1770 E PARK TER - FENCE f 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: FNCE17-0046
Description: 4'ALUM. FENCE
Estimated Value: 0
Issue Date:
Expiration Date:
PROPERTY ADDRESS:
Address: 1770 E PARK TER
RE Number: 172020 0386
PROPERTY OWNER:
Name: ANDERSON TERROLL J
Address: 1770 PARK TER E
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: SUPERIOR FENCE AND RAIL OF NFL
Address: 5470 HIGHWAY AVE
JACKSONVILLE, FL 32217
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.
rS,,tL"fi�3 FENCE WALL OR BARRIER
r - PERMIT NUMBER
u , ___ /),' PERMIT FNCE17-0046
City of Atlantic Beach
PERMIT TYPE: FENCE WALL OR BARRIER SUBDIVISION/COMM SITE: SELVA MARINA TAX MAP NO: 172020 0386
PERMIT SUB TYPE : FENCE UNIT 08 BLDG USE GROUP:
JOB ADDRESS: 1770 E PARK TER
DESCRIPTION:4'ALUM. FENCE
ZONED AS: TOTAL SQFT:0 SPRINKLERS:
TOTAL WORK VALUE:$0.00 TYPE OF CONSTRUCTION: BUILDING USE:
APPLICANT: PHONE:
MAILING ADDRESS: , FAX:
CONTRACTOR: PHONE:
MAILING ADDRESS: , FAX:
OWNER:ANDERSON TERROLLJ PHONE:
MAILING ADDRESS: 1770 PARK TER E ATLANTIC BEACH, FL 32233 FAX:
ARCHITECT: PHONE:
MAILING ADDRESS: , FAX:
COMMENTS
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PLAN CHECK 455-0000-322-1001 0 $17.50
FENCE 455-0000-322-1000 0 $35.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
STATE DBPR SURCHARGE 455-0000-208-0600 0 $2.00
STATE DCA SURCHARGE 45500002080700 0 $2.00
TOTAL:$81.50
ALL WORK TO CONFORM TO THE CURRENT EDITION OF THE INTERNATIONAL BUILDING CODE(IBC).
A 24 HOUR NOTICE IS REQUIRED FOR ALL INSPECTIONS.
Building Official: Issued By: Date.
Printed: Wednesday,August 23,2017 1 of 1 Or
01.,A,9,74, City of Atlantic Beach
PLICATION NUMBER
6$ -\ Building Department �^w (To be assigned bythe Building ng De aartment.
N �..i , p� �i `�, 9 P )
- 1 ..• 800 Seminole Road /
/se Atlantic Beach, Florida 32233- 5 A /� M7 �IsQ_ 17 - Oc�Jw
Phone(904)247-5826 • Fax(9f 247'6149 f 2u1! r L
P��; >/ E-mail: building dept@coab.us3 r Date routed:
City web-site: http://www.coab.diY°
APPLICATION REVIEW AND TRACKING FORM
Property Address: 177Q f: Qtc Tee_ Department review required Yes No
=-Building)
Applicant: ,S i)PG-21,O(L. �C� tinning &Z(3nin
` ree Administrator
Project: C c Work_s2)
Prlb1ic Utilities
Ptibi, Sdfety._
Fire Services
Review fee $ Agv Dept Signature ferir.
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. of applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by: 47(.._ i/< J . Date: 04 7
TREE ADMIN. Second Review: A roved as revised.
❑ pp ❑Denied. ['Not applicable
IC WORKS Comments:
G- �-✓-"
PU:�.IC UTILITIES
'-/D —17
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ['Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
01 v: City of Atlantic Beach APPLICATION NUMBER
Js `'• .� Building Department (To be assigned by the Building Department.)
A800 Seminole Road
��j
�u �r Atlantic Beach, Florida 32233-5445 (=l�e_t l 7 70
Phone(904)247-5826 • Fax(904)247-5845 (
*or �? E-mail: building-dept@coab.us Date routed: c''::,..)
2_/__4tt__7___
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I / 70 PA 1211 T Department review required Yes No
�6uildin�
Applicant: LAPe---y _,c ,(Z CrC-- fanning &Zonin
ree Administrator
Project: ,t`�: -•• is Works
`•• is Utilities
Fire Services
Review fee $ Dept Signature
Review or Receipt
Other Agency Review or Permit Required of 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: App
[V-roved. ['Denied. ❑Not applicable
(Circle one.) Comments: itiV
___
BUILDIN
PLANNING &ZONING Reviewed by: Date: d IO j 7
TREE ADMIN. Second Review: ❑Approved as revised. ['Den d. ❑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
�s==L`/r�, City of Atlantic Beach
�:3s � � Building DepartmentnECEIVEL)
APPLICATION NUMBER
/�, k s,� (To be assigned by the Building Department.)
iiii
s 800 Seminole Road r
�� Atlantic Beach, Florida 32233-544 . 2017
�i\)e-L. 17 - UcAL
Phone(904)247 5826 Fax(904)247- 49 0 r
01; !) E-mail: building-dept@coab.us Date routed: 674/1.
City web-site: http://www.coab.us , ,
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1.770 1 (t Qtc. TSI._ Department review required Yes No
p--
- `-Buildi`�R n-)Applicant: `tj UPG(2-I.C�C , E;3 C_ - lanning &Zonin _-
fee Administrator
Project: F. c -•• is Works`
1117r:-ic Utilities
41 Pttrlic-SafetyM
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 ❑Denied. I 'Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by:,/0444e1/4"....„, !1
Date: ,- -,
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
ir�J�irr1 City of Atlantic Beach APPLICATION NUMBER
d Building Department
t,� (To be assigned by the Building Department.)
r 800 Seminole Road
�� Atlantic Beach, Florida 32233 5445 [3C..( 1 7 - (JO4
����� Phone(904)247-5826 • Fax(904)247-5845
"`0;31�'� E-mail: building-dept@coab.us Date routed: ie214.41._. _
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1770 PA k1 . 'Y _ Department review required Yes No
( (a'Build ni q
Applicant: T 0PC%2.(,01.,, �- ,,;j( lanniinng &Zonin y
Fee Administrator
Project: PC „k)C-rte, -•• is Works'
•• is Utilities�y
'obit—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:
BUILDING
PLANNING &ZONING e� , -,
Reviewed by: Date:
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
10LAny. Building Permit Application Updated 5/5/17
,V
)r> City of Atlantic Beach OFFICE COPY
800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Fax: (904) 247-5845 �/
Job Address: I 1 ?O P4V(C 7E6`C� t A. e ., Permit Number: FN� 17 -O`erk,,
Legal Description RE#
Valuation of Work(Replacement Cost)$ 3 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New di • Alteration Repair Move D o Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial esidentia
• 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 perfor ed: ,{� 'FA t.-C- ( ^ (.,.‘,A4 i )1,./--1,-, f—IVCD d,�.i S / D Ef
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name:%&vti - '/ . A/W .' ' Address: (`1 )o ft)Atc tz\ t-7•..
CityA Z State Ft Zip 3 '2_2-3 3 Phone ,2 -ici -01 J-Li
E-Mail i AN0Ci -' VIS' G /SIL • ( Q
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: .,jo*'r'p/roz K-eAcei-/g4 L7!'
`� Qualifying Agent:
Address S-41 7 C.' !->'//f'6c)IV AVS City GkSZ//VU/6. State (L Zip 22 '
Office Phone CM y 38'2.- '22Z- 0 Job Site/Contact Number gO L/ 3c-2._ Z 2 2/
State Certification/Registration# ///A E-Mail
Architect Name& Phone# 4
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.
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.
a1 ignp. ,
5..�/ i ,
(Sign ure of Owner or Agent) + ( ,.ature of Contractor)
(including contractor) l/
Si ned and sworn to(or affirmed)before me this day of Signed and sworn to(or affirmed)before me this 7 day of
�S 7.0►1 , by TOl l-50,'o . 41,...; (%906ce: 21- , by 71/2k1/0\ G:—Ce,-KSCNirT
at
.,'',.'"if. KAREN C. 1dff° .t' +,. GRACE MACKEY ,:e.►r' .c�,: I •VIt.._ . . .. r.•.•
=.� p. Commission#FF 124673 `�°•., s- MY COMMISSION#GG 04209 MY COMMISSION#F 157186
=',.%7-•a: Expires June 25,2018 `� ' ; EXPIRES:October 27, Y�, -"i,°' EXPIRES September 4.2018
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pivo,'�'d Bonded Tlru Troy Fan In•u•ae8p9486.7ot9 %':'e dl1,o?. Bonded Thru Notary Public Uni ei-e7. 1
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Personally Known OR •ersonally Kn •-
[ roduced Identification f tinter' L .car-g__ [ 1 Produced Identification
pe o Identification: Type of Identification:
r ,5 I, �';= CITY OF ATLANTIC BEACH OFFICE
y Ow'WNER / BUILDER AFFIDAVIT COPY
•
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 TIIE 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 REOUIRED 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.
/2 1st ZiraLce__-A-a ��9-0-;5,' .
ADDREg S PHONE NUMBER
kercc)/1,...— ,. hidei6O1
PRINT NAME _n/ .
c.
l +.yam G 01 �/
SIGN TURE DATE
Before me this 2 day of I'114 f- 2011 in 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. --�r-'L-"-'�-�-
Notary Public at Large,State of IL ,County of I�
Personally Known r„rr=e
El Produced Identification- =aiR1' S KAREN C.HOFFMAN
in Commission#FF 124673
- '{-: Expires June 25,2018
Notary Signature: La�e.Y ��TzG _
• h% OonMdnroAq•Fah M�uno,e00..8.5ana
F:/BLDG/0wner-BuilderAffadavit;REVISED:4/16/2009 rJ _ '
MAP SHOWING
BOUNDARY SURVEY OF LOT 24, BLOCK 12, SELVA MARINA UNIT NO. 8, AS RECORDED IN PLAT BOOK 34,
PAGE 85 OF THE CURRENT PUBLIC RECORDS OF DUVAL. COUNTY, FLORIDA.
CERTIFIED TO: TERRELL J. & CINDY •.L. ANDERSON
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- CITY OF ATLANTIC BEACH JOB COPY
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IJ%WNER / BUILDER AFFIDAVIT
W N
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTIC
CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: Z y Z
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DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES: e 0 O ,, p
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STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED 0 CO E Z r`'
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT 0 0 8 8 Cill
{V
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 0 z Qz
SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE—OR 0 2
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR V ni CO
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING' it a
MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. 0u. W
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR 0 W I
AImR THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT ma 4'
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 t 0 N 0
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS 'a
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.
1?26 t�.� , lir � 62Y91-U/SY
AD 12.11..c69,9 // JT
��� PHONE NUMBER
/eri
PRINT NAME A i
SIGN• URE DATE
Before me this 2,ie day i7 4 f"' ,20/7 in the county of vv
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are trueand accurate.
Notary Public at Large,State of FL ,County of
Personally Known 5+"'rv�y'','% KAREN C.HOFFMAN
El Produced Identification- r. tie :F
_•: .: Commission#FF 124673
• , _- �P Expires June 25,2018
.Pf,(�Co Bonded Nu Troy fain Inurence 800-385-7019
Notary Signature: ��-i-r C I7 y
F:BLDG/Ovmer-Builder Affadavit;REVISED:4/16/2009
4
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MAP SHOWING
BOUNDARY SURVEY OF LOT 24, BLOCK 12, SELVA MARINA UNIT NO. 8, AS RECORDED IN PLAT BOOK 34,
PAGE 85 OF THE CURRENT PUBLIC RECORDS OF DUVAL• COUNTY, FLORIDA.
CERTIFIED TO: TERRELL J. & CINDY •.L. ANDERSON
JOB COPY
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ATTN:THD SERVICE PROVIDER-PLEASE UPLOAD THIS DOCUMENT IN INSTALLCONNECT(ICON)
,��• `'�- DO NOT FAX OR EMAIL THIS DOCUMENT
,. \> Home Improvement Agreement: Proposal for Fencing Installation
First Name Last Name Store# Lead#
Service Address
Date /' I i; e ,—
i 'i
!,_/y.-�i Y, 3 PRICE IS VALID FOR 30 DAYS FROM
/�''L.-7V J— 2DATE OF PROPOSAL
City State Zip
Ti/9/
Home Phone# Work Phone# Cell Phone#
Customer E-mail Address JOB COPY
Nearest Cross Street
PERMIT/INSPECTION INFORMATION -` `,
Homeowner to obtain permit ='
Permit Required? 0 Yes ❑ No (Install Professional-regalres a copy of permit before installation) Install professional to obtain permit
Selection$ : ='`� ! APPROXIMATE LAYOUT
ADDITIONAL COST OPTIONS FENCE FOOTAGE CONTAINED IN THIS PROPOSAL IS APPROXIMATE BASED ON FIELD
ADD THE PRICES IN THIS MEASUREMENT,PRICE WILL BE ADJUSTED BASED ON ACTUAL FENCE FOOTAGE USED,AS
COLUMN TO THE SELECTION SET FORTH IN TERMS AND CONDITIONS,L)
TAKE DOWN AND HAUL AWAY OLD FENCE$ , ENCE DI A GR AM i
PERMIT COST$ `C ,
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SUB TOTAL$ ) .,' t',' J r• --.�v` I
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SALES TAX$ + //C.J/-j C. 1 / `f,
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{.:,..,,.. a y.._.-.may.
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Partial Payment f 121 l+
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FINAL AMOUNT DUE J _ , l I
P-f Nem -/Al ' ffe-/s' `:6 CG. `,‹R F-AJ C'' .fK.7
(Due in full upon contract execution) //'' , -"G� ( , 77/,j) ,jj -"• 1;-- ?�'. ' :-/--.7.,7,.?:-
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Stock Product, dpecial Qrd�ur Product Design Approved by Customer 0_.
FENCE INSTALLATION RELATED TO GRADE:PLEASE INITIAL ONE�
PLEASING TO THE EYE FOLLOWING FLOW 1- I STEPPED MSTALLATPON
I1 -- --- _ 1_------ ---.-_—_I
FENCE TO BE LEVEL W(TH HIGHEST GRADE , SLIGHTLY UNEVEN GRADE WITH FENCE STEEP SLOPE WHERE FENCE CANNOT'RACK'
(CUSTOMER TO FILL IN GAPS) FENCE
MIG F E E V GROUND ENOUGH
RE LT 4 I LARGGPLADE E GAPS UPE
H S
- ENCWILL BE UNEVEN AT TOP FES-(CUSTOMER TO PILL IN GAPS)
Product/96(J,'/ Af4E'i. /` Product Product
Style:4trZIR -,- Height: 14 ' Style: Height: Style: Height:
Footage ../ "... If Gates: Footage If Gates: Footage If Gates:
Post Cap: ?f/ Color: / Post Cap: Color: Post Cap: Color:
Rail Type: f/' Post Type: .i, " Rail Type: Post Type: Rail Type: Post Type:
Picket Type: ' `, $ 're--7' .' Picket Type: $ Picket Type: $
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