1822 SEMINOLE RD - FENCE \ss. CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
j 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-2789
Job Type: FENCE PERMIT
Description: FENCE
Estimated Value: $5,700.00
Issue Date: 12/14/2015
Expiration Date: 6/11/2016
PROPERTY ADDRESS:
Address: 1822 SEMINOLE RD
RE Number: 172020-0508
PROPERTY OWNER:
Name: STEPP, GARY L
Address: 650 N ST JOHNS DR
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.
i1A;k, City of Atlantic Beach APPLICATION NUMBER
fr ,�� Building Department (To be assigned by the Building Department.)
800 Seminole Road
=' � Atlantic Beach, Florida 32233-5445
� r Phone(904)247-5826 • Fax(904)247-5845
%o;t p'1- t• E-mail: building-dept @coab.us Date routed: 1 Z ' Z (t E
City web-site: http://www.coab.us J
APPLICATION REVIEW AND TRACKING FORM
Property Address: L 8ZZ S EA\ i t' O LE RID Department review required Yes No
Building
Applicant: AcNCLt Cd}rn Err _ 0( ) Mannino&Zoninq�
Tree Administrator
Project: 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: JEApproved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Qom.- ��
Y � Date: /z/V/,r
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: 112,2 S& Ivt? S )6. Permit Number:
Legal Description Parcel#
Floor Area of Sq.Ft. t
Valuation of Work$5700. 00 Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): 4 Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial (kesidenti
If an existing structure,is a fire sprinkler system installed?(Circle one): N/A
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed: Fakl C& RE Poi it/r
Property Owner Information:
Name: 1 I C .[, tr Address: 122 V l/ 2t2 /W
City i� '/ r Stat ,(�Zi �Pho ?t g� ‘.77r
E-Mail or Fax#(Optional) 5.&41C-04/4A/ �p��977•JUL r vT
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: Qualifying Agent:
Address: City State Zip
Office Phone Job Site/Contact Number Fax#
State Certification/Registratio :
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 insta ,tions as indicated. I cert fy that no work or installation has commenced prior to the
issuance o a permit and that all work will be performed to meet the slaw',p p � of all laws regulating construction in this jurisdiction. This permit becomes null
and void f work is not commenced within six(6)months, or if construction . work is suspended or abandoned for a period of six 16)months at any time after
work is commenced I understand that separate permits must be secured for . ectricat 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 INTEND TO OBTAIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
t hereby ert fy that I have read and examined this a placation 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
2rovisions of any other federal,state, or local law regulating construction or the performance of construction.
signature of Owner Signature of Contractor
•
'rint Name 7U � "i �� Print Name
iefor e �, Before me
is G. I,y of k_b. . 20 Day of ,20
1 /__` -tt 7:. TOi I MISSION#FF 924951
rotary Public s: EXPIRES:October 6,20lgot Public
I,'f Rte R..•` Bonded Thru Notary Pubic Underwriters
Revised 01.26.10
CITY OF ATLANTIC BEACH
®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 TIIAT
LAW. TILE 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 TI-fAT YOU BUILT
IT FOR SALE OR LEASE, WI-IICI-I 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
I,ICENSES 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,
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.
'L 2 5 /17, /OZ: i . fib LaC 677cr
ADDRESS PHONE NUMBER
N6Y (510/
RINT NAME
7ALy-, (2.72//‘
SIG ATURE DATE
Before me this day of Q l_ ,20� e county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are rue aand accurate.
Notary Public at Large,State of ` .County of 0 V Q, \
❑Personally Known
Cjikoredeeed Identification ilk • •
t''' TONI GINDLESPERGER
1111011 M =;4 44 ' MY COMMISSION#FF 924951
s.; EXPIRES:October 6,2019
Notary Signatur-- ~ jjCA Bonded Thru Notary Pubfic Underwriters
W.
F:BLDG/Owner-Builder Affadavit;REVISED:4/16/2009
031V301 ION S3llfllfl/SNOIIVcNf10d ONf1080830Nf1 'AINf103 SI141 30 5080338 3f8fld 3H1 NI ONfIOJ 38 AVW IVH1 dVW SIH1 NO
NMOHS SV IVld NO 03SV8 SON8V38 NMOHS ION 38V 1VH1 SNO110181S38 210/ONV SIN3W3SV3 1VN011100V 38 AVW 383141
(M/8 ,001 '09ZZ ON Od08 AINf103)
3A180 b'18eif J VS
1
1
a
co
03 C I
V
I
I I £ 101 > I N
(d),001 Z w I
(10b)49L'66 (IOv)M„6S,85.69 I J 33n183s 113M3S 3S110H A21V1INVS
Otld 012110313 dVJ ON I i c3lONIS 31VAI8d 210d 1N3W3SV2 ,S
0800 ,9'CX,9'E Od'1,Z/! 'ONd `' dVJ OH
I •S O i-v 3Nf7 NO ''d'1 2/I "OW
'�� r NNM •• ....\ �v L 0 3)A9J3S 2J3M3S 3S110H A2itl1INVS
x 0800 ,5"Z _TOMS 31VAI8d 2J03 1N3W3SV3 ,S
i 1.9� I B'BZ F-
a i oo 0
o� Q 4
0 0 0 IP 8 r •.c M
o� F0 a :- Y 1101 � °'
�� 0 -
a)
to .I.'` r w +
�... mQN P-
_, N in
O O Q W 0800 , I `��� Opc'S C).�
F
Z , , , 0 0t`4k 3o N Q0_ O
O ON . o ' 08 vcl. 1 33
NZ (� • �, �I -110 a. ' 6'21 v
> ix- •AtlM3AI80. m x In N
Z w 'O^ '01400• �I °i :r a 2J3NOLLION00 81V e O P
Q) V/ .� • I N� N OVd 9NO3 .cX,c' . 0
O P kt..69 //,6 .1 I_ ,z v.} Oh 103 sz 0 z
C� r& C+�
"�
"act
dVJ ON
'd'l .Z/I 'OKI •X ,S-0 ,S'0 .co. $O
• _IL_—
'90 33833 000M ,9 •i 0 dY3 Orr
O3HS 1V13M1 d l,Z/J aN:
,00'001 (IOv)3„8Z,99.68S I
I (d)3„61.,LS.68S I N
I I ~
0
I Slol I -J
I
SI/OI/ZO 'Z,Lya ,OS=„I :TWOS
NOILV 10&1OD 20VO,L?IOW WOQLL2I.4 !ANVdWOD SONV If1SNI aI,LIJ. QNV'I 2i00,LSSM
'ONI S3OIA2I3S mu TIVCINMI 1.,LIWHOS Of AONV'N ''23f 'J.LIWHOS 'H Q'IwNOQ :O,L QEI,iLLeao
'VIA '4.LNf10O 'IVAf1Q ,d0 SU ODZZI Dfl8fld ,LNKI2If10 aH,L 3O 'OZ STJd '9E MOOS J.V'Id NI Qau2IOOS8 SV
6 .ON J.LINn V.NTINVIAI VAlaS
AO dVI'I NO NMOHS SV ` I x0O12 `f7 101
JO A A lfiS X1VQNnog DNIA&OHS dYN