488 Skate Rd 2013 fence 4f
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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Application Number . . . . . 13-00002547 Date 4/30/13
Property Address . . . . . . 488 SKATE RD
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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WILEY, ADELL N OWNER
488 SKATE RD
ATLANTIC BEACH FL 322333822
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Permit . . . . . . FENCE PERMIT
Additional desc . .
Permit Fee . . . . 35 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 10/27/13
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Special Notes and Comments
Fence must remain clear of drainage easement .
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 3S . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 3S . 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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11111 7-7,
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Cijty ofAtlantic E83 ach
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Ith appilicable
ills approval verl I
ther local land
loning, subdivision and o
development regulations, but does not constitute
approval for the issuance of permits. Compliance
with Florida Building Code and 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
LBuilding Permit.
Approved By:
Date*
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Addre�ss:. Permit Number:
Legal Description Parcel Sq.Ft
Floor Kriti:!:i :11' ITT. non-heated/cooled
Valuation of Work S Proposed Work heated/cooled
Class of Work(circle one): New 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 4
For multiple products use product approval form
o be performed:
Describe in detail the type of work t 7"
Property oWnerinformation: /A dd s:
Name: res
State Lgip ne
city�t�
E-Mail or Fax#(optional)
Contractor Information: r
Company Name: Qualifying Agent:
Address: city State-Zip
Office Phone Jo ite/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 to do the work i t tions as indicated. I certify that no work or installation h.as commenced prior to the
Application is hereby made to obtain a permit this jurisdiction. Thispermit becomes null
,ill be performed tome t t e sta so
r Lall laws regulating construction in od ofsi%)months at any time after
issuance of a permit and that all work w n rk is suspended or abandonedfor aWeri
and void if work is not commenced within six(6)months, or i onstructio urnaces,Boilers,Heaters,
work is commenced I understand that separate permits mu t e secured for Electricar Work,Plumbing,Signs, ells,Pools,
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 FINANCING9 CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereb certify that I have read and examine isa i andknow the same to be true and correct. All provisions of laws and ordinances governing this
d th* -pp icatio? ority to violate or cancel the
typ e o7l k will be complied with whether specified herein or not. The granting of a permit does not presume to give auth
wor e pe�formance of c' truction.
provisions of any otherfederal,state, or local law regulating construction or th
Signature of Owner Signature of Cont ctor
Print Name ........................... ..........................................................................................................
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Print Name ... ................. ........... .... ........ int Name
Pr
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Before 2me
is of
Before e 20 this Day of 20
this y of
SHIRLEY L GRAHAM
IES:February 14,2014 Notary Public
EXPIF
Notary Pu lic M Public uneowurs
*rAW Thru W Revised 10.24.12
CITY OF ATLANTIC BEACH
OWNER / BUILDER AFFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 'CONSTRUCTION
CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW.
S:
DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTE
STATE 'LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
YOU HAVE APPLIED FOR A pERWr UNDER AN EXEMPTION TO THAT
CONTRACTORS. TION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY.TO ACT AS
LAW. TBE EXEMP
CTOR EV-p
YOUR OWN CONTRA N TljouGH YOU DO NOT HAVE A LICENSE. YOU MUST
F. YOU MAY BUILD OR IMPROVE A ONE—OR
SUPERVISE THE CONSTRUCTION YOURSEL . YOU MAY ALSO BUILD OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING-
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000-00 OR LESS- THE BUILDING
MUST BE—FORYOU—RUSE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WrrHN ONE YEAR'
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WELL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WMCH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT
I AN UNLICENSED PERSON AS YOUR CONTRACTOR- YOUR CONSTRUCTION MUST
DONE ACCORDING TO TBE BUILDING CODES ANL) LONING REGULATIONS. IT IS
KE SURE THAT PEOPLE EMPL iYED BY YOU HAVE
YOUR RESPONSIBILITY TO MA ENSING
LICENSES pEOUIRED BY STATE LAW AND—BY COUNTY OR MUN—ICIPAL LIC
ORDINANC S.
S MAY BE LIABLE FOR INJ IE TO WORKERS THEY HIRE,
11. INJURY LIABILITY; SINCE OWNER
THE BUILDING DEPARTMENT �U`GGESTS WORKER'S CO PENSATION 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; UNLIC:_:NSED CO 4TRA rORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNLJhK I-LUkIDA—STATUTE NO.
455_228(j). AN-OCCUPATIONAL LICENSE IS NOT )EQUATE. 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. READ THE ABOVE DISCLOSURE
V.ACKNOWLEDGEMENT; I HEREBY ACKJNOWLEDGE THAT I HAVE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
bid
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PHONE NUMBER
tADDRE/9
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PRI E
Sl TURE <_j
Before me this 201,Ljin the—*of
day oi red herin by hirriself/herself and affians that
Duval,State of Florida,has personally appea
all statements and declarations are true andaccurate.
Notary Public at Large,State of County of
0 11,Known
==11dentm
Notary Signs
SHIRLEY L GRAHAM
F-./Mmc,oma-BuilderAffadavit;REVIS : 4/]6t2OD9 MYCOMMMION#DD957760
30
B Wded Notary Furmic urKmnvnu"
MW 13h.
City of Atlantic Beach APPLICATION NUMBER .
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445
-5826 - Fax(904)247-5845
Phone(904)247
ed:
Date rout
E-mail: building-dept@coab.us
Cityweb-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Department review required Yes Noi
Property Address: A A Bqwi��
Applicant: ning &4gaW
I ree Administrator
Project: 42iilw U
Public Safety
Fire Services
Review or Receipt Date
f P it Ve _
f Permit Verifli
Other Agency Review or Permit Required Foe rifled 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: EJA_'pproved. []Denied.
(Circle one.) Comments:
BUILDING
Reviewed by: P'al_J� Date:
TREE ADMIN. Second Review: MApproved as revised. F]Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: RApproved as revised. []Denied.
Comments:
Reviewed by: Date:
Revised OW27/10
IRECEIVED
�'..AV N City of AVantic Beach APPLICATION NUMBER ,'
Building Department. APR 2 5 2013 ii;--�-4.To be assigned by the.Building Department)
800 Seminole Road
....... Al
Atlantic Beach, Florida 32233-5445
-5826 - Fax(904)247-53-45--
Phone(904)2-47
Date r(
0, E-mail: building-dept@coab.us Puted-
Cityweb-site: http://vmfv.coab.us
APPLICATION REVIEW AND TRACKING FORM
Department review required Yes No
Property Address- 7-6--Ag( Bqjtdln�.
Appflcant:
Tree Administrator
fu
Project:
Public Safety
Fire Services
Other Agency Review or Permlit Requ�red Review or Receipt Date
� of PermR 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:
APPUCATION STATUS
Reviewing Department First RevieW: �Approved. F—IDenied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Da te:
TREE ADMIN. Second Review: DApproved as revised. []Denied.
P U41WORKS Q.0mm nts:
I UTI.�MES
T Date:
S:F1 E T Reviewed by:_
FIRE SERVICES Third Review: E]Approved as revised. [:]Denied.
Comments:
Reviewed by:- Date:
APR 2 5 2013 �A PPLI 11 CATION N,UMBER'.
City of Atlantic Beach
�(To ass apartment.)
Building Department be igned by the Building DL
BY:
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fa)((904)247-5845
-Daie routed:: 5
E-mail: building-dept@coab.us
Cityweb-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING- FORM
-Ve—s No
Department review recidired
Property Address: Ay Bu
Applicant: -I:—_ ning &ZoILing.,'
i ree Administrator
Project: ub
Public Safety
Fire Services
-an
W-W.
ffl!Xf1Q MW I"M
Review rw Receipt Date
Other Agency Review or Perrnft rRequired of Permit Verified By
-- I
Florida Dept.of Environmental Protection
Florida Dept. of Transportation
St.Johns River Water Managem ent District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
�ub
APPLICATION STATUS
Reviewing Department First Review: +pproved. E]Denied.
(Circle one.) Comments:
BUILDING #\V�3
�/*P+61- '��
PLANNING&ZONING Reviewed by: ate:
TREEADMIN. Second Review: F�Approved as revised. []Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: [�Apprcved as revised. F�Denied.
Comments:
Revievi,red by:
Revised OMVIO