2113 S Fairway Villas FNCE20-0090 PermitOWNER:ADDRESS:CITY:STATE:ZIP:
SLIGH WENDY 2113 FAIRWAY VILLAS LN S ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
169398 1038 FAIRWAY VILLAS
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
2113 S FAIRWAY VILLAS LN FENCE WALL OR BARRIER FENCE 6' FENCE $200.00
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. Approved list can be obtained at the Building Department at City Hall. Roll off 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.
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.
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.
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.
1 of 2Issued Date: 9/2/2020
PERMIT NUMBER
FNCE20-0090
ISSUED: 9/2/2020
EXPIRES: 3/1/2021
FENCE WALL OR BARRIER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
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
4 PUBLIC WORKS FENCING REMOVED INFORMATIONAL
Notes:
All old fencing and debris must be removed from job site by Contractor.
2 of 2Issued Date: 9/2/2020
PERMIT NUMBER
FNCE20-0090
ISSUED: 9/2/2020
EXPIRES: 3/1/2021
FENCE WALL OR BARRIER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $81.50
FNCE20-0090 Address: 2113 S FAIRWAY VILLAS LN APN: 169398 1038 $81.50
BUILDING $35.00
FENCE 455-0000-322-1000 0 $35.00
BUILDING PLAN REVIEW $17.50
BUILDING PLAN CHECK 455-0000-322-1001 0 $17.50
PUBLIC WORKS PLAN REVIEW $25.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R13089 $81.50
Printed: Wednesday, September 02, 2020 2:50 PM
Date Paid: Wednesday, September 02, 2020
Paid By: SLIGH WENDY
Pay Method: CREDIT CARD 358467347
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R13089
Building Permit Application Updated 10/9/18J
7k y City of Atlantic Beach Building Department ALL INFORMATION
giY..
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
r:p
IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@((c oab.us A-1 c-(hG
Job Address: a \N. -j c" k '"\ o\\.\. -S \c - S'
Pe it Number:
S-
Legal Description 3 l - 4 .' a c.-; - E-ra \s(I...t,bL a RE# f q 367 I O
Valuation of Work(Replacement Cost)$ 200 - Heated/Cooled SF
LC)
Non-Heated/Cooled
Class of Work: New Addition i>tfAlteration Repair Move Demo Pool Window/Door
Use of existing/proposed structure(s): Commercial tIchesidential
If an existing structure,is a fire sprinkler system installed?: Yes 3:1No
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: kv3.f 4 e S (:)h L. `t. Y1_fl,kL
CO ( rEt CE L s r--Q.
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name \Alie.,_v`.e.X-\,-\ S\ S Address a.\\3 ca_v1 t..,..•\ \);\\G. s \a V-k Sr"s_-k'..
City A--\\Cj.\\A C_ ('m( \,-, State C L Zip 3.-6-a 3 3 Phone ej cA Lp k.. 7 q 0
E-Mail f'k\..A.ti-\ v\Cc-& Crs OA.4..\ ` C-0"\,1
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company 'E-Q.\c 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 MIOU T F COMMENCEMENT.
Si ature of Owner or Agent)Signature of Contractor)
ned and sworn to(or aff •ed) before me thi day of Signed and sworn to(or affirmed)before me this day of
7(20,b . '& . Are .by
cr.g atu '. r - Signature of Notary)
Ali
Personally Known OR p!"•Y".4 ONIGINDLEally ' own OR
Produced Identification f.; z•` t•I MYCOMMISSIOt?li KAWA Idi tification
Type of Identification:m`'4. ' EXPIRES::Cigc6ntifiI:tion:
pu6 c Undeiwrere
warx.pu rw••,arw.Vu^f 1wFtM4w.ItMfrsen'.
FNCE20-0090
Afir Owner Builder Affidavit ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
9 800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERM
HIGHLIGHTED
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@COAB.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: I0211J c(mvt.c3 V\,` S t(IAN_ S rte.
Owner Name: t A CO\ \ C\ VL Phone Number: + DtJ (.Q (.f - -7 74 0
Mailing Address: a \.\.- caw,LcDet.\\.)aCAS City: t\.T ate: Zip: 3-0 'a-`v
Notarized Signature of Owner _ \___41.&.,&_„___ h.
T! egoing insttument was acknowledged before me this a5d: •f IA 2n the State of Florida, County
of A x.)v ,._,_,‘
ure of Notary Publi —.ow
4!I'
C-
rr---------fit"•" „.. TONT GINDLESPERGER
MY COMMISSION 0 GG 35.
i`` , ;
EXPIRES:Ociober6,2023
9 rsonally Known OR [ ] Produced Identification
Ar'
FF'O_,'
Bo nded'NNotary Public undenviers
of Identification: b' v
Updated 10/24/18
FNCE20-0090
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PROPERTY ADDRESS: 2113 FAIRWAY VILLAS LANE SOUTH ATLANTIC BEACH,FLORIDA 32233 SURVEY NUMBER: FL1402.0313 i
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I hereby certify Ihabt(u&l undalfritOvey of the hereon
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and to the best/of rr)y..kr(owletlge•and belief, IIs a true
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I inch = 20 feet license No.3708
Use of This Survey for Purposes other than Intended,Without Written Verification,will be at the User's Sole Risk and Without Liability to the Surveyor. i.Nothing hereon shall be Construed to Glue ANY Rights or Benefits to Anyone Other than those Certified,
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MUNICIPALITY OR WWW.FEMA.GOV,THE PROPERTY APPEARS TO BE AUTHORITY EASEMENT.
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