Permit Fence 61 Ardella 2011 itt, : ' x� CITY OF ATLANTIC BEACH
. :'i ". ) 800 SEMINOLE ROAD
' ATLANTIC BEACH, FL 32233
` INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002124 Date 6/20/11
Property Address 61 ARDELLA RD
Application type description FENCE PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 400
Application desc
Replace 6' cedar fence side and rear
Owner Contractor
BOEREM OWNER
61 ARDELLA ROAD
ATLANTIC BEACH FL 32233
Permit FENCE PERMIT
Additional desc .
Permit Fee . . . 35.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 12/17/11
Special Notes and Comments
Roll off container company must be on City approved list
and container cannot be placed on City right -of -way.
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 35.00 35.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 39.00 39.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
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tli 1..,.•.i\ CITY OF ATLANTIC BEACH
®WNER / BUILDER AFFIDAVIT
1. 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 REOUIRED 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. TELEPHONE THE
BUILDING DEPARTMENT (247 -5826) 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. ? ,
ESS PHONE NUMBER
- INT NAME /
)1•._ ' -„-- •-URE / DATE
1 1
Before me this/ day of
) r h -4
, 200 in the county of
Duval, State of Florida, has personally appeared e in by himself / herself and affirms that
all statements and declarations are tr d accu e.
Notary Public at Large, State of County of __
❑ Personally Known 7 %� - / f rl
`�rodursd 'den nation - / t � �/ R A. WHITE
t n IY.y��
( ,n • ., MY COMMISSION DEBOAH fl DD 634126
l
Notary .na re: /� / _` Q EXPRES: M 21, 2011
y ,, �, r,a,, Bonded Thru Notary Public Underwriters
F: BLDG /Owner - Builder Affadavit; REVISED: 4/16/2009
WARNING
Pulling an Owner /Builder Permit is Risky Business!
If you do not intend to do the work yourself and have been asked by
:° someone without a contractor's license to pull the permit, you are at risk of
financial harm.
Section 489.103 (7), Florida Statutes requires that when property owners
" act as their own contractor, they must supervise the work being performed.
4 Any person working on your building who is not licensed must be employed
by you, which means that you must deduct F.LC.A. and withholding tax and
provide workers' compensation for that employee.
4
Without workers' compensation insurance, you could
be held liable for injuries incurred on your property. .,
Typically, your homeowners' insurance policy will
not honor your claim if the work being performed
required a licensed contractor. You could end up
144' 44t ' responsible for thousands of dollars of medical bills
t
p , "fl Not only is it dangerous, but it's against the law.
Section 455.227(1)(j), Florida Statutes prohibits any person from aiding,
assisting, procuring, employing or advising any unlicensed person or entity.
Individuals who aid unlicensed persons may face fines of up to $5,000.
Is it worth ft
For more information, speak with your local building Florida Department&
department before you apply for a permit or contact the Bu
sIn Q)
Profess al
Department of Business and Professional Regulation at Regulation
850.487.1395 or online at www.MyFloridaLicense.com
License Efficiently. Regulate Fairly,
City tY o f Atlantic Beach
/ '"' APPLICATION NUMBER
r ' " ti� .. Building Department / 410 v„ , o be assigned by the Building Department.)
800 Seminole Road 4' Z
� Atlantic Beach, Florida 32233 -5445 "F !� en, / /" `
, / /
Ott .
r Phone (904) 247 -5826 Fax (904) 247 -5845 `� /Z 3 / �/
,7-
Email: building- dept @coab.us Date routed:
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 2 / ‘6.-6(c. d 4k k Department review required Yes No
Building
Applicant: - Planning & Zoning t.7
Tree Administrator
Project: - -1, - Lk Public Works ✓
f r� Pu is Utilities` V
Public Safety
Fire Services
66er
Review fee $ ,.' Dept Signet
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: pproved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date: C7�/ �/
TREE ADMIN. Second Review:
❑Approved as revised. ❑Denied.
3 , ` C ., me , ts:
ll• BLIC UTILITIES
s 2
PUB • ETY Reviewed by: Date:
FIRE SERVICES Third Review: DApproved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
r .A.e,J, City of Atlantic Beach APPLICATION NUMBER
r . f Building Department (To be assigned by the Building Department.)
800 Seminole Road / / //
°" r) Atlantic Beach, Florida 32233 -5445 (/ ( Z
Phone (904) 247 -5826 • Fax (904) 247 -5845 ` / ?� //
T j„ E -mail: building- dept @coab.us Date routed: / ,7
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: -e'.i% Department review required Yes No
Bull_ a T _-,
Applicant: /C.,/--v Planning & Zonin•
- e ' • ministrator
Project: „..—......_e_ Public Works
, Public Utilities
Public Safety
Fire Services
Review fee $= Dept 'Signature ` ..
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: Et pproved. Denied. i
(Circle one.) C , .-
BUILDING
/— PLANNING & ZONIN 1 �/ Reviewed by: �`'"'�”" –" Date: 5 .l 3 1//
TREE ADMIN.
Second - : ew: ['Approved as revised. ['Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
t., r City of Atlantic Beach
f��, ',, � APPLICATION NUMBER
as � , Building Department 414, b (To be assigned by the Building Department.)
=- 800 Seminole Roa /�
Ai
" °' Atlantic Beach, Flo 32233 - 5 445 ? T, / z L/
Phone (904) 247 -5826 • Fax (904) 24 ``_'~ °
/
o j t > E -mail: building- dept @coab.us " ileOlf --....________ Date routed: L ; ®��
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: C� ` � 4- -e �' c_ - Department review required Yes No
Building
Applicant: ( fZ(i') , t --- -i Planning & Zoning ✓"
Tree Administrator
Project: ;� C
Public Utilities ✓
Public Safety
Fire Services
Review fee '$- '
0
aCiept-Sigpature'' ”
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. DDenied.
(Circle one.) Comments: U� /
BUILDING t-
PLANNING & ZONING Reviewed by: - Date: .f7 ZY 4
TREE ADMIN. Second Review:
Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: DApproved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
Poeiz-ik_,