Permit Wind/door 555 Selva Lk 2011 CITY OF ATLANTIC BEACH
mRk . 800 SEMINOLE ROAD
utp ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
R
Application Number 11- 00001816 Date 3/25/11
Property Address 555 SELVA LAKES CIR
Application type description WINDOW AND /OR DOOR
Property Zoning TO BE UPDATED
Application valuation . . . 5800
Application desc
REPLACE WINDOWS AND ENTRY DOOR
Owner Contractor
CLAYTON THEODORE ET AL FISETTE CONSTRUCTION & REMODEL
555 SEVLA LAKES CIR. 2336 PINE ISLAND COURT
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32224
(904) 992 -4782
Permit WINDOW AND /OR DOOR PERMIT
Additional desc .
Permit Fee . . . 80.00 Plan Check Fee . . 40.00
Issue Date . . . Valuation . . . . 5800
Expiration Date . 9/21/11
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 80.00 80.00 .00 .00
Plan Check Total 40.00 40.00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 124.00 124.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
City of Atlantic Beach APPLICATION NUMBER
s t 4 Building Department (To be assigned by th Building Department.)
800 Seminole Road /
Sr 9 Atlantic Beach, Florida 32233 -5445 - f
Phone (904) 247 -5826 • Fax (904) 247 -5845
f s>r E -mail: building- dept @coab.us Date routed: '
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ) TJ a/ De e • t review required Yes No
B
Applicant: _ / - Planning & Zoning
Tree Administrator
Project: Get/ % / Public Works
Public Utilities
Public Safety
Fire Services
Re view f ee $. �w . '. k r Dept $ g naftare" h , t 4r.' 1 :0-r10,1 k n y
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: Approved. ❑Denied.
(Circle one.) Comments:
BUILDIN
PLANNING & ZONING
Reviewed by: / i y Date: 3b
TREE ADMIN.
Second Review: EApproved 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
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: c.c.S SeiUa tot& tot / &J ' A4] ad Permit Number: / / - /k /-6
Legal Description Lam" 102., Sal ✓a Li i lint -0 P14- lop • Li3 l I l� t 1 �
Valuation of Work $ 4 6a oo . 0
Class of Work (circle one): New Addition Alteration Clap
Move Demolition pool/spa window /door
Use of existing /proposed structures) (circle one): Commer Residential
If an existing structure, is a fire sprinkler system installed? (Circ one): Yes No N /A
Florida Product Approval #�S.I4 ') 112 SS, I r4.5.) 11 uyi 4 ( P;t ,4,,t II 2$9 , I i 320 ►0 For multiple products use approva orm ( aQb- l
Describe in detail the type of work to be performed: h/iv1 V✓ ✓Gp/a e (/ 4
1 )t , Ni 0111111110,iiik
1,1,1
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Property Owner Information:
Name: 4 Ia Address: 6T< `� & rJ
City State ��f Zip ZZ , Phone 2 y-
E - Mail or Fax # (Optional)
Contractor Information:
Company Name: t ' ,, *IA 4 > ,�, t IV Qualifying Agent: / v ( kik-
Address: ' ' � "
Office Phone II p . Job 1---- • _' — Cit - _ :. J • . L, State j( . Zip 32 -- ---
State Certification/Registration # _ - .r , ;y, � K A I I • o I. it
Archi Name & Phone # •l uu I d r.1t`[ j� ,- ,,
Engineer's Name & Phone # • _ ` ' , ' _H i'
Fee Simple Title Holder Name and Address 1 r • • IN 11 IONAL t '� '
Bonding Company Name and Address - i • • .. . i �' N 1 12
Mortgage Lender Name and Address (REVIEWED ; ,r. � ,
Application is hereby made to obtain a permit to do the work and installations as in, ica e ce` — 1 '
issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction as commr t
d u jurisdiction. This permit becomes it becomes null
and void if work is not commenced within six (6) months, or if construction or work is suspended or abandoned for aperiod 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 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 BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
1 hereby certify that 1 have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type 0 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 egulating construction or the performance of construction.
Signature of Owne
Signature of Co tor . _
I ./ /
Print Name 70 - o QOL v Print Name ,
II
Sworn to and subsc i ed before me Sworn to and subscribed before me
this L 1 Day of s7 �l , 20 1/ this 22 Day of /144124/7 , 20 1/
C4 — = i�'f;
Notary Public Nota P 1� . -11 - - - -- - - —
CHARLES BREWER •" "• J E. fERNANOEZ
Notary Public, State of Florida '��`
-'= SONY Pub11cR�lt�rl p
i2
Commission#DD941i897 ,■ •E My Comm. Expires Dec 7, 2014
�
' ' My comm. expires Dec. 15, 2013
0 r Commission #r EE 17906
114.07. Bonded Through National Notary Assn.
MAR -22 -2011 12:54 FROM: CLERK OF COURTS 904 270 1512 TO:92475845 P:1/1
NOTICE OF COMMENCEMENT
Permit No. //_- / k / 6 Tax Folio No. _
State of Florida, County of Duval
THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Description o property (legal description of property and address if available):
!� 4.t. rte.. :t 14ll,vlu+rs L. if
2. General Description ofim•rove.ments:
kt rivia //:17 ,. 4C ,, i. AA. J. Y * e - _ — — _.
3. Owner Information: -'• fT
a) Name and Address: S * , . a-
b) Interest in property: pv
c) Name and address of simple titleholder (if other than owner):
W
4. Contractor Information
:�. ' o kr . :,_.s. . 1
a) Name and Address: +•� �► - '1
b) Phone Number:_2 g _ _ .� SS
5. Surety Information:
a) Name and Address: ,
b) Phone Number.:
c) Amount of Bond: $
6. Lender Information:
a) Name and Address: .
b) Phone Number:
7, Person within the State of Florida designated by owner upon whom notices or other documents may be served as
provided by 713.13 (1)(a) 7, Florida Statutes:
a) Name and Address:
b) Phone Numbers of Designated Person:
8. In addition to himself/herself, Owner designates of to receive
a copy of the Lienor's Notice as provided in Section 713.13 (1) (b), Florida Statutes.
a) Name and Address:
b) Phone Number of person or entity designated by owner:
9 Expiration date of Notice of Commencement (The expiration date is one (1) year tram the date of Recording unless a
different date is specified: —
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 1N YOUR PAYING TWICE FOR
IMPROVEMENTS '1'O YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION, 1E YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING
YOUR NOTICE OF COMMENCEMENT.
The foregoing instrument was acknowledged before me this day of f4'-.C4 , 20 / I hilt pR 4 Nary 51Mm of Florida NO `ARY PUBLIC, STATE OF FLORID
I _ .cannisslAns 0094413 Print Name• I∎ I.. & .rl •:+ 12, ro., . .—