77 W 9th St 2014 fence 4 y�S J CITY OF ATLANTIC BEACH
J s�
800 SEMINOLE ROAD
J ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
FENCE PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 14-FNCE-438
Job Type: FENCE PERMIT
Description: 6ft fence
Estimated Value:
Issue Date: 12/11/2014
Expiration Date: 6/9/2015
PROPERTY ADDRESS:
Address: 77 W 9TH ST
RE Number: 170813-0080
PROPERTY OWNER:
Name: RIVERA, ANA
Address: 77 W 9TH ST
PERMIT INFORMATION:
FEES:
Fence/ROW $35.00
Total Payments: $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION � � m
CITY OF ATLANTIC BEACH N Q V 14 014
800 Seminole Road, Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904) 247-5845 By
Job Address: 771 j/ .S f�7 ( t, ZZ33 Permit Number:
Legal Description Parcel #
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$ Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repai Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one):, Commercia 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 approval form '.
Describe in detail the type of work to be performed: /ZQr�l4[tiS41-e-0-
Property Owner Information:
Name: e• ✓rY Address: -7 -7 Gt/
City FL State FLZip IZ233 Phone jt9 - ""Ok- 7131
E-Mail or Fax# (Optional) /o-f eMi.44— AZ 2 6) d) ~7. CDM
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: 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. 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 void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period 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 hereb 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 of work will be complied with whether specified 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 Owner aa (; �L Signature of Contractor
Print Name ............e IZ%✓erA - Print Name
.............................................................................................
s Before me
this ay of b 201 this Day of . 20
Ota Pu Y,o JENNIFER WALKER
Notary Public
MY COMMISSION#FF 011480 Revised 01.26.10
EXPIRES:April 24,2017
', o? gpnW Thru Notary Public Underwriters
P„ •`
`¢ CITY OF ATLANTIC BEACH
OWNER / BUILDER AFFIDAVIT
F
Will
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 TIIE 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.
77 Aj y' I'+r • &A . AL -?233 �'Oy- (ooh 7Z3`I
ADDRESS PHONE NUMBER
�� _. ?...1✓tri
PRINT NAME
SIGNATURE , / U DATE
Before me this I day of V 20 )n the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are trueand accurate.
Notary Public at Large,State of F'✓' ,County of
'�F/PPersonally Known
II � P, ( b
Produced Identification- U v
Notary Signature.
E:/I311-1300—er-Build 11 daz"REVISr.:4/11/1
ach
City of Atlantic Boo
APPLICATION NUMBER
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a
Building Departmeh-�.11 De y.>e pwilding Departmen
800 Seminole Road
Atlantic Beach, Florida 322:33-5445 F/V e 13
Phone(904)247-5826 - Fax(904)247-5845
routed:City web-site: http://w%Aw.ct:)ab.us )ate routed:
APPLICATION] REVIEW AND TRACKING FORM
g�j- --
Property Address:-77W 9T' Deparfam(ant review required )°os –halo
—
Building
Applicant: V < 3=nning Zoning
AR,1771
roject: 7mratar--.1
P
C Public Works
Public U tilides
Public Safety
Fire Sery=es:
Review fee $ Dept Signature
CONTRACTOR EMAIL ADDRESS
CONTRACTOR CONTACT #
APPLICATION STATUS
Reviewing Department First Review: ZApproved. []Denkerl
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed by:
Date-
TREE ADMIN.
Second Review: DApproved as revised. []Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES
Third Revievtf: ElApproved as revised. [IDenien'-
Comments:
Reviewed by: Date:
REVISED 09252014
MAN SHOWING SURVEY OF:
THE EAST 39 FEET OF THE WEST 44 FEET OF LOT 4, BLOCK 67, SECTION "H", ATLANTIC BEACH, AS
RECORDED IN PLAT BOOK 18, PAGE 34 OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA
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NOTES:
1. THIS IS A BOUNDARY SURVEY.
2. BEARINGS ARE BASED ON THE SOUTHEASTERLY LINE OF THE WEST 44 FEET OF
LOT 4, BLOCK 67, BEING SOUTH 20.12.00" WEST, AS PER PLAT.
3. THERE ARE NO BUILDING RESTRICTION LINES AS PER PLAT.
THIS SURVEY WAS MADE IN COMPLIANCE WITH
THE PROPERTY SHOWN HEREON LIES IN THE MINIMUM TECHNICAL STANDARDS AS SET
FLOOD ZONE "X" (AREA OUTSIDE 500 FORTH IN CHAPTER 61G17-6 OF THE FLORIDA
YEAR FLOOD PLAIN) AS DETERMINED FROM ADMINISTRATIVE CODE.
THE FLOOD INSURANCE RATE MAP, COMMUNITY
PANEL NUMBER 120075 0001 D, REVISED
APRIL 17, 1989 FOR ATLANTIC BEACH, FLORIDA.
'NOT VALID WITHOUT THE SIGNATURE AND THE DONN BOAT�yRIGHT�
ORIGINAL RAISED SEAL OF A FLORIDA LICENSED FLORIDA UC. SUR nn.1 II ADDL ►.i- i c :nnr
SURVEYOR AND MAPPER.'