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Permit Generator for Tower 469 11th St WP#14 CITY OF ATLANTIC BEACH � = 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5826 1..4 ,C)111 91 ' Application Number 11- 00001796 Date 3/22/11 Property Address 469 11TH ST WP #1 Application type description COMMERCIAL OTHER Property Zoning TO BE UPDATED Application valuation . . . 4000 Application desc install generator at telcom tower site (AB) Owner Contractor GOFF COMMUNICATIONS INC 3004 29TH AVE EAST BRADENTON BRADENTON FL 34207 (941) 955 -7106 Permit BUILDING PERMIT Additional desc . Permit Fee . . . 70.00 Plan Check Fee . . 35.00 Issue Date . . . Valuation . . . . 4000 Expiration Date . 9/18/11 Special Notes and Comments 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. If City's contractor, TB Landmark, is on site, coordinate with them and remain clear of their work area. Contact Tim Ward @ 545 -6715 or Brian Hickox @ 237 -3540. Contact Harry McNally at 401 -8101 to obtain access badges for Water Plant #1. Other Fees STATE DCA SURCHARGE 2.00 STATE DBPR SURCHARGE 2.00 UTIL REV PRE APP >3 HRS 25.00 Fee summary Charged Paid Credited Due Permit Fee Total 70.00 70.00 .00 .00 Plan Check Total 35.00 35.00 .00 .00 Other Fee Total 29.00 29.00 .00 .00 Grand Total 134.00 134.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. Number Pages: 1, Recorded Doc # 2011064810, OR BK 15549 Page 1583, 03/22/2011 at 02:15 PM, JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00 NOTICE OF COMMENCEMENT Permit No. Tax Folio No. 17 20Z6 - 0 00 0 THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property. and in accordance with Section 713.13 of the Florida Statutes, the following information is p in this NOTICE OF COMMENCEMENT. 1.Description of property (legal description): 17 - Z$ Z7 / ). 79/ PA-0i% t' �k Z ` . S*i 176) — o y OR 6cf i -12611 a) Street (job) Address: a 60; .11 4t) a, , \}; z Heat: k IL 3 z Z 3 3 2.General description of improvements: —17A S to. \\ tune c' r _ , ' . MM. AZ fi ,.. C't'he- 3.Owner Information a) Name and address: (�! riC 4 t kov c , c e , � ,c L per,,, i n Ae, Rd 44.4,c. 15.,..,i,, 0...3 z 2 3.3 b) Name and address of fee simple titleholder (if other than owner) S 0, c) Interest in property _ 0 14A es 4.Contractor Information e V / a)Nameand address: (c Ca "MUn tCct�ionS,Snc_ 3004 Z9 e. b Telephone No.: t>-/ /'Sj5"- 7i (o Fax No. (Opt.) v " C � . {,'�, t= L �yzr�r Jo S.Surety I a ) Name an d address: /U A b) Amount of Bond: c) Telephone No.: Fax No. (Opt.) 6.Lender a) Name and address: N /4- _ Phone No. 7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served: a) Name and address: /V //} _ b) Telephone No.: Fax No. (Opt.) 8.In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes: a) Name and address: ,&i /4 b) Telephone No.: Fax No. (Opt.) 9.Expiration date of Notice of Commencement (the expiration date is one year from the date of recording unless a different date is specified): 1 t; /A WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF C e MMENCEMENT. STATE OF FLORIDA , 4 / ' COUNTY OF PINELLAS 10. At �Ai_ ■ Si ature of Owner or Own Auth nrazed i f .; irector /Pa / r /Manager Print Name The foregoing instrument was acknowledged before me this % z' day of /71/9.C/f , 20 /1 , by I Onnc? A )uin i a 1< as —1.)1 FOC {-U (type of authority, e.g. officer, trustee, attorney in fact) for � C > t �t c_ � 3 C ;aC `� (name of party on beh If of whom I. ent was executed). Personally Known ,4 OR Produced Identification Notary Signature 7 2.072.42..e_ Q... A / , / d Type of Identification Produced / (print) b iL� >tT la ^ +t� ,: - OR Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I decl I : " • ' ve r ii a I at the facts stated in it are true to the best of my knowledge and belief. I T u ' v Bonded nm,rrot.,y I FORMS /NOC.rvsd ?p10 0 ,/ Signature of Natural Person Signing (in ine # 0.) Above BUILDING PERMIT APPLICATION 1/ / 7n, CITY OF ATLANTIC BEACH D 800 Seminole Road, Atlantic Beach, FL 32233 N Office (904) 247 -5826 Fax (904) 247 -5845 Mn • all Job Address: 1 49 I 1 Sd Permit Numbe : �rrlt tea- L R # / Nb k I 7 6 1 ar ce l I w 4 �,+ "'•: Legal Description 7-2S-29E 1.'79 ' 1�'t F oor • rea o q.Ft. S q Valuation of Work $ y, (50 0 Proposed Work heated /cooled AU /f r non- heated /cooled N/4 Class of Work (circle one): New Addi Alteration Repair Move Demolition pool /spa window /door ` Use of existing /proposed structures) ) (circle one): C ? Residential ----.„ If an existing structure, is a fire sprinkler system installed?-(Circle one): Yes No N /A Florida Product Approval # For multiple products use product approval form Describe in detail the type of work to be performed: J- ., s 1-c, \\ 3 e1 e_ t - - z; r - c1 -- P x'," s` j 1 c pew- . 0t'1` C.cz•1 - toAS +Oki e_ 3', -;- e_- Property , Q>1 Owner Information: Name: CA.Vy o tiL Zec.C. Address: gOO ,,,2.,,,.,\..,\\e_ YA City (= i(- -1 3(= c3,e-L. StateC -Zip-3 223 Phone ,u//4 E-Mail or Fax # (Optional) Al // Contractor Information: 5 0 c -�- / Company any Name: O C u a� , cc, 4 -t z� n S , c. , Qualif Agent: f l �..^'t €_ - o p State F Zip 'Z 5- Address: 7 00/-1 294, >4ele --�= City _i) t'cti�� t� p Office Phone 9y/ - 955 7/() G Job Site/ Contact Number 99/ -? Fax # 5 // - 70i - 3/0 S State Certification/Registration # C-6-_, 0 5Z 6 7 Architect Name & Phone # rt{ f A Engineer's Name & Phone # ``ia,■ e S (n, r o A 2 e) ,c ---- 9 5 l Fee Simple Title Holder Name and Address 4/4 / 1' Bonding Company Name and Address 41/I- Mortgage Lender Name and Address /li /A- E OOP Y Application is hereby made to obtain a permit to do the work and i isia 1 tions as indicated. 1 certify that no work or installation ltas cormrren prr to the issuance of a permit and that all work will be performed to meet the standards of all laws rregulating construction in th jruisdic This permit ced beco null No k void s co nm enced. 1 commenced nderstand thatrseparaterpermits or must be construction suspended secured for Electrical Work, Plumbing, a Welis, P S Bo i ler 1 s, time Heai s, Tanks and Air Conditioners, etc. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFOEMERECORDING YOUR NOTICE OF 1 hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and or•dinanc- governing this type of vvork will be complied with whether sppeci red herein or not. The granting of a permit does not presume to give . rthor•ity to ' . or cancel the provisions of any other federal, state, or local law re • elating construction or the performance of construction. Signature of Own: /..., iAllw - —,/ -1 — �p Signature of Contractor di, Print Name AA / U.711.f Print Name ,iti .. ,..S C: • __ Swoifl q and subscribed before me Sworn to and subscribed before me this /'.y Dof /) RCN ,20// this Da � of ► ,ilinuuc�bc : C , 201 0 2�7�,te ' . Z _ %f'` l ( act -'& Notary 'ublic nY'fi • EM.CALVERLEY Nota , 'ublic 01 : a • MISSION ii DD 774100 o~ ,ar P�� Revised 01.26.10 ��;- V EXPIRES: July 29, 2012 r • • •• • , JUSTIN CLARK '• , rid, Bonded 'Nu Notary Put* Underwriters 1 * _ , y * MY COMMISSION t DD 871431 s; , EXPIRES: March 17,4013 11111% /111,"- arm° CORPORATE OFFICE: G — 3004 29th Ave. East • Bradenton, FL 34208 (941) 955 -7106 Office • (941) 308 -3103 Fax L i / COMMUNICATIONS March 14, 2011 City of Atlantic Beach To Whom It May Concern: I, James E. Goff, authorize the following persons to have authority to act on my behalf to be my lawful Attorney and authorized agent in fact to act for me and complete and sign all legal documents, applications, and other paperwork, requiring my signature, pertaining to the registration of my company, setting up my license qualification file, the business tax receipt or acquiring, purchase, or implementation of a permit in the city of Atlantic Beach. Justin Clark of Goff Communications, Inc. My general contractors license number is CGCO58267. If you have any questions with regard to this request, please contact me at (941) 955 -7106. Thank you for your consideration in this matter. Sincerel , Jam- s Goff P sident Su . sc ibed and sworn o before me on this [ LA day of Mctrc.1'\ , 2011. k A. „,,,,,,,,,,, Not ' ary KATHRYN P M. KINNETZ - Not. bliC di ►�•� My Comm. Exp ires State Mar of 24Florida , 2013 �YZ 2, `� ” Commission N DD 868922 My commission expires 031 1 3 °ia` Bonded Through National Notary Assn. Personally Known X OR Produced Identification Type of Identification Produced ( (al t Briml CORPORATE OFFICE: " gr im Nr 3004 29th Ave. East • Bradenton, FL 34208 (941) 955 -7106 Office • (941) 308 -3103 Fax L i / COMMUNICATIONS March 14, 2011 City of Atlantic Beach To Whom It May Concern: I, Douglas L. Smith, authorize the following persons to have authority to act on my behalf to be my lawful Attorney and authorized agent in fact to act for me and complete and sign all legal documents, applications, and other paperwork, requiring my signature, pertaining to the registration of my company, setting up my license qualification file or acquiring, purchase of any permit in the city of Atlantic Beach. Justin Clark of Goff Communications, Inc. My electrical contractors license number is EC13004137. If you have any questions with regard to this request, please contact me at (941) 955 -7106. Thank you for your consideration in this matter. Sincerely, Douglas L. Smith Electrical Supervisor 11 Subscribed and sworn to before me on this ( day of Mara/ , 20K , ;P RY V � KATHRYN M. KINNETZ Not • , Pus iC 41/ s+06, Notary Public - State of Florida _ • My Comm. Expires Mar 24, 2013 "�,, - . P4. Commission • 00 868922 My commission expires 63( Zy 2613 •• � i '' `, Bonded Through National Notary Assn. Personally Known X OR Produced Identification Type of Identification Produced . I LAN :0 ; City of Atlantic Beach APPLICATION NUMBER 4 i, Building Department ~�� (To be assigne y the Building Department.) -� a '� 800 Seminole Road V�"" �`?$� sl Atlantic Beach, Florida 32233 -5445 i® ,� • ..,'' ` Pho (904) 247 -5826 • • Fax (904) 247 .., 4148 r ® ZO,, II �� • `` r Email: building-dept@coab.us L Date routed. HUH 9 • City web -site: http: / /www.coab.us APPLICATION REVIEW AND TR A KING FORM � Property Address: & 9 1/ r p • • - nt review required Yes No 4 �. L---.--,... _ Applicant: l� / cam iCi C S Winning & Zonin• 1 ` r Jr � o rator Pro blic • ks __- Project: /7 / / P f��72e � public Utilitie c 1 errnn 1 1D L • r Fire Services f s F2evievufee'$ 0 - ; ,, .. � rDept S ignatur e f g � Review or Receipt Date Other Agency Review or Permit Required 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: [Approved. ['Denied. (Circle one.) Comments: BUILDING PLANNING & ZONING Reviewed by: ' — `Date: //29// TREE ADMIN. Second Review: ['Approved as revised. ['Denied. 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 City of Atlantic Beach APPLICATION NUMBER j , 1 Building Department (To be assigned by the BuildiDepartment.) r 3 v 800 Seminole Road . i - 1 V ' Atlantic Beach, Florida 32233 -5445 q,� V Phone (904) 247 -5826 • Fax (904) ' 5845AR E-mail: n -de t coa b.us B bildi ? g p @ ail Date routed. City web -site: http: / /www.coab.us APPLICATION REVIEW A ACKING FORM Property Address: 1 ! j Sr D , -nt review required Yes No p L . I . Applicant: 1, / (0) 0 - ) A iC� err) S inning & Zonin• �f� is • trator Project: 'JS'j / , 1ZT7)24 ac.r- blic • ks public Utilitie £ i e— Gv fL [� Fire Services _ 4 , Revlevii fee $ ' n. i = ..., r D ep Signature � ' 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: (4' pproved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING & ZONING Reviewed by: 6: Date: 3 ;) TREE ADMIN. Second Review: Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES • BLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 i!r, _ City of Atlantic Beach APPLICATION NUMBER JS r r + �� Bu ilding Department (To be assigned by the Building Department.) i 800 Seminole Road- - ,;' Atlantic Beach, Florida 32233 -5445 Phone (904) 247 -5826 • Fax (904) 247 -5845 �� -"ot3 91" E -mail: building- dept @coab.us Date routed. 7 City web -site: http: /lwww.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: / /1 D _ nt review required Yes No Applicant: gi ( 0 A-7? / C i On s Wi nning & ZonintAIMMI r .. i trator Project: 47S / O' a� F ublic • ks i � £ V i 411 ublic Utilitie r. Fire Services a' a c" g+Y ""� e x p s-rr �v " S -14.1 'r er+gc 3 7i 7, 4 7. "`t 1 u � ✓Caf . p "" 7 '� 4 7 »z ,�t a s et a f`u ,, , ,d-, '.: t , a y s @ Re vl gw3 fe $. p S i g natur 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 Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLIC TION STATUS Reviewing Department First Review: Approved. [Denied. (Circle one.) Comments: BUILDING i CANNING & ZONIN Reviewed by: cV--- Date: .3 -- TREE ADMIN. Second Review: Approved as revised. ❑Denied. 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 .1r1 City of Atlantic Beach APPLICATION NUMBER d ,. Building Department (To be assigned b the Building Department.) 800 Seminole Road /1 — / ;j - , Atlantic Beach, Florida 32233 -5445 ea ' Phone (904) 247 -5826 • Fax (904) 247-5845 / '--fi, 9`" E -mail: building- dept @coab.us Date routed. / At City web -site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 1 9 // w S_7 DI -� nt review required Yes No _..._ Applicant: D (rY? fi j , / C err) S Pnning & Zonin. �� ilk trator Project: /haf? ��j g ,Qa77e Az— ublic • ks Ei6t 01 f i� 0 *1•J G � 41 _ic Utilitie T Fire Services _- � �f� f r� � �' 9� «s a ReviektasC x � ' w,', , . z „Dept k l . a 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: proved. ['Denied. (Circle one.) Comments: BUILDING C P T /c 04-4 - / PLA G & ZONING Reviewed by: 1 Date: "� t TREE ADMIN. Second Review: QApproved as revised. ['Denied. 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