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1505 JORDAN ST - FENCE (2) s\\ CITY OF ATLANTIC BEACH J 800 SEMINOLE ROAD 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: 16-FNCE-526 Job Type: FENCE PERMIT Description: 3 - 3/5 FENCE Estimated Value: Issue Date: 3/8/2016 Expiration Date: 9/4/2016 PROPERTY ADDRESS: Address: 1505 JORDAN ST RE Number: 172296-0010 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 FLORII):� BUILDING CODES. ` i-o-u rn City of Atlantic Beach Js APPLICATION NUMBER ,,�� Building Department (To be assigned-by1he Building Department.) J,: -800-Seminole Road /� 'I f. Atlantic Beach, Florida 32233-5445 /l0 F/VC Phone(904)247-5826 • Fax(904)247-5845 / "�ni.Sr' E-mail: building-dept @coab.us Date routed: � 2 //e0 City web-site: http://www.coab.us jjj APPLICATION REVIEW AND TRACKING FORM Property Address: Sara ,S�ja:1-0/4 7) Department review required Yes No Build',. Applicant: 0td die Planning &Zoning 3 V - • Project: _ - . 7) 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: XApproved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING // Reviewed by: / Dater/./ I( TREE ADMIN. / Second Review: DApproved 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: Revised 07/27/10 I ilr BUILDING PERMIT APPLICATION • CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: 15 h. c5 A c\ .&* Permit Number: Legal Description Parcel # Floor Area of Sq.Ft. Sq.Ft Valuation of Work$ di 6bO Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): dip Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structures)(circle one): Commercial 'esidenti. If an existing structure,is a fire sprinkler system installed? (Circle one): • •s No N/A Florida Product Approval # For multiple products use product approval orm (Describe in detail the type of work to be performed: 3\ ` - --�f,��, k C 3' - ec &: �n �� %- `� Property Owner Information: Name: tw■ �` –� Address: \ W O,-U�1 City 41� :r��4 & State I ip 3?�.37Phone ' -�-- °�'Z�-- 3 L\ E-Mail or Fax# (Optional) Contractor Information: CONTRACTOR EMAIL ADDRESS: Company Name: Qualifying Agent: Address: City State Zip Office Phone Job Site/Contact Number Fax# State Certification/Registration# Architect Name&Phone# 1n1E ( l- t Engineer's Name&Phone# 1111 1111 Fee Simple Title Holder Name and Address Bonding Company Name and Address 11:a� �11�� Mortgage Lender Name and Address 11111 X1 11 Application is hereby made to obtain a permit to do the work and installations as indi ated. I certi t at no wor' • •llatio has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all la s regulating construction in this jurisdict.n. This permit becomes null and void f work is not commenced within six(6)months, or if construction or work is . - ••••• • . . .. o s (6)months at any time after work is commenced. I understand that separate permits must be secured for Electrica Work,Plumbing, 1gns, "e , •a• , 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 thisplication and know the sane 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 provisions of any other federal,state, or local law regulating o ti uction or the performance of construction. Signature of Owne ��V I g �� Signature of Contractor Print Name `S" \' c cC N\\/V-- Print Name Bef• go . 41 Before me this D. • /a/ ,20 / this Day of ,20 —.Mk � +_I) otary Pub is g 'Y L Graham Notary Public My Commission FF 086990 Exp los 02/14!2018 Revised 01.26.10 ` CITY OF ATLANTIC BEACH \\,';-•:../.-_______:.)E);,19,- 'i% 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 TIIOUGH 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, WI-IICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST 13E DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE TI-IAT 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. 1 D� --: 1.7 cc -- c %)14-97,3-396,-1 ADDRESS P NUMBER �INT NAc�� cc \eX- P //Q. — a- \ \. ) URE DATE Before me this 2— day of / r `___. 20 n the county of Duval,State of Florida,has personally appeared herin by Ifin4self/herself an affirms that all statements and declarations are true and accurate. j� Notary Public at Large,State of r L County of * -V , cotxf��, Notary Public State of Florida ❑Personally Known .� .b :'11 a Shirley L(.,�,nam v My Cr'+wn1•+t.on FF 086990 educed Identification- / 0 0 E •<-0?/14,2018 L-4----- Notary Signatur • —a/ �,•I J f / _ _Ca - U F:/BLDG/Owner-Builder Affadavit REVISED: '/16/2009 MAP SHOWING SURVEY OF A PART OF LOT 1, BLOCK 2, ED SMITH SUBDIVISION AS RECORDED IN PLAT BOOK 26, PAGE 50 OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA, BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS: FOR A POINT OF REFERENCE, COMMENCE AT THE SOUTHEAST CORNER OF LOT 1, BLOCK 2, ED SMITH SUBDIVISION; THENCE NORTH 0'15'00" WEST ALONG THE WEST LINE OF LOT 1, A DISTANCE OF 53.33 FEET TO A POINT ON THE NORTH LINE OF PARCEL No. 172296-0000, AND THE POINT OF BEGINNING; THENCE CONTINUE NORTH 0'15'00" WEST ALONG THE WEST LINE OF LOT 1, A DISTANCE OF 20.66 FEET TO A POINT ON THE SOUTH LINE OF PARCEL No. 172296-0030; THENCE NORTH 89'36'00" EAST ALONG THE SOUTH LINE OF SAID PARCEL No. 172296-0030, A DISTANCE OF 100.00 FEET TO A POINT ON THE EAST LINE OF LOT 1; THENCE SOUTH 0'15'00" WEST ALONG THE EAST LINE OF LOT 1, A DISTANCE OF 20.66 FEET TO A POINT ON THE NORTH LINE OF SAID PARCEL No. 172296-0000; THENCE SOUTH 89'36'00" WEST ALONG THE NORTH LINE OF SAID PARCEL No. 172296-0000, A DISTANCE OF 100.00 FEET TO THE POINT OF BEGINNING. ------- -------- ------ I c I LOT 2 I 1 PART OF LOT 2 28'r PARCEL 172296-0040 ` I LOT 13 I N I 4 I I S.0' / ` I O -- -- ---- ---- ----� 20 I o Q I PART OF LOTS 1 AND 2 LOT 2 PARCEL 172296-0030 �.: I 73 > FOUND 1/2'IRON _______ p _-___ D = z PIPE.NO CAP R 28'06 E 98.09' FIELD] I> -i EAS Z N89'36'00"E 100.00' LOT 1 FDUNO 1/C•rs c HPE.No cAP w 0 O zo O 9 PART OF LOT 1 51.3' 1 .1 Lw cRE,E 0 N, o`6IV O 2 STORY N O o°o za _i DI o, U1 coNORE1t Drams a BRICK m■ • E (..n---—--—--— m °z e p I ICDNCREiE wALK ` NoW11505 SE I"/cI p G ---1 N S89'36'00"W 10 00 0 FOUND 1/2"�°N® M E PIPE, NO CAP I S89'36'00-W 99.91' FIELD) .,;, POINT OF I 1 2APRON PART OF LOT 1 BEGINNING PARCEL 172296-0000 O I oI _J LOT 14 Oc G I N N �iL I I u N CJ11 PART OF LOT 1 w uI PARCEL 172296-0020 POINT OF 26.7 �I REFE- RAE I NOTES: �__�- 1. THIS IS A BOUNDARY -- __ SURVEY. D ONN ER'S — 2. BEARINGS ARE BASED ON R OA D 1722968 000NBEIO GPNORTH 40' RIGHT OF WAY 89'36'00" EAST, AS PER PAVED OFFICAL RECORDS BOOK 15731, PAGE 933. 3. NO BUILDING RESTRICTION I IAJFC PCP PI AT