298 PINE ST WINDOWS / DOORS CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
r
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NE)IT DAY INSPECTION: 247-SS14
JOB INFORMATION:
Job ID: 15-WIND-963
Job Type: WINDOW AND/OR DOOR
Description: DOOR REPLACEMENT
Estimated Value: $1,200.00
Issue Date: 4/27/2015
Expiration Date: 10/2412015
PROPERTY ADDRESS:
Address: 298 PINE ST
RE Number: 170549-0000
PROPERTY OWNER:
Name: BERNSTEIN, FRANK AND KAREN,
Address: 298 PINE ST
GENERAL CONTRACTOR INFORMATION:
Name: JUSTIN LARSEN CONSTRUCTION INC
Address: POBOX1942 LIC#BELOW 4 GERALD GOLLOBIT
Phone: - -
PERMIT INFORMATION:
FEES:
BUILDING PERMIT FEE $56.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $60.00
PERMIT IN APPR(YVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODE&
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NE)Cr DAY INSPECTION: 247-5814
30B INFORMATION:
Job ID: 15-RAAR-962
Job Type: RESIDENTIAL ALTERATION
Description: repair siding and shed roof
Estimated Value: $7,500.00
Issue Dabs: 4/27/2015
Expiration Date: 10/24/2015
PROPERTY ADDRESS:
Address: 298 PINE ST
RE Number: 170549-0000
PROPERTY OWNER:
Name: BERNSTEIN, FRANK AND KAREN,
Address: 298 PINE ST
GENERAL CONTRACTOR INFORMATION:
Name: JUSTIN LARSEN CONSTRUCTION INC
Address: POBOX1942 LIC# BELOW 4 GERALD GOLLOBIT
Phone: - -
PERMIT INFORMATION:
FEES:
BUILDING PERMIT FEE $87.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $91.50
PERIHIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC REACH ORDINANCES AND ME FLORIDA
BUILDING CODES.
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City of Atlantic Beach 2- APPLICATION NUMBER
Building Department (To be assigned to
800 Seminole Road 1'�r. y the Building Department.)
Atlartc Beach, Florida 32233-5445 AN-44- 91f 2-
Phone(9(A)247-5826 Fax(904)247-5845
E-mail: building-dept@ccalb.us Date routed: Y12 e Lf
City web-site: http://�.mab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: it? 9 /i7l al, ej?qpa�ant review reguired Yes No
Applicant: 'i I Thee Administrator
Prcoject: —YJ'?942-4 PublicWorks
Public Utilities
Public Safety
Fire Services
Other Agency Review or Permit Required Review or ceipt Date
of Permit Verified 13Y
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johm River Water Management District
Any Caps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other
APPLICATION STATUS
Reviewing Department First Review: N694proved. ElDenied.
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed by: DateAWA�,—
TREEADMIN. Second Review: ElApproved as revised. E]Denied.
PUBLICWORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Ree,lewed by: Date
FIRESERMCES Third Review: ElApproved as revised. ElDenied.
Comments:
Reviewed by: Date
Revised 07127110
BUILDING PERMIT APPLICATIO
CITY OF ATLANTIC CH
800 Seminole Road,Atlantic eac , Fl, 32233
Office(904)247-5826 Fax 247-5845 �A POR �2 4��
Job Address: 4�04,f, �eAt rmit N -00cc>
Legal Description ' - Z3 -Z +Ale
Job Addir,
L-g'll Des, Se�3 pare 1# 1-7-OS L,
e . ,
Valuation of Work$ lnmwwff� oor ea o M.N. Sq.rt
JNNF� Proposed Work heated/cooled— non-heated/cooled
."goo
Class of Work(cimle one): New
Addition Alteration (Lepq Move Demolition poolfspa window/door
Useofe.xisting/pro used stracture(s) imle one): Commercial Residential
sus
If an existing structure,is a fire spriWer system installed?(Cirele one): Yes No N/A
Florida Product Approval#
For multiple products use-produw-tap—pro—varro-rm—
Describe in detail the type of work to be performed: Noc
Property Owner Information:
Name: kfi(�N - 816(A"k(� r, Addmss: ,Vg Pi"A
city State—ZIP--__.Phone ff
E-Mail or Fax�#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS,
Company Name:- -V.E- L., &A ,A,i,�Xw QualifyingA ent: J,4, Lry,,
Address: Itt State - ?b
OfficePhoneWy -MV--�(Ajj Job lit;�;tacl Number o �F,,# p
State Certification/Registration# C J3 _jZ 3_1
Architect Name&Phone#
Engineer's Name&Phone
Fee Simple Title Holder
Bonding Company Name and Address
Mortgage Lender Name and Address
4pplicatio is hereby made to obtain a permit to do the work and installations as indicated Icertify that no work or installation hascommencedprior to the
issuance o7apermit and that all work will bepe7formed to meet the standards ofall laws regulating constriction in thisjurisdiction, Thispirmalbecomesmill
and void ffwork is not commenced within sor(6)months or it'construction or work is sureWed or abandonedfor aWeriod til"sixg),months at any figeq�cr
work i,cameneaccd I understand that separate peraiiis must be secaredfor Electrica ifork,Plumbing,Sism, ills,Pook, entices,Boilers,H es,
Tanks andAir Conditioners,de. i
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 Y6VIi NOTICE OF
COMMENCEMENT.
centy,aba" a
war,will b!
liter"' f
"Pe 0'0_0 any o, er
prova to'of Own,
Sig nine
Prior N
Before me Before me
thisao Dayof .20 t6 t s 2) Day of. 1�pa,1 .2015
SCHALEASE SEN
, =", A
g7p
)4 AaAg!gn
Notary Public MY COMMI sic
EXRAES Ma
�,crn Revised 01.26.10
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road 45 2 2- �03
Atlantic Besch,Flonda 32233-54
Phone(904)247-5826 Fax(904)247-5845 Date routed
E-mail: buildingAelot@ctelb.us Off
Citymb-site: http/h�coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 2?1 Sr a_,,nent review required Yes No
TuLld
Applicant: _J �_ ZJf-S�Al 111`111111infing&Zoning
Tree Administrator
PublicWorks
Project:
Public Utilities
Public Safety
Fire Services
Qept Sigri
Other Agency Review or Permit Required .,Rpev
or.R
,,, rr,,ZP4 Date
Flonda Dept.of Environmental Protection
Flonda 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: I&Aioproved. ElDenied.
(Circle one.) Comments: pAo Ar
BUILDING
PLANNING&ZONING Reviewed by: Date:xkdl�, ;_
TREEADMIN. Second Review: ElApproved as wised. DDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: —Date:
FIRE SERVICES Third Review: E]Approved as revised. ElDenied.
Comments:
Reviewed by: —Date:
Revised 07127110
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233 rAP,
Office(904)247-5826 Fax (904)247-5845 24
Job Address: ALAL &A il 39 PermitNhu- 0=5±16�
Legal Description 10-&--J-(- -—2--S -,Pig 4AIV -c� Parcel# 17�05tl - ocxo
Floor 7Uea o --------
Sq.Ft. Fq-F-t—
Valuation of Work 4-7ff-0-0 Proposed Work heated/cooled— non-beated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition poollspa window/door
Useofexisting/pro osedstracture(s) ircleone): Commercial Residential
If an existing structure,is a fire sprinOr system imtalled?(Circle one): Yes No N/A
Florida Product proval#
For multiple pr�lsucts use-pr-o&u-ciap-pro-v-aTT5-r—m
Describe in detail the c of work to be perfonned: AL44e--
53�lz tlLf — LA;!—AN I
Property Owner Infornuation: L)
Name: Address: '34
city J&L�ZIPI,2�phone
E-Mail or Fm#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: Qualifying Agent: "SL--
Address:-qk,40 (A-E!�
Office Phone nIQrjs,J0AL— State
[221f�3 1�J S�te/Con ct Number j2jq-t��o �Fioc#
State Certification/Regishetion#-C_13C 7,
Architect Name&Phone#
Engineer's Narne&Phone
Fee Simple Title Holder N
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 commencedprior to the
is once ofaperenit andthal allwork will bepT
armealto meet the standards ofoll laws regulating comaruction in thisjurhatclion, This permit becomes null
month,,or ifconsm,ection or work is sne,aded.,abandamadjor a period of a16.),months at any inner,
wo,kacm,amenced i understand fact separate permits must be pecuredfor Elect c W
Tanks andAlr Conditioners,de. ri Work,Plumbing,sigm, 'ells,Peolse, momces,Bollers,He ons,
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 YOUi NOTICE OF
COMMENCEMENT.
I hum�orrt6 that1have read andusaunined this licapon analknow the same to be true andcomect. Allprotomposoflartandordinancesgov
� I
type a work will be complied with whothergei'M hernis or not, The granting of a permit does not presume to give auch to via or this
a the
Pro,miloup ofany otherfederal,state, or local at,mgulating construction or the performance ofcamoruction
Signature of Owner 14 &ALAU, sigraton,of contractor
Print Name Print Name 1-%)S
..................
BBefom me Before me
ofomm%
this.10 Day of Rp�s .201-05 this,10 Dayof A9prLl
t .2011S
L E
R Z2 tary
t MYCOMMISSION#FF 49 P1,11.
P, i.
L-N.t1Y.b1i.
EXPIRES M.,30,2017 Revised 01.26.10
oon�nss Funid&N0taWSem1u9.c.m
DO NOT WRrrE BELOW- OFFICE USE ONLY
Codes: 2UJU PLOKIDA ffU7D7NU-MDT-
Result (circle one):
Approved Disapproved Approved w/ Conditions
Review Initials/Date:
Development Size
Habitable Space Non-Habitable
Impervious area
Miscellaneous Information
Occupancy Group -
Type of Construction
Number of Stories
Zoning District
Max. Occupancy Load
Fire Sprinklers Required_
Flood Zone
Conditions/Comments:
Permit Number Tax Folio Number
NOTICE OF CONMENCEMENT APR
LLI
S TA TE 0 F FL OPJDA
COUNTY OF DUVAL 8 y
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property,and in
accordance with Chapter 713,Florida Statutes,the following information is provided in this Notice of
Commencement.
1. Description of property(Street address): P111t, IS+ 3220
Legal Description: !V -Jl� 0311:5- 03 —
2. Generaldescriplionof improvement: "'Ir sts"� Ropy", 3J
3. Owner information,
a. Name and Address: kare,�- strf�5-k "^
b. Interest in property: &0%12
c. Name and address of fee simple titleholder(other than owner):
4. a. Contactor's nameand iLddress'--T L44_sc i q4-4-o 14 5;L t-k,�01,ek,,3 Fr/, -52�w
b. Phone number: (�f oLt ) 3 -!1 1 Fax:number:
5. Surety Information:
a. Name and address:
b. Phone Number: Fax Number:
c. Amount of Bond:
6. a. Lender's name and address:
b. Phone Number: DW#2015094397.OR BK 17144 Page 2208,
Numt�Pages:1
7. Person within the State of Florida designated by Owner upon whom: Re�rde,104/27/2015attlt?:WANI,
be served as provided by 713.12(l)(a)7.Florida Statutes. Rcom Ft;ssell CLERK CIRCUIT COURT DUVAL
COUNTY
a. Name and address: RECORD NG$1 O.W
b. Phone numbers of designated persons:_
8. a. In addition to himself/herself,Owner desigamn of
to receive a copy of the Lienor's Notice as provided in Section 713.13(l)(b),Florida Statutes.
b.Phone number of person or entity designated by owner:
9. Expiration date of notice of commencement(the expiration date is one(1)year from the date of recording
unless a different date is specified)
WARNING TO OWNER:ANY PAYMENTS KADE BY THE OWNERAFTER THE EXPIRATION
OF THE NOTICE OF COM30NCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER
CHAPTER 713,PART 1,SECTION 713.13,FLORIDA STATUTES,AND CAN RESULT IN YOUR
PAYING TWICE FOR ll"ROVEMENTS TO YOUR PROPERTY.A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION.IF
YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Signal=of Owner(Ovmer's Authorized Officer/Director/Parmer/Manager: I.In Juj ) &4&4
(Signtory's Title/Office)
The foregoing instrument was acknowledged before me this ?Q day of Ann I 20-LS-
by_as for Y,
Notary:
Personally Known M
or Produced Indentification___-Type of identification Produced:
:2
M
My commission expires: 'MeI,j, 2,D4 aol-I a
In
Under penalties of perjury,I declare that I have read the foregoing and that the facts stated in it are true to
the best of my knowledge and belief.
z