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30 17th St 2013 fence CITY OF ATLANTIC BEACH J 800 SEMINOLE ROAD r' s) j ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 13-00002928 Date 6/28/13 Property Address . . . . . . 30 17TH ST Application type description FENCE PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc replace 6ft fence ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ DOWLIN DIANE M & WILLIAM A OWNER 30 17TH STREET ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit FENCE PERMIT Additional desc . . Permit Fee . . . . 35 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 12/25/13 ---------------------------------------------------------------------------- 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. City of Atlantic Beach AT APPLI C ION NUMBER �s r � Building Department I (To be assigned by the Building De artment.) A s 800 Seminole Road /� " 2 Z� �I Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-5845 > IT E-mail: building-dept@coab.us Date routed: G� City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 7H ST Department review required Yes No B " Applicant: o Nl�y L /V ' g &Zonin Tree is rator Project: is or 7F316—blic Utilitie u lic 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: [ETA/pproved. ❑Denied. (Circle one.) Comments: BU DiN PLANNING&ZONING Reviewed by: � � Date: 26 ZD 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 05/14/09 lvlAP 1S'H0\A/!1N!G BOUNDARY SURVEY OF- CERTIFIED TO: 17th STREET E 2 2' (.W,E A S IUR E D) LIJ jJ > Q. < Ld LLJ < --- < Li cc am Cz 01- M '0' Q) ca 0 u)== E= aUi a E CL EL'.E!:� — :3 0 ca r aE0— C)W 0 Lij 8:E .0 As M M rE -- Ea Ow 0 8W mCi W P r- 0 0 C wE; CD 0C.2 0 0 cm M 0 0 2-5 LL '7.r 0 Co 0 1M';;2 Q C --'0V "':t! a g -0EL E > CL C; a 0(o OM (M 4) cc a > > E? > :�2- N' .2 E CL'§ Q 5 C. M ca < Cl. S 79*27'22" W 24-08' (NAEASURED) 17 1 1 L I I I Ray Thompson I AM I I SURVEYING, f,,,• Going the DISTANCE for You 4613 Philips Highway,Suite 210 (PO TE-VEDR4TITLE, L.L.C. Jacksonville,Florida 32207 (Phone)904-448-5125 (Fax) 904-448-5178 'PE 9ASE✓ ISV flu" My RES?ONSTSLEE 7, 7-4 'SMR0 '�-ie oltlfvu.' STANL. SET FORTH 8r T�-:E-L 2: 31 ,z� -10„ 0S Q AAP N CHA?T.R Sir.7-6. FLC4RIv' Ull.",TO ,A7ZD: )SPIL 17. :NT. 37 -1;4is '-Jrl,�". �,qToF :7 LAND SURVEYS 0 CONSTRUCTION SURVEYS 0'SUE3DIViS!0f\1S Sy 1r� City of Atlantic Beach rE APPLICATION NUMBER Building Department I (To be assigned y the Building Department.) r 800 Seminole Road Atlantic Beach, Florida 32233-5445 Q Q Phone(904)247-5826 Fax(904)247-5845 �J E-mail: building-dept@coab.us LDate routed: Z� City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: Department review required Yes No O B " Applicant: o /� /V e2lanOg &Zonin Tree is rator Project: is or ublic Utilities ublic 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: pproved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: 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 05/14/09 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach, FL 32233 Office (904)247-5826 Fax (904) 247-5845 Job Address: 3C� 177' 5r APm.ne- I�cN Permit Number: ' Z / Z Legal Description Parcel# Floor Area of Sq.Ft. Sq*Ft Valuation of Work$ 12- 0 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) circle one):installed? Residential If an existing structure,is a fire sprinkler system nstalled? (Circle one): Yes No N/A Florida Product Approval# For multiple products use product approval form Describe in detail the type of work to be performed. Property Owner Informati Name: f ' Ad s: 7rr- City Stat ip JZ hone E-Mail or Fax#( pt onal) Contractor Information: Company Name: Qualifying Agent: Address: City State Zip Office Phone Job Site/Co ct 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 o do the work and installations as ' d* d. 1 cert that no work or ins lation has commenced prior to the issuance of a permit and that all work will be erformed to meet the standards of al regulating construction in this jur fiction. This permit becomes null and void f work is not commenced within six(6)months, or if construction or work i us ended or abandoned for aperiod six(6)months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Po s, Furnaces,Boilers,Heaters, 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 BEFORE COMMENCEMENT. YOUR NOTICE OF CO I hereb certify that 1 have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this type ofvwork will be complied with whether spec;ted h in or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of arty other federal,state, or local law r ting construction or the performance of construction. Signature of Owne Signature of Contractor Print Names//L c i�Q�► - I Print Name .............................. ................................_................_.................................................. . jt✓�.��✓.............. Be Before me 20 thi D of 20 this Day of M 9DL1s57760 Notary Pub is U 1Cs: EXPIRES:February 14,2014 � ' SWedTnruNotaryPulftUwfffftem Revised 10.24.12 CI'T'Y OF ATLANTIC BEACH OWNER / BUILDER 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: 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 TITS 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 WELL 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 Z0,'NTNG 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. 3129 /-7TK ST_ TLAcil-1 �LNLFc_. (�O¢ 2843- 57o? ADDRRESS, PHONE NUMBER C_ 14,y,?1 4,y., A Do cue-/,A,/ PRINT NAME /-ao SI -4e-, DATE Before me this-52 �y of20�n the county of rs Duval,State of Florida,has peonally appeared herin by himself!herself and affirms that all statements and declarations are true and accurate. pp� Notary Public at Large,State of ,County of �L L_ ❑Personally Known cad Identifi _ Notar _XFIRES:Fe l4rd Nolary Public Underwriters BP250U01 CITY OF ATLANTIC BEACH 6/28/13 Application Tracking Step Selection by Revision 08: 11:43 Application number . . . . : 13 00002928 Address . . . . . . . . . . : 30 17TH ST RE number . . . . . . . . . : 169590-0000- - Application type . . . : FENCE PERMIT NCR OLD ACCOUNT NUMBERS . . : AB19299 Tenant name, number . . . . : Type options, press Enter . 2=Change 4=Delete 5=View 6=Fast log 8=Action log maintenance 9=In/out maint Path ---- Key Dates --- - Review Summary - Opt Agency description Rev Step Req In Est Cmpl Resulted Stat By _ PLANNING & ZONING A O1 Y 06/26/13 07/04/13 06/26/13 AP EH _ PUBLIC UTILITIES A O1 Y 06/28/13 07/04/13 06/28/13 AP SLG PUBLIC WORKS A O1 Y 06/25/13 07/04/13 06/25/13 AP CK Bottom F3=Exit FS=Land inquiry F6=Add F7=Revisions FB=Misc info inquiry F9=Corrections report F10=View 2 F11=Sort by agency F24=More keys Graham Shirley From: Kaluzniak, Donna Sent: Friday, June 28, 2013 8:12 AM To: Graham Shirley Subject: 30 17th St. 13-2928 Shirley—this fence permit is approved—thanks, Donna Donna Kaluzniak, Utility Director City of Atlantic Beach 902 Assisi Lane Atlantic Beach, FL 32233 (904)270-2535 dkaliizniak@coab.us 1