCE
L = LENGTH O = CONCRETE
)TES: - ----.
BEARINGS ARE BASED ON THE PEAT BEARING OF N 02'10'34" E ALONG THE I REVISIONS
NORTHERLY BOUNDARY LINE OF SUBJECT PARCEL.
BY GRAPHIC PLOTTING ONLY THE CAPTIONED LANDS LIE WITHIN FLOOD ZONE ____ X AS SHOWN ON THE DATE DESCRIPTION
NATIONAL FLOOD INSURANCE MAP DATED APRIL 17, 1989, COMMUNITY NUMBER 120075, PANEL ___QQQ--Q.
THIS SURVEY REFLECTS ALL EASEMENTS & RIGHTS OF WAY AS PER RECORDED PLAT k/OR TITLE COMMIIMLNI
IF SUPPLIED. UNLESS OTHERWISE STATED, NO OTHER TITLE VERIFICATION HAS BEEN PERFORMED BY THE UNDERSIGNED.
THIS SURVEY NOT VALID WITHOUT THE EMBOSSED SEAL OF THE CERTIFYING SURVEYOR.
JOB # 11313 1 DATE OF HEI.D SURVEY: 05- 03-00 DISK N CD-3 I SCALE: 1" = 30'
• CER 1111CA EE
IiioN 2522 Oak Street I HE:RERY CERTIFY THAT THIS SIIRVLY WAS MAI) UNIX MY RISPONSIRLE CHARGE
IPS Jacksonville, Florida 32204 AND MEETS THE MINIMUM TECHNICAL STANDARDS AS SET FORTH BY THE FLORIDA
Vii f / (Phone) 904-389-5989 BOARD OF PROFESSIONAL SURVE'IORS AND MAPPERS IN CHAPTER 61617-6, FtORIDA
/1%eflAOMINISI .ODE, PURSUANT TO SECTION 472.072. F;.ORIDA STATUTES.
A . / / (Far) 904--389-6175
�snFIVE !nn i�nc _ . , .
c HAI I .1 All I I 0
I.ICT.NST ET BUSINESS // 6702 REGISTERED Sl1RVLY l AND MAPPER # 4670 SIAfE OF FLORIDA
LAND SURVEYS 0 CONSTRUCTION SURVEYS 0 SUBDIVISIONS