349 3RD ST FENCE CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
FENCE PERMIT
MUST CALL BY4PM FOR NE)Cr DAYINSPECTION: 247-5814
JOB-INFORMATION
Job ID: 15-FNCE-`1102
Job Type: FENCE PERMIT
Description: 4ft and 6ft fence
Estimated value:
Issue Date: 5/15/2015
Expiration Date: 11/11/2015
PROPERTY ADDRESS:
Address: 349 3RD ST
RE Number: 169823-0000
PROPERTY OWNER:
Name: HOFFMAN, DAVID A
Address: 349 3RD ST
PERMIT INFORMATIO 1:
FEES:
FenceIROW $35.00
Total Payments: $35.00
PERMIT IS APPROVED ONLY IN ACCKYRDANCE WITH ALL CITY OF ATLANTIC BEAC11 ORDINAN(7ES AND THE FLORIDA
BUILDING CODES.
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assignic ing Department I
800 Seminole Road by th�Build
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 Fax(904)247-5845
E-mail. building-depti Date routed.
City.eb-site http://�.mab.us
APP
0 be_s'
Date routed=
APPLICATION REVIEW AND TRACKING FORM
-E - -
Property Address: sxr #Department review rejuired 'fes No
Building
Applicant: '0W-;q r4 anning&Zorn
Tr-?F7MMTflHs7m—tor
Pu
Project: f k h7l Public Works
P
Public Utilities
-P-.bl.c—,cWety
Fire—Sewi�s _
Review fee Dept Signature
Other Agency Review or Permit Required Review or It
of Permit Verified By Date
Florida Dept.of Environmental Protection
Flonda Dept.of Transportation
St.Johns River Water Managernent District
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic BevffagWwd Tobacco
Other
APPLICATION STATUS
Reviewing Department First Review: ZApproved. DDenied
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed by: Date w�/'Z/ls
TREEADMIN. SecondReview: DAppro,vedasrevised. []Denied
PUBLICWORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date
FIRE SERVICES Third Review: ElApprovedas revised. ODenied.
Comments:
Reviewed by: Date
Revl�ed 07JVf10
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904)247-5826 Finc(904)247-5845
JohAddress: 3 9 3ta 5+- Permit Number:
Legal Description Parcel#
k loor Area of Sq.kt
Valuation of Work$ 1000-00 ProposedWork heated/cooled_ non-beated/cooled_
Class of Work(circle one): G) Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/pro osed structure(s)(drele one): Commercial 4 EResd ial
: Y 0 N/A
If an existing strucrure,is a fin sprinkler system installed?(Circle o y
Florida Product proval#
For multiple pr�'Nucts use-pro&u-c-tap—pro--arro-m—
Describe in detail the type of work to be performed: &:4 C�r' ou,,,f- 11 fat.&
Prouerty Owner Information:
Name: &�-td tjff�tall lro St
city NtateU,-z1p-3jL3a-Phone It* (-
E-Mail or Fac:4(Optional)
Contractor Information: CONTRACTOR ENL411,ADDRESS:
Company Nicine: 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 Naine and Address
4pplication is hereby made to obtain operant to do the work and installations as indicated. I certify that no work or installation has commencedprior to the
homance ofaticrome and that all work will beperformed to meet the standards ofall laws rcgulating constmetion in thisjuninficiam. Thispermubecomesnall
and void ff work is not commenced within six(6)months, or if construction or work is surended or abandonedfor a
Wp,rind of s tsg6,)in onthe a t any tim ej,,,er
el
work is commenced. I understand that separate permits most be securedfor Elecoricar Work,Pluinbing,Signs, d1s,Not; remea,Bellins,He en,
Tianks andAh,Conditioners,eta i
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 AT'rORNEY BEFORE RECORDING YOUi NOTICE OF
COMMENCEMENT.
I hsrr,�,certify that I have read and examinedthir licasion andfinue,thr,aeoo to be true and correct. Allprovisions oflaws and ordinances governing this
type a. work will be camplied.ith whes.1r,8feci?w§dhemM or not The granting of a permit does not Presume to give authority to violate or casi,el the
P,mosions.fany othefederal,state,or . .regulating construction or theperformance ofconsanaction.
Signature of Osvner P'ri-A A Signature of Contractor
/ // I
Print Nanic oirvov .........- .............- PrintNanie
Bef e Before me
11
thislyR Dawf/*04 this Day of
OA-,U - a 16oitn
otary P. eta Pu
LNotuyPublic #4FF.MllgM
Is J1
s E19PIREESF61 2 Revised 01.26.10
0-
i.�
b"
CITY OF ATLANTIC BEACH
OWNE R / BUILDER -AFFMDAVIT
1. rLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES PART I 'CONSTRUCHON
CONTRACTING'REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW.
DISCLOSURE STATEMENT TO.�XlU JIUN 489T03(7),FLORIDA STATUTES.
STATE LAW REQuIRES CONSTRUCTION TO BE DONE By LICENSED
L CONNUCTORS YOU RAVE APPLICD FOR A PERMIT UNDER AN E)CEMprION To THAT
AW THE EXEMPTI014 ALLOWS YOU,AS THE OWNER OF yOURpROpERTy
YOUR OWN CONTRACTOR FVPN THOUGH YOU DO NO �TO ACT AS
AT—FRYIST,—iHt-00N-.fkUC THAVEALICENSB. )OLIMUS
Ni-�IGYOURS�F. YOU NfAy DUILD OR"ROVE A ONE-OR
TWO EAIDTy RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDINGAT A COST OF$25.000.00 OR LESS. rHEBLUDING
IF M&Lar�ANDOCCUPANCY. ITMAYNOTBE:BLIILTFORSALF.ORIC.,�.Sr
YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITTEN ONE YE'AR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL P s AT YOU SUN T
ITFOR SALE ORLEASL WHICH IS IN VIOLATION OF MS 2 � TION, Yo1jh1.\), Nt;f
I
T
'E"94MMINO"'I -- Y CONSTXT�JCJ�N
G THE BUILDING CODES AND G 6 ATIONS I[ j�
10 MAKE SURE THAT PEOPL -N 1, Y Y )lit'
1[CENSES AND Y COON OR N ON _TL�v I
ORDINANCES. MICIPA LICENSINt,
it MJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HjPk
IHE BUILDING DEPARTMEWT�IUGGEqQ—V�0��� ",o'
PURCHASED _OMPENSATION INSURANCE BE
UL IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING -1 AX AND/OR FORM 1099 REQUIREMIENTS ON THE WORKERS-1 HEY
EMPLOY ON THEIR IMPROVEMENT TRADES,
iV. PENALTY; UNLICENSLO CONTRACTORS
CIRCUMSTANCES. W-1— ............ CANNOT BE EMPLOYED LINDER ANy
OWNERS BEING SUBJECT TO $5 C--
455-228(11�� AN'OCCUPATIONAI I CENSE' [S NOT 8 , Ou P'ENALT:TUN6WitW11DA STATUTE NO
SEE THE COU... . DFOUYFF THE OWNERSHOULD PHYSICALLY
�' UUMFLIENCY" OR THE FLORIDA 'CONTRACTORS
CERTIFICATE' TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR TELEPHONE THE
BUILDING DEPARTMENT(247-5a26)IF IN DOUBT.
V.ACKNOWLEDGEMENT;I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENT S FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
311 3c j
st FH-07 I E o 4-.
,,zJ 4,
.4
se�e me this f
-Zdayof
LUbURE
_OF AN]
F11!51l))
NoWr,signa�re 8
-;,=.wgEREF