373 12th ST - FENCE \� , CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
`` ;� ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
FENCE PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-FNCE-3421
Job Type: FENCE PERMIT
Description: replacing 6 foot fence after hurricane damage
Estimated Value: $8,500.00
Issue Date: 3/23/2017
Expiration Date: 9/19/2017
PROPERTY ADDRESS:
Address: 373 12TH ST
RE Number: 171919-0000
PROPERTY OWNER:
Name: DODARO, NICHOLAS & CATHY, *
Address: 373 12TH ST
PERMIT INFORMATION: PUBLIC WORKS:
All runoff must remain on-site during construction.
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.
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
f /(� 800 Seminole Road �1
`41w-, Atlantic Beach, Florida 32233-5445 "T - N C. -14
Phone(904)247-5826 • Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: U. ( oe1 V1-
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: De'aliment review required Yes No
:uildin•
Applicant: DA ' annii• : Zonis;,
Tree Administrator
Project: (•LQ\ ttLt tnce is Work
u is Utilities
Public safe y
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:
BUILDING
PLANNING &ZONING Reviewed by:'�..r.,�C.,...--*".-30"---� Date: (PO
TREE ADMIN. Second Review: A roved as revised.
❑ pp ❑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
City of Atlantic Beach APPLICATION NUMBER
( iL
, Building Department (To be assigned by the Building Department.)
- �-- \`2 800 Seminole Road 1 _ I / / _3
�'''':' r� Atlantic Beach, Florida 32233-5445 1 t" t C
\� / Phone(904)247-5826 • Fax(904)247-5845
•.%1110- E-mail: building-dept@coab.us Date routed: D 3 i O b
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: n-. \a- S4 . De•artment review required Yes o
uildin•
Applicant: tWIN2- ( Fannia. : Zonis'
Tree Administrator
Project: (L \Ct t VC--VDD-k- Rt Le . is Work
u is Utilities
Public . -
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: [ proved. Denied.
(Circle one.) Comments:
IUILDIN
PLANNING & ZONING Reviewed by: 'Y Date: 4 ul.A7
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
?syLvf'y, City of Atlantic Beach
APPLICATION NUMBER
�� Building Department (To be assigned by the Building Department.)
,`` 800 Seminole Road ! /
15•,,.1
�/ Atlantic Beach, Florida 32233-5445 l 1 FN C k—3 4 d-
Phone (904)247-5826 • Fax(904)247 $q�5
Ji1 �% E-mail: building-dept@coab.us PIHAn C 6 201/ Date routed: D310(0111-
City
web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 31"- ka- S-& , De•artment review required Yes No
iuildin.
Applicant: OW AP--( - annii• : Zon•1
Tree Administrator
Project: t t`u.ue_ (0—-VPD-k' cin(_Q vmlimpl.,
4
"Us IC - - y
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: ra4proved. ['Denied.
(Circle one.) Comments:
BUILDING A/09-
PLANNING &ZONING
Reviewed by: 2 Date: C0
TREE A MIN. Second Review: A roved as revised.
❑ pp ❑Denied.
4 % `C ,WORKS/ Comments:
PUBLIC UTILITIES
PUBLIuSAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
S'
800 Seminole Road �1 / ,
Atlantic Beach, Florida 32233-5445 T — N L -3��
Phone(904)247-5826 • Fax(904)247-5845
J.219'l" E-mail: building-dept@coab.us Date routed: D3 I 00[11
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 3 't �I S , De•artment review required Yes No
:uildin
Applicant: DA Ate.( ' anni. Zonis:
Tree Administrator
Project: t.�Pa(t ( -V - ctn�.e r . is Work
u. is Utilities
Public - e y
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: proved. ❑Denied. il3•1/
(Circle one.) Comments: • e ALAI.
BUILDING
PLANNING & ZONING Reviewed by: ,� p /Z
Y / Datec--3/2
TREE ADMIN.
Second Review: ❑Approved as revised. ❑i ied.
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
i 7 - -3 4z (
R.O.W.Permit Attachment of for
R.O.W.Permit# issued , 20 Atlantic Beach,FL 32233
Owner's Name: N\ C`A 010k S (gyp
l
Property Address: '2,'N 3
Subdivision: R.E.#: MAR 1 3 2017
BY:
REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of
, 20 , by Atlantic Beach, Florida, a municipal corporation organized and existing
under the laws of the State of Florida,hereinafter referred to as "CITY" and
of Atlantic Beach,Florida,hereinafter referred to as"USER".
WITNESSETH:
That the CITY does hereby grant the USER permission on a revocable basis as described herein the
right to enter upon the property of the City of Atlantic Beach for the purpose as described in the City of
Atlantic Beach Right-of-Way/Easement permit numbers noted above(copies attached).
This work is generally described as: --IkL (NG, C-
Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted
remains subject to relocation or removal on thirty (30) days notice by CITY to the USER, said notice to
USER shall be given by certified mail, return receipt requested, to the following address:
The depositing of said notice of cancellation in the United States mail shall constitute the notice of
cancellation and the burden is upon USER to keep the CITY informed of USER's proper address.
The USER shall promptly make any and all necessary repairs to any facility erected or maintained in
the exercise of the privilege herein granted and shall at all times maintain said facility in good and safe
condition.
In the event it is necessary for the CITY or the City's approved representative or other franchised
utility to enter upon the above-described property of the CITY, the USER shall replace at the USER's
sole expense, any and all material necessarily displaced during the action of maintaining, repairing,
operating, replacing,or adding to of the utilities and facilities of the CITY or franchise utility provider.
The facilities allowed by the permit shall meet the current requirements of the City Code, Building
IECEv Code,and all other land use and code requirements of the CITY, including
City Code Section 19-7 (h) which states "Driveways that cross sidewalks: City sidewalks may not be
replaced with other materials, but must be replaced with smooth concrete left natural in color so that it
matte tl1eGxg and adjoining sidewalks."
Building Department Page 1 of 2
City of Atlantic Beach, FL
a
•
The USER, prior to making any changes from the approved plans and/or method, must obtain
written approval from the City of Atlantic Beach, Public Works Department, for said change. The
USER shall, at the discretion of the CITY,be requested to submit as-built drawings showing the change
within thirty(30)days after the day of completion.
This permit shall inure to the benefit of, and be binding upon, the USER and their respective
successors and assigns.
USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY
laws and/or specifications, to include utilities locate requirements and use limitations/requirements of
public rights-of-way and other public land. USER further agrees that the CITY and its officers and
employees shall be saved harmless by the USER from any of the work herein under the terms of this
permit and that all of said liabilities are hereby assumed by the USER.
DATED and SIGNED this Iv day of Mc:trek, ,2014 .
•
By:
4101011Pi
-r
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this day of N`64-C1\ , 20 n , personally appeared before me, a Notary
Public in and for said County and State, FtDti(fit. and Oktic&t , the property owner of
S1(91_4 , Atlantic Beach, Florida, known to me to be the person(s)
described in and who executed the foregoing instrument; who acknowledged to me that he or she
executed the same freely and voluntarily and for the uses and purposes therein mentioned.
No Public for County and State
ti*+ ••, JENNIFER JOHNSTON
• ., MY COMMISSION#GG 042984
:" ,;`,io i EXPIRES.October 27.2020
,,off,o;'• Banded Tru Notary Public Underwriters
CITY OF ATLANTIC BEACH,FLORIDA,
a municipal corporation:
Approved:
Dona d D. ;'ob, �tz P.E.
Public Works Director
File: 12/12/16
Page 2 of 2
• 1
, . , 3.S-on 1 1 �J I `V LE
arSjy'��-' .,,
,-.. ... . uildin Permit Application �- .
g ++ ,l,
t City of Atlantic Beach `j l MAR - 6 201it 7
v 800 Seminole Road,Atlantic Beach, FL 32233 { IL )1
°f!ur Phone: (904)247-5826 Fax: (904) 247-5845 --------
Job Address: 31 3 12-+1-• S‘. Permit Number: 11—•FNC.6.-344( '
Legal Description RE# ►')
ua
Valuation of Work(Replacement Cost)$ iGo — Heated/Cooled SF n VA Non-Heated/Cooled A k
• Class of Work(Circle one): New Addition Alteration eMMO Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): CommercialResidential
• 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 the type of work to be performed:
lRe.nno� daw *'e•••••.CR..(•E'Rsm f1'-- i cra.ti.Q) av, ,tee r.late_e_ -*._,,AcA_ So,...w L
Sr2e k Lb er.4 tom.
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: Nt c 1''-' a 54 iVlOJ �cp(a(b Address: 33 3 (til% Sl_
City A (3J State FL— Zip 32-2-33 Phone t ''t 2S3 -c °
E-Mail naz do,ta @ ers-„.,c,..,,Pr ,
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: S-Fef I trJ S -0c'k:a•" Inc• Qualifyin Agent:
Address 7,1)66 LA S Kt.vi 1IV. S{e. bOI City'4 • a 151.ns-4rno Stater` Zip .32o9S
Office Phone 4:16:"t-t 6 Zit J- abb Job Site/Contact Number
State Certification/Registration# E-Mail
Architect Name&Phone# ri l q
Engineer's Name&Phone# I^Ia
Workers Compensation
Exempt/Insurer/Lease Employees/Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS, FURNACES, BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc.
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
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 OBTAI . e NCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
REC.'' l IN o YOUR NOTICE OF COMMENCEMENT.
f 4
(Signature of Own- or Agent including Contr tor) (Signature of Contractor)
Signed and worn to(or affirmed)before me this to day of Signed and sworn to(or affirmed)before me this day of
MAZefi .57. . .by IJi(.l\v 14 S v• •r t) ,by
��r A MIRIAM RIFF. _.� / digy
$ _ °t Notary Publ• tatj- �r•,. _
—a Commission# •',lrr(3gnature o iota (Signature of Notary)
''^'' My comm.expires Oct. 2018
[ )Per ally Known OR [ j Personally Known OR
[q-Produced Identification_ [ j Produced Identification
Type of Identification: - b 1.- Type of Identification:
' - _,I CITY OF ATLANTIC BEACH
"lir ®WNER / BUILDER AFFIDAVIT
i
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 1-IAVE 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 TIIOUGII 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 525,000.00 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 IIAVE BUILT YOURSELF WITIIIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE,'I'I-IE LAW WILL PRESUME TI IAT YOU BUILT
IT FOR SALE OR LEASE, WIllCII 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 HAVE
LICENSES) QLIIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
0
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, O
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED. V
IL!
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO c.0
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 0
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 U
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT. z Z
= J
31. 3 1l!-L\ St •iu`t-2c3_ oZs73 CL a o P o.1
ADDRESS PHONE NUMBER 0 W f- Z W
N1 c (Iv IQS .vJo(4 0 fn N
PRINT AME -- (JJ 1.7. Qeni
iEr 2tif
/ OZO2,SIGNA DATE 0 (/)
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Before me this t day of 1" accn A .20 i.in the county of 0 a2 W
Duval.State of Florida.has personally appeared herin by himself/herself and affirms that IJ.
all statements and declarations are true and accurate. Q0 W W
Notary Public at Large.State of � .County of fl I/ U ~ D. m
FL--- W d W
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❑Pcrsoru ly Mown d(-%A.0-4`S `" 0 Cl) W
%ProluceoldarM,cahon. eges4<C ..nS� ���"' JENNIFER JOHNSTON >
ICC W
' '' MY COMMISSION X GG 042984 Lire
W
- ,...a. :or EXPIRES:October 27,2020
Notary Signature: '•••?o4,.o',:•' Bonded Thni Notary Public Underwriters
CCa
rhll.11Ciuwnrr-Uudd:r An rq.KlrvtSmit7 4/l6^009
MAP SHOWING BOUNDARY SURVEY OF:
LOT 37, BLOCK 1 , SELVA MARINA UNIT NO. 1 , AS RECORDED IN PLAT BOOK 23,
PAGE 4 OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA
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