128-4 Seminole rd 2013 fence CITY OF ATLANTIC BEACH
\ Ss1
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00002405 Date 4/11/13
Property Address . . . . . . 128 SEMINOLE RD 04
Application type description FENCE PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
replace 6ft fence
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Owner Contractor
-
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ROBERTS, MORRIS& BARBARA TRUST OWNER
128-4 SEMINOLE RD
ATLANTIC BEACH FL 32233
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Permit . . . . . . FENCE PERMIT
Additional desc . . . 00
Permit Fee . . . . 35 . 00 Plan Check Fee
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 10/08/13
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Special Notes and Comments
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 . )
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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 ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
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City of Atlantic Beach
- and Zoning Department
planning
of
This approval verfies compliance with
applicable
zoning, subdivision inother ad local land
en regulations, but a o?tsn0Compliance
r� develop applicable
i I r approval for t issu Cade and all other aprements
with Florida Building eral rmitting requirements
Atlantic
local, State and FesEnature of the City
must be verified ding Official prior to the issuance of a
- �. .�q� I Beach g Permit.
• Building
r
Approved BY:
I I ate:
SIVE-D
�,� ��y City of Atlantic Beach qPR 0 2 2013 APPLICATION NUMBER
To be assigned b the Building Department.)
Building Department ( 9 Y 9 r„P
r ` 800 Seminole Road'00
V Atlantic Beach, Florida 32233-5445 1 —
Phone(904) 247-5826 • Fax(904)247-5845
afti ��r E-mail: building-dept@coab.us Date routed:
I = _4z'z—
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: �}
`7 �J�/ral�l/�r/ ✓`CS Department review required Yes No
'Building-..
Applicant: ���"!,�.r'L �' ,� ILI
tanning &46tfng
_ Tree Administrator
Project: �� �°� i1 � ublic Works'N
`!'ublic Utilities~'
Public Safety
Fire Services
416#1 ��
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
j Reviewing Department First Review: Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date:
TREE ADMIN.
Second Review: ❑Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
Reviewed by. Date:
PUBLIC SAFETY
FIRE SERVICES Third Review: ❑Approved as revised. []Denied.
Comments:
Reviewed by: Date.-
Revised
ate:Revised 07/27/10
RECEIVED
rr �,yrf� City of Atlantic Beach APR 0 2 2013 APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
`t 800 Seminole Road BY:
'j Atlantic Beach, Florida 32233
r Phone(904)247-5826 - Fax(904)247-5845f
E-mail: building-dept@coab.us Date routed: / �}
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Department required Yes No review
Property Address: ej��n�/l��%�� 1�C� De p
Building..
Applicant: Planning &Zing
Tree_Administrator
Project:
R� �� �y.G�- i -2J e f' ublic Works-
/ ubiic 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
PLANNING &ZONING Reviewed by: Date:_ ' J,
TREE ADMIN, Second Review:
❑Approved as revised. ❑Denied.
P nORK9 Comments:
BLI�r UTITIE
t�F Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. []Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
City of Atlantic Beach APPLICATION NUMBER
t , Building Department (To be assigned by the Building
D/epartment.)
800 Seminole Road
= vim Atlantic Beach, Florida 32233-5445
Phone(904) 247-5826 Fax(904)247-5845
t . E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
( -
Property Address: ��C fj'f//I/�S/ Department review required Yes No
��C►�
Building
Applicant: ()j� �/�� _Planning &ZgjJng
Tree Administrator
r 7- l ublic Works
Project: �� � . Cx � �- i f� _ -_
ublic Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Dateof 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:
APPY TION STATUS
Reviewing Department First Review: 52Approved. []Denied.
(Circle one.) Comments:
BUI
PLANNING &ZO Reviewed by: 2,��� ate: 0 Z
TREE ADMIN.
Second Review: ❑Approved as revised. ElDenied. �
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
BUILDING PERMIT APPLICATION D
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233 qp
Office (904) 247-5826 Fax (904) 247-5845 �Q
Job Address: �� Permit Number:
Legal DescriptionParcel#
oor Area o q. t. sq.Ft
Valuation of Work$ 6 d 0 0.0 Proposed Work heated/cooled non-heated/cool/d
Class of Work(circle one): New Addition Alteration Repair Move Demolition poouspa 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 approva orm
Describe in detail the type of work to be performed: Cz
Property Owner Information:
Name: Y z r �� Address: '06
City ( State Zip 33 Phone 1 - arl 1
E-Mail or Fax# (Optional) r o b -0
Contractor Information:
Company Name: Qualifying Agent:
Address: City State Zip
Office Phone Job e/Contact Number Fax#
State Certification/Registration#
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name d Address
Bonding Company Name Address
Mortgage Lender Name a ,Address
Application is hereby made to obtain a permit to do the work and installations as indicated. I cert that no work or installation has commenced prior et
o the
issuance of a permit and that all work will be performed to meet the standards of all laws rpegulating construction in thpis jurisdiction(. This permit becomes null
work isd ommenced.oti nderstand that separate per> s must be secutred for Electrical WorkaPlumb ng,�Signs,aWellsoPoolsxFurnaces,Boile stHeaiers,
Tanks and Air Conditioners,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
BE OR ERECORDING YOUR NOTICE OF
C
1 hereb certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
type ofYwork will be complied with whether spaw r l trei construction ogthe-antlegorma a opermit
constructionresume to give az�thority to violate or cancel the
provisions of any other federal,state, or local l p Tf f
Signature of Owner `` Signature of Contractor
Print Name t,bif.._o ..........1 ...:.........1 ..D. ............................. Print Name
............. ..........................................................................................
Before me
Bethisore/m D of - = =` this y of ,20-
NotaryPobiicUodenne' NOt y Public
Nota ublic =1 of d ndPd TM
---- " Revised 10.24.12
CIT'OF ATLANTIC BEACH
(OWNER / BUILDER AFFIDAVIT
1. 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:
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 HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
111. 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.ACKNOWLEDGEMENT; 1 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.
I � PHONE NUMBER
ADDRESS j� l
po !-6CRr-6- 1� _ ,L ka
T NAME
72
DATE
SIGN TURF
Before me this�day of <r L 2Q a the county of
Duval,State of Florida,has persona I appeared herin by himself 1 herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of L County
❑P#onally Known L �^
40roduced ldentfcation-
'muk-fFra�ua�m,_=_-�
MAHAj
31('d 9
m ��,�-t
Notary Sionatu?�. r �.Februar/14,1.rNotary Public Un
F:BLDG/O—m -Euildc Affad—it;REVISED: 16/2009