10 10TH ST #39 - ALTERATION HEADER \S, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
'�J131>f'
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-RAAR-2241
Job Type: RESIDENTIAL ALTERATION
Description: HEADER FOR PASS THRU IN KITCHEN
Estimated Value: $3,500.00
Issue Date: 9/25/2015
Expiration Date: 3/23/2016
PROPERTY ADDRESS:
Address: 10 10TH ST 39
RE Number: 170237-0090
PROPERTY OWNER:
Name: GREEN, JOHN T & EMILY E, *
Address: 10 10TH ST APT 39
GENERAL CONTRACTOR INFORMATION:
Name: BILTRITE HOMES CONTRACTING
Address: 4511 ISH BRANT RD MICHAEL D JONES
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $33.75
BUILDING PERMIT FEE $67.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $105.25
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
rj�-1P1j��J, City of Atlantic Beach APPLICATION NUMBER
J= \P' s, Building Department (To be assigned by the Building Departme .)
-- - -- .,,:.' 800 Seminole Road /� eine ZZ VI
6: - Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845 ' MIT/5
011 y? E-mail: building-dept @coab.us Date routed:
City web-site: http•l/www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: /v /11W Sr # 3 9 tadment review required Ye No
ng
Gi ,/L
Applicant: do Planning Wing
(i/ i ) Tree Administrator
Project: hirkt c, Public Works
Public Utilities
/4,-e4t4 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: [✓Approved. ❑Denied.
(Circle one.) Comments: o c
BUILDING /(/
PLANNING &ZONING F.624/15--�l
Reviewed by: Date:
TREE ADMIN. Second Review:
!Approved as revised. ❑D ed.
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
to
BUILDING PERMIT APPLICATION r,, P" es"Tr
CITY OF ATLANTIC BEACH �" -'-'°' `�' a
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5 11� ���2��2 22y/
L t--i_1_�%�V t
Job Address: �� �b S . .r 39 ,l l,P,j> t�tl,• per I ��+umber: 1
kiwi
Legal Description Par !III SEP 2 2 2015
oor Area o q. t. - I t �J f
Valuation of Work$ ,3,s'o o Proposed Work heated/cooled S'
Class of Work(circle one): New Additio Alteration Repair Move Demolition pool/spa win.owe••r
Use of existing/proposed structure(s) (circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes Eo N/A
Florida Product Approval #
For multiple products use product approva orm
Describe in detail the type of work to be performed: 2 f tr-q.� '{ e «�a/e. TA,,� `'0 rel.,�, of L'4c ,
pc/ 44,� k, i/. S rva,- , o is Orr.&- of ,ie-w he e0,e•r- is 72--
Property Owner Information: - C-L0 i S
Name: L e�`.e eh Address: / �0 'fL ii-i-Z,.....ge... L .39
C1Mai1 or Fax#(Optional) Stat Zip Phone QV r¢ - Z59- 3594.
Contractor Information: CONTRACTOR EMAIL ADDRESS:
•Company Name: l�(cTom:+4- eoti,f. t'��j Qualifyin Agent: C �, �o,.�s
Address: 4'S// ..2 844,,,-t 72 h 14. / City CiX State / Zip 3 2.-tav
Office Phone 904 3-o9. 3ov2- Job Site/Contact Number Qpy. Sixi.• 3cc2 Fax#
State Certification/Registration# C aG 1 2..57.57 2
Architect Name&Phone#
Engineer's Name &Phone# ` G/`,veto - Z- • G
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 for a period of six(6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical !York,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 hereb certify that I have read and examined this a placation and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specs aed 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, . ocal law regulating construction or the performance of construction.
signature of Owner ‘_ 0 _ , Signature of Contractor `j A I ' /,,`!,
'Tint Name Ir,./_„ / V S
p1�11...T.......C�Z61C>Ll Print Name C6rs(G
3efo :-••
1 AP ay )f ►.:' 1� 20 Befor ••- --...ii,- ,
I&e_ , thi��!. if iir, 20
4 No Publ' to of Florida • ‘ U I 7 Shi,ey L•t,Taham �(�
Syirley L e m v2,6 , .• My ion FF�6�§. ,
%,
�0 M Commission FF 086990 E : • ; MY !MA 0
Vp,..04 Expires 02/14/2018
NOTICE OF COMMENCEMENT
State of County of)14_ A.V_
To Whom It May Concern: Tax Folio No.
The undersigned hereby informs you that improvements will be made to certain real property,
the Florida Statutes,the following information is stated in this NO,TCE OF COMMENCEMENT and in accordance with Section 713 of
Legal Description of property being improved:
uor
Address of property being improved: f' „ i�
General description of improvements: ���- / `
Cre 4 , 3
r`�, _ ~ 0441— /ACC
Owner: G"' �
Jø4.t Address: Ai 0 ,,, s1- /,n`.r 51 Owner's interest in site of the improvement: 0-i1 ' `G ��►—. .
Fee Simple Titleholder(if other than owner): r., • 3
Name: .
Contractor:
WO L.
Address: / r
Telephone No.:_ 1 6 t(. .��. 3 2-7-to
�� Fax No:
Surety(if any)
Address:
Telephone No: Amount of Bond$
Fax No:
Name and address of any person making a loan for the construction oft: Doc#2015217300,OR BK 17309 Page 2483,
Name: Number Pages:1
Recorded 09/22/2015 at 02:51 PM,
Address: Ronnie Fussell CLERK CIRCUIT COURT DUVAL
Phone No: COUNTY
Fax No: RECORDING$10.00
Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other documents
served: Name: U s1 _/ may be
Address: S-1 . 4 t ;
r Ft„
Telephone No:
— -y �ga y Fax No:
In addition to himself, owner designates the following
713.06 2 person to receive a copy of the Lienor's Notice as provided in Section
( )(1�)t Florida Fhims himself, owner designates
in at Owner's option)
Name:
Address:
Telephone No:
Expiration date of Notice of Commencement(the expiration date 1
specified): o 8
(1) from the date of recording unless a different •:4 is
THIS SPACE FOR RECORDER'S USE ONLY OWNER row o
N m oP,
U 0 H
Signed: !ft.. /7 • 3-J E ao
/jl+l a TEH
Before me thi •
41, day •
of . • in tthe County ofDuval, h eZ u>is
Of Florida, asp: ona y appeared
Personally Known: '�r��✓'P�2r�
Produced Tde a``•Po%
Notary Public: �
My co 1' ion e�;,'0c1/ �
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