Permit Windows 1872 Hickory Lane 2012 , � `` z CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J =" ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
4.s. Jf3'
Application Number 12- 00000508 Date 5/16/12
Property Address 1872 HICKORY LN
Application type description WINDOW AND /OR DOOR
Property Zoning TO BE UPDATED
Application valuation . . . 15000
Application desc
WINDOW REPLACEMENT
Owner Contractor
PIERSON THIS OLD BEACH HOUSE INC
1872 HICKORY LANE 428A OSCEOLA AVE
JAX BEACH FL 32250 JAX BEACH FL 32250
(904) 249 -2904
Permit WINDOW AND /OR DOOR PERMIT
Additional desc .
Permit Fee . . . 125.00 Plan Check Fee . . 62.50
Issue Date . . . Valuation . . . . 15000
Expiration Date . 11/12/12
Special Notes and Comments
2010 FLORIDA BUILDING CODE, 2008 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 125.00 125.00 .00 .00
Plan Check Total 62.50 62.50 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 191.50 191.50 .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 f M
Office (904) 247 -5826 Fax (904) 247 -5845 IJ
/ APR 3 U 2012
Job Address:
/ ` 7 2 — 74(- 4 X --- „ Permit Number ,4 — 50 -J
Legal Description
Parcel # B,r
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ / S/ G CCd. Proposed Work heated /cooled non- heated /cooled
Class of Work (circle one): New Additio Alteration epair Move Demolition pool /spa window /door
Use of existing /proposed structure(s) (circle one): Commercial esidentia '
If an existing structure, is a fire sprinkler system installed? (Circle one): o N /A
Florida Product Approval # F. z/23
For multiple products use product approval orm
Describe in detail the type of work to be performed: 41 --- - 1 - F 72 --- Z ,,it/d aZ-e) Apo,
()110 //1 6- S - /Axel /lie.t,c.J W E 71 c--e A --
Property Owner Information: € . .4 *,, ,, 4., -O,... r., K. 4, .l .,
Name: 11/1 fZ- `7 .---y p/ C7. e- d A) x ; .
/ Address: FIE COPYi
City State _ Zip Phone „: L E -Mail or Fax # (Optional) 1 � .
t
a
Contractor Information:
Company Name: /7775 7t) gEfi w / 5L Qualifying Agent: /r/! /C/,//J7 CA4C.,4
Address: v/'Zt'3 -A OCe?rx 4 4 City bc t4J State FL Zip 3'Z2 co
Office Phone Sic f— 69c 2606 Job Site/ Contact Number 2 _ SYL5Fax # Ge - 2)43
State Certification/Registration # G — /S 1 -. 71-3
Architect Name & Phone # REARED F 1; 1 I i L I
Engineer's Name & Phone # r a ., -
Fee Simple Title Holder Name and Address . "
Bonding Company Name and Address • FMTTRFMRNTC AND CgNg.m S
Mortgage Lender Name and Address
t{EVIEWED BY: /17 ' DATE: 5.7 —! 2...
Application is hereby made to obtain a permit to do the work and inst : .... . - :,._: • • • ' /.. • , • , • • • a ion • • - 2enced prior to the
issuance of permit and that all work will be performed to meet the stan•ar•s o a aws r e a m —. . , °------ ---- --
gu g ° ' -. -: ermit 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 curt' time after
work is commenced . I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Bo Healers,
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 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 ofa 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 744 -4f---- -.- 1
Print Name l / / L C ? I t: "61
Print Name Mictiq.ac, GUicr—
Sworn to and subscribed before me Sworn to and subscribed before me
"bay of (Lit-- , 20 ►2_ • *'bay of P%P, ■ L , 20 t
N ary P is No ary 'lb is
IF ___ DONAL ii i"" ^ ' ' C. coM RAD
>, k` h Revised 01.26.10
,,, _ M.Y CO AC 224 ; , :'.N M OD
,y f . 94
s-' , EXPIRES: r 30, 2013 , t.0 . , t! '..K �. ° :-"amber 30 2013
, „' ; . , , Undenotero __, "ate) Public Uodenwifers
r te ' �ir City of Atlantic Beach APPLICATION NUMBER
Building Department
\i� (To be assigned by the Building Department.)
800
Atlantic tic Seminole Beach, For ea d
Atlantic Beach, Florida 32233 5445
Phone (904) 247 -5826 • Fax (904) 247 -5845 /
P :;'s; 3» E -mail: building- dept @coab.us Date routed: 'j // Z.
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: /17 2- Department review required Ye No
/" �Building�
Applicant: ///i's SF1(r# AS Planning & Zoning
Tree Administrator
Project: a) //✓ZDU� pf;? e ,. /j .7' Public Works
Public Utilities
Public Safety
Fire Services
b, ji"" ia, ,'i }f 4nMN "1"'!`-ttg',^ -'.
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: [Approved. ['Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING
Reviewed by: Date: � _ 1 2 —
TREE ADMIN. Second Review: A roved as revised.
❑ pp ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
Doc # 201 2 107433, OR BK 15946 Page 294,
Number Pages: 1
Recorded 05116/2012 at 09:54 AM,
NOTICE OF COMMENCEMENT JIM FULLER CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING $10.00
Permit No. /Z jC7� / 'Z j
Tax Folio No. 1`7 , =I ''). _ !. ;,
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Section
713.13 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT.
i .Description of property (legal description) - 2 z'' j - , _ L 5 } „ ,,.
a) Street (job) Address: f-, " 4 ' . t t
2.General description of improvements:
3.Owncr Information
a) Name and address: 1 ' : 1 N i C L - i G, t' r a t
b) Name and address of fee simple titleholder (if other than owner)
` c) interest in property
• 4.Contractor Information
`" a) Name and address: L • .,, .$P �'j &. 0, 4.'" / ' a, Ci ., :. 4 = ..'✓4 AYL 1:::, / - .r` : ,, h , , , ` ,:. I-,C r'
I b) Telephone No.: `
�; 5.Surety Information
Fax No. (Opt.)
a) Name and address:
b) Amount of Bond:
c/ Telephone e 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 he served:
a) Name and address:
b) Telephone No.: Fax No. (Opt.)
8.fn addition to himself, ovine „designates the following person to receive a copy of the Lietio> a Notice as provided iti Section
713.13(1)(b), Florida Statutes: Notice
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 EXPIRA'T'ION 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.
ti!'A rc; Ok' k't_tkRittp
COUNTY OF PINELLAS 1 L-. (IJ�C fit' ` --
^'���.� Signature of Owner or Owner's A,L,thorized O, fficer /Director /Partner /Manager
DONALD C. CONRAD, If! i
4 ah * MY COMMISSION # DD 943724 1 / /. i : (- L //2 (~''
3 -ter EXPIRES: November 30, 2013 Print Name
P,r.A. Bonded Thru Notary Public Underwrttets
The foregoing ins "a .r . • - this 1 . , d ay of A Pat l•-• 20 IA, by
as (type of authority, e.g. officer, trustee,
attorney in fact) for (name of pa on behalf of whom instrument as executed). s.
Personally Known OR Produced Identification Notary Signature
Type of Identification Produced (.... Name (print) - 1)ec4 A, 1..0 C` Co.14 - '15_
OR
Verification pursuant to Section 92.S2S, Florida Statutes. Under penalties of perjury, 1 declare that 1 have read the foregoing and that
the facts stated in it are true to the best of my knowledge and belief.
FORMS /NOC,rvsd20I0
Signature of Natural Person Signing (in line # 10.) Above