171 Club Dr ACC20-0066 Permit PacketOWNER:ADDRESS:CITY:STATE:ZIP:
HUGHES BRIAN P ET AL C/O HEEDE DAG O ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
170246 0020 ATLANTIC BEACH
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
171 CLUB DR ACCESSORY SINGLE OR TWO
FAMILY ACCESSORY 14' x 14' x 9' PERGOLA $4000.00
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 must be installed and approved prior to 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 ROLL OFF CONTAINER INFORMATIONAL
Notes:
Roll off container company must be on City approved list. Approved list can be obtained at the Building Department at City Hall. Roll off container
cannot be placed on City right-of-way.
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 management districts, state agencies, or federal agencies.
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.
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
1 of 2Issued Date: 10/21/2020
PERMIT NUMBER
ACC20-0066
ISSUED: 10/21/2020
EXPIRES: 4/19/2021
ACCESSORY PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $75.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $37.50
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 $100.00
TOTAL: $241.50
3 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration, including sod, is required.
4 PUBLIC WORKS RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site. Cannot raise lot elevation.
5 PUBLIC WORKS DECKING REMOVED INFORMATIONAL
Notes:
All old decking and debris must be removed from job site by Contractor.
2 of 2Issued Date: 10/21/2020
PERMIT NUMBER
ACC20-0066
ISSUED: 10/21/2020
EXPIRES: 4/19/2021
ACCESSORY PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $129.00
RERF20-0199 Address: 128 SEMINOLE RD 9 APN: 170602 0015 $129.00
BUILDING $125.00
BUILDING PERMIT 455-0000-322-1000 0 $125.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R13896 $129.00
Printed: Wednesday, October 21, 2020 4:03 PM
Date Paid: Wednesday, October 21, 2020
Paid By: DeVore Capital Contracting Consulting
Pay Method: CREDIT CARD 388373830
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R13896
t::ulr,,, Building Permit ApplicationritUpdated 10/ 9/18
Q'\
City of Atlantic Beach Building Department ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Oif1 r
IS REQUIRED.Phone: (904) 247-5826 Email: Building-Dept@coab.
usn y
Job Address: 171 Club Drive Permit Number:I'\Q` "w 6::,
Legal Description 5-69 16-2s-29e.172 Atlantic Beach PT Hotel Reservation recd o/r 16188-536 RE# 170246 0020
Valuation of Work(Replacement Cost)$4000 Heated/Cooled SF Non-Heated/Cooled
Class of Work: VINew Addition Alteration Repair Move Demo Pool Window/Door
Use of existing/proposed structure(s): Commercial Residential
If an existing structure,is a fire sprinkler system installed?: Yes No
Will tree(s)be removed in association with proposed project? Yes(must submit Separate Tree Removal Permit) VINo
Describe in detail the type of work to be performed:
Build a 14'x14'x9'wooden pergola in the NE corner of the property
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name Brian P.Hughes Address 171 Club Drive
City Atlantic Beach State FL Zip 32233 Phone 904- 294-6678
E-mail Brian229ATL@hotmail.com
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information OWNER/BUILDER
Name of Company Kohn Construction Qualifying Agent Thomas Kohn
Address 15 Guana Drive City Ponte Vedra Beach tate FL Zip 32082
Office Phone 803- 243-0395 Job Site Contact Number
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt Expiration Date
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 41f Work will be performed to meet the standards of all the laws regulating
construction in this jurisdiction. I understand that a,aeparate 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 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 OBI, FINANCING, CONSULT WITH YOUR LENDER OR AN ATTOR BEFORE
RECO' /NG YOUR ICE COMMENCEMENT.
Sig ie of Own or Ag Tttr Signature of Contractor)
ned a d sworn to(or a' 1'd)before - this •ay of Signed and sworn to(or affirmed)before me this day of
7O Cab ova S by
waEWA
kSigna • • - y Signature of Notary)
0
Personally Known OR Personally Known OR
Produced Identification tion
gar"''• TON!G R -
t3? iFti icationTypeofIdentification:
MMIS ON#GG 353178
u. IrP;
i';;:moi EXPIRES:October 6,2023
Bonded Thru Notary Public Underwriters
Owner Builder Affidavit ALL INFORMATION
HIGHLIGHTED IN
IV-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#:
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 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: 171 Club Drive,Atlantic Beach,FL 32233
Owner Name: Brian Hughes Phone Number: (904)294-6678
Mailing Address: 171 Club Drive City: Atlantic Beach State: FL Zip: 32233
Notarized Signature of Owner / 01
The f oing insttument was acknowledged before me this ZS day o 6m NC n the State of Florida, County
of cD\fc-Z
s(
1
Signature of Notary Pu I '
e
Personally Known OR [ ] Produced Identification el
Type of Identification:
Updated 10/24/18
7""`°`;,
TONT GIND ESPERGER3531111 '- MY COMMISSIOtJ#GG 178
E":
41.. •`; EXPIRES:October 6,2023
Bonded'Nu Notary Pub;ic Underwrttsrs
14' X 14' X 9'
ACC20-0066
Revision Request/Correction to Comments 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@coab.us PERMIT ACC20-0066
El Revision to Issued Permit OR n Corrections to Comments Date:10/09/2020
Project Address: 171 Club Drive, Atlantic Beach, FL 32233
Contractor/Contact Name: Brian P. Hughes -Owner/Builder
Contact Phone: (904)294-6678 Email: brian229atl@hotmail.com
Description of Proposed Revision/Corrections:
Revise Pergola to 12' X 12' X 9' dimensions to be within 150 square feet size requirements.
The setbacks are 6 feet from both the North and East property lines, 57 feet from the West property line,
and 82 feet from the South property line.
Attachments have been signed and dated by the owner.
Brian P. Hughes-Owner/Builder affirm the revision/correction to comments is inclusive of the proposed changes.
printed name)
Will proposed revision/corrections add additional square footage to original submittal?
ENo n Yes (additional s.f. to be added:
rlAtill proposed revision/corrections add additional increase in building value to original submittal?
No Q*Yes (additional increase in building va : $ r Contractor must sign if increase in valuation)
Signature of Contractor/Agent:fie
Office Use Only)
u Approved Denied u Not Applicable to Department Permit Fee Due$
Revision/Plan Review Comments
Department Review Required:
Building
Planning & Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities
Public Safety Date
Fire Services Updated 10/17/18
OR BE 12675 PAGE 1476
Addendum A
MAP SHOWING BOUNDARY SURVEY OF:
A PART or THE HOTEL RESERVATION AS SHOWN ON DAYPORT TERMINAL COMPANY'S MP OF ATLANTIC
BEACH AND RECORDED IN PLAT BOOK 5. PAGE 64. AND ALSO SHOWN ON PLAT NO. 1• SUBDIVISION -A-.OF ATLANTIC BEACH AS RECORDED IN PLAT BOOK 5. PACE 69 OF THE CURRENT PUBLIC RECORDS OF
DUVAL COUNTY, FLORIDA, SAID PART BEING STORE PARTICULARLY DESCRIBED AS FOLLOWS'
FOR A POINT OF REFERENCE. COMMENCE AT THE NORTHWEST CORNER OF CLUB MANOR.AS RECORDEDINPLATBOOK25. PAGE 62 OF THE CURRENT PURLIC RECORDS CF SAID COUNTY: THENCE NORTH
85'3215"EAST ALONG THE NORTH LINE OF SNO CLUB MANOR. A DISTANCE OF 96.25 FEET TO THEPOMOFBEGINNING; THENCE NORTH 0615'15'WEST. DEPARTING SAID NORTHERLY UNE.A DISTANCE OF Rri_QoI ift-99.84 FEET; THENCE NORTH 8344.45'WEST. A DISTANCE OF 10.00 FEET; THENCE NORTH 85-32'15" JEAST. 65.00 FEET: THENCE SOUTH 06'15. 15- EAST. A DISTANCE OF 100.15 FEET TO THE NORTHERLY
LINE OF SAID CLUB MANOR. THENCE SOUTH 85'32'15'WEST. ALONG SAID NORTHERLY LINE. A DISTANCEOF75.00 FEET TO THE POINT OF BEGINNING. SUBJECT TO AN 12 FOOT EASEMENT FOR INGRESS ANDEGRESSALONE, THE NORTH 1200 FEET OF THE ABOVE DESCRIBED LANDS.
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Permit Number:ACC20-0066 Description:14'x 14'x 9'PERGOLA
Applied:9/24/2020 Approved: Site Address: 171 CLUB DR
Issued: Finaled: City,State Zip Code:Atlantic Beach,Fl 32233
Status:RECEIVED Applicant:<NONE>
Parent Permit:Owner: HUGHES BRIAN P ET AL
Parent Project: Contractor:<NONE>
Details:
owner builder
LIST OF REVIEWS
SENT DATE
RETURNED
DUE DATE TYPE CONTACT STATUS REMARKS
DATE
Review Group:AUTO
9/24/2020 9/24/2020
SUBMITTAL
Permit Tech APPROVED
COMPLETENESS
Notes:
2 attachments-not signed
9/24/2020 9/28/2020 10/8/2020 ZONING Zoning DENIED
Notes:
Size:Pergolas are allowed up to 150 square feet,measured from the posts.The proposed pergola exceeds this square footage,please revise accordingly.
Setbacks:Please show that the pergola is at least 5 feet from all property lines.
9/24/2020 10/1/2020 10/8/2020 BUILDING Building APPROVED
Notes:
Denied by P&Z.
NOC needed.
9/24/2020 9/24/2020 10/8/2020 PUBLIC WORKS Public Works
APPROVED
W/CONDITIONS
Notes:
See Conditions of Approval that will be printed on Permit.
9/24/2020 9/24/2020 10/8/2020 PUBLIC UTILITIES Public Utilities
NOT APPLICABLE
TO DEPARTMENT
Notes:
Printed:Wednesday,07 October,2020 1 of 1 CENTRALSQUARE