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42 11TH FNCE18-0095 CITY OF ATLANTIC BEACH r� 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: FNCE18-0095 Description: 6'FENCE Estimated Value: 500 Issue Date: 9/14/2018 Expiration Date: 3/13/2019 PROPERTY ADDRESS: Address: 42 11TH ST RE Number: 170269 0000 PROPERTY OWNER: Name: BELILES GREGORY R Address: 24512 MOSS CREEK LN PONTE VEDRA BEACH, FL 32082 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. gs--ti`/r City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road K) _ s Atlantic Beach,Florida 32233-5445 �`F !"� Phone(904)247-5828-Fax(904) 247 5545 c grip'% E-mail: buildingdeptiJwab.us Date routed: Z City web-she: http:/Av w.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address 4 Z i 0 i S-F De rt hent review re uired Yes No n Applicant: 0CA-) �'Dc_4 , arinin SZonin /'� � Tree Administrator Project: y/ FLS 'Public Safety Fire Services Review fee $ �_ Dept Signature /zG ,;E 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 Distinct Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: ❑Approved. [-]Denied. PKIt applicable (Circle one.) Comments: BUILDING J PLANNING &ZONING Reviewed by: - Date: TREEADMIN. Second Review: ❑Approved as revise4. ❑Denied. [-]Not applicable PUBLIC WORKS Comments: . -PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Notapplicable Comments: Reviewed by: Date: Revised 00912017 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road 7� Atlantic Beach,Florida 32233-5445 Phone(904)247-5826-Fax(904)247-5845 41C 9 E-mail: building-0ept@mah.us Date routed: 8 z f City web-she: hftp:/Mmw.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 4L!L F C S--- De a nentreview required Yes No dinQDF Applicant: �L.y j.�ElL annin &tonin t Tree Administrator Project: Fh{�) CG i Wo ZEUgalithirties Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Reviewor Receipt Data of Perk Veriked 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: Approved. ❑Denied. ❑Not applicable (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed : Date: 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 05119/2017 City of Atlantic Beach APPLICATION NUMBER d`f Building Department (To be assigned by the Building Department.) 800 Seminole Road /� Atlantic Beach, Florida 322335445 FN) F rc_ Vt7� Phone(904)247-5826 Fax(904)247-5845 Q E-mail: building-dept@mab.us Date routed: V Z f City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: `'h hI ST De artment review required Yes No lldin Applicant: 0 L t Dc; , annin &Zonin Tree Administrator Project: u lic Ubl" Public Safety _ Fire Services Review fee $ 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: Approved. ❑Denied. ❑Not applicable (Circle one.) Comments: BUILDING 77 PLANNING &ZONING Reviewed by'4� Date: F-2 9- I 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. ❑Notapplic ble Comments: Reviewed by: Date: Revised 05/19/2017 rsu��rri City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road: FN CE , �_ _ ,J� Atlantic Beach, Florida 322335445 �L(J��`� Phone(904)247-5826 Fax(904)247-5845 E-mail: building-dept@wab.us Date routed: g Z t City web-site: http://w .wab.us APPLICATION REVIEW AND TRACKING FORM Property Address `t ZF �l JT De rtrnent review required Yes o lldin Applicant: OLo �-pE2, annin &Zonin Tree Administrator Project: FL�,_p CG Public Safety Fire Services Review fee $ Dept Signature im Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B Florida Dept.of Environmental Protection Ronda 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: lA pproved. ❑Denied. [-]Not applicable (Circle one.) Comments: UILDI G PLANNING&ZONING Reviewed by: Date: 28l/ Ir 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 OSn M017 Building Permit Application JPdated /g/fie City of Atlantic Beach 800 Seminole Road,Atlantic Beach,FL 32233 Phone:1104)247-5882116 Fax:(904)247-5845 Job Address: �Z t � F?I`IevrT«. IOch Permit Number:1y�.E Legal Description Lok.. 84.10 66%k-41 pl tc.h r, &)n (ri qo q Bey RE# Valuation of Work(Replacement Cost)$SOO - Heated/Cooled SF Non-Heated/Cooled _ • Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/DoorcQol'A vly-6G,f�44) • Use of existing/proposed structure(s)(Circle one): Commercialesidendo • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No J \bo • 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'R& bz 501t'j Ht rend, 415 Curntt of RaCA SaLkw` Zy b( qdd Z/ 61ok J dJ 4d_.. ie I`r'QIr (' cb hc?" et fine V d {o Yr Ot}clL ani: tl f �Florida Product Approval 0 for multiple products use roduct§P�Pro a Owner Information Om F- FW Name: lr'ce , Address: UIZ I) {• U rt Q O G city state 19, zip Z5A3 Phone "lit 49s' SLIM r_ < E-Mail C L , 2 2 Owner or Agent(If Agent, Power of Attorney or Agenry Letter Required) G LL Contractor Information IM Q Z Name of Company: "in " A'oe CormNn-I Qualifying Age - LL S Address City State Zip Office Phone Job Site/Conte tuber W Q State Certification/Registration# E-Mail — m C1 G3�ilI Architect Name&Phone# Engineer's Name&Phone# Workers Compensation ¢ C Ex t/Insurer/Lean Empbyees/Expiration Date Application is hereby made to obtain a permittogline work and installations as indicated.)certify that no work or installation has commenced prior to the issuance of a permit 96 that all work will be performed to meet the standards of all the laws regulationg construction in this jurisdiction.I understapjinhat a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEdERS,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 I D TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFO RECORDING YOUR NOOTIC�EpOF�COMMENCEMENT. — / /7 tiLrl W� (SignatureufOwneror Agent) (Signatur of Contractor) (in I dont a r) -7 SAned and sworn to(or.1117%)before ethisL day of Signed and sworn to(ora umed)before methis_dayof n(-Qj,by rQ R c e by (Signature of Notary) ft {, M.<ESPFAO igna reof Notary) tiYr 1 4S.°+CN4FF 82491 1 ]Personally Known OR pefmnally Known!tgt(xtoher 6,eo1B ( ]Produced Identification / Pr d ed IdenMieottdY PUCGUMer•aala Type of Identification: l� peoNderc[iOtaLICR�'�"� ,....,,, - REVOCABLE ENCROACHMENT AGREEMENT y: REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida,a municipal corporation organiudard exist'wg yrrlde`Ir the laws of the State of Florida,hereinafter referred to as"CITY"and '�l k of Atlantic Beach,Florida,hereinafter referred to as"SEW'. WITNESSETH: That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon the property for the purpose as described in the City of Atlantic Beach. This work is generally described as ��r, 21ttlT;rr �( FrAm �• bt Any facility maintained, repaired, erected, and/or install in the exercise of the privilege granted remains subject to relocation or removal on thirty(30)days' notice by CITY to USEJ2,said notice to USER shall be given by certified mail, return receipt requested,to the following address t{Z. I�al.fir. A-1(,{;,o ( FL 37,L33 • In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter upon the above described easement or property of the CITY,the USER shall replace at the USER's sole expense, any and all material necessarily displaced during the action of maintaining,repairing,operating,replacing or adding to of the utilities and facilities of the CITY or franchise utility provider. • The facilities allowed by the permit shall meet the current requirements of the City Code, Building Codes, Land Development Code and all other land use and code requirements of the CITY,including City Code Section 19-7(h) which states"Driveways that cross sidewalks: City sidewalks may not be replaced with other materials,but must be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks." • The USER,priorto making any changes from the approved plans and/or method,must obtain written approval from the City of Atlantic Beach Public Works Department,for said change within 30 days after the day of completion. • This permit shall inuretothe benefit of,and be bindingupon,the USER and their respective successors and assigns. • USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or specifications,to include utilities locate requirements and use limitations/requirements of easements,public right- of-ways and other public land. USER further agrees that the CITY and its officers and employees shall be saved harmless by the USER from any of the work herein under the terms of this permit and that all of said liabilities are hereby assumed by the USER. n /� ;T_ (�o,Lt/�Y Date 8� ,q 1,S Pro arty ner/Agent(signed in presence of Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL '7 /j / G The foregoing instrument was acknowledged this Z4 day of 20 l� by (—, r eF Or 'e S ,who personally appeared before me and rimed amen Si ler) ackn w�dged that he/ e i d the in rement voluntarily for the purpose expressed in it. Signature of Notary Public,State of hQddA Department Approval: Personally Known Produced Identification(Type) D L . Z 9 lQ -S'V- 3 33 Scott Wilflams,KhKic Work., it ctor ��u(w^'.:"••* TONI GINDUWEar.Ea 0:\ q_yc rnoMl 't♦ifr en reemem tlou Rev .t.,,q,R• yrdlPliRlinES Waer 6,219 W W PuacUknwAen pNr CITY OF ATLANTIC BEACH a OWNER/ BUILDER AFFIDAVIT f lP 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 PERNI T 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. TBE 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 MUNICIPAI, LI EN ING ORDINANCES. IL INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED, Ill. 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(247-5626)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. ` t I14,St. Aal 111 &I, )=b 71L 98j- IV3 ADDRESS PHGNENUMBER �'rce �t�t�GJ PRINT NAME SIGNATURE �!'/} DATE Before me Nla�OryN y "tcountyM Duval,StatedFlwk;Nea pamlully ep M1e' by NimseH/MnaHanE alfimniFM all stammeMs and Eedarelions are WI�eaI nibe. I .,�! l/ Notary Public at Lane,Stele of Cdumy of PuI ❑Penmeh wean i b., r0?:�f11N0lESPEFGER D woyame u.m�myoa_ way xl,MISSIGN IFF& 1 E'iplP,cS.Ochbef S 2D1D ntf,ryrLhL lMhiwbn Natal,Slpa.m: P'iHLIXiVmcBiIEn ARWrvi1:R9V®'.VINAU9