388 11TH ST - RESID ALTERATION i - \s� CITY OF ATLANTIC BEACH
c. 4 800 SEMINOLE ROAD
- - -�". ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
��JS,I� r
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-RAAR-2120
Job Type: RESIDENTIAL ALTERATION
Description: REPAIR AND REMODEL AFTER FIRE
Estimated Value: 590,000.00
Issue Date: 9/9/2015
Expiration Date: 3/7/2016
PROPERTY ADDRESS:
Address: 388 11TH ST
RE Number: 170092-0000
PROPERTY OWNER:
Name: VAN VOORHIS JR, EDWARD JAMES
Address: 388 11TH ST
GENERAL CONTRACTOR INFORMATION:
Name: E & R ENTERPRISES OF NORTH FL
Address: 2628 WEST END ST QA EDWIN CHARLES PUTTBACH
Phone: - -
PERMIT INFORMATION:
FEES:
STATE DCA SURCHARGE $6.60
STATE DBPR SURCHARGE $6.60
BUILDING PERMIT FEE $440.00
PLAN CHECK FEES $220.00
Total Payments: $673.20
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
City of Atlantic Beach
Js APPLICATION NUMBER
IA Building Department
(To be assigned by the Building Department.)
r `•� 800 Seminole Road
Atlantic Beach, Florida 32233-5445 j 5 Awe- 1�2
Phone(904)247-5826 • Fax(904)247-5845 C� Q
'"1.0;319' E-mail: building-dept @coab.us Date routed: / O 1��
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Acf !1 7 d 7 De artment review required Yilito
�� � �S� 5 uildin
Applicant: f.4° Planning &Zoning
9 9
d� L Tree Administrator
�
Project: fM i( /4'1 ��Q Public Works
/ttPublic
/TG e 4 6 Public Safety$41 Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified By Date
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: roved. ❑Denied.
(Circle one.) Comments:
:UILDINe
PLANNING &ZONING n /
Reviewed by: / Date: 8'
TREE ADMIN.
Second Review: [Approved as revised. ❑Denied)
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: DApproved 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 ELL: COP r
Office (904) 247-5826 Fax (904)247-5845
Job Address: 3 j Bg I t ��'
Permit t Number:/�-R��P L�4 - /2d
Legal Description 5" (' "-rt.-014-71c- RCN to t/z Le73'1—Parcel# 170090,
c, Floor Area of Sq t. -0000 Valuation of Work$ '13a o Proposed Work heated/cooled t
non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Mov molition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A
Florida Product Approval #
For multiple products use product approvar o rm
Describe in detail the type of work to be performed: RE'''4t R. £ CLE11 J 1.19 1'/R E 4
.Sw�ot[.E bol /IStL4Trc4j pay w4w 8IA17 P4( -t T
Property Owner Information:
Name:EDIAMIZ t VA &V 0pj3lS J fZ Address: 38B ( l`-N S
City ./411. ,1 fG $C N• Staten—Zip 32233 Phone 0 - /30C)
E-Mail or Fax#(Optional) ro A , j- rot 55
g j 3 ma; . co►-vA
Contractor Information: CONTRACTOR EMAIL ADDRESS: St.ciw i R u'{+ btu .�
P leptr.,;.1. co Ile\
Company Name: ENTiZ.QQI,SLS eR 4 FL,Qualifying Agent:tZW t 4 C- Air-FBA-CH'
Address: l:Nt' S7 City A i tom./?G 4-I
Office Phon 2-70 2-I Z7 S' Job Site/Contact Number c 13C State FL- Zip �j ZZ33
State Certification/Registration# C **-150 41 56 - (OuO 5�5G° Fax#
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 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 fora 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 and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type ofwork will be complied with whether speci red herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,state, or local law regulating construction or the performance of construction.
Signature of Owner ( ,,,� / <1(^J.
Signature of Contractor P(,�j����✓' V
'rrnt Name ��� " � _ c,,,{
r� /ar... nz..P...� . . . �61/ s Print Name ,Vtt C. PJt 1 134
3eforee Befor e
his Day of S t'.in-+a;.' ,20 /S this Day of _ -tv __ _
L. 4�t Pudic Stale d Florida - Notary Public Statue of Fbrida
Jotary Public C•,Durante , � `� C J Dtxante
140, I My Commission FF 084283 Notary I r i tic My commission
µ Expires 12/12/2017 or 1. Expires 12/1212017
' 1. i , i, /
NOTICE OF COMMENCEMENT I COPY
(PREPARE IN DUPLICATE)
Permit No. /5- Q/Qn)e-(2120 Tax Folio No. F I
700 g9 0000
State of PLO 2-I}P 4 County of i?U VA 1
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. cy
Legal description of property being improved: 3 - CO ! -MA AJZiC, L34G4,
Le-c- 1-1 IA/ t/a LT 39 8)-14. 13
Address of property being improved: j j Si. A-TuA47(l'✓ i a
32233
General description of improvements: P 1,PA t 1Q. F( 2 4 S e g-G- 4N4-/1/114E36-
Owner tbtAdJ AP b •-)AMOS ViL VA01264-Lc V R
Address 38g S !4j c'.��1 T6 C f3c 4 FL-. 3 2233
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
it)) Contractor it)) Contractor ` e- L` t eetSc.-- AJ02 7-1 �Loi2 4 L-LC
Address 740-`2-g WT D J LA -L((C /3C!Y j L 32 3j
Phone No. qoq •- 2:70- 2-I8 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
� 1
.� .r. .. Aft , 1 is
Signed:
Before me this day o ' ., , / in the
County of Duval, tate of.F�rida as personally appeared
� t,p.4.S Mai VcJrh,$ herein by
himself/herself and affirms that all statements and declarations herein
Doc#2015206149,OR BK 17294 Page 2347, are true and accurate
Number Pages:1 •
Recorded 09/08/2015 at 02:16 PM, Notary Pudic State d Florida
Ronnie Fussell CLERK CIRCUIT COURT DUVAL M J Durance
COUNTY ` My Commission FF 064283
RECORDING$10.00 Can Expires 12/12/2017
Notary Pub iI'c at Large,State of_ �, County of 6_, A
My commission expires:
Personally Known or
Produced Identification [��/�j%1 TE IMIIII