FNCE18-0064 CITY OF ATLANTIC BEACH
s> 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 INFORMATION:
PERMIT NO: FNCE18-0064
Description: install 4-ft. fence
Estimated Value: 250
Issue Date:
Expiration Date:
PROPERTY ADDRESS:
Address: 425 E SAILFISH DR
RE Number. 171378 0000
PROPERTY OWNER:
Name: JOHNSTONE RORY HAYES
Address: 425 SAILFISH DR E
ATLANTIC BEACH, FL 32233
GENERAL CONTRACrOR 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
j' Build-Ing Department (To be assigned by the Building Department.)
r 800 Seminole Road / �-'r Q
Atlantic Beach,Florida 32233-5445 0 L V_00& l
Phone(904)2475826 Fax(904)247-5845 (� 1 I� I I
E-mail: building-dept@wab.us Date muted: l5/
City web-site: hftp://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: `t '�" I ��.sh , nt review required Y No
� \ n Bud
Applicant: l n-+�i Tanning &Zoning
Project: \fl St CH
Public Utilities
u
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit VedFled B
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: rApproved. [-]Denied. . ❑Not applicable
(Circle one.) Comments:
BUILDING O�
PLANNING&ZONING Reviewed by: Date: G`/S"IO
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 051192017
City of Atlantic Beach APPLICATION NUMBER
;js •� Building Department /�. (To be assigned by the Building Department)
800 Seminole Road ECEIVE"
Atlantic Beach,Florida 32233-544 (_((.(��,1rr 0 ��lV y
Phone(904ding-d 828 m Fax(ab.us !J0 1 3 2M Date routed: Ulla I I$
E-mail: building-Uept(aJcoab.us
City web-site: http://w .coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: `t(y'� C — I -Sh Pf . DWA0ent review required Yes No
ll '
Applicant: I`\ (` Planning&Zoning
Project:
Public Utilities
u
Fire Services
Liey"feea _ : Dept Signature
Other Agency Review or Permit Required Review or Receipt Data
of Permit Verified B
Florida Dept.of Environmental Protection
Flodda 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: OApproved. ❑Denied. . ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING&ZONING r
Reviewed b :
Data:
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
City of Atlantic Beach APPLICATION NUMBER
. �r Building Department (To be assigned by the Building Department.)
'. . n 800 Seminole Road G+EIVEIj
r, Atlantic Beach,Florida 32233- +il _T 0 Gf-1 �-'�O(D y
\ Phone(904)2475826 Fax )24 f^ 1 1,z):
� I I
E-mail: buildingdept@wab.0 �tJN 13 Date routed: li/ l
City web-site: http:!lwww.coa
APPLICATION RNEW AND TRACKING FORM
Property Address: r j ash P� , Qwmament review required Yes No
Bull
Applicant: DwnS-( lamm�g&Zoning
Project: 1Il Sk(A I � �- FA � (1(� r
Public Utilities
u
Fire Services
Review fee $--7J0-'— Dept Signature Z
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verlged B
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Any 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: Ajle� Date:
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 0511913017
rsy+tiv City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road /^
Atlantic Beach,Florida 322335445
Phone(904)2475826 Fax(904)247-5845
E-mail: building-dept@Jwab.us Date routed: U/
Cityweb-site: http:// + .coab.us
APPLICATION REVIEW AND TRACKING FORM
r
Property Address: ` a-s "�`• I i'�.5�'1 P� . Degmgxlignt review required Yes No
� / But '
Applicant: (` ('15lanning B Zoning
Project: 1/l
Public Utilities
Fire Services
Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
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: y Approved. ❑Denied. . ❑Not applicable
(Circle one.) Comments:
BUILDING qq
PLANNING&ZONING Reviewed by�G" !I= Date: -I5(-18
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: Dale:
Revised 0511VA17
OFFICE C@BiYding Permit Application Updated 12/8/17
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
/,xI ,I 'Phone:(904)//11247-5826 Fax:(904)247-5845 c [- a
Job Address: 4,15 ScrOfii, NE AgtwltiL Hear nr fl � Permit Number:
` NCci
Legal Description IAFS P,16tk a*, C040AA ?0.ie45 lk^ir 7„Jo A RE#
Valuation of Work(Replacement Cost)$19-Heated/Cooled SF Non-Hearted/Cooled _
• Class of Work(Circle one) Addition Alteration Repair Move Demo Pool Window/Door
• Use of exist!ng/proposed structure(s)(Circle one): Commercialesidentia
• Ifan existing structure,is a fire sprinkler system installed?(Circle one): Yes NoN/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: C
LQhehavke� � ) li/fir � (SOP C6ra,� Itvol f., ^
iim
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: YOYN �Q�nV1C(M1P/�- 1� Address: LM 5961-!+Sit D"+•£
Cityktlnn ( &" State FL zip '32 9 33 Phone 904-563 -i41r
E-Mailt�Y'11�0InNC�t1n2 �Y✓IaAI C"
Owner or Agent(if Agent, Power of Attorney or Agency Letter Required) Ouy "
�
Contractor Information Set o ff /W&� G-ffiII
Name of Company: Vrt& 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 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.
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
RECO DING YOUR NOTICE OF COMMENCEMENT.
—rK a n i1 A N/A-
Signatur of Owner or Agent) (Signature of Contractor)
(including contractor)
Signed and sworn to(or a r ed)bef a this day of Signed and sworn to(or affirmed)before me this_day of
VCT nQ .M, pt .b o/ Cl— by
c/
(Signatureo Notary) ;•.,, TDM Oil ERG
MycoMMMiSSI0N#FF B2 na re of Notary)
co
I ]Personally Known OR I Y PI . Runar ti•iws
I I Produced Identification q''7 I
Type of Identification: Z/1117 S]( -Qt 3-$9V '] Type of Identification:
Building Permit Application Updated 12/8/17
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
J L^ 1 Phone:(904)247-5826 Fax:(904)247-5845 f- L �}
Job Address: ` 95 -A0al" Dl E,p..-1^A�.Ialcutt,L e`e�22G fl. 'iW^ Permit Number: r Nc-& —cc&q
Legal Description 1a 5,t�,ltuk `9*. qm�t(.A'1� P41m,s ooti1 �(Wu A REM
Valuation of Work(Replacement Cost)$e:l`.Jt/ Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one) Addition Alteration Repair Move Demo Pool Window/Door
• Use ofexisting/proposed structure(s)(Circle one): Commercial(Resident;.
• Ifan existing structure,is afire sprinkler system installed?(Circle one): Yes No N/A
• Submit aTree 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: ehi ce
Florida Product Approval M for multiple products use product approval form
Property Owner Information r+
Name: ?OYN )0DY1
�1y1f4P/LAa.tt*, TZ7Iitl0. Address: �5 CLU J-Gk , DIC,f
city A-il ne—�H&J* State VL Zip nL.1615 Phone 'JUJ-5bz5-1111
E-Mail ✓nr���D11Nr'�-�^� �Wt0.) CUM -
OwnerorAgent(If Agent,Power of Attorney or Agency Letter Required) OttJY)"
Contractor Information A(/jk Sok. OvJWAU &I`A"fes '
Name of Company: Qualifying Agent:
Address City State Zip
Office Phone Job Site/Contact Number
State Certification/Registration M E-Mail
Architect Name&Phone M
Engineer's Name&Phone M
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 dist(cts,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
RECO DING YOUR NOTICE OF COMMENCEMENT.
RECO
'\TA A &IA-
TSIgraturi of Owner or Agent) (Signature of Contractor)
(including contractor)
Md anted sworn to(or a r ed)befo ethic day of Signed and sworn to(or affirmed)before me this_day of
j ,b by
(Signature o Notary) A", , TONI GINDIESPERGai� ..fNoUmy)
YMyCOMM[SSICNaFF6,
[ ]Personally Known OR [ Y n
[ I Produced Identification q [
Type of Identification: -"LILY)-971AType of Identification:
BOUNDARYSURVEY
SURVEYNOTES
Y;OACRETEDRNE CROSSING OVER PROPERTY
LINE ON WESTERLY SIDE OF LOT.
BLOCK
CORNER BOF THEPROPERTYAND CROSS WTO THEY
5'DRAUJAGE3 UTILITYEASEMENTATREAR I
OFPROPERTY.
PROPERTYSUPPLIED BYCITY WATER&SEWER.
BLOT
O K427 SET 1�2•
°E I IRONLB 893
_
FOUND i 2' tier43-58M I ' E 98•
IRON R06
� NO I.D. N
N w 1
30.007 u I
I2A4 os Z
LW E N l OL
v.5 O
-302
1
BUILDING 59 ImP
#425 1`�
o � is N S 4Qe t
Axl a
LOT 5 I PLAT
BLOCK 27 I UMITS
15,
Pei
o f - -,30.1" N -1
m
s i - SET 1 2
;! N827A 58'E 99.82E(P) IRON
89
30.0' ; 1 FOUND7/2" I I
IRON R
NO I.D. i
1
COMh9UNITY D4&MENT
(APPROVED
y F? s m SURVEYOILSCERTIFIGTE A R G E T
� R.3Y�oilFYTUTIMEEJJWMY5.IF4
' n SURVEYING,LLC
LS.7893
Kenneth '19'y''9"e by SERVING FLORIDA
KenneM Osborne MONAIIFMYTPAWS 102
Oa:e:201)A2.22 WEnMMBE ,FL3 7
Osborne i2:a1:22-Os'ar STATEWIDE PIi0�1ltE(.12222.d l
KENNETHJOSB E STATEW FACSIU (M)7Ab05]6
.. Ri[EiSSInVALEYAVEYOR1Mwv>F,ewis �n��..���iixR�d.�t � VIEBSIIE: M1pHAEryetarveyiipnn
CITY OF ATLANTIC BEACH
OWNER / BUILDER AFFIDAVIT
1. FLORIDA STATUTES;
S, PART
CONTRAC NG'REQURES OWNER/BUT DER TO ACKNOWLEDR 489. FLORIDA GE THE LAW: 1 "CONSTRUCTION
DISCLOSURE STATEMENT FOR SECTION 489.103(1),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 ACC AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST
TR��CON TRLCCION YOURM?LF. YOU MAY BUILD OR NPROVE A ONE-OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR ` V
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. B 1 DIN 1"
i.^IST BE FOR YOLfR USB AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE ORLEASE.
IN YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
IT FOR THE COR LEASE,WHICH S IN VIOLATION OF THIIS COMPLETE,THE LAW S PRESUME THAT YOU EXEMPTION. YOU MAYUILT
NOT
IT FOR SALE OR LEASE, YOUR CON'TR CA• TDR YOUR CONSTRUCIION MUSTIT IS
r
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS.
n BVTIYOU RAVE
YOUR RESPONSTBUM TO MAKE SURE THAT PEOPLE ve.orn
RFOUIRPD BV STATP LAM! AND BY CON`1TY OR MN RCIPAI LICRNS
ORDOJANCPS
II. INJURY LIABILITY; SINCE AY 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. UNDER .
IV. PENALTY; LUL
N FU CONTRALTO c cAM1NOT BE EMPLOYED ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FL
ORIDA STATUTE NO(3
455228(1). AN"OCCUPATIONAL LICENSE"ISNOT ADEQUATE. THE OWNER SHOULD PHYSICALLY=
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORSS U 2 O
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THEM
O G
BUILDING DEPARTMENT(247-5826)IF IN DOUBT.
V.ACKNOWLEDGEMENT;I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE m C G
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF W F a G
OWNER-BUILDER PERMIT. TL
SIS
at 1fiS)n fir f _ (90y MBER 9I I 052(to
�
ONE NUMBER Q 2
ADDRESS 0U.
1v) S o�0` tA. OU. ma ¢
PRI ('/11
/II w
ogre Uw ¢
URE (\ G((J W
BBNIB Ina NistleY ofV a eM By M1l1114§IY/IwsalfoeM eMrma tliM
Ourol,Sple M FIOMe,Iles perWually apps
Bn sfaremaBce am eBuarema:Bl 1 aaccprere.
NWBryPublic at Islga.Btafe of Cou*of
D vwem.lry Kmm� ♦ ",.y TONT GINNES#FF V4
❑PMu®6 Nen4fls4 - } - NYCAMMSS'.PER924551
n.��' EXPIRES'.Octobsr 6.1019
`-BiN.:n^ Boaa.nlmmn FeiKumammlen
Nofsry Slgmw
F'/HI.W/Oww.BuiIMPRa4vi5 RLN14®:"Mm
t
p
Cash Register Receipt Receipt Number
City of Atlantic Beach R5427
nx v
DESCRIPTION ACCOUNTCITY PAI D
PermitTRAK $81.50
FNCE18-0064 Address:425 E SAILFISH DR APN: 171378 0000 $81.50
BUILDING $35.00
FENCE 455-0000.322-1000 0 $35.00
BUILDING PLAN REVIEW $17.50
BUILDING PLAN CHECK 455-0000-322-1001 0 $17.50
PUBLIC WORKS PIAN REVIEW $25.00
PWREVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-C 0 $2.00
STATE DCA SURCHARGE 45500002080700 0 $2.00
TOTAL • $81.50
Date Paid:Wednesday,June 20, 2018
Paid By:JOHNSTONE RORY HAYES
Cashier: BA
Pay Method: CHECK 1098 'ppb'
Printed:Wednesday,June 20,20183:30 PM 1 of 1 P