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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 ,,.11._,....,„ ^ c 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 '