333 SARGO RD - FENCE ' j
" \o, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ix ATLANTIC BEACH, FL 32233
\ N INSPECTION PHONE LINE 247-5814
FENCE PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-FNCE-498
Job Type: FENCE PERMIT
Description: FENCE - ADD NEW
Estimated Value:
Issue Date: 3/3/2016
Expiration Date: 8/30/2016
PROPERTY ADDRESS:
Address: 333 SARGO RD
RE Number: 171700-0000
PROPERTY OWNER:
Name: Warren, Thomas Raymond
Address: 333 SARGO RD ATLANTIC BEACH, FL
PERMIT INFORMATION:
FEES:
Fence/ROW $35.00
Total Payments: $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WI ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
4 0!...V.rie . ,City of Atlantic Beach
v j'' GI Building Department APPLICATION NUMBER
s� 800 Seminole Roan
{To be assigned by the Budding Department.)
15 �,- Atlantic Beach, Florida 32233-5445 J —�- �V
Phone(904)247-5826 • Fax(904)247-5845 E-mail: /
'"1.o;1»� building-dept @coab.us Date routed: Z�(
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address:333 SW-- O R-C Department review required Yes
q No
1 , Buildi,.
Applicant: (j)wC.-ik., 1/l.((aRkE - Owtoe !_Plannin. &Zoning
Tree A.mini _ •
Project: ~ E1u 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: AC Approved. ['Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING _
Reviewed by: �/�Date: 2,/Oy/i
TREE ADMIN.
Second Review: []Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:
Date:
FIRE SERVICES Third Review: DApproved as revised.
❑Denied.
Comments:
Reviewed by: Date:
2evised 07/27/10
i
I •
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845 1G - F(A)Q- 498
Job Address: ?j3 r5 n Permit Number:
Legal Description (J� Parcel #
Floor Area of Sq.Ft. t
Valuation of Work$ Proposed Work heated/cooled
non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structures (circle one): Commercial (ResidentiRD
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
Describe in detail the type of work to be performed: —10Y1-1-- kvL, i C h �� p �� 4- ��- huh
' i kd 6 n 3c,,r k/e
Property Owner Information:
Name: 1 OMGtS &tNe,n NOif(en Address:
City di / i State FLZi 2_2,-3- Phone�`� r(1)(o3-
E-Mail or Fax#(Optional) p 3 j (5(�3 44q
,3y-4P VICAIAC,r vtl�CyMG 11 ,l prvt
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: Qualifying Agent:-'
Address: City
Office Phone Job Site/Contact Number State Zip
State Certification/Registration# 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
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 ElectricalWork, 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 o/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
'rovisions of any other federal,state, or local law regulating construction or the performance of construction.
3ignattue of Owner Signature of Contractor
'Tint Name Print Name
�.e I fr'Jy.... rem
3efi •= pt'
zis ay of P 01 20 Before me
this Day of 20
Iotary T.
:
lc ``,i r MYCO " • 1
:.; Notary Public
�. •,4 EXPI•- :Oc••=r6,2019
•
'ARs....° Bonded . . Public Undenwiters
Revised 01.26.10
— s CITY OF ATLANTIC BEACH
y OWNER / BUILDER AFFIDAVIT
'm
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 WTTHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WIIICH 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 TFIAT 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826)IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
353 Sar-F P1 3)(�la3-4�7-
ADDRESS P NE NUM ER
G�v1doIyn WGrye n
PRINT NAME G 1' '
SIGNATURE \�_.- �'� (J�
DATE
Before e • day of Fel) 2)6n the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large, �-of r ,County of_�f( 1\1
Personall Known .i ,
Proroduced d Identification- '.1�.^/ ` dp
IFAMR � t
�,: TONI GINOLESPERGER
Notary Signature: v.
•
•1 = MY COMM tt FF 924951
� y; :a EXPIRES:October 6,2019
,; '•'d Bonded Thru Nast Pubic lhderwrilea
t n
F�lBLDG/Owner•Builder Affadavit;REVISED:4/16/2009
Boundary
Survey _f
LOT 18 LOT 17
BLOCK 25 BLOCK 25
S 0715'02" E 80.65' (PLAT)
• S 0715'29" E 80.53' (MEASURED) o
x 0'DRAINAGE AND UTILITY EASEWENT . = x Lt
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• •• - 328.01'(RSSEAURED)
N 0715'08" W 80.69' (MEASURED) BLOC(
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(60'RKIIIT OF WAY)
23'ASPHALT
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RLS N:06-12-1028
WENT
ADDRESS
� � M.2012-1031331
...::;- FIELD DATE 12-15-05
333 SARGO ROAD DRAFTER:AS
1'- 20' ATLANTIC BEACH,FLORIDA 32233
GRAPHIC SCALE APPROVED.FLT.
LEGAL DESCRIPTION:(AS FURNISHED) SCALE:1•-2(7
LOT 8,BLOCK 25,REPEAT OF PART OF ROYAL PALMS UNIT MO A AS RECORDED IN PLAT BOOK 31, __=ME
PAGES 16.18A THROUGH 160 OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY,FLORIDA __
BASIS OF BEARINGS:BEARINGS ARE BASED ON THE PLAT BEARING OF$(WOW W W ALONG THE SOUTHERLY BOUNDARY UNE OF SUBJECT PARCEL
LIST OF POSSIBLE ENCROACHMENTS: NONE
SURVEYOR INFORMATION: COORDINATED BY:
WIEN RESIDENTIAL , ..E,,
r •am Ray Thompson c*s
Jis.SURVEYING. Inc. LAND SERVICES,INC. % 41"
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UNWEANED OA ASIOIED. Reviewed&Accepted by:._.____ _._ Date . _.___ I Date __