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Permit Wind/Doors 660 Sailfish 2011 r R o a ° CITY OF ATLANTIC BEACH 8 4 ; 800 SEMINOLE ROAD , ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 Application Number 11- 00002507 Date 8/23/11 Property Address 660 SAILFISH DR Application type description WINDOW AND /OR DOOR Property Zoning TO BE UPDATED Application valuation . . . 3700 Application desc 10 winds 1 sgd and 2 exterior doors Owner Contractor TGM PROPERTIES BENNETT'S QUALITY CONST. CO 3723 BROOKVIEW DR SOUTH ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32246 Permit WINDOW AND /OR DOOR PERMIT Additional desc . Permit Fee . . . 70.00 Plan Check Fee . . 35.00 Issue Date . . . Valuation . . . . 3700 Expiration Date . 2/19/12 Special Notes and Comments *2007 FLORIDA BUILDING CODE W/2009 REVISIONS NATIONA1 ELECTRIC CODE *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. 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 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. , BUILDING PERMIT APPLICATION 1 CITY OF ATLANTIC BEACH . 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 r - 1 f , I ' '\, --- ( ilii j.. i',;,' . ,i - s ),,,, Job Address: 6, , --,c,,i, , -,-„,,,,,,, ,. )4,-,, ,_ ,,,„,, ,, f.„—,,,,,, ,- ermit Number: // -02 5 ,, , , ; L Z v _ ),, < _ ..) e ,:- Legal Description ') t c . ) c , .., - -- c Parcel # I / / i , ',,, , Floor Area of Sq.Ft. Sq.Ft ., Valuation of Wnrk $ , S2 41 , d 4 Proposed Work heated/cooled ' i / o' non-heated/cooled ..', — Class yr work (circle one). New Addition , Alteration Repair Move Demolition pool/spa vfindow/door Use of existing/proposed structure(s) (circle one): Commercial , - R.0Aential - If an existing structure, is a fire sprinkler system installed? (Circle one):- --- Yes (No ) N /A Florida Product Approval # - - PL. 4 l o , j 9 " 1C' 3 Sc 'is ; 11 5-- For multiple products use product apprdvai form I ‘ , , Describe in detail the type of work to be performed: ‘, t- k . ', -' -: ) \ / 1/4 i' ( 1; t-`‘,. i \ (" \ ` / 'I I ` i / t'l ; , ,, _ ..1 L I I , 1 : k • 741 - , . J , Property Owner Information: Name: . 1.. i ''' ,, \ : ,;, t ) , 71 c 3 Address: :--)-''''. . -\.) t '21 1 ( L t'' ': , - '. - - - ' ': v• . ....,_ , City , - , .‘, ( t,, (.., 0 d ist 5 State )-LZip .s:,), • I ''') Phone c l E-Mail or Fax # (Optional) c , i - ,.). q i - ,;,, o . 1 .,,. V i 1 .., .. . , Contractor Information: Company Name \ i ,14, \j,..\ 5 1 :-.\- , -:s6 A.is t. ' ( C ' '‘)A — Qualifying Agent: Address: ‘, ' '.:- t ‘. / ?) k.; 4 : City -- Yik _ .----- . v Office Phone ,: - 1 '-:11:),- -,) Job Site/ Contact Number V: f'. -- '-i. 6. <....::_j--'-:-- - ----- a4 b i , , t ____--- • - State Certification/Registration # 1 - ( . ' . LT; (_, ----,- , • , II . 5„. . Architect Name & Phone # c" \,,,;‘, u ,' t."k co' ,ft '''`A, \'' .. ,,,,II rii„ r j 1 . .., .,. , I t ■ \ , Engineer's Name & Phone # i .,-, , 1, '• , ...k.:. ( ..`j ..-,(:- : i k ( ' ( lui ... ,.! OD 1 ... ... • Fee Simple Title Holder Name and Address --- ',-; ,,.,„ <- .. P.. , DCO" ' - it Bonding Company Name and Address ,\ 1 ...• , t . • Iiil . p, b .. • 111 l il lik Mortgage Lender Name and Address A i I \ \, 1 Mill1111614 1 . ----- . .......--- Application is hereby made to obtain a permit to do the work and installations a\ . *, e, - • ...,:--- , -- wo k or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of ,',..- ...-- construction in this s jurisdiction. This permit becomes null and void if work is not commenced within six (6) months, or if construction or wor is suspinded or abandoned for cteriod of six _(6) months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work, Phimbing, Signs, Wells, Pools, Furnaces, Boders, Heaters, Tanks and Air Conditioners, dc, 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 certifi, that I have read and examined this application and know the sameto be true and correct. All provisions of laws cmd ordinances governingthis 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 n't - V,- :,...- Print Name ▪ i I -- :\...,v-- ''. I Print Name Le'' ,,; \ Sworn to and subscry4be Sworn to and subscribed b this g' Day of , 20// this a Da of 7...gf-7. , 201/ Nota blic ( Pu 4-.V..< Notary ublic „.0 ....7 DAVID H. STANFORD 01:•:. DAVID H. STANFORD * --:: c i i )7 - , , MY COMMISSION i DD 968953 * - - MY COMOISSION i DO Aii,953 - ' ^ -,;( • )-5 * EXPIRES: Apri110, 2014 dri EXPIRES: Apri110, 2014 d > . cjt Flooded Thru Budget Notary Service!, 1 4- om ocs Bonded Thar Budget Notary Services 2011- Aug -08 09:15 125FW /CF 904 - 741 -7999 111 August 8, 2011 To the City of Atlantic Beach, My name Is Todd Moldenhauer owner of Tgm Properties Inc. My Company owns 660 Sailfish drive 32233. Earl Bennett is allowed to pull a permit on my property. If you have any questions and or concerns please feel free to contact me directly at 904 - 291 -8311. • Todd Moldenhauer Tgm Properties c 1 Doc ## 201'1173600, OR BK 15680 Page 725, NOTICE OF COMMENCEMENT Re Recor orded Number R 1 08/09/2011 at 02:38 PM, JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY Permit No. /l _a O 7 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 1.Description of property (legal descrjption): lC.. a 0 6 o 3 ' - E I_ � C� 1 ►ti.5 (AA 1 a) Street (job) Address: (h D r , E f f tev,1 -a e ( , :L _ 3 a L 33 r 2.General description of improvements: (Z, t vvt,. p V R -l") 0 r\ o ' - y�,-t Q�9 r t e. K1_e r r op o Q' 3.Owner Information • .� -/ a) Name and address: �G— V� © ( ` te. S 2_0'4 c - ,sS(? LPG C. t Peati Coot (i7e4scis b) Name and address of fe simple titlehglder if other wner) ' � 3 Sa•A c) Interest in property e C S s Q t € \ �-E4 e b `1 4, 4.Contractor Information n �� a) Name and address: 17U^"^'e� S �^ . �� ( C0/1 L 2'� � =�-t� �?�Id1� 'pr. b) Telephone No.: Ci 04 - 9' jj a -'`t -36 3 I Fax No. (Opt.) --- J p , 5.Surety Information 2 a) Name and address: �. b) Amount of Bond: A c) Telephone No.: 3^ I Pi Fax No. (Opt.) r 1 t 6.Lender a) Name and address: In rp, Phone No. rti 1 A 7. Identity of person within the State of p'loTida designated by owner upon whom notices or other documents may be served: a) Name and address: h f b) Telephone No.: 1■1 Fax No. (Opt.) n / 1{ 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: ( A b) Telephone No.: n t tt Fax No. (Opt.) t t / R 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 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 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 PINELLAS 10. Signature . _Owner or Owner's Authorized Officer/Director /Partner/Manager CU I fd- �n� �r Print Name The foregoing instrument was acknowledged before me this day of , 20 // , by , h M `c�'e,vd 6 4t C✓ as �ive�t (type of authority, e.g. officer, trustee, attorney in fact) for AI � i eP a (name of party on be a of wh rument s exec ed). Personally Known V OR Produced Identification Notary Signature • Type of Identification Produced Name (print) ,b ace-2' ,' p/c 4,ti,1 n e ✓ 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. FORMS/NOC,rvsd2010 'b . DAVID H. STANFORD Si re o Signing (in line # 10.) Above ...., MY COMMISSION # DO 968953 *`� * EXPIRES: April 10, 2014 �� OF Floe" Bonded Thru Budget Notary Services (4 a . t'*5. 0 gi 2'. � ,--+ p 0 00 v Q\ A W N P •11 c A W N �-' ..,, C '0 CD . 9 A A b .0 >. ~ii. U? O >. Po C/s C /1 O O a• . a. ° 0 e) x • a ( 6C1p z 6 Z . a d ° 6 CcD • — 1" Fs a , a Z 4 G. . CD . w. Q" CD N O O `" iii,. = "= FA 8 .=. Q, Z 0 l f NJ co am � Z .---c4 V , C • co 1 1f F _t ro o U j N r� O ° Vl • -'> J', 4 bia (1 :' FS U y > ri co t _t a x 7 d o 0 �- L . —t,. . y `1 ' c CD - o P --) = r (77 5' 4 C ., C, p ,-+ CD ( D r 0 cD �! -7:I r 0 8, Y � o ma ` i -r lir �-- D �. / � ' 1 - t .., c �` r co vi E o e. CD . C N x E. 1 c 5 • a. 4. ff N ..r�z s N 0 o w �' C o ti c� i o O OA ,.-_, _ N 0 O o b � C � r°-` =. rb o < i1 t rn l/`' o o o 0. r F i p -7,--- r 0 ..., - ' 0 - . co c y J ! �• �. ou e o C P o con CL 7 5. 4) — a, 0 g 14 > f a W co o o ti O 1 N.I\ fli 0 CD o. u E. o. CD v2 tL:vp City of Atlantic Beach APPLICATION NUMBER „ Building Department (To be assigned by the Building Department.) 800 Seminole Road � Atlantic Beach, Florida 32233 -5445 ✓ Phone (904) 247 -5826 • Fax (904) 247 -5845 E -mail: building- dept @coab.us Date routed:' / /l City web -site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 6 6 r, r Department review required Ye 11 /� Building Applicant: 5 � et / /Z '� nning & Zoning ✓ ✓✓ Tree Administrator Project: / /4 /,,O / LAS Public Works Public Utilities / /� — i2 r D - UC S Public Safety Fire Services 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: roved. EDenied. (Circle one.) Comments: BUILDIN PLANNING & ZONING 9-17 —// Reviewed by: m ., Date: TREE ADMIN. Second Review: ['Approved as revised. ❑Deni PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 07/27/10 From:Joy Featherston FaxID:352- 376 -5741 Page 1 of 2 Date:8/23/2011 10:31 AM Page:1 of 2 Phone: (352) 338 -0552 Fax: (352) 338 -3568 Fax From: Joy Featherston To: City of Atlantic Beach Pages: 2 Fax: (904) 247 -5845 Date: 8/23/2011 08:31:29 AM Phone: ( ) - Subject: COI -DKB Enterprises Confidential Note: Information in this facsimile is confidential and intended for use by the individual or entity named If you received this telecopy in error, please immediately telephone us and return the original via U.S. Postal Message: From:Joy Featherston FaxID:352- 376 -5741 Page 2 of 2 Date:8/23/2011 10:31 AM Page:2 of 2 OPID:JF ,►CoR° CERTIFICATE OF LIABILITY INSURANCE DA 08!23111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on thls certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER 352 - 338 -0552 CONTACT NAME: Darr Schackow Insurance Agency 5200 - B Newberry Road 352- 376 -5741 (AIC, No, Ext): FAx Gainesville FL 32607 E-MAIL (A/c, No): John Darr Iv ADDRESS: CUS DKBEN - INSURER(S) AFFORDING COVERAGE NAIC N INSURED DKB Enterprises, Inc. INSURER A: Nw Insurance Co. Of America 25453 PO Box 331458 INSURER B : Depositors Insurance Company 42587 Atlantic Beach, FL 32233 INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD Y (MMIDD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 300,000 A X COMMERCIAL GENERAL LIABILITY ACP5905038551 07/31/11 07/31/12 RIM - S ( E o N cc r $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) _ $ 5,000 PERSONAL & ADV INJURY $ 300,000 GENERAL AGGREGATE $ 300,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS- COMP /OP AGG $ 300,000 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B ANY AUTO ACP5905038551 07/31/11 07/31/12 (Ea accident) 100,000 ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE HIRED AUTOS $ (Per accident) NON -OWNED AUTOS — $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DEDUCTIBLE RETENTION $ — $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER ANY PROPRIETOR /PARTNER /EXECUTIVE Y 1 N E L EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ I yes, describeunder DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) CERTIFICATE HOLDER CANCELLATION CITYATL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Atlantic Beach ACCORDANCE WITH THE POLICY PROVISIONS. 800 Seminole Road Atlantic Beach, FL 32233 AUTHORIZED REPRESENTATIVE O 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD Doc # 2011173600, OR BK 15680 Page 725, Number Pages: 1, Recorded 08/09/2011 at 02:38 PM, JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00 NOTICE OF COMMENCEMENT Permit No. 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. � o. 6 0 3 Y - 2 S - 2 - 9' E e. l At1�S (AAA 1 1.Description of property (legal desc • . n : Mk a) Street (job) Address: 0 2.General description of improvements: Q r ,rvr0 v#1. 0 r■ 0 ." I rL • (0 r t e )( nii of 0 Y ton 3.Owner Infor { i � t, . a) Name and address: .1-G--- Vv\ r N ("t f •te 2 0 4 ] e- SS � C # ' 6-142'" 6-142'" C,u`1e. W C lr' b) Name and address of fe�.simple titlehg tf lder other than gwner) 1.12'5 Ca■ c) Interest in property ' -t- S% ("Pt IAA e 1 "01 if- EC ( 4.Contractor Information 21 .41 CO (IA • 11 23 tb 9r• a) Name and address: b) Telephone No.: " - �- . Fax No. (Opt.) 5. Surety Information I q a) Name and address: 11 l b) Amount of Bond: IN c) Telephone No.: r , 1 tY Fax No. (Opt.) r ( r 6.Lender a) Name and address: f Phone No. r1 N • 7. Identity of person within the State of Flo da designated by owner upon whom notices or other documents may be served: a) Name and address: A 14 Fax No. (Opt.) n A b) Telephone No.: n. 0" S.In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.13(lxb), Florida Statutes: I a) Name and address: l ( Fax No. (Opt.) n R b) Telephone No.: 9.Expiration date of Notice of Commences (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 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 CO P MMENCING WORK OR RECORDING YOUR NOTIC E � LENDER OR AN ATTORNEY BEFORE E COMMENCEMENT. STATE OF FLORIDA 10. .... COUNTY OF PINE11 nS Signature . Dwner or Owner's Authorized Officer/Director/Parmer/Manager ()) mo ldt,.i .t.tr Print Name The foregoing instrument was acknowledged before me this / day of �' ��++ t-rf 44 , 20 // , by d N t S /7/RA/d 4I,t &e. N ©!*>Me4' (type of authority, e.g. officer, trustee, attorney in fact) for _�,4 14/u 6✓` (name of party on beir of wh • rume�nt s exec ed). Personally Known � OR Produced Identification Notary Si 8 nature / c e Name (print) / O hC /',/ b /544/4 se e Type of Identification Produced 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. FO /NOC n d20 Sig re o at Person Signing (in line # 10.) Above a¢''' .1.11•N- DA"asTAlti 6) * COMM SO i :Dos * EXPIRES: April 10, 2014 '',, „o,„0” Bolded ThuS *WI Sir**