331 4th st 2015 fence CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
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: 15-FNCE-126
Job Type: FENCE PERMIT
Description: REPLACE A SECTION OF 6 FOOT FENCE
Estimated Value:
Issue Date: 1/22/2015
Expiration Date: 7/21/2015
PROPERTY ADDRESS:
Address: 331 4TH ST
RE Number: 169834-0100
PROPERTY OWNER:
Name: HEWITT, DIANE M
Address: 150 EXECUTIVE CIR
PERMIT INFORMATION:
FEES:
Fence/ROW $35.00
Total Payments: $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233 ' JAN 16
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 33j- 14 54r"7t Permit Number: ------
Legal Description Parcel#
Floor Area o -Fq-Ft NqTT
Valuation of Work$ —Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration <5D Move Demolition pool/spa window/door
Use of existing/proposed structure(�) circle one): Commercial Residential
If an existing structure,is a fire sprUer system installed? (Circle one): Yes No N/A
Florida Product Approval#
For multiple products use product appr5vaor�m �
Describe in detail the type of work to be performed: rtlokce—
Property Owner Information:
Nam��.) if-wl# Address:. a ztle-le�
city t- i3eA.tA, —StateFL Zip qja33 -Phone 16q
E-Mail or Fax#(Optional
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: Qualifying Agent:
Address: city State Zip
Office Phone Job Site/Contact Number Fax#
State Certification/Registration 4
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
4pplication 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 ofa permit and that all work will be performed to meet the standards of all laws regulating construction in thisjurisdiction. This permit becomes null
and void ffwork is not commenced within six(6)months, or if construction or work is suspended or abandonedfor a period ofsUP6)months at any time after
work is commenced. I understand that separate permits must be securedfor Electrica-Work,Plu ingSiins, MsPools, urnacesBoileis,
Tanks andAir Conditioners,etc. Mb Heiziers,
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 YOVIi NOTICE OF
COMMENCEMENT.
I herelb certify that I have read and examined this a lication and know the same to be true and correct. All provisions of laws and ordinances governing this
_pp
work will be co�nplied with whether sfecifi-ed herein or not. The granting of a permit does not presume to give authority to violate or cancel the
Provisions ofany otherfederal,state, or local a w regulating construction or the peifio�mance ofconstruction.
Signature of Owner JL�- Signature of Contractor
Print Name D i L .
.......................................... ............................................................ Print Name
........................................................................................................................................
Bef I 0-\ Before me
thisw Dayof 01 this Day of )n
No ry ublic Notary Public
Revised 01.26.10
CITY OF ATLANTIC BEACH
OWNER / BUILDER AFFIDA VIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I "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
I (,T ."
LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PZPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE-A LICENSE. YOU MUS
SUPERVISE'I'HECONSTRIJCTIONYOtJRSE[IF. 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 14AVE 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 QR-MUNICIPAL LICENSING
ORDINANCES.
IL
11. INJURY LIABILITY; SINCE OWNERS MAY BE I IABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTM SU(j(3L61S WORKER'S CdMPENSATION 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 EMPI OYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIUA 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.
3 31
AUUHESS 0 C�L_
i Gh it- f-k/Iff PHONE NUMBEH
PRII T NAME
AIGAT RE 14 1 Cb
Before me this UA FE
y of__ 206in the county of
Duval,State or Honcla,nas personally appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of Countyof D\JvtA
0 Personally Known -3 —7
ItIo,wr
—713 11 -0
oduced Identification-
Notary Signature:
F:/BLDG/0e,-l3,nld1er VAI—vo,REVISE11D. 4/160-009
City of Atlantic Beach APPLICATION NUMBER
'-5' AJIJ*r�
Building Department (To be assigned by the Building Department.)
-2
800 Seminole Road
Atlantic Beach, Florida 32233-5445 I=Nc E— I
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us ate routed: L5
City web-site: http://www.coab.us L_�_ —
APPLICATION REVIEW AND TRACKING FORM
Property Address: 3a)t 4+ --' Sk Department review required Yes No
_Qj�Wing
Applicant: Dian +_'W tt Planning &zoning
A d rn i n ZTF-50—r
�eDl (
Tree
Project: Public Works
Public Utilities
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: fidApproved. [-]Denied.
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed by:Aez- 4���Date:
TREEADMIN. Second Review: []Approved as revised. nDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: FlApproved as revised. F]Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10