380 12th St Fence PW Building Permit Application Updated 10/9/18
7 i
City of Atlantic Beach Building Department **ALL INFORMATION
./ 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
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Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 380 12th St,Atl Beach,FL 32233 Permit Number:
Legal Description RE#
Valuation of Work(Replacement Cost)$1302 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 IZ[Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes Q1 No
• Will tree(s)be removed in association with proposed project? OYes(must submit separate Tree Removal Permit) VNo
Describe in detail the type of work to be performed:
Fence installation as shown on attached sketch
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name Amy Pollak Address 380 12th St
City Atlantic Beach State FL Zip 32233 Phone (434)825-5086
E Mail amymarisapollak@gmail.com
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Big Jerry's Fencing Qualifying Agent Jon Davis
Address 12620 Beach Blvd,Ste 3-131 City Jacksonville State FL Zip 32246
Office Phone 904-476-2528 Job Site Contact Number 904-476-2528
State Certification/Registration# N/A E-Mail Jon@BigJerrysFencing.com
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt el Expiration Date 2/13/22
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 Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this day of Signed and sworn to(or affirmed)before me this day of
,by ,by
(Signature of Notary) (Signature of Notary)
[ ]Personally Known OR [ ]Personally Known OR
[ ]Produced Identification [ ]Produced Identification
Type of Identification: Type of Identification:
Revision Request/Correction to Comments **ALL INFORMATION
HIGHLIGHTED IN
�5 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#: �'p`►'
CE20-0033
E Revision to Issued Permit OR I I Corrections to Comments Date:04/1412020
Project Address: 380 12th St,Atlantic Beach,FL 32233
Contractor/Contact Name: Big Jerry's Fencing/Jon Davis
Contact Phone: (904)476-2528 Email: jon@bigjerrysfencing.com
Description of Proposed Revision/Corrections:
RE# 171930
Legal Description- Fence installation
I Big Jerry's Fencing/Jon Davis 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?
❑No 17 Yes(additional s.f.to be added: )
• ill proposed revision/corrections add additional increase in building value to original submittal?
/No ❑*Yes(additional increase in building value:$ )(Contractor must sign if increase in valuation)
*Signature of Contractor/Agent: g41"----
T
(Office Use Only)
Approved ❑ Denied ❑ Not Applicable to Department Permit Fee Due$
Revision/Plan Review Comments
Department Review Required:
Building r _./ //le‘,.-,�-tea.
Planning&Zoning Reviewed By
Tree Administrator
Public Works ,1 //�
Public Utilities
Public Safety Date
Fire Services Updated 10/17/18
Description of Fence: Customer Info: 1Y,$F,
6' tall Shadowboxpressure treatedpine AmyPollak i
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Estimated 41' including gates 380 12th St ._-,-9
Atlantic Beach, FL 32233 d
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Note: Sketch is not to Scale
-»,1i City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
. 800 Seminole Road ��)
" "' Atlantic Beach, Florida 32233-5445 `t tet/ �O 13'
Phone(904)247-5826• Fax(904)247-5845
i3 9r E-mail: building-dept@coab.us Date routed: 0"'—
—T(�_
City web-site: http://www.coab.us �
APPLICATION REVIEW AND TRACKING FORM
Property Address: 310 Al- 7.---(ked Department review required Yes No
Building
Applicant: if irr i/,� ieiiedy Planning &Zoning
(� / Tr dmin. for
Project: 4 e e Public Works
U 1'ubric tilities
Public Safety
Fire Services
Review fee $ Dept Signature
Review or Receipt
Other Agency Review or Permit Required Date
of Permit Verified By O //' / -/f
Florida Dept.of Environmental Protection (� (/ ��/
Florida Dept.of Transportation ftrmi'J-
Army
St.Johns River Water Management District Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other: 1/4-le>
APPLI ATION STATUS
Reviewing Department First Review: Approved. ❑Denied. ['Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING iftr %i q,
Reviewed • . ,,�i/4 „4 Date:-17-vcl(/
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