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77 W 9th St - Permit FNCE18-0032 CITY OF ATLANTIC BEACH F 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 ;31 INSPECTION PHONE LINE 247-5814 FENCE WALL OR BARRIER - FENCE MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: FNCE18-0032 Description: & FENCE Estimated Value: 2000 Issue Date: 4/18/2018 Expiration Date: 10/15/2018 PROPERTY ADDRESS: Address: 77 W 9TH ST RE Number: 170813 0080 PROPERTY OWNER: Name: RIVERA ANA Address: 77 W 9TH ST ATLANTIC BEACH, FL 32233-3464 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. 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. * 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. City of Atlantic Beach APPLICATION NUMBER Building Department (To be aqs—siiggned by the Building Department.) 800 Seminole Road APR 0 7 2013 t— oc3 Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845 CS r;�t�r E-mail: building-dept@coab.us Date routed: 3 t City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 77W , 9 'z De artment review required Yes No uild' Applicant: Cupp 2 (— anning on -Tree Admrnis ra or Project: _ e�� _ ublic Works Utties Pu is Fire Services Review fee $ Dept Signature KoyL 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: BUILDING i PLANNING &ZONING Reviewed by: !/ Date: I� TREE ADMIN, Second Review: []Approved as revised. []Denied. ❑Not applicable PUB WORKS Comments: P LI UTILITIES 3-ISS PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: [-]Approved as revised. ❑Denied. []Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 ap� z Z��i3 003 Phone(904)247-5826 • Fax(904)247-5845 Y j 0j119' E-mail:E-mail: building-dept@coab.us ►':._ Date routed: 3 -s o l City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 7 7 V V t - ��T De artment review required Yes No uild' Applicant: Uc.Dn(2 C_ anning & on '-Tree Adminis ra or Project: ublic Works .dETis Utilities -rub is 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: VApproved. ❑Denied. []Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed b ate: TREE ADMIN. Second Review: []Approved as revised. ❑Denied. []Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date.- FIRE ate:FIRE SERVICES Third Review: []Approved as revised. ❑Denied. []Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 SrLIjJJ, City of Atlantic Beach APPLICATION NUMBER eiS r � Building Department (To be assigned by the Building Department.) 800 Seminole Road y C)0Z ,9 �� Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: 0 t City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: :7 7 De artment review required Yes No uild* Applicant: r e e Adminis ra ror Project: ublic Works is Utilities Pu is Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receiptof 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. []Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by:/ Date: 3-3(/- TREE 3(/ I 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 rSr�IjJJ„ City of Atlantic Beach APPLICATION NUMBER S S� Building Department (To be assigned by the Building Department.) 800 Seminole Road 2 Atlantic Beach, Florida 32233-5445 0OJ Phone(904)247-5826• Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: 3 l City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 7 C �`f� c�T De artment review required Ye No uild' Applicant: [— arming on 'Tree Adminis ra or Project: (� E n� u lic Works is Utilities Pu is 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: QApproved. ❑Denied. ❑Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: y 2 201 TREE ADMIN. Second Review: A roved as revised. ❑ pp ❑Denie ❑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 OFFICE COP'6uilding Permit Application Updated 12/8/17 City of Atlantic Beach 800 Seminole Road,Atlantic Beach,FL 32233 Phone:(904)247-5826 Fax:(904)247-5845 Job Address: WSJ Permit Number: �C�w l (7 '003 Legal Description RE# Valuation of Work(Replacement Cost)$ + '—Heated/Cooled SF Non-Heated/Cooled t'f • 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: Florida Product Approval# for multiple products use product approval form ProDertv Owner Information ' Name: Q r Address: W City or !` Ach` cState Zip 3-2Z 3 3 Phone '742-51-60e- 7135 E-Mail r-�er vi 0.— ACR (n0+,,10 i I ,e0,v1 Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company: Qualifying Agent: Address City State Zip Office Phone Job Site/Contact Nu r State Certification/Registration# E-Mail Architect Name&Phone# Engineer's Name&Phone# Workers Compensation Exempt surer/Lease Employees/Expiration Date Application is hereby made to obtain a permit to do th ork and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and t all work will be performed to meet the standards of all the laws regulationg construction in this jurisdiction. I understand that 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. 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. Q. o— (Signature of Owner or Agent) (Signature of Cont ctor) (includ contractor) i ned and sworn to(or affir e before me thi ��day of Signed and sworn to(or affirme efore me this day of by (Signature of ry (Signature of Notary) [ ]Personally Known OR Tb amo"E [ ]Produced Identification ,4 %IygoVpli Ac�Flc�� itfica n Type of Identification: i d' EX 1 r '20 Yp a'' BondedThioNotanHu� tM �' s rt+�'uy"r CITY OF ATLANTIC BEACH r� OWNER / 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 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. -71 o) 5� v��v� �� 9 ADDRESS PHONE N MBER PRINT NA 3130 1 SIGNATURE DATE Before me this-3aay of 2�n the county of Florida,Duval,State of has personally appeared herin by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of ,County of v L) V ❑Personally Known1 v/'1 o _ Q t� El Produced Identification- ` (� .oYg eia� TONI GINDLESPERGER MY COMMISSION#FF 924951 Notary Signature: = •. EXPIRES:October 6,2019 '11;F;°P' Bonded Thru Notary Public Underwriters F:BLDG/Owner-Builder Affadavit;REVISED: 4/16/2009 MAP SHOWING SURVEY OF: THE EAST 39 FEET OF THE WEST 44 FEET OF LOT 4, BLOCK 67, SECTION "H", ATL RECORDED IN PLAT BOOK 18, PAGE 34 OF THE CURR NT PI IRI IQ RECORDS DUVA City of Atlantic Beach Planning and zoning Department This approval verifies compliance with applicable zoning, subdivision and other local land development regulations, but does not constitute approval for the issuance of permits. Compliance with Florida Building Code and all other applicable local, state and Federal permitting requirements must be verified by ' ature of the C' of Atlantic Beach Building Off 1 prior to the ss ance of a Building Permit. oN Approved By: Co II �Ty�^lmrpunityr Dateelop��ent Director $ eC : -7 ��JJ r pC w k 66 J a VEI.OPM�r�`� p1�4v'Z. ,%36-o. . 31, ego P RpV x o0� ,z.F D AP l 0 4 ChA/N SEC 3 FENCE F£NCF P of N�00 / t'3g 00)x 1PF(RA'Z2 4 lRO 1�) 01 jCf P l l l O C0'V Q 9, ry. (^ ^ Q / t Q �v QJ O �= O N o� 0 �O Q O V �� =pcli 44, er Q/ (0 (1 O 69, p�A T � N pip"N0 1/2, 9.00) ° 2�`� N O ' �� 1 j 1 R� ° 6 o Ty D <N69. 0, 00 , P/pt T NL 3pE(�B 1"0' R/°yT S' D) o OF Wq Y U/I,—