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600 STURDIVANT AVE - FENCE ► �1,yr. r r:),,, � , CITY OF ATLANTIC BEACH f 800 SEMINOLE ROAD J � ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 r-J.219r FENCE PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 16-FNCE-2891 Job Type: FENCE PERMIT Description: FENCE Estimated Value: $350.00 Issue Date: 1/11/2017 Expiration Date: 7/10/2017 PROPERTY ADDRESS: Address: 600 STURDIVANT AVE RE Number: 170669-0050 PROPERTY OWNER: Name: MCWHIRTER ET AL, LYNN Address: 13791 WINGFIELD PL PERMIT INFORMATION: PUBLIC WORKS: All runoff must remain on-site during construction. Roll off container company must be on City approved list (Advanced Disposal and Realco Recycling). Container cannot be placed on City right-of-way. Full right-of-way restoration, including sod, is required. All old fencing must be removed from job site by Contractor. FEES: Fence/ROW $35.00 Total Payments: $35.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. r.-a,v • City of Atlantic Beach APPLICATION NUMBER K;y.lei Prrw .. Building Department �f. (To be assigned by the Building Department.) v '1 800 Seminole Road I ( Y; f"N C� _ Z ,�_l ' A� �r Atlantic Beach, Florida 32233-5445 A� U 3 �A11 I fit__ r- Phone(904)247-5826 • Fax(904)24 - 84 �on �? E-mail: building-dept@coab.us Date routed: l Z/ Z3D J I C%) City web-site: http://www.coab.us dY: APPLICATION REVIEW AND TRACKING FORM Property Address: 6(30 St U R.D 1 v A:J r Department review required Yes No :uilding) Applicant: J(^tik)E,R__ r -nning &Z&iTi —) Tree Administrator Project: P--- D C.- •lic Wo?Rs� . (Public UtiliI Public Safety Fire Services Review fee $ PZDept 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: APPLIC TION STATUS Reviewing Department First Review: pproved. ['Denied. (Circle one.) Comments: BUILDING / PLANNING &ZONING IlkAr."Reviewed by: Date: /.4 1 7 TREE ADMIN. Second Review: ['Approved as revised. ['Denied. P GWORK Co ents: PUBLIC UTILITIES PUBLIC SAF Y Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. ['Denied. Comments: Reviewed by: Date: Revised 05/14/09 S;:L .. City of Atlantic Beach APPLICATION NUMBER rjs : ''J s1 Building Department (To be assigned by the Building Department.) 800 Seminole Road \ _ F- NCE - ZB9 ,�i Atlantic Beach, Florida 32233-5445 w 4- Phone(904) 247-5826 • Fax(904) 247-5845 '-'2,-0;119',.0;1t�r E-mail: building-dept@coab.us Date routed: I Z/7---i;f5// City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 600 St-U 2-DIVA r Department review required Yes No / uilding) Applicant: CDG0 e i?____ �— nning &Zor rig—, P--- �— Tree Administrator Project: i—" E&_) CC— lic Worn Public Utilitie 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. nDenied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by:.�.� L/ /- ---------Date: /5717 TREE ADMIN. Second Review: Approved as revised. nDenied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. EDenied. Comments: Reviewed by: Date: Revised 05/14/09 �i�\,v � City of Atlantic Beach APPLICATION NUMBER J� r 1.X; Building Department (To be assigned by the Building Department.) 800 Seminole Road ` —1----N) I` N CE _ zE39 �� r Atlantic Beach, Florida 32233-5445 ! ,: Phone(904)247-5826 • Fax(904)247-5845 i / J ,j;t>>r E-mail: building-dept@coab.us Date routed: Z 1 C City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: ,6 Do S l u R,D I V a r Department review required Yes1 o ( uilding) t Applicant: C)co e2_ nning &Zoliilig---) Tree Administrator Project: rEi,_, Ce-. Public Wo`rR .`'ublic Utilitie -) 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: :UILDING PLANNI &ZONING — Reviewed by: / Date: /— It0 TREE ADMIN. Second Review: Approved as revised. ❑De • d. 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 1..i ri) City of Atlantic Beach APPLICATION NUMBER > Building Department ; (To be assigned by the Building Department.) y 800 Seminole Road _ _ Z . . __ s) �1'AN 03 2017 ` CC 9- I � Atlantic Beach, Florida 32233-5445 ;; '� 4 r Phone(904)247-5826 Fax(904)247-5 `o;t��? E-mail: building-dept@coab.us Date routed: Z/7-&/1 C-7 City web-site: http://www.coab.us -� APPLICATION REVIEW AND TRACKING FORM Property Address: ( i 012.D I V P Department review required Yes No ( i uilding) Applicant: _ OCADIO E .._ nning &Zornn Tree Administrator Project: CC- u lic VT/OTR Public Utilitiies—) 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 `i' Reviewing Department First Review: r�pproved. ❑Denied. /L�/ it one.) (Circle o ) Comments: dee #141-tdid W't'tne& BUILDING / / ( (/ � PLANNING &ZONING Reviewed by: Date. / i TREE ADMIN. Second Review: ❑Approved as revised. ❑Deni•d. 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 OFFICE COPY r '+' BUILDING PERMIT APPLICATION c) CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach FL 32233 ��Ji31�r Office:(904)247-5826 • Fax:(904)247-5845 ri\jv Job Address: (COO � rd( UC(/tu , Permit Number: Legal Description RE# Valuation of Work(Replacement Cost)$ J—r) Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): New Addition Alteration 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 No N/A • Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal Desc4ibe in detail the type of work to be performed: • P,UI e-e ( ) 4-0 rtiCIIced 0 n 7O 0 -64')r 01t Vc 4Cf- Florida Product Approval# for multiple products use product approval form Property Owner Information GA-( L- ML ,d h r i(�-�✓ l Sbiyatuct-vd--. Name: Address: bo . City A "(ic14 r.C., CSA State—Zip 3 047-33 Phone 9O cf - g03- &C(.O E-► ail k)11;Ife-ral jOe( ( SC� � . rte.-(- ciror Agent (If A t,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: Quajifying Agent: Address: City State Zip Office Phone Job Site/Conti/et Number State Certification/Registration# 7,/ E-Mail Architect Name&Phone# Engineer's Name&Phone# Worker's Compensation Exempt / Insurer / Lease - ployees / Expiration Date Application is hereby made to obtain a pe it to do the work and installations as indicated. I certify that no work or installation has commenced Trior to the issuance of a permit and tha all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. his permit becomes null and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period o fsix(6)months at any time ajier work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing, Signs, Wells,Pools,Furnaces,Boilers,Haters,Tanks and A r' ditioners,etc. dt� � Signature f Property Owner: 14 ` _ r ' Sign• �pia� tractor: Befo 2 1 `e' this, Day of A. h.: • Befo Yt&.tl s Day of m Notary Public: . , No • igyg r A I hereby certify that I have read and examined this applicati and know the s'j e and correct. All provisions of laws and ordinances governing this type of work will be complied with whether speci r not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other fe'- a:,ast A ..r local law regulating construction or the performance of construction. �pAx 2; Rev.3/14/16 f1.'''"r%, J "' CITY OF ATLANTICi BEACH OFFICE COPY IJ%WNER / 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 THE CONSTRUCTION IS COMPLETE, THE 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 TI-IE 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. co 5--)-orct.tva,,u-f- Av. A6 904 g0 3 -6c---kv ADDRESS PHONE NUMBER x.14( L M 72 — oigi ig, 1 14 e."----./ ._ ,5 , C., NATURE (Ei \ DATE Before me this Z iay of ✓ 20L�+t�f the county of Duval,State of Florida, as personally appeare herin by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of Pt l ,County of I�V(--/l ❑PersonallyKnown Produced Identdication- 0 _2E, p ...ss s z _k: n MYOMONEFRFG92E4R9 510 3. ;'J EXPIRES:October 6,2019 v.: "'3t;R.• Bonded Thru Notary Pubic Undewrite rs Notary Signature: O F:/BLDG/Owner-Builder Affadavir REVISED:4/16/2009