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38 STANLEY RD - FENCE „ r” I �� CITY OF ATLANTIC BEACH _ 800 SEMINOLE ROAD `'� ��,J ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 j''l/---z______...-l01119';"' FENCE PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 16-FNCE-886 Job Type: FENCE PERMIT Description: FENCE AMDE FROM PALLETS Estimated Value: $0.00 Issue Date: 4/22/2016 Expiration Date: 10/19/2016 PROPERTY ADDRESS: Address: 38 STANLEY RD RE Number: None PERMIT INFORMATION: FEES: Fence/ROW $35.00 ITotal Payments: $35.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACII ORDINANCES AND THE FLORIDA BUILDING CODES. ``/j, \ ATLANTIC BEACH -,1.)' )-�) PERMIT RECEIPT PACS _� 6 12 PERMIT DESCRIPTION: FENCE AMDE FROM PALLETS IR 2 �,�gEPCK PERMIT NUMBER: 16 FNCE 886 0` . OF P(\-�`N IN ADDRESS: 38 STANLEY RD eftil OWNER: P DATE ISSUED: FEES DUE: Fence/ROW $35.00 Totals: $35.00 WJmCx/l m t'(e ch lot 403n-Act 11 . Cc r►\ NI i COPY s rs '-LAIi-, BUILDING PERMIT APPLICATION FILE _ . 15 z' CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach FL 32233 1"`u'tl9r lS( ce, Office:(904)247-5826 • Fax:(904)247-5845 Job Address:36 S r64 f P P, 32233 /6 -/1t°/ f - e916 y Permit Number: Legal Description �J RE#_ Valuation of Work(Replacement Cost)$ 0 Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): New Addition Alteration Repair Mo = `- . Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial 'esid-. .. • 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 Remftq, Describe in detail the type of work to be performed: Florida Product Approval# for multiple products use product approval form Property Owner Information Name: J 4- &s Address: 3g V /0 4t 081 R 32233 City C Stati Zip32-133 Phone lbc( 3 V -7 i6,1 E-Mail h/°Man.siry ksa e/- in a 0, c 7, Owner or Agent (If Agent,Power of Atto ey or 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: 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 Tnor 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 work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of (6)months at any time after work is commenced. 1 understand that separate permits must be secured for Electrical Work,Plumbing, Signs, Wells,Pools,Furnaces,Boil s,Heaters, Tanks and Air Conditioners,etc. Signature of Prope ►, •wner:Boil 1 Signature of Contractor: Beforg,pae g this I. Day of 'Mr-( -�A ( '.�� :-fore me this Day of r `c? I GINOLESPERGER Notary Public:\ �-�ii i ,+ � MISSION K FF 924951 �,Public: FNotary;Lbfic Undermiters I hereby cert�that I have read and ex: - ,- , ion and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be c.-d 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 construction or the performance of construction. Rev.3/14/16 r .tt:'r/7-4, t, 'A CITY OF ATLANTIC BEACH 9, v UV WNER / BUILDER AFFIDAVIT 0.9;:Sf1 ' 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 PERMTC 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 I IAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WIIICI-I IS IN VIOLATION OF TI-IIS 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. giaitiey rcl 411(W-ti RC 37233 �� 3 3-7/h AD RESS / PHONE NUMBER Lf�ne't r�c /' PRI T NAME SIGNATURE DATE Before me this'6S day of 1 ally t—� kbin the county of Duval,State of Florida,has person ppeared herin by himself/herself an affirms that all statements and declarations are t e and accurate. Notary Public at Large,State of ( ,County of13 0 J Personally Known Or.A—4-� l.S�O- c 0 < ---C Produced Identification- T !`/l Timer. Notary Signature: ,:,::4.' :::::::::::19 ry g �► 951 1 FAILDG/Owner-Builder Affidavit;REVISED:4/16/2009 U Notary PubGC UndetWtiters rig yr�, City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) • `v 800 Seminole Road �1 _ G 5 � Atlantic Beach, Florida 32233-5445 �— lam' c )J(p Phone(904)247-5826 • Fax (904) 247-5845 /� / � 't0;119>" E-mail: building-dept @coab.us Date routed: 4 /LS I t (73 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address:.3v 0,[\_1 - De.artment review required Yes o Applicant: -3 ane-k O S (D Wne 111111:aanning &Zoning c� Tree �• • raor Project: `� f�� e ork. `� W l h- Public Works Public Utilities - S 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: BUILDIN PLANNING & ZONING 9-/ S^�� - - Reviewed by: �C)j/ Date: TREE ADMIN. Second Review: ❑Approved as revised. ❑Deni 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 �svr�J� City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) -y 800 Seminole Road fir N v Atlantic Beach, Florida 32233-5445 1 C� • Phone(904)247-5826 • Fax(904)247-5845 /�, ` �J;3I9� E-mail: building-dept @coab.us Date routed: `-t`• l S City web-site: http://www.coab.us ° APPLICATION REVIEW AND TRACKING FORM Property Address:3ej 2-'-ci-l`l • De•artment review required q ed Yes No :uil • Applicant: aCleA O OjeN CD Dr Q C— ing &Zoning Tree A• .ator Project: ' -r O e Public Works ( Public Utilities �Q L 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: KlApproved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: ��..L.�� spate: // jr /i TREE ADMIN. Second Review: A roved as revised. ❑ pp ❑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