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Permit Fence 143 Poinsettia St 2012 S CITY OF ATLANTIC BEACH j 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 DA Application Number . . . . . 12-00001758 Date 12/13/12 Property Address . . . . . . 143 POINSETTIA ST Application type description FENCE PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 100 ---------------------------------------------------------------------------- Application desc INSTALL NEW FENCE TO FRONT SIDES ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ SCHELL JOY OWNER 143 POINSETTIA ST ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit . . . . . . FENCE PERMIT Additional desc . . FENCE Permit Fee . . . . 35 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 6/11/13 ---------------------------------------------------------------------------- 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 . 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. BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: °`'+ �" I Permit Number: Legal Description b)t. b 4 a c Parcel# A41- `70 ga mor Area o q. t. 4J A41- Valuation of Work$ Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): Ne Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed 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 product app rova row_m Describe in detail the type of work to be performed: 7 C P, Property Owner Information: i Name: `1Cr e 1�a � 1 i � ddrd ess: c �S 4id . City 1 � c.. -j;^, }C, State Zip Phone CCS - ? 7 E-Mail or Fax# (Optional) Contractor Information: Company Name: tbm � C'k Qua mg Agent: Address: 'pi�, s� City ?Ock- State " f Zip ,�,�� Office Phone Job Site/Contact Number Fax# State Certification/Registration# Architect Name&Phone# Engineer's Name&Phone# Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and Address Application is hereby made to obtain a permit to do the work and installations as indicated. I certify 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 isnot commenced within six(6)months, or if construction or work is suspended or abandoned for a period of sixp5)months at any time after work is commenced. I understand that separate permits must be secured for Electrical Worlc, Plumbing, Signs, Wells,Pools, urnaces, Boilers,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 NOTIC + MENCEMENT. I hereb cerci t zat I h ad and mine a l a i n a d know t ie same to be true and correct. Al is zs of la a d o3 a c v ning this type of work ill be com i it a er e i e ot. Tl e granting of a permit does n presum o tv th l or ca e provistons of 1 t t nw tin constru on or the performance of constru tion. i iature of Co tractor Signature of Owner � S � .. . Print Name Print Name .. ..... �. , . :! .. �. ... z..1. .....��.�..�.. . �.��...........................'.................... BefoKDayof e Before!"%e this o✓ 20��- thi�&- Day of �� 20 Z a (��y Notary Public LORI A.WEST Notary Public Notary Public,State of Florida L,gUW=011107(dal My Comm.Expires Feb.11,2015 Notary Pu0 Commission No.EE 55093 My Comm.Exp1Ces Feb.11,2015 rhmmission No.EE 55093 CITY OF ATLANTIC BEACH OWNER / BIDER 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: ESTATE 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 *SUPERV ISE THE CONSTRUCTION- YOU MAY BUILD OR r%APROVE 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 BUII DING 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 E)EMPTION.. YOIV 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 REQ%UIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. Il. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'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 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. STATEMENT ANDTHAT ACKNOWLEDGEMENT; I I COMPLY WITH HEREBY ACKNOWLEDGE THE EREQUIREMENTS THAT I HAVE READ FORT THE DISCLOSURE OF AN OWNER-BUILDER PERMIT. PHONE NUMBER ADDRESS PRINT"NAME S R �,' - DATE e ore me is day of 20U in the county of Duval,State of Florida,has personally appeared herin by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of rj!!. County of 1/ LT Personally Known LORI A.WEST ❑Produced Identscation- Notasy Public,Skate of Florida My Comm.Expires Feb.11,2015 Notary Commission No.EE 55093 F:BIAG/Owner-Builder Affadavifi REVISED:4/16/2009 C 06, i pro- t q'�'TfA g� ` F E ° 4 City of Atlantic Beach + + Planning and Zoning Department I This approval verifies compliance with applicable zoning, subdivision and other local 'tend WV, 1�• I- development regulations, but does not constitute, approval for the issuance of permits. Compliance with Florida Builging Code apd all other applicable local, State and Federal permitting requirements must be verified by signature of the City of Atlantic Beach Building official prior to the Issuance of'a Building Permit. Approved By: eete _ Date: f F fill .� r rs ,1,fJ: City of Atlantic Beach �,� APPLICATION NUMBER Building Department 4 C (�� (To be assigned by the Building Department) r 800 Seminole Road T- ) Atlantic Beach, Florida 3223_3-_'7A45'------ .- , , ! / / l Phone(904)247-5826 • Fax(904)247-5845.,, 4 ' E-mail: building-dept@coab_us Date routed City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: I�3 PoAuk;W,Gu � Department review required Yes No Building Applicant: Planning&Zoning Project: / Tree Administrator Public Works Public Utilities 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: Approved. ❑Denied. (Circle one.) Comments: BUILDING P Reviewed by: _Date: ' Z TREE ADMIN. Second Review: Approved as revised. ❑Denied. PUB OR Comments: PUBLIC UTILIT S BLIC SAFETY Reviewed by: Date: RRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed Ealy: _ Date: I ?eviseJ �r City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Departrnent) i 800 Seminole Road / _ 7 Atlantic Beach. Florida 32233-5445 l Phone(904)247-5826 - Fax(904)247-5845 /1123 e) E-mail: building-dept@cciab_us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: �� j 'I Q"(,lYl,c�.(�/ Department review required Yes No Building Applicant: (1 b�� Planning&Zoning Tree Administrator Project: F—Na, Public Works Public Utilities 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: APPLIGATION STATUS Reviewing Department First Review: Approved. ❑Denied. (Circle one.) Comments: BUILDING PLANKING&ZONI Reviewed by: �-�� Date: l2 �,. TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SER\ACES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: fe:LL� Revised 07127110 City of Atlantic Beach "� � � APPLICATION NUMBER Building Department + (To be assigned by the Building Department) i 800 Seminole Road �� 1 / "�� • =; Atlantic Beach. Florida 32233-5445 - - Phone(904)247-5826 • Fax(904)247-5845 1�3 �i,ll�` E-mail: building-dept@coab_us Date routed: City web-site: http://www.mab.us APPLICATION REVIEW AND TRACKING FORM Property Address: � �-3 PnwatAlDepartment review required Yes No Building Applicant: V U� Planning&Zoning Tree Administrator Project: _Ncc Public Works Public Utilities Public Safety Fire Services Review fee $ Dept Signature ,v 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. ❑Denied. (Circle one.) Comments: BUILDING P_ PLANKING&ZONING Reviewed by: Date:�� d 2 TREE ADMIN. Second Review: nApproved 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 07127030