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Permit 1802 Hickory Lane (2)CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5826 Application Number 10-00000843 Date 7/09/10 Property Address 1802 HICKORY LN Application type description FENCE PERMIT Property Zoning TO BE UPDATED Application valuation 0 ---------------------------------------------------------------------------- Application desc replace Eft fence ---------------------------------------------------------------------------- Owner ------------------------ JOHNSON/OLOFSSON 1802 HICKORY LANE ATLANTIC BEACH FL 32233 Contractor ------------------------ OWNER ---------------------------------------------------------------------------- Permit FENCE PERMIT Additional desc . Permit Fee 35.00 Plan Check Fee .00 Issue Date Valuation 0 Expiration Date 1/05/11 ---------------------------------------------------------------------------- Special Notes and Comments Roll off container company must be on City approved list and container cannot be placed on City right-of-way. 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. ~Z tl NN N C ~1 --1 7> ~ ~ m o ° `~ ~~ ~ C z ~ N ~ a ~ ~ --+ ~" ~ i ~ w v~ ~ ~ ~ ,~ ~ o -~ ~ ~ ~ D ~1 ~~ ~ r ~ t -a ~ ~ ~ ~t-t o ~" ~~ ~ ~ b ;. ~ = C ~ m ~ _~ ~C ~ ~ ~~ ~ ~~ ~. ~ a ~ ~ ~ o ,~ C ~ ~ ©t: J cN O ~ ~ a r ~r n O ~ ~ ~, Z ~_ ~ ~, C~ o 0 `~. . X ~ A " ~ m ®~ ~ • ^ ~ ~~ } ~ V y ~ ~ ~ ~ A ~jO Z z Z o {t~ pO ~ Z h ~`~i ~n ~' ~ r*t ~ 2 h ~ a ~ c~ ~ n~ ~ ~ . `~ t,`t ~ c~ g ~~ i `~~z ~ ' v z ~ ~ (riCRl ~~ m ~ O Z p h +' ~ ~ n~ ~~ C ~~ Z m ~ a Q ~ a n a m N ~~ ~( N ~ C CA d ~ ~ ~ ~T1 = ~ Q ~ ~ ~ ~ ~~~ ~~s ~ ~~ 1. ~` © cn z r r ~ chi-, cV c n ~ ~ }""~1 -C ~ Ib ~° r`~ w ~ ~ ~ ~ z z ~- ~ -< ~ ~ ~ O a ~ ~ ~''~ ~.~~ m C t.!) O z ~ ~ Z, ~~ O ~ 1 t ~ z C }~ m ~ „_ om a ~ V) cn ~ ~ m ii °....,o ~ o ~ _ z r N ~ ~'' `~'~ .~ a ~ ~' ~ C ~ ~ ~a A~ ~~ o ~ ~ ~ c~ ~~ ` ~o °{~~ ~`< ~ ~ ~ cn ;o ant` ~! ~r `< 1 ~ %o C C~ cn~A z z n~i rn ~ ~ ~r ~ r-- .,, ~ ~ a O ,- r* ~ o `0 r ~ ~ ~" o ~ ~m ~ ~ C a ~, rJ t m o r `~-1 r, rte,-- ~ S tzar o ~ m~ ~°~~,, 4 ~ ~ -~ ~ ~ o 0 C c N t~3 ~y a ~?y y .~ c n =_ ~ ~+ Darn ~ _ ~, 0 ~ o .~ N .: "` ~ .~. ~ (n _ ~ F".y ~"` ' cn O +,p r ~ ~ O ` D ~ N ~ q a '.~~ ~ ,~ :~ ,-.~_ 'r) ~. , ,„;a .gas 5,~' City of Atlantic Beach Building Department 800 Seminole Road Atlantic Beach, Florida 32233-5445 Phone (904) 247-5826 Fax (904) 247-5845 E-mail: building-dept@coab.us City web-site: http://www.coab.us APPLICATION NUMBER (To be assigned. by the Building Department.) ~l' - ~~ " Date routed: APPLICATION REVIEW AND TRACKING FORM Property Address: ~ ~ ~ ~ Applicant: ~ ~`~~ ~ t~ ~ Project: ~~r:~f~r`~~, t(.~ ~7f X /l ~r ~~ ~ Department review required Yes No Bui '~~- tanning & Zonin e minis rator Public Works; u is i ities Public Safety Fire Services Review fee $ ~ Dept Signature Other Agency Review or Permit Required Review or Receipt of Permit Verified B Date 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: roved. ^Denied. (Circle one.) Comments: BUILDING NN11A NG & ZONI G PL r ~'~'~ . Reviewed b Y Date: !~ 7"~J ~D ~'" 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 ,~ ~ ssi v `~~!133 ~~'' City of Atlantic Beach Building Department 800 Seminole Road Atlantic Beach, Florida 32233-5445 Phone (904) 247-5826 Fax (904) 247 E-mail: building-dept@coab.us City web-site: http://www.coab.us ~ t~~~' ~~ APPLICATION REVIEW ~ f'_ 845 ~ ~ ,°~~ APPLICATION NUMBER (To be assigned by the B 'ld~~Department.) /i/f '~ Date routed: CKING FORM Property Address: ~. Applicant: U li(~~~ ~' /~•-~ ~ Project: y ~ Review fee $ De artment review re wired Yes No Bui tanning & Zonin minis rator Public Works. is i sties Public Safety Fire Services Dept Signature Other Agency Review or Permit Required Review or Receipt of Permit Verified B Date 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 (Circle one.} BUILDING PLANNING & ZONING First Review: ]Approved. Co-ments2,~~~~' , ~ ' " Reviewed by: ^Denied. '~ f~l jU Date: TREE ADMIN. Second Review: []Approved as revised. ^Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: QApproved as revised. ^Denied. Comments: Reviewed by: Date: Revised 05!14/09 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: ~~~~ ~ % ~ ~o r~tP ~~ h ~ Permit Number: Legal Description 1 ~ `~---•~P~'Oi rota vl oy.i~ ~. vy.,. Valuation of Work $ posed Work heated/cooled non-heated/cooled Class of Work (circle one): New Addition Alteration Repair Move Demolition pooUspa window/door Use of existing/pro osed structure(s) (circle one): Commercial Residenti If an existing struc~ure, is a fire sprinkler system installed? (Circle one): es No N /A Florida Product Approval # For multiple products use product approva orm Describe in detail the type of work to be performed: (f` ~ l~q Cc Name: ~(.~~ city .~~ E-Mail or Fax # Contractor Information: ~e n ~e (.~ ~ r~ e ~~~~ ~ Company Name: Qualifying Agent: ~ `' Address: City State Zip Office Phone Job Sitel Contact Number Fax # State Certification/Registration # Architect Name & Phone # Engineer's Name & Phone # Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and Address 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 alt laws rpegulating construction in thpis jurisdiction. This permit becomes null work is~ ommenced.otl understand that separate permits m st be secured for Electrical Worl~dPlumb ng, Sig s, aWells~P olsx~uTnaces~Boite~rs, Hewers, Tanks and Air Conditioners, eft. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF CONIlVIENCEMENT MA.Y RESULT IN YOUR PAYING TWICE FOR IlVIPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YO~[TR NOTICE OF COAEI~NCEMENT. I hereb certify that I have read and examined this a placation and know the same to be true and correct. Ald provisions of laws and ordinances governing this type ofYwork will be complied with whether speci zed herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other federal, state, or local Imv regulating construction or the performance of construction. Signature of Owner Signature of Contractor Print Name %vi~~..,~ ~~~5-C~ ti Print Name Sworn o an subscri d f e Sworn to and subscribed before me this a of 20 this Day of • 20 ~ : a%~.. SHIRLEY 1. GRAHAM ~>^ ,L.L. NO U 1C r °•. ~ EXPIRES: February 14, 2014 Notary Public •~fl,h`~ Bonded7hruNotaryPublicUndenvnters Revised 01.26.10 t ~'~,' ,~~ ~ ~` , CITY OF ATLANTIC BEACH 1 `'~> k ~ " Q9WNER /BUILDER AFFIDAVIT `` '~r~;~s~%` 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 IIvIPROVE A ONE - OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IIv1PROVE 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. YOU MAY NOT HIl2E 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 B'Y 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. TELEPHONE THE BUILDING DEPARTMENT (247-5826) IF IN DOUBT. V. ACKNOWLEDGEMENT; (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. ~ 2 ; c ~ o L~ ~ ~.. ~' 4 7 - 22s~6 (4 7~-G tai ADDRESS , PHONE NUMBER ~` / ( O DATE J~~ Before me this ~ day ofi C L- 20~C ' in the county of Duval, State of Florida, has personally app ared herin by himself !herself and affirms that all statements and declarations are true and accurate. Notary Public at Large, State of ~, County of ~. ~ K ^ Personally Known I~oduced Identific Notary F:BLDG/Owner-Builder Affadavi~ REVISED: <(~ I/ :~t+~^i%''• SHIRLEY L GRAHAM '~~ ~ MY CAMMISSION i< DD 957760 in~•. ~ EXPIRES: February 14, 2414 %r cd ~;~` Bonded Th+u Notary Public Underwmr>1M ..,-~"r'~"~ Z c of ~w'- n z v ~°~ ~ ~ ~ ~~ ~ o ?? ~ _-- _ N w a ~ ~ .~ f m :\~. ~. , ``s ~~ i I ~. ~-.. `.~ "'Cj p 'O 'd w.. {~ ~ ~ ' a '"~ tom' t'~ ~' a ~,g ~ ~~ ,~. .- ' ~ ti ~ ' ~ i ~m?~gc„~ ~~~~ ~~ ~~~~~ ~ ~,~ ~~ ~ ~~~ ~ ~ ~ ~~ ~ ~~-- ~- _ ~-' ~.~ <,... ,C t,o ~ J';. ~. . . Lw 'A ~. ~- ~~ ~~ ~~ ~ ~o z ~. ~ ' ~v ~m ~m ~~. o~~ R; 0 i •e n z 0 o~~~~~~ ~b.~~~ ~° ~~ z~ ~~ ~~~~~,~. c~ ~Za~~~ ~~~o~ ~~~~~ a~ ~ ~' g ~k spy I~ .~ ~' °~ O o a ~~ ~ "~p.~o 0 ~~ tt~ .~` ~ p ~'~ ~ ~. ~ ~ ~~~ ° b b ~' ~~~ p ~ ~~~~ C b~ ~ C ~ ~, ae V m b A 'b M "'~ ~ `~ o p' *i h ~ ~ i~ t ~ D ~„ ~ ~' ~ ~~g w@ p r`+ A ~ ~: ~ n ~ ' ^~ ~. o ~~ b ~ o ~. (ti\ $ r a~ b p 0 c a 1~tAF SHOWING B~UNI~A:R'Y SURVEY DF LOT ~~ .BLOCK -~- A5 SHOWN ON 11~.A.P OF SEL V.E'T M14,Q/~V.~1 uv I ~'' .VU 12 G ,z2F/~L,4T _ AS RECORDED IN PLAT BOOK~,~PAGES 29 OF THE PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA CERTIFIE© FOR.• $usA~„/ ~oiavs~ - ~ ,sE~uG7 T f~c.oF'sSv~v ~/~rresir~ ~~,vr~„~,~G., ,,ue ~ M. ~'- - ~ ZZ ~. ~. ~7 ~ sa• 53•• E ~,.~= 38. Z~ ~ cG Jam. 2. 5V_VU' ~~ ~ • ~~ lU , .. . . N~ ~ z~~' ta.a• a a M a a r ~ r ~• N '; N N ~ ! Gam R 4~,c~- , ZU O ,. N A. S M q~ A V IY1