553 DAVID ST RFNC24-0006 COAB Permit Form with Conditionsl.-4,/,-,-,,i,;,
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BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USEONLY
City of Atlantic Beach Building Department PERMIT# hF C24—000(0800SeminoleRoad, Atlantic Beach, FL 32233
ALL information required to processVii9.'' Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address Ti 53
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RE# 17c,c7c-C:VOC .
Legal Description f()- /6 /i -ZS -2c1E •o 5 7 GC/o - sec 3 %'t) YQ'to T 4,-/ Si-
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Valuation ofWork(Replacement Cost) b22l 2 'c)0 Heated/Cooled SF Non-Heated/Cooled SF
Class of Work: New ['Addition Alteration Repair Move EDemo Pool Window/Door
Use of existing/proposed structure(s): Commercialtesidential •If existing structure, is a fire sprinkler system installed?:Yes E No
Will tree(s)be removed inassociation with proposed project? Yes (Must submit separate Tree Removal Permit)_,a14o
Describe in detail the type of work to be performed:
i
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Florida ProductApproval# For mul iple products use Product Approval Information Sheet)
d Phone q! L 1- OO2_PropertyYOwner Information Name c•d c vt
1-- Address 5-5- ? E---),,,c S1-f City " `j #7 State FZ Zip ?2 2 3 3
f- Email Mi k. - /7 ' t r; Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)0.) Inform/la-on'Cr(70.. Contractor Information Name of Company Phone
Address City State Zip
Z QualifyingAgent State Certification/Registration#
J Email Job Site Contact Number
E Worker's Compensation Insurer OR Exempt Expiration Date
Architect's Name Email Phone
Engineer'sName Email Phone
Application is hereby made to obtain apermit to do the work and installations as indicated. Icertify 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 allthe laws regulating
construction inthis 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:Inaddition to therequirements ofthis permit, there may be additional restrictions applicable to this property that may befound inthepublicrecordsofthiscity/county, andthere maybe additional permits requiredfromothergovernmentalentities such aswater
management districts,state agencies,orfederal 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 YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE SITE OF THE IMPROVEMENT BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY EFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
igna ur(ner or Agent) Signature of Contractor)qSignedandswornto(oraffirmed)before me this 1 l dayof Signed and sworn to(oraffirmed)before me this dayof
Sail.VCAN , 2A-7i`4 by N1lGkl.(. A - l upsh in by
Signature of Notary Signatureof Notary
Personally Kno OR [ roduced Identification Personally Known OR [ ] Produced Identification
Type of Identification: FL- 2L- Type of Identification:
VANESSA ANGERS
MY COMMISSION#HH 244118
EXPIRES:March 23,2026
Owner Builder Affidavit ALL INFORMATIONy: - ,,,,,,,l
City of Atlantic Beach BuildingDepartment HIGHLIGHTED IN
p t GRAY IS REQUIRED.Y 800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: 12.-FVL2-1+ GOD(D
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRESOWNER/ 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 APPLIEDFORAPERMITUNDERANEXEMPTIONTOTHATLAW. THE EXEMPTION ALLOWS YOU, AS THE OWNEROFYOURPROPERTY, TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A ILICENSE.
YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF.
YOU MAY BUILD OR IMPROVE A ONE OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAYALSOBUILDORIMPROVEACOMMERCIALBUILDINGATACOSTOF $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 THECONSTRUCTIONISCOMPLETE,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 MUSTBEDONEACCORDINGTOTHEBUILDINGCODESANDZONINGREGULATIONS.IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSESREQUIREDBYSTATELAWANDBYCOUNTYORMUNICIPALLICENSINGORDINANCES.
II. INJURY LIABILITY;SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENTSUGGESTSWORKER'S COMPENSATION INSURANCE BE PURCHASED. .
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDINGTAXAND/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 SUBJECTTO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THEOWNERSHOULDPHYSICALLYSEETHECOUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORSCERTIFICATE" 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 ICOMPLYWITHALLTHEREQUIREMENTSFORTHEISSUANCEOFANOWNER-BUILDER PERMIT.
Job Address: ,j? 00-1../1 f er
Owner Name: M,j'l„r/-d L S h Phone Number: C6(X7 'j e/— /OC'-)Z
1MailingAddress: i
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k-state: Zip: ,c2 2 .?3
NotarizedSignature of Owner
The foregoinginstrument was ackno edged before me this/ r
of 1,rC g day of J G1111i f t.J 20 Z in the State of Florida, County
Signature of Notary Public
Personally Known OR [a-foduced Identification
VANESSA ANGERS Type of Identification: I L 0 L )b 1- LCIS 11 1f,w: Dw• I*? MYCOMMISSION#HH244118rte••ai,:c EXPIRES:March 23,2026
Updated 10/24/18
Fence Addendum Updated 1/14/2021
City of Atlantic Beach Building Department
A./.0;095-% 800 Seminole Road, Atlantic Beach, FL0;095—32233 PERMIT #OOPPhone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
f e/Z 3d' c5 3 i)c,uv I.
Property Type: Lot Type/ Features:
Residential One Street frontage (interior lot)
Commercial 0 More than one street frontage (corner lot, through lot,
etc.)
0 Swimming Pool
Fence Material: Fence Height (select all that apply):
63/Wood 0 Four Foot (4ft)
Chain Link Six Foot (6ft)
Vinyl 0 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 requiredfor blockwall 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)
LINO
Will tree(s) be removed in association with proposed project?
O Yes (must submit separate Tree Removal Permit)
I/ No
Conditions of Approval:
Roll off container company must beon 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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IISURVEYORS CERTIFICATE: LB p7893IHEREBYCERTIFYTHATTHISBOUNDARYSURVEYISATRUEANDCORRECTREPRESENTATIONOFASURVEYPREPAREDSERVINGFLORIDA
UNDER MY DIRECTION.NOT VALID WITHOUTARAISED TARGET 6250 N.MILITARY TRAIL,SUTE 102EMBOSSEDSEALANDF1 :),:r4UY M WEST PALM BEACH,FL33407
PHONE(561)640-4800OsborneD,1c.,nu.oers SURVEYING,LLC STATEWIDE PHON600 226-4807S/OA 727:,02000' STATEWIDE FACSIMILE(800)741-0576
KENNETH JOSBORNE WEBSITE.httpJltergetsulveying.netPROFESSIONALSURVEYORANDHOPPER06415
OWNER:ADDRESS:CITY:STATE:ZIP:
LAPSHIN MICHAEL A ET AL 553 David St ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
170575 0000 SALTAIR SEC 03
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
553 DAVID ST RESIDENTIAL FENCE ONE
STREET FRONTAGE Replacing fence $2000.00
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: 3/11/2024
PERMIT NUMBER
RFNC24-0006
ISSUED: 3/11/2024
EXPIRES: 9/7/2024
RESIDENTIAL FENCE PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $35.00
RFNC24-0006 Address: 553 DAVID ST APN: 170575 0000 $35.00
ZONING PLAN REVIEW $35.00
ZONING FENCE PLAN REVIEW FEE 001-0000-329-1003 0 $35.00
TOTAL FEES PAID BY RECEIPT: R26433 $35.00
Printed: Monday, March 11, 2024 9:10 AM
Date Paid: Monday, March 11, 2024
Paid By: LAPSHIN MICHAEL A ET AL
Pay Method: CREDIT CARD 10152557297
1 of 1
Cashier: TG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R26433