96 W 3rd St Voided shed permit 2013 BP251I03 CITY OF ATLANTIC BEACH 6/19/13
Application Tracking Individual Step Inquiry 09:40:04
Application . . . . . . . . 13 00002178
Address . . . . . . . . . . . 96 W 3RD ST
Application type . . . . . . . SHED PERMIT
Revision/Path/Step/Seq/Agency= A 01 00 PW PUBLIC WORKS
Required step, approval code = Y AP APPROVED
Date submitted, resulted . . = 2/20/13 2/28/13
Status code . . . . . . . . = DA DISAPPROVED
Reviewed by = LS LISA SHOWMAN
Org cmpl date, revised . . . : 3/01/13 3/01/13
Copies of plans . . . . . . =
Comments Print Date
Shed must be built off grade. Cannot fill in retention 2/28/13
area. 2/28/13
Bottom
Press Enter to continue.
F3=Exit F8=In/Out Status F12=Cancel F14=Action log inq
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..ej I 1- City of Atlantic BeachAPPLICATION NUMBER
Building DepartmentCr (To be assigned by the Building Department.)
800 Seminole Road
1 �r Atlantic Beach, Florida 32233-544 - �/ ��
Phone(904)247-5826 Fax(90 47 5845 ����
moo;1� E-mail: building-dept@coab.us Date routed: 7-be 13
City web-site: http://www.coab.us
APPLICATION REVIEW AND T ACKING FORM
Property Address: 96 ✓ Department review required Yes No
Applicant: 4�mwinistrator
oni
Project: X �� % ublic w
ities
Public Safety
Fire Services
Dep t Si* natureWay
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:
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied.
PWOKS Comments:
UBLI
-
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: []Approved as revised. []Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233i"�,
Office (904) 247-5826 Fax (904) 247-5845 QZil
H
_ r9 h Wed �ebruary 1 01
9 �� Public Underwriters
Job Address: �// Permit Num a ��
Legal Description Parcel# 8
oor ea o q. t• q•
Valuation of Work$ �d� d Proposed Work heated/cooled non-hea c2 0 013
Class of Work(circle one): New Addition Alteration Repair Move Demolition poo pa w'. o r
Use of existing/proposed structure(s) (circle one): Commercial Residential Y
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: ly�Q �X �QChol�d
ZPrort r6 o4 12—
Property
a Owner Information::] j
Name: a__ Address:
City State Zip2 Phone 1"
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: Qualifying Agent:
Address: City State Zip
Office Phone Job Site/Contact Numbe 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 work void
f work
is not
of commenced understand that sepain six rate permits musor t be secuconstructred for Electrical Work,Plumbing, Sigion or work is suspended or ns,or aWells,Poeriod ols x urnaces,Boilers,months at tHeaters,
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 EE OBTAIN ARE RECORDING OiTR NOTICE OF CONSULT WITH
YOUR LENDER OR AN ATTORNEY
Iherebcert
laws and
nces
overning
type gfYwork w will be complied with whether spteci iethat I have read and examinehis dlherein or not.o The granting of to permit does cnot pt. lrprovisions
rue and sumeto give authority for violategor cancel the
provisions of any other federal,state, or local law regulating construction or the performance of construction.
Xgnature of Ow A ASignature of Contractor
Print Name Print Name ..................................... ............................................................................................
, �_ .cL ....... . ...0-... .......�..4 -......
Befor,, Before me 20
this . ay o 5200 this Day of
2t�" '•kap, Sri1RLEYL GRAHAM otaiy Public
N �: _ lAy COMMISSION#DD 9,97760 Revised 10.24.12
EXPIRES:February 14,2014
flf °o`r Bonded Thru Notary Public Undernmters I
CITY OF ATLANTIC BEACH
(OWNS / BUILD ER A ��A�T�I�'
i
.j
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:
STATE LAV. 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. YOUMAY BUILD ORIMPROVE 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.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
M. 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; 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.
. �z L/L
ADD ESS PHONE NUMBER
NT NAME
iA S�<✓ DATE
SI�NA RE
V
B` re me this�` day of 20 /_Ip the county of
Duval,State of Florida,has personally appeared herin by h'lrhself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of L .County ofJ
0.Personally Known
0jPtoduced Identification-
; h�I
Notary SiRnatirre. + uFF.Fl�ht !
F:BLDG/Owns-Buildri Afta&e it,REVISED: 16/2009,c'f "i>,l,'::'.1ir'_.,. '4.201,t
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City of Atlantic Beach APPLICATION NUMBER
Js � Building Department (To be assigned by the Building Department.)
- 800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845E-mail: building-dept@coab.us Date routed: ��
City web-site: hftp://vmw.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: n" c a c J Department review required Ye No
Applicant: anning &Zoni
ministrator
Project: X �� S// ublic w
ities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
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: 2- 3
TREE ADMIN. Second Review: ❑Approved 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 07/27/10
City of Atlantic Beach APPLICATION NUMBER
js �ea Building Department (To be assigned by the Building Department.)
r '` 800 Seminole Road /3 _ 7178
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
x 4�; Date routed: 2 �d 13
E-mail: building-dept@coab.us
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 96 C3;,-C1 Department review required Yes No
Applicant: 4anning &Zoni
mir istrator
Project: X �� � ublic W
ities
Public Safety
Fire Services
{� � #N` F
Review fee $. De t Sig nature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
Florida Dept.of Environmental Protection
Florida Dept. of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: proved. []Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by:_ 24A'Z.J'O Date:
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
{ilk • ®'
Office (904) 247-5826 Fax (904) 247-5845 .; :h ti0
/� //, / CT t•...• a to ebrua 1 01
9 W r c� / 4,F} nded ry Public Underwriters
Job Address: Permit Num e �
Legal DescriptionParcel# B
Floor ea of Sq.Ft. Sq.
Valuation of Work$ 49 Proposed Work heated/cooled non-hea c F
2 0 013
Class of Work(circle one): New Addition Alteration Repair Move Demolition poo pa w r
Use of existing/proposed structure(s) (circle one): Commercial Residential Y
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: Sll�A -71
dYl e rfTE lU1411 12- ,"n h-1 CAg45
Property Owner Information:
Name: 5 G/ a, Address: /
..�. uw�.x�swuams�s
City State ip 2 Phone
E-Mail or Fax#(Optional) I '
Contractor Information:
o�
Company Name: Qualifying Agent:
Address: City tare"=7TIF
Office Phone Job Site/Contact Number
State Certification/Registration#
!VFED"FOR CODE CO-
Architect Name&Phone#
Fry OF AT Vff"
Engineer's Name&Phone# 7,PER
Fee Simple Title Holder Name and Address REQUIttm
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 i o wor or tnsta ation 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
ded or and work er
void
o wmenced.not
commenced within I understand that separate permits muor st be secured for Electrical Work,Plumbing,Signs,or construction or work is suaWells P periodol',XFui acesmonth Boilers at s,tHeaters,
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.OR AN ATTORNEY BEFORE RECORDING YOUCONSULT H
YOUR LENDER R NOTICE OF
COMMENCEMENT.
1 her eb certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work wtll be complied with whether speci ted herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,state, or local law regulating construction or the performance of construction.
knature of O Signature of Contractor
Print Name . .-.. ..... Print Name ..................................... ............................................................................................
......
Befor. Before me 20
this ay 120 La this Day of
SHIRLEYL GRAHAM otary Public
N IAY COMMISSION#DD 957760 Revised 10.24.12
EXPIRES:February 14,2014
` Rf;�yq• Bonded Thry Notary public Underwriters
- 7PY L CO
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:
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.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
III. 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; 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.
ADDRESS PHONE NUMBER
NT NAME
DO
SI RE DATE
Before me this C day of Y �� 20 —1 the county of
Duval,State of Florida,has personally appeared hedn by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of �L ,County of
❑Personally Known —
ElPfbduced Identification-_��, /
Notary S n.t re: GRAHAM
- 1 *; "AY C(�ASM!^�lOY ri DC 95x7!0
k?IHES:
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.. CITY OF ATLANTIC BEACH
®MWiR / Bl DER d JIDAV T
,j
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 PERMTT 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 VIOLATTON 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 REU1RED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
M. 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. D THE
OVE
RE
STATEMENTLANDETMHAT � I
HEREBY I COMPLY WITH ALL ACKNOWLEDGE ETHAT I HAVE EQUIREMEN SE FOR THEBIISSUANCE OF AN
OWNER-BUILDER PERMIT.
PHONE NUMBER /
ADD ESS
R NT NAMEW
azo n
Sl�#A RE DATE O
aCb pp the county of V A O A
B re me this day ofFe �� W Q
Duval,State of Florida,has personally appeare ¢ A
all statements and declarations are true and acc irate' IX
ic�,�
Notary Public at Large,State of
ounty 2COPY
O (�,
❑Personally Known E\ y� y(� O
EJR duced Identification- • {�{ ,-} E
ffrt Notary Signature: R A
f y U
F:BLDG/Owne_Builder Affadavix REVISED:�t/tsnoo9 ' '''•;,f, n ;�,