Permit Fence 120 Mayport Rd 2012 6) CITY OF ATLANTIC BEACH
/ LI 41 01 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000306 Date 3/28/12
Property Address 120 MAYPORT RD
Application type description FENCE PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
4FT FENCE
Owner Contractor
BEELER OWNER
472 IREX ROAD
ATLANTIC BEACH FL 32233
Permit FENCE PERMIT
Additional desc .
Permit Fee . . . 35.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 9/24/12
Special Notes and Comments
Avoid damage to underground water /sewer utilities. Verify
vertical and horizontal location of utilites. Hand dig if
necessary. If field coordination is needed, call 247 -5834.
Fee summary Charged Paid Credited Due
Permit Fee Total 35.00 35.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 35.00 35.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION /D @ � �-
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CITY OF ATLANTIC BEACH la - �7 [7- si.,l
800 Seminole Road, Atlantic Beach, FL 32233 ,L ! R 1 j r l ;
Office (904) 247 -5826 Fax (904) 247 -5845 �� ? I ' j
Job Address: . L ' , / l ' ' 4 / , / T l ° (,')'t ' 1 ) Per N u tuber• � -_
Legal Description 2 - ' 1 LL
g P i # 7 3 9 3r1 j -5 ,, 01 ftic' N
Le Parcel # 1 7 ...., -
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ Proposed Work heated/cooled n heated /cooled
Class of Work (circle one): New Addition Alteration, Repair Move Demolition pool /spa window /door
L - se of existing /proposed structure® circle one): - 7 - Commercial Residential
If an existing structure, is a fire sprinkler system insta`Iled? (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: ///0 " 3 '1 /t- t t / ' t,2- C I . • /- - ,,� 4 _
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A `./' //- 5 6e)L / ,, . 4 (tyoAff/ „A 1 /Pie 4/.- .,,t'ti -1/y,e 1� 9/: j
Property Owner Information:
•
Name:_, /,%r."t:tt"7 /Y !`- ; ; <"`0 /•42_ff / t'!"/ Address:1(t 44/4 //t.' / 7,j
City 14 iecsctr r.,c c r' State t� <Zip -3, ,, :r Phone c/ - 7 ) 7 -- t Y s -
E -Mail or Fax # (Optional)
Contractor Information: / �j�6n
Company Name: ' /<�" / `i Qualifying Agent: S ?L et " r
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 w obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance ofa permit and that all work will be oerformed to meet the standards ofall laws regulating construction in this jurisdiction. This permit becomes null
and void tfwork is not commenced within six"(6) months, or if construction or work is suspended or abandoned for a_ period of six 16) months at any time after
work is commenced. ! understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, 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.
1 hereby cent fv that 1 have read and exa this
type of work , will be complied with "whether specfI erein or not. grating be f true o pe d doesCnot All presumetto gr ve l au t hor ity t o y violate ° or cancel e
provis o f any other federal 'fate, or local law . gulating construction or the performance of construction.
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Signature of Owner
Signature of Contractor
Print Name rEN/il�/ � _G r j►�l �+s t.',10 4 �/
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._ ..............._...,. k.:.� -67--
Print Name
Swop to and subserib, d before i e - Sworn to and subscribed before me
lhisf ." Day of > , . 20/, this Day of 0
tT"7TT*1 3'1
othry , ub is „', 4 ;, MY COMMISSION # q0 811429 Notary Public
EXPIRES: Sapient* 19, 2012
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CITY OF ATLANTIC BEACH
WIRIER / BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING" REQUIRES OWNER I 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 COMMERCLAL BUILDING AT A COST OF S25.000.00 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 INJURES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKERS COMPENSATION INSURANCE BE
PURCHASED.
111 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455 - 228(1). AN `OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY `CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT (247 -5826) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER- BUILDER PERMIT.
4 1' ( / / j - I-I' /,/ ' /
ADDRESS PHONE NUMBER
PRJNT NAME l
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SIGNATURE DATE
1 I ,!
Before me this ' i day of y1f�1 1 1` - 20_ in the county of
Duval, State of Florida, has personally appeared herin by himself r herself and affirms that
all statements and declarations are true and accurate_
No Public at large, State ofd %[ ; County o ..J)Lt a t - C
1F1 G arsonall f Kncwrt
O Produced iden5rca6on-
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Notary sig tatur a c I 1 ty14 v SABRINA D. GREFR I
f .: 7 01vlMMION # DD 811429 ; f
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EXPIRES: September 19, 2912
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j — , City of Atlantic Bead
I o Planning and Zoning Department
p ; r This approval verifies aempIsncs ViMA applkisble
? A zoning, subdivision and othSr local land
i i S x m d velopment regulations, but doe$ not constitute
- r approval for the Issuance of permits. Compliance
. la with Florida Building Code and all Other applicable
•
• 0 ''' local, State and Federal perrnittin requirements
0 .' 4 mist be verified by signature of th City of Atlantic
s1 00' i S 1 00 � � qo s.. Bach Building, t0 sua Of a a s
0° 12' 00" W - 1 O Z. 00 CC E.cOao) O. O.T B lt .
0I` -" . -__--y- _.•••,— —/ -,� \ \6 M ON V MEN \' Ap p•o ed BY : 1677q7 iF/
4 s s ,y y{7 ev tlgpprent Director
Date:
rNe 12, 00006,306
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V1 P P O R T R O A D R
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01A r City of Atlantic Beac erA APPLICATION NUMBER
.4' s it s Building Departmen E+ D ( To be assigned by the Building Department.)
�- - 800 Seminole Road MAR 2 , .( j
z Atlantic Beach, Florida 3233 5445 Q 20 72 / 7 - d`(,1
Phone (904) 247 -5826 !Fad (904) 247 -5845
a E -mail: building- dept @coab.us Date routed: % f %Z—
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
' V t1 St
Property Address: /e"? G 771 If T Ju l Department review required Yes No
/ Bu.ildin
Applicant: e it:P» f e .---Plannin & Zg i
l
1 ree Administrator
Project: '`�
ir . e L - ublic work
ti ic,7{i iiti
c.
Pub i afety
Fire Services
a010 e0'PGti,
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: F &Approved. ❑Denied.
(Circle one.) Comments: •
BUILDING
PLANNING & ZONING ����
Reviewed by: — Date: 2/ 012- -
TREE ADMIN. Second Review: A roved as revised.
❑ pp ❑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
4 11.. 1.1 City of Atlantic Beach APPLICATION NUMBER
(4 / Building Department
j (To be assigned by the Building Department.)
800 Seminole Road ?
v A vL Atlantic Beach, Florida 32233 -5445 7 c (1
Phone (904) 247 -5826 • Fax (904) 247 -5845
':J,310 E -mail: building- dept @coab.us Date routed: 4/49/2
, %Z
City web -site: http: / /www.coab.us ` 'T
APPLICATION REVIEW AND TRACKING FORM
Property Address: 4? 6. -717 if 2 7 Jed Department review required Yes No
Building
Applicant: e f,(,.t'-7--) f e r''Planning &_49_,Eibaij
I ree Administrator
Project: 4 r i I ° e L •fiublic Worms
G Ubil fi II
u lc Safety
Fire Services
FteA 001$, ` r, : `Oii` : , b AZ
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: Q■pproved. ❑Denied.
(Circle one.) Comments:
BUI
PLANNING & ZONING 8hI.itc 3 /�y, /�Z
Reviewed by:
'�I"""— Date: GlJ/ / 2D
TREE ADMIN. Second Review: A roved as revised.
❑ pp DDenied.
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
,� f! :�.��r City of Atlantic Beach APPLICATION NUMBER
� Building Departmentr� (To be assigned by the Building Department.)
�p j 800 Seminole Road /.� / � Z (F'
j -, Atlantic Beach, Florida 32233 -5445
4 sP
I� /2 c
Phone (904) 247 -5826 • Fax (904) 247 -5845
' D,t �' E-mail: building- dept @coab.us " - Date routed: s���'fy //Z
City web -site: http: / /www.coab.us `7
APPLICATION REVIEW AND TRACKING FORM
Property Address: /e:'? A 6 ?r - 4 ° Department review required Yes No
/ Bu
Jld4n9 --
Applicant: 6 l(,`7') e Plannin & Zoni
/ r dministrator
Project: a y Ji ublic Work
u ublic
III
ublic Safety
Fire Services
Review fee $ 0 Dept Signature c, ... ---
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: E n pproved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING ���Z
Reviewed by: Date: /
TREE ADMIN. Second Review: Approved as revised. ❑Denied.
P , ..� 0 - omments:
IC L TIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
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