602 STURDIVANT AVE - FENCE ry\J\�� Sit 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-573
Job Type: FENCE PERMIT
Description: FENCE - 80'
Estimated Value: $1,000 00
Issue Date: 3/25/2016
Expiration Date: 9/21/2016
PROPERTY ADDRESS:
Address: 602 STURDIVANT AVE
RE Number: None
PROPERTY OWNER:
Name: MCWHIRTER ET AL, LYNN
Address: 13791 WINGFIELD PL
PERMIT INFORMATION:
FEES:
Fence/ROW $35.00
Total Payments: $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
0 b Office (904)247-5826 Fax (904)247-5845 I 6 _ N)C 5 73
Yit Job Address: 5'/i/rd t1UAt Permit Number:
Legal Description Parcel#
Q� Floor Area of Sq.Ft. q, t
Valuation of Work$ 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 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 — Lo Describe in detail the type of work to be performed: -i'PP/1 y be_ i n S7 (1ezf
aio pot i aiexh-e/114 70 -Pf-.
Property Owner
rtv Information:
Name:
City IQ h' U €V Address: C `t 41/i Al
ty StatI-L 7i 3;,7.-. .) Phone 90 f 'O 3 6 S-66
E-Mail or Fax#(Optional) Gt) A i r felt/ V be,((S o U J- • Mme'
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#
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 certibi 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 f work is not commenced within six(6)months, or if construction or work is suspended or abandoned for aperiod of six(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,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 cert�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 ofwork 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
orovisions of any other fed al state, or local law regul ing construction or the performance of construction.
Signature of Owner Y Signature of Contractor
3rint Name Ga.( I A G )( ( ,,,-
Print Name
3efore me Before me
his–]i" Day of - 71(Lotrat.— ,20 /IP this Day of ,20
"4":.' i'! Notary Public
Totary 1 i.• My CommubExpires Feb 10 2( 9' ;tt;'
,-�'�� 4 Commission#FF 169542.:' Revised 01.26.10
1 "''°'P Bonded through National Notary Assn.
ai'a,�.r�� City of Atlantic Beach APPLICATION NUMBER
Js � Building Department (To be assigned by the Building Department.)
800 Seminole Road c C�-7
r) Atlantic Beach, Florida 32233-5445 1 G- FN c-E. _ 5 ! 3
Phone (904)247-5826 • Fax(904)247-5845
�� E-mail: building-dept @coab.us Date routed: ...3./941,1p
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 40‘.e.- u (2Lp l v c 'pepartment review required Yes No
^ Buildin
Applicant: G f4 1 L_ 1 , \e TE -(Z —OW anning &Zonings
Tree dmimstra or
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: ,1C Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: � Date: 3/20 _
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 05/14/09
t L'vik
- ; CITY OF ATLANTIC BEACH
OWNER / BUILDER AFFIDAVIT
Ws I
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.
T6Md S — (00a i d1ta,d- 24 fL, 6/0 tc g'O3 (c 1l2C
I 'Y V,� 1 PHONE NUMBER
WeK
PRINT ME �l (VI t//'vl
SIGNARE
3 ) r
�/� ,,a., DATE
—1 Ill
Before me this day of I �. r p0 j in 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.
tr
Notary Public at Large,State of '� l� ,County of b Wal
1 HEATHER AL l``;
•Personally Known 4 ti —1..'1•%1 Notary Public-State at
}
❑Produced Identification-
( '-•. '` • My Comm.Expires Feb 10 ■1 :l
/ '~�rFd,�? Commission FF 1695 `
,''t ,,,,, Bonded tt mush National Not95
Notary Signatur �./
F:BLDG/Oier-Builder Affadavit;REVISED:4/16/2009