Permit Fence 1224 Ocean 2011 S ' CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
Application Number 11- 00001785 Date 3/17/11
Property Address 1224 OCEAN BLVD
Application type description FENCE PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
6ft and 4ft fence
Owner Contractor
LADA OWNER
1224 OCEAN BLVD.
ATLANTIC BEACH FL 32233
Permit FENCE PERMIT
Additional desc .
Permit Fee . . . 35.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 9/13/11
Special Notes and Comments
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
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.
Mar 03 11 07:22p CURTIS HILL 9046837158 p.
MAP SHOWING BOUNDARY .SURVEY OF
LOT 1 BLOCK �p 49 ACCORDING TO THE PLAT OF
MANDALA Yf NG
AS RECORDED IN PLAT BOOK 10 , PAGE(S) 11 OF THE CURRENT
PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO:'
JENINTIFER L. LAD& GIBRALTAR TITLE SERVICES,
OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY, AND EVERBANK. '
OCEAN BOULEVARD
50' R/W
50.18' (M)
UNDER (
50 (R)
- r7 3/ +"
WALK ^ v +
° - cV_ i�f d - o • -.
• . • ' - �o. 4' "CONCRETE *° ,WALK • . - •,
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immuislim 1.2. ,,.i�Ae STEP A MIN NM #
IMN NS r LAI0 E'IC rr NMI Mr" FISH
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CONCRETE
�� • 0.5' TO 0.9' . - y METAL
WALK o
L / ` ' SHED ^i 6 ',P. c , v CONC
�^ ` 0.5' -* 0 � 0 0� k k ON SKID■ STOOP ' �D� 2 r
SUBDIVISION BOUNDARY . . 1"
1 /2 • 5 6 . 18' (R '1,-5. 1 '
LB 3672 d d . LB 3672
..2: FILE COPY
LOT 2 BLOCK 4
ATLANTIC BEACH PARKWAY, UNIT NO. 2
PLAT BOOK 15, PAGE 83
FLOOD ZONE "X" . AREAS DETETUAINED 10 HE OUTSIDE THE 0.2% ANNUAL CHANCE FLOOD PLAIN / FL000 ZONE "X (MOOED)" . AREAS OF 0.276 ANNUAL CHANCE FLOOD: AREAS OF 1X ANNUM.
CHANCE MA114 AVERAGE DEPTHS OF LESS 1HAN 1 FOOT OR MATH DRAINAGE AREAS LESS THAN 1 SQUARE MILE: AND AREAS PROTECTED 6Y LEVEES FROM 1X ANNUAL CHANCE FLOOD.
V E Y 0 GENERAL 1OTEet.
J;;,..."—MS' 1. ANGLES ARE SHOWN FOR SURVEY.
g 2. STRUCTURE NO 1224 SHOWN HEREON LIES WITHIN FLOOD ZONE X AS
0 occr ncnrouupcn co c c 11 A rl nnn ueoc 0 l7J t Mn 1 TTATM 04-17 -1989
City of Atlantic Beach (To be assigned b the Building
Department.)
f
: i`- a '�lr��� APPLICATION NUMBER
, : ;� Building Department
' Atlantic Beach, Florida 32233 -54 � /0 ��
-� ti _ Phone (904) 247 -582 • Fax (904) 247 -5845
Date routed:
E -mail: building- dept @coab.us
�'; �� City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
`` O / Departmet review required �= / ( Q-�-- B �-
Property Address: ®-
Planning &Zon or L{,�,G✓L_ Tree Administrator MINION M
Applicant: / / Public Works M-
f V4 (0
Public Utilities N-
Project: :� public Safety _-
X64,3 a �t ,,��
�:� ,ate > ���� �
�'���� � � < DepSign e;
Review or Receipt Date
Other Agency Review or Permit Required of Permit Verified B
Florida Dept. of Environmental Protection
Florida Dept. of Transportation ■
St. Johns River Water Management District
Army Corps of Engineers MNIIIIIIIIIIIIIIIIIIINIII
Division of Hotels and Restaurants --
Division of Alcoholic Beverages and Tobacco 1111111111111111111
Other:
APPLICATION STATUS
Reviewing Department First Review: /Approved.
Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING / 1�►^� i .�
R by Date: �d
TREE ADMIN.
Second Review: []Appro sed ❑Deni ed
PUBLIC WORKS Comments:
PUBLIC UTILITIES
_I
r i`Jf� J � City of Atlantic Beach APPLICATION NUMBER
� , i' .;
Building Department (To be assigned b the Building Department.)
800 Seminole Road y/ ' 1 O �-'7 C-r�''
Atlantic Beach, Florida 32233 -5445 ! j
Phone (904) 247 -5826 • Fax (904) 247 -5845
E -mail: building- dept @coab.us Date routed: 3 -- �
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: /0u V (f .4--, —( Department review required Yes No
Building
Applicant: Planning & Zoning c�
Tree Administrator
Project:
41( V p Public Works tr
Public Utilities ✓
Public Safety
Fire Services
y "Vi 3 ''r kid r t. 1' � � 'r, x " � �, "� s S' s ; is
Review fee$ ,w ' , , DeptStgture R..hv z.. ,
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: roved. ['Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING 5 3 �l
Reviewed by: Date: I "/
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
Ma^ 03 11 07:21p CURTIS HILL 9046837158 p.1
•■•■•■=i.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
• 800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: ;l a5 L {" C t 0,0 ei v Permit Number: �/ - / 7I5
Legal Description S' CC, Ct.+0 C hf Parcel #
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ ( 2 ) 9W Proposed Work heated/cooled non- heated/cooled
,7 RepkCteerret t±
Class of Work (circle one): New Addition , 6teratio�n Repair Move Demolition pool/spa window /door
Use of existing/proposed structure(s) (circle one): Commercial • esidenti:
installed? an existing structure, is a fire sprinkler system nstalled? (Circle one): • es No N /A
Florida Product Approval #
For multiple products use product approval form nn
Describe in detail the type of ork to be performed: Cp I (Q, fk SJ ■ I (AO i J C C r 'c7ZJr?c(
Property Owner Info • , lion: - + 4 - = C_.
Name: l( I'1!- Y i_ = La do Address: rc), 4 Cee-6“\ �Pfti��G I/. ,hl
E - 3 2.&3
City tat L Zip 2 ?.Z?i3 Phone L ./; • ( /' J /
M ail or Fa x # (Optional) I `0 - 2 - „ Q� (,i ), ( rri \
Contractor Information: d y Q IANYtakei
Company Name: Qualifying Agent:
Address: City State FL 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 7 Vr.K h(SY'At.. J mc,4
Application is hereby made to obtain a permit to do the work and installatioYd as indicated. 1 certi& 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 is not commenced within six (6) months, or if construction or work is suspended or abandoned for a period of six [6) months at any time after
work is commenced. 1 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.
1 hereby certify that 1 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 specs Ted 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 /j't _ Signature of Contractor
Print Name ;,,� X 1--CfLkk Print Name _
Sworn tQand subscribed before me Sworn to and subscribed before me
this I Day of I 1 10?‘"1 , 20 (( this Day of . 20
Notar ubl' y,+' Notary Public
Revised 01.26.10
r• ' r '' , CARRIE A. WILKINSON „, MY COMMISSION # DD 751062
1 EXPIRES: January 23, 2012
d,' ; . Bonded Thru Notary Public Underwriters
7�l+ il. ---r
•
r ,ti l
r
f �" CITY OF ATLANTIC BEACH
'',`` r'' I ®WNER / BUILDER AFFIDAVIT
j `
- J
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.
III. 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.
ADDRESS PHONE NUMBER
\ r \ cr U
PRINT NAME /I
/
��� ��.��tr 3
�r
SIG AT RE • f DATE
Before me this / D day of 1
/1 r9 2"- " 20 7 in the county of
Duval, State of Florida, has personally appeared herin by himself / herself and affirms that
all statements and declarations ar and accurate. , _
Notary Public at Large, State of'� / DEBORAH A VOTE County o � : ; D 6 426
�-� /� C_ l--- 3o z) f 3 Z7 3C 6 o Pduced Idecation - GtlndedT flruNtitaNpubllEUridarNntet
Notary Signature � �
a t1 ..�/� _ / - ' a�
F: BLDG / Owner - Builder Affadavit; REVISED: 4/16/2009
,a � !-44 City of Atlantic Beach x APPLICATION NUMBER
r . Building Department (To be assigned b the Building Department.)
800 Seminole Road } '
Atlantic M q 21 410 / / ?
Beach, Florida 32233 -5445 $Y. ��
�� Vr Phone (904) 247 -5826 Fax (904) 247 -
; i E -mail: building- dept @coab.us Date routed: 3 —1
City web -site: http: / /www.coab.us -
APPLICATION REVIEW AND TRACKING FORM
Property Address: /ct ( 4, Department review required Yes No
Building
Applicant: 6-70k-d—` Planning & Zoning ✓
r Tree Administrator
Project:
I Public Works ✓
Public Utilities 1.// Public Safety
Fire Services
Revew�fee' ,i_a #, , D pt.zSlgare r r .'w
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: b pproved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed by. Date: 3/ ///
TREE ADMIN. Second Review: Approved as revised. DDenied.
p_ . Comments:
1: • :LIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
t ,�;-,,, City of Atlantic Beach APPLICATION NUMBER
o , �,› Building Department A ' .tv ` (To be assigned by t e Building Department.)
800 Seminole Road ' j/
j S V a Atlantic Beach, Florida 32233 -5 A � 20// l / 2 ? f
� Phone (904) 247 -5826 • Fax (• "'1k47 -5845
-. f ; ;) r E -mail: building- dept @coab.us "� -,.`` Date routed: J " - / 0 - 7/
City web -site: http: / /www.coab.us --�_
APPLICATION REVIEW AND TRACKING FORM
Property Address: /o c (/ &cY/'& ,4% Department review required Yes No
6 l k Building
7
Applicant: ^- 4Oflin
✓
ator
Project: r V h 7 u �c ,/
u1ic Utilities ✓,
is Safety)
Fire Services
Rev a ; fe . 1 4 4 � g Dep 5lg t re s z ,7,--.;,,
''kx ' .
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: cciApproved. ❑Denied.
(Circle one.) Co ments ' -
BUILDING //0/f:
PLANNING & ZONING ��' ,
Reviewed by: Date: I /y //
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. nDenied.
Comments:
Reviewed by: Date:
Revised 05/14/09