354 5TH ST - FENCE OIL S, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
3 ;r 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-1263
Job Type: FENCE PERMIT
Description: FENCE
Estimated Value: $1,371.00
Issue Date: 6/2/2016
Expiration Date: 11/29/2016
PROPERTY ADDRESS:
Address: 354 5TH ST
RE Number: 169842-0000
PROPERTY OWNER:
Name: HUNT, MITCHELL W AND TONYA W, *
Address: 14402 MARINA SAN PABLO PL
PERMIT INFORMATION:
FEES:
Fence/ROW $35.00
II Total Payments: $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
Bill DING CODES.
l
,•11.b`ly City of Atlantic Beach
f '\ BuildingDepartment APPLICATION NUMBER` s (To be assigned by the Building Department.)
, ,. y- , 800 Seminole Road
\J . - '"--- -: , Atlantic Beach, Florida 32233-5445 �' ���) `� Z��
\ Phone(904)247-5826 • Fax(904)247-5845
0509',- E-mail: building-dept@coab.us Date routed: 77.-ii
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 354 5i S7 Department review required Yes No
Building
Applicant: w(U ealannin &Zoni� ng>
Tree Administrator
Project: r C.n r t° 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: %�f.' ' (�
i� G�
y — Date: VI/ /4
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
)-m- _*
s 00..
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
iii800 Seminole Road,Atlantic Beach FL 32233
��Ji31Or Office: (904)247-5826 • Fax:(904)247-5845
I,Co -Fiv CE-I zC_. 3
Job Address: 35 L} 5th 5free t A V Permit Number:
Legal Description Lot 23, 5l ock6,/ P Iat No. I t SUbd 'A" A RE#
Valuation of Work(Replacement Cost) $ I31 i — Heated/Cooled SF N/ft Non-Heated/Cooled N/A
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Residents )
• If an existing structure,is a fire sprinkler system installed?(Circle one): 112P No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal N/4
Describe in detail the type of work to be performed:
Replacing robing 4'-eince with Same -fence, 3tf-[. Ioh9 3f1 irk AID`' high
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: TO a. }-kit Address: 54- 5% s et
City Ali an-ti c RF QeAf\ State FL Zip 322 3 Phone (' Ll) F. I-127 4
E-Mail ton t Vlwelt GI 2. ( C3 on a i l . Co m
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: Qualifying Agent:
Address: City State Zip
Office Phone Job Site/Contact Number
State Certification/Registration E-Mail
Architect Name&Phone#
Engineer's Name&Phon
Worker's Compensate
Exempt / Insurer / Lease Employees / Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated. I certifil that no work or installation has commenced
rtor to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating ru
constction 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 fig a
period ofsix(6)months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbin-
Signs, Wells,Pools,Furnaces,Boilers Heaters,Tanks and Air Conditioners,etc.
Owne
Prope of
Signature ' �
g P ,.. lbw. Signature of Contractor:
Befot me
this Day of ft a i=;` r t r-T ,, , 'panESPERGEDay o f
..
,., MY COMMISSION II FF 924951
Notary Public: • •_( --,.,,,,•,..c...�a= PIRES:October 6,2019
-WOP�,mNountlecrUnd n
I hereby certijj,that I have read and examined this application and 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
rr (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$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 TI-IE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WHICFI 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.
:35 Street niic- 13eachFL Ca'oy�61)-1774
ADDRESS 322 33 PHONE NUMB R
• [�hY0. \
PRIN NAME ll
2 m 60— �
Sf NA URE DATE
Before me this l day of 0 f\0 ,201(ae county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of ( ,County of (_,VcL
❑Personally Known
❑Produced Identification- t _tA0 7 r - - Z-71 . .i TONT GINDLESPERGER
7.1 MY COMMISSION
COMMISSIONIFF 924951-, EXPIRES:October 6,2019
Notary Signature: WEk `R t4Bonded Thru Notary Pablo U,
n
F:BLDG/Owner-Builder Atradavit;REVISED:4/162009