162 CAMELIA ST 15-RAAR-1746 Drywall Repairs, Garage ,-,,,JAJ,_,,,,:,
' t .. ,,,,.,,,,\
CITY OF ATLANTIC BEACH
,„.„ ‘J` 800 SEMINOLE ROAD
j y 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-1746
Job Type: RESIDENTIAL ALTERATION
Description: drywall repairs for garage door replacement
Estimated Value: $4.000.00
Issue Date: 7/22/2015
Expiration Date: 1/18/2016
PROPERTY ADDRESS:
Address: 162 CAMELIA ST
RE Number: 170846-0025
PROPERTY OWNER:
Name: WINDLEY JR ET AL. JOHN S
Address: 162 CAMELIA ST 162 CAMELIA ST
PERMIT INFORMATION:
FEES:
BUILDING PERMIT FEE $70.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $74.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904)247-5845
Job Address: I (02 (�I..YYI P,(l ST • Permit Number:�L
Legal Description /-3 ' /7-2-s 7?6 .c # /4// c'Parcel# /37." 6/ OD ZS
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$ Proposed Work heated/cooled /717 non-heated/cooled 15t8
y000.o a
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Residenti.
If an existing structure,is a fire spri kler system installed? (Circle one): • N/A
Florida Product Approval# 4//f"
For multiple products use produ t approval form // /� r
Describe in detail the type of work to be performed: Py k17,1�7 //I,I/,i rl Pler A74ti/rerpnw-U
y
7 r,e//ac-e J ai (4,6tv
Property Owner Information:
Name: tBe-eC-3 Address: 7. 3 Phi/ipc h/vvi e/)7 (7 �G 72ZSZ
City Jot x State dip 22.cg Phone 90 y 6 77 k' y77
E-Mail or Fax#(Optional)
Contractor Information: —�- �,�/
Company Name: JW� CrD�d ✓vc 70)6x101 LCLQualifying Agent: c6?i 1°5 /`?. Mqi rha (
Address: '7r 3 Phc fi 's Aiw y City .r State F1- Zip 3 Z Z x'76
Office Phone 9i `/— 677-K 777 Job Site/Contact Number 9p f/ z.3,.n 7., 77— Fax# 13 7 • 003 7
State Certification/Registration# 't✓G 4.937055—
Architect Name&Phone# A/419
Engineer's Name&Phone# A//4
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address ///j9
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 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 after
work is commenced. I 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", d=.amined this a plication and know the same to be true and correct. All provis',' of laws and ordinances governing this
type of work will be compled/iv t whether specified herein or not. The granting of a permit does not presu ' to ve authority to violate or cancel the
provisions of any other federa,s • e,or local law regulating construction or the performance of construction.
Signature of Own r 1 Signature of Contractor Air*/ //
/ Ay ri
Print Name 47 4y, Print Name Ja er I),ilia/1A ili
Sworn to and subscribed before me Sworn to and subscribed before me
this I Day of -_ . k 20 ^ this S Day of t I o , 20/f
_ /A .t
_ �
Notary Public No a • is
Revised 01.26.10
?0%•!;,p..';:,_ KASANDRAJOYNER
:f.: ft MY COMMISSION t FF 229035
.1—..,,v, ..7:4.4;-:"'� KASANDRA JOYNER
�' -�'. a EXPIRES:July 4,2019 tt *� MY COMMISSION t FF229005
i ±.°_t:td.`` Honored Ttuu Notary Pubic lkben•niMn "• �. EXPIRES:July 4,2019
`^ ""°�` t''>iL,1t`". Bonded Thro Notary Pubic Undenslitsrs
PCKS /< E ,� ! niff
JACKSONVILLE FIRE AND RESCUE tip (. :la
I; LL W DEPARTMENT °��
9 �soDy� -` \tt4 n.t
yo9 $� Is FIRE PREVENTION DIVISION
FSCUE O0" �,�,
FIRE SAFETY INSPECTION BILLING FORM
STATE OF FLORIDA STATUTE 633.081(1)
CITY OF JACKSONVILLE ORDINANCE 2004- 1003
Business Name: 50.a `\4_S .2._sS0 41cFs Date: "S"— 2_`‘ —( S
Inspection Type: i K. 4.,'. Occupant Use:
1,
Inspection Address: 3 3 .; f --V,o,,,.;�■_c i- Occupant Load:
City, State: A--■ 1 I-1_
Zip code: 3223'3
Email Address: Business Telephone:
Billing Information:
Billing Address: Billing Telephone:
City, State: Zip code:
Inspection Information:
Square Ft: I 62)0C,
TIN: (FEIN/SSN) Number: — '3 S 2..I) 140
Citation or Warning Issued?Yes alll No MO Scheduled Return:
Citation/Warning number(s):
Inspection Notes:
Fire Extinguisher:. .. /y Alarm:
Sprinkler/Riser:
Hood:-. Hood Cleaning: Hydrant: _
This occupancy mee -194timum fire • : y requirements at this time. Yes M
I acknowledge receipt of this inspection form. Inspector
A
Initial
Recipient Name: go,'-i:seS td6 1/E Inspector Name: m I&u e (. DI P1 ekr-
Recipient Title: Inspector Contact Number:
515 N.Julia Street Jacksonville,Florida 32202(904)630-0445 FAX(904)630-4203 Rev.03/2014
NOTICE OF COMMENCEMENT
!PREPARE IN DUPLICATEI
Permit No. 15-RAAR-1746 Tax Folio No.
State of Florida County of Duval
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: /1 -SY /7- -776
ger
Address of property being improved: /6 2_ (K vx?r'/i c3 --C74
General description of improvements: ,'1ko 1"(' (re f/n 7! arj Dl. r '/ "7" ` r p/
ory
Owner (et- j� 1.-(. G
Address 7563 Philips Hwy Jacksonville,FL 32256
Owner's interest in site of the improvement Fee Simple
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor JWB Construction Group — 71' , ;J'
Address 7563+Philips+Hwy,+Jacksonville,+FL+32256
Phone No. Fax No.
Surety(if any)
Address Amount of bond$
Phone 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 Florida.other than himself,designated by owner upon whom notices or other
documents may be served:
Name
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
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 OWNER
Slgnad: th DATE �1 1
Before me tttMMMh111 / day of J I 2'. #+ �'In ,
County of Duvv .State of Florida.has personally appeared
herein by
himself horsed and affirms that alt statemonta and declarations herein
are true and accurate - _
KASINDRA 1�MB
J.7} ; MY CcSSION 1 FF 228035
EXPIRES:July 4,2018
eawe tlw tatar t>.ae Udrwra
Notary Public at Large ate of l ( . . County or
My commission expires:
Personally Known _.or
Produced Identification