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227 BELVEDERE 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 NE)(T DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 15-FNCE-641 Job Type: FENCE PERMIT ection of 8ft Description: 6 ft fence and possibly a 12ft wide s Estimated Value: Issue Date: 4/2/2015 Expiration Date: 9/29/2015 PROPERTY ADDRESS: Address: 227 BELVEDERE ST RE Number: 170507-0000 PROPERTY OWN--R: Name: YARBROUGH, INES Address: 227 BELVEDERE ST GENERAL CONTRACTOR INFORMATION: Name: OWNER Address: Phone: - - PER lIT INFORMATION: PLANNING AND ZONING: 8' x 12' PARTITION WALL MUST BE 5 FEET FROM SIDE AND REAR PROPERTY LINES. FEES: Fence/ROW $35.00 Total Payments: $35-00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALI, CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. j City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 L4- I Phone(904)247-5826 - Fax(904)247-5845 E-mail: building-dept@coab.us Cityweb-site: http://www.coab.us Date routed: APPLICATION REVIEW AND TRACKING FORM -z_?'--1 13CtVr_4f'rtS+ De a red Yes No Property Address: Department review requi B u if d i(ni Applicant: S Va r k�) YOLA Planniii g &Zoning T T or j ree Administra or Project: Public Works— Public Utilities jzf--f— C�+i f+ f-W Public SaEfety U_ ic Fire EService]s�� Review fee $ Dept Signature Other Agency Review or Permit Required Review or Date — of Permit Verified By Florida Dept. of Environmental Protection Florida Dept.of Transportation St.Johns River Water Management 6-1s-trict Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: MApproved. FIDenied. (Circle one.) Comments: 1ed [��o X 12 -%ef BUILDING s etr 41 PLANNING &ZONING 000 TREE ADMIN. Reviewed by:__A.� Date:_V,As- Second Review: [-]Approved as revised. ODenied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: DApproved as revised. F]Denied. Comments: Reviewed by: Date: Revised 07/27/10 BUILDING PERMIT APPLICATION � T P) �[ � T M CITY OF ATLANTIC BEACH MAR 18 800 Seminole Road, Atlantic Beach, FL 32233 It Office (904) 247-5826 Fax (904)247;,5845 Igg A-01 /.ob Address: Permit Number: Legal Description Floor Area of Sq.Ft. Parcel Sq.Ft Valuation of Work$ Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): New Addition Alteration (EepDair Move Demolition pool/spa window/door Use of existing/proposed structure(s) circle one): Commercial tesidenti es 0 If an existing structure,is a fire sprin=system installed? (Circle one): E4% N/A Florida Product Approval# For multiple products use product approvaFFo_rm Describe in detail the type of work to be performed: c kt:L 416,11 &A!1<,5 b/y i yx �-e q r Property Owner Information: Name: Address: city_,4 -State7gZip hone !t 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 ,,o he e ade ana er d he work and n a la ns as nd ca d e t ths"no work or installation has commencedprior to the y i f c r i at,ng c n tructfo nthisjurisdiction. This permit becomes null or , 0 or mit to 0 0 t tom tt i S' ' ti i 1 s d a�b d ned� eriod of sixj6u)months at any time after 0 0' pi be e med he tan r al . sus e ul ix k nd, 'p a io s r by"d th t rk � f P s 0 ance a a e, an a r s, or st Ut 0 r f h )m t issu t al w (6 mi t 1 0 w p and void f P k s not com en ed thin s r f I P, S. s s cure or c rica or U I g, ig's, 'or is co 0 i m c w 0 Obe e d Ele t �1� k n idis,Pools, urnaces,Boilers,Heate k enced. I under ta'd t at separate permits mu t rs, 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 FINANCING9 CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. Ihere 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 111work will be conriplied with whethers or cancel the recifiFed herein or not. The granting of a permit does not presume to give authority to violate provisions of any otherfederal,state, or loca aw regulating construction or the peFfo�mance of construction. Signature of Owner ly�Z4 -1 (2Nt1,ff.(A Signature of Contractor 4,R 6 Print Name ........................................................................................................................................ Print Name - 1;� I/ ............................ ..0 . ............................... Bef Before me Miy this 1�iOayy of _yy)0\y_ . 2015 this Day of 20 Notary " Notary Public JENNIFERWALKER Revised 01.26.10 mycommissim#f-Foli'm EXPIRES;ApOl 24,2�17 .'W Bomid-i?"Notary F0110 undemitell-i CITY OF ATLANTIC BEACH W\\,IER / BUILIDER _AFIF 11DAVIT 1 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I "CONSTRUCTION CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DfSCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES: STATE LAW �,EQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU f LAVE APPLIE-D FOR A PERNffT UNDER AN EXEMPTION TO THAT LAW. TFIE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERT11.TO ACT AS YOUR OWN CONTRACTOR EVFN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST S(-.Ii'E.RVI.S.I-,' IIIF',CON",'Il��ICTION 'Y'OLIRSEI-F. YOU IVLAYDUILD OREVIPROVE A 01\1E-OR IW'0 FAiVILLY RESIDENCE OR A FARM OUTBUILDING. YOU NLAY ALSO BUILD OR I1\4PROVE A COMAERCIAL BUILDING AT A COST OF$25-000.00 OR LESS. Tum BUFLDING NEUST BE FOR YOUR USE AND OCCUPANCY. ITMAYNOTBE BUILT FOR SALF OR LEASF. IF YOU SELL OR LEASE A BUILDING YOU I1AVE BUILT YOURSELF WITTEN ONE YEAR AFTER TT1E CONSTRUCTION IS CO1\dTLETE, THE LAW WILL PRESUME T14-AT YOU BUILT IT FOR SALE OR LEAS-'-'_ WFUCH IS IN VIOLATION OF TTT[S E)[E-1VfPT-1ON. 101-11\1A)� N01- AN UNI ICENSE-1-1 f'ERSON AS-YOUR CONTRACTOI�_ YOUR CONSTRUCTION MUST BE DONE ACCOBDINOTO TEE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR Rl".SPONSI-1311-11�' -1-0 MAKE SURE THAT PEOPLE EMPLOYED BY 'w'0L) HAVE LICENSES REOUIRED 3Y STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANC S. It. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED 111. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD A LSO 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 PENALT Y UNDER FLORIDA STATUTE NO. 455-228(l). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUAT E_ THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICAT1E OF COMPETENCY" OR THE FLORIDA "CONTRACTORS E CERTIFICAT F To A CER TAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE I's BUILDING DEPARTMENT(2-17-5826) IF IN DOUBT. V.ACKHCiWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STAT EMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. (j Gt_V& p T A inLI-A go tf G�q y- FTHONE NL"BER �MDDRESS r PRINT NAME 4ca INS SIGNATURE DATE 11 Q—*\ Before me this-day of 215 in the county of Duval,State of Florida,has pers(;nally ar'pe�ied herin by himself/hersell and affirms that all statements and declarations are true_an,.��jccurate. County o, L Notary Public at Large,State ofE Old El Personally K ok,.,n fj,F-Koduced Identincation- NotaFy Sign@L' M:� L.ild..Affi,.d-it;RF VISED: 4/1 ':;i9