Permit Bath Remodel 5420 Capella 2011 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
ti
INSPECTION PHONE LINE 247 -5826
Application Number 11- 00001873 Date 4/05/11
Property Address 5420 CAPELLA CT
Application type description RESIDENTIAL ALTERATION
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
2 shower conversions
Owner Contractor
NAVAL CONTINUING CARE NORTH RIVER BUILDING SOLUTIONS
RETIREMENT FOUNDATION, INC
1 FLEET LANDING BLVD 6771 SHINDLER DR
ATLANTIC BEACH FL 322334599 JACKSONVILLE FL 32222
(904) 838 -9179
Permit RESIDETNIAL ALT /OTHER
Additional desc .
Permit Fee . . . 70.00 Plan Check Fee . . 35.00
Issue Date . . . Valuation . . . . 3500
Expiration Date . 10/02/11
Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONALELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
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 4.00 4.00 .00 .00
Grand Total 109.00 109.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
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NOTICE OF COMMENCEMENT Number Pages:
Reco O at 6
AIM C CL ERK CIRCO2: "UIT PM OURT O CUVAL
COU
Permit No, W 3 °•]
RECORDING $10 00
Tax Folio No.
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 provided in this NOTICE OF COMMENCEMENT.
I.Description of property (legal description): ‘51-42-0 cpy e i is (rf'. - A-1 I t hC geacl - fL
a) Street (job) Address:
2.General description of improvements: Sk pw.e re A Qv CkAlcz
3.Owner Information I , 1 �� %
a) Name and address: LC Ova@ FiPe-F LO" CL 6 — A.} c c — L 3 ZZ 33
b) Name and address of fee simple titleholder (if other than owner) —
c) interest in property OwA -
4.Contractor Information 2 i 1
a) Nam and address: jV c. Tr. 1N ', ,1 4 e.i k�iti1 !d 11t� 0AS LC-C. t. 7 �C H 1, �CZ z ✓ 0/ { � J Fax No. O ( 3 - Z " ate T L
b) Telephone No.: 8),)e-co---1.9 ( p ' t) Z 1 _
5. uety Information "
a) Name and address:
b) Amount of Bond:
c) Telephone No.: Fax No. (Opt.)
6.Lender
a) Name and address:
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:
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:
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):
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 COMMENCEMENT.
STATE OF FLORIDA
COUNTY OF PINELt.AS 10.
Signature of Owne or Owner's Aut -d Officer /Director /Fanner /Manager
�dSt) K A
Print Name • A w-
The foregoing instrument was acknowledged before me this 1 day of /'rW-C 4- , 20 f ( , by
'1 i tk A 4if4 as MGR, 3I e4. - 0‘Gu t C ZiCs_ (type of authority, e.g. officer, trustee,
attorney in fact) for ri.46( f- A „JC. (name of party on behalf of whom instrument was executed).
Personally Known OR Produced Identification Notary Signature `',
Type of Identification Produced Name (print) (t te7
OR
Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I have read the foregoing and that
the facts stated in it are true to the best of my knowledge and belief.
, . 4 , ,
, ELIZABETH TESKE � � '— / •
roanasmoc sd?oiu t.a Ns
'II 1 .
Notary Public - State of Florida Signature of Natural Person Signing in Ii 10.) Above
• !' r My Comm. Expires Apr 5, 2013 • =P, �� Commission # DO 867829
' J Bonded Through National Notary Assn. I
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: 5 L) 2--O C-4 I \ct_ CA", Permit Number: /1 18 73
Legal Description Parcel #
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ - 5 5OO Proposed Work heated /cooled non- heated /cooled
Class of Work (circle one): New Addition Alteratio Repair Move Demolition pool /spa window /door
Use of existing /proposed structure(s) (circle one): Commercial esiden tia
If an existing structure, is a fire sprinkler system installed? (Circle one)e ` - o M
Florida Product Approval #
For multiple products use product appr oval or
Describe in detail the type of work to be performed: a - 5 totApfl ez, AV elS io AS - 1 21 A) 1 ,...)a 1 151 pan f
\6t l\JPs A f , A5 l 1
Property Owner Information:
Name: MC( RF — V f4 64'1 Address: Qne r tJ CA.AJAo 0 givJ.
City +Ictvl -k gear gate e.-Zip 3ZZ33 Phone
E-Mail or Fax # (Optional)
Contractor Informa``ti__on: ti c\ `
Company Name: 1 c 4k tc i lid: ( �o11.t o4S Qualifying Agent: ,7oS\ Lt4 \Quit
1—Z k O Cit Rt�' s,nVi 11c State RL Zip 3Z2ZZ
Address: � — l S ► na� - �
Office Phone Job Site/ Contact Number $ 3.2:,'-I I-6 Fax #
State Certification /Registration # (r C 1 = -.---
-
Architect Name & Phone # `Tata;'u+.0 rib Vi a. -
Engineer's Name & Phone # — - C BEAC. y 1 /,` A!` 1 ' z = ` ° " �"`'�""
Fee Simple Title Holder Name and Address — Sr:� Y�RMITSFORADDITIe N: �
Bonding Company Name and Address — -.= e e y .1 1 ' AND CONDITIONS. �� 1 81111 �' N �1, • Mortgage Lender Name and Address — �p npjr : 4 /1
_ c?" «] 729'C isBX :r ' ify E tit ,: work or instat I . ' .
Application is hereby made to obtain a permit to do the worti nn ins , •' .I .n in ' 0340 pernZr! s ►�� '
jsa ante of a permit and that all work will be performed to n - •- _•• - -••_ -- + (6) months at any time a ter
and void if work is not commenced within six (6) months, or if construction or wor is suspen.e.- or ..
work is commenced. 1 understand that separate permits must be secured for Electrical Work, Plumbing, Signs, ells, 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 MEN BERMENTE YOUR NOTICE OF
l hereby ertify 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 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.
Signature of Owner Signature of Contractor
Print Name �.... w,
Print Name �OSI-��.A q�N��p> ��.......
Sworn to and subscri ed before me Sworn to and subscribed befole me "70 this g Day of MA/Ltd , 20 G I this R Day of �IM.rsY,�
LTLABETH TESKE Notar Pf blic ` 1
Notary Pu c °��" °°s''•• y ? ' •§i Notary Public - State of Florida
gat' `f : Notary Public • State of Florida �l • I
�\ ► � ' n M Meef9111lPXpr19 2013
�• � •; My Comm. Expires Apr 5, 2013 �� Commission # DO 887829 I
‘, -s Commission # 00 867829 l °4 - O f 1
°f ` Bonded Through National Notary Ann. I
' }!•�`�� Bonded Through National Notary Assn. 0 _
City of Atlantic Beach APPLICATION NUMBER
l,;
(To be asst ned b the Buildm De artment
�= �� � " B uilding Department (T g Y g p )
r _ x t, s 800 Seminole Road j #y�
y� � r� . Atlantic Beach, Florida 32233 -5445
Phone (904) 247 -5826 Fax (904) 247 -5845 Date routed
F.,)?" E -mail: building- dept @coab.us
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ZD l ,4 - /- //'L . � �
; , ;g ent review required Y No
Building
Applicant: 7 7 0 el /) ing & Zoning
/ Tree Administrator
Project: p.);-4 R-R 1 6/') V fn tris Public Works
Public Utilities
/l" //j //D") S Public Safety
Fire Services
;� : 6,s m „f i
c s r u STS tiI tf -'m �-f ms ±.re w a w17 .r'e
Re�iew�fee $ .; v fr,�. � z� Dept lgnat urea:
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
1
Reviewing Department First Review: EA ['Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING
Reviewed by: /lid, Date: 4- /' 4 1 —
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. 7Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09