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605 PLAZA - FENCE S CITY OF ATLANTIC BEACH s) 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-1123 Job Type: FENCE PERMIT Description: NEW 6' FENCE Estimated Value: $20.00 Issue Date: 5/19/2016 Expiration Date: 11/15/2016 PROPERTY ADDRESS: Address: 605 Plaza RE Number: 171219-0000 PROPERTY OWNER: Name: SKOWYRA, TED Address: 605 PLAZA PERMIT INFORMATION: FEES: Fence/ROW $35.00 Total Payments: $35.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH AL.L. CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. s r �a,�/ City of Atlantic Beach APPLICATION NUMBER ' � Building Department (To be assigned by the Building Department.) 800 Seminole Road22 -rj' ,______je Atlantic Beach, Florida 32233-5445 1G - F N C, —( I zJ Phone(904)247-5826 • Fax(904)247-5845 1 \<..../..01119%- E-mail: building-dept@coab.us Date routed: S/ 1 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 6QS R-Pc-XPt- �2 Department review required Yes No Building Applicant: y �{Q(,v (`� I ming &Zonifig ( Tree A rilirrtstraQr Project: Pe r\e_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 II// PLANNING &ZONINGReviewed by: ,/dn.....< <- Date: 5�, L 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 V '�`' BUILDING PERMIT APPLICATION �S \ r,, .5 r CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach FL 32233 �1.o;'11)r Office:(904)247-5826 • Fax: (904)247-5845 1 ,-Fi •3 CE_ I ( 7 3 Job Address: OJ i)(aycA '1 r zz 3 Permit Number: Legal Description RE# Valuation of Work(Replacement Cost)$ ZCD Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): New Addition Alteration MI, f Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercia 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 in detail the type of work to be performed: Fe_f‘e_e_ — 6 ' Florida Product Approval# for multiple products use product approval form Property Owner Information Name: s kook (J Address: 6105 Y 'k pr City M �Al C a�.. State_Zi u - - 26' 77 E-Mail p Phone �� 7 y y Owner or Agent (If Agent,Power of Attorney 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: e alifying Agent: Address: City State Zip Office Phone Job Sit ontact 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 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 commence, within six(6)months, or if construction or work is suspended or abandoned or a period o/'six(6)months at any time after work i mmenced I understand that separate permits must be secured for Electrical Work,Plumbing, Signs, Wells,Pools,Furnaces,Boilers,Hea ,nks and LI Conditioners,etc. II /19 Signature of Property Owner: '� Signature of Contractor: Befokiap this I t(JDay of 1 k k 7 Z© i :- • - - Day of -�I• ' :+q�at sync TONI(i1NDIESPERGE Notary Public: k.IA-a A_1 ` ": ,• �{Y COMMISSION t F : 4s51 11- ,•,, •: ',�,�,._,s,gots 1. .. .:* lbw Notary•ub o Underwriter ••1111,1)% Bprd�d AO I hereby certib,that I have read and examined this app on a ' know the same to be true and correct. All provisions of laws and ordinances governing this type of work 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 provisions of any other federal, state, or local law regulating construction or the performance of construction. Rev.3/14/16 '„ CITY OF ATLANTIC BEACH ''' ®WNER / BUILDER AFFIDAVIT --On 9e 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 1-LAVE 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 I3UILD 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 11AVE BUILT YOURSELF WITHIN ONE YEAR AFTER Ti IE CONSTRUCTION IS COMPLETE, 1I IE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE. WITICH IS IN VIOLATION OF TI-IIS EXEMI'TION. 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 TI IAT 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. 05 PLck O � 3za33 ''o y 4qV2 &7 7 ADDRES PHONE NUMBER Skolki 4 PRINT NAME ( �i o (6 /ac / SIGNATURENI!7_1".01011.111.1M - DATE Before me this day of 20/(ate county of Duval,State of Florida,has personally appeare herin by himself/herself and affirms that all statements and declarations are true and a rate. ►^\ Notary Public at Large,State of_F \ ,County of TONI GINDLESPERGER ❑PersonallyKnown z.; ,u ,.c MY COMMISSION#FF 924951 L Produced Identitica on- I / / I _ / Z `�.':��.•ti= EXPIRES:October 6,2019 r.. . Bonded Thru Notary Pubic Underwriters Notary Signatu1011011111 .� ./ P:IBLDG/Owuer-Builder Alfadavii.REVISED•4'162009 54/611/ sfl i A m n O A t� 0.0 Cf , �f ,_ • n• o 0701 • oZ` r id to W • 1 � ..1' o 0 V)'1 0 V r.. ,. 7 \` O -' CO C v r p, _ �! '� �\ 1�t �J �12..� " -1021 tr. t . 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