1448 Camelia St RFNC22-0091 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
BLAKELY MATTHEW ET AL 1448 CAMELIA ST ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171079 0030 ATLANTIC BEACH SEC H
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
1448 CAMELIA ST RESIDENTIAL FENCE ONE
STREET FRONTAGE 6' FENCE $8000.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
WORK WITHOUT PERMIT 455-0000-322-1000 0 $110.00
ZONING FENCE PLAN REVIEW FEE 001-0000-329-1003 0 $35.00
TOTAL: $145.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property
that may be found in the public records of this county, and there may be additional permits required from other
governmental entities such as water management districts, state agencies, or federal agencies.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
1 of 1Issued Date: 8/8/2023
PERMIT NUMBER
RFNC22-0091
ISSUED: 8/8/2023
EXPIRES: 2/4/2024
RESIDENTIAL FENCE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
e-----' Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
4--4.2,c
IS REQUIRED.Phone: (904)247-5826 Email: Building-Dept@coab.us
r
Job Address: S ti D C C L ' Permit Number: kFN CZ 1 ` 6 9 I
Legal Description C-7 t^ g\.Lt
Ac6 RE# Ii I 0 1 421 •- 00 30
x Valuation of Work(Replacement Cost)$ Q t 0 Heated/Cooled SF Non-Heated/Cooled
Class of Work: tl lew Addition LR iteration C pair Move Demo DPool LHWindow/Door
Use of existing/proposed structure(s): Commercial QResidential
If an existing structure, is a fire sprinkler system installed?: Yes No
Will tree(s) be removed in association with proposed project? Yes(must submit separate Tr'e Removal Permit) No
Describeccin detail the type of work to be performed:
to T-k CAA Yv
fc ;
J
t•ic.IUa ;i.,..,4,.,Approval# for multiple products use product approval form
Property Owner Information
Name V\!A'A tA-µt41 Address tL{`-\. , Cv`w'T'Ce`t' bt •
city P t\c v k b c.,h State t"-‘— Zip 3 272-3 7 Phone S 0'1 • +3 -Z-1 l ,.,,
E-Mail ts..#`D k..v`M't, 1 cd 1& crv,,,v/• w.,..
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 Con t 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
RECORDI O R N IF COMMENCEMENT.
j
Si natu Owner or t)Si ture of Contractor)
Si:ned and sworn to(or a• irm-d)bef•r- me
this day pf Signed and sworn (or affirmed)before me this day of
o.. 1
Tr
4& e. AS I' 4IVA..by
YNGe ONI GINDLESP -
A. <% . 4i
MY COMMISSION#G 'il' " .tu.tr,"Signature of Notary)
s'•wail,: a EXPIRES:October 6,2023
ti3, °e` Bonded Thru Notary Public Underwriters
ersona yin OR Personally Known OR
Produced Identification
r—
Produced Identification
Type of Identification:
Q (' Type of Identification:
I rL`!r Owner Builder Affidavit ALL INFORMATION
s j HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.r n
800 Seminole Rd, Atlantic Beach, FL 32233
4_,T:9'r
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.
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)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: ;/" k L
1-
1`6 Liam-`' ' -
n
Owner Name:
11 '`
G ` Phone Number: —lay ''0 11 k V)1.-
S1MailingAddress: S CO" S City: I `Lh t State: CL
Zip: 32'1'53
Notarized Signature of Owner
Th regoing instrument was acknowledged be ore me this y 202 7,.in the State of Florida, County
Signature of Notary Public 12
Personally Known OR [ ] Produced Identificatio
SS
Type of Identification: 1
t'av a,TONI GINDLESPERGER
Updated 10/24/18
tk, ;= MY COMMISSION#GG 353178
1.
RES:October 6,2023
P F O' 6mdn: .hru N,`-r ?uhriC Underwriters
fv' ')- Fence Addendum Updated l/14/2021
City of Atlantic Beach Building Department
r
800 Seminole Road, Atlantic Beach, FL 32233 PERMIT# t2ENL2..z ----
Phone:Phone: (904) 247-5826 Email: Building-Dept@coab.us D09
Job Address: Date:
Mi-iS Cckrilt ck I 2C "2;Z
Property Type:Lot pe/ Features:
B'Residential C /One Street frontage (interior lot)
O Commercial 0 More than one street frontage(corner lot,through lot,
etc.)
0 Swimming Pool
Fence Material: Fence Height (select all that apply):
Wood 0 Fc2yr Foot(4ft)
Chain Link Six Foot(6ft)
Vinyl 0 Other
Block/Stone (Plan details required for footings and/or
retaining walls)
n
2 Other LO t.i tvi Mt-iTLk
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?
O Yes(must submit separate Revocable Encroachment Agreement)
CYNo
Will tree(s) be removed in association with proposed project?
O YesYe (must submit separate Tree Removal Permit)
o0,1c
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.
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ALL CORNERS POUND h
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EXCEPT WHERE NOTED.
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