128 BEACH AVE RFNC21-0054 . 0-4/1-r, Building Permit Application Updated 10/9/18
40
"Y s) City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
�'f-Y IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us ~7
Job Address: (2�p S G.t b- tkv v , Permit Number: R K C.•C._( -005 4-
Legal
Legal Description t-b 't. 7- 3\• c-Ae--. 3 1t S ,1�A,'v/;C,,.,. A RE# 1 1 (3 �iU-1 - 0O40
Valuation of Work(Replacement Cost)$ q0 p , o. Heated/Cooled SF h\/A_ Non-Heated/Cooled Vf)_.
• Class of Work: i'7New Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial lgsidential
• If an existing structure, is a fire sprinkler system installed?: (=Yes �Jo
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ENO
Describe in detail the type of work to be performed:
(N4 Co4�cA, Lt( 'r tt.
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name W11-1-1Ac14 SaCtilK.14J Address 133 Brzttctt k/ 1uE
City ,43 ClL— (77 ACti- State ft.- Zip Phone (4t4 )cri3Coll
E-Mail For-two a ow.Cow%
Owner or Agent(If Agent, Pdwer of Attorney or Agency Letter Required)
Contractor Information �7
Name of Company f�c> l'e'\ c\ 1•rA.-1 ��N t' C.-Qualifying Agent (Zo\,.c. .)-- '- - v^a-./wpb-c.i
Address 1 O % .S frl-\G... c, 'S l,.R,, c•••- -1-c Z-?'4) City A -\G.n1-%.. c ck State)' r Zip 'L, 2.L3
Office Phone Qc.t-1- S-1 c-1`6147 Job Site Contact Number 6k0'I - SHS- 1s1 t.
State Certification/Registration # C.,15 Cc.) 53-5 3 E-Mail I Q-- 1,...2-, \,,,.(k c o_.i--L. ✓`+ZA—
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 IMPROVEMENTSJO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING R�� 1J YOUNOTICE OF COMMENCEMENT. /
(Signature of Own r Agent) p (Signature o • -
Si ned and sworn to(or affirm d)before m thiscJL)day of S n d and(worn to(or ffir ed)before me hit I day of
by 1 Y/ I se
-(/% ") by o hOpt v1 v 41•—
(Signature of Notary) Gign-4, , .ta
•:.. rpt.. CYNTHIA SAMIIITO ELLISEN I
f: , ,F:1 Notary Public-State of Florida
X]Personally Known OR ( _� `; Commission a GG 958394 '[ ] Personally Known OR
?or n. My Comm.Expires May 17,2024 ( ._ ' TONI GiNDLESPERGER
[ ]Produced Identification [ ] Produced Identification ;o.• : •�:
Type of Identification: ( Bonded through National Koury Assn. (f Type of Identification: '•4 c+: MY COMMISSION#GG 353178
n�
••.i 3: tXF'IRES:October t1,2023
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Fence Addendum Updated 1/14/2021
City of Atlantic Beach Building Department
,, ' v 800 Seminole Road, Atlantic Beach, FL 32233
_on> PERMIT# E NC I —
Phone: (904) 247-5826 Email: Building-Dept@coab.us OU
Job Address: Date:
t2`0 $L4-Cit-- ikv— LthA
Pr erty Type: Lot Type/ Features:
Residential 0 O e Street frontage (interior lot)
❑ Commercial ore than one street frontage (corner lot,through lot,
etc.)
❑ Swimming Pool
Fe9,e6 Material: Fere Height (select all that apply):
LE/Wood our Foot (4ft)
❑ Chain Link 0 Six Foot(6ft)
❑ Vinyl ❑ Other
❑ Block/Stone (Plan details required for footings and/or
retaining walls)
❑ Other
Fence Location:
Please submit an accurate and current boundary survey showing all existing improvements (including building footprint,
driveway,swimming pool, etc.) and location of fence/wall and any gates. Plan details required for block wall footings and/or
retaining walls and any portion or fencing above 6ft in height.
Will the fence be built in an easement?
�sNo
(must submit separate Revocable Encroachment Agreement)
Will tree(s) be removed in association with proposed project?
s (must submit separate Tree Removal Permit)
No
Conditions of Approval:
• Roll off container company must be on City approved list. Roll off container cannot be placed on City right-of-way.
• All old fencing and debris must be removed from job site by contractor or homeowner.
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.
MAP SHOWING BOUNDARY SURVEY OF
LOT 2, BLOCK 31, SUBDIVISION "A" ATLANTIC BEACH. AS RECORDED IN PLAT BOCK 5,
PAGE 69. OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO:
MICHAEL K. DIAZ AND KELLY A. DIAZ
HILLCREST TITLE AND TRUST AGENCY, LLC
FIRST AMERICAN TITLE INSURANCE COMPANY
BEACH AVENUE
,40'44011 04 WAY;
50.00' (PLAT)
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(UNLCSS1/201410IRO1141/50RNO1E0)HOEMTIFiCA
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• NOTES: REVISIONS
1.BEARINGS ARE BASED CO 140ASSUM�O _BEARING OF S 1.3_43_439_VI____ALONG THE
SOUTHERLY BOUNDARY LINE OF SUBJECT PARCEL. DATE DESCRIPTION
2. DY CRAPH'C PLOTTING ONLY INE CAPTIONED LANDS LiE WITHIN 0L000 ZONE _ -)1 AS COWAN ON THE
NATIONAL 0.0001NS4JRA#CE 4AP'16700 .3I310 3, 2013. CI.11YINITY NU40ER 121S75, RANEI _O409_lt_. •
3. 514$SURVEY REFLECTS ALL EASEI.IENTS &RIGHTS OF WAY AS PER RECORDED PLAT&/OR TITLE COMMITMENT
K SUPPLIED. UNLESS OTHERWISE STATED, NO OTHER TITLE VERIFICATION HAS BEEN PERFORMED BY THE UNDERSIGNED.
4: THIS SURVEY IS NOT VALID WI'HOW AN AUTHENTICATED EI.ECT900IC SIERATURE AND AUTHENTICATED ELECTRONIC SEAT.
308 # 29598 I DATE OF FIELD SURVEY: OA_27_16 - I SCALE: 1' = 20
I Ray Thompson CERTIFICATE
SURVEYING, Inc. i{6091 E.-Carry NAT 14(15 ' y.°E UNDER NY RE90N90E 0PARC
AND wrETs n¢STAACOROS f . A��1L1�• T FORD.ay T.+C rEa+mA
4 wANO Tx , EssoN E NJ •' • CNARTEA 5-I r,rLGRIDA
( I ATAI.14S1RATIVE C.: • .ANT" DN 0 LO41°A STATUTES.
Going the DISTANCE for You 4g;i4�
i `I IIII 1825 University Boulevard West .' VA
i h . ' 1 Jacksonville,Florida 32217 — iA. —
r ' (Phone)904-448-5125 R_LSITRCL SJR., • ANU,4APPCR 146 STATE C." 1LPTDA
(Fax) 904-448-5178 L*"+,SE.1luSNF`}s 7469
LAND SURVEYS 0 CONSTRUCTION SURVEYS a I-sCswEY` BDIVISIONS