Permit 1290 Ocean Boulevard '�. % ,
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
r
Application Number . . . . . 10-00000368 Date 4/08/10
Property Address . . . . . . 1290 OCEAN BLVD
Application type description FENCE PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
4ft and 6ft fence
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Owner Contractor
------------------------ ------------------------
ALTICK OWNER
1290 OCEAN BLVD.
ATLANTIC BEACH FL 32233
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Permit . . . . . . FENCE PERMIT
Additional desc . .
Permit Fee . . . . 35 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 10/05/10
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Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/ 105- 106 SUPPLEMENTS .
2007 FLORIDA BUILDING CODE - RESIDENTIAL.
2005 NATIONAL ELECTRICAL CODE.
*ALL FENCES OR ENCLOSURES OF LAND SHALL BE SUBSTANTIALLY
CONSTRUCTED.
*SCHEDULE FINAL INSPECTION ONCE FENCE HAS BEEN COMPLETED.
PERMIT AND APPROVED SURVEY MUST BE AVAILABLE FOR FINAL
INSPECTION.
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 35 . 00 35 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 35 . 00 35 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ft -C of Atlantic Bear
Y _h .-- - ; -----
BUIlding Department
300 Seminole ftacl APF1LfC;ATtoN'NUM8ER
(To be assigned by the Bu
.......... Affantic seach,Florida 322,3 11ding Departrnent)
3-5445
Phone(904)2-47-5826 - Fax(9
E-mail- buffd1ng-deptQcoab.Us G4)247-5845 -------
CHY web-sife: htfP.-,r/WWW-0oab.US Data r6tjt4d.
APPLICATI
ON REVIEW AND TRACKING FORM
PrOPerty Address: /C�,�10
No
Applicant
nnin
PrMoiect. Adminftft-ator
bffc
U Imc
Fire Services
PW
Other AgencY ROVIOW Or ftrTnit Required Review or Rweipt Daft
of Permit Verffied By
Flor! a Dept of konm �fal Protection
Florida DepL of Transportation
St Johm Piver Water lVanagement District
Army Corps of Engineers
Division of Hafels and Restaurants
Aicohoric BSVerageS and T413bacoD
Other
APPUCATION STATUS
ReviffWlng Department First Review. P(Approved. DDenied.
(Circle one.) Gommenft.-
BUILDING
PLANNING&ZONING Reviewed by.-=6e2 Date.
TREE ADMIN.
Second Review,- ElApproved as revised- FlDenied-
PUBLIC ORKS Comments:
PU I (L��
P LI S ETY Reviewed by: D at e:
X/
Ff ES --ES Third RGv!P-w-- ElApproved as revised. FlDenied.
Gomments.
Reviewed by: Date:
BlIfsed
City Of Atlantic Seach
E3ut1ding Department APPLICATIO
I N NUMBER
r, gn� )y th�
800 Seminofe Roarj (To be assigned by the Building Department
Atlantic Beach,Florida 32233-5A45
PhOna(904)247-5826 - Fax(9G4)
V'F"3 E-mail- building-deptgcoab.us
Date mw4d.-
Gitlyweb-sffe-- fittP-11www.caab.us [J. Date r�b�uted
APPLICATiON REVIEW AND TRACKING FORM
PrOPSOY Address: /C�1'0 Jei'09,1V F/,/j De ant review required Yea No
Applicant: 'e�0 -7/1 te nnin &
Project-.: Adminisftattor
ublic
U IQ Safety
Fire Services
Z..
�`C��Mb-Rl 0
Other Agency Review Or Permit Required Review or Receipt Date
Flar'Efa Dept Of EnvirOnmenfBf Protection Of Permit Verified By
Florida DeprL of Trarmportaffan
St J0190 R-wer Water Uanagement Disffict
AwW Carps of Engfneem VN0
DMs!Qn Of Hotels and Restaurants
DivWon of Aicafinfin RP-vPmT= andTobacm
Other
APPLICATION sTATus
R
—aviewing Department FirstReview. 4APProved. FIDenied.
(Circle one-) Comments:
BUILDING
PLANNING&ZONING
Reviewed b.y-___�
TREE ADMIN. Date.:e
Second Reviewz ElApproved as revised. FlDenied.
PUBLICWORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: EIAPPrOved as revised. E]Denied.
Comments:
Reviewed by: Data:
-A.
A City-of Atlantic Bear_h
Building Department r\PPLICATION NUMBE
R
800 Seminole Roact (To be assigned by the Building Departrne
Atlantic Beach,Florida 3"3,,,5A nt)
.45
PhDne(904)247-5825 - Fax(9o4)247-5845
E-mail' buffding-dePtQcoab-us
GFLY web-sits- httP--1/WWvV'.coab.us [Date routj4d,-
APPLICATION REVIEW AND TRACKING F O- RM
PrOPSrty Address: De anLr M'"m-tfir Mquired Yes No
Applicant: I.annin &
Project: 7- AdminiSb7ator
ubffc
Ut1i
U Ima
Fire Services
Other Age R aw or Receipt
Rey Review Or P�BrEnft Required of Parmit Ve ad By Daft
FlGrila DePt Of Environmental Protection
Florida Dept
St Johns River Water Management fact
Distri
Amiy Corps of Engineers
DWIGn of Hofels and Restaurant-,
DIVWan Of Alcohniia RP=1vro9-"m1= and TobacDD
Other
APPUCATION STATUS
P,eviewing Department First Review- [:]Approved. FIDenied.
(circle one.) GOMMants:
BUILDING
A0
N ING&ZONING
Reviewed 13.
TREE ADMIN. Date:
. SecondRevlaw-� ElApprovedas revised. FIDenied-
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ElApproved as revised. FIDenied.
Comments:
Reviewed by: Date:
MAP SHOWING SURVEY OF
THE NORTH 12 . 50 FEET OF LOT 5 AND ALL OF LOT 6, BLOCK 49,
MANDALAY AS RECORDED IN PLAT BOOK 10, PAGE 11 OF THE CURRENT
PUBLIC RECORDS OF DUVAL COUNTY.
CXEAU SOULEVAW- 0
M AU r>A L Af A.IJ r.M u E- B-f pLc,-I -) ZZ
( S-- IZIL.%A-T A-f-)
A I-y-
.54'
CIA
12— PIPE
Imou Pips
rn
q
t-
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0
3,4-3 0
r7 1XIC
Iq PADS 0
vZ'y 2 E.. w QC10 0
0
0 Ej 0-'Z -Twr- sou-r" 3-7.5
OF LOT 5 &JO-T -5 4
Lu'r IUCLU C>ED
Uj dr
fwc
D rv�E'�2
0
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vewcX
50.o 12.S 9(3.
Imou PIPE LP 2 15 o' imam PIPE
L 07 �.P
5L.OcK 4
A-TLAU'FIL BEALVA
NOTE:
THERE MAY BE ADITIONAL RESTRICTIONS THAT APPLY
NOTES: THAT ARE NOT SHOWN ON THIS SURVEY BUT MAY BE FOUND
1. This is a tcoanc-1-ary s,=jey. IN THE PUBLIC RECORDS OR FACILITIES OF THIS COUNTY.
2. Flood zone Y, as best ascertained frcm Flood Insurance
Rate Map, comunity panel no.,-zowis-000tmdated 4-1-i-ac�
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904) 247-5845
Job Address:
TAJ z�0 1, Permit Number:
Legal Description
�Pv a r�ce I
Valuation of Work$
Class of Work(circle one): New Addition Alteration R
T-Tse Of existing/proposed structureQ)(�ircle one): ie?alr Residen�__tDia=molition Pool/spa window/door
If an existing structure,is a fire sprinkler system instaflCeOPM(Cerrcle one es
Florida Product Approval# es 0 N/A
For multiple products use pit Oduct approval form
Describe in detail the type of work to be performed: tk�-C--�,,/C C- Tlt/�p
7- b-0 0 7-
Prop�rty wner Mormation. k,
Z/�C_—I-'-
Name:
city Address:_
E-Mail or FZ#�(Optional SiitQTZ- Zip _U Phone
�ia
Con -actor Information;
Company Name:
Address: Qualifying Agent:
Office Phone city State zip
Job Site/Contact Number
State Certification/Registration# Fax 4
Architect Name&Phone#
Engineer's Name&Phone
Fee Simple Title Holder Name and Address-
3onding Company Name and Address
qortgage Lender Name and Address
b de b a e o d th k and n alla a naic or installation has commencedprior to the
Ii ah. n is e y ma to at-n rm'" 0 e wor Zt, i s' "' ns s law thisjurisdiction. Mis permit becomes null
be ed to m �stan� 0 a'
"k"s ae fs
trl,ctj ar�'
on
"'re Ject,
m es c eriod o months at any time after
r and a,a 0 t k pi' e �nt or c
r it or w
p p 0
ss anc ap
1 0 "s not commenced thin sft(6)m
nle �a ft w 0
w rk , "st" t,P at,Per iis t
d nd dt a e ar b dfor E
u 0
,nd void
",k is 0"'
"ks
�dA Con 0 ers,ea i1ls,PoolsNlrnaces,Boileis,Heaters,
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEAUNT MAY RESULT IN YOUR PAY-ING TWICE FOR LVIPROVEMIENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING9 CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
here cer!ify that I have read and examined this a plication and know the same to be true and correct. Allprovisions oflaws and ordinances governing this
ec, ed herein or not. The granting of a permit does not presume to give authority to violate or cancel the
111work will be co�nplied with whether ;t
rovisions of any otherfederal,state, or localsiaw'regulating construction or the P6fo�mance of construction.
ipature of OwnerN,,A ZV-1
Signature of Contractor
rint Name
............................. Print Name
WO and,s scri d fo e me Sworn to and subscribed before me
ds this Day of In
Y L GPAHAM
ION ff DD 957760
otary U IC 1�
21-1y=bjlk;U,1-1�1-�Ftrjjers Notary Vubtle
Revised 0 1.2 6.10
CITY OF ATLANTIC BEACH
(OWNER / ]BUIELDER AFFIDAVIT
1. 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 APPL11ED FOR A PERMIT UNDER AN EXEMPTION TO THAT
LAW. TBB 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 E\4p
ROVE 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 MAYNOT BE BUILTFOR SALE ORLEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER TIIE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME TILAT 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.
11. 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(l). 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 PERMIT.
�2W6 �)CZ5;�A) (,,2) C--;� �// - -
ADDRESS PHONE NUMBER
0 1:2 1 ,19 Z/C- /z---
PRINT NAME2
SIGNATUR15 L)A I t:
Before methis. dayof -,2011)inthecountyof
Duval,State of Florida,has perso6ally appeared herin by�j�mself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of County of A;,�k\jo-,L
�P ally Known
d ..d ldenfifi �Z,
'ur
Notary Signature: xvIvIt SHIRLEUY L 0 HAM
M�—COMMISSION#DD 957760
EXPIRES:February 14,2014
F:/BLDC,/0—Duilder Affadavit FiNISPD: A6/2009 Bonded Thru Notary Public Und8rwriters
� IF
0111
City of Atlantic Beach
Building Departrnant APPLICAT
[ON NUMBER
300 Serninofe Road (To be assigned by the Buff cling Deparftmjnant)
Atlantic Beach,Florida 32233-5,f45
Phone(904)247-5820 - Fax(9G4)247-534Ei A�
.a3p E-Maik bul[ding-dept9coab.us
Dade routie'd.
City web-stLe: hltP--1/WWW.coab.us F
APPLICATION REVIEW AND TRACKING F O- RM
Property Address: /C'?�e De ravbmw raqUi No
Applicant: nn n &
Admints r
Praiect.- ubgc
' Uff
U a
Fire Services
gqpp
Other AgeEleY Review Or Permit Required Review or 911pt D a ta
Florida Dept ot ErMrOnm8rital Protection Permit ed By
Florida Dept— ---ffon
St Johns Rker WalOr lWanagement District
AMY Corps of Engineers
Divis�'Qn Of MtalS and Restaurants,
Division of
Other
APPLICA TION STATUS
Reviewing Department FirstReviewt EgA/pproved. FIDenied.
(Circle one.) Comments:
PLANNING&ZONING
TREE ADMIN. Reviewed bT. Date._,?�O /C)
Second Revlew�- ElApproved as revised. enied-
PUBLICWORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: DApproved as revised. ElDenied.
Comments.
Reviewed by- Data-
zlifsed G5114109