366 SEMINOLE RD - FENCE N \s, CITY OF ATLANTIC BEACH
} 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
J INSPECTION PHONE LINE 247-5814
FENCE PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-FNCE-859
Job Type: FENCE PERMIT
Description: 4FT FENCE
Estimated Value:
Issue Date: 4/12/2016
Expiration Date: 10/9/2016
PROPERTY ADDRESS:
Address: 366 SEMINOLE RD
RE Number: 170427-0000
PROPERTY OWNER:
Name: ANDERSON, MARY K
Address: 366 SEMINOLE RD
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.
01 A ,pfi�, City of Atlantic Beach APPLICATION NUMBER it PI I Js Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845 02-Ak-111c �? E-mail: building-dept @coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 36 , SiMiloll. j Department review required Yes No
Bui
Applicant: O ) /� —' Planning &Zoning
i ree Administrator
Project: LI 1 reA(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: Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: J/14
TREE ADMIN. Second Review: Approved as revised. ❑Denied. / v
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
i"Alj`4,. BUILDING PERMIT APPLICATION
JSr
• J-t\
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
rini9 Office: (904)247-5826 • Fax: (904)247-5845
Job Address: 3 40 4 j,e.frf/4o f.2 eo&L_ Permit Number:
Legal Description RE#
Valuation of Work(Replacement Cost)$ Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): grAddition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed strut re(s) (Circle one): Commercial Residential
• 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 detai '
l the performed:
/
Florida Product Approval# for multiple products use product approval form
Property Owner Information r- p
Name: Aal'/ l`, /dJ1Sor1 Address: 2 6 6 rn/K o 1� D a
City ((Hie/4Z,z., 4£et cl, State Zip Phone (- D q) 2 41 7_ 7 5-9a
E-Mai 161.1€-A- 36. 6 er yyta' ` . too,
Owner or Agent (If Agent,Power of AttomeKr Agency Letter Required)
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.
Contractor Information:
Name of Company: oft--t Qualifying Agent:
Address: City State Zip
Office Phone Job Site/Contact Number
State Certification/Registration# E-Mail
Architect Name & Phone #
Engineer's Name & Phone#
Worker's Compensation
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
pnor 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 Electrical Work,Plumbing,
Signs, Wells,Pools,Furnaces,Boilers Heaters, Tanks and Air Conditioners,etc.
Signature of Property Ow er: � (.A , ' ■ gr Signature of Contractor:
Befor e
this Day of ..I 111 .a I ' Before me this Day of
'‘‘§i Notary Public. /_ _ �/ ./i.,—__ Notary Public:
I her:,y ee':u4 thatalyhMA aid/ ldrW* ed this application and know the same to be true and correct. All provisions of laws and
ordi :11f. i ol'entiingytbisrgyhls,of work w 1 be complied with whether specified herein or not. The granting of a permit does not
pres r._ire t+Ht st&,vFajt&r c, cel the provisions of any other federal, state, or local law regulating construction or the
perf• fficketf c actelm2ota
A. — et 9 - Rev.3/14/16
1/177O )41lb it-A e 6,
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2.. ; CITY OF ATLANTIC BEACH
s>
(3%WNER / BUILDER AFFIDAVIT
�rIt 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.
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SIGNAT (114 DATE
Before me this i 2 day of 20Ln the county of
Duval,State of orida,has personal) ppeared herin by hi self/herself and affirms that
all statements and declarations are true and accurate. T�� ^
Notary Public at Large,State of F I ,County of l�Y�/K.
❑P rsonally Known / /_ �- '
ducedldentif`,1�'• v '7
Notary Signa Ar : Y�) Y'J
F.BLDG/Owner-Builder Affadavit.REVISED:4/16/2009 �] 2 — V "' 9 -e
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IS SHOWN AS A COURILS'Y ONLY AND DOES NOT CONSTITUTE A CERTIFCA17ON OF SAME.
TRI-STATE LAND SURVEYORS_,56 INC. 731_X235
8411 BA YMEADOWS WAY SUITE #2, JACKSONVILLE,
LEGEND BEARINGS BASED ON ---- LINE AS SHOWN.
• CRNC. MON THIS SURVEY DOES NOT REFLECT OR DETERMINE OWNERSHIP. • ;. °" __ '_ "'
• IRON COP. K
NOT VALID WITHOUT THE SIGNATURE AND THE 0RrG/IJAL RAISED SEAL .+�°;
(SET WITH CAP /LB +szr) �"
-x-FENCE OF A FLORIDA LICENSED SURVEYOR AND ;YAPPER. r
FURNISHED,o IRON C .(FOUND) THIS SURVEY BASED UPON DESCRIPROI AS I U„NISHED, AND WITHOUT
® CROSS CUT BENEFIT OF A TITLE BINDER/ABSTRACT OF i7TLE AND/OR DEED RESEARCH. i ce:;' .
B.R.L BUILDING RESTRICTION LINE � ^'•'',`":` ,
ESN`T EASEMENT LARRY a EDDY, P.L.c No. 4144
R/W RIGHT-OF--WAY SCALE / GLENN M. iROADSTREFT, P.S.Y. NO. 5814
CON COVERED AREA ,�_ / /
CENTERLINE ` i,., 1r.u_
A/C AIR CONDITIONING PAD -- �" - -.I
(R) RADIAL DISTANCE FIELD WORK DATE. 7-g- OQ ISTERED SURVEYOR AND MAPPER,
106713
MAP SHOWING BOUNDARY SURVEY OF
LOT Z(Z BLOCK -- AS SHOWN ON MAP OF
' 4t..-1-0411Z- 5>10 Al Z
AS RECORDED IN PLAT BOOK /0 PAGES 15 OF 77-IE PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA
CER7IF/ED FOR: /1/74LY /G . A//2 /z.50&/ ' rep/A Li %TAE or J4 C. 01J✓/c1� /lc_ .
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THE PROPERTY SHOWN HEREON APPEARS TO LIE WITHIN FLOOD HAZARD ZONE X AS 7SCA�ED FROM FLOOD
INSURANCE RATE MAP 0001 FOR THE CITY OF 4 7--L. . RCG/., FLORIDA DATED VV 61
IS SHOWN AS A COURTESY ONLY AND DOES NOT CONST1TUTE A CERT►FCATION OF SAME.
TRI—STATE LAND SURVEYORS, INC.
8411 BA YMEADOWS WAY SUl7E #2, JACKSONVILLE, FLORIDA 32256 (904) 731-7235
LEGEND BEARINGS BASED ON LINE AS SHOWN.
• CONC. MON THIS SURVEY DOES NOT REFLECT OR DETERMINE OWNERSHIP.
• IRON COR.
(SET WITH CAP i U3 4927) NOT VALID WITHOUT THE SIGNATURE AND THE OH1G/NAL RAISED SEAL
—X—FENCE OF A FLORIDA LICENSED SURVEYOR AND MAPPER._ _
0 IRON COR.(FOUND) THIS SURVEY BASED UPON DESCRIPTION AS FURNISHED, AND WITHOUT
0 CROSS CUT BENEFIT OF A 777LE BINDER/ABSTRACT OF 37TLE AND/OR DEED RESEARCH. 1 •
B.R.L BUILDING RESTRICTION UNE
ESU•T EASEMENT = ZO • LARRY G. EDDY, P.L.S. No. 4144
R/W RIGHT—OF—WAY
SCALE: / GLENN M. EROADSTREFT, P.S.M. NO. 5814
COU COVERED AREA l l t f'"-'� //
C CENTERLINE