278 SEMINOLE RD - DEMO (2) rJ : ` =J CITY OF ATLANTIC BEACH
.~-, x�-) 800 SEMINOLE ROAD
` ATLANTIC BEACH, FL 32233
"-t'' 1 % INSPECTION PHONE LINE 247-5814
DEMO - COMPLETE
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: DEMO18-0026
Description:
Estimated Value: 20000
Issue Date: 9/13/2018
Expiration Date: 3/12/2019
PROPERTY ADDRESS:
Address: 278 SEMINOLE RD
RE Number: 170512 0000
PROPERTY OWNER:
Name: LAGNER JENNIFER A
Address: 278 SEMINOLE RD
ATLANTIC BEACH, FL 32233-4143
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
,
Phone:
Name: CBI CONSTRUCTION, INC.
Address: 5472 FIRST COAST HVVY SUITE 6
FERNANDINA BEACH, FL 32034
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.
,,,:1 1..:1-r)r\
�: ' IA Permit Conditions
. z City of Atlantic Beach
-:_,..6-71,•,-
19'-
Permit Number: DEMO18-0026 Description:
Applied:8/29/2018 Approved:9/13/2018 Site Address:278 SEMINOLE RD
Issued:9/13/2018 Finaled: City,State Zip Code:Atlantic Beach,Fl 32233
Status:ISSUED Applicant:<NONE>
Parent Permit: Owner: LAGNER JENNIFER A
Parent Project: Contractor:<NONE>
Details:
LIST OF CONDITIONS
SEQ NO ADDED DATE REQUIRED DATE SATISFY DATE TYPE STATUS
DEPARTMENT CONTACT REMARKS
1 9/5/2018 UNDERGROUND WATER SEWER INFORMATIONAL
UTILITIES
PUBLIC UTILITIES Public Utilities
Notes:
Avoid damage to underground water and sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is
needed,call 247-5834.
2 9/5/2018 DISCONNECT AND CAP INFORMATIONAL
PUBLIC UTILITIES Public Utilities
Notes:
Disconnect and cap water and sewer lines.
3 9/5/2018 INSPECTION PRIOR TO INFORMATIONAL
DEMOLITION
PUBLIC UTILITIES Public Utilities
Notes:
Must call the Inspection Line at 247-5814 to request an inspection of the disconnected and capped water and sewer lines PRIOR to demolition.
601
Printed:Thursday, 13 September,2018 1 of 1 0
TRAKtT
li 1
s=ut,-.4,, City of Atlantic Beach
APPLICATION NUMBER
d - f;'A Building Department (To be assigned by the Building Department.)
(i;
800 SeminoleRoad
.. � Atlantic each, Florida 32233-5445 a 18•--o02-40 QZ
; ; _° .7W
Phone(904)247-5826 • Fax(904) 247-5845
�? E-mail: building-dept@coab.us Date routed: fzc1fjg
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Li 8 Sm ( lems De.artment review required Yes No
(Buildin
Applicant: CB l Planning &Zoning
Tree Administrator
Project: -Dem 0 =ublic Wor
I. 'u. is Utilities
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. Not applicable
(Circle one.) Comments:
BUILDING Wo ' `' nee -f- ,e rep..Wed
PLANNING &ZONING Reviewed by: Date: e-30- 1 O
TREE ADMIN. Second Review:
'Approved as revised. [1Denied. I INot applicable
PUBLIC WORKS Comments: ,
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: I 'Approved as revised. I 'Denied.
nNot applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
-51,A,v:r1 City of Atlantic Beach APPLICATION NUMBER
Js Building Department (To be assigned by the Building Department.)
A • tla Seminole Road
s Atlantic �Q
tlantic Beach, Florida 32233-5445 � � QZ
Phone(904)247-5826 • Fax(904)247-5845
—40160' E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
•
Property Address: 2.13 Sem (n O l c Department review required Yes o
IL;ildin
Applicant: CSB ' Planning &Zoning
Tree Administrator
Project: O u lic Work
u is Utilities
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: I vrApproved. Denied. I 'Not applicable
(Circle one.) Comments:
CIL:131Q
PLANNING &ZONING
Reviewed by: r Date: 9-3'7 g-
TREE ADMIN. Second Review: A roved as revised.
❑ pp ❑Denie Not applicable
PUBLIC WORKS Comments: .
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. I 'Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
,i Lh•ric,, City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned bythe BuildingDepartment.)
9
800 Seminole Road
- Atlantic Beach, Florida 32233-5445 AUG �►`b LS.—O02�0
Phone(904)247-5826 • Fax(904) 247-5845 U� 29 �� `j
M1
E-mail: building-dept@coab.us Date routed: ___E[24-41
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
•
Property Address: Li 3 Sem, t n O I De•artment review required Yes No
//�� Buildin.;
Applicant: l�B t Planning &Zoning
Tree Administrator
Project: ---DeTa O ublic Work
u is Utilities"
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:
APPyeATION STATUS
Reviewing Department First Review: I tirApproved. I (Denied. ❑Not applicable
(Circle one.) Comments: g
BUILDING
PLANNING &ZONING Reviewed by: c.� Date: /—eA/
TREE ADMIN. Second Review:
'Approved as revised. I IDenied. I 'Not applicable
PUBLIC WORKS Comments: .
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: I (Approved as revised. (Denied. I Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
t' ,To; Building Permit Application
City of Atlantic Beach
'
800 Seminole Road,Atlantic Beach, FL 32233
\
-1:',.c.nt 9r Phone: (904) 247-5826 Fax: (904) 247-5845
Job Address: 2-7 S S 41yiu---)-1 J 20o • Permit Number:DMO18 —O 1524
Legal Description RE#
Valuation of Work(Replacement Cost)$,2D!006 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial esidential
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes ED N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to/� be performed: /
iS�/pyr eeki-i !-ptY. No Tree-C 4 ht a,,,,,,,,,..)
Florida Product Approval# for multiple products use product approval form
Property Owner I formation I /
Name: / � 4 .elQgll-C/ Address: 017rs—enl�irlrA
City ,;;__ _ 'AV/C <C; // Sate J zip 3 ,2,33 Phone 9 /€ . .2o
E-Mai! f ;I7/// " __/€/y / a N/4//, 601i
Owner Agent(If Agent, Power/of Attorney or Agency Letter Required)
Contractor Information ` /^'
Name of Company: C,B/ Cev1.f�ri/d/41--./ ( Qual�'ng Apra: v"///Cah . 4./e 67'C
Address/9O/zshma1 rAtk 44 .�7?-rag City, /�(6(�/�4Bed 6 State ,f Zip,34}x34/
Office Phone 9oy39 -- (00 Job Site/C ttact Numb r 3$— O�$"
State Certification/Registration I� /S'/ZOo7 E-Mail OW 4/Coley s-�1Yf
Architect Name&Phone# A/ ',-
Engineer'
4
Engineer's Name& Phone# �-
Workers Compensation oliM //S4'1"..e
Exempt OM Lease Employees/Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
REC• ' DING ' • UR N'TICE OF COMMENCEMENT.
1 9 ,
rignature of Owner or Ant including Contractor) (Signature of Contractor) 944
ned an• sworn to( r affirmed)befor- me is Z. day of Sig •d and s orn to(or ffir ed) befire m- is day of
i• _t� ►_ I _l ‘by J2/1/II - t A . i �4 r, �L7) , b,/ i ,.i ' _,•
�
�_ .%.111� � • , 1 '. 'his`
W (Sig OF o Not, ) (Signature• Notary
64r oi; ., DIANA L.MCGHEE ,/
;: Notary Public-State of Florida PATRICIA J.GIBBS
-. p` Commission$GG 212117 (4)
'a oFnMy Comm.Expires Apr 29,2022 MY COMMISSION#GG069613
[ ersonally Known •I��.,,,,,,,,..•�•` [ Personally Known OR[ ] Produced Identifi.:ti. Bonded through National Notary Assn. EXPIRES:FEB 05,2021
[ ] Produced IdentificationBonded through 1st State Insurance
Type of Identification: Type of Identification:
a J 0 Pf; TREE &VEGETATION AFFIDAVIT FOR INTERNAL OFFICE USE ONLY
s City of Atlantic Beach PERMIT#
P Community Development Department
)11111,
800 Seminole Road Atlantic Beach,FL 32233
-UR �% (P)904-247-5800
SITE INFORMATION D
ADDRESS 027 r Sem/40/C,,p
ke a_c) 1/44 // ?m-c6��
SUBDIVISION 7� BLOCK LOT
RE# /7,, 23 /?s — 0 00(/ KRESIDENTIAL ❑ COMMERCIAL ❑ OTHER
APPLICANT INFORMATION
NAME 27/' C ' PHONE#
ADDRESS v?2 $ ?4/alp/ CELL# d�V
CITY %A7 jQ �� STATE ZIP CODE
EMAIL Q'/ti✓ 6 /s,b4/` lel, OWNER ❑ LEGAL AUTHORIZED AGENT
I affirm that I have reviewed the provisions of Chapter 23, "Protection of Trees and Native Vegetation", of
the Municipal Code of Ordinances for the City of Atlantic Beach Florida and/or I have participated in a pre-
application meeting with the Administrator of those regulations. Subsequently, I affirm that no regulated
trees and no regulated vegetation will be damaged,destroyed and/or removed from the above-described
property and/or adjacent properties including right-of-way.
I TIFY THAT FORMATION PROVIDED IS CORRECT: 'gnature of Property Owner(s)or Authorized A ent
(/1°)7 6%2 r
URE OF APPLICANT RINT OR TYP AME D E
SIGNATURE OF APPLICANT(2) PRINT OR TYPE NAME DATE
611
Signed and sworn before me on this Ca day of 1/6&1�' , do 0 by State of !, / )
11i (// County of / I!a/
Identification verified:
Oath Sworn: ❑ Yes a-Ne 4
.►!�
PATRICIA J.GIBBS
r�` `'"`� MY COMMISSION#GG069613 Notary Signature \
EXPIRES:a FEB 05,t Insu021rance
a"d Bonded through 1st State Insurance My Commission expires,_
04 TREE AND VEGETATION AFFIDAVIT 03.01.2018
MAP SHOWING BOUNDARY SURVEY OF
LOT 468 AND THE NORTH HALF (1/2) OF LOT 469, SECTION 1 SALTAIR, AS RECORDED IN PLAT BOOK 10,
PAGE 8, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO:
JENNIFER A. DEERY
PONTE VEDRA TITLE, LLC
OLD REPUBLIC NATIONAL TITLE ISURANCE COMPANY
LOT 458
LOT 457 LOT 456 LOT 455
75.00' (DEED)
N 2239'08" E 74.91' (MEASURED) 0.5'
li s...—.—
x 1.0'J 0 9' x 0.T
i i• LOT 469 . LOT 468
x
o
w ; 0
R CC
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1.1 2 � / Wa
if_
J2 arn - 000 �A —14.1.- - w oF- 01 IECX tt.2' O0 ! / a O
LOT 470 —14.0
0 Za}iI'7 y N /^ LOT 467
p !louse_ 7 V e_ 7.3 * 0 '1 s
GN STORY
0 SRAME x W
i n ED #278 :
" 7.3'ID v 0
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CO --14.0' iW
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,.sl;. ATLANTIC BEACH BUILDING DEPT.
,. r40:44t
=.0 DEMOLITION — PROPERTY OWNER
RELEASE FORM
1P1-01310''
Date: July 3, 2018
To Whom It May Concern:
I /We the current property owners of: Lot 468 and the North Half(1/2) of Lot 469, section 1 Saltair
Block 278 Seminole Rd
Legal Description of Property
AKA 278 Seminole Rd Atlantic Beach FL 32233 have contracted with to have
(Address of Property)
Cole Builders Inc. to remove the Single Family
(Company Name) (Single Family,Duplex,Commercial,etc.)
Prior to the construction of : Single Family
As a condition of issuing the permit we agree to the following:
1. All utilities are to be located and clearly marked.
2. Once house is removed, lot is to be graded and leveled.
3. All construction debris is to be removed from the property.
4. Affected area is to have grass or seed in place.
5. Erosion control devices will be put in place and will remain in place until grass
has covered affected area or new structure is completed and landscaping is in
.,place.
%)4. ---.
Sign no/
'
Signature
THIS SPACE FOR RECORDER'S USE ONLY
OWNER i p
Signed: / � l M a i k s S C�Lor cl A Date: j U
1 ea 11
Before me this (, day of -71.; xi , in the County of Duval,State
Of Florida,has personally appeared 7-r Q j�- &( _ LA y\c
Notary Public at Large,State of Florida,tounty of Duval.
My commission expires: t)yl C l')_ t '')-0 f'-`-a,---
Personally
-`�Personally Known: or
Produced Identification: t(i v 2 i s -,
`"!S.*. MARISSA LORDA
_.: ,• 1 MY COMMISSION 8 GG 228145
' -:: :•o 7 EXPIRES:June 12,2022
Bonded Pau Notary Public meta