332 4th St DEMO20-0024 Driveway Removal Permit PacketOWNER:ADDRESS:CITY:STATE:ZIP:
Bill and Kate Morgan 332 4th St Atlantic Beach FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
169816 0000 ATLANTIC BEACH
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
332 4TH ST DEMO PARTIAL remove driveway $1200.00
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 EROSION CONTROL INSTALLATION INFORMATIONAL
Notes:
Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line (904-247-
5814) to request an Erosion and Sediment Control Inspection prior to start of construction.
2 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
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: 9/15/2020
PERMIT NUMBER
DEMO20-0024
ISSUED: 9/15/2020
EXPIRES: 3/14/2021
DEMO PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
DEMOLITION 455-0000-322-1000 0 $100.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
TOTAL: $125.00
3 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.
4 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration, including sod, is required.
5 PUBLIC WORKS RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site. Cannot raise lot elevation.
6 PUBLIC WORKS DOCUMENT IMPERVIOUS AREA INFORMATIONAL
Notes:
Strongly suggest thorough documentation of impervious areas be recorded.
7 PUBLIC WORKS DECKING REMOVED INFORMATIONAL
Notes:
All old decking and debris must be removed from job site by Contractor.
8 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Contractor.
2 of 2Issued Date: 9/15/2020
PERMIT NUMBER
DEMO20-0024
ISSUED: 9/15/2020
EXPIRES: 3/14/2021
DEMO PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $125.00
DEMO20-0024 Address: 332 4TH ST APN: 169816 0000 $125.00
BUILDING $100.00
DEMOLITION 455-0000-322-1000 0 $100.00
PUBLIC WORKS PLAN REVIEW $25.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
TOTAL FEES PAID BY RECEIPT: R13262 $125.00
Printed: Tuesday, September 15, 2020 4:13 PM
Date Paid: Tuesday, September 15, 2020
Paid By: Bill and Kate Morgan
Pay Method: CREDIT CARD 362207589
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R13262
Building Permit Application
City of Atla ntic Beac h Bui ld i n g Department
800 Sem ino l e Road , Atlantic Beac h, FL 32233
Phon e : (904 247-5826 Em ai l : Bui l ding-Dept@coab.us
Updated 10/9/18
"A LL INFORM AT ION
HIG HLIG HTE D IN GRAY
IS REQUIRED .
Job Address: _,.]d:"'~.-...:;:J:,o...l,;,.J...~!!,;f-~~..6.&4J~'C'. ___ permit Nu mber: Le,,' Dem'ptioo /U hjVJJ 1. ba do d,i,ivtuJCIdj, RI~"~======~
Valu at ion o f W o rk (Replacement Cost) S r# / bJ,O 0 Hea t e d/Co o l ed (j _____ Non -Heated/Coo led _____ _
•
•
Cl ass of Work: D New DAddition DAlteration D Repair O Move OOe mo O Poo l D Window/Door
Use of exi sting/proposed structure(s): OCommercial ~si d e nt ial
• If a n eKisl i ng structure, is a fire sprinkler syste m installed?: D Yes )2ffo
• W ill tree s be removed in associa tio n with (0 ose d ro "ec? DYes must submi t se arat e Tree Removal Permi 0
Owner or Agent (If Agent, P er o f Attorney or Agency letter Req uired) _____________________ _
Contractor Information
Name of Com p any ________________ Qualifying Agent ----::c-:c---",--------,
Address Ci State Zi p
Office Ph one Job Site Con'''-'~t~N~u-m~b-e-'----'----'------~
State Certifica ti on/Regis t ration # _________ E-M ail ______________________ -'
Architect Na me & Phone #.-,-_______________________ -" __________ _
Engineer's Name & Phone # _,-__________________ -, ______________ _
Workers Compensation Insu r er OR Exempt 0 Expi r ation Date '-______ _
Application is hereby made to obta i n a permit to do th e work and installations as indicated. I certify that no work or in stallation has
commenced prior to the issuance of a perm it and that ali work will be performed to meet the standards of ali the l aws 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 CO NDITI ONE RS, 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
f ederal agencies.
OWNER'S AFF IDAVIT: I certify t ha t ali 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 AITORNEY BEFORE
R NOTICE
(Signature of Co ntractor)
Signed and sworn to (or affirmed) before me thi s L day of Signed and sworn to (or affirmed) before me this __ day of
<. -" 'Q~v..;.' ~'l<A __ ~_~,by _______ _
""' ....... ~ .. JENNIFERJOHNSTOH "-t' u ,W··f",;;., MY CO ~.I.IISSlON /I ~~~ , t re of Notary) '';~'"' ~. l;! EXPI RES : 0cI0ber21 , 2020
-;.-01 ~<>..<ij.; 6anded T1VU No:art P!bIic UrcIeMI\III1 "" .. '
(Signature o f Notary)
l Pers !ly Known OR
[ =.d Iden t ification ,\ \_
Ty pe of Identifica tion : r (..... M ~Il h S .LL ,)..r<.
! I Pe rsonally Known OR
! I Produced Ide ntification
Type of Identification: _____________ _
Owner Builder Affidavit
City of Atlantic Beach Building Department
800 Semino le Rd, At lantic Beac h, FL 32233
Phone: (904) 24 7-5826 Email: Building -Dept@coab.u s
··ALlINFORMATION
HIGHLIGHTED IN
GRAY IS REQUIRED .
PERMIT #: ______ _
I. FLORIDA STA TUTES ; CHAPTER 489, FLORI DA STATUTE S, PAR T 1 "CO NSTRUCTI O N CO NTR ACT IN G" REQUIRES
OWNE R / BUILDER TO ACK NOW LEDGE THE LAW:
DISC LOSURE STATE M ENT FOR SECTION 489.103(7), FLOR ID A STATUTE S:
STATE LAW REQUIRES CO NSTRU CT ION TO BE DONE BY LI CEN SED CO NTR ACTO RS. YOU HA VE APPLIED
FOR A PERMIT UNDER A N EXEMPTI O N TO THAT LA W. THE EXEMPTION A LLO WS YOU, AS THE OWNER
OF YOUR PROP ERTY , TO ACT AS YOUR OWN CO NTR ACTOR EVEN THOUG H YOU DO NOT HAVE A
LI CE NSE .
YOU MUST SUPERVISE THE CONSTRUCTION YOURSElF .
YO U MAY B UILD OR IMPROVE A O NE OR TWO FAMi l Y RES I DENCE O R A FARM OU TBUILDIN G. YOU M AY
ALSO BUILD OR IMPROVE A CO MMERCI AL BU ILDIN G A T A COS T OF $25,000.00 OR LE SS .
I IT M AY NOT BE BUILT FOR SA LE OR LEASE.
IF YOU SE LL OR LEASE A BUI LDING YOU WITHIN ONE YEAR AFTER THE
CO NSTRUCTI ON IS COMPLETE , THE LAW WILL PRE SUME T HA T YO U BUILT IT FOR SALE OR LE ASE , WHICH
IS IN VIOLATIO N OF THI S EXEMPTION.
YOU MAY NOT HIRE AN UNLICEN SED PERSON A S YOUR CONTRACTOR . YO UR CO NSTR UCTIO N MUST
BE DONE ACCORD IN G TO THE BUILDING CODES A ND ZO NIN G REGU LA TI O N S.
IT IS YOUR RE SPONS I BILITY TO MAKE SURE T HAT PEOPLE EMPLOYED BY YOU HAVE LICENS ES
RE UIREO BY STATE LAW AN D BY COUNTY O R MUNICIPAL LICENSING ORDINANCES .
II. INJURY LIABILITY ; SIN CE OW NE RS M AY BE LI ABLE FO R INJUR I ES TO WORK ER S THEY HI RE, TH E BUILDING DEPARTMENT
SUGGESTS WO RKER 'S COMPEN SA T ION IN SU RA N CE BE PUR CHASED ..
III. IRS W ITHHOLDING ; OWNE RS HIR I N G WORKERS BECOME EMPLOYERS A ND SHOULD ALSO OBSERVE I RS W ITHH OLDING
TAX A ND/OR FO RM 1099 REQUIREMENTS ON TH E WORKERS THE Y EMPLOY ON THE IR IMPROVEME NT TRADES .
IV. PENALTY; UN LI CEN SED CO NTR ACTORS CAN N OT BE EMP LOYED UND ER ANY CIRCUMSTANCES . OWNERS BEING SUBJ ECT
TO $5,0 00 PEN ALTY UND ER FLORIDA STATUTE NO. 455-228(1). A N "OCC UP ATI ONAL LI CE N SE " IS NOT ADEQUAT E. TH E
OWNER SHO ULD PHYSICALLY SEE THE CO UNTY "CE RTIF ICA T E OF COMPETE N CY " O R TH E FLORIDA "CO NTR ACTO RS
CER T IFICATE" TO ASCER TA IN I F A PER SON IS A LI CE NSED CO NTR ACTOR . CO NTACT T H E BUI LDING DEPARTMENT (904-
247-5826 OR BUILDING -DEPT@COAB .US ) IF IN DO UBT .
V. ACKNOWLEDGEMENT; I HEREB Y ACK N OWLEDGE T HAT I HAVE REA D TH E ABOVE DIS CLO SURE STATEME NT AND THAT I
COMPLY WITH AL L THE '1QUIREMENTS FOR TH E ISSUA N CE OF AN OW NER -BU I LDER PERMIT.
Job Add ress: J J{) u.JL,t)u ..,J~
Ow ner Name , ~ G.f1 Phone Numbe" »1-J 1?-11t!;S
Ma;li ng Add re ss: --L<~fO!.lt::l'"J..----=--_ C ;t y~ j5adstat",j .. [ Z;p lrun
Notariz ed Signature 0/ Own er L..h',7a&.;/w~W'-"''£'~''&"d~~~",-_~ ____________ _
The foregOin g instrument was ack n
of O ...... " ...... l
....\i~lk.:!W:,; 20,Win the St a t e of Florida, Coun t y
•
1F"':;i~="",,,,",,=:O"",,,,,,,,,,,,,,,~S i g nature of No t ary Public rx-E J .-iA:!t·W~.. JENNIFER JOHNSTON _ /It
(.{ ':.~ MVCO~t.lISSION'GG042984 1 Personally Known OR [\.of"'P rod u ce Id e ntjfi ca tio n
<'!-;. .~.; EXPlRES' 0cI0bet 27 ,,-'~" .~ .. ,' . '" l..... ' •• J? .. "",~ Balded fl'wow Nola')' Public: UOOtIv.ritin j ' , \ • IJ
ype o f Ide nt if ication : _e",-,L.~ .. o-OL( .uAlL} L",,-, _IL--'\'!.LL( ... L"O:J..>JJ,,-<c~ _______ _
Updated 10/24/18
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