Permit Fence 156 Seminole 2011 o $ ` `; CITY OF ATLANTIC BEACH
, �, _ _ I f
Ir , ;, ) 800 SEMINOLE ROAD
j 4 ATLANTIC BEACH, FL 32233
4, ' INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002176 Date 6/23/11
Property Address 156 SEMINOLE RD
Application type description FENCE PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
replace Oft fence
Owner Contractor
SIEFKEN DAVID R OWNER
156 SEMINOLE ROAD
ATLANTIC BEACH FL 32233
Permit FENCE PERMIT
Additional desc .
Permit Fee . . . 35.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 12/20/11
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.
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.
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ri.A./; City of Atlantic Beach APPLICATION NUMBER
^ � A Building Department "�U � golf (To be assigned by the Building Department.)
F 800 Seminole Road 13 'S7 //- / 7
^..,, 'c - r, , •r Atlantic Beach, Florida 32233 -5445
Phone (904) 247 -5826 - Fax (904) 247 -58
' E-mail: building - dept @coab.us Vi'//1
Date routed:
City web -site. http: //www.coab.us
APPLICATION REVIEW AND TRACKING FORM
r � Department review re
Property Address: .� �P ��f� / /� �� required Yes No P 4
Bu'
Applicant: f 77 L e fanning & Zo — riltm
Adman strator
Project: . & •7-,i r /'`� (/ ublic Words
I
___Iig_U till ies,
Public Safety
Fire Services
Reviern� fed $ r ; ,
. 4 1 , , . E Y _.: . , 1 e ,, r -,:'' ;: ' , '
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: / j
TREE ADMIN. Second Review: DApproved as revised.
T ❑ pp ❑Denied.
p `., / ,r„. - omments:
•U. " i 1 I IES
• 1; ' FE Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
r Y'Sr`l�,�f�+ City of Atlantic Beach APPLICATION NUMBER
j �
• a Building Department (To be assigned by the Building Department.)
S � 800 Seminole Road J
v
: ,7 = r Atlantic Beach, Florida 32233 -5445 // — 0 / 7
Phone (904) 247 -5826 - Fax (904) 247 -5845 f /O
,f-' v E -mail: building- dept @coab.us Date routed: � / ///
City web -site: http: / /www.coab.us /
APPLICATION REVIEW AND TRACKING FORM
Department review required Yes No
Property Address: ` ��0 sf lyj I /1jQ�� £c P Q
Bu'
Applicant: f2 W771_1 !arming & Zon 1
minis rator
Project: re . 7� 5' f � f • ublic 1111 - • is Utili i-
Public Safety
Fire Services
Review fee $r E H f f 4 :476a8Ig tore V5 : 4;,1 = F
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: Lved. EDenied.
(Circle one.) Comments: 1/4';'.(-
BUILDING /
�LANNING & ZONING Reviewed by: 1 4 - °4-4-- ' — Date: lO - - �1
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
ct.m Ci of Atlantic Beach
r + r , ; tY` APPLICATION NUMBER
Js1 Building Department ,/iN (To be assigned by the Building Department.)
800 Seminole Road C I ?Q
J
"'� g '�.) Atlantic Beach, Florida 32233 -5445 tl�''.
j rf // - / 7
Phone (904) 247 -5826 • Fax (904) 247- : '-- � o;; i9 % E -mail: building- deptQcoab.us -`, Date routed: �_
City web -site: http: //www.coab.us ` ` =./
APPLICATION REVIEW AND TRACKING FORM
', . Department review required Yes No
Property Address: .� �
Bu '
Applicant: /2/677i-,e- fanning & Zonfig
,�/ dministrator
Project:
pi A& 7-71 / r f 7) f ublic Worms
iic tila
— Public Safety
Fire Services
RevieVit fees $ : ' ' _ _ Veiftt r06 `t° , ,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: )// V 1
BUILDING p_ 4)(G� ...
PLANNING & ZONING Reviewed by: Date: y' i7)/ /
TREE ADMIN. Second Review: ['Approved as revised. ❑Den' .
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: (Approved as revised. DDenied.
Comments:
Reviewed by: Date:
Revised 07/27/10
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 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.
1 5( Sem 1 9 - 334 -12J
ADDRESS PHONE NUMBER
& .,j{ kg"
PRINT NA
SIGNATURE DATE
Before me this ( day of jenf 241 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.
� ✓c
Notary Public at Large, State of f /' , County of
El Personally Known L '2 5•/ 7 to C 4 7
Identifica'•n - cccJJJ 11111111M-
.Z 1. II I SHIRLEY L. GRAHAM
4" °- , MISSION 11 DD 957760
Notary Sign_ _ 4 -r� WI 1 � �s/S. - _ • • ary 14,20 14
f • '�''O=
Bonded - Mu Notary Public Underwriters
F: BLDG / Owner - Builder Affadavit; REVISED: 4/16/200 .-^•-