325 4TH ST - FENCE PERMIT ' . `` !), CITY OF ATLANTIC BEACH
-"- .2 800 SEMINOLE ROAD
f-. ATLANTIC BEACH FL 32233
\ '
INSPECTION PHONE LINE 247-5814
FENCE PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-FNCE-2509
Job Type: FENCE PERMIT
Description: 6ft fence
Estimated Value:
Issue Date: 11/4/2015
Expiration Date: 5/2/2016
PROPERTY ADDRESS:
Address: 325 4TH ST
RE Number: 169833-0000
PROPERTY OWNER:
Name: Kline, Christopher John
Address: 325 4Th ST
PERMIT INFORMATION:
FEES: ---- -Fence/ROW $35.00
Total Payments: $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office (904)247-5826 Fax(904)247-5845
lob Address: ,3?c5 441 S+ AA-WA-lc ack r---L Permit Number:
regal Description
5-l.Q'I l lQ -.5- °1 f Parcel# I 11)61 g�3 -00(X)
Floor Area of Sq.l:t. Sq.l•t
ialuation of Work$ J,DOO Proposed Work heated/cooled non-heated/cooled
7-lass of Work(circle one): Addition Alteration Repair Move olition pool/spa window/door
Jse of existing/proposed structures)(circle one): Commercial Residenti
tu
If an existing structure,is a fire sprinkler system installed?(Circle o • No N/A
lorida Product Approval#
For multiple products use product approval form I n `
Describe in detail the type of work to be performed: r n.6v� r -F Old •-ko 4v1 2 Slc1 e S 0 f
-- Pro r OA1a 0. rle ) -row- pu-4 t +3 ( .
Property Owner Information:
Name: S h LC) Kt t r1 Qi Address: 3.95 _4 3+'
City Aa ' • C i'1 • State Zip 7a33hone 261 •43r1 . s-21.-2 cg
E-Mail or Fax#(Optional) 5 ti OMa-t I6 jtJiO.EJW
Contractor Information:
=� Qualifying Agent: ` • ��e •-� -j/1
Company Name: 1 C1( C2 • d f5 g SGYt , I !fie �(— Zip 3aas
Address: O ,'n ��r� City
Office Phone 6 �$3• i.o 3
°I J. t - ontact Numbettc(1 /a • 38_ .a_ _ # Gi o-a.(..n• ,t..g
State Certification/Registration#
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance ofa permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for aperiod of six(6)months at any time after
work is commenced I understand that separate permits must be secured for Electrical-Work,Plumbing,Signs, Wells,Pools, Furnaces, Boilers,Heaters,
Tanks and Air Conditioners,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU BRECORDING WITH
YOUR LENDER OR AN ATTORNEY BTO OBTAIN EFORE OUR NO IC OF
COMMENCEMENT.
I hereby certify that I have read and examined sthis iplacation and know the same to be true and correct. All provisions of laws and ordinances governing this
type f work ill other e f complied state,h whether
or therl law regulating construction Brae performance ofmae permit cdoes not.presume to give authority to violate or cancel the
p f any federal,
144
Signature of Owner — ,• I. /-1....4-4,_, Signature of Contractor
Print Name SKi }•
10._.__..... .�t!'?t Print Name ....
Sworn to and subscribed,before me Sworn to and subscribed before me ,20
this )-/ Day u.G ......,00 f0 bt�- 20 i`j this pAm"tt,...._.......
o`'" •O '• !•N MYCOMm..I....#dFF157186
_, ;_DAVID EARL FLEISCHMANN a..
• 1 MY COMMISSION#FF1571ae rxatAFS September 4,2018
Notary Public'.1,;,mod ' EXPIRES September 4,2018
Notary Public
I t!:• ri•• FIntichNotary$PICr corn
Revised 01.26.10
�`� CITY OF ATLANTIC BEACH
'J fi%WNER / BUILDER AFFIDAVIT
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 THE 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. THE 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 REOUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
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.
37/c '4-' $C--Ke-e41°C( 707 ?"lsc'
ADDRESS PHONE NUMBER
C(..rtS �(rfn42.—
PRINT NAME
t 0/2-Z7/ce-
SIGNA 7 ///�6-1—' t‘he
Before me this 2Z.day of 1 ,20 t the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are truprid accurate.
id
Notary Public at Large,State of ` ,County of ZZA/g..-
Povally Kno• L - i
uced I••ntifica .n-
Nota :.,,t . fir__ Notary Public State of Florida
Shirley L G.-aoam
F:BLDOIOwner-Builder Affadavit;REVISED:4/16/2009
1;,-
�,o,,olP MY pines 2/14/2 FF 086990
rr Expires 02/14/2018
g2-' I L 7
.;f!_:+;v ,, City of Atlantic Beach
APPLICATION NUMBER
;• ilk �, Building Department
,a (To be assigned by the Building Department.)
f� tla tic Seminole Road ! ICJv 6 J
��4 - -- -r Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 Fax(904)247-5845
E-mail: building-dept @coab.us Date routed: AO 22AS
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: .32,4K s7-- Department review required q Yes No
Building
Applicant: 0 to 7) k nning &Zoning
Tree Administrator
Project: _ 6 I IL, C Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature •
Other Agency Review or Permit Required Review or Receipt
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: ]Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING / !
Reviewed by: .O Date: t Z u
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
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