Untitled �1 ' CITY OF ATLANTIC BEACH
Ss1`,-.. 0 800 SEMINOLE ROAD
gidit:� ATLANTIC BEACH, FL 32233
0;119INSPECTION PHONE LINE 247-5814
FENCE WALL OR BARRIER - FENCE
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: FNCE17-0095
Description: 6' FENCE
Estimated Value: 1000
Issue Date: 1/5/2018
Expiration Date: 7/4/2018
PROPERTY ADDRESS:
Address: 380 11TH ST
RE Number: 170090 0000
PROPERTY OWNER:
Name: WOOD THOMAS C
Address: 380 11TH ST
ATLANTIC BEACH, FL 32233-5532
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.
0.mri , City of Atlantic Beach APPLICATION NUMBER
J4 - {1 Building Department (To be assigned by the Building Department.)
s 8tla Seminolec Road FN C l 7
1
�� Atlantic Beach, Florida 32233-5445
++ qc:Yi_S
Phone(904)247-5826 • Fax(904)247-5845 I Z�Z—?--(1,7
-.i 0;3 9r E-mail: building-dept@coab.us Date routed: 6 1
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 3E0 1 t—ti. S ( Department review required Yes No
(building
Applicant: Caw it . -(� - anning &Zoni .
Tree Administrator
Project: Ca ( FSC£ u is
ublic Uti i i ,
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. I 'Not applicable
(Circle one.) Comments:
BUILDING �
PLANNING &ZONING Reviewed by:`%s.. G-•, -- /Date:f —�— I 6j
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
1..,,u flr� City of Atlantic Beach APPLICATION NUMBER
(--
I:'At Building Department (To be assigned by the Building Department.)
ru < 800 Seminole Road ` y
,, Atlantic Beach, Florida 32233-5445 ((S�EC 2 ? 2017
Phone(904)247 5826 Fax(904)247 5845r z Z�
,..,fil �r E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: �so i C11 . ( Department review required Yes No
gUilding
Applicant: OW i\_. ---(2-- planning &ZoniTnj.,
Tree Administrator
Project: (_, ' ( FEr c E _ u lc
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: VrApproved. FIDenied. fNot applicable
(Circle one.) Comments:
BUILDING
r /
PLANNING &ZONING Reviewed b mate: 42;2 17
TREE ADMIN. Second Review: nApproved as revised. nDenied. 1Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: nApproved as revised. I IDenied. nNot applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
rig v�r�r) City of Atlantic Beach APPLICATION NUMBER
Js s� Building Department (To be assigned by the Building Department.)
800 Seminole Road FN .` y
Y Atlantic Beach, Florida 32233-54459.4
iiiG
Phone(904)247-5826 • Fax(904) 247-5845 I z Z---?--0j31q? E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
De artment review required Yes o
Property Address: 5S0iC.-ri-= � ( q
ffuilding
Applicant: EC..ice--�2- ,Tanning &Zonih-
Tree Administrator
Project: ( Fe_m 'c
ublic Uti i i ,
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: r Approved. nDenied. nNot applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by: Date: /- 31:90/f
TREE ADMIN. Second Review: Approved as revised. nDenie . I INot applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: I (Approved as revised. nDenied. nNot applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
sya,yfJy, City of Atlantic Beach APPLICATION NUMBER
4s �* ' S, Building Department (To be assigned by the Building Department.)
r. 800 Seminole Road �� ` 7_
,, Atlantic Beach, Florida 32233-5445 CE
Phone(904)247-5826 Fax(904) 247-5845 DEC Z 7 2O� Z Z� , l
4695
2-0;319%' E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ago ,I Cut S ( Department review required Yes No
(� Building
/
Applicant: C.L3 1QC—(2--- /Planning &Zo ii
Tree Administrator
Project: Ca F u is Warks- ,
-u•Iic Uti i i-
Public Safety
Fire Services
Review fee $ #7 Dept Signature +^--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
ReviewingDepartment First Review: A roved. nDenied. Not applicable
p I � pp
(Circle one.) Comments:
BUILDING
PLANNING &ZONING �L
Reviewed by: Date: /A-/f
TREE ADMIN. Second Review: Approved as revised. nDenied. nNot applicable
PUB ORK Comments:
P BLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: nApproved as revised. nDenied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
114
Building Permit Application Updated 12/8/17
' 2 City of Atlantic Beach
VillW 800 Seminole Road,Atlantic Beach,FL 32233
f Phone: 904)247-5826 Fax:(904)247-5845 7
Job Address: 3'0 l ,, O. c- `• rcft, CI3 33 Permit Number: Ft c 17 O 9 S
Legal Description 5-et 1e•25 -ZI� 414.44-..... &,. 44'37. F i/Z 37 Rt#'k )
Valuation of Work(Replacement Cost)$ t I C»O Heated/Cooled SF CC Non-Heated/Cooled 0
• Class of Work(Circle one): New n..itio Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial CR7sidential,
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes e) 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
tve of work to be performed:
S"'rvct c.L av �v�t +l C e-z.t1 ' b b ecp Cr-Act C-trA (-4-444Leet ri4- or
-1-L eaeoIt av. lx(-4- i‘olz o,P ptcp141.. q C-1- 901. L ' t1 tl.AU a.ro
9a/af►F
Florida Product Approval# for multiple products use product approval form
Property Owner Information t
Name: oWMat 7�c Address: 320 i rat ST
City /4 v\#t c ( C State FL. Zip 'IL Z 33 Phone 7b/ 7/• 79413
E-Mail 4-a,.>e�no/r l: yak6o. C.O✓vl
Owner or Agent(If Agent, Power o4+Attorney or Agency Letter Required) `"`t.owtslS l cn+ocr
Contractor Information
Name of Company: S< <VE/m4✓\ i L /�ia 1). Qual yang Agent: L.J4 S:1'�1/M, �
Address y49,� l c lt. eel' City uvlv:1, State IPL.. Zip 32207
Office Phone ctbl• 750-6882- Job Site/Contact Number
State Certification/Registration# E-Mail %;I ocr 11,AaAct•eNc.L Z. sC v. i . God
Architect Name&Phone# <I
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. NOTICE: In addition to the requirements of this
permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and
there may be additional permits required from other governmental entities such as water management districts,state agencies,or
federal agencies.
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. J
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) (Signature of Contr. tor)
(including o'tractor) ']
ed and swo to or affirm,. .efore - this `-m
• n ay of Signed and sworn to(or affirmed) •efore me this day of
�7 by O MI'I NW"' by
,- ,‘I i Pa Illa
G �"- •-- (Signature of Notary)
s
[ ]Personally Known OR _': ( *
! ; 'b"t'L'�„`el„,1CN#' 01 ]Personally Known OR
r EXPII?f c:Oct.bor 6,2015 ]produced Identificati+n
[ ]Produced Identification -."',4.&•'. Sanded Thr;Nat^r,,P;e;::Inriminter
Type of Identification: ype of Identification:
-- . 's CITY OF ATLANTIC BEACH
xr ;._ii
13%WNER / BUILDER AFFIDAVIT
4 iil1r
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.
-WO (I`t 4 A L✓1T,c 8ECi '
. c6‘7/` S 71. 7q Z.
ADDRESS � � PHONE NUMBER
- I S o a
PRINT
iaak --------- -1Q------ Z/2Z/i7
_f- y',, i DATE
Before me this dayof Off• 20 171n the countyof
Duval,State of Florida,haspersonallyappeared herin by himself/herself and affirms that
all statements and declarations are true and accurate. ,
Notary Public at Large,State r ( ,County of 0 V"a.- (
o Personally Known
❑Produced Identification- 0 -` ,5 4a. 1 ,4*;;;.?, TCFll f iNGLESPER+�F:R l
:1 Cr. I: 'ON 0 FF 924951
- - I E.Oi u. ;:.i ' r 6,2019
j %`'- b:r�r. ,,..'t ,''c Jroenrmter '
Notary Signature: .e ..-._ . - - ..................
F:BLDG/Owner-Builder Affidavit;REVISED:4/16/2009
MAP SHOWING BOUNDARY SURVEY OF
LOT 37 AND THE EAST 1/2 OF LOT 39, BLOCK 13
ACCORDING TO THE PLAT OF
ATLANTC ; : :ACH
AS RECORDED IN PLAT BOOK 5- , PAGE(S) 69 OF THE CURRENT
PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO: THOMAS C. WOOD, FAYE M. WOOD,
STEWART TITLE OF JACKSONVILLE, INC. ,
WELLS FARGO HOME MORTGAGE, INC.
AND WATSON & OSBORNE, P.A. "^ p.-' ....,. .,.
--
17)
1 _
4 ELEVENTH STREET .. .
,.
74.76' (M) E!`i Ja�, ,i
i .
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OMEN 75.00 (R) 1/2- IP
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BLOCK LOT 4/3 1 ! S p J ( 55; ' ... .. ^ LOT 35
I d j EAST 1/2 ( ne' o o BLOCK 13 w
� K BLOCK 13 • -.., cbvEREO\ L_
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ry. 9O.'3Z4. Cit1 frUziantic Beach
25.00' (R)x �O.25.00' (R) 3000- R) a�'! x if a{�51 and Zoning
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CAP NOT °' +75.00 ' (R) FENS NO Pr
CAP
READAOLE 74.08' (1i) ON LINE
LOT 42 LOT 40 LOT 38 LOT 3$
BLOCK 13 BLOCK 13 BLOCK 13 BLOCK 13
E Y pt AL NOTA
i��r/7Alo.R ., '1.ANGLES ARE SiON 1111S SURVEY.