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1858 Selva Grande Drive FNCE18-0045 IT CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 FENCE WALL OR BARRIER - FENCE MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMA77ON: PERMIT NO: FNCE1 8-0045 Description: FENCE AND GATE STRUCTURE Estimated Value: 500 Issue Date: 4/30/2018 Expiration Date: 10/27/2018 PROPERTY ADDRESS: Address: 1858 SELVA GRANDE DR RE Number: 1695425020 PROPERTY OWNER: Name: FLEMING THOMAS K Address: 1858 SELVA GRANDE DR ATLANTIC BEACH, FL 32233-4526 GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Name: Address: Phone: PERMIT INFORMATION: Please see aftached 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 SITEBEFORE 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. Permit Conditions City of At.lantic Beach Permit Number: FNCE18-0045 Description: FENCE AND GATE STRUCTURE Applied:4/23/2018 Approved:4/25/2018 Site Address: 1858 SELVA GRANDE DR Issued:4/30/2018 Finaled: City,State Zip Code:Atlantic Beach, FI 32233 Status: ISSUED Applicant:<NONE> Parent Permit: Owner: FLEMING THOMAS K Parent Project: Contractor:<NONE> Details: OWNER BUILDER LIST OF CONDITIONS -STATUS SEC�Nb ADDED DATE REQUIRED DATE SATISFY DATE TYPE DEPARTMENT CONTACT REMARKS 1 4/25/2018 ON SITE RUNOFF INFORMATIONAL PUBLIC WORKS Scott Williams Noies:� All runoff must remain on-site durihg,construction. 2 4/25/20-18 + ROLL OFF CONTAINER INFORMATIONAL PUBLIC WORKS Scott Williams Notes: Roll off container company must be on City approved list(Advanced Disposal,-Realco Recycling,Shapell!s,,I,nc.,Republic Services,Donovan Dum st6rs). Container cannot be plac6d,on City right7of-way. 3 4/25/2018 RIGHT OF WAY RESTORATION INFORMATIONAL PUBLIC WORKS Scott Williams Notes-., Full'right-of-way restoration,includin'�6d,is required % 9 4 4/25/2018 FENCING REMOVED INFORMATIONAL PUBLIC WORKS Scott Williams Notes:- All old,,f6n,cing must ble,,removed from job site by Contractor. Printed: Monday,30 April,2018 1 of 1 11�.W City of Atlantic Beach APPLICATION NUMBER ...... Building Department (To be assigned by the Building Department.) 800 Seminole Road S z � iQ c� 8 OCA-, Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904)247,�5_�45` E-mail: building-dept@coab.us Date routed: 4LZs J( Cityweb-site: http://www.coab.uis APR 2 lKi Iv APPLICATION REVI�W-ANDJR I �.�%CKING FORM Property Address: 2(---L-V-A CREW—Pt Department review required Yes No Applicant: )co anning &Zoning '7re 1111 or TC Wo r�kj� Project: 4�lic UtilitiesD Public--§a—fety Fire Services Reviewfee $ Dept-Sig-hature 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: JApproved. ElDenied. ONot applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed _Date: TREE ADMIN. Second Review: DApproved as revised. E]Denied. []Not applicable P�uso Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: E]Approved as revised. F]Denied. ONot applicable Comments: Reviewed by: Date: Revised 05119/2017 �"APPLIPA City of Atlantic Beach TION NUMBER o'. ,e,assigne 'e Building Dep6rtmeht)- Building Department 800 Seminole Road I QC[ A lantic Beach, Florida 32233-5445 or. -mail: building-dept@coab.us -41 i; �i APR 2 4 2013 Phone(904)247-5826 - Fax(904)24775845 Lp Ll Z. E Lj"e.. Do ed City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 135 S 2(---L-V-A CP- Department review required Yes No Lg�_uilcrin Applicant: 0W'&D6Z_ �nn i n g &Z oTi n_g-�> tz o"OtbItc WorkB---' Project: Public§a-fety Fire Services view fee $ De t.Si nature 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 STATILIS Reviewing Department First Review: ElApproved. [:]Denied. Dallot applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: F 4 i ]Approved as revised. F�Denied. F]Not applicable PU ORKS Comments: r -7 B-L-1 QTIQTIE- P Ll SAFE Reviewed by: Date: FIRE SERVICES Third Review: [:]Approved as revised. E]Denied. ONot applicable Comments: Reviewed by: Date: Revised 05/19/2017 City of Atlantic Beach APPLICATION NUMBER Building Department (To beassigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904) 247-5845 E-mail: building-dept@coab.us Date r.o'uted: 4/zs Cityweb-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 1(5,SBS C---LV-A CF—,W_D Department review required Yes No elk q Applicant: Uc'k) P a ffnn i n g�&—Zo—n�in g- or 7 t 7 is r� Project: &C_ 1-D/G-) E2!ftc�Work� 7" eg—lic Utilitie U:-- I Public Safety Fire Services R7� evieW feo $ 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: RAepproved. [:]Denied. [:]Not applicable (Circle one.) Comments: IVO C/OL.,bl�e Pep, -_,R VI,L�—IN_G_ PLAN.NING &ZONING Reviewed by: 4 TREE ADMIN Second Review: [:]Approved as revised. [:]Denied.v []Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ElApproved as revised. OlDenied. ONot applicable Comments: Reviewed by: Date: Revised 05/1912017 City of Atlantic Beach APPLICATION NUMBER Building Department (To beassigned by the Bu.ilding Department.) 800 Se inole Road FiQcp- i(f) , oc-A-S Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-5845 E-mail: building-dept@coab.us L Date routed: 4 Zz,3 J( City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: (55S 2 c---L-v-A ��_D D Department review requited Yes No 4-9uildina_�> Applicant: �n �ryg-8c-zdning �_T Project: jEE2Nia&�rk 4E2 Llic Utilities�2- Public—Safety Fire Services eview e $ Die P .1110— 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 FirstReview: pproved. F�Denied. [—]Not applicable (Circle one.) Comments: BUILDING Date: Reviewed by:4�_f TREE.ADMIN. Second Review: ElApproved as revised. DDenied. FNot applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: E]Approved as revised. []Denied. E]Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 Building 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 6C)A cw� Job Address: Permit Number: Legal Description R E# Valuation of Work(Replacement Cost)S Heated/Cooled SIF Non-Heated/Cooled • Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door 155 • Use of existing/proposed structure(s)(Circle one): Commercial Residential __1 N/A • 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:I'? cZX C.A_ 6VsT_k. J,��Ch-kptQ. )V, Florida Product Approval# for multiple products use product approval form PropertV Owner Information 01 A�,_ V It Address: Le- I .A� Name: city State Zip _'-3PZ2-7 3w—Phone E-Mail Cre-An r V 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 Number State Certification/Registration# E-Mail 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 und.erstand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS, FURNACES, BOILERS, HEATERS,TANKS,and'AIR CONDITIONERS, etc4N'(gjTil'C*E�:IlMad�ifio—nilt-oTt.=equi��li,is �e a a i, Yerteir, I gv On a q nt�tal egLyipesIs q, as a glaMage �e is. -e ag cicigsLoj ,�al e9opesIs q _25 f Fd— ..e.rLa' 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 R.ECORDrGYOUR NOTICE OF CbMMENCEMENT. (Signature of Owner or Agent) (Signature of Contractor) (including contractor) S* ned an sworn to affirrqgd-Abefore me thi y of Signed and sworn to(or affirmed)before me t is day of C_�_/ ThorK& FI&Ai cA- by by ------------ ota a ry) TONI GINDLESPERGER Personally Known OR Persor virE 0 RMY COMMiSSION#FF 924951 Produced Identification �—/J Produ( EXPIRES:October 6,2019 C�> NF.,., 40d Thru Notary Public Underwriters Type of Identification: ype of 11 A At, CITY OF ATLANTIC BEACH OWNER/ BUILDER AFFIDAVIT 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I "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 TEE 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 YOU K 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,WFIICH IS IN VIOLATION OF TEIS EXEMPTION. YOU MAY NOT I-ERE 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. 11. 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(l). 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 DI.SCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. fit ADDRESS NE NUMBER PRINT SIGNATURE Before me this Zs_ ay of 20 16 the county of Duval,State of Florida,has personally peared herin by himself herself and a rms that all statements and declarations are true and accurate. Notary Public at Large,State of County of El Personally Known n 13 Produced Identification- TONI GINDLESPERGER Notary Signature: -1 My COMMISSION#FF 924951 EXPIRES:October 6,2019 FAUDG/Omer-Builder Affadavit;REVISED:4116/2009 Bonded Thru Notary Public Underwriters lo ol ;L J�4 i AI 71