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Permit Fence 1632 Park Terrace West 2012 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 12-00001202 Date 10/03/12 Property Address . . . . . . 1632 W PARK TER Application type description FENCE PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc 6 ft fence ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ AYCOCK THOMAS J III & MARY ANN OWNER 491 SATURIBA DR ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit . . . . . . FENCE PERMIT Additional desc . . Permit Fee . . . . 35 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 4/01/13 ---------------------------------------------------------------------------- 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 . Roll off container company must be on City approved list and container cannot be placed on City right-of-way. (Approved: Advanced Disposal, Realco, Shappelle ' s and Waste Management) . ---------------------------------------------------------------------------- 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. Prepared By: E A C T A is LANDSURVEYORS g ;We �11' C�"Cho PROPERTY ADDRESS: 1632 PARK TERRACE W. ATLANTIC BEACH,Florida 32233 SURVEY NU MBER: FI-1106.2215 FIELD WORK DATE:7/5/2011 REVISION DATE(S):(r..O 7/512011) 1z FL 1106.2215 ppLMWOOE) LANE(RIM BWNDARYSURVEY 5/8,Fir DWAL COUW TABLE: NO ID LI 5 1 105G'50P E GG2.9 V(F) @ Bm CO 51 1059'392 E GG3.0 I'M 30 k LOT 17 /?1 ri '0' > f3t-r\G NO ID *05 14115 FENCE 0.75 0.51 If (Pp 1/2,Fir NO ID Lo Is T t)W CONIC, t �7 LOT /5 BLK G 112-FIF W NO ID 01' '76.05 k Os W 7 B.r V'f 1/2*FIF LOT 19 NO ID FENCE 0.21 W 13LK G T NOTE5; I hareby CW* Of taW dw~ 5ETBACK INFORMATION 5HOWN ON FLAT,NOT VERIFIED PW&Iyhm wdm to ft bad of my FENCE OWNMtllr NOT DETERMINED kW1018* Ofa "mog 8g"bym ROWN 80md k?Ch** SJ-17offt 40 0 20 40 GRAPMC SIC= (In fe!p�j_ KEITH A STEPHENSON 1 Inih 46f fL' 816of b RAWWINneyorandikilmer LicarmeNmGM Use ofThIs Survey for Purposes other than IntendedW1thoutWftwVwfficaWnwW beat the thees Sole MA and Wthout Uabft to the Surveyor. Nothing hereon shell to Construed to Give ANY RWO or Bermft to Anyone Other then those Certftd. F, Prepared By: ,, ,E "" ACTA Y 0 L A N D S U R V E R S 'Z5 PROPERTY ADDRESS: 1632 PARK TERRACE W. ATLANTIC BEACH,Florida 32233 NUMBER: FL1 106.2215 Z Z' FIELD WORK DATE:7/SI2011 REVISION DATE(S):(,.v.0 7/5/2011) FL 1106.2215 F,,-\L�,1WOOL) U-%NE(FM BOUNDARYSURVEY DUVAL COUNTY TABLE: NO ID LI 5 1 105G'50"E GG2.9 I'(P) @ BI-K.COR. 51 1*59'39'E GG3.0 P(M) 30. LOT 17 112-FIF NO ID DLK G c0511-7-f- 15 0 -A'1 FENCE 0.75 0.51 E 5GO 1/2'MP NO ID -4 59 i��101 X, -A. 0, LO n LOT /5 ra 13LK G b' G 112-FIF NO ID C- bb 3A� City of Atlaktic BeaT Lo Planning and Zo 9 Plk' 17 ov (f t This approval verifies compliance with applIcable -wn" bd' n and ther local land 0 oes not constitute a 1/2,FIF LOT 19 pprovalfor the isrkua c its. Compliance NOID DLF,G 4daluildtWg CotO all other applicable FENCE 0.21 W local, StWfe and Federal permitting requirements must be verified by signature of the City of Atlantic Beach Building Official prior to We hmanoe of a S 'P Building PermiL BE NOTE5; h&19by m* Of laigon desaftd 5MACK INFORMATION 5 PVPO*hw Wx6m to ft b90 of my FENCE OWNER5hIF NOT Is a 01'a A un m twirl Ly U Fb*o Boad dwaftd In CAWW &417offt 40 0 20 40 GRAPIRC SCALE (In Feet) KEITH A STEPHENSON I inch = 40' & StAS of Fb*I'Miliniand!MffWjff efill MWW UMM No.6621 use ofThis survey for Purposes other then intended,without written Verification,will be at the Usees Sole Risk and Without Uebft to the Surveyor. Nothing hereon shall be Construed to Give ANY Rights or Benefits to Anyone Other then those Certified. 7777717`777:'77 City of Atlantic Beach q F _,p 12 201Z APPLICATION NUMBER .4� Building Department (To be assigned by the Building Department.) 12-d -Z_ 800 Seminole Road Atlantic Beach, Florida 32233-54ws Phone(904)247-5826 - Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: 91 12— Cityweb-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 102 Department review required Yes No Bui Applicant: -Planning&zonin Tree Administrator Project: 17— 1--rW 7 Ilic Public Safety Fire Services Review fee Dept Signature 14-4— 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: #Approved. ElDenied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: .0� Date: TREEADMIN. SecondReview: ElApproved as revised. DDenied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: r__JApproved as revised. FIDenied. Comments: Reviewed by: Date: Revised 07/27110 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road 0 Z- Atlantic Beach, Florida 32233-5445 z Phone(904) 247-5826 - Fax(904)247-5845 --ruffl, E-mail: building-dept@coab.us Date routed: Cityweb-site: http://vAw.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 102 Department review required Yes No Applicant: _Planning &Zoning Tree Administrator Project: 17— rW(7-e� 5i�� - Q PTTE§5 Public Safety Fire Services Review fee $ Dept Signature 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: K3A' pproved. E]Denied. (Circle one.) Comments: BUILDING :]P EN:NI N:G &DZON I N Reviewed by: —2416,�a"-2 Date: TREE ADMIN. Second Review: nApproved as revised. nDenied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: nApproved as revised. nDenied. Comments: Reviewed by: Date: Revised 07127110 City of Atlantic Beach APPLICATION NUMBER SEP 12 2012 Building Department (To be assigned by the Building Department.) 12- -/ Zoz- 800 Seminole Road Atlantic Beach, Florida 32233-51UY J Phone(904)247-5826 - Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: z 14, _rf, r Department review required Yes No Bui C_ Pha,nning&ZoEin Applicant: 4 2 Al :_3�> Tree Administrator Project: 17— _�o Public Safety Fire Services Review fee $ Dept Signature Review or Receipt Date Other Agency Review or Permit Required of Permit Verified By Flodda 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: �Approved. [-]Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: FlApproved as revised. nDenied. 4P OPR Comments: U TIE -1-1 - y Reviewed by: Date: PUB I SA Y FIRE SERVICES Third Review: MApproved as revised. E]Denied. Comments: Reviewed by: Date: Revised OV27110 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office(904)247-5826 Fax(904)247-5845 Job Address: 163-L "f 1,C, Permit Number: Legal Description Floor Area of Sq.Ft. Parcel# Nq-11t Valuation of Work S �62000��- Proposed Work heated/cooled non-heated/cooled I Class of Work(circle one): New E3 Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s)(circle one): Commercial (lesidentia es If an existing structure,is a flre sprinkler system installed? (Circle one): N/A Florida Product A �proval# For multiple progucts use product approv-aTTo—rm Describe in detail the type of work to be performed: Property Owner Information: Name: TZ jwco Address: 3-7— V\)1_1�-iooTk- 7i�y',v - city (Z el StateMZip 1,32 Phone 130 ---),z I- E-Mail or'Fax# (Optional)'- Contractor Information: Company Name: Quali in gent: Address:' City State Zip Office Phone Job Site/Contact Numbpp---- Fax# State Certification/Registration# Architect Name& Phone# Engineer's Name& Phone 4 Fee Simple Title Holder Name and Address Bonding Company Narne and Address Mortgage Lender Name and Address a re deto obtain a pe4it o do the work and installations as indicated I certify that no work or installation has commenced prior to the i he ma becomes null d ha al k be performed to meet the standards ofall laws regulating construction in thisjurisdiction. Thispermit r'-ity t t wor X f months at any time after 7 it P"c 0 isps ..ce 0 ape and-'Old ifw"k ,not co_me"ed w hin si;c(6)months, or ifconstruction or work is suspended or abandonedfor aWeriod o six(6 is c, "', , rt., t at k n d I de d h eparate permits must be securedfor Electrical Work,Plumbing,Slkns, idls, Pools, Ftirnaces, Boileis, Heaters, Tanks and Air Conifitioners,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 here certffy that I have read and examined thi licatilon and know the same to be true and correct. All provisions oflaws and ordinances governing this 0 1111workwill be coTplied with whether sfe'�si fie§herein or not. The granting of a permit does not presume to give authority to violate or canc�l the provi.st.ons ofany otherfederal,state, or local aw regulating construction or the peFformance ofconstruction. Signature of Owner_ Signature of Contractor Print Nani SwQ� A L, Print Name ....................................... . ..... ........ .................................... .........I...................................................................... ................................ e 77h . ..... S n to ubscribedb-6`16Te, me Sworn to and subscribed before nie wr th s Day 20 this Day of 20 0 ry c- HAM o ry Public hly comm,SSION D 76o r 957 EXPIRES:Februaty 14 2014 Revised 0 1.26.10 8011dod Tl,,rij NOtary Public U11 �erwriters "k CITY OF ATLANTIC BEACH OWNER / BUILDER AFFIDAVIT 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I "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 EXENTTION TO THAT LAW. TBE EXENTTION ALLOWS YOU,AS THE OWNER OF YOUR PROPER-m TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR"ROVE A ONE—OR TWO FANULY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A CONRvIERCIAL BUILDING AT A COST OF$25�000-00 OR LESS. THE BUILDING MUST BE FOR YOUR 11SELAND 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 TBE CONSTRUCTION IS COMPLETE, THE LAW WELL PRESUME TI-LAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXENTTION. YOU MAY NOT HIRE AN UNLICENSED PERS AS YOUR CONTRACTO 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 ST TE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANC S. 11. INJURY LIABILITY; SINCE R INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMEN SUGGESTS W S COMPENSATION INSURANCE BE PURCHASED. Ill. 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 SUBJEL;I 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. a6e 6 3 PHONENUM BLK ADDRESS 2- PRINT NAME DATE SIGNATU Before me this day., .2�/_�Irl the county of Z_ Duval,state of Florida,has I .r by himself herself and affirms that all statements and declarations are true and accurate. __'� Notary Public at Large,State of county of Z— Ell Pe ally Known roduced Identifit GRAHAM Notary i nature::: COMMISSION#DD 957760 EXPIRES:February 14,2014 Bonded Thru Notary Public Underwriters R/BLDG/0�ff-Build�Affada�it RMSED:4/16/2009 11,11