1305 Main St Fence Permit Submittal Fence Addendum Updated 1/7/2021
';; City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Property Type:
Al Residential
❑ Commercial
Lot Type/ Features:
i$ One Street frontage (interior lot)
El More than one street frontage (corner lot, through lot, etc.)
❑ Swimming Pool
Fence Material:
❑ wood ECEBVE
I)
❑ Chain Link
❑ Vinyl
FEB 042021
El Block/Stone (Plan details required for footings and/or retaining walls) BY:
❑ Other
Fence Height:
❑ Four Foot(4ft)
Six Foot(6ft)
❑ Other
Fence Location:
Please submit an accurate boundary survey required showing all existing improvements(including building footprint,
driveway, swimming pool, etc.) and location of fence/wall and any gates. Plan details required for block wall footings and/or
retaining walls and any portion or fencing above 6ft in height.
Will the fence be built in an easement?
❑ Yes (must submit separate Revocable Encroachment Agreement)
IA No
Will tree(s) be removed in association with proposed project?
❑ Yes(must submit separate Tree Removal Permit)
14j No
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.
'�s''="Jr: . Building Permit Application Updated 10/9/18
:1:;City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233
HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: /306 M Pr!d f 1 . , tT Vt 372,3 3 Permit Number:
Legal Description �f 1 fl }r-�. aa T RE#
Valuation of Work(Replacement Cost)$µ`e J D •!/7 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ,PJ New ❑Addition ❑Alteration ❑Repair DMove El Demo ❑Pool DWindow/Door
• Use of existing/proposed structure(s): ❑Commerdal OResidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes [No
• Will tree(s)be removed in association with proposed proiect?OYes(must submit separate Tree Removal Permit) ONo
Describe in detail the type of work to be performed:
(,J ( , �P.r,CL. Rip 10-4"4 -c4-N r- (A14_,,r e� Oi cl � 1(J. (Alt.-j - I-I h rti yg/
Florida Product pproval# for multiple products use product approval form
Property Owner Information �� //
Name 1, O6. Address )3 o 47,1L S
City :'r1 .►._ _ �a i! State Zip 3 21,33 Phone
E-Mail rlI Q° • N e\ t`-> "i Yl a \./Ci C3111/1.CA.i . CC,
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information l`-'I e lA.c -e_ Cc,
Name of Company Qualifying Agent
Address City State Zip
Office Phone Job Site Cont tuber
State Certification/Registration# E-Mail--
Architect Name&Phone# _
Engineer's Name&Phone# .
Workers Compensation Insurer ----- OR Exempt 0 Expiration Date
Application is hereby made to obtain a permit to do the w.-. and installations as indicated. I certify that no work or installation has
commenced prt"o the issuance of a permit and that all work be performed to meet the standards of all the laws regulating
const i n in this jurisdiction. I understand that a separate permi'•''ust be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
W LLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR COND •NERS,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
REC RDING YOU NOTI MENCEMENT.
/ (S' t r of Owner or Agent) Signature of Contractor
Signed and sworn to(or affirmed)before me this 3<day of Signed and sworn to(or •ffirmed) • .re me this day of
\-fb'L ('y , QGQ1 , y U [ �0��,,r��otetr0if/ ,b
C< .i.,0... vt/VLi'. i
(Signature of Notary) ; assOnl�'.,. 1.: ignature of Notary)
croTAgy %
\\•
[ 1 Personally Known ORp F�Pso ;. Chown OR
..�Produced Identificati.n �.o TIP•• %�•�entification
Type of Identification: `. L.4' \..1 ti. ~®.. 4.,. .. L ;411f cation:
Owner Builder Affidavit '*ALL INFORMATION
HIGHLIGHTED IN
%. City of Atlantic Beach Building Department GRAY IS REQUIRED.
'
i 800 Seminole Rd, Atlantic Beach, FL 32233
r,; /
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 RESPONSIBIUTY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES
REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES.
II. INJURY UABIUTY; 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-DEPTPCOAB.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: 1305 Main St.Atlantic Beach, FL 32233
Owner Name:Julia Rogers Phone Number: 8325849315
Mailing Address: 1305 Main St. City: Atlantic Beach State: FL Zip: 32233
Notarized Signature of Owner ------ /
The for oing instruent was acknowle•: •efore - this Ki day of ---CLT Octr\/ , 20)) , in the State of a, County
of 00(2.M Ci 4A tJA
��,`‘ BEN/ye'',. 5, 0 Signature of Notary Public` �#` �
f�,aslOA Fi . �I i
/00AF . 'v. (3.
; [ ) Personally Known OR kroduced Identification
�
Z
., PUBS ti':' Type of Identification: r O Y I aGI Y 1 Y�V LI I'1
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VARE POLE
MAIN STREET
(50' RIGHT OF WAY)
FINAL SURVEY: 3-21-2002 NOTE: FOUND ALL IRONS
FOUNDATION SURVEY: 1-8-2002 NOTE: FOUND ALL IRONS
REVISED 10-12-2001 TO SHOW 3" THROUGH 5" HARDWOOD TREES NOTE: FOUND ALL IRONS
LOCATED ALL 6" OR LARGER HARDWOOD TREES: 4-4-2001 _ NOTE: FOUND ALL IRONS
I HEREBY CERTIFY THAI THIS SURVEY, PERFORMED UNDER MY RESPONSIBLE DIRECTION MEETS THE LEGEND
MINIMUM TECHNICAL STANDARDS FOR LAND SURVEYORS IN ACCORDANCE WITH CHAPTER 61017-6. FLORIDA • FOUND CONCRETE MONUMENT
A!`MINISTRATIVE CODE (PURSUANT 10 SECTION 472.027, FLORIDA STATUTES). AND FURT';ER C4_Kftry THAT • 1/2" FOUND IRON
THERE ARE NO VISIflt_E ENCROACHMENTS UPON THE SUBJECT PROPERTY EXCEPT AS SI ICW!'I. 8 R.l. t161LDIN6 RIIETTRIZ 44 TtiV
& CENTRAL ANKLE
MOTE: THE LOT SURVEYED HEREONAPPEARS TO LIE W!TIIIM RomCL.ARSON AND Awt"/aINCATEJ; S
. L ARR CULENGTH
Z^':ES "X' AS SCALED FROM THE FLOOD INSURANCE RATE 1643 NALDO A'.'., JACKSONVILLE. F:... :7207 P.C. CHORDINT
CURVATURE
MAPS, COMMUNITY PANEL „_NQ...�j�,QZ,�R OOp10, DATED 4•17-H4. P.T. POINT OF TANGENCY
P.R.C.POINT OF REVFJISE CURVE
SURVEYED MARCH 27 2001. �l P.C.C.FOUND OF COMPOUND CURvE
1,24-. !r• j i G�� R/W RIONT-OF-WAY
SCALE:__1" - 20' (((t/tV//JJJ • O.R.V.OFFICIAL RECORDS VOLUME
REGISTERED SURVEYOR NO. 4487, FLORIDA J.E.A. AUp7f({ORI�YLLE ELECTRIC
FIELD BOOK 624 PAGES 64-68 JOSE A. HILL JR. RCP REINFORCED CONCRETE PIPE
677 14 -OH-OVERHEAD UTILITY LINE
SURVEY NOT VALID WITHOUT EMJNOSSED SURVEYOR'S SEAL