168 SEMINOLE RD - BATH REMODEL C
i� S, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
A. r ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
\0.R19r
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-RAAR-1603
Job Type: RESIDENTIAL ALTERATION
Description: demo old shower, install new tub, vanity, toilets, and lights
Estimated Value: $9,000.00
Issue Date: 7/22/2016
Expiration Date: 1/18/2017
PROPERTY ADDRESS:
Address: 168 SEMINOLE RD
RE Number: 170595-0000
PROPERTY OWNER:
Name: MCKNIGHT, W SCOTT
Address: 168 SEMINOLE RD
GENERAL CONTRACTOR INFORMATION:
Name: TDB CONSTRUCTION INC
Address: 423 ST AUGUSTINE BLVD QA THEODORE DAVID
BERKSTRESSER
Phone: - - — — - —
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $47.50
BUILDING PERMIT FEE $95.00
Total Payments: $142.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
C__-\ City of Atlantic Beach APPLICATION NUMBER s•�, Building Department (To be assigned by the Building Department.)
- 800 Seminole Roadfib— pik��- �bb3�� Atlantic Beach, Florida 32233-5445 FPhone(904)247-5826 • Fax(904)247-5845
0E10 E-mail: building-dept@coab.us Date routed: 1'1‘15\"P
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: t\058 St-C(1-1/4(-1 0`it_ g_o De artment review required `iffslo
uilding
Applicant: T')6 Cvc\SA ful(,-)A —1-(\c, • g Zoning
Tree Administrator
Project: (31mO 6\d Sh0,0/2-( t k f>S\-ak l Ae,,,,Avt6 Public Works
Public Utilities
V d`nv.k‘t Ito'A -k l \51.(0-S 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: roved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed by: rn 1?,-- Date: 71
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
•
� .,�,` FILE COPY
rir 1r�L' , BUILDING PERMIT APPLICATION
JS
1
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
l''.401119%- Office: (904)247-5826 • Fax: (904)247-5845
1 b — CzA POZ-- I,ka03
Job Address: 11!D S Se iii,k I v o ) f Rd Permit Number:
Legal Description RE#
Valuation of Work(Replacement Cost)$ 91000 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration `pair Move Demo Pool Window/Door
• Use of existing/proposed structure(s) (Circle one): Commercial Residential
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes Ca 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:
Dert,tO 0 ki SAowr12 .1-,.'ccIt// Nei-c- 7:6f 0ecti.k( y/ 7 t/e744-' h� 1-71S
Florida Product Approval# kVA f} for multiple products use product approval form
Property Owner Information
Name: o,•.; I ci l uo k s et4 Address: I (... g se wt,', ...0 ( k) Rd
City i4.11a,.-\- c i3c-1-. State FL-Zip '32233 Phone 10 Li- 70 7 3 6 6 1
E-Mail A c t^i e1.1-.0-1,u o Rse ii 1 c 1,,,,•a._1 . ,44
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: II r pp
Name of Company: TDB Cov.. -fie V CT1'0\A L c Qualifying Agent: ( Lee dotze D r✓e QkS±iee5Seie
Address: 9 2 3 5-f. 4,./.,s-1-,,,e 6 l. of City 1n x 2,--1.1 State Zip 3 2 2 SO
Office Phone Job Site/Contact Number 7 D y- '4, 3--/6 3 2.
State Certification/Registration# C GG /Se (,6S 7 E-Mail -t—p B lie,Ks.fat cf,'otruc@ Pa lie .dot m
Architect Name &Phone # TD R
Engineer's Name &Phone# L1/4
Worker's Compensation
xemp / Insurer / ease mp oyees Expiration Date o a F/p
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has comme al ,, x
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 jurisdic m w d
This permit becomes null and void if work is not co ,••• • within six(6)months, or if constriction or work is suspended or abandoned � y w
period of six(6)months at any time after work is co menced. nderstand that separate permits must be secured for Electrical Work,Plum 'n� .Q
Signs, Wells,Pools,Furnaces,Boilers,Heaters,,anks and Air 6 i nditioners,etc. • .2 m
Signature of Propert Owner: _ //Jam- Signature of Contractor: ' A g
Before) e
'0 ( V Before me this '
this JLC Day of t�I. l� ��j Day of � � �
I I t DONNA GORA / de
Notary / _ NoayPubic,Str�fd itiic: 1l ,1 w �� 1 �lI
Nota Public: Uomn lonrrrr121 oN
1
..'. MY aemn ses Phy 8.2018
I hereby certi6 that I have read and examinebe tru and correct. All provisions of laws and
ordinances governing this type ofwork will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violte or cancel the provisions of any other federal, state, or local law regulating construction or the
performance of construction.
Rev.3/14/16
NOTICE OF COMMENCEMENT
-----State of r VZ l CFO., ---County of 70 i ���7 V� Tax Folio No. � O'1 • O CcO ----- ---------
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 NQ ICE OF CQQ NCE/41)1T.
Legal Description of property being improved: i0 g / —aS —;Ai //`f 3altall iee
for 0/3
Address of property being improved: (‘;, 6 SektAlikole A+'b..M C acich. 3zz_z
General description of improvements: (2e tA,t p A€ 1 VV11i't s e P o -N
Owner: loSE DiNti EL 1411.1..). Address: k( .11'Npth" 17-4 Pc'LPNCV-t3eisCit . GL 37.Z33
Owner's interest in site of the improvement: (00
Fee Simple Titleholder(if other than owner):
Name: II
Coractor:Tb\_c?oA c,Re I. tR.e E21 42_QS,S eye. 11)B si-*
Address: 4 2 3 St iiiu71 tiS-{-ts tnF 8c-1A, F C_ 3 2:2_,5-0
F Telephone No.: gp y. 4 3_1 G,3 Z Fax No: 9Oq
Surety(if any)
Address: Amount of Bond$
Telephone No: 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 of Florida, other 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 S ' U E ONLY OWN R \ <
poi
A.SARVER Signed: Date: /Za X16
'ipAl
WWI PINIC >s . F Before ethisl iiii day of J u.i. . in the county of Duval,State
Cittiapn t May11 FT 2 .2011 Of Florida,has erson 1 appeared c9 S- b art i l vo 4,5,4
•;-` �h�+�.ER�irp 14, P Y PP °� 'Ct"+
�tittq�/�I�MtarlNogryAaa Personally Known: kiLof or
Produced Iden f canton:
Notary Public.
Doc#2016169012,OR BK 17645 Page 318, My commission expires: ,.5 `p
Number Pages:1
Recorded 07/22/2016 at 03:24 PM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING$10.00
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