Permit 334 6th Steet CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
-5826
INSPECTION PHONE LINE 247
lilt
Application Number . . . . . 10-00000566 Date 5/12/10
Property Address . . . . . . 334 6TH ST
Application type description FENCE PERMIT
Property Zoning . . . . . . . RESIDENTIAL SINGLE FAMILY
Application valuation . . . . 0
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Application desc
replace 6ft fence
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Owner Contractor
------------------------ ------------------------
PURNELL RUSSELL OWNER
334 6TH ST
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 . . 11/08/10
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Special Notes and Comments
Roll off container company must be on City approved list
and container cannot be placed on City right-of-way.
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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.
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4, VE4D APPLICATION NUMBER
City of Atlantic Beach 10 (To be assigned by the Buildin Department.)
Building Department 11AY 0 7 20
800 Seminole Road
-5445
Atlantic Beach,Florida 32233
Phone(904)247-5826 - Fax(904)24 Date routed:
P. OR E-mail: building-dept@wab.us
City web-site: hftp://v~.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: De artment review re uired Yes No
Buil
anning &Zonin
Applicant: inistrator
ublic Wor
Project: rj� .. I
Public Safety
Fire Services
Review 11 fee $ Dept Signature
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: - I , .
APPLICATION STATUS
Reviewing Department First Review: Approved. FIDenied.
(Circle one.) comments:
BUILDING
PLANNING&ZONING Reviewed b Date:_S�L�_ J
TREE ADMIN. Second Review: nApproved as revised. nDenied.
PU AORK Comments:
U W9RK C ment
�ate:
/a Reviewed by: Date:
PUB C FETY
;y
FIRE SERVICES Third Review: nApproved as revised. nDenied.
;' 0 -
Comments:
Reviewed by: Date:
Revised 05114109
public Utilities Plan Review Comments
Date: /0
Project Name/Address: _33q 61i_ & kpphcati I on Permit 4: /0 0
:Check Rox
Appliration T racking Comments to A- Ad
Comment
Avoid damage to.underground watcr/sewer utilities. Verify vertical and horizontal
location of utilities. Hand dig if necessary. if field coordination is needed, call
247-5834.
Ens eter boxes, sewer cleanouts and valve covers are set to grade and
visible. ist be covered
A sewer cleaaout must be installed at the proper�y line. Cleanout=
,with an RT1 concrete box with metal lid. Cleanout to be set to grade and visible.
iist be installed-if irrigation will be
T`reductd pressure zone bacl:flow proventer Tn ow preventer must be
provided or if there is a private well on the property. Backfl
tested by a certified tester and a copy of the results sent to Public Utilities.
ed. If plans change, any fire line installed
Plans note the buildmg will be unsp -read meter in a properly sized vault and an
must be metered with a Sensus touch
appropriate bacl:flow preventer installed. Backflow preventer must be tested-by a
certified tester and a copy of the results sent to Public Utilities-
If fire sprinkler sy is provided, contact Malcolm Clemons at 247-5 83 9 for 71
backflow requirements. At a minimum,will.require double check backflow
ureventer.
�ire be metered with a Sensus touch-read meter. Meters laraer than 2"
13
must be installed in a vault as noted in JEA specificatiOns.
City of Atlantic Beach APPLICATION NUMBER
yell, I epa
(To be assigned by the Build' D rtme]lnt.))
Building Department
800 Seminole Road
-5445
Atlantic Beach,Florida 32233
Phone(904)247-5826 - Fax(904)7-47-5845
Date routed:
E-mail: building-dept@coab.us
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
3,7 Ll I— Department review required-] Y
es No
Property Address:
Applicant: Pfanning &Zoning-)
,tree-Administrator
Project-.-��!If,L. ublic W
Public;Sal
wFireServices
keview fee Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified
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
ry
Reviewing Department First Review: �ejApprovecl. nDenied.
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed br_ZJA:�� Date: to
TREE ADMIN. Second Review: E]Approved as revised. FIDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: MAPProved as revised. FIDenied.
Comments:
Reviewed by: Date:
Revised 05114109
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845 outed- �6_1& z
E-mail: building-dept@coab.us L-Ia—terc
City web-site: hftp://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 31,7 6-72)' Department review required Yes No
Bui' *
Zl=an!n!ing faZ��onin
Applicant" &Z:21
-tree-Annninistrator
Project, --P-ub I ic:W��Or
Public Safety
Fire Services
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
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: ElApproved. [-]Denied.
(Circle one.) Comments
BUILDIN
14 8,Z
CPLAIN 'ING 8,ZON
Reviewed by: q Date: 6-- 7-/0
TREE ADM IN. Second Review: FlApproved as revised. [:]Denied. lei
PUBLIC WORKS Comments:
&tP E610)
PUBLIC UTILITIES ED 0AJ PI-6
PUBLIC SAFETY Reviewed by: Datc
FIRE SERVICES Third Review: &IA-'pproved as revised. FlDenied.
Comments:
Reviewed by: Date: S 7-//)
Revised 05/14109
CITY OF ATLANTIC BEACH
'OWNER ]BUILDER AFFIDAVIT
I. FLORIDA STATUTE& CHAPTER 489, FLORIDA STATUTES PART 'CONSTRUCTION
CONTRACTING"REQUIRWS OWNER/BUILDER TO ACKNOWLEDGE iHE LAW.-
DISCLOSURE SIATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES:
STATE LAW REQUIRES
CONTRACTORS. CONSTRUC77ON TO BE
LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR DONE 13Y LICENSED
7
YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT
YOUR OWN CONTRACTOR i"
PROPERTY TO ACTVAS
SUPERVISE THE CONSTRUCTEVEN THOUGH YOU DO NOT HAVE A LICENSE. Y ST
OU
TON YOURSELF. YOU MAY BUILD OR IA4PROVE'�OU
_0
RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO,;�O_NER
0 1
VYOM�IMPROVE A C MMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS T BUILD OR
F_�� SELL OR LEASE A BUILDING YOU* -HE BUILDING
f�R�Yotji�T�'AND OCCUPANCY IT MAY NOT BE BUILT FOR-SXLi'60a;�
AFTER THE CONSTRUCTION IS COMPLE HAVE BUILT YOURSELF WITHIN ONE yj;�j
IT FOR SALE OR ILEA I SE, WHICH IS IN VITE, THE LAW WILL PRESUME THAT YOU BUILT
!I i�11 1''E Q!3 I 1 11 1:1 1 1 1 OLA77ON OF THIS EXEMPTION. yjQ
It 31 ils� [11� __MAY NOT
TRUCTION MUST
BE DONE ACCO.R_D1_ :��&TRACJ() y _
NG _ _& YOUR CONS
TO THE BUIEDIN Gi CODES AND ZONING REGULATIONS.
YOUR RESPONSIBILITY To
LICE]n��!EOUIgE MAKE SURE THAT PEOPLE IT IS
ORDINA,% _ I? BY STA 1E LA OV AND By CO, y
VE
XAVANISAML I ICFNSING
11- INJURY LIABILITY- SINCE—OWNE13 io�
THE BUILDING DE �1!i�� ' E FOR INJURI TO WORKERS THEY HIRE
PARTMENT SUGGES:FS'''
.PURCHASED. RKER'S COMPENSATION INSURANCE 13�
I"- 'RS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
013SERVE IRS WITHHOLDING TAX ANDIOR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; 111INI_11(12i��J)
2 "d N6§513JECT f0_'j_5 50-0 E , =MP1,211 [i
.PWMMT�ANEI WNERS g7E PENALiVONDER FLOR' ' 4WER —ANY
455-228(l). AN !�!QQIIIPLAT 1 L11-11::j= IDA STATUTE NO.
SEE THE Co- _�Qtliilj
UNTY 'CERTI—FICATE- 11-15�_QEQUAT_E. THE OWNER SHOULD PHYSICALLY
OF COMPETENCr 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.
Ot -=7
ADDRE .972
2U"el F, PCA r14 ej I PHONE YUMBER ----------
PRINT NAME
1IMMATURE DATE
gd()re ffm this dayof 21�_/Din the county of
_0
Duval,Stat.9 of Fwda,has powhay appm# hadn by Wmgglf hmelf and affi,that
all aetrlf4o 0 dWg*ons are tr�and acturste, ------ - -
0� SHIRLEY L GRAHAM
courty d zA*` OMMISSION#DD 957760
4F
EXPIRES:February 14,2014
bonded Thru Notary Public underwriters
H E A
'RL Y L G M
�'('OMM,SSION I ID 957760
'FIRES.Februa yj 4 201 4
a T�ru t q Pu U e_raem
d N a tr n
CITY OF ATLANTIC BEACH
OWNER BUILDER 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 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 BUILDIN
MUST BE FOR YOU k 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.
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
Ill. 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.
.334 429hm sive** 01(0 L4- .97,Z W1 7
ADDRESS PHONE NUMBER
Rus;el 5, PCAMell
PRINT NAME
1116FIATURE DATE
Before me this_��of 20j/0in the county of
Duval,State of Florida,has person ly appea by himself herself.and affirms that
re j� =n
4 -
all statemarIts and declarations are trus and 0
;2�L
Notary Public at LarW State Of County of SHIRLEY L GRAHAM
_�IRR '. S
rtlfo
WCOMMISSION#0957760
Hy Know
EXPIRES:February 14,2014
t3onded Thru Notary Public Underwriters
FIBLDG/0"a-Bolder Affadamt;REVISED:WM009