371 SKATE RD - SHED 0 L- rev,
A 'P CITY OF ATLANTIC BEACH
s) 800 SEMINOLE ROAD
tr ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
�J;31Fi
SHED PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-SHED-98
Job Type: SHED PERMIT
Description: NEW SHED
Estimated Value: $3,008.00
Issue Date: 5/11/2016
Expiration Date: 11/7/2016
PROPERTY ADDRESS:
Address: 371 SKATE RD
RE Number: 171672-0000
PROPERTY OWNER:
Name: NACCA ET AL, RICK V
Address: 456 SKATE RD
PERMIT INFORMATION: UTILITY DEPT.: PUBLIC WORKS:
Ensure structure(s) remain out of easement at rear of property.
All silt must remain on-site during construction.
FEES:
PLAN CHECK FEES $32.52
BUILDING PERMIT FEE $65.04
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $101.56
PERMIT IS APPROVED ONI,I IN ACCORDANCE WI I'll ALL (TIT OF Al LAN II(: BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
MAP SHOW/NG BOUNDA R Y 'JR VEY OF
LOT 4 BLOCK ._..24—AS SI- ?kW ON MAP OF
REPLAT OF PART OF ROYAL PALM' LJNIT TWO A
AS RECORDED IN PLAT BOOK 31 PAGES 16-160 OP 77 CURE, T PUBLIC RECORDS OF OUVAL COUNTY FLORI A.
CERTIFIED TO.
1 1_
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2ESERAt •7 c A 32 0 ti 904 805•--003 N'
P.C. POINT OF CURVATURE LEGEND "" FAX' 904 eas-9ap�g
(T)BEARINGS SHOWN HEREON ARE BASED ON P.T• POINT OF TARVATUR 'R
THE EASTERLY RIGHT OF WAY LINE OF P.R.O. POINT OF REVERSE CURVE -D_ R'�I� ••SKATE ROAD AS 507.16'02'E, PER PLAT. P.C.C. POINT OF COMPOUND CURVE 'w on'.L SOT ( TNG ANGLE)
P.O.C. POINT ON CURVE Car-CH- r'm
(2) THIS PROPERTY HAS NOT BEEN ABSTRACTED 8;R P• au I.WN RTeerc Rngi�7.24T T.R. _. °,°E°„plF.�nLR o�R�
FOR EASEMENTS, COVENANTS, RESTRICTIONS CU- C ,; p � OVER
A..
R" RICHT-OF-WAY
-. ■•N� ��Ru CO�I01f
(3) UNDERGROUND UTILITIES SERVING THIS O.R.V. OFFICIAL RECORDS vOI.UuE . (P�C. _"'._E
PROPERTY HAVE NOT BEEN LOCATED OR O/L ON LwE - M +1RQN _PIPE -` C
SHOWN BREAIf UNE P - ' PtJ�t7svR.
(4)IT IS THE LENDER'S RESPONSIBILITY TO SCALE 1=-20' - �r•DETERMINE FEMA F.I.R. MAP STATUS FOR THE
LIFE OF THE LOAN ON THE PROPERTY SHOWN �'- .'
ABOVE, SURVEYOR HEREON WILL CONFIRM 6-30-11 ' �� `�,�
FOR ADDITIONAL FEE. QA 7E or F7E/Q y7lRY£Y - `` L'C
.B. 531 PG. 3 NOT VALID ufnaaur n✓FsYONanirrc OR✓G/NAL RASED GLENN Al. BROAD_ ?EET fL;A'.• CSRT Na
SEAL Qt•A FLOR/QA L/CF✓SEO SUl✓/FYoh :MAPPER 5814 LB ..7 671
QPDE'R Na 7Q 1� 1— 4
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH OFFICE CO PY
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845
Job Address: 3 1 I S kik{@ Qo.r of Permit Number:/6-
Legal Description h etv I? k (L f (t —4w Lj Ste.' Parcel#
FlOor Area of J' Sq.Ft. Sq.Ft
Valuation of Work$ 3 0 0 $. y Proposed Wok heated/cooled non-heated/cooled V
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
Describe in detail the type of work to be performed: S E
Property Owner Information:
Name: 1 L K NA(I h Address: � Sc 5144- k 14. 1 6, 3 2 2 3 3
City A+1G,n{ C Nock State ELZip 3 'ZZ33Phone goy 8 q I 2.1 4 S-
E-Mail or Fax#(Optional)
Contractor Information: /� �
Company Name: ,JAL S F eC4 StC' 6CA&A S fQ Qualifying Agent:
Address: 506 Of at City Sa.' 6+�
I State CA zip Ir ?
6
Office Phone �I 12 �L 3 '° b Job Site/Contact Number - Fax# p
State Certification/Registration#
Architect Name&Phone#
Engineer's Name&Phone# gw� �gdoer t DL - 626 - e 206
Fee Simple Title Holder Name and Address 1
Bonding Company Name and Address ! , • A • • - 4 ( • t rx n t •Otte,
Mortgage Lender Name and Address •
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
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 f6)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.
1 here cert that I have read and examined this a plication and know the same to be true and correct. All provisions laws and ordinances governing this
type ofwork will be complied with whether specified herein or not. The granti of ng 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.
Signature of Owner C Signature of Contractor
Print Name I c tc N . Ccd Print Name
Sw.k_1111 d • . • i.ld before me Sworn to and subscribed before me
this f Da 0_ a / ,20 ( �O this Day of 20
c. 'b r„ � R
Notary Public - I �r
�: MY COMMISSION It FF 924951 NI ,ry Pu. lc
t,.;..�� EXPIRES:October 6,2019
qty,`
Revised 01.26.10
BondedThNNotary Pubk.Underwriters
J ;:s L:1,'1 ;s
� OFFICE COPY
_ 3 CITY OF ATLANTIC BEACH
'i%WNER / 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$25,000.00 OR LESS. THE BIDING
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 MAY
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 REIUIRED 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.
S [<.� 1 � 11-1-104(6 32z GL. a
ADD'ESS
9 1 6 2V U zoc
N I4 1 PHONE NUMBER
PRINT NAME ,• & i i �C M ,7L
SIGN,f
I 3 � Co
// DAT
I
Before me this 1' day of L` a county of
Duval,State of Florida,has personally appeared herin by himsele self and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,S-te of_r County of 1 UV' '
❑Personally Known
'oduced Identification- . * 4
Notary Signatu . Q �� ei'•, TONIGINDLESP
�J i ERGER
t• . ._ MY COMMISSION>f FF 924951
F:BLDG/Owner-Builder Affadavit,REVISED:4/16/2009 t •� EXPIRES:October 6,2019
`I�•.a,h Bonded TM Notary Publ c Underwrters
4•
I
ari \:1 Mac's Feed, Seed & General Store r�
50Phone 912-843-2008 008 Fax912-843-ia31562
OFFICE COPY
DERKSEN Phone-912-843-2008 Fax 912-843-2714 �/
• nu ail u•PIMA Meer:Kenny Yoder 478-5544708
. _
'SELECT ONE: •usi sat 0 Imrr ro own I o 36 NO o 6o MO I BUILD AT EDDIES PLANT RIC f BIZZ
SALESMAN: Macs Feed Please Fill In Date DATE:
Choose Building Sale Type
' New-Order Sale jFlesse select One Of The Building Types 0 Treated E COND •2 Metal
•
--- ---'— Peened O Ilea Vale•Treated O N Meld O Palle d E CONO O U t"ane
-O Palmed tlleyfwuse O Treated vleylw„se
,i0'tx12c Cnppee E Utility__ E Sam ______ NOM.NOM.COLOR& TRIM COLORS,
BARN BEST VALUE ROOF COLORS:
CABIN al Pathan Pewter Gray Metal
COTTAGE SHED __—, _ _ "EXTRA OPTIONS'DESCRIPTION CODE COST
GARAGE UM CP 0 $0.00
.LOFTED BARN 1
o $0.00
;Lotted Barn Cabin 0
Side Lofted Barn S Ie LBC ( Prepaid Hlallpne Andgrs$25.00 Each Installed HURANCH $100.00
Side Utility 8'Walls i Side C 0 $0.00
!Utility 8'Wails 12X12 Deluxe LBC
- 0 $0.00
Lofted Ubfrty 8_Walls OM1eta C i_. 0 $0.00
SELECT YOUR PAYMENT DUE DATE t 0 isr 0 5Th 0 10TH 0 ism ROOF $0.00
PURCHASER NAME Ryan Barber CONENTER ROOF $0.00
CO-Cell "ROW, CO-Wk Ph: TOTAL $100.00
MAILING ADDRESS DELIVERY ADDRESS
371 Skate Road 371 Skate Road
City: Atlantic Beach State: Florida Zip432233
County:0 D amp,Oty City
State: Florida ZIP(32233 County:
HOME PHONE: 904-626-8206 Own !Rent: Land 7
WORK PHONE: Landlords Phone:
CELL PHONE: Landlords Name:
Employer:
CASH SALE UTX-12x12 RENT-TO.OWN-SALE
1 SALES PRICE $2,720. 1 SALES PRICE $0 00
• 2 OPTION COST(Describe Above) $100. 2 OPTION COST (Descnbe Above)
3 TOTAL PRETAX COST(LINE 1•LINE 2) $2,820. 3 TOTAL COST (LINE 1 • LINE 2 1 $0.00
4 SALES State TAX (LINE 3 x 0.07000 $197.40 4 Cost Reduction AMOUNT
12 Exempt TOTAL SALES TAX(LINES 4) $197. 5 NET Cost Reduction(LINE 4+1.0+tax rate 1.07000 S0.00
I 6 TOTAL COST we TAX(LINE 3•5) $3,017. 8 AMOUNT TO RTC/(LINE 3-Line 5) $0.00
7 CASH RECEIVED 7 MONTHLY PAYMENT (LINE 8+ $0.00
8 NET AMOUNT DUE(LINE 0-LINE 7 $3,017. 8 M!State SALES TAX (LINE 7 x 0.07000 $0.00
9 TOTAL SALES TAX(LINES 8) $0.00
10 TOTAL PAYMENT(LINE 7+LINE 9) SO 00
11 FALSE $0 00
12 FALSE SO 00
' 13 TOTAL RECEIVED(Method.Cal-CC-Cash
FOR ALL REPAIRS FAX TO KY SHOP AT(270)-
Email repair s@derksenbuildings.com
DRIVER TO PICK-UP REMAINING-BALANCE-
ESTIMATED DELIVERY
10 TO 21 WORKING Days Weekends Are Not Considered Working Days
O-:'ON of*WING:SHOW STANDARD"Mgeita)"THEN PLACE YOUR'OP12i5-
Kl .'•,.14,EflE 8eve1 1}+ *om 012.0f 5 OiNMk)eLa&oppons 1DOORS FACING
DIRECTIONS
'ix,.btr San I .�.
perksen Buildings and its awls are NOT responsible for permits,setbacks.restrictions,or covenants PLEASE contact your local
codes department or Homeowners Association.It is up to the c-t¢ton1$rtgi decitte whether ground_topdision5_arQ
suitable for delivery. 'perksen Bulldinps is NOT responsible foryaj or driveway damage. Free delivery and set up
includes ONE TRIP.additional trips may incur CHARGES to the customer I.the customer.have mad the disclosure.Terms And
Conditions Of Sale and fully accept the terms provided therein.
National Design and Inspection
501 North Jackson Ave. Suite 2
Byars Building
Russellville,AL 35653
July 24, 2015
Mr.Jim Richmond
Florida Department of Business and Professional Regulation
Manufactured Building Program
1940 North Monroe Street
Suite 90A
Tallahassee, Florida 32399-0772
RE: Plan Approval: Residential Lawn Storage Shed
Manufacturer: Weather King Portable Buildings
Plan Number/Name: Utility Building
Dear Mr. Richmond,
Pursuant to the requirements of the Florida Department of Business and Professional
Regulations,the above referenced documents have been reviewed for compliance with:
2014 FBC, 5th Edition
2011 NEC (NFPA 70)
These plans comply with Florida Product Approval Rule 61G20-3.006 (FAC).
A signed and sealed set of plans are maintained on file in the Third Party Agency office of
National Design and Inspection.
All mandatory comments have been satisfied and plans are approved for construction by a
modular building manufacturer that is currently approved by the Department of Business and
Professional Regulations.
If you have any questions or require my assistance in any way, please do not hesitate to contact
me.
Respectfully submitted,
414/
/
,
John Farinelli, CBO, MCP,SMP49
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s ail,,, City of Atlantic Beach � CErven APPLICATION NUMBER
6, . "- 1a Building Department (To be assigned by the Building Department.)
hr 800 Seminole Road i JAN 141016
��w f�l Atlantic Beach, Florida 32233- 445 S����
Phone(904)247-5826 • Fax Z297247-5845
,`J E-mail: building-dept@coab.us — Date routed: ` c
City web-site: http://www.coab.us �`– — / Ffr2
APPLICATION REVIEW AND TRACKING FORM
Property Address: E7 ( S k RI-E., R ppvi Department review required Yes No
f� \ � C.Li:
Applicant: 4 \k(�_1� i V P\ C CF - o A„�� , Manning,,Zoning. 1
Tree Administrator
Project: I v EW ('' C _crublic Work-§---)
'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: proved. ['Denied.
(Circle one.) Comments: `fee Alci e l ‘ 101(4%
BUILDING
PLANNING &ZONING Reviewed by: _ /.'`�---- Date: /10/ /Y
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 07/27/10
•
r Nike . City of Atlantic Beach APPLICATION NUMBER
i- Building Department (To be assigned by the Building Department.)
. � 800 Seminole Road s-) / j '
� Atlantic Beach, Florida 32233-5445 I G 1 S ry�� c)8
J� r
Phone(904)247-5826 • Fax(904)247-5845
_on 9% E-mail: building-dept @coab.us Date routed: 1 I c
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: E < 0 PJ Department review required Yes No
cildina
Applicant: R 1�_l� �� C C — pw� anning &Zoning
Tree Administrator
Project: `J (`i; G� �-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: T
BUILDING
PLANNING & ZONING Reviewed by:�.^ !/ i— Date: I//�t//C
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 07/27/10
p�� . City of Atlantic Beach JA�V APPLICATION NUMBER
` Building Department 2a10 (To be assigned by the Building Department.)
/i $1 800 Seminole Road //
Atlantic Beach, Florida 32233-5445 q_ �O` / I S �
v Phone(904)247-5826 • Fax(904)247-5845
E-mail: building-dept @coab.us Date routed: 1 / I L '
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ( k Rr'r E, 1.\ Department review required Yes No
1Buildinq_
Applicant: R'e,,j� w C C FA - Ow, - z_. . , anning &Zoning
Tree Administrator
Project: I ) E.W
( 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:
APPL ATION STATUS
Reviewing Department First Review: Approved. Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: ) Vte: / /20//A
TREE ADMIN. Second Review:
❑Approved as revised. ['Denied.
IC WO K Comments:
0'4
•UBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
s!. if,,, City of Atlantic Beach APPLICATION NUMBER
�s � Building Department (To be assigned by the Building Department.)
800 Seminole Road
1 q
�r Atlantic Beach, Florida 32233-5445 1 G - S f(�D - !8
Phone(904)247-5826 Fax(904)247-5845
'` 1111 %' E-mail: building-dept @coab.us Date routed: / I FOP
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: k p -i p(�(J Department review required Ye No
�Buildin
Applicant: R 1 c_K M p C c j - Ow _ Manning &Zoning
Tree Administrator
Project: N) E=_W S (� C� ublic WoiTc�;
��ublic 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: [oved. ❑Denied.
(Circle on Comments:
BUILD!
PLANNING &ZONING Reviewed by: Date: !'22��
TREE ADMIN. Second Review: ❑Approved as revised. ❑Den d.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ElApproved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10