Permit 85 W 5th Streeti f ~~i~ ~
,~,~' ~'~
~.-~, ~` '~ s ~,, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
~~'-~ ._.. ~ y~~ ATLANTIC BEACH, FL 32233
f INSPECTION PHONE LINE 247-5826
.`.•-~ ,t S --~ j
Application Number OS-00031563 Date 11/09/05
Property Address 85 W 5TH ST
Tenant nbr, name REPAIR WALLS/WATER DAMAGE
Application description RESIDENTIAL ADD/RENOVATE/ALTER
Property Zoning TO BE UPDATED
Application valuation 4600
Owner Contractor
------------------------ ------------------------
ORCHID TRACE APARTMENTS CREATIVE CONTOURS
1601 ARDEN WAY
JAX BEACH FL 32250
(904) 237-7388
----------------------------------------------------------------------------
Permit BUILDING PERMIT
Additional desc .
Permit Fee 105.00 Plan Check Fee .00
Issue Date Valuation 4600
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 105.00 105.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 105.00 105.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BiJILDING CODES.
BUILDING OFFICIAL
~'`%-s~ `'''r`~:a CITY OF ATLANTIC BEACH c~:
~~1~ BUILDING /ZONING DEPARTMENT ~D iggins `'
~~, ~ - -~f 800 Seminole Road < ~'-C7d~f~
~` Atlantic Beach, Florida 32233
,:`, ~Fi1 J,, (904) 247-5800
(904)247-5845 Fax
www.coab.us
PLAN REVIEW COMMENTS
Permit Application # (~,~} -,~% ~ Z.~'c
Property Address: ~~~ ~, ~ ~~ ~~~{~~-~-`
Applicant: ~~,p % (" ~~Q ~~ V ~~ ~~ ~r~r ~3-'~
Project: 1 QC_'~1 _~.,~~~~ -Frr}n~ 1.1)~.-f~v' ~,( ~_11'l~ l1f
This permit application has been:
`~" Approved
~ Reviewed and the following items need attention:
Please re-submit your application when these items have been completed.
Reviewed By: ~- Date: ~ 1 ~3 ~o,S
Date Contractor Notified:
CITY OF ATLANTIC BEACH
BUILDING PERMIT APPLICATION
Is approval of Homeowner's Association or other private entity required? _~~1~ If yes, please submit
with this application.
Procedure: In order to expedite issuance of permits, please follow all steps and provide all information as
appropriate. Incomplete applications may result in delay in issuance of permit.
STEP 1. Please submit Building Permit Application, Notice of Commencement, Owner/Contractor Affidavit if owner
is contractor, and two (2) complete sets of construction plans to the Building Department, which is located
at the Atlantic Beach City Halt, 800 Seminole Road, Atlantic Beach, FL 32233 Telephone: (904) 247-
5826
STEP 2. In addition to construction and engineering detail, plans must contain the following information as
appropriate for the type of work being performed. Scale of drawings should be sufficient to depict all
required information in a dear and Legible manner.
Address and contact information of person to receive all correspondence regarding this application (please print).
Name:
Mailing Address. ~,:
Telephone: - ~ ~ a Fax: ~ - .!L_ E-Mail: IL/f-J~ (~'(, 1 C-h,~ 7I
800 Seminole Road -Atlantic Beach, Florida 32233-5445
Telephone: (904) 247-5800 Fax: (904) 247-5845 ~http:Nwww.coab.us
9/13/04
Date:
I hereby certify that I have read and examined this application and attached documentation and know the same to be true and
correct. All provisions of the laws and ordinances goveming this type of work will be complied with, whether specified herein or
not. The granting of a permit does nat presume to give authority to violate or cancel the provisions of any federal, state or local
rules, regulations, ordinances, or laws in any manner, including the goveming of construction or the pertormance of construction of
the property. I understand that the issuance of this permit is contingent upon the above information being true and correct and that
the plans and supporting have b or shall be provided as required.
~ ~~~ ~~ ~~
Signature of Owner: ~= -
AS TO OWNER:
Sworn to and subscribed before me this .~T day of ~~~~~~~ , 20.
State of Florida, Courrty of Doti al
~ Pu61c - she a,
Flodae
~M~IOn ~ ODD a~,w5"~
Signature of Contractor:
AS TO CONTRACTOR
.~
No 's Signature: 2 ~ - ~
Personally known v
^ Produced identification
Type of identification produced
Dante: //~ ~ S`
Sworn to and subscribed before me this ~~ S ~( day of ~~~~~ ~~7'C-~ , 20
State of Florida, County of Duvai
riotary' ignature:
Nohry~ E' ~-'~ERS Personally known
_, ~ My Ile ~N al Flpr~ ^ Produced identification
1~ Type of identification produced
5~
800 Seminole Road • Atlantic Beach, Florida 32233-5445
Telephone: (904) 247-5800 •Fax: (904) 247-5845 •http://www.coab.us
9113104
Page 1 of 1
Transaction #: 749742
Receipt #: 710320
Cashier Date: 11/2/2005
2:22:35 PM
(KPEARSON)
.SHE CfRC
~~: VN, CI/IO 4,j,
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~~: t ~R
roUNN. ~
Jim Fuller
Clerk Circuit Court
Duval County
330 E. Bay Street Rm 103
Jacksonville, FL 32202
(904) 630-2044
I I I I I I I VI I I VIII VI I I I II I I VI I I I II V I I I
Print Date:
11/2/2005 2:22:11 PM
Customer_Inf~rmatio_n_ Transaction Information Payment Summary
DateReceived: 11 /02/2005
Source Code: BEACH
Q H H& A CONSTRUCTION INC Q Code: BEACH
Over the
Total Fees $10.00
645 MAYPORT RD STE 3A Return Code;
Counter Total Payments $10.00
ATLANTIC BEACH, FL 32233 Trans Type: Recording
Agent Ref
Num:
1 Payments
$10.00
p = CHECK 2629
1 Recorded Items
BK/PG:12859/1089 CFN:2005403920
R ~ (N/C) NOTICE Date:11/2/2005 2:22:29 PM
COMMENCEMENT From: ALLIGOOD LYNN
ETAL To: COMMENCEMENT
INDEXING 3 $0.00
RECORDING 1 $10.00
0 Search Items
0 Miscellaneous Items
5°~
file://C:\Program%20Files\RecordingModule\default.htm 11/2/2005
H H & A CONSTRUCTION, INC.
645 Mayport Road, Suite 4C
Atlantic Beach, FL 32233
904.241.4619 • faz 904.241.7976
hhaconstruction bellsouth.net
Addendum: November 2, 2005
Scope of work
85 W 5~' St.
Atlantic Beach, Fl 32233
Insta115 rolls of R-13 insulation.
Insta1121 Pcs gypsum board 4x8 sheets
Insta113/<" base trim
Insta112 3/4" casing
Install carpet in 3 bedrooms, hall and stairs
Install 12x 12 ceramic the in kitchen and living room.
Paint entire interior of apartment.