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1625 Atlantic Beach Dr ACC20-0047 Permit PacketOWNER:ADDRESS:CITY:STATE:ZIP: ADAM LEOPOLD AND JENNIE D LEOPOLD FAMILY TRUST 1625 ATLANTIC BEACH DR ATLANTIC BEACH FL 32233- COMPANY:ADDRESS:CITY:STATE:ZIP: TYPE OF CONSTRUCTION: REAL ESTATE NUMBER:ZONING:BUILDING USE GROUP:SUBDIVISION: 169505 1080 ATLANTIC BEACH COUNTRY CLUB UNIT 01 JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK: 1625 ATLANTIC BEACH DR ACCESSORY SINGLE OR TWO FAMILY ACCESSORY OUTDOOR KITCHEN, WALKWAY & LOUVERED ROOF $45000.00 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. 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: 1/8/2021 PERMIT NUMBER ACC20-0047 ISSUED: 1/8/2021 EXPIRES: 7/7/2021 ACCESSORY PERMIT CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 FEES DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT BLDG 2ND PLAN REVIEW FEE 455-0000-322-1006 0 $50.00 BLDG 3RD PLAN REVIEW FEE 455-0000-322-1006 0 $75.00 BUILDING PERMIT 455-0000-322-1000 0 $280.00 BUILDING PLAN CHECK 455-0000-322-1001 0 $140.00 PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00 STATE DBPR SURCHARGE 455-0000-208-0700 0 $8.18 STATE DCA SURCHARGE 455-0000-208-0600 0 $5.45 ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 $100.00 TOTAL: $683.63 2 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL Notes: All runoff must remain on-site during construction. 3 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. 4 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL Notes: Full right-of-way restoration, including sod, is required. 5 PUBLIC WORKS RUNOFF INFORMATIONAL Notes: All runoff must remain on-site. Cannot raise lot elevation. 6 PUBLIC WORKS DECKING REMOVED INFORMATIONAL Notes: All old decking and debris must be removed from job site by Contractor. 2 of 2Issued Date: 1/8/2021 PERMIT NUMBER ACC20-0047 ISSUED: 1/8/2021 EXPIRES: 7/7/2021 ACCESSORY PERMIT CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 DESCRIPTION ACCOUNT QTY PAID PermitTRAK $683.63 ACC20-0047 Address: 1625 ATLANTIC BEACH DR APN: 169505 1080 $683.63 BLDG SUBSEQUENT PLAN REVIEW FEES $125.00 BLDG 2ND PLAN REVIEW FEE 455-0000-322-1006 0 $50.00 BLDG 3RD PLAN REVIEW FEE 455-0000-322-1006 0 $75.00 BUILDING $280.00 BUILDING PERMIT 455-0000-322-1000 0 $280.00 BUILDING PLAN REVIEW $140.00 BUILDING PLAN CHECK 455-0000-322-1001 0 $140.00 PUBLIC WORKS PLAN REVIEW $25.00 PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00 STATE SURCHARGES $13.63 STATE DBPR SURCHARGE 455-0000-208-0700 0 $8.18 STATE DCA SURCHARGE 455-0000-208-0600 0 $5.45 ZONING PLAN REVIEW $100.00 ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 $100.00 TOTAL FEES PAID BY RECEIPT: R14542 $683.63 Printed: Friday, January 8, 2021 1:19 PM Date Paid: Friday, January 08, 2021 Paid By: ADAM LEOPOLD AND JENNIE D LEOPOLD FAMILY TRUST Pay Method: CREDIT CARD 411841006 1 of 1 Cashier: CG Cash Register Receipt City of Atlantic Beach Receipt Number R14542 ~+; CENTRALSQUARE Building Permit Application Updated 10/9/18 City of Atlantic Beach Building Department 800 Seminole Road, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: _______________________________________________________ Permit Number: ____________________________ Legal Description ________________________________________________________________ RE# _________________________ Valuation of Work (Replacement Cost) $_________________ 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 □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) □No Describe in detail the type of work to be performed: Florida Product Approval #______________________________________________ for multiple products use product approval form Property Owner Information Name ______________________________________________ Address _________________________________________________ City ____________________________________ State _______ Zip _______________ Phone ________________________________ E-Mail ______________________________________________________________________________________________________ Owner or Agent (If Agent, Power of Attorney or Agency Letter Required) _________________________________________________ Contractor Information Name of Company _______________________________________ Qualifying Agent _______________________________________ Address________________________________________________ City___________________ State ________ Zip_______________ Office Phone ____________________________________ 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 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 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 FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. ___________________________________________________ (Signature of Owner or Agent) Signed and sworn to (or affirmed) before me this ____ day of ___________, ________, by ____________________________ ________________________________ (Signature of Notary) [ ] Personally Known OR [ ] Produced Identification Type of Identification: ______________________________________ ___________________________________________________ (Signature of Contractor) Signed and sworn to (or affirmed) before me this ____ day of ___________, ________, by ____________________________ ________________________________ (Signature of Notary) [ ] Personally Known OR [ ] Produced Identification Type of Identification: ______________________________________ **ALL INFORMATION HIGHLIGHTED IN GRAY IS REQUIRED. 1625 Atlantic Beach Drive, Atlantic Beach, FL 32233 45,000 X X X X Adding a short walkway from the driveway to the garbage court and an 11' long outdoor kitchen island, a louvered roof to cover it, and two hurricane torches to our existing pool deck. Current impervious surfaces = 36%. Addition of the walkway will add 1% for a total of 37%. Adam & Jennie Leopold 1625 Atlantic Beach Drive Atlantic Beach FL 32233 949-838-4783 adam@leopold.us.com Owner Jax Outdoor Kitchens, LLC Larry Riley 2540 Kirkwood Cove Lane Jacksonville FL 32223 904-716-2907 jaxoutdoorkitchens@gmail.comL11000036268 X 7/13/2022 Lot 5, Atlantic Beach Country Club Unit 1, according to the map or plat thereof, as recorded in Plat Book 67, Page(s) 52 through 54, of the Public Records of Duval County, Florida PARCEL ID: 169505-1080 I co t- 0 _J 7.5' JEA EASEMENT -<' -0 0 0 N ' L,J = ll) -N r> LO "' z O.R. 16660-1236 65.00' r-1 I I LOT 5 -1, b V 2· s · .___ _ _____,_l -------' '------21----'1 11' Outdoor K itchenIsland 36'I [-I -Louvered Roof / 112.'"=□----=-□ --�-=□___,,,"--.--��/----+-=1□ I I I I 'rI 0l(tD _jl �I l() I I I I l I I I II 0 <( 1 1·:,,,' .. : .. , I l y � ! I \I''I I ; : ' ' 'I t I 1 + f I 'i t••I L I I I 19.2' 25' 1::::1· �' • •I I lI • • I lI • • lillJllll-1 ' I I 1-J-1--,-1.,' 20 B.R.L .. ·. · I I I t I J l I f I .' I I I' • • ' rI ' . I 1 1 I I I I J l J l I T I t 1 1 I I r C 1 I f ·1 J -I I l l 1 I I I I I l f f f I I I I l I I I I t I l r T T I 1 I 1 1 I I I I I I I • I I I I I I I I I I J I l 1 1 t 1 11·/ ·.•.•,•.·.·.•.•,•.· 3.3' BRICK / · : BR.ICK PA VER� PA VER ENTRY --0) I I .DRIVEWAY � -WALK ·•1•1111111 0 111111 1"1 I I I I I 1 I I l I "-.I I I I , I I I i I ,, I I I I I I I I I It I • I I I I # I I I I I I I l I I ; I t') t') \7 I I I ·Il I I I I I I ,� ,: I I I l I I 12.s' II I I __J I 1 1' _...... I 1 I I r,. ()" I I I • • I 10 � • I ------------ N14•27'25"W (BEARING BASE) 65.00' ATLANTIC BEACH DRI (50' RIGHT OF WAY) 0 0 • t- 0 F ND NA I L A ND D i sc L e f L t v ,4 i l ON l l : 5 8 4 8 ~ 8. 1J f" No 1 / 2 ' ' I P M IL L E R 38 4 8 -~ • v, I N -. . 1 P. T . I ' I 3 • 'I I . I H + It - id µ b l , u.. . ~ - r ··· -w ·:. .. · A/ c p I i le d - : ·. i t ' .• ·!. J I : i ·~- •- q ~ I ~ Jt1 - - I ,1. I 1 1 . -· : I I ► I I '11 : 5 ~- ~ ' ~'! . ; I I , . ' , : • • '• • • 1 2. 7• C OV E R ED I I .s · I I 2 0 ' x1 0 • J t ,4 , .. _ to u , P l v f t N r . ' E:A s t M t N r I W OO D ( 0 • EN TR Yr- . . > 9 .2 · 6 1. 3 TW O ST O R Y FR A M E RE S I D E N C E #1 6 2 5 F . F . E. = ( 1 0 . 6 7 ) 4 8 .7 > • • s1 s • 3 2 • 3 s " w L I • rr · • -· -------, , 2 . o' 4 F ND 1/2 '' IP M IL L tf? 0 848 (/) • .pi.. rJ "' .. ~ 01 : f'TI r N o 1 , <. .... 384 8 Updated 10/24/18 Owner Builder Affidavit **ALL INFORMATION HIGHLIGHTED IN GRAY IS REQUIRED.City of Atlantic Beach Building Department 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: ______________________________________________________________________________________ Owner Name: ____________________ _______ Phone Number: Mailing Address: City: ___________________ State: ___________ Zip: Notarized Signature of Owner The foregoing instrument was acknowledged before me this _____day of ___________, 20___, in the State of Florida, County of _________________ Signature of Notary Public __________________________________________________ [ ] Personally Known OR [ ] Produced Identification Type of Identification: _____________________________________________________ A t l a n t i c B e a c h C o u n t 1 y C l u b H o m e o w n e r s A s s o c i a t i o n , I n c 4 1 4 O l d H a r d R d S u i t e 5 0 2 F l e m i n g I s l a n d , F L 3 2 0 0 3 P h o n e : 9 0 4 - 5 9 2 - 4 0 9 0 F a x : 9 0 4 - 2 6 9 - 2 7 2 9 A d a m L e o p o l d a n d J e n n i e D J a c o b s o n 1 6 2 5 A t l a n t i c B e a c h D r A t l a n t i c B e a c h F L 3 2 2 3 3 A R C H I T E C T U R A L A P P R O V A L 1 6 2 5 A t l a n t i c B e a c h D r D e a r A d a m L e o p o l d a n d J e n n i e D J a c o b s o n : 8 / 6 / 2 0 2 0 W e t h a n k y o n f o r y o u r a b o v e r e f e r e n c e d a r c h i t e c t u r a l s u b m i t t a l , a n d a r e p l e a s e d t o i n f m m y o u t h a t s a m e h a s b e e n C o n d i t i o n a l l y A p p r o v e d . Y o u m a y p r o c e e d a c c o r d i n g t o t h e i n f o r m a t i o n p r o v i d e d w i t h y o u r a p p l i c a t i o n m a d e p a r t o f t h i s a p p r o v a l , t h e C o m m u n i t y G u i d e l i n e s , a n d f o l l o w i n g c o n d i t i o n s : 1 ) S u m m e r k i t c l , e n a p p r o v e d a s d e s c r i b e d i n s p e c i f i c a t i o n s a n d i n l o c a t i o n s l , o w n o n s u r v e y , a t t a c l , e d a n d m a d e p a r t o f t l , i s a p p r o v a l . 2 ) P e r g o l a c o , u l i t i o n a l l y a p p r o v e d a s d e s c r i b e d i 1 1 s p e c i f i c a t i o n s a n d i n l o c a t i o n s l , o w n 0 1 1 s c l , e m a t i c d r a w i n g p r o v i d e d b y o w n e r , a t t a c l , e d a n d m a d e p a r t o f t l , i s a p p r o v a l . T h i s a p p r o v a l i s c o n d i t i o n e d u p o n r e c e i p t o f f i n a l p l a n s t o c o n f i r m a t t a c l , m e n t m e t h o d o l o g i e s , a l i g n m e n t o f c o l u m n s w i t ! , e x i s t i n g c o l u m n s , e t c . 3 ) P e r g o l a c o l 1 1 n 1 1 1 s s l , o u l d a l i g n w i t ! , e x i s t i n g c o l u m n s a n d b e o f t l , e s a m e s t y l e a n d c o l o r . 4 ) C o l o r o f p e r g o l a s l , o u l d m a t e ! , w l , i t e t r i m o f 1 , o u s e . 5 ) B a s e d 0 1 1 t l , e s u r v e y o f y o u r l o t , i t a p p e a r s t ! , a t t h e e a s t e m e d g e o f t l 1 e w a t e r o f t l , e p o o l i s e x a c t l y a t t l , e 5 ' s e t b a c k . T h e p e r g o l a a n d a n y e x t e n s i o n s a b o v e g r o u n d s l , a l l N O T e x c e e d t h i s l i n e a n d e n c r o a c l , b e y o n d t h a t 5 ' s e t b a c k . 6 ) F i n a l p l a n s s h o u l d s h o w d e t a i l s o f t l , e c o l u m n b a s e a t p a v e r s ( i . e . , a n y e x p o s e d s u r f a c e s s l , o u l d b e c l a d w i t h p a v e r s , e t c . ) t o e n s u r e t ! , a t t l , e r e a r e 1 1 0 e x p o s e d c o n c r e t e a r e a s . 7 ) N o a d d i t i o n a l i m p e r v i o u s s u r f a c e i s r e q u i r e d o r a u t l , o r i z e d f o r t h e s e i m p r o v e m e n t s . 8 ) P e r g o l a s l , a l l c o m p l y w i t h a n y w i n d l o a d , a n c l , o r i n g o r o t l , e r s t r u c t u r a l r e q u i r e m e n t s o f a n y a p p l i c a b l e g o v e m i n g a g e n c y . T h i s a p p r o v a l c o n c e r n s o n l y y o u r s u b m i t t e d a r c h i t e c t u r a l p l a n s . I t i s y o u r r e s p o n s i b i l i t y t o o b t a i n a n y e a s e m e n t s , p e r m i t s , l i c e n s e s a n d o r a p p r o v a l s w h i c h m a y b e n e c e s s a r y t o i m p r o v e t h e p r o p e r t y i n a c c o r d a n c e w i t h t h e a p p r o v e d p l a n s . T h i s a p p r o v a l m u s t n o t b e c o n s i d e r e d t o b e p e r m i s s i o n t o e n c r o a c h o n a n o t h e r p r o p e r t y o w n e r ' s r i g h t t o u s e a n d e n j o y a l l p o s s i b l e p r o p e r t y r i g h t s . A p p r o v a l o f t h i s s u b m i t t a l d o e s n o t c o n s t i t u t e a w a r r a n t y o r r e p r e s e n t a t i o n b y t h e A C C , o r a n y d e v e l o p e r o r l a n d o w n e r , t h a t t h e p r o p o s e d i m p r o v e m e n t s w i l l b e c o n s i s t e n t w i t h t h e d e v e l o p m e n t p l a n s o f a n y o t h e r l a n d o w n e r . 1 F u r t h e r m o r e , t h i s a p p r o v a l d o e s n o t i n a n y w a y g r a n t v a r i a n c e s t o , e x c e p t i o n s , o r d e v i a t i o n s f r o m a n y s e t b a c k s o r u s e r e s t r i c t i o n s u n l e s s a s p e c i f i c l e t t e r o f v a r i a n c e r e q u e s t i s s u b m i t t e d , a n d a s p e c i f i c l e t t e r o f " v a r i a n c e a p p r o v a l " i s i s s u e d b y t h e p a r t y e n t i t l e d t o e n f o r c e s u c h s e t b a c k s o r r e s t r i c t i o n s . T h i s a p p r o v a l a l s o d o e s n o t c o n s t i t u t e a p p r o v a l o f a n y t y p o g r a p h i c a l , c l e r i c a l , o r i n t e r p r e t a t i v e e r r o r s o n t h e s u b m i t t e d p l a n s . C o m p l i a n c e w i t h a l l a p p r o v e d p l a n s i s t h e r e s p o n s i b i l i t y o f t h e O W N E R o f l e g a l r e c o r d , a n d a n y c h a n g e t o t h e a p p r o v e d p l a n s w i t h o u t p r i o r A C C a p p r o v a l , s u b j e c t s t h e s e c h a n g e s t o d i s a p p r o v a l , a n d e n f o r c e d c o m p l i a n c e t o t h e a p p r o v e d s u b m i t t e d p l a n s . T h i s a p p r o v a l s h o u l d n o t b e t a k e n a s a n y c e r t i f i c a t i o n a s t o t h e c o n s t r u c t i o n w o r t h i n e s s o r s t r u c t u r a l i n t e g r i t y o f t h e c h a n g e p r o p o s e d . A l l l o c a l b u i l d i n g c o d e s m u s t b e m e t . I f a B u i l d i n g P e r m i t i s r e q u i r e d , o n e m u s t b e o b t a i n e d f r o m t h e a p p r o p r i a t e g o v e r n m e n t a l a g e n c y . I n a d d i t i o n , y o u a s t h e p r o p e r t y o w n e r a r e r e s p o n s i b l e f o r p o s i t i v e d r a i n a g e d u r i n g a n d a f t e r c o n s t r u c t i o n . N o w a t e r d r a i n a g e i s t o b e d i v e r t e d t o a n y a d j o i n i n g l o t s . A l s o p l e a s e n o t e , y o u a r e r e s p o n s i b l e f o r c o n t a c t i n g t h e a p p r o p r i a t e U t i l i t y C o m p a n i e s p r i o r t o a n y e x c a v a t i o n o r d i g g i n g . W e a p p r e c i a t e y o u r c o o p e r a t i o n i n s u b m i t t i n g y o u r r e q u e s t f o r a p p r o v a l . R e s p e c t f u l l y , ; ~ ~ · I B y : ~ L A I , , . , . - . , ; ~ ' , H e r b e r t B o y e t t , A r c h i t e c t u r a l R e v i e w C o o r d i n a t o r F l o r i d i a n P r o p e r t y M a n a g e m e n t F o r : A t l a n t i c B e a c h C o u n t r y C l u b H o m e o w n e r s A s s o c i a t i o n , I n c . 2 A t l a n t i c B e a c h C o u n t r y C l u b H o m e o w n e r s A s s o c i a t i o n , I n c 4 1 4 O l d H a r d R d S u i t e 5 0 2 F l e m i n g I s l a n d , F L 3 2 0 0 3 P h o n e : 9 0 4 - 5 9 2 - 4 0 9 0 F a x : 9 0 4 - 2 6 9 - 2 7 2 9 A d a m L e o p o l d a n d J e n n i e D J a c o b s o n 1 6 2 5 A t l a n t i c B e a c h D r A t l a n t i c B e a c h F L 3 2 2 3 3 A R C H I T E C T U R A L A P P R O V A L 1 6 2 5 A t l a n t i c B e a c h D r D e a r A d a m L e o p o l d a n d J e n n i e D J a c o b s o n : 8 / 6 / 2 0 2 0 W e t h a n k y o u f o r y o u r a b o v e r e f e r e n c e d a r c h i t e c t u r a l s u b m i t t a l , a n d a r e p l e a s e d t o i n f o r m y o u t h a t s a m e h a s b e e n a p p r o v e d . Y o u m a y p r o c e e d a c c o r d i n g t o t h e i n f o r m a t i o n p r o v i d e d w i t h y o u r a p p l i c a t i o n m a d e p a r t o f t h i s a p p r o v a l , t h e C o m m u n i t y G u i d e l i n e s , a n d f o l l o w i n g c o n d i t i o n s : 1 ) P a v e r w a l k w a y a p p r o v e d a s d e p i c t e d i 1 1 s p e c i f i c a t i o 1 1 s p r o v i d e d b y o w 1 1 e r , a t t a c h e d a u d m a d e p a r t o f t l t i s a p p r o v a l . 2 ) W a l k w a y a p p r o v e d w i t h p a v e r s t h a t m a t c h e x i s t i 1 1 g d r i v e w a y a 1 1 d w a l k w a y a s s l t o w 1 1 i 1 1 p l t o t o g r a p l t s s u b m i t t e d b y o w 1 1 e r , a t t a c h e d a 1 1 d m a d e p a r t o f t l t i s a p p r o v a l . 3 ) U t i l i t y l o c a t e s a r e r e c o m m e n d e d p r i o r t o a 1 1 y e x c a v a t i o 1 1 . T h i s a p p r o v a l c o n c e r n s o n l y y o u r s u b m i t t e d a r c h i t e c t u r a l p l a n s . I t i s y o u r r e s p o n s i b i l i t y t o o b t a i n a n y e a s e m e n t s , p e r m i t s , l i c e n s e s a n d o r a p p r o v a l s w h i c h m a y b e n e c e s s a r y t o i m p r o v e t h e p r o p e r t y i n a c c o r d a n c e w i t h t h e a p p r o v e d p l a n s . T h i s a p p r o v a l m u s t n o t b e c o n s i d e r e d t o b e p e 1 m i s s i o n t o e n c r o a c h o n a n o t h e r p r o p e r t y o w n e r ' s r i g h t t o u s e a n d e n j o y a l l p o s s i b l e p r o p e r t y r i g h t s . A p p r o v a l o f t h i s s u b m i t t a l d o e s n o t c o n s t i t u t e a w a r r a n t y o r r e p r e s e n t a t i o n b y t h e A C C , o r a n y d e v e l o p e r o r l a n d o w n e r , t h a t t h e p r o p o s e d i m p r o v e m e n t s w i l l b e c o n s i s t e n t w i t h t h e d e v e l o p m e n t p l a n s o f a n y o t h e r l a n d o w n e r . F u r t h e r m o r e , t h i s a p p r o v a l d o e s n o t i n a n y w a y g r a n t v a r i a n c e s t o , e x c e p t i o n s , o r d e v i a t i o n s f r o m a n y s e t b a c k s o r u s e r e s t r i c t i o n s u n l e s s a s p e c i f i c l e t t e r o f v a r i a n c e r e q u e s t i s s u b m i t t e d , a n d a s p e c i f i c l e t t e r o f " v a r i a n c e a p p r o v a l " i s i s s u e d b y t h e p a r t y e n t i t l e d t o e n f o r c e s u c h s e t b a c k s o r r e s t r i c t i o n s . T h i s a p p r o v a l a l s o d o e s n o t c o n s t i t u t e a p p r o v a l o f a n y t y p o g r a p h i c a l , c l e r i c a l , o r i n t e r p r e t a t i v e e r r o r s o n t h e s u b m i t t e d p l a n s . C o m p l i a n c e w i t h t h e a p p r o v e d p l a n s i s t h e r e s p o n s i b i l i t y o f t h e O W N E R o f l e g a l r e c o r d , a n d a n y c h a n g e t o t h e a p p r o v e d p l a n s w i t h o u t p r i o r A C C a p p r o v a l , s u b j e c t s t h e s e c h a n g e s t o d i s a p p r o v a l , a n d e n f o r c e d c o m p l i a n c e t o t h e a p p r o v e d s u b m i t t e d p l a n s . I n a d d i t i o n , y o u a s t h e p r o p e r t y o w n e r a r e r e s p o n s i b l e f o r p o s i t i v e d r a i n a g e d u r i n g a n d a f t e r c o n s t r u c t i o n . N o w a t e r d r a i n a g e i s t o b e d i v e r t e d t o a n y a d j o i n i n g l o t s . A l s o p l e a s e n o t e , y o u a r e r e s p o n s i b l e f o r c o n t a c t i n g t h e a p p r o p r i a t e U t i l i t y C o m p a n i e s p r i o r t o a n y e x c a v a t i o n o r d i g g i n g . 1 W e a p p r e c i a t e y o u r c o o p e r a t i o n i n s u b m i t t i n g y o u r r e q u e s t f o r a p p r o v a l . R e s p e c t f u l l y , - - / : - ; ; : , ~ i l B y : F o r : > e r e : - \ , I H e r b e r t B o y e t t , A r c h i t e c t u r a l R ~ J ; W i l l ! o r i , F l o r i d i a n P r o p e r t y M a n a g e m e n t A t l a n t i c B e a c h C o u n t r y C l u b H o m e o w n e r s A s s o c i a t i o n , I n c . 2 ACC20-0047 Revision Request/Correction to Comments City of Atlantic Beach Building Department 800 Seminole Rd, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email: Building-Dept@coab.us 0 Revision to Issued Permit Project Address: Contractor/Contact Name: Contact Phone: OR D Corrections to Comments Email: Description of Proposed Revision/ Corrections: 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? No D Yes (additional s.f. to be added: ____________ ) •~ill proposed revision~~orrec~ions ad~ addi_ti~nal increase in building value to original submittal? l!:JNo Dves (add1t1onal increase In building val . $ __________ , ntractor must sign if increase in valt.:a-:ion) {Office Use Only) {/Approved D Denied D Not Applicable to Department Permit fee Due$ _____ _ Revision/Plan Review Comments _____________________________ _ Department Review Required: Building Planning & Zoning Tree Administrator Public Works Public Utilities Public Safety Fi re Services Reviewed By Date Updated 10/17 /18 ACC20-0047 Building Permit Application City of Atlantic Beach Building Department 800 Seminole Road, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email: .;;;;..;:..:..;..:;,.;=.;.~...;;;;:_=...::;...:........:::::-=.:::::..::::::..:.;;;:.:::, Job Address: __ l_o ..... · ---,,---c----../t+-c:-,-_1 ~'1:_•:_:-=------------ Legal Description ------'L-Li!:+-+-..l::::.l!~L-.--L!..-l--,FJ..~'2-~i:z:::::::..e:2._t__ __ ~l&JlLIJ.-kW4t'.I-L¥-- Updated 10/9/18 **ALL INFORMATION HIGHLIGHTED IN GRAY IS REQUIRED. Valuation of Work (Replacement Cost) .,, __ --=:.,c...i~.,L_ __ 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 ~Residential • If an existing structure, is a fire sprinkler system installed?: □Yes ~o • Will tree s be removed in association with ro osed 0 Describe in detail the type of work to be performed: A.L._..,,..,,.,.,..u,, Ii ed +lt.e Florida Product Approval # ___________________ for multiple products use product approval form Property Owner Information Name ----~----,,-: City -~~~L4--..LL.; E-Mail s, Owner or Agent (If Agent, Power o Attorney or Agency Letter Required)--+:~.::.=-.,!_£.~--------------- Contractor Information Name of Company ________________ Qualifying Agent _______________ _ Address City ________ State ___ Zip _____ _ Office Phone Job Site Contact Number ----------------St ate 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 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 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 FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE 6 YOUR NOTICE OF c .. -v, .. ,.,.ENCEMENT. / {Signature of Contractor) Signed and sworn to (or affirmed) before me this __ day of -----____ ,,by ___________ _ (Signature of Notary) [ ] Personally Known OR [ J Produced Identification Type of Identification: _____________ _ ACC20-0047 Owner Builder Affidavit City of Atlantic Beach Building Department 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 ANO 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 .. Ill. 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 11 IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE 11 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: Owner Name:f :i:t< Mailing Address: Notarized Signature of Owner The~n1in~r.ument was ackno 0 f ~~tt,:& in the State of Florida, County [ ] Personally Known OR ~duced Identification Updated 10/24/18 ACC20-0047 AFFIDAVIT FOR ATTACHING A NEW STRUCTURE TO AN EXISTING TO: Building Inspection Department, City of Atlantic Beach, 800 Seminole Road Contractor: __ {1.,,.._w __ fl_tt_" ___ B_--_t.1._J_' ___ (_cte_-___ ,-___________ _ Permit Nnmber ------ As the Contractor for the proposed new structure located at the above address, I have persona Uy viewed with the above named home owner those portions of the existing structure on which portions of the proposed new structure are to be attached for structural support. I am confident that the drawings and details included with this permit application depict the existing conditions of the host structure, and the members of the existing structure upon which the new structure are to be attached are sound with no rot or deterioration. The home owner has been advised by me that, in my best judgment based on experience and know]edge of structural adequacy, the members of the existing structure upon which the new structure are to be attached are sound with no rot or deterioration and will support all structural loads and forces imposed on them. By signing below, I hereby declare that I will hold the City of Atlantic Beach harmless and release it from any responsibility and liability for any adverse consequences or failures resulting from this work, and further that I will not initiate, execute or eajoin any legal action against the City of Atlantic Beach for such consequences or failures. A copy of this document will be recorded as an official :record with the Building Inspection Department permit history so that any and aU futur buyers/olnters of this property may be made aware of th~~1.1.:, of work performed on this s ctur • 1 ona ID Type·-==-,_4,dd.~~~~£:::.~~~~::_ ________ _ F: building/affidavit for attaching a new structure to an existing structure,docx Commission II GG 140597 My Comm. Expires Sep 4, 2021 7/21/09 e Lo t 5 - 16 2 5 At l a n t i c Be a c h Dr i v e 65 ' - - - - - - - - ~ r - - - - - - - - - - - 7 ' 14 ' I/ 20 ' [[ Ex i s t i n g Po o l De c k N e w Lo u v e r e d Ro o f Ho m e Revision Request/Correction to Comments **ALL INFORMATION HIGHLIGHTED IN GRAY IS REQUIRED. City of Atlantic Beach Building Department 800 Seminole Rd, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT #: _____________________ Revision to Issued Permit OR Corrections to Comments Date: ________________ Project Address: ____________________________________________________________________________________ Contractor/Contact Name: ____________________________________________________________________________ Contact Phone: ______________________________ Email: _________________________________________________ Description of Proposed Revision / Corrections: __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ I_______________________________ 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? No Yes (additional s.f. to be added: _____________________________)  Will proposed revision/corrections add additional increase in building value to original submittal? No *Yes (additional increase in building value: $____________________) (Contractor must sign if increase in valuation) *Signature of Contractor/Agent: _______________________________________________________ __________________________________________________________________________________________________ (Office Use Only) Approved Denied 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 □ □ □ □ □ □ □ □ □