Permit Fence 158 Belvedere 2011 r C
64 ,,Atc",1 '` CITY OF ATLANTIC BEACH
r4 A 800 SEMINOLE ROAD
o...7)14t, ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
P 4 on
Application Number 11- 00001696 Date 2/28/11
Property Address 158 BELVEDERE ST
Application type description FENCE PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 2200
Application desc
REPLACE FENCE WITH 6' TALL WOOD STOCKADE
Owner Contractor
PHILLIPS OWNER
158 BELVEDERE STREET
ATLANTIC BEACH FL 32233
Permit FENCE PERMIT
Additional desc . REPLACE FENCE
Permit Fee . . . 35.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 8/27/11
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.
-4V 6./ 4 City of Atlantic Beach APPLICATION NUMBER
Building Department Pep V o be assigned by the Building Department.)
A v 800 Seminole Road
Tv� Atlantic Beach, Florida 32233 - 5445 0 / - ` - �
" T" Phone (904) 247 -5826 Fax (904) 247 -58
"ott >' Email: building dept @coab.us Date routed: ° lC
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: � S - Department review required Yes No
Building
Applicant: Planning & Zoning
Tree Admintrator
Project: e ak lic V or ✓
c PubTic Utilities v
Public Safety
Fire Services
Aevie fe $ �r ' ai i c ai ��.,.' . * '
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: WApproved. ❑Denied.
(Circle one.) Comments:
BUILDING 4/411--
PLANNING & ZONING Reviewed by: Date: 02 10 1 r4
TREE ADMIN. Second Review: A roved as revised.
❑ pp ❑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
Jr ,,�, City of Atlantic Beach
APPLICATION NUMBER
14-0 Building Department
$ ,z � g p (To be assigned by the Buildin Department.)
.+ tla Seminole Road
7/ �� Atlantic Beach, Florida 32233 -5445
Phone (904) 247 -5826 • Fax (904) 247 -5845
�r E -mail: building- dept @coab.us Date routed: f /
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: /S3 /--/i7e Department review required Yes No
Building
Applicant: Planning & Zoning
Tree Admi s • trator
Project: lic VVor
-_ u�lic Utilities v
Public Safety
Fire Services
,10 Revie �: t ... De1Signat e ` �
wir
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: !A pproved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed by, Date:
TREE ADMIN. Second Review: ['Approved as revised. ❑Denied.
P , : ;• WOR Comments:
Z —/ 8-
P : ' - ETY 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
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: /37 Permit Number: 1/ ' i& &
Legal Description Parcel #
Valuation of Work $ `o?."--0
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool/spa window /door
Use of existing /proposed structure(s) (circle one): Commercial Residential
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /A
Florida Product Approval #
For multiple products use product approva orm
Describe in detail the type of work to be performed: 4°4 c ; ,// ,$)[�� G, /3 jt -fa, gL R.1 vac y
_,ey �o
e , , 1 06 4 /
Property Owner Information:
Name: • j U.4n i +Q / - ) / / iis Address: /4 .erp L 1Jecie re_ S
City ,47G.sirt/T,c /3xtc.A Statel U3 3 Phone ,, - - - ` " /1...._
E -Mail or Fax # (Optional) , . • _ , I ea... II „ _, , , • , „
Contractor Information: �/ U
Company Name: Qualifying Agent: FFe 7 .
Address: City ar!ate Zip /1/
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 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 all laws regulating construction in this jurisdiction. This permit becomes null
and void if work is not commenced within six (6) months, or if construction or work is suspended or abandoned for aperiod 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, F urnaces, Bo 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.
1 hereby certify that 1 have read and examined thisplication and know the same to be true and correct. All provisions of laws and ordinances governing this
type o1 work will be complied with whether speci aed herein or not. The granting of a permit does not presume to gave authority to violate or cancel the
provisi of any other fed- tate, or local law regulating construction or the performance of construction.
0 .„„7"-----
Signature of Ow - `4.-- — - 1 Signature of Contractor
Pr int Na a _ >7 ( t o _ , j !) , > Print Name
Swor % . subscribe _Fore me Sworn to and subscribed before me
this " e bay of , ,. 20 // this Day of , 20
/ , /
Notary Public Notary Public
„,,, „ DEBORAH k WHITE
9 ,,,, MY COMMISSION # DD 634126 Revised 01.26.10
” y EXPIRES: May 21, 2011
s A. -'i` or ti ded rn N public Underwriters
Z/2 <2 3 . V 3 70
t
'; CITY OF ATLANTIC BEACH
a' ®WNER / BUILDER AFFIDAVIT
-wi ,
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 REOUIRED 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.
/ , 5 f 4 L ✓e.c/ &re- . 9� i S'7 9
ADDRESS S^ PHONE NUMBER
PRIN r � h1 `-Q► 1 ! 4
. !.. „ „. ✓ L _ � 1 —/
'/ /i
/ SI AT R' DATE /
Before me this ! day of 20 �� in the county of
Duval, State of Florida, has pers ally appeared herin by himself / herself and affirms that
all statements and declarations are true and accurate.
—
Notary Public at Large, State of , County of `;w:... DEBORAH A WHITE
/ 9 * et .,Y MY COMMISSION # DD 634126
❑ Personally Known ,� / / t / i . 4i�s
Produced Identification - ( �— 9 � ( Z 37 /J Y ' V . '' c, EXPIRES: May 21, 2011
ki.4.6204,_ , of S yr;: Bonded Thru Notary Public Underwriters
4
Notary Signature: /
F: BLDG / Owner - Builder Affadavit, REVISED: 4/16/2009
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