2317 Barefoot Trace FNCE19-0036 Replace Fence FENCE WALL OR BARRIER PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH FNCE19-0036
800 SEMINOLE ROAD ISSUED:4/12/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 10/9/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PIM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicableto 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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
2317 BAREFOOT TRACE FENCE WALL OR BARRIER FENCE replace 4-ft. aluminum fence $1500.00
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1694630622 OCEANWALK UNIT 02
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
ABRASS STEVEN J 2317 BAREFOOT TRCE ATLANTIC BEACH FIE 32233-6604
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR 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
AT-FORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF CONDITIONS
Roll off container company must be on City approved list. Container cannot be placed on City right-of-way.
I I PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes
All bff must remain on-site during construction.
2 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL
Notes:
Roll off container company must be on City approved list(Advanced Disposal,Realm RecWling,Shapells,Inc.,Republic Services,Donovan Durcipsteirs,
Phillips Containers,JDog/Dennis Junk Removal,All American Roll Off,WCA Waste Corporation). Container cannot be placed on City right-of-way.
3 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration,Including sod,is required.
ls�usdl Date.4/12/2019 1 of 2
FENCE WALL OR BARRIER PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH FNCE19-0036
800 SEMINOLE ROAD ISSUED:4/12/2019
ATLANTIC BEACH, FL 32233 EXPIRES: 10/9/2019
4 PUBUCWORKS FENCING REMOVED INFORMATIONAL
N.'.
All Id f�,�,�g UA LEN�...d fromjob site by Contractor.
DESCRIPTION ACCOUNT QUANTITY PAIDAMOUNT
BURDI NG PLAN CH ECK 455 0000 322 DELL 0 $17.50
FENCE 455"OL322 1000 0 $3S.w
PW REVIEW BUILDING MOD OR ROW 0010000,329 1004 0 $25.00
STATE DBPR SURCHARGE 45SEDOOD-208-0700 0 $2.�;
STATE DCASURCHARGE 455�203-0600 0 $2LOO
TOTAL:$81.50
Issued Date:4/12/2019 2 of 2
City of Atlantic Beach APPLIWON NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach,Florida 32233-5445 J\)UA 41 10
Phone(904)247-5826 Fax(904)247-5845
E-mail: building-dept@wab.us Date nouted:
City web-site Into 11www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 2=enl review required Yes No
Applicant: _Pjannina&Zoninib
mmistrator
Project, +4� <��
_Eublic Utilities�>
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review t Date
Of Pemult=y
Florida Dept of Environmental Protection
Flonds Dept.of Transportation
St.Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other
APPLICATION STATUS
Reviewing Department First Review: roved. ElDenied. E]Not applicable
(Circle one.) Comments: 11orpp
BUILDING
PLANNING&ZONING Reviewed ls'!!z '4�- Date:
TREE ADMIN. Second Review: ElApproved as revised. ElDenied. [-]Not applicable
PUBLICWORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date,
FIRE SERVICES Third Review: E]Approved as revised. [:]Denied. E]Not applicable
Comments:
Reviewed by: Date:
Rx�imscl 05119)2017
Building Permit Application updr�diolvlis
City of Atlantic Beach Building Department '*ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 2317 Barefoot Tracer AB 32233 Permit Number: f� If&[Cl- C040
Legal Description RE#
Valuation of Work(Replacement Cost)$ 1500.00 Heated/Cooled SF_rN6p'W1afW
ED
• Classo[Work: ONew OAddition OAfteration [DRepair L]Move ODemo []Pool []Window/Door
• Use of existing/proposed structure(s): E]Commercial OResidential
• If an existing structure,is a fire sprinkler system installed?: OYes ONo MAR 18 2019
• Will treels)be removed in association with Dr000sed oroiect?1TYes(must submit SeDarate Tree Removal Permit) ONO
Describe in detail the type of work to be performed: Cepnir4mgt-
Replacing old fence with anew fencer : C7E
11r, H.C,�6t.� _�UOCAICIITIW I
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name Steve and Suzefte Abrass Address 2317 Barefoot Trace,
city Afland,Beach State FL Zip 32233 Phone W&571-5816
E-Mail ueeff.@.tx..ne1
Owner or Agent(if Agent, Power of Attorney or Agency Letter Required)
Contractor Information
NameofCompany Qualifying Agent
Address City_State_Zip
Office Phone Job Site Contact Number
State Certification/Registration If E-Mail
Architect Name&Phone#
Engine,er's Name&Phone If
Workers Compensation Insurer OR Exempt o 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 regulating
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
RECOR!!!;r
OF COMMENCEMENT.
145,19 nature of Owner or Agent) (Signature of Contractor)
Sligned and sworn to(or affirmed)befoZ,me this_a day of Signed and sworn to(or affirmed)before me this_day of
I by
JENNTER JOHNSTON
y MmMISSION#Go N go eo Notary) (Signature of Notary)
�,E a ocrxe,9,2020
k�,
L sona Known OR Personally Known OR
roduced Identification I Produced Identification
Type of Identification: Type of identification:
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OCEANWALK ASSOCIATION,INC.
C/O SIGNATURE REALTY AND MANAGEMENT,INC
1301-A PENMAN RD JACKSONVILLE BEACH,FL 32250 904-241-5221XI 16 F:904-241�3581
REQUEST FOR ARCHITECTURAL REVIEW FOR ALTERATION OR ADDITIONS
The ARC Board meets the 4th Tuesday of every month.ARC requests and documentation must be
. d b
receive !y-�srnagem prio on on fty) for delivery to ARC.
OWNER'S NAME- I l-�� � =-
OWNER'S MAILING ADDRESS: �17/
PROPERTY FOR ARC REQUEST: -5-y—
DAYTIME P HONE:%a q-,17-1--,-571 C E LL:-TZ L—0V0 FAX:
VAWUT �EOF ALT2=NORADDMON(DESCRIBE IN DETAIL):
ee
e
NOTE: Any extorter additions requires a COPY OF YOUR SURVEY and site plan with requested addition(changes).
PLEASE NOTE: Approval by the Association does not guarantee that my erected fence or structure will not oncroach a
neighboring property.Association will not be held liable for any such encroachments am costs associated with moving an
installed force due to this approval.
TI IE FOLLOWING MUST BE SUBMITTED WITH THIS APPLICATION:
1. Plans or drawings from the vender(be sure,they me licensed and insured on protect youmelfl)
2. Materials on be wed such as paint color(paint chips most be attached with this to=)
3. Description of prrjsc�estimated date of commencencenot.
4. Darveway,changes require survey and site plans.
5. I=Removal requires ARC approval (first)with a letter from an Arboxim City of Atlantic Beach requires approval as
well in many owes.Contact City of Atlantic Beach at 904-247-5800 for Arborist and father details.
*Cuumg down fices WITHOUT PRIOR APPROVAL will result in fints flumn HCA and City of Atlantic Beach.
OTHER IN
�Z:ZM=COMMITTEE TO CONSIDER WHEN REVIEWING TIES REQUEST:
CONTRA,CTORfVENDOR INFORMATION:
COMPANYNAME: PHONE: 2 j�j- ZI
CITY
ADDRESS: 17--2 1 X-1-4 _,_Z�STATE_ZLZ ZIP-_Z.22-11-
LICENSE NUMBER- PERMffrNUMBER:0gZ.4 gjg:� DATE ISSUED
Note:Only the PROPERTY OWNER as listed an the title to the projerty4day request my archilectural changes.
if a contractor is hired it is the owner's responsibility in be am(hey have proper insurance and licensing for the work being
done.It is also the o,,,,'s regisansibility to aware permits am obtained tbrough the City of Jacksonville prim to starting work
and for forwarding final inspection reports to the association upon completion.
Please note this approval is for architectural revies,purposes onlyl This approval does not overrale my Federal,State or
Local governing agencies,regulations,permits roqumereats,M. It is the responsibility of the property owner to obtain and
comply xvith such. The Association is released from all boundary line disputes.The owner is responsible for obtaining their
survey to confirm lot How and casements PRIOR to starting my work.
NOTE-.If Approved,Us project most be started within 90 DAYS from the date of this approval of this approval will be
considered null and void requiring resumossion of such request The ARC has 30 DAYS from the date of receipt M Aftept
or decline the request.
FOR ARCHITECTURAL REVIEW USE ONLY-DO NOT WRITE IN THIS AREA
Review,date:—Revunval by
Cnamincints:
Approved: (YES/N(H arRainuirif"Disapproval:
im seat back to owtuar for further inficroustion/cmisideration,an what dam
PerWit Required? (YES/NO)If required,was copy submitted?(YESNO)
Final Inspection Dade:_Did project comply with application (YES/NO)
if no,what action is on be taken
Steve and Suzette Abrass
2317 Barefoot Trace
Atlantic Beach,FL 32233
February 17,2019
Dear ARC:
We are requesting approval for 2 projects.
1. Backyard Fence- when we purchased the property,there was a 4 foot
wooden fence in the backyard.(see survey,old fence denoted in yellow) Over
the years it fell into disrepair and we had it removed. Since then,our
neighbors on all 3 sides have added fences. The homes to the north and east
have 4-foot aluminum fences. The one to the south has a 6-foot wooden
fence. We wish to add a 4-foot aluminum fence(same style as neighbors) to
contain our recently added dog. This can be done by adding small sections
on the northwest and northeast corners of the property to complete the
existing boundaries of the neighbor's fences. We would also extend from the
southeast corner of our house to our eastern property line to complete the
enclosure. These are denoted In red on the survey.
2. Landscape Improvements-addition of approximately 6 viburnum plants on
north side of front yard,between driveway and property line. Denoted in
blue on the attached survey.
We would be glad to host the ARC to answer any questions they may have.
Thankyou,
Steve and Suzette Abrass
From: Julle Hammond jahammonds0egmall com
Subject: ARC Request-Abrass 2317 Barefoot Tracer
Delta: March 11,2019 at 102B PM
TO: steve�abrass net
Go: Julie Hammond jahammond&)�gmai;com, Michele Richey"in inichelericheymartin(�com�t.net, Michele Richey Martin
mricheynnanIn&srmlf1.�
Steve&Suzette,
The ARC Commithea has approved your ARC Request for replacement of fance and additional landscape. Please make
sure your landscape addition is within the Oceanwalk Covenants and Restrictions,Article III, Paragraph 3.4 Landscaping
and 3.5 Fences requirements.
Therefore,this email is the approval for your ABC Request.
Plewaa respond to this email when all work has been completed.
Regards,
Julie Hammond
ARC Chair
Oceanwalk HOA
Julie Hammond
Email: jahammond6O@qmail corn
Call:703-585-4054
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach,Flonda 32233-5445
Phone(904)247-5826 Fax(904)247-58,15
E-mail: building-dept@coab.us Date routed:
City"b-site: http1Awm.coaIb.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 13sipaLtMent review required Yes No
Applicant: _.Elaaoinq&Zoninj
ministrator
Project: (44)1 -6[tq1Alf\LuV) JjWNagrkaR-
Public Utilities-3
Public Safety
Fire Services
JLeyJlqWJ@q,$ 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
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other
APPLICATION STATUS
Reviewing Department First Review: ElAppi-oved. E]Denied. 26 applicable
(Circle one.) Comments:
BUILDING 40'
PLANNING&ZONING Reviewed to Date:
TREE ADMIN. Second Review: E]Approved as revised. DDemed. E]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date
FIRE SERVICES Third Review: E]Approvedas revised. DIDenied. E]Not applicable
Comments:
Reviewed by: Date:
ReWsedOW1912017
City of Atlantic Beach APPLICATIGIN NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlanfic Beach, Florida 32233-5445
Phone(904)247-5826 Fax(904)247-5845
E-mail: buildfing-dept@coalbus Date muted:
City web-sile hftp://�.coab us
APPLICATION REVIEW AND TRACKING FORM
Property Address: aak"N �af 14&"T1((-k view required Yes
Applicant: C) f\k-r — No
.24gggg_&Zonin?b
Project: IV\-"(\,t A, Tuse-Atiministrator
(�Puibfic Rtflfle,
Public Safety
Fire Services
t Signature
Other Agency Review or Permit Required Review or Relcel pt Date
of Permit Verif ad By
Flonda Dept.of Environmental Protection
Flonda Dept.of Transportation
St.Johns River Water Management Dishict
Any Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other
APPLICATION STATUS
Reviewing Department First Review: M;;pmved. E]Denied. E]Not applicable
(Circle one.) Comments:
(:EE_MZ`
PLANNING&ZONING Reviewed by: /71 oo� Date:31�2"2ol
TREE ADMIN. Second Review: E]Approved as revised. []Denied.V E]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date
FIRE SERVICES Third Review: ElApproved as revised. ElDenied. E]Not applicable
Comments:
Reviewed by: Date:
Revis.d 0511912017
City of Atlantic Beach APPLICATIUN NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233 5445 MAR 2 0 2019 �tkt�ltf- owfo
Phone(904)247-5826 I'm(_iO4)244945
E-mail: building-dept@coab.us By.� Date muted
Cityweb-site: hftp:/1�coabus
APPLICATION REVIEW AND TRACKING FORM
Property Address: aak"k (�af A--6t_T(4_Lk �=!7 law required Yes No
Applicant: C) =MygLin
.q&Zoninj
Project: < ImeAdministrator
(40.bk�filffill
Public Safety
Fire Services
Review fee $ Dept Signature qw"
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
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: ElApproved. VDInied. E]Not applicable
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed Date
TREE ADMIN. Second Review: G2rApproved as revised. DDenied. E]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed byl�a' Date:
FIRE SERVICES Third Review: E]Approved as revised. E]Denied. ONot applicable
Comments:
Reviewed by: Date:-
CITY OF ATLANTIC BEACH
Department of Public Works
1200 Sandpiper Lane
Atlantic Beach, Fl.32233
��tj J19 (904)247-5834
PUBLIC WORKS PLAN REVIEW COMMENTS
Date: 3/21/19 Property Owner: Suzette&Steve Abrass
Permit III: FNCE19-0036 Email: suzette(@abrass.ne
Review Status: DENIED Site Address: 2317 Barefoot Trace
THIS PLAN REVIEW IS ONE OF MULTIPLE DEPARTMENT REVIEWS
Correction Items must be submitted to the Building Department at 800 Seminole Road.
Submittals that respond to only one or a few correction items will not be accepted.
Revisions may not be submitted until ALL departments have completed their respective reviews.
Revisions must be submitted to the Building Department and must respond to EACH department review.
PUBLIC WORKS CORRECTION ITEMS:
A Revocable Encroachment Agreement must be submitted. APPROVED
The form is on our website under Building Department-"Permit Applications and Forms 10
and also at the Building Department located at City Hall.
PUBLIC WORKS CONDITIONS OF APPROVAL: NN
(Thefollowing comments will be printed on your permit as Conditions of Approval)
• All runoff must remain on-site during construction.
• Roll off container company must be on City approved list(Advanced Disposal, Realco
Recycling,Shapells, Inc., Republic Services, Donovan Dumpsters, Phillips Containers,
JDog/Dennis Junk Removal,All American Roll Off,WCA Waste Corporation). Container
cannot be placed on City right-of-way.
• Full right-of-way restoration, including sod, is required.
• All old fencing must be removed from job site by Contractor.
Scott Williams, Public Works Director swilliamsLEDcoab.us/904-247-5934
Resubmittal Notes: All revisions and changes shall clearly stand out from the rest of the drawing on the sheet as a
revision by way of completely encircling the change with"clouding". The revision shall also be identified as to the
sequence of revision by indicating a triangle with the revision sequence number within it and located adjacent to the
cloud. The revision date and revision sequence number shall also be indicated in a conspicuous location in the title block
for each sheet on which a revision for that sequence occurs. For projects still in the initial review stage and permit
pending,all sheets with revisions shall be inserted into each set of drawings. The original sheets must be clearly marked
"VOID" but are to be left within the set of drawings. Complete new sets of drawings will not be accEp1g1 ADDITIONAL
ITEMS MAY BE REQUIRED DEPENDING UPON NEW INFORMATION AND CLARITY OF FINAL PLANS SUBMITTED FOR
REVIEW.
Page I of 1
0.\Public Works\ADMIN\PIAN REVIEW COMMENTS\FNCE19-0036(Owner-Abrass).docx
Revision Request/Correction to Comments "ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept(okozibms PERMIT#:&_C(E,�-003G
L1 Revision to Issued Permit OR Corrections to Comments Date:
Project Address: _��/ /Z-,
Contractor/Contact Name:
Contact Phone: fo 9/-J 71-, ZL/4 _Fmail:
Description of Proposed Revision It Corrections
I affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
• Will proposed revision/corrections add additional square footage to original submittal?
11 No 11 Yes(additional s.f.to be added:
• Will proposed revision/corrections add additional increase in building value to original submittal?
[]No 0-Yes(additional increase in building value:$-)(Commoor must sign If inomase in valuation)
-Signature of Contractor/Agent:
(Office Use Only)
/Approved 11 Denied Not Applicable to Department Permit Fee Due
Revision/Plan Review Comments
Department Review Required:
Building
Planning&Zoning Reviewid By
Tree Administrator E_=r,
,-.�PubficW.,k�s
��Utiliti�es APR 08 2w
Public Safety
Fire Services BY. bite' I
Jpmat,d10117118
0 REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT,issued on this day of
by the City of Atlantic Beach,Florida,a municipal coup . n orgam ws te State of
Florida,hereinafter referred to as"CITY"ar
of Atlantic Reach,Florida,hereinafter referred to as"USER".
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 If ht-of-Way Permit 0
This work is generally described as Z;n� ///7_
Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to
relocation or removal on thirty (30) days' notice by CITY to USER, s none S I be gi=ified mail,
return receipt requested,to the following address
• 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 property of the CITY, the USER shall replace at the USER's sole expense,my 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 ftanchise 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,prior to making my changes from the approved plans and/or method,most 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 inure to the benefit of,and be binding upon,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 linnitationstrequirements of 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 order the terms of this permit and that all of said liabilities m hereby
assumed by the USER.
-1/V1 Date__
Projedowner/Agent(siga?�Zpt�senceLof Notary Public) /
STATE OF FLORIDA,COUNTY OF DUVAL E 20ft
The foregoing instrument was acknowledged this day of
by zeite kP-U,, (4bms-& who personally appeared before me and
'ad l;I:tne 0
ed he/te instrument voluntarily for the purpose expressed in it.
Approved I Public Works Department:
Persanally Known
Produced IdentificaTo—n(Type) A,fe� 7 --?9 1 -7 45 7C� 0
'e" TONI GIWLWERGE]R Scott Wfthfs, Interi
MYCOMMISSIGN#FFI)��S
;R 1
62
EXPIPH.W.berG2019
um�
,dnillL Owner Builder Affidavit OFFICE COPY ..ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
1p Phone: (904) 247-5826 Email: Buildinrir-Deot(Mccab,us PERMIT M FWC&_/9-0079
1. FLORIDA STATUTES;CHAPTER 489,FLORIDA STATUTES, PART I-CONSTRUCTION CONTRACTING' REQUUS
OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES:
Z
_1 C.) 0
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APIEg F:
FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THEO Z
OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A (.) (.) 00
LICENSE. LU i= 0
YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. 0
ING. YO"
YOU MAY BUILD OR IMPROVE A ONE ORTWO FAMILY RESIDENCE ORA FARM OUTBUILD Z
ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING ATA COST OF$25,000.00OR LESS.
THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. ITMAYNOTBE BUILT FOR5ALEOR tA Z
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE LL U-
CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE,k%
15 IN VIOLATION OF THIS EXEMPTION. LU M
YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. 0
YOUR CONSTRUCTION NtSE a
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. Ix Wx
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(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. CONTACT THE BUILDING DEPARTMENT(904-
1247-5826 OR BUILDING-DEPTODCOAB.US)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.
Job Address:. RCire_�0C)-I TMCe IP,
Owner Name: S(k-ze�aArSA-eue, Norcsc, –Phone Number: (5c)(1) b-7 )-5c9)6
_? State: zip: sdd
MailingAddress: 931 eOre_T00t _VfQCr City: (3
Notarized Signature of Owner
The foregoing instrument was acknowle edbeforemethis day of Karct) , 20 Ir-)in the State of Florida, County
of nk I Ir'n I –a —1
Signature of Notary Public 0 �
JENNIFERJOHNSTDII I, lion
3 x? EXPIRES ONober272W
MyC0MM1S8J0N#GG1u2W
] Personally Known ORE Vldc.d ldent�,f
Type of Identification:
Updaft,dI0124118