294 Poinsettia FenceProperty Address: 0 9 Y
Applicant: 6 &)—n E 4
Project: G —
41
Review fee $
Department review required Yes No
Bui '
"Planning & Zonin
Tree Administrator
Public Works
Public Utilities
Public Safety
Fire Services
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:
City of Atlantic Beach
APPLICATION STATUS
APPLICATION NUMBER
J' St
f
Building Department
800 Seminole Road
Denied.
(To be assigned by the Building D artment.)
/ �ee G�
Comments:
Atlantic Beach, Florida 32233-5445
_
y
a
%E
Phone (904) 247-5826 • Fax (904) 247-5845
E-mail: building-dept@coab.us
PLANNING & ZONING
z
Reviewed
a �r
Date routed:
f/ Date:
TREE ADMIN.
City web -site: http://www.coab.us
❑Approved as revised.
❑Denied.
PUBLIC WORKS
APPLICATION
REVIEW AND TRACKING FORM
Property Address: 0 9 Y
Applicant: 6 &)—n E 4
Project: G —
41
Review fee $
Department review required Yes No
Bui '
"Planning & Zonin
Tree Administrator
Public Works
Public Utilities
Public Safety
Fire Services
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:
Revised 07/27/10
APPLICATION STATUS
Reviewing Department
First Review:
❑Approved.
Denied.
(Circle one.)
Comments:
,S� L A, -H.<
BUILDING
PLANNING & ZONING
Reviewed
by:
f/ Date:
TREE ADMIN.
Second Review:
❑Approved as revised.
❑Denied.
PUBLIC WORKS
Comments:
PUBLIC UTILITIES
PUBLIC SAFETY
Reviewed by:
Date:
FIRE SERVICES
Third Review:
❑Approved as revised.
❑Denied.
Comments:
Reviewed by:
Date:
Revised 07/27/10
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: �
Permit Number:
Legal Description
oor Area o t Parcel #
Valuation of Work $ Z0001 Proposed Work heated/cooled I � 5 Q, t
non-heated/cooled
Class of Work (circle one): New Addition Alteration Repair
Use of existing/proposed structure(s) (circle one): Commercial
If an existing structure, is a fire sprinkler system installed? (Circle one)
Florida Product Approval #
For multiple products use product approva orm
Describe in detail the type of work to be performed: w� w"
r dam_ f i.. 6 i3 -n,24 �i 4 e- C_C✓o r
Name:
City State _Zip
E -Mail or Fax # (Optional)
Company Name:
Address: Qualifying Agent:
Office Phone City
Job Site/ Contact Number
State Cenification/Registration #
Architect Name & Phone #
Engineer's Name & Phone #
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Move Demolition pool/spa window/door
esid �
es No N /A
0—
Mate Zip
Fax #
pis
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 per formed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void o work is not commenced within six at months, or if construction or work is suspended or abandoned for a_perzod of six (6) months at any time after
work is commenced I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, tzntaces, Boilers, Heaters,
Tanks anti Air Conditioners, etc.
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.
I hereb certify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type olf work will be complied with whether speci zed herein or not. The granting of a permit does not presume to gave authority to violate or cancel
Provisions of any other federal, state, or local law regulating construction or the performance of construction. I the
Signature of Owner
Signature of Contractor
Print Name
�.. .......{.-P..................................................................
Print Name
..................... _ _
Befo
this Day
otary Public
Shirley L Graham
My commission FF 086990
Expires 02/1 412018
Before me
this Day of
Notary Public
Revised 01.26.10
2
CM OF ATLANTIC BEACH
WN.11J1t\l /�'V JiJiJD.LL'JR _UF IDt 11 V l 11
V. FLC)PdDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 'I "CONSTRUCTION
CONTRACTING" REQUIRES OWNER / BUILDER TO ACKNOWLEDGE THE LAW..
NDISCLOSURE STATEMENT FOR SECTION 439.103(7), FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONIRA.CTORS. YOU 11AVE APPLIED FOR A PERI ET TINDER AN EXEMPTION TO THAT
LAW. THE EXE.MPTIOid 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, CQN.�1-10-JCTION YOURSEI-P. YOUMAYBUILD ORUV2 VEA ONE—DR
TWO FAivllLY RESIDENCE ORA FAP.M OUTBUILDIN(a. YOU MAY ALSO BUILD OR
IMPROVE A COMBIIE.R.CIAL BUILDING AT A COST OF x25-000.00 OR LESS. TI -E 1aM- )TNG_
MUST BEFOR YOURUSEAND OCCUPANCY. IT MAYNOTBEBLIII.-I FOR SAL 1- 0R i I:\�I
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITTHN ONE YEAR
AFTER THE CONSTRUCTION IS CONvIPLETE, THE LAW WILL PRESUME THAT YOU BIJrf T
IT FOR SALE OR LEAS s- WTIICH IS IN VIOLATION OF THIS E)MMpTION.I;
1111 1 11'J I I�11 tt_'I Iv,tila PLRtiUN :1S YQLiR C=ONTRACTOiZ YOUR CONSTRUt TION MT1S"f
NL lluN> �t WRDINi 'r0 THE BUILDING CODES AND ZONING REGULATIONS. I I I
S'Cl P I,I IlliJtilRlIII l() M1h_17. SIIRf 111.1 I' I'Ic-UI'LE EAQT_.UYEL') Cal lttl _IL_�\1.
LIt I Idyl, I I-'t�UI1�JU �Y 51:111�L11b' r1NU By COU)Jf1' OR 111LIWC11'AL Lll6NSftltr
if. If\ -'JURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY I-'11RE,
1 HE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED
OVV. VPS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM -1099 REQUIREMENT S ON THE WORKERS T E IEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. rENALTV; UNLICENSI_D CONTRACTORS CANNOT BE EMPLOYED UNDER
CIRCAUft+iSTNCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTANY
E NO.
455-2288(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CER I iF )GATE OF COMPE T MY' OR THE FLORIDA 'CONTRACTORS
CERTIFICA I E" TO ASCERTAIN T AIN 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.
4DDRESS — �� C+! �V 0 ✓ O
PHONE NUMBER
F11 f� l T U
O�bNHlurt
Before me this ?day of 20
Duval, State of Florida, has personally e2ied herin by himself/ Iherselfthe nand z
all statements and declarations are a ani! eiccurate.
Notary Public at Large, State of_ _, Couniy of
014
I■
f�:A3T_UG/Otuner-L'uild�r Affrdavir, l2t:\��iEL; C/l o'�
ATE
Notary Public State of Florida
Shirley L Graham
�1:j My Commission FF 086990
i a ExPirQc 02/14/2018
Ordered By:
9
M,�Sf]f•! r�f,''W. 1G ANY
.
unmirnited
PROPERTY ADDRESS: 294 POINSETTIA STREET ATLANTIC
e
BEACH Florida 32233
-sz
rltLD WORK DATE, 12/19/2011
REVISION DATE(S):(.o 1yt9noltl
1y6�d o.r.a.
FL 1112,0998
BOUNDARYSURVEY
TABLE:
L 1
DUVAL COUNTY
5 24°23'59" W 24.82' M)
O.R.B. 12936
L2 N 25°00'00" E 25.10' (D)
PG 377
N 24°49'26" E 25.05' (M)
I/2" PIP
NO ID
h
O
�OPp
O.R.B. 1 1712 ��
O -P-5, ! 1 134
56
S'G.5 PG 1052
FG 644
11
C
RsB°DoDo,F .,
NORTH 25, 10' OF
Lcr 53,9
-lt
Y 5 +,c t F��, N'i'ss
(NOT INCLUDED)' /' Gl
e�LLw7 y�
LOT 540
.c�
LOT APPCAP.S 70 @C 5F.P.VICED Vr CITY INATCR AND 5EWER
PENCH O"AMNER5HIP NOT DETERMINED
/hereby cer#,y that th/s Sketch
MOP- rtyhes been made un
knowledge and belief, it Air(n
Flodda
Use o/This Survey for
SURVEY NUMBER: FL1112.0998
described
best ofmy 7 /
Won ofa sunmy
the Florida Boar'
r5J-17ofthe
20 I t0 10 20
-- I
GRAPHIC SCALE (In Feet) Nn'
1 inch = 20' ft. �Iv�
Intended, jthouWj with Give nVI htfi [lon,willbeatthe Users Sole Rlsk andwlthcut Llabllhytothe Surveyor,
heConstsved to Give ANY Rlghts or Benefits to Anyone Other than rh— �_,—,
FLOOD INFORMATION:v °
R �I•
By performing a search with the local governing municipals orwww. POINTS OF INTEREST
fema.gov, the property appeals to be located in zone X & A This Property NONE VISIBLE
was found in the CITY OF ATLANTIC BEACH, community number 120075,
dated 04/17/89,
1/2' PIP
NO ID
@ B.C.
=CLIENTUMBER "" LARA HOFS ii'Ne'6�� REALTORD
DATE. 12/19/2011 '
n ,... fa 904.465.3140' w,�
BUYER: PETER S. LOGSDON; ROBERTA W. LOGSDON � � 4 � IN '; � � 4
LARAREALTORC YAHOO.COM U�ffmfted
SELLER: SHOWCASE MODEL HOMES a
"`" T,. WWW.LARAHOFFMAN.COM
CERTIFIED TO: PETER B.
SHEFFIELD LOGSDON• ROBERTA W. LOG, X
N;'OSBORNE AND
TITLE SERVICES; FIRST AMERICAN TITLE INSURANCE ' Rc
COMPANY; PRIMELENDING, A PLAINSCAPITAL COMPANY
This is page 1 of 2 and is not valid without all pages. ~ Wand 5Urveyors, Inc. www,surveystars.com
x``'• .� r LBtt 7337 P 866.735-1916 • F 866.744.2882
112220 Towne Lake Drive, Suite 55 • Ft. Myers, FL 33913
1y6�d o.r.a.
mpcP/
b,6 %
o
rye" %
'r
/
wcG'a
3
q
I/2' PIP
11045
11
C
described
best ofmy 7 /
Won ofa sunmy
the Florida Boar'
r5J-17ofthe
20 I t0 10 20
-- I
GRAPHIC SCALE (In Feet) Nn'
1 inch = 20' ft. �Iv�
Intended, jthouWj with Give nVI htfi [lon,willbeatthe Users Sole Rlsk andwlthcut Llabllhytothe Surveyor,
heConstsved to Give ANY Rlghts or Benefits to Anyone Other than rh— �_,—,
FLOOD INFORMATION:v °
R �I•
By performing a search with the local governing municipals orwww. POINTS OF INTEREST
fema.gov, the property appeals to be located in zone X & A This Property NONE VISIBLE
was found in the CITY OF ATLANTIC BEACH, community number 120075,
dated 04/17/89,
1/2' PIP
NO ID
@ B.C.
=CLIENTUMBER "" LARA HOFS ii'Ne'6�� REALTORD
DATE. 12/19/2011 '
n ,... fa 904.465.3140' w,�
BUYER: PETER S. LOGSDON; ROBERTA W. LOGSDON � � 4 � IN '; � � 4
LARAREALTORC YAHOO.COM U�ffmfted
SELLER: SHOWCASE MODEL HOMES a
"`" T,. WWW.LARAHOFFMAN.COM
CERTIFIED TO: PETER B.
SHEFFIELD LOGSDON• ROBERTA W. LOG, X
N;'OSBORNE AND
TITLE SERVICES; FIRST AMERICAN TITLE INSURANCE ' Rc
COMPANY; PRIMELENDING, A PLAINSCAPITAL COMPANY
This is page 1 of 2 and is not valid without all pages. ~ Wand 5Urveyors, Inc. www,surveystars.com
x``'• .� r LBtt 7337 P 866.735-1916 • F 866.744.2882
112220 Towne Lake Drive, Suite 55 • Ft. Myers, FL 33913