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2019 BEACH AVE - FENCE cc Luton, CITY OF ATLANTIC BEACH rr) it r, 800 SEMINOLE ROAD V ATLANTIC BEACH, FL 32233 It `) INSPECTION PHONE LINE 247-5814 FENCE WALL OR BARRIER - FENCE MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: FNCE17-0005 Description: OWNER BUILDER Estimated Value: 0 Issue Date: 5/25/2017 Expiration Date: 11/21/2017 PROPERTY ADDRESS: Address: 2019 BEACH AVE RE Number: 169708 0000 PROPERTY OWNER: Name: LOWTHER CARRIE L Address: 2019 BEACH AVE ATLANTIC BEACH, FL 32233 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 II 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 0 exceeds and estimated value of$7,500. I ?i1 ti. City of Atlantic Beach APPLICATION NUMBER :i . r Building Department , �1 .„� (To be assigned by the Building Department.) 800 Seminole Road 51 t:). Atlantic Beach, Florida 32233-5445 (v C.E.-I -7 - 0 COS Phone(904)247-5826 • Fax(904)247-5845 •473 %� E-mail: building-dept@coab.us Date routed: 519 117 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: Z 01 9 6 J C Department review required Ye ''No uildin Applicant: Fc t��J .=, 0(,D Q..D Ert_____ nning &Zorw Tree Administrator Project: FEivCC -ublic Works 'ublic Utilitie .ull _I ey 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: �j �UILDIN� / ,/ D C> PLANNING &ZONING Date: 5..." . /> .`7Reviewed by: 61 y- TREE ADMIN. Second Review: DApproved 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 City of Atlantic Beach APPLICATION NUMBER _s' t.> Building Department (To be assigned by the Building Department.) 800 Seminole Road /� mow-rf Atlantic Beach, Florida 32233-5445 1 N CE-1 - C0 00-SPhone(904)247-5826 Fax(904)247-5845 ��j? E-mail: building-dept@coab.us Date routed: 5 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: C, o l ! EcAQ, Deeaarttmment review required Yes No uilB din Applicant: o O l.O PD anning &Zonin Tree Administrator Project: ublic Work j ublic Utilitie u e Fire Services teview 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 )� Z 3/ Reviewed by'/�C � Date: l 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 sLNr City of Atlantic Beach APPLICATION NUMBER JS 4 ` Building Department Mq) n :,; (To be assigned by the Building Department.) (� ,• 800 Seminole Road 9 �. // Atlantic Beach, Florida 32233-5445 ?017 F m CE-1 - 000S Phone(904)247-5826 • Fax(904)247-584 -'71111197- E-mail: building-dept@coab.us Date routed: 5 9 j 17 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 01 Ecna-4 De.artment review re•uired Yes No �— :uildin. Applicant: `1.-- Gam. , E(,&i.7( ening &Zonin. Tree Adminis ra or Project: �iv CC- ublic Works ublic Utilitie u fety 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: voL o�ewidawai4 BUILDING PLANNING &ZONING Reviewed by. Date:'471 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 rs1.:vpr City of Atlantic Beach APPLICATION NUMBER + .�,n� Building Department (To be assigned by the Building Department.) -- 800 Seminole Road =4' Atlantic Beach, Florida 32233 5445 (' (v cc -1 —1 - 0 00-S Phone(904)247-5826 • Fax(904)247-5845 0;119:- E-mail: building-dept@coab.us Date routed: `. i `—'I i 1 7 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: Z 01 9 6 .cAQ,e4 u/i De•artment review required Yes No :uildin• Applicant: z4 , 0(,Op3&{t, -'anning &Zonin• Tree Administrator Project: Fc CC ublic Works ublic Utilitie u fety Fire Services Review fee $ Dept Signature *-- `''1/4-- 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: 7 - - APP (CATION STATUS Reviewing Department First Review: reApproved. ❑Denied. (Circle one.) Comments: /� , I BUILDING 'v PLANNING & ZONING Reviewed by: /, Date: ��o 17 TREE ADMIN. Secondments: roved Review: A ❑ pp as revised. ❑Denied. C WORK PUBLIC UTILITIES 4 5--9-17 PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: I iApproved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 OFFICE COPY BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH DAT T. •� "~ 800 Seminole Road,Atlantic Beach FL 32233 Office:(904)247-5826 • Fax:(904)247-5845 1(7 Job Address: �/1 l03/ /9C) -' 4 6' Permit Number: Legal Description RE# Valuation of Work(Replacement Cost)$ 119c0. Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): New Addition Alteration 40 Move I- o Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial 'esid- ■ If an existing structure, is a fire sprinkler system installed?(Circle one): Yes N/A • Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal Describe in detail e type of ork tye performed: "s/ '•sc c /� ��q�'9n�i956C d- /L' ?O 7 , /,r +1g5 Florida Product Approval# for multiple products use product approval form Property Owner Information Name: felZ, Grrf�� 07c)/ a.6G�I d�'�� Address: 1City /1•771/ 4)4:c. State/GZip 3i P3-7 Phone /%c5`3 —a9 77 E-Mail QoS L- 5,GOr c ,ACJS. AG‘---- Car` P n•‘cti ( Owner or Agent (If Agent,Power of Attorney or Agency Letter Required) WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE u VL RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR " • ` - tyway D TO OBTAIN FINANCING CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. Contractor Information: MAY - 2017 Name of Company:_ _ Qual. ng Agent: Address: Office Phone Job Site/C tact Number181IC Beach, FL State Certification/Registration# E-Mail 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 rior 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. Rios!. becomes null and void if work is not commenced within six(6 months, or if construction or work is sus ended or abandoned or a period o,j'six(6 months at any time after work is com •erstand that separate permits must be secured for electrical Work,Pluming, Signs, Wells,Pools,Furnaces,Boilers,Heaters it Conditioners,etc. Signature of Prop-�'; Signature of Contractor: Bef me this Day of &.,S. A jrj._______Before me this Day of ':'•• TONI GINDLESPERGER Notary Public: Q '`''a• I 924951 w f F '1/41;;_..:047,.."'" _ .:047..a: EXPIRES:October• r W 'SFf,S:, bonded Thru Notary PubicUnderwr�ters I hereby certib,that I have read and examined this application and know the same to be true a d correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other federal, state, or local law regulating construction or the performance of construction. Rev.5/2/16 - `1 CITY OF ATLANTIC BEACH r 00%WNER / BUILDER AFFIDAVIT OFFICE COPY '..os i s • 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, WIIICH 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. maig ! 62' /76)C �3y - �� 77 ADDRES 7HONE NUMBER PRINT NAME /-- AM 7 3` ,-)/7 SIG),,. URE DATE Before me this 3 'A day of )''`6-q .20J 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 Ot l.J et I 5 --- �;pJENNIFER JOHNSTON ❑Personally Known ' yY/tS ` e Produced Identification- l ( L .1L- ` Notary Public Unde rnrite s •,,' � ? Bonded Thru let. :* MYEXCPIMREMSIS:SOcIOtoNbGG1,0204229084 • _ ! /Notary Signature: . ..I. 4— %ki,:tiA.' II i F./BLDG/0wner-Builder Affidavit;REVISED:4/16/2009 P Sy WING N P.:'i a� tirc.G e�U °� lg �� NSA RecoADS oFC 93Ch Y S� o�,,, - R V DVA c�kTyC• rRR6j pu�pRe�p �� 0 °Roq. arc F Pp R �fro CH/CqC0 n��►FD RNtice LC avr • i 1 l