2066 BEACH AVE WINDOW 2016 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
WINDOW AND/CR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-WIND-167
Job Type: WI N DOW AN D/O R DOOR
Description: window replacmnt
Estimated Value: $8,000.00
Issue Date: 1/26/2016
Expiration Date: 7/24/2016
PROPERTY ADDRESS:
Address: 2066 BEACH AVE
RE Number: 169716-0000
PROPERTY OWNER:
Name: MILLER B/E, JONES DOROTHY,
Address: 2066 BEACH AVE
GENERAL CONTRACTOR INFORMATION:
Name: GOLDEN HAMMER RESTORATIONS
Address: 2210 Lake Shore BLVD QA JERRY RODGERS WILSON
Phone: - -
PERMIT INFORMATION:
FEES:
BUILDING PERMIT FEE $90.00
STATE DCA SURCHARGE $2.00
PLAN CHECK FEES $45.00
STATE DBPR SURCHARGE $2.00
Total Payments: $139.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445 Jb '7
Phone(904)247-5826 - Fax(904)247-5845
r.FJ E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us I — —
APPLICATION REVIEW AND TRACKING FORM
Property Addr ss: A Depa ent review reiq_�uirred�-Yes 7'N�_o
uildin
Applicant: g &Zoning
Tree Administrator
Project: 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
i�Approved.
Reviewing Department First Review' F�Deniecl.
(Circle one.) Comments:
(E D DIN G
PLANNING &ZONING
Reviewed by: Datel
TREE ADMIN. Second Review: DApproved as revised. F
]Deni"
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: [JApproved as revised. nDenied.
Comments:
Reviewed by: Date:
Revised 07/27/10
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233 OFFICE COPY
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 2066 Beach Rd. Atlantic Beach Fl 32233 A r n-yl
Legal Description Floor Area of Sci.Ft. Parcel Sq.Ft
Valuation of Work$ 8,000 Proposed Work he-lated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spae��Sor
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/A
Florida Product Aeproval # FL I 1147-R5
For multiple products use product approval form IE FE
Describe in detail the type of work to be performed:Replace 2 sets of windowE i Pella
I ql� F�,JIAN 2 1 2016
U ul I ul
Provertv Owner Information:
Name:—Carla Miller Addre
City State—Zip—Phone
E-Mail or Fax# (Optional)
Contractor Information:
Company Name:Golden Hammer Restoration Inc.
Address:22 10 Lake Shore Blvd. City Jacksonville
Office Phone 904-880-2004 Job Site/Contact Number 904-545-9005 —Fax
State Certification/Registration# CGC-1510821
Architect Name&Phone#NA
Engineer's Name& Phone#NA
Fee Simple Title Holder Name and
Address NA
Bonding Company Name and Address—All Lines Ins. Blanding Blvd Jacksonville
Fl
Mortgage Lender Name and Address
_NA
A,n ican 7,s here mode ana ermit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
,,be performed to meet the standards of all laws regulating construction in thisjurisdiction. This permit becomes r-4.'
to 0" ' p
a 'ta d th " r'V
P' 0 by
anc'0 Perm n 't a -0
_0, is" t com w t
a d f k 0 menced 'Inn six(6)months, or if construction or work i's suspended or abandonedfor aWeriod of six�6)months at any time ai.er
is co,.",c, I, stan t at
,k d nde d h eparate permits must be securedfor Electricat Work, Plumbing, Signs, idis, Pools, Furnaces, Boilers, Heaie-s,
Tanks andAir Conifitioners,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 herelb certify that I have read and examined this a 1* , -r 7d correct. All provisions of laws verning thi,
lied with whether speci pp teation and know th a4Pe tpe at and ordinances
Th
work will be comp hy,tArpermit does not presume to o
fied herein or not. J, give auth �jjy to violatyor,�,ancel tl
provisions of any otherfederal,state, or local law regulating constructio r eqw nl�ance of construction.
r
Si-nature of Owneror"A�A&,�__i(k2s 4
At, pignature of Contract
CO
Print Name Print Name
............. .............. .. ...........................................................................
'i�� ..................
Sworn to and subscKibe before me Sworn to and subs before me
this IC�-Day of 20 k(,-- this A45*%Day of_crked _QA�tA 20/6
z cs.� ^pmu —
Qa,n ?L� — awry. rI.
Notar��ublic No�4y Public
Doc # 2016013584, OR BK 17433 Page 2252, Number Pages: 1, Recorded
01/20/2016 at 12:41 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
NOTICE OF COMMENCEMENT OFFICE COPY
(PREPARE IN DUPLICATE)
Permit NcL. 67 Tax Folio No.
State of.!j — county of
To whom It may concern:
The undersigned hereby Informs You that improvements will be made to certain real property,and In
accordance with Section 713 of the Florida Statutes,the following Information Is stated In this NOTICE OF
COMMENCEMENT.
Legal description of property being imProved:031
tKAJ if .9
Address of property being improved: --A
LLAtAt'c- fb"&
General description of improvements:
,wne, C_Ak�N
Address
_.
Owner's Interest In site of the improvement ..A
Fee Simple Titleholder(if other then owner)
Name
Address
Contractor Golden Hammer Restoration.Inc.
Address 2210 Lake Shore Blvd.,Jacksonville,FIL 32210
Phone No.904-880-2004 Fax No.904-388-3354
Surety(it any)International Fidelity Insurance Company
Address 1060 Maitland Center common#147,Marland,FL 32751 Amount of bond �100-000_00
Phone No.407-661-4076 Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name
Address
Phone No. Fax No.
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other
documents may be served:
Name
AC ldress
Phone No. Fax No.
In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in
Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option)-
Name
Address
Phone No. Fax No.
Expiration date of Notice of Commencement(the expiration date Is one(1)year from the date of recording unless a
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY -OWNER
Slgn.d:�A 1 .1 A0 DATE
Set..
aay or In the
l.�
of . ,��_ re
County h L_t ra� run.
'"rsonally
TAX T I (_t h..in by
MM III hQrS0W$nd affirnns that at statements and dedaratfora hMIn
are=and scmate
'(4k. Cf.
�V,VUDIIC at Large.Slate of
My comnission expires: -,-,fi"ty odEANJ�AL
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