1783 E PARK TER RFNC22-0054 Building Permit Application Updated 10/9/18
ik.,2, City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
��f-- IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us •
Job Address: I-2B -P/0 K --1- --11--42//e---6— CL:�S/ I FN C Z - b054
Permit Number:
Legal Description x-07 A.7 /3 Cc)Ck / V _567_11 j m.412 'i (/// 7-111-1-#
Valuation of Work(Replacement Cost)$ Z,�•JJ?-� — 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 ,esidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes / No
• Will trees)be removed in association with proposed project? ❑Yes(must submit separate' 1` Tree Removal Permit) ❑No
Describe in detail the type of work to be performed: cG n_�Nn/CF /?�L7rC' ./6`j /9 %j /� -p CCA
W /77-1 rYr=7z-0 F6' VV-c-- f 6,7
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name ,`U (A /Z /C C / Address r7ig3 1Pcx-v- 1 e,rJ[ btr e ?
City .4TL-f-.�*7l /36C, State F/ Zip 3? 2 33 Phone ?' '- 7�'- 5-3 3.---v
E-Mail - 1',,,s nt,_) E -
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company 4 rfO/2 .. 4 (-6-11. 1 ►y� Qualifying Agent l//Uf) /2 /C C I
Address ? S-4--T.) , 0-A 4d /3 L l/ City T/�X/ State FL- Zip 3 j 2 `/6
Office Phone 9oV— 6W- /LOC) Job Site Contact Number
State Certification/Registration# E-Mail -r • , • • - • % - - • -r. • • __
Architect Name&Phone# .��IG.5 ak43-S colOdf>\Q Pr/ CC L:-Cvl'fer,C bfr-^-
Engineer's Name&Phone# ___
Workers Compensation Insurer OR Exemp'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 COMMENCEMEI�IT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY F YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNE :EFORE
RECO !NG UR NOTICE OF COMMENCEMENT.
,
(Signature of Owner or Agent) (Sig r:ture of Contractor)
Signed and sworn to(or a r -d)before m• t / y of Signed and sworn to •r affirmed)before me this day of
y 4,4 tf L02-2-- ;+cJ titsCG l , ,by
-tur- Nom;,. - (Signature of Notary)
[ ]Personally Known OR [ ]Personally Known OR
[ ]Produced Identification bi[ 1 Produced Identification
Type of Identification: Type of Identification:
rSir\,,J„ Owner Builder Affidavit **ALL INFORMATION
111/
HIGHLIGHTED IN
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. I
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: / 7R3 f,/Ze.: -7�r Q- 6-- -57- ,47-L , cisi, 34?)
Owner Name: b.A I . u f b /2-t c a ( Phone Number: /dy a /`lam ter-)
Mailing Address: /),fJ i,1/? R_--(1.0, 6` City: A7Z/f-WeTia (, State:�� Zip:,3 -2J
Notarized Signature of Owner 4 /
ik
The oin instru ent was acknowledged before me this I 8 day i' Q _ ,202 n the State of Florida, County
n
Signature of Notary Public ' --"72--- ----k----
-
[ ] Personally Known OR [ ] Produced Identification
Type of Identification:
Updated 10/24/18
Fence Addendum Updated1/14/2021
City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233
PERMIT #
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
Property Type: Lot Type/ Features:
[Residential 'y('One Street frontage (interior lot)
❑ Commercial ❑ More than one street frontage (corner lot, through lot,
etc.)
Swimming Pool
Fence Material: Fence Height (select all that apply):
pit/Wood ,lFour Foot (4ft)
❑ Chain Link X 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?
❑ Yes (must submit separate Revocable Encroachment Agreement)
r No
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
tiNo
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.
image0.jpeg
r MAP SHOWING SURVEY OF •
11
PLAT; OCK 14, SENA MARINA UNIT NO. 8, AS RECORDED IN
OOK
$ 34, PAGE 85, OF THE CURRENT PUBLJO RECORDS OF
-1. DUVAL COUNTY, FLORIDA. tt Y..
0 1
S A T U RIBDRIVE
100' RiGNTA-OF-WAY
14.
•
, 1 1 ...I, if
SCALE: t' = 20'
of
+J LOT 11
.ter i LOT 12
zI
7 6'YgOD
Sa8'42'09'E F'ENCE V 127.94' (FIELD)
Fora®yam.IRON
888'42'51"E 0.07` 128.02' Fotr. '7' t�0NF
~ APE HO CAP I 1 PIPE NO.^.4P
5",.; o�w s.- r1 erecK 416 2
( //_,• ///
V 3 `r aQT Ni 7' / co—
<e•
Q och
f as ""�� • r o.
ce ' 9I; /
Itt .1
3°-9` ////// . //// Poop r LOT 13
�� 7 / EouiPu� a
�
_ b� -STORY BR, ( (--`x '"' : 1 1 4 REST:E.'CE No. -7830,--....�•-
_� L CV
Q ////////////////////st. ..r.e%///////////////////ar '(47
o'• -r SI /c I e'i+rc c-�nicE 0
Z I r O '
Z • j . m fn
CONCRETE DRIVE ,
1.2 Y,� 0.3
r 6V x x '�6'wpCD x +,
F«,"° 1 — :' N8915 13 133.40' ,D 1r ------
Ft"4°NO OAP PIP_.NO CAP
N8914'05-W \\. YS"133.92' (FlELD)� -
� -
y1I g� t LOT 14
�;_iin71.
LOT 9 "I
ds
in i ((��
LOT COVERAGE CALCUi..4",OM
ro 01 .
2 1 LOT AREA = 12,$85 S.F.
;P:i 4
n a BUILDING AREA = 2,637 S.F.
SHED AREA
;'--,r•:,,.."' CONCRETE ORIVE/WAL' = 1.278 S.F.
.-c - 'ill, = 443 S.F.(not included)
ti t 1,, . 2t. POOL -
"*' > fi POOL DECK 1,824 S.F.
1 4- •
/ y
TOTAL
1S11NG IMPERV10U
L07CO5YERA:+REkGE == 5.82345.23.S F.
K„
`'•,.,�x�-"..
S t r.s
THIS SURVEY IS CERTIFIED TO:
13� _ ,' t WO
DAVID RiCC1 DEBORAH.
3 xP
JIMMY PATRONIS
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * *
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE: 10/12/2020 EXPIRATION DATE: 10/12/2022
PERSON: ROBERT A COLEMAN EMAIL: ROBERT.ANT.COLEMAN@GMAIL.COjv1
FEIN: 834085813
BUSINESS NAME AND ADDRESS:
AFFORDABLE FENCING AND TREE SERVICE LLC
9800-2 BEACH BLVD.
JACKSONVILLE, FL 32246
SCOPE OF BUSINESS OR TRADE:
Fence Installation and Repair-
Metal,Vinyl,Wood or
Prefabricated Concrete Panel
Fence Installed By Hand
IMPORTANT:Pursuant to subsection 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under
this section may not recover benefits or compensation under this chapter.Pursuant to subsection 440.05(12),F.S.:Certificates of election to be exempt issued
under subsection(3)shall apply only to the corporate officer named on the notice of election to be exempt and apply only within the scope of the business or
trade listed on the notice of election to be exempt.Pursuant to subsection 440.05(13).F.S.,notices of election to be exempt and certificates of election to be
exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate,the person named on the notice or certificate
no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a certificate at any time for failure of the person
named on the certificate to meet the requirements of this section.
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 E01240872 QUESTIO 4S?(850)413-1609
0
2021 -2022 LOCAL BUSINESS TAX RECEIPT
`- .i I JIM OVERTON,DUVAL COUNTY TAX COLLECTOR
231 E.Forsyth Street,Suite 130,Jacksonville,FL 32202-3370
Phone:(904)255-5700,option 3 Fax:(904)255-8403
https:llta x col lector.coj.net/
Note—A penalty is imposed for failure to keep this receipt exhibited conspicuously at your place of business. This
business tax receipt is furnished pursuant to Municipal Ordinance Code,Chapters 770-772,for the period
October 01, 2021 through September 30,2022 ,
AFFORDABLE FENCING AND TREE SERVICE LLC
•
9800-2 BEACH BLVD
JACKSONVILLE, FL 32246
•
ACCOUNT NUMBER: 324311
BUSINESS NAME: AFFORDABLE FENCING AND TREE SERVICE LLC
PHYSICAL ADDRESS: 9800 BEACH BLVD
SUITE 2
JACKSONVILLE, FL 32246
CLASSIFICATION CODE: 323079 PUBLIC SERVICE OR REPAIR, NOT SPEC
COUNTY TAX: 13.75
MUNICIPAL TAX: 36.25
COUNTY LATE PENALTY: 3.44
STATE LICENSE NO:
MUNICIPAL LATE PENALTY: 9.06
TOTAL TAX:• 62.50
RENEWAL
VALID UNTIL September 30, 2022
• •
***ATTENTION***
THIS RECEIPT IS FOR BUSINESS TAX RECEIPT ONLY.
CERTAIN BUSINESSES MAY REQUIRE ADDITIONAL STATE LICENSING.
This is a business tax receipt only. It does not pen-nit the receipt holder to violate any existing regulatory or zoning laws of
the County or City. It does not exempt the receipt holder from any other license or permit required by law. This is not a
certification of the receipt holder's qualifications.
JIM OVERTON,TAX COLLECTOR •
THIS BECOMES A RECEIPT AFTER VALIDATION.
Paid INT-23-00122545 02/21/2022 $ 62.50
•