186 Pine St siding permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
SIDING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-SB14
JOB INFORMATION:
Job ID: 17-SIDE-3113
Job Type: SIDING PERMIT
Description: HARDI SIDING OVER Tl-1 1 SIDING AND TRIM
Estimated Value: $5,075.00
Issue Date: 1/30/2017
Expiration Date: 7/29/2017
PROPERTY ADDRESS:
Address: 186 PINE ST
RE Number: 170627-0115
PROPERTY OWNER:
Name: VAN OSDOL, KENNETH
Address: 186 PINE ST
GENERAL CONTRACTOR INFORMATION:
Name: RADON PROFESSIONAL SERVICES
,CGCO57793
Address: 336 14TH AVE QA WILLIAM TONY DAVENPORT
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $37.69
BUILDING PERMIT FEE $75.38
STATE DBPR SURCHARGE $2.00
STATE DCA SURCHARGE $2.00
Total Payments: $117-07
PERNIFF IS APPROVED ONLY IN ACCORDANCI� WITH ALL Cl� OF AICLASTIC BEACH ORDINANCES AND ME FUORIDA
BUILDING CODE&
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road 17- S L QG�[ 0
Atlantic Beach, Florida 32233-5445
Phone(904)247-SB26 - FaX(904)247-5M5 Date routed:
E-mail: building-dept@wab.us
City web-site: hftp://�.mab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: [ 9�0 PIADC- -'�7 De artment review requi.red Yes No
Applicant: RrA 1�)C)t__� Pp Fp_�� Planning&Zoning
Tree Administrator
9t
- a
D t.r
Prop a rty
App !cant
Project: 'S (C) IK)(�; I— ublic Works
Public Utilities
Public Safety
Fire Services
fZjeview fee $_ Dept Signature
Review or t Date
Other Agency Review o Perritit Required of PermitVerificecliBly
Florida Dept.of Environmental Protection
I Oda Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineers
IT11 ision of Hotels and Restaumms
Division of Alcoholic Beverages and Tobacoo
-&-her:
APPLICATION STATUS
Reviewing Department First Review: OApproved. E]Denied.
(Circle one.) Comments:
(9�;D
PLANNING&ZONING Reviewed by:— /r O�— Date:
TREE ADMIN. Second Review: FlApproved as revised. ODeniedw
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:—
FIRE SERVICES Third Review: FlApproved as revised. [-]Denied.
Comments:
Reviewed by: Date:—
Revised 05114109
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH OFFICE COPY
800 Seminole Road,Atlantic Beach, FL 32233
Office(904)247-5826 Fax(904)247-5845 3
Job Address: IS6 PA& !�_r, Permit Number:
Legal Description/P-M 41C :j&2W 4g,,j 167&CPamel#
riomAreatil Sq.Ft. Still
Valuation of Work$ ProposedWork heated/cooled 124<- non-heated/cooled 32,c
Class of Work(circle one): New Addition teration Repair Move Demolition pool/spa window/door
45Ei;D
Use of existinglpr osed structure(s) circle one): Commercial Residential No N/A
If an existing struNure,is a fire a riler a stelm installed?(Circle one):
Florida Product Approval# 2
For multiple products use product approval form
Describe in detail the type of work to be performed: 14.sIAZI TAXIA ffdAZ' 1-4 4 !2W",J& C-D 0"e
+
Property Ci;..r Information:
Nameleilge2% b'"Z?0-t. ddress: 146 PiAl. �7'
E-Mail or Fax#(Optional) ?3__Phone �Ex 4 - Z2
Contractor Information:
C o in p any N am e:I?A,(&,!3 &-F�,: r PA ae�9 Qual
Ad ess: 3?11 11/�1 AU A.). City 'StaInAL Zip 322,49 0
Offt.,e Phone 76 Job Site/Contact Number. C-91- 1210 Fax# 7fz_ 1"f:
State Cerfifi,2"eg,,tmton# ,'/_e Q5771?1
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Tide Holder Name and Address e.
Bonding Company Name and Address
Mortgage Leader Name and Address
Application is hereby made to obtan aperunit to do the work and installations as indicated. lcurtf,that no work or installation has commencedprior to the
issuance ofa permit and that all work will beperformed to meet the standards ofall laws regulating construction in thisjurisdiction. This permit becomes null
and void ifwork is not commenced within sis(6)months or ifoonatruction or work�gs�syended or abandonedfor aerind ofsag),months at any time
el
work is communiclul I understand that separate permits must be securenjor Ele F Work,Phumohng,Slg� tells,Poets, maces,Boilers,H
Tanks and Air Consfifioners,do
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 WIT`H
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING Y6UR NOTICE OF
COMMENCEMENT.
literal, certify that I have read and asamined this lue.tion ud know the me to be true and correct. Allprovisions oflaws and ordinances governing this
type 97.ork will be com rd
pli�d�ith.4eth�r�fe�iiedhomin�not. The granting ofa permit does not presume to give authority to violate or cuncel the
provisions,ofany miurfedural,state,or local avv regulating construction or the psrformanc�ofcourvartion.
Signature of Owner L—i ,.� Signature of Contractorr4j;�
PrintName 10A. PrintName
Sworn to and subscribed before me SworrLtq and subscril e eq,
'6'. ........
ay T 7
th,,,s
is
this,j!&_Dayof q"tl $ Day I'vuPmr.W,
Notify Public-StAti f Fteulda "My Public-Vido of Woo
<t lawaftsics #FFZ5623 c000ssoll"#if 97511411
CAlfairy Public my Gwas.Isow"M"S.2020 No u2c my C"o,isgiss a"5.rill;
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10e r rylf � -14-- 1-7- Si 10&-- 3113
NOTICE OF COMMENCEMENT OFFICE COPY
State of FL- Tax Folio No.
Countyof 00yat
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 Staturtes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of properLy being improved: 10-14 /./-2-!r -2?45 W7,,9& 5e,3 ldr&T'
Address of property being improved: I G 17C 11 " 5—, dr4AA-r'e 80k4 �ft 3223.3
General deocriptionof improvements: 14 W�L LAg S:,fi-,Jq &
-s7
Owner: W,,.l ImA 0-C D,L- Address,
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor: PAZOAJ IOR6,=. C e"I", r-C
Address: 33 4 IM ftl- A) . Ta:jt eavel lo�C
Telephone No.: Z rw/ Fax No: Zji4- ge q-
Surety(if any)
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of my person making a loan for the construction of the h Doc#201702DO61,OR BK 17856 Page 1622,
Name: Nurnber Paqw.I
Recorded=261201 7 at 11:39 Am,
Address: Ronnie Fu.sell CLERK CIRCUIT COURT DUVAL
COUNTY
Phone No: Fax No: RECORDING$10.W
Name of person within the State of Florida,other than himself,designated
served: Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Liencor's Notice as provided in Section
713.06(2Xb),Florida Star=. (Fill in atOwner's option)
Name:
Address;
Telephone No: Fax:No:
Expiration date of Notice of Commencement(the expiration date is me(1)year from the date of recording unless a different date is
specified):
TIM SPACE FOR RFCORDEWS USE ONLY 0 ER
Sii::,
g,ne Data 1 [17
Before me this day of Z00 in the County of Da,,A State
- - - - - - - 0111.6da,has AW V
Notary Public a Large,State of my of Duval.
My commission expires:
Personally Known: or
Produced Idemi