1303 Camelia St FNCE19-0086 'r_%� FENCE WALL OR BARRIER PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH
FNCE19-0086
800 SEMINOLE ROAD
ISSUED: 7/26/2019
0ji19' ATLANTIC BEACH. FL 32233 EXPIRES: 1/22/2020
MUST CALL • • 904 247-5814 BY , PM FORDAY INSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • ' ! BUILDING
CODCODEJ. NEC, IPMC, AND CITY OF BEACH • ! OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
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.
• : ADDRESS: ! • OF • •
1303 CAMELIA ST FENCE WALL OR BARRIER FENCE FENCE $1200.00
TYPE OF !
• • GROUP:
1710510020 ATLANTIC BEACH SEC H
COMPANY: AD! ' STATE:
• Ar ! • '
WILLEY ARTHUR GARFIELD 1303 CAMELIA ST ATLANTIC BEACH FL 32233-1810
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
ATTORNEY 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.
1 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff 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,Realco Recycling,Shapells,Inc.,Republic Services,Donovan Dumpsters,
Phillips Containers,1Dog/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.
Issued Date: 7/26/2019 1 of 2
b1i FENCE WALL OR BARRIER PERMIT PERMIT NUMBER
\JS g)
CITY OF ATLANTIC BEACH FNCE19-0086
ISSUED: 7/26/2019
800 SEMINOLE ROAD
+�
oil 9r ATLANTIC BEACH. FL 32233 EXPIRES: 1/22/2020
4 PUBLIC WORKS FENCING REMOVED INFORMATIONAL
Notes:
All old fencing must be removed from job site by Contractor.
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 45S-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$81.50
Issued Date:7/26/2019 2 of 2
YS%%'7;_ City of Atlantic Beach APPLICATION NUMBER
U 0 Building Department (To be assigned by the Building Department.)
v 800 Seminole Road 1 N)c� _ u�p
s' Atlantic Beach, Florida 32233-5445
Phone(904)247-5826- Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: 7149
l
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: � 0 �.Acw�E�ca S7 Department review required Yes No
uildin
Applicant: _ anning &Zoning
n Tree mi
Project: 'M Cho �� - E�UC� ublic Works
u lic Utilities
ety
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:
APPPdATION STATUS
Reviewing Department First Review: Approved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by: X/ 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 0 511 9/2 01 7
Building Permit Application Updated 10/9/18
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.
�t5123
� 3 F 1 9
Job Address: 0 3 l �M�/i ,�k St /� IA,) E rC ,j5PAc k � Permit Number: �C-`
� alvc'�<La j,
Legal Description le-3-1 3� Z,S - L ,SEC Al /�f�An�f,C �p��GIZP7' y RE#
Valuation of Work(Replacement Cost)$ 1 ZOO Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ❑Residential
• If an existing structure,is a fire sprinkler system installed?: Dyes ❑No
• Will trees be removed in association with proposed ro'ect?Oyes must submit separate Tree Removal Permit ❑No
Describe in detail the type of work to be performed:9 y� /
(90t-0 F,1,144 BAC k i-� f4
C
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name� 11,.�,n ��11�F _AJ, -3j,3 Address / ]�t,3 04n"4,4
City A+J AA�r4 l3F,-k_ State Ll_ Zip 3 z Z 7 3 Phone S'-. 2--
E-Mail A0 - Z) `5 Ca� 13 w /fcrn::tL�_ , dt..-t.
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company 5�_O ( 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 Insurer OR Exempt❑ 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
RECORDING YOUR NOTICE OF COMMENCEMENT.
(Signature of OWu r or Agent) (Signature of Contractor)
Sined and sworn to(or affi ed)before me this day of Signed and sworn to(or affirmed)before me this_day of
FThors. ONI GINy
-- DLESPE
= '
,,; t MYCOMMISSION:FF924 signatureo� Notary) (Signature of Notary)
' ;' EXPIRES:October 6,2019 J
'$c, Bonded
Notary Public Underwriters
[ ]Personally Known OR [ ]Personally Known OR
[ ]Produced Identification � J -� Produced Identification
Type of Identification: /'�t I �t 7 Type of Identification:
It I lyj.,
Owner Builder Affidavit "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@coab.us PERMIT#:
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 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.
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
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. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.US) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I
COMPLY WITH ALLTHE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
Job Address: 1303 0_o�� h A 54Av--e'/ t'�l lAtAe,. 9,0,4, t, F[-
t` Z! SZS L 2—
Owner Name: Phone Number:
Mailing Address: /3t�3 C �M� (, %L zip: Zma �gt �
2 33
!V
Notarized Signature of Owner
Thejoi:egoing in rument was acknowledged before me thisqdAf2 �in the State of Florida, County
of L
Signature of Notary Public �-
[ ] Personally Known OR [ ] Produced Identification
Type of Identification: —4. Cyj
�jUpdated 10124118
WE
TON G10LESPE9GER
MY COMMISSION k FF 924951
o' EXPIRES:October 6,2079
Bowed Thru Notary public Underwiters
City of Atlantic Beach APPLICATION NUMBER
S Building Department (To be assigned by the Building Department.)
' 800 Seminole Road FN CE _ E3
y., Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: /7 11
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 30-:�) L' P�MEctg �? Department review required Yes o
uildin
Applicant: arming &Zoning
Tree mi
Project: \1\3 C7 �EX_)CjZ!777 ublic u liWorks
c Utilities
ety
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: NKpproved. ❑Denied. ❑Not applicable
(Circle one.) Comments: �/ � drp'er4ffi-ell �-Pyr ins a61 a fPf&/'t _V
ILDIN
PLANNING &ZONING Reviewed by: Date: yl
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
rs"Vi;�. City of Atlantic Beach ! APPLICATION NUMBER
1VE
�S Building Department (To be assigned by the Building Department.)
800 Seminole Road
� .
-� Atlantic Beach, Florida 32233-5445 JUL 2 2 2019
Phone(904)247-5826 - Fax(904) -5845 ' 7
E-mail: building-dept@coab.us trVDate routed:
City web-site: http://www.coab.us _ ---
APPLICATION REVIEW AND TRACKING FORM
Property Address: 0� � '►'�Ef (a �? Department review required Yes No
uildin
Applicant: anning &Zoning
n ` Tree mi
Project: Vy Cho C�' `V—&Q CT�- ublic Works
u rk Utilities
ety
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
t
PLANNING &ZONING
Reviewed b : Date:
TREE ADMIN. Second Review: []Approved 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
:rS�Li; City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
s� Atlantic Beach, Florida 32233-5445 FN C E t cl- F31
s
Phone(904)247-5826- Fax(904)247-5845 A
E-mail: building-dept@coab.us Date routed: /—7 A
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Q—N't'\6C('q S7 Department review required Yes No
��zzrr��
uildin
Applicant: O &JNDefZ anning &Zoning
n \ Tree
Ky mi
Project: CXD � ` &XDC�— ublic Works
u lic Utilities
fety
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. R<ot applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by: 4/4--- Date: 7-Z
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
MAP SHOWING BOUNDARY SURVEY OF
LOT _ _ _'¢ _ BLOCK 225 AS SHOWN ON MAP OF
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AS nECOnDED IN PLAT BOOK _ __ PAGES -34 OF THE CURRENT PUBLIC RECORDS OF DUVAL CO., FLA
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I HEREBY CERTIFY THAT THIS SURVEY, PERFORMED UNDER MY RESPONSIBLE DIRECTION, MEETS THE MINIMUM LEGEND:
IECHNICAL STANDARDS FOR LAND SURVEYORS IN ACCORDANCE WITH CHAPTER 21HH-E. FLA.ADMINISTRATIVE CODE 0 CONCRETE MONUMENT
(PURSUANT TO SECTION 472027.FLORIDA STATUTES),AND FURTHER CERTIFY THAT THERE ARE NO VISIBLE ENCROACH- 0 FOUND IRO"
MFNIS UPON THE SUBJECT PROPERTY EXCEPT AS SHOWN ON THIS SURVEY. O SET IRON - LS 1701
r44QQ�ERTIFICATE; THE LOT SHOWN HEREON IS IN FLOOD I.R.L. BUILDING RESTRICTION LINE
7nvENF __1+ AS SHOWN ON THE FLOOD INSURANCE RATE CLARSON AND ASSOCIATES, INC. ^ CEOINTRAL ANOLI
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MAX COMMUNITY PANEL No 120015• 0001 D . DATED'•4.17-Al 101,3 HALDO AVII. JACKSONVILLE, FLA 72207 A ARC o1STARce
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