1667 E Park Terr - Replace 13 Windows 5 f CITY OF ATLANTIC BEACH
;-� 800 SEMINOLE ROAD
..t —�'' ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
r�
\ JF11> r
WINDOW AND /OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247 -5814
JOB INFORMATION:
Job ID: 16- WIND -264
Job Type: WINDOW AND /OR DOOR
Description: WINDOW / DOOR - REPLACE 13 WINDOWS
Estimated Value: $5,015.00
Issue Date: 2/9/2016
Expiration Date: 8/7/2016
PROPERTY ADDRESS:
Address: 1667 E PARK TER
RE Number: 172020 -0218
PROPERTY OWNER:
Name: HARVEY, DAVID M
Address: 1667 PARK TER
GENERAL CONTRACTOR INFORMATION:
Name: HOMERITE WINDOWS AND DOORS
Address: 4801 Executive Park CT N BLDG 200 STE 207
Phone: 904 - 296 -2515
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $37.54
BUILDING PERMIT FEE $75.08
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $116.62
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
i= L`lr,� City of Atlantic Beach
s ?� Building Department APPLICATION NUMBER
800 Seminole Road
(To be assigned by the Building Department.)
15 s . Atlantic Beach, Florida 32233 -5445 — (U _ ZC,
ma i
Phone (904) 247 -5826 • Fax (904) 247 -5845
\J;31�� E-mail: building- dept @coab.us I /
City web -site: http: / /www.coab.us Date routed: / 3 / ` p
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1 6627 PaRK ( g,k • G De nt review required Yes o
li £
Applicant: uildin
pp cant: motor l c t N p O � _ ii, & Zoning V
3 Rc,y Tree Administrator
Project: � 7 VI f N 001, 5 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:
APPLIC ATION STATUS
Reviewing Department First Review: I tofic proved. 1 (Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING
Date• > Y//6
Reviewed by:
TREE ADMIN.
Second Review: I (Approved as revised. I IDeni .
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: 1 (Approved as revised. I !Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
1
I
I
f1 !I � '� "! CITY OF ATLANTIC BEACH 1 I 1 I rsny
/"� 800 SEMINOLE ROAD, ATLANTIC BEACH, FL 32233 O v
4
i- Y OFFICE: (904)247 -5826 FAX NO.:(904)247 -5845
�/ BUILDING - DEPT @COAB.US t -� \` _ Z I / V 64-
- = BUILDING PERMIT APPLICATION DUVAL COUNTY
1. JOB ADDRESS: n 4_4_ a 2. VALUATION OF WORK 3. SQ. FT. UNDER ROOF
1 4 P .�I� zz,,e�.�� 'x 46 so i .
4. LEGAL DESCRIPTION: J 5. CLASS OF WORK: 6. USE OF STRUCTURE:
❑ NEW BUILDING ❑ DEMOLITION ❑ RESIDENTIAL
LOT 1 BLOCK i 3 SUB DIVISION S 4 1 vc' Yv-, ,'L „ t ❑ ADDITION ❑ CONVERTING USE ❑ COMMERCIAL
7. DESCRIPTION OF WORK: ❑ ALTERATION ❑ ACCESSORY BLDG. 8. FIRE SPRINKLER:
i t, L L ❑REPAIR ❑ POOL /SPA ❑YES ❑N /A
,.. + -J i 3
d ) ❑ MOVE ❑ OTHER I ❑ NO
PROPERTY OWNER: CONTRACTOR: ARCHITECT / ENGINEER:
9. NAME: 1 15. COMPANY NAME: 23. COMPANY NAME:
, qp I4- A /V4y i-k-evyrc J ii
16. NAME: 24. LICENSEE NAME:
10. ADDRESS: 17. STATE OF FLORIDA LICENSE NO.: 25. STATE OF FLORIDA LICENSE NO.:
\Lvl'1 ADDRESS: ,,, rf .-/ -C..t CG+C_ i 7
at. L ra t C L l 3, 77 18. ADDRESS: 26. ADDRESS:
4 $0t f)w., I' C1 k L.1.-
-4 iz-t aa,�ic,
11. OFFICE PHONE: 12. FAX NO.: 19. OFFICE PHONE: 20. FAX NO.: 27. OFFICE PHONE: 28. FAX NO.:
`iOL is' 4'O'( - a4(' b' s c - ar(. .)sus loci Q5 G�s►F
13. CELL PHONE: 21. CELL PHONE: 29. CELL PHONE:
X 1'3` -t- t% • 6' Cl0 . c3 gyp-.
14. EMAIL ADDRESS: 22. EMAIL ADDRESS: 30. EMAIL ADDRESS:
FEE SIMPLE TITLE HOLDER: BONDING COMPANY: MORTGAGE LENDER:
(IF OTHER THAN OWNER)
31. NAME: 33. NAME: 35. NAME:
32. ADDRESS: 34. ADDRESS: 36. 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 Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters, Tanks, Air Conditioners, etc.
OWNER'S AFFIDAVIT - I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construction and zoning. I will not occupy or use the referenced building or any part therof, until all inspections are finaled and
prior to obtaining a certificate of occupancy or completion issued by the building official, as required by law.
WARNING TO OWNER: ***
YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
OWNER or AGENT CONTRACTOR
(If Agent, Power of Attom- • Agency Letter Required) t _ , _ l (0 er CI )
Signed: 4 �LL La/ L Date: x 51� I. /c /i C-. Signed. MOKI J '139tp / / 4, Before me th _ c)- da o /-'' - C 20'> • the county of Before me this t2 clay of -1C , 20', in the county of
Duval, State o' looms!ti peippgally, appeared' ,I:_N 111 Duval, State of Flo t. ... ...I, - ___J_
' • �� G; 130928 , 1 , sip ROYAL GATES DEAREN III
• •',•
herin by himse / -,, ^ d affirms that all state'menfS. �P rations are hedn by himself 1 h. El `, E) I� Q(kl� 1d declara •ns are
_ �OT>f' Domed TNo Tro an Moirsne.8003$5.7018
true and accur. -
.8r...' . true and accurate. " Y F
Notary Public at Large, State of , • `, -/ /�, County of Di"/ / Notary Public at Large, State of " • , County of 1. L' ` I . f
fi`Personally Known I42ersonally Known
❑ Produced Ident o ❑ Produced Ident capon - a,/
Notary Signature: , Notary Signature:
BLDG01 Permit Application Bldg: REVISED: 12/18/2008
Doc # 2016025946, OR BK 17450 Page 1176, Number Pages: 1, Recorded
02/03/2016 at 03:37 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
•
/ FILE . cop
/' NOTICE OF COMMENCEMENT
Permit No/ — W j It; ,P,— p 6 y
/ Tax Folio No. y
State of Florida. County of Duval
THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Deksription of property (legal description of property apd address if available):
-2,9 )-\c, I \'
- S' CA - Q—S 6 Se. I VC, E�
Cr; Uv�- G
H C L 1` - 7 TW-, 13
2. General Description of improvements:
3 -tp Ia Y r+ - r — ..1 - .. t.a --. c
3. Owner Information:
a) Name and Address: b I I/ ■C ((v(g 7 P� .�-� • cac- ''
I4 rf 4 z .24.. 6.c
b) Interest in property: P4.— c� ( 14. r L t y 91
c) Name and address of simple titleholder (if other than owner):
V 4. Contractor Information: ,L //
a) Name and Address: Apo. �i ,e, 1- -t., r1...W . Aiwa. 4. Qo. T K� l 4X TC c1, M ✓ 7 / e- /s C e
IN9.i)ixd - P 1 er. ejpit (D 5 I S 5 U •C v ZGJ Q t�3 a T
5. S urety b ) Phone Inf C_t:aC I Sr a 7J) f` $ 3 �, (- a) Name and Address:
b) Phone Number:
c) Amount of Bond: $
6. Lender Information:
a) Name and Address:
b) Phone Number:
7. Person within the State of Florida designated by owner upon whom notices or other documents may be served as
provided by 713.13 (1)(a) 7. Florida Statutes:
a) Name and Address:
b) Phone Numbers of Designated Person:
8. In addition to himself/herself. Owner designates of' to receive
a copy of the Lienor's Notice as provided in Section 713.13 (1) (b), Florida Statutes.
a) Name and Address:
b) Phone Number of person or entity designated by owner:
9 Expiration date of Notice of Commencement (The expiration date is one (1) year from the date of Recording unless a
different date is specified: r1•va._- 1 0/-0 f C.
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART
I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING.
CONSULT WITH YOUR 1,ENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING
YOUR NOTICE OF COMMENCE ENT. '' / I �f
. .. fit /, Aim" �/ W L% Y� l/l l lC(J V e
't• •:tore of Owner or Own: 's • uthorized Offic /Director/Partner /Manager Signatory's Printe Name & Title/O e
The foregoing instrument was acknowledged before me this ,-,2 day of J "G , 20 /(o, by //
i V t-, 4 / J.,ct.< v (, as for
(Name of Verson) (Authority Type, i e Officer orney) e of Party Instrument was Executed for)
6lOZ AM setldx3 r : u NO Y PUBL C , STATE OF FLORIDA
8b806l Ad # uoissltuwoo lid a '
111 N Print Name: � areC �1 Q-f y'�
321Y30 S31VJ 1VA0 � !� „?1�r /
fdCPersonally Known
L Identification/Type:
Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I have read the
foregoing and that the facts stated in it are true to the best of my knowledge and belief.
Signature of Natural Person Signing Above
0
Revised 10/1/2009