314 12th Street fence CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
FENCE PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-FNCE-921
Job Type: FENCE PERMIT
Description: 6FT FENCE
Estimated Value:
Issue Date: 4/24/2015
Expiration Date: 10/21/2015
PROPERTY ADDRESS:
Address: 314 12TH ST
RE Number: 171924-0000
PROPERTY OWNER:
Name: GOLDKNOPF, JOSHUA& LESLIE,
Address: 314 12TH ST
PERMIT INFORMATION:
FEES:
Fence/ROW $35.00
Total Payments: $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: '31 q 1 21
Permit Nu ber:
Legal Description Parcel# By
lici Nrea o q. ST_q7 Et
cl. t
Valuation of Work$ Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New A0 Alteration Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one):
Commercial Residential
If an existing structure,is a fire spriKel 4stem installed? (Circle one): Yes No N/A
Florida Product Approval 4
For multiple products use prodFuc—t—a—ip)i—p)—r—ov—aTfo—rm—
Dese *be in detail the type of work to be perft r e
d hk W(04 TM(t will Ix mw_d
Yb N Isorveq , W11 qtL
Property 0wnPr1nfnrma1-,n--
Name: 0 d
city
E-Mail or Fax# (Optional) Phon 7D Z_LA- I 1 1 4—
Contractor Information:
Company Name: Qualifying Agent:
Address: city State Zip
Office Phone Job Site/Contact Number —Fax-#
State Certifica—tion/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
4pplication i's 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 of a permit and that all work-will be pe�formed to meet the standards of all laws regulating construction in thisjurisdiction. This permit becomes null
and void if work is not commenced within six(6)months, or if construction or work is suspended or abandonedfor eriod of six�6)months at any time after
Tanks andAir Conditioners,etc. It for Electrical Work, Plumbing,Sikns,awl lis,Pools, Purnaces,Boilers,Heaters,
work is commenced. I understand that separate permits must be sec red
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.
I hereby certify that I have read a examine t 's lication anCknow the same to be true and correct. All provisions of laws and ordinances governing thi's
f
wheth �,n 0 The
type.). work will be complied s ciz here granting of a permit does not presume to give authority to violate or cancel the
provisions of any other e te, or 4Q al w ulatinge struction or the Performance ofconstruction.
Signature of Ow er Signature of Contractor
Print Name ... .............. ........... Print Name
..... . ......................................................
........................................................ .............................................................
Before
%P e me
th
thi —D y of is
blic State of F1 Day of
Shirley L Graham
y i"ion FF 086990
Nota P1 t Public
Revised 01.26.10
CITY OF ATLANTIC BEACH
0 N ER / BUILDER -AFF MAWT
W
1. FLORIDA STATUTES; CHAPTER 489,. FLORIDA STATUTES, PART -1 "CONSTRUCTON
CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW.-
DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUT E S:
STATE LAW '-tEQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU 1�LAVE, APPLIED FOR A PERISAIT UNDER AN EXEMPTION TOTHAT
LAW. THE EXENIPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY
YOUR OWN CONTRACTOR R3LPM TT-TC)T T('-U',,'OU DO NOT HAVE A LICENSE.
YOU IVLAY BUILD OR 11\4PROVE A ONE-OR
iwu rA1V1U-T-Tn=, h-NCE OR A IAlkM WBUILDING. YOU IVIAY ALSO BUILD OR
HVIPROVE A COMVIERCIAL BUILDING AT A 5,000.00 OR IFSq-
LIUST BE FOR YOUR USE AND OCCUPANCY.*T -1HE BIM.
IF YOU SELL OR LEASE A BUILDING YOU
LF WITTM= YE
AFTER 17qE CONSTRUCTITON IS COIVIPLETE, TIJE LAW WILL PRESUIVIE TMIJIAT YOU
IT FOR SALE OR LEAS-'-'- CH IS IN VIOLA11ON OF S E)CME I\V/f P IF-1 0
YOUR CON
To TBE BUILDING CbDffl� A1\M 7nNING REGULATIONS.
I If. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD A LSO
OBSERVE IRS WITHHOLDING -1 AX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
PO,ULJU P,='�AE=I:�(-UND-E-P-,TLOT-,T7=UTE NO.
1). 77MCUPAT IONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
ST-:::-E: THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTO IDS
CERTIFICATE" To A SCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
11
BUILDING DEPARTMENT(2-17-5826) IF IN DOUBT.
V.ACKHOWLEDGEMENT; 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.
zi h
6q - 5zq -1112-
ADDRESS PHONE NUMBER —
PRINT NA
SIGNATUR DATE
Before me this day of tl county of
Duval,State of Florida,has pers nally r-ipp P.ed erin by himself/herself and affirms that
all statements and declarat tions are true ant. cc rat a-
Notary Public at Large,Sta'a Count
0 PKso/nally Kno-
�Vroduccd ntilica' n-
Notary Public State of Florida
Shidey L Graham
Notary Sionawre: My Commission FF 086990
Expires 02/14/2018
Affil.&-;REVISED 4/1 :�9
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assi n�py, the Building Department.)
800 Seminole Road M4
Atlantic Beach, Florida 32233-5445 74)
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: 1 # 2-11
Cityweb-site: http://www.coab.us I I
APPLICATION REVIEW AND TRACKING FORM
Property Address: /27W S7- Department review required Yes No
Building
Applicant: 64() elci le— Cra—nning&Zonfin_g---�o
I ree AarnlnistraTo—r
Project: PublicWorks
Public Utiliti s
Public Safety
Fire Services
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: PApproved. ElDenied.
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed by: JoK./ Date:
TREE ADMIN. Second Review: FlApproved as revised. F]Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: RApproved as revised. [:]Denied.
Comments:
Reviewed by-.- Date:
Revised 07/27/10