Permit Fence 500 Plaza 2012 lit
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
I r INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00000688 Date 6/05/12
Property Address . . . . . . 500 PLAZA
Application type description FENCE PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 1000
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Application desc
Gft fence
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Owner Contractor
------------------------ ------------------------
SANDS REX OWNER
500 PLAZA
ATLANTIC BEACH FL 32233
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Permit . . . . . . FENCE PERMIT
Additional desc . . NEW 61 FENCE REAR YARD
Permit Fee . . . . 35 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 12/02/12
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Special Notes and Comments
Avoid damage to underground water/sewer utilities . Verif
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.
(Approved: Advanced Disposal, Realco, Shapelle ' s and Waste
management)
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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 ONLV IN ACCORDANCE WITH ALL CITV OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
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CRY Of Atlantic Beach
BUIlding DOPartfnent APPLICATION NUMBER
SW Seminole Road (ro be als'siigned by
Atlantic Beach, Florida 32233-5445 the Building D"rtmerfl
Phone(904)247-5826 - Fax(904)247-5U5
E-mail; building-dept@coab.us
C"Y"b-800: WIDIA1,11.1,16.u. EDate routed:
APPLICATION REVIEW AN.D TRACKING FORM
Property Address: '5�lz ' -
�164�
De artrngnt rai. Mired Yes No
Applicant: Building
Project: T AurninfStrator
u
U lic Safetv
F-ire services
Other Agency Review or Peffnit Required Review 0 eipt
Florida Dept. of Permit Date
Florida Dept
St.Johns River Water Management District
Army Corps
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Mer
APPLICATION STATUS
ROViewing Department First Review: EIAPProved.
(Circle one.) Comments: ElDenied.
BUILDING
PLANNING&ZONING
TREE ADMIN. Second Review: [E]JAp Reviewed by: Date:
PUBLIC WORKS Comments: E04 enied.
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: DAPProved as revised. E]Denied.
Comments:
Rev fewed by:
RwIW 07WIlo
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904)247-5845
Job Address:
Legal Description Number:
$ oor ea o Pa�rcel
q t q.
roposed Work hea*t�d/cooled
Valuation Of Work �p
P roopr o s�ed '�o Erk
Class of work(circle f1011-heated/cooled--------
One): New Addition Alteration Repair Move Demolition Pool/spa window/door
Use Of�X'�ting/proposed structure(s)(circle one):
If an existing structure C
Florida Product A I is a fire sprinkler system insta,l ommercial jRes;identia
ed?(Circle one): s
pproval# es 0 N/A
For multiple proaucts use P_To_du`ct_apP_rov—aMor—m
Describe in detail the type Of work to be Performed:
k�o/
V211ST11Y-0--an 'r Infor
e ma
tion-
Name:
city Address: ora�
State Zi—p
E-Mail or Fax (Optional) P. Phone
Contractor Informat' ------------
Company Name:
Address:
Qualifying Agent:
Office Phone city
Job Site/Contact Number State
State Cert'f-lcat'On/Registration# # /-IP
Architect Name& Phone# -----------
Engineer's Name& Phone#
Fee Simple Title Holder Name and Address
Bonding Company Narne and Address
Mortgage Lender Name and Address
4PPlication is hereby mad,to qbtain a permit to do I
issuance o a Permit an at all ork work and installations as indicated I c�rtify that no wo
and void i work is not c01nmen willbeperforme to meet the standards of all laws *
work is within six(6) rk or installation has commencedprior to thE
commenced I un ers months or ifconstructio regulating constryclion in
ndA!r on n or work is sus �dqd or abandonedfor eriodofsix
Tanks a iff,11 ers, that separate permi;s must be securedfor fie'ct'r'tc'74 thisJurisdiction. ThisPernzilbecomeS171111
ork,Plumbing,S,,jn. 0
w1dis, Pools, j,)months at aj7V time aftel,
urnaces, Boileis, Heaters,
WARNING TO OWNER:
COMMENCEMENT MAY RE YOUR FAILURE TO RECORD A NOTICE OF
SULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING9 CONSULT WITH
YOUR LENDER OR AN ATTORNEY-BEFORE RECORDING YOUR NOTICE OF
NT.
y that I ha,,read and examined th a plication and know the same to be true and correct. 411provisionso aws and ordinances governinq this
I hereby cert�f COMMENCEME
type pf workivill be complied with whether s I'S
Provisions ofany otherfedepat state, ?ci Xd' herein or not. The granting of a permit does not presume to give authority 10 violate
or to at 4 fl
raew regulating struction or the peCfOrmance ofconsruction. or concO the
signature of Owne
Print Name W Signature Of Contractor
........................................7( .............................................. Print Narne
Swor d subscribed Ir re me ..............I........................................... ...........................................
this I�Inay of
20 Sworn to and subscribed before Me
this — Day of --------120
pub t, 7j��p I
Nota
BMW nru NoWy PW*UnderWm Revised 0 1.26.10
CITY OF ATLANTIC 11EACH
E)WNER / BtUDER
AFFIDAWT
L FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES PART 'CONSTRUCTION
CONTRACTING'REQUIRES OWNER/BUILDER TO ACKNOWLEDGE�HE LAW:
DISCLOSURE STATEMENT SECTION 489.103(7),FLORIDA STATUTES-
STATE LAW REQ
CONTRACTORS UIRES CONSTRUCTION TO
LAW. TnEE * YOU HAVE APPLIED FOR A PERNITT UNDE BE DONE By LICENSED
Y NEAPTIONALLOWs YOU,AS T R AN E-XEA4PRON TO THAT
S OUR OWNr CONTRACTOR EVEN THOUc HE OWNER OF YOUR PROPERTY.TO ACT AS
UPERVISE THE CONSTRU _,H YOU DO NO
CRON YOURULE YOU MA T HAVE A LICENSE YOU MUST
TWO FAMLY 15E_-j� , 11
IE OR A FARM Y BUILD OR IAIPROVE
RAPROVE A C OUTBUILDING.
OACNAERCIAL BUILDING AT A C YOU MAY ALSO BUILD OR
ST BE FOR Yo
USE AND OCCUPANCY OST OF$251000.00 OR LESS !g BUILDING
IF YOU SELL 0 . IT MAY NOT BE BUILT . T
R LEASE A 13UILDING FOR SALE OR LEASE.
AFTER THE CONSTRUCTION IS COA4PL YOU HAVE BUILT YOURSELF MTHIN ONE
IT FOR SALE OR LEASE, WHICH IS IN ETE, THE LAW WILL PRES YEAR
UME THAT YOU BUILT
HIRE AN UNL VIOLA-RON OF THIS EXEAvRON. YRYL�MAYNOT
_11:1���" UNLICENSED PERSO AS
iE DONE ACCORDING To OURCONIRACTOR YOURCONS
TRUCT70N MUST
YOUR RESPONSIBILITY To U)VES AND ZONING REGULATIONS. IT IS
Ep Fj S,
ICIENSES REOUIRFT. r A KE SURE THAT PEOPLE _F_11P�LOYED�B
Y YOU HAVE
V
Q �O
TE I AW 4ND B
Y CQUNTY R Cl NSI
AL Ll�ENG
11- INJURY LIABILITY; SINCE OWNERS MAY BE LLIA
THE BUILDING DEPARTME_N_T��G��W�T�S'_-�_ FO�R IN��JUR�IE
W%B LEU�
0
�V I _Q TO WORKERS THEY HIRE
PURCHASED. ORKER'S COMPENSATION INSURANCE B�
Ill. IRS WITHHOLDING,-OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHH�LDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKER THEY
EMPLOY ON THEIR IMPROVEMENT TRADES. S
IV- PENALTY; UNLICENSED CONTRACTORS CANNOT B
�� ! :� 1;11 1
9@��PSTAN6ES, OWNERS BEI ll� zi III:l�,� )YED UNDER ANY
1 $5,000 PENALTY UNDER �l
455-228(l). AN'OCCUPATIONAL LICENSE"IS NOT ADE
SEE THE Co�.1111`1� 1Y QUA THE OWNER SH' OULD PHYSICALLY
l�,ER�'IFICATE OF t_(JT E.
CERTIFICAT OMPETENCY" OR THE FLORIDA "CONTRACTORS
E" 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
OftER-BUILDER PERMIT.
Q-0 2-4
ADDRESS THONE NUMBER
DATE
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CRY Of Atlantic Beach r,
Me"and Zoning
7' Thle'approve
o A;` 18 M Verifies Gor"Phn",VA
zoning, subdivision-a
evelo r nd Oth4i 16041 land,
development regulations, but does.4W co
OPProval for the issuance of permits., notilute
with I Flofia Su#dlnq Code and an Compliance
ce at, offw applies*
Fi
local, $tat*and Federal P's"Oftnill Mquirementi
must be varilled b&:f i a
0 gn furs Of the CkY Of Aftrft
Beach eul�lnq. J*r so
BP25OU01 CITY OF ATLANTIC BEACH 6/04/12
Application Tracking Step Selection by Revision 16:46: 14
Application number . . . . : 12 00000688
Address . . . . . . . . . . : 500 PLAZA
RE number . . . . . . . . . : 170703-0202- -
Application type . . . . . : FENCE PERMIT
NCR OLD ACCOUNT NUMBERS . . : AB06133
Tenant name , number . . . . :
Type options, press Enter .
2=Change 4--Delete 5=View 6=Fast log 8=Action log maintenance
9=In/out maint
Path ---- Key Dates Review Summary -
opt Agency description Rev Step Req In Est Cmpl Resulted Stat By
PLANNING & ZONING A 01 Y 06/04/12 06/13/12 06/04/12 AP EH
PUBLIC UTILITIES A 01 Y 06/04/12 06/13/12 06/04/12 AP DK
PUBLIC WORKS A 01 Y 06/04/12 06/13/12 06/04/12 AP LS
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F3=Exit F5=Land inquiry F6=Add F7=Revisions F8=Misc info inquiry
F9=Corrections report F10=View 2 F11=Sort by agency F24--More keys
CITY OF ATLANTIC BEACH
V
OWNER BUILDER AFFIDAVIT
1. 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 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 RAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
I __ - I
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(l). 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.
0
ADDRESS PHONE NUMBER
PR I 4NT M
8 N TURE DATE
Before me this day of 2/,I—in the county of
Duval,State of Florida,has pe Ily appeared�herin by t Tim—self I herself and affirms that
curate.
all statements and declaration true and accurate.
�e
Notary Public at Large,State of County of DEWWAMA"Vff I i:
pf;�sonally Known MY COMM&"ll EE057349
EXPIRES:May 21,2016
El Produced Identification- Borided Thru Notary Pubk UnIlerwnlers
Notary Signet
R/BLDG/0�er-Build�Affada�i�REVISED:4/16/2009