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�s CITY OF ATLANTIC B EACH
'.! 4 "4: ' ' s -� 14 s) 8 00 SEMINOLE ROAD
y ATLAN BEACH, FL 32233
'`-) -":;,, INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000409 Date 5/03/12
Property Address 420 W DUTTON ISLAND RD
Application type description SHED PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 400
Application desc
5x5 shed
Owner Contractor
WIGLEY HIROMI OWNER
420 W DUTTON ISLAND DR
ATLANTIC BEACH FL 32233
- -- Structure Information 000 000 INSTALL 5 X 5 PLASTIC SHED
Permit ACCESSORY STRUCTURE NEW RES
Additional desc . 5 X 5 PLASTIC SHED
Permit Fee . . . 55.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 400
Expiration Date . 10/30/12
Special Notes and Comments
2010 FLORIDA BUILDING CODE, 2008 NATIONA1 ELECTRIC CODE
*CALL FOR FINAL INSPECTION WHEN SHED COMPLETE AND ANCHORED
TO MEET 120MPH WIND LOAD.
Slab cannot be in the storm water retention area.
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 55.00 55.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 59.00 59.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
emik— City of Atlantic Beach
, Building Department
APPLICATION NUMBER
800 Seminole Road (To be assigned by the Building Department.)
111‘ Atlantic Beach, Florida 32233 -5445 /2 - , Q
Phone (904) 247 -5826 • Fax (904) 247 -5845
;p E -mail: building- deptt�coab.us Date routed: ® //�
City web -site: http: //www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 12e Al AM/0 id I: t review re. uired Yes No
Applicant: ea) /Iliz 8 Zonin•
���a �X � Tree Administrator _ -
Project: rublic Works, _ -
Public Safety
Fire Services _ -
t , F J : t
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: roved. ['Denied.
(Circle one.) Comments: /� / 5'
,, L Y . , L - , J
BUILDING ' '8t k)4 ttr'N cenr stfru S
PLANNING & ZONIN �, /
Reviewed by: ®t f Date: /` /Z--
TREE ADMIN. Second Review:
Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: DApproved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
BUILDING PERMIT APPLICATION l "on""�v "'"""'"" " A •c t .,,
CITY OF ATLANTIC BEACH `'
800 Seminole Road, Atlantic Beach, FL 32233 k N FILE C
O
Y
ffice (904) 247 -5826 Fax (904) 247 -5845
Job Address: 4;,t74. Lrlia,,.k_
4 7 c. e L2 Permit Number: ' —may
Legal Description
Floor Area of Sq.Ft. Parcel # S rt
Valuation of Work $ 4 l'G/ Proposed Work heated /cooled
n - heated /cooled
Class of Work (circle one): New 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 prod ap proval form
Describe in detail the type of work to be performed: r
r
Property Owner Information:
Name: I-t 1 * ,Y4 / ( WI 101 Address: 9
L- , rf z rlc�C a City /i
I�f%G State I L.Zip �- _ � Phone .•
E -Mail or Fax # (Optional) n rj� . c _ —_
Contractor Information: O /, /f / o
Company Name: ' �
Address: Qualifying Agent:
Office Phone Joy --� State Zip
State Certification/Registration # ��R CO COMPDAN -1
Architect Name & Phone #
SEE PERMITS FOR ADDI
Engineer's Name & Phone # T;{ A J
Fee Simple Title Holder Name and Address QUIR MENTS AND CONDITIONS.
Bonding Company Name and Address
Mortgage Lender Name and Address �_ �t � ' ' ' 414 an'�7:f11 /I�ILfiT��, l
Application is hereby made to obtain a permit to do the work and installations as indicated. I certibt 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 (6) months at any time after
work is commenced. I understand that separate permits must be secured for Electrical; York, Plumbing, Signs, Wells, Pools, F urnaces, Bo Healers,
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.
I hereby 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 of work 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 7)----N. Signature of Contractor
Print Name / j2o/It / W ai...ely Print Name
Swor t d subscri • • before i Sworn to and subscribed before me
O t 's / Day of • / ° _ , 20 /7" - this Day of 20
AF , / - v./
Notary Public AWH Notary Public
a , , � , , D EBORl 1 V 1 N� E X5734
"' MY CAMMISSION
. 11 EXPIR S: M ay 7 20t 5 f w �� ��/�)
�� tuNotanP''h c;Undervrt�l _ `,, ,- W 7� _ Revised 01.26.10
p , 00" "' 1j �jJ
CITY OF ATLANTIC BEACH
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.
11. 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.
V2' /17,7%_ ZS� aiv 9i ws - �� /o
ADDRESS PHONE NUMBER
PRINT NAME k 0 +5
•
SIGNATURE DATE //
Before me this l day of , 20 f min the county of
Duval, State of Florida, has personall ppeared herin by himself / herself and affirms that
all statements and declarations are t nd accurate.
Notary Public at Large, State of , County o
❑ Personally Known / _ 7 - /W 4 Lj 6 ��
+produced Identification - L ( V -�1" ` "' '
/ _ S rf DEBORAH AM ;i r
�• . MY CAMMIS.`-
- , �� ', EXPIRE`` Notary signature��/ ��I
C(22-A46_ aat BondedThrn
",
aTYa rt, 1 DEBORAH AMANDA wHnt
F: B M1
LDG /Owner - Builder Affadavit; REVISED: 4/16/2009 "'9
sr: � :.e MY COMMISSION / EE 057349
;r ' ' UQ'111CO. M4 21 2f,,a
Bonded Thru Notary Public Underwriters
Lr 1 I ,l l 11
� i,li Y
•. W ' : ; Ki i 1 ,; F t Ctions
Da rt Yo /0 i
ursel prote � F; .r most ,, uctures or possessions.
jii,lil, ' : IIli TIE
,
includes: Apo '' .- 1_ DOWN
•
rn M lu, . J , . 4; . fat • & 60 5 Y
Part ? ;;,
075 � ��'' 1,
1 ' l,1, , .� �I�i ) FILE C
II { , c. nW M n MkRiW `nq...'+WTa+4"a6MG.rgv#,� IW� 4,n
il k, j ''
I Iii ' ► ": i
I L . r 1 f --,2_,.
I i .
II M
1. Install ground anch cl to � ! 4 ql; I ; piling as possible at all four comers.
A. Install anchors a s g „, , urn (screw) anchor into the round.
B. A starter hole, u " 1/3 the E T kli g
eye is level wt : ` , grow '!° l u ongth can used to start anchor into the ground. Once the anchor
. I',li 4 e call and pack area around the anchor eye.
C. Anchor eye sho a o i i - just a :� � vel. LI ,
-
2. Cable can be secur: the ild'
, ,' , ,;� i the following methods.
A. Attach one end e ca I t, iiL k . r using the wire rope clip. Cable goes thru the anchor eye and is
clamped to , . in g t the roof to the opposite anchor, loo
anchor eye cable cable
2). Place the cable over t
thru anch ,l,l jto
tighten nuts. Re for ole 'lr"ai1 gh to attach to the anchor. Pull cable ti 9 h loop attach 2 wire rape clips,
, I;`
B. Attach cable to % 1 ice l P
u , i
w it4.10 � y ►7 onal hardware required, bolts, washers nuts an wire rope clips.
'17'7 All available at , , � : local � al' , . ., i ly.
l
I ! �1; ; ,> f
NOTE: 1 hi 1 , !
These instructions a sag +' `
g , . -, ► a s r ment to small shed not located in high wind areas.
detailed anchor rlegw ` , .., ' a` 71 � more .
. zone charts for r area. You may need additional �a ors,
cable, wire clamps . er fo ' I ' , � attachments
i I �,�� , , I to the s to meet local or state requirements.
' ,1111
� . � drte�n w X 11 � ' , OO x) month Umlted Warranty
.' , . I h enegven a ' ,- a ,, , ,.: ad in accordance with the manufar timers recommendations
ass H,, , cap
dad acities are guaranteed for 12 months from date or
w, � ' . i � tonal or workmanship.
11,,_, returned pre 4 y, i , ry. TIE DOWN ENGINEERING will replace without charge the
, . , ape are not covered by this warranty and while this warranty
, - �1 may also have other rights with vary from state to state
Instruction #08091 1 ' ' ~
+illii ~ ;!i :,111 m
TIE DOWN EN( IEEA'QN _?55 Villanova Drive SW • o
Atlanta, GA 30336 TIE m
- ww.cuec1. J. . ar» (404) 344 -0000 Fax (404) 349-0401 DOWN Q
Z0 /Z0 39ad 1VH1N3S01 ela t'Z9986Et'06
9Z:T0 ZTOZ /ZI /170
,, City of Atlantic Beach RECEIVED
, Building Department APPLICATION NUMBER
A " 800 Seminole Road APR 1 2 2012 (To be assigned by the Building Department.)
ti
-1vx4111111, I Atlantic Beach, Florida 32233 -5445 2 w Id
Phone (904) 247 -5826 • Fax (904) apjy45
E -mail: building- dept@coab.us Date routed: / /1..— City web -site: http: / /www.coab.us ` �..
APPLICATION REVIEW AND TRACKING FORM
Property Address: V 7C1 / '' � '' ' ' : = . ' t review required q red Yes No
Applicant: ea) /1/1 he
.!, - 1 . • � � & Zoning
u Tree Administrator
Project: JM :/S $X -ublic Works,
:'"*`u • is Utilities 2)
Public Safety
Fire Services
Other Agency Review or Permit Required Review or Receipt
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:
APPLICATION STATUS
Reviewing Department First Review: Okpproved.
(Circle one.) Comments: ['Denied.
BUILDING
PLANNING & ZONING
Reviewed by: Date: ! � ' �3
TREE ADMIN. / �
Second Review: ['Approved as revised. ['Denied.
P te'
ir
C ORKS C. ments:
PUB IC SAFETY Reviewed by:
Date:
FIRE SERVICES Third Review: []Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07127/10
JA
{ i City of Atlantic Beach
Building Department REC;II . it APPLICATION NUMBER
.
11 800 Seminole Road (To be assigned by the Building Department.)
5' - m Atlantic Beach, Florida 32233 -5445 APR 1 $ 201
Phone (904) 24 ing 7 -5826 co 2Fax 1 - (904) 2 5 2 - / d
E -mail:
p� s �
City web -site: http: / /www.coab.us " — date routed: ,,.,/ ` /
APPLICATION REVIEW AND TRACKING FORM
Property Address: zo ti
h / ;ij i,, t review re • uired Yes No
Applicant: ULl.� /✓,e ..rW.
Project: x,14 c)( Tree Administrator _-
e ' ublic Works_ _
.rigEMEMMInim
Public Safety ==
111111MMIIIMEN MO
A! . a 4 't ,
v e y C :, n t^ .. ',,
n
Other Agency Review or Permit Required Review or Receipt
annimis
Florida Dept. of Environmental Protection of Permit Verified B Date
Florida Dept. of Transportation ■ --■
St. Johns River Water Management District
Army Corps of Engineers -_
Division of Hotels and Restaurants - -M
Division of Alcoholic Beverages and Tobacco .
Other:
APPLICATION STATUS
Reviewing Department First Review: FA pproved.
(Circle one.) Comments:Q ❑Denied.
BUILDING �tt /` Al) 1 1 ) ) - / 1,, � $ I O1v )A ?'a
PLANNING & ZONING /
Reviewed by:
... /6- TREE ADMIN. D a t e:
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
J