1785 BEACH AVE - WINDOW REPLACE j r\,y\
r , ,i.,-r . •. 'S, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
j " '��' ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
J131 .)`
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-WIND-1202
Job Type: WINDOW AND/OR DOOR
Description: WINDOW REPLACEMENT
Estimated Value: $5,900.00
Issue Date: 5/27/2016
Expiration Date: 11/23/2016
PROPERTY ADDRESS:
Address: 1785 BEACH AVE
RE Number: 169677-0000
PROPERTY OWNER:
Name: PIATAK, THOMAS
Address: 1785 BEACH
0 GENERAL CONTRACTOR INFORMATION:
Name: GREEN MACHINE
I Address: 267 SOPHIA TER SUITE 112
Phone: 904-436-5151
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $39.75
BUILDING PERMIT FEE $79.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $123.25
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
s!5L'ir,,; City of Atlantic Beach APPLICATION NUMBER
v: t Building Department (To be assigned by the Building Department.)
- e •-. .. ... 800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
?,,eft0r E-mail: building-dept@coab.us Date routed: F2q- 1
City web-site: http://www.coab.us j
APPLICATION REVIEW AND TRACKING FORM
Property Address: I 7f:5 EE e.t+ P vc Department review required Yes No
GREFio
/ : ••",
Applicant: 1\/ / ((1) c - . g&Zoning
Tree Administrator
Project: w (V 0 0 t,0 Re_- pus_c&-i,A,e,„ -/-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: Vv."
O c
31 ILDIN /IV/
PLANNING&ZONING 1
Reviewed by: Date: s�o�S-1 1b
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 07/27/10
d
BUILDING PERMIT APPLICATION FILE COPY
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233 i
Office(904)247-5826 Fax(904)247-5845 1 t0---WW 0-I ZO�
Job Address: 17's BEI V i 1 ,V E Perm r:
41—
C MOP c iCr a. Lor 58
Legal Description /6-- /1) 1 — ZlE •ZC N n"f°Parcel M 4444 77-60D co
oar Area o Sq.Ft.
Valuation of Work S 900 Proposed Work heated/cooled non-bated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pooL/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Residential
If an existing structure,is a fire sprinkler stem installed?(Circle one): Yes No N/A
Florida Product Approval r: 51."1 I it 77• '
For multiple products use product approva form
Describe in detail the type of work to be performed: f pp
EP/OL 1A 1 r1 uw3
Fronerty Owner InfortnattIoei
NameTl l�k(Cj, T IMA k dre . /7� ,g&�al Au/
City� tTt L ijtf Statefhone '1dY 34 1- $2 Ob
E-Mail or Fax#(Optional)
Contractor Infor ation: CONTRACTOR EMAIL ADDRESS: 7�
Company N me: /SC - , ,d.. ,ere rcF _ t I l u`alifying Agent: J�`ISI E3 t3 ISN O P
Address:?(07 Dihitt Teri City 37'-Aar' State--f- 4. Zip 32.04f-
Office Phone q • —5151 Job Site/Contact Number Li 3(o--5,5'( Fax#
State Certification/Registration#
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 as herebt'made to obtain a permit to do the work and installations as indicated. I cert6 that no a,rk on a„ta!ation Juno commented prior r„rho
1551101u ca powdered ilia(all work will be perforated to CCI the standards of all Jaws regulating Construt lanaMO in OJ Jurudict nun. I his permit be,,r,:,s ors/r
and void(/work Is nor commenced wiR
thin six(6)months.or sf crmstruclian or a iii is us,<•nded or nJuuudn ed for a ,r riu.J i,t su rfi,nnmtt,_r at on.;rime oilier
work ham commenced. I undrrsia d that separate permits must he secured for Electrical Hort.Mu g,Sign', 1►Jeps,Paols.Furnaces.Boilers.Heaters.
Tanks d AN CamJd.mss ale.
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 herebyI have read and examined this c kation and know the same to be are and correct. All provisions Jews and this
type of work will complied wish whether spec J herein or nat. The"waft of a permit dors nor premise to give authority to r l err— Clothe
provision"ofany other federal.state.or local Jaw regulating construction or dte performance ofco+ rwctlan.
tgnature ofLz_4:YP., , Signature of Contractor ii-__ LIO'Y
— Print Name ._21,.--YiCiit.•_ i�1c�� .. Print Name JCj3_ _S.. .__ i5 11CP
Befog (X t., Before me nn
this,!(? Day of 1/1 .20 r (Q this Day of /-1 a LI .20/6
Notary Public ci Notary tc
Revised 01.26.10
_=o. "°ti..: BRETT C HAURY
t" •€ MY COMMISSION 8FF138933
€a,,6.des EXPIRES June 29,2018 .""
`
`'" 4:' BRETT C HAURY
(407)398-0153 FloridallotaryService.com SI;rte ,,
•I MY COMMISSION#FF138933
?o;," EXPIRES June 29,2018
(407)398-0153 FloridaNOtaiyse MCe.com
111
I
NOTICE OF COMMENCEMENT
State of___—._-- _--� County of_ _— -- -.—__ Tax Folio No. __---___ ________ _
fo Whom It May Concern:
The undersigned hereby informs you that i::proveutents will be made to certain real property,and in accordance with Section 713 of
the Florida Statutes,the following information is stsiqin this NOTICE OF COMMF.NC 1. �e
Legal Description ofproperty
nbeing improved: / f O q ZSR Zct 4TL nit
IT
oi 1417-3 8
Address r rt beingimp roved: < 8.� 6 • AVE , (i19 t c 13010
property P n ,I�,
General description of improvements: �'-t' f7 __too OPAL) 32_2 3
owner: j /f 1 g n Prif r K Address: / 8� /SE -!1
I j 0G
� 7
Owner's interest in site of the improvement: f L
T t /3i %ii 32233
Fee Simple Titleholder(if other than owner):
Name:
Contractor4� MAG, 'dpi a 1-C8tc1 / j U C
Address: ZIP1 3014
ilei Mt Fi 3?iYi 5"
Telephone No.:101113-(0— S' Fax No:
Surety(if any) _____
Address:
Address: ___- / _ _Amount ofBond S
Telephone No: f/ 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 o Florii.- Aber than himself,designated by owner upon whom notices or other documents may be
served: Name:—
Address:
Telephone 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 Statues. (Fill in at Owner's option)
• Name: _
Address: ___--
Telephone 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
Sign) s �• _-f _._ Dass JN J9l.
Before me' is_�n day of___te=a-_en ___in the t"om*of Davi,State
Of Florida,has persgn3lly appcsred J
Pr •.. Pcnaully Known: 7C or
_..��;, BRETT C HAURY • rmducatldentifcy.io, n:� — /i(7 "--
inn •I MY COMMISSION #FF1300:13 Notary Public pjna (pVRrn
f'ft�-�A' EXPIRES June 29, 2013 Mycomrnissionexpires:
_ _ /VI"
(407)398-0153 FloridallotaryServIco,com�y
Doc#2016119953,OR BK 17576 Page 1734,
Number Pages: 1
Recorded 05/27/2016 at 08:14 AM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING$10.00