1757 W Park Ter Fence Submittal • '�- Building Permit Application Updated 10/9/18
-0 City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
'%; IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 1757 Park Terrace West, Atlantic Beach , FL 32233 Permit Number:
Legal Description lot20 block 12 Accrording tp Plat of Selva Marina unit 8 as recorded platRE# 172020-0378
Valuation of Work(Replacement Cost)$ AGO Heated/Cooled SF Non-Heated/Cooled
• Class of Work: IXNew EAddition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Wind EIVE
• Use of existing/proposed structure(s): DCommercial WResidential APR 2 2 2021
• If an existing structure, is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree e-.Describe in detail the type of work to be performed:
Homeowner will be installing privacy fence around back and sideyard per the attached survey.
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name Blaine Peterson Address 1757 Park Terrace
City atlantic beach State FI Zip 122'13 Phone 904-669-7q57
E-Mail )kk;nz e(lt.,�.'N Z,;'-' S :,
• • t &,4-1Owner or Agent(Agent, Power ofAttorney or Agency Letter Required)
Contractor Information
Name of Company 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 YQUNE OF COMMENCEMENT.
ignature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed before me this a'2-'day of Signed and sworn to(or affirmed) before me this day o'
41_, aP,a , by ACClVv1 ?0 t(C)OV) , , by
_�_/�Iu____ _ __
^' qY P(� , •� •� r. +RDA (Signature of Notary)
iV</;...Nl�
= : c MY COMMISSION#GG 228145
'-n.,:,,,,-04..S.7 EXPIRES:June 12,2022 I'�
[ ] ersonally Known OR BoodedmruNotaryPubiicUndenvriters lr I ] Personally Known OR
[ Produced Identification [ 1 Produced Identification
Type of Identification: �1' 1 L t"CJ TI C P ll S Type of Identification:
fl--.7-: Fence Addendum Updated 1/14/2021
i City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233 PERMIT #
Phone: (904)247-5826 Email: Building-Dept@coab.us
Job Address-1
N(u,,t I c It ri g` Date:
i 7 S7 l� krrk..c.� Lvt 5T Li1A,is l
Property Type: Lot pe/ Features:
ResidentialOne Street frontage(interior lot)
❑ Commercial ❑ More than one street frontage(corner lot,through lot,
etc.)
❑ Swimming Pool
Fen,e Material: Fece Height (select all that apply):
Li} d Ld F ur Foot(4ft)
❑ Chain Link la Six Foot(6ft)
❑ Vinyl ❑ Other
❑ Block/Stone(Plan details required for footings and/or
retaining walls)
❑ Other
Fence Location:
Please submit an accurate and current boundary survey showing all existing improvements (including building footprint,
driveway, swimming pool,etc.) and location of fence/wall and any gates. Plan details required for block w II footings and/or
retaining walls and any portion or fencing above 6ft in height.
5 Gti'77a C Iv ( .
Will the fence be built in an easement?
❑ Yds (must submit separate Revocable Encroachment Agreement)
No
Will
Will tree(s) be removed in association with proposed project?
❑ Yes(must submit separate Tree Removal Permit)
12/1‘;o
Conditions of Approval:
• Roll off container company must be on City approved list. Roll off container cannot be placed on City right-of-way.
• All old fencing and debris must be removed from job site by contractor or homeowner.
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.
Owner Builder Affidavit **ALL INFORMATION
's rj�"1,7��s HIGHLIGHTED IN
°' City of Atlantic Beach Building Department GRAY IS REQUIRED.
ilr�
= 800 Seminole Rd, Atlantic Beach, FL 32233
�'';1"" 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 f QUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER/ PERMIT.
Job Address: /757 �0 . ' rr`Fce (h-t r7 47G.�,,z&t det,� - ez 3)
Owner Name: L6/j4r i.,V 41 J"./ Phone Number:
Mailing Address: 17 S 7 a Ze rr'r4C City: A1C.,t`L fisc h State: rt-- Zip: 3?? 3 7
Notarized Signature of Owner /9
The foregoing instrument was acknowledged before me this 2.7 day of APRT , 20 2.1, in the State of Florida, County
of Duval
Signature of Notary Public 0I c I� '
•
't►!". CHRISTIAN GUS
,' MY COMMISSION 117153 [ ] Personally Known OR [ oduced Identification
i,* o0 EXPIRES:April 13,2025 ff__ I
%M1.••' Bonded7In+NolaryaublcUnderwrfers Type of Identification: I L I) L
Updated 10/24/18
MAP SHOWING BOUNDARY SURVEY OF
LOT �2n0 �jB/L�OCK 12 ACCORDING
�TpO THE PLAT OF
AS RECORDED IN SLAT B OKE 3MAE PAGE(S) UNI 5 NO. OF THE CURRENT
PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO:
BLAINE I. PETERSON AND KERI M. PETERSON, CALIBER HOME LOANS, INC. ,
FIRST AMERICAN TITLE INSURANCE COMPANY
AND GIBRALTAR TITLE SERVICES, LLC
PARK TERRACE WEST X _A.......—
(60.R/w)
N 03'03'10" E 114.12' (R)
N 03'03'10" E 114.13' (M) 1.5'_CURB & GLITTER
BEARING REFERENCE LINE 4'X4"
N''.... ' CONCRETE
v ' MONUMENT
1/2" �': ��` ' 1/2' WITH 3/4'(IP)
(IP) 0 (IP) CENTER
• . - • 'kr— •
244.12' (R)
a' " 243.58' (M)
3
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O 17.1'/ ry�Y A. A 18.0's�
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7 ,9 I 21.7'
I. I O
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LOT 19 N 1 0 1 LOT 21
BLOCK 12 3 ^ a 1—STORY N AC 1 N L.i BLOCK 12
• ,*,; BRICK ❑PAD w
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a I BRICK } I S'
0RDCD
co Y 17.0 27.5' - STEPS YELL I co L
In ON C co
to Z I 8.8 I 22.3' STOOP ( N tO
COCO
Z
o FLORIDA I N
- ROOM
1
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WOOD I IYd (u(I t-` (.
31.1' STOOP
I
LOT 20 I .
I BLOCK 12 '
I
I
• •
1/2"
(IP) S 03'06'21" W 114.01' (M) 1/2
S 03'03'10" W 1 1 4.12' (R)
"P A R K"
PER PLAT
FLOOD ZONE "X" — AREAS DtItHMINED TO BE OUTSIDE THE 0.2X ANNUAL CHANCE FL000 PLAIN /FLOOD ZONE "X (SHADED)" — AREAS OF 0.2X ANNUAL CHANCE FLOOD; AREAS OF 1X ANNUAL
CHANCE WITH AVERAGE DEPTHS OF LESS THAN 1 FOOT OR MATH DRAINAGE AREAS LESS THAN 1 SQUARE MILE; AND AREAS PROTECTED BY LEVEES FROM 1X ANNUAL CHANCE FLOOD.
E Y O GENERAL NOTES:
R % ,s'''
123....
. BEARINGS ARE BASED ON PLAT BOOK 34. PAGE 85
2. STRUCTURE NO.1757 SHOWN HEREON UES MAT SN FLOOD ONE X(SHADED) AS BEST DETERMINED
3. THISISFA SURF CE 7sj4H, Y ONL THE EXTENDT OF UN t1 GROUND FOOTINGS. PIPES AND
A S S O C I A T E D SURVEYORS INC• UTILITIES IF ANY, NOT DETERMINED.
D 4. JURISDICTIONAL AND/OR ENVIRONMENTALLY SENSITIVE AREAS IF ANY, NOT LOCATED BY THIS SURVEY
LAND & ENGINEERING SURVEYS 5. THIS SURVEY BASED ON LEGAL DESCRIPTIONS FURNISHED. THE PUBLIC RECORDS WERE
I''I % NOT SEARCHED BY THIS SURVEYOR FOR EASEMENTS. TITLE, COVENANTS, B.R.L'S
F— 3846 BLANDING BOULEVARD RESTRICTIONS, CLOSURES, TAKINGS OR ORDINANCES, ETC.
6. THE HEAVY LINE SHOWN HEREON, MAY NOT INDICATE ACTUAL OWNERSHIP..JACKSONVILLE, FLORIDA 32210 7. UNLESS OTHERWISE STATED ALL IRON PIPES FOUND HAVE NO IDENTIFICATION.ON.
J j 904-771-6468
BRL
L
L AC = AIR CONDITIONER PSN = PROFESSIONAL SURVEYOR MAPPER
O / CERTIFICATE OF AUTHORIZATION NO. LB 0005488 E BT = BUILDING TIETR[CTION LINE R = RADIUS
i .... S S V 0 BTN = BETWEEN (R) = RECORD
E (C) = COMPUTED FROM RECORD RLS = REGISTERED LAND SURVEYOR
N C&R = COVENANTS L RESTRICTIONS R/W = RIGHT OF WAY
I HEREBY CERTIFY THIS SURVEY WAS DONE UNDER MY D (CHR) = CANNOT READ CHORD (TYP) = TYPICAL
OR LBB.. 54
DIRECT SUPERVISION AND MEETS THE MINIMUM TECHNICAL CONC = CONCRETE O SET IRON PIPE R OR RE8
ASSOC SURV' L488
STANDARDS FOR LAND SURVEYING PURSUANT TO CHAPTER 5J-17.050 & EBVD = ELECTRIC BOX • ' ' ' ' 'FOUND IRON PIPE (IP) OR PIN
THROUGH 17.052, FLORIDA ADMINISTRATIVE CODE, CHAPTER 472, F.S. A EJETA = ELECTRIC: JACKSONVILLE ELECTRIC LAUTHORITY ONUMENT(CM)
®' . . .F •OUND CROSS CUT
CONCRETE MOR DRILL
AIL DISC
•- = LENGTH OF ARC
P "I /.4. / B LB = LICENSED BUSINESS —X—X—X—X—X—X—%—CHAIN LINK FENCE
/' LS = LICENSED SURVEYOR —I—I—I—I— METAL FENCE
—W—W—W--1h—W—W—W— WIRE FENCE
BY: _ i�a1 /J w' >�E (M) = MEASURED n n n n n n a W000 FENCE
rNLD = NAIL & DISC VINYL FENCEI
CHARLES B. HATCHER FLORIDA CERTIFICAT NO. 3771 ORB = OFFICIAL RECORDS BOOK _ -- VINYL
UTILITY
CHARLES L. STARLING FLORIDA CERTIFICAT NO. 4579 A PPCCV = POINTIQ RECORDS VOLUME FIRE HYDRANT
RAYMOND J. SCHAEFER FLORIDA CERTIFICAXE NO. 6132 T PCC = POINT OF COMPOUND CURVE RISER
I PEG = POOL EQUIPMENT PAD ®. -WATER MEIER
PI = POINT OF' INTERSECTION
UTXJTY ME
JOB NO. 75982 I DATE 02/03/2020 N PRC = POINT OF REVERSE CURVE
PRN = PERMANENT REFERENCE MONUMENT 'it' 'DIAMETER
SCALE: 1" = 30' DRAFTER G.B.H. S PT = POINT OF TANGENCY ANCHORPLS = PROFESSIONAL LAND SURVEYOR D CENTRAL ANGLE
NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER