Permits 494 Beach Ave CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
INSPECTION EMAIL REQUEST:
Building dept&coqb.us
Application Number . . . . . 07-00000920 Date 6/27/07
Property Address . . . . . . 494 BEACH AVE
Application type description ROOF
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 5000
------------------------------------------------------------------- ---------
Application desc
RE ROOF
------------------------- ------------------------------------------------ ---
Owner Contractor
----- ----------- ----- -- - ------------------------
SIMPSON HANSON ROOFING INC
494 BEACH AVENUE 2714 CORTEZ RD
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32246
(904) 641-6328
----------------------------------------------------------------------------
Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 65 . 00 Plan Check Fee . 00
Issue Date . . . . valuation . . . . 5000
Expiration Date . . 12/24/07
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ------- ---
Permit Fee Total 65 . 00 65 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 65 . 00 65 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
C� 0
BuILDING PERMIT APPLICATION /_/0
CITY OF ATLANTIC BEACH P/A� IC�i
800 Seminole Road,Atlantic Beach FL 32233
Office: (904)247-5826 e Fax: (904)247-5845
Job Address: 2�Z 4,le- 47-L (>sJ, 1--/Permit Number:
Legal Description
Valuation of Work(Replacement Cost) S o
Class of Work(Circle one): New Addition CA_1te_rat_iou�) Repair 5ve
Use ofexisting/proposed structure(s Circleone): ----Co—mmercial 4�Reside6enffti 01
(Circle one): s 0 1A
If an existing structure, is a fire sprMler system installed? e�ss
0
Is approval of homeowner's association or other private entity required? (Circle one): �%es
Describe in detail the type of work to be performed: P ct v ii�, ,q�r4 f tZy)o,
Property Owner Information
Name: 41-04erz 5.". 0 5 . :j Address: 6ecL&,_/, A"
City Arz�- 6&_4 State F(Zip 32�;- Phone
Contractor Information:
Name of Company: ��kel �C? Qualifying Agent: Te.-4r
I /T I a 0J.__? 4,1 C C t-,l 0 H
Address: Ca,-Taz cal city T-->C State lhf Zip 1:17-
Office Phone �e 1'/-3 3 Job Site/Contact Number 9 C,1-/-3'/3
State Certification/Registration C C q 7 V/5 -Office Fax# 9&-e-1-6 YZ
Architect Name&Phone 9
Engineer's Name&Phone#
Application is hereby made to obtain a permit to do the work and installations as indicated I certi that no work or
fy_
installation has commencedprior to the issuance qfapermit and that all workwill be per/ormedto meet Me standards ofall
laws regulating construction in thisjurisdiction, Thispermit becomes null and void ifivork is not commencedwithin six(6)
months, or if construction or work is suspended or abandonedfor a period 9f six (6) months at any time qfter work is
commenced I understand that separate permits must be securedfor Electrical Work, Plumbing, Signs, Wells,Pools,
Furnaces,Boilers,Heaters, Tanks andAir Conditioners, etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF CONUMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR fWROVEMENTS TO YOUR PROPERTY. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMNENCEMENT.
i hereby certify that I have read and examined this application and know the same to be true and correct. Allprovisions9f
laws and ordinances governing this type ofwork wX be complied with whether specified herein or not. Thegrantin qfa
I
permit cloes not presume to give authority, to violate or cancel the provisions bf any other federal, state. or local law
regulating construction or the performance of construction.
Signature of Property Owner. VA14 Signature of.q4K1q0or:
vk� , - ��L-&:�i_
S ibed ba OT V 1C.,
I STATEOFFLORIDA
Sworn tgAnd Ub ore
of sworn to a44- ibbd b
this2_5"bay this D NWM14988
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SONa _
0 THRU 14-NOTARYi
Notary Publi Notary Public: s/
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REVISED 03.05.07
NOnCE OF COMWNCEMENT
Stateof T-_L1QYZ_1r?A Tax Folio No.
County of 170qAL
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 NOTI
,CE OF CO
Legal Description of property being improved: Y 9 1/ 6ee�CA `5;L.;L 13
Address of property being improved:- C_HL4 OtFAC�A r/ lain
General description of improvements: (2e__rce.*
Owner. Address: "--19-f 6ea-o-A .4-c 4TL 8j F1
Owner's interest in site of the improvement: /:�-_ g /?/
( c
Fee Simple Titleholder(if other than owner): AZI-11—+
Name: AdA
Contractor K 4 ICI C.7
Address: 7--7 Te-7- 7'7 4
Telephone No.: &4_V_ Fax No: 9 -el
Surety(if any) Amount of Bond$
Address: Fax No:
Telephone No:
Name and address of any person making a loan for the construction of the improvements
Name: Al/rf
Address:
Phone No: Fax No: g4114-
Name of person within the State of Florida,other than himself,designated by owner upon whom notices of other documents may be
served: Name: ev-Z
Address:
Telephone No: �L/JA Fax No: A44!L-
in addition to hhuselt owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)ft Florida Statues. (Fill in at Owner's option)
Name: A//Pf-
I
Address: I W
!L/Z—t
Telephone No: 6Z Fax No: AJ
Expiration date of Notice of Com�nencement(the expiration date is one(1)year from the date of recording unless a different date is
specified):
TMS SPACE FOR RECORDER'S USE ONLY
/,W4 A * -
: ;?, "M4_t��e:
o lethy
. Z%
re �!��day in the Cojmty of Duval,State
Florida,has personally ap
Pewikts -
4otary Public at Large,State;oFTIo N C1
DOC#200MOO61,OR BK 14056 Page 1858- A I
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Number Pages:1
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Filed&RecmW(W27r2w at OW.10 AM, �OUNTY Ursonally Known: or
JIM FULLER CLERK CIRCUIT COURT DUVAL C MM 561 Identili�a�on:
RECORDING$10-00 44i
CITY OF ATLANTIC BEACH
DEPARTMENT OF BUILDING
800 Seminole Road -Atlantic Beach, FL 32233 - Tel- 247-5826 - Fax: 247-5877
PLUMBING PERMIT
PERMIT
LOCATION INFORMATION
Permit Number: 24418 Address: -494- - BEA—CH A_v-ENUE
Permit Type: PLUMBING ATLANTIC BEACH, FL 32233
Class of Work: ALTERATION Township: Range: Book:
Proposed Use: 'SINGLE FAMILY Lot(s): Block-. Section:
Square Feet, Subdivision: ATLANTIC BEACH
Est.. Value: Parcel Number:
Improv. Cost: OWNER-INFORMATION
Date Issued: Name: 'SIMPSON:1 ROBERT
Total Fees: - 46.50 . Address:`404 BEACH AVENUE
Amount Paid: 46.50 ATLANTIC BEACH, FL 3223a
Date Paid: 7/10/2002 Phone: (904)242-7362
M
Work Desc: INSTALL 9 FIXTURES-OP PLO 81WO
CONTRACTOR(S) APPLICAT.0-N—MES
B & G PLUMBING M 46 50 '
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SPACE, A 10 OWNE
,FAILURE TO COM. THE
PROPERTY OWNER
ISSUEb ACCORDING,TO APPR SUBJECT !ON
TO REVOCATI
FOR VIOLATION OF APPLICARI E
Oper! CHERYLE Type: OC -Drawer: i
Date: 7/11/.02 01 Receipt no:. 72225
14
A NTIC BEAC BUILDIN PERMITS-BUILDING 1.- $46.50
00100003221000
494 -BEACH
.:,CK CHECKS 11451
CITY OF ATLANTIC BEACH
APPLICATION FOR PLUbMING PERMIT
JOB LOCATION:— q3q 6§�Aco Ave
OWNER OF PROPERTY: TELEPHONE NO.
PLUMBING CONTRACTOR 10 L omo i iv 4 < 0
CONTRACTOR' S ADDRESS - 1,3cyg-7 o5FAe_y i?LV4p
STATE LICENSE NUMBER:— ZF<dl2 -s7 ? TELEPHONE:- I 13-,3,f 2,S-
HOW MANY OF THE FOLLOWING FIXTURES INSTALLED
SINKS SHOWERS
LAVATORY WATER HEATERS
BATH TUBS DISHWASHERS
URINALS DISPOSALS
CLOSETS WASHING MACHINE
FLOOR DRAINS SHOWER PANS
SEWER WATER
REPIPE OTHER
TOTAL FIXTURES: x $3 . 50 $15 . 00
MINIMUM PERMIT FEE $25 . 00
SIGNATURE OF OWNER:
SIGNATURE OF CONTRACTOR:
-----------------------------------------------------------------
INSTALLATION OF PLUMBING AND FIXT URES MUST BE IN ACCORDANCE WIT14
THE MOST RECENT EDITION OF THE SOUTHERN STANDARD PLUMBING CODE.
CALL A DAY AHEAD TO SCHEDULE INSPECTIONS - (904 ) 247-5826
SEWER CONNECTIONS MUST BE CALLED INTO PUBLIC WORKS FOR INSPECTION
PRIOR TO COVERING UP - (904) 247-5834
CITY OF ATLANTIC BEACH
DEPARTMENT OF BUILDING
800 SEMINOLE ROAD-ATLANTIC BEACH,FL 32233-TEL: 247-5826-FAX: 247-5877
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 24340 Address: 494 *BEACH AVENUE
Permit Type: REMODELING ATLANTIC BEACH, FL 32233
Classof Work: REPAIR Township: Range: Book:
Proposed Use: §NGLE FAMILY Lot(s): Block. Section:
Square Feet: Subdivision- , ATLANTIC BEACH
Est. Value: . Parcel Number: V .
Improv. Cost: 7,000.00 OWNER INFORMATION
Date Issued: 6/25/2002 Name: . SIMPSON, ROBERT
Total Fees: 68.00, Address: 494 BEACH AVENUE
Amount Paid: 68.00 ATLANTIC BEACH, FL 32233
Date' Paid: 6/24/2002 Phone: . (904)242-7362
Work Desc:. REPAIR EXISTING-GARDEN BLDG.,.PAINT HOUSE, INSTALL DOOR
CONTRACTOR(S) APPLICATION.FEES
CORNELIUS CONSTRUCTION COM.PAN 68.00
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ISSUED ACCORDING To A
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........... ......
Oper: CHERYLE Typel OC Diawer:-1
Date: 7102/92:01 Ribiipt no: - '70148
14 PERNITS7-BUILDING 1 .$68.06
1A
A TIC BEACH bUILDI!!,DEPT. 494-BEACH
CK.CHECKS.. 3582 $68.00
Trans date. 7/02102 Time: 16:.29:23
r" Book 10543 Page IL328
5 MIN. RETURN;
--�q' kg,P-*00Wfi432
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PHONE #
,r11328
NOTICE OF COMMENCEMENP
AIN 03245c39'PN
QV"CIRWIT CM
WA CUP
TO WHOM IT MAY CONCERN: TNT FUM
I REMIM
The undersigned hereby informs all =ncerned that improvements will be made to certain
real property, and in accordance with Section 713.13 of the Florida Statutes, the following
information is stated in this NOTICE OF COMMENCEMENT.
Description of Property f)Ucy-) Avi� -
&-f L A�jr Tic- -Bci-v, fl - 87-233
General Description of improvements
Owne of3EiZT
Address:— )-jq fE7A,-ri A-V E A-T-i-A o7-1e- -0,f t+ -P-L- -32C3-i
Owner's interest in site of-improvements:
Fee Simple Title Holder (if other than owner)
Name -5A A
Address
Contractor A W,A R F-T 4z�j E.L)Q-5
Address rl 1 12 i-4 rl5r AT'L- -F-5ct4 - f7L - -3 2753
Surety (if any) '�'l
Address— Amount of Bond
Name of person within the State of Florida designated by owner upon whom notices or other
documents may be served:
Name OAR/,-,
Address r7l' 192! -5T A-rL- -Pc" . FL. -32236
In addition to himself, owner designates the following person to receive a copy of the Leinor's
Notice as provided in Section 713.13(l)(F), Florida Statutes. (Fill in at Owners option).
S7;Q-7i5 e 1"�Cca A!�
Co'l'v ry 'h'CN J`m`e bey- t �s I
109
Address:—Lf-4� Af C,_.' A 11-e OL 4 1'( 7�
4GIIA
Owner
-Swnm tz
efore me this day of
MAUREEN IONG
Notary Put:Alc-state of Rama
h4y rommis!�icn&4;gm Mar 31.2012 Nota.
'a;=
commlWan# C7.,rD7,,
X"ECEIVED
�Iii t
2 4
C y -ic Bea c 1i
"" of Attant
L;.'.d1n3 and Zo.11,Ig
City of Atlantic Beach 800 Sendnole Road -Atlantic Beach,Florida 32233-5445
Phone: (904)247-5800 FAX (904)247-5805 - hnp://www/ci.atlantic-beach.fl.us
BUILDING PERMIT APPLICATION ,
FOR SINGLE-FAMILY OR TWO-FAMILY (DUPLEX) CONSTRUCTION
(INCLUDING NEW CONSTRUCTION, REMODEL, ADDITIONS
AND ALTERATIONS, MOVING OR DEMOLITION)
JOB ADDRESS.-4 I -:F>vAe_+i Am_ DATE
AP P L I C A N T—A_. 60-
ADDRESS 1/ (!3 TIL :nkr, PHONE: 24R - 1q7t G
LEGAL DESCRIPTION: BLOCK NUMBER LOT NUMBER ZONING DISTRICT
CONTRACTOR & (fQP_MF_LAQ5 STATE LICENSE NUMBERC�15 CO 40IQ
ADDRESS -If 1q"-4 PHONE 14q - 4170
CITY AJ� I STATE F L- zrp 3Z2a_"3 FAX
DESCRIBE PROPOSED USE ANDWORKTOBE DONE T"EPAIR WX%t5-t - _ 6ARDEVI Bj_v)
Pihwr t+oU,:SF_-/ i�J_STA�U_
PRESENT USE OF LADd OR BUILDING(S)
VALUATION OF PROPOSED CONSTRUCTIOTO lt�
Is this an addition? If yes,what are the dimensions of the added space: feet by feet
Will the added area be heated and cooled? �J co New electrical or increase in service?�
New plumbing fixtures? JJO New fireplace? t�0 New heating/air conditioning?
Is approval or Homeowner's Association or other private entity required? 10 If yes,please sub 't with this application.
WILL THIS PROJECT INVOLVE CHANGES IN ELEVATION, SITE GRADE OR ANY USE OF FILL
MAIKYJAL?
L!TN - Applicant certifies that no change in site grade or fill material will be used on this project.
M YES. See Step 2 below. Approval of the Public Works Department is required prior to issuance of a Building Permit.
PROCEDURE: (In order to expedite issuance of permits, please follow all steps and provide all
information as appropriate)
STEP 1. Verify zoning designation and proper setbacks for the proposed construction. If you are unsure of this information,please contact the
Planning and Zoning Department at 904-247-5817. In order to correctly verify zoning designation, please have Property Appraiser's
Real Estate Number available.
STEP 2. Contact the City of Atlantic Beach Department of Public Works to detennine if a pre-construction or post-construction topographical
survey or grading plan is required. (If n6t required, written verification must be provided with this application.) The Department of
Public Works is located at: 1200 Sandpiper Lane,Atlantic Beach,FL 32233 Telephone:(904)247-5834
6/18/02
STEP 3. Please submit Energy Code Forms,Notice of Commencement,Owner/Contractor Affidavit if owner is contractor,and four(4)complete
sets of construction plans to the Building Department,which is located at the Atlantic Beach City Hall, 800 Seminole Road, Atlantic
Beach,FL 32233 Telephone:(904)247-5826
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 a required information in a clear and legible manner.
I. Current survey showing the property boundary with bearings and distances and the legal description.
2. Location of all structures,temporary and permanent, including setbacks,building height,number of stories and square footage. Identify any
existing structures and uses.
3. Existing and/or proposed driveways.
4. If required by the Department of Public Works,a pre-construction topographical survey.
5. Any significant efivironmental features,including any jurisdictional wetlands,CCCL,natural water bodies.
6. Impervious Surface area calculations. (Swimming pools may be excluded from total Impervious Surface.)
7. Other information as may be appropriate for individual applications.
I HEREBY CERTIFY THAT ALL 0 PROVIDED WITH THIS APPLICATION IS CORRECT.
SIGNATURE OF OWN ATE,
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND
CORRECT. ALL PROVISIONS OF THE LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL 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 FEDERAL,STATE OR LOCAL RULES, REGULATIONS,ORDINANCES,OR
LAWS IN ANY MANNER,INCLUDING THE GOVERNING OF CONSTRUCTION OR THE PERFORMANCE 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 SUPPO DATA HAVE BEEN OR SHALL BE PROVIDED AS
REQUIRED.
SIGNATURE OF CONTRACTOR r DATE V
low
AwWrf f 11-e
ADDRESS AND CONTACT INFO,��TION OF' PERSON TO RECEIVE ALL CORRESPONDENCE REGARDING
TMS APPLICATION (PLEASE PRINT)
NAME, r Ll
MAIL ING e Ss
PHONE.-ZLIO (g FAX---- E-MAIEL
F
SWORN AND SUBSCRIBED BEFORE ME MIS DIAY 0!
STATE OF FLORIDA,COUNTY OF DUVAL
NOTARY'S SIGNA
AS TO OWNER: M-1;ersonally known
Produced identification
Type of identification produced
AS TO CONTRACTOR: Personally known
Produced identification
Type of identification produced
6/18/02
CITY OF ATLANTIC BEACH
PERMIT APPLICATION REMODEL,ADDITIONS, OR ALTERATIONS,
MOVING, DEMOLITIONS
Owner(s) f�r,61EV,T ---)i0F0cj-k
Job Address t4<71 1-1 Brzaai AVE-, On �&o Phone
Lot# Block or Unit# Subdivision
Contractor State License#
Address rf I )T-�4 Phone Q f,4 Ci , 6A 17(2
city ig e-ri - State zip 31
Describe work to be done J�FmrjDEL Exk �T- UQL( Li 14 E�Efi w- 6
Present use of buildin 'JIT3Ti64
Valuation of Proposed Construction
Proposed use P LA Y c)j�-,L Lc (T-:7—
Is this an addition? k�V If yes, what are the dimensions of the added space: ft. x
Will the added area be heated and cooled? New electrical (or increase) k;V
New plumbing fixtures? 1'�c New fireplace? �jr — New Heat/AC? �,, o
SUBMIT THREE (COMMERCIAL)TWO (RESIDENTIAL) COMPLETE SETS OF PLANS,S INCLUDING
SITE PLAN, SURVEY, ENERGY CODE FORMS, NOTICE OF COMMENCEMENT, AND OWNER/
CONTRACTOR AFFIDAVIT, IFqWNER IS CONT CTOR.,
.,�T�ACTOR.� , —Ne
Signature of OWNER. &J�At�, — Date:. 0
V
Signature of CONTRACTOR Date
STATE OF FLORIDA
COUNTY OF_2:�U V)9-L
Sworn to (or affirmed)and subscribed before me this day of 200 /
AS TO OWNER: Notary's Signature
0 Personally known
MAURM40OG 'Er--Produced Identification
Notay PubQC-StOft Of RcddO
Cam"*Won 80"s Mar 31,200121 Type of identification produced...
CoWmbsion#CC720781
Sworn to(or affirmed)and subscribed before me this_day of .1200
AS TO CONTRACTOR: Notary's Signature
0 Personally known
0 Produced Identification
Type of identification produced
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CITY OF ATLANTIC BEACH PERMIT CALCULATION SHEET
Address QA "�e AC�-k
D a t e 4� (26-4)z —
Heated Square Footage �0(0_per sq f t = $
Garage/Shed per sq ft =
Carport/Porch $_per sq f t = $
Deck @ $_per sq ft = $
Patio @ $_per sq ft = $
TOTAL VALUATION: $
00 , 0 C, a
eq occ. s Vs-- "
Total Valuation 1st $ $ U-4D
("0 d)&
Remaining Value $6.c"D per thousand
or portion thereof
TOTAL BUILDING FEE $
+ 1/2 Filing Fee $ A3-
( ) Fireplaces @ $15 . 00 $
BUILDING PERMIT FEE $
WATER IMPACT FEE $
SEWER IMPACT FEE $
WATER METER/TAP $
CAPITAL IMPROVEMENT $
SEWER TAP $
) RADON (HRS) . 0050 $
SECTION H PAVING $
HYDRAULIC SHARES $
CROSS CONNECTION $
) SURCHARGE . 0050 $
OTHER $
OC
GRAND TOTAL DUE $ 60 PO
ADDITIONAL PERMITS OR FEES: Mechanical_, Plumbing
Electric/New Electric/Temp_; SwimmingPool
Septic Tank Well Sign Finish Floor Elevation
Survey— Other
CALCULATIONS and/or NOTES :
RECEIVED ,
v �i 2 4 ro
CItY of Atlantic Beach
Bullidinc, and Zoning
City of Atlantic Beach 800 Seirdnole Road -Atlantic Beach,Florida 32233-5445
Phone: (904)247-5800 FAX (904)247-5805 - http://www/ci.atlantic-beach.H.us
BUILDING PERMIT APPLICATION
FOR SINGLE-FAMILY OR TWO-FAMILY (DUPLEX) CONSTRUCTION
(INCLUDING NEW CONSTRUCTION, REMODEL, ADDITIONS
AND ALTERATIONS, MOVING OR DEMOLITION)
JOBADDRESS24% - _-'PjU:6e_44 Am- DATE
APPLICANT A- <DBoF_wus ci�nt. lzoloce-��
ADDRESS -1/ (!3 SIX -
46 PHO 2 45 -q7 1) G
LEGAL DESCRIPTION: BLOCK NUMBER LOT NUMBER ZONING DISTRICT
CONTRACTOR M. (fVRjJE" U_'S STATE LICENSE NUMBER C-13 Cc
ADDRESS -11 (V -�r- PHONE 14q - q70 c,
CITY STATE zip 3Z23__-'5 FAX
DESCRIBE PROPOSED USE AND WORK TO BE DONE T-�EPPj I 6ARrw�A Bj_v�!
Pmw- f+0U,6F,/ 16�J-6rp%u- Z>O'Diz-
PRESENT USE OF LANJ�ORBUILDING(S)
VALUATION OF PROPOSED CONSTRUCTIOrO
Is this an addition? If yes, what are the dimensions of the added space: feet by feet
Will the added area be heated and cooled? New electrical or increase in service?�
New plumbing fixtures? 00 New fireplace? 6n New heating/air conditioning?
Is approval or Homeowner's Association or other private entity required? in If yes,please sub�mit with this application.
WILL THIS PROJECT INVOLVE CHANGES IN ELEVATION, SITE GRADE OR ANY USE OF FILL
MATE A ?
I
91'0. LApplicant certifies that no change in site grade or fill material will be used on this project.
[I YES. See Step 2 below. Approval of the Public Works Department is required prior to issuance of a Building Permit.
PROCEDURE: (In order to expedite issuance of permits, please follow all steps and provide all
information as appropriate.)
STEP 1. Verify zoning designation and proper setbacks for the proposed construction. If you are unsure of this information,please contact the
Planning and Zoning Department at 904-247-5817. In order to correctly verify zoning designation, please have Property Appraiser's
Real Estate Number available.
STEP 2. Contact the City of Atlantic Beach Department of Public Works to determine if a pre-construction or post-construction topographical
survey or grading plan is required. (If ri6t required, written verification must be provided with this application.) The Department of
6/18/02 Public Works is located at: 1200 Sandpiper Lane,Atlantic Beach,FL 32233 Telephone:(904)247-5834
STEP 3. Please submit Energy Code Forms,Noticc of Commencement,Owner/Contractor Affidavit if owner is contractor,and four(4)complete
sets of construction plans to the Building Department which is located at the Atlantic Beach City Hall, 800 Seminole Road, Atlantic
Beach,FL 32233 Telephone:(904)247-5826
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 clear and legible manner.
I. Current survey showing the property boundary with bearings and distances and the legal description.
2. Location of all structures,temporary and permanent, including setbacks,building height,number of stories and square footage. Identify any
existing structures and uses.
3. Existing and/or proposed driveways.
4. If required by the Department of Public Works,a pre-construction topographical survey.
5, Any significant environmental features,including any jurisdictional wetlands,CCCL,natural water bodies.
6. Impervious Surface area calculations. (Swimming pools may be excluded from total Impervious Surface.)
7. Other information as may be appropriate for individual applications.
I HEREBY CERTIFY THAT ALL WITH THIS APPLICATION IS CORRECT.
SIGNATURE OF OWN 5t'07Ma;=DATK
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND-
CORRECT. ALL PROVISIONS OF THE LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WELL 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 FEDERAL,STATE OR LOCAL RULES, REGULATIONS,ORDINANCES,OR
LAWS IN ANY MANNER,INCLUDING THE GOVERNING OF CONSTRUCTION OR THE PERFORMANCE 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 SUPPO DATA HAVE BEEN OR SHALL BE PROVIDED AS
"'J I
"LANS AND SUPPO DATA 1.
REQUIRED.
SIGNATURE OF CONTRACTOR DATE. (0 1/
P SON Tn RVrvlrvlw r T
ADDRESS AND CONTACT IN(FO TION OF PERSON TO RECEIVE AALL CORRESPONDENCE REGARDING
THIS APPLICATION (PLEASE PRINT)
Ah/114
NAME 111MM 111AJ Ll
MAILING A6JRESS
r
PHONE �0 FAX
E-MAIL
SWORN AND SUBSCRIBED BEFORE ME THIS DIAY OF?
STATE OF FLORIDA,COUNTY OF DUVAL
NOTARY'S SIGNA
y
AS TO OWNER: 2-fersonali, known
Produced identification
Type of identification produced
AS TO CONTRACTOR: Personally known
Produced identification
Type of identification produced
6/18/02
CITY OF ATLANTIC BEACH
PERMIT APPLICATION REMODEL,ADDITIONS, OR ALTERATIONS,
MOVING, DEMOLITIONS
Owner(s) t�n f3 5 V,T Pn Q�-k
Job Address-i4cf 1-1 BEAek Ave,-AT�-B6" Phone
Lot# Block or Unit# Subdivision
Contractor imppe-If4Ra Lomleuon State License
Address rt 1 )9'11' :5-v- Phone qO(t- 2 ik(j - q
City A-n-- F� - State zjr) -31 2
Describe work to be done- 'RECOL DEL Exll I wej PAI�� HLL--;F—
I kN--5TALk- -Dnom---
Present use of buildin 619R.OF--iO �L)PeQF--�S — A;T-TTij�e:� 'ROOM
Valuation of Proposed Construction
Proposed use P WA Y IAc)Q:5 IF—
Is this an addition? k�Q If yes, what are the dimensions of the added space: ft.x
Will the added area be heated and cooled? New electrical (or increase)- )10
New plumbing fixtures? W New fireplace? �jr — New Heat/AC? 0o
SUBMIT THREE (COMMERCIAL)TWO (RESIDENTIAL) COMPLETE SETS OF PLANS,S INCLUDING
SITE PLAN, SURVEY, ENERGY CODE FORMS, NOTICE OF COMMENCEMENT, AND OWNER/
CONTRACTOR AFFIDAVIT, IF qWNER IS CO CTOR.,
Signature of OWNER Date: 0 0
V
Signature of CONTRACTOR Date
STATE OF FLORIDA
COUNTY OF 7�iO V)9wL
Sworn to (or affirmed) and subscribed before me this z;41-6- day of 19110-,,y - , 200/
AS TO OWNER: Notary's Signature
0 Personally known
MAURM404 le'--Produced Identification
Natay"ic-State of Florlda
pN E=C0MMhs9jon Bq*%Mor 31,2002 Type of identification produced
Co"mhslon 0 CC720781 - S-SY-2- '7'7,Q- 3- L1016-0
Sworn to (or affirmed)and subscribed before me this day of 200
AS TO CONTRACTOR: Notary's Signature
0 Personally known
[I Produced Identification
Type of identification produced
0
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APPROVED
CITY OF ATLANTIC BEACH
BUILDING OFFICE
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CITY OF ATLANTIC BEACH
DEPARTMENT OF BUILDING
800 SEMINOLE ROAD-ATLANTIC BEACH,FL 32233-TEL: 247-5826-FAX: 247-5877
--P-E--R-M--ITI—NF -O--RM-A--TI-O—N------ ------L0-C--A-T-1-0-N IN-FORM--A-T-lO--N----------
- 1-9,79- 2
s
Permit Number: Ad s: 4W BEACH AVENUE
Permit Type: REMODELING ATLANTIC BEACH, FL 32233
Class of Work: ALTERATION Township: Range: Book:
Proposed Use: SINGLE FAMILY Lot(s).- Block: Section:
Square Feet: Subdivision: ATLANTIC BEACH
Est.Value: Parcel Number:
Improv. Cost: 6,000.00 OWNER INFORMATION
Date Issued: 3/27/2000 --Wa—me.—SEUP ROBERT
Total Fees: 60.00 Address: 488 BEACH AVENUE
Amount Paid- 60.00 ATLANTIC BEACH, FL 32233
Date Paid: 3/27/2000 Phone: (904)242-7362
Work Desc: PAINT, INSTALL DOOR, SHELVING
CONTRACTOR(S) APPLICATION FEES
-06R-N—ELIUS CONSTRUCTION t0-VVAl4)( 60�00
Inspe-ptions Required-
NOTICE-INSPECTIONS MUST BE REQUESTED AT LEAST 24 HOURS PRIOR TO INSPECTION
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 VIOLKTION OF APPLICABLE PROVISIONS OF LAW.
$60.00 14
Date: 3127100 V Receipt: @0453E8
A T N T I C B E A C HIX�1 LD 1-1�NG EPT. CHECKS
CITY OF ATLANTIC BEACH
DEPARTMENT OF BUILDING
800 SEMINOLE ROAD-ATLANTIC BEACH,FL 32233-TEL: 247-5826-FAk 247-5877
PERMIT INFORMATION
LOCATION INFORMATION
Permit Number: 19792 -A4r --4&
Permit Type: REMODELING ATLANTIC BEACH, FL 32233
Class of Work: ALTERATION Township: Range: Book:
Proposed Use: SINGLE FAMILY Lotfs). Block: sectiom
Square Feet: Subdivision: ATLANTIC BEACH
Est.Value: Parcel Numbei-:
Improv. Cost: 6,000.00 OWNER INFORMATION
Date Issued. 3127/2000 –Wa—me, 9W08-0—N, ROBERT
Total Fees: 60.00 Address: 488 BEACH AVENUE
Amount Paid- 60.00 ATLANTIC BEACH, FL 32233
Date Paid: 3/27/2000 Phone: (9D4)242-7362
Work Desc: PAINT, INSTALL 600k,-8-R8LVING
CONTRACTO�RtS)___ APIPLiCATiON FEES
-ObikN—iE�L—it)8�C-o—NgTkUtTi-ON COMPANY PER M IT--------- --6 0.00
Inspections Required
NOTICE-INSPECTIONS MUST BE REQUESTED AT LEAST 24 HOURS PRIOR TO INSPECTION
r
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- --- � -- – - --- I
"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
L TOR VIOLATION OF APPLICABLE PROVISIONS OF LAW.
A� NfC&—BLHIU�—ILDING EPi:.--- Date: 3/27/0001 Receipt: 0045368
CHECKS 2346
iffle
U4
TV k Book 9579 Page 246
j ' N
amme ppealm on
Alk A Aci
AU-40re Of (9vmnWnrjmtrtd
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The undersigned hereby Infonns all concerned that Impravenwrits will be nwdo to certain real
property, and In amordance with section 713.13 of the Florida Statut@4 the following Intonnation
is stated In this NOTICE OF COMMENCEMENT.
D*vuiplian of proporty-..--�-1
................
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A Recorded
Owrw's Wored In oil@ of Ow lospevam 03/274lg 1gvl%Po
mmy v L;UUK
CLERK CIRCUIT COURT
foe U-N4 r*w holdw W 011W 0" 0WW) WAL COWTY
TRUST FUND S 1.00
RECORDING S 5.00
............................... ....................................
pl�
C&Wt$dW.... (3(9 C.QSNEAJ.U4 .........
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as providod I"SUIllon 713.13 11) (Flo F'IWWI ltsliutm (Fill 16 at OwroWs optim),
... .... - --------
CITY OF ATLANTIC BEACH
PERMIT APPLICATION REMODEL, ADDITIONS, OR ALTERATIONS
MOVING, DEMOLITIONS
Owner (s) :
nR r"7'1 1 P3 6 m
y- Phone: 24 7 to Z
Job Add��ess:
4; y-
Lot Block or Unit # Subdivision:
Contractcr: -PE6(7y GENEL)LI-S State License # e-f3eO�J!017107
Address: ) 96�4 L-5F-mi0QLr- -RV- Phone No: I*qq-
city ATL.-Amne Be-ti- State EL- Zip Code -32233
Describe work to be done: P
)KBT-411 gpook
Present use of building: .56L ;�7fAl-
Vaivation of Proposed Construction: On. 00
A
Proposed use: FM
Is this an addition? 6 If yes, what are the dimensions of the added
space: ft. X ft. Will the added area be heated and
cooled? New electrical (or increase) ?
New plumbing fixtures? gO New firepiace?t3h New Heat/AC? 0,0
SUBMIT TIMEN (COMORCIAL) TWO (RESILENTI-Al) CCMPLETE SETS OF PLANS, INCLUDING
SITE PLAN, SVRVEY, ENERGY CODE FORMS, NOTICE or COMdENCENENT, AND
OWNERICONTRACTOR AFFIDAVIT, IF OWNER IS CONTRACTOR.
Signature OWNER: Akb44yze���,'�'�e: 3- 2e-* e9O
Ar 66MWate:
Signature CONTRACTOR �A --?- 2-6 00
AS TO OWNER:
197
Sworn to and subscribed before me this day of 2000.
C xl-t3—
NOTARY PUBLIC
AS TO CONTRACTOR: ':Aghw "N
J-42. POdaAwalft
MyWWW10N#=
Sworn to and subscribed before me this day o f 62t,MRS
'Ic.. --400""Odo
80'OeD 7NRU M FAIN INSURAa,11C,
NOTARY PUBLIC
PSR-2044
09992
DEPARTMENT OF BUILDING
CITY OF ATLANTIC, BEACH,
FxFxiT T11PMXTjM
LOCATM INMR, "TION
'Permit Number: 99912 Address: 494"SFAdH AVENU
1 11 1 n E
Permit Type: 'BUILDING '�7
A-TLA*Tic, tZACH? FLORIDA 3 2 2,$3'
Class of Work! ALTERATION
L DESCRIPTION
Constr . Type: CONCAZTZ�,-; Lot : Section*
Proposed Use: OkiVEIR
AY townshipt- RNG:
Dwellings : j Code: 0 t0divisio'n',-- ' AfLANT
1 C SEAc%
Estimated value,: S0100
'Improv. Cost.: $0,00
Total roes.i,
0 0
' Amount P
d $25.-00
D 4/13/95 -
7Wor ZTE DRIVEWAY
",*XTION
$25,00
IT
Add
WATER 1)(PACT FEE $0 .0()
-BEACH, FLOP-IDA 32233 MPACT FELK $0.00
Ph
'7
0- iwlg "'o,
?'OP� ----— 7
INI JON , RADON.,C
1. :1 1 $0 .00
Name CAP""!TAL IMP. Ovz� $0 .00
Address V SEWER.I TAP ,
$0.0'0
License,
Type. 1
FE19 $0 .00
CHARGE
;�100
P
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SCHAR01/ATL.,SCH t 00
Notts:
NOTICE ALL CONCRETE FORMSAND FOOTINGS MUST BE PECTE6,SEFORE p R
PERMIT
V01b SIX MONTHS AFTER DATE;OF ISSUE
BUILDING MATERIAL,RUBBISH,AND DEBRIS FROM THIS WORK MUST NOT B81 ,LA�E
IN PUBLIC SPACE,AND MUST BE
CLEARED,UP�AND HAULED AWAY 13Y EITHER CONTRACTOR OR OWNER'
"FAILURE,TO COMPLY WITH THE,MECHANIC'S LIEWL
AW" CAN
SULT IN
RE
THE PROPERV OWN15R PAYINGTWICE FORtHE'S !L NO-IMPR ENTS"
M
ISSUED ACCORDING TO APPROVED PLANS WHICHARE PART OF TH18,PERMITL AND SUBJECT TO REVOC
ATjOt4 FOR
*rION
VIOLA OF APPLICABLE PROVISIONS OF LAW.
Per
C P
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VOW
ATLANTIC DOW
WACH,BVILDIN 0000
Dater A 41
70
By:
:0-
,—I P, ( ("',F t6 kA- �-/
CMbF--ATL`AN`T1C' BEACH
PERMIT APPLICATION REMODEL, ADDITIONS OR ALTERATIONS
DEMOLITIONS
Owner(s) : ia- ik-1(,*Q -
Address: Phone:
Lot #— Block or Unit # Subdivision:
Contractor:
State License #
Address: -Phone No:
Describe work to be done:
Present use o*f building:
Valuation of Proposed Construction:
Proposed use:
Is this an addition? If yes, what are the dimensions of
the added space: ft. X — ft . Will the added area
be heated and cooled? New electrical (or increase)?
New plumbing fixtures?_ New firepl&ce?_New Heat/AC?
SU&tM-TWffJ9—C70-KPEE—ii SETS OF PLAN$:�v INC .Lwz-z lqvivir6y"-
-ENZRQY a 0IMS 0 CE OF COMHENCEHANT'.,L,,'AND- 0WNER/CONTRA-CTOR
ACT6k.
J
Signature=0WNER: x1 Date:
Signature CONTRACTOR7,�/, Date:
License Supplied.- '--------
Liability Insurance:
Worker's Compensation Insurance.
:AS
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BUILDING AND ZONING INSPECTION DIVISION
CITY OF ATLANTIC BEACH
ATLANTIC BEACH, FLORIDA S2133
APPLICATION FOR MECHANICAL PERMIT CALL-IN NUMBER
IMPORTANT Applicant to complete all items in sections 1, 11, 111, and IV.
Street Addrtss:,
LOCATION
OF Intersecting Streets: Betwoork And
BUILDING
6� I Sub-division
11. IDENTIFICATION — To be completed by all applicants,
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 attach9d plans and specifications which are a part hereof and in accordance with the City of Jacksonville ordinances and standards
of good,prectice listed therein.
Name of Wchanizal Contractors
Contractor (Print) 6CEWA) Master ry) �k 12"a --715
Name of
hoperty Owner
Signature of Owner Signature of
Architoct at Engineer
or AWIterized Agent
A, Type of heating fuel: IS OT14ER CONSTRUCTION SEI NG 0 1 ONE ON
XEWMC THIS BUILDING OR SITE I
(3 Gas—[3 LIP [3 Natural 0 Central Utility
IF YES, GIVE NUMBER OF CONSTRUCTION
C) on PERMIT
13 OtIW Specify
IV. WCHANICAL 11119UMAINT TO K INSTALLED NATURE OF WOR]k
(pravwis complete ust of components on bock of this form) Residential or Commercial
"*at 0 space 0 Itaceaw X Ce"toall 0 PAW Now Building
Air COWWWRinv, C3 Itoom Central Existing Building
X 0 K
xWc� System: Me 10 1 Thickness Replacement of existing system
Maximum capacity cf.W Now Installation(No system previously InstafteL I d)
Extension or add-on to existing system
C3 Kohi"nstlion 0 Other— Specify
13 Coaling lowel Capacity 9-pim
13 Flas sprinlillm: Numbw of has
0 Elevator 0 Weaft C3 &"Isto? THIS $PAM P" offm Un ONLY
13 :60"400 PumPL —(number)
1). invowber) Itemaltis
93, LM o"fell —(numbwl
IJ*fimd p1mum Y~ Permit Approved by—
bun
Permit In
OOW SpOcilly
XJff AURQUIPMENT
AIR CONNTION]ING AND REFRIGERATION EQUIPMENT C%"d I ty API11*Vft
Dewitpuca XodW NUMba manufaetaw (19111111111)�
t
DEPARTMENT OF BUILDING PERMIT NO. 7193
CITY OF ATLANTIC BEACH,FLORIDA
PERMIT TO BUILD
THIS PERMIT MUST BE POSTED ON JOB
Date 10-17-85 19 T
50.00 50*00CKT
Valuation$ 1'FJ(2'AMM Fee$ 1q b_5 L, I A 10/1718
7193 90f)CAC
This permit not valid until above fee his been paid to City Treasurer,and is 95id 1 1 111/17/8
subject to revocation for violation of applicable provisions of law. �1
1 000
This is to certify that OCEARST&TE IMATIMO, PIXL %AAW.L.LJ.%A-4.LLV-;r
has permission to bJX REM' HT & AM ODMIT=ING
Classification REMENMAL Zone
Owned by
Lot Block S/D
House No. 494 BEAM AVENUE
According to approved plans which are part of this permit
NOTICE—ALL CONCRETE FORMS
AND FOOTINGS MUST BE IN-
SPECTED BEFORE POURING.
PERMIT VOID SIX MONTHS
AFTER DATE OF ISSUE
;U
P. 0 Building material, rubbish and debris
2-q from this work must not be placed
in public space, and must be cleared
up and hauled away by either con.
tractor or owner.
M 1019=
Building Official.
FOR OFFICE PERMIT DATE CONTRACTOR
USE ONLY NUMBER
PLUMBING
ELECTRICAL
SEWER
WATER
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