175 13th St RFNC23-0086 • ' RESIDENTIAL FENCE PERMIT PERMIT NUMBER
• s CITY OF ATLANTIC BEACH RFNC23-0086
v 800 SEMINOLE ROAD ISSUED: 9/1/2023
'zvalsge
ATLANTIC BEACH. FL 32233 EXPIRES: 2/28/2024
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.
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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
175 13TH ST RESIDENTIAL FENCE ONE 4' and 6' FENCE $1500.00
STREET FRONTAGE
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171836 0000 MANDALAY
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
KATSIKAS SIDNEY NELSON 175 13TH ST ATLANTIC BEACH FL 32233-5711
TRUST
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.
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
ZONING FENCE PLAN REVIEW FEE 001-0000-329-1003 0 $35.00
TOTAL: $35.00
Issued Date:9/1/2023 1 of 1
Ji:,. BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
F.: . City of Atlantic Beach Building Department PERMIT# REN C,Z3-0C (p
s"' 4 800 Seminole Road, Atlantic Beach, FL 32233
**ALL information required to process
-0 '' Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address kl S— \'-lp'1~ Vr fN..)r`c.. / t 6te.,<<-,� c-l. 132.2:2;5 RE# 11 I �3c; - LSV
Legal Description -{ - \7 1•Cf'J (�— (Q OD C) . . , l' LO .\l 1, 6 -2. S - 2,'. E--
Valuation
Valuation of Work(Replacement Cost) I (0 ID Heated/Cooled SF V/A_ Non-Heated/Cooled SF A/A-
- Class of Work: EkNew ❑Addition ❑Alteration DRepair ❑Move ❑Demo ❑Pool ❑Window/Door
- Use of existing/proposed structure(s): ❑Commercial l.(esidential
- If an existing structure,is a fire sprinkler system installed?: ❑Yes 1111.4
- Will tree(s)be removed in association with proposed project? Dyes(Must submit separate Tree Removal Permit) Dol
Describe in detail the type of work to be performed:
7
rti— cC__
Florida Product Approval It Ai A" (For multiple products use Product Approval Information Sheet)
Property Owner Information Name 5*, c , , y,S..k S, ,c.c, Phone 904_ 2.2,7> . _3
Address 1-7 (., l'L --- 55.4. City is_. , 'Cly State ft-- Zip 1)2233
Email c- ,r,, ,,,,� I 51`%c,'wner or Agent(If Agent,Power of Attorney or Agency Letter Required)
b ``M G; I , G J^
Contractor Information Name of Compilrfy l /) 1 /,4-- PhoneAddress City /V State Zip
Qualifying Agent State Certification/Registration#
Email Job Site Contact Number
Worker's Compensation Insurer OR Exempt ❑ Expiration Date
Architect's Name Email Phone
Engineer's Name Email Phone
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 R-FA1tORE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING TWICE
FOR IMPROVEMEIy,TSTO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN
ATTORNEY BE E R •R• NG OUR NOTICE OF COMMENCEMENT.
i
(Signature of Owner or Agent) Signa u e of Contractor)
Signed and sworn to(or affirmed)before me this / day of Signed and sworn to(or affirmed)before me this day of
CID io 1'6) by 1 ,'„,. -rc. by
Signature of Notary ��- Signature of Notary
[ ] Personally Knowrr' OR [ roduced Identification [ ] Personally Known OR [ ] Produced Identification
Type of Identification: ' .I) L_ Da.mt� Loud i k-aS Type of Identification:
r t 1AM1
;in`•".1.*.L.4•: VANESSA ANGERS
;t' :•) MY COMMISSION#HH 244118
s• : �` °j EXPIRES:March 23,2026
�ij.,i,�. Fence Addendum Updated 1/14/2021
.,' 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: 3 LL?„-5 Date: /I , 2,.3f 1b-4` s /\.�14,-1c., .�6c r� l /
Property Type: Lot Type/ Features:
-
C7,R,Res ,,�0 e 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 Four Foot (4ft)
❑ Chain Link ix 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?
KNI-o
❑ Yes (must submit separate Revocable Encroachment Agreement)
Will tree(s) be removed in association with proposed project?
CI Yes (must submit separate Tree Removal Permit)
T7 ._o —
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
f ,
•
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. I
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: \'7'(- 1y ' 5A— / 1l, t..--I i �— lW z,,,_ L Fl, ',2-1-3)'3Owner Name: S Is,- � cc ` �C44---- .(
xC4 S Phone Number: 90 L/ - 2,.3 - g---s�3
Mailing Address: // 1/ City: / State: // Zip: //
Notarized Signature of Owner
The foregoing instrument was acknowledged before me this II'`' day of Se 14 1, 20 2_, in the State of Florida, County
of 1-_-x,v ,L 1
Signature of Notary Public -----
[ ] Personally Known OR k] Produced Identification
"��" awton La-4.S tit(-sl _f
:�•• �; VANESSA ANGERS Type of Identification: l I)t, � k�
A :. MY COMMISSION#HH 244118 '
.•.foF«,P: EXPIRES:March 23,2026
Updated 10/24/18
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SURVEYORS
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