Permit Remodel 5403 Capella Ct 2011 ,r ✓J1
0 4 CITY OF ATLANTIC BEACH
\ ? �, ITS
J - 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002022 Date 5/03/11
Property Address 5403 CAPELLA CT
Application type description RESIDENTIAL ALTERATION
Property Zoning TO BE UPDATED
Application valuation . . . 2850
Application desc
interior remodel bathroom
Owner Contractor
NAVAL CONTINUING CARE NORTH RIVER BUILDING SOLUTIONS
RETIREMENT FOUNDATION, INC
1 FLEET LANDING BLVD 6771 SHINDLER DR
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32222
(904) 838 -9179
Permit RESIDENTIAL ALT /OTHER
Additional desc .
Permit Fee . • • 65.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 2850
Expiration Date . 10/30/11
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 65.00 65.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 69.00 69.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233 //7 :- ---...
Office (904) 247 -5826 Fax (904) 247 -5845
, 11/ ' n4 l .. 7
Job Address: . ' ' '=x c 1 k u-r. Permit be 2 t.
Legal Description 5q03 ( -We-WA- C Parcel #
F oor Area ot Sq.Ft. Sq.Ft " --
Valuation of Work $ J 8s0 Proposed Work heated /cooled non - heated c d_.. /
Class of Work (circle one): New Addition Alteratio Repair Move Demolition pool /spa window /door
Use of existing /proposed structure(s) (circle one): ommercial Residential
Ilan 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: ccikose . s�. c 1, , •- 4 F �)u� l
f e __ ,,,,, e 0 , rt Lit k4 -- .:„.. a .. ,1_, a U .c. tw 4.. A 5 ,A 1l `�''�
Property Owner Information:
Name: ,.
Address: ON. Fleet 1 Rift rk ■•
City .1s State rL Zip 3U33 Phone
E -Mail or Fax # (Optional)
Contractor Information: ,, jj�� i j �` jj
Company Name: jt, 4•Ji f' 41c. it,' &I rons Ct.C. Qualifying A aj51✓l,tkA ;r . QVt
Address: (Q - 1 - 71 <SL,, .,,at a F,IJ�i. City T��
r,ksa e snl� State r ' /.` Zip rzzz.-
Office Phone `)oar dig cirri Job Site/ Contact Number Fax #
State Certification /Registration # C GrC.. ( ' t gAt, j
Architect Name & Phone #
Engineer's Name & Phone # -
Fee Simple Title Holder Name and Address __
Bonding Company Name and Address —
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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 aperiod of six (6) months at any time after
work is conunenced. 1 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 -. 4.
F application r r 1 . * -- '' I s d ordinances governing this
1 hereby cerlifja ea nsr d this a lication and know the same to be true and co g g
work will be comp ied it v eth specified s eced herein or not. The granting of a permit does not presume to give authority to violate or cancel the
type . o fYy comp
provisions provisions of any other federal, state, or local law regulating construction or the performance of construct
Signature of Owner �"^°` Signature of Contractor 1 AMI■:. - ii
Print Name �st4 wit- _ 1A-r r-t
Print Name 421 /
Sworn to and subscribed before me Sworn to and subscribed before me
this S Day of NtAP. -Cry . 20 11 this 5 j y of X 1.4 20 "
` Notary Pu, is ,,,, � '
Notary Publ' � Mai it;ItRlid}iSll Q Florida
ELIZABETH TESKE
�'
- s p � ELIZABE TESKE .
ao �, ` ; Notary Public -Stat of Florida • !, •r My Comm. Expires Apr 5, 2013
'_ My Comm. Expires Apr S, 2013 � r � commission N DD 8671129 +� C n Commission DD 867829 '' °' Bed hewn National Natant Assn
MAY -3 -2011 10:08 FROM: CLERK OF COURTS 904 270 1512 TO:92475845 P:1 /1
Doc # 201109 i L i z t 4 , O R B K 155188 Page 2120.
Number Pages' 1
NC/TICE' OF COMMENCEMENT Recorded 05/03/2011 at 10:18 AM,
JIM FULLER CLERK. CIRCUIT COURT DUVAL
COUNTY
Permit No, 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,Dcsc'iprtion of property (legal descripuioo):
Wig- vrt
a) Strcet (job) Address: __ 9iO3 (_ fir. _ " ""
2.0eneral description of improvements: - Cnn 1 r ,5 r tnletiti 1,,,,,,,1,,1 W.% Li_ . _
• �T!'�G� •/I I�M,1� 4`"•6
� 111r�A1 � SIAdI MOM
3.Qwncr Information — -
a) Name and address: ALcce F
b) Name and address of fee simple titleholder (if other than owner) iJne rice, GI„, j,
c) !merest in, property � -
A,Conitractor Information
cti9 a) Name and address: __ALA_ , j k+fc�i yS ►l d 1S , L�.G
D ` i b) Telephone No.: _ loci R58 .• 'f( 7/ Fax No. (Opt.) 10 if - y 3 -? $
S.Stn•ety .Information
a) Name and address:
b) Amount of Bond: - _._.
c) Telephone No.; Fax No, (Opt.)
6,1-ender — •
a) Nante 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) Nanie and address: --
b) Telephone No.: _ Fax No. (Opt.) — _
S In addition to himself, owner designates thc following person to receive a copy of the Licnor's Notice as provided in Section
713,13(1)(b), Florida Statutes;
n) Name and address: -` _- —.
b) Telephone No.: -• _... _ Fa x 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): -
WA.RN!NG TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART i, 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
INSI'FC TION. IF YOU INTEND 11) OBTAIN FINANCING, CONSULT YOUR [,ENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. •
r -,l•r; or f l outnA JI
C401.4.4'11/ UI' PINELLAS 10. 1, '•-•'•. . A
Signature of Owner �� orOwner's Auto O ff;ceteDitt;c1 r'IYartner;Mrnagcr
. Print Name n
The foregoing instrument was acknowledged before me this a day of , rAatzCt , 20 f t , by
', St' OPc1i i 6..t7 — as / -,P.. o f ,, a‘Ur C-. Sd (type of authority, e.g. officer, trustee,
attorney in tart) for -YW,.T LA+4ti r. t (name of party on behalf of whom instrument was executed).
Personally Known ✓ OR .Produced Identification __- _ Notary Signature _ � �;` _ -
Type of Identification Produced . _ — Name (print) .. I ►�� -,b / f4-
OR
Verification pursuant to Section 92.525, Florida Statutes. Under penalties o.fperjury, I declare that l have rcad thc foregoing and that
the facts stated in it are true to the best of my knowledge and belief.
-
Ir)kMIi /NU , d
C,r,2 IQ �p�. Il • <5
lZA ELIZABETH TESKE Sisoniare of Natural Person Sig/ (in lint ;# 10.) Above
a II I Notary pu01k - State of Florida . My Comm. Eoplom Apr S. 2013
-,: Comd�esion I DO win •
r ' *pit '''',\ CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
w
I NSPECTION PHONE LINE 247 -5814
4 '":4 o 1.19
Application Number 11- 00002022 Date 5/04/11
Property Address 5403 CAPELLA CT
Application type description RESIDENTIAL ALTERATION
Property Zoning TO BE UPDATED
Application valuation . . . 2850
Application desc
interior remodel bathroom
Owner Contractor
NAVAL CONTINUING CARE NORTH RIVER BUILDING SOLUTIONS
RETIREMENT FOUNDATION, INC
1 FLEET LANDING BLVD 6771 SHINDLER DR
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32222
(904) 838 -9179
Permit PLUMBING PERMIT
Additional desc .
Sub Contractor . ASHLEY PLUMBING CO INC
Permit Fee . . . 69.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 10/31/11
Other Fees STATE PLBG DCA SURCHARGE 2.00
STATE PLBG DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 69.00 69.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 73.00 73.00 .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: 5U 03 e r PER1vIIT# 1/ �oa�
NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer Shower 2...
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory 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 Sink 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. **
❑ Other
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 Phone Number
Plumbing Company 5w; ) V A J Office Phone 3 4 3 Fax 3 9 9
Co. Address: � n , C � V.� City x State f - Zip 32/Z07
t
License Holder (Print): tw ` l I Ab t '•! i ` State Certification/Registration #
Notarized Signature of License Holder /�'
_
o kivivi l f .te . KELSEY
R STROBE worn and subscribed before me t is (- ay of 'fit, 20 l �
:•. MY COMMISSION # EE035103
t '? EXPIRES October 17, 2014 . ignature of Notary Public (' ; JAO
(4Q19$1 FloridaNata �ervice.com