1964 BEACHSIDE CT INTERIOR REMODEL CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
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-1050
Job Type: RESIDENTIAL ALTERATION
Description: interior remodel
Estimated Value: $4,500.00
Issue Date: 5/6/2015
Expiration Date: 11/2/2015
PROPERTY ADDRESS:
Address: 1964 BEACHSIDE CT
RE Number: 169542-0586
PROPERTY OWNER:
Name: CARNES, DARCY S
Address: 1964 BEACHSIDE CT
GENERAL CONTRACTOR INFORMATION:
Name: GBN CONSTRUCTION, INC.
Address: 6054 -8 AR ARLINGTON EXPRSY BRADEN J NEGAARD
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $36.25
BUILDING PERMIT FEE $72.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $112.75
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
MNMNENMNN�
City of Atlantic Beach
Building Department APPLICATION NUMBER
800 Seminole Road (To be assigned by the Building Department.)
Atlantic Beach, Florida 32233-5445 hvp-
Phone(904) 247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed:
Cityweb-site: http,://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 44L ICA A�Lj�
D artment review required Y s No
Building
Applicant: Al anning &Zoning
Tree Administrator
Project: Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt
Florida Dept. of Environmental Protection of Permit Verified By Date
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:
ing Department FH rs t n, APPLICATION STATUS
"00'
Reviewing Department First Review: [qApproved. OlDenied.
I
(Circle one.) Comments:
: BUI LDI N
E�
PLANNING&ZONING
TREE ADMIN. Reviewed by-.._,,:� Date:
Second Review: FlApproved as revised. En-]De d.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: []Approved as revised. []Denied.
Comments:
Reviewed by.- Date:
Revised 07/27/10
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
FILE COPY 800 Seminole Road, Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904)247-5845
LJLJ 10
lsck, r "Lj
Job Address: 1CN04(
Legal Description
ea� Parcel#
�j hq q
T�
Valuation of Work$ oor ea o q. t.
Proposel ork�hea�t�e�d/cooletd no-n-theated/cooled
Class of Work(circle one): New Addition <Z:9t7er_at_ion'� Repair Move Demolition pool/spa window/door
Use of e�xi�ting/proposed structure(s)(�ircle one):
Commercial <Ree;side�ntial
stem installed?
s
If an existing structure,is a fire sprinkler sy (Circle one es 0
Florida Product proval #
For multiple prosucts use pro uct approva orm
Describe in detail the type of work to be performed: 1Ze_pjc_. kj-�a,,,e
1 4, �_ G +
4xj. 4-0 e- 5koL C11 +S
Property owner Information:
Name: rvx', cl-I.Qd c 0, S"Llf-r-1-to —Address: (11 (.q
city k c State Lr-�-Zip 3 z z-3
E-Mail or Fax#(Optional) 8 9�ntNa Phone. & A�17_0 _�jl
-0
Contractor Information:
Company Name:_ Gi (3 L4_
Address: (60 Sy-e f�rll_ C,Qualifying Agent: d_#_
4 City
OfficePhone %�b SiiM/Con�tZt i�imh State Ft-- Zip
RE Job Sile/Contact umber 73- 7a 6 o Fax
State Certification/Registration # -CC-' Cd i ?2to 6 1 # S-,3 0 9
Architect Name& Phone# K K
Engineer's Name&Phone# A
Fee Simple Title Holder Name and-Address
Bonding Company Name and Address
Mortgage Lender Name and Address
A atl n s he eb ade 0 obana erm the work-and n!talla i�n. a at on a., ommencedprior to the
)7his ermit becomes null
st 11
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an a e and ha al
It _M not m t t p
'su 0 p k 'n ed h, 6
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" 's , c u, rs
T rk co' e ed de t 'd that se arate perm, must be' e ed E 2 6 on s at,,a ter
s an r C
, an on S, 'P s, ".n, 0 ;;�fime af
nk dA dit, er X Els, aces,B Heafers,
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.
Iherebycerjtfy that1have read and examined thisap fication and know the same to be true and correct. Allprovisions of laws and or&nances governing this
formance of construction.
ction or the pei
OJ work will be co�nplied with whether e9d herein or not Ae granting of a permit does not presume to give authority to vio ate or cance the
provisions of any otherfederal,state,or localsfaewc1r=1ating construi
Signature of Owner Signature of Contrac Vor ,.,4
C
Print Nam �'�DORI
..... ..................... .................................... Print Name
. . . ........
..........................4............
Sworn to and;Spbscri efore e ..._ ... 4 ........... ......
;ak�� - — Swo d subscribe e
this of 20 d I is 3&Day e
20 J/S'
Notary P ]c
Con""'SS'01) 464 13 otary
s.on i-
my Conifnis"'on f My Cornmis-on f X;ml
July 2?242.1!,,A,
July 29, 20118
This instrument Prepared By:
Name
Address FILE COPY
Permit No. Tax Folio No.
NOTICE OF COMMENCEMENT
STATEOF I' Lorida
COUNTYOF
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: (legal description of property, and street address if available)
q /3 e-c,cA S'i'c I— C-0(,-J-+
o,�,+j, I?e-- cA , FZ- 3 ?3
2. General description of improvement:
/Ze I"L C-1— k--('4CA e�.1 -L /Z. +
VZ C'tc S-di:57 , C--k'1-1-P -,,-iA -kovr-�',-j
3. Owner information
a. Name and address: Zo-na. and mirlow. goder", &qcA 4WA
b. Interest in property: J'R1qAHC' 'Scow-hj fi,
c. Name and address of fee simple titleholder (if other than owner):
4. Contractor: &
a. Name and address: &6N CaA9+fUC4i()9% 1 it, 4r to,V,40n i�r).
b. Phone number: joqi--71�7-�332 -r I (
f a'C.KSdn1jj1kj FL. 73-LZ
c. Fax number (optional, service y fax is acceptable):
10V-7 2.1- V30 1
5. Surety
a. Name and address:
b. Amount of bond $
c: Phone number:
d. Fax number (optional, if service by fax is acceptable):
6. Lender
a. Name and address:
b. Phone number:
c. Fax number (optional, if service by fax is acceptable):
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as
provided in section 713.13(1)(a)7., Florida Statutes:
a. Name and address:
b. Phone number:
c. Fax number (optional, if service by fax is acceptable):
8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided
in Section 713.13(l)(b), Florida Statutes: -q
a. Name and address: C) a g Cc ,S+rL.A_ (00 E;
b. Phone number: q 0 4 - ')XS-- 3 3 aS-
c. Fax number (optional, if service by fax is acceptable): q04 - 7,:) 1 S-30
9. Expiration date of notice of coin me ncein ent. (the expiration date is I year from the date of recording unless a
different date is specified)
Sworn to and subscribed before me bya'v-)r-- Signature of Owner
who is personally known to me or produced
as ide ifiqati0i, and -v%,Iio (lid take Owner's Name C)
an oath, this ;tic day of
Owners Add'ess:
-Aia wEte 8?e ar k Xt
Isignature of Not-ar
Printed name of Notary lane
Commission No./Expiration:—
Seat: ......,,, LORI JANE MEROLLt
Commission FF 1464 1,1
My commi.;"lun f
July 29. 2018
ALI, INFORMATION MUST [77 JTPED OIZ 11K I N I E D I-E-C,FBL 10 COMPLY WITH RECORDING REQUIREMENTS.