Permit 15 Forrestal Cir fence 2011 tr-f rL�l r
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
►;� ATLANTIC BEACH,FL 32233
' INSPECTION PHONE LINE 247-5826
I V1
Application Number . . . . . 11-00001602 Date 2/03/11
Property Address . . . . . . 15 FORRESTAL CIR
Application type description FENCE PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
----------------------------------------------------------------------------
Application desc
4 FT FRONT AND SIDE AND 6FT REAR FENCE
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
PARKER, RICHARD & IDA OWNER
15 FORRESTAL CIRCLE
ATLANTIC BEACH FL 32233
----------------------------------------------------------------------------
Permit . . . . . . FENCE PERMIT
Additional desc . .
Permit Fee . . . . 35 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 8/02/11
----------------------------------------------------------------------------
Special Notes and Comments
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 .
Roll off container company must be on City approved list
and container cannot be placed on City right-of-way.
----------------------------------------------------------------------------
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 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.
BUILDING PERAM APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904) 247-5845
)b Address: / rri S 7 L ( . / Z A/ Permit N
egal Description Parcel#
Floor Area of Sa.Ft. q
aluation of Work$ Proposed Work heatedlcooled 6� ne�6' /
lass of Work(circle one): New Addition Alteration Repair Move Demo liti o spa /door
se of existing/proposed structure(s) (circle one): Commercial Residential l/
'an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A
.orida Product Approval#
Dr multiple products use product approval form yr'�
escribe in detail the type of work to be performed: /Jew C N Lin k icon t st,,i -ld66 S o
1-&116? ad-r O�,p 'rfv -h00WJs 00S} 0-f,ce
ropertV Owner Information:
ame: 5 2q,^&Lr Address: /S ho-eZifSfU/ Cir. _jz
ity_ Ic rt eG &WL4 State fLZip ' 22 Phone 90y-,Yf7- 7`''k U
-Mail or Fax#(Optional) cioJ d,L Ver A:�?Nab n�ci, �.COr►1
mtractor Information:
)mpany Name: Qualifying Agent:
ldress: City State, Zip
ffice Phone Job Site/Contact Number Fax#
ate Certification/Registration#
7chitect Name&Phone#
Lgineer's Name&Phone#
:e Simple Title Holder Name and Address
rnding Company Name and Address
ortgage Lender Name and Address
plication 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
'tante 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
i void f work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of sax(6)months at any time after
rk is commenced I understand that separate permits must be secured for ElectHear Work,Plumbing,Sikns, Wells,Pools,Furnaces,Boilers,Heaters,
xks 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.
!re b certify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
of work will be complied with whether speci red herein or not. The granting of a permit does not presume to give authority to violate or cancel the
visions of any other federal,state, r to Z law la 'ng construction or the performance of construction.
M
Aature of Owner C Signature of Contractor
at Name Print Name
..............................----------------.-........ ........................................................................ ......................................................--...............................................................................
ofs scrib d befor e Sworn.to and subscribed before me
ay of �°°^ � this Day of 20
L.G HAM
(;ttip,U;$IOI14 DD 957160
r C G i hru Not s Public Urdervrtitefe Notary Public
Revised 01.26.10
BOUNDARY SURVEY
LOT 19 E3 1-00K"1ATLANTI0 BEACH VILLA IJNIT NCI. 1
.. AS RECORDED{N PLAT/DEEO BOOK 30 PAGE(S) 3B" OF THE CURRENT PUBUC RECORDS OF DUVAL COUNTY.FLORIDA -
1775131 - ❑a❑❑ PROFESSIONAL S1
1.a' S 69°31F25" E 75.❑OI o.�• LAND PLANNERS
293a SUNSEK9 ROAD, SUITE
X p,0• X (90-4) 896-9388
L❑T 20 B' LOT 1 9. LOT F113
BLOCK f'
- - -I B:EREBY L'ERTFFY, That U
- .ur.cy made under my re:
t.4e latest 1llnSmum Teehnl
X pm=ultated b the Florida
" - - and )tappers,by
dIGL
• Pursuant to Sc cLoa 172,02'
(3 - O - .. notes and nota Uon■ ahoxxt
❑ ❑ 02-07-07A
11: DAT3 11M y -11C
❑ r EI
r- O r t
141-tLI 1(S.B' 43.20 1 6.0 x THURRAN B. KING F)
❑ �` !O10.00' NTATIOX. MuoV) asu .ycr ande7rn doe•
tt
the
C1 _❑ - rctaxz:int 1cf;,rm%uoa eho•n
❑ CAR O ❑ _ - olermpi.E•bouada:7 line dlsp
N" E p 1 STF]RY FRAME D ,- N rest ictIre coceaanty. omen
O
Ft r- it 1 S � T` CI facts that as accurate and
N N H - ❑ THIS SURYEY 1S PREPARED A;
N - OF THR CLIENT NA-VE:D MIZE(
- 77 - AN ORIGINAL SLGNATILIRS A:.'D
•r• PORT 33.30 16.01 ((] _ PFEEPARLD AKD CERTrMD rO'.
r T ;A 3O.D'H.R.L.
30.0'B.R.L.- t.•
/ � RACHE.
N �
14
CERTIFIED T0:
• : ; STEWART Gu)
T N 4OS.1 1' P C. STEIYART TITLE
o.a'
N 69°3125 W 75.0,9E
030
F[]RRESTAL 01R. N13RTH ( ET 11 PJW SCALE.
N°.: ❑l.cup: 1:20
DRAN.4 DY: B.N.
SEC. TTTI
NOTE: .
F.T.R.M. FLOOD ZONE:
6EAMN139 VAB_n FROM THE NORTH RAV COM3fUtITY PA.cL No.:
LINE OF FORRESTAL CIR. NORTH N.69°31'2g'W.
DATE OF F.I.R.M. INDEX:
ADl3Rr,UTIONS• - LTIRYS:ATA: SLTrIMY ANNA A.11O S: RASE HOOD EM.UION:
AVC -ATR OONUT10HOt Fti -TIRE k7DRUWT PC. -PACE A -CELTS 0 -TND.CCNC.MONUMENT (NO LD.) -NO IDENTDTCATICH 1
A3pn -A7HALT FNM -F04ND - PA -PAWER K�CN NAIL D -DECREE OF CUMC M -SET CCC"--YCNWENt � __X-71 -GRAN Lw frNCC
EY- -B'_'UCH MAX CAR -CARACE P.O.B. -MNT Or CEGTTWNCI R -RAVUS •. -fN0.UtCPT M•PE/R00 -f—+^--TARE PENCE NO. PEVISIt
UAL :%=RESTAICTICF UNE FK -WY WE P.O.C. -PLAOYY
NT OF CENCEMENT L -LENGTH CF ARC O -SET ARCH P61E/RO0 --O--O- -WOCO FENCE
(r) CACORA7M N.V. -HEM WALL. (RL) -P—NAL LME C -LENGTH OF CHORD -}- -FNIX DRRL H0.E/(JtOST _CY_-CY--O%IMH D CAMMASICN
CAA -CENTER LINE LIL -UCENSE OUSNESS RLS -RfCSTERED LAND'SURtTYOR CS -040V E£A"G -}- -SET i%[LL HCIE --E--C-- -C%VMhDELECTFUC PIP-
-FIELD MEASURED R/Yf -=NT-CF-XAT T -LLNCM OF TANGENT -FN0.PA NA& --T--T— -OMtHEAD TELEPH3+E SERV.
V DC�TXD•i'OR01 IM -YA,40LE - SAN. -SAUAT&RY PC -POINT OF CLURVATURE -SET P.K RAIL POaER POLE(vA=XCGHG)
Cl, -C31NTY ROAD MOH. -woWkENT S►. -SCREENED PC" PL -POINT EF INTQTyC71CH O -END.NA "I
(NELALXF1BOtG. )
-T'.QD - OAK -cfncLAL.RECORD VOUNE T.B.Y. -TEUPONARY MON YAK PT -POINT CF IA4GENCY o -SET NAL/J.9C -BFNpi MNM.flfYATrii "
�A} -GEED BOCK. (P) -PLAT - VMS. -TP.A.I<SFORS+ER PCC OF C WM'NO CURVATURE A -FN0.TRAM-'RSE PCMT --CONCRETE
-tl^.D`IOOI( Pcp. :pcm CONTROL POINT MU. -fr;JW PRC :PONT-PCTNT OF f�R$E a'RVAnURE A -SET TRAW.SE POINT. �-a -ASPHALT
°r, '-r"SH TLOOR ELVATtOR P.RP. -PIFaI RO R04M PCNT R.Y. -LY.TER LETFR PMT -POhT OF NCH-TAxCENCY ® -FNS.R/e Uw+C MON:YLNT
r
0
BOUNDARY SURVEY A ACCURATE
of T TOPOLOGY
1T 19 BLOCK "7 ATLANTIC BEACH VILLA UNIT Nd. 1
/DEED BOOK 3.0 PACE(S) 5OF hiE CURRENT PUBLIC RECORDS OF DUVAL COUNTY,FLORIDA
INC . ..
177581 - 0000PROFESSIONAL SURVEYORS & MAPPERS,
• LAND PLANNERS .1
9 69°31125° E 75.00'
9978 3UL'BEAIE-ROAD, SUITS 2, JACYSONVIt33,-FL32257
Z❑ B' L❑T 1 9. °'' LOT 18 (904) 8e6-93a6/FAx 88a-9387
�J F•�.�wa-oc(
BLOCK_ • 'I HYRERY CERTIFY, That this map depicts the results of a field �--v
- survey made under my responalble direction and compiles with
the latest Ulnimum Technical Standcrds for Surrey., as
x promulgated b the Florida State Board of Professional Surveyors
sad YappOre. �pter t11GIT. Florida Administrat! Code:
Pursuant to Section 472.027, Florid Statutes,Subject to all -
13 notes and notations shown hereou. _
0 02-07-07 02-06-07
❑ ❑ DAPS T:£ID 1rO LESI:D . ! DATS YAP SIGNED
❑ r ❑
rEl
ItI1 v3.B' O 43.2D 16.0' x 3. THUMUN B. ICING FL,CERTIFICATION No 4424
a V N C7.0 (3 X--
t.7- , (n - - ):OTAriON: This surrey does not constitute a Utiaseazoh by -----t--ct
N �`� mTD•dC - Surveyor and U:erebre the undsrs.'gned makes no eerLincatfon \J
(•� - reLez un; lnfar %tion shown or not shown hexon pertaining to
t)1
XCAR easements elaias of easements, rights-of-xray,setback lines,N a I HTF3RY FRAME ca overlaps, bouuda•7 line disputes, agraemeOG,reservations.
O E cl _ restrictive covenants, arrnerahip title evidaac.,or any other
R£9 '+� 13 O facts that an accurate sad eurreut Ulla search"may dUclose.
N N Ql 3 ❑ THIS SURVEY is PREPARLD AND CERTIFIED TOR TRE EfCi37Si':E USEN OF TRS CLtENT MAXED HEREON A.ND 1S NOT VALID Ui•2£SS ff BEARS.'Z 33,20' 1 B•O' tj1 { AN ORIGNAL SIGNATURE AN-0 AN M OOSSED SURVEYORS SLAL
-1• n t rItEPARLD A" CE.RTI V FOR:. '
t Y e e 30.0'H.R.L.
/ :'••�, q RACHEAL MATED
C'ERTjMD TO: .
.;4 ".
:'n f-IRST MADN1.19. i
( STEWART OUARNTY COMPANY
T ' 2Q3.11' P.C. EITE\VART TITLE JACKSONVILLE, INC.
D.2'
N 69°31'25" W 75.001 r
PROJ. No.: 07.030 SIMET i OF I
FO R II E STAL 01R. NORTH ( 60 R/W SCALE: 1:20 F.B./PG(a): 84/30 S
DRAIfa BY: B.N. CHECKED BY: T.B.K.
` SEC. T?i'P. RNG.
NOTE:
F.I.R.M. FLOOD ZONE:
I3EARINf3a BASED FROM THE NORTH Ft�fW CO
_gUU:;INV PA-`�-EL No.: 1201375- C00t D >�
LINE OF FORRESTAL CIR. NORTH N.69 31025%V.
DATE OF F.I.R.14. INDEX: 04-17-89
Pa _PACE .,CUM rATA SM7EY A A.1,)ONST BASE FI/DOD ELTI ,7R0N: N/A
O --TRo,cava LpAIRTtIT . (No to.) -No MWXAIM 1
PJL PAWER VAN NAA. D -IXGt¢OF=yr, ■ -SET CC#;r.MONUMENT __II--Y—-04AN trx MCC
PA& -MNT Or DEGMM R -RAirVS •. -PRa eta,PIPE eo -r—r---WE TERM No. REVISION DATE
/.Qa -PLANT a<COYYOKiLENi L -tENGtN OF MC O -SET tRCH PIPE tC 0 --O--D- -LOCO rDKE
((R6) -PWAAL UNE C -LD+,-,TN tf emm -MD.oRRL ROLE//.GGRRGYsS CY--CY--O.fRHtAD CAA"5101
f13. -RECSTERM IMO"SUItMEym C9 -CHOV ecm:mc $ -SET COLL NOIE/CRE/S3 _-C--C-_ -OL4o7Pl�onLcviC t•Mt .
"V -f:CHT-CF-WAY T -UNL:N Cf TAYCcCNT -Ma P.K Nar. --i'-T— -O�ERNCAD IMPN.7rE SUN.
SAM
-SAMTA4Y PC -PONT Or CAVAAARC -SET PJL NA& ¢ POa9l POE[(aOOOXCaIa)
&F -SCRMED PORN PI -PCMT OF NTtRSECT•at QQ -mum CSX tYETAta(TLBOIAJlS3)
TRAm -TCUPORARY DWCH YAWL PT -PCMT Cf TARCERCY O -SET NAALEJD'.'9C •� _-BOTCH YAie(*ES.E1/A1rN
TRANS -TRMV*Mdx PCC -PONT OF C'OspO Ro O7RwANAE 6 -Tr+a 7RtNztSE PENT - A. -CONOtCTE
b0. -M:KIo PRC -PANT OF REKRSE COMArAC A -SET 7RANVSE PUNT. -ASPKALT -
Tut. -VATTR YE1TR PNT -PORT OF NCH-TAMC04CY a -FNa ft/s,CON_ow'WERT
ri '1',� City of Atlantic BeachF'-��EIVEDMn
MBER
Building Department ing Department.)
Y S 800 Seminole Road JAN 2 2011Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)24E-mail: building-dept@coab.ushz
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: j f� /'Or���! �L �- Y Department review required Yes No
Applicant: Planning &Zonin
Tree Administrator
Project: `� I i"0� T Ag Publi ork
P hlic-.Utilities
Public Safety
Fire Services
Revlewfee$" Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: [�pproved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed b& Date:
TREE ADMIN. Second Review: DApproved as revised. ❑Denied.
4USORKS Comments:
LITiy S
,AF Reviewed by: Date:
FIRE SERVICES Third Review: FlApproved as revised. ❑Denied.
Comments:
i
Reviewed by: Date:
Revised 05/14/09
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road /
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Department review required Yes No
Applicant: ')(,O i% Planning &Zonin
Tree Administrator
Project: 1/ 1 rU� T ubli rk
Utilities
�j4041 Public Safety
Fire Services
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: QApproved. f Denied. aa�
(Circle one.) Comments: �a �n .,4A 4$A-+'i
BUILDING -y"404,4
CLANNI=G & ONING
Reviewed by:
TREE ADMIN.
Second Review: 6Approved as revised. PDenied.
PUBLIC WORKS 4z
nts: �C� (-(A
PUBLIC UTILITIES �' � Vv�a� p
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: []Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
x 800 Seminole Road,Atlantic Beach, FL 32233
Office (904)247-5826 Fax(904) 247-5845
fob Address: �� �/'s 7Z ( 9V PermitN
regal Description Parcel#
Floor Area of t. q
Jaluation of Work$ Proposed Work heated/cooled 49 n*e�� /c
lass of Work(circle one): New Addition Alteration Repair Move Demohtr o spa /door
Jse of existing/proposed structures) (circle one): Commercial Residential
f an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A f
Florida Product Approval#
Tor multiple products use product approval form yr# r
)escribe in detail the type of work to be performed: ,c ety C 'il Li n k �.�c� r�oo�f � iSideS of
j�copC��® woo Fei1cC' Gat f�T �G '✓f
IV 010,45 USS r1t#�GG
'roperty Owner Information:
Tame: Address:
;ity /a/N-�G ,( -ar StateF�Zip 2APhone 90,Y- 7— 9-'k
Mail or Fax# (Optional) &�6^ ig&f-/► o COM
',ontractor Information:
;ompany Name: Qualifying Agent:
Lddress: City State' Zip
lffice Phone Job Site/Contact Number Fax#
tate Certification/Registration#
,rchitect Name&Phone#
ngineer's Name&Phone#
ee Simple Title Holder Name and Address
�onding Company Name and Address
fortgage Lender Name and Address
oplication is hereby made to obtain a permit t�ormdto
do the work and installations as indicated I certify that no work or installation has commenced prior to the
nuance of a permit and that all workwzll be peemeet the standardsofall laws regulating construction in thisjurisdiction. This permit becomes null
zd void ifworkis notcommenced within six(6months or if construction orork ipya_perzod of six 6)months at any time after
ork iscmmencd I understand that separapermits must be secured for Electzzcal Work,Plumbing,Signs, Dells,Pools,Furnaces,Boilers,Heaters,
Wks and Air Conditioners,etc
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR Il"ROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
iereby certz;fy that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
oe j work will be complied with whether specif ed herein or not. The granting of a permit does not presume to give authority to violate or cancel the
•ovisions of arty other federal,state, r to I law la ' g construction or the performance of construction.
'.gnature of Owner Signature of Contractor
-int Name Print Name
var s scrib d befor e Sworn to and subscribed before me
i ay of "^ this Day of . 20
bP rYLEY L.
nn�:CGn JAI5s0,1 V DD 957760
of c M,rU I hru Not,-,'Public uriderwrftem Notary Public
Revised 01.26.10
} CITY OF ATLANTIC BEACH
`r ®WNER / BUILDER AFFIDAVIT
I. 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.
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.
Is
ADDRESS PHONE NUMBER
PRINA
a o�
GNATURE DATtz
Before me this t2 day of 20L in the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of �,County of Q..L
❑P rsonally Known
roducedldentifica'
Notary Signatu
1'11.E I L.NRPV 1ry�
F:BLDG/Owner-Builder Affidavit;REVIS 't 9:* fi MMISSIO�;Y pp 857780
N Notarypublic Ull�
0
BOUNDARY SURVEY A ACCURATE
of
T 19 6LOOK 1ATLANTI❑ BEACH VILLA UNIT NLO. 1 T TOPOLOGY
'DEED BOOK 30 PAGE(S) aft! OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY.FLORIDA _ INC .
177581 - 0000 PROFESSIONAL SURVEYORS & MAPPERS,
a' LAND PLANNERS L
5 69°31'25° E 75.001 c.n• �_�-"
9998 SUti9Fk9 ROAD. SUITE 2. 7ACLSONVILI3.YL32257
B' LOT 1 9. LOT 1 S (904) e66-93a6/FAX aa6-0.167
za E3 LO G Kra,'
-I> REHY CERfiIFY. That this map depicts the results of a field
survey mnda under m� reapotvlbla dtreetioa and compltte with
the laiest ULn!murn Teehrilc.1 Standtrda for Sune7i, as
x promulgated brr the Florlda State roard of Professional Sur*yors
- - _ and Mappers. Chapter 61GLT. Florida Adrafn LstraUve Code: - r�
Pursuant to SecUon 472.027• Florida Statutes;Subleet to all - -�
- Q .. notes and notiUons shown hercou.-
02-07-07 02-06-07
0 • A/0 O DAT3 nmtfo IE7ED .1 DATE WSIGNED '
W l�.a' ❑ 43.30 16.0' x 3 THUPUM B. KING FL.CERTIFICATION No 44.24
I) 1, �} 111 NOTATION: Tho rurvor does not eoesUtuta a title rears!
�= IDN O.OD - Surveyor and therefore the underv!gned,males no .T6 atioa ` \J
CAR - reg !.armada shown or not shown hereon pertalnl" to 1
(17 - m _ easemcri cWma of aaremcats, rights-of-way,setback liner, -
IV" 1 8Tf]RY FRAME 13 - overlaps, bounda.T line disputer,'agreements, reser—Cloaa. r•.L
O E O , Pl _ rertrfcUre covenants, ownership t1Ue evideace,or s,ay otbar
❑. RXa 0 1 3 D� O facts that as accurate and current Ulla scarch'aay disclose.
N / N
Eq O THIS SURVEY is PREPARED AND CERTIFIED COR M EXCLT I'M USE i )
El N OF THE CLIENT NIXED HERRON AND 15 NOT YMM UNLESS rr BEAFLS
PORT 33.30 1 6, AN ORIGENAL SIGNATURE AND AN KXBOSSED SUR17EYOFS SEAL
PLFEPARED Ah•D CERTRL£D rOR:. '
., =�.• t r—e 30- -._ 30.0'B.R.
/ .}. .t RACHEAL MATED
CT
E N P r). CER7-,F D TO: .
f-tRST MA13NUS.
STEWART OUARNTY COMPANY s
306.11' P.C. 9TEWARTTITLE:JACKSONVILLE, INC.
N 69031'25' W 75.[7.0'
PROJ. No.: 07.03O SHE l OF 1
FOR R E STAL C I Re N I7 RTH ( 6 0 R/W ) SCALE: 1:20 F.B./FG(s): 8 4/3 0 S
DRANK BY: M.N. CHECKED BY: T.El.K.
SEC. TITP. RN G.
F.I.R.M. FLOOD ZONE: rx'
NOTE:
BEA12INGS BASED FROM THE NORTH R1W COI3MUTlIIY PANEL No.: 1 20075- 0001 D l�
LINE OF FORRESTAL CIR. NORTH N.69e31'25%V.
DATs OF F.LR.M INDEX: 04-17-89
CUM TATA: SMMY ANNOTATIONS. BASE FiP3OD Ei:.L'YATION: N/A
PA ..FACE L ••DELTA O -fND.SONG YONUI101T (NO LD.) -NO IDENtIF1GATCH I .
PJC. -PA73CER MON NANL D -DECREE CF CvR4E 1 -SET CORM WO M W -_X—k---CHAN LW FINM
PA& -PANT of vEawrn a -RAWS •. -FWD,PON►IPE/k Co -r—r---vac MCC No. PEVISION DATE
P.D,C. -P-XNT OF COWENNCEYCHT L -LENGTH CF ARG O -SET►CCN PWEJROD —D--D- -YA700 FDJCE.
V -RA.'%AL UNE C -LENGTH OF CHORD -FW0.Dietl H0.Sjj.CROSS -_C'f--C1(•-OIARMEAD GAMXMS;M
RLS. -wasTERLD We SURVEYOR C3 -cmav ecx"C $ -SEI lN'c(L HCLE/CROS'S --C—C-- -ON43eNEAD mrcmC PMt -
R/W -1=HT-CF-WAY T -Uyr—.H V TA:40RT -FNM PA MAL --T--T— -OLERHEAD MEPIi-WE SRX
SIN. -SA`RTA4Y PC -PCe.'T OF CURVATURE -SET P.NC MNL ¢ POMR POLE(WOOOXCOHG•)
S.P. -SCREENED PCROt R -POINT NX DNTMSECr,•lf Q -FWD.HAIL'DISK (URAL)(E18FRQASsI
T.B.NL -TCUPOtARY BOrH LARK PT -PCWi OF TMOENCY 8 -SET HALX-i-i K $• -Bt?NM YAFattE11-T-
TRAMS -•T%ARSCORLER PCC -PCWT OF C7LPRJHD CURVATU� a -1WD.TRA,_ PUNT C�� -CCHCRETE
170. -a•;N� PRC -PCTNT OF RL-WASE CL•RVAT+JRE A -SET TRAbCSE PGWE. C67 -ASPHALT '
Wx -v/.TER t£iER PMT -PONT CF HUs-TAWCENCY H -(N0.R/e GONG.NONANCNT
BP250U01 CITY OF ATLANTIC BEACH 2/02/11
Application Tracking Step Selection by Revision 13:28:26
Application number . . . . 11 00001602
Address . . . . . . . . . . : 15 FORRESTAL CIR
RE number . . . . . . . . . : 171747-0000- -
Application type . . . : FENCE PERMIT
NCR OLD ACCOUNT NUMBERS . . : AB18004
Tenant name, number . . . .
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Path ---- Key Dates --- - Action Summary -
Opt Agency description Rev Step Req In Est Cmpl Last Type By
_ PLANNING & ZONING A O1 Y 01/31/11 02/04/11 01/31/11 AP SD
_ PUBLIC UTILITIES A 01 Y 01/31/11 02/04/11 01/31/11 AP LS
PUBLIC WORKS A 01 Y 01/28/11 02/04/11 01/28/11 AP LS
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