151 SEMINOLE RD - BATH REMODEL ilk
�, ; \_S, CITY OF ATLANTIC BEACH
,;_ s;.•>..N l 800 SEMINOLE ROAD
' ,... ATLANTIC BEACH, FL 32233
..)V -;:y-7-f"
INSPECTION PHONE LINE 247-5814
Ji31�f"
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-RAAR-2609
Job Type: RESIDENTIAL ALTERATION
Description: INTERIOR BATH REMODEL
Estimated Value: $4,500.00
Issue Date: 11/9/2015
Expiration Date: 5/7/2016
PROPERTY ADDRESS:
Address: 151 SEMINOLE RD
RE Number: 170609-0000
PROPERTY OWNER:
Name: SHERWOOD, BRIAN D
Address: 151 SEMINOLE RD
GENERAL CONTRACTOR INFORMATION:
Name: RADON PROFESSIONAL SERVICES
Address: 336 14TH AVE QA WILLIAM TONY DAVENPORT
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $36.25
BUILDING PERMIT FEE $72.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $112.75
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION OFFICE COPY
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845 ( 3 - ( .A/AR _2
Job Address: i CI Se-m I fiCA (2-c9- Permit Number:
Legal Description GU •- - I 7 • ZS •- &' - e-4-- arcel#
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ 14S-bQ Proposed Work heated/cooled 41 non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structures))(circle one): Commercial iResidentia----\
If an existing structure,is a fire sprinkler system installed? (Circle one): 'es o N/A
Florida Product Approval #
For multiple products use product approval form
w.6) IDURo Roet 6Ac/covt Gr6AR,/
Describe in detail the type of work to be performed: 6,i-e, tr( rn-0 —'Y 2 -h I e. -- Ssu J
h t �; Imo-,.- if - o-U 4e-fr-a 5n i\-5 1 S,' L —A-) 0 std
Property Owner Information:
Name: t 1 s/A _ Address: b
T �� l SP Inc rt e, t
City tun: �L Q_, ._.,rru State of.. Zip 3Lti3 3 Phone
E-Mail or Fax# (Optional)
Contractor Information: /1p Company Name: /i.i-m cr.k...& Qualifying Agent: 7- a r>)' z/1
Address: 3 3 1 f City,14-7( &4 L State Ztp3 2 )- b
Office Phone 1 • ,- Ai b Job Site/Contact Number qv •'Sq 1. 1 2-.1 u Fax# 'toys • 7Jp - 381t4,,
State Certification/Registration# C_5C- iT) -7Cy 3
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 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.
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
ype o 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
7rovisions of any other federal,state, or local law regulating construction or the performance of construction.
ii nature of Own V)C 4 /f(�'
g Signature of Contractot�i �
Tint Name L (Sq race/ Print Name r O, � 625-`
;worn to and subscribed before me Sworn to and subscribed before me
him Day of ,�.�_._�.� this Day of ;V= _ k2�, , 20 I S'
) ,, " STEPHEN HAFT • •
�"IY P
-,� '' e`� Notary Public-State of Florida 1 „„v,,,,,,,, STEPHEN HAFT I
Public ->>1Pw . , • , 1 ,� , . •..A.'o�,..�..,,,N, Commission#EE 1%483 , Comm. Expires May 5,2016
'4,6 OF,l`°Os 1 7:‘,.. u�r� Q:
. Bonded Through National Notary Assn. =;,-���? Commission#EE 195483
R Wised 01.26.10
Bonded Through National Notary Assn.
NOTICE OF COMMENCEMENT OFFICE COPY
State of Fl. Tax Folio No. t rI L 601 -0 o c'1::
County of )
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: / 0..t. (-7 US I
Address of property being improved: { i( n �C £ Ll 1z. 6 l 3 ZL 3
General description of improvements: �ja % lZU�.,�cka
Owner: L( S A-- e( Address: (5( Se.m,tom„S 0--g) a ' P
Owner's interest in site of the improvement: �b
Fee Simple Titleholder(if other than owner):
Name:
Contractor: $(24.1 .,,, c s
Address: 33 Co 4) 1 `�J
—ti. 4-6, Z �
Telephone No.:/ 841 D Fax No: "Z:3 y- 2- • a c�,G
Surety(if any) — 5�
Address: Amount of Bond$
Telephone 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:
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
Signed: Lj /
efore me is Z day of •,J 2,e,I Sin the County of Duval,State
Doc#2015252517,OR BK 17356 Page 755,
Number Pages:1 f Florida,has personally appeared C.� s. T2�LLc-
Recorded 11/03/2015 at 09:37 AM, otary Public at Large,State ofiF'--3 �•��•�#�►•�} — — — — •
Ronnie Fussell CLERK CIRCUIT COURT DUVAL Ey commission expires: , 'P 9;.o j fQ STEPHEN HAFT
COUNTY ersonally Known: r/ =2'. Notary Public-State of Florida or
RECORDING$10.00 roduced Identification: C ' ` t My Comm. Expires May 5,201b
•
Commission•tt 1954113
'' Bonded Through National Notary Assn.
— •
ola.t �. City of Atlantic Beach
�S �:� Building Department APPLICATION NUMBER
= '- 800 Seminole Road (To be assigned by the Building Department.)
:: rr Atlantic Beach, Florida 32233-5445 I s - R A f` - Z GO'
Phone(904)247-5826 • Fax(904)247-5845
j;; >%• E-mail: building-dept @coab.us C
City web-site: http:/lwww.coab.us Date routed: 4 /� J
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1 5 t SEm i t\)0LE 0\ Department review required Ye No
Applicant: wilding:
A
pp nt: R PRO S EYt c F S Plann ni g &Zoning
YF21 � Re„,,„, ,,t Tree Administrator
I
Project: !U Public Works
Public Utilities
Public Safety
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: if pproved. ❑Denied.
(Circle one.) Comments:
UILDI
PLANNING &ZONING `� r
Reviewed by: Date: //- 97r
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denie .
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
I