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Permit 780 Camelia St 2012 Q CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 12-00001113 Date 9/12/12 Property Address . . . . . . 780 CAMELIA ST Application type description FENCE PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc add 4ft fence ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ LYLE NELLY ET AL OWNER PORTER TANIA K JTRS 780 CAMELIA ST ATLANTIC BEACH FL 322332522 ---------------------------------------------------------------------------- Permit . . . . . . FENCE PERMIT Additional desc . . Permit Fee . . . . 35 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 3/11/13 ---------------------------------------------------------------------------- Special Notes and Comments Avoid damage to underground water/sewer utilities . Verify vertical and horizontal location of utilities . Hand dig if necessary. If field coordination is needed, call 247-5834 . Fence cannot be on the City right-of-way and can only be 41 tall . ---------------------------------------------------------------------------- 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. MAP SFJOWNG SURVEY OF ENE P,I ML AS RECORDED IN ET--207--- BOOK PAGE r E 71-1 ki T — OF T E J�A TY V FLOM OF CU�— COUN FOR LOT Co 14P t/ .4 LOT I LCIT I L07-Z cii Atlantic Beach ty A Planning Zoning Departmert This approval ve compliance wNh applIcable zoning, subdivi a and other local land development regu lons, but does not constitute approval for the of permits. ompliance ,with Floridi Build) a and all other applicable ocal, State and F r I permitting requirements ust be verified by sl ture of the City of Atlantic each Bu I "Or to#10 Issuance at a uilding PermiL %ppZved By. -,-,)'7- zi Lc-)T Ar Date: L-(-,T L Page 1 of I C, 478 890 S31 4, P 102.00 .02.M Sol SM SOS M 801 so$ 830 780 781 1 TD9373 0000 791 990. 7SI 750 731 7 747 102 102 7 711 722 731 ?w 712 7 0 202 709 710 701 7w 703 102 "2 .02 102 635 632 701 65, 650 0 121ft Sw http:Hmaps.coj.net/output/DuvalMapsSQL_itdgism3 195 63 06465 3 4.png 8/24/2012 City of Atlantic Beach APPLICA71ON NUMBER Building Deparbnent (ro be assigned by the Building Dqwkwt SW Se"nole Road Atlantic ;, i 11. Florida 32233-5445 -11113 Phone(904)247-5M - Fax(904)247-5845 E-nmil: bullding-dept0wab-us Date routed: cilyvmb-aho! ft-JA~.e"b.u0 APPLICATION REVIEW AN D TRACKING FORM Property Address: mpartment mview mgulmd Yes No Applicant 11 Aanning&Zbqod�, T "--! Project: blic b ic ULM lic S ty —Oft�blic Safety Fire Services Offter Agency Review or Permit Required Review or Receipt Date of Permft Veffled By Flonda Dept.of Enviromental Protection Florida Dept.of Transportation St.Johns River Water Management District Affny Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and TobaccD APPLICATION STATUS Reviewing Deprtment First Review: 0-�--Iproved. ElDenied. (Circle one.) Comments: twiw -M 4(-,, in & BUILDING J"d-5. JW- Reviewed by: P� IN.� Second Review: [][Approved as revised. ElDenied. Date: /27/22L2 PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: E]4proved as revised. DDenied. Comments: Reviewed by: Date: Reyisat!0=10 City of Atlantic Beach APPLICATION NUMBER Building Deparbnent (TO be msWrod by ft Builft Dapwbmt) 800 Seff*X*Road AMWft d 1,Florida M&3-54,45 12 -1113 Phone MN)247-5M - Fax(904)247-5845 Date route E-mall. building-dept@coabms x d: 01YW&4ik! W-JAWAU.&Wh.U* APPLICATION REVIEW AND TRACKING FORM Property Address: 'Wo C*-77tF ) io,- Departlnent review re"Ired Yes No -Buimkw---- Applicant (Planning&Zoninci> Project: Ilc Ic Public Safety Fire Services 00w Agency Review or Pennit Required Review or Receipt Daft I of Pemft Ve~By Florida DepL of Protection Florida DeVL Of Trareportation SL Johns Rhw Water Management DisMd Affny Corps of Enoneers Division of Ho"and Restaurants Division of AW"c Beverages and Tobacm APPLICATION STATUS RevWMng Departrnent First Review: roved. ElDenied. (Circle one.) Comnients: PAM BUILDING PLANNING&ZONING Reviewed by: Date: , TREE I 4EAE , ,rf ond Review: E]Approved as revised. E]Denied. 0 P ments: UCFIU Z PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: [3Approved as revised. 0Denied. Connywrits: Reviewed by: Date: Rawisodll=10 City of Atlantic Beach APPLICA71ON NUMBER Building Deparbnent 4618 - Cro be assioned by the BLnl*V Depamxwt 800 SernfrWe Road 7 A*w*--Beach,FWda 3=33-544�-,- -5826 - Fax( Phone(904)247 904y i'W5 E-nmll. bLdk1ng-dept@coab.us Date routed: CifyWO&ORLS! W-JAVWW.e6*b.UQ APPLICATION REVIEW AND TRACKING FORM Property Address: Department revkm required Yes No Bu0P9---__ Applicant AL ,Planning&Zonind:> ish-alor I-WeerA�Jni Project: blic Wo j�;_ Ic IMCS__" A b ic Ufi -Public Safety L-Fire Services Other Agency Review or Permit Required "low or Receipt Date of Permit Verified By Fbnda DepL of Envimmental Proteclion FWWa DepL of Transpodahm SL Johns River Water Management Dishict Arnry Corps of Engineem Division of Hotels and Restaurants Division of Alcoh�c Beverages and TobacoD Other 2-Si 1 J APPLICATION STATUS RevimMng Department First Review: 00Approved. DDenied. (Circle one.) Comments: j2, BUILDING PLANNING&ZONING Reviewed by: Date: TREE ADMIN. Second Review: ElApproved as revised. FlDenie�. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: E34proved as revised. FIDenied. Comments: Reviewed by: Date: Rewiwd 07WIlD CITY OF ATLANTIC BEACH OWNER / BUILDER AFFIDAVIT 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I "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 EXEWTION TO THAT LAW. THE EXEWTION 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. YOUMAYBUILDORUVTROVEAONE—OR TWO FANnLy RESIDENCE 40R. A FARIA OUTBLTILDINU YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000-00 OR LESS. THE BJMXRN� 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 WITI-IN ONE YEAR AFTER TEE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXENTTION. YOU MAY NOT HIRE AN I JNLICENSEDIERSON AS YOUR ONTRACTQR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS' IT IS YOUR RESPONSIBILITY TO N4AKE SURE THAT PEOPLE LOYED BY YOU HA LICENSES REQUIRED BY STATE LAW AND BY COLyNTy OR MUNICIPAL LICENSINNG ORDINANCES, IL INJURY LIABILITY; SINCE OWNERS MAY BE IABLE FOR INJURIE TO WORKERS THEY HIRE� THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPEN6AIION 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 $5,00U PENALTI Y-UNDER FLORIDA 6 1 A I UTE NO. 455-228(l). AN-OCCUPATIUNAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPE]ENCY' OR I HE 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. PHONE NUMBER ADDRESS 6E PRINT NAME�,r, A SIGN da1' --C AL?m-the county Of Before me this ji iky�p..,ed her,,, Duval,State of Florida,has per ky himself/herself and affirms that all statements and declarations are true and accurate. a -I — Notary Public at Large,St te of county of::a_ 11 Personally Known [%-�duced Identiicatio 'o SHIRLF�L.=GRAHAM M " D 9'7760 T r MY CO I WAS-13ION#DD 957760 Notary Sig lure: u 'y 0 _S I�XP IR-FS:February 14,2014 Sundk-d Thru Notary Public un-lerwriters FJBLDG/0—r-Builder Affadavit;R-I.-VISED: 4/16/200 _ p, BUILDING PERMIT APPLICATION (CITY OF ATLANTIc BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax(904)247-5845 Job Address: Permit Number: Legal Description ril Floor Area of So Ft. Parcel# Sq Ft Valuation of Work Proposed Work he'aited/cooled non-heated/cooled Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s) (eircRe 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 product approval I—orm Describe in detail the type of work to be performed: ./W ZP /7/Wi-�_ a-1000 Provertv Owner Information: Name: Ille-I& �2LC_ Address: City Xa—c4�L- State l'tip Phone E-Mail or Pax# (Optional 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 Narne& Phone 4 Fee Simple Title Holder Narne and Address Bonding Company Narne and Address Mortgage Lender Name and Address p a �,e node er" t 10 do he wor,1 and insa"Zions a.'fnd,'ca or installation has commencedprior to the aic io ' r y o'o 0' 11 le" e arm dto, t h a a la s is e, n a'd h all 'a'rk a p me e s n� rd3 w thisjurisdiction. Thi3perinitbecomesnyll , c f h,,or Z Instruction or.1ork su aWeriod of sixji�)months at anv time after r is ot c wo wi p) P' ' �ap k o_inncd i hin, (6 ,Ot 'ssu nce o and 'id f t is c 0 ,d rst" t at SPr, Pri s in. t "c e 'r, f T. k d tj d h te b d or Elect"m e S Pools, urnaces, Boileis, Heaters, 'k, .dA,, 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 cerf�fy that I have read and examined thi's application and know the same to be true and correct. All provisions of laws and ordinances governina this ope p�work'Wll be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate 01-CG17C�l the provisions of any o1herfederal, state, al law regulating construction or the peFformance ofconstruction. Signature of Owner A,' Signature of Contractor Print Narne Print Narne .................................................................................................................................. .............................................-------------- ......................................................... S scr�ibve 'Irie Sworn to and subscribed before nle t c ) 3— Z nay t 2 120 this Day of 20 Nota Notary Public SHIRLE jmmlwl ,'iycow!�11110 'DD957760 Revised 0 1.26.10 :XPiRES:Febrijary 14,2014 d,�d T��L;Notary Public Underwriters