Permit Fence 2039 Selva Madera 2011 '" r CITY OF ATLANTIC BEACH
;. 800 SEMINOLE ROAD
r ATLANTIC BEACH, FL 32233
Olt INSPECTION PHONE LINE 247 -5814
M
Application Number 11- 00002199 Date 6/16/11
Property Address 2039 SELVA MADERA CT
Application type description FENCE PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
replace 6 f t fence
Owner Contractor
ALLEN OWNER
2039 SELVA MADERA CT.
ATLANTIC BEACH FL 32233
Permit FENCE PERMIT
Additional desc .
Permit Fee 35.00 Plan Check Fee . . .00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 12/13/11
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.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH /�
800 Seminole Road, Atlantic Beach, FL 32233 / L 11 M re
Office (904) 247 -5826 Fax (904) 247 -5845 ' U fl
,�,((
'! •� 2011 V '
Addy : o? 0 3 `j SSEI v n? 19- �tf /� efi A T /i +nf 1 RE4ermit N ' Y ber:
Legal Description Parcel # _
t
Valuation of W4I.i$ / ¥ , co Proposed Work h /cooled n heated /cooled
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
installed? an existing structure, is a fire sprinkler system nstalled? (Circle one): Yes No N /A
Florida Product Approval #
For multiple products use product approva orm
h s xibe 4140141 *, Qf, a i* : Pfrforbiedi VL) d / 7 ( Car if FIN C �Q
pKo arty Order Information:
Name 7 zCSA AJ' a Address: Q7°3 5 / ,fl Pci F/?F? C'1
City 4 c.- U E c 1, f/ 246'3 - g hone o — $(S3
E -Mail or Fax #: (al)
Contractor Information:
Company Name: Qualifying Agent:
Address: City State 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
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, 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.
I hereby certify that I have read and examined thisplication 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 performance of construction.
Signature of Owner Signature of Contractor
Print Name ct L L g rJ Print Name /
Sworn tpand subscribe. before me Sworn to and subscribed before me
this l - 5 . ter? ,tti 20 this Day of , 20
.,,,,,, SHIRLEY L. GRAHAM 760
Notary Public , « ' ,•. ' : Mx N. Febru'3ry 14 2 o1a Notary Public
' Public Under nrders
RA F �
.� ---- Revised 01.26.10
00.
f 1 s.�,.
ti. ` "� CITY OF ATLANTIC BEACH
(OWNER / 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; 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.
(9 6 - ? Sedv-el. A Carc4A a a . 4 - 2 est- is - 6 --K -- -:-3
ADDRESS ,, PHONE NUMBr 2
SO- 5/7/d 0 //V id
— / /
f?R1N'i NA� /
SIGNATURE DATE
Before me this / day of j "` f , 20A 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. j r
Notary Public at Large, State of PL , County of bolt V Va
❑ Personally Known /4;1— A
(roduced lde :601-1- J
1; Y . SHIRLEY L GRAHAM ■
• 4 it !+h '44 MY COMMISSION # DO 957760
.I j : -.1 EXPIRES: February 14, 2014
Notary Signat..«.,;r� " ' _ ., ' •A Bonded Thru Notary Public Underwriters
:gnaw
ill
F:BLDG /Owner - Builder Affadavit REVISED: 4/16/2009
■
. / City of Atlantic Beach APPLICATION NUMBER
r "�? Building Department (To be assigned by the Building Department.)
' 800 Seminole Road // / 9 /
v — ^ �'� E =r Atlantic Beach, Florida 32233 -5445
/Phone (904) 247 -5826 Fax (904) 247 -5845 6 /SA/
olil �:- E -mail: building- dept @coab.us Date routed:
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: (46 9 .4. � vet., L77 4 Clftt-, Department review required Yes No
Buildin.
Applicant: 6 (,c) `2 y Z — ' annin & Zorn
ree Mministrator
Project: 1
e i.t'1('t ilimi nT
171. lc Utili 'es
Public Safety
Fire Services
Re view ferric' . bq } r ,t 614:60 Sig gture T Ili `:i ,
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: (Approved. ❑Denied.
(Circle one.) Comments:
BUILDING o IA
PLANNING & ZONING Reviewed by: Date:'
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 07/27/10
r j rl,9) -, . i ,. City of Atlantic Beach i APPLICATION NUMBER
� Building Department V � (To be assigned by the Building Department.)
> � � g 800 Seminole Road -1.'
E ' - "� = , Atlantic Beach, Florida 32233 -5445 , SUN r 3 ZO f� // / 9 1
.: Phone (904) 2 -5826 Fax (904) 5 /-
. art»'" E -mail: building- dept @coab.us \ Date routed: (0 /3 //
City web -site: http: //www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: c 4 1 ' , c) S i - / t a, 7) C4 ' t. Department review required Yes No
p
Buildin •
Applicant: 6 tt) `rif z_ - : annin & Zo •
i ree dministrator
Project: !Q 6 1 iviet rfPIJ , 1vwwT •• is Works
!R• is Utili 'es
Public Safety
Fire Services
N r 4 F its . 1 ��r Y � :'.
f�evievic fed �fi � � �`� "'��. � e °�:1 epSigtuie�: � {� � ..: �" .. > `� a �. f
Other Agency Review or Permit Required Review or Receipt Date
of Pe 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: [Approved. ❑Denied.
(Circle one.) Comments: I0 Approved.
-/: BUILDING 0 // (, ,
PLANNING & ZONING Reviewed by: Date: oyht
TREE ADMIN. Second Review: DApproved as revised. ['Den' .
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: (Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
A`
ri yvp rir „ City of Atlantic Beach APPLICATION NUMBER
.: ' `. Building Department (To be assigned by the Building Department.)
800 Seminole Road ✓(/jV // _ c. / 9
- g �- . ,, Atlantic Beach, Florida 32233 - 1--.-. t
Phone (904) 247 -5826 • Fax (904) -5845 � r7f j 6/3///
,:�- j :- E -mail: building- dept @coab.us Date routed:
City web -site: http: / /www.coab.us \
APPLICATION REVIEW AN RACKING FORM
Property Address: c489 St hiteu 4di, / Department review required Yes No
Buiidin•
Applicant: 6 (d) `7'7 y,. — , ann inq &Zak
ree • dministrator
Project: ( d T • -11(t . rfPi4 Kill HIT - .. is Works
7
Public Safety
Fire Services
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: Approved. ❑Denied.
(Circle one.) Comments:
BUILDING f
PLANNING & ZONING Reviewed by: Date: ti / , 1f'
1
—
TREE • ! IN. Second Review: Approved as revised. DDenied.
P = VA0 - K omments:
7 0" i
• U = }}JsTILIT '
k 1p•"/ --
: LI = •4ETY Reviewed by: Date:
FIRE SERVICES Third Review: (Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
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