168 SEMINOLE RD - FENCE e .s; x:,°�, CITY OF ATLANTIC BEACH
k ss 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Q.J;31
FENCE PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-FNCE-3787
Job Type: FENCE PERMIT
Description: replace wood fence - 6 feet in back & 4 feet in front
Estimated Value: $5,456.00
Issue Date: 4/27/2017
Expiration Date: 10/24/2017
PROPERTY ADDRESS:
Address: 168 SEMINOLE RD
RE Number: 170595-0000
PROPERTY OWNER:
Name: Halvorsen, Josef D
Address:
PERMIT INFORMATION: UTILITY DEPT.: PUBLIC WORKS:
Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible.
A sewer cleanout must be installed at the property line. Cleanout must be covered with an RT1
concrete box with metal lid. Cleanout to be set to grade and visible.
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.
Fence cannot be placed on City right-of-way.
All old fencing must be removed from job site by Contractor.
FEES:
Fence/ROW $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITII ALL. CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
/s , CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Total Payments: $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
0Jayf City of Atlantic Beach APPLICATION NUMBER
Js # � Building Department (To be assigned by the Building Department.)
800 Seminole Road /1_Fn10E- ?J1-kU 9-
Atlantic Beach, Florida 32233-5445 I
Phone(904)247-5826 • Fax(904)247-5845
!P E-mail: building-dept@coab.us Date routed: dg I F 1 1 1 1
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I (0% S Li/-n ,x'1_ _De artment review required Yew No
LAI
Applicant: dL anning & O-niers
Tree Administrator
Project: k 12_011.u2_ \„zo t Vila - Pak Work j
r �n� Public Utilities
� j1 PublicSa e
Wta- \A �i
Fire Services
DepMfgrfata
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: /00
BUILDING
PLANNING &ZONING Reviewed by: Jill Date: 4-f.076 �7
TREE ADMIN. Second Review: Approved as revised. ❑De d.
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
sy>>yj' City of Atlantic Beach APPLICATION NUMBER
41: - Building Department (To be assigned by the Building Department.)
r .t(, , 800 Seminole Road y1_�nlC C_ 31-59-
Atlantic Beach, Florida 32233-5445 1 1"
Phone(904)247-5826 • Fax(904) 247-5845 �
" ;tit%" E-mail: building-dept@coab.us Date routed: D(4 I I-^! 1 1 1
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I (o' S Lir^ tn6lR.._ 6 • De.artment review required Yes No
Applicant: 01, nnin &Zorn
Tree Administrator
Project: k �v\L&(. L woob Wu — (D ‘k r\ �Pr—blic Works
Nett LIC Lk- .`A \r i Public Utilities
j{ n Public sarety
Fire Services
Review fee $ Dept Signature
I Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept.of Environmental Protection _
Florida Dept. of Transportation
ii St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
1 Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: Approved. ❑Denied.
(Circle one.) Comments:
BUILDING V
PLANNING & ZONING
Reviewed by: 4//-- ---- Date: �� I
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
I
5I.J-vf;.,,, City of Atlantic Beach APPLICATION NUMBER
S r to Building Department nEGEWEr) (To be assigned by the Building Department.)
At i 800 Seminole Road q 1_Fn JC L_ 31-69-
;-.i -,/ Atlantic Beach, Florida 32233-5445 -. I I" l� f
\ � Phone(904)247-5826 • Fax(904) 247-584i;'R 19 2017 Date routed: OL
{I I C1 I I
0,3i9%' E-mail: building-dept@coab.us q Li
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I (OC S LiorN t,(16�.€__ 6 . Department review required Yes No
ui •
Applicant: OL+ Aannin &Zoni
Tree Administrator
Project: ( is\(t.0 w043& V•t'1(Q — �- •,�1) l u lic Works
rr Public Utilitie)
NoLtL - ) Lk- j l . k,R �� �(1"k Pu lic-Safe-ty
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: #fiidd 61.74 �
BUILDING
PLANNING &ZONING �/� r
Reviewed by.: ,,e4 d alp Date:f../147_
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
?S'a'�ir, City of Atlantic Beach APPLICATION NUMBER
�S�rtR � Building Department _.1 _ Iv
(To be assigned by the Building Department.)
j� , 800 Seminole RoadE-i> ��- �10E- 3���
,- Atlantic Beach, Florida 32233-5445 I"
� Phone(904)247-5826 • Fax(904) 7-5 f 1 9 2017O
19-
0;tior E-mail: building-dept@coab.us Date routed: I l I
City web-site: http://www.coab.us
BY._
APPLICATION REVIEW AND TRACKING FORM
Property Address: I ( Lire tn6lR__ 6 . De.artment review required Yes No
�uidin )
Applicant: DkANA.424Cznnin &Zorn
Tree Administrator
Project: k iv\ 1.12_.. woo& Veru co- ,() (F�ublic Work j
Public Utilities
\Otta' ) * F-1 k'n . f\-V Public-Sarety
Fire Services
Review fee $ Dept Signature •�Y,.
i
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:
4/4—BUILDING
PLANNING &ZONING Reviewed by: )1*76--hi, &'11----
Date: /7//7
TRE A DMIN. Second Review: ❑Approved as revised. ['Denied.
C WOR Comments:
cam✓
'r PUB � ILIT IES
l 7
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
�t-1i1= Building Permit Application FILE copy
City of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
=9'119'- enc�))� 11 �? lPhone: (904)247-5826` Fax:(904)4 247-5845
Job Address: (VlU '��Iti11Iv, F.-C ' �I 1)(,YI -)9 l Permit Number: 1 i 4--N � ()COQ=ryO�
- -a 5 `1 E ,114 `a ���(Q ✓ Sc - (Alj.t (3 RE# -4 ()SIC 1 5
Legal Description IC--s3 ) lT
Valuation of Work(Replacement Cost)$ .1L(1 S(L • 00 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): esu Addition Alteration Repair ,Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercia Residential
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes to N/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:
`��
( 1 ct�.,+`n t,�=�,t: 4-0(1U. Gl.:�C Or,c� �1�.' ,r� In ct c�� y ' .�,`n
LA,�' d £ d -1 v v L(�L-•�-e 1�►---e w
Florida Product Approval# for multiple products use product approval form
Property OwnerrrInformation 1� I - n �?kX_
Name: f- I�GZk\te, {J4N( S-e�`� Address: t1� ST (Y`�llr- V( f"1" �L-, 0 .ar)3
City_ \--("1cwc \C rack State 0- Zip 3.)-D-';3 Phone '1 V`{ - Z1(+% 3%i-`��
E-Mail DCA t'1 i-t' (• \r1(.741 <5-.Y 1 (-;z) 4),(Y1 CA. l ( (,L� y
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) LY' h 1 c( '1tCl
Co -ctor Information �?
Name of Compan . Y e'n(-�- Qualifying Agent:
Address ' C "� _ da— City • L... L 1 1 ' . e Zip
Office Phone IN-4 1 3(= t- •• • - .nta r
State Certification/Registration# -„ •
Architect Name&Phone#
Engineer's Name&Phone •
Workers C. . ion
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 ANCINGCONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
R : • i IN I UR NOTI OF Co MENCEMENT.
311IM
('ielnirof Owner or Agent including Contractor) (Signature of Contractor)
-• and sworn to(or affirmed)before me this l`1 day of Signed and sworn to(or affirmed)before me this day of
PS)f'\ 1 by ,by
JENNIFER JOHNSTON ��VA
* MY COMMISSION#GG 042984 , (Signat o tary) (Signature of Notary)
EXPIRES:October 27,2020
"••',,so;;So Bonded Thru Notary Public Under niters
,�....,�.. I r
( I Personally Known OR [ ]Personally Known OR
(Produced Identification c p ( ]Produced Identification
Type of Identification: n J L I J\t C tAt `T� Type of Identification:
,,Ys1-44,lr2.:.
'.Y:"It
CITY OF ATLANTIC BEACH
'~� •) Ii%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 Co
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS V
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE •
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING •
LU
ORDINANCES. —°"-
GO
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, 03
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE C]
PURCHASED. -".3
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 THg
BUILDING DEPARTMENT(247-5826)IF IN DOUBT. Z
N •
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE = 2 -.
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF Ate V 2 Q
OWNER-BUILDER PERMIT. W O C� ..
Caoo a
a C.� t . La :.. a -c.. ?�ZZ35 10± i cii r - �Co�( W V Q V G
ADDRESS PHONE NUMBER G 2 Q O
• .. _ _ . .. Vu' y
P. N7 NAM c. y z C�
I � (�l Q ( 0ii. L¢ �LlLfi
DATE
WI'
Before me this I day of AV 6 ` 20i in the county of W
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that W '' NCP i
all statements and declarations are true and accurate. /�
Notary Public at Large,State of . L �.]
- ,County of LL q 4. S
• R I a
❑Personally Known !� •`J A v c l``E nS , eek s01:v JENNIFER JOHNSTON
I roduced Identification- - • ., • - MY COMMISSION#GG 042984
• '0...:.,•!!‘„:o` EXPIRES:October 27,2020
. ,\ op; Bonded Tiw Notary Public Underwriters
Notary Signature: , A A� _ .�' .' y r .1 lb•
F:/BLDGIO wner-B ui!der A ffadavii:REVISED:4/16/2009