Permit 316 4th Street CITY OF ATLANTIC BEACH
�? 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 10-00000516
Property Address . . . Date 5/03/10
316 4TH ST
Application type description FENCE PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
-----------------------------------------------------
Application desc
Eft fence
----------------------------------
Owner Contractor
------------------------ ------------------------
HOLMES, MARK OWNER
ATLANTIC BEACH FL 32233
-------------------------------------------------
Permit . . . . . . FENCE PERMIT
Additional desc . .
Permit Fee . . . . 35 . 00 Plan Check Fee 00
Issue Date Valuation 0
Expiration Date . . 10/30/10
------------------------
------------------------
Fee summary Charged Paid Credited Due
----------------- -------- ----------
Permit Fee Total 35 . 00 35 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00
Grand Total 35 . 00 35 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITV OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BULLDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904) 247-5845
fob Address: 34, 4% (;4- A 3�L3 Permit Number:
3
Legal Description
Valuation of Work S 7.00 our ea o t, Parcel#
Proposed Work heated/cooled non-heated/cooled
Dass of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one
If an existing structure,is a fires sprinkler ) Commercial Residential
p system installed. (Circle one): Yes No N/A
,lorida Product Approval#
For multiple products use product approveform
)escribe in detail the type of work to be performed: 36 P, ¢.,c_e__.
?roper?roperty Owner Information:
Name: /L 0{Gy ' -
Address: Z73 %�Q�� �LL
�ity State Zip YL3 Phone z y` a 4 3
?-Mail or Fax#(Optional)
contractor Information:
�ompany Name: ifyin Agent:
address: - State Zip 3 o ca
office Phone �ju4 -2r-)o-� n Job Site/C er Fax#
State Certification/Registration#
architect Name&Phone#
engineer's Name&Phone#
iee Simple Title Holder Name and Address
3onding Company Name and Address
Vlortgage Lender Name and Address
4pplication 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
ssuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void if work is not commenced within six(6)months, or if construction or work is susppended or abandoned for a_period of six�6)months at any time after
vork is commenced I understand that separate permits must be secured for Electrical'Work,Plumbing,,Signs, Wells,Pools, urnaces,Boilers,Heaters,
ranks and Air Conditioners,etc.
WARNING TO OWNER: YOUR.FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR EWROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COM MNCEMENT.
herebcertify that I have read and examined this a plication and know the same to be true and correct. fill provisions of laws and ordinances governing this
ype ofYwork will be complied with whe r speed herein or not. The granting of a permit does not presume to give authority to violate or cancel the
)rovisions of any other federal,state, r ocal taw regulating construction or the performance of construction.
>ignature of Ow f Contractor
'riot NameY
............................................................. Print Name
� .
V, .........................................................................................................................................
s,�o to a ld sL2 scaP .
b dfor e Sworn to and subscribed before me
- —
�'0'' this day of 2C
M COMMISSION 9 DD 957760 —
o, t PIKES:February 14,2014 tai"% L;cb ILC
onded Thru Notary Public underwriters
Revised 01.26.10
CITY OF ATLANTIC REACH
OWNER. s BUILDER AFFIDAVIT
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 TEE 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.
It. 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. TELEPHONE THE
BUILDING DEPARTMENT(247-5826) 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 PER T.
A017RESS PHORE NLXV19ER
2, 7 �
PRINT NAME
SIGNATU DATE
Before me this day ofri L 20 in the county of
Duval,State of Florida,has personal) appeared harin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at large,State of County of'4btu VZZI
❑Pelly Kno
roduced I firafio
�L
SHIRLEY L.GRAHAM
(�! NAY COWSSION#DD 957760
P1RH`February 14 2014
Bonded Thru Notary Public Underwriters
DUPLES'S
FD I.F. 50.0' FD LP.
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_ . ___._.».e: RECEIVED
4TH STREET
PLOT PLAN
1
City of Atlantic Beach 'C>8j,T .;
Building Department ]assigned
ATL
�S APR 2 9 201® (To be by t .)
800 Seminole RoadAtlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)2 d5E-mail: building-dept@coab.usDate
City web-site: hftp://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: CZ/V 11 7;Y Department review�� p requ!red Yes No
Applicant: � � &Zoni
Tree Administrator
Project: ublic Work
tilities
/1"A16
� � � _ Public Safety
Fire Services
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
Florida Dept.of Environmental Protection
Florida Dept. of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by: Date: 2SVV
TREE ADMIN. Second Review:
QApproved as revised. ❑Denied.
P C C mments:
LI ILITI S
PUB C SA T
ET' Reviewed by: Date:
FIRE SERVICES Third Review: QApproved as revised. ❑Denied.
Comments:
i
Reviewed by: Date:
Revised 05/14/09
City of Atlantic Beach
g j'a
Building Department APPLICATION NUMBER
° 9 (To be assigned by the Building Department.)
800 Seminole Road
N� Atlantic Beach, Florida 32233-5445 �j'--
Phone(904)247-5826 • Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: pp7 J
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: CZ& Department review required Yes
q No
Applicant: &zoni
Tree Administrator
Project: ublic Work
;-Utilities
_ /C � /S � _ Public Safety
N Fire Services
r
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATI TATUS
Reviewing Department First Review: &fproved. ❑Denied.
(Circle one.) Comments:
BUILDING
LA NG &ZONIN
Reviewed by: Date: 27
E ADMIN. Second Review:
❑Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: []Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
p/+
City of Atlantic Beach Building Department APPLICATION NUMBER
APR 2 8 2��0 (To be assigned by the Building Department.)
s 800 Seminole Road
Atlantic Beach, Florida 32233-5445 —
Phone(904)247-5826 • Fax(904)24
"� tt E-mail: building-dept@coab.us ' Date routed: 7 1 '
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: /gyp 7 —' Department partment review required Yes No
Applicant: &Zoni
Tree Administrator
Project: ublic Works
Yx" tilities
I EE
/C � `� V
_ Public Safety
A Fire Services
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
L.Other:
APPLICATION STATUS
Reviewing Department First Review: Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING �
Reviewed by: Date: 77 /
TREE ADMIN. Second Review: A roved as revised.
❑ pp ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: QApproved as revised. ❑Denied.
Comments:
I
Reviewed by: Date:
Revised 05/14/09
r CITY OF ATLANTIC BEACH
;1 OWNER / BUILDER AFFIDAVIT
L 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 TTIE 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 CO affiRCIAL 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 TBE 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.
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
111. 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{1j. 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. TELEPHONE THE
BUILDING DEPARTMENT(247-5826) 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 PER T.
ADEPESS
PHO N
2,7
(1 R c�
PRINT NAME
SIGNATU DATE
Before me this C�? day of rl L20Bin the county of
Duval,State of Florida,has personal) appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of_ County of:1�uvxzl�
❑Pe ally Kno
roduced l fira5o
�L f
SHIRLEY L.GRAHAM I
MY COMMISSION#DD 957760
Nora r' na�rlre: �XPI -Februagr--14,2014
i
Bonded Thru Notary Public Underwriters
F:BLDG/0-m -3.iiJs,A`ffi ",ti R'eVE— . 4ii612009 ' ..... -
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FD I.P.
50.01 rD IF.
WENED
4TH STREET .n,n L V
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PLOT PLAN
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City of Atlantic dea,q)
RERRINI
D
')J< r(*R h-WilPf ,ee
Date.te. I+ASpEy Tvoe: f(: Draver: J
4l+?9/10 00 Recei,:t no.. 4.4139
Oescri°tion Quantitv
BP pole 343 Arom►t
BUILDJW 14RN)lf;
ee
Tender detail
CC CRETiIT CARL►
Total tendered $E6.90
Total oavaent Qj•ee
Trans date: 4/?9/le Tire: U.-A:39
HP Officejet 7410 Log for
Personal Printer/Fax/Copier/Scanner Information SystemsCITY O
904-247-5845
Apr 27 2010 4:46PM
Last Transaction
Date Time Type Identification Duration Pages Result
Apr 27 4:46PM Fax Sent 918659087710 0:25 1 OK
0V1LD
NOTICE ,
OF
FpgR ADDITIONS or CORRECTIONS
DO NOT REMOVE
=;ADDRESS DATE
r7 r-
THIS JOB HAS NOT BEEN MPLETED
The following additions or corrections shall be made
before the job will be accepted.
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RFS ECT FEE CHARGE
It is un awful for any Carpenter, Contractor, Builder or other
persons, to cover to cause to be covered, any part of the
work with flooring, lath, earth or other material, until the
proper inspector has had ample time to approve the
installation.
After additions or corrections have MMECH—_
been made contact the Building Dept.at 247-5826 for an inspection. Office hours are Monday through Friday
i
8:00 a.m.to 5:00 p.m.
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NOTICE
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DO NOT REMOVE
=JOBSS DATE
P Ian ",
311
THIS JOB HAS NOT N COMPLETED
The following additions or corrections shall be made
before the job will be accepted.
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❑ Contractor, Builder or other
It is unlawful for any
Carpenter, anyart of the
l persons, to cover toga h,se to be
bor Bothe a m,ateriall, until
the
the
work with floor".nglath,
had ample time to app
proper Inspector
installation. BLDG
After additions or corrections have ELEC
w been made contact thea tion.OD Ce MECH�---
at 247-5826 for an insp h Friday PLMG--- ---
hours are Monday throng
•m•
8:00 a.m.to 5:00 p