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350 3RD ST - FENCE ip.,AVI:r 6 ‘41 iir X =.„ CITY OF ATLANTIC BEACH -1 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 'r.r;3 S) INSPECTION PHONE LINE 247-5814 FENCE WALL OR BARRIER - FENCE MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: FNCE17-0007 Description: 6 foot wooden fence Estimated Value: 1500 Issue Date: 5/24/2017 Expiration Date: 11/20/2017 PROPERTY ADDRESS: Address: 350 3RD ST RE Number: 169784 0000 PROPERTY OWNER: Name: Jacqueline Henderson Address: 350 3RD ST ATLANTIC BEACH, FL 32233-5232 GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Name: Address: Phone: PERMIT INFORMATION: Please see attached conditions of approval. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. * A notice of Commencement is only required for work exceeding an estimated value of $2,500. For HVAC work, a Notice of Commencement is only required when HVAC work exceeds and estimated value of$7,500. I I 0 ri,,, City of Atlantic Beach APPLICATION NUMBER , # ' Building Department (To be assigned by the Building Department.) ;t 1 800 Seminole Road ! 1(& t2--00011 •• r Atlantic Beach, Florida 32233-5445 ��- T Phone(904)247-5826 • Fax(904)247-5845 er fry,01119 E-mail: building-dept@coab.us Date routed: tb. 1 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: .ISD 3(A S* De•artment review required En o P te" 111M� Applicant: D..) (1 .2-( �_'lannin. &Zo . == Tree Administrator Project: 29 - D C* -P-41 L Public Safety Fire Services Review fee $_ Dept Signature Review or Receipt Other Agency Review or Permit Required 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: [1 approved. ['Denied. (Circle one.) Comments: CBUILDING) PLANNING &ZONING Reviewed by: ../ ' `edDate: S'/7'/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 si.����i;.i; City of Atlantic Beach APPLICATION NUMBER .fit r _ Building Department (To be assigned by the Building Department.) c JM i:..--•.,,' , . � 800 Seminole Road c^ 1 /' _ Atlantic Beach, Florida 32233-5445 1 1`)C ( —00D1- Phone wF Vr Phone(904)247-5826 • Fax(904)247-5845 b - '' 1110 E-mail: building-dept@coab.us Date routed: W L tDi Li- City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 3SD 3r_ 4 - Department review required Yes No Buildii Applicant: Dc4 n L-( tanning 8._.1.z. Tree Administrator Project: —Ic $=: :)---.----.----, --- _p_4„k Public Safety Fire Services Review fee $ Dept Signature j Review or Receipt Other Agency Review or Permit Required of Permit Verified By Date 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 b .5/2-3/ n i Date: 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_J\ City of Atlantic Beach APPLICATION NUMBER v' / •,, Building Department ; - 1 (To be assigned by the Building Department.) 800 Seminole Road L. g ^` r2 Atlantic Beach, Florida 32233-5445 1 N�-G -���� Phone(904)247-5826 • Fax(904)24 84AY 2017 L0;119� E-mail: building-dept@coab.us Date routed: I tDi Li- City web-site: http://www.coab.us BY: APPLICATION REVIEW AND TRACKING FORM Property Address: -ISO 3'I S--1- . Department review required Yes No Applicant: D,.) w1 .n—fcPlanning &Zonin� Tree Administrator Project: _ [0 – >- - IP $141: .- - 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: [pproved. ❑Denied. (Circle one.) Comments: fee litehei 4amtalivBUILDINGLri PLANNING &ZONING Reviewed b : Date:f-1�1 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 ;j1-.A•':rie,'#14111V6 BUILDING PERMIT APPLICATION k i.--i "• �S r Li• wo CITY OF ATLANTIC BEACH DATE 800 Seminole Road,Atlantic Beach FL 32233 5, 17 '/7 Jii1tr Office:(904)247-5826 • Fax: (904)247-5845 Job Address: ,°r� �� /�' Permit Number: FlU C E II-0004 Legal Description RE# Valuation of Work(Replacement Cost) $ Imo"`' Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): New. Addition Alteration Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s) ( ircle one): Commercial Residential • If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N/A • Submit a Tree Removal Pennit Application if any trees are to be removed or Affidavit of No Tree Removal Describe in detail the type of work to be performed: BC-tud ck �� ' FT ice • Florida Product Approval# for multiple products use product approval form Property Owner Information 2 Name: ye' deb,., S' ;;/,na�yy Address: J,2 ,'Id ;4 . City 1� �,/Vir� ��Lfsi Stater-L. Zip SaQ33 Phone tct ( i o<E-Mail Sc{Iry l,n`\ l.7,0 Ma.: • ' Owner or Agent (If Agent,`Power of Attorney or Agency Letter Required) C)4JAkJ" 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 FINANCING, CONSULT WITH YOUR LENDER CA. . . ,1 1 RECORDING YOUR NOTICE OF COMMENCEMENT. E I v Contractor Information: Name of Company: MAY - 3 2017 Qualifying Age>� • Address: City i Stcite Zip — Office Phone Job Site/Contact Number State Certification/Registration# E-Mail ---------- - _T Architect Name &Phone# - • Engineer's Name &Phone# Worker's 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 laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6) months, or if construction or work is suspended or abandonedor a period of six(6)months at any time after work is commenced 1 understand that separate permits must be secured for Electrical Work,Plumbing, Signs, Wells,Pools,Furnaces,Boilers,heaters, Tanks and Air Conditioners,etc. Signature of Property Owner: I _ Signature of Contractor: Before pe this 3i Day of FUM ,4 C 11- Before me this Day of Notary Public: ma— Z Notary Public: I hereby cera t ;reg• a } :jy i. _ a I rtion and know the same to be true and correct. All provisions o�•laws and ordinances ove r,, li=I with whether specified herein or not. The grantingofa permit does not presume to give , . vie 7,- .l g iiimp�p•ovt ons of any other federal, state, or local law regulating construction or the erformancof c i� ;'.,I::•t. ,'r eond�d7hriitic i orim i Rev. 5/2/16 EIVEij y�,yr, City of Atlantic Beach APPLICATION NUMBER d r#'' ` i� Building Department (To be assigned by the Building Department.) '-• I.- \\ 800 Seminole Road MAY 15 2017 r,• o Atlantic Beach, Florida 32233-5445 1 J CE ( }—00�� r Phone(904)247-5826 • Fax(904)247-§845 h. '� - yid- E-mail: building-dept@coab.us - Date routed: 1 ICA I'l City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: ISO 3 _ t S - • Department review required Yes No B1 Applicant: _ Dt,) n i2_( c Planning &Zonir Tree Administrator Project: t;, _ -1)b.-k- .-t'1Le P '— Mc Mc Utilities.) Public Safety Fire Services ` Review fee $ �% Dept Signature M,N 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 PReviewing Department First Review: Approved. I (Denied. (Circle one.) Comments: 411 BUILDING � PLANNING &ZONING Reviewed by: �, / - ,"���� Date: ✓c r1' (7 i TREE ADMIN. Second Review: Approved as revised. ❑Denied. WORKS�ents: PUB -/c::- � PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: I Revised 05/14/09 S,�L��. - _' ,1 CITY OF ATLANTIC BEACH J f , 'J%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 r IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT ' I-TIRE 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 IL.. LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. , rrs S` 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 PHYSICALL(W SEE THE COUNTY ''CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTOR() IN CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THZ BUILDING DEPARTMENT(247-5826) IF IN DOUBT. Q = J Z \ V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSUF Z O V U r.STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF ,N W O 0 OWNER-BUILDER PERMIT. O (n f' Z U V o V 4 PHONE NUMBER Z z ' I ,i d-f- s5--C) . 1-C-0 5{ - `762c,- 60.9 —2TcS r: < 0 ADDR S C� �y+c . V N \�1 PRN NAME' CC < I�- z O Ew R -- /?- LL ICS. ' Ct I • SIGNATURE DATEA O a L>: �I� ` WF- w5 0 ?- Before me this day of `v" 20_1n the county of W V CO W Duval,State of Florida,has personally appeared herin by himself/herself and affirms that all statements and declarations are true and accurate. 5 cc Notary Public at Large,State of FL— ,County of INA.J G1 JENNIFER JOHNSTOCIC �Rersonally Known "� ��� • _ MY COMMISSION#GG 042984 '" EXPIRES:October 27,2020 ❑Produced Identification- ,��.•a •L..."so?i Bonded Thu NotaryPublic Underwriters Notary Signature: A-A V. 1I� +,t, ' J F:/BLDG/Owner•Builder Affidavit;REVISED:4/16/2009 1 nirsv J I IALL I 40' RIGHT-OF-WAY BENCHMARK E1 FOUND P.K. NAIL & DISK 120. 00) . DURDEN TTRRA!}Y. PT., IN ASPHALT ELEVATION••(8.32) NAV.D. 1988. Oli 4' CONCRETE WALK • iD WATER METER �' �' ED p FIRE HYDRANT _ ° • A a 20.00' 10.00' o 61 ,: `� 50.00' 50.00' 20.00'• x -CZ LU m 01l (0® Z IRON PIPE -�x- ^ 6'aI I� l Z Q J 2.s' o TION • Y cid: • • • • o; !.r • ci • 62 1'0 15.0' a. 30 oVE OAIr-,�V"u � 4r cO O Y . , LL Z _ o• , y9 (' . \--BENCHMARK�2 • • hSET P.K. NAIL DISK 0 DURDEN TRAY. PT., IN NORTHWEST •R 0 FACE OF 10"PALM TREE 55.1' • 40A' • a ELEVATION'(11.40) NAV.D. 1988 // &•& LF. o TOP OF WALL ,• •• J ELEVATION: (10.27) illg O W f 1 > n • rn ix i1.3 '• •'1.7' ,— D 1 10.0' I— 143 WTe_ N O (n o FOUNDATION e^ _ ^ v (8`MASONRY STEM WALL ONLY) L. LL I- 0 o 0 d F O O W Z p RLI : o - �, I� � •10.0' Q z _ _, ' y15.o' I/ W c a TOP OF WALL 1.._ 1- 56.5' ELEVATION: (10.27)\ O O r, J J ,36.' ° • Lc: ' PROPOSED•CONCRdE DECKING OO • 4. • 14.0' _J _J3.0 �' I / • 0 TO 'OF WALL 6.3' Li • F DIVA 0N: (9.32)-\ N a . o o� Pza 3o N a 143 7 • •°• ZOO 02 N 0 /.. NOTE: , O PROPOSED RETENTION POND TO BE�� o< -, 0 0 CONSTRUCTED WITH THE 24X13 FEET TOP AT ELEVATION (8.0)AND THE 22X11 • &"-' s• ••°• ••. d N m Bilk re) OTTOM AT ELEVATION (7.5). HOUSE TO ; & 5.0' BE F11TED WITH GUTTERS WHICH FLOW a Z ~ UNDERGROUND TO PROPOSED RETENTION 14.0'�� O Z W /� O W POND THEN AT ELEVATION (8.0) FLOW .p (/••j•( ct © j �1 J UNDERGROUND TO RIGHT OF WAY 'p \J •61 ~ O 0.5' X� 50.00' • 50.00' • 20.00' •x0ti_ O 20.000.1 10.00/i O. — 0.6' 0.6' 1.9 LLI 0.2' 6' 4 IRON PIPE a ATION 120.00' Id, 0 "' z O Lu z D oZ CITY OF ATLANTIC BEACH 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 "s 1 IMPROVE A COMMERCIAL BUILDING AT A COST OF S25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. ..'Ai Q S' IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR I— Al 1'i.R THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT Lt. Cl) 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 I BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT I ,.2 a. YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE ,. 7 (9) LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ..: ORDINANCES. II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEM IIR THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANgE . ' PURCHASED. V III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD'A1=SLT`� " —"'— 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 PHYSICALLj SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTOR() CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THZ BUILDING DEPARTMENT(247-5826)IF IN DOUBT. a = .d Z ..1Va.O V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSUFI. Z F. STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF A _ p OWNER-BUILDER PERMIT. 0 co G ZO • QV ¢ ADDR S PHONE NUMBER Z W ,01-)0 n V y ., PRINT`NAME Q a U / V j 0 Lie W SIGNATURE DATEW Ill, _Q W 3 Before me this 3 day of ! `t"k` 20_61n the county of V Duval,State of Florida,has personally appeared herin by himself/herself and affirms that ; Q; all statements and declarations are true and accurate. Notary Public at Large,State of 1 .County of tJ C( NSTOC r COMMISSIONR #GG 042984 (7-Personally Known �' a EXPIRES:October 27,2020 ElProduced Identification- ss', o?''.# Bonded UN' Notary Pudic Underwriters ,of_ — —--- Notary Signature: )41V-IN.),-1,. F:/t3LDG/0yam-IIui I Affndavit;REVISED:4/16/2009