Permit Remodel/Repair 532 David St 2012 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00000835 Date 7/05/12
Property Address . . . . . . 532 DAVID ST
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 4280
--- ------------------------------------------------------------------------
Application desc
REMODEL BATHROOMS AND REPAIRS TO FRONT PORCH
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Owner Contractor
------------------------
------------------------
LINDLEY THOMAS JACK ET AL KM CUSTOM BUILDERS, INC.
502 EDBURTON CT 2850 TUSCAROR TRAIL
HILLSBOROUGH NC 272789712 MIDDLEBURG FL 32068
(904) 298-4607
--- Structure Information 000 000 REMODEL BATHROOMS AND PORCH REPAIRS
Occupancy Type . . . . . . RESIDENTIAL
---+------------------------------------------------------------------------
Permit . . . . . . RESIDENTIAL ALT/OTHER
Additional desc .
Permit Fee . . . . 75 . 00 Plan Check Fee 37 . 50
Issue Date Valuation . . . . 4280
Expiration Date 1/01/13
y------------------------------------------------------------------------
Special Notes and Comments
2010 FLORIDA BUILDING CODE, 2008 NATIONAL ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
--- ------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
--- ------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 75 . 00 75 . 00 . 00 . 00
Plan Check Total 37 . 50 37 . 50 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 116 . 50 116 . 50 . 00 . 00
PERNH IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDIING CODES.
I
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: -5-32- AiV16 Jam% � rr� ��tff�� 3 2233 Permit Number: 12 ra)
Legal Description Parcel#
Po Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$ %2_id Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existipg/proposed structure(s) (circle one): Commercial �eso
If an existing structure,is a fire sprinkler system installed? (Circle one): 63
Florida Proquct Approval#
For multipl products use product approva orm
Describe in!detail the type of work to be performed: '
Property Owner Information:
Name: Sn,4L-ib a v- Ai M Zwaaq Address: CT.
City MLSo&qtk6-HState NC_Zip72 7S Phone
E-Mail or Fad# (Optional) S7ac y�it►d (eu 4rv,cu I. c,�•1-i
Contractor Information:
Company Name: lwj emira") s -✓I Qualifying Agent: - 2K n G
1,.wAlJ
Address:Z :us T i- ity M
State �c Zip 3 zoue
Office Phon26V-Z1)(- '11,07 i e on act IN UITIOCT 1,
State Certifi tion/Registration# + + DFOR CC
. ,,..:�
Architect Name&Phone#
Engineer's Name&Phone# ;
Fee Simple Title Holder Name and Addr s RE
Bonding Company Name and Address
Mortgage Lender Name and Address REVEEWEDBY: D ,,,
Application is hereby made to obtain a permit to do the work and installation sindicated. 1 certify that-no wor or installation has commenced prior to the
issuance of ape mit 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 f work is not commenced within six(6)months, or if construction or work is suspended or abandoned for aperiod of sixP6)months at any time after
work is commenced. 1 understand that separate permits must be secured for Electrical Work,Plumbing, Signs, Wells,Pools, urnaces,Boilers, Heaters,
Tanks and Air Conditioners,etc
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COM I NCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TOY YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereby certify hat 1 have read and examined thisplication and know the same to be true and correct. All provisions of laws and ordinances governing this
type o work wil be complied with whether speci red herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of an other federal,state, or local law regulating construction or the performance of construction.
Signature of Owner Vj,k o►.. Signature of Contractor
Print Name
Print Name
�'!..4.. .... ..._t.in.A.�.d.y........................................................ L..l..1. :........ .-....L-1 %yt ...........................................................
Sworn.to and subscribed before me Sworn to and subscribed before me
this 3L-Day of A,l, 20 k this r]�Day of N_J ,� 200.
l t,ue
-+-
Notary Public VALERIE K.KNIGHT Notary ublic VALERIE K.KNIGHT
��,a��"P+�.,,• �� ,�
Notary Public-State of Florida aP # -State of Florida
i• •i M.Comm_Eueir.a Wv 91 WA
JUL-3-2012 10:28 FROM: TO:92475845 P:1/1
.NOTICE OF COlVIlI2ENCEMENT umber ages I g OR 8K 75989 Page 88, - -
Number Pages 1
Recorded 071'03/2ot Z at 10:31 AM
JIM FULLER CLERK CIRCUIT COURT DUVAi_
COUNTY
Pcnnit No, RECORDiNc;510.00
Tax Polio No. -
TI JE i.INDERSIGNED hereby gives notice that imlprovements will be made to certain real property,and in accordance with Section
7111�of the Florida Statutes,the following information is provided in this NOTICE OF COMMENCEMENT.
1.0uscription of property(deaf des('rrptfnn):
A)Strcet U01i)Address._
2.Gencral description of improvements: /�-:T
3.Owner Information
R)Name and address: - _�j• ��,/����, �-a
b)Name and address of fcc simple titleholder(if other' e�owner)
c)Interest in property erg
4.001108ctor Information
a)Name and address::
b)Telephone No.: _ Y - . � �{(,•v
—� Fax No.(opt.)
Surety Information —
a)Name and address:
b)Amount of Bond:- r
c)Telephone No,: Fax No,{Opt.}_
0.1.endcr
a)Name and address:
Phone No.
7. Id.cniity of person within the State of Florida designated by owner upon whont notices or other documents may be served:
a)Name and address:
b)Telcphone No.: _ Fax No,(Opt.}
13.1n addition to himself,owner designates the following person to receive a copy of the Licnor's Notice as provided in Section
713.13(1)(b),Florida Statutes:
a.)Name and address:
Wl'clephonc No.:_- _ Fax No.(Opt-).
9.ExpitItion date of Notice of C'ommcncernent(tbe expiration date is one year from the date of recording unless a different date
is speciNd):
WARNIING TO OWNER: ANY PAYMENTS MADE BY TIIU,OWNER AFTER TM I,,XPIIiATION OF THE NOTICE OF
COMM ENCF,MENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAP'i ER 713,PART I,SECTION 713.13,
FLORIIDA.STATUTES,AND CAN .RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.
A NOTICE,QF COMMENCEMENT MUST BE RECOitDED AND POSTED ON THEJOB SITZ%t3FFORE THE FIRST
INSPF. TION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT YOUR LENDER OR AN ATTORNEY BEFORE
COMIvIENC ING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
STATV',op F t,ORIUA
c:rnmTx VF PINELLA3 10.
Signature of Owner c)r 4,,acr"s uthori7,ed Office rcctpr/p�rU�er/IVIan�f�r
Print Name
The foregoing instrument was acknowledged before me this 1 ` day of Lcsa 20 .,by -f�NQ[�DQC\Cs
11 � (type of authority,e.g.officer,trustee,
attorney;in fsct)for (name of party on behalf of wbom instrument was executed).
Personally Known /OR Produced Identification_ Notary Signature
i
'hype of identification Produced Name(print).. ... C'Gl 'C�E? �-
OR
Vcrificatjion pursuant to Section 92.525,Florida Statutes_Under penalties of perjury,i declare th
the facts;stated in it are true to the best of my knowledge and belief. a�"Y"••., VALERIE K.KNIIINlT
Notary Public•State of Florida
rorthty N�c,k�ndmio - z• My Comm.Expires May 24,20th
Signature of Natural Ferson Signing(in t e 92
., •,•, een'm through National Notary Assn.
Jul. 3. 2012,10: 25AM ZELEN RISK SOLUTIONS No, 8678 P. 1/1
ACORD CERTIFICATE OF LIABILITY INSURANCEDATE(NMIDDNYYY)
PRODUCER 0710312012
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Zelen Risk Solutions,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
7964 Devoe St. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
Jacksonville FL 32220 INSURERS AFFORDING COVERAGE
INsuRso ', KM Custom Builders,Inc. NAIC#
INSURERA: Seneca 5p0cialtrinsuranc?�CompRaEny
2850 Tuscarora Trail
INSURER B:
INSURER C:
M)ddleburg FL 32068 INSURER D:
COVERAGES INSURER E:
THE POLIGIE$ 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 OTH1;R DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERUIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR IT
POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
G NERAL LIABILITY
Llktys
A EACH OCCURRENCE $1,00Q 000
COMMERCIAL GENERAL LIABILITY BAG1014524 0612112012 0612112013 DAMAGE TO RENTEDPRE
$100,000
CLAIMS MADE a OCCUR MED EXP(Any one rson) $5,OOQ
PERSONAL&ADV INJURY $1,000,000
GENERAL AGGREGATE s2,000,000
N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP qpp $Z OQQ OQO
X' POLICY PIFQj
RO LOC
A' ONOBILE LIABILITY
ANY AUTO COMBINED SINGLE LIMIT $
(Es accident)
ALL OWNED AUT05
SCHEDULED AUTOS BODILY INJURY $
(Par person}
HIRED AUTOS
NON-OW NED AUTOS
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE $
(Per accident)
G RAGE LIAINLITY
ANY AUTO AUTO 0 4LY,EAACCIOE:NT $
I
j OTHER THAN EA ACC $
AUTO ONLY: AGG $
FV VCESSIUMBRELLA LIABILITY
EACH OCCURRENCE S
OCCUR CLAIMS MADE AGGREGATE $
' DEDUCTIBLE
RETENTION S $
WORKERS COMPENSATION AND WC STATU- DTH_
EIAPLOYERS'LIABILITY
ANY PROPRIETORMARTNERIEXECUTIVE E.L.EACH ACCIDENT $
OFFICEWMEMBER EXCLUDED?
IP yes,describe under E.L.DISEASE-EA EMPLOYEE $
P � p VISIONS below
OTHER
E.L.DISEASE-POLICY LIMIT S
DESCRIPTION QfF OPERATIONS!LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Fax(904)241-5845
FILE
COPY
CERTIFICAiTE HOLDER CANCELLATION ,
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION
City of Atlantic Reach DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL PAY$WRITTEN
800 Seminole Blvd NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
I
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
Atlantic Beach,FL 32233 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE 1 / • /�}� CLIIA}
\Y► , �(J I
ACORD 25 2001108) ACORD CORPORATION 19$8
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POSt Rakkmr'S I Service Date: 147 12-MIap Code: Branch#
w A o E.e..Wr.ee s "
' HANDYMAN SCOPE OF WORK
5754 C Proposal#
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Custoniier Signature:
NDR-SAS-046 (Revised 04-11
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P.O. Box 3399 • Pante Vedra Beach., F-L 32004-3399
10066 Sawgrass Drive West • Ponte Vedra Beach' FL 32082 • (904) 285-0091 • Fax(904) 273-0682
p Fernandina Beach • (904)277-0090 • St. Augustine(904)940-PEST
j Jacksonville (904) 223-4255 • Orange Park (904)2.72-6601 • Georgia(9'12)544-0866
Toll Free(866)4 NADERS J(866)462-3377
www.naderspestraiders.com
sCity of Atlantic Beach
Building Department APPLICATION NUMBER
800 Seminole Road (fo be assigned by the Building Department.)
Atlantic Beach,Florida 32233-5445
Phone(904)247-5626 - Fax(904)247-5845
E-mail: building-deptaecoab.us Date routed: ��.
City web-site: http:1 wrw.coab.us
APPLICATION REVIEW AND TRACKING FORMA
Property Address: �d7 l ent review required Yes No
Buildin
.&2 w0000l
Applicant: anning&Zoning
Tree Administrator
Project:; Public Works
Public Utilities
A-4L Public Safety
Fire Services
Mimi
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
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: 124proved. ❑Denied.
(Cir Comments:
(=BUI(DING'
PLANNING&ZONING Reviewed by: Date:
TREE ADMIN. Second Review: QApproved as revised. [-]Den4(d.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC'SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: []Approved as revised. []Denied.
i
Comments:
Reviewed by: Date:
Revised 07/27110
i