1330 Ocean Boulevard INSULATION / SHEETROCK -j�:-L`1 r
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`S, CITY OF ATLANTIC BEACH
_ 800 SEMINOLE ROAD
Cr ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
30B INFORMATION:
Job ID: 15-RAAR-1754
Job Type: RESIDENTIAL ALTERATION
Description: SHEETROCK/SPRAY FOAM INSULATION
Estimated Value: $10.000.00
Issue Date: 7/22/2015
Expiration Date: 1/18/2016
PROPERTY ADDRESS:
Address: 1330 OCEAN BLVD
RE Number: 171847-0000
PROPERTY OWNER:
Name: PALEY. SEAN & ALICIA, *
Address: 1330 OCEAN BLVD
GENERAL CONTRACTOR INFORMATION:
Name: GREEN ENERGY BUILDERS
Address: 13720 Old St Augustine RD # 8-293
Phone: - -
PERMIT INFORMATION:
FEES:
BUILDING PERMIT FEE $100.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $104.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACII 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
,hob Address: J .3Q ', /V $L Ui:1 Permit Number:
Legal Description — , — • Parcel#
�'alualion of Work S O r rea o s{.I t. Sq.Ft
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{O co c V Proposed Work heated/cooled non-heated/cooled —'
Class of Work(circle one): Ne% Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Residential
Iran existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
Florida Product Approval#
For multiple products use product approval form i /
Describe in detail the type of work to be performed: it . 4 Vf f I1 ' L'-G G
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Property Owner Information: S 0- e0(-- 1 A` AV
Name: L C I A '011 �C - Address:1330 6>czl' -_L U
City :OIL' .11 %M.Mi State Zip _ Phone.
E-Mail or Fax#(Optional)_____ ______
Contractor Information: y� {
Company Name6etW kit G f l JJf, S Qualif ing Agent: M l� £ 1
Address: L�S-f;irf /L/7 City 11 State FL.�Z p s 9
Office Ph ne Job Site/ ontact Number Fax#got, -2/7_OQ�,o
State Certification/Registration# C G C /S //r] �,
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. l 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 if 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 comnenced I understand that separate permits must be.secured for Electrical Work, Plumbing,Signs, Wells,Pools, Furnaces,Boilers, Ifeaiers.
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 here/•cerdfi&that I have read and examined this a plication and know the same to he true and correct. Al!provisions of laws and ordinances governing this
rite a work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions ofanv other fede al.state,or local law regulating construction or the performance ofconstruction.
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Signature of Owne 4. eA7 q, v Signature of Contractor
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'rim NameJ __ _1.....�Z:.L_ Print Name
;7 o and subscribed fore me Sworn to and subsc ••ed before me
h D jof j (,, v) ,20/ this 2Z Day of a 20111
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;MIE NGUYEN •� u• tc
h:a ',• :'ublic, State of New York
No 01 NG6257217 4:1%.* wANOA .S3; b •_: 6.10
Qualified in Tompki.s County �.� :.: MY COMMISSION it FF 101189
mission Expires 3�1-- .11,45 _- W..-.. EXPIRES:March 28,2018
,4�,f�• Bonded Thru Notary PuGic Undenniera