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145 PINE ST - FENCE 6. ' ` CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 9r INSPECTION PHONE LINE 247-5814 FENCE WALL OR BARRIER - FENCE MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: FNCE17-0018 Description: 6 foot wooden fence Estimated Value: 2495 Issue Date: 6/14/2017 Expiration Date: 12/11/2017 PROPERTY ADDRESS: Address: 145 PINE ST RE Number: 170635 0200 PROPERTY OWNER: Name: WELLS JOHN BENJAMIN Address: 9009 W 131ST ST OVERLAND PARK, KS 66213 1 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$7,500. O.:ay;yCity of Atlantic Beach APPLICATION NUMBER , ,,, . Building Department (To be assigned by the Building Department.) 800 Seminole Road 0 Atlantic Beach, Florida 32233-5445 j ��C (� Phone(904)247-5826 • Fax(904)247-5845 l?.6;t19%- E-mail: building-dept@coab.us Date routed: °St 111 114- City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: t Lt-S- tM-- Sis- - De artment review required Yes/No ildin ✓ Applicant: D W (1 .^( anning &Zoning Tree Administrator Project: tQla,l.L p$Oo* t. ccAcn c U2 ublic Works Public 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 pproved. ['Denied. . ❑Not applicable (Circle one.) Comments: :UILDING PLANNING &ZONING Reviewed by: /41 1 Date: S.'.3d-/7 TREE ADMIN. Second Review: A roved as revised. ❑ pp ❑Denied. ['Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: Approved as revised. ['Denied. . ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 otAJvr City of Atlantic Beach APPLICATION NUMBER :r i4-,; • Building Department (To be assigned by the Building Department.) r 4 �:� 800 Seminole Road A, j• Atlantic Beach, Florida 32233-5445 FN C b 11 — O 01 (? Phone(904)247-5826 • Fax(904)247-5845 j v E-mail: building-dept@coab.us Date routed: 03-114111 - City S1141Ii 'City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: i LIS- i M- St- . Department review required Yes No : ildin• Applicant: 0 ti (\-L( warming &Zoning Tree Administrator Project: Ctplac..2 t.O P0o* +„..oCasn ue �blic Works- Public 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: I/IApproved. ❑Denied. . ❑Not applicable (Circle one.) Comments: !� BUILDING PLANNING &ZONING 3 2_3 /)_Gi) Reviewed by. Date.: TREE ADMIN. Second Review: QApproved as revised. ['Denied. . ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: QApproved as revised. ['Denied. . ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 (--- 4111L f1,,tV/ City of Atlantic BeachAPPLICATION NUMBER Building Department s �;y,;.._�.K � (To be assigned by the Building Department.) � 800 Seminole Road �� ! I^ _ O6s Atlantic Beach, Florida 32233-5445 4 �,��� Phone(904)247-5826 Fax(904)2 8 ^ll 7 ti ! \Jiffs E-mail: building-dept@coab.us2 2 0 1/ Date routed L�S City web-site: http://www.coab.us r• I0 APPLICATION REVIEW AND TRACKING FORM Property Address: I Lt-S- (' t IU-- S*1-- Department review required Yes No Cauilding __ Applicant: 0 t,J n-t,{ anning &Administrator Zonis r Tree Project: CLplakiL O4&* wpc&n lk ubli Public 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 f Reviewing Department First Review: 1,/jApproved. ❑Denied. . I INot applicable (Circle one.) Comments: 114Wad4-1014 BUILDING PLANNING &ZONING Reviewed by: i 4/' _ /, ,,�+ate: •TREE ADMIN. Second Review: ❑Approved as revised. Denied. . ❑ ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: (Approved as revised. ❑Denied. . ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 p '' , Building Permit Application Updated5/5/17 P 11 ) City of Atlantic Beach ' 800 Seminole Road,Atlantic Beach, FL 32233 OFFICE COPY J 0' Phone: (904) 247-5826 Fax: (904) 247-5845 FA)CE (1 - OOcg Job Address: 14Rn� S� Permit Number: Legal Description ))�� RE# Valuation of Work(Replacement Cost)$ ZLF F) 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)(Circle one): Commercial Residential • If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No 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: l /O.f_. .e...NCA__ \--a\cj< Ly.C.U • — Lo '— ec\a e, U .350 a Florida Product Approval# for multiple products use product approval form Property Owner Information ` Name: ,.�QQ' A Ki R ��1,S Address: )£\S--- ----Pi r S City --A+ i‘,i\-, T p C\ ,c 6State F'! Zip 3 ..13 3 Phone q j 3 —z -se- (31$qV E-Mail • �w.AS 111 S CF' S\-3C r rk`• MT Owner or Ant(If Agent, Power of Attorneybr Agency Letter Required) Contractor Information .- - —� I Name of Company: Quali '•; 'gent: , (�� ii '�� �I !ice=-- Address Ci tate Zip Office Phone Job Si • ontact Number State Certification/Registration# , ail N AY 1 $ 2011 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 OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. Illr • - / � (Si nature of Owner or Agent) (Signature of C.• ractor) (including contractor) / C7 �i/gp d and sworn to(or affirmed) •-yore : this ! C..�ay of Signed and sworn to(or aff' ed)before me this day of V 1 ,ZO (7 , by S_ A by i IIA =- ._ : .• • .�-:tfi, • (Signature of Notary) 5, ..»y '," NY COMMISSION#Fr"924 {�',. EXPIRES:October 6,2019 1 ;',4"f.Q Bonded Thr;Notary Publre Underwrters a1 [ ]Personally Known OR' [ ]Personally Known OR [ ]Produced Identification if � [ ]Produced Identification Type of Identification: `i•1� ( QS - ►J T N€S Type of Identification: Lt•Ce k S r '-'''.1i,:..1 =CCITY OF ATLANTIC BEACH OFFICE COPY ' 0 WNER / BUILDER AFFIDAVIT rJI:IJ . • 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.us I. 455-228(1). AN"OCCUPATIONAL LICENSE"IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY 0 SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORSZ N O CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE< = J z h J BUILDING DEPARTMENT(247-5826)IF IN DOUBT. U Q 0 • Q c Z ' • V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE2 w O p STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF ANO CO H Z H OWNER-BUILDER PERMIT. 000 8 G W F., QO . I zy 5-- 2/.0..v_ -Z1- N\--\1\(;\(c0 CI Zrx Z • ,i•-• ADDRESS 1 c)AlJs PHONE NUMBER U N U) — IX Z �►, i--- _ \ \\s Q I—o W PRINT NAME / Q 0 W W j: _%� .. 5 / 17 W � WCC 02 •�0ATURE Allow— DATE l rQ �('\A� W V N W W Before me this May Gay of MAI` 20nin the county of W Duval,State of Florida,has personally appear d herin by himself/herself and affirms that all statements and declarations are true and accurate. r 11'`.,,.$r .; TONI GiNDIESPERGER LU / a* :._ MY COMMISSION#FF 924951 Notary Public at Large,State of I' ,County of 0 v�'( ' :? EXPIRES:Ot tph6b6r. ,. /// !' 'Irii tSotary Public lJnde 1 rs ❑Personally Known CC U Z ._ — /1 4- ( — a�""�—. ❑Produced ldentificatio Il, is © c-{� MY COMM ''•IQ, .' EXPIRE: t;c ' • BondedThtui;'�f, • 5 mil, 1 Notary Signature: II, F:/BLDG/Owner-BuilderAffadavit;REVISED:4/16/2009 1 I MAP SHOWING BOUNDARY SURVEY 5017n4 Ye OF. I .OT OF • • ao BLOCK -.= AS SHOWN ON MAP OF SA LTA ►R SEc7701,/ AS RECORDED /N PLAT BOOK /c5 PACES 3 PACES /` OF THE C' E.a- Pg)c3uc eca�as o1= CERTIFIED T0: o _ DUVAL Ca, Fc-A FIRST .. r • - r•t. . '4ME7¢Ic•4N •c. • ' . • lagUI A . CE 0OMPAt,ly \NAT' oN 4 •o58oizNE apt, PIN& S Reay (So'R/w) . 5.22°t0'O0" W • FD://gI.P , NO 'A 25.00 • Fp)/s''I.P. • 7,,,...1,...c.€4.13%.€ Z7.3.oo' a • • • R.2' 'g.4' 2 5.00• I • :•DRIVE • • 1 ( .,-sz It r ft • O N . . . • . % I r '. • ON[. CO• CwAti OO I- W z,+o snag _•-1 Z . J . _ 7.'; 13.9' h U tt gy`'Y.'m 8 4 YY--�? n 2-SroRy ' ii. a_ O 4 FRAME r , DuP�x < N2115 ; 1 - / w r 1 fl N d •v I Z?0 3.7' ,i I * t6- Q �r N AAc Z 1 rno M lIZ � a , 7 to 4.�t 9 o {� r J----' -� 0 1p LL .1 -- 11.9' J�V 7 N C t G 'i .+ TeoRy rl WooD NE i /I z ,,eovEPd#44(•I D6K---`I. zz`/f /' 7 ✓ t.1.t. CEcwacBs L.•Y-' 7. `' . ...MCARL11LS Oy J_ _„ .s `i .. (. ,S7' F ZS. g�rr� O J laCWA12. Z5.00. s�;z95 • ,n 0 k�1 No,t. S.22)10'OO"W. % ,\ , ___J ) •1 L 0 T 6,9O LOT 1089 LOT is 963 ,-1 ! � G • ILEC4�Ec.44,Eo TLflcENut\vtEd Su+E\ -( .• L.,.$•2boS: \,.J.c, ZobS '533(. FERRET AND AASAS'OCIAT�',S; INC.. 1614•ATLANTIC UNIVER'5ITY.CIRCLE, .JACKSONVILLE.,: FLORlOA,..3220f PHONE': 90.4 -0$.=0040•• • FAX: 904 .:805-•eEiB• GENERAL NOTES I P.C. POINT OF CURVATURE LEGEND R RADIUS -11`, P.T. POINT OF TANGENCY A DELTA (INTERIOR ANGLE) ;" 1)BEARINOS SHOWN HEREON ARE BASED ON P.R.C. POINT OF REVERSE CURVE A ARC LENGTH P.C.C. POINT OF COMPOUND CURVE C CHORD • S.ZZ•10'00"W. Besua 1-1-‘e- 6'Ly R/W P.O.C. POINT ON CURVE C8 CHORD BEARING L.ANa of PANE STREET B.R.L. BUILDING RESTRICTION LINE A/C NR CONDITIONER I I: 2)1HI5 PROPERTY HAS NOT BEEN ABSTRACTEDCENTER UNE CONC. CONCRETE FOR EASEMENTS, COVENANTS, RESTRICTIONS I.P. IRON PIPE R/W RIGHT-OF-WAY I. • FD. FOUND O.R.V. OFFICIAL RECORDS VOLUME 3)UNDERGROUND ENCROACHMENTS AND UTILITIES SERVING THIS PROPERTY HAVE NOT BEEN LOCATED OR SHOWN SCALE ,,. _2.o' /if! 4)THIS PROPERTY APPEARS TO UE WITHIN / FLOOD ZONE "X AS SCALED FROM 3-20-2.0e1 F.E.M.A. FLOOD INSURANCE RATE MAP, PANEL 12.0075- oo,o I b . DATED y_-/q_89 DATE OF FIELD SURVEY CARL S. COUE. RSON, FLA. CERT. NO.NO. 31292 LB N 6715 F.B. 2.1(' PO. 5.-2. NOT VALD !M►NOUT INE SKMATURE& 77 °R O NAL RAISED SEAL OF A FLORIDA UCERSED SURVEYOR & MAPPER ORDER NO. 200 I-!1 98