1639 Ocean repair due to car crash 2015 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
e
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-RAAR-162
Job Type: RESIDENTIAL ALTERATION
Description: repair damage to house due to vehicle
Estimated Value: $9,062.00
Issue Date: 1/29/2015
Expiration Date: 7/28/2015
PROPERTY ADDRESS:
Address: 1639 OCEAN BLVD
RE Number: 169564-0000
GENERAL CONTRACTOR INFORMATION:
Name: PAUL DAVIS RESTORATION OF
Address: 5795 MINING TER QA MICHAEL G. MUMFORD
Phone: - -
PERMIT INFORMATION:
FEES:
BUILDING PERMIT FEE $95.31
STATE DCA SURCHARGE $2.00
PLAN CHECK FEES $47.66
STATE DBPR SURCHARGE $2.00
Total Payments: $146.97
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
City of Atlantic Beach APPLICATION NUMBER
(To be assigned by the Building Department.)
Building Department
800 Seminole Road -5445 ml z
Atlantic Beach, Florida 32233
Phone(904)247-5826 - Fax(904)247-5845 Date routed:
E-mail: building-dept@coab.us
City web-site. http://wvvwcoab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: er-;7 '61(101 UppaitMent review required Yes 0
Building
-D,4 V _5 Q 8,Zoning
Applicant: ?, OA/ 'W r
Tree Administrator
Project: el j Public Works
Public Utilities
AA A'S F-Public Safety
Fire Services I
Review fee $ Dept Signature
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: PA-Pproved. DDenied.
(Circle one.) Comments:
PLANNING 8,ZONING Reviewed by: Date�
TREEADMIN. Second Review: FlApproved as revised.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: RApproved as revised. []Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
BuILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845
/639 e,�)Cg^Arj BL_vr>, Permit Number: -,9,4/94
Job Address: 1-5
Legal Description OC454,4 6Rovozer Parcel# 10,569-COO_
6P P loor Area ot
Valuation of Work$ Proposed Work heated/cooled "-)y non-heated/cooled
Q-1)
epai Move Demolition pool/spa window/d L)
Class of Work(circle one): New Addition Alteration (5;� All
Use of existing/proposed structure(s)(circle one): Commercial (�Re�identm�
If an existing structure,is a fire s nkler t . t 11 d?(Circle one): 7—es--No N/A
I ,,4s ent ins
Florida Product Approval# 1= 2� 7�,77
For multiple products use pl-oduct hpilirdval-form' r P" oF
Describe in detail the type of work to be performed: VEH QiE Z>801669_
C In 0 Bcoci,� OA.) FP,,-otj-r E'(_,er_v4T)o,,j
Property Owner Information:
Name: 6 1- Address: /6-�q &_Vb
State Zip,3?W3Phone '70't--
City*
E-Mail or Fax#(Optional)
Contractor Information: Oil
Company Name: &-y- DAVi_-2 R�F�70RPT)QrJ Qualifying Agent:
�01/7 FokV-.-)
Address: 6?1 ILI" Ty -djL1_6_ State kz- zip
�t_ I City _--TACX 4
Office Phone J�- 7ML-j��7�7 -Job Site/Contact Number 7 7- -;t,3��/ F ax# 7-W- 15
State Certification/Registration# - C5C_ f�45VZ.5'Q
Architect Name&Phone# FOE—
Engineer's Name&Phone# F -70-7-97/—
Fee Simple Title Holder Name and Address 1,jA
Bonding Company Name and Address 6)A
Mortgage Lender Name and Address W4
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commencedprior to the
issuance ofa permit and that all work will beperfbrmed to meet the standards ofall laws regulating construction in thisjurisdiction. This permit becomes null
and void ifwork is not commenced within six(6)months,or ifconstruction or work isisusp;n4dreed,;r1UimbanndgonSedgfnor,aWeriod ofsixP,6)months at any time after
ctr ca a i A
work is commenced. I understand that separate permits mitst be secured for Ele ells,Pools, urnaces,Boilers,Heaiers,
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 YOIT]i NOTICE OF
COMMENCEMENT.
I here dication and know the same to be tnie and correct. Allprovisionsgo
certf�that I have read and examined this app ,I laws and ordinances governing this
type a work will be complied with whether specified herein or not. The granting of a permit does not presume to e anthority to violate or cancel the
provisions ql'any otherfederal,state,or local law regulating con ction or the performance ofconstruction.
Signature ofOwner It Signature of Contractor
Print Name )C Print Name ",/, zoa
.............. ..
......................... .............................................................................
Sworn tgo-tnd subslcri�pd before,me Swo to and sofbcri before me
's y
this av of APP_Pi_L4-j, .20 /V th Da 20
Notary Public 't r,Pu
Revised 0 1.26.10
MELODY ANDREWS IRWIN
MELODY ANDREWS IRWIN
MY COMMISSION#EE841091
MY COMMISSION#EES41091
EXPIRES October 07,2016
EXPIRES October 07,2016
-v 1:39"153 FlondaNataryService.00m
007�39"153 FlondallotsrySerAce com
NOTICE OF COMMENCEMENT FILE COPY !,
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
2oq1-9Ae IL750—
State of F1, County of k2VVAIL-
To whom it may concern:
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:
ace-A,j t)A)IT 407
Address of property being improved: /6-37 pce�,j Be—ip, ftPgpc ScH�
— A2,2 3-3
General description of improvements: ViEpfir-Lr-
-To C-Alu
Owner Ato!5,j
Address oce-A'i B-L-vS.
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Paul Davis Restoration of North FL
Address 2111 N. Liberty St. Jacksonville FL 32206
Phone No. 904-739-6047 FaxNo. 904-739-lS96
Surety(if any) N/A
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name N/A
Address
Phone No. Fax No.
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other
documents may be served:
Name N/A
Address
Phone 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 Statutes.(Fill in at Owner's option).
Name N/A
Address
Phone 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 Signedo QQ� DATE
Before n�fi thi's '-ILI day of ' Q-"j�-m()A 2W�I in t e
!Z C y of Duval,StA of Florida,has personally appeared
,'I -
, 0 14�71 herein by
20,5014985,OR BK 17041 page 165, himself/her-self and affirrms t I,stle ents and cl t h
are true and accurate ME 67XW64EW8 IRWIN
Doc#
Number Pages:I
t 10:44 AM, M COMMISSION#EE841091
Recof ded 01/22/2015 a iDUVAL
CIRCUIT COURT
Ronnie Fussell CLERK
I October 07,2016
1 3 Fforsdat!N
COUNTY , ( mrow
RECORDING$10-00 Notary Public at Lar ta of---- cons
My commission exppires:
Personally Known or
Produced Identification I