1285 LILY ST - FNCE20-0021 OLAPr City of Atlantic Beach APPLICATION NUMBER
o Building Department (To be assigned by the Building Department.)
800 Seminole Road
a I ) �Nc�2,O- 00z(
Atlantic Beach, Florida 32233 5445
Phone(904)247-5826 Fax(904)247-5845 J / Z c
t 9' E-mail: building-dept@coab.us Date routed: {
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Department review required Yes No
Property Address: l z��S L i L y � � �i dig• q
Applicant: w C rC_- Planning &Zoning j)
Tree Administrator
Project: Public Wor sk
C Public 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: DApproved. DDenied. � Pable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date: 3-i7- Zd
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 05/19/2017
City of Atlantic Beach APPLICATION NUMBER
Building Department ..,. �� (To be assigned by the Building Department.)
%. 'A-1, 800 Seminole Road I v
,`_ ) (
/ Atlantic Beach, Florida 32233-5445 O��
Phone(904)247-5826 Fax(904) -514AR 1 t� e 2021 Date routed: �l I Z
l E-mail: building-dept@coab.us �l uL 1
City web-site: http://www.coab.us BY:
APPLICATION REVIEW AND ACKING FORM
Property Address: I ZP>S L I Lv E T Department review required Yes No
( Tuildii
Applicant: LA) G(Z_ ,fanning &Zoning j7.)
Tree Administrator
Project: Co, I— �IvCC Public W ks
Public 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: pproved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING
•
PLANNING &ZONING
Reviewed b • j►f - Date: n
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 05/19/2017
o i t;.� City of Atlantic Beach APPLICATION NUMBER
r, ;.o, Building Department (To be assigned by the Building Department.)
:, 800 SeminoleRoad
AFNS��� oz(
l
r AtlanticticBeach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
�- 9' E-mail: building-dept@coab.us Date routed: t3 z o
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ! zCS' S L l Ly ST Department review required Yes No
!3F`uilditj
Applicant: r �C f _- arming &Zoning j
Tree Administrator
1'�
Project: l7 ( I'— ENC_. Public W k
Public Utilities
Public Safety
Fire Services
;Re iew 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: pa ['Denied. ['Not applicable
(Circle one.) Comments:
BUILDING "�
PLANNING &ZONING J"+ 3-Z
Reviewed by: —�% �— Date: c.,
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 05/19/2017
(itj7 .
City of Atlantic Beach APPLICATION NUMBER
1\ Building Department (To be assigned by the Building Department.)
800 Seminole Road
\� r� Atlantic Beach, Florida 32233-5445 F--- )C-e-2,C)" 0 OZ(
Phone(9 c Fax 247-5845
�!�;t»:- E-mail: building-dept@coab.us Date r�outed: J( (3 /
3 ! Z 0
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1 Z.F)E � l Ly _�, i ' Department review required YNo
Building
Applicant: 0(�Ju C—fe-- nning &Zoning_,.)
Tree Administrator
Project: ( f r I'- Er C EPublic W- ori
Public 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: rqrpproved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
UILDIN
PLANNING &ZONING
Reviewed by: fly Date: 4/-/')C-J
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 05/19/2017
Yt "'• Building Permit Application OFFICE COPY Updated 10/9/18
:‘1 totrod,' Ilk 1; City of Atlantic Beach Building Department **ALL INFORMATION
v 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
-on V' IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 12,35- L•Jy 3 FR-U Permit Number:F CE2.-0 — 00Z-
Legal Description cncv RE#
Valuation of Work(Replacement Cost)$ 3 00 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: New Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial EfICsidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes l
• Will tree(s)be removed in association with proposed project? DYes(must submit separate Tree Removal Permit) ONo
Describe in detail the type of work to be performed: a Q rN,,,ck.vi ' Et•nc,'.J }-3 L2. I%A-OA(1 ''O W
C\Q34- 0 L!- V,c l(. y n ,or 000)1. z
IJ Z
Florida Product Approval# for multiple products use product apprpya�Z0 I
d d
Property Owner Information O h- J`'
r; W p
Name Ad"^^. 13ti„ �r "f•c;A Address ILir i..-3%( -#'•-(.-1- (� L'n t=' Z F.W..
City At-V--a 't f
-, (3cc.4, State t--1.- Zip 322-33 Phone 3 z I -S-01- Cor 3 i (� 00 U 0
E-Mail 13c,.zarn Ee.i-J.,@ y.l•roo• Co-^' Q r: Q 0
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) 0 Q 0-
Contractor Information OW C•
Fu
Name of Company Q ifying Agent CC B F-•z
w
Address ity State Zip U. U” t
Office Phone Job ' e Contact Number L7 ® L A
X m
State Certification/Registration# ail iLl u R p
Architect Name&Phone# jJ C) N 77 W W
Engineer's Name&Phone# > CC LU
Workers Compensation Insurer OR Exempt❑ Expiration Date W >
W
Application is hereby made to obtain a permit to ,,o the work and installations as indicated. I certify that no work or instalfSion has CC
commenced prior to the issuance of a permit a . all work will be performed to meet the standards of all the laws regulating
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 w.a/eczap.arrnent,dii, tate agencies,or
federal agencies. v• ; - . ..t 3
of
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that allt%vor i b o ance with all
applicable laws regulating construction and zoning. ' � �
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICEt f 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 OTICE OF COMMENCEMENT.
(Signatur: a .wner or Agent) (Signature of Con •.ctor)
' ned and sworn to(or . ed) .efore m- his /3d. of Signed and sworn to(or affirme,. before me this day of
1 J 20w, , d`e..41.r.?a .10•_ - - nG1 , by
•Si:n1 P ota (Signature of Notary)
,�,pY P(,n.. [ ]PP:Mr*Pk�lewA§R
[ ]Personally Known OR � :'�•' '•:�
[ 1 Produced Identification , :m: 1:�� _
,. : :s.;7'. .;d;T P@iPit 4 2023
Type of Identification: , 1.: c0'. gondedThruNotary Public undeneters
JOB COPY **ALL INFORMATION
- /r,,, Owner Builder Affidavit
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
• u
800 Seminole Rd, Atlantic Beach, FL 32233
01 'r Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: filitedo c o2/
I. FLORIDA STATUTES;CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES
OWNER/ BUILDER TO ACKNOWLEDGE THE LAW: W
DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES: NN
5 Z �.
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIg 0 0 �►
FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWN it W _ a
OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A I( cu 0 ZQ
LICENSE. U U d V o
YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. W H Q
YOU MAY BUILD OR IMPROVE A ONE OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU I A< cc0 Z
ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. J THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEA E.I- cn Z
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE p 1 u�
CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE,WIVICIt f1C
IS IN VIOLATION OF THIS EXEMPTION. , aC] •
w jm:
y. �
YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MU4 f- w � D
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. W U N w La
IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES > ¢ w
REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. W w
LC CC
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$5,000 PENALTY UNDER FLORIDA STATUTE NO.455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEE THE COUNTY"CERTIFICATE OF COMPETENCY"OR THE FLORIDA"CONTRACTORS
CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.US) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I
COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
Job Address: �2$S L1.y S-rte..•4- 3ZZ-33
Owner Name: }stet.,, Phone Number: 3Zt -SDI—(o
Mailing Address: 1Z2S L.1 S1/4-nc.4- City: •,4-1-I0..i.t 13 1--«A. State: Zip: 31z 33
Notarized Signature of Owner
Th egoing Inst ument was acknowledged before is( day of 2020n the State of Florida, County
ofvV
Signature of Notary Publi C. er
OFFICE
COPY Personally Known OR [ ] Produced Identification
Approved By Permit Desk Type of Identification: IThL_
Building Department
City of Atlantic Beach, FL
��••••••., Updated 10/24/18
I :�;r"`•''u4� TONI GINDLESPERGER
.:*1 MY COMMISSION#GG 333178
,,For FLo',; EXPfRES: ber , 2
Bonded Thru NotaryOctopublic 6Unde203Titters
•
• MAP SHOWING BOUNDARY SURVEY OF:
•
LOTS 1, 2 AND 3, BLOCK 213, SECTION "H" ATLANTIC BEACH, AS RECORDED IN PLAT
BOOK 18, PAGE 34 OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA N
LOT 3 /
(ALSO KNOWN AS THE BEAUBOUEF TRUST BY CLIENT) 30' ALLEY AS PER ORD. 90-82-74
FOUND 1/2"IRON 1 FOUND 1/2"IRON �
FOUND 1/2"IRON PIPE DURDEN N 89`02'00' E 102.00 PIPE DURDEN to
PIPE DURDEN L.B. #6696 u t�_� e p,5•�L.B. jH6696
L.B. 16696 — 0.4'-� u
. ® �� / 50.00' �.'9q` e, 00 •
,
CIL
48. '
/ 9q. q�\�. 25.0' ..._ 0 WELL
/ •I TOfO O/ "94- __-._COVERED- _'
I 'H"s'r/.q� "9 : 1 �CONCREiE� -
'eao 33.0' 1 . r 42.0'
I I \ ,
I i o J� i t LOT 1 n LOT 1 M
I LOW o W
I .wk, AREA I ; mI I � X4.3• I N
I �ao N• 1
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•
RESIDENCE #1285 - 0
\` TOP�F6NK 0 I I 11
0 1
33.1'I I f4.7' v,
/ 8 (\o 1 �COONCETaE` h LL I LOT 2
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LOT 2 ® • �_ l \
l.L LL_J •c- L 23.0ILI
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0 r mI
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Z n o LOT 3
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•
ASPHALT/ oi
GRAVEL i J i� m
ORM'
•
•
• LOT 3 a
-;//7..............„..--- ..1,
FOUND 1/2" L.-" 7.5'B.R.L. .—.._—...r
'e IRON PIPE
NO IDENTIFICATION
cy.2'NORTH
i
FOUND 1/2"
SU 1/2"IRON PIPE DURDEN S 89`02 00" W 102.00 IRON PIPE
NO IDENTIFICATION
LB. 16696
LOT 4
LOT 4
NOTES
THIS PROPERTY UES
IN
FLOODINSURANCE � DWN COUNTY.�OFCICE COPY JACKSSOTMLLE BEACH,COMMMAP UNITY 007,MAP/PANEL N
I20JIC-D408-.J,REVISED NOVEMBER 2,2018
,iperoved By Permit Desk BEARINGS BASED ON THE EAST RIGHT-OF-WAY UNE OF
LILY STREET AS BEING N 01'16'00*W
ref BUILDING RESTRICTION LINE(B.R.L.)BY PUT
ADAI FQ �Q�N��NtaCB 1ORELLO 20'FRONT AND REAR, 7.5'SIDE
I� VUS�F�J,,K^^4in. Beach, FL ALL LOTS SHOWN HEREON LIE WITHIN BLOCK 213
} ({�(O7 ULAN -,-DENOTES B'WOOD FENCE EXCEPT AS NOTED
OLD EPUBUC NATIONAL TITLE INSURANCE COMPANY .THERE MAY BE ADDITIONAL RESTRICTIONS THAT ARE NOT SHOWN ON
THIS SURVEY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF .
. DUVAL COUNTY.FLORIDA.
r I I hereby certify that this survey meets the ,
A minimum technical standards os set forth by
DURDEN I the Florida Boord of Land Surveyors, pursuont to
/I\ Section 472.027 Florida Statutes and Chapter
SURVEYING AND MAPPING, INC. I 5J17 Florida Administrative Co
1ON5-B 3RD STREET, FLORIDAATH
I I 1 JACKSONVILLE BEACH, FLI32250
(904) 853-6822 FAX 853-6825 i ggia
LICENSED BUSINESS NO. 6696
FLORIDA REGISTERED SURVEYOR No.470
N.BRUCE DURDEN,Jr.
SURVEYOR'S NOTE,
THE SURVEY HEREON WAS MADE WITHOUT THE BENEFIT OF ABSTRACT OR SEARCH OF TIRE AND SIGNED DECEMBER 23, 7019
THEREFORE THE UNDERSIGNED AND DURDEN SURVEYING AND MAPPING.INC.,MAKE NO CERTIFICATIONS
REGARDING INFORMATION SHOWN OR NOT SHOWN HEREON PERTAINING TO EASEMENTS,CLAIMS OF SCALE: 1" = 20'
EASEMENTS, RIGHTS-OF-WAY.SETBACK LINES,OVERLAPS,BOUNDARY LINE DISPUTES,AGREEMENTS.
RESERVATIONS OR OTHER SIMILAR MATTERS WHICH MAY APPEAR IN THE ABSTRACT OR SEARCH OF TITLE. WORK ORDER NUMBER: 19740 B-9602
THIS SURVEY NOT VALID UNLESS THIS PRINT IS EMBOSSED WITH THE SEAL OF THE ABOVE SIGNED.