807 Camelia St FNCE19-0120 6' FENCE WALL OR BARRIER PERMIT PERMIT NUMBER
14 \
CITY OF ATLANTIC BEACH FNCE19-0120
ISSUED: 10/23/2019
800 SEMINOLE ROAD
ATLANTIC BEACH. FL 32233 EXPIRES: 4/20/2020
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:
807 CAMELIA ST FENCE WALL OR BARRIER FENCE 6' FENCE $0.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170936 0000 ATLANTIC BEACH SEC H
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
GASKINS JENNIFER ET AL 807 CAMELIA ST ATLANTIC BEACH FL 32233
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.
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: 10/23/2019 1 of 2
:.5•1 '`Pr FENCE WALL OR BARRIER PERMIT PERMIT NUMBER
gz„
;-...>. FNCE19-0120
CITY OF ATLANTIC BEACH
v~ 800 SEMINOLE ROAD ISSUED: 10/23/2019
911 ,a EXPIRES: 4/20/2020
ATLANTIC BEACH. FL 32233
4 PUBLIC WORKSI RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site. Cannot raise lot elevation.
5 PUBLIC WORKS FENCING REMOVED INFORMATIONAL
Notes:
All old fencing and debris must be removed from job site by Contractor.
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 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $81.50
Issued Date: 10/23/2019 2 of 2
rs�1..;vi��, City of Atlantic Beach APPLICATION NUMBER
S • r) Building Department (To be assigned by the Building Department.)
800 Seminole Road � R , I
i),. r
Atlantic Beach, Florida 32233-5445 F-'�i cl9'— 1 Z O
Phone(904)247-5826• Fax(904)247-5845 / 3 + Q
o;� ur E-mail: building-dept@coab.us Date routed: 1 1
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: E)C57 err {\ Department review required Yes No
j�uildin
�°
tannin &Zonin
Applicant: �..i(.� f�F.� <``�'
Tree Administrator
Project: 7 �ubl NO
(ublic Utihtie
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. I_ !Denied. of applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: — � Date: /0
TREE ADMIN. Second Review: Approved as revised. Denied. I 'Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: nApproved as revised. ❑Denied. nNot applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
a
I
( ui
City of Atlantic Beach APPLICATION NUMBER
�" •�d Building Department (To be assigned by the Building Department.)
...; 800 Seminole Road �fi C (� _/
�r Atlantic Beach, Florida 32233-5445 'V l l
Phone(904)247 5826 Fax(904)247-5845 i O 13
"�-rni q%' E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: E5CC-7 EI4crr\ EjL. ( A Department review required Yes o
! Epildini---)
Applicant: C.%(AD 1 ,)E(2-- nnin &Zonin
�. 9 9
Tree Adm.iinrs£raof r—
Project: 6 1 I❑.M Cdub
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: Approved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING rry
Reviewed by: Date: /0 17
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
ri�Ly; City of Atlantic Beach APPLICATION NUMBER
dkillt Building Department (To be assigned by the Building Department.)
800 Seminole Road ( _ 1I7
5� •r
Atlantic Beach, Florida 32233-5445 F�0.E L9 1 L 0
Phone(904)247-5826 • Fax(904)247-5845 0 I
E-mail: building-dept@coab.us Date routed: 1 I
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 5C)‘-7 r [ j2 Department review required Yes No
uildini)
Applicant: L/)(A71v e(2— arming&Zonings)
Tree Administrator
Project: ‘Q P-E.ML� dub .i&uk
(>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: pproved. Denied. Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by:L%% d 47 1 Date: � 1
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
,. City of Atlantic Beach _ APPLICATION NUMBER
jS ,, Building Department (To be assigned by the Building Department.)
e 800 Seminole Road = r (
� Atlantic Beach, Florida 32233-5445f1C 2019 _ l - ' Z.O
Phone(904)247-5826 Fax(904)247-58450T a 9
Jii yr E-mail: building-dept@coab.us 1 ' Date routed:
City web-site: http://www.coab.us BY:_
APPLICATION REVIEW AND TRACKING FORM
Property Address: Ft507Ei?Arr\ ( f Department review required Yes No
r uildin& _
Applicant: lA.ti71U Eg— ( fanning&Zonings)
Tree Administrator
Project: 6-2 ( 1E /Publ •Wnrks
(ublic 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: 4proved. Denied. INot applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING �
Reviewed b : ,. ,/,% ,_ Date: G
,4'A' Imo:�1lfi
TREE ADMIN. Second Review: Approved as revised. I (Denied. I '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
OFFICE COPY
s'': � Building Permit Application Updated ��
10 9 18
. =' City of Atlantic Beach Building Department **ALL INFORMATION
1rr zHIGHLIGHTED IN GRAY
800 Seminole Road, Atlantic Beach, FL 32233
"`T '9'' IS REQUIRED.
Phone: (904) 247-5826 Email: uilding-Dept@coab.us
Job Address: p 0 7 CiA Li A- S--1—: Permit Number: P7-10 CC:-Lq--0(Zc)
Legal Description _RE#
Valuation of Work(Replacement Cost)$ 4 00. Oa Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ElCommercial ❑Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed:
l K6tAL L re,,,)c_E-
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name BREtUE ALL iW/IEWf Z. 6A5Klf.SAddress 'Q7 G t' L!A ;-f'
City AtLA1� 13E—eta-1 State FL 3 'Zip Z 3 3 Phone CO`>t ; /
66
Lks y 9
E-Mail ERE t•-it Alk-414 ALL IAA_A. .I® �, I L • CO"A
Owner or Agent(If Agent, Power of A torney or Agency Letter Required)
Contractor Information
Name of Company Qualifying Agent
Address City ate _ 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 he work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit nd 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 Owner or Agent) (Signature of Contracto
' ne and sworn to(or a ' •)before me thi _ day f ,Signed and sworn to(or affirmed •efore me this day of
?C1LCI,b 1 ► i. ��A °LS ctS , ,by
11.11MI
' *.•. ur J• `• (Signature of Notary)
I -;54 .^Y cTONI GINDLESPE- w
.. 4...71, MY COMMISSION#FF 925951
. . c•.-: 7,, n...,ber6,2019
[ I Personally Known ORDfcUnder•riters [ I Personally Known OR
[I Produced Identification= [ )Produced Identification
Type of Identification: Type of Identification:
rtAil , Owner Builder Affidavit OFFICE COPY **ALL INFORMATION
r HIGHLIGHTED IN
-, "' City of Atlantic Beach Building Department GRAY IS REQUIRED.
r
ri
800 Seminole Rd, Atlantic Beach, FL 32233
`J'S'r Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT# XPIP/111-717/1-1
:
o/LG
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 ISA LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT(WCOAB.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: 101 CAtM-E-c,1 ,a S+ `/
Owner Name: 13g.Fkk ALL.1440/�C/VOV 1 FSR. f e4sk/NJ Phone Number: 9D ii ` s'g613119
Mailing Address: $O7 CA .4Ac L/A 51 City: A+LAK416 a;644 State: FL Zip: 32Z 33
_----may
Notarized Signature of Owner - --_.
054
Th egoing insilrument was acknowledged before me this 13 day " ,20( ,1n the State of Florida, County
ofCD11CcA
Th
Signature of Notary PublicII
�- /
[ ] Personally Known OR [ ] Produced Identification�lq
Type of Identification: (---� z z^ `t Z Z -8Z- g ! -
— � ""` Updated 10/24/18
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