179 PINE ST - WINDOW r SA CITY OF ATLANTIC BEACH
s) 800 SEMINOLE ROAD
;r ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-WIND-861
Job Type: WINDOW AND/OR DOOR
Description: 3 WINDOWS
Estimated Value: $2,400.00
Issue Date: 4/13/2016
Expiration Date: 10/10/2016
PROPERTY ADDRESS:
Address: 179 PINE ST
RE Number: 170635-0075
PROPERTY OWNER:
Name: PERRY, SUSAN
Address: 179 PINE ST
GENERAL CONTRACTOR INFORMATION:
Name: RADON PROFESSIONAL SERVICES
Address: 336 14TH AVE QA WILLIAM TONY DAVENPORT
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $31.00
BUILDING PERMIT FEE $62.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $97.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
aiL.a,` City of Atlantic Beach APPLICATION NUMBER
Js �� Building Department (To be assigned by the Building Department.)
/ 800 Seminole Road // /, ) ,i/4 _ '
1511 -r,l Atlantic Beach, Florida 32233-5445 W �iV f� lV f
Phone(904)247-5826 • Fax(904)247-5845 I1
"rvit �? E-mail: building-dept @coab.us Date routed: 7 /
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: /79 / //✓c J Department review required Yes No
p Y
/ cnning &Zon Appli cant: n:M !d �8/ f�"C. ing
/, � > _ Tree Administrator
Project: UCH/�..)e I eO/a CE/frn T Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature IOU
Other Agency Review or Permit Required Review or Receipt Date ! 04
of Permit Verified By T(40Dike T
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St.Johns River Water Management District -t 11'O�
`Z r
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: roved. ['Denied.
(Circle one.) Comments: r04 rvc /;oil (2,4,t0.- oi
BUILDING On S ) ,-
PLANNING &ZONING , I/•/D -/6
,ma
Reviewed by: / i /� Date:
TREE ADMIN. Second Review: ❑Approved as revised. ['Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
•
BUILDING PERMIT APPLICATION j r y
CITY OF ATLANTIC BEACH r , , . V
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: (7 c1 P "ICJ e S (. Permit Number: /6- 4,/ 40 -c G(
Legal Description PE /O-/a l 6 -2 5 - 2-1 Parcel#
'/
'—Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$- r eU. Proposed Work heated/cooled / 0 8'Z non-heated/cooled / t(2
Class of Work(circle one): New Addition Alteration pair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial ' -sips iti.
If an existing structure,is a fire sprinkler system installed? (Circle one): 4774 N/A
Florida Product Approval # I"/4-71/C ' z' 4/74)
For multiple products use product approval l form
Describe in detail the type of work to be performed:
- t2 e "LAC e ( ) LA) (O t,t)
Property Owner Information:
Name: 5 3 9 /1-r.) Pe i2.2�. Address: 1 7 9 (r'� e
City A 7Ga,") .1 cc f3 l-, State ft Zip Phone
E-Mail or Fax# (Optional)
Contractor Information:
Company Name: R A4' N (�12 of 5 e1i ur a es Qualifying Agent: 1,3 7 OA i P ()vie 7
Address: 3 34 /y 11 4U_ Kt. City c f,t•c 13 QAc 1, State j L Zip 3 2 2- 6-0
Office Phone Job Site/Contact Number �qt • /2 /o Fax#
State Certification/Registration# ( , C 0.a-7 7 9 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. 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 ElectricalAFork, Plumbing,Signs, Wells, Pools, urnaces, 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.
I 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
type of work will be complied with whether sseci red 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 loca . :ulating construction or the performance of construction.
r
Signature of Owner ‘ A-.(-4/34k- 'P Signature of Contractor 14 1)4- J1 is 7
Print Name 5 LAS an -e - Print Name
Sworr o and subscr'b-d eforg.lw ` . _ _ _ Sworn to and subscri d before me
t I fi Day of 1 � •. : : Day — — — ahaLat •
i !, this 1LDa of - - —
s'M, STEPHEN HAFT
�, •mss: Notary Public-State of Florida � • aY pCB-,
'_•; �; •E My Comm.Expires May 5,2016 ( 4 P `, `�� Notary Public-State of Florida
4 aF �� My Comm.Expires May 5,
Public Commission#EE 195483 Not U liC , P Y 2016 '
/t(;°'• Bonded Through National Notary Assn. rF��oP°- Commission#EE 195483
',""•" 8Rte040131g09a6UN0aryAssn. 1
Pmewqr•wwwwwwwomeipsx.”.■wmirms, eel
NOTICE OF COMMENCEMENT
/ nom- (PREPARE IN DUPLICATE)
Permit No. /6` bti/ nm- sr,6/ Tax Folio No.
State of fiC County of al VA L
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. 10- 16 — 2_ S – 2-7
Legal description of property being improved: ree.�e- - t�,.• �. }- t .-. -
Address of property being improved: / 7 ti P,'.•c c, S 7 .4/L ,0 7%. g e,"6 4
General description of improvements: R,�7.0 y 4 i. n oz,A t✓.,, t+,,1 3-71;414 < e(t• ."' '
13 , `3 d is, ,h(' ,611119'! e -f f 4 5 17,}-L( •
o Owner '7 LJ s' ,A,,, r -,,„'-rs'-cr ' 0 0
Address 7 7 % P t`sL e `7. .4 71--4`7'e 13 c'✓�ce,4 (� j
Owner's interest in site of the improvement 0
n la Fee Simple Titleholder(if other than owner) ..�. g_ �/
Name ( , � ��, i °' EL
Address r CO ontractor / ii-41 m ji t-�/to. s; <_zr i1;e J �.1 _
Address ; y 4• l V 71 :f}t/ ,k - -4{.V- g(s?.0-cit /1 1' 2-S, �. ® I
Phone No. Fax No. CO y
Surety(if any) = Z
Address Amount of bond$ • 1.... ® (,U
Phone No. Fax No. _
Name and address of any person making a loan for the construction of the improvements.
Name
Address P f ,ir W
Phone No. Fax No. Z --›'
Q = J Z
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other d 0 Z O
documents may be served: Q
Name A),/' 0 W !=, C
om00 4
Address V () p V G
Phone Na. Fax No. W F,,. Q to
oZQ2Q
In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in V J N N
Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option). O Q 2 W
Z
Name U.
Address 71'' G 0 a Ul m
Phone No. Fax No. w W
W V N W
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a W CC W
different date is specified): E
Q W
THES SPACE FOR RECORDER'S USE ONLY OWN R cc
Signed: : \ & DATE Le (/'Z /
Before ma this ( day of .4:M/G1.4111. in the
County of Duval,State of ride,has personally appeared
�,.: Page nf.�.5 r herein by
Doc,r_U 6081492,OR BK 17524 age 341, himself/herself and affirms that all statements and de larations herein
Number Pages. 1 are true and accurate • o a��
Recorded 04/12/2016 at 12:49 PM, 1 ,,`nY P"
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
,,a oa,,, STEPHEN HAFT
4 -', Notary Public-State of Florida
COUNTY :::• !�? •E My Comm. Expires May 5,
RF_GORDIi IG$10.00 1 :N» Dial « Y 2016
Notary Public at Large,State• C6i of o. (fi mission • EE 195483
My commission expires � ... y l,.ma1 Notary Assn
Personally Known r -
Produced Identification L! �,/
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