1758 W PARK TER - FENCE CITY OF ATLANTIC BEACH
.�: 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
40.219.r.
FENCE PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
lob ID: 15-FNCE-2676
Job Type: FENCE PERMIT
Description: REPLACE FENCE
Estimated Value:
Issue Date: 11/16/2015
Expiration Date: 5/14/2016
PROPERTY ADDRESS:
Address: 1758 W PARK TER
RE Number: 172020-0360
PROPERTY OWNER:
Name: BELL SR TRUST, RICHARD W
Address: 1758 W PARK TER
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 TILE FLORIDA
BUILDING CODES.
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1 SURVEY NOTES ,
PAVER DRIVE CROSSES OVER PROPERTY (Vic) M _Px-MS ,s-a c P.C.UNE ON EASTERLY SIDE OF LOT. A-1--)P Po-)<4m!'}/'6
THERE ARE FENCES NEAR THE BOUNDARY
OF THE PROPERTY.
•
PAGE 2nF2PAGES
y9E ' Al N A
BOUNDARY SURVEY LB#7893
Z t F! c 4 T A"'
`�4 p qTq
4 l^ E TARGET
No.2883
SURVEYORS CERTIFICATE
I,��-I LLC
W
° a /HEREBY CERTIFY THAT THIS BOUNDARY SURVEY
e IS A TRUE AND CORRECT REPRESENTATION OF A
t SURVEY PREPARED UNDER MY DIRECTION.
'y'l• pCS,AN,OF . P NOT VALID
R EANOWITHOUT ANAUTHENTICATEDELECTRONIC SERVING ALL FLORIDA COUNTIES
,, R I {, SIGNATURE AND AUTHENTICATED ELECTRONIC SEAL,
it v - OR A RAISED EMPQttimA, I geGNATURE.
lyde O. (r�fY��e 6250 N.MILITARY TRAIL,SUITE 102
oN CN=ayue0.LkNeat. WEST PALM BEACH,FL 33407
C=US 04 Target
McNeal 9OU PHONE (561)640-4800•
(SM,NEI�) 2o+sm.zs 1e:oezg- FACSIMILE (561)640-0576
°a 0° STATEWIDE PHONE (800)226-4807
_ AA21 kwrrtx>Ilua3 STATEWIDE FACSIMILE (800)741-0576
N._
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rtttlttttttt .
v- ,.....--.•, .., , CITY OF ATLANTIC BEACH
\J IU%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 TI-TAT 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.
Jose t)A-i2� Ti2,2�}c 6- t,�J (5G i)8-7c:, - 'Ic' I
ADDRESS PHONE NUMBER
L-i-/,2,L'.-s 6Artic,c',-,
P, NT NAME
- - rl►01 s
SIGNATURE DATE
/ j��nn
Before me this day of ► �I�JVe m wf-2015—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 FL ,County of �);Jek,t =•1"m MY ALEX N.POWERS
%0 " COMMISSION#FF 897944
❑Personal! Known n
JR Pr y (�D r C�`Cam^ 7 0,3_o + !dr` EXPIRES:July 12,2019
Produced Identification- f� s Pf Bonded Thru Notary Punk llndtsrrriterts
,
Notary Signature:
qZ./ ��
F:/131,DQ!Owner-Builder Affidavit,REVISED:4/16/2009
I
1..A;Tr City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
2 Atlantic Beach, Florida 32233-5445 !'"/✓�� ' c �J v / 6
` Phone(904)247-5826 • Fax(904)247-5845
`�o�t E-mail: building-dept @coab.us Date routed: ////3//f
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: /75V 6,4 r Department review required Yes No
Building
Applicant: O f� E I`,, ,Panning & o ng,
ee Ham! is rator
Project: 1/1-77) C f, r Public Works
Public Utilities
(!Ir arg Public Safety
Fire Services
Review fee $ Dept Signature
Review or Receipt
Other Agency Review or Permit Required 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: dj�,..u., ( - Date: /,iJJi„f
TREE ADMIN. Second Review: A roved as revised.
❑ pp ['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
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904)247-5845
Job Address: /.75F- P Permit Number:
Legal Description Parcel#
Floor Area of Sq.Ft. q, t
Valuation of Work$ j/9'OO Proposed Work heated/cooled f} non-heated/cooled A.)%iJ
Class of Work(circle one): AMP Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial CResidential
�
If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No
Florida Product Approval#
For multiple products use product approval torm
Describe in detail the type of work to be performed:P cftcE- S -rrOry o F W&SrE2N anon/0412Y FC-n►E, ADD
P i H t..z r 0 P O R T 1 6 1 4 oN A T W\J 8o,440012-V. U R A--r y a.) tn.) w�s1-6-2N ac)DA-2.,' DOE— -r o F o R,-
S A•t'& y2E . ►J F 6-,u c r` -0 HA•t/E- SFr C�4 5.1 , F E-"J c E r0 HA -4PT'cr,9T-g
Property Owner Information:
Name: i[ c CA-k501) Address: 175 PA-12 K 76-P-12/4‹.6- IA/
City A--n-ii .►rre Ree+c-i State Fi-Zip3J.213 Phone (5C E-1.0 rc I
E-Mail or Fax#(Optional)Crtrus(4-w0Qo e'G i Art. Corti
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: 111/p. Qualifying Agent: i J/A
Address: N/ — City N/4 State OM- Zip I'J 41
Office Phone Job Site/Contact Number kJ/f} Fax# Aidel
State Certification/Registration# NJA
Architect Name&Phone# lJ/A
Engineer's Name&Phone# /O/M}
Fee Simple Title Holder Name and Address OA-
Bonding Company Name and Address r///A
Mortgage Lender Name and Address F444-6-5-p=1-a- 13►9•e■J(� Ro),31 1 '(I PsrrS t u 2&-r-1 pi-, 15aIQ_ ,/
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 tf work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a pertod 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,Healers,
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 certify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,state, or local taw regulating construction or the performance of construction.
Signature of Owner Signature of Contractor /J/Pr
Print Name ZI2.—c (, - ioOD Print Name 6/P-
Before r ,� r r Before yne
this C►"Day of f V 0y • 20�� this N/A-Day of /J/f l ,20
'any Pt )tic Al 4' ;;1:..' ;,+ RS Notary P�.iblic
MY COMMISSION*FF 887944
.1:a EXPIRES:July 12,2019 • Revised 0].26.10
' Pi' ' Bonded Thru Notary Pubic Underwnters