1270 OCEAN BLVD - ALTERATION , CITY OF ATLANTIC BEACH
ss
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-RAAR-1615
Job Type: RESIDENTIAL ALTERATION
Description: RENOVATE EXISTING BEDROOM AND BATHROOM,
RAISE CEILING
Estimated Value: $40,000.00
Issue Date: 7/22/2016
Expiration Date: 1/18/2017
PROPERTY ADDRESS:
Address: 1270 OCEAN BLVD
RE Number: 171823-0000
PROPERTY OWNER:
Name: STONE,MITCHELL A & CHRISTINE L, *
Address: 1270 OCEAN BLVD
GENERAL CONTRACTOR INFORMATION:
Name: SIGNATURE HOMES & DEVELOPMENT
Address: 731 DUVAL STATION RD QA REX JONATHAN
WILLIAMS
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $125.00
BUILDING PERMIT FEE $250.00
Total Payments: $375.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
rs.:���r City of Atlantic Beach APPLICATION NUMBER
�s - � Building Department (To be assigned by the Building Department.)
_;" 800 Seminole Road I - I
��� �� Atlantic Beach, Florida 32233-5445 I COO RAA (O
Phone(904)247-5826 • Fax(904)247-5845
LS
g;ti�% E-mail: building-dept@coab.us Date routed: '7 f t S-2) /1
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 7-70 EeEç1cj &Ain Department review required Yr No
cc� uilding_
Applicant: J l G N AT v ( . [—Aoryte---_,S r+iri9-&Zoning
Tree Administrator
Project: RE.-.1\_DcDvA`TG____ 6€.0R(.0O4A__ _ Public Works
� Public Utilities
f -'i 64 — Public Safety
R {-\-(,S C: GE( L( 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: /a C.__ Taj +-`i II o v4--UILDIN �V
PLANNING &ZONING '7. (I ., 6
Reviewed by: Date:
TREE ADMIN. Second Review: ['Approved as revised. ❑Denie .
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
S r, - E Cop
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r �'► CITYF
O ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
\Ji31Svr Office: 904 247-5826 • Fax: (904)247-5 4
c � 85 J61 _ Pic1AP - ICo1S
Job Address: 1 '),--T 0 0 GC etv.. k V 1• Permit Number:
Legal Description RE# ri �S,t 3 ,0000
Valuation of Work(Replacement Cost)$ to, 1) Heated/Cooled SF ?OO Non-Heated/Cooled
• Class of Work(Circle one): New Addition teration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): ommercial 1'esidential
• If an existing structure, is a fire sprinkler system installed?(Circle one): Ye ICI N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
Pe v\ovC,- -e ten;s�� be oNA,,., (0(4. 1-aom.) �\'il\"AnPS . -- CCKKk3(4 CAZ
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: Nqk t- , 15 St otic. Address: I)--7-20 O c,eb-v‘ N. v .
City A*\o w if., cL. State Zip 3��3-5 Phone
E-Mail
Owner or Agent (If Agent,Power of Attorney or Agency Letter Required)
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.
Contractor Information: /
Name of Company: P t.o' _ s ' % . ualifying Agent: -ex (j 1( OL t,-,\J
Address:73( p vv e, 3 i, , *1. i 3 ,1 `,D'1-i City S State Zi 1- 1 3) ') (g
Office Phone Job Site/Contact Number -7 5 9 - (1 8'67
State Certification/Registration# C Pi C b a 6. E-Mail Ce K IA/1 (\+ct„t,tu 65 �, A cA S .
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Architect Name&Phone# J
Engineer's Name&Phone# ,(s,v Po vk c4 o , .(4') -.'0%08
Worker's Compensation
Exempt / Insurer / Lease Employees / Expiration Date
Application is hereby made to obtai' .permit to do the work and installations as indicated. 1 certify that no work or installation has commenced
prior to the issuance of a permit a • t'•t work will b rformed to meet the standards of all laws regulating construction in t is jurisdiction.
This permit becomes null and void if w. s no[corn . within six(6)months, or if construction or work is suspended or ''andoned for a
period of six(6)months at any tim-after : ' omme I understand that separate permits must be secured for Electric, ork,Plumbing,
Signs, Wells,Pools,Furnaces,Bo ers, -�ters Tanks Zf 'r Conditioners,etc.
Signature of Prope l wner: _Atli !'' /, / - --
gn p �I►i I■U��1,�/II Irak./ Signature of Contractor:
Bef q�e � i ����... ��
thisT� Day of ,�a /,t _� Before me this --�.�, rfip?"ltr'_—I'O` �p
� ,au �� , 924••1
Al
Notary Public: Ali& Notary Publi:.—• ;` , stk.,,_ . A19 mi
r"-J
filo
I hereby cert that I have read and examined this application and know the same to be true and correct. All provisions of!. and
ordinances governing this type of work 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.
Rev.3/14/16