Permit Fence 1825 Hickory Ln 2011 6 = CITY OF ATLANTIC BEACH
5 � ° . s -4 800 SEMINOLE ROAD
J . ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
'� 0.111 fir
Application Number . . . . . 11- 00001980 Date 5/09/11
Property Address 1825 HICKORY LN
Application type description FENCE PERMIT
Property Zoning TO BE UPDATED
Application valuation . 0
Application desc
replace fence 6ft
Owner Contractor
KING, THOMAS M & ALINE Y. OWNER
ATLANTIC BEACH FL 32233
Permit FENCE PERMIT
Additional desc .
Permit Fee . . . 35.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 11/05/11
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.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH � /1)?
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845 /Pi 1 ; r --) P
Job Address: /(2 � G '& �/ / i177, Permit N fi r;
Legal Description / Parcel #
Valuation of Work $ 9 Q D c Floor Area of Sq.Ft. Sq.Ft
Proposed Work heated /cooled non - heated /cooled
Class of Work (circle one): New Addition Alteration epair 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 approval form
Describe in detail the type of work to be performed: 0124:1e e - 1 7 Stt1ti ' 1 back [e to )c Mt
b" i� t31, (pot 1:1 S lock Ade - s
Property Owner Information: '/
Name: 1 -oir S (-ll 4..45 Address: I8 3 182-5 i]l iekor Lo
City ;l� i`c c,1 Late Ft:, Zip 233 Phone (904 2- 4 2-- 1' t.
9 3-L
E -Mail or F # (Optional) T IG.•i nq ( ,4 rrc, et �} i \/ e sblu +; () Ai , c d rik
Contractor Information:
uali A�nt:
Address: Name : i ation: J
Company : C L ' / �' t Ca • '
1 � - /Z.1,, 403 s ili; State rC Zip 32.214
2
Office Pho - �r',/�r• : it contact umb Fax # p
State Certificatio ' egistratio
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 s i �t � •
PP P / . • t • at .work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet the standards o al 1' ' s 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. / understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, 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 / have read an' • . mined this plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complie, •'tth whe , er specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other fed al, state, or to al law regulating construction or the performance of construction.
Signature of Owner a/4\- Signature of Contractor
Print Name ILf * A s Print Name
Sworn to and subscrib; d befor me Sworn to and su ribed before me
this 22_ Da�,. 1 � / 20 1 1 this Day , 20
Notary Public X Notary ublic
ti
;'� SHI • GRAFWN Revised 01.26.10
*; .*?
MY wION#DD957760
1` �' `-: EXPIRES: February 14, 2014
,
,R ," bonded Thru Noay Public Undervrtiters
^� + S
, . CITY OF ATLANTIC BEACH
\ . - ®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 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455 - 228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT (247 -5826) IF IN DOUBT.
V. ACKNOWLEDGEMENT; 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER- BUILDER PERMIT.
t l e 2 s the- L,Iv (:/ 2�Z. 9 9?2
ADDRESS f PHONE MBER
wai Ivy.
PRINT _
DI-^- zz- gal)
SIGNATURE DATE
Before me this • day of , 201, in the county of
Duval, State of Florida, has personal) appeared herin by himself / herself and affirms that
ail statements and declarations are true nd accurate. f /)
Notary Public at Large, State of �" , County of Lff V a, L.
"❑ Pe,onally Known ,.--.
roduced Ident —
SHIRLEY L GRAHAM ,
Notary Sighalu * 7I + t INA MY COMMISSION # DD 957760 1
,• '- EXPIRES: February 14, 2014 '
F:BLDG /Owner - Builder Affadavit; REVISE P : 4/16/2 09 ,q • Bonded Nu Notary Public Underwriters ■
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NOTES:
T. This is a boundary survey.
� �� ' � City of Atlantic Beath
I
� �� � Building and Zoning
Y t..lp f , M City of Atlantic Beach �gPPLI�C TIOIV NUMBER T
uS Building Department 1(To be assigned by the Building Department +
- - Asa
v 800 Seminole Road
Atlantic Beach, Florida 32233 - 5445
fir Phone (904) 247 - 5826 • Fax (904) 247 - 5845
x Date routed
o'? E -mail: building- dept @coab.us � _:
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: /12 6 M ter) t Department review required Yes No
Buildirx}
Applicant: IOWA �CIL- nnina & Zoni
r Administrator
Project: /Q �°�'! t L. - • • is Works
•li Utiliti-
Public Safety
Fire Services
_ e a SR g - jam 4;
Rvtevu fek$ �_ , . ..,4 ::� D s E i a# r Witki .. ,
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: pproved. ❑Denied.
(Circle one.) Comments: _ �/ __ / �= rip
BUILDING
PLANNING & ZONIN� Reviewed by: f .cfZ Date: �' Z
TREE ADMIN. Second Review:
nApproved 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
Yi j City of Atlantic Beach
th.t IC� ION. NUMBER
Building Department � , z (fo be ass gned the Budding Department } ,
s > J s f 800 Seminole Road QTR L , l . + y �: T ' � fi
Atlantic Beach, Florida 32233 - - .. ' toll � a �' �
�
r ' t` Phone (904) 247 -5826 • Fax (9�+Z -5845 -
oJt . E-mail: building- dept @coab.us +; Date ed � �`��
City web -site: hftp: //www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: // /h17 Zirri f Department review required Yes No
Buildint}
Applicant: 0WL)/) c - P'rnninq & Zonir
f Administrator
Project: C c works
Public Safety
Fire Services
e-t7 �� +�
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
Amiy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed by: Date: 7 //
TREE ADMIN. Second Review: QApproved as revised. ❑Denied.
p : l�� WO :. /A� Comments:
• //
PU : L C SA ETY Reviewed by: Date:
FIRE SERVICES Third Review: []Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 05114(09
,i'.. City of Atlantic Beach ` t ' s L CATIQ.N
' NUM ER
s r �� a� o be as nkrfi th BLA011 O arhnent
=,, �� Building Department ...,j�� Cr y g e c� �g p-� � ,�
800 Seminole Road �� �J �.. y yry �,., �.�
R 2
~, Atlantic Beach, Florida 32233 -5445 Phone (904) 247 -5826 • Fax (904) ' 845 all $ W a
-on 0r E -mail: building- dept @coab.us F ^r
City web -site: http: //www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property �•- d a Address: / ��C ^ ` =e Department review required Yes No
Builder}
Applicant: 4ion JCL anning& Zoni
ree Administrator
Project: C- l Pa6tic world
, b tiliti
Public Safety
Fire Services
i".,erq .em„ ar.�' �!r �7 C �,'� ��i,�f." �'�a.5�".4r�' v�
Revlevl�fe4 ,.. ,2 ® it.. it.
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: /% pproved. ['Denied.
(Circle one.) Com ents•
BUILDING /& / f0/
v 1-hJ
PLANNING & ZONING Reviewed by: Date: ! �T fr / �/
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 05114!09