825 Plaza Fence Submittal - Building Permit Application Updated 10/9/18
.: ._:,:( City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
st v IS REQUIRED.
/
( �jPhone: (904)(9 247-5826 Email: Building-Dept@coab.us
Job Address: 8 a aza_ Permit Number:
K. Legal Description :U—(pO -��—(.9..5 -Dei E:R - a 1 R:fdm tiff +4- Gro? � 3 RE# /-?-0- 000C
Valuation of Work(Replacement Cost)$ / q 3' , 00 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: rs ❑Addition ❑Alteration ❑Repair OM ve ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ❑F(esidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes GINo E C E 1 V E
t---
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separat ee Remov�Ipermit
Describe in detail the type of work to be performed: MAY [[ 202
1_,'1 CA--1:-y BY.
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name /-}-I,(h%' il
G (S '..40-1 Address & 2- 7 Ty
6'\-....
City iq-f(axLet-L QC4-i ,� /, State FL Zip ,..Zc i3 Phone 'T0-1) 60 Z..5--3 /s
E Mail (ij a S,' o)S )/,�"'(� ,coo-
44-1
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company / r viS • F �- (U Qualifying Agent
Address! ?aaG2 7'a/l o, (/ /_�/4i._ City Tote*satAl State FL Zip 3aaOco
Office Phone 'Cj(J. E` - 3 -'a Job Site Contact Number 70 Yc7'1--rte'( 3 3
State Certification/RegisCration# > =a 0` E-Mail ill u//C C ',i.3 1 ��'1 op .Coal
Architect Name& Phone# I
Engineer's Name&Phone# I
Workers Compensation Insurer fiie(�h!?�,(p,- -, it jur OR Exempt 0 Expiration Date (C l i/a
Application is hereby made to obtain a permit- the work and installations as indicated. I certify that no work or in tallation 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�F'YOU INTEND
TO OBTAIN FINANCING, CONSJLT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDIN YO�JR NOTICE J �MMENCEMENT.
NCA
mho/MkL
(Sig toe ofZ caner or Agent) (Signature of Contractor)
i ned and sworn t r aff u -• before me thh l y f Signed and s ,orn to(or affirmed)before me this day of
r ifc c , 2ozi,b1, hrQl `--N. Iy , , by
t I >
,,g��} (Signature of Notary)
l
;;a..^"Y° l► INDLESPERGER
- , MY COMMISSION#GG 35 7
PersonallyKnown OR '"" �ers.mally Known OR
[ 1 �. �.�`�o: EXPIRES:October 6,20
[ 1 Produced Identification ?`.AFF°P` Bonded Thru Notary Public Unde Prrso-Aced Identification
Type of Identification: `�–� Identification:
.-t v• Owner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
1 City of Atlantic Beach Building Department GRAY IS REQUIRED.
~ 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 REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
Job Address: s as Halo.. //""
Owner Name: /r([�.i'v q S �Jt Phone Number(0i) 002.3 —7-? /S—
Mailing Address: ( ( City: % I State: („_ Zip: 3a..,.13 1
/
Notarized Signature of Owner / .„/(9- 46
The o oing instrument was acknowledged b- o - me this I say Mau.-I, 22-[ in the State of Florida, County
of Lr\/'•0..,
Signature of Notary PublicLki.
[ ] Personally Known OR [ ] Produced Identification
Type of Identification: 0
Updated 10/24/18
ts?y -, TONI GINDLESPERGER
` . 'c•*'• MY COMMISSION#GG 353178
"' EXPIRES:October 6,2023
r Bonded Puy Notary Public Underwriters
'"'f' `-'7:':
sem►
BOUNDARY SURVEY
LOT 1LOT I
r SET,3 - BLOCK I ,2 BLOCK I
IRON ROD
a
...--• L B#7893
N 8520'02"W FOUND 17
$0.65' /RONPIPE
N 05' __
S'D&UE
! LOT o s'
3 BLOCK I
LOT 23
BLOCK I
10
0
SURVEY NOTES of
CONCRE 1 E DRIVE CROSSES THE PROPERTY BOUNDARY 110'
LINE ON THE SOUTHERLY SIDE OF THE LOT LaJ �.
►� ad U
THERE ARE FENCES NEAR THE BOUNDARY OF THE
al
56.3' 13.4' p� O
PROPERTY AND THEY CROSS INTO THE 5'D.&U E.AT 0)
THE REAR OF THE PROPERTY W ,�
'� CouCl-4
D&U E.MEANS DRAINAGE AND UTILITY EASEMENT 0 N RESIDENCE !� I
B.S.L.MEANS BUILDING SETBACK LINE #825 0
Z N N
Nt0
56.3' Z
_ _ 132'
0.2'
J
@ S W.CORNER
m
OFLOT 18 432.60' IRONP UND E •j •,
NOIR CI-
0 •
FOUND l l
IRON ROD
p S 85'37'27"E 80 Nolo
f • -o • ,•. 65�_—_ ,
••8'CONCRETE WALK • ' —
•
,
CCNCRFiCURS
_��—pO _
-PLAZ 80' RAN (IMPROVED)
.t , , ; , ,4.,„
P No 6415 F '^ SURVEYORS CERTIFICATE TAR G
• I HEREBY CERTIFY THAT THIS BOUNDARY SURVEY - ,. T
1 e I$A TRUE A10 CORRECT REPRESENTATION OFA S �,r -G LLC
SURVEY PREPARED UNDER MY DIRECTION J V iLl�V 1{ai'1V 1,lnr'
NOT VAI D WITHOUT AIT AUTHENTICATED EL EC'RONIC
y. SIGNATURE AND AUTHENTICATED ELECTRONIC SEAL.
STATE OF LB#7893
OR A RAISED EMBOSSED SEAL AND SIOUATURE
°,, , ,,,. 0 ...* U,q,allyapn.Aby SERVING FLORIDA
Kenneth J.�RM,h,D,°,n, 6250 N MILITARY TRAIL SUITE 102
// D,le.7oI91 I.
c// � Osborne I11s°.o° WEST PALM 51)ep4oFl 33407
aoo
PHONE j56116d0-a800
,d (SIGNED) ��))1- 1�GGcC STATEWIDE PHONE (8001226-4807
KENNETHJOSBORNE ,'1ff7illTlTrT"AIT11��(�ptr7�, STATEWIDE FACSIMILE j800)741-0576
PAT,LSSIONAL SURVE rOR.ND MArrI R 14 S WEBSITE hllp:d,E 15UMe)In[j nel
Fence Addendum Updated 1/14/2021
City of Atlantic Beach Building Department
W800 Seminole Road, Atlantic Beach, FL 32233
jf 9- PERMIT#
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address:
/ Date:
( G�
cio� S P/cz/
�
Pr erty Type: Lot T� Feaes:
Residential D--61-ie Street frontage(interior lot)
❑ Commercial ❑ More than one street frontage(corner lot,through lot,
etc.)
❑ Swimming Pool
Fen Material: Fen,e Height (select all that apply):
Wood ouour Foot (4ft)
❑ Chain Link 0 Six Foot (6ft)
O Vinyl 0 Other
O 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 wall footings and/or
retaining walls and any portion or fencing above 6ft in height.
Will the fence be built in an easement?
❑ Y (must submit separate Revocable Encroachment Agreement)
No
Will tree(s) be removed in association with proposed project?
❑ Yes ust submit separate Tree Removal Permit)
No
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.
11‘ Armstrong Fence Co.
Phone Number CONTRACT
Date Job#
www.armstrong-fence.com
4"\A"-yz\
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Phone-Job Site Sales Rep
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ContactName Fax Number
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Proposal To: 13,,-,:.- : : — , - xi (cu....4 - __--„,„ Email Address
Job Name: / N
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Job Address: ...-'' C e ir.2.„-\ RA — ---- , City://--f l•:--k 4-;-+Jc -477--. , State: . Zip:--7e--2...•.?
Billing Address: City: State: Zip:
I El-Standard 8"x 24"
• ... ____. .. 1...._______ _________________ _ __, ' -'--------- 0 Plated
/ , , r
„k.iv_,0 rfice_ , thiLcy\ Lines
vvecial
„f,
rVII 1 I Terms 1
7.. 1/l/D
. . .7,.....7,_
/ / /- 471 D
_ --r-- ---m_
I Gates W
-,/ i / I D
' / I Jackhammer
#holes _.,...
,.. ---- li'--- • / i .
I Coreptai
,--
_L_ jholes
-r _.i. ,„ocarbee--r 7 .
/ i / / . , • ' • "
-i F Ae----4--_, -,-
1-me t--- 'LP g-aft-i--...t. ..1,0..t4._' 4_14‘. -----7-Y:. 0 Torch 0 elder;
j -4-,,,, II- 0 Laddr
1 0 Hammer
0 Other t'
-_--..------) - '
4- 1 6,4124---,,P-dvie-c.
FENCE STALLATION RELATED TO GRADE: PLEASE INTIAL ONE
I LEVEL PLEASINGTOTHE EYE FOLLOWING FLOW STEPPED INSTALLATION FOLLOWING ROLL
STRAIGHT TOP STEPPED CONTOUR Color
. ,
•-
STEEP SLOPE WHERE FENCE CANNOT-RACK' ^------
I - -, Type ..„,.....--7
I
Patt --
, •,. A 1 - ------__i______-1
SLIGHTLY UNEVEN GRADE WITH FENCE ENOUGH TO FOLLOW GRADE AND MUST BE
FENCE TO BE LEVEL WITH HIGHEST GRADE FOLLOWING FLOW OF GROUND STEPPED,RESULTING IN LARGE GAPS UNDER CHAINLINK AND ALUMINUM ONLY
(CUSTOMER TO RLL IN GAPS) -FENCEWILL BE UNEVEN ATTOP- FENCE-(CUSTOMER TO FILL IN GAPSI 0 9GA Tension%Kr
I 0 7GA TensicrtiWire
Special Instructions: A 7/ r 6 r i ,..., , ,...„,-t- .. Oi,„3px-frace/Truss
GATE 1 GATE 2
0 SNG ODD ,./-O SNG ODD ,/
FRAMEWORK 0 Galv 0 K/K 0 K/T 0 T/K 0 T/T O SLIDE 0 CANT / 0 SLIDE 0 CANT-
O Color 0 OPERATOR 0 OPERATOR
FABRIC 0 Galv Line Posts / Rails / Terminals Barb Wire DIA AUGE DIA GAUGE
0 Color
Footage Ht. Gauge Mesh Size Space Vayie Size Gauge T/M Size Gauge 0 Galv lum POST POST
f
z 0 0 3 rands HT HT
•
SIZE //
,,.,,,,, ,„/ „-- /0 0 0 9-60 3 Sstrtraanriddss
SIZEI cHS FRAME HITcES FRAME
/1/7
7 03 Strands
/-
06 Strands 0 SNG ODD ' 0 SNG 0 DD
0 SLIDE 0 CANT 7 0 SLIDE 0 CANT
0 OPERATOR 0 OPERATOR
Footage 7le HtLiColor
n sts Pickets R ' # / DIA AUGE DIA AUGE
. ,'
Space , Size Space Vof Rails tize ' POST / POST
,
/
XT HT ArT HT
SIZNV SIZE /
FRAME HINS FRAME
../
,---- / ,-/ J.LTCH tCH
Line Posts Pickets Rails Trim Trees
Footage Style Ht. Good Type
Side Wood Size Space Size #of Size Clear Line _
Remove
_
- ' ,
Fence -
1- .-il - i '''--./ :77-p '17/' '''",)
- .
Haul Fence ---
Trench -- —
, -
This offer guaranteed for.30-days
By execution of this document, Buyer Accepted by Property Owner: FOR THE SUM OF: $ / / -
acknowledges that he/she has read and ,,, If AFC Tax: $
understands the terms and conditions SiBldg.Permit: $
gnature Date
set forth on the reverse and front side TOTAL: $ ,' - ., :.•.,
hereof and within any attachments. 0 Customer Initial Down Payment: $ .'' 1 •
I have read the Terms & Condtions
Seller shall not be responsible for and on reverse side BALANCE
Buyer shall hold harmless Armstrong 0 et 0 VISA
Fence Co.from any and all damages or
Accepted By (AFC): 0 En 0 73•A #
liabilities resulting from any cut or dam- Exp. Date:
aged lines including, but not limited to,
gas,water, sprinkler,electric,telephone, Signature Date 0 Please charge my card upon substantial completion
Initals
fiber optic, cable. Buyer shall comply - Terms:Cash due upon substantial completion
1 Year Limited Warranty
.
with all applicable statutes and codes re- LEAVE FENCE SIGNS INTACT FOR
lating to the location of utility lines. WARRANTY TO BE IN EFFECT
CUSTOMER Li Jtgit. -a iii—L. h_al _-1