Permit Fence 311 10th St 2012 .4' "top\ - Kj z CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
j ,: ATLANTIC BEACH, FL 32233
'\, F`�y INSPECTION PHONE LINE 247 -5814
d~
Application Number 12- 00000380 Date 4/10/12
Property Address 311 10TH ST
Application type description FENCE PERMIT
Property Zoning RES SF DISTRICT
Application valuation . . . 6400
Application desc
INSTALL NEW WOOD 4' AND 6' FENCING
Owner Contractor
PERSONS, JR., ROBERT OWNER
311 10TH STREET
ATLANTIC BEACH FL 32233
Permit FENCE PERMIT
Additional desc .
Permit Fee . . . 35.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 10/07/12
Special Notes and Comments
Roll off container company must be on City approved list
and container cannot be placed on City right -of -way.
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.
fi a City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
c • 800 Seminole Road 12 '�6)
r� Atlantic Beach, Florida 32233 -5445 2
Phone (904) 247 - 5826 Fax (904) 247 - 5845 4 _
_on c E - mail: building dept @coab.us Date routed:
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 32/ / c ��` Department review required Yes No
Applicant: *C-0/2 e/- - Manning & Zoning
Tree Admmottrator
Project: Cam (ublicWorks�
CPu & UtThtie
Public Safety
Fire Services
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: Elk pproved. ❑Denied.
(Circle one.) Comments: )/
BUILDING t– rfi &'- -
PLANNING & ZONING /S� 2—
Reviewed by: �' /� Date:
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 07/27110
City of Atlantic Beach APPLICATION NUMBER
it Building Department (To be assigned by the Building Department.)
7:4171;) 800 Seminole Road !
Atlantic Beach, Florida 32233 -5445 0 1
Phone (904) 247 -5826 • Fax (904) 247- 5845 _
''L o? pit E -mail: building- dept @coab.us Date routed:
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 32/ ( Department review required Yes No
Applicant: - 0C,C/✓) e,- planning & Zoning Th
Tree Admi i trator'
Project: CA C- public Works
c Pu bC c UtThiiei�,
Public Safety
Fire Services
Review or Receipt i '
Other Agency Review or Permit Required • Date .
of Permit Verified By �; ;
Florida Dept. of Environmental Protection `• � i ,�f
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: C / Date: 6 /�
TREE ADMIN. Second Review: Approved as revised. ❑Denied.
PUJ, •-' ORKS • mments:
'UBLI UT LITIES
/�
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: nApproved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
? slay City of Atlantic Beach APPLICATION NUMBER
4 Building Department (To be assigned by the Building Department.)
800 Seminole Road
i 2
-,. Atlantic Beach, Florida 32233 -5445 C 2 7
Irw Phone (904) 247 -5826 • Fax (904) 247-5845 -
s))' E -mail: building- dept @coab.us Date routed:
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 327 / ' ? 4<' S Department review required Yes No
Building
Applicant: -6 -0.9 r c_ Planning & Zoning
Tree Admmi
Project: C� (`public Works
( Pu lb Ib c IJtilitie
Public Safety
Fire Services
Review or Receipt .100" -'
Other Agency Review or Permit Required of Permit Verified By Date
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:
APPL CATION STATUS
Reviewing Department First Review: Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
CANNING & ZONING--2 - � � Z
( Reviewed by: D
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 07127/10
CITY OF ATLANTIC BEACH
- ' i :/ 4 1: WNER / 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.
Sit /0/ / ` /
7� .sr, / h zi.4 i it 322-33 (504) i1 -
ADDRESS / 1 PHONE NUMBER
R 'r 4. Pinsk;, Ja.
PRINT N E c
4 /7c77 1 . 01
SIGNATURE DATE
Before me this S of 20/ the county of
Duval, State of Florida, has person appeared herin by himself / herself and affirms that
all statements and declarations are ue nd accurate.
Notary Public at Large, State of i�"' '— , County of rte„•+. 'tp�., DE13 ^; N # EE 057349 ; h
�' �/'J L ' Ga r 7 L , m J` . M EXPIRES fiery Public Uncle r ! ,
❑ Personalty Known • 2 T 7 70 � �` e«dedWu
�Producedldentification - � J ��•
j
Notary Signature: L
F: BLDG / Owner - Builder Affidavit REVISED: 4/16/2009
-r, . 0 _ ,L)C /y '
'.. D n 7 c 2 � 2 1:1 '
ITID< LO O m mo
I
N 0 �;Dp r ',I O 0` I �m
0.m DD 71 ZMNO y oo z
x— X—
N ; C Z (/� * 00 r O .0 • m m 53. °o= DOm /�
I D Z fTl ° z / / / 30N33 NNn I
00 to C D _ z M M x —x —.—
Gi o D _..1 Z p D X --< 0 D D ao 00 3 0 ' __. �ON�� 000n1 ,ti
I C) I— �- �D cm c�: 3A _ *l m M K O
e.--. O v: n (O � a) CO 7
D G7 W - I '� co • n m m il ,, . -o o-o —off — o ao o - 0 - o —
Z D m fTl D Z 1 3 �. ca < swill >I9188 HLIM
o c� O C7 _ _.to a a L T. 30N33 INN WnNMfl .i
(T XI C ? O O r *i O Q Q , .
O 5- 73 D K Z C � 7 ^� c um c " - r u,
PI 3 0
�. n c
O r D � XCD � O m(3 m c,ca Q o
70 0 o D ° o m
CD 5 N= �I�0 -I - 0 m 1 o�3 ° m v O o -I N � 0 ■
° m O� - 0 K 170 v mc o7 �? a �� - E CAW Z
co o E m rf x i
N Up — I D m y9. , -� � o
z CO 2 of �Ll v, .- cu n o N
m XI ^ - I (0 r n 0 (n O m o c° o c� � v N O
Q S S
V / -- n --1 O -i m
W M D `L N00 )18 RU c � 30N33 dWnNIWnIV /� O C o❑ e❑ o❑ 0-0
L 0= O > m ° +o v,�ummairi ' D V
> p _ m O N1VM 313210N00
0 r Dm Z 0 xi m0 6'4
Z Z ° O Z'S2 N 9
F ° 7, -I cri
0 o - o
m o � �m w
CO C M r>* rig g g m, 2
= A _
.
m _ _ 8
o-I rn O Z � _ c z ° z ° C)) > D = z o S'S
O 0 a Xi Z m� <Omm -1w 7� m
D D � < =r� OZ� c n u.) - o + o30N:
D . A r D�' � � �Z � G� cn 1 mzI /
v) ' C < O M CO cc Z o
N _ c • 00 �-< <c g c m N N
l
<< D X m D - m Z N
�1 C o� D OD D O tO •
CO C7 x Oc �� ° ,z � m ao
Z I
z C�Py
CP • O = (n K - D D = C O
O 0 _ { D cnz C cn mX
K Zl c_ O Dr
> X mm -I m:< 11 I�
M 0 'u O N b
m7 cn ` m ° Ico
Z d � O =D UC)
0 m M 0 c Dr m
�• -
= D u) •
f = co A O� O r O
ITI z - 0 "0 O O r-
S z Z fZ �� W 1 `_ � _���
O 0 L
tcr.) O 07 r
L,4 d 0
O Adl
A
N N . 3AI
..01 (9
•
O I -0 o
r� mZ r
O
01313 ,LO'OS l M„00,8 L.90N ° y, N
VroH 4 ,00 * 05 L M.00,9 L.90N 3JN33 NNfI NIdHO ,4 N A,
- n- X
.... X�X- x- X- X_X_1(�X�1I - X - X--_Lx -
o
N
b0 N 31321ONOO /4 C
�JJ m
U. O O
2 \ 73 -.-1
0 (n
M
O o �� p ZZ
O m r 0
r
N m z „ co D
Fo � D
S Ai
z x W 4 w , I O1 T
,f'st u m N u 1 0 O 0 v
• I S ■ N x T\
\ 'z�0 _0 - - ■ Or
A w
sox n� c Z i O - mD 0
+ 4 l m D < -� p m C7 —I
tt O
41 zm �� I p °\ ctoz 79
CA 0Z m 4 0) _„,-1 m,
--� C17 , O m 00
z I o m ° —
D 7J ( C
}
. V
-13 D
wow ,9 30N33 HNn NIVH3 ,4 .�r —Y — X — e. D OD
,00 * 05 1 3„06,9 L.90S m z ( - ' 0 -1
x1313 ,OZ'OS CI 3„ l0,1c.90S `° � (.1V D m 1 m z
O
/11 I O --,
-I ' - I 0 co
v) 17
` C"1 O=
0-
5 ' so° c ›
<v)
r
,
-0 Qc\'' 1 1 ›
---n--
I - - -
]YOi•1 0118nd O3AVd
3O 1HO1e1 H101M 318VINVA
a 1Sv00 1SV3
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
77f-
Job Address: 3 / l / Sz' r Ar A% 7c t c9 , Ft! t3.5' Permit Number: ,
Legal Description Lei +tee y c /3 l r #.,. i �,�� t3�GCk arcel # / " OC7(� S
/ Floor Area Sq. t. A+t A.N-14 ". '6i Sq.Ft
Valuation of Work $ 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/ structure(s) (circle one): Commercial
If an existing structure, its 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:` (.(c -re— i'1'1'Is��i c F E)(tc.i i i..& iJ Lb wc,DOC.si
(its- 12Lt WelitLi&itrr ?Or 5 jw-) Lori 30112-1)04A) t���7++�:,(��- �iti su664,.rizb
Property Owner Information:
Name:R,3Iis1 Aa,l C - {zA M �? .02 :Address: 31 t t .1 - 1 - 1 - 5 i. /} T L nlik. • .+3z-++ L. 3.2). 3
City (� i i1c. (t 9 - c State /"-- LZip32- 3 Phone `t6t-i1 a — v t t 6
E -Mail or Fax # (Optional) r? rs, ti1s3 r .v TM -0Z lAw ! COW
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 certibi 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 a period of six J6) months at any time after
work is commenced. I understand that separate permits must be secured or Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, 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 l 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 local law regulating construction or the performance of construction.
Signature of Owner Signature of Contractor
Print Name /'t -6:� f Print Name
Sworn subsc be. before-1 - Sworn to and subscribed before me
,
th' Day of �� (� 20 (1. this Day of 20 law
. otary Public D : rv .1111, •
cep '•,,': MY COMMISSION # EE 057349 Notary Public
� r Q EXPIRES: May 21, 2015
p•
6
_ . Bonded Thru • ota Public•ervriters • Revised 01.26.10