Permit Repair Water Damage 1805 Sea Oats 2012 CITY OF ATLANTIC BEACH
r 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00000834 Date 7/09/12
Property Address . . . . . . 1805 SEA OATS DR
Application type description RESIDENTIALOTHER
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 2400
----------------------------------------------------------------------------
Application desc
REPAIR WATER DAMAGE SHEATHING AND STUCCO
-----------------------------------------------I----------------------------
Owner Contractor
------------------------ ------------------------
JOHNSON BRIAN & MEGANNE MARTIN & BURKE CONST, INC
1805 SEA OATS DR 749 NOTTINGHAM FOREST CIR
ATLANTIC BEACH FL 32233 ST JOHNS FL 32259
(904) 504-8380
--- Structure Information 000 000 BATH REMODEL AND PORCH REPAIRS
Occupancy Type . . . . . . RESIDENTIAL
----------------------------------------------------------------------------
Permit RESIDENTIAL ALT/OTHER ,
Additional desc BATH REMODELS AND PORCH REPAIR
Permit Fee . . . . 65 . 00 Plan Check Fee 32 . 50
Issue Date . . . . Valuation . . . . 2400
Expiration Date . . 1/05/13
----------------------------------------------------------------------------
Special Notes and Comments
CALL FOR DRY IN AND FINAL INSPECTIONS
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 65 . 00 65 . 00 . 00 . 00
Plan Check Total 32 . 50 32 . 50 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 101 . 50 101 . 50 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION zk A3,
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233�, /
Office (904)247-5826 Fax (904) 247-5845w v
Job Address: 1 C) SLD �0,tS �+'o��e ��Irtr���r 12��.3
Co+ �eCC� PermitNumber:
Legal Description HiQ`- SN i�� m�L�, .� vim;i �,�.
Valuation of Work$ c2�p0 Pao
roposed Work heated/cooled ✓ t
non-heated/cooled
Class of Work(circle one): New Addition AlterationR� Move Demolition pool/spa window/door
Use of existing/pro osed structure(s) (circle one): Commercial es��I
If an existing structure,is a fire sprinkler system installed?(Circle one): 'mss— N/A
Florida Product Approval #
For multiple products use Frouct approval form
Describe in detail the type of work to be performed: s!lJl4:f
62
Prooerty Olwner Information•
Name: . * arnr���Ulnt25n�^
Address: &25 S c«
City (a i ll n AA,ic Eco l^ State FC
E-Mail or Fax# (Optional) Zip_3�a 3 3 Phone-,2, :3 p y t{g$6
r nne c,nr,�„x
Contractor Information:
Company Name:, Q Al 16r/ rr zoll/ Qualifying Agent:
Address: d'
Office Phone d¢ �� pl City ��.4 te_�=L Zips
9 j Job Site/Contact Number 5efte Fax#
State Certification/Registration# G/LG O 39 /
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. /certify that no work or installation has commenced prior to the
issuance ofa permit and that all work wzll be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes inti!
and void if work'is not commenced within s (6)months, or if construction or work is suspended or abandoned for apertod of six(6)months at airy time after
work is commended. 1 understand that separate permits must be secured for Electrical Work, Plumbing,Signs, Wells, Pools, Furnaces, Boilers, 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.
1 here b certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing phis
Ope olYwork will be complied with whether speci ied 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 F'
Print Name ( i.e scn.e S
......................_............................... Print NameSwoIV//f
..,7Gff t�L......
thisTx ,�o and subs a before me Swor to and subscr' d efore me
thisTA Day of��
2011 t is
Day of
20
Nota Public V
U urm�-r f� to is
'% VANESSA L.JOYCE
Notlsry Public•State of FlorWs
h TA Cprr.'ssion#EE 120438 My Comm.Expires Jan 9W¢s 01.26.10
Expires August 9,2015 I Commissbn#r EE 154034
low Ivu Tmy fain ir^nna 10 ms..70*,r
IWA*a TWO NOW Ndary Min.
Y� _
FROM INSURE—RLL
l (TUE) JUL 3 2012 10 . 16/ST. 10 . 13/No. 6800000818 P 1
A�CJI� 3
may. CERTIFICATE OF LIABILITY INSURANCE li IU: Lb
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFpRMAT10N ONLY AND CONFERS NO RIGHTS UPON TWE C:ERIFATEoarE(NalltroarrrY)
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY AMEND, EXTEND QIP ALTER THE COVERADE 07DER.
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUINGER HOLDER, THISREPRESENTATIVE OR PRODUCER,qNp THE CERTIFICATE WOLDER. AF8Y TWE POLICIES
IMPORTANT: If the certificate holder an ADDITIONAL INSURED,the ($). AUTHORIZED
the terms and Conditions of the policy,certain pollciee m reulI�Y(I�)must be endorsed, ff SUBROGATION I$WAIVED,subject to
Certificate holder in lieu of Such endorgein s require en endorsement, A statement on this certlNcate does fiat confer rights to the
PRODUCER
INSURE-ALL INSURANCE AGENCY 904-725-493 CONTACT
184p UNIVERSITY BLVD.8QUTH 904-726-0408 PItpNE
JACKSONVILLE,FL 32216
MICHAEL 8.ESSA EMAIL I (!uc Ne►:
AD Eft
ucER IP e:MARTI-1
MARTIN 8,BURK S7RUCTION IN
IN5URERls1 AN°N'ORDING COVERAGE -
INC. INSURER_ A AutO Owlhers Insurance Co. N=N
749 KNOTTINGHAM FOREST CR. INsuil a:FLORIDA CITUS 8 BUSINESS_IND. 1$98
JACKSONVILLE,FL 32259 INSURER C:Westem Surety Companies --
INSURER 15:
�—
INSURER G: T
COVERAG S CERTIFICATE NUMBER: R F:
THIS ISI CERTIFY THAT TME l'Ol ICiE5 OF INSURANCE LISTED BELOW NAVE SEEN ISSUED TO THE INSURED NAMED ABpVE FOR T
1NDICA'fED. NpTW{TMSTANDINO ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT pH OTHER REVISION NUMBER:
CERTIFICATE MAYO ISSUED OR MAY PERTAIN, THE INSURANCE AFFpRpED BY THE POLICIES DESCRIBEDTHRHEREIN IS SUBJECT TO ALL WHTHE TERMS,
HE POLICY PERIOD
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMIT$SHOWN MAY HAVE BEEN REDUCED CI S I HERDOCUENT WITH RESPECT TO WHICH THIS
INTS'R TYPE OP IN;URANCE AOOL ---
GENERAL LIABILITY LICY NUMBER M�Y EFF LILY FXP
LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE ; 300,
CLAIMS MADE I --I OCCUR P
A X 250DED 78547$47 "'E0 ENP(Any ons eor,I, :� ----
06/01111 06/01/12 PERSONAL 6 AOV IN FURY ; SOO,G
.. 78547$47 06/01112 06101/13 "'
GEN L POLICY
GATE LIM{TAPPLIES PER GENERAL AGGREGATE $ 600,0
POLICY — LOC PRODUCTS-COMPIOP A i 600
AUTOMOMLE LAMUTy
S
ANY AUTO COMBINED 81NGLE LIMIT
_ ALL AWNED AUTOS BODILY INJURY(Per person) i '
SCHEDULED AUTOS BODILY INJURY(Per acGdsM) ;
HIRED A11T08 PROPERTY DAMAGE
NON-OWNEDAUTOS (Pxacoident) 3
i
UMBpELLA Ul OCCUR S
. ExCE(Is Lu►s Cu►IrL4�4E EaCH OCCURRENCE
_ S
DEDUCTIBLE AGGREGATE S
RETENT -
WORKERS COMPENSATION S
AND N:+IIP�o+ a.UABIUTY ;
B ANY PROPRIETOR/PARTNFR¢XECUTIVE Y/N X WC STAT o -
OFFICER,AIEMBER EXCLUil N/A 10635446 04/01/11 041d9/12
(mend"in MH) E.L.EACH ACCIDENT _
If as..dstcrbe udder 10635446 04/01/12 i 100,0Q
04/01/13
DE RIP OF OPERATI LO E.L,DISEASE-EJA EMPLOYE 3-100100*
E.L.DISEASE-POLICY LIMIT 3 500,0
BEBCR PTION OF OPERATIONS I LACATIQNS I VEHICLES(Attach ACOR0101,AtldNlenal Rsmarka Schedule,N
ARPENTRY INTERIOR mos span Is required)
Fax:904-247,5045
CERTIFICA HOLDER
CITYATL CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 09 CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WELL
CITY OF ATLANTIC BEACH ACCORDANCE Wl THE POLICY PROVISIONS. BE DELIVERED IN
600 SEMINOLE RD.
ATLANTIC BEACH,FL,32233 AUTRORIZEP REPRESENTATIVE
MICHAEL B. S
ACORD 23(2009/09) The ACORD Hants and logo are ®1988-2 ORD CORPORATION. AH
g registered marks of ACORD fights reserlrep,