Permit Fence 250 Nautical 2011 ,,,4, CITY OF ATLANTIC BEACH
v I
r , , .: 800 SEMINOLE ROAD
. ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
401.15
Application Number 11- 00002171 Date 6/16/11
Property Address 250 S NAUTICAL BLVD
Application type description FENCE PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
REPLACE 6FT FENCE
Owner Contractor
FORBUS, ALLEN OWNER
250 NAUTICAL BLVD.
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
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.
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.
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LAND SURVEYORS P.O. DON 21161 JACKSONVILLE, F(_/1 3f?2I7 RO4 /7'I- O7i' ?.
+Nil 1 Mf:nf-nY CrfTIFY THAT THE ADOVE _. r.''�,�...._ WAS SURVEYED nY '''
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ME •: AND THAT THE ______ - / 4 .- .-- _. ... ... ._.�.... LOCATED UPON n
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A , t10WN AND THAT THERE AR E NO ENCROACHMENTS UPON SAID
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i ORDER MO..
r 51- \ .17 City of Atlantic Beach 1 C' ■ APPLICATION NUMBER
r a, Budding Department ✓(/ v (To be assigned by the Building Department.)
800 Seminole Road N 0 71 / 7 /
- -,,?-:%0109.,- � •' ,:we-,.--- '- , Atlantic Beach, F lorida 32233 -54451 . , 6 20'11 /
Phone (904) 247 -5826 - Fax (904) ' 45 \` — VA•9 /I•.,i� .,. E -mail: building- dept @coab.us Date routed:
City web -site: http: //www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: c>267 C iv a � l 2 C4- L ill 41 Department review required Yes No
�
/' p Building_----- -
Applicant: 0 W� 4 ' arming & Zonin
z=ivvi - • - stator
Project: T4_.fia (/ E, ( E Public i •
u • is afety
Fire Services
0
, . h t & s 1 � i +� 1 �yk r u
Reviewiee ri K. , ! Rep $Igngture _4_�. , F 3, 4.7_,
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
PLANNING & ZONING Reviewed by: Date: .2 l/
TREE ADMIN. Second Review: ❑Approved as revised. ['Denied.
P c 4, i - . C • mments:
B ( II UTIL S
PUBLIC AFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: 250 Nautical Blvd South
Legal Description Parcel #
Floor Area of 80 Sq.Ft. Sq.Ft
Valuation of Work $ 1400.00 Proposed Work heated /cooled non - 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
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: Replace part of an existing fence.
Property Owner Information:
Name: Helen Forbus Address:250 Nautical Blvd South
City Atlantic Beach state Fl Zip 32233 Phone 904 - 962 -1719
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: Affordable Fenci • tlet
Address: 10211 Beach Blvd City Jacksonville State FL
Office Phone 641 -1200 Job Site/ P. 'tact Number 641 -1200 Fax #
State Certification/Registration # 10000383
Architect Name & Phone # Marty Snyde
Engineer's Name & Phone #
Fee Simple Title Holder Name and
Address
Bonding Company Name and dress
Mortgage Lender Name and ddress
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 sus nded 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, Plambing, Signs, Wells, Pools, F urnaces, Boilers, H
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 ertify that I have read and examined this a plicati and know the same to be true and correct. All provisions of laws and ordinances governin this
type of work will be complied with whether specified here or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal, statf, or local law regula ' g co or the performance of construction.
Signature of Owner - / ' i Signature of Contractor
Print Name y + z # f 4 1 i. . �s N INV•
.. EXPIRES: Februaiy.14,2o14
Sworio and subscrib: a befor - me 4n ThroNetanPubb*Norkho .d subscribed before me
this J D. of 4 „. k`stii , , • ay of . 20
ar
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CITY OF ATLANTIC BEACH
.T' '4- • , ,),;
IJ% WNER / BUILDER AFFIDAVIT
1. 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.
•
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.
(6 rii. L ek 4 IIid go i 6 )6 2 - i 7/
ADDRES ,,--- PHONE NUMBER
PRINT NAME /
r fA 1 ✓ ///
IG A Irk E —; II DATE
Before me this 3 day of - -- , 20, in the county of
Duval, State of F orida, has personally appeared herin b himself / herself and affirms that
all statements and declarations are true d accurate.
Notary Public at Large, State of , County of U C
❑ Pe nally Known % � -- - •__.-___
roduced Identifi - on �x"l�U° - -
k: �•� � L f3RAF1AIN
MY COMMIS510N # DO 957760
7 ,1 ' :�►; EXPIRES: ry PIRES: Februa 14, 2014
Notary Sigre: � _ Bonded - _
F'. BLDG /Owner - Builder Affadavit; REVISED: , 6/2009
r /L,ATJ City of Atlantic Beach APPLICATION NUMBER
rji ` > Building Department (To be assigned by the Building Department.)
`� 800 Seminole Road
VI Atlantic Beach, Florida 32233 -5445 // 2177
.J
� � / Phone (904) 247 -5826 Fax (904) 247 -5845 /
'.,�ol;l E -mail: building- dept @coab.us Date routed: cv
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: °�-? `' ' Department review required ' Yes No
P rtY
Buildir _
Applicant: i
CA & Zon n
Tr. rator
Project: - / 6 • Public Works
I I i Public Utilities
Public Safety
Fire Services
Review fee $r .,i =.:A.Wi , xi Depf Sig ,attire 1 r . -A
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
J
Reviewing Department First Review: E Approved. ❑Denied.
1/1/(
(Circle one.) Comments:
Fi Vcc ./t NhT d ( 4 o C-.f al C/a S,c,i, �G„�.�
BUILDING ! — O +- S °�- � ---
PLANNING & ZONING 1 41+#11
Reviewed by: t la Date:
TREE ADMIN. Second Review: QApproved as revised. []Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
! r1�y��.
rt r „ City of Atlantic Beach APPLICATION NUMBER
r ~• Building Department � ( To be assigned by the Building Department.)
y 800 Seminole Road 0
E : - ''" "''''' % . Atlantic Beach, Florida 32233-5, j: , v ' 0 1! / 1 ` ° / 7
Phone (904) 247 -5826 - Fax (• v- -. - 845 VS)
,: u;,i> E -mail: building- dept@coab.us Date routed: _ /1
City web - site: http: //www.coab.us '
APPLICATION REVIEW AND TRACKING FORM j ll AA kid
Property Address: c3� U _ r1 V a U1 COL L II11b Department review required Yes No
Builder _-
Applicant: 10 W Z- �P9anning & Zoni
Ir - A - 'r••
Project: //A e b lC j /9--7)() E Public 4. • _
ii • 'c Utilitie
Public Safety
Fire Services
Revidif fees$: r M: , . ' .;' ;'1i _ ri 005.1 t o E ,71 i 4
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
PLANNING & ZONING Reviewed by: Date: r _...6
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
s-- \Jr,�,, City of Atlantic Beach APPLICATION NUMBER
c+, Building Department (To be assigned by the Building Department.)
.� 800 Seminole Road / ' /
J
' Atlantic Beach, Florida 32233 -5445 /1 .
Phone (904) 247 -5826 • Fax (904) 247 -5845 j /
•:`0;:1> E -mail: building - dept @coab.us Date routed: _ VS/ /_i
City web - site: http: //www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: -_ r' V U a U.,/ 1 Ct C. FIV A Department review required Yes No
Building._
Applicant: D (,( ) a , Winning 8 Zon
74:.x.+.. •• • strator
Project: Tyikt e f, 6 r 9-7--)C Public Wo
' • •c Utilitie
u • is afety •
Fire Services
fevie fed$ r Y E� g- *, , .i P_ ... r -t
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: DApproved. ❑Denied. �,L
(Circle one.) Comments: (0�, ,a,�,pk G `'��'
BUILDING 5' fl le.
PLANNING & ZONING Reviewed by: Date: y _3 . /
TREE ADMIN. Second Review:
['Approved as revised. ['Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: DApproved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10