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583 COASTAL OAK LN - NEW CONTRACTOR PERMIT rr" S,` CITY OF ATLANTIC BEACH f 800 SEMINOLE ROAD j .4404,9w7 ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 SINGLE FAMILY DWELLING NEW MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 17-SFR-2930 Job Type: SINGLE FAMILY RESIDENCE Description: new contractor to finish home with less than 10% left to complete Estimated Value: $287,500.00 Issue Date: 1/10/2017 Expiration Date: 7/9/2017 PROPERTY ADDRESS: Address: 583 COASTAL OAK LN RE Number: None PROPERTY OWNER: Name: Procoin LLC Address: 2637 CENTER COURT DR WESTON, FL 33332-1832 GENERAL CONTRACTOR INFORMATION: Name: OSSI CONTRACTING LLC , CGC1514019 Address: 13349 STONE POND DR JACK OSSI JR Phone: - - PERMIT INFORMATION: FEES: BUILDING PERMIT FEE $100.00 Total Payments: $100.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. �'�.,.i,, BUILDING PERMIT APPLICATION E© IE 0 M C )r CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach FL 32233 JAN — 4 2017 --...';',.-)219•,- Office:(904)247-5826 • Fax:(904)247-5845 Job Address: C,E3 41pa ,4( 07Irk itive Permit Number: i - 5 FT--a TSO Legal Description ty-1- W RE# Valuation of Work(Replacement Cost)$ Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): New Addition Alteration Repair 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 No 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: j N Ls t_t 0 r , --SFR. -E7,355 CA-1.4 R-Ge r1 ac,-- PQr0 Florida Product Approval#_ for multiple products use product approval fonn Property Owner Information Name: /-7,Jc E - "ef c,47e/o Address: 2527 84? / 7 or City_ Gi2 m1 Stateiq Zip .9 3327 Phone Fs-z-/-,_3,3 265 E-Mail 4t/>Qz_ ,4g-d /b Co 8 7 . 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: IA ,L of Company: 05-5% Co h f 1 N.) WL Quali 'ng ' gent: t L. S S Address: I ( ( 2 3 G2 0 S42.b. "(')s i1: Ee/ l{ City A k, .i1., :. State Zip 22 C Office Phone 9 .y `cd o ?i9� Job Site/Contact Num i er t)3 S 1.7 Y-6/1-7/5Zs State Certification/Registration# CGL lam/40/ f E-Mail -q-ft 04.1 ?F0749/4Go r.e 0,7, Architect Name &Phone# Engineer's Name&Phone# Worker's Compensation ,./ 0 2 e empt sur:, ea - mp o"ees xpi . on l ate Application is hereby made to obtain a permit--to d the wo and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that al 'work wXlbe performed to meet the standards of all laws regulating con ction in this jurisdiction. This permit becomes null and void if work is not Jco menced within six(6) months, or if construction or work is . pe ded or abandoned.[or a period ojsix(6 months at any time.after wo is m en '•d. I understand that separate permits must be secur',for El,ctrica Work,Plumbing, Signs, Wells,Pools,Furnaces,Boilers,Heat• `'T ks 'nd Air Conditioners,etc. , /ice ,__ ��s Signature of Property Owner:' 4�—' Signature of Contractor: ice; Before me this TVI.Day of 3 LI.A k.k -�1. , 0 11- Before me this `tom 0. of JO- U&C./y l 3 D Il- NotaryPublic: `r ✓ t `�I .--� 11 Notary Public: ; 4 -) ` , - 7_________, IFE^ • NS ON I herebj_�. ':'s, It I haANNIFkR49l �T4 Kited Jiis application and know the same 1. b :. c,.Y, d cote, .,,; -r loop q i anis and ordina.,( lf..,), ingiN M1l+ €NWP42PM'b complied with whether specified h, ¢4p :4 . Wi .,-J �0.: rnu 1 does not presumt fts. . grtha�(P( ES:.Q ,OerV.2020 ccl7tc provisions of any other_fe eral, I'm. .t., al I tary.. �•n or the per/rn,;: rfr ,' �eJ');,8rondedMAINotaryPublicUnderwriters o.i o Bon -- , t .. �. A -- --__..—_—_ cv. ' 6 TERMINATION OF BUILDING PERMIT BY PROPERTY OWNER I /1 -'c /l 4 014, 11O am the owner of e.,7 C0045•77)-(-- fs,4/( 4 - 4 e4 c`b c-t.ie and have contracted withci Z /# 7Y mit-/iS for improvements on the above property, under Building Permit I have terminated my contract with the above contractor, before completion of the project, and wish to transfer the Building Permit to C75s/' C'oAli,'Ci7.✓G L C . I understand that financial and contractual issues may still apply and are civil matters between the owner(s) and contractor(s) and we agree to hold the City of Atlantic Beach harmless in those matters. Details(optional) IAIIIIOIIIIIIILUIII A copy of this form will be sent to the original contractor. Property Owners Name 7 r. /u ' /d Phone Number ,303 -6Z Address 277 DfwiM7 -c„ii . --7C.- 3.3327 Signature of Property Owner - _ Date 49//°,1//7 Before me this 912 day of a0.Y'Aut.0.4,1 20, lq 07.04 d JENNIFER JOHNSTON .ignature of Notary Public j _ . ii, MY COMMISSION#GG 042954 1 1° Ai EXPIRES:October 27.2020 ..„,...„tri Bonded Thu Notary Public UndarvidtM V--