1909 Mealy St Fence Permit Submittal (b.).
. 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
IS REQUIRED.
Phone: (904) 247-5826/Email: Building-Dept@coab.us
-rr
Job Address: `CIO�'t I,\¢'a1 y ^t-.. 1-1ilCi hc-ICBead, R• Permit Number:
Legal Description rer\('C 24 -4/2 17`2S- 261E Lewis SubdivinfinRE# J-) 7 3 i 1 (.(c L
Valuation of Work(Replacement Cost)$ ,Z0 Heated/Cooled SF tqictNon-Heated/Cooled i 1 - i
• Class of Work: [ w ❑Addition ❑Alteration ❑Repair ❑ ove ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial esidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes er o
• Will tree(s) be removed in association with proposed project? EYes(must submit separate Tree Removal Permit) [ No
Describe in detail the type of work to be perf rme
- 6+n�1 Fre ur-e i r .ea -ec facKsfiite yte-Ceince aaurvi l keine(pvcipevty
, ire ani ar :A(ka_ Ferre--tc, I the ,
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name T ,G we Address 1q 09 Lien lv '� —
City tatA, t P€c�rlit i State FL. Zip 37735 Ph ne etiv4-•-504 )ta�,l5
-
E-Mail �rtv�(t„ q tPp.Q (ii AA a. 1 w CD WI
Owner or Agent(If Agent,Power of AttorlTee/or Agency Letter Required)
Contractor Information RECEIVE
Name of Company ►VtAQualifying Agent
Address City State ttore 2 5 2021
Office Phone Job Site Contact Number `
State Certification/Registration# E-Mail AY.
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 YOURNpTICE OF COMMENCEMENT.
j
(Signature of Ovner or Agent) (Signature of Contractor)
Signed and sworn to(or affirm d)before me this ZS day of Signed and sworn to(or affirmed) before me this day of
Ail n y , 20A by \\ M\CA ,, , , by
(Signature of Notary) (Signature of Notary)
[ ]P sonally Known OR °/,4}.,.I MY � I Iiir( {OR
[ Produced Identification n ,` E l? , I ificaticn
Type of Identification: FL k/L ...feje• Boaded �i} .14, .-k
Owner Builder Affidavit **ALL INFORMATION
's'rt ' HIGHLIGHTED IN
`' 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: itirbi \l.11,-{Veet i 64-101121G B.P.oIC.h, FL. 32233
Owner Name: 4 d E. E.,`ADpAo Phone Number: q 04-504-- 104-5
Mailing Address: `CMCI MQr49 E yc e( City: gl,it'kC'_ vril State: -t. Zip: '37 Z33
Notarized Signature of Owner k,\n i. n' t • -�1-Q
The foregpipg instrument was acknowledged before me this ZS day of 1' [i '/ , 20 21, in the State of Florida, County
of Dip/ii
Signature of Notary Public CM/1/7T/CA---d./4- 61.-
[
] Personally Known OR [' Produced Identification
•,t•!ti CHRISTIAN GILES
MY COMMISSION 011H 117153 J
EXPIR6S:Apit3,20Z5 Type of Identification: ` p
00.4 Tlru Notary Pubic U deewMara
Updated 10/24/18
n''1\'jri`' Fence Addendum Updated 1/14/2021
City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233
-Luft 9,- PERMIT#
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
'3 z2-33
VIVI MPQty } , fiflahfi'c Veocli,R-• .5M Ai k PPQ
Property Type: Lot Type/ Features:
C9'Residential f!7'6ne Street frontage (interior lot)
❑ Commercial ❑ More than one street frontage (corner lot,through lot,
etc.)
El Swimming Pool
Fence Material: Fence Height (select all that apply):
[Wood our Foot(4ft) 21.2. f F
❑ Chain Link ix Foot(6ft) qcp , 841".
❑ 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 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?
❑ Ye must submit separate Tree Removal Permit)
0
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.
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PROPERTY ADDRESS:1909 MEALY STREET, ATLANTIC BEACH,FLORIDA 32233 SURVEY NUMBER: FL2102.5036 .,,
FL2102.5036 ' 4/
BOUNDARY SURVEY
DUVAL COUNTY FIi
1WP
DUTTON ISLAND ROAD W. NO ID
______A (CHURCH ROAD-PER PLAT) r a.c. 0'
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LANDS DESCRIBED IN r°
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$I s LANDS DESCRIBED IN ' '
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SURVEYOR'S NOTES: '
FENCE OWNERSHIP NOT DETERMINED. I . .],., GRAPHIC SCALE(In Feet)
tW,�/ (�P&? linch=30'ft.
SURVEYORS CERTIFICATION: POINTS OF INTEREST:
wall L45
}----i-..,,,.. I hereby certify that this Survey of the lands NONE VISIBLE
SE R described hereon was made under my direct
OtN � supervision,and to the best of my knowledge
5646 Y and belief is a true and accurate representation
jof said lands and meets the Standards of
through
_ Practice set forth in Chapter 5J-15.050 through
A
��` Si-15.053,Florida Administrative Code, ,EXACTA
...4 W pursuant to section 472.027,Florida Statutes. Exacta LdS.,y a,LLC
�O STATE OF
c` This survey is not valid without the signature and . Lana surveyors.LLG LUMP
is FLORIDA 4� original raised seal of a Florida licensed surveyor 9tOFal wayLatr Drve,,cc8vvm 11 Fo6tlMye,it330i5
�2Oy, ._s- and mapper,except when the electronic
'L SURVE 0 signature and seal of a Florida licensed surveyor
and L. mapper is affixed hereto. AFFILIATE
KENNETH WARD ":_'-. Florida Land
State et Florida P'°`'seee"S"ey°and Mapper - - Title Association
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License Number 5648 MEMBERSFL'-TA e.„-.
Exacta Lard!unworn,LLC I LB!!7H
DATE OF SURVEY: 03/10/21
FIELD WORK DATE:2/24/2021 SEE PAGE 2 OF 2 FOR LEGAL DESCRIPTION
PAGE 1 OF 2-NOT VALID WITHOUT ALL PAGES
REVISION DATE(S):(REV..1 3/10/2021)