171 Club Dr fence permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
_r !jig'
FENCE PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-FNCE-1734
Job Type: FENCE PERMIT
Description: replace existing fence with stockade wood-style fence
Estimated Value: $1,000.00
Issue Date: 8/24/2016
Expiration Date: 2/20/2017
PROPERTY ADDRESS:
Address: 171 CLUB DR
RE Number: 170246-0020
PROPERTY OWNER:
Name: HUGHES, BRIAN P
Address: 171 CLUB DR
PERMIT INFORMATION: PUBLIC WORKS:
Full right-of-way restoration,including sod, is required.
All runoff must remain on-site. Cannot raise lot elevation without measures to retain runoff.
FEES:
Fence/ROW $35.00
Total Payments: $35.00
PERMIT IS APPROVED ONLY N ACCORDANCE WITH ALL CRY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES
yt�r City of Atlantic Beach APPLICATION NUMBER
Building Department
�i 800 Seminole Road (To be assigned by the Building DepadmentJ
�., Atlantic Beach,Florida 322335445 Icn—FNCb— 1�3y
Phone(904)247-5826 - Fax(904)247-5845
`1191' E-mail: buildingdept@wab.us Date routed: O$ IOeII I(p
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 111 CI1.1LLu b!,4R om
ent review required Yes No
Applicant: O'Wt\,L( — blan AwIW &ZonininistratorProject: fl Ptf{(�1�l�&.164A t FL p lflji yt sStD(�galt Wood—St \e- Ftag lities�I tfetyces
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
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:404ao��Date: /
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
yfl v' City of Atlantic Beach
-gpPElsa�lenf
-- .- �
Building Department --- ..
I 800 Seminole Road 'r�' - rip (To be assigned by the Building Depadment.)
J V) Atlantic Beach,Florida Phone(904)2475826-Fax(904)247- AU6 Q E 21116 j b�FN--C�-«may
'=o;i o'er E-mail: -site: b us Date routed: - �$ ( Oa I II
City web-site: httplAwnv.coab.us �—_
APPLICATION REVIEW AND TRACKING FORM
Property Address: belvA CSewicesT
ent review required Yes No
Applicant: DWp,L( — �f' af1 f�IAA�1l C &Zonin
inistrator
Project: tLpku(� tx��-hnN (y6 1rJj ra
lielities
fety
ces
Review fee$ Dept Signature
Other Agency Review or Permit Required Review or Receipt
Florida Dept.of Environmental Protection of Permit Verified B Date
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: fgpproved.
1 QDenied.
(Circle one.) Comments:
BUILDING
PLANNING&ZONING
Reviewed by: Date:� �i�
TREE ADMIN.
Second Review: QApproved as revised. QDe led.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:
Date:
FIRE SERVICES Third Review: QApproved as revised. QDenied.
Comments:
Reviewed by: Date:
'ised 05/14/09
� i
00;19
City of Atlantic BeachAPPNC-ATi6htBurhhng DepaRnnen -- ._.._. NUMB€R---
800 Seminole Road (To be assigned by the Building Department.)
Atlantic Beach,Florida 32233544 TAUGU3 2016 1W—FN�Phone(904)247-5826 Faz(904 1E-mail: building-dept@wab.us Date routed: O$10 al I I
City web-site: hftp:1?r .coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 111 —t.Lb Of iU,( CF!reSewicesT
ent review required Yes No
Applicant: OWt\1.( — Kf; an t4knht t &Zonin
inistrator
Project: �P�p(A fXt�linA A With lie s
St0( od� WDt>Lt_Sty�Q Ff lielities
ety
ces
Review fee$__ Dept Signature man
Other Agency Review or Permit Required Review or Receipt
Florida Dept.of Environmental Profedion of Permit Verified B Date
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.
APPLIC TION STATUS
Reviewing Department First Review: PApproved.
QDenied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by: r y ('I
TREE ADMIN. te:Second Review:
QApproved as revised. QDenied.
P .WORKS Co menta:
BLICy.TILITIES
is-3- /Jo
PUBLIC SAFETY Reviewed by:
Date:
FIRE SERVICES - Thirtl Review: QApproved as revised. QDenied.
Comments:
Reviewed by: Date:
,ised 05/14/09
I
BUILDING PERMIT APPLICATION rem
" CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
fi 9
Office:(904)247-5826 • Fax: (904)247-5845
Job Address: �7l C�6.9 �5^•---L Permit Number: _1IOC -134
Legal Description #
Valuation of Work(Replacement Cost)$ )000 Heated/Cooled SF Nou-Heated/Caoled
Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
Use of existing/proposed structure(s)(Circle one): Commercial < esi ent
• 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: P)At.0 e xi 5 -y -?c—, —i $1p r/Gf..1c
Hao, 5 ykc rr: u
Florida Product Approval# for multiple products use product approval form
Property Owner Informati
on Ad' @ at, •Ce^4.`4e•C•^ \ J-33 .4 S"O B
m
Nae: s Address: 71 eez,-R i vc
City T/..vaaNyy>r'c GAr,a State/- Zip 2A?33 Phone_ ctrl 29r{- (o/7?
E-Mail rSrigN ZZ9/9TL (� ora, "/ cc.•,
OwnerorAgent (lf Agent Fiw,erof Aman or Agaaytsms Required)
RESULTIN TO
R PAYING TWICE FOR IIMMPROVEMENS TO YOUR PROPERTY IF IIEND
TO OBTAIN FINANCING CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTI7(fE OF COMMENCEMENT.
Contractor Information:
Name of Company: Q Wi ng Agent:
Address: State Zip
Office Phone Jo ontact Number
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone
Worker's Compensa '
xempt usurer ase anti oyees portion ate
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation hos commenced
Igor to the issuance are permit and that all work will be performed to meet the standards of all laws regulating construction in thisjurisdiction.
Igor
permit becomes null and void if work is not commence2 within sic(d months, or if construction or work is susppeended or abandoned((or a
ppeeriodo/'six(d,months at any time ajkr,work iscommenced Iunde a�that separate permits must be securedfort'learicol Work,Runs arg,
Ssgng Wets,pouts,Purnoces,Boilers,Heaters,Tonks andAm C ' tiers,etc
r—� l� 1 OAO �c� IlCnc�fl(
Signature of r�
Belo a me Signature of Contractor.
this_U Day of I of
uVGQMWSSIONSFF 1
Notary Public:
I hereby certify that I have read and examined this applicotron and know,the same to be[rue and correct. A[I provisions oflaws and
ordinances governing this type of work will be complied with whether spelt/t'ed herein or not. The granting of a permit does not
presume to give our Only to violate or cancel the provisions of any other federal, state, or local law regulating construction or the
performance ofcomimcdon.
Rev.3/14/16
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CITY OF ATLANTIC BEACH
OWNER/ BUILDER AFFIDAVIT
rn v'
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 459.103(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 BUDDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT MAYNOT 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,TIO;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 BAYE
IICENSES REQUIRED BY STATE LAW AND BY CO 1NTY OR MUNICIPAL LICENSING
ORDINANCES.
I. 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 ANV
CIRCUMSTANCES. OWNERS BEING SUBJECT TO$5,000 PENALTY UNDER FLORIDA STATUTE NO,
455-228(1). AN"OCCUPATIONAL LICENSE'IS NOTAD QUATE 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.
>G`/5 6�g iC T � e 3J3- 6SD�
ADDRESS PHONE NUMBER
MME
vRl �✓y� i'�J�K�Y�
SIGNATURE //__ DATE
Before ma iM1ia�deya 2�4LXItM1e wea)a
Duval,St a Fbdda,M1es Pereonallya bdn MM1imeelf/IlerseM erM etg:melNat
alatatenaentaanddaclara4on...La.ada«web. y^`
Notary Pubo at Large.state of Countya
❑Personally FMnp f /, �.r�.r
0 P:Wu®dIGnIMU4 - 4 ( ro3 —LL( �� 05;--'-
TOM GINDIESPEPGBi
Ir' MY COMMISSION 4 FF 924951
- EXPIRES:Ocbballi 2019
Notary Signature
: — -o 4�'. . £ BnM®1iAry NLay PuHc llNwaaa
FIBLDGpxmervBuildm AO&M�REVIS®'NRRW9
EXHIBIT A. LETFBR OF AiTuoRIZAnON DRN 70
i
/Ci41h
#4(Z40 I L*X Is herebyauthorieed to act on behalf of
�RJ/knl 0. l i6tfr-S the owner(s)of those lands described with.n
the attached application,and as described to the attach ed deed or other such proof ofovmership as may
be required by the City of Atlantic Beach In applying for a development permit.
i
i Mute of Ow erorownK egal Representative
}� Pratte Name P f" 6
MaAMrg Address �____
ones Z4 •�a7g. 9dt/.ZQc��°7�'. B?rANZ2R�fli-lar ..
ar Fax m�atf'_— IMtL_�.OriJ
J
f
State 0f:
Courtry of; �
Signed and�sworn beforeme on this- aayo _OR" by
/
I IdentiRration vMlRed: td�
l:r
Oaths n, T" Yes No
aeamman.M.
a�10�,Yo�. a
. LIx
MyCwnmission expires: 6y 1,111•• ,} -----
FXH(&7TA Letter ofAuthor(iorpbn_sro5:ro.ro