Permit Shed 490 E Sailfish Dr 2010 ` CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
�Jjilt
Application Number . . . . . 10-00001184 Date 10/07/10
Property Address . . . . . . 490 E SAILFISH DR
Application type description SHED PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 1260
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Application desc
NEW SHED
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Owner Contractor
------------------------ ------------------------
RADTKE WILLIAM OWNER
490 SAILFISH DRIVE
ATLANTIC BEACH FL 32233
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Permit . . . . . . BUILDING PERMIT
Additional desc . . SHED
Permit Fee . . . . 60 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 1260
Expiration Date . . 4/05/11
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Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONALELECTRIC CODE
*CALL FOR FINAL INSPECTION WHEN SHED COMPLETE AND ANCHORED
TO MEET 120MPH WIND LOAD.
Shed must be a minimum of five feet from rear and side lot
lines .
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 60 . 00 60 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 64 . 00 64 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
MAP SHOWING BOUNDARY SURVEY OF
LOT 13, BLOCK 10, AS SHOWN ON MAP OF
REPLAT OF PART OF ROYAL PALMS UNIT TWO A
AS RECORDED IN PLAT BOOK 31, PAGE 16, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLA.
CERTIFIED TO: WILLIAM RADTKE; UNIVERSAL LAND TITLE; FIDELITY NATIONAL TITLE; WELLS FARGO
SCALE: 1"=20' DATE: 05/25/10
SEP 2 7 2010
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Piargrr�.911b Department
I 58" I �r �P)
r— m mI o N S82 43 This approval v t? omplianee with applicable
i zonir:g. subdivision an other local land
—+ I development regulations, b t does not constitute
approval for the issuance otj permits. Compliance
U' with Floa Building Code and all other applicable
10' EASEMENT FOR IoLOTS e and Federal pekmitting requirements
I DRAINAGE & UTILITIES must be verified by signaturetof the City of Atlantic
Beach Building O al prior to the issuance of a
Building Permit.
II Approved By: R
0
Date: J., m�t n tx eve opment rea' w
�/P7
THERE MAY BE ADDITIONAL EASEMENTS AND/OR RESTRICTIONS THAT ARE NOT SHOWN BEARINGS BASED ON PLAT AS SHOWN
ON THIS MAP THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THIS cnl wTY 11Kinronon11.1„
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
' 800 Seminole Road
,r Atlantic Beach, Florida 32233-5445 �' +
Phone(904)247-5826 • Fax(904)247-5845
E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: pep#4pient review required Yes No
Applicant: elz) _)7 le— tanning &Zoning
f
Tree Administrator
Project:
ubIic Utilities
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:
LDING
(LANNING &ZONING Reviewed by: """ Date:
TRE€-ADMI N
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:
I
Revised 05/14/09
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
j Atlantic Beach, Florida 32233-5445 ` <r
' Phone(904)247-5826 • Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: ! .T
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Pgpartnnent review required Yes No
Applicant: QUtanning &Zoning
Tree Administrator._.
Project: � / �bJ;cv�rlss
ublic Utilities
Public Safety
Fire Services
Y s a < r�„
_DeptsSignaturet r . t .� ..az
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:
6UILDIN
PLANNING &ZONING 9' �o
Reviewed by: Date:
TREE 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
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
q 800 Seminole Road 2 2010 Cj? /iQ
j r Atlantic Beach, Florida 32233-5445 ! !0
f ` Phone(904)247-5826 • Fax(904) 2 �5
_J,3 E-mail: building-dept@coab.us Date routed: ! 7
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 7 i141A Qgparlment review required Yes No
Applicant: SPlanning &Zoning
Tree AdminiWafor
Project: �/Y _i.ibl,c WnrJss�
ublic Utilitie's��
Public Safety
Fire Services
Revievtt feet$ r t . . _ DeptSigna#ure
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: 0 v
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied.
Comments:
20
PU IC
Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
BUILDING PERNIIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904)247-5826 Fax(904) 247-5845
Job Address: 3� � ,��5� J/Ji!/6 >`ase 444an4,tC 0ac Permit Nu
Legal Description S4yraae 6ke, 9 S f Parcel#
oor Area ot Sq.Ft. t
Valuation of Work$ 17-(ao Proposed Work heated/cooled -heated/cooled
By
Class of Work(circle one): 6v Addition Alteration Repair Move Demolition poo spa win r
Use of existing/proposed structure(s) (cirinstalled?
one): Commercial esidden
If an existing structure,is a fire sprinkler system (Circle one): Yes No
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed: ?Ia °rLG 64rrn�,e 6464 in. j1,k uafd. Ab
Property Owner Information:
Name: Al`/l f rr? ? Address: re
City "r n hc_ tea&C S,t�ate&Zip LG s" Phone ioY' 11:3 A',
E-Mail or Fax#(Optional) �//.//s..r . iS:�1,�i(z 6e t/S,.4iMMc/.irliG
Contractor Information:
Company Name: Qualifying Agent:
Address: City State Zip
Office Phone Job Site/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 inI certafy 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 all laws regulating construction in this jurisdiction This permit becomes null
and void f work isnot
commenced within six(6)months, or if construction or work is suspended or abandoned for aerlod of szx6)months at anytime after
work is commenced I understand that separate permits must be secured for Electrical Work;Plumbing Signs, ells,Pools, urnaces,Boilers,Heaters,
Tanks and Air Conditioners,eta
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMAMNCEMENT 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.
I hereb certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
type o1 certify
will be complied with whether specified 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 law regulating construction or the performance of construction.
Signature of Owner Ls/� -- Signature of Contractor �,_./—
Print Name //�� c✓ °............................ Print Name - �h sr� it...�✓. ...
i. .t.��n.....
Sworn to and subscribed before me Sworn to and subscri ed bee me
this P?- Day of tan this.2-3 Day of
........ ...
9 ` Y '% JASON DRACH JASON DRACH
rida
is
Not u M Comm.Expires Aug ,2014 Notary •'=
y p g do MY Comm.Expires Aug 9,2'14
Commission EE 14543 , iseci tW EE 14543
CITY OF ATLANTIC BEACH
~. h OWNER / BUILDER AFFIDAVI , �.
TOG L-1
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PAR 59N"YgTOON
7
CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LA
DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTE BY
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 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.
II. 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(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 PERMIT.
M_,,�Ul S4 pr"Ve
ADDRESS PHONE NUMBER
Wrll., Q� -lbt,Pi
PRINT NAME
2'7ja4�20/6
SIGNATURE DATE—r
Before me this 2A7day of S �CGrv*bei ,20(0 in 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 F(,W I Psi ,County of PV Y O`
'�. JASON DRACH
❑Personally Known _ �.�rµv��ei,''.
Q �r° °. NotaryPublic State 01 Florida
toducedldentfication- 1`L /EBS -14�'/N�L` Expires Aug My Comm. ExP
• r Commission EE 14543
s, o;
Notary Signature:
F:BLDG/Owner-Builder Affadavit;REVISED: 4/16/2009