596 N Nautical ACC19-0033 Replace w/Pavers RESIDENTIAL OTHER PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH
ACC19-0033
ISSUED: 5/22/2019
800 SEMINOLE ROAD EXPIRES: 11/18/2019
ATLANTIC BEACH. FL 32233
MUST CALL INSPECTION PHONE LINE (904) 247-5814
Y 4 PM FOR NEXT DAY INSPECTION.
• • • • • • • • • t • • • aA
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 IT
districts,state agencies,or federal agencies.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
RESIDENTIAL OTHER SINGLE OR replace wood deck with
596 N NAUTICAL BLVD TWO FAMILY RESIDENTIAL pavers $1800.00
OTHER
TYPE • INGUSESUBDIVISION:
I CONSTRUCTION: NUMBER: GROUP:I•
170703 0346 SEASPRAY
COMPANY: ADDRESS:
• FF •
BLACKWELDER JOHN W 596 NAUTICAL BLVD N ATLANTIC BEACH FL 32233-4119
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.
LIST OF CONDITIONS
Roll off container company must be on City approved list. Container cannot be placed on City right-of-way.
1 PUBLIC WORKS EROSION CONTROL INSTALLATION INFORMATIONAL
Notes:
Full erosion control measures most be Installed and approved priorto 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:5/22/2019 1 oft
RESIDENTIAL OTHER PERMIT PERMITNUMBER
CITY OF ATLANTIC BEACH ACC19-0033
800 SEMINOLE ROAD ISSUED: 5/22/2019
. '2 P ATLANTIC BEACH. FL 32233 EXPIRES: 11/18/2019
3 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL
Notes:
Roll off container company must be on City approved list(Advanced Disposal,Reelco Recycling,Shapells,Inc.,Republic Services,Donovan Dumpsters,.
Phillips Contalners,JDog/Dennis Junk Removal,All American Roll Off,WCA Waste Corporation). 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 1 PUBLIC WORKS DECKING REMOVED INFORMATIONAL
Notes:
All old decking must be removed from job site by Contractor.
DESCRIPTION ACCOUNT QUANTITY PAIDAMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $60.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $30A0
PW REVIEW BUILDING MOO OR ROW 001.0000-32?1004 0 $25.00
STATEDBPRSURCHARGE 455-0000-200-0700 0 $2.co
STATEDCASURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$119.00
Issued Date:5/22/2019 2 of 2
, t City of Atlantic Beach APPLICATION NUMBER
.j Building Department (To be assigned by the Building Department)
800 Seminole Road
Atlansc Beach, Florida 322335445
Phone(904)2475826 Fax(904)247-5845
E-mail: buildingdept@coab.us Date routed: 417,21 11
City web-site: hdp:/hvww.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: �, I V AUTICQ(_ f)� De rr nent review re uired Ye No
/7� u:,din
Applicant: ( J�.y7 f�C= � Planni oning
'' ,, ^^ c& 1. Tree Administrator
Project: VA3no � l.` JE—��'�_ W r Public orks
P0.Yl{ S u is Ines
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review
of Permit Verified B or Receipt Date
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: I�Ji Approved. ❑Denied. ❑Not applicable
(Circle one.) Comments:0 „l • „��{ /Wrovod o f all �Pf04�n-k5
�
BUILDING
PLANNING&ZONING Reviewed by: Date: 5'-7-9015?
TREE 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:
Revlaed 05119/2017
City of Atlantic Beach //--w� APPLICATION NUMBER
Jr� P Building Department 0 $ '1...+ (To be assigned by the Building Department.)
f 800 Seminole Road 1 _O0 53n Atlantic Beach, Florida 32233-5445 ar� igY it
Phone(904)247-5826 Fax(904)2 M 84 J �'
Email: building-dept@mab.us 111111 Date routed:
-- Cityweb-site: http:/Mrvv ,coab.us -.
APPLICATION REVIEW AND TRACKING FORM
Property Address: E5 /(g�N)(V)TICi\L. ) De rtment review required Yes No '
Applicant: ( J(A7 tsD C_ � Plannin Zoning
ILIPL� , ^^��
� '��\r— /� Tree Administrator
Project: 1A300 � L�_l E:;O C W. Public
P0.Y�< u is ii ies
7 Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St Johns River Water Management District
Any Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: VApproved. ❑Denied. ❑Not applicable
(Circle ohne..)) Comments:
Ci
't-G' V
PLANNING&ZONING Reviewed b ^ Dale:
TREE ADMIN. Second Review: ❑Approved as revised. []Denied. ❑Not applicable
'PUBLIC WOfMM Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 0511912017
,.t City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by fha Building Department.)
1 800 Seminole Road _OO �3
:1 Atlantic Beach,Florida 32233-5445
Phone(904)247-5826 Fax(904)247-5845
i'r;g;tlur. E-mail: building-dept@coab.us Dale routed:
-- City web-site'. hftp:11www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: �7-/�n ��AU71.L'-A l... ��4SeNices
t reviewre wired Yes No
/7�
Applicant: ( /( ,L7 �� oning
� ,1(AD
QL strator
Project: (ADnn � L= )ELK L'i"tJ
PAALf S
s
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
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. ❑Di of applicable
(Circle one.) Comments:
PLANNING&ZONING Reviewed by. ` k% A _. Date: J5 —/
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. ❑Not applicable
PUBLIC WORKS Comments:
a JASLIC UTILITIEq
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. []Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revlsed 0511912017
., ;1::>,'"%-� Building Permit Application OFFICE COPY UPdoted=d�/Ja
City of Atlantic Beach Building Department "ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
yr
Phone: (904) 247-5826 Email. Building-Dept IS REQU[RED.coab.us ^ ^
Job Address: 5% Naof.4AL BWo N• A%A-+ . Belt J A- 3129 F Permit Number: N0- 1 - 003 3
Legal Description �Or I IS Loo,I if SM 96 ' 210014 3S Nil 6Y16YR REM
Valuation of Work(Replacement Cost)$f,r1IM/�00 Heated/Cooled SF I_�_Non-Heated/Cooled 'V
• Classof Work: ❑New OAddition fdAlteration ❑Repair C]Move ODemo ❑Pool 0Window/Door
• Use of existing/proposed structure(s): OCommercial ®'R/esidential /
• If an existing structure,is afire sprinkler system installed?: OYes R4. �
• Will tree(s)be move in association with proposed ro' V❑ s mu sub it se arate T e Removal P rmit BNo
Describe in detail the type of work to be performed: 'R�IOOE mrksp& (V%]AI �yppoEp OFtd • l PtnrF
W" 161 2ol QRvFA- OFA p�
Florida Product Approval M _ for multiple products use product approval form
LU
Property Owner Information U
Name{)t{ 'R4EL&yj Lncw✓ Addresses •r 1 ' VLb AJN t
9Ou lk/L•70Z7
CitV.—r�1'A- P's'µ State Zip 53293 Phone
E-Mail COM F� Q
Owner or Agent(If Agent, ower of Attorney or Agency Letter Required)
Contractor Information C7 U U p 0 U a
o
Name of Company�� ci
, f Qual' gAgent Fw
Address y State Zip L
Office Phone Job a Contact Number-Mail �*� 3
V "' H
State Certification/RegistrationM � W
Architect Name&Phone M s
Engineer's Name&Phone M w m
Workers Compensation Insurer OR Exempt 0 Expiration Date
Application is hereby made to obtain a permi to do the work and installations as indicated.I certify that no work or instal I M j p
commenced prior to the issuance of a perm" and that all work will be performed to meet the standards of all the laws retITN w w
construction in this jurisdiction.I understa d that a separate permit must be secured for ELECTRICAL WORK,PLUMBING, NS, in w
WELLS,POOLS,FURNACES,BOILERS,HEAT RS,TANKS,and AIR CONDITIONERS,etc. NOTICE:In addition to the requireme[M ofthis w
llit
permit,there may be additional restrictions applicable to this property that may be found in the public records of this couy,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
RECORD[ f7 QBE OF COMMENCEMENT.
latureof w er or Agent) (Signature of Contractor)
da r�sworn to or affr )before et ay Signed and sworn to(or affir )before methis_day of
i N
atu (Signature of Notary)
:A", TON,GINOLESP ER
MY CO w1651ONaFF9 51
r
enanally Known OR >i .; [%PIKES.Odober6,2019 I I Personally Known OR
[ I Produced Identification `t?,p;L acne=a Tn.iaun P�e�"umer«n,en [ I Produced Identification
Type of Identification: Type of Identification:
Owner Builder Affidavit "ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
' Phone: (904) 247-5826 Email: Building-Dept@coa b.us PERMIT M:
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.
IL INJURY LIABILITY;SINCE OWNERS MAYBE 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(l). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEETHE COUNTY"CERTIFICATE OF COMPETENCY"OR THE FLORIDA"CONTRACTORS
CERTIFICATE"TO ASCERTAIN IF A PERSON 15 A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPTLMCOAB.US)IF IN DOUBT.
V. ACKNOWLEDGEMENT;I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT
COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
Job Address: 06 Vft-frAi- SWP ME krcAurJt- BGAraI k -31s33
Owner Name: (O-N `I ,Maud .6A6A. Phone Number. qa/-- 414-7,173
Mailing Address: 6q& VO IJ City: State: Zip: 91133
Notarized Signature oJOwner
The foregoing instru ent was ackno d before me this ,2 in the State of Florida, County
of_ �
Signa[ fNotaryPuh
I Personally Known OR[ I Produced Identification
Type of Identification:
4dtiyA.2, TONT GISS0N#ERG 1
dam�^^ MY COMMISSION.FT 9249q uptlakn10124/18
1kf_2E, IXPIRES:OpWber6,2019
tY+ BoautlTNU Naha vubleuNSmAors
MAP OF BOUNDARY SURVEY
DESCRIPTION.
LOT 1. BLOCK 3. OF 'SEASPRAY' ACCORDING TO THE PLAT THEREOF AS RECORDED
IN PLAT BOOK 36, PAGES 64. AND 64A OF THE CURRENT PUBLIC RECORDS OF DUVAL
COUNTY, FLORIDA.
UP00
-er-, ru.
. .
AJL)5-r vvjco
IA. P;IL SNE
I- LOT I
BLOCKSEE! 74
11
8'�.�olell K'���T3� LNLYEE L� �I�I Fv
A PA110
o
14 wla
w.wLOT
L%K3
/W'r
el I
woo
-rkcLl- IT5
n SEMCM OAa
3q,F-AT'Klln c.n 1111 01 1.
WE,. 'o A", T, AVW
BY N. &JC2KlCEA WAS OPS&YOOP Dcwbj
'IMT TM]TITLE CREDIT WIW-,F,�IrZ0
M
IS OIxfM5Idl5 Affic ShMIJ IfOZA. p-O
r3gV
A.
SExExR 91¢PLP 0.<
�T.1�1101 111T�lIN PY3L+c j��
E W w Ao'tloa�5w'u"6'
0,AEs -�Mcm
SCALE 1' 30
19 ll=r011rumm
-1 .11
VWA�fl 'ABITI U'AHr
1�.-E"W'.
T.ll�'�.w m' gag �.,EFg A,
qffil�-r
P,
WB
C. A�
• , —Ls �- p
AW ca"A,�m 2
L
k'
l'--
PROJECT INF(
TI N .
FIELD OSURVEY DATE FIRST COAST LAND 74IE7:72-�
OT PLAN CfLkWN BY. MCF
I BOUNDARY
5-13- B SURVEYING, INC.
F B D
FED A VIE BY, Tw
COTfif)DA 8A LANE AVE. S. SUITE IM aMr4 '�.FL.�ju
F._ ,, 7� F. to
Im 111FrCATE W- LB 71 OUAM
F 7
7 T 779-7724
trNrAL