615 Amberjack Ln RFNC23-0022 Fence App t=.' Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
,4 ,
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
-�°`:1� IS REQUIRED.
// Phone: (904) 247-5826 Email: Building-Dept@coab.us nI
Job Address: bis - Moe �3fr k-- LA I Permit Number: �F1 v UL --Gt)L1
22
Legal Description Lti' I l '1OI 51 ? J# v pr-t-ms UN - DiQ 1; RE# illi () -coop
Valuation of Work(Replacement Cost)$ 3'''t.1 1 ; t-3 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 'Residential
• If an existing structure,is a fire sprinkler system installed?: DYes ❑No
• Will tree(s) be removed in association with proposed proiect? DYes(must submit separate Tree Removal Permit) ENNo
Describe in detail the type of work to be performed:
WOOD �E(cr (51-1)(1/40C) — ( rfl at en(s11No o Au F-0m,C
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name ( Q-1(. t-{ V-Q-40 .,J Address 4 1i Q►gAil., NS A GA-Nt
City ' "\-'v IL (3EN )-f State 1=L- Zip 3 0- '3 Phone °S.-4 - 31.C' -144
E-Mail tie 0-v- tKf 1 . C .0 Q alvtAit-. f t)''""
Owner or Agent (If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Qualifying Agent
Address City State Zip
Office Phone Job Site Contact Number
State Certification/Registration# E-Mail
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 na;
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
RECOE�^1OT F COMMENCEMENT.
(Signature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)before me thisZ-7 day of Signed and sworn to(or affirmed) oerore me tnis aav
�teL�_ , , 0(1'C &nut Crrrhi;vi0 , , by
:i '''
. \ VANESSA ANGERS__
i.E
NGERS— -
:.; r'' 1 MY COMMISSION#HH 244118 gnature of otary) (Signature of Notary)
p"• ;Fri EXPIRES:March 23,2026
]Personally Known OR [ ] Personally Known OR
Cif rY14ttati 0 Dl- 1-I63-Z10-g1-y.LS-0
Owner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
f. City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
C2
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: �FN CD
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: If. A-001-' t t- t41-141-,
Owner Name: R2-1(— 1-1612-11-A, NI'J Phone Number: 13S i 1670 7 60K
Mailing Address: &'1S 14-N4 t* - L4A1 City: ATLANT-i L l?E' -cif State: FV Zip: 3 1-1- 3
Notarized Signature of Owner
fat
.>
The foregoing instrument was ac nowledged before me this 2 j day of NC`y , 2023, in the State of Florida, County
of ,ajic
Signature of Notary Public
[ ] Personally Known OR [>1ProducedId�cation
Type of Identification: DL o5c--2 11-2 - 1 O
C Weer y. ile y(►vkavlei
Updated 10/24/18
Fence Addendum Updated l/14/2021
City of Atlantic Beach Building Department
% 800 Seminole Road, Atlantic Beach, FL 32233 PERMIT# 4T' C.23-hU�
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
(01.0 At^ t1t- it v._ L4/46- kn A-NTy l?cWM N,3 ►.g/ 0/"/ 1-` /v3
Property Type: Lot Type/ Features:
JAI Residential El One Street frontage (interior lot)
❑ Commercial C More than one street frontage (corner lot, through lot,
etc.)
❑ Swimming Pool
Fence Material: Fence Height (select all that apply):
• Wood ❑ Four Foot (4ft)
❑ Chain Link KSix Foot (6ft)
❑ Vinyl ❑ Other
El Block/Stone (Plan details required for footings and/or
retaining walls)
El 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)
Cg No
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
g 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.
DERED BY:
s.
WILLIAM s 11
_ - .; LLAT Y I ` ` .---'•
'?OPER Y ADDRESS:615 AMBERJACX LANE ATLANTIC REACH,FLORIDA r7rn1SURYEY NLd>4f9ER 13Ci094� \�
:ELD WORK DATE:►ityu,s REVISION DATFi51:eery* viva/13 ~
t \Y�}
R t 309.09945 ' 1 e4
3OUNDARY SURVEY S I a 44 .
DUVAL COUNTY 30 8a 1 N 2.3`.• 't 110.0 -- _ M LcT Z2 1
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WOOD FENCE
Section 2328 FBC
6' 0" Maximum
t
1.-0.,
1
f , �•. 2x4 No 3. So Pine PT
Wood Rails Attached to Post
With four 1Od Nails(min )
2'-0'• • •
+ 4x4 No.2. So. Pine PT
Spaced as follows
1
Z,-0„ Fence height Post Spacing
above grade
6'-0"
5' 0"
4'-0" O C
5'-0" 0.0
4,-0., 6'-0.. O C
1*--0'' _1' Wood Pickets 5/8"Min Thickness
attached to each rail with
two 16 Ga.stapies 1-314" long
---_,-T._.-- Zi-t-..„.1.. ...:411-4-*"
''?� "Q Finished side of wood fence
Z,0 • • must face outward toward
'.'. % = neighboring property or street
H r=
, , "fa'74 . ''.i
moi''w;r ,,- _��
10"diameter
_; 10- �.— concrete filled
hole
m -
LOWES®
Home Improvement Warehouse
NOT
III II III I it 111111 III II DELIVERY DATE: TIMEAVAILABLE
A.M.
/ / P.M. DRIVER:
Customer Name: CARLOS NANEZ TOVAR 1842 LOWE'S HOME CENTERS, LLC 1 of 1
Phone#: (904) 714-8573 DELIVERY ADDRESS:
Invoice#: 80107 Date: 02/22/2023 615 Amberjack Ln
8:00 AM - 8:00 PM
Salesman#: 4149088 JOSE SANTIAGO ATLANTIC BEACH, FL 32233
DUVAL CO ALT PHN: (904) 714-8573
Delivery Instructions:
Please delivery AM (if its possible) call customer 1 hr before 904-714-8573
Carlos Nanez
INITIAL ITEM # ITEM DESCRIPTION MODEL QTY UNIT UNIT PRICE
552328 4-4-8 TREATED #2 GRADE TIMBER Y2L40408-GC 26 EA * 8.72
196087 2-4-8 TC TREATED #2 PRIME 0G2P20408-AG 78 EA * 4.40
197672 2-4-16 TC TREATED #2 PRIME 0G2P20416-AG 3 EA * 8.82
313302 6-6-8 TREATED #2 GRADE TIMBER Y260608-GC 3 EA * 24.13
293316 SAKRETE 60-LB CONCRETE MIX NA 16 BAG * 4.31
52517 3/4-5-1/2-6 DE S4S PT PICKET 105692 575 EA * 4.66
1842 02/20/2023 ORIG IVO: 80107 I 3693.52 1 20.00 3417.23
PRINT ID: S1842MAD FULL PRINTING INVOICE DELIVERY MERCHANDISE TOTAL
TOTAL CHARGE
Please check the merchandise to ensure all items are received. Lowe's is
not responsible for Pick-up shortages after you leave Lowe's warehouse.
Your signature acknowledges the completion of all initialed and checked
applicable tasks above, as well as signifies receipt of all Delivered
merchandise/items listed above. Your not signing acknowledgement of
receipt, however, does not mean that such merchandise was not delivered.
RECEIVED AND ACKNOWLEDGED BY:
LowE's®
Home Improvement Warehouse