385 Garden Ln - 5ft Fence ri - G'
S S\ CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J _jr' ATLANTIC BEACH, FL 32233
INS PHONE LINE 247 -5814
FENCE PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247 -5814
JOB INFORMATION:
Job ID: 15 -FNCE -2943
Job Type: FENCE PERMIT
Description: 5ft fence
Estimated Value: $1,350 00
Issue Date: 1/5/2016
Expiration Date: 7/3/2016
PROPERTY ADDRESS:
Address: 385 GARDEN LN
RE Number: 172020 -5206
PROPERTY OWNER:
Name: HINES ET AL, MICHAEL
Address: 385 GARDEN LN 385 GARDEN LANE
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.
,- S!.ait City of Atlantic Beach APPLICATION NUMBER
S ♦1
rJ k ; %so Building Department (To be assigned by the Building Departme t.)
s� 800 Seminole Road , /e ` - 29 2
9
1 Atlantic Beach, Florida 32233 -5445 ,�� f/V O .J
Phone (904) 247 -5826 • Fax (904) 247 -5845
o 0 Email: building-dept@coab.us Date routed /J
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 3 4,ede /"7'I Department review required Yes No
Building
Applicant: 6 ,ix) ' 71. L` d( CRranning & Zoning
n GG Tree Administrator
Project: c T t1 C L Public Works
Public Utilities
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: CgApproved. ['Denied.
(Circle one.) Comments: (/ Ct 1
�t 4'
BUILDING
PLANNING & ZONING Reviewed Date: 5
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
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: 38S 6orie ,4e. / 3223
Permit Number:
Legal Description
/J� . Floor Area of Sq.Ft. Parcel #
Valuation of Work $ • Proposed Work heated /cooled t
non- heated /cooled
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool /spa window /door
Use of existing /proposed structure(s) (circle one): Commercial Residential
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /A
Florida Product Approval #
For multiple products use product approval form S'?"
Describe in detail the type of work to be performed: .:;;; i - . f C f , / u L 0
Property Owner Information:
Name: :(1.642 I \ 36c 6-41 "t .A#t
City ., , i ` � Address:
h State Zip r Phone 9.. gl y 7 -S74 7 3a1 e, it o
E -Mail or ax # Optiona) II • - A • , _ ar •
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: °. ,(1 ',L ••• 4/ G-
Address: 31 Qualifyin ge t:
Ad Phone , er State Friffid FT:
� Job Site/ Contact Number Ty Zip 32 J 73
State Certification/Registration Fax Fax #
Architect Name & Phone #
Engineer's Name & Phone #
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
issuance
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
and void iif s cotm hat all menc work within bx performed or2if eet the standards co struction or ork is sus
e o abandoned for a of six This permit
the at a y timesa null
ter
wo 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 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, o local la regi ati g construction or the performance of construction.
f
Signature of Owner o � r�7 Signature of
g Contractor
'rint Name 14/• G 174 t / tP S Print Name
3efo• •e
his `'
�: 1 of ,� _ 20 (/
� Before me
a 1 . A. — -- - - -
this Day of 20
oriaa
Shirley L Graham otary Public
M' Commissi FF
, xpiros 02A 8 086990
Revised 01.26.10
J €
.�b yr
CITY OF ATLANTIC BEACH
'J% WNER / BUILDER AFFIDAVIT
4 ust 9 �
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 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.
38s 640QI Lin e , ,/i. /4 k nL , FL ' O \ f —S7, -7
PHONE NUMBER
44:
N Li .p / 44 n' , fr..
MU 2/ 2
T
,/, s -
DATE (((
Before me this day of i. 20/_6: the county of
Duval, State of Flori a, has personally app eared herin by mself / herself and affirms that
all statements and declarations are true and accurate. /
Notary Public at Large, State of FL , County of J (�
❑ P pally Kno
roduce • -. 'cation - ,i /
_ / 4 Y P O Notary Public State of Florida
Notary Signa � T�. Shirley L Graham
NIIW a 7 My Commission FF 086990
pj • Expires 02/14/2018
F Builder Affadavit; • VISED: 4/16/2009
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7I'ES: 1N THN•: PUBLI(' RECORDS ore FA( 11i:.,.4'(, 11 �... '
This is a boundary survey. I .y i 11
Flood zone x as best ascertained from Flood Insurance 1<1,ti:
s bes _ certa>_ � 1 .1994
I F'-
Rate Map, ctxnnunity panel no.l2.o15 000lo dated 4 11. s
Bearing datum based on s our 61 eI LIVE of c.AeoEL Lau 1!
13EIkn.. 1J.89 ' 08 4Le E BUilisi 1g anc 2..iTzIng
I HEREBY CERTIFY TO: MICUAEL . 1- ,IIJES , t...,o21.-,EST
Mo2TLALE ' Lot-1 rior,IrJE ALT, -1 LAUD TITLE 1Lmuf: AUCE
„� GcHPAL (
THAT THIS SURVEY MEETS THE MINIMUM TECHNICAL STANDARDS AS
SET FORTH BY THE FLORIDA BOARD OF LAND SURVEYORS, PURSUANT
Marvi ! .B ank TO SECTION 472.027 FLORIDA STATUTES AND CHAPTER 21 HH -6
� y ' FLORIDA ADMINISTRATION CODE.
2866 MANGROVE AVE. FLORIDA REGISTERED SURVEYOR NO 4470
JACKSONVILLE, FLORIDA 32246 Marvin R. Banks
(904) 641 -2520 SIGNED MAecF1 3o 19 94
SCALE: I" • z o•
3039
THIS SURVEY NOT VALID UNLESS THIS PRINT IS EMBOSSED WRH THE SEAL OF THE MOVE SIGNED