808 AMBERJACK LN FOUN18-0006 RES PERMIT RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH FOUN18-0006 4
800 SEMINOLE ROAD ISSUED: 12/12/2018
��sS19' ATLANTIC BEACH. FL 32233 EXPIRES: 6/10/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • '
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:
808 AMBERJACK LN RESIDENTIAL ALTERATION Foundation Repair-
RESIDENTIAL Underpinning $6000.00
TYPE OF
ZONING: :D •
• • GROUP:
1711410000 ROYAL PALMS UNIT 01
COMPANY: ADDRESS:
FOUNDATION SYSTEMS, JACKSONVILLE
INC. P.O. BOX 50545 FL 32240
BEACH
• ADDRESS:
HAWORTH CHARLES F ET 168 ST LUCIE ST FLORAHOME FL 32140
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 • .
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $85.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $42.50
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
Issued Date: 12/12/2018 1 of 2
s
RESIDENTIAL PERMIT PERMIT NUMBER
r .w ' CITY OF ATLANTIC BEACH FOUN18-0006 e
800 SEMINOLE ROAD ISSUED: 12/12/2018
ATLANTIC BEACH. FL 32233 EXPIRES: 6/10/2019
TOTAL:$131.50
Issued Date: 12/12/2018 2 of 2
City of Atlantic Beach APPLICATION NUMBER
�s ( Building Department (To be assigned by the Building Department.)
800 Seminole Road t! U R I f Q O Oc
Atlantic Beach, Florida 32233-5445 '� �V 1 (�
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: Uzz
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: U� p (ll ��� ��G� De rtment review required Yes No
Buildin
Applicant:
Tree Administrator
Project: r) Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection �b
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: Approved. []Denied. ❑Not applicable
(Circle one.) Comments: fVOc—,
PLANNING &ZONING
Reviewed by: Date:
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
OFFICE COPY
`S Building Permit Application Updated 10/9/18
J -
City of Atlantic Beach Building Department "ALL INFORMATION
J 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Fax: (904) 247-5845 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 808AMBERJACK LANE Permit Number:
Legal Description 30-60 17-2s-29e royal palms unit 1 lot 1 blk 3 RE# 171141-0000
Valuation of Work(Replacement Cost)$6.000.00 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New []Addition ❑Alteration EnRepair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): DCommercial QResidential
• If an existing structure, is afire sprinkler system installed?: Dyes D./No
• Will trees be removed in association with proposed ro ect?' es must submit separate Tree Removal Permit RNo
Describe in detail the type of work to be performed:
FOUNDATION REPAIR--UNDERPINNING
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name NANCY)SASSER� Address 168 ST LUCIE ST
City FLORAHOME State FL zip 32140 Phone `9/z — 387— 0 7 7 7
E-Mail tyd
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) n/a
Contractor Information
Name of Company FOUNDATION SYSTEMS,INC Qualifying Agent BILLY C MCMAHAN
Address205-2 EDGAR ST City ATLANTIC BEACH State FL zip 32233
Office Phone (904) 241-4425 Job Site Contact Number
State Certification/Registration# CB C059308 E-MaiIOFFICE2FOUNDATIONSYSTEMSINC.COM
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation Insurer BRIDGEFIELD OR Exempt❑ Expiration Date 09/02/2019
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 YOUR NOTICE OF COMMENCEMENT.
i
(Signature of Owner or Agent) ' (Signature of Contractor)
Signed and sworn to(or affirmed)gygrethis STN day of Signed and sworn to( irmed)before me this�� day of
Mor, &/z , Zp/f, by /1/ NCy 7S1 RS�S9tZ OEC, Z-0/e/, y it C. /firiY>A�J,o/l/ C
V.r) 'i .i✓I O G�d
(Signature of Notary) ;"` s `�o•s e
BILLY C MCMAHAN tsar"P�a,, ALBERT MORENO
_��'- MY COMMISSION tt FF290603 =_�• �`�' Notary Puhllc-State of Florida
N-Personally Known OR [ ] Personally Known OR N �:a`�e; Commission#FF 239295
EXPIRES May t3,2019 produced Identificatio ±.F �° My Comm.Expires Jun 9,2019
[ ]Produced Identification OF
Type of Identification: 4407)3N-Q 53 Ror car Type of Identification: Bonded through National Notary Assn.i
NOTICE OF COMMENCEMENT
State of FLORIDA Tax Folio No. 171141-0000
County of DUVAL
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713
of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved:
30-60 17-2s-29e ROYAL PALMS UNIT 1 LOT BLK 3
Address of property being improved: 808 AMBERJACK LANE,ATLANTIC BEACH FL 32233
General description of improvements: FOUNDATION REPAIR--UNDERPINNING
Owner: NANCY T'SASSER Address: 168 ST LUCIE ST,FLORAHAME FL.32140
Owner'sinterest in site of the improvement: OWNWE
Fee Simple Titleholder(if other than owner): N/A
Name:
Contractor: FOUNDATION SYSTEMS INC. BILLY C MCMAHAN CBC 059308
Address: 205-2 EDGAR ST.,ATLANTIC BEACH FL.32233
4J Telephone No.: (904)241-4425 Fax No: (904)249-4813
y fin/
Surety(if any) N/A
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name: N/A
Address:
Phone No: Fax No:
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may
be served: Name: N/A
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b), Florida Statues. (Fill in at Owner's option)
Name: N/A
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Signed: ��i�GL ,L ���a�t _ Date:
Doc#2018286320,OR BK 18620 Page 1608, 3efore me this day of in the County of Duval,State
Number Pages: 1 Df Florida,has personally appeared /l//9 NG`-1 7 SA 5 S 12
Recorded 12/06/2018 12:28 PM, 14otary Public at Large,State of Florida,County of Duval.
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL My commission expires:
COUNTY Personally Known: X 1111CLY C 11111111113111111111M IN or
RECORDING $10.00 Produced Identification:
EXPIRES May 13.2019