Permit Remodel Bath 664 Beach 2011 , " - � CITY OF ATLANTIC BEACH
`
7- , ' TEL
800 SEMINOLE ROAD
- ATLANTIC BEACH, FL 32233
J
INSPECTION PHONE LINE 247 -5826
`"401•119
Application Number . . . . . 11- 00001806 Date 3/18/11
Property Address 664 BEACH AVE
Application type description RESIDENTIAL OTHER
Property Zoning TO BE UPDATED
Application valuation . . . 7500
Application desc
SEE ATTACHED APP
Owner Contractor
MELANCON, DEJEAN OWNER
664 BEACH AVE
ATLANTIC BEACH FL 32233
Permit BUILDING PERMIT
Additional desc .
Permit Fee . . . 90.00 Plan Check Fee . . 45.00
Issue Date . . . Valuation . . . . 7500
Expiration Date . 9/14/11
Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONALELECTRIC 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
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 90.00 90.00 .00 .00
Plan Check Total 45.00 45.00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 139.00 139.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
NOTICE OF COMMENCEMENT
State of
/ ^+4 ` ' �' -- Tax Folio No.
i
County of ,,,t1 a. °: , .
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:
Address of property being improved: ' < -! % A1��'� 7V t o `c:x L h -f { L., r'
i
General description of improvements: � . r ,e,L.Y'te, ' f : °"L
Owner: ` ,) t-- ' 1/4 i 2, LatkeiC /fie k ito ,. Address: ( !; `C i -;-(11 A `jG.) -p (. z J / / W1 t,. 6+ 4' ,:it : 7 :t .
Owner's interest in site of the improvement: ll j!,!I;c. - A..-Y.J 'll,
Fee Simple Titleholder (if other than owner):
Name: r'•. l - f
- �.i?Jl1 (`
Contractor: t irk /� , �(ij(
Address: 626 te A ' A1! Yf P i f�',�,�Cttl`' i 4 4 . e � l,( 53,( "
Telephone No.: j C - 1:219 - !)4' 7r Fax No: q ` f j66 c%/
Surety (if any) i /A
Address: Amount of Bond $
Telephone No: Fax No:
i
K v o h'ace i o u
L10C # ,:ii ,:ii t =: ilti GLb , `J ,'i. K "i "
Name and address of any person making a loan for the construction of the impro' Number ages 2Q1 at 04104 PM
JIM -- FULLER CLERK CIRCUIT COURT DUVAL
Name: COUNT`,'
Address: RECORDING $i0 00
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: f. /..,-
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 OWNE y +
Signed: -d:
(, (, �I - �--- �- Date: �� �f /¢
:' 'l. ' ANGELA V. SCARBOROUGH Before me this 1 t day of in the County of Duval, State
°� = " MY COMMISSION # EE069645 Of Florida, has personally appeared r� .P' a_ r. 0- Q 1, r
� Notary Public at Large, State of Florida, County of Duval.
-'�;,;', EXPIRES March 14, 2015 � L{ Z U l
My commission mA -
mission expires: ,-
(407) 398 -0153 FloridaNOtaryServica.com Personally Known: +'--- or
Produced Identification:
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233 [E @ 0
Office (904) 247 -5826 Fax (904) 247 -5845 Il
(o 4 -{ B EA D A &Xv c.� - Af 1. 54C/ 1 I - " Y
Job Address: Permit Nu � I ber: ,,
By
Legal Description Parcel #
n Floor Area of Sq.Nt. , / t
' l l J
Valuation of Work $ Cb Proposed Work heated /cooled ''t`) -i non- heated/cooled
Class of Work (circle one): New Addition ' teratio i Repair Move Demolition pool/spa t ' I do t door
Use of existing /proposed structure(s) (circle one): Commercial ' - side.
If an existing structure, is a fire sprinkler syst m installed? (Circle one): No N /A
Florida Product Approval # /293.3 6v; Qem
For multiple products use product appro for •
Describe in detail the type of work to be performed: CI L /�� l R pl erAabt-
w 1 U' / pr j kph c. e feeln,L. d - h 6/11(
Property Owner Information:
Name: EakI Al ebitCet..1 Address: U4 P,EA-11 AVenILI.& Af c
City : % ac State I " Zip Phone 16 Q��
E - Mail or Fax # (Optional) in- a AJC J ' , c
Contractor Information: �
Company Name: Qualifying Agent:
Address: City State Zip
Jfdce Phone Job Site/ Contact Number Fax #
State Certification/Registration #
Architect Name & Phone #
Engineer's Name & Phone #
ee Simple Title Holder Name and Address
3onding Company Name and Address
Mortgage Lender Name and Address
fpplication 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
ssuance 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
ind void i`'work is not commenced within six (6) months, or if construction or work is suspended or abandoned for a eriod of six r6) months at any time after
vork is commenced. I understand that separate permits must be secured for Electrical Plumbing, Signs, W ells, Pools, Furnaces, Bo Heaters,
ranks and Air Conditioners, etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COM ENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
hereby certify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
ype 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 other federal, state, or local law regulating construction or the performance of construction. „ •..,,,
>ignature of Owner Litt Lre ∎A Si tra
j G --7 '
il
'riot Name Gi MEbkicelo f L v
AMRYIU.zYM{1M
;worn and subscribed before me Sworn to ana suvscrib'alieTre me w
hi 'l ay of 'n/l a 20 RE��) R C ODE f'(1MPj,j jf'Ei , 20 il
f,� U , �c�, CITY OF A _ LAN _ TIC BEACH
dota bhc . „e " *.. ; AN LA V. SCARBOROUGH No : ;5 11 ,, �� ' ' '"" 11 • 1 I '� ' "_ MY COMMISSION # Et<069o45 ,` 1 . • NTS AND CONDITIONS.
' ' " ' ` a' m Revised 01.26.10
' ?o.; EXPIRES March 14, 2015 '�i ---
(407) 398 -0153 Florida NotaryService.co m REVIEWED BY: DATE• J ^w `" 1
// . : t t it s
�
/ CITY OF ATLANTIC BEACH ' .___ } , r ®WNER / BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING" REQUIRES OWNER / BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT
LAW. THE EXEMPTION ALLOWS YOU, AS THE OWNER OF YOUR PROPERTY, TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST
SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE — OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST OF $25,000.00 OR LESS. THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
0. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND /OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455 - 228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT (247 -5826) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER- BUILDER PERMIT.
(t each -Avoq oz 1 t I clog - 5o9-a (priT
ADDRESS �! - PHONE NUMBER
',./(-5.2N1 191 r 94.
PRI AME
E / 0
SIGNATUR DATE
Before me this l { day of Wfl c 1^ 201t in the county of
Duval, State of Florida, has personally appeared . herin by himself / herself and affirms that
all statements and declarations are true and accurate.
� 11
Not, ` L Public at Large, State of .- , County of d
Personally Known tir " ANGELA V. SCARBOROUGH
❑ Produced Identification - ,' ' ' -' �:•: MY COMMISSION # EE069645
' -74
Notary Signature �`� V EXPIRES March 14, 2015
�i �//� L .- V - (407) 39 3 FloridallotaryService.com
� �/� � �'7� -
F: BLDG / Owner - Builder Affadavit; REVISED: 4/16/2009 U
CITY OF ATLANTIC BEACH PRODUCT APPROVAL SPECIFICATION SHEET (short form)
As required by Florida Statute 553.842 and Florida Administrative Code 9B -72, please provide the information and approval
numbers on the building components listed to be utilized on the construction project for which you are applying. We
recommend you contact your local product supplier should you not know the product approval number for any of
the applicable listed products. Statewide approved products are listed online @ www.floridabuilding.org
Category/Subcategory Manufacturer Product Description FL Approval # (s)
EXTERIOR DOORS
a. Swinging
b. Sliding
c. Sectional /Roll Up
d. Other
WINDOWS
a. Single /Double Hung
b. Horizontal Slider
c. Casement
d. Fixed L (1E) I 01 / I a quo I rpAd )z 9N,3
e. Mullion
f. Skylights
g. Other
PANEL WALL
a. Siding
b. Soffits
c. Storefronts
d. Glass Block
e. Other
ROOFING PRODUCTS
a. Asphalt Shingles
b. Non - Structural Metal
c. Roofing Tiles
d. Single Ply Roof
e. Other
STRUCTURAL COMPONENTS
a. Wood Connectors
b. Wood Anchors
c. Truss Plates
d. Insulation Forms
e. Lintels
f. Others
NEW EXTERIOR ENVELOPE
I understand that, at the time of inspection, the following information must be available to the inspector on the jobsite:
1. A copy of the product approval.
2. The list of performance characteristics which the product was tested and certified to comply with.
3. A copy of the applicable manufacturers' installation requirements.
Furthes,l undecstand a product may have to be removed if approval cannot be demonstrated during inspection.
DC/ 37/ 7 1 /
Applic 47. ignature Date
H: /Product approval spec sheet short form.xlsx
EXISTING CONDITIONS 11' -4" 11' -10"
3' -10" 5' -8" „ =5"
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5' -8" 1' - 6y" 2' -8" 2' -8' 7' -8y"
11' -4" 0 ' -2'
39' -0"
2nd FLOOR PLAN
Scale= 1/4' - 1'
12' -10"
7' -2" 5' -8" 4' -7"
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I:4\ Project: 664 Beach Avenue, Atlantic Beach
Date: 3/15/11
THIS INSTRUMENT PREPARED BY:
Richard C. Peper, Jr., P.A.
8833 Perimeter Park Blvd. #602
Jacksonville, Florida 32216
RECORD AND RETURN TO:
Richard C. Peper, Jr., P.A.
8833 Perimeter Park Blvd. #602
Jacksonville, Florida 32216
RE PARCEL ID #:
BUYER'S TIN:
WARRANTY DEED
THIS WARRANTY DEED made this 16th day of March, 2011 by Polly Bell a /k /a Pauline C. Bell, an unremarried
widow., hereinafter called Grantor, and whose address is 303 Peacock Dr. NW, Marietta GA 30064 to Dejean Melancon
Jr. and Laurie C. Melancon, his wife., hereinafter called Grantee and whose address is 664 Beach Ave., Atlantic Beach,
Florida 32233.
(Wherever used herein the term "grantor" and "grantee" include all the parties to this instrument and the
heirs, legal representatives and assigns of individuals, and the successors and assigns of corporations.)
WITNESSETI
TI - IAT the Grantor, for and in consideration of the sum of Ten and NO /100 Dollars and other valuable
considerations, receipt whereof is hereby acknowledged, hereby grants, bargains, sells, aliens, remises, releases, conveys
and confirms unto the Grantee, all that certain land situate, lying and being in Duval County, Florida, viz:
The East 75 feet of Lot 5, Block 16 of Daniel & Ilackett's Replat of Block
16, Atlantic Beach, according to plat thereof as recorded in Plat Book 9,
Page 35 of the public of Duval County, Florida
Signed, seal- d and delivered in our presence:
zir
Cm1 ./
,ness Signature Polly Bell
reg./9 / /
e
Witness l'rintect ignature-
Vc‘
ityess Sign
Witness Printed Signature
STATE OF GEORGIA
COUNTY OF
The foregoing instrument was acknowledged before me this 16th day of March, 2011 by Polly Bell a/k/a Pauline C. Bell,
an unremarried widow.. He/She is personally known to me or has produced 6-; 4. 4 p (21 Yank L, 6c/0,56s
as identification. 7i725-13
Notary Public, State 9 oui ty Aforesaid
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lotarySignat 0\1111111/// (Title or Rank)
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11-4.1 - City of Atlantic Beach APPLICATION NUMBER
j 4' Building Department (To be assigned by the Building Department.)
A 800 Seminole Road
Atlantic Beach, Florida 32233 -5445 f
Phone (904) 247 -5826 • Fax (904) 247 -5845
--r It 9 E -mail: building- dept @coab.us Date routed: 010 / 7
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: (i6i/ ,t a eh ' - • - + ent review required Ye No
Buildin•
Y
/No
O l{) �L � Planning & Zoning
Tree Administrator
Project: Pgai a A brni -- Public Works
, L /t7 /� Public Utilities
W / 6 Z O (�S t !/)' Public Safety
Fire Services
Revle, feet -*fgR ' , r Dept rgpa df 6 7.
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 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: dp roved. ['Denied.
(Circle one.) Comments: J 0 c „vet eel
BUILDING
PLANNING & ZONING Reviewed by: Date: 3 — / c- - /
TREE ADMIN. Second Review: Approved as revised. ❑D ied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
, c) N ' ,pp; !)'
-,., * ii , : ° ' S
.- �
CITY OF ATLANTIC BEACH
r ) 800 SEMINOLE ROAD
6 ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
-- C)S )
Application Number . . . . . 11- 00001806 Date 3/21/11
Property Address 664 BEACH AVE
Application type description RESIDENTIAL OTHER
Property Zoning TO BE UPDATED
Application valuation . . . 7500
Application desc
BATH REMODEL /REPAIR
Owner Contractor
MELANCON, DEJEAN OWNER
664 BEACH AVE
ATLANTIC BEACH FL 32233
Permit PLUMBING PERMIT
Additional desc . REPLACE 3 AND RELOCATE 1
Permit Fee . . . 83.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 9/17/11
Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONALELECTRIC 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
Other Fees STATE PLBG DCA SURCHARGE 2.00
STATE PLBG DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 83.00 83.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 87.00 87.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
// __ Ph (904) 247 -5826 Fax (904) 247 -5845
JOB ADDRESS: (p t�'( T?3 ch f,1��i12 -� PE> lrr # �� / 00
•
NEW O EPLACEMEN Project Value $
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 1 Septic Tank & Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor S ink Toilet 1
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory 1 Water Heater
Other Fixtures Water Treating System
RE -PIPE:
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor S ink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
❑ Lawn Sprinkler System- Number of Heads ❑ Well **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection. **
ji Other r e [ 0 cc . -c 1, / - )1
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. I hereby certify that I have read
this application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether specified
or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name L t7 j ( ? C in M e,ta l - T L R Phone Number b — ',)11)7C
Plumbing Company l � • At ! : 4. 1 6 :11 Office Phone 2L-P -Q L Fax D.4 9
Co. Address:
L 0 20-e- va->��--\ 1 City_ State \
License Holder (Print): ilt, it -� _ _ _! Sta rtificationlRegistration # CFC ���
Notarized Signature of License ' older 4 , ..9,„,„ G tia e
MICHELLE L CREWS Sworn and su before me this 21 day of \' kQYCh 2011
�• MY COMMISSION # EE037670 (� (�
EXPIRES October 26, 2014 Signature of Notary Public
1/4 �i Ck Q.Q . Cl S
,a7. '. 53 FloridallotaryServic..cam
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