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Permits 1969 Beach Ave ,1 CITY OF ATLANTIC BEACH - 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 09-00000830 Date 6/09/09 Property Address . . . . . . 1969 BEACH AVE Application type description ELECTRIC ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc INSTALL CIRCUITS ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ GREIDER, JACK FRANKLIN ELECTRIC SERVICE 1969 BEACH AVENUE 13810 SUTTON PARK DRIVE N ATLANTIC BEACH FL 32233 SUITE 627 JACKSONVILLE FL 32224 (904) 629-4925 ---------------------------------------------------------------------------- Permit . . . . . . ELECTRICAL PERMIT Additional desc . . Permit Fee . . . . 70 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 12/06/09 ---------------------------------------------------------------------------- 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 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. � CITY OF ATLANTIC BEACH 80 Q 0 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 I r i OFFICE:(904)247-5826•FAX NO.:(904)247-5845 BUILDING-DEPT@COAB.US ELECTRICAL PERMIT APPLICATION DUVAL COUNTY 1°JOB ADDRESS. .' 2;15 THIS'A'SUB PERMIT. 3:DATE `tb9 BCAc-H AVC DYES PERMIT#: 9 svN 09 PROPERTY OWNER:` 4.NAME: 5.ADDRESS IF DIFFERENT FROM JOB ADDRESS: S.PHONE: ELI TRACTOR: 7.NpF OF COMPANY: B.ADDRESS.: R 13610 s%31ro4 aR.+c v . N . 06 A 9.STATE OF FLORIDA LICENSE NO: 10.CELL PHONE: 11.FAX NO.: FIE 1301 36711b 6ggH iss 3-7o�1'Z. 12.EMAIL ADDRESS: 13.OFFICE PHONE: 14. ZSARWIrAd oA.CAS-r,VCr 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 commenced within six(6) months,or if construction or work is suspended or abandoned for a period of six(6)months at any figie after work is commenced. CONTRACTORS SIGNATURE: , 16:CLASS OF WORK:`' 17.SERVICE:, 18,METER)NUMBER... ❑MULTI FAMILY-#OF UNITS: OtlRESIDENTIAL INGLE FAMILY ❑TEMP SERVICE ❑COMMERCIAL 13ADDITION 13TRAILOR 19.BUILDINGc'`'' „-: 19.CURRENT CODE ❑ALTERATION ❑SIGN SOLD ❑NEW ❑'05 NATIONAL ELECTRICAL CODE ❑REPAIR ❑POOL/SPA ❑REWIRE ❑OTHER: ALLELECTRIGALWID 20.TYPE OF SERVICE: ❑OVERHEAD BIINDERGROUND ❑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: [30. LIGHTING FIXTURES: INCANDESCENT: FLUORESCENT&M.V.: FIXED APPLIANCES: 0-30 AMPS: 31-100 AMPS: OVER 100 AMPS: FIRE ALARM: ❑YES ❑NO 2931 DO NOT APPLY TO NEW SINGLE FAMILY,MULTI-FAMILY AND ROOM ADDITIONS SMOKE DETECTORS: NUMBER: RECEPTACLES: 0-30 AMPS: 31-100 AMPS: OVER 100 AMPS: SWITCHES: 0-30 AMPS: 31-100 AMPS: OVER 100 AMPS: 32.AIR CONDITIONING:'. ` #OF UNITS: COMP. MOTOR HP RATING: AMPS: HEAT KW: #OF UNITS: COMP. MOTOR HP RATING: AMPS: HEAT KW: 33;MOTORS: NUMBER: VOLTAGE: HP: KVA: NUMBER: VOLTAGE: HP: KVA: 34.TRANSFORMERS: UNDER 60OV: NUMBER: KVA: OVER 60OV: NUMBER: KVA: 35.MISCELANEOUS REPAIRS: DESCRIBE IN DETAIL: �NSfA1.L 1,00 S 1.XTY AµQ C,12CJITS 691E TAOKII-FS$ WI. N BLDG02 Permit Application Elec:REVISED:12/18!2008 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ►;,� ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 09-00000826 Date 6/09/09 Property Address . . . . . . 1969 BEACH AVE Application type description PLUMBING ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc 1 fixture ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ GREIDER, JACK F.W. FAIR PLUMBING CO. 1969 BEACH AVENUE P.O. DRAWER 51558 ATLANTIC BEACH FL 32233 JAX BEACH FL 32250 (904) 241-7191 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING PERMIT Additional desc . . Permit Fee . . . . 42 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 12/06/09 ---------------------------------------------------------------------------- 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. t CITY OF ATLANTIC BEACH 09- I I I e4 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 7 w n OFFICE:(904)247-5826•FAX NO.:(904)247-5845 BUILDING-DEPTCCOAB.US " soh , PLUMBING PERMIT APPLICATION DUVAL COUNTY r`1"rJOS ADORES$: - " '2.IS THIS'A`.SUB-PERMITv - - ;`3.DATE` 13 NO ❑YES PERMIT#: PROPERTY OWNER -777777 4.NAM�A 6 le A n'/ �ry� A 5.ADDRESS IF DIFFERENT FROM JOB ADDRESS: B.PF{OyE�' (/ �G7 1/Vl /{ PLUMBING CONTRACTORr 6 l! /�' }� ���//�}/ 8.ADDRESS.: 7.NAME OFC PANY:„A k ESS.: _/ 9.STATE OF FLORID IC SENO 10.CELL PHONE: �+ _ 11.FAX NO.: r 12.EMAIL ADDRESS: CC'' b T7 13.OFFICEPHONE:� V /_ -)/ 9 14. 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 commenced within six(6) months,or if construction or work is suspended or abandoned for a period of six(6)months a n ti fter work is commenced. CONTRACTORS SIGNATURE 16F NATURE OF WORK: 18:CURRENT CODE: ❑NEW 0'07 FLORIDA BUILDING CODE- [3 RE-PIPE PLUMBING ❑OTHER: 18.NUMBER OF FIXTURES. BATH TUB SEWER CONNECTION BIDET SHOWERS DISH WASHER SHOWERS PANS DISPOSAL SINK DRINKING FOUNTAIN WATER CLOSET TANK FLOOR DRAIN WATER CLOSET VALVE HOSE BIB WASHING MACHINES ICE MAKER WATER CONNECTION INTERCEPTOR WATER HEATER LAVATORY URINALS LAUNDRY TRAY OTHER(SPECIFY): ROOF DRAIN 20.PLUMBING PERMIT FEES: PERMIT ISSUING FEE: $35.00 TOTAL FIXTURES: x $7.00 (PER FIXTURE) + $35.00 = BLDG03 Permit Applica0ion Plumb:05 05 09 4 Department of ti s , Environmental Protection _k% 1004 A Marjory Stoneman Douglas Building Jeb Bush 3900 Commonwealth Boulevard Colleen M.Castille Governor Tallahassee, Florida 32399-3000 Secretary November 18, 2005 CERTIFIED MAIL Jack L. Greider c/o"Dennis j' Hams, Architect, P.E. Atlantic Beach,Florida 32233 Dear Mr.Williams: DENIAL OF APPLICATION FILE NUMBER: DU-336 APPLICANT NAME: Jack L. Greider Your pursuant to Section 161.053,Florida Statutes,for construction or other activities seaward of the coastal construction control lin to your failure to complete the application. The enclosed final order represents an agency determination. In the event that a legally- sufficient petition for hearing is not timely received,you have the right to seek judicial review of this final order,pursuant to Section 120.68,Florida Statutes,and Rule 9.030(b)(1)(c)and 9.110,Florida Rules of Appellate Procedure. To initiate an appeal, a Notice of Appeal must be filed with the Department of Environmental Protection, Office of General Counsel, and with the appropriate District Court of Appeal within thirty(30)days of the date this final order is filed with the Agency Clerk. The Notice filed with the District Court must be accompanied by the filing fee specified in Subsection 35.22(3), Florida Statutes. Any person whose substantial interests are affected by any decision of the Department on the application has the right to request an administrative hearing in accordance with the provisions of Sections 120.569 and 120.57 of the Florida Statutes. Should you desire an administrative hearing, your request must comply with the provisions of Rule 28-106.201 of the Florida Administrative Code, as indicated below. Send requests for hearings to the Department of Environmental Protection, Office of General Counsel, 3900 Commonwealth Boulevard, Mail Station 35, Tallahassee,Florida 32399. The Department must receive the request within twenty-one days after your receipt of this notice. "More Protection, Less Process" Printed on recycled paper. Dennis M. Williams, Architect, P.E. November 18, 2005 Page 2 When the Department receives an adequate and timely filed request for hearing, the Department will request the assignment of an administrative law judge. Once an administrative law judge is requested, the referring agency will take no further action with respect to the proceeding except as a party litigant,as long as the Division of Administrative Hearings has jurisdiction over the formal proceeding. Section 120.54(5)(b)4, Florida Statutes and Rule 28-106.201(2), Florida Administrative Code, explain what must be included in a petition for a formal administrative proceeding. (a) The name and address of each agency affected and each agency's file or identification number, if known; (b) The name, address, and telephone number of the Petitioner, the name address, and telephone number of the Petitioner's representative, if any, which shall be the address for service purposes during the course of the proceeding,and an explanation of how the Petitioner's substantial interests are or will be affected by the agency determination; (c) A statement of when and how the Petitioner received notice of the agency decision; (d) A statement of all issues of material fact disputed by the Petitioner or a statement that there are no disputed facts; (e) A concise statement of the ultimate facts alleged, including a statement of the specific facts that the Petitioner contends warrant reversal or modification of the Department's action; (f) A statement of the specific rules or statues the Petitioner contends require reversal or modification of the Department's action,including an explanation of how the alleged facts relate to the specific rules or statues; and (g) A statement of the relief sought by the Petitioner, stating precisely the action that the Petitioner wants the Department to take with respect to its action. A person may request an extension of time to petition for an administrative hearing. The person filing the request for extension must do so within the time limits for filing a petition described above and serve all parties with the request. The request must state why an extension is needed. The Department will grant an extension only when good cause is shown. If a petition or request for extension of time is filed,further order of the Department becomes necessary to effectuate this notice. Accordingly,the Department's final action may be different from the position taken by it in this notice. Actions undertaken by you under this permit, pending the lapse of time allowed for the filing of such a request for hearing, may be subject to modification, removal, or restoration. Failure to petition within the allowed time frame constitutes waiver of any right that such a person has to request a hearing under Section 120.57 of the Florida Statutes and to participate as a party to the proceeding. If a legally sufficient petition for hearing is not timely received this notice constitutes final agency action. When this order becomes final,any party to the order has the right to seek judicial review under Section 120.57 of the Florida Statutes and Rule 9.030(b)(1)and 9.110 of Dennis M. Williams, Architect, P.E. November 18, 2005 Page 3 the Florida Rules of Appellate Procedure by filing a notice of appeal with the Department of Environmental Protection, Office of General Counsel, Department Clerk, 3900 Commonwealth Boulevard, Mail Station 35, Tallahassee, Florida 32399, and with the appropriate district court of appeal within thirty days after this final order is filed with the Department Clerk. The notice filed with the district court must be accompanied by the filing fee specified in Subsection 35.22(3)of the Florida Statutes. Any subsequent intervention will only be at the approval of the presiding officer upon motion filed under Rule 28-106.205, Florida Administrative Code. A person whose substantial interests are affected by the Department's proposed agency action may choose to pursue mediation as an alternative remedy under Section 120.573 before the deadline for filing a petition. Choosing mediation will not adversely affect the right to a hearing if mediation does not result in a settlement. The procedures for pursuing mediation are set forth below. A person may pursue mediation by reaching a mediation agreement with all parties to the proceeding(which include the applicant,the Department,and any person who has filed a timely and sufficient petition for a hearing)and by showing how the substantial interests of each mediating party are affected by the Department's action or proposed action. The agreement must be filed in(received by) the Office of General Counsel of the Department at 3900 Commonwealth Boulevard, Mail Station 35,Tallahassee,Florida 32399-3000,by the same deadline as set forth above for the filing of a petition. The agreement to mediate must include the following: (a) The names, addresses, and telephone numbers of any persons who may attend the mediation; (b) The name, address, and telephone number of the mediator selected by the parties, or a provision for selecting a mediator within a specified time; (c) The agreed allocation of the costs and fees associated with the mediation; (d) The agreement of the parties on the confidentiality of discussions and documents introduced during mediation; (e) The date,time,and place of the first mediation session,or a deadline for holding the first session, if no mediator has yet been chosen; (f) The name of each party's representative who shall have the authority to settle or recommend settlement, and (g) Either an explanation of how the substantial interests of each mediating party will be affected by the action or proposed action addressed in this notice of intent or a statement clearly identifying the petition for hearing that each party has already filed,and incorporating it by reference. (h) The signatures of all parties or their authorized representatives. As provided in Section 120.573 of the Florida Statutes,the timely agreement of all parties to mediate will toll the time limitations imposed by Sections 120.569 and 120.57 for requesting and holding an administrative hearing. Unless otherwise agreed by the parties,the mediation must be Dennis M. Williams, Architect, P.E. November 18, 2005 Page 4 concluded within sixty days of the execution of the agreement. If mediation results in settlement of the administrative dispute,the Department must enter a final order incorporating the agreement of the parties. Persons whose substantial interest will be affected by such a modified final decision of the Department have a right to petition for a hearing only in accordance with the requirements for such set forth above, and must therefore file their petitions within twenty-one days of receipt of this notice. If mediation terminates without settlement of the dispute, the Department shall notify all parties in writing that the administrative hearing processes under Sections 120.569 and 120.57 remain available for disposition of the dispute,and the notice will specify the deadlines that then will apply for challenging the agency action and electing remedies under those two statutes. Please direct any questions pertaining to this final order to me by letter at the above address, or by telephone at 850/921-7849. Sincerely, (r e t Manager ureau oI'STeaches an Coastal Systems DAKJdw Enclosures Certified Mail #: 7004 1350 0000 1908 7645 cc: Bobbie Nelson, Field Engineer City of Atlantic Beach Building Official Jack L. Greider, Property Owner pA01Efi10 STATE OF FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION Division of Water Resource Management Bureau of Beaches and Coastal Systems FLOR A 3900 Commonwealth Blvd.-Mail Station 300 Tallahassee, Florida 32399-3000 (850)488-7708 FILE NUMBER: DU-336 D APPLICANT: Jack L.Greider c/o Dennis M. Williams, Architect,P.E. 1969 Beach Avenue Atlantic Beach,Florida 32233 DENIAL OF A COASTAL CONSTRUCTION CONTROL LINE PERMIT APPLICATION SUBMITTED PURSUANT TO SECTION 161.053,FLORIDA STATUTES FINDINGS OF FACT: An application for authorization to conduct activities seaward of the coastal construction control line was filed by the applicant named herein on May 27,2003. A timely request for additional information was mailed to the applicant on June 24, 2003. Another request to submit the necessary information to complete the application and notification that the application will be denied was mailed to the applicant on October 12,2004. As of the date of this final order the requested information has not been received and the applicant has not requested additional time in which to submit the information. CONCLUSIONS OF LAW: The applicant shall have 180 days from the date the Department mails a timely request for additional information to submit that information to the Department.If an applicant requires more than 180 days in which to respond to a request for additional information, the applicant may notify the Department in writing of the circumstances,at which time the application shall be held in active status for a period of up to ninety days. Additional extensions shall be granted for good cause shown by the applicant. A showing that the applicant is making a diligent effort to obtain the requested additional information shall constitute good cause. Failure of an applicant to provide the timely requested information by the applicable deadline shall result in denial of the application pursuant to Rule 62B- 33.008(7),Florida Administrative Code.Based on the foregoing considerations,the Program Administrator of the coastal construction control line program of the Bureau of Beaches and Coastal Systems pursuant to Deputy Secretary Directive "Delegation of Authority",DEP Directive 137,effective May 14,2001,hereby denies the application for the proposed activities identified in the project description below. LOCATION: Between approximately 205 feet and 335 feet south of the De artment of Environmental Protection's reference monument R-43, in Duval County. Project addresstlantic Beach. PROJECT DESCRIPTION: For the replacement of existing wood bulkhead with new wood bulkhead. Done and ordered this day of 2005, in Tallahassee,Florida. FILING AND ACKNOWLEDGEMENT e of Florida- FILED, lorida FILED, on this date,pursuant to S120.52 Dep ent of Env' onmental Protecti Florida Statutes, with the designated Department Clerk, receipt of which is hereby acknowledged. y . cN al, P. ., Program Adm nistrator /C Bureau o Be ch nd Coastal Systems eputy Clerk Date 1, 6181 DEPARTMENT OF BUILDING CITY OF ATLANTIC BEACH J . .. --- � w� . .� � �T1 9N,PE PERMIT INFORMATION bOCATION SNPOR �._ T? a t Number. 16.1#1 address, 1969.,:BEACX AVINUk Permit "Ty-petME HANlOAL ATLANT'M BEA cff, MAID& `i7l ass crk.AbTSRATION,'. IZGA,b�',ES14�R.Z PT ON � C oat r, Tp :CONCRZTE, Bl Lx t: Twp s Proposed Us S:e ctican A Subd':0 , 4 Dwellings: 0 Siibdivl.sioriw Est . Value, 0 .0C mprov.. Cost ; 0 .00 f Amount ter /1998 ate Nark > e BI�NSER �. . TON, APPLICATION FEES,. .--- - j 27.00 Add>: r� ENUX 8� PLORIDA' 322 how v " .._ ,15 C R OR.At I ON Name a DO, 1 AN 4` ATS y ANLL A1� JAX SEAOTJ�i' 32254 Li c: CAC93,976 k I~ / T" F 1 NOTES: a a i NOTICE ' INSPECTION MUST BE 1�EQUESTED AT!:EAST 24 HOURS PRION TO INSPECTION :p i 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 �TAILURE TO COMPLY WITH THE MECHANICS' LIEN U4VU CAH RESULT IN THE PROP911TY OWNERPAYING TWICE FOR BUILDING IMPROVEMENTS* ISSUED ACCORQtNG TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND;SUBJECT TO=REVOCATIQN; FOR VIOLATI )N OF APPLICABLE PROVISIONS OF LAW. 7 8f'1+I Aim CKCKS 4 ` LANT BEIJACH BLDIN EPA TMENT I2 y BUILDING AND ZONING INSPECTION DIVISIOW-,, " J- CITY OF ATLANTIC BEACH n ATLANTIC BEACH, FLORIDA 32233 V eX..�lrV APPLICATION FOR MECHANICAL PERMIT CALL-IN NUMBER IMPORTANT — Applicant to complete all items in sections I, II, III, and IV. I. f_Q LOCATION Sfreef Address:1 F _4q 0K) n- OF Intersecting Streets: Between ��1`i 0 And BUILDING � � Q� Subdivision II. IDENTIFICATION — o 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 attached plans and specifications which are a part hereof and in accordance with the City of Jacksonville ordinances and standards of good practice listed therein. Name of Mechanical Contractors (� Contractor (Print) �®(\-)oL�c�N � `� r T Mester Name of Property Owner Signature of Owner Signature of or Aufhori:ed Agent Architect or Engineer III. GENERAL INFORMATION A. Type of heating fuel: B. IS OTHER CONSTRUCTION BEING DONE ON Elo,dric THIS BUILDING OR SITE? ❑ Gas—❑ LP ❑ Natural ❑ Central Utility IF YES, GIVE NUMBER OF CONSTRUCTION ❑ Oil PERMIT ❑ Other — Specify IV. MECHANICAL EQUIPMENT TO BE INSTALLED NATURE OF WORK (Provide complete list of components on back of this form) f, Residential or ❑ Commercial Heat ❑ Space ❑ Recessed O Central O Floc ❑ New Building Air Conditioning: ❑ Room ❑ Central Existing Building ❑ Duct Sysfem: Material Thicknen ),Replacement of existing system Maximum capacity c.f.m. U New installation(No system previously installed) 1-1Extension or add-on to existing system ❑ Refrigeration O Other — Specify ❑ Cooling tower: Capacity g.p.m. ❑ Fire sprinklers: Number of heads_ ❑ Elevator ❑ Monlift ❑ Escalator (number) THIS MACE FOR OFFICE USE ONLY ❑ Gasoline pump& (number) (RaceiwdI ❑ Tanks (number) Remarks ❑ LPG contains;r+ (number) ❑ Unfired pressure vessel ❑ Boilers Permit Approved by Date .— b ONser — Specify Permit Fee LIST ALL EQUIPMENT AIR CONDITIONING AND REFRIGERATION EQUIPMENT Capsofty A roving Number Unita Description Model Number Manufacturer (Zbns) cY -y PSS- DEPARTMENT.OF BUILDING 1 CITY OF ATLANTIC BEACH i PERMIT INFORMATION ..... _, .. --- -�- LOCAT1ON INPOR ATI00 .. . {{ Permit, irbr. ,4IQ Addrea. EACRAV +iIJ i Permi t 'TyP .PLtI iHI iG. ATLANTIC .U�BACH FLI)RIDA 32233 ' Class of Cr eat r. rt----. --- LEGAL 3E6CRIPTION ork:ALT BAT ONLTwpWOOD Flxmz, Block: ,Type K � Proposed Ua+ ect i on; Bubd•t. Rng 0 � Use 11 r� . subdivision. Wit . Value. Improv. Cos� Total 'r25 .00 Ancxnt »» ' Cat a W7 HEATV { - � #s., N5� -- � ION �., »- «» � ..� . APPLICATION FEES �...�..__�.. �_ a PERMI { E �AddrUz - 3 K � lip VLOR IDA r � } . . Co Rei ORMATIO�i Addr'. 13'39'1 BLV- 4V X2224 Exp TW4„lt+.'AA5i V, 'nA NOTES: ` NOTICE-ALL CONCRERM TE FOS AND FOOTINGS MUST"BE INSPECTED B !#I EFORE POU NG PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE BUILDING MATERIAL,RUBBISk AND DEBRIS FROM THIS WORE{MUST NOT BE PLACED If PUBLIC SPACE,AND,MUST BE CLEARED UP AND"HAULED AWAY BY EITHER CONTRACTOR OR OWNER "FAILURE T© C MPLY WITH THE MECHANICS' I.I N LAW CA#4 RESULT IN -HE PR©PERTY OWNER PAYING TWICE FOR BUILDING IM PF t ' EMENT i." , . ISSUED ACCORDING TOL APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND' SUBJECT TO 14VVUCATt V FOR �11C?kAftt N C?F APPLICABLI PROVISSION$OF LAW. Y k ATLANTIC BEACH BUILDING DEPARTMENT fAllcl '� By. ..... i a i CITY OF ATLANTIC BEACH APPLICATION FOR PLUMBING PERMIT JOB LOCATION:_1,9(®`7 � �/ L �'_ ,OWNER OF PROPERTY: a PLUMBING CONTRACTOR CONTRACTOR' S ADDRESS: _ STATE LICENSE NUMBER: � ."� %� TELEPHONE: 55-cgj HOW MANY OF THE FOLLOWING FIXTURES INSTALLED SINKS SHOWERS LAVATORY WATER HEATERS BATH TUBS DISHWASHERS URINALS DISPOSALS CLOSETS WASHING MACHINE FLOOR DRAINS SHOWER PANS { OTHER #+ TOTAL FIXTURES: x $3 . 50 + $15 .00 MINIMUM PERMIT FEE — $25 .00 SIGNATURE OF OWNER: SIGNATURE OF CONTRACTOR: ----------------------------------------------------------------- 4 INSTALLATION OF PLUMBING AND FIXTURES MUST BE IN ACCORDANCE WITH 4 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 (IT U.J.,ertifirate of QDrru anq LOC-AT7.014 v"' M T I I I i�'O P M A T 10 ii A,.d d I c-z; 1'_J`69 BEACH AVENUE P i i. T' b U I L D 114 G A'fL4-?VF1( bEACH, FLORIDA 22. A!.�i r IT 1 ON LEGAL W-11i"CRiPT1011 - WOOD FRAIN% L_jt. t i on d 'j6'L-' SINGLE PAMILI' FMG .0 xa,c L:l Cie 0 0 bd i Vi z,,i L-I I t�t;r' .1"A t �.3, CE'.a - - _ _. UWNER I14ORMA TION I fn I Z 0 0 0 0 C.I Name JACK GREIVER 1, ta.I F,ti-o 1E, 15. A J.u`-e in i�; 1969 BEACP AVENUE Am C:j k + Paid, 00 ATLANTIC BE.,°.CH, FLORIDA Pa hov;e COW3TRUCT REMOULING PER H,ANS CITY OF P epartmen# of PuiXbi�g �Itspertivn This Certificate issued pursuant to the requirements of Section A103 of the Southern Standard Building Code certifying that at the time of issuance this structure was in compliance with the various ordinances regulating building construction or use. B­ Date: 5:2� POST IN A CONSPICUOUS PLACE ti O T I C E T O C 0 N T R A C T 0 R S S C II L u U L h u r 1 N S P E C T I U II S Hecqueste for inspections will be accepted from 8100 All until 4100 I'll. All inspections will be made the following day between, S 1 00 All and 4100 PM. SCHEDULE OF IIISPECTIONS i 1. I"oatinp . 2. Rough Plumbing 3. Slab A: 4. F'rttminy, Rough Electrical, Mechanical, Top '.Wut Plumbing, I"ii'r.l�l.nc�r� 31t3u1ttL:LUtt ' .'rl • 5. Final Inspection G. Certificate of Occupancy ; Other inspections may be required in certain situations. Iluilding Card IIUST be posted or no inspection will be made. Pour no concrete or cover-up any work until building card is SIGNED by the inspector. You will be required to uncover any work that has not been inspected. In case of failed inspection, X10. 00 re-inspection fee must be paid prior to calling for re-inspection. ' BUILDING DEPARTMENT CITY OF ATLANTIC ' BEACH 249-2395 . ' 1'�L��rtrcliC v�cctCl — i ld7t��t 716 OCEAN BOULEVARD Lot Mo --------Section #-------- 1'.0.ROX26 ATLANTIC BEACH.FLOHIDA 32233 Subdivision: T'EIXHIONE(904)249-2395 Streit 11nme DESCRIPTION OF WORK or Addreas t If in a FLOOD HAZARD Flood Zone:--------------area complete page 3. Brief Descriptions__________ J a S • � 1�� L _�j,/l �� r Class of Works t �/f / c�y`�� •/��n�[..,, C��^/ (New/Remodel/AdditionI Z011I11G INFORMATION ( �r� ^ � Type of Construotions__ _z� y_____________ Zoning Proposed Districts use:___ 1�1D _asC,t�_____ Estimated Value Exceptions or Materials Variances Granted: Solid or ------------------------- ----------- Filled Grounds Roofs OWNER INFORTIAT1Ofi -� Method of llrntings___-----_--- -_ Property Owners� - _ ��- --- - Phones 11oiling -------- Address !- 7_ L -------------- Zip t-- `�=:` j ----- CONTRACTOR INFORMATION Vay A zc� �J Contractor: pp__ _ _ ___ _ Phones Mailing --------------------- DLIIIding and- ------------ -------------- Addres�t --------------------- Zoning. ------------------------------------------------ Zips ---------- Expiration License Humber: Dates In consideration of permit given for doing the work as described 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 all rules and regulations of the City of Atlantic Beach. �., lr;.i Al,I � S \\ Uwnr_r Signnture el --- 1 /$4 _-- — Contractor Signature Date ---------------------------- ------------ r�" FLOODPLAIN DEVELOPMENT INFORMATION '. . ..'! �'1�C...f rA '10' Y'1'.I.16 'I elopmentt' c►i.`•►, t`1 ' 'New'�'.Bui.lding'� , r AIterations,.;to. Exis ting Building Flood Zone Required Floor Elevation4 4i Actual (as built)Lowest Floor El.evati,on.. If located within a flood hazard zone.;(zone 'A) a survey trust. be made after the slab has been our ed,' certifying that` the 'lowest floor elevaE- o-ti` Is equal to ora .o.ve the base.. flood' elevat3.on ' established—lo-i- that zone . : ►:: 1� ':� +'t++. r.r.i'1►':J:!,I� I r' ' No Final Itispectioti will be made 'and No Certi,ficate''of Occupancy will be issued until the survey , is 'on"file'with':the• Bui,ldiktg Department: CORMENTS Applicant acknowledgement :' It understand that' the''issuance 'of this permit is conti.tigent upon the 'above''i.nformation'being'•correct and that the plans and supporting data have •"beeti or. shall be 'provided as required . I agree to comply with 'all applicable 'provisions of Ordinance No , 25-7-11 and all other laws or ordinances effecting the proposed developemnt . ' .1. •.+ ,,I . . ti ( ,.r•.t,i::1:t;�'Iurt.E R t ' Date Applicantis Signature '++ t .. . t:) r:• (Ia'',1l "r , r'tJl:_) I x 't ------------------..------- -,.,-.,--p--,.-,----.,- -nnP.,,.q- --- ---_. --- ------------- Department Use 1 = I Survey filed wi tli the Builditig Department on' Certified Lowest Floor Elevation Required Lowest Moor Elevation . . . . . ' Buildi,t)g Department Representative ; l ' �,�'�'' ' �� •+!;J III: i 001794 DEPARTMENT OF BUILDING u CITY OF ATLANTIC BEACH E r L> ATIO INF NATXON I' x mit N I Addx ou i 969 BEACH AVENUE' P ry t Tett : t1 4IC l A'I"t. NT +D BEACH, I~'L OR DA 32233 Close 0:f WO ilk ---- -� LEGAL '09SC�t��FTTCI� : �.I Sect�.on . Pioposed Use, RUG,,. 0 I +�Aira� D +iNr ► ubd vit Kaxx s iE ra d id is R. ! .00 Z rtPx tam. Cd . DO Totel, 04 Act- � ��a """`'. ,•'S �,s, mt sr. .5�"� .4ik � y{ �+v y��.y;. �"ria. �q ;NAPPi.ICATION t"�+l�S f ai.a 7. 50. Adder * WATER IKPACT IFEE �.. �►f3. 00 OR IIPA ellP aI�C3.K3+D fi�ggN �NI RA R OAS,, R. �}} ,rte. -, + em x" `EG 2 ` WATVR TAP 3.00 u. . ' - AtAp Sr1 :00- JACRE-INSPECT FEE $0.00 Av € NOTES: 7.tlTL NOTICE- A1L-.�4NCaE`I'E fORMBA�ialD FD©TIN.t`�SeMUST Bf INSPEGTED BEFORE'POURI � • � r� t I r PERI I'IT VOID SIX MONTHS AFTER DATE OF ISSUE BUILDING MATERIAL,RUBBISH AND etRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE CLEARED UP AND HAULED,AWAY Bl'`EITNER CONTRACTOR OR OWNER. "FAILURE TO Cow 11 ' CATH THE MECHANICS' LIEN LAW CAN RESULT IN" THE PI OPe,R" Y'll. TWICE,FOR SUILPING MPROVEMENTS: ;swwACCORDING TO APPROVED PLANS,WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR "viblATl©N OF At�PLiCABLE.PROVIStONS Ol`LAW. ATLANTIC BE CH SUIIDIN q ARTM NT CITY OF ATLANTIC BEACH, FLORIDA lye Approved by APPLICATION FOR ELECTRICAL PERMIT TO THE CHIEF ELECTRICAL INSPECTOR: DATE: 19 IMPORTANT NOTICE: IN CONSIDERATION OF PERMIT GIVEN FOR DOING THE WORK AS DESCRIBED IN THE FOLLOWING, 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 ELECTRICAL REGULATIONS, CODES AND CITY OF ATLANTIC BEACH ORDINANCES. 45 G ELECTRICAL FIRM: MASTER EL TRICIAN GNAT RE JOURNEYMAN NAME— ADDRESS: 1&.9' r�P ��A- -- RFD—BOX- BLDG. FDBOXBLDG.SIZE BETWEEN: RES.14. APT. ( ) comm.( 1 PUBLIC ( 1 INDUS. 1 1 NEW( ) OLD ( ► REW.( i ADDITION ( I TRAILER ( i TEMP.( i SIGNS ( ) SQ. FT. SERVICE: NEW( ) INCREASE ( ) REPAIR>4.- FEE _ CONDUCTOR SIZE AMPS COPPER ( ALUM. SWITCH OR BREAKER AMPS PH W VOLT RACEWAY EXIST.SERV.SIZE 2 61�-Q AMPS PH W /'ZO/OLT RACEWAY FEEDERS NO. SIZE IND. SIZE I NO. SIZE LIGHTING OUTLETS CONCEALED OPEN TOTAL RECEPTACLES CONCEALED OPEN TOTAL 0.90 AMPS. 81.100 AMPS, SWITCHES INCANDESCENT FLUORESCENT&M.V. FIXED 0.100 AMPS. OVER APPLIANCES BELL TRANSF. AIR H.P. RATING H.P. RATING CONDITIONING COMP.MOTOR OTHER MOTORS AMPS CEIL HEAT: KW-HEAT 0'1 OVER MOTORS H.P. I VOLTAGE PHS NO. 1 H.P. VOLTAGE PHS MISCELLANEOUS TRONSFARMFRS' UNDER 600 V. OVER 600 V. A P P L I C A T I O N F O R B U I L D I N G P E R M I T CITY OF At'24al c aux - 94sa4 REQUIRED SUBMITTALS 716 OCEAN BOULEVARD Each application for building P.0.BOX 25 permit will be accompanied by ATLANTIC BEACH,FLORIDA 32233 two complete sets of pians, including TELEPHONE(904)249-2395 a detailed site plan indicating location of utilities, parking, size of yards and other pertinent data; one set of Florida Energy Efficiency Code sheets; recent survey (on new construction) SCHEDULE OF INSPECTION Requests for inspections will be accepted from 8:00 AM until 4:30 PM. All inspections will be made the following working day. 1. Footing 2. Rough Plumbing/Sewer CALL IN WITH PERMIT 3. Slab NUMBER FOR EACH TRADE 4. Framing, Rough Electric, Mechanical, Top Out Plumbing 5. Insulation, 6. Final Inspection/Issuance of Certificate of Occupancy ------------------------------------ BUILDING CARD MUST BE POSTED OR NO INSPECTION WILL BE MADE Pour no concrete or cover any work until building card is SIGNED by the inspector. You will be required to uncover any work that has not been inspected. 910 fee is required for all re-inspections. PROPERTY DESCRIPTION 716 OCEAN BOULEVARD Lot #-_ ___Block #--------Section #-------- 11.0.BOX 25 ATLANTIC BEACH,FLORIDA 32233 TELEPHONE(904)249-2395 Subdivision:--------------------------------- Street Name A/q �� DESCRIPTION OF WORK or Address:_1 1 b L__ eAL�1 -- -------------- If in a FLOOD HAZARD Flood Zone:..............area complete page 3. Brief (� CCID�AG@ Description: 00 --------- ------ A s s S ��------- Class of Work: 0E (New/Remodel/Aa�#dY, u�v:ri______________ ZONING INFORMATION Type of Construction. VJO�D '�rA�� ----------------------- Zoning Proposed District: Use --------------- Estimated Value $--- -.0OQ____----__ Exceptions or Materials:__________________________ Variances Granted:_________________________ Solid or Filled ------------------------------------------- Ground:-------------Roof:----------- OWNER INFORMATION Method of Heating:__________________ Property Owner: Ti cv'. ji gr T`f -__--- ----------- -----t------------------ Phone:-------------- Mailing Address l Clio C1 __ ��`�^ ---- ----'c-=-S�C.�.---- S-I ------------------------ Zip:----3 Z 23�----- CONTRACTOR INFORMATION Co»traclorsSa,uifZ oo}>>J6 CQN1�_---------------- Phones -------------- ------- ---- - - Mailing Address: � _NQf � -�S-M---- -------=----- -- Zip: =JZZJ�O o Expiration License Number: C C _ C O3 �/ o ------------------ Date:_6_.30 " 2. 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 RE � Y 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, r REGULATIONS, ORDINANCES, OR LAWS IN ANY MANNER, INCLUDING THE GOVERNING OF CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION OF THE PROJECT. I UNDERSTAND THAT THE ISSUANCE OF THIS PERMIT IS CONTINGENT UPON THE ABOVE INFORMATION BEING TRUE AND CORRECT AND THAT THE PLANS AND SUPPORTING yss+!?Frlra� DATA HAVE BEEN OR SHALL BE PROVIDED AS REQUIRED. Date ___ Owner Signature .: � - - Contractor Signatur ___Date_/ 2-------- r FLOODPLAIN DEVELOPMENT INFORMATION Type of Development: -------------------------------------------- Flood Zone: ----------------------- Required Lowest Floor Elevation: --------------- If building is located within a flood hazard zone, a survey must be made AFTER THE SLAB HAS BEEN POURED, certifying that the LOWEST FLOOR ELEVATION is equal to or above the base flood elevation established for that zone. No final inspection will be made and no certificate of occupancy will be issued until the survey is on file with the Building Department. COMMENTS: Applicant Acknowledgement: I understand that the issuance of this permit is contingent upon the above information being correct and that the plans and supporting data have been or shall be provided as required. I agree to comply with all applicable provisions of Ordinance No. 25-7-11 and all other laws or ordinances affecting the proposed development. Date--------------Applicant's Signature-------------------------- ---------------------------------------------------- Department Use Required Lowest Floor Elevation ----------------- As Built Lowest Floor Elevation Survey Filed Filed with Building Department ----------- ----------------------------------- Building Department Representative page 3 y 01 .8 DEPARTMENT OFBUILDING CITY QF ATLANTIC BEACH P'ERNITffNA ' Gt *it Nuobox i 1 -------- LOCATION 'Tur ftMATTON ,amt T' Add�re� s' BEACH AVENUE Fa BIILDAt C t 0-f Work x Abfw�IT t?N A"I`f.AKTIC ORACIF, FLORIDA RIDA 32233 k "' LEGAL DESCRIPTIO � 'Constr. ,, �`5't�t'.3 Wt1D F`NAl�1i" <I..�'st,x �.� ---------- Pr aPowed U�ol gjg FAMILY 81a asks Dwell iog x O Cod*, f? 'la t E a page: Q F Estimated' Value t Subd�.�r�.�r3 on t " C i OCt pr► 7x Ct V. 1} OWNER INFORMATIONi , 00.00 Name x JACK 6IR I DER Amo-u 00 Adds'eaas' 1,960 BEACH AVENUE r0*C �ATL _ANTIC� BEA.CN, FLORIDA 32233 Pi# P"' �� ay'L. Cv D # F F ION FEES% :a 4�;5 ''ER!' . W WATER It'fp4 FEE ad �r r rc /r 'RADON GAS-R. R. S. ���i' �U� '►Ilt�� r� :. ... . . *10. 00 WATER TAF. � I `0 HYDRAULIC SHARE so, 00 R E-I NSPCC' FEE 00.00 NOTES- NOTICE-ALL CONCRETE:FORMS AND FOOTINGS MUST BE INSPECTBd BEFORE POURING PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE :BUILDING MATERIAL,RUBBISH AICD DEBRIS FROM THIS WOR 'CLEARED UP AND HAK MUST NST 8E PLACED IN PUBLHAULED AWAY$YYfHER CON CONTRACTOR OR OWNER. C SPACE,AND MUST BE `FAILURE TO COMPI X WITH THE MECHANICS' THE PR®PER7`Y ©INNER PAYING TWICE FOR BU LIEN LAW CAN RESULT IN BUILDING IMPROVEMENTS." �t1Ed AC+CORDlN0 TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUB t NOF APPLICABLE PROVI$iCJNS OF LAW. JECT TO RE V4CATIO V FOR DH BUtk�D1NG DEt#f > 1! siT; X i 3 + Y xA r tt�S 13 10 {'. ` PPP AR 0;1C 8 ASH \�v v 2 Y is { is a�a i �v'Ty IN Building and Zor CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 J131�r- Application Number . . . . . 04-00029245 Date 11/04/04 Property Address . . . . . . 1969 BEACH AVE Application description . . . MECHANICAL ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 Owner Contractor ------------------------ --- --------------------- GREIDER, JACK FLORIDA WEATHER INC. 1969 BEACH AVENUE 1117 BEACH BOULEVARD ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32236 (9 04) 249-1290 ------ ----------- ---------------- ------------- ------- ----------------------- Permit . . . . MECHANICAL PERMIT Additional desc . . Permit Fee . . . . 79 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Fee summary Charged Paid Credited Due ------ ----------- ---------- ------- --- ---------- ---------- Permit Fee Total 79 . 00 79 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 79 . 00 79 . 00 . 00 . 00 PERmff IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES u BUILDING OFFICIAL r , CITY OF ATLANTIC BEACH MECHANICAL PERMIT APPLICATION Date: loic /wner of Property: D V� PeJ / b Address:: ?6q &,nJj Contractor: F7CO4/D 14 r�� / 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 ordinances and standards of good practice listed therein. III. GENEP,,AL INFORMATION A T of heating fuel: B. Electric IS OTHER CONSTRUCTION BEING DONE ON THIS ❑ Gas: —LP Natural _Central Utility BUILDING OR SITE? K10 ❑ Oil ❑ Other–Specify IF YES,GIVE NUMBER OF CONSTRUCTION PERMIT IV. MECHANICAL EQUIPMENT TO BE NATURE. I WORK _ INSTALLED V Residential or Commercial New Building (Provide complete list of components on back of this form) Existing Building 0 Heat _Space _Recessed _Central _Floor Replacement of existing system O Air Conditioning: Room Central 0 New Installation(No system previously installed) O Duct System: Material Thickness 0 Extension or add-on to existing system Maximum capacity c&n ❑ Other-Specify 0 Refrigeration ❑ Cooling tower: Capacity gpm ❑ Fire sprinklers: Number of heads THIS SPACE FOR OFFICE USE ONLY ❑ Elevator: _ Manlili_Escalator (Number) (Received) Cl Gasoline pumps (Number) 0 Tanks (Number) Remarks 0 LPG containers (Number) Cl Unfired pressure vessel Permit Approved by Date O Boilers ❑ Other–Specify Permit Fee LIST ALL EQUIPMENT AIR CONDITIONING AND REFRIGERATION EQUIPMENT Number Units Description Model Number Manufacturer Capacity Approving (T4s) Agency 1 Cove Ser' 4 s HEATING–FURNACES,BOILERS,FIREPLACES Number Units Description Model Number Manufacturer Capacity Approving T A enc TANKS How Many Nominal Capacity Type Liquid Name of Serial Approving And Dimensions Contained Manufacturer No. Agency 800 Seminole Road•Atlantic Beach,Florida 32233-5445 Phone:(904)247-5800•Fa::(904)247-5845• httn://www.ci.atlantic-beac".us I/I4/03 Address — Heated Square Footage @ $ per sq ft = $ Garage/Shed @ $ per sq ft = $ ' Carport/Porch @ $ per sq ft = $ Deck @ $ per sq ft = $ Patio @ $ per sq ft = $ TOTAL VALUATION; Total Valuation 1st $ Remainder Valuation per thousand or portion thereof --------------------------------------------, Total Building Fee $ ADDITIONAL PERMITS and/or FEES REQUIRED j + 2 Filing Fee Mechanical ; Fireplaces @ 15.00 $ Plumbing j BUILDING!PERMLT FEE $ Electric/New ------------------------------------------------- Electric/Temp Septic Tank BUILDING PERMIT $ Well WATER METER CHARGE $ Scai1iuting Pool SEWER IMPACT FEE $ Sign WATER IMPACT FEE $ Water Connection MISCELLANEOUS $ Sewer Connection $ Water Meter $ Elevation Certificate GRAND TOTAL DUE ---------------------------------------------------------------------------------------------- CALG'ULATIONS and/or NOTES PLANS REVIEW CHECK LIST Address1iS�G+�� i�- ----------Owner - j���i�--------------- Legal Description_4'ef 4�p -------Contractor__2 --------------------------- -----____--License Number License on File YES NO Section 24-101 * Zoning Regulations Zoning District-------------- Proposed Use Required Lot Size Actual Lot Size ___��k.... Setbacks Required Provided Section 24_17 front -------- CORNER LOT INTERIOR LOT rear --- - ------ Flood Zone side-1 ✓ _____ __ ___ ____ Required Elevation ........ side-2 -------- -------- Max. Height Allowed__________ Proposed Height____ Section 24-82 * Minimum Lot Coverage Required Heated Area ________ Proposed Area_____________ Section 24_161 * Offstreet Parking Number Spaces Required_______ Spaces Provided Section 24-82 * Duplicate Buildings Is there a similar building within 500' of proposed building?YES NO Utilities Water and sewer service is to be provided by: ----- Buccaneer Utilities _____ City of Atlantic Beach Utilities ----- Private Source SEPTIC TANK WELL Plans Reviewed by%------------------------------Date ---------------- Building Permit #__________ ISSUED DENIED CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 09-00001209 Date 8/26/09 Property Address . . . . . . 1969 BEACH AVE Application type description RESIDENTIAL OTHER Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 2000 ---------------------------------------------------------------------------- Application desc NEW FRONT DOOR ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ GREIDER, JACK SUNSHINE COAST CONSTRUCTION 1969 BEACH AVENUE 513 VIKINGS LANE ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233 (904) 208-1084 ---------------------------------------------------------------------------- Permit . . . . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 40 . 00 Plan Check Fee 20 . 00 Issue Date . . . . Valuation . . . . 2000 Expiration Date . . 2/22/10 ---------------------------------------------------------------------------- Special Notes and Comments *2007 FLORIDA BUILDING CODE W/ 105- 106 SUPPLEMENTS . 2007 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. WINDOW AND DOOR INSPECTION: *INSTALLATION INSTUCTIONS REQUIRED *ALL STICKERS ARE TO REMAIN ON THE WINDOWS *PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 40 . 00 40 . 00 . 00 . 00 Plan Check Total 20 . 00 20 . 00 . 00 . 00 Grand Total 60 . 00 60 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. `rat�.•�.r`l"r�ri `IS CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD > ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 P� Application Number . . . . . 09-00001803 Date 12/02/09 Property Address . . . . . . 1969 BEACH AVE Application type description RIGHT-OF-WAY PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc CONCRETE DRIVE TO PAVERS ---------------------------------------------------------------------------- Owner Contractor ------------------------ --------- --------------- GREIDER, JACK OWNER 1969 BEACH AVENUE ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit . . . . DRIVEWAY PERMIT Additional desc Permit Fee . . . . 35 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 5/31/10 ---------------------------------------------------------------------------- Special Notes and Comments Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible . Note that septic to sewer conversion will be required in the future . It may be a good idea to have a contractor install the sewer line before the driveway is built . Cannot block Beach Avenue at any time . ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 35 . 00 35 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 35 . 00 35 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. 10 10123/2009 09:42 9047335515 PAGE 02/02 ,1b1'AP SHOWING SURVF'Y OF Recorded in Plat — .........- _ --------Public Records o!AutW Co..eta. lor:.HiQ.l�....Q.�,�.��__.................................................. LEGEND ron e Denote lron EU R. L. CROASD , tsc CObJP'A,NX Nor INC, x-■-a..i Denote*rate CIVIL ENGINEERING & SURVEYING Date...✓��f�/7... s'AK wnnt.e remanent 4,29 Cast Adams Srreef • Jacksonville, Fld, Seale I"� �Q_ _ Reference 1.1to"ent - aFCEeI'111- // [] /��]� hk, Ll5A N,ert^C7dK •' 7 4 ,7 /T I /C, f f /Y ,5'Q'� r N CERTIFICATION: This survey meets the nti minimum technical standards for a boundary survey as set Forth by the �5 10 C , Florida 0oard of Land Surveyors, pursuant to Section 472.027, Florida Statutes. SIGNED: 'yf � j Ito e to a w 2�3 .57'ORY c,g. CON(. 1310CR ILE coPY Fi Yo-n�,Na,/969 - � r ts, 4 - io.e' 3z.r• o/. ftr 7'f FILE C ,r; •Cont. ';Q 'rd.. 50-06' rr^` N 6,4R,4 PL's LSI i. (]l / I 0, `IJ R0,4 fY 14/ sob xxv.Si0f0 54072.59005 p . City of Atlantic Beach APPLICATION NUMBER Building Department h C 1 3 20 1)9 (To be assigned by the Building Department) 800 Seminole Road _ Atlantic Beach,Florida 32233-5445 s� Phone(904)247-5826. . Fax(904)2 --=- E-mail: building-dept@coab.us Date routed:- City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 1910 / ��Q.C/� � Department review required Yes No Building Applicant: &4Planning&Zoning T minrstraior Project: C(5� 'i✓E 'T TAVfe-S lft�=s Public Safety Fine Services e e Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept of Environmental Protection Florida Dept of Transportation St.Johns River Wa6er Management District Amry Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other. APPLICATION STATUS Reviewing Department First Review: proved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by: �w Date: �tl TREE ADMIN. Second Review: roved as revised. IPP []Denied.' PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: QApproved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 0514409 CITY OF ATLANTIC BEACH s 0\ti CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS 800 Seminole Road 904-247-5800 ;i Ail 5445 Fax 904-247-5845 antic Beach,Florida 32233 Date � � ��} � [PERMIT# SUED BY THE CITY Job Address r Ci } �� I'►1'� �L Permitee: � L�� L7Y�L�Q./���I Telephone# 61 Permittee Address: CA , '.a 0111 1 Off` Requesting Permission to Construct: �l� l �` I I�dl h�t � U'Q` Vel PA�tl;✓�`� Location: (Reference to Cross-Street) 1. Applicant declares that prior to filing this application he has ascertained the location of all existing utilities, both aerial and underground and the accurate locations are shown on the sketches. A Letter of Notification was mailed to the following Utilities/Municipalities: ii will Gra 0., Jacksonville Electric Authority Yes( ) No ( ) Date: Bell South Telephone Company Yes( ) No ( ) Date: Ferrell Gas Yes( ) No ( ) Date: Comcast Yes ( ) No ( ) Date: 2. Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation, alteration or relocation of all, or any portion of said street or easement as determined by the Director of Public Works, any or all of said poles, wires, pipes, cables or other facilities and appurtenances authorized hereunder, shall be immediately removed from said street or easement or reset or relocated hereon as required by the Director of Public Works, and at the expense of the Permittee unless reimbursement is authorized. 3. All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the supervl Ion of �G/s- /�� 7 (Contractor's Project Superintendent)located at 3/5 /3yS' �4X Telephone#: 5'3� O¢// 4. All materials and equipment shall be subject to inspection by the Director of Public Works or his designee. 5. All city property shall be restored to its original condition as far as practical, in keeping with city specifications and the manner satisfactory to the city. 6. A sketch of plans covering details of this installation, as well as, a copy of a recent survey shall be made a part of this permit. Calculations showing any 'increase in impervious ,area on owner's lot or in the city Right of Way are to be included with this application. 7. This permittee shall commence actual construction in good faith with 20 days. If the beginning date is more than 60 days from date of permit approval, then permittee must review the permit with the Director of Public Works to make sure no changes have occurred in the area that would affect the permitted construction. 8. It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right, title and interest in the land to be entered upon and used by the holder, and the Holder will, at all times, assume all risk of and indemnify, defend, and save harmless the City of Atlantic Beach from and against any and all loss, damage, and cost of expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges. 9. The Director of Public Works shall be notified twenty-four (24) hours prior to starting work and again immediately upon completion. OWNER � Signed: .r��_ - — Date: r c°i �•�.' � Before met/s <:�21dayof V L� in the County of Duval, ANDREA W.SSR State Of Florida, has personally appeared TA C�C_ LL - 4 -- o fJi���f T<+' NOTARY PUBLIC Notary Public at Large,State of Florida,County of Duval./ STATE OF FLORIDA My commission expires: �[�/ 11 L `47,&14 � ) , .� Comm#DD0928443 Personally Known: ✓ oLrl Expires 9/28/2013 Produced Identification: "X CITY OF ATLANTIC BEACH 08-Qv I I I I I P7800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 OFFICE:(904)247-5826 a FAX NO.:(904)247-5845 BUILDING-DEPT@COAB.US BUILDING PERMIT APPLICATION DUVAL COUNTY 1,JOB ADDRESS: 2 VALUATION OF WORK: 3.SO.FT.UNDER ROOF i 13 .u.Gli Nitnut, s b�o 4.LEGAL DESCRIPTION: 5.CLAss OF WORK: 6.USE OF STRUCTURE: 413(� NEW BUILDING ❑DEMOLITION RESIDENTIAL LOT `�BLOCK_SUB DIVISION ❑ADDITION ❑CONVERTING USE ❑COMMERCIAL 7.DESCRIPTION OF WORK: ALTERATION 11ACCESSORY BLDG. 8.FIRE SPRINKLER: X610 o G''ANG 04&1/6' w 'elj4e /Ad/E� J�, ❑REPAIR ❑POOL/SPA ❑YES NIA ❑MOVE ❑OTHER ❑NO PROPERTY OWNER: CONTRACTOR: ARCHITECT I ENGINEER: 9.NAME: 15.CO Y NA E: 23.COMPANY NAME: �r JT tck'� 6YV Alf"Wil 16.NAMEr 24.LICENSEE NAME: 10.ADDRESS: mnGiL 17.STATE/�'OF FF1L/OiRI'DA LICEINSEINO.: 25.STATE OF FLORIDA LICENSE NO.: 14'&1 &C 1, 18.ADDRESS: 1 � � 26.ADDRESS: maw4iC 06(hSIS 131 &O 1 .OFF CEQ�IF t 12.FAX NO.: 19.OFFICE PHONE:I' 20.F NQ: '0 27.OFFICE PHONE: 28.FAX NO.: 13.CELL PHONE LJ• 21.CELL PHONE`ISTL-3 /�,� �•'t7]` 29.CELL PHONE: 14.EMAIL ADDRESS: 22.EMA11.7ADD S: ✓ �/y v nes �y 30.EMAIL ADDRESS: SIMPLECljtr FEE TIAL (IF OTHER THAN OWNER)HOLDER: /�V BONDING COMPANY: Gr MORTGAGE LENDER: 31.NAME: 33.NAME: 35.NAME: 32.ADDRESS: 34.ADDRESS: 36.ADDRESS: 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 laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6)months, or if 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, Air Conditioners,etc. 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. I will not occupy or use the referenced building or any part therof, until all inspections are finaled and prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law. *** 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. - OWNER or A ENT CONTRACTOR 0f an of Attorney cr Ag atter Required) (Qualifier Only) Signed: Date:z 0 Signed: Date: Before me this day of 2001 in the county of Before me this day of 2007 in the county of Duval,State of Florida,has personally appeared Duval,State of Florida,has personally appeared herin by himself/herself and affirms that all statements and declarations are herin by himself/herself and affirms that all statements and declarations are true and accurate. true and accurate. Notary Public at Large,State of �- County of Notary Public at Large,State of__,County of -ET-Personally Known ❑Personally Known ❑Produced Identification-_ ❑Produced Identification- Notary Signature: -! ,(�r ,mss t �1�- / Notary Signature: iwr ReA tai.BEYER ',;(J 1 ARY .'IJRLIC COAB FORM BLDG01:REVISED:'.!=?TA,i E OF FLORIDA ;ornm#coon A43 4 f , ires 9/28!2013 R.O.W. Permit Attachment of for R.O.W. Permit# issued 72005 Atlantic Beach, FL 32233 Owner's Name: J Q CtL 6yn d ein Property Address: (t CO �ti °tom Subdivision: Lot#/ Block#: 0 R.E. #: opo► REVOCABLE ENCROACHMENT PERMIT THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of , 29e, by Atlantic Beach, Florida, a municipal corporation organized and existing under the laws of the State of Florida, hereinafter referred to as "CITY" and of Atlantic Beach, Florida, hereinafter referred to as "USER". WITNESSETH: That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon the property of the City of Atlantic Beach for the purpose as described in the City of Atlantic Beach Right-of-Way/Easement permit numbers noted above (copies attached). This work is generally described as: (Oacinq 415+1ha (w6 . Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to relocation or removal on thirty (30) days notice by CITY to the USER, said notice to USER shall be given by certified mail, return receipt requested, to the following address: The depositing of said notice of cancellation in the United States mail shall constitute the notice of cancellation and the burden is upon USER to keep the CITY informed of USER's proper address. The USER shall promptly make any and all necessary repairs to any facility erected or maintained in the exercise of the privilege herein granted and shall at all times maintain said facility in good and safe condition. In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter upon the above-described property of the CITY, the USER shall replace at the USER's sole expense, any and all material necessarily displaced during the action of maintaining, repairing, operating, replacing, or adding to of the utilities and facilities of the CITY or franchise utility provider. The facilities allowed by the permit shall meet the current requirements of the City Code, Building Codes, Land Development Code, and all other land use and code requirements of the CITY. The USER, prior to making any changes from the approved plans and/or method, must obtain written approval from the City of Atlantic Beach, Public Works Department, for said change. The Page I of 2 USER shall, at the discretion of the CITY, be requested to submit as-built drawings showing the change within thirty (30) days after the day of completion. This permit shall inure to the benefit of, and be binding upon, the USER and their respective successors and assigns. USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or specifications, to include utilities locate requirements and use limitations/requirements of public rights-of-way and other public land. USER further agrees that the CITY and its officers and employees shall be saved harmless by the USER from any of the work herein under the terms of this permit and that all of said liabilities are hereby assumed by the USER. C, DATED and SIGNED this _day of 0,9r Ahem ,2001. CITY OF ATLANTIC BEACH, FLORIDA, By: a municipal corporation: Prope Ow : BY / /�a �2wc � 1 nJ✓ Jim Hanson, ty anager Attest: 101 RickTarper,j#ublic Works Director STATE OF FLORIDA COUNTY OF DUVAL On this <I day of200 , personally appeared before me, a Notary Public in and for said County and State, um-f k-v,,u 1_ , the property owner of 'Mi--kc L . 61 4DE-re,�/�., Atlantic Beach, Florida, known to me to be the person(s) described in and who executed the foregoing instrument; who acknowledged to me that he or she executed the same freely and voluntarily and for the uses and purposes therein mentioned. Notary Public in for said CountylaState Pr erty Oer (to be signed in presence of the Notary) ANOMI+W.M"K a'su- cJARY PUISLIC STATE OF FLORIDA Expires 3126,,2013 Page 2 of 2 NOTICE OF COMMENCEMENT State of � Tax Folio No. County of I)vy-aA 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 COMMENCEMENTi�'„ ' yi' Legal Description of property being improved: /-,C+ &Q NCY41 anhe, d CE7 Vi yL. Address of property being improved: I it 11 Wa a-, e n VIC- General description of improvements: 'rt I�( ls�l n�� C�Y��iA`� � a� ���' �� vj,o„aj6tl 4 on L 5 lA re- - bo e �- /� Owner: �i C� e � Address: 40_ �u �c���L4 tLc J " Owner's interest in site of the improvement: (✓Le Fee Simple Titleholder(if other than owner): Name:�/� Contractor: ! Y t o i,-OCL ii�a ���,, t, Address: �1� t /'I Y� a x ful h Telephone No.: Fax No: -� 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: Address: 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 (I)year from the date of recording unless a different date is specified): THIS SPACE FOR RECORDER'S USE ONLY OWNER Signed: % _ tom- Date: L5Q Before me thi,( _ day of Oct- _in the County of Duval,State £{OM?,.jI+se ld '3 Of Florida,has personally appeared .1 4 C_K- L• 2"SZ60G❑#wuiu'-), Notary Public at targe,State of Florida,County of Duval. 11Q12ifJI-�in l'�i1,r', Nty commission expires: - 1,3 onen ci MfibPersonally Known: t/ or Produced Identification: ai:�39'M�ls�lu�dU ` 8re � � �? - gCRIVED City of Atlantic Beach APPLICATION NUMBER Building Department OCT 2 1 2009 (To be assigned by Building Department:) 800 Seminole Road Atlantic Beach, Florida 32233-5445 >. 199 " d Phone(904)247-5826 • Fax(904) - .+ E-mail: building-dept@coab.us Date routed: City web-site: http://Www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: �9� / ��QC/� � Department review required Yes No .Building Applicant: Lr/Q ��1C ,�E� f Planning &Zoning nn -- Tr ministrator Project: Y714-4--2�'%Vpf, TD TAVE4S s Luc uflmft Public Safety Fire Services 'IM117101 00 11", Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B Florida Dept.of Environmental Protection Florida Dept of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: Approved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: a- �O TREE ADMIN. Second Review: [-]Approved as revised. ❑Denied. PUB I C W@ KS Comments: BLI TI ES PUBLI AFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05114.109 Public Utilities Plan Re-i iew Comments Date: f o 21 IG)J Initials: Project Name/Address: I q�� Fe0.c� AUe APPfication Permit-#: .Check Box Application Tracking Comments to Add Comment Avoid damage to underground water/sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is needed, call ❑ 247-5834. Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and 2 � visible. A sewer cleanout must be installed at the property line. Cleanout must be covered with an RTI concrete box with metal lid. Cleanout to be set to grade and visible. A reduced pressure zone backflow preventer must be installed if irrigation will be provided or if there is a private well on the property. Backflow preventer must be ❑ tested by a certified tester and a copy of the results sent to Public Utilities. Plans note the building will be unsprinkled. If plans change, any fire line installed must be metered with a Sensus touch-read meter in a properly sized vault and an ❑ appropriate backflow preventer installed. Backflow preventer must be tested by a certified tester and a copy of the results sent to Public Utilities. If fire sprinkler system is provided, contact Malcolm Clemons at 247-5839 for backflow requirements. At a minimum, will require double check backflow ❑ preventer. Fire lines must be metered with a Senses touch-read meter. Meters larger than 2" ❑ must be installed in a vault as noted in JEA specifications. 41 I(Ia`e 4W s4p/05,C !/V Cmn uers/cv'J6e a4o'—"' /71AV 'X Awe, 104io ,fi r, A4P ° NOTICE OF COMMENCEMENT State of rico da- Tax Folio No. County of ous o 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 COMMENCEMENT Legal Description of property being improved: L.V+ &0 NcAO A+fayIh4, (-)xa((7 Urv,4 Z Address of property being improved: iq i &a al n u- General description of improvements: repwu tyl S k h (spry-rete o U'e uJ IV" o Q d�-Fi o r a-l 5 re, Owner: & yt tdti� Address: a ell , &aa—, Owner's interest in site of the improvement: Fee Simple Titleholder(if other than owner): Name:�/� Contractor: I Y �0 t22ol a Address: ' 1 Telephone No.: Fax No: 2A Z—0!%- 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: Address: 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 from the date of recording unless a different date is specified): THIS SPACE FOR RECORDER'S USE ONLY OWNER Signed: Date: ,5 Before me th', day of tt" in the County of Duv I,State £LOZI9,/S 99jlebe3 Of Florida,has personally appeared _j fq CK t £1r►9Zfif;' a#wuroD Notary Public at Large,State of Florida,County of Duval VataO"t�A0 1of1.S=. My commission expires: DIl9(1c J.1?b i i>i Personally Known: I/ or a�y 1 > �Z�B13'M d�cluid'd Produced roduced Identification: