1763 SEMINOLE RD - WINDOW , ,i.., 1_,J.v.i:rjo ,
' '�sf CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
�J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
\JJ319
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-WIND-392
Job Type: WINDOW AND/OR DOOR
Description: WINDOW REPLACEMENT
Estimated Value: $3,030.00
Issue Date: 2/25/2016
Expiration Date: 8/23/2016
PROPERTY ADDRESS:
Address: 1763 SEMINOLE RD
RE Number: 169636-0200
PROPERTY OWNER:
Name: SHADDEN, ELIZABETH B TRUST
Address: 1761 SEMINOLE RD
GENERAL CONTRACTOR INFORMATION:
Name: PELLA WINDOW AND DOOR
Address: 7818 PHILIPS HWY QA JAMES SAMUEL ROWLAND
Phone: - -
PERMIT INFORMATION:
FEES: - - - - —
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
PLAN CHECK FEES $32.58
BUILDING PERMIT FEE $65.15
Total Payments: $101.73
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Doc # 2016033865, OR BK 17461 Page 131, Number Pages: 1, Recorded 02/16/2016
at 10:11 AM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00
Permit Number_
Parcel ID Number/(s9(e3(D•O.v
NOTICE OF COMMENCEMENT
State of Florida
County of''e∎A
The undersigned hereby gives notice that the improvement(s)will be made to certair real property,and in accordance with
Chapter 713,Florida Statutes,the following information is provided in this Notice of Commencement.
1. Description of property(legal descr tion of the property,and street address if available)
Address(-7 1.3ex-wyL,L a
Legal Description •age \)sin m.t a Lox 4S-
2. G neral description of impveent(s)
�uP_a om W�vdA`u
-
3. Owner Information
Name ..ek\Q w Phone&Fax Number
Address "7(a M vs4 t Lahti r • in — s.Lh_F4 Jla>aj
Interest in Property6W'f`e'
4. Fee Simple Title Holder other than owner shown above)
Name \ Phone&Fax Number.
Address
S. Comx ``_
Name e �w.Jab,-ass 4-rb 64'4-) Phone&Fax Number
Address xe-.50 W S . w WOfA A " .T0
6. Surety Of any)
Name Phone&Fax Number _
Address WA
7. Lender(if any)
Name" Phone&Fax Number
Address"B. Persons with the State of Florida designated by Owner upon who notices or other documents may be served as
provided by 713.13(1)(a)7,Florida Statutes.
Name (l in Phone&Fax Number
Address ,•l`Y
9. in addition to himself or herself,Owner designates the following to receive a copy of the Lieror's Notice as provided in
713.13(1)(b),Florida Statutes.
Name Phone&Fax Number
Address
10. Expiration date of Notice of Commencement(the expiration date is one year from the date of recording unless a
different date is specified: — --
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 1, 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 YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE
OF CO1 MENCEM .f!L .f l _ — /". GG iC Ie T �'e ti
Signature of Owners orOwne Authorized Off icer/Ouector/ nner/Manager `_ Print Marne
Sworn to(or affirmed)and subscribed before me this l day of T 4-4y3 ,20/(a by t e\.s ,4,11N
■1.11k1/l_ (type of authority.e.g.officer,trustee,attorney in fact)for (name of party on
oehail 11 `whom instrument was executed. personally known to me or )c produced
h as identification.
G RISTINEOwaLEY
g ry ofNota I, (Seal) 4141 AlY CCNIASSICN•FFOMR
34%.,c■ EXPIRES:Amoy 29.2018
&Mid Wiry Rae Urlanwin
Name(Print)
--AND--
Verification pursuant to Section 92.525,Florida Statutes. Under penalties of perjury,I declare,that I have r the for oing and
that the facts stated are true to the best of my knowledge and belief. Jib/Li
Signatory of Natural Persbn Signing fin Wye al l Above
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1r riL.4 tavil 1 "+ " tfUILDINGPERMITAPPLICAT pI N plea- Kati-1m '7( eAi 7;7'6574'10!0
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845 / /�
Job Address: 17(03 Set,,,,,.a\e. R._ Permit Number: /6-W/ 4'/ 3?�
Legal Description S•a 36 sacean Cc<uw ,N.a L0, parcel#/(a 9 (134-,„„ OFFICE COPY
Valuation of Work S 363k - Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pooVspa windodoor
Use of existing/proposed structure(s)(circle one): Commercial ' identi:
If an existing structure,is a fire sprinkler system installed?(Circle one): 'es No 6/7-;\.;
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed: gmA 0,ew. 3 ,,4,,,.1u•••, s.?, 5,.6r.1,•..+¢`
Property Owner Information:
Name: veo\e. 5\,,„.U..&" Address:f71.3 St.n...•o\- f -
City -\ww\rve., ..C ■ State 1..-Zip 34). Phone creM-y1S•Yu 4b
E-Mail or Fax#(Optional)
Contractor Information:
Company Name:p�\*-w•v�aaw 45- (=A45- (=A0--.5 Qualifying Agent: S rw 0
a1/4.slara ff o ►'
Address: 5f W Sao�a+ ply City/_e v-r w o+3 State fit- Zip 3,I L f S
Office Phone 7.4-2-4o37-eV a Job Site/Contact Number-rd,-(t3 7_4-Y 0 b Fax it �I
State Certification/Registration#VI -61-fl.-71 S a- r
Architect Name&Phone It
Engineer's Name&Phone# _ , F C o D 216
Fee Simple Title Holder Name and Address ' i r C
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby nark to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced •or to the
issuance ofa permit and that all work will be performed to meet the standards ofall laws regulating construction in this Jurisdi tint This permit
and void i work is not commenced within sLs )months,or iifconstruction o rwork is suspended or abandoned fora ppeeriod o ls"6)months at•miff work is commenced /understand that separate permits must be secured for EkeMcal Work,Plumbing,Signs,Wells,Pools,/Caimans,Boilers J/-„e,s,
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 hereby certify that I have read and examined this ication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of Ywork 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
provisions of any other federal,state,or local law regulating construction or the performance of construction.
Signature of Owner �(A L(- 2.x:.1 _ Signature of Contractor
Print Name , c (ti c s^ Print Name aa• ow�ww
Sworn V and subscribed before me Swompand subscribed before me
s ay of 'F- ' .20 i this _ 'DDay�of�,'F&V) ,20/(e
Notary Public Noy Public
awstslEOwari:Y =,W4-'- vised 01.26.10
f: : INCOMI SSIONIFF067377 K E) S:Jt umy 28,2018
r 6073 I 2r..
d''''''' MARYLOU SESAK
I,jl� 1 MY COMMISSION#FF146073
7�a�rr/
f EXPIRES Juls 29,2010
--
(4071 0151 FlorkfatidaryServke.com
s!I -,, . .City of Atlantic Beach
Buildin De artment APPLICATION NUMBER
�c I4\'� g p (To be assigned by the Building Department.)
,1 g 800 Seminole Road /- �/
yry ____'r. Atlantic Beach, Florida 32233-5445 /�! — �j/Y a — 39z
Phone(904)247-5826 • Fax(904)247-5845
�o ni9, E-mail: building-dept @coab.us Date routed: 2 /G//,
City web-site: http://www.coab.us
i APPLICATION REVIEW AND TRACKING FORM
/ 74 J d �� ment review required Yle �
Vo Property Address: Building
Applicant: /i� 1-nbd °tannmoning
Tree Administrator
Project: ta-2/2,66) FL Atezinc4r 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: I 'Approved. ['Denied.(Circle one.) Comments: j� ('��
Reviewed by:
':UILDING / `�
PLANNING &ZONING
1&
TREE ADMIN.
Second Review: ['Approved as revised. ❑Devi Date: c2//
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
1
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