335 4th St fence permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
FENCE PERMIT
MUST CALL BY 4PM FOR NE)Cr DAY INSPECTION: 247-5814
JOB INFORMATION:
Job TD: 16-FNCE-2668
Job Type: FENCE PERMIT
Description: REPLACE 6 FENCE IN THE BACK SIDE YARD
Estimated Value: $1,000.00
Issue Date: 1/23/2017
Expiration Date: 7/22/2017
PROPERTY ADDRESS:
Address: 335 4TH ST
RE Number: 169834-0300
PROPERTY OWNER:
Name: GRANT, PEGGY
Address: 335 4TH ST
PERMIT INFORMATION: PUBLIC WORKS:
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.
All old fencing must be removed by Contractor.
FEES:
Fence/ROW $35.00
Total Payments: $35.00
PERMIT IS "PROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC REACH ORDINANCES AND ME FLORIDA
BUILDING CODES.
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)247-5845
(I --'.Do, E-mail: building-dept@wab.us Date muted:
City welb-site; htp:/M�.coalbms
APPLICATION REVIEW AND TRACKING FORM
Property Address: &--2, kDepartment review required _Y_e_sF1No`J
a Building
Applicant: _QWk_7)e-P_ _.trffFFn—,ng &Z2nF
" 'Strtr
t r minnstrz tor
Project: ic Works
ublic Utfliffe—s:>
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review
Of Perlt=PBY Date
Florida Dept.of Environmental Protection
Florida Dept.ofTransportation
St.Johns River Water Management District
Army Corp.of Ertgmeers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other: _J
APPLICATION STATUS
Reviewing Department First Review; JEApproved. OlDented.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: O5� L--_0_—D,te- I$Al//
TREEADMIN. Second Review: []Approved as revised. E]Denled.
PUBLICWORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: —Date,--
FIRE SERVICES Third Review: ElApproved as revised. E]Denied.
Comments;
Reviewed by: —Date
Revised 06114109
EGEIVE"
E
-';�"V t
City of Atlantic Beach 7DEC 0 1 2016 APPLICATION NUMBER
Building Department (To be assigneidby the Building Department.)
800 Seminole Road BY.
Atlantic Beach,Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@wab.us Date 7muted:
City web-site: hftp:/Awww.coab.us Ju
APPLICATION REVIEW AND TRACKING FORM
Property Address: &ss Wt—reviewrequired —Y—esTN-ol
Building
&Z
Applicant: ;,EMEnnig d
re Admi m.tnator
Project: ic Works
ublic Utilitle97�>
Public Safety
Fire Services
Review fee 1i------- Dept Signature
Other Agency Review or Permit Required Rev =ply
low B Data
Of permit
Nda Dept.of Environmental Protection
Florida Dept.ol"Fransportation
St.Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaurants
-DMAsion of Alcoholic Beverages and Tabs=
Other.
APPLICATION STATUS
Reviewing Department First Review: VApproved. E]Denied.
(Circle one.) Comments: 4-it 4ili
BUILDING
PLANNING &ZONING Reviewed by: /4%"�� D ate: /vp—//
TREEADMIN. Second Review: E]Approved as revised. DDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date
FIRE SERVICES Third Review: E]Approved as revised. []Denied.
Comments:
Reviewed by: Date:—
Revised 05/14109
_'1VE
City of Atlantic Beach APPLICATION NUMBER
Building Department DEC 0 1201 To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach,Florida 32233-5445 162– r"06–: –2(� 68
Phone(904)247-5826 - Fax(904)247
E-mail: huNding-dept@coaltous
City web-site: http:/Jvvww.coab.us;
APPLICATION REVIEW AND TRACKING FORM
Property Address: ?)SS Department review required Yes No I
Building
Applicant: 0 CADA_D el�?_ ning on
APP"CATI
6 0 be 'gred b
Date r utsd
a kan to
rtm e
uldmg
mng&Z m
Project: co tp re ministrator
Public Safety
Fire Services
Review fee $ Pep�Signature '5cf, __
Other Agency Review or Pennit Required Review t
of Permjt=PBY Date
Florida Dept.of Environmental Protection
Florida Dept.of-Fransportation
St.John.River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other.
APPLI�ATIONI STATUS
Reviewing Department First Review: VpProved. []Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: 5��4/e A� Date: 12/2- 6
JJ
TREEADMIN. Second Review: E]Approved as revised. nDenied.
ORKS C ants:
S
P 2�
)J UTILITI
:7'ePpfuNi u/ _/V
PUBLIC SAFETY Reviewed by: —Date:
FIRE SERVICES Third Review: ElApproved as revised. E]Denied.
Comments:
Reviewed by: —Date,
Revised 05114109
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beatolt FL 32233
Office:(904)247-5826 - Fax:(904)247-5845 (0
Job Address: 2)a5 11A Permit Number:
Legal DescriptionNELfoa\ -ptne-C RE#
I
Valuation of Work(Replacement Cost)$_Laoj�'_Heated/Cosolled SF Non-Heated/Coolled
air Move Demo Pool Window/Door
• Class of Work(Circle one): New Addition Alteration (��)
• Use of existing/proposed structuare(s)(Circle one): Co mmial midt
If an existing structure,is a fire sprinlcicr�system installed?(Circle one)
: Ws N/A
Submit a Tree Removal Permit Application if my tnees are to be removed or Affidavit of No Trein Removal
Describe in detail the type of work to be performed:
Florida Product Approval# fia�multiple products use product approml farm
Property Owner Information
Name: Address: ZZ) 1�ffw_+
City A&tE�S�tatCJZp Z VA 15z% S_Sot�
�Phone
Owner Ag t fAtamorAsncy1,uarRqum:d)__\,
WARNING TO OWNER: YOUR FAILURE TO RECORD A N E OF MAY
0
OTIC� IF YOR
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PR PERT�Y TEND
TO OBTAIN FINANCING CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTIft OF COMMENCEMENT.
Contractor Information:
Name of C . "A-114f(mm Fellel Pulp" ifying Agent:
Address: 40M UAU ( oil City_State Zip
Office Phone gD� )er
State Certification/Registration# —E-Mail
Architect Name&Phone#
Engineer's Name &Phone#
Worker's Compensation
Exempt i Toaster j �ase EmpTo—yees I mpicatim Date
Application is hereby made to obtain a permit to do the and installations as indicated. I csrft�that an werk or installation has commenced
re nMIjr
gor to the isnames,afa permat and th I all uark will e rmod to meet the standardy of all la�s,regulaaag construction in thisjunsalction.
his permit becomes null and mid i isaot. �thins&(6�!nonthsorifmn�tmefion,or�rkiss-,-ndedor a a
gA ta, name, khram ne d.1._,._.1- Zb a.I do,_
me s- 0 ' a - ,an Air n - ncm�a
'g.,4f.M,%7beF musy, a e 1 he", "GINDLESPEMEN
WCOMMSSIOWFW24951
Signature of Pro Owner: %ZgWtobsr 6.o 19
Bg�2Be am me 'a Y.
ffD.y of
Notary Publi . tary Pub
I hereby cerlify that I have read and cramined this application and know the same to be true and correct. Allprovisions aflaws and
ordinances governing this type yafwork will be complied with whether seecyled herein or not. Aegrantin$ ofapernutdoes not
presume to give authority to via ate or cancel theprovisions of any otherfee cral,state. or local law regulating construction or the
perforniance tirconstruction. Rev.3YI4116
CITY OF ATLANTIC BEACH
OWN
�vl ER/ BUILDER AFFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I 'CONSTRUCTION
CONTRACTING'REQUIRES OWNER I 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 CONSMCTION YOURSELF, YOU MAYBUILD ORIMPROVE AGNE-OR
rwO FAMILY RESIDENCE OR A FARM OUIBUMUING- YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000 00 OR LESS- THE BUILDING
MUST BE FORY019-U—SE-AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE ORLEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUMB THAT YOU RUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION' YOU MAY NOT
HIRE AN UNLi PER ON AS YOUR CON�CT R. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZOi REGULATIONS IT IS
YOUR RESPONSIBILITY To MAKE SURE THAT PEOPLE EMPi 3Y YOU HAVE
LICENSES RFOITIRED BY STATE LAW AND py COUNTY OR MUNIC AL LICENSIN
ORDINIANCES,
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTM61NT �6GGESTS WORKERS COMPENSATION INSURANCE BE
PURCHASED.
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 ANN T BE EMPLOYED UNDER ANY
-dJ0 - 5 �— -
CIRCUMSTANCES. OWNERS BEINM &T;5 $5,6 6 ENA17Y UNDER FLORIDA STATUTE NO.
455-228(l) AN-OCCUPATIONAL LICENSE' IS NOT ADEQUATE, THE OWNER SHOULD PHYSICALLY
'CONTRACTORS
SEE THE COJNTY�CERTIFICATE OF COMPETENCY OR THE FLORIDA
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.
l?D(j '?S=� 5f)C)!'�
A SS PHONE NUMBER
WAP
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