1732 ATLANTIC BEACH DR RESO24-0065 gc---4''-., Building Permit Application
r Updated 1019/18
' • City of Atlantic Beach Building Department "ALL INFORMATION
,. r 91 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
P�ho�ne: (904) 247-5826 Email: Building-Dept( coah.us IS REQUIRED.
Job Address: 11 '4 1- Aii. ,y, ...a , € : '4 - V�-'�✓E3
Permit Number:
Legal Description -7 — I r`7- '-7,Q, nu 7(8 q
Valuation of Work(Replacement Cost)s . qso Heated/Cooled SF— Non-Heated/Cooled____
• Class of Work: ONewdition DAlteration ORepair OMove ODemo DPool OWindow/Door
V
• Use of existing/proposed structure(s): OCommercial XResIdentlal
▪ If an existing structure,is a fire sprinkler system installed?: OYes LINO
• Will tree(s)be removed in association with proposed project?OYes(must submit separate Tree Removal i-ermit)
Describe in detail the type of work to be performed:
nc I1 4. /`nl ''.--,,,.:-.%;
1
Florida Product Approval# for multiple products use product approval form
Property Owner Informatl/onn , -' •
�`t r• ,
Name 90f-PA0n ‘ gar. `V'"rv..ck i— Address (I7i L /--'' , k . 6 ✓i
City �. State P : Zip ` ?.7 7 Phone
E-Mail jig, (in f '-,A.,,, i' f fi,..
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information J il, t
Name of Company t ('r C.. Qualifying Agent ' t `. Kt fit(
Address M,,c) �� ' ><- /1,,41 City la-'1'ic•.r'i- )Sc 6:r.1n State !"l Zip131-7-{
Office Phone Job Site Contact Number
State Certification/Registration# E-Mail ,fin 4 (7 lx7 - /,'- i. - ei r-+
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer A Try SI- -_ OR Exempt in Expiration Date Q)/3 C/2.Y
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 FIN• CING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORD 441. R N• ICE OF COMMENCEMENT.
ri .. _--------— - ---
(•uU. rof Owner or Agent) --- �� •^ (Signator • Contractor) _____-____ .._
Sied and sworn to oqr,affirmed)before me this day of Signed and sworn to(or a rme• before me this I day o
3VM..-_,_ 1,-1.by r'Fc l r as Go ,,�.- --_:,,,„ T,�,,b : '�.
,., a •*r- -, .. 4e - -Q _
(Signature if '.tary) -�. ire •taryj
Personally Known OR ersonally Known OR ,o.,"';:'g;'-, r '
p•. TONI GINDLESPERGER
;14;Produced Identification LAURA HAZELWOOD I Produced Identification_' .a '
�aie : MY COMMISSION 4 HH 407122
Type of Identification: f *"�' ,,, , 'haw_____ Type of Identification: •�_-,xi
e of Florida -.,FOF o� ; 1<xPIRbS.October 6,2027
- Comm*HH380528
Expires
NOTICE OF COMMENCEMENT
Permit No. _._.__—...-._. Tax Folio No. A/9)OS` ( ?
State of Florida,County of Duval
THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with
Chapter 713,Florida Statutes,the following information is provided in this Notice of Commencement.
I Description of propertyylegal description of property and address if available):
131_
2. General Description of improvements:
1'`53a1t
pa);()
3. Owner Information: /^ ► 1' 1! ? ' " '
a)Name and Address: j1'j� (4' V(b("4 4'9 afOr'
b)Interest in property: i
c)Name and address of simple.titleholder(if other than owner):
4. Contractor Information: •
l
a)Name and Address: Kettell.Inc. \\
b)Phone Number:(904)372-72211
5. Surety Information:
a)Name and Address: — ,b)Phone Number.
c)Amount of Bond:$ --_-�
6. Lender Information:
a)Name and Address:
b)Phone Number: —
7. Pelson within the State of Florida designated by owner ., whom or other documents may be served as
provided by 713.13(1)(a)7,Florida Statutes:
a)Name and Address:
b)Phone Numbers of Designated Person.
8. In addition to himself/herself,Owner designates -__of to receive a
copy of the Lienor's Notice as provided in Section 713.13(1) '.), ' •rida Statutes.
a)Name and Address:
b)Phone Number of person or entity designated by owner:
9. Expiration date of Notice of Commencement(the expire on date may no . before the completion of construction
and final payment to the contractor.but will be one(1) ear from the date• recording unless a different date is
specified:.
WARNING TO OWNER:ANY PAYMENTS MADE Y THE OWNER AFTER T EXPIRATION OF THE NOTICE
OF COMMENCEMENT ARE CONSIDERED IMP PER PAYMENTS UNDER C PTER 713,PART I,SECTION
713.13.FLORIDA STATUTES,AND CAN RESU IN YOUR PAYING TWICE FO IMPROVEMENTS TO YOUR.
PROPERTY. A NOTICE OF COMMEN MUST BE RECORDED AND STED ON THE JOB SITE
BEFORE THE FIRST INSPECTION. IF YO INTEND TO OBTAIN FINANCING. CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE OMMENCING WORK OR RECORD YOUR NOTICE OF
COMMENCEMENT.
Under pc , • , declare that I have read the foregoing notice of commencement an that the facts stated
the -' •: • e best•f my knowledge and belief.
A1 / �
rm% k�i3'..t-41Sign o'O ••a er's A • • -.Officer/Director/Partner/Manager Signatory's Printed Name&Title/Office
The foregoing instrument w: acknowledged before me by means o ysical presence orponline notarization.
this/19 day of, o 20.,"1,by t 6t01'v,Q(.who is personally known to
(Name of Person)
me or produced — —_ as ide tification,as d 1,4140
(Type of Authority,e.g. offcer,attorney in fact,etc.)
for (Name. InstriblUtA HAzikwooD VVta atu kdoock
NOUN PublicTA Y PUBLIC SIGNATURF/—Lk
OF` L,ORIDA
Law
= COrr1f State A Florida Hh1380528 Commissioned Notary Name: 1.!/lvc �t'�
(A'I, 'Wary Seal Ano c) 3 29/2027
Revised 1/1/2020
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�• \' CITY OF ATLANTIC BEACH
X5;;1
..) 800 SEMINOLE ROAD
\J "~ ATLANTIC BEACH,FL 32233
;.. (904)247-5800
SURVEY AGREEMENT
NOTICE
All new projects creating more than 250 Square Feet of impervious surface or requiring on-site storm water
retention,including swimming pools,will require pre-construction and post-construction topographic surveys,
as required by COAB, Section 24-66 and described in Bulletin 2-18,Surveys. The surveys must be new
original documents,from a licensed surveyor, signed, sealed, and dated.
Other small projects, such as fences and construction less than 250 SF,will not require a new topographical
survey,but a current original-size survey with all relevant details is still needed. These surveys,when included
as part of a building permit application,must be complete,up-to-date, and original size and scale, as produced
by the surveyor.
Copies of old surveys lacking details or copies not of original size cannot be accepted. Building permit
applications with unacceptable surveys cannot be reviewed and the application will be returned to the
applicant.
Thank you for your cooperation in this matter.
AGREEMENT
I have read and understand the Notice above and affirm that the outdated survey I am
submitting is still accurate and complete, and all structures and impervious surfaces on the
property are shown on the survey.
I further understand that, if the survey is found to be inaccurate or incomplete, a $50.00 Plan
Resubmittal Fee will be charged; or if the permit has been issued, a Stop Work Order will be
posted with the associated $110.00 Fee. ��
JOB ADDRESS_._ _ 11.I' _ '�, = 1 ✓e,
11
OWNER or CONTRACTOR (Print) I 1l/:l1" °k,df Cif b lb ?j)(dor
Signaturei
Date__
1