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885 SEMINOLE RD - FNCE20-0026 i....Ao— City of Atlantic Beach ,� APPLICATION NUMBER f .-'' Building Department ��j�� (To be assigned by the Building Department.) `f 800 Seminole Road Fn) ( 0-04-)a6 -/ Atlantic Beach, Florida 32233-5445 91119;� MAR 1 2020 /fir (904)247-5826 • Fax(904)247- 5 4 /. 11 v E-mail: building-dept@coab.usDate routed: 3'3:f as B City web-site: http://www.coab.us Y______ APPLICATION REVIEW AND TRACKING FORM Property Address: p Stn.( AoLt e60, Department review required Yes No Build Applicant: 0 1-N) R1-1Planning &Zonin) . Tree Administrator Project: ft )V(j�L-� k-AcQ �blic or s '1JPublic Utilitie Public Safety Fire Services Review fee $ Dept Signature Review or Receipt VL,iNL-( 1 Other Agency Review or Permit Required of Permit Verified By Date Florida Dept.of Environmental Protection )0\),'A --94`` Florida Dept.of Transportation i (�W0,1- St.Johns River Water Management District Army Corps of Engineers it Division of Hotels and Restaurants .\ Division of Alcoholic Beverages and Tobacco t v r4 Other: ve eo APPLICATION STATUS 1 Reviewing Department First Review: Vpproved. ❑Denied. ❑Not applicable (Circle one.) Comments: BUILDING F PLANNING &ZONING Reviewed b • , ,j/I _ Date: .r • 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. I 'Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 „ VYY11C1 LJ{d111. 1 %III WVII 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@coab.us PERMIT#:FNCE20-0026 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. II. INJURY LIABILITY; SINCE OWNERS MAY BE 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(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA"CONTRACTORS CERTIFICATE"TO ASCERTAIN IF A PERSON ISA LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT (904- 247-5826 OR ?IIIID!NG-DEPT(«COAB.US ) 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. ob Address: 885 Seminole Road )wner Name:Rena M Coughlin Phone Number: 904.403.7459 Mailing Address: 1632 Beach Ave , City:Atl.ntic Beach State: FL Zip: 32233 Notarized Signature of Owner ricr-eecA.--, , A, , / _ -he foregoing instrument was acknowledged before m- is l ' day of c/,� 20 Zjn the State of Florida, County A Signature of Notary Public [ ] Personally Known OR [ ] Produced Identification Type of Identification: Updated 10/24/18 c;t,avr City of Atlantic Beach APPLICATION NUMBER rj Building Department (To be assigned by the Building Department.) A 'fi 800 Seminole Road FA) c-EN 0--0036 Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845 ��;��� 7;qE-mail: building-dept@coab.us Date routed: 3133 30c)--a City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: � Sten t A Department review required Yes No CBul d) Applicant: V tJ 1\1--/ Planning &Zoning-2) Tree Administrator Project: k-nc.0 Public Public Utilitie7 u is Safety Fire Services Review fee $ Dept Signature --\ Review or Receipt Other Agency Review or Permit Required of Permit Verified By Date `` e r Florida Dept.of Environmental Protection �i X Florida Dept.of Transportation r1 °` 1 St.Johns River Water Management District IJP Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: pproved. Denied. ❑Not applicable (Circle one.) Comments: BUILDING /�7 PLANNING &ZONING Reviewed by: l/ � � - 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: Approved as revised. Denied. Not applicable Comments: Reviewed by: Date: Revised 0 511 9/2 01 7 S, y,�. City of Atlantic Beach APPLICATION NUMBER Js Building Department (To be assigned by the Building Department.) r 800 Seminole Road t- Wa Atlantic Beach, Florida 32233-5445 r O k MirPhone(904)247-5826 • Fax(904)247-5845 L J�jr E-mail: building-dept@coab.us Date routed: ���Ib City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 0 0c Stn t n��L 1��, Department review required Yes No 073 Applicant: 0 t-J (\L-/ Plarnin_g &Zoning Tree Administrator Project: _ 1t?\J.i.Lt- -i U2 Public ores J (ublic Utilitie Public Safety Fire Services Review fee $ Dept Signature Review or Receipt Other Agency Review or Permit Required of Permit Verified By Date `\�-'a Florida Dept.of Environmental Protection �v" j�1 ,{ Florida Dept.of Transportation ( ),A)` 1 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 'Approved. I 1Denied. Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: 2V TREE ADMIN. Second Review: I 'Approved as revised. nDenied. UNot 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 City of Atlantic Beach APPLICATION NUMBER tr:, BuildingDepartment (To be assigned by the Building Department.) - 800 Seminole Road F-� C La o -Wa KJ-Atlantic Beach, Florida 32233-5445 l Phone(904)247-5826 • Fax(904)247-5845 O. E-mail: building-dept@coab.us Date routed: 3/3a 1 a City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: p W'S--- Stn.( nUl-_ ._1 , Department review required Ye No ' Build' Applicant: 0 Planning &Zorn Tree Administrator Project: 1 p �V(� n(,Qic of `�( Public Utilitie PUbllc Safety Fire Services Review fee $ Dept Signature Review or Receipt D� Other Agency Review or Permit Required of Permit Verified By so,xDate \-'V` a Florida Dept.of Environmental Protection .� Florida Dept.of Transportation O ` I 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: proved. ❑Denied. Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: {ten n 471 •G�/•Do Date: TREE ADMIN. Second Review: Approved as revised. ❑Denie . ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: I /Approved as revised. I (Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 ' o'' Building Permit Application ,Jpdated10/918 F. 1111. City of Atlantic Beach Building DepartmentQFFICE COPY **ALL INFORMATION 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY --,..44.09,- IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: iSiC C{isfW Al sLG 'V Permit Number: Fn) C La D -©oa(t Legal Description TZ -4 i aei-A;a$ / srz n>1‘A. - 4. 1 RE# / 700z4, - o e OO Valuation of Work(Replacement Cost)$ $DD . OD Heated/Cooled SF Non-Heated/Cooled • Class of Work: ❑New DAddition DAlteration rigtepair DMove DDemo DPool DWindow/Door • Use of existing/proposed structure(s): DCommercial VResidential m AR 2 0 2020 • If an existing structure, is a fire sprinkler system installed?: DYes ❑No • Will tree(s)be removed in association with proposed project?DYes(must submit separate Tree Removal Permit) 110 Describe in detail the type of work to be performed: , R.4.1 la G fPf ra-/-t� ,-/ Pa.K-t-Qs bit A-+ela r( - e�uzati - Florida Product Approval# for multiple products use product approval form Property Owner InformationLU ,,�,► Name ICK A— G A / ,I•/ Address f`!,3 2 3>G�c4 v► U tAc, , City 4-?"I. 8 c-h State AL Zip 3ZZ 73 Phone f OiC tfa 3 _14 Cl) E-Mail ♦( C il. V �L.1:tit 4�I�O/V d"o�i't'c--tit , 'I' P ,J Q O Owner or Agent(If Agknt, Power of Attorney r Agency Letter Required) p.,....._4_11-47._U Contractor Informationo w z Name of Company /C!/i- Qualifying Agent U V C:1 O d V 0 Address City State ZipIA 2Office Phone Job Site Contact Number 0 Q p Q State Certification/Registration# E-Mail 0 _J Cl) Architect Name&Phone# IX 4 Z Engineer's Name&Phone# 0 u. u, cc Workers Compensation Insurer OR Exempt o Expiration Date O w w 5: a. IX m Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or insti ntjal) p commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws ril6n C7 ij w construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,5GNS, CC w WELLS, POOLS,FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE:In addition to the requirerrklkts of this w rr permit,there may be additional restrictions applicable to this property that may be found in the public records of this cofFlty,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 FINANCI lG, CO ULT WITH YOUR LENDER OR AN ATTORNEY BEFORE REpact NG YOU ' . i)TICE OMJVIENCEMENT. (Sig :ture of O ne or Agent) (Signature of Contractor) Signed and sworn to(or affirmed)before e this day of Signed and sworn to(or affirmed)before me this day of it,___ 4 • a by V ti\c4 jhlt. , , by •?o,rFY.. JENNIF - - Uiii�-1`• •`' (Signature of Notary) ie. "!� ;�; MY COMMISSION#GG 0 �.'��t�"e of Notary) n6u =;F vim. EXPIRES:October 27,2020 ,,R Bonded Thru Notary Public Underwriters [ ]Pe sonally Known •• [ ]Personally Known OR [tWroduced Identification [ ]Produced Identification Type of Identification: FL- j✓i v.R., S .kC.._tilLi`Q Type of Identification: a Double Sided Document• This is a Double Sided Document This is a Double Sided Documer.�t • .. • REVIEWED FOR CODE COMPLIANCE i CITY OF ATLANTIC BEACH SEE PERMITS FOR ADDITIONAL n II n II REQUIREMENTS ND CONDITIONS 0 O D !{� � 0 m v O REVIEWED BY: / —B-4--T-F-_____ Seminole Road '4m,) 20' CURBED ASPHALT D � g (PLATTED AS SHERRY ROAD) m 0 rn Das a..s 13 n D N107J8'42'W 130.05' (m) b 0:J Co 130.00'�P) 3 Q ■ ■ (0.1. ON) 0 f n; C m , ,, cal D-.1 r m (n D j m I c _ nn O -' 'D Z m Z O O OD (25.5') � aA CnD m 0 Qisl 7N N m _._ . I& Az DD j m -�N 00 n CD .( ro Om Ono a W m v , 1.1.1 ril XJ Z03 0 v m0� ' t0� m -DZA �` 3A50 <, D a�;..,....,,J-*- -Cf3) 2 Z N Df+171 �tO1 692' =� NOZ�� D � N a 0 D _ .r..›. (n -� ^' 80 �I'�I� c- ?++ (0.3' OFF) Dg z zxm D _ y ■ z 2 cn Ovtri 0 z P,Q, • _ .. n o mED N P J 130.00'(P) N c, n r4 N N 0 M I 3 . C. Q S10'07'33'E 129.28' (m) 3 g O ` .mss Dm D D ONS D o 0 r Z O Dzei.cc,..c.A_Al 0 m 0 Z --I En O Dn 4 ,.,... . ._ ii.,--,44.k.'51-se--4 -CMILCLI"Al nmZ n 0 z m CD v, mZs i� .1 11 0 O D " -0 K :; D42 0 mvn �D� C rfrTl > m< a r g mm O NOTICE OF COMMENCEMENT /� State of /- L es (2, , r) A Tax Folio No. County of ' v4 V " 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 is stated in this NOTICE OF COM ENCEMENT. Legal Description of property being improved: _ 5"iµ9 L ; , `,0-44.-e, Address of property being improved: !I v c ` I- ti`a- / General description of improvements: bGWGli /epi cr- %/ Owner: /. C&. & l4 12/0-,J Address: Al' 3 Z 9.e.a.. , Av-e.A' Owner's interest in site of the improvnt: _ Fee Simple Titleholder(if other than owner): Name: Contractor: Address: OFFICE COPY Telephone No.: Fax No: Approved By Permit Desk Surety (if any) Building Department _ City of Atlantic Beach, FL Address: Amount of Bond$ _ Telephone No: Fax No: Name and address of any person making a loan for the construction of the improvements Name: A.)/ - 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: HGin P � - b0 Address: L1 ae- Telephone No: fa 5-3 `74 /4-2-cr 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 atwnero ` — s option1 Name: Lf-(�L £ .0 Address: �a /�` 5b Telephone No: /trI/ 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 4e_e_ Signed: ate: 3 - a a - Zo Before me this day of in the County of Duval,State Of Florida, has personally appeared Notary Public at Large,State of Florida,County of Duval. My commission expires: Personally Known: or Produced Identification: