1386 ROSE ST RESO18-0064 PAVER PERMIT RESIDENTIAL OTHER PERMIT PERMIT NUMBER
RES018-0064
CITY OF ATLANTIC BEACH
ISSUED: 1/23/2019
800 SEMINOLE ROAD
ATLANTIC BEACH. FL 32233 EXPIRES: 7/22/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK-]
RESIDENTIAL OTHER SINGLE OR add paver pool deck &
1386 ROSE ST TWO FAMILY RESIDENTIAL replace concrete patio with $9500.00
OTHER pavers
TYPE OF REALESTATE BUILDING USE
ZONING: SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1710630300 ATLANTIC BEACH SEC H
COMPANY: ADDRESS: CITY: STATE: ZIP:
KETTELL INC. 1860 MAYPORT RD ATLANTIC BEACH FIL 32233
OWNER: ADDRESS: CITY: STATE: ZIP:
MADDOX JANICE KAYLENE 1386 ROSE ST ATLANTIC BEACH FL 32233-2647
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR 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.
E�711L� LIST OF CONDITIONS
�Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 r PUBLIC WORKS EROSION CONTROL INSTALLATION INFORMATIONAL
Notes:
Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line(904-247
-5814)to request an Erosion and Sediment Control Inspection prior to start of construction.
2 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
Issued Date: 1/23/2019 1 of 2
RESIDENTIAL OTHER PERMIT PERMIT NUMBER
RES018-0064
0 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 1/23/2019
ATLANTIC BEACH. FIL 32233 EXPIRES: 7/22/2019
3 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL
Notes:
Roll off container company must be on City approved list(Advanced Disposal,Realco Recycling,Shapells,Inc.,Republic Services,Donovan Dumpsters,
Phillips Containers). Container cannot be placed on City right-of-way.
4 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration,including sod,is required.
5 PUBLIC WORKS DECKING REMOVED INFORMATIONAL
Notes:
All old decking must be removed from job site by Contractor.
0�
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PU REVIEW BUILDING MOD OR ROW 001-0000-329-1007 0 $25.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
-1 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600
TOTAL: $54.00
Issued Date: 1/23/2019 2 of 2
City of Atlantic Beach SA APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
11 "—Ce IV sr
V 800 Seminole Road
z Atlantic Beach, Florida 32233-5445 (D 6
Phone(904)247-5826 - Fax(904)?47-5845C
19, E-mail: building-dept@coab.us Date routed:
City web-site: http://vmw.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: _P_ Department review required Yes No
Building
Applicant: -3-VA Planning &Zoning
Tree Administrator
Project: ( e0Vq_Le
<
c Pul5fic URHE�
[LiM 4 aad �od pa�)V_l cu 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:
APPIL)CATION STATUS
Reviewing Department First Review: [�(Approved. []Denied. E]Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed b)c. Date:
TREE ADMIN. Second Review: []Approved as revised. []Denied. []Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: DApproved as revised. E]Denied. E]Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
01 City of Atlantic Beach APPLICATION NUMBER
Building Department 'Ecefvra (To be assigned by the Building Department.)
800 Seminole Road — ah� � c,- —
Atlantic Beach, Florida 322 3-54 Pcr 0 1 6
Phone(904)247-5826 - F x( 0 7-58416 5 2018
I It E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.ust .,.— I -
APPLICATION REVIEW AND TRACKING FORM
Property Address: Department review required Yes No
Building
Applicant: Planning &Zoning
Tree Administrator
Project: 1) L_j u b I rc—W o r k s 2)
t_ie—s
D\1 Public UtilTi
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: E]Approved. ODenied. [PIN t licable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date:
z
TREE ADMIN. Second Review: FlApproved as revised.' F]Denied. F]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: F]Approved as revised. E]Denied. F]Not applicable
Comments:
Reviewed by: Date�
Revised 05/19/2017
Building Permit Application Updated 12/8/17
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
Phone-(904)247-5826 Fax:(904)247-5845 COO
Job Address: ; 300 yl� Permit Nymber: �_k_s 0 1 1� _q
_�L 030,c�
Legal Description 5e(- V/ It SrLs uz .2 -L1AAZAtt 17/0�- 7 —
Valuation of Work(Replacement Cost)$ q.500 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): Ne,(��Adit:iq>lteration Repair Move Demo Pool Window/Door
• Use of exi sti ng/pro posed structure(s)(Circle one): Commercial Q Residential DEC 4 2018
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes N N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Remroval
Describe in detail the type of work to be per-formed:
C
L
Add Pavg-�- Rnl Da/c 4- J�u)klt_
Florida Product Approval# for multiple products use product approval form
Propertv Qwner Information
Name, Address: A3,0
6t k4 lej!:d
Cit A Ar1*1!.3"�(-A State L—L Zip 31 Z, ? Phone
E-Mail
Owner or Agent(if Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of q;:rpany: Qualifyin Agent:
Address (Z/ft� City de�-VState Ft zip 3z z- 5 7
�V/,, /_j &el 3 A:le
Office Phone nZ '72 Zi Job Site/Conta Number -7-7
State Certification/Registration# E-Mail ;nl&r7� V 5-eM
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation r---,
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
RE77 7j:U NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) 7Ae (Signa�ture�of Cntr'lfctor)
(including contractor)
/ioned and sworn to(or irmed)before me this 3 d of Signed and sworn to(or affirmed)before me this day of
IN y 04 04-4,1,Vi, 'rv—
JENNIFER JOHNSTON HN
JENNIFER JOHN
AL My COMMISSION#GG 042984 PA
MY COMMISSIOMN
EXPIRES:October 27,2020 at r otary) EXPIRES r Si,
October 2 202 (Sig ture of Notary)
V Pu 1.U.,ir'it,
BoWed Thru Notary Publir UndOrwrit9m q. Undo U-
b
0.. BondedThru Notary Public
L I�prsonally Known
[qProduced identification rochurpri Identification
Type of Identification: �7L, Type of Identification: F L Z4L e-0�J_
NOTICE OF COMMENCEMENT
State of Tax Folio No.
County of
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713
of the Florida Statutes,the following information stated in this NOTICE OF COMMENCEMENT.
L I Description of property being improved: 10-3y 1-1- 7-s- z4 sit-H 4. 4-
XJILL4 3 P>/" 7-3L/ Re -12' 17/t%,75 , 03LOO -
Address of property being improved: " I 'DT-4 Rose -Qftee!L , 4h�-X2z?5,,,-,1,4 FZ ?Z-Z .7-3
General description of improvements: (�� 'qev�it)
Poe &e,,k ejo��;nA 61 A# Poe
Ownera t�;w M946X Address: -3Z7- 3
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor:
Address:- 197Y OA eA EZ -37-z -73
Telephone No.: Loy Fax No:
Surety(if any)
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name:
Address:
Phone No: Fax No:
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may
be served: Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b), Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Doc#2018282485,OR BK 18615 Page 1191, ;igned: Date: 03/tV
Number Pages: 1 )MI the County
Recorded 12/03/2018 01:47 PM, lefore6k this ':�S' dayof D4-CJLMb1 of Duval,State
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL )f Florida,has personally appeared 3a at L 4- A4 d d 0�( —
COUNTY 4otary Public at Large,Stat of Fl 'd County of Duval.
" ON a, I - - -
RECORDING $10.00 Ay commission expires: VF��- ....
NJ
JLNWtKJUHNZ)1 ON
3ersonally Known:
T COMMISSION 042984
:1roduced Identification:
2020
Bonded Thru Notary Public Undenvifters
r-7DESCRIPTION:
SOUTH 12. 5 FEET OF LOT 2 AND THE NORTH 112 OF LOT 3, BLOCK 234
7�i-
OF SECTION "H" ATLANTIC BEACH" ACCORDING TO THE PLAT THEREOF
AS RECORDED IN PLAT BOOK 18, PAGE 34 OF THE CURRENT RECORDS
OF DUVAL COUNTY, FLORIDA.
SCALE: 1 " 30
v
5ta F.I.P.
BLOCK
CORNER
NO 1.0.
.w
NORTH 37.5'
LOT 2
BLOCK 234
LOT 2 1
BLOCK 233
F.I.P. 112
F.I.P NO 1.0.
NO
S89'48-28-E 127.06 (P6M)
0.8
a - : ..
F-I.Pj)1�2%
NO .0
S. 2 5
1 STORY
LOT*2 MOOO FRAME
BLOCK 234
11386
.v
N. 25.0'
0
LOT 3 33.4"
BLOCK 234
0 9 TZITI
F.1.P.'112 N89-46-26-W 127,00(PW
F.1.P. 112'
NO 1.0.
..No 1.0.
LOT 3
BLOCK 233
SOUTH 25.0'
LOT 3
BLOCK 234