Permit 375 4th St 2011 shed r1 f CITY OF ATLANTIC BEACH
s)
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 11-00003023 Date 12/27/11
Property Address . . . . . . 375 4TH ST
Application type description SHED PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 3000
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Application desc
NEW SHED
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Owner Contractor
------------------------ ------------------------
BENNETT OWNER
ATLANTIC BEACH FL 32233
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Permit . . . . . . ACCESSORY STRUCTURE NEW RES
Additional desc . .
Permit Fee . . . . 65 . 00 Plan Check Fee 32 . 50
Issue Date . . . . Valuation . . . . 3000
Expiration Date . . 6/24/12
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Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONAL ELECTRIC CODE
*CALL FOR FINAL INSPECTION WHEN SHED COMPLETE AND ANCHORED
TO MEET 120MPH WIND LOAD.
* Shed is currently built before permit was issued, plans
that are now reviewed and approved shows that the shed
shall be dismantled and moved so that the setbacks shall be
observed according to the City of Atlantic Beach' s building
ordinances . *
* Call for all neccessary inspections during the build back
of this structure . *
On-site storage not required. Added impervious surface is
less than 400 SF.
Roll off container company must be on City approved list
and container cannot be placed on City right-of-way.
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
ENG REV BLDG MOD OR ROW 25 . 00
STATE DBPR SURCHARGE 2 . 00
UTIL REV MODIF OR ROW 25 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
PERMIT ISPRM41)1614 ' WP,4*kDANCE WI*PAIS 0CITY OF ATLkR-FI %EACH ORDINANEAQAND THE FLORIDQ0
BUILDING CODES.
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
{,r
t INSPECTION PHONE LINE 247-5814
c
Page 2
Application Number . . . . . 11-00003023 Date 12/27/11
Plan Check Total 32 . 50 32 . 50 . 00 . 00
Other Fee Total 54 . 00 54 . 00 . 00 . 00
Grand Total 151 . 50 151 . 50 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
DEC-20-2011 10:59 FROM:CLERK OF COURTS 904 270 1512
T0:92475$45 P:1/1
NOTICE OF COMMENCEMENT
verm.it.No. 11-30,;L? Tax Folio No.
State of Florida,County of Duval
T14E UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with
Chapter 713,Florida Statutes,the following infonnation is provided in this Notice of Commencement.
1. Description of.pro crty(legal description of property and address if available):
L- 2 G, --t 2r 'f2
2. General Description of improvements:
Fr
tR[-fin; S2o u�hse a�vD . l03 so
Per-
3. Owner Information.
ev)ia.)Name and Address: Ins" tt,, 94094y
b) Interest in property:__ —
c} Name and address of simple titleholder(if other than owner):
4. Contractor Information:
a.)Name and Address: —VJ I&C
b) Phone Number-
5. Surety Information:
a)Name and Address:
b) Phone Number:
c)Ainount of Bond: S
6, Lender Information:
a)Name and Address: _
b) Phone Number:
7. Person within the State of Florida designated by owner upon whom notices or other documents may be served as
provided by 713.13 (1)(a) 7,Florida Statutes:
a)Name and Address: Sri` (-L - Z71 S' 4f I"-v ST , A6 -
b)Phone Numbers of Designated Person: -219
S. In addition to himself/herself, Owner designates S_ J1 ofd to receive
a copy of the Lienor's Notice as provided in Section 711.13 (I)(b),lglorida Statutes.
a)Name and Address:
b)Phone Number of person or entity designated by owner-
9 Expiration date of Notice of Commencement(rhe expiration date is one(1)year from the date of Recording unless a
different date is specified:
WARNING TO OWNER: ANY PAYMENTS MADE 13Y THE OWNER AFTER THE EXPIRATION OF THE
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER.PAYMENTS UNDER CHAPTER 713, PART
1, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR.
IMPROVEMEN'T'S TO YOUR PROPERTY. A. NOTICE OF COMMENCEMENT MUST 13E RECORDED AND
POS"T"ED ON THE JOB SITE BEFORE THE FIRST INSPF..C;TION. .CF YOU INTEND TO OBTAIN FINANCING,
CONSULT Wf1 H YOUR LENDER OR AN AT'T'ORNEY .BEFORE COMMENCIN
YOUR NO'r[CE OF COMMENCEMENT. fµ --FILE COPD
.Y -
The foregoing instrument was acknowledged before me this 20 day of � � ,,.,,,
DoO9 2011273378,OR 8K 15802 Page 162, NOT?fftTI?U]3LIC1S—TAE5 OF FLORIDA
Number PNgw: 1
Reem)wd 12120/2011 at 10:17 AM, Print Name:
,JIM FULLER CLERK CIRCUIT COURT DUVAL
ECORY
Rp Personally$10.00 y Known
IQ.Itlentification/Type: S
Verification pursuant to Section 92.525,Florida Statutes. Under penalties of perjury,T declare that I,have read the
foregoing and that the facts stated,in it are true to the best of my knowledge and belief.
` r'� sxIptl=y
Si re of Property Owner
: PdbCOMA11SSIbNlaD957760
_ WIRE&February 14,2014
'•Rl«n" 8onded'(hruNbryrRib
lk{hw�hy nn
R.evi,ticd. 10/1/2009
CITY OF ATLANTIC BEACH
Building Department
f 800 Seminole Road
�. Atlantic Beach,Florida 32233
(904)247-5800
PLAN REVIEW COMMENTS
Permit Application # //-
Property Address: Z25 `/A
Applicant:
Project: J A r1
This permit application has been:
Approved
Reviewed and the following items need attention:
�A,��
/v /oo
f
44-
Please
re-submit your application when these items have been completed.
Reviewed By: il, Date:
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904)247-5845
Job Address: Permit Number: 1120.�3
� L /��
Legal Description OeYI�i,7' Parcel# L. �-
oor Area o q. t. q t 5ycr
Valuation of Work$ Proposed Work heated/cooled D non-heated/cooled
Class of Work(circle one): Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/pro osed 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: (.0agIT6r3" A#19 OUT c6r S� � QrQ
tlylk��!� _l,_G"4_c�.. AeR',eek Cps re SG ,cc
Property Owner Information:
Name: Address: 319— 4r"4 ST
City CtrmState_ iv .3t , _Phone (.7q• (a Sta.3 3(6
E-Mail or Fax#(Optional) r lam'be M»er7A ) A-Ir &£T-
Contractor Information:
Company Name: pew- ly-S s 1,60- 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 nd installations as indicated. 1 certify that no work or installation has commenced prior to the
issuance of a permit and that all work wall be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void if work as not commenced within six(6)months, or if construction or work is suspended or abandoned for a period 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, Boilers, Heaters,
Tanks and Air Conditioners,eta
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 hereb certify that 1 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 ofYwork will be complied with whether speci ied 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 IX
Print Name 5-1'U�trT..... e,Nr1t.�........................................................... Print Name
............................................................ ..........................................................................
Swor and subs before me Sworn to and subscribed befor e
this y of 0 20 � this Day of 20
9-7-15. SHIRLL. 957760
Notary u tc rXP.....Febn�ary 142o�a N ary Public
% Bonded Thr.N.I PI'IWL Und�M1�ihw
"- Revised 01.26.10
CITY OF ATLANTIC BEACH
a (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.
3 7 5 _ an lc'7 T (6!G 3 L7
ADDRESS QQ PHONE NUMBER
Sn .C�eN Kot
CA
AMEURE DATE
Before me this o day of 20_I I in the county of !!l19UlNallllc+
F
Duval,State of Florida,has personally appeared herin by him elf/herself and affirms that
all statements and declarations are truuFILE
ei}nd accurate. ��
Notary Public at Large,State of Y L County
�7 Personally Known '��./O �' " A
[produced Identifi n- �(f' "`.�'�.Py SHIRLEY L GRAHAM
Fla
try COMMISSION'#DD 957760
EXPIRES:February 14,2014
Notary Sign ure: ';pd �' Bonded Thru Notary Public Underwriters
F:BLDG/Owner-Builder Affadavit;REVISED:4/16/2009
,, .;yCity of Atlantic Beach APPLICATION NUMBER
j r }t Building Department (To be assigned by the Building Department.)
800 Seminole Road P 3
=r Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845 Date routed:
v,t1�r E-mail: building-dept@coab.us
City web-site: http://Www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 7Z 4 �T Department review required Yes No
uildin
Applicant: (,C�/IIE�. anning &Zonin
ree Adminikrator
�Fublic Works
Project: U u lic tilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
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:
TREE ADMIN. Second Review: ❑Approved as revised. ❑ enied.
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
rS 1N: City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
r 800 Seminole Road 2—
Atlantic
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: z ZO /�
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 7 `y' d'T De artment review required Yes No
11-15 uildin
Applicant: anning &Zonin
r ree ministrator
Project: ub1ic Works
u lic Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
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: XApproved. ❑Denied.
(Circle one.) Comments:
BUILDING
ANNING &ZOMNG f
Reviewed by:
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 05/14/09
syir1, City of Atlantic Beach APPLICATION NUMBER
Building Department L J' (To be assigned by the Building Department.)
800 Seminole Road f „
""` - �r Atlantic Beach, Florida 32233-54J5 � �� /
Phone(904)247-5826 • Fax(04.X 47-5845
E-mail: building-dept@coab.us : Date routed: ZO /�
City web-site: http:!lwww.coab.us '—�` -
APPLICATION REVIEW AND TRACKING FORM
3u- r�tProperty Address: 7 7 �T Department review required. Yes No
uildin
Applicant: 1�0J111bz_ anning &Zonin
ree Administrator
Project: � (, ublic Works
u lic tilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
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. p
(Circle one.) Comments: /*, � )_ t_ h�-4—
BUILDING
PLANNING &ZONING v Reviewed by: Date: W• 2_ 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 05/14/09
City of Atlantic Beach ' APPLICATION NUMBER
Building Department 9 Pr (To be assigned by the Building Department.)
800 Seminole Road '0'6C2
!7
Atlantic Beach, Florida 32233
Phone(904)247-5826 • Fax(9 -5845
;;19% E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
3 Property Address: 7� 4771- d'r Department review required Yes No
uildin
Applicant: 1�wlv',5� anning &Zonin
ree dministrator
Project: c7" U ublic Works
u lic tilities
Public Safety
Fire Services
Review fee $ / / Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
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:
BUILDING
PLANNING &ZONING
Reviewed by: Date:
TREEAB91N. Second Review: ,Approved as revised.
❑ ❑Denied.
P BL ments:
PUBLIC UTILI ESj
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05114/09