1877 BEACH 2016 BATH REMODEL CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
j v ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-RAAR-60
Job Type: RESIDENTIAL ALTERATION
Description: INTERIOR REMODEL
Estimated Value: $7,400.00
Issue Date: 1/22/2016
Expiration Date: 7/20/2016
PROPERTY ADDRESS:
Address: 1877 BEACH AVE
RE Number: 169682-0000
PROPERTY OWNER:
Name: PIETAN, JERAL H
Address: 1877 BEACH AVE
GENERAL CONTRACTOR INFORMATION:
Name: INSPIRED HOMES LLC
Address: 2215 3Rd ST
Phone: 904-237-2711
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $43.50
BUILDING PERMIT FEE $87.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $134.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
rsyJ1J City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
z� Q
Atlantic Beach, Florida 32233-5445 w
Phone(904)247-5826 • Fax(904) 247-5845
E-mail: building-dept@coab.us Date routed: /
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: /D 7 /AJC d-o A Department review required Yes o
Buildin
Applicant: �/7,�/12 +a 7V21 FS GLC Planning &Zoning
Tree Administrator
Project: 2��( 6�� �� 7-�i�/Q� 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: Approved. ❑Denied.
(Circle one.) Comments:
ED3)
PLANNING &ZONING Reviewed by: Date:
TREE ADMIN. Second Review: ❑Approved as revised. ElDeVied.
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 OFFICE COP'S
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845
Job Address: Permit Number./
V �
Legs!Description._La* `{Z- Aci Pairreel#
`.Floor Area-oT_.. ---
Valuation of Work$--1 00 Proposed Work heated/cooled wu heated/eooled�_
a �� a ..a c H�q�a i .�� a6
Class of Work(circle one): New Addition Alteration jep;-P Move Demolition pool/spa window/door
Use of existing/pro structures) circle one): Commercial $s�es 'No N/
if an existing structure,is a fire sprin itler system installed?(Circle one): r
Florida Product Approval#
For multiple products use product ipprova form
Describe in detail the type of work to be performed: Q•'� vv�- a lc�c f Rµ - �, Tv pS,�
Property it Information:
Nacre: cl r e-r' _ Address: Z44-4% MOSS
CityStaGC � i7_: Phone
._ V_; -__..___ ...� -
E-Mail or Fax#(+Optional)_.__._ �-
Cractvr infermadon; 'u r/ 0 I'l)s p t£d h a m els F10l', da-
out. Ca ref
� .___-_..__ s )"Cr
Company Name: T"1� 'rr v'. �.1 _— Qualifying A> C
Adthem.-. Z L 5 -W '. l�E ......_. City J Px.' - - _ ___ -��_--ZP Z'3'....
p 1'c��{ i.3 t1 Job Site/Contact umber Fax#
State Certification/Registration#
Architect Name&Phone --
Engineer's Name&Phone#
Fee Simple ride Holder Name and A
Bonding Company Name and Address
Mortgage Lender Name and Address
tp� by made to obtain a permit to do the work incl installations as itedlcated. I cerhJy that Ito work or installation has commenced prior to the
is3atatusR and that alt work wail be rmed to meet the suusda�ds of all taws regulating covutructaon!n this jurisdiction. This permit become°twit
and void �var�k as not camn+enced within sax(ti mnnths,or if earrstruetzon or work is sus toted or abandoned fora.pew���a)r►t� ��A �
�i��� n�drstand that separate permits mtut be secured for EGadrteot�Wsr�k,P?un�blts8.StStrs, W
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 BBE CEME ORE RECORDING YU!i NOTICE OF
[hereread this teation and know the same to be true and correct All pravisaons of laws and ordit+anees governing thLv
type of wor+E cotttpll dd w r Ci t�herein or not. 77w granting of a permit does not pres&me to give authority to violate or canoe!the
provraions of any other federa state,or gelating construetian or the ptrformatace of eorutneetaon.
1 a
Signature of OwnerSignature of Contractor
Print Name Print Name
Sworn to and sub -om me- sworn to and subscribed before me
this Z? Day of c -"_ t! this'� Doty Of- ,: .�`�,— ,20
Vii;•. � . 8
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