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375 4th St pergola permit CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 ACCESSORY STRUCTURE NEW RES MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 IOB INFORMATION: Job ID: 16-ACST-2078 .Job Type: DETACHED ACCESSORY STRUCTURE NEW Description: 10' x 12' Pergula Estimated Value: $1,700.00 Issue Date: 10/19/2016 Expiration Date: 4/17/2017 PROPERTY ADDRESS: Address: 375 4TH ST RE Number: 169846-0110 PROPERTY OWNER: Name: MARSHALL, DOUGLAS Address: 375 4TH ST PERMIT INFORMATION: PUBLIC WORKS: Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact Public Works(247-5834)for Erosion and Sediment Control Inspection prior to start of construction. All runoff must remain on-site during construction. Roll off container company must be on City approved list and container cannot be placed on City Right- of-Way. (Approved:Advanced Disposal, Realco Recycling, Republic Services,Shapell's,Sunshine Recycling and Waste Pro). Full right-of-way restoration, including sod, is required. Any plan change must be submitted as a Revision to the Building Department. FEES: PLAN CHECK FEES $29.25 BUILDING PERMIT FEE $58.50 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CRY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. I CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 0 STATE DCA SURCHARGE $2.00 STATE DBPR SURCHARGE $2.00 DEV-REVIEW SFR UNIT $50.00 Total Payments: $141.75 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. � uf Building Department 800 Serminole _ _. .— - (-To he-AasPsiPgnLeidEb�yFthIOe NBu-NiltlIi-n1Mg Di3e€pRad-m—ent.) - Road y Q Atlantic Beach,Florida 322335445 Phone(904)247-5626 Fax(904)247-5645 V E-mail: building-dept@ccab.us Date routed: City web-site: hdp://www.coab.us - APPLICATION REVIEW AND TRACKING FORM Property Address: 75 1 S! De artment review re ulred Yes o ulldin Applicant: W K)E IL anning&Zonin �� r I I Trea A mlm re or Project: �RaIt u licworks ubic In ublic e Fire Services Review fee$ - Dept Signature - Other Agency Review or Permit Required Review or Receipt Date Floridaental tla Dept.of Environprotection of Permit Verified Florida Dept.of Transportation St.Johns River Water Management District Anny Caps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS FPUBLICWORKS Department First Review: Approved. QDenied. one.) Comments: DIN ) / &ZONING Date: ( o`d'I p Reviewed by: DMIN. Second Review: []Approved as revised. QDenied. Comments: PUBLIC UTILITIES I PUBLIC SAFETY Reviewed by: Date: I FIRE SERVICES Third Review: QApproved as revised. QDenied. Comments: Reviewed by: Date: tbvised o7n7No City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) li 800 Seminole Road Atlantic Beach, Florida 32233-5445 L -R cs—f- c� J Phone(904)247-5826 Fax(904)247-5845 �patj E-mail: building-dept@coab.us Date routed: City"b-site: MpJA w .coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 37S W tX .¢4 Department review required Yes No B " Applicant: OuXl2 tonin (I�� Tree Administrator Project: N CGLIA �Q X I Z' Public Works —T Public Utilities Public Safety Fire Services Dept Signature Other Agency Review or Permit Required Review or Reeeipt 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: WApproved. [-]Denied. (Circle one.) Comments: BUILDING Reviewed by� �/�� 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 C4 of Atlantic Reach --APPLfeATION NUMBER— Building . -_- o Department gE IV (To be assigned by the Building D 800 Seminole Road 9 apartment.) Atlantic Beach, Flonda 32233-5445 I ZC-7 Phone(904)247-5626 Fax(904)247-5 SEP 16 2016 Email: buildingdept@wab.us City web-site: httpa/w wab.us Date routetl: BY: APPLICATION REVIEW AND TRACKING FORM Property Address: �]5 9- V�_ Sr De artment review re utred Yes No ildin Applicant: IA2 ND F�['_ anning&Zoning Project: �{"�fI 01 Tu lic corms or ) (j,�l� A. K � � f u lic Works U It C III ublic e Fire Services Review fee$ Dept Signature N gency Review or Permit Required Review or Receiptof Permit Verified B Dateept.ol Ernironmental Protectionpt.of Transportation River Water Management Districtps of Engineersf Hotels and Restaurantsf Alcoholic Beverages and Tobacco APPLICATION STATUS Reviewing Department First Review: N Approved. []Denied. (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by: Date: --30 TREEADMIN. Second Review: ❑Approved as revised. ❑D led. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 07/27110 City DI Atlantir Beach --- APPLICATION E`+C'�.i ���rrr,,, -- —APPLICATION NUMBER Building Department IC V En, (To be assigned by the Building Department.) .) 800 Seminole Road SEP 1 k 7 Atlantic Beach, Florida 3223& s Z�Is ) _ G�� Phone(904)247-5626 Fax 47-5845 d 3 \(_�t_p> E-mail: buldngtlept@coab.us dddJJJ Date routed: City web-site: him//www.coab.us �---- APPLICATION REVICEW AND TRACKING FORM Property Address: 37.5 4` SI. De artment reviewre uired Yes No ddin Applicant: Oy)&D Eice >PFanning&Zonin r Tree A mim reor ) Project: Rc, `0 � � K � Z ( u lic Works 5r-Frublic Ufllii ublic a e y Fire Services Review fee $ Dept Signature X_11_'\ 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:obacw Other: APPLI,CATION STATUS Reviewing Department First Review: Approved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by: TREEADMIN. 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 07127110 APPLICATION .m CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach FL 32233 i1 ns Office:(904)247-5826 • Fax(904)247-5845 Job Address: 37S- 9+AZGt PemuttNumbnefr: Legal Description roc # 2- 0{� f-o t Z$,Q 10 1, 6 "Aa RE# 1 6O 18i `P 6 — 2 l L O S4. :ub %dam Valuation of Work(Replacement Cos $ 7� 6V.OOHeated/Conoled SF &z a} Non-Heated/Cooled Qn. pL.*(wae. • Class of Work(Circle one): New OAddition Altemhon Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial Residential • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes NoN/A • Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal Describe in detail�he t e of work to be puerf'ormed: t cti oar e o 10' Ai,, lL', Pe.."�yyw )w A;w f AA L� ^ \��OFtN o-40 P9 T 6- P/ac.dts t tr:dn�twr Q i..+ a�,.�I S r Ee.A n tl.t ,/Less. _ ! r t.r Su AttA-l.•d e�ns..+•^^a Florida Product Approval# for multiple products use product approval farts Property Owner Information It j� Name: 1)\eta lar d rf'ksdlki u r JF6d4A), P.MOASAddress: J 7S- /--o Nr'H. Sf City At 1 A,,Ja2StateeZip-32233Phonc oL�R (- 41LS- , E-Mail ons (xe.�.f A. . Gen L�eLo ub Corn Owner or Agent (ffAgeKPowegof Attomeyoi AgencYLater Raryimdl 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 NOTIGrE OF COMMENCEMENT. Contractor Information: Name of Company: N n Qualifying Age t/ Address: City State Zip Office Phone Job Site/Contact N er State Certification/Registration# Architect Name&Phone# Engineer's Name&Phone# Worker's Compensation xempt i nearer a employees xpiation Date Applimtlon is hereby made to obtain a permit to d t e work and installations as eradicated. f certify that no work or installation has commenced ynor ro the issuance ofa permit and that a!J work wilf be performed to meet the smndards ofall lows regulating coaasnuction in[his jurisdiction. This permit becomes nul!and void tf work is not commenced within six(6 months, or ifmnstrvclion or work[s suspended or abandoned for a pesiod ofsir(61 months at any time after work is commenced I undersmnd that separate permits must be searedfor Etenricd Work,Plumbing, rgng ells, ools,Furnaces,Bo' ,Heelers,Taasks and Aa Conditioners, d vnd o„,•.� Signature ofPrope er. � Signature of Before me this�Day of B f 0(6 ,�.n","'.ti�,x TONI GINnESPEPGEa - MY COMMISSIONYFF924s51 Notary Public: N � �Ia:EXPIPEa:October 6,2019 I hereby certify that l have read and examined this a ' ation and know the same to be true and correct. All envisions,of laws and ordinances governing this type of work will be complied with whether specifred herein or not. The granting of a permit does not presume to give authority to violate or tantel the provisions of any other federal, state, or local law regulating construction or the performance ofconstructson. Rev.3/14/16 "J CITY OF ATLANTIC BEACH OWNER/BUILDER AFFIDAVIT I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 'CONSTRUCTION CONTRACTING'REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW DISCLOSURE STATEMENT FOR SECTTON489.103(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 S P RVI BTHE ONc I!"r'r YOU MAY➢URD OR IMPROVE A ONE-OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COhRNERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE B IDM MUST BH FOR YOUR ISE AIJD OCCUPANCY. IT MAYNOT BH BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THC CONSTRUCTION IS COMPLETE, THH LAW WILL SOME THAT YOU BUILT IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU AY NOT HH2E AN LmR ICHN D P R ON A YO TRA R YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RBSPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSEC REQUIRED BY STATE LAW A BY COUNTY OF MUFE IPU LIMSING ORDINANCES. II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION PURCHASED. INSURANCE BE 111. 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; ULIC NSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANYCIRCUMSTANCES. 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. ADDRESS F,uetl You/ S3O� j8 ( —yLZ $ PHONE NUMBER X4 #SIGNATUR AA S ,4 �1 � R,� r0-nG P /✓/A/2 Cgd_4L GATE/ Before me rola�nav of �y,za/6 In the county of Befen Stere o(FlorMa,has persona pP dlreMbyhmmOlmreaXendaffamsbmt aI.Mmmenta and aeclarepnna arc tel accurate. '['�` Notary Public at Lege,State o/�,County of C) ; yNa M ba 4 -164 - 6-443 Notary Sieneture: va*yo^-'%qk. TONI GINOLEBPENOER riot.orm...v-awlmna a.wr:xsvlseo:al»ros : - 1COMM1NSSION i FF924951 ' - EXPIRES:Octaber6,21119 b .....� eaWAmvlblaryl�uroxnws A,. TREE & VEGETATION AFFIDAVIT ______ _ City of Atlantic Beach r _rJ Department of Community Development Planning&Zoning Division 800 Seminole Road Atlantic Beach,FL 32233 f (P)904 247-5800 IF)904 247-5845 'PERMIT v SECTION I-APPLICANT INFORMATION rOwnpper(s) rLegal Authorized Agent- NAMEOFAPPLICANT 60E& 9 I4,S ��. /" '�✓t'SHr<L� L 1, /' _ �,�t/LSFI{LLL 2�aona� NAME OF COMPANY N/A,/� ADDRESS OF COMPANY /a / A PHONE � CELL (3p 38 _q.Z2 €MAIL � -Qe CONTRACTOR CERTIFICATION NUMBER` ATLBCH BUSINESSTA%RECEIPT NUMBER SECTION 11-SITE INFORMATION STREET ADDRESS OF PROPERTY 37S -otttk S -F71. RAiG Ilan a ddresshasnabeenossgnedtathisMperty,mntaatheA88ulld1ngnepaWao.t(90Q247-w6to requestm address. LEGAL DESCRIPTION L_.AS f' n LOT 8 BLOCK 6 SUBDIVISION A /*Anti 64 REAL ESTATE NUMBER �/ LOT OR PARCEL SIZE: XOSO FT AC /� RESIDENTIAL COMMERCIAL OTHER(SPECIFY) //1V/D � O✓LR .Qµ.A�2rQ ,(n '�"�i ( CO.a rtR wGTiOW 1 affirm that I have reviewed the provisions of Chapter 23, "Protection of Trees and Native Vegetation"of the Municipal Code of Ordinances for the City of Atlantic Beach,FL and/or I have participated in a pre-application meeting with the Administrator of those regulations. Subsequently,I affirm that no regulated trees and no regulated vegetation will be damaged,destroyed and/or removed fmmthe bove-describedoradjacentpmperties in conjun n with thisproject. IGN URE OF tK SIGNATURE OF OWNER Signed and sworn before me on this day ofs .I- Au 16,b State of . y r-io.�i a /ns 6 . /�+.s((, If �,,,,� / A4AeiAafl County of wu Identification verified: (YAG-z-4- (04 -y.1p�44.3 Oath sworn: n yes r No se �''s TOMGlwi.E9PERGEB otarySignature MY0WM1 10NtFF92(991 EXPIRES:0caxxa,M19 REV TVA 1 9a mNwvywtte umnw6o yCommission expire s: _ LC?27.KMK e N8 OECA I.S N' 25.W.W"PUTT Slit 5'W. [{[N 1.5 N ;USC{ — I.Li —fF110E oar 0.2 E 51 oAr>=so woro a2T 5 Wia LM2Nmom 6 m m DoT an.MocNe R n Lor2s,eLaace QS zs GAR. \� A.C.ze � aJ lw . . uv o0 2 � N W N PAVER3 Q � L U� NTs a al.w u i 1 SB3.2BVJW 26.00 RAi FOURTH STREET (40'RAN) I I k1l y I 4 Steil P( Wdd The null lesdl Said a t✓x Fr- 2xe6c" tat o l HAI L.1 o (z) vd,EdL lx�est to L-F� �T' �x� P�>• � �X1�11F� Webb t�K diJowr -R!:, F-,ri- H o � �� oma• r�a�-. D �ehlo. tEVTIt-" I -111— I�-111_ 16u - �Pse.Wz T)°Ps zsoovur FOURTH STREET (49 RIW) 4 �n m � GAZES VO i � r i rj(..©p IZ�of til-pu m� 43 Pa�61 � /.Z z 6 if 6 1 -- go � J I