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338 Sargo ACC18-0036 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 oil INSPECTION PHONE LINE 247-5814 ACCESSORY- SINGLE OR TWO FAMILY ACCESSORY MUST CALL BY 4PM FOR NE)Cr DAY INSPECrION: 247-5814 PERMIT INFORMATION: PERMIT NO: ACC18-0036 Description: Storage Shed Estimatedvalue: 200 Issue Date: Expiration Date: PROPERTY ADDRESS: Address: 338 SARGO RD RE Number: 1716850000 PRO�NER: Name: SIMS MARY J Address: 408 ROYAL PALMS OR ATLANTIC BEACH, FL 32233-3926 GENERAL CONTRACTOR INFOR14ATION: 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. NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property that may be found in the public records of this county, and them may be additional permits required from other governmental entities such as water management districts,state agencies, or federal agencies. * A notice of Commencement is only required for work exceeding an estimated value of $2,500.For RVAC work, a Notice of Commencement is only required when HVAC work exceeds and estimated value of$7,500. Building Permit Application Updated 12/8/17 City of Atlantic Beach 800 Seminole Road,Atlantic Beach,FL 32233 Ph a:(904)247-5826 Fax.(904)247-5845 - 043< Job Address: 01, 'ZZ a Permit Number: Acc(g' Legal Desc(iption 6L4+ _�>+o nff<'e_7! 6 /N e- RE#rr2f��]� Valuation of Work(Replacement Cost)$ Z 0 CD Heated/cooled SF_Non-Heated/Cooled— • Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door • Use of existingtproposed structure(s)(Circle one): Commercial Residential • If an existing structure,is afire 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: '�> Florida Product Approval 4 for multiple products use product approval form ="fterfin rm. - Z) I Addres, J�rg aL �/ r State r4e, Llp_;�` — V�'�'Phonev'/� city 6EX ON1 kic K I .11� o!��w -XIM E-Mail Owner or Agent(if Agent,Power of Attorney or Agency Letter Required) Contractor Information Name of Company: Qualifying Agent: Addres CItV_State Zip— Office Phone Job Site/Contact Number State ZIP— Otytact Job S.t./C.n Number State Certification/Registration#_ -Mail Architecat Name&Phone# ,P Engineer's Name&Phone# Workers 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 the issuance of a permit and that all work wilt 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.NOTICE:In addition to the requirements of this permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and there may be additional permits required from other governmental entities such as water management districts,state agencies,or federal agencies. OWNER'S AFFIDAVIT:I ceftify 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, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. W�4 heA (SignatureofCa ractor) (Signature of Ownj or Agent) (including i raclor) §igned and sworn to(or affirmed e remett'is_,Zdayof Signed and sworn to(or affirmed)before ethis_dayof Anti 42 2017 b by 0 (Signatithe of Nota %ry) (Signature of Notary) I Personally Kn n 0 Personally Known OR I Produced Id.:7tffical� Produced Identification Type of Identification:= Type of Identification: City of Atlantic Beach 0 be APPLICATION NUMBER r Building Department (To be assigned by the Building Department.) S Atiantio Beach, Florida 32233-5445 Kc I% - =0 Ott Seminole Road Phone(904)247-5826 Fax(904)247-5945 E-mail: building-dept@wab.us Date routed: City web-site: http:JA�ww.coab.us APPLICATION REVIEW AND TRACKING FORM ant review required 09 0 Property Address: ,33 9 a,N 0 B . . V ning &Zoning Applicant: MT7 re or Project: Pubkc-Wa u ic UtillEtle's ub ic afety Fire Services Review o t Date Other Agency Review or Permit Required of Permit=PBy Florida Dept.of Environmental Protection Flonda Dept.of Transportation t. ohns River Water Management District Amy Corps of Engineers Division of Hotels and Restaurants ivision of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: [KApproved. E]Denied. [-]Not applicable (Circle one.) Comments: P(D Y�, BUILDING PLANNING &ZONING Reviewed by: Date: 6-/ S7-/ S- JApproved as revised. F -]Not applicable TREEADMIN. Second Review: ]Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date:- FIRE SERVICES Third Review: [JApproved as revised. DDenied. E]Notapplic�able Comments: Reviewed by: Date:- �ised 0511912017 City of Atlantic Beach APPLICATION NUMBER Building Department (To be asr�lgnecl by the Building Department.) 800 Seminole Road Atlantic Beach,Florida 32233-5445 Phone(904)247-5826 Fm(904)247-5845 E-mail: building-dept@coab.us Date routed: cityarelb-site: hftp:/A�.coab.uS APPLICATION REVIEW AND TRACKING FORM Property Address: 33 9 SCLN 0 -DepadMent uired Yes No Applicant: Project: S �A eb C--pu U�s er Public Utflities) 7 b'c a e� "ce, LERUrTe STewices ,Review fee Dept SignatuTp . Other Agency Review or Permit Required Review or Receipt of permit Verified By Date Florida Dept.of Envuonmental Protection Florida Dept.of Transportation Et.Johns River Water Management District Amy Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other. APPLICATION STATUS Reviewing Department First Review: ElApproved. enled. E]Not applicable (Circle one.) Comments: BUILDING f/ce 61 PLANNING &ZONING Reviewed lby:'��' Date: 6'20-11? TREEADMIN. Second Review:/ZApproved as revised. DDerried. E]Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES -)'2 PUBLIC SAFETY Reviewed by:,A;1 Date: I� FIRE SERVICES Third Review: E]Approved as revised. ElDenied. ONot applicable Comments: Reviewed by: Date:- Revised 0511912017 CITY OF ATLANTIC BEACH 800 Seminole Road Atlantic Beach,Florida 32233 REVISION REQUEST/CORRECTIONS TO PLAN REVIEW COMMENTS Dat,�'Z� Revision to Issued Permit Corrections to Comments Permit#-ke (0 0 Pruject Address Z)k)jf?-E�0 Contractor/Contact Name M cs� I 6� �: (0 W Phone cj�04 - Z49 - 2800 Email K3 0 t\D C— Description of Proposed Revision/Corroctioun: Permit Fee Due F7 Additional Increase in Building Value Additional S.F. By signing below,I affirin the Revision is inclusive of the proposed changes. (printed name) Signature of Contractor/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 — A— <=MKin�——&Zomn Reviewed By �g Tree Administrator Public Works Public Utilities 6 Public Safety Date Fire Services City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road I Atlantic Beach,Flonda 3223M445 1 � - CEIIV ftcC19 - Phone(904)247-5826- Fax(904)247-584� E-imail: building-dept@coab.us . JUN 11 2N Date muted: City web-site: hftp:/A�.coab.us 1i M APPLICATION REVIEW ARD-TRACKING FORM Property Address: 339 B .. . ant review re uIred Yes No anning &Zoning Applicant: TrUe-ATtIr[TI'lliffnator Publi S Project: u Ic Utilities re Services ub k; afety Fi Review fee Dept Signature Re !a%!or Recell'.4. Data Other Agency Review or Permit Required of Pve..t Verified Florida Dept.of Environmental Protection Florida Dept.of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Nision of Alcoholic Beverages and Tobacco APPLICATION STATUS Reviewing Department First Review: 5tApproved. []Denied. E]Notapplicable (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by Date: TREEADMIN. Second Review: E]Approved as revised. DIDenied. E]Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date:— FIRE SERVICES Third Review: E]Approved as revised. E]Denied. [–]Notapplicable Comments: Reviewed by: Date:— Revised 0511912017 1 — * I �I_ PPLICATION NUMBER City of Atlantic Beach IV A Building Department (ro be assigned by the Building Department.) 800 Seminole Road ACC 19 - 02 Atlantic Beach,Florida 32233�5U5 JUN 11201 Phone(904)247-5826 Fax(904)247-5845 11 E-mail: building-dept@coalh.us Date muted: Cityweb-site: hftp:/Avvnv.coab.us APPLICATION REVIEW AND TRACKING FORM -33S A _DepaAlipent re Property Address: (SC viewrequired Yes No] C_914a�� Applicant: %;Q=p Project: <-'PU -PuVic Utilities.,) -PuBlic 9afety Fire Services R vie fe ,p , W,_ e Dppt Signature Other Agency Review or Permit Required Review Date of Perlit=PBIY Florida Dept.of Environmental Protection Florida Dept of Transportation St.Johns River Water Management District Amy Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: [JApproved. E]Denied. applicable (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by: Zq��_ Date: TREEADMIN. Second Review: E]Approved as revised. DDenied. []Not applicable PI�ORKS , Comments: B6 PU LI AY�VtY Reviewed by: Date' FIRE SERVICES Third Review: DApproved as revised. E]Denied. EINotapplicable Comments: Reviewed by: Date:— Revised 0511912017 o�, CITY OF ATLANTIC BEACH (OWNER / BUILDER AFFIDAVIT 1. 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 SUpERVISETBEQQNSTRUCTION YOURSELF, YOU MAY BUILD ORIMPROVF AONE-OR TWO FAMILY RESIDENCE OR A FARIA UUIBUILDM. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDINQ MUST&FOR)MURUSE AND OCCUPANCY IT MAY NOTES BUILTFORSALE ORLEASE. 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- YOO MAY NOT HIRE AN UNLICENSED EWSON AS YOUR CONTRAMIL YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUR,DINU uuuub AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY To MAKE SURE THAT PEOPLE EMPLOYED BY Y-Qu HAYE LICENSES REQUIRED By STATE LAW ANI2 By CQ-UNTY OR MUNICIPAL LIMSING ORDINANCES. IL INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE EOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPEN5AIIUN INSURANCE BE PURCHASED. ill. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX ANDIOR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNUCENSE- CON C ANN B EMP YED UN CIR( UMSTANCES. OWNERS BEING SUKFE—CT TO$5,000 PENALTY UNDER FLORIDA STATUTE No. 455-228(l) AN C "01FE"15 NOT ADEgQ&TE. THE OWNER SHOULD PHYSICALLY C'T 'a COMPFTENUY- OR 'CONTRACTORS SEE THE' C09k IkeE THE FLORIDA CERTIFICATE' TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826)IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. -739 — C�j TD—MESS TH—ONENUMEER PRINT E SIGNATURE 1 DATE Before m Mis dy of 001 COO—Mll—8-9 ft ocu�-IY-f )�I,StetccfFIbdd8,Ms�1IY8PPeered wneymmeelfloe,eaffawaffloeftt .,I euterocree.oe cocurawn,..toee.oc!-co,o&e Nct.oPubIkatUT%SteIecI F( Co.*cf—D—u� c:7 S10- Z 7 TOMEINDLEVE My CON MISSION I FRF"KE4R95 I 4—�=EXPIR ES Octobers,oig Note,st,natumo F,re�A�k�reb:VLW. mmmmmmr`*— VO )cm MAP WINING SURVEY OF LOT 17, BLOCK 24 , REPUAT OF PART OF ROYAL PALMS JJIT TvtO A, �F� REC,-JHDED IN PLAT BOCK 31 , PAGES 16 , 16A, 16B, 16C, AND 16D OF THE a-RR&IT �--JbLiC RECORDS OF DUVAL Ca.NTY, FLORIDA. I 3 t4/k Q�\Q `)p er --ske- J CCL6 [ e— ov e r- 4�x 4f PLAT POP—vyl — Z* ze2� N �WWey L Iv j57 V) i 1 HEREBY CERTIFY THAT THE PRDRERTY SHC14q HEREON IS IN FLOOD ZCNE "C" AS SHOO" ON TI-E FLOOD HAZARD BO-I\DARY YAP FOR THE CITY OF ATl-AfjTf(, BEACH, FLORIDA. I HEREBY CEIRTIFY TCi 'AILLARD W. SIMS AND NAM SOCK THAT I HAVE SURVEYED TH�- t LANDS AS SHCIAN IN THE ABOVE CAPTION AND THAT THIS N/AP IS A TRUE AND -OF;FZECT REPRESENTATION CF THAT SURVEY AND TH,4T THE SLRVEY REPRESENT�:D HEREON WETS THE MINIM-M STANDARD REQUIREl,'ENTS ADOPTED BY T�E =LORIDA SOCIETY OF PROFESSIONAL LAND SLRVEYORS AND T�E FLORIDA LArf) TITLE ASSOCIATIGIN. DONN W. BOATWRIGHT. S. FLORIDA REG LAND SrJRVEYOR No 32�� SCALE: i ro' BOATIMINUT LAND SURVEYORS, INC DATE sIGNED DRAWN BY: 130 PENMAN SUITE 'D IF S. JACK$DkVLLE =, FLORIDA 241-8550 sHaT J- :IF