457 Sailfish Dr 2014 Fence :ll � ' % CITY OF ATLANTIC BEACH
s) 800 SEMINOLE ROAD
J ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 14-00000923 Date 7/07/14
Property Address . . . . . . 457 SAILFISH DR
Application type description FENCE PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
6ft fence
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Owner Contractor
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BROWN, BENJAMIN JR OWNER
457 SAILFISH DR E
ATLANTIC BEACH FL 32233
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Permit . . . . . . FENCE PERMIT
Additional desc . .
Permit Fee . . . . 35 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 1/03/15
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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.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: ��Per�mitumber:
Legal Description Parcel#
Floor ea o q.Ft. t
Valuation of Work$ oZ.S?I, Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addrtio 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#
For multiple products use product approva orm
Describe in detail the type of work to be performed: 117!57�-c.- ,
Property Owner Information:
Name: A-^w uIn Address: �S �.Z-t l ,�, �j
City Stat _Zip Phone 3
E-Mail or Fax#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: ATAN-- k Qualifying Agent:
Address: City State Zip
Office Phone Job Site/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
Application is hereby made to obtain a permit to do the work and installations as indicated 1 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 void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for aperiod of six_(6)-months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools,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 RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereby 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 o1 work will be complied with whether speci ied 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.
Signature of Owne x
� r/ Signature of Contractor
Print Name dW�1 �!Z ,
a............................... .. Print Name
Be f e .,•y- , EBORAHAMM IMAV�iITE Before me
tl Day of z �� this Day of 20
EY$RES:May
PON
Notary Public Notary Public
Revised 01.26.10
CITY OF ATLANTIC BEACH
(OWNER d 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 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 R\4PROVE A ONE—OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
EVIPROVE A COMVIERCIAL 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 TBE 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.
191. 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 STAT UTE 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.
AESS PHONE NUMBER���
PRINT N
SIGTURE DATE
Before me this day Ae .2a
20!'in the county of
Duval,State of Florida,has pppeared herin by himself/herself and affirms that
all statements and declarationd accurate.
�Y y
Notary Public at Large,State of ,County of ar BEBOFIq�
p Personally Known ,yj e f' Map RMISSIO E"ME
/❑Produced Identification- r—'_ L h G /�/ \ �fi••` QHS M� 2015 0573a9
Bonded Y21,
7 Public Under,#e,,
Notary Sionatur .
F:BLDG/Owner-Builder Afhdavi�REVISED: 4/16/2009
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City of Atlantic Beach APPLICATION NUMBER
rj Building Department � CEIVED (To be assigned b the Building Department.)
800 Seminole Road � � 9�3
�r Atlantic Beach, Florida 32233- 45 �f(,� d
Phone(904)247-5826 • Fax(004)23840 0 ?014
Lojo9' E-mail: building-dept@coab.us Date routed: (0
City web-site: http://www.coab his?r��___
APPLICATION REVIEW AND TRACKING FORM
Property Address: ff7.Jtf7/ 5A � Department review required Yes No
Build'
Applicant: Q /A) Tree Administrator
Project: ub
ublic ili
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: k�proved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date:
TREE ADMIN. Second Review: []Approved as revised. ❑Denied.
LI OR Comments:
C UTILITIE
PUBLIC SAFE Y Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
City of Atlantic Beach APPLICATION NUMBER
s s' o be assi the Building Department.)
Rg
w Building Department
800 Seminole Road 9,z—?
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Pro ert Address: ( / d/ Department review required Yes No
p y Buildin
Applicant: Q�,J &ZpHing
Tree Administra or
Project: u '
ubli ilA
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Dateof 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: r ��
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 05114109
SyV];lJ City of Atlantic Beacham APPLICATION NUMBER
S r � Building Department `-��; t (To be assigW-
Phone
the Building Department.)
i. .�f uN �/ 9'800 Seminole RoadAtlantic Beach, Florida 32233-5445 , �9(904)247-5826 • Fax(904)247-5845 ��f�(
E-mail: building-dept@coab.us Date routed: (0
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ( ��� c�/� Department review required Yes No
Buildin
Applicant: Q 10annin &Zoning
Tree Adminis ra or
Project: Lub w
ublic Ill i I i
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:
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
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