1661 PARK TER E - FENCE /n
'� CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
jCr 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-3509
Job Type: FENCE PERMIT
Description: FENCE
Estimated Value: $100.00
Issue Date: 4/7/2017
Expiration Date: 10/4/2017
PROPERTY ADDRESS:
Address: 1661 E PARK TER
RE Number: 172020-0216
PROPERTY OWNER:
Name: KETTERINGHAM ET AL, BARNEY B
Address: PO BOX 20229 PO BOX 20229
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.
0-,\`�r City of Atlantic Beach
S r l-',, Building Department APPLICATION NUMBER
`i 800 Seminole Road ���� (To be assigned by the Building Department.)
r� Atlantic Beach, Florida 32233-5445 MAR 17 2017 I —��ION _ 3 ��
Phone(904)247-5826 • Fax(904)247 5
�r�;;ivr' E-mail: building-dept@coab.us �: Date routed: -�
/ i7I17
City web-site: http://www.coab.us (((
APPLICATION REVIEW AND TRACKING FORM
Property Address: I Cv 6 I Pir_ARK LkRAQ_t /- Department review required Yes No
_CEuilli_ _..._...
Applicant: o 1.0E4 . tanning &Zoning.
^-- Tree A mini
Project: D 0c156016-WOrks
ublic Utilities .
Public Safety
Fire Services
r
Review fee $ ,� ,.' Dept Signature 1_ l
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:
APPLI ATION STATUS
Reviewing Department First Review: Approved. ['Denied.
(Circle one.) Comments:
BUILDING V/A—
PLANNING
&ZONING1. 1.2.--_ 3/� ` '
Reviewed byV� Date:
TREE ADMIN. Second Review: QApproved as revised. ❑Denied.
P .:WORKS Comments:
'U:LIC UTILITIES
3- zo r7
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: QApproved as revised. ❑Denied.
Comments:
I
Reviewed by: Date:
Revised 05/14/09
1
�s!_.,t1 , City of Atlantic Beach
`�s 4\ Building Department ( APPLICATION NUMBER
To be assigned by the Building Department.)
800 Seminole Road
o
Atlantic Beach, Florida 32233-5445 17 -rN cL- 3 C )
Phone(904)247-5826 • Fax(904)247-5845
'°L1,1>%, E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I to 67 ( PARK ( CggAat uired Yes NoL Department review re required
.�uildir
Applicant: LONDE- fanning &Zon ng
Tree A mini
Project:
ublic Utilitles�
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: kpproved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by: �.� , Date: .?// 11
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
rsy�r�;l� City of Atlantic Beach APPLICATION NUMBER
1SBuilding Department (To be assigned by the Building Department.)
2 800 Seminole Road
\ ' c) Atlantic Beach, Florida 32233-5445 t 7 — NCC" 09
r
Phone (904)247-5826 • Fax(904)247-5845
��J;6 E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: \ (p 6, ( PRRK L p}e_E Department review required Yes o
Applicant: U.)f\DF—� _fanning &Zoning
Tree A.mirn - •
Project: (Public Works
public Utilitie�j
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: proved. Denied.
(Circle one.) Comments:
UILDING
PLANNING &ZONING /
Reviewed by: �� Date: 2 r /7
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
-t `-r � City of Atlantic Beach APPLICATION NUMBER
6� ti�� f1, Building Department
', , EC (To be assigned by the Building Department.)
A `.r 800 Seminole Road E�
0... Atlantic Beach, Florida 32233-5445 17 -F-
\,._._ V c c _ 3S O�
Phone(904)247-5826 • Fax(904)2 58k4R 1 7 2017
':J ; �r E-mail: building-dept@coab.us Date routed: a
City web-site: http://www.coab.us BY
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1 lD(, ( PRK ( CkRAa t 6- Department review required Yes No
Applicant: VJ�F-�____ tanning &Zoning---,s
-
`�-- Tree A mini trats3T
Project: — c) e Public Works >
ublic Utilities
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. at 3-xe',7
(Circle one.) Comments:
Jee 014a 60414441
BUILDING
PLANNING &ZONING l . -
Reviewed by: A`. ., Date31Z2/
TREE ADMIN.
Second Review: ElApproved as revised. ❑. ed.
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
tom'. BuildingPermit Application
OFFICE COPY
sr pp
itt
fir-V
s > f City of Atlantic Beach
�w
800 Seminole Road,Atlantic Beach, FL 32233
'j Phone: (904) 247-5826 Fax: (904)247-5845
/ �!/ 3 ? i -1- "NCE 350
Job Address: 164 l TAIe.k ThRRACE �ATL 6c–+I)PL-Per umber:
Legal Description t o`�' 6. i3 Loc--1( 3 S/(1 PIA l2-)NA (.AN 17 4f 6 RE#
Valuation of Work(Replacement Cost)$/00 Heated/Cooled SF NA Non-Heated/Cooled M-It
• Class of Work(Circle one): New ddition Alteration Repair Move o Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Residentia
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No /A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal NA
Describe in detail the type of work to be performed: fy.►Sl 4 LL. 6 f F'€NCE rpoM Ij0(.1$ E TO
Ekes–r)NG AtVJOIN ING. FENcs NG -
Florida Product Approval# for multiple products use product approval form
Property Owner Information L j�
Name: ARNEN( I<6TTEKINSG-N4M Address: *6 1 PARK T R &
C
City AT!... 13 C1 State FL Zip 3�- 3 3 Phone (9044) A 29-7$2-2--
E-Mail
- -
E-Mail D4kNE.Y. 7TC—1l'`)G.14M @L1VE.COjM
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: Oiv')N&R Qualifying Agent: tJl
Address N A City NA State 1UA Zip 1J4
Office Phone NA Job Site/Contact Number
State Certification/Registration# NA E-Mail NA
Architect Name&Phone# nbQ
Engineer's Name&Phone# /44
Workers Compensation NA _
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 OBTAIN F ► a , ► CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORD! NOTI OF COMMENCEMENT.
TII
gn. ure of Owner or Ag: tincluding Contr.c 1 r) (Signature of Contra or)
i ned . d - orn to(or affirme. be'ore • • this .00',":ay of Signed and sworn to(or affirmed)bef a me this day of
a • , zO(7y _4 ,by
_ ! IIM
(Signature o l otary) (Signature of Notary)
Oiii,•; TONIGINDLESPERGE# 924
•
E'= MY COMMISSION rF 9
• ` io= EXPIRES:October 6,2019
rffeersonally Known 4 it''.:-:•b4 gcnded11, No:aryPublicUnderonters [ ]Personally Known OR
[ ]Produced Identific:ti_t�""" [ ]Produced Identification
Type of Identification: Type of Identification:
OFFICE COPY
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I. -,��t1
�l CITY OF ATLANTIC BEACH
s ,
_ ` '0%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. 'ITIE EXEMI'T'ION 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 CONS IRE ICI ION 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 ANI)OCCUPANCY. IT MAY NOT 13E 13(111:f FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BIJIL'I YOURSELF WH I TIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME TI IAT YOU BUILT
II'FOR SALE OR LEASE,\VHICII IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
RE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES 2E )LIIRED BY STATE LAW ANT) BY COUNTY Qt. 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
t CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA 'CONTRACTORS
•
• CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826)IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
•
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
I ( "PARK TezRACE E
y Alt- I cii (904( 6L5�-$VZZ
ADDRESS PHONE NU OBER
'&412W Y - — . Tri , AAA
PRINT NAME .
°34 /7
SIGNATURE DATE
Before me thisay of J y \.�C .2a in the county of
Duval,State of Florida,has personally appeared herin by hl self/herself and affirms that
all statements and declarations are
�true
Jand accurate.
Notary Public at Large,Stale of 1— ( ,County of t l ,U4 et.---( ,;,k;,
rI ersonaly Mown
ProiucedlderMcalion- . -�V.PiPi - TONIGINULESPERGER
7 MY COMMISSION#FF 924951
°' .1 EXPIRES:Otaob r 6,2019
illATI
,, r ` ' Banded Thru Natal Public Underwriters
Notary Signature: 0411 ` ' F,,,.fa r
F.mLtx;'O,t,,.AuiWYAm,,L,,ir,RFVLSIi) vicdetv '