63 Beach Ave FNCE19-0071 6' (-:31----.iwy-yr.., FENCE WALL OR BARRIER PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH FNCE19-0071
r - � ISSUED: 10/9/2019
''-'40�:i9"
800 SEMINOLE ROAD ATLANTIC BEACH. FL 32233 EXPIRES: 4/6/2020
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM 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 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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
63 BEACH AVE FENCE WALL OR BARRIER FENCE 6' FENCE $2300.00
TYPE OF REAL ESTATE I ZONING: I BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170219 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
DARABI FARZIN A 63 BEACH AVE ATLANTIC BEACH FL 32233-5257
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
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: 10/9/2019 1 of 2
rS‘..ivi I City of Atlantic Beach APPLICATION NUMBER
rJ �` Building Department (To be assigned by the Building Department.)
r . 800 Seminole Road �7
r' Atlantic Beach, Florida 32233 5445 NCE�� oO /
, Y.
ry ,' Phone(904)247-5826 • Fax(904)247-5845 / / ����^ _
r 0 1119%- E-mail: building-dept@coab.us Date routed: lel `-�
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: GS 12 Eccert l iV E rie)5partment review required Ye No
uildinq_D
Applicant: 0 (10 1D-Ere_ ,Planning &Zonin
Tree Administrator
Project: CO t t ,ND�� (-----Public Works
Public Uti hies _
Public 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: E pproved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
UILDI
PLANNING &ZONING Reviewed by: ' `� Dater'/ "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
Building Permit Application Updated 10/9/18
1 ~ City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
,)
was IS REQUIRED.
Phone: (904) 247-58266f"Email: Building-Dept@coab.us
Job Address: 6fi �� d /41‘e Permit Number: I—t\C,E (9"0 0 7
Legal Description RE#
Valuation of Work(Replacement Cost)$ ,230 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition glAlteration 'aepair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial 1esidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes It No
• Will tree(s) be removed in association with proposed project? EYes(must submit separate Tree Removal Permit) Lz'-No
Describe in detail the type of work to be performed: /
c1 enC
Florida Product Approval# for multiple products use product approval form
W
Pro•ert Owner Information �a(� ��� Ca)
Z
Name /tea V11 (a hi Address (23 _ N n
City Al . tate r L Zip 3 )33 Phone 9U4/-07.77' � x o \.
E-Mail fr �i � ��`y(J��/ eL
' .4 ZH
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) O m - La W
Contractor Information / ❑ p F-
Name of Company �� /01-407/4A/ Qualifying Agent W V Q V O
Address City State Zip O 1::
CC Z
Office Phone Job Site Contact Number 2_4_2 a
State Certification/Registration# E-Mail ‘�+ F. r H
Architect Name& Phone# CC LL t 6
Engineer's Name&Phone# LL oW y
Workers Compensation Insurer OR Exempt❑ Expiration Date W a CC m
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or install bt ❑ fa
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws reg tiQ CO La
La W
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SILSiJS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE: In addition to the requiremert2of this LU
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 FINAN ING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECO'DI - �O NOTICE 0 COMMENCEMENT.
i /A'...%
/ (Signature of Owner or Agent) (Signature of Contractor)
S' ned and sworn to(or affirmed)before m this i1'J!' day of Signed and sworn to(or affirmed)before me this day of
e , 2_01 , Fct z 4 )Qrczbl, , by
(Signature of Notary) (Signature of Notary)
,.e "•":+i;: JESSICA A CLARK
[ ersonally Known OR MY COMMISSION#GG0$0246 [ ] Personally Known OR
[ ]Produced Identification vvo, EXPIRES May 07,2021 [ ]Produced Identification
Type of Identification: Type of Identification:
Owner Builder Affidavit **ALL INFORMATION
's� ���'�' HIGHLIGHTED IN
j '° City of Atlantic Beach Building Department GRAY IS REQUIRED.
5 800 Seminole Rd, Atlantic Beach, FL 32233
'`C''ttr 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 ATA 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 ISA LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.US) IF IN DOUBT.
A
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: 63 &ad 4Vt
......
Owner Name: rezrzjn Sa gb) Phone Number: 901q---(:))99—e413
Mailing Address: ' k'; ,•,%j Cit TL zip:p: &;433
Notarized Signature of OwnerI ,� /
The egoing instrument was ack/ledged before me this r 0 day of c(5-VI - ,20 lei in the State of Florida, County
of V QI
Signature of Notary Pu d' z_,JA .A _ ;• e_____
/
.,,,
???S''..... JESSICA A CLARK &.]4rsonally Known OR [ ] •roduced Identification
MY COMMISSION#GG000246
t
EXPIRES May 07,2021 Type of Identification:
Updated 10/24/18
i�Lyj City of Atlantic Beach APPLICATION NUMBER
h ,n
Building Department (To be assigned by the Building Department.)
� � 800 Seminole Road Q
j �� Atlantic Beach, Florida 32233-5445N CE 1 �� I
Phone(904)247-5826 Fax(904)247 5845 // l
!r It y E-mail: building-dept@coab.us Date routed: l.42 L t e.i t cl
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: GS [SE,Ret-k P\ IEi Department review required Yes No
(ilding
Applicant: CD GO ND C-fe___ _' anning &Zonin•
' Tree Administrator
Project: CO t ,i'\-D�� ( Public Work
. f Public Utilitie
Public 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. ' L ['Not applicable
(Circle one.) Comments:
1�5 ) \ wl hcove ilia,
DLX\4 r• C"�C. i S /�
BUILDING K�&1(� 665/i I 1 (n (S4f'11 i (&fi�P y � _
PLANNING &ZONING Reviewed by: act Date: t0'2.�'J-1 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. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
�;irLf City of Atlantic Beach APPLICATION NUMBER
ifl
Building Department (To be assigned by the Building Department.)
A
800 Seminole Road A `
Atlantic Beach, Florida 32233-5445 F`v C.E. 'O 07
Phone(904)247-5826 • Fax(904)247-5845 //
.r; ) E-mail: building-dept@coab.us Date routed: (CV 8�l9
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: COS (SE,RaA P .(1e jeyartment review required Yes No
ilding
Applicant: 0 GO NO-ere_ `PTanning &Zonin
_ ' Tree Administrator
Project: Co 1 ( Public Works
Public Utilities)
Public 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:
APPLIC ON STATUS
Reviewing Department First Review: Approved. nDenied. ❑Not applicable
(Circle one.) Comments:
BUILDING I I
PLANNING &ZONING Reviewed by: Date: -
TREE ADMIN. Second Review: Approved 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 05/19/2017
EcEIVE )
0,=1,y., City of Atlantic Beach APPLICATION NUMBER
_i *fry Building Department .JUN (To be assigned by the Building Department.)
"`- : 20 2019
'�41� � 800 Seminole Road ffQ
1:5
,. - Atlantic Beach, Florida 32233-544 Ry FN C.E.l l"0 07 I
Phone(904)247-5826• Fax(904)2473845-- ---__
. (.0/
.r E-mail: building-dept@coab.us Date routed: lc [8/l9
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: GS EE,pket-k (- 1(e De artment review required Yes No
uilding
Applicant: 0(A-.) ND-Ere_ _ anning &Zonin
_ • Tree Administrator
Project: CO ( ' �1\.D C� (Public Works
Public Utilities
Public 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: I-07Approved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONINbth/Reviewed b -- i ��_ ifs,. , 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 05/19/2017
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