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Beach Ave 211 st , CITY OF ATLANTIC BEACH °. 1 , 800 SEMINOLE ROAD „ Alia ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5826 Application Number 05- 00030379 Date 5/19/05 Property Address 211 BEACH AVE Application description . . PLUMBING ONLY Property Zoning TO BE UPDATED Application valuation . . . 0 Owner Contractor SIMMONS, SYLVIA SANVILLE, MIKE PLUMBING 211 BEACH AVE. P.O. BOX 802 ATLANTIC BEACH FL 32233 GLEN ST. MARY FL 32040 (904) 259 -3497 Permit PLUMBING PERMIT Additional desc . SEWER Permit Fee . . . 42.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Fee summary Charged Paid Credited Due Permit Fee Total 42.00 42.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 42.00 42.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. ( %) 1 .4%. ‘ ettevc 4441 BUILDING OFFICIAL *=,, CITY OF ATLANTIC BEACH PLUMBING PERMIT APPLICATION Date: 5 5 `° Property Address: 1 / -r? (- / 4J-c. Owner: 1' '-'J �: = elephone #: 2 7ri -- Contractor: // .Lf.6) ,53 j✓�/l�r�, t��r�r Telephone #: Sk. ' c 4 9-I/ Contractor Address: /7 7t Gcs , - .1 /0 Fax #: ���` `7 D In consideration of permit given for doing the work as described in the above statement, we hereby agree to perform said work in accordance with the attached plans and specifications which are a part hereof and in accordance with the City of Atlantic Beach ordinance and standards of good practice listed therein. Installation of plumbing and fixtures must be in accordance with the most recent edition of the Southern Standard Plumbing Code. Plumbing Type: If other construction is being done on this building or site, • ❑ New list the building permit number: ❑ Re -Pipe Number of Fixtures: Bath Tubs Showers Closets Shower Pans Dishwashers Sinks Disposals Urinals Floor Drains Washing Machine Lavat Water Sewer Water Heaters Other Fees Permit Issuing Fee: $35.00 Total Fixtures: X $7.00 + $35.00 = 800 Seminole Road • Atlantic Beach, Florida 32233 -5445 Phone: (904) 247 -5800 . Fax: (904) 247 - 5845. http : //www.ci.atlantic- beach.fl.us 8 � ! :. w �= CITY OF ATLANTIC BEACH S s � J � � - 800 SEMINOLE ROAD ATLANTIC BEACH, FLORIDA 32233 INSPECTION PHONE LINE 247 -5826 40.219 Application Number 04- 00027683 Date 2/10/04 Property Address 211 BEACH AVE Tenant nbr, name SURGE SUPPRESSOR Application description . . ELECTRIC ONLY Property Zoning TO BE UPDATED Application valuation . . . 0 Owner Contractor SIMMONS, SYLVIA BILL THOMPSON ELECTRIC CO, INC 211 BEACH AVENUE P.O. BOX 330150 ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233 (904) 249 -5601 Permit . . . ELECTRICAL PERMIT Additional desc . . Permit Fee • • • • 70.00 Plan Check Fee . . .00 Issue Date . . . . Valuation . . . . 0 Special Notes and Comments 200AMP,1PH,3W,240 /120VOLT,2 "RACEWAY SURGE SUPPRESSOR Fee summary Charged Paid Credited Due Permit Fee Total 70.00 70.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 70.00 70.00 .00 .00 a 1 BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE, AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER. "FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS" ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. r BUILDING OFFICIAL CITY OF ATLANTIC BEACH ELECTRICAL PERIVIIT APPLICATION Aotir,) t ,., Date: 2 (Q) I CA Property Address: C. t 6..ecte h A e... _ .... Owner: -...):t mirn art5 Telephone #:61(:A) Z4-I - 7r/g Contractor: Bill Thompson Electr.i.(- Cc, , , K.. Telephone #: (904) 249-5601 Contractor Address: 49 W. 7th St AtlantiL. 3ach, FL 32233 Fax #: (904) 270-0540 In consideration of permit given for doing the work as described in the above statement, we hereby agree to perform said work in accordance with the attached plans and specifications which are a part hereof and in accordance with the City of Atlantic Beach ordinance and standards of :ood .ractice listed therein. Building: 1 Building Type: 0 1 railet I Service: If other construction is 0 New C2E_Residence Li feint). ID New being done on this building Or site, list the building C2f- Old D Commercial 0 Signs 0 Increase Permit number: • 0 Re-wire 0 Addition Sq. Ft. _ 0 Repair Conductor Size: AMPS: COPPER EJ ALUMINUM 0 Switch or RACE Breaker AMPS PH W VOLT WAY Existing Service -7.-11% RACE • f Size AMPS --- ,"-‘.K2 PH / W ,..3 VOL WAY 2 ' Feeders: NO. SIZE NO :31.Z.1., --, NO SIZE Lighting Outlets CONCEALED OPEN Receptacles CONCEALED OPEN 0 0 AMPS 11100 AMPS Switches --f- Incandescent Fluorescent & M.V. Fixed 0.100 AMPS OVER BELL Appliances TRANSFER. Air H.P.RATING H.P. RAT ING CEILING KW-HEAT Conditioning COMP. MOTOR OTHER MOTORS AMPS HEAT ,... , Motors 0-1 H.P. VOLTAGE PH I NO. OVER 1 H.P. PHS — UNDER600V — I OVER600V Transformers NO. KVA NO. KVA _ No.Neon_Transf. Ea._Sign ' Miscellaneous Ce7e ce7y7e;_c_c7L.,-- 1 800 Seminole [toad • Allaiith' Leacti, Fiorida 32233-5445 Phone: (904) 247-5800 . Fax: (904) 24 /-')1) ):,), . nup://www.clatlantic-beaeh.fi.us ' ‘7F/g ,4-g Xe r LAN, .� , CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5826 Application Number 08- 00000623 Date 5/19/08 Property Address 211 BEACH AVE Application type description SWIMMING POOL /SPA Property Zoning TO BE UPDATED Application valuation . . . 38400 Application desc new pool Owner Contractor SIMMONS BLUE HAVEN POOLS & SPAS 211 BEACH AVE. 12041 BEACH BLVD ATLANTIC BEACH FL 32233 STE. 20 JACKSONVILLE FL 32246 (904) 620 -0090 Permit BUILDING PERMIT Additional desc . Permit Fee . . . 225.00 Plan Check Fee . . 112.50 Issue Date . . . Valuation . . . . 38400 Expiration Date . 11/15/08 Special Notes and Comments All excavated soils must be placed on owner's property. No fill to be added to City Right -of -Way. *2004 FLROIDA BUILDING CODE W/'05 -'06 SUPPLEMENTS. 2004 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. REQUIRED INSPECTIONS: *POOL STEEL *ELECTRICAL GROUNDING AND BONDING *FINAL (PUMPS MUST BE RUNNING FOR FINAL) Fee summary Charged Paid Credited Due Permit Fee Total 225.00 225.00 .00 .00 Plan Check Total 112.50 112.50 .00 .00 Grand Total 337.50 337.50 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. yr J Uy u, Q 04''441 ¢ Q W O In i:`' Z ( 3 N 0 ell c CC v1 O k C 1 ti. i`. O M r} 4 q '. q, a W e ms„ 0 7' •' L . - -Uq 02a a tu Q - Y ci U t t -�J.Q �� o ((� I o a X o cry r r-t m z .4. y q• ' . 4 mow`' it . �y C I CI 0 r ' ' .'° _ • � aC 4. � C C] t Val � Z • -,...111 . . 41 �o � y Q W' �o tri o Fa • : , •:. „... * I . 5, e..11 . Q , Ci %R.*/ CI CC ill til CL:. Ill , *0 '" *C), , 1 to ca •i" ti.i' rP-,4( 0 CC ca .D J, Q► ' � � 0 `.J' 0 0 C1 to NI o ) i tr) IF', e t 0 (. . O a 3' �c� Z z ��1 W¢ c„�Zvi v r s c ` ¢ t z S 0- ' -� �. �a W d US EL. cl s x � "4.1 G0. 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(0 ----,--, ;... -,,,, ik_i_c_ - 2 :., ) — 4 - 4 .--.1 0 J .1 i � i :•: d W 1 • '9 > o • M . co M M O N --'`-Z. 0 J' Ws O 6 Q a co p � 13 lila i - � a I 17 .i gi if' „ i a) U (n 0 ) } 0 o 'S$ •E 1.14 =N0 a 8 ° U o o a r c 1 c�w 0 0 °3 NI (1) IU � '� 11411111 4. \ 0,0 e G: re-E1*(f. ..i W ►- «°Ise U _ . 05/09/2008 09:36 904 -620 -0090 BLUE HAVEN JAX PAGE 01/02 fr BLUE 'ga 12041 Beach Blvd. Suite 20 • Jacksonville, Florida 32246 .1114E Phone: 904.620.0090 Fax: 904.620.0206 s�as� ® General E -Mail: bluehavenjax@bellsouth.net bellsouth.net World's l ar • rat: FAX MEMO DATE: I - o e Pages incl cover: FROM: ! ,j.�� �ii/A/ TO: ■ j k'/c%. c°,4fe FAX: 1 Z +7— S 'a4 --3 REGARDING: z. if , 44-c/1 ,4 Jt- MESSAGF: 4 . etiAs �) TtfL- ,!-A2s "7` -0 6- rf-N J J c ct.J r -. vc7Y4 40f,R ro/ -6-sxe ✓D '4-02,14/ • . a '!o5 77.05 . V(' (l, • • • • • • I - 1 � ,., s BUILDING PERMIT APPLICATION rj f � " ' "` , n . ' CITY OF ATLANTIC BEACH • v 800 Seminole Road, 'Atlantic Beach FL 32233 u ?OOP Office: (904)247 -5826 • Fax: (904) 247 -5845 Job Address: 211 B CA,c H A v .E. Permit Number: - Legal Description L1 i *F 1-x zy 5 1 JRD)v t 5 1 d kl " A" Valuation of Work (Replacement Cost) $ 5b G fD Q . • Class of Work (Circle one): Addition Alteration Repair • • Use of existing/propose P structure Circle one): Commercial • - sidentia • If an existing structure, is a fire spr u er system installed? (Circle one): • es lo ASKO • Is approval of homeowner's association or other private entity required? (Circle one): Yes No Describe in detail the type of work to be performed: 'Foe) L °r Poo L rE►JC l N 4-r Property Owner Information Name: 54 1("4-I,ARTT) oil' M0 o5 Address: 211 -AcH AvE • City AT / .} i, i, r L I e' 1-1 • State F I Zip '322 3,� Phone 2 • 119 S Contractor Information: � ,_ 3 .01/39 -- mitt I<t Name of Company:1 v AVM 1 i'00/._ Qualifying Agent: Ke. n h e_ rY1 Q rJ vtka i Address: I2 041 e,ca.xc.l. (31 ve,1 - z 6 City Luc- Son dri 1 le- State 1=`- Zip 32z 4 Office Phone ' T O - c z.o -00 t 0 ob Site /Contact Number 9 oq - 24 a — q 70 Co State Certification/Registration # ef 0-- - l' 7 5 Office Fax # 1.0g-6 Architect Name & Phone # Engineer's Name & Phone # �ro►2 ODN G4-. Sh v aticd5on (a72. N. 5 i ri 0 l e 1,3 l trdd 2 b 0 / - - ,do 32267 PE $4. 11333 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 permit and that all workwill be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void ijwork is not commenced within six (6) months, or f'construction or work is suspended or abandoned for a period of six_ (6) months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters, Tanks and Air Conditioners, etc. WARNIN G TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPRO ► 4 R TO YOI TR PROPERTY. IF Y • U ,. INTEND TO OBTAIN FINANCING, CONSULT WI p' + elllir nD1• n' • r. � i - Y BEFORE RECORDING YOUR NOTICE OF COMIVIE , 1' !i P II I I " CE CITY O AT • Ti ' ' 'hereby certify that I have read and examined this application and , ow the sa, ot :; ' • . ,• , ; 6 - ) • :; j .t pr ovision' of laws and ordinances governing this type of work will be complied lith whet. ... •;_ , ; IL '' : ; Is ! 6 Ir anting a permit does not presume to give authority to violate or cancel t • provisions n any of er •, • • • • , • •; • local • regulating construction or the performance of construction. REVIEWED BY: DATE: - 0 8 b �- r Signature of Property Own=' ! .. ;time ,1 of Contractor: Sworn to and subscribed before me Day + co o o. an y subscribed before me this Z Da of 4' 41 z 0 0 S .' Da of 4/1A=/ 2va c' �— : 1t ' // L Notary Public: �/ . , r e i +Nd,Wva+€w"Ja wnt vi:sy Pe: AA./ �,,;, =•.�. •�+•� _ "`°' o 11. ,ti ti ' . w �..�.��� y,p,•,• ON WINCHESTER •, Commission DD 723778 , .1 ••v WEST NCHE S -=. Expires January 26, 2012 ; *:� ;* Commission DD 687689 REVISED 03.05.07 • ' xf,,,' m , Bondedn Troy Fain kmxence800388.7019 ` Expires June 21, 2011 _ . , i Bonded 'Nu Troy Fein Insurance B00- 385-7019 FLORIDA DEPARTMENT OF `PROlEfiION= ENVIRONMENTAL PROTECTION Bureau of Beaches and Coastal Systems k FLORA 3900 Commonwealth Blvd., Mail Station 300 VISSOMMigaggsr Tallahassee, Florida 32399 -3000 Telephone (850) 488 -7708 NOTICE TO PROCEED • Permittee Name: Permit Number: DU -401 Richard L. and Sylvia N. Simmons Permit Expires: April 23, 2011 c/o Bobbie Nelson Bobbie Nelson Beachside Consulting, Inc. 29 Bay View Drive St. Augustine, Florida 32084 You are hereby granted final authorization to proceed with the construction or activities authorized by this notice. Authorized work must conform with the project description, approved plans, and all conditions of Chapter 62B -33, Florida Administrative Code, and any preconstruction requirements, and all permit conditions of the Final Order. Project Description: Construction of a landward swimming pool, excavation and placement of fill. Project Location: Between approximately 385 feet and 435 feet north of the Department of Environmental Protection's reference monument R -52, in Duval County. Project address: 211 Beach Avenue, Atlantic Beach. Special Instructions: A preconstruction conference is required. The permittee shall comply with all permit conditions. Questions regarding this notice should be directed to the undersigned at the above address. ( Valerie Jones, Permi anager ate VJ /sc cc: Permit File Permit Information Center Trey Hatch, Field Inspector Richard L. and Sylvia N. Simmons, Property Owner City of Atlantic Beach Building Official Post Conspicuously on the Site DEP Form 73 -131 (Updated 2/06) fi n CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5826 Application Number 08- 00000887 Date 7/01/08 Property Address 211 BEACH AVE Application type description ELECTRIC ONLY Property Zoning TO BE UPDATED Application valuation . . . 0 Application desc pool Owner Contractor SIMMONS OCEAN ELECTRICAL CO., INC. 211 BEACH AVE. 13725 BEACH BLVD # 17 ATLANTIC BEACH FL 32233 JAX BEACH FL 32240 (904) 249 -3112 Permit ELECTRICAL PERMIT Additional desc . Permit Fee . . . 75.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 12/28/08 Fee summary Charged Paid Credited Due Permit Fee Total 75.00 75.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 75.00 75.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. 1r -1 LJSi \ CITY OF ATLANTIC BEACH Q oµ. 800 SEMINOLE ROAD, ATLANTIC BEACH, FL 32233 V . ' L OFFICE: (904)247 -5826 • FAX NO.:(904)247 -5845 BUILDING - DEPT ©C OA B. U S ' a P ELECTRICAL PERMIT APPLICATION �_�� �� � : DUVAL COUNTY ii ❑NO C,�L7 �� ... � ^ 0 / , , <3 c / c_-4 '4 V "L i A ES PERMIT #: Du— / 1 / 'r ,: 4 n 5,.+7 d 4,, 7 , #%,.. „o.,. r t ,,,.: wr s ,, 2 „SRS'. , le ''',.,4. :''' d . J. .. � Pk. �ie„'',1.; ' 41 ,£w,sx "��6s.�"n.»`r, *1a'. s : "' 4. NAME: . d,,,,Y „,?,,,n , _ 5. ADDRESS IF DIFFERENT FROM JOB ADDRESS: S � 6. PHONE: VIA vN 2 9 i7©. _ " e 7 NAME OF COMPANY: , ,,,Nia „e. t ,,,,, sz. 5 .' * , ' `* * , o �, r s 7” r :'.4.! zr ' { _ '' A L 8. ADDRESS.: y Oc—eu � ” <....� c0 73 -2.2 S- / (3 f o i7 .T4 - ` Fi 9. STAIV OF FLORIDA LICENSE NO: 10. CELL PHONE: 11. FAX NO.: c/ 3 v0 J- x-1 9 — y2/ 577 S' 12. EMAIL ADDRESS: 13. OFFI E PHONE: 14 OC - e a 1( 1, c. e a //S C -ti.�1 Y ,3 ' // Z. _ 15. Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void if work is not comment within six (6) months, or if construction or work is suspended or abandoned for a period of six (6) months . - die after work is commen • CONTRACTORS SIGNATURE: ,, � _ / L. ` .... _,, `..,. I . r , ,., w, P,, :. '.' .,T c' e. i 7t'.. 7f,'±' ': c;',. tl n1" .r..,,yv ;:r i ❑ MULTI FAMILY - # OF UNITS: :ESIDENTIAL 74INGLE FAMILY ❑ TEMP SERVICE ❑ COMMERCIAL ' ❑ ADDITION ❑ TRAILOR 137211E ,• ,,.. , r 0N a ; .. ' °�1 , ,_ , z ,; ::. l " ❑ ALTERATION ❑ GN ❑ OLD ❑ NEW ❑ '05 NATIONAL ELECTRICAL CODE ❑ REPAIR • -00L / SPA ❑ REWIRE ❑ OTHER: i ati . 1 y u !AL ... , , 4 ; ri, z, Y T",, m .^° :,' :ti i . S ". .£n. ., , <. . ,x... ,., I.a ei „ ....i 20. TYPE OF SERVICE: ❑ OVERHEAD ❑ UNDERGROUND ❑ UNDERGROUND UP POLE 21. NEW SERVICE: CONDUCTORS PER PHASE: ❑ POWER IS ON ❑ POWER IS OFF 22. SIZE OF CONDUCTOR: AMPACITY: ❑COPPER ❑ ALUMINUM 23. SWITCH OR BREAKER SIZE: AMPS: PH: W: VOLT: RACEWAY SIZE: 24. EXISTING SERVICE SIZE: AMPS: PH: W: VOLT: RACEWAY SIZE: 25. FEEDERS: # OF AMPS: # OF AMPS: # OF AMPS: 26. LIGHTING FIXTURES: INCANDESCENT: FLUORESCENT & M.V.: 27. FIXED APPLIANCES: 0 -30 AMPS: 31 -100 AMPS: OVER 100 AMPS: 28. FIRE ALARM: ❑ YES ❑ NO 29-31 00 NOT APPLY TO NEW SINGLE FAMILY, MULTI - FAMILY AND ROOM ADDITIONS 29. SMOKE DETECTORS: NUMBER: 30. RECEPTACLES: 0 -30 AMPS: 31 -100 AMPS: OVER 100 AMPS: 31. SWITCHES: 0 -30 AMPS: 31 -100 AMPS: OVER 100 AMPS: ''; '° f '� ' " r w , �`$!a" ¢ , a # a£ < z g „. `. - v n -, .� 11 a m , . ,. __. , z £. ,. �,. .,. �:.� ... «.. ,,. � .,, � ., a "= i�, r � .k < �,$�� § ° ,r r.. v": °: ,.. i ?�..., .c��.. c� � e ,��t, �uR.. # OF UNITS. COMP. MOTOR HP RATING: AMPS: HEAT KW: # OF UNITS: COMP. MOTOR HP RATING: AMPS: HEAT KW: ,, r�.::` �` ry :a s' ?> , >" s s ," a 't`. v gill - - s%r Ir , p,,.q FZ'$ 9 F , ,, n "' x 3n . 8 .b . � k"e' a i � ,6 . � ... .X _ uv1s ,ua5 ° r NUMBER: VOLTAGE: HP: KVA: NUMBER: VOLTAGE: HP: KVA: 's ,a k°• , .4 . , �f & r 1 I� " as s s E ^, a r ,�x us.� � � �.`%� � sa., <z..#�,e�it.� ,�, . . �...�;,� ,ta:*u�. a ,tea.: ° b r,� � �wd. <N �< U x, aeA�.., � r m A, UNDER 600V: NUMBER: KVA: OVER 600V: NUMBER: KVA: ~.w �. a , . , ... t", :.. . , 14K . IL .f«,:' „3%a M, ;s 4-44 :4c04.,' a? ..',tn .s, 441,N s.,., n:4_' , DESCRIBE IN DETAIL: COAB FORM BLDG02: REVISED: 1/10/2008 This Space Reserved for Clerk's Recording NOTICE OF COMMENCEMENT This Instrument Prepared by: Name: North Florida Pools, Inc. DBA Blue Haven Pools & Spas Address: 12041 Beach Blvd., Suite 20, Jacksonville, FL 32246 Telephone: 904 - 420 -0090 Fax No: 904 - 620 -0206 STATE OF FLORIDA COUNTY OF v vAl— Permit Number Tax Folio Number 110 Pi? —0000 The Undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal Description of property being improved: Lot 1 f311‹ 27 Subdivision "A " Plat Book S Page (p County Dv vim( Co Street Address 2-t1 3each A., City, State, Zip M1+ta-i.vI --t c, C&c& rr-t.3 2. General Description of improvements: In ground Concrete Swimming Pool 3. Owner information: ,( Name(s) 3clL.vi i21c�4PRZI) ,3 Imo) iA/ Mailing Address 211 1:3 s c- H / v E . City, State, Zip Q t . ,' c EI •) f 2 . 3 2Z Interest in Property: Fee Simple Name and address of fee simple titleholder (if other than Owner): N/A 4. Contractor: Name: North Florida Pools, Inc. DBA Blue Haven Pools & Spas Address: 12041 Beach Blvd., Suite 20, Jacksonville, FL 32246 Telephone: 904 - 420 -0090 Fax No: 904 - 620 -0206 5. Surety: Name and address: None Amount of bond: None t, ?� 6. Lender: Name =} ,; , Mailing Address: 7. Person(s) within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7, Florida Statutes: Name, Address & Phone # 8. In addition to himself or herself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.06(2)(b), Florida Statutes: Name, Address & Phone 9. Expiration of Notice of Commencement. (One (1) year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN 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 COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. 3-r, r.7„5=; -.( "R, I,.. ( rnfmc : 60 5 - ve' igiiatur o 9., f Owner or Owner's Authorized Officer/Director /Partner/Manager Bite ■ Signatory's Title /Office: Owner The forgoing instrument was acknowledged before me this L day of ,44 4 Y , Z 00 8 , By SYt - VJA Sim ,r+40,4 as Owner we► Namr of PPrenn • • • O ' �n CITY • %F ATLANTIC aJ'SAC fist � PERMIT B al" Z IVNINI DEPARTMENT APPLICATION # . �, 000 Seminole Road Atlantio Beach, Florida 32233 !� • ` (904) 247 -5800 (904) 247 -5845 Fax www.coab.us • APPLICATION T CKING FOR R RED DEPT: • Y N PLANNING Prope Address: // �iA-Gr // /11/E- 1� BUILDING Y N PUBLIC WORKS • Applicant: I .- !' VE — 8 Y N . PUBLIC UTIUTfES Y 14 FIRE DEPT. Project: D a J Y N PUBLIC SAFETY •APPROVAL 5 o REQUIRED AGENCY: RECEIVED BY: INITIAL' DATE Y H D.E.P UFS,_tt,;," ...w,. - . CARPER IX Y N ARMY CORPS of ENG CARPER o Y N HOTELS & RESAURANTS HUFSTETLER D APPLICATION STATUS ' CIRCLE ONE • SITE BU1LD1 DA AP REVIEWED BY: INITIAL: DATE: 0 1ST REV ® k•e Sono ill 5 O • PLANNING 6UILDING 0 0 2ND REV ® • PUBLIC WORKS PUBLIC UTILITIES FIRE DEPT. PUBLIC SAFETY 0 _�', 3RD REV • r ' ' 1 '�'�` CITY OF ATLANTIC BEACH • • 7 �: PERMIT r _, j BUILDING / ZONING DEPARTMENT • • APPLICATION # • ��` 800 Seminole Road q a M m11 i s Beach, Florida 32233 6 d/ "<",---.0.7 247 - 800 "<",---.0.7 (404) 247 -3845 Fax • 'www.coab.ns • • • APPLICATION TRACKING FORM • �L c .. - . DEPT: c.7( /1 .L� EA -a Iii 11�c «' +k PLA NNING Property Address: /�' w C !� BUILDING 1 , r--;. Ira= P UBUC WORKS App)l1CAIIt: K -Z U.1C' d G5 Y Ai . PUBUC UTILITIES Y N FIRE DEPT. Project: 6 Z' Y N PUBUC SAFETY • w • APPROVAL i; a REQUIRED AGENCY: RECEIVED BY: INITIAL DATE Ili a Y N D.E.P HUFSTETLER • a Y N S•J.RW.M. CARPER _ Y N ARMY CORPS of ENG APE t- o Y N HOTELS & RESAURANTS HUFSTETT ER • APPLICATION STATUS CIRCLE ONE • SITE BUILDING DA AP REVIEWED BY: IN NITIAL• DATE ❑ ❑ 1ST REV ❑ L - Ste"" d 5 /d7 Dr • . . . . . . #10 ❑ 1 ❑ 2ND R E V I D ❑ j I • LDiNG PUBUC WORKS PUBUC UTILRIES . • FIRE DEPT. PUBLIC SAFETY - _ • ' • 0 ❑ 3RD REV ❑ ❑ BUILDING PERMIT APPLICATION t V CITY OF ATLANTIC BEACH f•-• 9,iSt� 800 Seminole Road, Atlantic Beach FL 32233 Office: (904)247 -5826 • Fax: (904) 247 -5845 Job Address: 2 t I f`3 c H A vE . Permit Number Legal Description I./ r t rut 2 Sir tv � t p ►J " A Valuation of Work (Replacement Cost) S .3D (D'. • Class of Work (Circle one): p ( Addition Alteration Repair ove • Use of existing/proposed structu sj Circle one): Commercial TF siden • Ilan existing structure, is a fire sprinkler in er system stalled? (Circle one): es o AVM ■ Is approval of homeowner's association or other private entity required? (Circle one): Yes No Describe in detail the type of work to be performed: 'oe>L °t• >oJ., CELIC. / Nc-T Property Owner Information N a m e : 5 vi vsA v p 6 r tr1 a u `> Address: 2M EACH Avg • City Art .f xr . State EL Zip -32-z , Phone 2-41 •'1 19 Contractor Information: tit 10 3 . 0 39 - � '1 ILt Name of Company: ► r 1-1AvF> i� Qualifying Agent: Ke n v► o W c ,> E ut r 1 Address: 1� 041 43 ud 131M 1 42-2 r City (`u. oil v; t le State Pc— Zip 32z Office Phone R Ott - to z-o -00 't 0 ob Site/Contact Number 9 o c(- .49 - q 7b State Certification/Registration # C- l'51e 7 b 5 Office Fax # q ocf -lo zo -ozo6 Architect Name & Phone # Engineer's Name & Phone # C --dr2• oonl b. 5h o p.irdsnrt (01 2- N. Sera i rip t e. i3 ilic k 20b 3 7 t'E tf• l i 3 33 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 workwill be performed to meet the standards ?fall laws regulating construction in this jurisdiction This permit becomes null and void ilwork is not commenced within six (6) months, or y' construction or work is suspended or abandoned for a period of six (6) months at any time der work is commenced I understand that separate p must be secured for Electrical Work Plwnbing, Signs, Wells, Pools, Furnaces, oilers, Heaters, Tanks an Air Conditioners, etc. 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. thereby certify that Acme read and examined this r in lication and know the same to be true and correct. All provisions of laws and ordinances governing this type of work wt be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other federal, state, or local law regulating construction or the performance of construction. Signature of Property Own - _ / ,r � Signature of Contractor. 7 /'t,•/dhi ( I.. L.. SMtirvvs Sworn to and subscribed before me Sworn to and subscribed before me this 2• Day of 4 41 Zo P Pl this 'Z Day of 44 •O S ANA Notary Public: {./ Notary ' . • 4 AKA ki Z-tS r . • commission DD 723778 WESTON WINCHESTER _ 26, 2Q12 Canmission DD 687689 REVISED 03.05.07 ' : `,Y r esearm '' = Expires June 21, 2011 Etondad Th u Troy Fain insurance 80085.7019 FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION Bureau of Beaches and Coastal Systems FL A 3900 Commonwealth Blvd., Mail Station 300 Tallahassee, Florida 32399 -3000 VIIIMONISSINIOW Telephone (850) 488 -7708 NOTICE TO PROCEED Permittee Name: Permit Number: DU-401 Richard L. and Sylvia N. Simmons Permit Expires: April 23, 2011 c/o Bobbie Nelson Bobbie Nelson Beachside Consulting, Inc. • 29 Bay View Drive St. Augustine, Florida 32084 You are hereby granted final authorization to proceed with the construction or activities authorized by this notice. Authorized work must conform with the project description, approved plans, and all conditions of Chapter 62B -33, Florida Administrative Code, and any preconstruction requirements, and all permit conditions of the Final Order. Project Description: Construction of a landward swimming pool, excavation and placement of fill. Project Location: Between approximately 385 feet and 435 feet north of the Department of Environmental Protection's reference monument R -52, in Duval County. Project address: 211 Beach Avenue, Atlantic Beach. Special Instructions: A preconstruction conference is required. The permittee shall comply with all permit conditions. Questions regarding this notice should be directed to the undersigned at the above address. Valerie Jones, Permi anager a te VJ /sc cc: Permit File Permit Information Center Trey Hatch, Field Inspector Richard L. and Sylvia N. Simmons, Property Owner City of Atlantic Beach Building Official Post Conspicuously on the Site DEP Form 73 -131 (Updated 2/06)