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170 Poinsettia St 2013 fence �1%.- - CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 13-00002694 Date 5/31/13 Property Address . . . . . . 170 POINSETTIA ST Application type description FENCE PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc NEW 6FT FENCE ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ KOONS, AMY E OWNER 12963 FRINGETREE DR W JACKSONVILLE FL 32246 ---------------------------------------------------------------------------- Permit . . . . . . FENCE PERMIT Additional desc . . Permit Fee . . . . 35 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 11/27/13 ---------------------------------------------------------------------------- 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. -6. irk 7j T?m -w 71� z 1:zl� tity:of fttl On. a. -z6n -be�partrnent, -Thij appj,6vilverifleA corfiONance. -6n:, -6th wiinjg, d. -z dubdivisi ad land.' r:eqb1diioni;'.Outdods fiot-con�titbte, - develop�ffent' -of pem Coinpliance. qp�ovijl.for the lt�uafide its� 6 Floilda Buildirid Codit and'alt bi�er q0pl1'qqb1e' wit 16c9l;State a6d,F6der0l"perniffing Tequiperniatft -City,'of Atlaintid.'. m6si beVirified by tignatuie of thei f -gui 'to the Issuanoe.d a Beach, [ding.Of$� or Building Pffr,nmt*. Poproved "batw tip*. I�ne 0.- Man S, min, 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: 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 USEAND 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 TIES 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. 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(l). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826) IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. AD ESS P�IIDNE NUMBER &M, n yt� PRINT ME j 7 11, - V�/, SlGkAIVREr DATE Before me this day of 20 L3 in the county of Duval,State of Florida,has personally appearedyerin by himself herself and affirms that all statements and declarations are true and accurate. of Notary Public at Large,State of County of JENNIFER WALKER MYrOMMISSIONOFF011480 EI Personally Known f EXPIRES:Apiril 24.2017 M4m1roduced Identification- kj� Bonded Thru Notary Public Underwriters Notary Signatur,�Lwz)��,,� Ll " V FfBI-DG/0—Builder Affada�it;REVISED: 4/16/2009 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH MAY 2 0 2013 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: "Y Permit Number: Legal Description Floor Area of Sq.Ft. Parcel# Sq.Ft Valuation of Work$—,5 Proposed Work heated/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) (�ircle 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 iTr--oduct ap`p`rov_aT7-6rm Describe in detail the type of work to be performed: d bgck= j 44 Prot)ertv Owner Information: C Name: Address: 0 city Stat zp� Phone ou�Lp E-Mail or ax#(Option 1) Contractor Information: Company Name: Qualifying Agent: Address: city —State Zip Office Phone Job Site/Contact Number Fax# State Certific istration.# 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 commencedprior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in thisjurisdiction. This permit becomes null ter and void if work is not commenced within six(6)months, or if construction or work is suspended or abandonedfor a period ofsix Z�months at any time af work is commenced I understand that separate permits must be securedfor Electrical-Work, Plumbing,Signs, Wells,Pools, I urnaces,Boilers,Heaters, Tanks andAir 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. Ihere 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 VIwork will be coTplied with whether specifLed herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisi.ons of any otherfedgral,state, or local aw regulating construction or the pe�fbrmance of construction. Signature of Owne Signature of Contractor t Print Name ................................................................................................. Print Name Ao--�q. ........................................ ............................. .............................. .......................................................... Befog,ine Before me this Day of . 20 this Day of . 20 Notary Public Not ublic "P,", JENNIFER WALKER my COMMISSION#FF 011480 Revised 10.24.12 EXPIRES:ApdI 24,2017 Bonded Thru No tery Pub k UnderwMers City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 A; Phone(904)247-5826 - Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: 5 '1'2,o City web-site: http://vmw.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: zo J'—'n- C Department review required Yes No Applicant: Zanning &zoning_) '-T�_ Fm Rin—i sTr-alo—r ?915-lic WorkO Project: r) _V_ublic 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: PApproved. OlDenied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: E]Approved as revised. FIDenied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: E]Approved as revised. OlDenied. Comments: Reviewed by: Date: Revised 05/14109 1-4.ECEI VED i City of Atlantic Beach MAY 2 1 Z013 APPLICATION NUMBER Q Building Department (To be assigned by the Building Department.) 800 Seminole Road Y: Atlantic Beach, Florida 32233-54 Phone(904)247-5826 - Fax(904)247-5845 E-mail: building-dept@coab.us Date routed. City web-site: http://vNm.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: A A_40_� Department review required Yes No- B u i!.d��, Applicant: P&a-nning &zoning A—d-m-i Fni sTr-aTo-r Project: i�ie diti Public Safety Fire Services Review fee Dept Signature 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 APPLICATION STATUS Reviewing Department First Review: kApproved. [-]Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: A;�" Date: TREE ADMIN. Second Review: []Approved as revised. F-]Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: FlApproved as revised. [-]Denied. Comments: Reviewed by: Date� Revised 05/14/09 F:"ECTEEIVED City of Atlantic Beach y APPLICATION NUMBER 7MAY 2 12013 Building Department (To be assigned by the Building Department.) 800 Seminole Road Y: Atlantic Beach, Florida 32233-54 Phone(904)247-5826 - Fax(904)247-5845 Date routed: E-mail: building-dept@coab.us Cityweb-site: http://vmw.coab.us APPLICATION REVIEW AND TRACKING FORM / ZQ _�q i-3ic Department review required Yes No Property Address: I ' / ,s: 6� 130 Kanning &zoning Applicant: Project: Jp -Dr) --P—ublic Safety Fire Services Review fee Dept Signatura�� 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: pproved. ElDenied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: 4�21 Date: TREE ADMIN. Second Review: F]Approved as revised. ElDenied. WP RKS C nts: ITI S U TIL PUBLICS F Y Reviewed by: Date: FIRE SERVICES Third Review: DApproved as revised. nDenied. Comments: Reviewed by: Date: Revised 05/14/09