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457 Sargo rd 2015 Shed CITY OF ATLANTIC BEACH j 800 SEMINOLE ROAD J ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 SHED PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 15-SHED-263 Job Type: SHED PERMIT Description: 6 X 8 SHED Estimated Value: $575.00 Issue Date: 2/23/2015 Expiration Date: 8/22/2015 PROPERTY ADDRESS: Address: 457 SARGO RD RE Number: 171499-0000 PROPERTY OWNER: Name: FREEMAN, JUANITA Address: 457 SARGO RD PERMIT INFORMATION: PLANNING AND ZONING: UTILITY DEPT.: CONDITIONS OF APPROVAL: Second shed: There is an existing on the property. The code prohibits more than one shed on a property. The existing shed will have to be removed before the new shed can be built. Avoid damage to underground water/sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is needed, call 247- 5834. Remain out of the easement; there is a sewer main in the easement at rear of property. FEES: BUILDING PERMIT FEE $55.00 STATE DCA SURCHARGE $2.00 STATE DBPR SURCHARGE $2.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 ` Office (904)247-5826 Fax (904) 247-5845 Job Address: IS-7 S4,zgp Permit Number: l Soft Z6 Legal Description',#c(b Parcel# oor ea o q. t. q. t Valuation of Work$ Proposed Wd& 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): 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 perform d: C �G Property Owner Information: Name: 9'?7 f i Address: ��r E-Mail or Fax#(Optional ty ) 6 Cd tat Zip��2 Phone 77 _ 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 E� Application is hereby made to obtain a permit to do fhe work and installations as indicated. I cert fy 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 f work is not commenced within six(6)months, or if construction or work is suspended or abandoned for aperur of six( 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,eta 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 cert 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 ofYwork will be complied with whether specs red herein or not. The granting of a permit does not presume to give authority to violate or cancel the grovisrons of any other federal,state, or local law regulating construction or theperformance of construction. Signature of Owne Signature of Contractor Tint Name Print Name ..................................................................................................................................._. 3efor e r-- Before me ,is of 20/5 this Day of 20 U at Florida lotary Public hirley L am ,� pa IJy commi ion F oassso Notary Public '?oK Expires 0211 18 Revised 01.26.10 MAP SHOWING SURVEYiF b a - REPLAT OF PART OF ROYAL PALMS UNIT TWO A RECORDED IN PLAT BOOK 31 PAGE 16,16A2 6W"tpc RECORDS OF DUV� CO., FLA. FOR Noplow Builders tv 16 X r Q t,i V ` � or � 1oT L 2365 V `, N Cx co mm" smawn I � ±N IN r i k } i maw --- -- - - -- 7S _.__ � I a 1 ' i � v 1 t k 1 I - S7-ob., :raw•.,:_. j i 7 V I !o s P j cb 1 I it _1 A =` CITY OF ATLANTIC BEACH � a OWNER / BIDER AFFIDAVIT 1. FLORIDA STATUTES; C ?AP T ER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSUTENLENT FOR SECTION 439.103(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 ENENTTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY.TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGI-1 YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONS.I RUCTION YOURSELF YOU MAY BUILD OR MROVE A ONE-OR TWO FAMLLY RESIDEINCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25.000.00 OR LESS. THE BUILDING MUSTBE FOR YOURi.?�;z AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEA`:;?.A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME TN-,T YOU BUILT IT FOR SALE OR LEASE_WHICH IS IN VIOLATION OF THIS E)CENIPTION. YOU MAY NOT IIIRL 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. It. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPART,ILI`Cl SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. Ill. IPS 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(l). AN"OCCUPATIONAL LICENSE" IS NOT A.DEQUAT E THE OWNER SHOULD PHYSICALLY SEE THE COON TY "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 STATT EMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER.PERMIT. ADDRESS E PHONE NUMBER ttl`Gt?L tlA �_ t.e.11"/77Q Alt .PRINT N , SIGNATURE �/j/�f DATE E V Before me this day of / N✓ 2n the county of Duval,State of Florida,has personally appear red herin by himself/herself and affirms that all statements and declarations are true ,ci accurate. , Notary Public at Large,State of��_,County of V LL ❑Personally Known �7L r� v_ducedldentification- �Y_ Notary Public State of Florida Notary Situra: Shirley L Graham My Commission FF 086990 F:/ELDG/Owner-Euilder Affadavih RF.VISEU:411 009 ~ oFTL� Expires 02/1412018 DleYoAnlfEch®r Kit Instrcti®ns Fprotection for most outdoor structures or possessions. Includes. 3011 Anchors, Wire Clamps & 60 ft Cable Part #59075 CD 1. Install ground anchors as close to the building as possible at all four corners. A. Install anchors using a straight rod to turn (screw) anchor into the ground. B. A starter hole, up to 1/3 of the anchor length can be used to start anchor into the ground. Once the anchor eye is level with the ground, backfill the soil and pack area around the anchor eye. C. Anchor eye should be just above soil level. 2. Cable can be secured to the building using the following methods. A. Attach one end of the cable to an anchor using the wire rope clip. Cable goes thru the anchor eye and is clamped together using the wire clips (2). Place the cable over the roof to the opposite anchor, loop cable thru anchor eye. Cut cable to have enough to attach to the anchor. Pull cable tight, attach 2 wire rope clips, tighten nuts. Repeat for other side. B. Attach cable to the side wall studs.Additional hardware required, bolts, washers nuts and wire rope clips. All available at your local hardware supply. NOTE. These instructions are for suggested attachment to small shed not located in high wind areas. For more detailed anchor requirements, see the wind zone charts for your area. You may need additional anchors, cable, wire clamps or other forms of anchor attachments to the shed to meet local or state requirements. Twelve(12) Month Limited Warranty All tie down anchors,when installed in accordance with the manufacturers recommendations and when used within the suggested capacities are guaranteed for 12 months from date of purchase against defects in material or workmanship. If returned prepaid to the factory.TIE DOWN ENGINEERING will replace without charge the defective part.Labor delays or damage are not covered by this warranty and while this warranty gives you specific legal rights,you may also have other rights with vary from state to state. o� Instruction#08091 - - 0 1�1 TIE DOWN ENGINEERING INC. "r Wind Zone: 1 Anchor Description: 1/2".x 30".Eye Anchor w/4"Helix. Model Number. 59055 0 Building Width Building Length{ft} ( ) 5 6. 8 10 12" 14 16. 18. 20 22. 24 26 28 3.Q 32. A 5 ._..2 2 2 _ 2 2 2 2 2 2 2 6 - 2 2 2 2 2 2 3 3 3 3 -" 3 7 2 2 2 2 2 3 —3 -3 3 3 2 2 z._ 2 2 2 3 3 3 3 2 2 2 _ 2 2 2 2 2 3 3 3 3 . 12F7- _ - 2 2 -- 2 2 2 2 2 3. 3 3 3 3 2 �2 2 2 2 3 3 3 3 3 14 - - - - 2: 2 _ 2 3 3. 3 - .3 4- 4 _._...4 18 _ _ __.. _ _ Z 3 3 3 3 --3 4 4 4 4 4 4 7,F1 Wind Zone; 2' N Anchor Description: 1/2!'x 30'Eye Anchor w/4"Helix. Model Nurnber: 59055 W Building Width Building Length(ft.) Q (ft). 5 6 8 , 10 12. 14 1G .98 _ 20 22 24. 26 2$ 30 32 5 2 2 3 4 4 . 56: 6 7 7 8 9 9 10 11 6 - Z 3 3 4 5 5. 6. 6 7 Q 7 - - 3 3 4 4 5 5 6 6 7 7 8 8 9 8 _ 3 3 4 4 5' S 6 6 7 7 -g g' g ' 3 3 4 4 5 5 6' 6 7 7 g 8 N 12 - - - - 3 4' 4 55 6' 6 7 7 $ 8 14 _ _ = 4 5 5 6 6 7 7 8 8 El 8 9 16 5 5 6 6 7 7g 18 - - - - - - - 6 6 7 7 8 8 9 9 NWind Zone: 3 Anchor Description: 112"x 30"Eye Anchor w14"Helie �■y Model-Numbet 59055 ZW Building Building Length(ft) Width O (ft) 5 6 8 10 12 14 16 18 20 22 24 26 28 30 32 5 2 3 4 4 5 6 7 —7 8 9 10 10 11 12 13 6 3 3 . 4 5 5 6 7 7 8 9 9_.- 10 11 12 A 7 = 3 4 8 3 4 4 5 6 8 8 9 9__ 10 11 — 4 5 5 6 _. 7 7• 8 8 9 10 10 z12 10 - - 3 4 5 .5 6 B 7 8 8 .9 9 a 10 - 4 5 5 6 6 7 8 8. 9 g 10 N 14 - - - 5 5 6 7 7 8 8 -9 10 10 9 9 10 11 18 7 7 8 9 9 10 11 11 Notes: 1) Maximum 102"building height. 2) One anchor shall be placed at each corner of building. 3) Any required anchors between corners shall be spaced equidistant apart from each other. 4) Number of anchors required per side shall be determined by finding quantities listed in columns. Calculation Chart Instructions Example: Note* Wind Zone II chart shows 12' x 18' building: - - - - - - - - - - 1. Looking in 12' column - Use lowest value in the 12' column for the ' - 1 - - - - - - - - - number of anchors 3 2. Looking in 18' column - find the corresponding width of 12' to obtain the number of anchors for the 18' side . . . . . . . . . . . . . . . . . . 5 , , Wind Zone II (if building width exceeds the widths shown in the Building Width 12' x 18' Shed column, use the lowest number of anchors in the corresponding Building Width column) ' - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - *NOTE: Anchors at the corners shall be counted only once in the quantity required for each side or face of building. ,� ` - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - , 3. Total Anchors needed per 12' x 18' shed in Wind Zone 11. . . . . . . . . . . . .12 .1 Building Building Length(ft.) Width (ft.). 5 6 8 10 12, 14 ( . 18 20 22 24 26 2$ 1 30 32 5 2 2" 3 4 4 . 5 & 6 7 7 8 9 9 10 11 6 - 2 3 3 4 5 5 !6. 6 7 7 8 9, 9 10 7 - - 3 3 4 4 5 5 6 6 7 7 8 8 - 9 8 - 3 , 3 4 4 5 5 6 6 7 7 8 8 9 10 - - - 3 3 4 4 5 6" 6 7 7 8 8 12 - - - - 3 4" 4 W-5 2 6 6 7 7 B 8 4 5 5 6 7 7 8 8 9 16 - _ 5 5 6 6 7 7 8 8 9 18 - - - - - - 66 7 7— 8 8 9" 9 w Basic Wind.Zone Map W t o'�.ExiWNo N w_ WA M f, ND tr it MN NH ti OR ID SD W1 y WY MI NY Vq Ct NB 1A FA .MA IL IN OH Cf RI NV UT CO NS KS MO KY WV VA �B CA � 4 OK AR TN NC 4� AZ NM SC ou IAMS AL GA M w TX 01 A 0 7pne Y e U a AK Zany FL 7 a 20 HI 6 a NOTE: See Section 3280.305(c)(2)for areas included in each Wind Zone. g 0 3 I • � I I - • � � I � 1 I I I � 1 � � I � I � � City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) AN-dO 800 Seminole Road Jr24 3 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 Property Address: 7A9 Q U Department review required Yes CELWdinn Applicant: 4anning &733"N 6 ,y Q LTree Adminis rator Project: U �L� is Works Zlic Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receiptof Permit Verified By Date 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: 116"p'—roved. ODenied. (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by: Date:!O��-/'a - /S— TREE ADMIN. Second Review: ❑Approved as revised. ❑De ed. 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 / Building Department (To be assigned by the Building Department.) l.. ~ 800 Seminole Road 101) Atlantic Beach, Florida 32233-5445 G (p 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 Property Address: Ycll De artment review required Yes No in anning & o Applicant: Tree Adminis rator Project: X ?L� PubTis Works lic Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Dateof 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: sGG A44 BUILDING PLANNING &ZONING � � S Reviewed by: Date: � TREE ADMIN. Second Review: ;KAroved as revised. pp ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 07/27/10 FEB p -_ ay a_Q- �LL a_u �,� City of Atlantic Beach Building and Zoning nt 800 Seminole Road s) Atlantic Beach, Florida 32233 J -ter Telephone(904)247-5826 Fax(904)247-5845 �JS3 http://www.coab.us February 12, 2015 457 Sargo Road Zoning Review Comments 1. Second Shed: There is an existing shed on the property. The code prohibits more than one shed on a property. The existing shed will have to be removed before the new shed can be built. The city will consider approving the new shed if a written statement is given that states the old shed will be removed within an acceptable time frame as agreed upon by staff. Derek W. Reeves Zoning Technician G j�V' � � y BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach, FL 32233 Office (904)247-5826 Fax (904) 247-5845 Job Address: 5�2,��y ,�� Permit Number: Legal Description.YAC C Parcel # Valuation of Work$ ?�� Proposed es d w he ted/cooled t 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): 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 perform d. Xr Pronerty Owner Information: Name: Address: S City Z Stat LZip.32.2,3-3—Phone. 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# 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 asrdinicated. I cert that no work or installation has commencedpriorotheissuance of apermit and thatawork wibe performed to meet the standards of ll laeguatngconstructionin this jurisdiction. This permitbecomes ulland void f work isnotcommenced within s (6)months, or if constructionor wok is suspended or cbandoned 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,Phrntbing,Signs, ells,Pools,Furnaces,Boilers,Heaters, Tanks and Air Cononers,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 a plication and know the same to be true and correct. All provisions of laws and ordinances governing this type j work will be complied with whether specf ted herein 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 regulating construction or the performance ofconstruction. >ignature of Own e Signature of Contractor Tint Name Print Name ................................................................................................................................... .................................................................................................................... .................... le Before me lis of 20/5 this Day of 20 U ' at Florida fotary Public hirley Lam ov My Comm. ion F 086990 Notary Public 'top €xpirsc 0211 18 i Revised 01.26.10 CITY OF ATLANTIC BEACH OWIER / BUILDER AFFIDAVIT 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATENlENT FOR SECTION 489.103(7),FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU 1-IAVE 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 CONS I RUCTION 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 TT_i_1 AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEA'i? A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS CONIPLETE, THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE.W[IICH IS IN VIOLATTON OF THIS EXENPT`ION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO TTS BUILDING CODES AND ZONING REGULATIONS. IT IS Y01_IR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. It. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTM,EP:T 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(l). AN"OCCUPA T IONAL 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. ,eels�p- Aq� .-av A-IV psly ADORE ! PHONE NUMBER PRINT , SIGNATURE DATE Before me this a day of / �1✓ 2�n the count/of Duval,State of Florida,has personally a+_geared h.dn by himself/herself and affirms that all statements and declarations are true^-ci accurate. Notary Public at Large,State of County of V LL s eKnown P ducedldentirice � tion- o °�e Notary Public State of Florida Notary Si tura: Shirley L Graham y d My Commission FF 086990 F:/BLDG/O�+m Builder Affadavi�RFVISED: d/1 —1009 ~?Op It Expires 02/1412018 J, MAP SHOWING SURVEY `b - L .c=> REPIAT OF PART OF ROYAL PALMS UNIT TWO A RECORDED IN PLAT BOOK 31 PAGE 16,16A,l!&I"& RECORDS OF DUVAL CO.,*FLA. FOR Peaplew Builders l / 8Q , 6. F Z4 , ob a Alu1 Z .3 ,s 440 e a ` N vj City of Atlantic Beach _ APPLICATION NUMBER (To be a Building Department by the Building Department.) 800 Seminole Road •-� �� — 24 3 f Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-58B 4t Date routed: E-mail: building-dept@coab.us By: T City web-site: http://www.coab.us _! APPLICATION REVIEW AND TRACKING FORM Pro erty Address: Y5- 7 r Q U Department review required Yes No p in Applicant: anning &Z6TON Tree Adminis rator Works Project: lic Utilities Public Safety Fire Services Review fee $ Dept Signature Review or Receipt Other Agency Review or Permit Required of Permit Verified By Date 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: E4Approved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by: Date: L G 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 S City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) i 800 Seminole Road 1 r') Atlantic Beach, Florida 32233-544 rXE1 r Phone(904)247-5826 Fax(90 ' -58 Date routed: -2- E-mail: E-mail: building-dept@coab.us FEB ® h City web-site. httpJlwww coab.us X015 APPLICATION RE CKING FORM �5- 7 Q O De artment review required Yes No Property Address: in arming & o Applicant: to aTree Adminis rator Works Project: �/J J�_lJ lic Utilities Public Safety Fire Services Review fee $ , , Dept Signature /-1!� 4," Review or Receipt Date Other Agency Review or Permit Required 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: i i7� Date: Z TREE ADMIN. Second Review: [-]Approved as revised. ❑Denied. ELICW R� Comments: BLIC UTILITIES PUBLIC SAFE Reviewed by: Date: FIRE SERVICES Third Review: [-]Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 07/27/10