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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