174 Jackson Rd RFNC21-0095 4' -5 % RESIDENTIAL FENCE PERMIT PERMIT NUMBER
,' RFNC21-0095
V� CITY OF ATLANTIC BEACH ISSUED: 7/15/2021
.� 800 SEMINOLE ROAD
-ri;319',' ATLANTIC BEACH. FL 32233 EXPIRES: 1/11/2022
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
174 JACKSON RD RESIDENTIAL FENCE ONE 4' FENCE $2485.00
STREET FRONTAGE
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172146 0000 DONNERS S/D PT LOT 2
17-
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
BELVIN DANERI DIANA ET 174 JACKSON ROAD ATLANTIC BEACH FL 32233
AL
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
/ONINC f I NCI PLAN REVIEW FEE 001-0000-329-1003 0 $35.00
TOTAL:$35.00
Issued Date:7/15/2021 1 of 1
''.".: Building Permit Application Updated 10/9/18
4 ;i City of Atlantic Beach Building Department **ALL INFORMATION
' 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
°
;'t�� IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: + iA LACt6c F7, 06,---t-‘,_444N-Q„. %. c4,. tiry3 Permit Number: RFNC21-0095
Legal Description 194:C9- O \OS 45. U:0Nl,4EQ' 6110275; i 6-AN RE# V-19. 1 -o301>
Valuation of Work(Replacement Cost)$ 7,4?5,17 Heated/Cooled SF Non-Heat CEIVE
E
• Class of Work: EtNew ❑Addition DAlteration ❑Repair ❑Move ❑Demo ❑Pool ❑Windo oorJUL 1 2 2021
• Use of existing/proposed structure(s): ❑Commercial QResidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes EINo BY:
• Will tree(s)be removed in association with proposed project? CYes(must submit separate Tree Removal Permit) 'Jo
Describe in detail the type of work to be perfprmed:1I' V404.al j►AGr i.14-Ft' 9 i 'llt.E ii.0 1.tilitot••1 4Q
I.,it4e/614.D "r ' tz.k V AAA►-+\HUi-it 1.ar.c-:--,' '�Nc wig Tik A-CE eT in4 4-f etes N v4vui A.
Val-ta-k.'m•
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name ti - c2ANsoa-a 9, Lij\U Address %rig UtiY---.. CIA QF.
City Al- ANT\C•- 4 State Zip 1,22ry2Phone(10406%0-ec
E-Mail 41700N NA f(5 ►1D'-'`
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name ofC2om•any • le OW-5540 •`,. If )tea _Qualifying Agent
e711".
Address p -1' 0 Al n . - f►� NA- City X,1G 4.. . - State (ar• Zip 4277,W
Office Phone ' r)ti"=•-=' 554\ Job Site Contact Number
State Certification/Registration# E-Mail&ctttSV5 -> 45ftb4i®t(''( 1.044
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer ,_0-__ ,�_.•. ._ OR Exempt❑ Expiration Date
Application is hereby made to obtain a permit to do the work . d installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all . irk will be performed to meet the standards of all the laws regulating
construction in this jurisdiction. I understand that a se.:rate 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 N ATT EY BEFORE
RECORDING YOUR N TI E OF COMMENCEMENT. (— __
(Signature of Owrfer or Agent) Til• /}t) Signature of Contractor)
dl
Signed and sworn to(or affirmed)before me this 23. day of Si;ri-d and s or to(or affirmed)before me this jl day of
ZO2,[ ,bIDan t ?. 15e-101h t U V , -—i3-1 ,Ipy1-�.te-i'tCa? ,,ktCKSC11
/ 6
. 'iAl
.
(Signature of otary) f (Sift atyro Votary) MELISSA 0 PINECA
..:'W
�mD•i Notary Public•State of Ficrica
40, - -��-- - .— . I "'`�'. C,mmission%GG9623tI
a n.:,
Perso7,a!!y Known OR ( -4;i'?o .. WILLIAM H.HUDSON fl Personally Known OR 4 •• My Comm.Expires Mar 2,2024
[ i Produced Identification I rff//' `: Notary Public-State of r iwI4 Produced Identification- a _ _ _ _
Type of Idn:entificatio
1.vtee; Commission#GG 27B6GRrype of Identification: 11 UUC,.• VOW" C.ft
,n° M jCD um.Expf,es Dec 5,2O2
Bonded through National Notary Assr.
9
Fence Addendum
Updated 1/14/2021
' sr City of Atlantic Beach Building Department
, r
- 800 Seminole Road, Atlantic Beach, FL 32233 PERMIT# RFNC21-0095
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
r14 Vitt5ti A-tVAAN:L Pte+11--UZi% ri \ \'c1-
Property
Type: Lot Type/ Features:
0 Residential 0-One Street frontage(interior lot)
❑ Commercial ❑ More than one street frontage (corner lot,through lot,
etc.)
❑ Swimming Pool
Fence Material: Fence Height (select all that apply):
LI Wood Et Four Foot(4ft)
❑ Chain Link ❑ Six Foot(6ft)
❑ Vinyl ❑ Other
❑ Block/Stone(Plan details required for footings and/or
retaining walls)
O Other t►�M1uAA
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?
❑ Yes (must submit separate Revocable Encroachment Agreement)
EZT-No
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
0 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.
(.........-- MAP OF BOUNDARY SURVEY
DESCRIPTION AS PROVIDED BY CLIENT:
PART OF LOT 15, DONNER'S SUBDIVISION, ACCORDING TO A PLAT RECORDED IN PLAT BOOK 8,
PAGE 4, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA, MORE PARTICULARLY
DESCRIBED AS FOLLOWS: BEGINNING AT A POINT IN THE NORTH LINE OF SAID LOT 15 AT A
POINT 140 FEET WEST OF THE NORTHEAST CORNER THEREOF, AND RUNNING THENCE WEST
70 FEET; THENCE SOUTH 109 FEET; THENCE EAST 70 FEET; THENCE NORTH 109 FEET TO THE
POINT OF BEGINNING.
DESCRIPTION AS SURVEYED:
PART OF LOT 15, DONNER'S SUBDIVISION, ACCORDING TO A PLAT RECORDED IN PLAT BOOK 8,
PAGE 4, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA, MORE PARTICULARLY
DESCRIBED AS FOLLOWS: BEGINNING AT A POINT IN THE NORTH LINE OF SAID LOT 15 AT A
POINT 140 FEET WEST OF THE NORTHEAST CORNER THEREOF, AND RUNNING THENCE WEST
70 FEET; THENCE SOUTH 105.5' FEET; THENCE EAST 70 FEET; THENCE NORTH 105.5' FEET
TO THE POINT OF BEGINNING.
P.O.B.
S.N. 6 D.
JACKSON ROAD R/N VARIES LB 7261
RHONE FIRST COAST
BOX F.I,v. l ' 1.00' 140.00'
--- I�10-- MI14,..n1111
M.P.
N.E. COR1774ERLOT
E 15
(PART NOW IN
RIGHT OF WA
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m STEPS
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SCALE: 1" = 30' ///jam ` ,,.. .. X
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42, X
EAST 70.00'
SURVEY NOTES: S.I.R.C.
F.I.P. 1/2" FIRST5/B
11 INTENTIONALLY LEFT BLANK. LS 6645 L87261
I2 UNDERGROUND UTILITIES. FOUNDATIONS OR OTHER
IMPROVEMENTS WERE NOT LOCATED BY THIS SURVEY.
13 ACCORDING TO THE FEDERAL EMERGENCY MANAGEMENT AGENCY
FIRM NAP PANEL NO. 12031C 0406 H EFFECTIVE 06/03/2013,
THE PROPERTY DESCRIBED HEREON APPEARS TO LIE IN ZONE 'X'.
RFNC21-0095
14 THIS SURVEY PERFORMED WITHOUT BENEFIT OF AN ABSTRACT.
TITLE SEARCH, TITLE OPINION OR TITLE INSURANCE. CERTIFIED TO AND FOR THE
15 DIMENSIONS ARE SHOWN IN FEET AND DECIMALS THEREOF EXCLUSIVE BENEFIT OF:
AND ARE PLAT AND MEASURED UNLESS SHOWN OTHERWISE.
LHAYWOOD M. BALL. P.A.
/6 ALL EASEMENTS ARE PER PLAT UNLESS SHOWN OTHERWISE. OLD REPUBLIC NATIONAL TITLE INSURANCE CO
m BEACHES HABITAT FOR HUMANITY, INC.
c 17 THERE MAY BE A001TIONAL RESTRICTIONS THAT APPLY WHICH ARE NOT SHOWN
a ON THIS SURVEY WHICH CAN BE FOUND IN PUBLIC RECORDS OF SAID COUNTY. ADDRESS:
m09 THIS SURVEY DOES NOT GUARANTEE OWNERSHIP. 174 JACKSON ROAD or,m1
Di ATLANTIC BEACH, FL.
N
19 TEMPORARY, NON-PERMANENT IMPROVEMENTS AND/OR MAN-MADE ITEMS
SUCH AS, BUT NOT LIMITED TO THE FOLLOWING: BUILDING MATERIAL,
o STORAGE PODS. PAVER BLOCKS. RUBBERMAID OR PLASTIC UTILITY 1:(‘/I;c3.1 wi
BUILDINGS NOT ON FOUYNDATIONS, VEHICLES ON BLOCKS MAY BE ON
S' THIS PROPERTY BUT NOT LOCATED OR SHOWN.m 110 LEGAL DESCRIPTION PROVIDED BY CLIENT.
NOTICE OF LIABILITY: THIS SURVEY IS CERTIFIED TO THIOSE INDIVIDUALS SHOWN ON / ''THE FACE THEREOF. ANY OTHER USE, BENEFIT OR RELIANCE BY ANY OTHER PARTY ISl��/a STRICTLY PROHIBITED AND RESTRICTED. SURVEYOR 15 RESPONSIBLE ONEY TO THOSE // CLYDE 0. KLEECK
CERTIFIED AND HEREBY DISCLAIMS ANY OTHER LIABILITY AND HEREBY RESTRICTS THE FLORIDA REGISTERED SURVEYOR AND MAPPER NO. 2546
RIGHTS OF ANY OTHER INDIVIDUAL OR FIRM TO USE THIS SURVEY. WITHOUT EXPRESS NOT VALID WITHOUT THE SIGNATURE 6 THE ORIGINAL RAISED
m` NRT TTEN CONSENT OF THE SUFRVEYOR. SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER.
a
a`Ci F..C.M. -FOlAVO CONCRE iE AIR)CAP C.M. CONCRETE M7M/ENi SEC-SECTION FEN - FENCEEADNE -OVERHEAD ELECTRIC
/// F I.R.C. -FO(XA IRON ROD AMO CAP P.T. POINT OF TANGENCY TMP- TOWNSHIP CLR -CLEAR C.L.F.-CHAIN LIM(FENCE
F.I.R. -EWA)IRON ROO P.C. POINT OF CWVA TUE PGE-RANGE ENO - FDUAO M.F,-N000 FENCE
i F.I.P. -FOUND IRON PIPE U.E. UTITLITY EASEMENT P.O. -POINT OF INTERSECTION (P1 -PLAT C.B.-CHORD REARING
• S.I.R.C. -SET IRON ROO AND CAP O.E. CPAINAGG EASEMENT A C-AIR TO SCALE MNG LNIT EL -ELEVATION N.M.-MATER NETER
L F NSD -FIELD NAIL IAD DISK FIG G RIGHT OF NAY (PA) -PROPOSED ESMT -EASEMENT P 6 M-PLAT 6 MEASURED
lc) -CALCULATED MEASUREMENT C/L CENTERLINE IE -EXISTING COR - CORNER M/H-MAH/RCLE
%i FIELD SURVEY DATE _\ FIRST COAST LAND ORDER PROJECT INFORMATION 9512/25067/25585
w
PLOT PLAN
1 BOUNDARY 06/12/06 SURVEYING, INC. DRAWN BY: TNP
.wREVIEWED BY: VAN
, UPDATED os/fo/2o14 � 640-222 EDGEWOOD AVE S. JACKSONVILLE, FL. 32205
LL UPDATED 03/06/2015 PHONE (904) 779-2062 FAX (904) 779-7784
\ZINAL J \ CERTIFICATE NO. LB 7261 . //
fes, Owner Builder Affidavit **ALL INFORMATION
it' 46 HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
�
Yy
� v J11
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
RFNC21-0095
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 ATA 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: 114 6.A.Wbt1 c2-9 lrtt...Ak-kac. . '37"2.. )17
Owner Name: 1' 'f 1,v\-N Phone Number: Ipt0 /9o91.
Mailing Address: City: A-At�-%% - Qt k-1 State: �1 Zip:
Notarized Signature of Owner 9Qy114t' ,e.
The foNgo�rg,innstrument was acknowledged before me this /2.. day of ()�� , 202J. in the State of Florida, County
of lJ IJ t
Signature of Notary PublicGj.//7/1.Crt1�! �'�'✓I l
:�. CHRSTIANGILES [ ) Personally Known OR[1.Y roduced Identification
MY COMMISSION#HH 117153
EXPIR6S:Aptil 13,2025 j-/ p�
BoodedThruNotary Public Unerrnters Type of Identification:
Updated 10/24/18