335 4TH ST - FENCE Srv1r
. CITY OF ATLANTIC BEACH
ss1
Ai j 800 SEMINOLE ROAD
..... .1 - ATLANTIC BEACH, FL 32233
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INSPECTION PHONE LINE 247-5814
FENCE PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-FNCE-2029
Job Type: FENCE PERMIT
Description: NEW 6' FENCE
Estimated Value: $3,500.00
Issue Date: 9/12/2016
Expiration Date: 3/11/2017
PROPERTY ADDRESS:
Address: 335 4TH ST
RE Number: 169834-0300
PROPERTY OWNER:
Name: GRANT, PEGGY
Address: 335 4TH ST
PERMIT INFORMATION:
FEES:
Fence/ROW $35.00
Total Payments: $35.00
PERNIIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
MIMING CODES.
� -- ; City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road c
Atlantic Beach, Florida 32233-5445 - - 1 1V zCZ''
Phone(904) 247-5826 • Fax(904)247-5845 /
\'0101)•• E-mail: building-dept@coab.us Date routed: �/ !Q
l/ (47
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: a35 , n t review required Yes No
Applicant: 0c-o(\
-- ator
� (
Project: END�.� 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: v te: q/t0//G
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. [1Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
/
- r �� ' BUILDING PERMIT APPLICATION
J 1
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
<::14'2t19Office: (904)247-5826 • Fax: (904)247-5845
lco- F-NCE._ZoZ5j
Job Address: 5 0 &.c t-V- Permit Number:
-
Legal Description RE# 1 CO 9 4 - 300
Valuation of Work(Replacement Cost)SZ)5 0 0 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): • Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s) (Circle one): CommercialCR---Q-dejltiaD
• If an existing structure, is a fire sprinkler system installed? (Circle one): Yes ED 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:
1ç1 Pt\Q _
Florida Product Approval# for multiple products use product approval form
1
Proper Owner
Information
Name' b 71 c EI _
City l >Iic 6WLI\ State R. Zip3 233 Phone ROY i 5 3 5-3D5
- nt\yC@ (oI .Go►v\
Owne 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 Inform._ion: 411
Name of ComnY: I P 1 l Q. ( ualifin Agent:
Y g
�
Address: 11 I € A11_t-t- City -..)Ck.si. State Zip F1. 3Q.�0
Office Phone qt-A 1 0 - OiD 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
prior to the issuance of a permit and that all work will be perfonned to meet the standards of all laws regulating construction in this jurisdiction.
This permit becomes null and void if s rk is not corn Iced within six(6)months, or if construction or work is suspended or abandoned for a
period of six(6)months at any time a work is co m •d. I understand that separate permits must be secured for Electrical Work,Plumbing,
Signs, Wells,Pools, Furnaces,Boile 'eaters, ,n' ' ' Air Conditio ' ,etc.
/ ' ,,\
Signature of Pro.-rty owner: tip / . 41_ Signature of Coritrac .r:Bef
. y ! C '' �',-'� ,, myr119�CN t FF 924951 \/,-
this Da of � l Before me <�,_
r' :;3 EXPIRES:October 6,2019
%R 'n° Bonded Tbru Notary Public Underwriters I
Notary Public: _ $ Notary P • '•-
I hereby certi that I have read and examined this 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 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 fe eral, state, or local law regulating construction or the
performance of construction.
Rev. 3/14/16
Am*
CITY OF ATLANTIC BEACH
r/
®WNER / BUILDER AFFIDAVIT
�DIt Jr
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 THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WHICII IS 1N 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.
t" +reit- coy p-5�0AP CRESSPI-ONE NUMBE
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Lnt
"IN iA �/ +
IGN frI/ \ T o0 0J `!r
DA9 f
Before me this 8 day of 100.6 t 244 in the county of
Duval,State of Flonda,has perso ly ppeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of F( .County of CiTh()VOL.
❑Personally Known �� r� O I! 'tion- ! Z- s ' " O UEXPIRES:October 6,2019
• , 111111
ti'J Bonded Thru 43:Z Publ•c Under 19;
Notary Signature: '�_
Ft/BLDG/Owner-Builder Atfadavit;REVISED:4/16/2009
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j'r PERMIT RECEIPT
/`JFiI> September 9, 2016
PERMIT DESCRIPTION: NEW 6' FENCE
PERMIT NUMBER: 16-FNCE-2029
ADDRESS: 335 4TH ST
OWNER:
Fence/ROW $35.00
Totals:
$35.00
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