615 AMBERJACK LN - FENCE �`S '14 .AL�J rJv,t
z � S, CITY OF ATLANTIC BEACH
v;,,,, j 800 SEMINOLE ROAD
j ;". ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
J1119�
FENCE PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-FNCE-1616
Job Type: FENCE PERMIT
Description: 6 ft 4 ft fence
Estimated Value: $440.00
Issue Date: 7/8/2015
Expiration Date: 1/4/2016
PROPERTY ADDRESS:
Address: 615 AMBERJACK LN
RE Number: 171186-0000
PROPERTY OWNER:
Name: Downing, Hartwell And
Address: 615 Amberjack LN
PERMIT INFORMATION:
FEES:
Fence/ROW $35.00
Total Payments: $35.00
PERMI"I IS APPROVED M1.1 IN ACCORDANCE WI"I'II ALL cl"rV OF ATI.AN]I(' BEACH ORDINANCES AND TIn FLORIDA
BUILDING CODES.
ORDERED BY • 1 a. ..,*
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R E A L T Y ,. .
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PROPERTY ADDRESS:615 AMBERJACK LANE ATLANTIC BEACH,FLORIDA 32233 SURVEY NUMBER:1309.0994
FIELD WORK DATE vrvJ,3 REVISION DATE(S):ie'v.1 9n 3.0013)
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FL 1309.0996 I IN,-% c
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FLOOD INFORMATION: POINTS OF INTEREST
BY PERFORMING A SEARCH WITH THE LOCH:GOVERNING III SHED OVER 5'U.E.&D.E.(2)FENCES OVER 5-U.E.&D.E.(3)
MUNtCIPAUTY OR WWW.FEMA.GOV,THE PROPERTY APPEARS TORE CONCRETE DECK OVER S'U.E.&D.E.
LOCATED IN ZONE S.THIS PROPERTY WAS FOUND IN THE CITY OF
ATLANTIC BEACF,COMMUNITY NUMBER 12(1)75,DATED 05/03/13
CLIENT NUMBER: ,DATE:9/13/2013 KIM STORM REALTOR°
A
BUYER:Ji•n Dennis OFFICE•(901)112-7960 ���2LL
NOBILE-(90/)742-7960 nuuA11O.
IN(
SELLER:
SIORI TAR00.CON •
CERTIFIED TO:JIM DENNIS E A C T
Land Surveyors,Inc. ..e.,.,.R,e�.
This is 1 of 2 and is not vald without all s. / CAw»sls,e•,a1.1...yu
page pages IM»n I•We15a,.TtYnPw.S�s'I•rT w1e+.ILin11
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I► �, CITY OF ATLANTIC BEACH
'`' r OWNER / BUILDER AFFIDAVIT
rxj)
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 '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
LAW. THE EXEMPTION ALLOWS YOU,AS'HIE OWNER OF YOUR PROPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST
SUPERVISE THE CONSTRUCTION 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. TIIE 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 HAVE 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 OR MUNICIPAL LICENSING
ORDINANCES.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
I THE BUILDING DEPARTMENT 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE' TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826)IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
I' 4-4,./_ .L L...., ?( 2 _ >ff- 7
ADDRESS PHONE NUMBER
1—Q,4,A".a...1'7,
PRINT NAME
11 SIG E OAT
Before me this day of ,20_ in the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of ,County of j�
❑Personally Known 1 f 1 1. /t , 2 l 7 x -.
❑Produced Identificatio frilliP/ ` J I �J V
� �►u Notary Public State of Florida
Notary '•nature: ia� ��� ��,. Shirley L Graham
/• II c My Commission FF 08699C
pj p./ Expires 0211412018
F BLDG/Owner-Builder Affadavit,REVISED.4,16/2009
1
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH _~-,- -----
800 Seminole Road, Atlantic Beach, FL 32233 1 L L L
Office (904)247-5826 Fax (904)247-5845 1 1 -
Job Address: Y
4 _ — .■ Permit N .,,ber: /���
�1, a tat 5, i • '&1 ohs U ru. AN accm. . , ► S .,�3o) " '
Legal DescriptioL41-1,
...- , t a' A At I' , _ C L.. if Parcel# 1 li, —• i r, a-
,//'''' oor • ea o q, t. t
Valuation of Work$ �r"�1d• Proposed Work heated/cooled non-heated/cooled /7---
Class of Work(circle one): New ditio ■ Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Resi ntial
If an existing structure,is a fire sprinkler system installed?(Circle one : s—No N/A
Florida Product Approval#
For multiple products use product approva _orf m /'
Describe in detail the type of work to be performed: ‘.F fi G h J ;- ) 4 : iii,f
Property Owner Information:
Name:U i c 4-nna Fa Aural I- 1 af1tAgt posh v/wi Address: (0
(C (LCD Lt City -d-tc,,4c. be_aa. Stat� .Zip,/3ZZ33Phonet Uy —
D5- ( l Z a1( --(16,2_-
E-Mail or Fax#(Optional) ' 35
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 as indicated. I certify 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 If work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six_(6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical{York,Plumbing,Signs, Wells,Pools, Furnaces,Boilers,Heaters,
Tanks and Air Conditioners,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 cert fy that I have read and examined this a plication and know the same to be true and correct. All provisions laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granti of ng of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,state, or local law regulating construction or the performance of construction.
Signature of Owner V(C7l .QA /(Z?J+V( Signature of Contractor
Print Name VI C611 ck. (4-&-✓i e Print Name
Befo ,1- Before me
this I Wit' �, •2' 20 —, Day of ,20
fi.N.-'.' ''ub is ' :.. u,eue,o AWNS • •
'ublic
epuol j 3o a3e3S ollgnd hie3oN
Revised 01.26.10
ot.:11 r+ City of Atlantic Beach
` Building Department T APPLICATION NUMBER
j� ( o be assigned by the Building Department.)
800 Seminole Road /� 7/E — /���
,�� Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
`r j 10- E-mail: building-dept @coab.us Date routed: `6.
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
•
Property Address: /c AV 6gr/nct LI , ^,.. A
'4. nt review required Yes No
Applicant: 0 t() )") lL pp. Tninci&Zonin
L Tree A.ministrator
Project: (it Y r r CJ , e ii 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: Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING 0��� r// L,
Reviewed by: �` f Date:
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