Permit Repair Fire Damage 1721 Beach 2011 ` keat'? ` ' \ CITY OF ATLANTIC BEACH
;,, 800 SEMINOLE ROAD
° s)
ATLANTIC BEACH, FL 32233
. INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002392 Date 7/27/11
Property Address 1721 BEACH AVE
Application type description RESIDENTIAL OTHER
Property Zoning TO BE UPDATED
Application valuation . . . 6000
Application desc
repair fire damage (beam)
Owner Contractor
LANE, JR., E.W. C.G. CONSTRUCTION OF JAX
3790 ORTEGA BLVD. 11111 -70 SAN JOSE BLVD
JACKSONVILLE FL 32210 SUITE 319
JACKSONVILLE FL 32258
(904) 288 -6850
Permit RESIDENTIAL ALT /OTHER
Additional desc .
Permit Fee . . . 80.00 Plan Check Fee . . 40.00
Issue Date . . . Valuation . . . . 6000
Expiration Date . 1/23/12
Special Notes and Comments
*2007 FLORIDA BUILDING CODE w/2009 REVISIONS
NATIONA1 ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
* PLEASE CALL FOR A ROUGH FRAMING INSPECTION BEFORE DECKING
OR COVERING UP ANY OF THE REPLACED STRUCTUAL LUMBER; THEN A
FINAL INSPECTION WHEN PROJECT IS COMPLETE. MJONES.*
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.
At: ;Mgr ■4 ;t" .3-,,
i
i BUILDING PERMIT APPLICATION i '"_ • CITY OF ATLANTIC BEACH E'
800 Seminole Road, Atlantic Beach, FL 32233 , LE CO P III
Office (904) 247 -5826 Fax (904) 247 -5845 t
` � 3 9 a-.-
Job Address: 17)-4 �" A'� • Permit Number: /1
Parcel #
Legal Description _ P
Floor Area of Sq.F't. Sq•Ft
I
Valuation of Work $ 117
/� .(� ��,C�C/ f/��,� Proposed Work heated /cooled ( non - heated /cooled 2-40
Class of Work (circle one): New Addition Alteration ' epair Move Demolition pool /spa window /door
Use of existing/proposed structure(s) (circle one): Commercial ' esidenti• No N /A
If an existing s r installed? is a fire sprinkler system nstalled? (Circle one):
Florida Product Approval #
For multiple products use product approval form �c'
l the type of work to be performed: D}��l/�llf., ; �o7ORc -k-- '"" ��
Describe in detail yp Tatj'
..1.1 ___0 A. �. Pri
-1- .- 5
Property Owner Information:
Name: 1L= _..., . .►
Address: r ''' Pr
City Stat= /_ ip 1 U Phone •3n�go
E -Mail or Fax # (Optional) - \ \�
.......
Contractor Information:
r . '
.mss . y 'p Quali :Agent: v ' ' 0.) Z3
Address: Name: City ' ,.. 4 �, _ Zip 3 zz
Address: � - 0 Sand �'as�" ',G i. !� "44 � .r' t • . r 6; S3
S 7 A RID .. Si ontact umbe 1..�
Office Phone :, . - -
State t
Certification/Registration # 5 ;#A, — • . -�
Architect Name & Phone # `= _ -i ►
Fee Simple Title Holder Name and Add' .
Engineer's Name & Phone # \ `,, � 1 1. r� =�►�
" � ' NIIIIImmulm 0 wpm
Bonding Company Name and Address .:
Mortgage Lender Name and Address ��v g
the
Application is hereby made to obtain a permit do the t ° meet the standards of all laws regulating tha truction in this juris di This permit b ion has commenced a nd a nd v o i ce of and peermit mit of commence that all work will be perer form pp construction or work is work is� mmenced. 1 understand d within six that separate permits or must be secured for Electrical Work, Plumb ng, Sig a Wells, P o ls , x Fur naces, Boilers, Heaters,
Tanks and Air Conditioners, etc.
WARNING TO OWNER: YOUR FAILURE AYING RECORD FOR IMPROVEMENTS
TICS OF
COMMENCEMENT MAY RESULT IN YOUR
TO YOUR PROPERTY. IF YOU INTEND EFORE RECORDING YOU
CONSULT NOTICE OF H
YOUR LENDER OR AN ATTORNEY COMMENCEMENT.
type her f c that 1 h read w d ith whether t eciied n or not. The granting of true
o permit correct. dry to violate cancel this
the
t si wok any t rfe federal, w p
provisions of any other federal, state, or local law regulating construction or the performance of construction. /
Signature of Owner • _ •_ r 1 I • 1 Signature of Contractor % .--/
_
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Print Name
I
_- E
Swo I ' r .`' A. e.,_
Print Name &siJj4b T. ✓N
4 .) � • M y /i 7349 Swo • , , 20
2 this Da; iv .�A.
this D, �. ° %.t . � , / „ Y ,. ' 2 2oi 41 7 /, a . ' 1
r.-6(___, -,. Z '''3 Ic 7c) / N
Notary Pubh " '
�itary Public
Revised 01.26.10
JUL -27 -2011 15:39 FROM: CLERK OF COURTS 904 270 1512 TO:92475845 P:1/1
( NOTICE � OF COMMENCEMENT
Permit No. 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 of property (legal description of property and address if available):
1724 5 t _
2. G cral Description of improvements:
3. Owner Information
a) Name and Address: / J 1 A-re /7 Z! �tf4. /41 14 . AG 7 2 ?3
b) Interest in property: ?- era
c) Name and address of simple titleholder (if other than owner):,.
X7'1
4. Contractor Information:
a) Name and Address: ex4,4.AD ,pj i0 - 70.41 Talc 34,1103q if , ft 3 a 3
��p b) Phone Number: �G, p� ,,
V - ; (( S' / s✓ if 7 etiv
P "\ 5. Surety Information:
V a) Name and Address:
b) Phone Number: . /
_ 41 I
c) Amount of Bond: $
6. Lender Information:
a) Name and Address: _ 1 , f
b) L hone Number: I ' ( E
7. Person within the State of Florida designated by owner upon whom notices or other documents may be served as
provided by 71.3.13 (1)(a) 7, Florida Statutes:
a) Name and Address: 0060/00 :.r. �'-�J `i 1, k — ?o SS' :To'e' yo, �.. T+ . 3 z 2 3
b) Phone Numbers of Designated Person:
S, 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 (I) 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
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 J013 SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING
YOUR NOTICE OF COMMENCEMENT.
The foregoing instr as acknowledged before me this ? day of , 20
Pcie,) / 1 I • __ .1 ,
t , ' ../k- / .,, ','(/LP=L.,,,. 67--;±
'OTARX PU `> lwa ,'"'' *, 9 a
Print Name: ,I -' :h, � �. ` �,
$ ersonally .
0 Identification/Type:
Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, Ideclarc that I have read the
foregoing and that the facts stated in it are true to the best of my knowledge and belief
OR BK i5bbfs Pa 72b, _ \A4aJ)1 Ob ia„
uoC # 411163)W,
Number Pages: 1 Signature of Property Owner
Recorded 07)27.2011 at O:i•51 PM,
JIM FULLER CLERK CIRCUIT COURT DUVAL t
couNT`( `
RECORDING $10.00
Revised 10/1/2009
:fl. x` City of Atlantic Beach
4S t, Building Department APPLICATION NUMBER
8 00 Seminole Road (To be assigned by the Building Department.)
Atlantic Beach, Florida 32233 -5445 / — ! e�
Phone (904) 247 -5826 •Fax (904) 247 -5845
;t s)%? E -mail: building- dept @coab.us — 7 /
City web -site: http: / /www.coab.us Date routed: / ! Zojf
APPLICATION REVIEW AND TRACKING FORM
Property Address: 2- /
L Erjram- nt review required cm Applicant: ( -i- , �Buildi . NO
Planning & Zoning ==
Project: Tree Administrator
% " ' Li:.� — Public Works _-
r s a Public Utilities MI
Public Safety --
Other Agency Review or Permit Required Review or Receipt i_-
of Permit Verified B Date '"'_- ="=-
Florida Dept. of Environmental Protection _�.
Florida Dept. of Transportation —"'`
St. Johns River Water Management District
s
Army Corps of Engineers —
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other: -
•
APPLICATION STATUS
Reviewing Department First Review:
(Circle one.) MAPProved. ❑Denied.
Comments:
BUILDING
PLANNING & ZONING
Reviewed by: i
TREE ADMIN. Date: 9-a 6 /j
Second Review: []Approved as revised. OD - nied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY
Reviewed by:
FORE SERVICES Third Review: Date:
[ ]Approved as revised. ❑Denied.
Comments:
Reviewed by:
Date:
Revised 05114109