860 BEGONIA ST - FENCE s, CITY OF ATLANTIC BEACH
A l 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
J /v
INSPECTION PHONE LINE 247-5814
J;319?
FENCE PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-FNCE-988
Job Type: FENCE PERMIT
Description: FENCE
Estimated Value: $800.00
Issue Date: 5/3/2016
Expiration Date: 10/30/2016
PROPERTY ADDRESS:
Address: 860 BEGONIA ST
RE Number: 170926-9950
PROPERTY OWNER:
Name: WORSHAM, ARTHUR RICHARD
Address: 554 BOWLES ST
PERMIT INFORMATION:
FEES:
Fence/ROW $35.00
Total Payments: $35.00
PERMIT IS •PPROVED ONLY IN ACCORDANCE WIT11 AI.I. CITY OF A'I'I.ANI'IC IWACII ORDINANCES AND THE FLORIDA
BUILDING CODES.
�S�:Lyf City of Atlantic Beach APPLICATION NUMBER
t, ;�� Building Department (To be assigned by the Building Department.)
800 Seminole Road _
Atlantic Beach, Florida 32233-5445 lD (Vl -
Phone(904)247-5826 • Fax(904)247-5845 1 Z�
E-mail:EE-mail: building-dept @coab.us Date routed: (/
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: dCjQ e)e.-"G.ON AST Department review required Yes No
B l l�n�n
Applicant: RtekAk_p a- N „m[ _ Planning &Zoning
IreeA
Project: CE 3 Cf 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: Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by:,0:,Z, (7 Date: V2-7/6(
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
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233 (1/:3; ��Office (904)247-5826 Fax (904) 247-5845 (0- -c1&8
Job Address: 860 Begonia Street, Atlantic Beach, Fl, 32233 Permit Number:
Legal Descrintirm 18-34 38-2S-29E .117 SEC H ATLANTIC BEACH LOT 2 BLK 144
Parcel# 170926-9950
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$ Proposed Work heated/cooled 0 non-heated/cooled, 0
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(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 We-
Describe in detail the type of work to be performed: Install 1 ew 6ft wooden Fence, o West awl South Side e,„/
Property Owner Information:
Name: Richard Arthur Address:554 Bowie eet __---„
City Neptune Beach State FL Zip 32266 P one 904-422-7
E-Mail or Fax# (Optional)richardwarthur @gmail.com
Contractor Information:
Company Name: Owner/Richard Arthur Qualifying Agent:
Address: 554 Bowles Street City Neptune Beach State FL Zip 32266
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 BB&T
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 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 months at
v
work void o commenced. I commenced within six understand that separate permits or must be secured for work is Electrical Work,!Plumbing,Signs,a Wells, Pools,XFurnaces, Boilers, Heaters,
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 examin,� this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whet, sieci ied herein or not. The granting of a permit does not presume to give authority to viol, e or cancel the
provisions of any other federal,state, or ,, 1 w r•:ulating construction or the performance of construction.
Signature of Owner r � Signature of Contractor ,., . 4 :.
Al Print Name , .i /T� � Print Name 4Lr1 i,,,/
Sworn to and subscr'••• before,me Sworn to and subscr'•ed before me
th.., D of . , 20 ' thh 7 P:y of _ . ,20
Notary Publi•” State of Florida .��� :11 y �
•otary P, 1� ,lei."_
.; ����`^ �� Notary Public•Sta of Florida ■
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MAP SHOWING BOUNDARY SURVEY OF
LOT 2, BLOCK 144, SECTION "H" ATLANTIC BE?.Ci„ :'5 RECORDED IN FLAT BOOK 18,
PAGE 34, OF THE CURRENT PUBLIC RECORDS OF 1OUVAL COUNTY, FLORIDA.
CERTIFIED TO:
EDITH KAVANAUGH ARTHUR
88&T
AMERICA'S CHOICE TITLE C'.:;VPANY
CHICAGO TITLE INSURANCE COMPANY
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LEGEND: '
O -SET 1/2'REBM PC .. POINT Oi CURVATURE
STAMPED py PT - POINT OF TANGENCY
t
• .FOUND 1/2'IRON RON PIPE
NO IDENTIFICATION PRC " POINT OF REVERSE
(UNLESS OTNERWSE NOTED) CURVATURE_
Rim 4'x4'CONCRETE MONUMENT 'CC ', POINT OF POUNO
A/C AIR CONOITCNER /„•. r CONCRETE
—K— .. FENCE �--'� _ -
RFVICIMC
CITY OF ATLANTIC BEACH
OWNER / 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 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 S25,000.00 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 REOUIRED 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 LICENSES'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.
S CH j30,h sI-t.l- — 1-A4---11101 "/
ADDRESS PHONE NUMBER
PRINT NAME
1/0 6 L 7/Led
SIGNATURE // DATE
Before me thi day of .20Y 4n the county of
Duval,State of Florida,has personally peared herin by himself/herself and affirms that
all statements and declarations ar a an accurate. /J
Notary blic at Large,State o ,County of �`�
Personally Known
Produced Identification- ............ , D.RENE ANGERS
� y lri<S
Notary Sgn.;���/���� cmnn - 'o ary Public-State of Florida
t • .? My Comm.Expires Jul 28.2018
F:lBLDri/Chvatr-Builds AQadavit;REVISED:i/l. -
Commission 8 FF 108565
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