41 6th St RESO21-0084 Turf System s
r,,,A, ��� RESIDENTIAL OTHER PERMIT PERMIT NUMBER
r u I RES021-0084
dE
CITY OF ATLANTIC BEACH
ISSUED: 12/6/2021
800 SEMINOLE ROAD
�J;t19', ATLANTIC BEACH. FL 32233 EXPIRES: 6/4/2022
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:
RESIDENTIAL OTHER SINGLE OR
41 6TH ST TWO FAMILY RESIDENTIAL SYNTHETIC TURF SYSTEM $7400.00
OTHER
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170112 0000 BROOMES R/P LOTS 1,2
BK15
COMPANY: ADDRESS: CITY: STATE: ZIP:
PUTTING GREENS OF GREEN COVE
NORTHEAST FLORIDA dba 4422 INDUSTRIAL PARK RD - UNIT 2 SPRINGS FL 32043
SOUTHWEST GREENS
OWNER: ADDRESS: CITY: STATE: ZIP:
MARGOL RODNEY S 2029 N 3RD ST JACKSONVILLE FL 32250
BEACH
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.
1 PUBLIC WORKS EROSION CONTROL INSTALLATION INFORMATIONAL
Notes:
Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line(904-247-
5814)to request an Erosion and Sediment Control Inspection prior to start of construction.
Issued Date: 12/6/2021 1 of 2
RESIDENTIAL OTHER PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RESO21-0084
5 '
800 SEMINOLE ROAD ISSUED: 12/6/2021
sa ATLANTIC BEACH. FL 32233 EXPIRES: 6/4/2022
2 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
3 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL
Notes:
Roll off container company must be on City approved list. Approved list can be obtained at the Building Department at City Hall. Roll off container
cannot be placed on City right-of-way.
4 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration,including sod,is required.
5 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Contractor.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $90.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $45.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.03
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$139.03
Issued Date: 12/6/2021 2 of 2
JOB COPY
NOTICE OF COMMENCEMENT
State of ch,/-7 G[ Tax Folio No. /7,0 1/ a V U 6
County of _1�f14-1
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713
of the Florida Statutes,the following information is stated in this NOTICE OF COMCEMENT1
Legal Description of property being improved: �.—DO/ 1e' S /�y E LD f. / E h L D f 3 5-S1'.
Address of property being improved: 9, t'` tt'ire- ..i--
// --
General description of improvements: /457'$D —/z:4
Owner: /. Ai/ • I /�� Address: ,[471/ 44 - `� —' /9fkc /J+;
e1P / C
Owner's interest in site of the improvement` J-fl 1 � �/ ft_ 3��13
Fee Simple Titleholder(if other than owner): _
Name: /' �`
Contractor: 04147/1/GL,Le_5.1 �i•-e. � 5 ZIT jie-�107 I//,
S ,',--R---
Address: I/V, 1hGIGc S.74'/a-/.__. .rL4 PC;I . 4
Telephone No.:ft/ -- a Cs-44 "a2ocl' Fax No: ��`� g'60,--/..1 S 3 o 3
Surety(if any)
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name: ff ///4L
Address: /'�f 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:
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:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1)year om$ late o iigni g ii diffe ent date is
specified): �,0, ':- MY r. MUISSI0N#GG 353178 —
.v.44`•7.i EXPIRES:October 6,2023
THIS SPACE FOR RECORDER'S USE ONLY OWNER ,�/f "..df•"? Bondedm"'Notary`PublcUnd ers
Signe 4 /i '/'� `'�J/_ Date: /V/c)'6, /
3efore me thi Z Ct day of r V • in the Cou y/of Duval tate
Doc 11 2021 2821 44,OR BK 19977 Page 1371, �,"�
Number Pages 1 7f Florida,has personally a re. ZAGt/A l T/Cc/^5 0
Recorded 10/26/2021 01:09 PM, Votary Public at Large,Stat of orida:So 'y of val. O
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL Vly commission expir •
COUNTY ia.)ersonally Known: �. t -____ft,....________.- - or
RECORDING $10.00 'roduced Identification:
REVIEWED JOB COPY
By Mike Jones at 11:28 am, Nov 04, 2021 &,W..k-- (00 pceUrcc';
PQ�t' v ��
Building Permit Application I.4-1d0 -/9/28
_, City of Atlantic Beach Building Department ••ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: IT fleot@coab.us IS REQUIRED.
Job Address: !Ii 641 5t f-t-Ian�IL �:rL) Permit Number: RE -S 0 /EDi - C---)0e) 4
Legal Description V-_)`Wr i'CSS ►� t✓
� L - I S I/Z L LS 4 3 So tRf# I /-701 ( Z - V +ix.) C,)
1
Valuation of Work(Replacement Cost) ('Liao Heated/Cooled SF Non-Heated/Cooled
• Class of Work: jt:New (_IAddition L]Alteration C]Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): f,ICommercial ❑Residential
• If an existing structure,is a fire sprinkler system installed?: DYes LiNu
• Will tree(s)be removed in association with proposed project?Utes(must submit separate tree Removal Permit] No
Describe in detail the type of work to be performed:_tr‘5 k4,ULA c1 St(n-1-hek)L -{-uC-
Ac
S ys-11-m Cl+ tWk cc ce c'I Y1 ='cY c1--Yir i c\ 't As-kc 1\ o t i Lea W /0 (Y-f 0 4-e
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Florida Product Approval# for multiple product use productucapproval form,, ,, 1
`)l Property Owner Information/ ✓►, Ui'n 5 t,t( BC)ii- 60 ( , -' (,t)&-
Name 1/Z4LjG 1n in i- a Address 1•�'! 6,• -Lt _ /re
City ' S-&4,17' Ac'1-,_ v State FL Zip 3,?.."-3 3 Phone
E-Mail e,e--6t-Zji) l;a. - /[ G--)s--1
Owner or Agent(If Aget,Power of Attorney or Agency Letter Required) Ceo-NAS
Contractor Information } _J Ct SOf1Ur 1��- bn PR , c, NL
Name of Company S �In Wes `Ail
�CeelAS OA Qualifying Agent F
Address�y 4. .�ylt1 uS C. qr K 417..City(Q C. (L'l12_S a State Ft Zip 3zO 13 Lt—
Office Phone ny A ge/ Job Site Contact Number cIpil/ 3 S /7-J Z
State Certification/Registration# E-Mail G h r t 5+t INS CD Sf.Jtic� 'j(x X. Cc i'v ,
Architect Name&Phone# k.\ Ci
Engineer's Name&Phone# r\1
Workers Compensation Insurer -1'c'o') a-`e_c- OR Exempt 0 Expiration Date TU ly 3/t.Ze2 2
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 ATT'RNEY BEF• :
RECORDING YOUR NOTICE OF COMMENCEME ' •
Ehz i/2 J /
(Signature of Owner or Age (Signatt f Contractor)
need a d sworn to(or ff "ed .efore me this ' e day of Signed nd sworn to or affirmed)be .1-- me thix, Zda o
C *___,ZO/I b . , .r './1 "IIMAIIIIIII A., el f(✓ . ,by l-_IJllPi7. 1�_:_
'gn ture of '•�^. aAN91Q ROSSETTl
Z /Z _ �.i. j------ ••..';., Coavnkslon 0 HH 187360
` f/ %•.-,a; Expires October 17,2025
( I Personally Known OR I I Personally Known OR "•••f•°•f 0 ' Bonded T ruTroyFaYrMance 803-385-7018
i I Produced Identific (1oduced Identificauo —••• I
Type of Identification ` - Type of identification:f L I2L– E�
r J t it 1 " J
., MYCOMMISSION#GG 353178
,,' A: EXPIRES:October 6,2023
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