930 Sailfish Fence Permit App Building Permit Application Updated 10/9/18
J
ew • City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
'r •j t)r IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Addres9: 3G ..... CZ ( -A l S k Permit11 Number:
Legal Description \ l �� lL)At.* t (--of < ( 11 K 4 RE# 17 I ( c) - UC%OC
P C%t 1 CL �l ,'�'l S
Valuation of Work(Replacement Cost) $ 5-.40 Heated/Cooled SF Non-He. • i • •
• Class of Work: ❑New ❑Addition DAlteration ❑Repair ❑Move ❑Demo ❑Pool ❑Wind':I•/D
, IV 73202fi
• Use of existing/proposed structure(s): ❑Commercial ❑Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No BY:
• 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:
Rppi ce., y ' T, /I C , ...., /( hlc ,
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Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name (� o�� , .� � !wc-Jn �
Address •3� �t�� �l�ih
City ��f( ,5c.G e k State 1= Zip ?2.Z �3 Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
—
Name of Company I�Y�•1t/•-t J-e s. ..j 1--.^-c Qualifying Agent
Address J��rZ hatef i'k 0/,rel ///-/fy ✓� sc..:lit rZ.>OCity ;J/kksc,,.,,-/IC, State /----L Zip _j7J-.5o
Office Phone q/,9'-4{,,6 Vic; Sc Job Site Contact Number i s>, jl,. i r: /
State Certification/Registration# E-Mail J.014 ./rci/ L' c,,,,,.•)-f;•e.Fn'r�1✓ , /✓?k
Architect Name&Phone# J MA L L CO)f)
Engineer's Name&Phone#
Workers Compensation Insurer Ail Tr/5A OR Exempt o Expiration Date 3`:27„,i
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.
x (Signature of Owner or Agent) (Signature of Contractor)
).2�( ,-J
Signed and sworn to(or affirmed)(before me this 13 day of Signed and sworn to(or affirmed)before me this 23 day of
IANVAAtV, �w , by N.45 Ivc�J Z� by I �' SL
oia�°u,• .. (Signai�g�Or• � r[Signa u •
p ¢�. NELS State
_ ' 1'^` NotaryPublic•Statc of Florida +�: Notary Public-State of Florida
• Commission M GG 247646 •x; : mmission A GG 247646
My Comm.Expires Au y h..' My Comm.Expires Aug 9,2022
[ ]Personally Kno Oft""""'goaded through National Notary [ ]P oduceld Ide�t f caOtion Bonded through Natio notary Assn.
[ ]Produced(dent. . i/ _��`^
Type of Identification: • LD i b ltaolait►� ) Type of Identification: °. •
Owner Builder Affidavit **ALL INFORMATION
��. HIGHLIGHTED IN
— ' City of Atlantic Beach Building Department GRAY IS REQUIRED.
V 800 Seminole Rd, Atlantic Beach, FL 32233
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 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 IS A 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 REQUIREMENI5 FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
kr', 1)—
Job Address: 1O �G c)'ScMwPtl c =C.. .3,02•0
Owner Name: ne 1/: C 4ya►-,1" Phone Number:
Mailing Address: 44..74 5() Or- City: 4-f knhfr_ 64,0-. State: F'-- Zip: aJJ
Notarized Signature of OwnetA
The oing instrument was((((((acknowledged before me this ay of r\10,1 ,20 ZCi, in the State of Florida, County
of vA
Signature of Notary Public rd_S oicm
[ ] Personally Known OR [ ] Produced Identification
Type of Identification:(05 a I&4[o (03 `IO
NELS
Updated 10/24/18
K n Notary Public.State of Florida
' Commission n GG 247646
'L ' My Comm.Expires Aug 9, 611
Bonded through National Notary Assn,
REVOCABLE ENCROACHMENT AGREEMENT
, **ALL INFORMATION
\,J City of Atlantic Beach HIGHLIGHTED IN GRAY
ti . p� 800 Seminole Road,Atlantic Beach,FL 32233 IS REQUIRED.
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation organized and
existing under the laws of the State of Florida, hereinafter referred to as "CITY" and
of Atlantic Beach, Florida, hereinafter
referred to as "USER".
WITNESSETH:
That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon
the property for the purpose as described in the City of Atlantic Beach.
This work is generally described as g€ 1c.C€ Aci.J)
Any facility maintained, repaired, erected, and/or installe In the exercise of the privilege granted remains subject to
relocation or removal on thirty(30)days'notice by Sol
i ,sai notice to USER shall be given by certified mail, return
JJV0receipt requested,to the following address cS`
• In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter
upon the above described easement or property of the CITY, the USER shall replace at the USER's sole expense,
any and all material necessarily displaced during the action of maintaining, repairing, operating, replacing or
adding to of the utilities and facilities of the CITY or franchise utility provider.
• The facilities allowed by the permit shall meet the current requirements of the City Code, Building Codes, Land
Development Code and all other land use and code requirements of the CITY, including City Code Section 19-7(h)
which states "Driveways that cross sidewalks: City sidewalks may not be replaced with other materials, but must
be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks."
• The USER, prior to making any changes from the approved plans and/or method, must obtain written approval
from the City of Atlantic Beach Public Works Department, for said change within 30 days after the day of
completion.
• This permit shall inure to the benefit of, and be binding upon, the USER and their respective successors and
assigns.
• USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or
specifications, to include utilities locate requirements and use limitations/requirements of easements, public
right-of-ways and other public land. USER further agrees that the CITY and its officers and employees shall be
saved harmless by the USER from any of the work herein under the terms of this permit and that all of said
liabilities
are hereby assumed by the USER.
Date I lb 3/J.01--6
Property Owner/Agent(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this 2_3(d day of i p✓ , 20 2-6 ,
by DDi fZ ,who personally appeared before me and
(printed name of Signer)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
JL) S t' Department Approval:
Signature of Notary Public,State of Florida , � � (pj ��
[ ] Personally Known FL
:N.,-Produced Identification (Type) F L:____ Scott Williams, Public Works Director
r`v .. c ' umH\Applic i} . s\wor & celceut
Or i Is\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
Notary - tate or Honda
Commission k GG 241646
My Comm.Expires Aug 9,2022
Bonded through National Notary Assn.
FNCE20-0133
LOT 23 , BLOCK 4, ROYAL PALMS UNIT ONE
AS RECORDED IN PLAT/DEED BOOK 30 PAGE(S 6o -6c FOF THE CURRENT PUBLIC RECORDS OF b if V P L COUNTY, FLORIDA
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RECEIVED
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RECEIVED
By Jennifer Johnston at 3;33 pm,Nov 12,2020
II J O n COPY FNCE20-0133
ro I DATE: 11/11/20206
QUOTE GOOD UNTIL: 11/26/2020
f' \ L f f' ,'LIGHTSTREAM
Financing Available
Submitted To: Tracy Corson Representative: John MacLeod
Street: 909 AMBERJACK LN
City,State, Zip: Atlantic Beach FL Phone: 904-333-3410
Phone: (904)524-2249 Email: jmacleodIifrontlinefencing.net
Email: chriscorson41@a}mail.corr
75'Chain-link fencing 4'tall
: :::::
I A I,4'tall Shed
4'tall
12 Gate
House
I I
Hang fencing on left side
Posts and top rail are in ground
Home owner supplied
Provide labor, materials&equipment to build and install 136 linear feet of 4'tall galvanized chain-link %
(1) 5'wide chain link gate(1) 12' Double Chain-link Gate
No,f{emoval or Disposal I
Price: $ 1,800 7p O. Deposit: ,r) Li Pe;IL
.,-
REMOVE/DISP NO POST SPACING: 10' #OF 3'or 4'GATES:
FINISH SIDE: OUT CONCRETE: YES #OF 5' or 6'GATES: 3
TYPE CHAINLINK POST SIZE: 2X2X72 LATCHES: Post Mount
STYLE: LINEAR FEET: 151 ATTACHMENTS: IN GROUND
GRADE: FOLLOW GATE FRAME: STEEL COLOR: Galvanized
HEIGHT: 48" GATE STYLE: Chain link GATE SWING: OUT
? WARRANTY: 2 YEARS ON CRAFTMANSHIP&HARDWARE
IUWE,THE OWNER/AGEN: 01 THE PREMISES MENTIONED HERIN, HEREBY CONTRACT WITH YOU AN ,AUTHORIZE YOU AS THE CONTRACTOR TO
FURNISH ALL NECESSARY LABOR AND MATERIALS TO CONSTRUCT THE IMPROVEMENTS DESCRIBED HEREIN.IN THE EVENT THE PAYMENT IS NOT
MADE AS SPECIFIED,Frontline Fencing Inc RESERVES THE RIGHT TO EXERCISE THE PROVISIONS PROVIDED FOR UNDER THE FLORIDA MECHANICS
LIEN LAW. ALL EXPENSES ASSOCIATED WITH COLLECTION,INCLUDING BUT NOT LIMITED TO ATTORNEY,COURT FEES,AND ASSOCIATION COSTS.
ALL MATERIALS ARE GUARANTEED AS SPECIFIED. ANY ALTERATION OR DEVIATION FROM THE ABOVE SPECIFICATIONS INVOLVING EXTRA COSTS
Wlu. BE AN EXTRA CHARGE OVER AND ABOVE THE AGREED UPON PRICE INCLUDING A REASONABLE CHARGE FOR ADDITIONAL PROFIT AND
OVERHEAD. ADDITIONS,CHANGES OR DEVIATIONS WILL NOT BE EXECUTED WITHOUT WRITTEN ORDERS BY THE OWNER OR OWNERS AGENT.THE
OWNER/ AGENT ACCEPTS FULL RESPONSIBIUTY FOR LOCATING, STAKING AND CLEARING FENCE LINES, AS WELL AS DEED OR SUBDIVISION
RESTRICTIONS. Frontline Fencing Inc IS NOT UABLE FOR DAMAGES OF ANY NATURE DUE TO UNDERGROUND OBSTRUCTIONS. IN CONSIDERATION
OF SAID WORK AND SERVICES BY THE CONTRACTOR,CONTRACTS ARE GOVERNED BY TERMS AND CONDITIONS AS STATED ON SECOND PAGE.THE
OWNER/AGENT ACCEPTS THE SPECIFICATIONS AND TERMS OF THIS AGREEMENT. 3.5% WILL BE ADDED •' CREDIT OR DEBET CHARGES
THIS PROPOSAL IS VALID FOR 30 DAYS.
CUSTOMER ACCEPTANCE CC., �c�(1,,, OFFICER ACCEPTANCE /, /----------