600 Aquatic Dr fence permit City of Atlantic Beach APPLICATION NUMBER
Building Department Cro be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-51145
E-mail: building-dept@wab.us Date routed:
City web-site: http://�.mab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: QuincT(c bf'�_ Department review required Yes No
Build
Applicant: CA.) eaE% &Zon-IrM>
Tree Administrator
Project: F-F--i,-D C'f'- Public Works
Public Utilities
Public Safety
Fire Services
Review f(
,11111111L.— Dept Signatu
'law P.'y Date
Other Agency Review or Permit Required Of Permit
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St.Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: NApproved. []Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: ke--�— Date:
TREEADMIN Second Review: DApproved as revised. FIDenied.
PUBLICWORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: —Date
FIRE SERVICES Third Review: DApproved as revised. DDenied.
Comments:
Reviewed by: —Date
Revised OW14109
BUILDING PERmrr APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
"L-.,L -
I —v Office:(904)247-5826 - Fax:(904)247-5845 161-
Job Address: CC)C� A t u ot+�C*- 0 Permit Number:
Legal Description RE# -7 c-- 7-c>(z)
Valuation of Work(Replacement Cost)��—zoC) Heated/Cooled SF—Non-Heated/C,old
• Class of Work(Circle one): New Addition Alteration Repair Mow Demo pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Residential
• Ifan existing structure,is afm�sprinkler system installed?(Circle one): Yes No N/A
• Submit a Tree Removal Permit Application if my trees we to be realoved or Affidavit of No Tree Removal
Describe in detail the type of work to be perfirmied: 4
Florida Product Approval# for multiple inaducts use modud appmvai on,
Property Owner Information
Name: IV\�ClAaQA 5"t-Q-\'Atn1rt Address: 60C� Aq5v.AZC- Or,
City —State FLZip '�2-?-3 3 Phone 2 o(4- 3 19-"' 57,6
E-M 1 EV&AwA�L 4 k X qo q - 4.,4
OwnerorAgent (ifAgcutPaweafutcrie,A,..,te#.a.,
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 NOTffli OF COMMENCEMENT.
Contractor Information:
Name of Company:
ng Agent r---------�1
Address: ity tate Z,
Office Phone Jo Contact her AW 17—2M
State Certification/Registration# E- ail I U
Architect Name&Phone#
Engineer's Name&Phone#
Workees Compensation
...ced
risdicHon.
in�,d a,.
. ing,
Ihereby certify that lhave read and examined this application and know the same to be true and correct. Allprovishms aflaws and
ordinances governin this type rwork will be complied with whether specfed herein or not. The granting of apermit does not
I,g
0 at e
Pr uZatogiveaut orby to via ate or cancel theprivisions of any otherfe, eral, state, or local law regulating construction or the
pe�a nee a(construction.
Rev.3/14/16
CITY OF ATLANTIC BEACH
OWNER/ BUILDER AFFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING'REQUIRES OWNER BUILDER TO ACKNOWLEDGE THE LAW.
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DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES:
U USE SE CE ON M FLOM TU
CHUBS
STATIS, LAW REQUIRES CONSTRUCTION TO BE DONE By LICENSED
HAVE APP AN E I
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMP THA
UR PROPERI
0� HAVE L CENSI
LAW. T�lffi EX�EMIPTION ALLOWS YOU,AS YO TION TO I
RA F
7 M 0' 'MTROV
WH W YO
YOUR OWN CONTRACTOR EVEN THOUGH THE OWNER OF YOUR PROPERTY,TO ACT AS
M C TH U 0 NOT A
SUPERVISE Y YOU DO NOT HAVE A LICENSE. YOU MUST
m YOU AY B LD OR
STEEN
AMIL BE Q()NSTRUCT'QN YOURSE1 F, YOU MAY BUILD OR IMPROVE A ONE—OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDTNG. YOU MAY ALSO BUILD OR
LA BOIL IN ARM m
LES
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25 000.00 OR LESS. THE BUILDING
AN T
Mlal9EEEQ&)MMMF,AND OCCUPANCY. IT MAY NOi BE BUILTFOR SALE OR LEASE.
UHL
EL
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
UAW m m
AFTER THE CONSTRUCTION is COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF TIES EXEMPTION. YOU MAY NOT
B HIRE AN YOUR CONSTRUCTION MOST
E 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 STALE LAW AND BY COUNTY QX Af CIpAL LICEOING
DRDELNCES kq_
It. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJU
THE BUILDING DEPARTM � Y,T��W�y Ut�LRIES TO WORKERS THEY HIRE
PURCHASED. ENT SUGGESTS WORKER'S COMPENSATION INSURANCE Bi
Ill. 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
455-228(l). AN-OCCUPATIONAL LICENSE;-IS NOT AD D ST LIT
CIRCUMSTANCES��VVNERS BEING ��UBJECT TO $5,666�'ENALIV UNDER LORI A AT ENO.
EQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY 'CERTIFMTE OF COMPETENCY' & 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.
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PRINT NAME
SIGNATURE
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N.ony Publi..t Stat.a County f-)v ctj
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CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
#j
FENCE PERMIT
MUSTCALL BY4PM FORNEXIDAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-FNCE-1881
Job Type: FENCE PERMIT
Description: NEW 4' FENCE
Estimated Value: $200.00
Issue Date: 8/24/2016
Expiration Date: 2/20/2017
PROPERTY ADDRESS:
Address: 600 AQUATIC DR
RE Number: 171818-5200
PROPERTY OWNER:
Name: STEIMERT, MICHAEL
Address: 600 AQUATIC DR
PERMIT INFORMATION:
FEES:
Fence/ROW $35.00
Total Payments: $35.00
PER� IS "PROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC REACH ORDINANCES AND THE FLORIDA
RUILINNG CODES.