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1830 SEMINOLE RD - FENCE ;sr=L�f�JCity of Atlantic Beach ;1, Building Department APPLICATION NUMBER 800 Seminole Road (To be assigned by the Building Department.) Atlantic Beach, Florida 32233-5445 ' l Vii;:-. ) (0 F N)C.0 Phone(904)247-5826 • Fax(904)247-5845 -P!,'11,!!)7 E-mail: building-dept@coab.us NO 1 7 2016 City web-site: http://www.coab.us Date routed: ( (c J(e, tka APPLICATION REVIEW AND TRACKING FORM Property Address: 183 0 (J ou&- Department review required Yes es No Buildin. Applicant: 0 ( i.� Planning &Zonin. Tree Administrator Project: C 4Rub►ic Works 4::-:Pubic I i itie Pub �'ublic Safety Fire Services` Review fee $ Dept Signature 1` Other Agency Review or Permit Required Review or Receipt of Permit Verified By Date 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: APPyCATION STATUS Reviewing Department First Review: roved.A PP UDenied. (Circle one.) Comments: BUILDING PLANNING &ZONING �J Reviewed by: --- / etA---> 1 I / tG Date: TREE ADMIN. Second `7 "if WORKS Comme ( Zl e� 'UBLIC UTILITIES PUBLIC SA ETY/6 L Date: FIRE SERVICES Third ReIV �c t pc Commer ( 1SDate: ! Revised 05/14/09 - :, BUILDING PERMIT APPLICATION : CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach FL 32233 *: J;tSt.'- Office:(904)247-5826 • Fax:(904)247-5845 r f' r–Nec —2587 Job Address: ( 0 3o S t N OL D MICA(1 Permit Number: Legal Description .�' ' KAcut v(�e at( 'eQ F #-5)333 Valuation of Work(Replacement Cost)$ 'COO Beate,/Cooled SF _on-on-heated/Goole • Class of Work(Circle one): New Addition Alteration Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercialesidenti • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes Com! N/A • Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal VI Describe in detail the a of work to be performed: �Q (eplaft o(d elto dak_c d rtrt'(61/1 C. lna�ti,ei c1 WI w int I t "� t I U+ (( (p1 t_ Florida Product Approval II for multiple products use product approval form Property Owner Information I Name: tp i ( i(�� Address: I �C1 2-at t1/173C3- !)oQ '1) iCity `� tpL StateFC-Zip ? Z7" Phone ao%, (,�t 3 E-Mail 5i- ,h 14;tt **-U-0 914a,J. (ori Owner or Agent (If Agent,Power of Attorney or it gency Letter Required) S+Z 4)katAAL ,t,((Ca . WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF Y U- NTEND TO OBTAIN FINANCING, CONSULT WITII YOUR LENDER OR AN AT R E .BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. `` Contractor Information: Name of Company: Address: Qua gent: ity State Zip Office Phone J. : e/Contact Number State Certification/Registration# E-Mail Architect Name&Phone# Engineer's Name& Phon- • Worker's Compens. ': Exempt / Insurer / Lease Employees / Expiration Date Application • rereby 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 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 abate,onedfor a period ofsix(6)months at any time after work is commenced 1 understand that separate pen»its must be secured for Electrical Wo Plumbing, Signs, Wells,Pools,Furnaces,B err,-.4eaters, Tanks and Air Conditioners,etc. l Signature of Prope a wner: '...- 1 \P- ignature of Contractor. Befor e this � a of . Mir :: :)._ 117 ,L I 0 - Before me this Pay of Notary Public: I 9 Notary Publ•,. I hereby certift-that I hove read and examined this application and -now the me to he true and comet. All prn'isions of laws and ordinances governinl> this type optt '.':••••.,• •• •••---- -= her specified herein or not, The granting of'a permit does not presume to give authority to r• r�r0, parrcc�t't;tlit o.E6RFllfi ))an ,oilier,fe eral, state. or local law regulating-construction or the per/onnmree n/construction. ••.� MY COMMISSIOPI0 FF 925951 t; : .;4,: UPi'r'.ES:October 6,2019 3 ndcd Tho Notary Public Underwriters l Rev.3/14/16 -i}.t1,Yi CITY OF ATLANTIC BEACH 75.11 0 WNER / BUILDER AFFIDAVIT -4Jif)jr 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. as( O -e)`-'Ll. `ircft -Naafi 6/oc(r-�rb. �c •65 .�/ L,�A - TM� r` l L r(�(�i(k �/ PHONE NUMBER I NAick Ait l e t. K_v SIGNATURE ---\(?-4it-' pp__ In/ DATE Before me this lL'day of IV W ,20 I(fin 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.J Notary Public at Large,State of \ ,County of 1)Lkf(;(Q ❑Personally Known ©I. :7&`�� - E Produced Identification--, 4 /i.� "- 0 Notary Signature: '— . r .7±1111 ONT GINDLESPERGER9 �� MY COMMISSION#FF 924951 EXPIRES:October 6,2019 F:/BLDG/Owner-Builder AlTadavit;REVISED: 4/16/2009 ,re goaded Thn.IJoary Public Undetw!dErs MAP SHOWING BOUNDARY SURVEY LOT 5, BLOCK 1 AS OF SHOWN ON MAP OF SELVA MARINA UNIT NO. 9 AS RECORDED IN PLAT BOOK 36, PAGE 20, OF THE CURRENT PUBLIC RECORDS OF CERTIFIED TO: ERIC & CBC IONSTEPHANIE MILLER; FIRST AMERICAN TITLE; NATION AL COUNTY, FLA. SCALE: 1"=20' AL BANK I DATE: 12/30/13 I 0 I LOT I "_ II N89'57'19"E(P) 100'(P) I I N89 53 26 E(ACT) 100.26'(ACT) I •.2 •. 0. NO CAP _:...� ...,.:��►o �I Cm. 3'X3' CONC. PAD DrAIR CONDITIONER I No 'CAPat C-Yd 56/1‘k 30 < 12.5' 3.5 N 20.2' w ¢ V cn '61ZZ ` IV all CCONC. 22.8'VERED 25.0' zo cn o V) 03 d d COVERED 9.9' N D 0 / TILE • , _ O Z O 12.0' N N ; ^' CONC. N p N r n COVERED / ,� �` POND � D V) O --1 SCREENED �\ ,� O 2.3' 12.9' , R1 m 0 X1 rn CONC. s �, qk 3' CONC. WALK ° ; 24.8 v D_ W NI WATER METER • O gp 0O N? COQUINA 01 / \ 0 WALLI BRICK 0 Ql��� COQUINA-� D 20.3' PAVERS o DWALL V -re vo D BRICK BRICK PATIO N - w e" Imn:CON :.e F.,3 .� •.....,/ BRICK • ..1 ,„ DRIVEWAY, ° I- - • •PAVERS o Y 8.0' • 38.6' a-v °, 29.4' Il Ut CONC. PADS x I Ip A3112"CONDITIONER LOT 5 FND. 1/2' I.P. • NO CAP ii. p s.—___- --_-- ----- i 0.5 0.5' .1 S89'54'07"W ACT I FND. 1/2' I.P. ) o S89'57'19"W(P) ) 100100'(PACT) NO CAP cNn II I I LOT 4 C...4 V 03 00 V I I ERTIFICATIONS; 09/23/15 SATURBIA DRIVE ERTIFICATIONS; 01/28/14 (COUNTY ROAD NO. 2280, 100' R/w) Y BE ADDITIONAL EASEMENTS ANTI Alp crcroin,,.."... ....- _- ;,51- p,,,, City of Atlantic Beach .,-)' APPLICATION NUMBER � Building Department , 800 Seminole Road 4' (To be assigned by the-Building Department.) to Atlantic Beach, Florida 32233-5445 oV Z. Phone(904)247-5826 • Fax(904 7-5g45 f �JiJ ' I —F N)C C,— J 7 1 - E-mail: building-dept@coab.us City web site: http://www.coab.us b IT:- APPLICATION REVIEW AND TRACKING FORM • Property Address: 1 830 S lit(jvaL(._— ,(0 Department review required q Yes No Buildin._ Applicant: 0 (A_7IL) Planning &Zonin. Tree Administrator Project: re..to ',e_ 4 ublic Work ia •ublic Utilities [-- •.;lie Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt of Permit Verified By Date 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. /1-1,--4(Circle one.) / I (Denied /1-1,--4� Comments: �e thii-i tkw4 _ , BUILDING L(/ PLANNING & ZONING Q� Reviewed by: Date: ///e-6946 TREE ADMIN. Second Review: I (Approved as revised. I Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: I (Approved as revised. ❑Denied. , Comments: Reviewed by: Date: Revised 05/14/09 , ,,srL`� , City of Atlantic Beach APPLICATION NUMBER �3 ' i +s Building Department (To be assigned by the Building Department.) <,-- 800 Seminole Road I / _� ;� i Atlantic Beach, Florida 32233-5445 1 V—F N CE- — 2E7 Phone(904)247 5826 Fax(904)247-5845 A'!ogl>% E-mail: building-dept@coab.us Date routed: L t ii 1 (, City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 183 0 Etyt t& ou 1210 Department review required Yi7 No Buildin Applicant: a (...0, ) EJ Planning &Zonin Tree Administrator Project: r-gioce u lic_Works ublic Utilities • 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. I (Denied. (Circle one.) Comments: fu (� BUILDING "' PLANNING &ZONING Date: /�"/ /6 Reviewed by: f�. TREE ADMIN. Second Review: ❑Approved as revised. ['Den d. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: I 'Approved as revised. Denied. Comments: Reviewed by: Date: Revised 05/14/09 quk t. aS;I Ijyi ' '` ° CITY OF ATLANTIC BEACH '' _ OWNER / BUILDER AFFIDAVIT 'dJft V' 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 BUILDI -G" �-m� MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEA ' . LSI = z IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YE [n ® 0AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUI T — IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY ATLL HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MU LU 0 BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT LU YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HA n r 0. LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSI z co ORDINANCES. J La II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY , E,Q. O THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURAI C E PURCHASED. 11J 0 III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOUL ALSO) O Iii OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKER TRLY 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 DISCLOS 'No STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF Z OWNER-BUILDER PERMIT. V 43 \ • i 0 6 O -e)?`-k..k kna NC. Ni3ad,- 610(4. 1-i b. (,0 c t. cal 0 ADD ESS kt /�� T/�1� PHONE NUMBER O (,)r. i P I NA E Zg I .:,, , Ur (M ` „�'2 ( f ' ((P • ?oi(). 0 . g SIGNATURE DATE 0 5 p A I^/ U. O 6L tu Before me this ^day of IVW�1, ,20 I le in the county of 0 4ii Duval,State of Florida,has personally appeared herin by himself/herself and affirms that Iii 5 all statements and declarations are true(and accurate. Po V I 0 NotaryPublic at Large,State of i Countyof ` v.v 9 � 4 0 Personally Known411 _ 7 .� 8 Produced Identification- IA Ok .4i1 :7//�z *o IFY or �:.......,, TONI GINDLESPERGER Notary Signature: '— �a—ii r'',�, '= MY COMMISSION#FF 92�95t 't r` *= EXPIRES:October 6,2019 - •og F:/BLDG/Owner-Builder Affadavit;REVISED: 4/16/2009 6 os iv �4 Bonded Thw Notary Public Underwriters wa. SEMINOLE ROAD co .(COUNTY ROAD NO. 608, 100' R/W) Z x@!Mi4iii=K) Agemr- 8oCP H (BEARINGS BASE) ct 91'(P) z3 Q S00 02 41 E 3 90.92'(ACT) o O z -_ `� ° _ ,\ N A f O Z aj �. �a 378.87(P) a J WtoU O O c Z A LC7 Z N cy5 < z W O LY, U c N ti d O cz O cioz ma 0o� • .° of p E. O W U OO a Um N J N m W .W a'a o, ° o N U) 0 O U F - - - - -I-i'6 1 - - �� — _ _25' .R.L - - - - - - - - CO z �j . . 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