275 Sailfish Dr 15-RAAR-1341 fire damage repair permit 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-1341
Job Type: RESIDENTIAL ALTERATION
Description: FIRE DAMAGE RESTORATION
Estimated Value: $22,033.00
Issue Date: 6/12/2015
Expiration Date: 12/9/2015
PROPERTY ADDRESS:
Address: 275 SAILFISH DR
RE Number: 170579-0000
PROPERTY OWNER:
Name: PETERSON TRUST, TERRY LEE
Address: 1500 SELVA MARINA BLVD
GENERAL CONTRACTOR INFORMATION:
Name: HOWARD CONSTRUCTION (GC)
Address: 580 WELLS RD STE 3 QA DONALD TOWERY
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $80.08
BUILDING PERMIT FEE $160.17
STATE DCA SURCHARGE $2.40
STATE DBPR SURCHARGE $2.40
Total Payments: $245.05
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION ie --411
CITY OF ATLANTIC BEACH D 3 7�
800 Seminole Road,Atlantic Beach,FL 32233 IlJplfl JUN 8
Office(904)247-5826 Fax(904)247-5845 ,
Job Address: 7Z-IS Unl{-7-6rj' PermitN m1By !Z-�3Y1
Legal Description IO1-2S- ?-qIF 1.014 S4R-Al1Ls'parcel# I7OS`I 1 — OOb0
�loo�e�—SqTt ��
Valuation of Work$�Q,�=proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Useofexisting/proposed structure(s)(circle one): Commercial Residential FILE COPY
If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
Florida ProductApproval#
For multiple products use product approve orm
Describe in detail the t e of work to be performed: {�1Rc c{av`^0.9e R-�-Pa-)K.S
Cc"V AA
Pronerty Owner Information:
Name: Tet�y �� Pc}�a¢sw, Tju 'ddre s: lsoo Selvez. �aRlna. BIvoI
Cih01-F'lank�c Beo�ln StateFE2ip32236Phone _
E-Mail or Fax#(Optional)
Contractor Information: � Kik f C 41-ey ,��U--"6a6
�17Y1�(jLSC•�
Company Name:T1®wgpo� (1i�ca-12iAC' tr ` -"6al6ym_g-A$2m:'
Address_on t t?d15 2 City � Fax# Zip s
Office Phone�Wt 542 Job Site/Contact Nnmher O Fa7c#
State Certifiication/Registration# GKSgGls12$1I0 �cGl 1 DO
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
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. Icertify that no work or installation has commencedprior to the
issuance ofapermit andthat all work will beper ormedto meet the standards ofall laws regulating comtmction in thisjunsdiclion. Thispermitbecomesmdl
and void fwork is not commenced within six(61 .1 nths,or fconsiruction or work is surpended or abandoned for ayeriod ojsiu/b)months al any time ager
work is commenced. I understand that separate permits most be secured for Eledricol Work,Plumbing,stens, WNis,Pooix fiurnoces,Rollers,m ers,
Tanks and Air Condidonem ere.
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 Mii NOTICE OF
COMMENCEMENT.
I here certify that I have read and examined this plication and know the same to be true andcorrecl. A!l provisions of laws and ordinances governing this
type a work wilt be complied wish whether s ci ted herein or not. The granting oja permit does not presume to give authmiry la violate or cancel the
provusiom atony other feeder/Aa'l,sytokle'.'or/lo/'c��al f�a,v/nre�g/ul—sting cartshuction or the yerformance ofcanstruction.
Signature of OwnertXN"'T a"�-,11.G/O Signature of Con�tractoyr� n�r /
Print Name T ......,,,,;.Q..... .Y. .[.115 -....._.................... Print Name .....,I,.L.Q4..E.T�W.tJ..l1,-.
Swom to and subs ed before me � Swom to and subscribed before me
this D f 20 this Day of 2015
Notary PublicMMk tAMxatldbr IC JENI IFEX KOSKI
11 Dram FF 22M9 i"� ' r'i uy Public-State of Hand
h n�/ e _ •e My Comm. Exptrar Oct 27,201 vlsed 0l.26.10
r IQ q tea'}' Cmnmlenlon At FF D35309
SOMM TAmu(M WIMAI Kau,Assn.
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road "1- /3 y/
Phan(904)27-582632Fax(905 /��/ n
Phone(9 ail ing-de 26 Fax(904)247-5845
E-mail: -site gdepwww.co us Date routed: tP
City web-site: http://www.wab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: �75_
:;W_ p�,�{, nt review regaired Yes No
y/'11 .. \ __pp/� Building
Applicant: /, VW 1hfb 0/7 577?U 0�70-r-) Planning B Zoning
Tree Administrator
Project: rf/}f,� Public Works
�� Public Utilities
Public Safety
Fire Services
Review fee
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: Ltf pproved. ❑Denied.
(Circle one.) Comments: ,� 1
BUILDING 1 I O
PLANNING&ZONING VVV Reviewed by: Date: G
TREEADMIN. Second Review:
❑Approved as revised. ElDenief
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 01121110