225 SHERRY DR - SEMINOLE INDIAN CHICKEE „,...,..,
____,„..,70, CITY OF ATLANTIC BEACH
a ' 800 SEMINOLE ROAD
\,,, ._
J, y ATLANTIC BEACH, FL 32233
'2.0;3 9%' INSPECTION PHONE LINE 247-5814
ACCESSORY - SINGLE OR TWO FAMILY ACCESSORY
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: ACC18-0039
Description: Seminole Indian Chickee
Estimated Value: 0
Issue Date: 7/27/2018
Expiration Date: 1/23/2019
PROPERTY ADDRESS:
Address: 225 SHERRY DR
RE Number: 169804 0000
PROPERTY OWNER:
Name: MORTENSON MARIE
Address: 225 SHERRY DR
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
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 there 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 HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
•
Cash Register Receipt Receipt Number
T5IINFCity of Atlantic Beach R5829
DESCRIPTION I ACCOUNT QTY PAID
PermitTRAK $161.50
ACC18-0039 Address: 225 SHERRY DR APN: 169804 0000 $161.50
BUILDING $55.00
BUILDING PERMIT 455-0000-322-1000 0 $55.00
BUILDING PLAN REVIEW $27.50
BUILDING PLAN CHECK 455-0000-322-1001 0 $27.50
PUBLIC WORKS PLAN REVIEW $25.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
ZONING PLAN REVIEW $50.00
ZONING REVIEW SINGLE AND TWO FAMILY
001-0000-329-1003 0 $50.00
USES
TOTAL FEES PAID BY RECEIPT: R5829 $161.50
Date Paid: Tuesday,July 24, 2018
Paid By: MORTENSON MARIE
Cashier:JJ
Pay Method: CHECK 1093
/!!
Printed: Friday,July 27,2018 11:02 AM 1 of 1 fi
TRMNiT
Atli LD!NG
1Ir ;:,i, NOTICV
;-, it 0 OF
ADDITIONS or CORRECTIONS
°P � OFFICE ClyOTREMOVE
d19
JOB ADDRESS DATE
THIS JOB HAS NOT BEEN COMPLETED
The following additions or corrections shall be made
before the job will be accepted.
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1 I$55.00 REINSPECT FEEO CHARGE
It is unlawful for any Carpenter, Contractor, Builder or other
persons, to cover or to cause to be covered, any part of the
work with flooring, lath, earth or other material, until the
proper inspector has had ample time to approve the
installation.
After additions or corrections have BLDG �- -----
been made contact the Building Dept. ELEC
at 247-5814 for an inspection. Office MECH
hours are Monday through Friday PLMG
8:00 a.m.to 5:00 p.m.
J1 City of Atlantic Beach APPLICATION NUMBER
\ � Building Department (To be assigned by the Building Department.)
ss
2 800 Seminole Road G� OO��
c) Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904) 247-5845
E-mail: building-dept@coab.us Date routed: 7 (l t$
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: z.:2-5 3iteraiDepartment review required Yes No
�
Applicant: pn art V-� e ' ax.R��,, ��//. (Planning &Zoning
Tree Administra or
Project: Sepkilabte, t\dian C.h c kee, Public Works
ub is i sties
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: Approved. I (Denied. iNot applicable
(Circle one.) Comments:
BUILD ►
PLANNING & ZONING Reviewed by: f� Date:��
TREE ADMIN.
Second Review: Approved as revised. nDenied. Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: I lApproved as revised. nDenied. Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
-il,AtTr City of Atlantic Beach APPLICATION NUMBER
rf t �, Building Department (To be assigned by the Building Department.)
800 Seminole Road
G� g 0 1
1 Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: <<
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Z:2:5 311Department review required Yes No
Applicant: l e. ' cce,k. Planning &Zoning
ree Admmisira or
Project: Semi t o(e, k1 c[i ,n Cin is kee� Public TJfiWork
ubliclities
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: Approved. nDenied. ❑Not applicable
(Circle one.) Comments:
BUILDING 7
PLANNING &ZONING Reviewed by: Date: 1 2-18
TREE ADMIN. Second Review: Approved as revised. nDenied. 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
5 \- ,\ City of Atlantic Beach APPLICATION NUMBER
5 S; 2\ Building Department ' ' (To be assigned by the Building Department.)
-_ 800 Seminole Road 03/
\w. -• Atlantic Beach, Florida 32233-5445 t JUL 1 1 2018 Ig-�GI O
/ Phone(904)247-5826 • Fax(904)247-` $5
U9 E-mail: buildin de t coab.us ` Date routed: / /
��;31� 9- P @
City web-site: http://www.coab.us BY.
APPLICATION REVIEW AND TRACKING FORM
Property Address: VIS 3heryti De artment review required Yes No
Applicant: rn all e 'p(lat.R. Planning &Zoning
ree Adminissrat'or
Project: Semi.h6(.6 f\d.ian Cln. d ee, Public Works
ub is 1 sties
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: It/Approved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed byf Date: ,'"U`-'4,40 ADMIN. Second Review: Approved as revised. ❑Denied. 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
rS�.A,, re City of Atlantic Beach APPLICATION NUMBER
J, / , \ Building Department � @' . (To be assigned by the Building Department.)
=-.,,,,,,,� 800 Seminole Road R-CG/ �y oo31
,ti
� ': Atlantic Beach, Florida 32233-5445 JUL 1 1 �018 l A
Phone(904)247-5826 • Fax(904) 247-58 (I
11\U,il�r E-mail: building-dept@coab.us gY, �`
1
Date routed: ?/ 11 /5.
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 7:2'5' 3hefiti Department review required Yes No
art ��,, ��// Planning onn
Applicant: TY\ £ 'InGLek. g &Zg'
'Tree Administrator
Project: Se/M 0146(e, 4\dian at c kee, Public Works
'ub'c II ' 'ties
_Public Safety
Fire Services
Review fee $ 7
Dept Signature .N�
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: DApproved. ❑Denied. Not applicable
(Circle one.) Comments:
BUILDING l
PLANNING &ZONING ----" /..-Reviewed by: w Date: 7 i z/i,V
TREE ADMIN. Second Review: _Approved as revised. ❑Denied. Not applicable
PUB WOR Comments:
UBLIC UTILI IES
PUBLIC SA TY Reviewed by: Date:
FIRE SERVICES Third Review: (Approved as revised. (Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
Dem 10►r✓ !
"" °?:. '--•••- • : Permit Application Updated 12/8/17
(,� "� City of Atlantic Beach
\- _/
titr•�,� 800 Seminole Road,Atlantic Beach,FL 32233
//�� Phone:(904)247-5826 Fax:(904)247-5845
Job Address: d.2 5 S I,er r 'D/"' Permit Number:
Legal Description 21-38 U,-2?25 6 I'l. ,.-J- II:441es S/v Loic RE# ) 9 9Oy -t^'OQO
Valuation of Work(Replacement Cost)$ / SU Heated/Cooled SF Non-Heated/Cooled I SO
• Class of Work(Circle one):Or Addition Alteration Repair Move D•.i. Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Resid-•
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No
• 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:
Coal ,v o A Sre wl de_ ,L-.1GQ,"4.
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: a,4-i'2 M err,ic ago.," -Mca Address: 242.5- cA a-fr- ��—
City f-( 3C 11 State-ire_ Zip 322T3 Phone a50-
E-Mail 1 -y - 2RArt .100-
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: Qualifying Agent:
Address State Zip
Office Phone .- i. ite Contact Number
State Certification/Registration# E-Mail.
Architect Name&
En ' ame&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 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.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 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 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.
(Signature of Owner or Agent) (Signature of Contractor)
(including contractor)
Si ned and sworn to(or affirmed)before me this day of Signed and sworn to(or affirmed)before me this day of
k V� aQ)f' y PAC.,tUt ,by
d(Cli-001N0‘. J
(Signature of otary) (Signature of Notary)
Personally Known OR 1is'"�e' LATASHAMCKLEVEY [ ]Personally Known OR
tQ"
[ ]Produced Identification 2•4; Notary Public State of Florida [ ]Produced Identification
Type of Identification: ,R' Commission#GG 219889 Type of Identification:
°' ' My Comm.Expires May 20,2022
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PAGE 2 OF 2 PAGES
f- =� BOUNDARY SURVEY
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°.,, a I HEREBY CERTIFY YHAr THIS BOUNDARY SURVEY
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PREPARED UNDER MY ON7ECT/ON. (J j�v [moi j j r J y�Jam,,
J TATF#. _ ~NIST VALID WITHOUTANAUTHENTICATED ELECTRONIC
�} L O Rim+. ,1GNATUREANDAUTHENTICATEDELECTRONICSEAL, SERVING ALL OF FLORIDA
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4,U q 0��'` �`••�OR A RAISED EMBOSSED SEAL AND SIGNATURE.
_•��'` 6250 N.MILITARY TRAIL,SUITE 102
' WEST PALM BEACH,FL 33407
PHONE (561)640-4800
��,�"� FACSIMILE (561)640-0576
(SIGNED) `� / �rt y^ STATEWIDE PHONE (800)226-4807
CLYDE O.MoVEAL,PROFESSIONAL SURVEYOR AND MAPPER#2883 STATEWIDE FACSIMILE (BOO)741-0576
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SEMINOLE TRIBE OF FLORIDA
LICERTIFICATE OF AUTHENTICITY LI
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THIS CERTIFIES THIS IS A TRUE 10 x 15
CHICKEE HUT BUILT BY THE SEMINOLE TRIBE OF FLORIDA.
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NAME: RYAN MACK
LOCATION: 225 SHERRY DR, ATLANTIC BEACH FL 32233.
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ENROLLMENT NUMBER M1009
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