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2233 SEMINOLE RD I RES22-0099 !` ;'r, Building Permit Application Updated 10/9/18 City of Atlantic Beach Building Department **ALL INFORMATION ., � 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED. Job Address: 2233 Seminole Roade,Unit 1 Atlantic Beach,FL 32233 Permit Number: RES 2-Z — 009 Legal Description 09-2S-29E Ocean Village One-condominium Dwelling 1 OJR BK 4277-972 RE# 169519-0102 Valuation of Work(Replacement Cost)$20.000 Heated/Cooled SF 1307 Non-Heated/Cooled 0 • Class of Work: ONew ❑Addition OAlteration 6Z!Repair ❑Move ODemo OPo OWindow/Door • Use of existing/proposed structure(s): ❑Commercial glResidential • If an existing structure,is a fire sprinkler system installed?: OYes ViNo • Will tree(s)be removed in association with proposed project?❑Yes(must submit seprate Tree Removal Permit) iZINo Describe in detail the type of work to be performed: I New cabinets, change outlets, new plumbing stops Florida Product Approval# for multiple'products use product approval form Property Owner Information Name Scott H.Silver Address 2233 Seminole Roade,Unit 1 Atlantic Beach,FL 32233 City Atlantic Beach State FL Zip 32233 Phone 443-924-1632 E-Mail scott56silver@gmail.com Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) Contractor Information Name of Company Artium Company Building,LLC Qualifying Agent Todd Holloway Address 13826 Weeping Willow Way City Jacksonville State FL Zip 32224 Office Phone 904-662-2845 _ Job Site Contact Number State Certification/Registration# CGC 1525536 E-Mail Todd©artiumco.com Architect Name&Phone# Engineer's Name&Phone# Workers Compensation Insurer OR Exempt Ex iration Date 01/19/2023 Application is hereby made to obtain a permit to do the work and installations as indicated.I ce ify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the st ndards of all the laws regulating construction in this jurisdiction.I understand that a separate permit must be secured for ELECT )CAL 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 mana ement districts,state agencies,or federal agencies. OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work wil 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 Pkit PERTY. IF YOU INTEND TO OB ` FINANCI , CO •ULT WITH YOUR LEN ER OR AN ATT •NEY BEFORE REC• DI Y• R OTICE •. COMMENCEMEN . J •lir. es_cy �� '• / - ,.,;- -'411111111w7 i na'�:• :Winer- •ent g ) (Signat re of Contracto Signedandsworn to(or affirmed)before me this day of Signed and sworn to(or affirmg be re me this-s day of P ✓fL1 , 1/1Y,'") ,by .CV-.)14CWV'1' ] .✓ v1 , ZZ • . Ail DI I Ow MICHAEL if f@ of No1Hry) (Signatur=� otary) ,ip Notary Public-State of Florida F y ' Commission#HH 151037 ` Of FL, [ )Person. y Known ORMY Comm.Expires Jul 8,2025 [ j Personally Known OR SHANNA T S .a••; Notary Public-Statetate of of Florida [ Produc-. ltrent �(r [4-Produced Identificati• 'a '"41140.1` Commission is HH 101893 �—E 1 �+� Ty-pe of Identification, t'i �` ' = - Type of Identification: M Comm.Expires 9!.! Jul 1,2024 .. it Ocean Village Condominium Association of Atlantic> leach,Florida CIO Marvin&Floyd Realty,1825-A North Third Street,Jacks nville Beach,FL 32250 (904)249-8599 Office& (904)2494598 Fax,karen-floyd@,rnarvm-group.com Architectnrai Review Retract for Alteration or Addairiong Owner's Name: �c�CiTr Unit Numtler: Owner's Mailing Address: - 1:-P1 3a,23 Date Submitted: Daytime Phone: Home/Cell Pone: 4 v q } SPECIFICATIONS OF WORK TO BE !+� �rrAACCOMPLI. D:j, . fS Men � V1 v..cry-. ' [ _ W)° ri tjail?°?qor>.4-1;zm T2,e29;JA,A/lktC14e` G'c)1AjM4/1-SA.1" -47 tIcritA2et-e6 "QC `` -Nap ke 41130,e1N Yon.MT.ST provide t e fo owing information: 1. Complete description,including plans,of alterations or additions. 2. Type of materials to be used and a sample of colors. Drawings and specifications prepared by a registered engineer for these alterations au}i a statement that the proposed work will not jeopardize or compromise the safety,structural integrity antt soundness of the building Contractor Information(y using a licensed Contractor—License will b verified): Contractor Name: ' 't OM t. i E Lt : i 3$3a(G •rL��i fj fob � 77 � C ��u i e State: ;Gip Code: CrS .0 1 Phone number: cefir, �j J License N bee. C,2,6+°�,`, 0a1L5S 1" Contractor Signatt( :7J e-XG("-•- /f p Lt'cty Date: 0✓ �'``�� ARCHITECTURAL,REVIEW Approved: R;�h t-fvUrr✓ (ARC, 4- Approved: Denied: Date of revicw:2gfi Approved by ,!fwer'v ,.1ih��/,L1_ wit I�1./_/./ t���aV�� '%'Z.G•G/.�-Iti L trF. 1 h LV h rf e /C04jditions of Approval: et /, ta/I/ .4 6.40[ ��, 4,• 625 t,d c " C '� a 1Reason for Note:Only the owner listed on the title to theproperty may request architectural approvals.If atractor is hired,they must provide the Association with proof of licensing and insurance prior to commencing work. They mint also provide copies of City of Atlantic Beach building permits and final inspection reports. Note:This approval is for architectural review purpose only.This approval does not overrule any Federal,State or Local governing agencies roguiaiiunm,permit requirements,etc.,for the desired construction.It IS the responsibil:t>{.ot the condo owner to obtain and comply with such.Unit owners are responsible fur damage,including future damage,to the stmucturtl as a result of this alteration or addition. NOTE:Project must be completed within four(4)months from the date of this approval or this approval will be considered null and void requiring a resubmission of another package for approval,Additionally,the ARMC has 30-days from the date this request is received to act on this request.DO NOT START WORK WITHOUT AN APPROVAL AND/OR DENIAL.Please make note of this requirement. File Date: Final Inspection Date: OVA Form-01 (2012) - j