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179 Pine St 2012 water damage repairs CITI� OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 -5814 INSPECTION PHONE LINE 247 r Application Number . . . . . 12-Q0000955 Date 8/07/12 Property Address . . . . . . 179 PINE ST Application type description RESI'DENTIAL OTHER Property Zoning . . . . . . . TO RE UPDATED Application valuation . . . . 7512 --------------------------------------- ------------------------------------- Application desc WATER DAMAGE REPAIRS --------------------------------------- ------------- Owner Contractor ------------------------ ----- ----- PERRY SUSAN R C PARKER THE HOUSE DOCTOR 179 PINE ST 10218 SOUTHERN GLEN CT ATLANTIC BEACH FL 322334011 JACKSONVILLE FL 32256 (904) 955-0155 --- Structure Information 000 000 WATER DAMAGE REPAIRS Occupancy Type . . . . . . RESIDENTIAL --------------------------- ----------- ------------------------------------- Permit . . . . . . RESIDENTIAL ALT/OTHER Additional desc . . 45 . 00 Permit Fee . . . . 90 . 00 Plan Check Fee Issue Date . . . . Valuation . . . . 7512 Expiration Date . . 2/03/13 ------------ -- ------------------------------------------------------------- Special Notes and Comments 2010 FLORIDA BUILDING CODE, 2008 NATIONA1 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 90 . 00 90 . 00 . 00 . 00 Plan Check Total 45 . 00 45 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 139 . 00 139 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY 01 ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDING PERMIT Ajf'PLICATION CITY OF ATLANTic BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 FaK (904) 247-5845 J 7UL�,2 5 2 012 Job Address: IT I &C Permit Numa;- Legal Description 'Floor ea o q.Ft. Parcel# --S-qTt -1 eated cooled 11 8 Valuation of Work$ froposedWork non-heated/cooled Class of Work(circle one): New Addition Alteration Re ir Move Demolition pool/spa window/door Use of existing/pro osed structure(s)(circle one): Commercial esidentiaf1- If an existing structure,is a fire sprinkler system installed? (CircleDne) E4's� N/A Florida Product Approval 4 For multiple products use�roduct appr—oval form ed: cllr�w Describe in detail the type of work to be perform \j Property Owner Information: Narne: 5LJ-.s perr K ---- - Address:_; 179 —?zjje, s city State,7yZip Phond 904f xq&-tos4l, E-Mail or Fax# (Optional)--01-�� CA ft cgt2 Aj Contractor Information: Company Name: C. C., 0. b.-,t.,'Q'ua`ifying Agent: RoLafc(�Cft i�-(- city -Ale-K ,( State Address: 10Z/9 ..,50u-yhtt t Ct- Z i P Jk 4—ri Office Phone 90Y -7..., 6--0 1 4,16 State Certification/Registration C 5 DE Architect Name&Phone# EACH Engineer's Name&Phone# DITIONAL Fee Simple Title Rolder Name and Addr ONS. -1 U I Bonding Company Name and Address Mortgage Lender Name and Address REVIEWEDBY.--- Application is hereby made to obtain a permit to do the wor an i tallations as in icaTeZat 11.V stallation has commencelp"r-i-0,Pm-me, f a permit and that all work will be er ormed to eet t e stan ar s o all ws regulat' construction in t isjurisdiction. This permit becomes null issuance o_ Fnde abandonedfor a period ofsi%)months at any time after and void if work is not commenced within s' (6)months, or i construction or wor .su Wor I work is commenced I understand that sep rate ermits must e secure or Jor ca k�Plumbing, Signs, Wells, Pools, urnaces,Boilers,Hea ers, Tanks andAir Conditioners,etc. WARNING TO OWNER: YOUR FAIL RE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR AYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO BTAIN FINANCING9 CONSULT WITH YOUR LENDER OR AN ATTORNEY BEF RE RECORDING YOUR NOTICE OF COMMENC MENT. aws and rdi nee overning this I here rtify that I have read and examined this application and know the same t6 be true and correct. All provisions o e or cancel the vsume viol o7b type . .�cerk will be complied with whether specified herein or not. The grantinA of a permit does not presume provisions of any otherfederal,state, or local regulating construction or the per(ormance of construction. Signature of Contractor Signature of Owner PrintName ........................ Print Name ................................ Sworn and,subscri d before me Sworn o and subscr' efore me this TA Day of -20 7 this Day of SAMM WCOMMINNiDD853524 N ,NpIRES:Mjjbh�30, 13 pIRES.Match 30,2013 Bo�dW Thru N*q Pubk un&mdm Notary Public Ttru ply*UNWWM I. I I NOTICE OF COMNMNCEMENT Permit No. TaxFolioNo. TIM UNDERSIGNED hereby gives notice that improvements wil I be male to certain real property,and in accordance with Section 713.13 of the Florida Statutes,the following information is provided in th!s NOTICE OF COMMENCEMENT. I.Description of property(legal desc*don, a)Stmet(job)Address:j �Ij e- 7 2t z 2.Gencral description of improvements: J:rdtc- A r- Ke-S.1or 6A, b'ke- 3.Owner Information a)Nameandaddress: -5as&A ?,errtj 177 t9o� b)Name and address of fee simple titleholder(if d1her than owni-r) c)Interest in property 4.Contractor Information a)Name and address: '90LO Oje PUW b)Telephone No.: 1)Off SS--jO 1 5-5 Fax No.(Opt.) 5.Surety Information a)Name and address: b)Amount of Bond: Fax No.(Opt.) c)Telephone No.: 6.Lender a)Name and address: Phone No. 7.Identity of person within the State of Florida designated by owner UPOI i whom notices or other documents may be served: a)Name and address: b)Telephone No.: Fax No.(Opt.) 8.1n addition to himself,owner designates the following person to receive a copy of the Lienor s Notice as provided in Section 713.13(l)(b),Florida Statutes: a)Name and address: �)Telephone No.: Fax No.(Opt.) 9.Expiration date of Notice of Commencement(the expii�iieai—date is 0 it—year from the date of recording unless a different date is specified): WARNING TO OWNER: ANY PAYMENTS MADE BY THE OW NER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAY UNDER CHAPTER 713,PART 1,SECTION 713.13,Y FLORIDA STATUTES,AND CAN RESULT IN YOUR PAYING I WICE FOR IMPROVEMENTS TO YOUR PROPERT A NOTICE OF COMMENCEMENT MUST BE RECORDED ANE 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(OMMENCEMENT 4:�-1 STATE OF FLORMA COUNTY OF PP#0#*W4&DL'L1f-0L 10. ger Signatur!!o Ow"mnerr r I -)&A Print Na:rie The foregoing instrument was acknowledged before me this 25+k day of JL& 20'2- by &5kn as A/10 ____(type of authority,eg.officer,trustee, attorney in fact)for (nj me of party on behalf of whom instrument was executed� Personally Known OR Produced Identification Signature Notar3 Type of Identification Produced FL DRIVOL Name(Print) PC 00—78 0-41- 7q9-0 OR Verification pursuant to Section 92.525,Florida Statutes.Under pen of perjury,I declare that I have read the fbregoing and that the fortq 4aled *n thp-heAt' knowledge and belief. 0 iow—=�s FORMS, EXpw4M March 30!=.2013] Signatt re of Natural Person Siping(in line#10.)Above Wod Thru"My Pdft nommompa"Now City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) $00 Seminole Road -5445 12 Atlantic Beach,Florida 32233 Phone(904)247-5826 - Fax(904)247-5845 I Date E-mail: building-dept@coab-us routed: City web-ab: ft!1&vm.coab-u9 APPLICATION REVIEW AND TRACKING FORM Property Address: F1 -27 '1- J7- Dqggrtment review required Yes No ( Building--�) Applicant: -D6e7--a,,e- Planning &Zoning Tree Administrator Project: W a Public Works Public Utilities 'L7)tkg 7-6 A) 01-TF4 Public Safety Fire Services Review or Receipt Other Agency Review or Permit Required of Fermit Verified By Date 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: [2�-Pproved. FIDenied. (Circle one.) Comments: C�� PLANNING&ZONING Reviewed by:_ Date: 7-25'�'-(2- TREE ADMIN. Second Review: ElApproved as revis4-d. FlDeni�d. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: E]Approved as revised. E]Denied. Comments: Reviewed t 1y:_ Date:- Revised 07127110