1163 Beach Ave (1165) 2015 siding and windowCITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
BUILDING PERMIT FEE $60.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID:
15 -WIND -12
Job Type:
WINDOW AND/OR DOOR
Description:
door replacement
Estimated Value:
$2,000.00
Issue Date:
1/14/2015
Expiration Date:
7/13/2015
PROPERTY ADDRESS:
Address:
1163 BEACH AVE
RE Number:
170272-0000
PROPERTY OWNER:
Name:
ADAMS, CHARLES P
Address:
1163 BEACH AVE
GENERAL CONTRACTOR INFORMATION:
Name:
WORSHAM CONSTRUCTION CO INC
Address:
2329 URBAN RD QA RONALD E WORSHAM
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES
$30.00
BUILDING PERMIT FEE $60.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICAT
FP � CITY OF ATLANTIC BEAC .�
4 800 Seminole Road, Atlantic Beach, FL 33 SAN 5 O'
-- � Office (904) 247-5826 Fax (904) 247- 5
Job Address:4*9 �� (�(/✓/ ���� Pe B
Legal Description Parcel #
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work T. d"40. QQ_ Proposed Work heated/cooled non-heated/cooled
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/pro osed structure(s) (circle one): Commercial Resi
If an existing structure, is a fire sprinkler system installed? (Circle one): es o N /A
Florida Product Approval # FL 154 13 - /
For multiple products use product approvalform
Describe in detail the type of work to be performer �� �E_ �h
Property Owner Information:
Name: 4C#4eLe6 6FAA-+,t�_ 4(? Address: 1lb S� ��= -� 4v`c
City � � akj6E-2 r f- State Zip 3z! 33 Phone
E -Mail or Fax # (Optional)
Contractor Information• CONTRACTOR EMAIL ADDRESS•'1404Slgitwt 4t MA -(-40 t
Company Name: W0j26fjq+,A 4::�yt L65 e,_ Qualifying Agent:
Address:3z`j (J2 CityState�� Zip 'E 2,f
Office Phone Job Site/ Contact Number- SQS'- z3 .5�7 Fax #
State Certification/Registration # 6f_-1,e—elm' 4?1 Z
Architect Name & Phone # Wl
Engineer's Name & Phone # At sE
Fee Simple Title Holder Name and Address /XAI
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. I certify that no work or installation has commenced prior to ti
issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes nu
and void f 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 any time aftc
work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, urnaces, Boilers, Heater.
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 hereby certify that 1 have read and examined thispltcation and know the same to be true and correct. All provisions of laws and ordinances governing thi
type o1 work will be complied with whether speci ted herein or not. The granting of a permit does not presume to give authority to violate or cancel th
provisions of any other federal, state, or cal law regulating construction or the performance of construction.
Signature of Owner Signature of Contract r
Print Name u .,.1 s...._v.1.�..'..G!`� ....�itr�".. s....,� • Print Name
Before ri}eDa of 20 �� Before pie
this ii'"- y um thi - Day of 't' 20
Notary Publi Gina M rowier otaty Publi
M Commission EE 84042�3 �j � Gina M Fowler
My
Se
�i, 1 7.7 16 840426
c r. ,fres Commission
2016
FILE COPY
State of�
To Whom It May Concern:
peymt� # 15 to l /vi) - /a
NOTICE OF COMMENCEMENT
County of 0 t/ya I Tax Folio No.
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of
the Florida Statutes, the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: /I& 6� a�� dpv
Address of property being improved: 116 6-
General description of improvements: c5ie12 e—'' 4 7Z9 ?` rr. 27 .
Owner:ll�;t'', t�-� F_AhS A Address: ff6:5 �-
Owner's interest in site of the improvement:
Fee Simple Titleholder (if other than owner): _
Name:
IAp Contractor:
Address: 0- C.� .9N oe,.6x 7 -44qc ,;t,s2
Telephone No.:v 5 = 2-13�t�-7 Fax No:
Surety (if any)
Address: Amount of Bond $
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name:
Address:
Phone No: Fax No:
Name of person within the State of Floris.:; , ether than himself, designated by owner upon whom notices or other documents may be
served: Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b), Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement (the expiration date is one (1) year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER 1
Signed: 1� Y .mss_ Date: 12-'
Before me this ti-- day of Ne curl "� in the County. of Duval, State
Of Florida, has personally appeared V.N;
Personally Known: ✓ or
Das # 20115002546. OR DK '1702Produced Identific i6 Rage 309, NotaryPublic:
Number Pages: 1 My commission expires:
Recorder! 01/06/201$ at 11:08 ANI,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL ��parvrs� Notary Pudic State of Florida
COUNTY Gina M Fowler
RECORDING $10.00 < My Commission EE 840426
� W Expires 10/17/2016
City of Atlantic Beach
�s = Building Department
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone (904) 247-5826 - Fax (904) 247-5845
E-mail: building-dept@coab.us
b it - + @//www coab us
APPLICATION NUMBER
(To be assigned by the Building Department.)
/.� /JWAIt - /2-
City we -se. p.
APPLICATION REVIEW AND TRACKING FORM
- G ` �,!
_o- 11 vs -
Property Address: /` V C? CIA C/A /T ► De artment review required Yes o
Building
g &Zoning
Tree Administrator
Public Works
Public Utilities
Public Safety
Fire Services
Applicant:
Project: 66e
Review fee $
Dept Signature
Other Agency Review or Permit Required Review or Receipt Dateof 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:
A001 IPATlnAI CTATIIA
Reviewing Department
First Review:
Approved.
❑Denied.
(Circle one.)
Comments:
BUILDI
PLANNING & ZONING
Reviewed by:
Date: ! ' 21
TREE ADMIN.
Second Review:
❑Approved as revised.
❑De ed.
PUBLIC WORKS
Comments:
PUBLIC UTILITIES
PUBLIC SAFETY
Reviewed by:
Date:
Third Review:
❑Approved as revised.
❑Denied.
FIRE SERVICES
Comments:
Reviewed by:
Date:
Revised 07127/10
i
J�
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
�\ INSPECTION PHONE LINE 247-5814
ss\ CITY OF ATLANTIC BEACH
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID:
15-RAAR-7
Job Type:
RESIDENTIAL ALTERATION
Description:
siding
Estimated Value:
$27,000.00
Issue Date:
1/14/2015
Expiration Date:
7/13/2015
PROPERTY ADDRESS:
Address:
1163 BEACH AVE
RE Number:
170272-0000
PROPERTY OWNER:
Name:
ADAMS, CHARLES P
Address:
1163 BEACH AVE
GENERAL CONTRACTOR INFORMATION:
Name:
WORSHAM CONSTRUCTION CO INC
Address:
2329 URBAN RD QA RONALD E WORSHAM
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES
$92.50
BUILDING PERMIT FEE $185.00
STATE DCA SURCHARGE $2.78
STATE DBPR SURCHARGE $2.78
Total Payments: $283.06
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
y ILE cu
%/G 3
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: �a6ei 29,�7 k1VZ7' // 4'5'Permit Number:
Legal Description
Parcel #
JAN 0520/.�IU
rloor Area of �,q.rt. �Sq.rt
Valuation of Wor $ Proposed Work heated/cooled non-heated/cooled
Class of Work (circle one): New Addition Alteration Repair Move Demolition poo/Spa _ wndgw/dpor y���
Use of existing/proposed structure(s) (circle one): Commercial <
Resi t
If an existing structure, is a fire sprinkler system installed? (Circle one): es o N /A s
Florida Product Approval # FILE k
For multiple products use product approval form
Describe in detail the type of work to be performed:���
Property Owner Information:
Name: ? 6ibA�tS Address: 11'65'_
City � State Zip 2, 55, Phone
E -Mail or Fax # (Optional)
Contractor Information• CONTRACTOR EMAIL ADDRESS•\401## 9 -iv( AWL Eo M
Company Name: W0j2aUgj t w /�Qualifying Agent:
Address: UR -6+0 aP t> CityState�� Zip
Office Phone Job Site/ Contact Number 7Q!5t- SQS- y3 sF Fax #
State Certification/Registration # GT3G ell02¢3
Architect Name & Phone # Nl
Engineer's Name & Phone # IV/14-
Fee
Vsa-Fee Simple Title Holder Name and Address ��A-
Bonding Company Name and Address
Mortgage Lender Name and Address IfA
'?S7 ---res
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance of a permit 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 if work is not commenced within six (6) months, or if construction or work is suspended or abandoned for aperiod of six 6) months at any time after
work is commenced. 1 understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters,
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 I have read and examined this plication and know the same to be true and correct. All provisions of laws and ordinances governing this
ci
type o1 work will be complied with whether speied 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 cal law regulating construction or the performance of construction.
�_-,,_,,ee
Signature of Owner Signature of Contract r
Print NameVNO.,, 1V5 S i'v 1 k M �<i . Print Name
................................................................ .................... .... 3 ............... . . .... .....GHQ .................................................
Beforerr} e , Before }ne
this t; Day of. 20 �4 this '- Day of
Notary Publl Gina M Fowler ot, rY Publi
My Commission EE 840426
Expires 10/1712016
Gina M Fowler
My Commission EE 840426
Tsai W.1267w16
Building L:�c�6naft-uei-�'. � !APPLICA� ON NUMBER
800 Seminole Road
. i -o be assigned by the Building Deparlm,nt-)
-�_
- - Atlantic Beach, Florida 322:33-544.5
Phone (904) 247-5826 - Fax (904) 247-584.5
City web -site httpl/www..^oab.us II Date routed:
�,� �= P 9(3 TP(0 h!! yREV4 W �� AND TRACK ONG FORA
E�'825 eric�r C]��6� /�V, / - �rArSC1• ��` !hent U•Pck"Oe.
io — ---_-- --- - ---- _ esu, r-e®ia�ou-e
Building
ipE�bliUiri'° ��-�a��� Qy) anning Zoning
-
9
I ree Administrator
'u'e�u'G: %► G} Public Works --
Public Utilities
Public �;afety -
=ire Ser•�:��s.:.. .
Review fee sl'— - — - ,L- Si
-- n r le��a�Pi�c
l" WNTRAOTOP
;'eviewineg rD' epa
(Circle one.
U7GZO
LAN
TREE ADMIN
PUBLIC WORT
PUBLIC UTILITI
PUBLIC SAFE -1
FIRE SERVICE
ED 092520-14
G
APPLICATION STATUS
Yes
First Reviemr: _ Approved. [:]Denie,.
Reviewed by: --i
-�_ Date:
Second i evic-mr: -
❑Approved as revised. ❑Denie -
Reviewed by:
Third Revien!if. Approved as revised. ❑Denie -.
Corm-rrents:
Reviewed bv:
Date:
Date: