2033 SELVA MADERA CT 2016 FENCE ' '` \S CITY OF ATLANTIC BEACH
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-662
Job Type: FENCE PERMIT
Description: FENCE
Estimated Value: $4,000.00
Issue Date: 3/24/2016
Expiration Date: 9/20/2016
PROPERTY ADDRESS:
Address: 2033 SELVA MADERA CT
RE Number: 169506-1646
PROPERTY OWNER:
Name: WOLFROM. LEWIS J
Address: 6482 GRISTMILL SQUARE LN
PERMIT INFORMATION:
FEES:
Fence/ROW $35.00
Total Payments: $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
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2,), ,,:/!....A:,..-T.;:,„:„2,\ BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
-,=E)1119r Office: (904)247-5826 • Fax: (904)247-5845
I (6.--E"7 cc,- 6,6Z_
Job Address: 2 °33 S . /'"14 p ra- C-,- Permit Number:
Legal Description RE#
Valuation of Work(Replacement Cost)$ 171006 o° Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteratio Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial esidenti
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
V- e r\c_e__
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: L e S . U)o l-cr-e•---- Address: 2 o33 Se.l.-,_ f(a- ro- Cr
City f44-(0,,,4;c.. ,& Stateh.-Zip 3 2233 Phone SI I - V 3 6 - ,-o so
E-Mail l;t„)o(-cron1 J uee;aa,,_vAe_4-
Owner or Agent (If Agent,Power of Attorney o r
Agency Letter
Required) �J
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.
Con- . . . . ,. : 'on:
Name of Company: •ualifying Agent:
Address: Cites_ State Zip
Office Phone Job • II act Number
State Certification/Registration# E-Mail
Architect Name &Phone
Engineer's N. 1 - :• ' one#
Wo , - '- ompensation
Exempt / Insurer / Lease Employees / Expiration Date
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
Tnprior 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.
his 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 ofsix(6)months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,
Signs, Wells,Pools,Furnaces,Boilers, eaters,Tanks and Air Conditioners,etc.
i
Signature of Prope S wner: ∎ 7,1) —_ _—_ -
i tor:
Bef�r�ne � / TONIGINDLESPERGE•
this IC) Day of ,11�� li►1��� 4' MY C �t F4 . Da
� -I p:��:a= ��rS:0�to
.'•.';►,4,' '�'. Bonded Thru Notary Public Underwriters
Notary Public: _____ L.� ,otary Public:
I hereby cert�that I have read and examined this application 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 vio/late or cancel the provisions of any other federal, state, or local law regulating construction or the
performance of construction.
Rev. 3/14/16
:.•S 1.L14r
0 71 r
t,,-. -`.AC;';° CITY OF ATLANTIC BEACH
ACH
u� — 1J%WNER / BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA
CONTRACTING"REQUIRES OWNER/BUILDER TO AC NOW EDGE THE LAW:
"CONSTRUCTION
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.
°3 3 S�,lvc,.._ /`'LA__,a C-- S7/ 134- s;vso
ADDRESS
PHONE NUMBER
-7 _ 1
PR! N• E
/ oo y /
SIG • RE E a/co?
1 (n1,�(�1� �//��, DATE I
Before me this 1 8 day of 1 Y � kaiN 2L iD,the county of
Duval,State of Florida,has personally appeared herin by hiifnself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large, -te of F I ,County of V fQ
❑ ersonally Known r
roduced Identification •( ja A
(A lL/ 8 O4-4F-----)v
.s;;;;
City of Atlantic Beach APPLICATION NUMBER
} � Building Department
(To be assigned by the Building Department.)
800 Seminole Road / � ^ \
Atlantic Beach, Florida 32233-5445 I (IJ N ,
Phone(904)247-5826 • Fax(904)247-5845
AL-).219'i. E-mail: building-dept @coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: zo � S UV � f\Rj2\ j (pepartment review required Yes No
Building
Applicant: L1(S \JC-A,F2Om `�Vljl� nning &Zoni
ree Administrator
Project: - r ��C e 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: fKApproved. ['Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed Date: 3/2///‘
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. I 'Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09