Permit Fence 159 3rd St 2011 j r-1 t�1 aria
r 3' i ' CITY OF ATLANTIC BEACH
1 , 800 SEMINOLE ROAD
0 V " ATLANTIC BEACH, FL 32233
\, INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002286 Date 8/29/11
Property Address 159 3RD ST
Application type description FENCE PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
4ft fence
Owner Contractor
RILEY, DONALD OWNER
159 3RD STREET
ATLANTIC BEACH FL 32233
Permit FENCE PERMIT
Additional desc .
Permit Fee . . . 35.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 2/25/12
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.
4
BUILDING PERMIT APPLICATION
i CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 - 5845
Job Address: / / 3 2 ` 'S t 4 „5 2
c ,2 5 3 Permit Number:
Legal Description / Parcel #
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ 50 0 Proposed Work heated /cooled non - heated /cooled
Class of Work (circle one): ew 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 orf m
Describe in detail the type of work to be performed: ;t GJ C _, 4
� 'j G
0c, /�nc e
Property Owner Information:
Name: �� I Address: l 02
City /� t State ip 3 a .2 33hone '7 t� L
E -Mail or Fax # (Optional) ( 70r 7 / ..? 4
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 (period of six (6) months at any time after
work is commenced. I understand that separate permits must be secured for ElectricalWork, Plumbing, Signs, Wells, Pools, F urnaces, 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 this a plication 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 cal law regulating const on or the performance of construction.
r
Signature of Owner L X' Signature of Contractor
2
Print Name /
A/i / / Print Name
Sworid subscribed bef.. - ,, e
this 'I Day of f � 20 / Sworn to and subscribed before me
this Day of 20
, / /01 404
1 otaiy Public " � '
�`� : " MY COMMISSION # EE057340 Notary Public
*, r ;* May 2 1,
<, EXPIRES: Y 2015 e[w
- , 1 � . Th NOW/ ublicUnd Revised 01.26.10
!� od f� Bonded
y
, 1.:s 57W.lc,
CITY OF ATLANTIC BEACH
%-' OWNER / 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
I AW. 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
LITRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. OR. 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.
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED UNDER THE HOMEOWNERS INSURANCE POLICY TO CLEARLY PROTECT THE
OWNER.
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
CIRCVMSTANCES. 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 1 COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
ADD PHONE NUMBER
'2 '4' R1 1 e-4
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SIG TUR 1 DATE
Before me this --- day of All , 'Minn the county of
ANDA W
-4)1" DEBORAH AM;.;r:
Duval, State of Florida, has .
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, ” o so nded hru Notay Publv I
herin by hlmseff / herself and affirms th all statements and declarations are
true and accurate.
Notary Public at Large, State . County of Av.-1,-e
-
13 Porton* Known e' e 4' I , „ ,,
>T" duc.a Id.ntm 4,
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PLAT NO. / ,S U3 D / V /S 1 OA/ ,)
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Duval County, Florida in Plat Book 5 Page 6.9
RE�HEGKED FEB. 14,i01°J
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REGA/ECXEO JULY /7 /96.. NO CiV.A va.es /VECE.SSA.QY. Robert M. Angus and Associates
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'c,W ALL CO A /E. IRONS. Consulting Civil Enginters and Surveyors
FvR czAne..r , C.P /OE.Qf• F.?.oNSON O'NEIL S.-bG • 10 i-kENVRICKS AVE.
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Jacksonville, Florida
Job No. ,8 - L " ' t - 4 S9 - File No. 4 3 F - 2'2
•s!- >`lr City of Atlantic Beach APPLICATION NUMBER
j` r c 'a\ Building Department artment
(To be assigned by the Building Department.)
1 800 Seminole Road // _ Z z �
u _ ': �:� , - Atlantic Beach, Florida 32233 -5445
Phone (904) 247 -5826 • Fax (904) 247 -5845 /J 1
\-
Email: building - dept @coab.us Date routed: / /
City web -site: http: / /www.coab.us /
APPLICATION REVIEW AND TRACKING FORM
Property Address: S - b S - 7 7 - Department review required Yes No
Applicant: i e_
planning & Zonilpg%
Tree Ad
Project: 1/r ( 71(/6 ublic wort u icUtilitie
Pufety
Fire Services
Reyie fed ,� I ,
v Si g r t gept� tg # re -4 ,y, ,c,, _: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
Reviewing Department First Review:
pproved. K ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING 7 /6J2ct Reviewed by: ?kilif- 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 07/27/10
RECEIVED
•sLA ` ,. City of Atlantic Beach APPLICATION NUMBER
� Building Department JUL 0 5 2011 (To be assigned by the Building Department)
800 Seminole Road // fo-
c � , " �� Atlantic ntic Beach, Florida 32233 -5445
Phone (904) 247 -5826 • Fax (904) 247 -5845 "^ '
^Lojti > %' E -mail: building- dept@coab.us Date routed: 1/
City web -site: http: / /www.coab.us ,
APPLICATION REVIEW AND TRACKING FORM
Property Address: / t: ) j) 3 --f- 7 -- Department review required Yes No
,,
Applicant: c': GC.° 7 7 1 Planning & Zonjng%
Tree Administrator
Project: j (f ublic Worjss%
ublic Utilitie
Public Safety
Fire Services
R.WieV , fei8 . 4 i;s,IR : , r 4 1 t rif? ::6 :F*A 97A-IET
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: O Date: 7/C)
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
, City of Atlantic Beach APPLICATION NUMBER
o j ,.
Building Department JUL 0 5 2011 (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233 -5445 �. /� - 2 2 ''
J Phone (904) 247 -5826 • Fax (904) 24 �^ __ , �., E -mail: building-dept@coab.us Date routed: / 1/
City web -site: http: //www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: / 9 . . j) , -7 Department review required Yes No
Applicant: C" l[. �7 Planning & Zoning'
// Tree Administrator
Project: 7� r I f -4 e- - ublic Wo_dri
• u • is Utilitie
u • is Safety
Fire Services
lWilieVi�. f ee $r ? 4- ' � rofigi,'0 Pj s as d „ 7 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: p proved. ['Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING A
Reviewed by: Date: 7 ., -7/
TREE ADMIN. Second Review:
['Approved as revised. ❑Denied.
le , ORKS o m - nts:
ot ate lj
PUB IC S . FE -` Reviewed by: Date:
FIRE SERVICES Third Review: ElApproved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10