690 Plaza RESO21-0040 Backyard Paver PatioOWNER:ADDRESS:CITY:STATE:ZIP:
TODD CAMERON D 690 PLAZA ATLANTIC BEACH FL 32233-4162
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171293 0000 ROYAL PALMS UNIT 02
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
690 PLAZA
RESIDENTIAL OTHER SINGLE OR
TWO FAMILY RESIDENTIAL
OTHER
backyard paver patio $5500.00
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 ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during 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: 5/21/2021
PERMIT NUMBER
RESO21-0040
ISSUED: 5/21/2021
EXPIRES: 11/17/2021
RESIDENTIAL OTHER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
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 $100.00
TOTAL: $125.00
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 INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Contractor.
2 of 2Issued Date: 5/21/2021
PERMIT NUMBER
RESO21-0040
ISSUED: 5/21/2021
EXPIRES: 11/17/2021
RESIDENTIAL OTHER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $125.00
RESO21-0040 Address: 690 PLAZA APN: 171293 0000 $125.00
PUBLIC WORKS PLAN REVIEW $25.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
ZONING PLAN REVIEW $100.00
ZONING REVIEW SINGLE AND TWO FAMILY
USES 001-0000-329-1003 0 $100.00
TOTAL FEES PAID BY RECEIPT: R15878 $125.00
Printed: Friday, May 21, 2021 9:53 AM
Date Paid: Friday, May 21, 2021
Paid By: TODD CAMERON D
Pay Method: CREDIT CARD 458055033
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R15878
Final Plumbing
Final Electrical
Final HVAC
CC Final
Final Building*
Swimming Pool Steel
Swimming Pool Safety
Electrical Grounding & Bonding
Swimming Pool Final (Bldg)
Swimming Pool Final (PW)
Formed Columns/ Beams*
Masonry Cell Fill
Structural Steel*
OTHER:
OTHER:
OTHER:
OTHER:
OTHER:
Power Pole
Silt Fence
Piers/ Stem Walls
Underground Plumbing
Underground Electric
Foundation/ Footing
Slab**
Retaining Wall Footing
Driveway
Sewer (Building Dept)
Sewer Tap (Utilities Dept)
Rough Electric*
Rough Plumbing/ Top Out*
Rough Mechanical*
House Wrap
Wall Sheathing
Roof Sheathing
Tie-down Framing Connections
Rough Framing
Roofing In Progress
Window/Door In-Progress
Insulation Ceiling
Insulation Wall
Exterior Lath
Stucco Scratch Coat
Exterior Siding In-Progress
Brick Flashing & Ties
Early Power
Gas Rough
Gas Final*
* When all rough electric, plumbing, mechanical are complete but before any work is
covered up.
* When all gas piping is complete and wallboard is installed but before gas is
attached to any appliance. All outlets must be capped and pipe pressurized at a
minimum of 15 lbs.
* For new living space: When all construction work including electrical, plumbing,
mechanical, exterior finish, grading, required paving and landscaping is complete
and the building is ready for occupancy, but before being occupied
Additional inspections may apply to your project if your project
contains these elements:
INSPECTIONS REQUIRED FOR BUILDING PERMITS
To verify compliance with building codes, inspections of the work authorized are required at various points of the construction.
The following inspections are typically required for residential projects:
Date: Initial: Date: Initial:
_____________________________________________________
Permit Type
____________________________________________________
Permit No.
__________________________________________________________
Job Address
____________________________________________________
Contractor
POST THIS CARD WITH PERMITS AND PERMIT
DOCUMENTATION IN FRONT OF BUILDING
Construction Hours per City Code: 7am—7pm Weekdays; 9am—7pm Weekends
Building Department Public Works/Utilities Fire Department
Phone: 904-247-5826 Phone: 904-247-5834 Phone: 904-630-4789
Fax: 904-247-5845 Fax: 904-247-5843 Fax: 904-630-4203
* When forms and reinforcing steel, anchor bolts, sleeves and inserts, and all
electrical, plumbing and mechanical work is in place, but before concrete is poured.
* When all structural steel members are in place and all connections are complete,
but before such work is covered or concealed.
** FORM BOARD ELEVATION CERTIFICATE MUST BE ON-SITE FOR SLAB INSPECTION
Building Permit Application Updated 10/9/18
C-•City of Atlantic Beach Building Department ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233HIGHLIGHTED IN GRAY
IS REQUIRED.
LLP
hone: (904) 247-5826 Email: Building-Dept@coab.us
I?Job Address: Pu `c,..Zc. Permit Number:
Legal Description 30-0-AR \-1-25-2cA_E. Rc..1c,\Pc\r .)(1;2 Lo\B.O \k.7Z RE# Vi 12 -3-OY ")O
Valuation of Work(Replacement Cost)$ 5;500 Heated/Cooled SF Non-Heated/Cooled
Class of Work: dNew Addition Alteration Repair Move DDemo Pool Window/Door
Use of existing/proposed structure(s): Commercial ESResidential
If an existing structure,is a fire sprinkler system installed?: Yes No
Will tree(s)be removed in association with proposed proiect? Yes(must submit separate Tree Removal Permit) 'No
Describe in detail the type of work to be performed: 2e-k,c, S,,:,,% `'X„,,vs wAA., n cv Q•c -,1-
3. , 5r'c,.\\ vex" x,, ov\ k-o oG
5 t
Qnc .X S v\9 GA,rc.c. ,
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name ec.,v t<o n \oaf\ Address 6q() Q\(,.:7
City AN\c c- c.ca„ State \-L_ Zip X223-Phone Z•5---I13ti-1`\Lk
E-Mail C q @\ic,\noa e cc5c•'‘
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) 0\_.)c\—c-
Contractor Information
Name of Company \ . S- —z c` Qualifying Agent cu S,c1Y7 S v
Address VAS-16\ f-.\\\ r'f 1k City Jcsc\&Sor ' \ S=1_ Zip ',ZZc-2Z
Office Phone A011-1--V ,-1/4.:.22.2\ Job Site Col tact Number
State Certification/Registration#_2-7/13.3-e- ail
Architect Name&Phone#
Engineer's Name-. ' one#
W rs Compensation Insurer OR Exempt o 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 hag
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
REC OTICE OF COMMENCEMENT.
Signature of Owner or Agent) Signature of Contractor)
Sired and sworn to(or affirmed)before me this_I a
ay of Signed and sworn to(or affirmed)before me this day of
iV\
i , 3D6 ( , .y - Caei ct v , -0 by
t -; -. Signature of Notary)
R..
4.:....,....
JENNIFER JOHNS
MY COMMISSION 1t HH
057579TON
7. .a :' EXPIRES:October Y0y4 ( ] Known ORPersonallyKnownOR '•`:??: g Personally
Wroduced Identificatign under' + ( ]Produced Identification
Type of Identification: f L c . i ,,, ' _ L k ,I1 111' Type of Identification:
Owner Builder Affidavit ALL INFORMATION
p HIGHLIGHTED IN
b 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: GaO 111111111114F
Owner Name: etc , A Phone Number: VA-7k-14-r8
Mailing Address: CCM 1b Zc. City: pAke..,.k:L State: r L Zip: ',ZZ 33
Notarized Signature of Owner
M
The foregoing instrument was acknowledged before me this I a day of 1" QN ,20a-1, in the State of Florida, County
of 0,A Oct
Signature of Notary Public
01;•*. JENNIFERJOFWSTON
MYCOMNWtSSKW#H4057579
Personally Known OR [ roduce Identification
r,T EXPIRES:October 27,2024
Fg.W 8atle:I ntuNoWyPubicUndawdars Type of Identification: rt- i 1 J 1-,C t p l
Updated 10/24/18
MAP SHOWING BOUNDARY SURVEY OF
LOT 20 BLOCK 8 AS SHOWN ON MAP OF
ROYAL PALMS UNIT T1V()
AS RECORDED IN PLAT BOOK 30 PAGES 94-94A OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY FLORIDA
CERTIFIED TO, CAMERON 0 TODD.Cl AIRE L TODD BANK OF ENGLAND
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ABOVE SURVEYOR HERE ON/At l CONE IP 6.1
OK ADDITIONAL FEE DATE OF FIELD SURVEY NAI HAN P.PERRET,FLA.CERT.NO0 LB-6715
F B 16A PG. 73 NOTVAi•1I..1,I:,IT111(SIONATURtAORKUNALIlAISI2SEALO1A1LOR:UALICENSEDSURVEYORBMAPPER ORDER NO 2014-338
MAP SHOWING BOUNDARY SURVEY OF
LOT 20 BLOCK 8 AS SHOWN ON MAP OF
ROYAL PALMS UNIT T1V()
AS RECORDED IN PLAT BOOK 30 PAGES 94-94A OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY FLORIDA
CERTIFIED TO, CAMERON 0 TODD.Cl AIRE L TODD BANK OF ENGLAND
OSBORNE 8 SHE FEIEI D TITLE SERVICES,LLC,FIRST AMERICAN TITLE INSURANCE COMPANY
11D E C-E 6 V kr
DEC 132016 '
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PC PONT OF CURVET/HE R RA'H111
9I AHINGSSNOVM HEREON ARE BASED ON
PI ATM Ol T..NOEN., ARD CRETE(CONTRA_ANGEL
THE SOUTHERLY RAN LINE OF PLAZA AS16C6161 OF REVERSE MEMARL AAT:/ERGO.
PER PLAT rcc mhT osc oo.oCIlIA2 CROM u.oRn
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PROPERTY HAVE NOT BEEN LOCATE 0 OH
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SCALE 1'
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LEE or TME LOAN ON THE PROPERTY SH3-11-14
ABOVE SURVEYOR HERE ON/At l CONE IP 6.1
OK ADDITIONAL FEE DATE OF FIELD SURVEY NAI HAN P.PERRET,FLA.CERT.NO0 LB-6715
F B 16A PG. 73 NOTVAi•1I..1,I:,IT111(SIONATURtAORKUNALIlAISI2SEALO1A1LOR:UALICENSEDSURVEYORBMAPPER ORDER NO 2014-338