2021 SELVA MADERA CT - WINDOW / DOOR �j r ✓' CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
j ` _ ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-WIND-1951
Job Type: WINDOW AND/OR DOOR
Description: NEW GARAGE DOOR
Estimated Value: $7.870.00
Issue Date: 8/20/2015
Expiration Date: 2/16/2016
PROPERTY ADDRESS:
Address: 2021 SELVA MADERA CT
RE Number: 169506-1650
PROPERTY OWNER:
Name: BURBRIDGE. H CLINTON
Address: 2021 SELVA MADERA CT
GENERAL CONTRACTOR INFORMATION:
Name: D & D GARAGE DOORS INC
Address: 1177 CATTLEMEN RD DALLAS MILLER
Phone: 941-371-7242
PERMIT INFORMATION:
FEES:
BUILDING PERMIT FEE $89.35
STATE DCA SURCHARGE $2.00
PLAN CHECK FEES $44.68
STATE DBPR SURCHARGE $2.00
Total Payments: $138.03
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
0,1.11 f , City of Atlantic Beach APPLICATION NUMBER
: S Building Department (To be assigned by the Building Department.)
- - _ •s 800 Seminole Road \ , / C
uv -, Atlantic Beach, Florida 32233-5445 i� `��l l Q 1 J
Phone(904)247-5826 • Fax(904)247-5845
—A01.09' E-mail: building-dept @coab.us Date routed: S/1'7 ll S
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ZC)2- ( SE.LV-R C v \N6 2 Department review required Yes No
Building)
Applicant: 1 J 1- i\kp,c D 00 Planning -Zoning
Tree Administrator
Project: M E(,J C t.AGE -L 00«_ Public Works .
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
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:
APPLICATION STATUS
Reviewing Department First Review: pproved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING •fi_Qftç Reviewed by: Date: U
TREE ADMIN. Second Review: ❑Approved as revised. ['Denied.
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
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845 j 5 -W I N b -1'15
,Job Address: P+Ci-\.Seltt/q i aAe a C� Permit Number: —
Legal Description • '' 1 i►• -- t
— ,..5, C. Parcel # IG1 —/6,'0
oor Area of Si.Ft. S(i.1•1
Valuation of Work $ .71-70 t �e? Proposed Work heated/cooled non-Ittaled/cooled
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial Residential
if an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N IA
Florida Product Approval # I .tom
l'or multiple products use pro act approva orm
Describe in detail the type of work to be performed:_ C. .C-a52C -e-rAL --
CAcs•()al ATLI A-3o/-SO
Property Owner Information:
Name: PW'ACVNQII —t Address: go 94 �'latA er
City Akkan.k1C � h . tate .Zip '3�.S?Phone 4t04 vici
3„-9 g
E-Mail or Fax # (Optional)
Contractor Information:
Company Name: D4 I) (7O - P.VOO(5 Qualifying Agent: TD a f k c, Mi I I ex
Address: I l7 [ CQ-f+l e(-nen Woo.b City Sarctsol-c-L State FL Zip 34 2
Office Phone eid4 1. 3'11.7a4 _ Job Site/ Contact Number ,joej Biadr (IN•535.-wbP tx # (0.1 t, 3`1'7, (8011
State Certification/Registration # C.13Q.I 5 7 OS
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. I certify that no work or installation has commenced prior to the
issuance of a permit and that all work trill be per formed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes mull
and void if work is not commenced nit/gin six(6)months, or if construction or work is suspended or abandoned for a period of six f6)months at any tinge after
work is commenced. I understand drat separate permits must be secured for Electrical Work, Plumbing, Signs, t4 ells, Pools, Furnaces, Boilers. //eaters.
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 am -ra 'ne is.a,plication and know the saute to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied wit et, cci rein or not. The graining of a permit does not presume to give authority to violate or cancel the
provisions of am other federal,sr I, or al re mho: construction or the performance of construction.
Signature of Owner A _ A_ _ / Signature of Contractor ♦�/'lG
eV Print Name hI.C.I.t;h.'Ovl Fug`4' / iii- Print Name Dan as._....M.i...Il..er
Swot /tad subs ' ed before n 0 Sworn to and subscri ed before me t
this Day of , . ._` ._.4 �� ---_—_�-' this 13 Day of 5 20 I.
r
— !4. I `- / ..,/ M _t TARREE HOU. —
Notar', I't )I1 CATHERINE B.WHALEY ( Notary Public SS' -j' I,: Notary Public•State of Florida
as :r Commission#EE 1351266 •c My,Comm.l E Qiresi SIR X23,2018
.-.�,-k`' Expires March 11,2017 =;-;,,E—-,. P= cCommtsston #4 203072
'fi t„
eaaeamur F� °%, Bonded Through National Notary Assn.
Troy bmincee0038S700
NOTICE OF COMMENCEMENT
State of County of 1)CAA/' Tax Folio No.
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 OMM NCEMENT.
Legal Description of property being improved: t4 Q
c _ i 1 l e-. E of .&
Address of property being improved: lO mil 'f tlJQ ez C'1 Ak66�L
General description of improvements: �,ac2 c�c taaeWA,-. 1.
Owner: 1"lyeh,14 e. Address: Sic JAG I(�IQ l' '�c%QS� C
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):•
CV
Name: o
Contractor: t &ate € Po s, �c o
o
Address: qt-a5 \<i s it r g
CL
Telephone No.: �' ���� ��� Fax No: ���{-37 Q-� �
Y ij D!
cn o v
Surety(if any) ,�
o Lo fr 8
Address: Amount of Bond$ o 0 °
Telephone No: Fax No: o �,o J 0
u� mO cn
z
Name and address of any person making a loan for the construction of the improvements c°v a z°v!
8
Name: 8g § §8 O 2
w
OZn_tQOw
Address:
Phone No: Fax No:
Name of person within the State of Florida, ether than himself, designated by owner upon whom notices or other documents may be
served: Name:
Address:
Telephone 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 Statues. (Fill in at Owner's option)
Name:
Address:
Telephone 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 S
Signed: Date:
Before me thi J ii day of tem� in the�o u a State
Of Florida,has personally eared �' ' f f[�
Personally Known:
Produced Identi S on:
6?Ot-sot-ow "ICI SI>; �,.,,.
L LWz L ILpJ4 Sal Es.: I 1 J
999 33#uaSSIWWOO .,`.
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