390 10th St fence 2012 CIT1,( OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
App lication Number . . . . . 12-CO001119 Date 9/11/12
Property Address . . . . . . 390 10TH ST
Application type description FENC!E PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0 -----
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Application desc
3ft fence
---------------------------------------- ----------------
Owner Contractor
------------------------
------------------------
PRIDEAUX MARK E & CHERI L OWNER
390 10TH ST
ATLANTIC BEACH FL 32233
--------------------------------------- -------------------------------------
Permit FENCE PERMIT
Additional desc - -
Permit Fee . . . . 35 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 3/10/13
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Special Notes and Comments
Avoid damage to underground water/sewer utilities . verify
vertical and horizontal location of utilities . Hand dig if
necessary. If field coordinationlis 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 ONLV IN ACCORDANCE WITH ALL CITV OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
S u ry(.:,k Y
MAP SffO- 'WG BOUXURY S17VEY OF
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city;T—Atlan c Beach
Planning and Zon! ig Department
This approval verifies coff illance Wth aprlQlt"
zoning, subdivision av d other local hind
development regulations, ut does not co stilvt�e
,1] rVAM
approval for the issuance f permits. Corn liance, 7%q
with Florida Building Code and all other ap licable
local, State and Federal I iermitting requir ments
must be verified by signati re of the City of lantic W,
Beach Building Official Pr or to the issuan of a
Building Permit.
Approve
pi", -
L Date:
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TW PIIVPW?rr SP40M HEREIN APPEA" IV IX WOW It #""Ro JOW 1( AS FROU FLOW
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IS DAM AS A CMPRTY GWY AOkV DOES NOT COWNJUIE CERWrAMW OF SW-
TRI—STAM LAND S VEYORS, INC.
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CITY OF ATLANTIC BEACH
A OWNER / BUILDERAFFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA $TATUTES, PART I "CONSTRUCTION
CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNGNLEDGE THE LAW*
DISCLOSURE STATEMENT FOR SECTION 489.t03(7),FROFJDA STATUTES:
STATE LAW REQUIRES CONSTRUCTIO1, TO BE DONE BY LICENSED
CONTRACTORS. YOU RAVE APPLIED FOR A PERM T 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 CONSTRUCTI YOURSELF. YOU MAY BUILD OR IMPROVE A ONE—OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILEING. 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. ITMAYNOTBEBUILTFORSALEORLEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BI JILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAI V WELL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE. WHICH IS IN VIOLATION 01, THIS EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRA TOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES kND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT P-'_OPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY C)UNTY OR MUNICIPAL LICENSING
OR-DINANC S.
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 CA INOT BE EMPLOYED UNDER AN
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(l). AN-OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENGC' OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826)IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE RECUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
r3(� C) a q a 3
ADDR�SS PRONE NUMBER
N�0'r k- ��\ A
PRINT NAME
\ A A
s, )k4 DATE
0#1 URE
Before me this dayof 2049�ie county o
elf
f/
Duval,State of Florida,has personally app d 74erin by imse / erself and affirms that
I
re
all statements and declarations are true an accurate.
DL41_11� "" ) DEBORAH AMANDA WHITE
Notary Public at Large,State of County of
M�COMMISSION#EE 057349
EXPIRES:May 21 2015
El Wrsonally Known
- D � R(O nle"hUN.t.,Ypbll.curidLrw�ter
duced Identification
Notary Signatuja4e4�
FJBLDG/0�u-Build�Afffida�i�REVISED:4/16/2009
BUILDING PERMITAPPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlanti-,Beach, FL 32233
Office(904) 247-5826 Fax(904) 247-5845
JobAddress: j PermitNber:
V/
Legal Description Parcel# 'q
644 Floor Area of N.Ft. _S( t
Valuation of Work$ Proposed Work eated/cooled n ;n2 coe�2�.
Class of Work(circle one): New Addition I Iteration Repair Move Demolition pool/spa window/door
Use of existing/pro osed structureQ)(circle one): Commercial 0. IZ�s�identiaN,
es
If an existing strucrure,is a fire sprinkler system installed? (Circle e): es No N /A
Florida Product Approval#
For multiple products use product approval To-rm
Describe in detail the type of work to be performed: A", FWC-
Property Owner Information:
Name: V��V_ Address:
city ja State��Zip 0�2,--)Z3 �hon(
E-Mail or Fax#(Optional
Contractor Information:
Company Name: WAY.- Qua]i fying Agent:
Address: city. State Zip
Office Phone Job Site/Contact Number Fax
State Certification/Registration#
Architect Name&Phone#
Engineer's Name&Phone 4
Fee Simple Title Holder Narne and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
a her d na er dh work dta n 7cated I certify that no work or installation has commencedprior to the
c i ma 00 1 mit to 0 1 e to i's "atio s as""' /I
e o d he stan�ards a ws regulating construction in thisjurisdiction. This permit becomes 1711
e r 0 fsixpo)months at any time qfter
nd h al k r e m 11 0 '
n e , f hs or, c _,tr.cto or . k suspended or abandonedfor a period o
r
(6), t
s ,e'y ep
e it- a' wo w
k ,'t c._ nced thin s 0 0 r
;h rat p rmiis t ,scur f !car Work,Plumbing,Signs, Wells, Pools, urnaces, Boileis, Heaters,
�ap is a e e b ed or Elect,
'�po nce io
's .,-d 0
d I understand t at"P
f
"'k is com"'c'
T.nks andAh.Cn .tio."S,'ta
WARNING TO OWNER: YOUR FALU"F TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR YING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO BTAIN FINANCING9 CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFO RECORDING YOUR NOTICE OF
COMMENCEVENT.
lhere certify that I have read and examined th lication and know the same to I e true and correct. All provisions of laws and ordinances governing thi's
,�Iwork will be coTplied with whether 111csifM herein t The gr hting 4?f a permit does not presume to give authority to violate or calW�l the
provisions ofanyoiherfederal,state, orlo Isfaaw regulating cons ru� nor epeFfcrinanceofconstruction.
gr
or
S
At A
Signature of Owner Signature of Contractor
Print Name Print Name
............. &.mv.........................................
S J#td��Subs ed be'lore me4�_ S orn to and subscribed before me
'wo
t i
h is I ay of AMMkNDAA Day of 20
COMMISSION#EE 7345
A
PIPES:May 21
Notary Public ru otary PUNC ipublic
Revised 01.26.10
-3
eoCity of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigied by to BLd&v Delmdmat
8W Sernincob Road 2 9
Aflan6c Beach,Fkxida 32233-5445
W- Phone(W4)247--AWS - Fax(W4)247--W5
E-nalf. bu0d1rxj-dept@coab.us Date-,ted:
cilyma"ifa! MIA-JA~-e6*b-U0
APPLICATION REVIEW AND TRACKING FORM
7-W J�— bepartment rwiew required Yes No
Property Address:
Buildoing-,
i -
alanninIg&Zonin--
Applicant g-)
ministraW
Project: -Pui-bllc Wofft-"
U
Fire
R ww or Receipt
Offm Agency Review or Pennit Required Dote
Of ermit VwWwd By
FkorWa DepL of Envirownental Protection
Fkddo DepL of Transpodation
1 SL Jd=River Water Management District
Army Cmps of Engirwers
Division of Hotels and Restaurants
Division of AWwfic;Beverages and Tobaccco
codw.
AP, PLICATION STkTUS
Rev"ft First Review: AAWroved. E]Denied.
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed toy:_ —Date,
TREE ADMIN. -]Denied.
Second Review: oApproved as revised.
P KS qom"Mft:
e
S
u
7
U ILI S
PU
Reviewed ty: Date:
PU C SAF��
FIRE SERVICES Third Review: E]Approved as revised. ElDenied.
comments:
Reviewed by: Date:
Raioiml 07)27110
City of Affantic Beach APPLICATION NUMBER
Building Deparbrient (ro be assigriied by the BuMV DepmMot)
800 Somkx*Road 12 -
Adenbc Beach,Flonde 32233-54�
Phi m(904)247-5M - Fax(904)247-5845
E-mak bulkling-dept@cciab.us Date routed: 4Z2
Cilyw&"ife! WJ-Ammo.ambme f
APPLICATION REVIEW AND TRACKING FORM
Property Address: 7-,11 Depar1lInOntmiewre4pdred Yes 1110
Bull!d0ing-,
Applicant afannir:ig 7&ZoniR[,,) 97
Project ublic WbrW
U CrUDIK2m�!--�
Fire Services
00m Agency Review or Permft Required or Recelit Date
c0if ft Veriloind Sy
Floride Dept of %A a I!rum 11IMm I Protection
Florida DepL of Transporbdon
SL Johns Rmer Water Mermgmetit DiOld
AraW Corps of Engkmers
Division of Hbbb and Restaurants
Division of Akx*wft Beverages and Tobacco
APPLICATION STATUS
Rev*wMg Depas himili- First Review: Eq(j�roved. DDenied.
(Circle one.) Convuents:
BUILDING
(P�LA7NNING&�ZONI Reviewed by: D.-ft:
TREEADMIN. Second Review: DApproved as revised. F]Denied.
PUBLIC WORKS Comrnents:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed toy: Date:
FIRE SERVICES Third Revi&= []Approved as revised. [JDenied.
Conunents:
Reviewed t y: Date:
Ra4mod 87WIlD
19Qk;VP1 City of Atlantic Beach APPUCATION NUMBER
Building Deparbrient (To be assipied by the Buikow Depwknat
SW Semiriole Road 12 -
Adardic Beach,Florida=334445
Phone(904)247-5826 - Fax(904)247-5845
Date rouled:
E-mail. bu0dkxj-dept@coab.us
ejfyMal�-*b! Ift!JAA0WW-d6*b.U*
APPLICATION REVIEW AND TRACKING FORM
7-W Department revilmmmquired Yes No
Property Address: z�) _e
Bui!d0jpU--.,
Applicant afEnIn4g&Zoniii-�D
minisbaW
Project A-15"u-blic Works-)
U
Fire Services
Other Agency Review or Permit Required or Receipt Date
Of ennit Verified By
FbrWa DepL of Environmerft Protecfion
Florkla DepL of Transportabori
SL Johns Rww Waler Managernent Disbid
AmW Co"of Engireers
DkWm of Holeft and Restaurants
Divisim of Aku*ac Beverages and Tobacco
Other
APPLICATION STATUS
RevieWing Deparbrient Fimt Review: PJ�kproved- ElDenied.
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed Dy Date:
TREE ADMIN. Second Review: E3Vproved as revised. E]Denied-
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed I)y: Date:—
FIRE SERVICES Third Review: E]Appmved as revised. ElDenied.
Comments:
Reviewed by: Date:
Revisad=110