375 3rd St RFNC23-0026 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
GOLOMBEK ELLEN JOAN 2001 LINCOLN ST UNIT 1524 DENVER CO 80202
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
169824 0015 ATLANTIC BEACH
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
375 3RD ST RESIDENTIAL FENCE ONE
STREET FRONTAGE
Replace fence on side, side
of gate, and back $5500.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
ZONING FENCE PLAN REVIEW FEE 001-0000-329-1003 0 $35.00
TOTAL: $35.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property
that may be found in the public records of this county, and there may be additional permits required from other
governmental entities such as water management districts, state agencies, or federal agencies.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
1 of 1Issued Date: 3/21/2023
PERMIT NUMBER
RFNC23-0026
ISSUED: 3/21/2023
EXPIRES: 9/17/2023
RESIDENTIAL FENCE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 3 3 ((` Permit Number: ("T IV C 2.;-VI.'-/
Legal Description A+67 3e TPe.-
Or
r ko-r
Valuation of Work(Replacement Cost)$ 50 U Heated/Cooled SF Non-Heated/Cooled
Class of Work: 1gblew Addition Alteration AOlepair Move Demo Pool Window/Door
Use of existing/proposed structure(s): Commercial 'residential I D°'
If an existing structure,is a fire sprinkler system installed?: Yes No as-,q9
Will tree(s)be removed in association with proposed project? Yes(must submit separate Tree Removal Permit) No
Describe in detail the type of work to be performed:
tv\e-te,.e t`2>r0 0 Ski! S1 . c
Florida Product Approval# for multiple products use product approval form
Property Owner Information
y
Name / 6o fd fn bd Address 3 5
p
City State Pt— Zip 3 &3 3 Phone 303-1{16 '1
E-Mail _Q{'DJ't'N C A sC'O +
Owner or Agent(If/tent, Power of Attorney 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 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 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
ORDING 4 NO OF COMMENCEMENT.
ure of Owne . •_ • Signature of Contractor)
ned and s orn to(or affd)before me this--5 clay ofSi ned and sworn to(or affirmed)before me this day of
7O t .4. O ( Olr`b by
ature ,l '!, Signature of Notary)
Personally Known OR Prrr'Lc, •
sLESPER Ps. •Ily Known OR
Produced Identification MY COMMISSION#GG
rod ( -d Identification
Type of Identification: ` 'Ys .' •` EXPIRES:October 6,
I' ntification:
F'o'F:;° Bonde. i ru `•v. • ••IicUn A
A'!' Fence Addendum Updated 1/14/2021
11 City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233 PERMIT #C- Z o
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
gil- v__), s-r
i4aec )'qoa 3
Property Type:Lot Type/ Features:
it Residential fr 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):
Wood X Four Foot(4ft) CYN, jAa L
Chain Link Six Foot (6ft) Pfv, glAata. back,Ottrti- ked2—
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)
21 No
Will tree(s) be removed in association with proposed project?
Yes(must submit separate Tree Removal Permit)
M 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.
Owner Builder Affidavit ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
ii
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: C,23yvv`'
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(a CO4B.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: 31-s 3iLb ST i\-A-` x\ C - -iN 1=1-- B-.71).3
Owner Name:en 6.0 1-0 irbC../ Phone Number: 303' T'78"35 0
Mailing Address: City:State: Zip:
Notarized Signature of Owne 41111114.11 ,` l
Thf
fo oing instru ent was .cknowledged before me this -.T ay of 0 the State of Florida, County
of li Vr O
Signature of Notary Public 9
Personally Known OR [ ] Produced Identification
TCt•ll GiNDLESf'ERGEP. Type of Identification:
a
MYEXPIRC0 4M1SSIONES:Oc 3he#GGr v,
230523317B
f'a"' Jnderxriters Updated 10/24/18
t `:
EordadihruNo.ary_
NOTICE OF COMMENCEMENT
State of FLOQ-1T)Pt Tax Folio No.
County of 0.3 V
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713
of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: RC - OCVVA S •OO\ 9—/4' -c7p E'_ 13
35 ee+ ofi a b ')k 5--
AddressAddress of property being improved: ,_61-5" 3Q-b ST 1443 3?c733
General description of improvements:PnC'i.e
Owner:Al/en GvlvmbJC_ Address: 5 346 61 fib 3A;283
Owner's interest in site of the improvement:
Doc#2023044345,OR BK 20603 Page 332,
Fee Simple Titleholder(if other than owner):Number Pages: 1
Recorded 03/07/2023 09:46 AM,
Name: JODY PHILLIPS CLERK CIRCUIT COURT DUVAL
COUNTY
Contractor: 5e1 RECORDING $10.00
Address:
Telephone No.: Fax No:
Surety(if any)
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name: /Vijq
Address:
Phone No: Fax No:
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may
be served: Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b), Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER01
Signed Date3/VCX5
VANESSA ANGERS
Before - is 7 day of Ma mil in the County of Duval,State
MY COMMISSION
Of Florida,has personally appeared till 640vhhe.lt
Notary Public at Large,State of Florida, ounty of Duval.
i g.,F. EXPIRES:March 23,2026
My commission expires: 23 2 o2(p
Personally Known: or
Produced Identification: fL,1 L 6-71-4S1 — 21C— 55=721-0