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Permit Remodel 5112 Polaris 2011 -4..A ' CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD , ' ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 Application Number 11- 00002023 Property Address Date 5/03/11 5112 POLARIS CT Application type description RESIDENTIAL ALTERATION Property Zoning TO BE UPDATED Application valuation . . 2100 Application desc interior renovations 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 RESIDENTIAL ALT /OTHER Additional desc . Permit Fee . . . 60.00 Plan Check Fee .00 Issue Date Valuation 0 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 60.00 60.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 64.00 64.00 .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 Office (904) 247 -5826 Fax (904) 247 -5845 D L £ LE a L Vi Job Address: t, ,,, 511T f0141 OS Permit Nu tl ijr: MAY 02 2011 t Legal Description 51 l L "o tax C4 , Parcel # By Y oor A rea o q. t. q. Valuation of Work $ a t 00 Proposed Work heated /cooled non- heated /coo et Class of Work i crcle one): New Addition ( ) Repair Move Demolition pool /spa window /door Use of existing /proposed structure(s) (circle one): Commercial 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 orb m Describe in detail the type of work to be performed: 51..0v4e cA , (N '4 V5 0 ,S t 0 )p rvl O t 51n o ,P n r ins-R.1 W4( ,`7.04.4. A 4;1 e be - ft,. ,,,l ,n. "6 J�.IVCS . Property Owner Information: l Name: A C(` 1R F Address: bike F-1 ee4 1,3,,, Y; 4-1 )/ ).,c1. 4 City lcj- $eac,. State Et 31233 Phone E -Mail or Fax # (Optional) Contractor Information: 11 Company Name: Moc-rI:. \rep g,�,I�; S,(�- I Qualifying Agent: . 4.t—fl ,M. ,,,\ Address: (61 S 1 , , lc. City ' Son..r) 11 t State ft_ Zip S7l22., Office Phone 83$ -el t /et Job Site / Contact Number f.37 . 91 Fax # State Certification /Registration # CGGtS t% t Q 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 a period of six (6) months at any time after work is commenced. 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. I hereby certify that I have read and examined this a placation and kno the same to be true and correct. All rovisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. w The gra a rm' w to give authority to violate or cancel the provisions of any oilier federal, state, or local law regulating construction or the e ni e o z . o Signature of Owner ,� � Signature of Contractor Ackric---- Print ame N , (AA HA 1‘-+- - Print Name G iq k 1 Sworn to and subscribed before me Sworn to and subscribed before me this 8 Day of /�ARet , 20 1( this 2- Day of MA) , 201% q_j Notary Publi.� -----,dr.... f"- .m. – ..... — — — Y ; .;,a� % ", ELIZ ABET H TESKE Notary Pu C I is LI •, V s Notary Public - State of Florida r' ° � ` � Y P ��' ELIZABETH TESKE ' • My Comm. Expires Apr 5 2013 . ¢s 3 ig� i�1 r 2013 ofida ,; , � Commisalon N 00 867629 z "} r a p +ns Apr 5, ?013 °`" Bonded Through National Notary Assn. Commisalon # DD 867x2! ,anu Bonded Through National Notary Assn. ' CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 13119. Application Number 11- 00002023 Date 5/04/11 Property Address . . . . . 5112 POLARIS CT Application type description RESIDENTIAL ALTERATION Property Zoning TO BE UPDATED Application valuation . . . 2100 Application desc interior renovations 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 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: 511z ? d 1, /-s (.e T P ERMIT # f 1 eot NEW OR REPLACEMENT INSTALLATION: Project Value $ 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 92_—_ 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 ink 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 ** ** SIRWD 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 f ` p \ WLl,O Office Phone 3q3 951 Fax qq 0S5 Co. Address: 1735 IA/11 5 ri"l/x City 'TN( . State F Zip ?, 2:2-07 License Holder (Print): CAN 5 ft Y ` t ' State Certification/Registration # Notarized Signature of License Holder A4'. "■ 7 i • , KELSEY R 5Re E I Sworn and subscribed before me t is Li d y of 20 1 ( •`; ,.i MY COMMISSION.* EEiO35103 — ' EXPIRES Octet 17, 014 Signature of Notary Public L C ' .� Q o (407130! -0153 Fk44114o N R com