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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 x� I 1 1 �D•i„ \ / I loo I = I WE oCOVEREDI ONCRE I o so/ \: \ • I —. / 0 — H II 2 STORY WOOD FRAME • 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 W O zs.r I " ® O /� W Q° • LOT 2 ® • �_ l \ l.L LL_J •c- L 23.0ILI ' „ .- F-- Q — — ___I T_o \y/ V/ F-U z �. - (n 2(n �: 0 r mI J N CONCRETE I V Fene e. U • DRIVE _I �o j O Z n o LOT 3 .rc • 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.