150 2ND ST - DRIVEWAY PERMIT �S` ire DRIVEWAY PERMIT PERMIT NUMBER
s1 DWAY18-0028
"`� CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ISSUED: 11/2/2018
`'rti9" ATLANTIC BEACH. FL 32233 EXPIRES: 5/1/2019
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.
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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
150 2ND ST DRIVEWAY SINGLE OR TWO driveway addition $3000.00
FAMILY DRIVEWAY
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170211 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
SONSHINE447 ATLANTIC BLVD 05 ATLANTIC BEACH FL 32233
CONSTRUCTION, INC.
OWNER: ADDRESS: CITY: STATE: ZIP:
194 Beach Avenue LLC 1541 Shipsview Road Annapolis MD 21409
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.
:: 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 DRIVEWAY APRON INFORMATIONAL
Notes:
All concrete driveway aprons must be 5 inches thick,4000 psi,with fibermesh from edge of pavement to the property line. Reinforcing rods or mesh
are not allowed in the right-of-way.
Issued Date: 11/2/2018 1 of 2
1.-ti'` DRIVEWAY PERMIT PERMIT NUMBER
'fir
' DWAY18-0028
J _ V CITY OF ATLANTIC BEACH ISSUED: 11/2/2018
800 SEMINOLE ROAD
ATLANTIC BEACH. FL 32233 EXPIRES. 5/1/2019
2 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.
3 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
4 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL
Notes:
Roll off container company must be on City approved list(Advanced Disposal,Realco Recycling,Shapells,Inc.,Republic Services,Donovan
Dumpsters). Container cannot be placed on City right-of-way.
5 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration,including sod,is required.
6 PUBLIC WORKS MAXIMUM DRIVEWAY INFORMATIONAL
Notes:
Maximum driveway width within the City right-of-way is 20 feet.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 $50.00
TOTAL:$75.00
Issued Date: 11/2/2018 2 of 2
S-:vp,��� City of Atlantic Beach APPLICATION NUMBER
JS ...4-,*„,, � Building Department flEcEiI.# mTo be assigned by the Building Department.)
:,!r'A••'
800 Seminole Road
`�_..,_ ,_ . Fe Atlantic Beach, Florida 32233-5445 SEP ' ' e i k O er F
r Phone (904)247-5826 •• Fax(904)247-58 2018 /1
..`�., 1
--an �:- E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 15D (4 SA . Department review required Yes No
c ` �(� Buil.'..__
Applicant: �.�U(N�Y� I_ (�
.
. -�,\.S�( L�I`� ! Planning &Zoning
Tree Administrator
aG. Public Wor sProject: (j./-1J,Q.,1-) D�m C,� �,�>r\ � �`�
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: Approved. Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed i : ,, ,,, 'i�, late: e.„-,../op
TREE ADMIN.
Second Review: ['Approved as revised. ['Denied. fNot 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
1;7. ', 'fE
tp 1= REVOCABLE ENCROACHMENT AGREEMENT
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach,Florida,a municipal corporation
organized and existing under the laws of the State of Florida, hereinafter referred to as"CITY"and
i c1' Oitiek fto/ oLC.c— of Atlantic Beach,Florida,hereinafter
referred to as"USER".
WITNESSETH:
That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon the
property for the purpose as described in City of Atlantic Beach.
This work is generally described as !/'L ,/.-',4.i
jJ� 4 '//,14��
Any facility maintained, repaired, erected, and/or i stalled in the exercise of the privilege granted remains subject to
relocation or removal on thirty(30) days' notice by CITY two 31SER,said notic to USER shall be given b certified mail,
return receipt requested,to the following address /S// -liti cyr ta) /fl oe, / ,,A -w's /1/4/ .2_,/ 9 .
• In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter
upon the above described easement or property of the CITY,the USER shall replace at the USER's sole expense,
any and all material necessarily displaced during the action of maintaining,repairing,operating,replacing or adding
to of the utilities and facilities of the CITY or franchise utility provider.
• The facilities allowed by the permit shall meet the current requirements of the City Code,Building Codes. Land
Development Code and all other land use and code requirements of the CITY,including City Code Section I9-7(h)
which states"Driveways that cross sidewalks: City sidewalks may not be replaced with other materials,but must
be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks."
• The USER,prior to making any changes from the approved plans and/or method,must obtain written approval from
the City of Atlantic Beach Public Works Department,for said change within 30 days after the day of completion.
• This permit shall inure to the benefit of,and be binding upon,the USER and their respective successors and assigns.
• USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or
specifications,to include utilities locate requirements and use limitations/requirements of easements,public right-
of-ways and other public land. USER further agrees that the CITY and its officers and employees shall be saved
harmles by the USER from any of the work herein under the terms of this permit and that all of said liabilities are
hereb snm&rl hSER.
111
Date 877-A)
Property ner gent(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL C/
The foregoing instrument was acknowledged this ' 0 day of01_, -1(). .r 20 I (��(
by Pn• EVkfr6c4e lam`, ,who personally appeared before me and
(printed name of Signer) Tracey Paulsen
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in ', NOTARY PUBLIC
/ •`'w . , 'STATE OF FLORIDA
-4-,0111"'V,1:- Comma GG212743
A.i4 10 Expires 4/30/2022
Signature of Notary Public,State of Florida
Department Approv
Personally Known_ V
Produced Identification(Type)
,:/i/�_ • _
Scott i riams,Public corks i ector/ �—
1 0:‘r' 3r. 1 . :.. p
H:\Master Forms\Public-Utilities Works Forms\Revocable Encroachment Agreement 2.5.18.docx
Revision Date:2/5/18
orgf,.
/•i
i ;.
j. RIGHT-OF-WAY/EASEMENT PERMIT
' Permit#Issued by the City of Atlantic Beach
P)"RIVIITrgE RESPONSIBLE FOR NOTIFYING 811 AND OBTAIN/NG UTILITY LOCATES
Job Address /TO 7-71ei S j Phone V OQ g36 ?Sb
Permittee //1/ Qfac( ,Qu LZ-C Email lj ,S,ya of c tri r:Ngr,tv( , callRequesting Permission to Construct Vie/Ai/v/0/
Location(Reference to Cross-Street) Zk( S? eZf4.& 4.i-1 _ g:r , F- ---
• Permittee declares that prior to filing this application they have ascertained the location of all existing utilities,
both aerial and underground and the accurate locations are shown on the sketches.
• Whenever necessary for the construction,repair,improvement,maintenance,safe and efficient operation,
alteration or relocation of all,or any portion of said street or easement as determined by the Director of Public
Works,any or all said poles,wires,pipes,cables or other facilities and appurtenances authorized hereunder,shall
be immediately removed from said street or easement or reset or relocated hereon as required by the Director of
Public Works and at the expense of the Permittee unless reimbursement is authorized.
• All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed
under the supervision of ,t) /11C`' ,eeoc1.1 QQ (Project Superintendent)
with Company Name j�5 wi,pt_ erers� E Phone 7,eV 975 7s-C2
• All materials and equipment shall be subject to inspection by the Director of Public Works.
• All city property shall be restored to its original condition as far as practical,in keeping with City specifications
and the manner satisfactory to the City.
• A sketch of plans covering details of this installation,as well as a copy of a recent survey shall be made a part
of this permit. Calculations showing any increase in impervious area on owner's lot or in the City
right-of-way are to be included with this application,
• The permittee shall commence actual construction in good faith within /1) days. If the beginning date is more
than 60 days from date of permit approval then pennittee must review the permit with the Director of Public
Works to make sure no changes have occurred in the area that would affect the permitted construction.
• it is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's
right,title and interest in the land to be entered upon and used by the holder,and the holder will,at all times,
assume all risk of and indemnify,defend and save hannless the City of Atlantic Beach from and against any and
all loss,damage and cost of expenses arising in any manner of the exercise or attempted exercises by the holder of
the aforesaid rights and privileges.
• The Director of Public Works shall be notified twenty-four(24)hours prior to starting work and again
it•mediately u'on completion.
/�- l
S. Date 8/A5//9
'erlit;igned in presence of Notary Public)
STA E OF •RIDA,COUNTY OF DUVAL !
The foregoing instrument was a knowledged this day of 6` /_/ _
,20 / j,%
by-1�I \ C�ti{rL, h( ill(�, who personall eared b
(printed name of Permittee) Yp efore me and
acknowledged thnthe,'s#tesiiured the instrument voluntarily for the purpose expressed in it.
/
Personally Known ✓✓✓
Signature of Notary Pu�c,State of Florida Produced Identification(Type)
Tracey Paulsen
NOTARY PUBLIC
STATE OF FLORIDA
;111.711-3"':Comma GG212743
'' is ' Expires 4/30/2022
11ECElliV1
r Building Permit Application I SEP 1updated5/5/17
4 E.,,
City of Atlantic Beach 2018
�' 800 Seminole Road,
• J_t� Atlantic Beach, FL 32233IL
'sem Phone:(904)247-5826 Fax:(904)247-5845
Job Address: if/ ZnV,` p�) Al, l - ��
Permit Number: 4
Legal Description RE# /75Z // 6e.dd
Valuation of Work(Replacement Cost)$ A/006 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Additi AlteRepair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one)ratio: Commercial litsictlen
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes ,No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
77,e/d' Id Ay /d4'6171
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: /iy 01,P--L. /Cc/ -L Address: /5-5// .5-4"//f%L✓ 4°4
City /9-44/0//5 State 4IO Zip -/4' Phone TF#' £ t
E-Mail A �/--
Owner or Agent(If gent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: )fvrs,WNt �ersq £ gAgent: ¢(fc) fA�
J C uali in C
Address '11/ /!if7ti4-s(/31u./ -.S yl
City_ �� � state�( Zip 32Z3'J?-
Office Phone 0 OM' 7S43 Job Site/Contact Number g,%
State Certification/Registration# fit C l7-S'Sl/141 E-Mail F /#i r%X (3e-'th) f_ eyi*V l . i.:• .1
Architect Name&Phone#
Engineer's Name&Phone# ---
Workers Compensation n(j�
44 Exempt Insurer/Lease Employees/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 all work will be performed to meet the standards of all the laws regulationg
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.
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 FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING I : k *TIC-.E OF COMMENCEMENT.
4...nature of Owner or Agent) (Signature of Contractor)
(including contractor)
'fined and sworn5)
,to(or affirmed),efgre m this day of Si ned and sworn to(or affirm•• . . - , _thi / day of
— � v XlJ 4 b,
ratey
NOTARY PUBLIC '" y
NOTARY PUBLIC �'
- fir '�. STA ,o au re of Notary) tIiii:
STATE OF ?1f�t'
�'sCorrtrr GG21 7$ .of Notary)
I Expires 4/30/2022 -14 Comm#GG212743
ip' 10. Expires 4/30/2022 i"
(vf Personally Known OR ['J Personally Known OR
[ I Produced Identification [ )Produced Identification
Type of Identification: Type of Identification:
� '.S < Jr! ;;� CITY OF ATLANTIC BEACH
`'\ e0EI800 Seminole Road
' � " Atlantic Beach,Florida 32233 viro
\J,il9r
11 OCT 172018
REVISION REQUEST / CORRECTIONS TO P AN REVIEW COMMENTS
Date / Uit/t% Revision to Issued Permit)r Corrections to Comments Permit#b \ p Lt 8-3QZ3
Project Address /5-0 24d 9- if ,<,g (/ ?
Contractor/Contact Name 'f 5.L/44• (3r Z,c. &1 ) /� . I W4i1/C/
Phone CO 0;V 675-- j Email r)--2- 44/,7e Af ie./ .) t f,# i(, G
Description of Proposed Revision/Corrections: Permit Fee Due$
1(O( 6)I7 I f-rrteifi tig—
Additional Increase in Building Value $ Z-C6t, - Additional S.F. k , --
By signing below,I f5(1£4l affirm the Revision is inclusive of the proposed changes.
(printed na(ne)
/0/7,e
S e of retractor/Agent(Contractor must sign if increase in valuation) Date
(Office Use Only)
Approved Denied Not Applicable to Department
Revision/Plan Review Comments
De•a ment Review Required:
:uilding
LI,i/A0--igi.nnin. & _spin. Revie y
Tree Administrator
u is Worcs
lic Utilities G �a 004
Public Safety Date
Fire Services
r,,,,jr
Js\ 800 Seminole Road
�� �;� OFFICE COPY CITY OF ATLANTIC BEACH
,� Atlantic Beach,Florida 32233
�y. Jiilt-r
REVISION REQUEST/CORRECTIONS TO PLAN REVIEW COMMENTS
Date /Jf 7/�� Revision to Issued Permit}� Corrections to Comments Permit# OW Pik(! 8 -• ,o b 0 7.....5Project Address /5-0 G24d 59 414,4 t' tel '3�
Contractor/Contact Name/11y75i7zlrlf, lea-r Z,c i/9-I ) Re ,Nn'2,tkdl
Phone 41G*g;i5 `75'ao ? Email t-y iii-lL eye-,f k '7fildi C , C
Description of Proposed Revision/Corrections: Permit Fee Due $ '^C,"
211101 GdA7 / frnei pp).44_
.fe
Additional Increase in Building Value $ Z-cW J Additional S.F. Ai/I--
By
iI--
By signing below,I 15// 4) /2 CT.ig,)Sv7 affirm the Revision is inclusive of the proposed changes.
(printed na e)
____ „____ /0/7,e
S e of o tractor/Agent(Contractor must sign if increase in valuation) Date
(Office Use Only)
Approved 2r- Denied Not Applicable to Department
Revision/Plan Review Comments
De a ment Review Required:
uilding iii
Imilm • • • Reviewed By
Tree Administrator
u is Worcs
blic Utilities / ,"- — /81-
Public Safety Date
Fire Services
�)1 ,.11/4,� CITY OF ATLANTIC BEACH
'11 800 Seminole Road
lip;f - '� Atlantic Beach,Florida 32233
REVISION REQUEST/CORRECTIONS TO PLAN REVIEW COMMENTS
Date lU z11 b Revision to Issued Permit Corrections to Comments Permit #jl /Pti/j'°67-k'
Project Address /0 Z sr ie f( -7.-.--7---9-3
Contractor/Contact Name 6;7J<-1S,/) / t,Ø4'*t
Phone v"#V32 75-4'3 Email Zr72,5*-i/�rGs �✓ g—t%71/
Description of Proposed Revision/Corrections: Permit Fee Due $
krAr -)/-4(
Additional Increase in Building Value $ if# Additional S.F.
' �
By signing below,I �/QQ I'1�ll 4L'iVW4*1 affirm the Revision is inclusive of the proposed changes.
(printed nape) �j
Sig of C ntractor/Agent(Contractor must sign if increase in valuation) Dat
(Office Use Only)
Approved C Denied Not Applicable to Department
Revision/Plan Review Comments
Department Review Required: ,4
Building
C--
Planning & Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities / -� Q
} I — / U
Public Safety Date
Fire Services
C—tvi City of Atlantic Beach APPLICATION NUMBER
4, ,A Building Department (To be assigned by the Building Department.)
� Atlantic8tla SeminolecRoad U I
, �� Beach, Florida 32233-5445 {J 1
'`' Phone (904)247-5826 •• Fax(904)247-5845 �-/
oo4
rp'e: . 1/ U(,;t19r• E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 13 V a S-\ . Department review required Yes No
c,� r , Buil
Applicant: ��V(1SK1 N.C. (�W,1�,S\y I•_ �`� 1 (-Planning &Zoning
Tree Administrator
(Public Wor
Project: 13,114_1.9( DLm (��(\ 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: Approved. denied. I INot applicable
(Circle one.) Comments: ,/ /
BUILDING eeU Fei(e I { p ffee s
C J
PLANNING &ZONING Reviewed by: ,,,,i . / ----- Date: - p 18-I o
TREE ADMIN. Second Review: Approved as revised. ❑Denied. Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES /4-ea 4e /71 -
PUBLIC SAFETY Reviewed by: 647-- 1C/ -2.4- i-- Date: g
FIRE SERVICES Third Review: Approved as revised. Denied. ❑Not applicable
Comments:
Reviewed by: Date: (6/"R i {D
Revised 05/19/2017
rCITYS y \J r�,_,
S
OF ATLANTIC BEACH
L,,, J 800 Seminole Road
, Atlantic Beach,Florida 32233
'�Jiil 9r
REVISION REQUEST / CORRECTIONS TO PLAN REVIEW COMMENTS
Date i O (1 (% Revision to Issued Permit)( Corrections to Comments Permit# a04-YL B
�J (30Z_8
` Project Address /5-0 24d 5r l4/l4. ‘ d� �y
Contractor/Contact Name z3 5i'J4s. (ter ZiC 1/-t ,t) 7C/wg/tiel
Phone 6/d 7/i 5 67 5. 3 Email .r.,'y j,76 05,6 f.J g- l' i</ G
Description of Proposed Revision/Corrections: Permit Fee Due$
VI-ali Wil I (-r4e1 16'191'4 4—
A-A ie
Additional Increase in Building Value $ Z-5-1(-4/ Additional S.F. A.)71---
By signing below,I t�C/£'J ,?l(7X IA14affirm the Revision is inclusive of the proposed changes.
(printed naa e)
/0/.7 .
Stat e�tractor/Agent(Contractor must sign if increase in valuation) Date
(Office Use Only)
Approved Denied / Not Applicable to Department
Revision/Plan Review Comments Fen c-e ( ey, h t
Deja ment Review Required: ,,,° Gf�
:uilding
iu.nnin• & _•fin• Reviewed By
Tree Administrator
icworesd (0 _2_ 6-_ � Q
lic Utilities U
Public Safety Date
Fire Services
c �t1.
t
,. , • , 4 CITY OF ATLANTIC BEACH
.+t.
, 800 Seminole Road
4
71 P Atlantic Beach,Florida 32233
REVISION REQUEST/CORRECTIONS TO PLAN REVIEW COMMENTS
07//ig
tT -1( 8—oo7 ,Date Revision to Issued Permit Corrections to Comments‘ Permit#
Project Address `526 41 yr i 14,G !4t/L
Contractor/Contact Name 4,,,,,,„/7y 6-11-j7—__J_Ak: 13i -4 riAL.gfAvi/rii
Phone l 1g3 Email , /j--!iz e.65rt)
Descriptio of Proposed Revision/Corrections: Permit Fee Due$
Additional Increase in Building Value $ /-) Additional S.F.
By signing below,I affirm the Revision is inclusive of the proposed changes.
(printed name)
Signature ntractor/Agent(Contractor must sign if increase in valuation) Date L
(Office Use Only)
Approved Denied / Not Applicable to Department
Revision/Plan Review Comments / / // PeedS G�I� Ce -ICGl�
Department Review Required:
Building _, _ir4Zr
. ing &Zoning Reviewed By
Tree k. - . •
Public Works � G_1 _ t
Public Utilities 1.
Public Safety Date
Fire Services
illECEINE
Building Permit Application I Updated 5/5/17
i- %1SEP 1 1
City of Atlantic Beach 201$
I 800 Seminole Road,Atlantic Beach, FL 32233
Phone: (904)247-5826 Fax:(904)247-5845
Job Address: /'✓O Z
Permit Number: 1-� 0
,( (��f , Q. .- 001`Q Qr
Legal Description RE# 17HZ 1/ 66O6
Valuation of Work(Replacement Cost)$ - jJob Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Additio Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial siders ' i
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
72kiii V 1)/ &.I'/e i
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: %iiFc.6. Ai >_.L Address: /5-5// $%px//fit✓ , -/
City 4if)/}/ /S1 / State /Z Zip /yd 9 Phone T0 �& 7 ' J
E-Mail ,k
Owner or Agent(If gent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: j efe.VPF'L 4.10154----- (- QualifyingAgent: fc) & tetx l
Address fir //li t,13(a s- City_/ 'A'fsl4e .44_• State K1 Zip 3ZZ3 3
Office Phone o4/ 03e 7S61 Job Site/Contact Number "Mr -e f
State Certification/Registration# i,€C-/7-r4//)r(1 E-Mail S r:-.4 yc ii-A- ar..frJ C. c77,,'^;yy , 4
— 17,11
/
Architect Name&Phone#
Engineer's Name&Phone# ---
Workers
—Workers Compensation Alli
exempt insurer/Lease Employees/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 all work will be performed to meet the standards of all the laws regulationg
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.
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 FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING •URN ICE OF COMMENCEMENT. vim^
A (-23--
,nature of Owner or Agent) (Signature of Contractor)
(including contractor)
'fined anorn to(or firmed) e m this 5 day of Si ned and sworn to(or affir * • e thisa)day of
t, z—l—r3ee,7' . 11�-/7
V. Cg .NOTARY PUBLIC NOTARY PUBLIC,
STATE OF FL R1DA `
�� RRia ature of Notary) . ‘illiii
' -+STATE OFF. }Pfd of Nota
•:-"Comm*GG212743 Notary)
• ,- - 4 Comm#GG212743
/ % Expires 4/30/2022 • "•" '
ih Ill Expires 4/30/2022
[vj Personally Known OR [I Personally Known OR
[ I Produced Identification [ )Produced Identification
Type of Identification: Type of Identification:
TREE & VEGETATION AFFIDAVIT
,- - 11 City of Atlantic Beach
s) Department of Community Development
PZ
J , �;, 800 Seminolelanning& Roadoning Division Atlantic Beach,FL 32233
(P)904 247-5800 (F)904 247-5845 PERMIT#
SECTION I-APPLICANT INFORMATION f— Owner(s) (— Legal Authorized Agent*
NAME OF APPLICANT LJ 73/11 11 C1) • v/ �, ( MO/10.1.4- A• LLL
NAME OF COMPANY cipiciikt 4 4_ 7
ADDRESS OF COMPANY *1 ,4/444 e( I4S ,444_4 41-, 3Z-33
PHONE city 9 '/543 CELL 90 r..)NT EMAIL 4firtik„4 eie_/4.J e_7/4+11.[/.
CONTRACTOR CERTIFICATION NUMBER e5C ll�C�i(g 6
ATLBCH BUSINESS TAX RECEIPT NUMBER
SECTION II-SITE INFORMATION
STREET ADDRESS OF PROPERTY /C4 ?Ai sr p!ge14- gl
illA
lion address has not been assigned to this property,contact the AB Building Deportment at(904)247-5826 to request an address.
LEGAL DESCRIPTION
LOT BLOCK SUBDIVISION
REAL ESTATE NUMBER LOT OR PARCEL SIZE: SQ FT AC
RESIDENTIAL COMMERCIAL OTHER(SPECIFY)
I affirm that I have reviewed the provisions of Chapter 23, "Protection of Trees and Native Vegetation"of the Municipal Code of
Ordinances for the Cit of Atlantic Beach,FL and/or I have participated in a pre-application meeting with the Administrator of those
regulations. Subsequ f fly,I affiru - . •d trees and no regulated vegetation will be damaged,destroyed and/or removed
fro a : • e-d •or adj. •nt properties in conjunction with this project.
SIGNATURE r F iN ER SIGNATURE OF OWNER
Signed and sworn before me on this dayof �/ b State of Flail W
g ! ���{f , 41::•M ' Y
\ % fgCounty of 1' jVO.Identificationverifi :Oath sworn: Yes w(— No
I
I
v Tracey Paulsen
.v.-49.1. NOTARY PUBLIC tory Signature
s • 4 STATE OF FLORIDA qi
REV-TVA-v;.;-v Own GG212743My Commission expires: /1 ° ZZ
El Expires 4/30/2022
_) SHOWING SURVEY DF
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LOT 6, BLOCK 31, ATLANTIC BEACH AS RECORDED IN PLAT BOOK 5, PAGE 69 OF THE
CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED To: GRAPHIC SCALE
DERICK WOOLVERTON
ARNOLD WOOLVERTON i__ 30 4E 60 I
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KATHLEEN SCHULTZ "`'
I SUNSHINE TITLE CORPORATION L 1
( IN FEET )
1 ALLIANT NATIONAL TITLE INSURANCE 1 inch = 30 feet.
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® It`M' — GENERAL NOTES 1 i
1 1. THIS SURVEY MAP DOES NOT REFLECT OWNERSHIP. 1
2. UNDERGROUND PORTION OF FOUNDATION/FOOTER NOT LOCATED.
3. THERE MAY BE UNDERGROUND UTILITIES NOT SHOWN ON THIS SURVEY. 1 1 p:p J
1 5. UNLESS OTHERWISE NOTED. RECORD AND MEASURED DIMENSIONS AGREE.
1 1 6. THE RELATIVE LINEAR DISTANCE ACCURACY FOR THIS SURVEY EXCEEDS 1:10.000.
ABBREVIATION. pEFINInON F QV.1 7. ALL MEASUREMENTS ARE IN U.S. STANDARD FEET AND WERE MADE WITH A THEODOLITE pt.?'N/2'IP
AND ELECTRONIC DISTANCE MEASURING DEVICE AND/OR STEEL TAPE CA8. THE DIMENSIONS OF THE BUILDING SHOWN HEREON DO NOT REFLECT EAVE OVERHANG,
IF ANY. P ILLEGIBLE I
(C) CALCULATED DATA \ 10. ALL BUILDING TIES ARE PERPENDICULAR TO THE PROPERTY LINES, UNLESS INDICATED f
(P) PLAT DATA I
BLDG. BUILDING 11. THIS SURVEY MAP AND/OR SURVEY REPORT AND THE COPIES THEREOF ARE NOT VAUD
WITHOUT THE SIGNATURE OF A LICENSED SURVEYOR AND MAPPER AND THE ORIGINAL
EM ELECTRIC METER RAISED SEAL.
FND. FOUND 12. NO TITLE OPINION OR ABSTRACT OF MATTERS AFFECTING TITLE OR BOUNDARY TO
IP IRON PIPE THE SUBJECT PROPERTY HAVE BEEN PROVIDED. IT IS POSSIBLE THERE ARE DEEDS
OF RECORD, UNRECORDED DEEDS. EASEMENTS OR OTHER INSTRUMENTS WHICH COULD
OHE OVER HEAD ELECTRIC LINE AFFECT THE BOUNDARIES.
13. NOTICE OF LIABILITY: THIS SURVEY IS CERTIFIED TO THOSE INDIVIDUALS SHOWN ON `
THE FACE THEREOF. ANY OTHER USE, BENEFIT OR RELIANCE BY ANY OTHER PARTY IS fi'IP
STRICTLY PROHIBITED AND RESTRICTED. SURVEYOR IS RESPONSIBLE ONLY TO THOSE . APII.EBBL_O i
CERTIFIED AND HEREBY DISCLAIMS ANY OTHER LIABIUTY AND HEREBY RESTRICTS
THE RIGHTS OF ANY OTHER INDIVIDUAL OR FIRM TO USE THIS SURVEY, WITHOUT EXPRESS
WRITTEN CONSENT OF SURVEYOR.
'---- -------n--' A R 11-- '1117-8—TPT,i_\\--c,...-::-- -c-----1-':-.-f- --&----A' ,-:'..8.---n(c,---1 A-iti-rr±" ,.,-' ''ic\l-r---- ,1
SURVEYORS - MAPPERS - LAND PLANNERS I
P.O. BOX 10046 — FLEMING ISLAND, FLORIDA, 32006 — PHONE 904 215-0707 — FA>( 904 215- 0711
I HEREBY CERTIFY THAT THIS BOUNDARY SURVEY,
PERFORMED UNDER MY RESPONSIBLE DIRECTION, MEETS THE MINIMUM TECHNICAL STANDARDS FOR LAND SURVEYORS IN ACCORDANCE WITH CHAP':ER
61G17-6, FLA. ADMINISTRATIVE CODE (PURSUANT TO SECTION 472.027, FLORIDA STATUTES).
r ,/ _
‘-.__,. .•''' d ` `r��- ✓ L✓fir
CHARLES R. BASSETT JR., REGISTERED LAND SURVEYOR FLA. NO. .591
' SURVEYED OCTOBER 23, 2012 GIL D. HOWATT, REGISTERED LAND SURVEYOR FLA. NO. 47111
I LICENSED BUSINESS NUMBER 8628
BEARING DATUM BASED ON NOT APPLICABLE —_�
FLOOD ZONE "X" (UNSHADED) AS BEST ASCERTAINED FROM THE FLOOD INSURANCE RATE MAP, COMMUNITY PANEL N0. 120075 0001 D, DATED APRIL 17, 19E.9
FIELD BOOK NO.: 806 PAGES) 21 LEGAL: NOT APPLICABLE WORK ORDER NO.: 10-12-0',
COMPUTER FILE NAME: ' 101204.DWG SCALE: 1" = 30' FILE NO.: L-663() '
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