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Permit Jasmine Permeter Fence 2007 • - ' '' CITY OF ATLANTIC BEACH ; 800 SEMINOLE ROAD --' , , - „ -, ' s ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5826 INSPECTION EMAIL REQUEST: Building-dept(Wcoab.us Application Number 07-00001187 Date 9/05/07 Property Address 404 JASMINE ST Application type description FENCE PERMIT Property Zoning TO BE UPDATED Application valuation . . . 0 Application desc 404-504 fencing 6ft and 4ft Owner Contractor OWNER Permit FENCE PERMIT Additional desc . Permit Fee . . . 35.00 Plan Check Fee . . .00 Issue Date . . . 9/04/07 Valuation . . . . 0 Expiration Date . 3/02/08 Special Notes and Comments *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. *EMAIL INSPECTION REQUESTS TO BUILDING-DEPT@COAB.US Avoid damage to underground water/sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is needed call 247-5834. There is a 4-inch water main on the northeast corner of the property in the 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. r ''` „„ s , , ,, CITY OF ATLANTIC BEACH PERMIT 2 l t BUILDING / ZONING DEPARTMENT APPLICATION # c) 800 Seminole Road ,, '� Atlantic Beach, Florida 32233 O 2"-- d 7 :4 JF,19% (904) 247 -5800 f, � tl ; -/ (904) 247 -5845 Fax www.coab.us ; t APPLICATION TRACKING FORM REQUIRED DEPT: J Y N PI ANNIN(, Property Address: �, S a ( J m Z Y N BUILDIN = Y N PUBLIC WORKS Applicant: WI ) �-- ( . Y N PUBLIC UTILITIES Y N FIRE DEPT. Project: initt l } PP W W Y N PUBLIC SAFETY -e Vt,CO APPROVAL REQUIRED AGENCY: RECEIVED BY: INITIAL: DATE: cc w Y F D.E.P HUFSTETLER D I I 2 al Y E N S.J.R.W.M.D. CARPER Y N ` ARMY CORPS of ENG CARPER . Y IV HOTELS & RESAURANTS HUFSTETLER APPLICATION STATUS CIRCLE ONE: SITE BUILDING DA AP INITI . DA . 0 0 1ST REV 0 Ell Vi , 4 PLANNING /1: 14 N N.1 8C I ~ M rt OS BUILDING 0 0 2ND REV 0 0 I PUBLIC WORKS PUBLIC UTILITIES FIRE DEPT. El I 0 3RD REV 0 0 PUBLIC SAFETY Return this form to the Building Department once you have entered your comments into the AS400. r '' -ric;• BUILDING PERMIT,APPLICATION 5 -" f CITY OF ATLANTIC BEACH -6 Iv °" 800 Seminole Road, Atlantic Beach FL 32233 Office: (904)247 -5826 • Fax: (904) 247 -5845 Job Address: j 0-1' ry . <. --1 6- 6't -S e� - ' Permit Number: Legal Description f , - 4 / 32 - 2 C — Z I F- S >z H /...-4+ / 6 (Q i/ 1 2:0 Valuation of Work (Replacement Cost) $ 7c • Class of Work (Circle one): e w Addition Alteration Repair Move • Use of existing/proposed structure i rcle one): - Commerciale dent" • If an existing structure, is a fire spr' er system installed? (Circle one): Yes 1 N /A • Is approval of homeowner's association or other private entity required? (Circle one): Yes Describe in F e„,.. e., c rof- k pop eir- detail the type of work to be performed: � ` 9 / Property Owner Information Name: ‘Ni 1 (1 s o . H, C_.c r * ✓' Address: /© 5f (3 e.A. c _e, / City Aft- Lc State F_Zip 32133 Phone Voy J — i 'ZI l Contractor Information: Name of Company: Ow Qualifying Agent: Address: City State Zip Office Phone Job Site /Contact Number State Certification/Registration # Office Fax # Architect Name & Phone # Engineer's Name & Phone # 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 rior to the issuance o permit and that all work will be performed to meet the standards of all laws regulating construction in this j of jurisdiction. This permit bec null and void if work is not commenced within six (6) months, or construction or work is suspended or abandoned for a period of six (6) months at any time after work is commencedf I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters, Tanks and Air Conditioners, etc. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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. thereby 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 of work 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 er ormance of construction. Signature of Property Owner: &'6V1- f Signature of Contractor: Swom to and subscribed before me Sworn to and subscribed before me this ;� Day of . .r ... .,.�.,�r.,�,, Day of / O. . ` ,, 'ay K CUNNIGtiAM ,.f :°, - -\,, 6 `:?-,. Notary Public State of Fonda , Notary Public:„■l .41111[�I■ : " '.: • I'M Commission Expires FeMtic0 ublic: O ,' p , ' '`4 OF FI ��� '77. P , Commission # DD 523638 �' i n. "'� Bonded By National Notary Assn. F REVISED 03.05.07 Special Information for Owner/Builders 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 1.11k: LAW The exemption allows you as the owner of your property, to act as your own contractor even throughyou do not have a license. You must supervise the construction yourself. You may build or improve a one -family or two - family residence or a farm outbuilding. You may also build or improve a commercial building at a cost of $25,000 or less. . The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease more than one building you have built yourselfwithin one (1) year after the construction is complete, the law will presume that you built it for sale or lease, which is a violation of this exemption. You may not hire an un- licensed person as your contractor. Your construction must be done according to building codes and zoning regulations. It is your responslility to make .sure that the people employed by you have licenses re Tired by state law and by county or municipal licensing ordinances. In addition, the owner must supervise construction and becomes liable and responsible for the employees he/she hires. This responsibility includes, but may not be Jirnited to: 1. Workers Compensation, for workers injured on the job. 2. Social Security Tax must be deducted from employee's wages and matched with owner's funds. 3. Federal Withholding. Since owners must be liable for injuries to workers they hire, the Building Division suggests Workers Compensation Insurance be purchased unless the homeowners insurance policy clearly protects the owner. Owners hiring workers become employers and should also observe IRS withholding tax Form 1099 requirements on the workers they employ on their improvement work. Unlicensed contractors cannot be employed under any circumstances. Owners are subject to a $5,000 penalty under Florida Statute #455.288(1) instigated via Building Division citations. An Occupational License is not adequate. The owner should physically see the county Certificate of Competency or the Florida Contractors Certificate to ascertain a person is a licensed contractor. Telephone the building Division ( 247- 5826 )if in doubt. I hereby ckn wiedge that I have read and understand all the above on this / Day of � . Owner id�r Si a ttire Address I l '' /.-, 1.-(1 -2.✓ I c t S — 4€ 2/ / Print Name Telephone Number STATE OF FLORIDA: COUNTY OF DUVAL l 1 /� Before me personally appeared `,� J \ 1 1 t 11,Y , e Q1 '( +c-r to me well known to be the individual and owner builder described in and who executed this instrument and severally acknowledged the execution thereof to be his own free act and deed as such owner builder hereunto authorized. WITNESS my hand and official seal this) V day of i . .1 atAt lent. ic Beach:Co and State aforesaid. ,10.11/4 K. CUNNINGHAM . t > y 2 i. � , • 1 F ORIDA 4 Y ' �'� N otary Public - Stale d Flo�itM p ��ItNam • �. 'O / .. L .,l - 11 .1 y commis Expires F *24, ... 2 / 2t , � commission c op 5 . MY COMMISSION EXPIRES: Ol - i U . 1 0 ''' Wilt .. e : . N o Personally Known • • t7- Identification: n n ;� r S r :: I vI�� k ' P Ezi - _! — . hi - , + ,1 i - � 0' --o-c) (i-c* 4 - (B IT _.1 mac„ • o ? _- .,(62) t 1 y . T i \Ni ' ' Ni Nk h,, r lc i J O• L. Z° I si, Y II b i � , roz 1 v -F • `n s r ._ 6, N �� r ' 0 k STS tit F s 3 J \ I,1 50' 1 I ' 25' 1 C.7 N n m P.: - ,, M A n S c' 1' .10 10' 15' nor a 1 . z. .. , -.,, g-c' i N r � 1 o U i W % 1% 1 .fiz lel 1- 11 : ' ', k l a r • 1,—.. — for 1 ' � t R r z zxt I' k- C , r h y ' '' o u 1 ��,-, m ■ 1 1441 �' N In z• -- I r ' a Ix • • V N 1 ' CITY OF ATLANTIC BEACH J BUILDING / ZONING DEPARTMENT APPLICATION Z # 800 Seminole Road o P Atlantic Beach, Florida 32233 p (904) 247 -5800 (/ 0 (904) 247 -5845 Fax r a 1 www.coab.us 1) APPLICATION TRACKING FORM REQUIRED DEPT: Y N • =■■ I. Property Address: yQ 1_, 5 .5r11;11 g- - Z Y N BUILDING Y N PUBLIC WORKS Applicant: j ) fl (- ( IY N PUBLIC UTILITIES 1 � 7 L I ( Y N FIRE DEPT. Project: ,`, _ Y N PUBLIC SAFETY ftVLC -lam APPROVAL REQUIRED AGENCY: RECEIVED BY: INITIAL: DATE: W U ILI Y D.E.P HUFSTETLER 0 w Y N S.J.R.W.M.D. CARPER Y N ARMY CORPS of ENG CARPER Y HOTELS & RESAURANTS HUFSTETLER APPLICATION STATUS CIRCLE ONE: SITE BUILDING DA ,APP INITI . DA . ❑ 0 1ST REV 0 I r ,,,---- PLANNI * CAN far R£ /N Xi( t en✓O.S genie A BUILDING 0 2ND REV If) 2! 0 SiP 0 VA/ OT PUBLIC WORKS L� PUBLIC UTILITIES ?en /m/ j■VAG. /Z .5ho (,,1. FIRE DEPT. 0 ❑ 3RD REV ❑ ❑ PUBLIC SAFETY I qr 1 1 � _J t,1 o il° / c Return this form to the Building Department once you have entered your comments into the AS400. Sec. 24 -157. Allowable Height of Fences and Walls. (a) Within Required Front Yards, the maximum height of any Fence or wall shall be four (4) feet. (b) Within Required Side or Rear Yards, the maximum height of any Fence or wall shall be six (6) feet. * (c) On Corner Lots, no fence, wall or Landscaping, exceeding four (4) feet in height, shall be allowed within ten (10) feet of any Lot Line which abuts a Street, provided however, that clear vehicular and pedestrian sight distance shall be maintained at any Street intersection. (d) The height of fences and walls shall be measured from grade to the top of the Fence or wall. Where a Fence or wall is erected at the junction of properties with varying elevations, the height of the Fence or wall shall be measured from the side with the lowest elevation. The use of dirt, sand, rocks or similar materials to elevate the height of a Fence or wall on a mound is prohibited. (e) The maximum height of retaining walls on any Lot is four (4) feet. A minimum of forty (40) feet shall separate retaining walls designed to add cumulative height or increase site elevation. �LyrJ " BUILDING PERMIT APPLICATION /; " .,. CITY OF ATLANTIC BEACH �; ;,,. t , 800 Seminole Road, Atlantic Beach FL 32233 ` f�135� ,...,,, Office: (904)247 -5826 ® Fax: (904) 247 -5845 ob Address: J o- f',1" .)4. - f - Si C • 1 t ' Y , -- Permit Number: ,egal Description ( ' - .1 - 32 _ 2J - 2-?/ S Q-c H / •, r / — 6 a .L v-.l ID „- t e Valuation of Work (Replacement Cost) $ / � 09 ® Class of Work (Circle one): ew Addition Alteration Repair Move If Use of existing/proposed structure ircle one): - Commercial cirditte. nrtiat • If an existing structure, is a fire Tr' er system installed? (Circle one): Yes N /A El Is approval of homeowner's association or other private entity required? (Circle one): Yes 4, o )escribe in detail the type of work to be performed: 1-:e.' . c, e_, .t..110(..... k prop e,r--k (- 1--- (.....-::„ ...." -ts, a 0 cr,z Droperty Owner ner Information dame: /- J , (1 , "6 , ..- A4-+ C - r- L & ✓.. Address: /o . -S' 8 e.e. c_i-. /4"v-e- :ity , f A State Fc_Zip 3 22:13 Phone 96v J - 1 2.//' : ontractor Information: lame of Company: 00.,1 - Qualifying Agent: address: City State Zip )ffice Phone Job Site /Contact Number state Certification/Registration # Office Fax # \.rchitect Name & Phone # engineer's Name & Phone # application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or nstallation has commenced prior to the issuance of permit and that all work will be performed to meet the standards of all aws regulating construction in this jurisdiction, This permit becomes null and void ifwork is not commenced within six (6) nonths, or be construction or work is suspended or abandoned for a period of six (6) months at any time der work is :ornmenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, FVells, Pools, Furnaces, Boilers, Heaters, Tanks and Air Conditioners, etc. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU NTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY 3EFORE RECORDING YOUR NOTICE OF COMMENCEMENT. 'hereby certify that l have read and examined this application and know the same to be true and correct. All provisions of 'aws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a iermit does not presume to gave authority to violate or c a n c e l th provisions of any other federal, state, or local law °egulating construction or the er ormance of construction. 17: >ignature of Property Owner: ("' "', t ' JSeofConfractor: >worn to and subscribed before me Sworn to and subscribed before me his Day of — thy, _ Day of � tw.rn . a..,,, nz f ayp, K Cf1AM 1P a UNNING Notary Public - State of Florida votary Public : ■IMMINIPSII■ i . • —'' • • EM Commission Expires Feigiti9 Agublic: (/ , Commission # DD 523638 pp , ' �%∎,,' Bonded By National Notary Assn. l' REVISED 03.05.0" N----- 5= - , CITY OF ATLANTIC BEACH JI f s' BUILDING / ZONING DEPARTMENT APPLICATION L # R.k �,. \,, � ,,, 800 Seminole Road Atlantic Beach, Florida 32233 j � a 7 _ ., < r r (904) 247 5800 ( / � (� (904) 247 -5845 Fax � Id F , 1 ` ( www.coab.us A1' APPLICATION TRACKING FORM REQUIRED DEPT: I / 6 4 5a 4 2 Y N Property Address: �'m /'�� Z Y N BUILDING = Y N PUBLIC WORKS Applicant: j) - ( . Y N PUBLIC UTILITIES Y N FIRE DEPT. Project: Ini �� 1 t ' Und) Y N PUBLIC SAFETY • "F- K.0-0 APPROVAL REQUIRED AGENCY: RECEIVED BY: INITIAL: DATE: cr w w Y D.E.P HUFSTETLER I- uj Y N 1 S.J.R.W.M.D. CARPER Y N ARMY CORPS of ENG CARPER Y HOTELS & RESAURANTS HUFSTETLER APPLICATION STATUS CIRCLE ONE: SITE BUILDING DA AP — INITI . D I 0 ❑ 1ST REV 0 , r /9, PLANNING * e4 N /bs e£ /N Gt/ L rt »Os .......------„..) BUILDING /IC I) 0 7 0 0 2ND REV 0 . 1/ UBLIC WORK PUBLIC UTILITIES FIRE DEPT. ® ❑ 3RD REV PUBLIC SAFETY Return this form to the Building Department once you have entered your comments into the AS400. $� f BUILDING PERMIT APPLICATION r � t h e - -) CITY OF ATLANTIC BEACH ,, t r 800 Seminole Road, Atlantic Beach FL 32233 Office: (904)247 -5826 * Fax: (904) 247 -5845 ob Address: J �- f . , ... —I- �" t ' 17r e.. A-- Permit Number: ,egal Description /j ' —J 4 ' is - 2 S - 2 - I / s e-.c._ F ( •a ` f I' — 6 (l.L V 12-0 1 ,- t. Valuation of Work (Replacement Cost) $ /� C. ® Class of Work ((Circle one): ew Addition Alteration Repair Move ® Use of existing/proposed structure ew ., one): - Commercial es is > ® If an existing structure, is a fire six' er system installed? (Circle one): Yes N /A�-� a Is approval of homeowner's association or other private entity required? , (Circle one): Yes i_) )escribe in detail the type of work to be performed: Fe_v 6 c ... �,roc.,,,, Z prop G / 1 � .-, 1 .-- f , : ,e cxiZ ' roperty Owner Information dame: o ( (, c% H, C- t.sr--4-0-,.- Address: /® re- �c.J, 1/4,- :it ,/ 1 - Q State Fi..Zip 3 2133 Phone 96S' _f - 5 '2 - I l - 2ontractor Information: lame of Company: 00.J i --+.- Qualifying Agent: \,ddress: City State Zip )ffice Phone Job Site /Contact Number ;tate Certification/Registration # Office Fax # \.rchitect Name & Phone # engineer's Name & Phone # 1pplication is hereby made to obtain a permit to do the work and installations as indicated I certify that no work or nstallation has commenced prior to the issuance of a permit and that all workwill be erformed to meet the standards of all aws regulating construction in this jurisdiction, This permit becomes null and void if work work is not commenced within six (6) nonths, or Y construction or work is suspended or abandoned for a period of six (6) months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters, Tanks and Air Conditioners, etc. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMIVIENCEIVIENT MAY ZESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU NTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY 3EFORE RECORDING YOUR NOTICE OF COMMENCEMENT. 'hereby certify that have read and examined this application and know the same to be true and correct. All provisions of 'caws and ordinances governin - this type of work will be complied with whether specified herein or not. The granting of a Ter mit does not presume to give authority to violate or cancel the provisions of any other federal state, or local taw °egulating construction or the er ormance of construction. iignature of Property Owner: ‘ / of Contractor: ;worn to and subscribed before me Sworn to and subscribed before me his Day of t Day of � � s ` n�. w,.k: -i i/ K CUNNIN � ` ti p RY ii % a°� „`'; Notary Public Slate of Florida Notary Public:_ /� - _y ' : , = ,• -.' : • iM Commission Expires Feig.,§t p�O ublic: :1 2t r o Commission # DD 523638 " 8 r.A" Bonded By National Notary Assn. REVISED 03.05.0 Special Information for Owner/Builders 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 TH E LAW. The exemption allows you as the owner of your property, to act as your own contractor even throughyou do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two - family residence or a farm outbuilding. You may also build or improve a commercial building at a cost of $25,000 or less. . The building must be for your own use and occupancy. It may not be built for sale or lease. Ifyou sell or lease more than one building you have built yourselfwithin one (1) year after the construction is complete, the law will presume that you built it for sale or lease, which is a violation of this exemption. You may not hire an un- licensed person as your contractor. Your construction must be done according to building codes and zoning regulations. It is your responsibility to mane sure that the people employed by you have licenses required by state law and by county or municipal licensing ordinances. In addition, the owner must supervise construction and becomes liable and responsible for the employees he/she hires. This responsibility includes, but may not be limited to: 1. Workers Compensation, for workers injured on the job. 2. Social Security Tax must be deducted from employee's wages and matched with owner's funds. 3. Federal Withholding. Since owners must be liable for injuries to workers they hire, the Building Division suggests Workers Compensation Insurance be purchased unless the homeowners insurance policy clearly protects the owner. Owners hiring workers become employers and should also observe IRS withholding tax Form 1099 requirements on the workers they employ on their improvement work. Un Iicensed contractors cannot be emuloyed under any circumstances. Owners are subject to a $5,000 penalty under Florida Statute #455.288(1) instigated via Building Division citations. An Occupational License is not adequate. The owner should physically see the county Certificate of Competency or the Florida Contractors Certificate to ascertain a person is a licensed contractor. Telephone the building Division (247 -58261f is doubt I hereby ckn wledge that I have read and understand all the above on this / Day of _! . Owner r S i atare Ades f i " C• l�rr '.✓ -.j 4-j 57/ -- Z/ l Print Name Telephone Number STATE OF FLORIDA: COUNTY OF DUVAL \\ nn r Before me personally appeared lk) \ 1 I (Al 1 ., C Q ,r v to me well known to be the individual and owner builder described in and who executed this instrument and severally acknowledged the executionthereofto be his own free act and deed as such owner builder hereunto authorized. '�'O WITNESS my hand and official seal this) U day of A atAtlautic Beach. Count and State aforesaid. K. CUNNINGHAM Y ' .1 :I, • 1 F ORIDA ' '' P Sta .of Fl ori da V 171 ,. _,� Notary Public 2Q P r . t Nam _ ' � i► I _ L i ': .� c ommission Feb s• ' r 523638 28 s. C9mm " +�^ Expires DP .. MY COMNIISSION EXPIRES: ' 0 104, • ' . °n c Nat ional N ota n g - e 6Y ❑ Personally Known ki- klentification: 27 _ �� " �''r'�� CITY OF ATLANTIC BEACH ! ,� F s BUILDING / ZONING DEPARTMENT APPP APPLICATION ` A '-'H'^^"^ y, 800 Seminole Road N # Ai Beach, Florida 32233 /�� �r� % (904) 247 -5800 P- � �, � (� J;31J (904) 247 -5845 Fax ���1 , �� ) ° i ,' www.coab.us f , A'1 APPLICATION TRACKING FORM REQUIRED DEPT: 1.� t Y N PI ANNI + r 1 '�Y111 N�i Y N BUILDING Property Address: L I z 1"' Y N PUBLIC WORKS . Applicant: LU (J Y N PUBLIC UTILITIES re Y N FIRE DEPT. Project: f617 I' 4 t I Wl h Jt b Y N PUBLIC SAFETY f- LC-C) APPROVAL REQUIRED AGENCY: RECEIVED BY: INITIAL: DATE: CC w U Y D.E.P HUFSTETLER H Y N S.J.R.W.M.D. CARPER LIJ Y N ARMY CORPS of ENG CARPER Y HOTELS & RESAURANTS HUFSTETLER APPLICATION STATUS CIRCLE ONE: SITE BUILDING DA INITI . DA . 0 1ST REV A , / I v , ,,-- — PLANNING * CA N Hts-r 5C /N A r4 os BUILDING 0 ❑ 2ND REV 0 0 PUBLIC WORKS P :L 'U I, T FIRE DEPT. 0 0 3RD REV ❑ PUBLIC SAFETY Return this form to the Building Department once you have entered your comments into the AS400. Public Utilities — Distribution & Collection Date: 8/21/07 Initials: Project Name /Address: Install 4' - 6' wood fence / 404 -504 Jasmine St. Application/Permit #: 07 -1187 Check Box Application Tracking Comments To Add Comment Avoid damage to underground water /sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is needed, call 247- P t,l W 5834. Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible. ❑ A sewer cleanout must be installed at the property line. Cleanout must be covered with ❑ an RT1 concrete box with metal lid. Cleanout to be set to grade and visible. A reduced pressure zone backflow preventer must be installed if irrigation will be provided or if there is a private well on the property. Backflow preventer must be tested ❑ by a certified tester and a copy of the results sent to Public Utilities. Plans note the building will be unsprinkled. If plans change, any fire line installed must be metered with a Sensus touch -read meter in a properly sized vault and an appropriate ❑ backflow preventer installed. Backflow preventer must be tested by a certified tester and a copy of the results sent to Public Utilities. If fire sprinkler system is provided, contact Malcolm Clemons at 247 -5839 for backflow ❑ requirements. At a minimum, will require double check backflow preventer. Fire lines must be metered with a Sensus touch -read meter. Meters larger than 2" must ❑ be installed in a vault as noted in JEA specifications. 0 0 0 0 0 F:\Public Works \PlanReviewConunents- PU.doc s: = BU ILDING PERMIT'APPLICATION 7 CITY OF ATLANTIC BEACH �r 800 Seminole Road, Atlantic Beach FL 32233 x;35 Office: (904)247 -5826 6 Fax: (904) 247 -5845 ob Address: G- . —f- c 6 t" t' S'i' e.:.___+ Permit Number: ,egal Description (k - ]'1 22 - 2 C - 17 S F I `i I / , I?.L i.< 12 0 , „- & Valuation of Work (Replacement Cost) $ /._..s 09 rfi ® Class of Work (Circle one): ew Addition Alteration Repair Move a Use of existing/proposed structure ircle one): - Commercial Chi a If an existing structure, is a fire spr er system mstalled? (Circle one): Yes N /A ® Is approval of homeowner's association or other private entity required? (Circle one): Yes (1:Sa )escribe in detail the type of work to be performed: R ,,#) c e...- eX roc- prop se---1- '/' ry.,, t-- 4 .„..(:,,,e, aocr)z ➢roperty Owner Information Jame: tJ " I : c . i-'- C. ,r- -, ' Address: / re' 8 e J A-v-e_ :ity c_ a State FLZip 3 2237 Phone shy J — "Z-/ t contractor Information: lame of Company: 00,J v,.,�-- — Qualifying Agent: k.ddress: - City State Zip office Phone Job Site /Contact Number ;tate Certification/Registration # Office Fax # i.rchitect Name & Phone # l'ngineer's Name & Phone # application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or nstallation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all aws regulating construction in this jurisdiction. This permit becomes null and void ifwork is not commenced within six (6) nonths, or if construction or work is suspended or abandoned for a period of six (6) months at any time after work is ommenced. I understand that separate permits must be secured far Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters, Tanks and Air Conditioners, etc. WARNING TO OWNER: YOUR FAILURE TO RECORD A. NOTICE OF COMMENCEMENT MAY ZESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU NTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY 3EFORE RECORDING YOUR NOTICE OF COMMENCEMENT. 'hereby ertif� that I have read and examined this application and know the same to be true and correct. All provisions of 'aws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a 2ermit does not presume to gave authority to violate or cancel the provisions of any other federal, state, or local law ' egulating construction or the er ormance of construction. 3 tur of Property Owner: /i Z- 9( / /61f ` " Magna e P rty Q �.�✓[ Signature of Contractor: iwom to and subscribed before me Sworn to and subscribed before me his Day of <.::. ,.,. Day of 7 " � `f r . ; IV Y ' K. CUNNINGNAM P'0.%''. �. /. ,` Notary Public - State of Florida Notary Public: / .1111/11.,, : ' , • iM Commission Expires Fe1p.� A ublic: ,;����~' Commission # DD 523638 Bonded By National Notary Assn REVISED 03.05.07 Special Information for Owner/Builders DISCLOSURE STATEMENT for Section 489.103(7), Florida Statutes: - _ _ - STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERM. UND ER AN EXEMPTION TO THE LAW The exemption allows you as the owner of your property, to act as your own contractor even throughyou do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two - family residence or a farm outbuilding. You may also build or improve a commercial building at a cost of $25,000 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. Ifyou sell or lease more than one building you have built yourselfwithin. one (1) year after the construction is complete, the law will presume that you built it for sale or lease, which is a" violation of this exemption. You may not hire an un- licensed person as Your contractor. Your construction must be done according to building codes and zoning regulations. It is your responsibility to make .sure that the people employed by you have licenses required by state law and by county or municipal licensing ordinances. In addition, the owner must supervise construction and becomes liable and responsible for the employees he/she hires. This responsibility includes, but may not be limited to: 1. Workers Compensation, for workers injured on the job. 2. Social Security Tax must be deducted from employee's wages and matched with owner's fiends. 3. Federal Withholding. Since owners must be liable for injuries to workers they hire, the Building Division suggests Workers Compensation Insurance be purchased unless the homeowners insurance policy clearly protects the owner. Owners hiring workers become employers and should also observe IRS withholding tax Form 1099 requirements on the workers they employ on their improvement work. Unlicensed contractors cannot be employed under any circumstances. Owners are subject to a $5,000 penalty under Florida Statute #455.288(1) instigated via Building Division citations. An Occupational License is not adequate. The owner should physically see the county Certificate of Competency or the Florida Contractors Certificate to ascertain a person is a licensed contractor. Telephone the building Division (247 -5826 if in doubt. I hereby . ckn • wledge that I have read and understand all the above on this /67 Day of _�! . Owner - r puddt Si.' ature Address ' ( r.G c,-, r - 9 L i T --- 't u/ Print Name Telephone Number STATE OF FLORIDA: COUNTY OF DUVAL ) 1 1 /� Before me personally appeared \ 1 \ � Wink link , C Qr / +-V to me well known to be the individual and owner builder described itn and who executed this instrument and severally acknowledged the execution thereofto be his own free act and deed as such owner builder hereunto authorized. ------Th WITNESS my band and official seal this) 0 of 1 . j atAtlantic Beach County and State aforesaid. K�NGHAM •�s �Y '" ei' 1 t', ST 8? F ORIDA "Y P S tate of Florida :?;•► Notary Public Feb 28, Q IVEItNam- l %► Al AL ,ti mission Expires 2°1 1 ; '4, Y com ! # op 523638 MY COMIVITSSION EXPIRES: A- i tP • 1 ° I ' " ""4 .. Bonded BY Natio Not min - ❑ Personally Known entification: n r, . .<-•• 1 . ' , ,` r ? ice ' _t c ogt , 4, I n2' _ _ ! 2Y. _ .- C� G 'i - 4. I-- e t A; 'D', -- --4f '9) WO ) Z 8' -.M.--- .• . ?'i- -^(t2) ,v' I I - z) , ■ 1 O J -4 51 b 01 V 1,.. . a f'' pi, ; � : I ll 102' I I L J I " 1 - 1 N t 57 IV) A s; I1I I. `s N L._ 1 G M r .� 0 J .� H 1y I 50' I I xi '" �, 1 ^ ' 1 ' , ;:.to' t0' , 15' toe' i H Q Z — , • 1 I , 1 I0Y ill x k ill i s f Rol • G I • t V1 ((N; I � {` 1 It . . • r ..� 1. p 11 . 1 K N ! 1 1 t o p • 1' , .. I 102' • t 7.f". ,x tx 1° 'f'' . 1 y °'! t Y al � • �? k s , (•I �I; 5 o i� I rn n .�. pl I S O O 11 1! - -- • Y -t" r 1 ' yl 0 `I ' . ♦♦ ; `) —M/a 0 © II t:. ° - t1`- __ ___ {6, 6TH STREET WEST WEST t • (1• \ \ \ \ \ � �� ` ` �\ — - 6. ( 50. R iii Z ♦ a� i . �.I.t, a c Q ® 61'9!" -- —_ . __ - __ . _� . __ - __ _V r I PO ViE A l'V'` T fr A MA Cfl t5.9 t1 Special Information for Owner/Builders 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 ENDER AN EXEMPTION TO Tag LAW. The exemption allows you as the owner of your property, to act as your own contractor even through you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two - family residence or a farm outbuilding. You may also build or improve a commercial building at a cost of $25,000 or less. • The building must be for your own use and occupancy. It may not be built for sale or lease. Ifyou sell or lease more than one building you have built yourselfwithin one (1) year after the construction is complete, the law will presume that you built it for sale or lease, which is a violation of this exemption. You may not hire an un- licensed person as your contractor. Your construction must be done according to building codes and zoning regulations. It is your responsibility to make .sure that the people employed by you have licenses required by state law and by county or municipal licensing ordinances. In addition, the owner must supervise construction and becomes liable and responsible for the employees he/she hires. This responsibility includes, but may not be limited to: 1. Workers Compensation, for workers injured on the job. 2. Social Security Tax must be deducted from employee's wages and matched with owner's funds. 3. Federal Withholding. Since owners must be liable for injuries to workers they hire, the Building Division suggests Workers Compensation Insurance be purchased finless the homeowners insurance policy clearly protects the owner. Owners hiring workers become employers and should also observe IRS withholding tax Form 1099 requirements on the workers they employ on their improvement work. Unlicensed contractors cannot be employed under any circumstances. Owners are subject to a $5,000 penalty under Florida Statute #455.288(1) instigated via Building Division citations. An Occupational License is not adequate. The owner should physically see the county Certificate of Competency or the Florida Contractors Certificate to ascertain a person is a licensed contractor. Telephone the building Division C247 If in doubt. I hereby ckn wledge that I have read and understand all the above on this /6 Day of . Owner d r S i at re Address Print Name Telephone Number STATE OF FLORIDA: COUNTY OF DUVAL 1 / � Before me personally appeared . t 11 1 \ 1(1 ryt , C Qr r r to me well known to be the individual and owner builder described in and who executed this instilment and severally acknowledged the execution thereof to be his own free act and deed as such owner builder hereunto authorized. WITNESS my hand and official seal this) V day o i . Ja. atAtlantic Beach :County and State aforesaid. E irit. Notary Public -State of F P rl tNam lit A . i AL om mi Expires Feb 28, MO GQmm iion # DD . 523638 2 MY COIvIIvIESSION EXPIRES: Ol - i N ational N gnded BY ❑ Personally Known b- Rientification: 2