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680 SAILFISH DR - FENCE 11 S .. -_- Jas f 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-3775 Job Type: FENCE PERMIT Description: new 6 foot wooden fence Estimated Value: $1,900.00 Issue Date: 4/27/2017 Expiration Date: 10/24/2017 PROPERTY ADDRESS: Address: 680 SAILFISH DR RE Number: 171211-0000 PROPERTY OWNER: Name: BERNSTEIN, VEDA L Address: 680 E SAILFISH DR gi PERMIT INFORMATION: PUBLIC WORKS: All runoff must remain on-site during construction. Roll off container company must be on City approved list (Advanced Disposal, Realco Recycling, Shapell's Inc.). 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. City of Atlantic Beach APPLICATION NUMBER ( ?i'. � Building Department (To be assigned by the Building Department.) moi. 800 Seminole Road i�_ Ft !��_3 �:. -r Atlantic Beach, Florida 32233-5445 1 !v \Y� Phone(904)247-5826 • Fax(904)247-5845 l ' i \fii 0- v E-mail: building-dept@coab.us Date routed: o tL t• l- t i q City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: (.0S s i 1i,sk1 p( . Department review required Yiey No Applicant: Cjk.-J (\.Q ( c Planning &Zonir Tree Administrator Project: 't.\.1"--3 ErZOn W00 -1'1 -(1((' (ublic Works j 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: Q proved. ❑Denied. (Circle one.) Comments: BUILDI PLANNING &ZONING Reviewed by: t}') Date: i4.?6 nTREE 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 ,i:51.J->>\,, City of Atlantic Beach APPLICATION NUMBER �� Building Department (To be assigned by the Building Department.) • 800 Seminole Road _ �I Atlantic Beach, Florida 32233-5445 `� �)v �£ 3 Phone(904)247-5826 • Fax(904)247-5845 f 0;31�� E-mail: building-dept@coab.us Date routed: oL{ 4 11 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: CO$O SQ:AVi.s 1 p( . Department review required Yes No Applicant: aL.) n L Planning & Zonis Tree Administrator Project: \-�.� ��S c WOOCV1-f -{I(� 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. (Circle one.) Comments: BUILDING PLANNING & ZONING Reviewed by:��,.,.� �� Date: V/Y/17 TREE ADMIN. Second Review: A roved as revised. ❑ pp ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: I !Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 rs->>`p;;,,., City of Atlantic Beach • APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 1� FNPhone(904)247-5826 • Fax(904)24fi8ECE %JrE- \ 4PR 17 2017 �oliio- E-mail: building-dept@coab.us Date routed: DLitt " City web-site: http://www.coab.us By. APPLICATION REVIEW AND TRACKING FORM Property Address: COSO SA.i SV 9( Department review required Yes No C Building Applicant: OL) f\ C Planning &Zonin Tree Administrator Project: (�-Q.� �-�� woi)rn Works---7) 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: APP CATION STATUS Reviewing Department First Review: Approved. Denied. A /f"�'J (Circle one.) Comments: cle I�tF itti BUILDING Ci Attild PLANNING & ZONING r Reviewed by. // _ , - y 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 rc1.,A1,�, City of Atlantic Beach APPLICATION NUMBER v' / Building Department (To be assigned by the Building Department.) (' 2 800 Seminole Road i�_ ��IC�^3i_, �,, Atlantic Beach, Florida 32233-5445 'vPhone(904)247-5826 • Fax(904)IrCEIVEI) MR 1 7 2011 • i\J,319',' E-mail: building-dept@coab.us Date routed: O -t 4I I-11 City web-site: http://www.coab.us `` APPLICATION REVIEW AND TRACKING FORM Property Address: 0O SA.:A SVI Q( • Department review required Yes No cBuildmg Applicant: O — (\-124 C. Planning & Zoning, Tree Administrator Project: t.-k--3 EU. (:)0-\ WO06‘.0.-t1 '2--(1(. Public Works-----s ublic Utilities Public Safety Fire Services Review fee $ , • Dept Signature Xyl 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: APP ICATION STATUS • Reviewing Department First Review: Approved. ❑Denied. (Circle one.) Comments: A/ BUILDING PLANNING &ZONING /� Reviewed by: 5_,L `� Date:/4- ate: /S I7 TREE ADMIN. Second Review: A roved as revised. ❑ pp ['Denied. cs_LP WORKS Comments: UBLIc UTILITIES L/--/-7,-- 7 PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. ['Denied. Comments: Reviewed by: Date: Revised 05/14/09 6/1 f c9vt.c_S 42, coce b .u.5 ata .3464 e" i,�, Building Permit Application ; 1 Y FILE City of Atlantic Beach copy lifiri 800 Seminole Road,Atlantic Beach, FL 32233 ‘ 110-4. s 0_ Phone: (904)247-5826 Fax:(904)247-5845 � ( f RJob Address: U O �IL�SV1, 01/ Ail f-'ch Permit Number: VI-F( 31 4 S Legal Description LA" a C0 IISloaea 5 RE# Valuation of Work(Replacement Cost)$ 1 ICJ U Heated/Cooled SF li\A Non-Heated/Cooled r.A- • Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door A✓\CP__ • Use of existing/proposed structure(s)(Circle one): Commercia Residential • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A 'i • 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: (\i4^ J CQ 4# W aok. fsbA ce_. Florida Product Approval# for multiple products use product approval form Property)Owner InformationII (� ,/� Name: V '" ✓(QSS Address: leg-1(s 1 tS� iJ✓ City 1 -- . Bch State Gt Zip 3aa33 Phone 9Oc-4 (6 S4�'7 E-Mail \It 1i[SSn 'ys& - 1 -G Owner or Agent(If Agent,Power o`-Att8rney or Agency Letter Required) Contractor Information Name of Company: Qualifying Agent: Address City State Zip Office Phone Job Site/Contact Number State Certification/Registration-t#, E-Mail Architect Name&Phone# Engineer's Name&Phone# 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 OBT IN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECO D NG Y URN TICE OF COMMENCEMENT. (Signature of Owner or Agent including Contractor) (Signature of Contractor) Signed and sworn to(or affirmed)before me this I'day of Signed and sworn to(or affirmed)before me this day of An \ , ak ,by _, ,by \ _. i I) ;:� JENNIFcI� OHI t li!turel Notary) (Signature of Notary) "4 Z. .a. ';* MY COMMISSION#CO 042984 W...1,.: ,4 a EXPIRES:October 27,2020 '�;,o oP; Bonded Thru Notary Public Underwriters I rmogrimarrirormeme , [ ]Personally Known OR ()Produced Identificationt [ ]Produced Identification Type of Identification: �r"JOA S\<<--t.411e Type of Identification: El 7 f'rtrif.:4 �} CITY OF ATLANTIC BEACH Y l�%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 THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REOUIRED 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN"OCCUPATIONAL LICENSE"IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826)IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. (o$a sOUKsk At. q (010 S2"--7 ADSSS f4&vLij PHONE NUMBER P T NAME r�tICIGNATURE DATE Before me this I' day of ' N-4 t \ .20 / in the county of Duval,State of Florida,has personally appeared herin by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of r ,County of ti et 1 O Peraonaily Known I'J f C vt`Q( C JENNIFER JOHNSTON Produced Identification- J •Al is MY COMMISSION#GG 042984 hi y: EXPIRES:October 27,2020 • �:o geed Thru Notary Public Underwriters Notary Signature: )t "�'�' F:IBLDG/Ovmer•Bwlder Affacavit;REVISED:4/16/2009 R.O.W. Permit Attachment of for R.O.W. Permit# 19' FNCE--' 11-S- issued , 20 Atlantic Beach, FL 32233 Owner's Name: Oak_ 1,'oi.✓(2 5 / VL 1 R- 3"X33 Property Address: l0 46,0 �I'`�j k YJ✓� - �c.� 1 14-1-(2.01";c G Subdivision: R.E. #: REVOCABLE ENCROACHMENT PERMIT _THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of trr— � , 20 , by Atlantic Beach, Florida, a municipal corporatioq ocgan.ized and existing --:under thelaws of the State of Florida, hereinafter referred to as "CITY" and Vo,( ✓(Q S S 112' of Atlanti! Beach, Florida, hereinafter referred to as "USER". N WITNESSETH: nThat the CITY does hereby grant the USER permission on a revocable basis as described herein the right to to enter upon the property of the City of Atlantic Beach for the purpose as described in the City of Atlitic Beach Right-of-Way/Easement permit numbers noted above (copies attached). This Jork is generally described as: UJ p OSI v {3V-1 io G AC1L_ 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, ty certifiedmail, return receipt r uested, 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 Codes, Land Development 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 matches the existing and adjoining sidewalks." Page 1 of 2 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. DATE$ and SIGNED this q--\h day of Ap{1 , 20 i *-1 By: I 1_ . Al Property Owner (to be signed in presence of the Notary) STATE OF FLORIDA COUNTY OF DUVAL On this , day of Apr p r , 20 I- , personally appeared before me, a Notary Public in andor said County and State, (�A\)G,1 curd WT\d , the property owner of USD Sa, V Sy , 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. `r *ea! No.•. • Publ V i l+r said County and State R w r. :�+ ° '• JENNIFER JOHNSTON . MY COMMISSION#GG 042984 '% '.� EXPIRES:October 27,2020�oar Bonded Ttuu NotaryPublic Underwriters tips , CITY OF ATLANTIC BEACH, FLORIDA, a municipal corporation: Approved: t ^ Public Works Director .ScCif Miall/ File: 12/12/16 Page 2 of 2