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Permit Fence 1140 Seminole Rd 2010 '\J1j t CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ............... ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 10-00001196 Date 10/12/10 Property Address . . . . . . 1140 SEMINOLE RD Application type description FENCE PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc 6FT FENCE ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ GARTLAND, HENRY OWNER 1140 SEMINOLE ROAD ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit WIWIO FENCE PERMIT Additional desc . . Permit Fee . . . . 35 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . - 4/10/11 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 35 . 00 35 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 39 . 00 39 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road 0 07) Atlantic Beach, Florida 32233-5 A4 7-5845 Phone(904)247-5826 - Fax(9 7-5845 /0 E-mail: building-dept@coab.us ?0/0 L Date routed: City web-site: hftp://www.coab.us APPLICATION REVIEW AN RACKING FORM Property Address- 112L Department review required Yes- No Building Applicant: Planning &Zoning Tree Administrator Project: Public Works Public Utilities Public Safety Fire Services 2 ep - 5, 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: �Approved. F]Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: F]Approved as revised. FID P Comments: cnp Qil k' BLIC UTILITIES IC WSAFETY Reviewed by: Date: FIRE SERVICES Third Review: FlApproved as revised. FIDenied. Comments: FILE Reviewed by: Date: Revised 05/14109 City of Atlantic Beach S I tp APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road �010 Atlantic Beach, Florida 32233-5445 i Phone(904)247-5826 - Fax(904)247-584 J-t E-mail: building-dept@coab.us L Date routed: City web-site: hftp://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: le2k Department review required Yes No Building Applicant: Planning &Zoning Tree Administrator Public Works Project: Public Utilities Public Safety Fire Services IN" i`b e 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: [KApproved. [-]Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by Date- TREE ADMIN. Second Review: FlApproved as revised. RDenied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: []Approved as revised. ElDenied. Comments: Reviewed by: Date: Revised 05/14/09 1.1% 1 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road -5445 Atlantic Beach, Florida 32233 Phone(904)247-5826 - Fax(904)247-5845 LDate routed: �F E-mail: building-dept@coab.us City web-site: hftp://vmw.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: Department review required Yes No Building Applicant: Planning &Zoning Tree Administrator Project: Public Works -Public Utilities 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: RApproved. RDenied. (Circle one.) Comments: BUILD & e �1,,AANNING &ZONI Reviewed by- Date: TREE ADMIN. Second Review: ElApproved as revised. RDenied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: RApproved as revised. FIDenied. Comments: Reviewed by: Date: Revised 05/14109 BuILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach, FL 32233 Office (904)247-5826 Fax (904) 247-5845 Job Address: r6bPermit Number: ffj& V , Legal Description Parcel# Floor Area of Sq.Ft. Sq M Valuation of Work :,�40d Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): cew Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/pro sed structure(s) (circle one): Commercial (IC�s_i�dential , If an existing struclTre,is a fire sprinkler system installed?(Circle one)�- ",Yes ==go3 N/A Florida Product Approval# For multiple products use product approval form Describe in detail the type of work to be performed: E'ALL 2& IM_29?1_� ZZ Alf Property Owner Wormation: - ' ' e- �'��S�tate I CZ �jZip E-Mlo�r F44�(Optio�nal Contractor Information: Company Name: Qualifying Agent: Nddress: —city State zip Office Phone Job Site/Contact Number Fax State Certification/Registration 4 A,rchitect Name&Phone# Engineer's Name&Phone# Fee Simple Title Holder Name and Address Bonding Company Name and Address Vlortgage Lender Name and Address ica hereby ad ain a rmi do t work and insia'lati�ns as ind or installation has commenced rior 0 he s � ul rn 71 he an ar a' thisjurisdiction. Yhis permit bpco,,,n' f k fs fter a or 0 ' P' 0 h to 0' ork p be e� d to_ t p 3suance 0 aperm" , at "w ft p 'o t , or, c % 'trcft, r ,,d vo'd work not commenced W,hin (6) h, 0 n I r aWeriod q U16 months at any time a i st t� t spar,,pe it,must ,secure f 0, 1 ctn I Fs. ul f d,, b d E e Pools, urnaces,Boileis,Heaters, vo,k 3 comm'nc"i 'n a e r n jr Con . 0 ers, anks a dA ditz n etfid WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMAIENCEMIENT MAY RESULT IN YOUR PAYING TWICE FOR EMPROVEMIENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. -here cer!ify that I have read and examined this application and know the same to be true and correct. Allprovisionso verning this ,�.e to g�146 and ordinances zo 'Pwork-will be coTplied with whether s ed herein or not. ne granting of a permit doe jauthor' to vio or cancel the )rovisions of any otherfederal, regulating construction or the peTfoi7nance ofconsM2 r state, or local Pn.e 'igriature of Owner Signature of Con�tra�etor ,JF to violltee, )rint Name 1166............. L PrintNalne .. .................... .........4��.A........... . ... ... ...........M��....... ............. !*onp�jditsubscribS�be�fg� Sworn to and s;ubscrib 'e ore me Day of of his 20/ this Day of '20 N. TE EXPI-RE&M Notary Pu �otary Public aY21,2011 i�. 0 L)Orldiid Thru Notary Public undowrq,,. Revised 0 1.26.10 �O /7 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 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. [I. 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. V6116 D JdQ ADDR�Ss PHONE NUMBER �c A f-D,h PRINT NAME (0 SIGNATURE DATE Before me this t- I day of &7�� 20L0 in the county of Duval,State of Florida,has personalloppeared herin by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State ofl��44)__,County of 13 Personally Known q,Prod.ced ldentffication- 0 L z-S 21 7 0 Mal ,jndl, Notary Siqnature: 1`11ILDG/Owner-Builder Affadavit;REVISED: 4/16/2009 SEP-29-2010 15:10 FROM:CLERK OF COURTS 904 270 1512 TO:92475845 P:1/1 Doc V 201=79zo,vK bK 16361 Page 2391, NOTICE OF COMMNCEAMN-T Number Pagee:1 Recorded 09rdMI 0 at M:13 PM. JIM FULLGR CLEPK CIRCUIT COURT DUVAL COUNTY p0mlit NO. RECORDING$10.00 TM UMTrjtST0NED hereby gj�nodoe that impravements wiH bo made to ocrtain mal proporty,and in accordeay.,vnth Scation, 713.13 ofthe Florida Statutes,the following infarmntion is provided in this NOTICE OF COMONCENIENT. iMcmiption,ofproperty(kgal Hff-,U a)S"(job)Addrcss: pei�r I C& A. 2.Geacml dmaiption of improveme=: r-e Ale&_ 3-C �mcr Lm%rmaliOn ";FZ s,��3 a:-9j 1.4 e 92 12 gr-L Q Al t) I 114 A a)Na=and add1w b)INa=andaddrowof��s=�Ia titleholder(if other thaniownci) in pmperty 4.ContmCW blblmWiOn a)Na=and address: fn �_A4-lqphr, JQ laxi b)Telephone No.: flax No.(Opt) 5.5mity loibmadon A)Narm&Dd address! b)Amotmt of Bond: c)Telephone No.: Fax No.(OPL) 6.L0dar a.)Nama and address: PboneNo. 7.J11couty of person within the Stm OfFlorida designated by owner upon whom notica or otm dom=em May be swmd-. a.)Nm=and addrm:.___ b)Telcphow No.: Fax No.(Opt) S.rn addition to WaLvA ow=dosigasm the Wowing person to recelve it cM of1he Lienor's Notice w providod in Section 713.13(l)(b),Florida Staucs: a)'Namo and address: b)Tclq&one No.:_ FzK No.(OPL) 9Yj;0mijon dato ofNoticc of Commencernemit(the expiration date is one year Erom tho date of reeordfmg unless a differept date is cpedfied)-, WARNiNG'TO OWNER: ANY PAYbZNTS MADE BY THE OVFNER AFTER THE EXPIRATION OF T]9Z NOTICE OF COMMNCXWNT ARE CONMDZRKD DeRopER PAYMZN-0 UNDER CHAPTER 713,PART I,SECTIDN 713.13, nOR,j)A S*rATUTI&S ,,AND CAN RESULT IN YOUR PAYING TWICE FOR MeROVEMEM TO YOUR PROPKIRTY. A NOTICIP,OF COIQ�MNCEMENT MW BE REC03tDED AND POSTED ON THE JOB S1=BEFORE THE FIRST YNSPSCTION. M YOU INTEND TO OBTAIN FINANCTNG,CONSULT YOUR LENDER OR AN ATTORNEY BEFORE CONIMNCING WORK OR RECORDING YOUR NOTICE OF MMEN7btZNT. .,._All'W��6 WATIR UP MMMA 4 &D C0UmT0v=mUQm ,jX,-va,( 10- A 1 71, 6 jjj t�=ofC)wmcrarOwmw'sAutbonMCdCM5=/06CCbXA'WtmCrRANDW ...A Ll .&,4 R T A/27 Prwsmo of .20_,/O,by n8fbrcgoftjnstuumtvm acknowledged beftommeft�:7:�-1—r—day G t , __)e C, (type of authority,P-g.officer,trustee, as_ :42" attorney In oket)for ALec,1�7 (�77-n n47-i-eD (name ofparty us behaffofwhDm instroamot was=Clmtmf� personally Known OR.Produced 14=06cation Notary SWO&b= 1 70 Typo ofTrim.itification Produced IC-CIP '54f/0 3'j 2-25 INN= 0 P. VMiSomdon pmmmutto Section92.525,Florida Sulute".Under pecaltift ofpmjury,I dcclarc,thatI have read te f'oregoin-1Z aad dul DGQW tho ftcts sWed in it am true to the hest ofmy knowledge and belicE __ Z� A. W COV#ffi"I DD 634125 S i P not"af MAI ." SHOWING SURVEY . "'F LOT 2 AND THE NORTH .5 FEET OF LOT 1, BLOCK 8', SIELVA MARINA UNIT NO. 3, AS RECORDED IN PLAT BOOK 29, PAGZ 27JOG-EPTHER WI'M LOT 3, BLOCK B, SELVA MARINA UNIT NO. L�, AS RECORDED IN PLAT no PAGE 28, ALL OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. /37�57' Z- 14 v ri \q A(1, -40- jc"7 -7� Z,6 �A/(�f-J L z I-q 7�9 7-0