594 AQUATIC DR - FENCE ci CITY OF ATLANTIC BEACH
;- 800 SEMINOLE ROAD
15�: j ATLANTIC BEACH, FL 32233
01119%' INSPECTION PHONE LINE 247-5814
FENCE WALL OR BARRIER - FENCE
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: FNCE17-0066
Description: 6' FENCE
Estimated Value: 0
Issue Date: 10/19/2017
Expiration Date: 4/17/2018
PROPERTY ADDRESS:
Address: 594 AQUATIC DR
RE Number: 171818 5198
PROPERTY OWNER:
Name: BISHOP JOHN BUTT
Address: 544 OCEAN BLVD
ATLANTIC BEACH, FL 32233-5340
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.
r/1,i-viCity of Atlantic Beach APPLICATION NUMBER
;3 �g Building Department (To be assigned by the Building Department.)
800 Seminole Road 1 t�}G�_ �� �O
�t, �r Atlantic Beach, Florida 32233-5445
Phone (904)247-5826 • Fax(904)247-5845 J
Pj;t 9r E-mail: building-dept@coab.us OCT ' Date routed: I i�/i 3/ 1 7
City web-site: http://www.coab.us 3 2011 `
APPLICATION REVIEW AND TRACKING FORM
Property Address: I, �- t� U O1LQ Yç_ Department review required Yes No
Buildin9
Applicant: gt {�D& .;_Fanning &Zoning)
Tree Administrator
Project: G F E Cg �Pats'crV °r ',
is i sties
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: ❑Approved. ❑Denied. Not applicable
(Circle one.) Comments:
41,1t
PLANNING &ZONING Reviewed by:__V tej7 �--------- Date: l''9/( 7/i 7
TREE ADMIN. Second Review: Approved as revised. ❑Denied. ❑Not applicable
P WORKS
/O —/7-/7 Comments:
UBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: Approved as revised. ElDenied. ['Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
5v.1;.4., City of Atlantic Beach APPLICATION NUMBER
6Spr t, Building Department (To be assigned by the Building Department.)
-,••-, 800 Seminole Road
Atlantic Beach, Florida 32233-5445 1(-'iv 17 C°6' (/
O
K-, Phone(904)247-5826 • Fax(904)247-5845 f
0:319'' E-mail: building-dept@coab.us Date routed: 1 0 it 3/ 1 7
City web-site: http://www.coab.us - - ` -z-
APPLICATION
-APPLICATION REVIEW AND TRACKING FORM
Property Address: 59 4 % L)G1:-4l J 1 Department review required Yes No
Bui ldin —
Applicant: CD( k) Ia�P nning &Zoning)
�� Tree Administrator
Project: Cc F Ei) c -Prtgic or 2)
(`�Gblic i -t-_-_-_-_-)
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: Approved. Denied. ❑Not applicable
(Circle one.) Comments:
PLANNING &ZONING Reviewed by / Date:(d—/`6 — 17
TREE ADMIN. Second Review: A roved as revised. Denied.
❑ pp ❑ ❑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
01-A`tr,6 City of Atlantic Beach APPLICATION NUMBER
JS 3‘ Building Department (To be assigned by the Building Department.)
= p 800 Seminole Road y /
"mo �r Atlantic Beach, Florida 32233-5445 nn r 1(�m C.e. 1 / ` COG �O
Phone(904)247-5826 • Fax(904)247-584SC 1 1 3 207
, E-mail: building-dept@coab.us Date routed: f l �1 7
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: -5 -)1, U c 41 Q Dr- Department review required Yes No
Buildin
Applicant: C &DER t /arming &Zoning
Tree Administrator
Project: ( F Ef CF '•• is 'Tor
1. Ic U I itie
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: v Approved. ['Denied. ['Not applicable
(Ci
rcle one.) Comments:
&ZONING Reviewed by:jiii _01 '1y Date: /0-/e."7
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
?Sl-up,,,, City of Atlantic Beach APPLICATION NUMBER
4S ,;>‘ Building Department (To be assigned by the Building Department.)
800 Seminole Road
'-'17 �� Atlantic Beach, Florida 32233-5445 I 1\�C I / OU OA
Phone(904)247-5826 • Fax(904)247-5845 I
"4SJBI9' 0 A a3/E-mail: building-dept@coab.us Date routed: � t 7
City web-site: http://www.coab.us `
APPLICATION REVIEW AND TRACKING FORM
Property Address: t 4- Aco)0:-----k_Q____ D t`- Department review required Y7 No
�' Buildin
`
Applicant: ( I\DE=j � tanning &Zoning )
Tree Administrator
Project: G FE/0 C �Patslic WorRS---
(� is i ities3
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 4proved.
Reviewing Department First Review: I ❑Denied. ❑Not applicable
(Circle one.) Comments:
QUILDINa
PLANNING &ZONING Reviewed by: /ltd - Date:/D /7"l7
TREE ADMIN. Second Review: ( 'Approved as revised. ['Denied. [iNot 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
,„.A.,.,, Building Permit Application Updated 5/5/17
x�-
-. �r City of Atlantic Beach OFFICE COPY
800 Seminole Road, Atlantic Beach, FL 32233
'lir'
Phone: (904) 247-5826 Fax:(904) 247-5845
Job Address: q�( iz� tC-- ;�r ,. < Permit Number: h N C-G 1 7 Q
Legal Description RE#
Valuation of Work (Replacement Cost)$ 22-DO Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration p
ReairMove Demo Pool Window/Door
• Use of existing/proposed structure(s) (Circle one): Commercial Res enti
• If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No
• 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: ("�
Acice -tjt eJL� �iniz'c 4'C�
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: J Inv ( ke 9) Address: 15 C`C �( c__ '"vc
City —f(rxn4 rc.. '� i State Zip Phone_qDte ,;oi-t-37
E-Mail j h'r4s4v() by e_ 44.6 ,GO'Jt
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: N ir' -- Qualifying Age :
Address City State Zip
Office Phone Job Site/Co . t Number
State Certification/Registration# E-Mai
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation
Exempt/Insurer/Lease Employees/Expiration Date
Application is hereby made to obtain a p- it to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of. sermit 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.
Signature of Owner or Agent) (Sign�tdre of Contractor)
(includi ..contractor) /
Stene and sworn to(or affi .1) efo - e this 13 day of Signed and sworn t or affirmed) before me this day of
ZCdl,7 ,b • an r.t Mn b
r
(Signature of Nota MO (Signature of Notary)
'', TONI G1NDLESPER ER
l I . MY COMMISSION#FF 9`4951
•i:-.:•,-,..-.-:.!.-a' October 6,2u 19
[eKersonally Known OR '1,1 ', -,--:-,..,;:.>.' udedT`mtw:a.yPuorcUnderwrter [ ]Personally Known OR
[ ]Produced Identification -=-`'`s' [ ]Produced Identification
Type of Identification: Type of Identification:
S LAI/ri .
CITY OF ATLANTIC BEACH
! ) OWNER / BUILDER AFFIDAVIT
K
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 REQUIRED 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.
sco`f R 9,c_._` A, e R'b-t 3 z (
ADDRESS PHONE NUMBER
' okf.in ,511
PRINT
10/ t3/ ( 7
SIGNATUR DATE
Before me this I'day of O 0---4 ,200in 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 l a_ ,County of ` v0..-(
e Personally Known
0 Produced Identification- /
11 TONI GINOLESPERGERG ER
,... MY COMMISSION#FF 924951
'8= EXPIRES:October 6,2019
Notary Signature: . Oa. __ ` 4 • ..:.,-,,,,.0Bonded Thru Notary Public Underwater
F:/BLDG/Owner-Builder Affadavit;REVISED:4/16/2009
AP
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CHARLES BASSETT &• ASSOCIATES, INC.
215 CENTURY 21 DRIVE ( 904 ) 7?4 9433 32216
SURVEYORS. ENGINEERS AND LAND PLANNERS JACKSONVILLE, FLORIDA
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SCALE. RE°I••rERED SURv(vOR NO 1776, FLA`