Loading...
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