805 Amberjack Ln 2012 fence CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00001045 Date 8/21/12
Property Address . . . . . . 805 AMBERJACK LN
Application type description FENCE PERMIT
Property Zoning . . . . . . . TO 13E UPDATED
Application valuation . . . . 0
--------------------------------------- -------------------------------------
Application desc
6ft fence
--------------------------------------- -------------------------------------
Owner Contractor
------------------------ ------------------------
TESTER WILLIAM J OWNER
805 AMBERJACK LN
ATLANTIC BEACH FL 322334224
---------4----------------------------- -------------------------------------
Permit FENCE PERMIT
Additional desc . .
Permit Fee . . . . 35 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 2/17/13
--------------------------------------- -------------------------------------
Special Notes and Comments
Roll off container company must ba on City approved list
and container cannot be placed on City right-of-way.
(Approved: Advanced Disposal, ReaLco, Shappelle ' s and Waste
Management)
--------------------------------------- -------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- --- ------- ---------- ----------
Permit Fee Total 35 . 00 35 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 35 . 00 3S . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT I kPPLICATION
CITY OF ATLANTic BEACH
800 Seminole Road, Atlant�c Beach, FL 32233 12- —1d ey�—
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 9,o5- Permit Number:
Legal Description
Ck"c- Parcel#
11oor Area ot Sr.Ft. Sq.Ft
Valuation of Work$ *2-V Q Proposed Work eatell/cooled non-heated/cooled
Class of Work(circle one): 6� Addition Alteration Rel air Move Demolition pool/spa window/door
Use of existing/proposed structureQ)(�ircle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed: ..c r <0jj%A_rs,
Property Owner Information:
Name: Address: "L0.ej-.AJ'1
City U"k,�, State TL Zip Phonc okk Ito- - IW4(--7
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: Qualifying Agent:
Address: city State Zip
Office Phone Job Site/Contact Number Fax'#
State Certification/Registration#
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Narne and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations as indi mted. I certify that no work or installation has commencedprior to the
issuance oja permit and that all work will be per
. formed to meet the standards of all lays regulating construction in thisjurisdiction. This permit becomes 771111
and void if work is not commenced within six(6)months, or if construction or work is Fuspended or abq�donedjbr a period of sixp�)months at a17V time after
work is commenced I understand that separate permits must be secured r Electri mr Work,Plumbing,Si ns, Wells, P ols, urnaces, Boileis, H '
Tanks andAir Canifitioners,etr_ fo i eaters,
WARNING TO OWNER: YOUR FAIL E TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR P YING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO 0 TAIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFO RECORDING YOUTi NOTICE OF
COMMENCEA ENT.
I hereby certify that I have read and examined thisiap U d know the same to be true and correct. All provisions oflaws and ordinances governinz this
ec e§ication an
ope of workivill be complied with whether herein or not. The granting o"a permit does not presume to give authority to violate or canC�l the
provisions ofany otherfederal,state, or localsfaaw�egulating construction or the peFfo;mance ofconstruction.
Signature of Owner -f4j.yj, Si mature of Contractor
A
Print Narne Pr i nt Name
...... ......(I..................1. <,
........... .............................................................. I .........................................................................................................................................
SW'Orn an scrib d before me S orn to and subscribed before me
this y of 20 I'Z— Day o 20
SHIRLEY L.GRAHAM
6 #
N#DID 95776
y P1
Notary EXPIRES:Fe7bruary 147,M ta Public
P 1, U
'ry u c J�
d rwr
rwr ers
Bonded Thru Notary Public underwr ers
Revised 0 1.26.10
BEACH
CITY OF ATLANTIC
OWNER / BUILDER FIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I "CONSTRUCTION
CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNC WLEDGE THE LAW:
FDISCLOSURE STATEMENT FOR SECTION 489.103(7),F LORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTI TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERIV IT UNDER AN EXEMPTION TO THAT
"�,
LAW. THE EXENTTION ALLOWS YOU,AS THE OVq FER OF YOUR PROPERTY.TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DC NOT HAVE A LICENSE. YOU MUS
SUPERVISE THE CONSTRUCTION YOURSELF. YOUMAYBUILDORHVIPROVEAONE—OR
TWO FANRLY RESiDENCE OR A FARA1 OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST 0 '$25,000-00 OR LESS. BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT MA'NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL&R—LEASE A BUILDING YOU HAVE I UILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE,THE LA W WELL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WFUCH IS IN VIOLATION THIS=_MPTION. Y U MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRA_"TOR_ YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS- IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT I EOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY ('OUNTY OR MUNICIPAL LICENSING
ORDfNANCES.
Ij. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE�
THE BUILDING DEPARTMENT SUGGESTS WORKHR'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 C NNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,00(1 PENALTY-UNDER FLORIDA STA71 UTE NU.
455-228(l). AN-OCCUPATIONAL LICENSE" IS NOT ADEC UATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETEN(,Y' 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 TF AT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REDUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
qD4
ADDRESS PHONE NUMBER
PRINT NAME
DATE
SIGNATURE
Before me thisL-3 day of a6!5(As 20_a in the county )f
Duval,State of Florida,has personally appefred herin by himself herself an I affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of County of
[I PeDprrally Known
[JA-'roducsd Ide,tificatil-n-
SHIR.EY L GRAHAM
MY COW IISSION#Dr
Notary Signatu EXPIRV-February 14,2014
Bonded Thru qotary Public Wd,,�romters
F:/13LDG/C),�m�r-Builder&fad.,i�REVISE : 16/2009 J
City of Atianbc Beach APPUCAT110N NUMBER
Building Deparbnent
800 Sendnole Road AUG 14 M2 (To b'-`Vned by the Bukft DePar"')
Atlantic Beach,Florida 32233-54451
Phone(904)247-M6 - Fax(904)04X/'5845._
E-mall. bugdkxj-dept@coab.us - ------- Date routed:
CRY mo&4ifes! M1P-JAwAv.ea&b.u*
APPLICATION REVIEW AN TRACKING FORM
Property Address: Department revfmm required Yes No
B
Applicant lPlanning& in-9-----
Prolect :��Wbrks�
mmic utilftie-�
Public Safety
Fire Servicats
Odw Agency Review or Permit Required Reviiew or PAwAtilt Date
of I lermit Veriffed By
Florida Dept of ronn Protection
Florida Dept.of Tramportation
St.Johns River Water Managernent District
Amy Corps of En&wers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
APPLICATION STATUS
A A
Reviewing Deprtment Fimt Review: qrApproved. [-]Denied.
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed by loge Datettz
TREE ADMIN. Second Review: OApproved as revised. []Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed bjF: Date:
FIRE SERVICES Third Review. []�Approved as revise I. nDenled.
Comments:
Reviewed by: Date:
RwindORIVID
City of Aflanfic Beach APPUCA71ON NUMBER
Building Departntent AUG-14 2012 (To be assowd by dw&"v Dqwkmrt)
800 Sernhiole Road
Aftft Beadi,Florida 322 .0
33-;��y:
Phorw(904)247-5826 - Fax
E-mail. buNdng-dept@coab.us Date rouled: 00
cilyma"ile! MfP!jAWW.W*b.u* - I
APPLICATION REVIEW AND TRACKING FORM
I
Property Address: fd�r *#e t
Deparbnent review required Yes No
B
Applicant Planni2l&Zoning------
-TrmAdrnlnl�r
Project
mmic utilities
Public Safety
Fire arvices
Odw Aaency Review or Permit Required Ro-view or Receipt Daft
of F ennit Viertrad By
Florida DepL of Environmental Protection
Florida DepL of TrawporWon
SL Johns River Water Management District
Araky Co"of Engineers
Division of Hotels and Restaurants
Division of Akx*wlc Beverages and Tobacco
ogler
APPLICATION STATUS
Revw*ing Deprtment Fimt Review: b(Aproved. E]Denied.
(Cirde one.) Comments:
WILDING
PLANNING&ZONING Reviewed by: Date:
TREE AWIN.
Oecond Review: []Approved as revise 1. E]Denied.
PU RKS rits:
UBUC ILITIES
"UBU
j
PUBLIC SAF Reviewed b): Date:
FIRE SERVICES Third Review: []�Approved as revise I. []Denied.
Comments:
Reviewed by Daft:
Revised 07)27MO
AMkCity of Atlantic Beach APPLICA717ION NUMBER
Building Deparbrient (To be assigned by the Building Deparknwt)
800 Sernlnole Road 12-
Atlantic Beach,Flodda 32233-5"5
Fax(904)247-5845
Phone(904)247,M6
E-mall: building-dept0coab.us Date routed:
City vmb-eife! ft!1AwAv.6wb.u*
APPLICATION REVIEW AN TRACKING FORM
Property Address: Departmrit review required Yes- No
B�
Applicant: fanning&Zoning---�
MM—Ad r
Project: -Pu-V1Ic:_Wbrks
TWic Ufilrdib�>
Public Safety
Fire Services
Other Agency Review or Permit Required Review or Receipt
1 of F lermit Vedfled By
Florida Dept.of Environtnental Protection
Florida Dept.of Transpodation
St.Johns River Water Management District
Arnvy Corps of Engirwers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
APPLICATION STATUS
Reviewing Deprtment First Review: E!�Pproved. DDenied.
(Circle one.) Comments:
BUILDING
PL�$I@NG&ZO�NING�
Reviewed b V:_ J"Y' Date:—Od/a
Second Review: E]Approved as revised. []Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed bi r: Date:
FIRE SERVICES Third Review: DAPProved as revise j. DDenied.
Comments:
Reviewed b): Date:
Robot!6707110