631 BEACH AVE - INTERIOR REMODEL s\ CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J " �'' ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-RAAR-3062
Job Type: RESIDENTIAL ALTERATION
Description: NOC REQUIRED - INTERIOR REMODEL - LAUNDRY
ROOM AND BEDROOM
Estimated Value: $10,000.00
Issue Date: 1/25/2017
Expiration Date: 7/24/2017
PROPERTY ADDRESS:
Address: 631 BEACH AVE
RE Number: 170113-0000 _
PROPERTY OWNER:
Name: HUDSON, MICAHAEL ASHTON
Address: 319 12TH ST
GENERAL CONTRACTOR INFORMATION:
Name: SIGNATURE HOMES & DEVELOPMENT
, CBC048996
Address: 731 DUVAL STATION RD QA REX JONATHAN
WILLIAMS
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $50.00
BUILDING PERMIT FEE $100.00
STATE DBPR SURCHARGE $2.00
STATE DCA SURCHARGE $2.00
Total Payments: $154.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
til - ��r, City of Atlantic Beach APPLICATION NUMBER
�s A"--•• l Building Department (To be assigned by the Building Department.)
If. I �s) 800 Seminole Road 17— PkRR _3
...,_ Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
_on g? E-mail: building-dept@coab.us Date routed: I / Z0(1 7
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: G.3 I a£ 1Cl-4 11VG
De artment review required Yes No
uilding
Applicant: S._ (G w PV-FUZC 1-10 M 6-S Planning &Zoning
I Tree Administrator
L
Project: e-e(Q... RcL Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Sna
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. El Denied.
(Circle one.) Comments: /i ,t I'
NDC poi - �i'c� Dv� c�Y 5jarr`prl a ( - ►ie O{ ��
BUILDING ,�y�
PLANNING &ZONING Reviewed by: / 'y Date: /-.7q-/7
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
� L,,,� BUILDING PERMIT APPLICATION
rN
r
CITY OF ATLANTIC BEACH
\ � 800 Seminole Road,Atlantic Beach FL 32233
'ti�r V Office: (904)247-5826 • Fax: (904)247-5845
Job Address: 6.3 ( ue,„,,1,, AVe. Permit Number:
Legal Description RE# 17 C) I I —0 0 0C)
Valuation of Work(Replacement Cost)$ 10)6O Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition a lteratioI Repair Ms - 1- s Pool Window/Door
• Use of existing/proposed structure(s) (Circle one): Commercial 'esidential
• 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 rr
work to be performed- W L.AA ev. 413G'Y‘t`n` 5"n 1- �‘"' .
t ro,w.c. o�v J�� I J 6e.)rt.crrA
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: SLA0 vN --"\v 5 Address: 30.-.°` *earl
City State\ Zip 3)..),1-S 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: t r on. Vire. a 6\•-•\.6t-- C1\1• Qualifyin Agent: RN.31 �, \ , ,ct,M
Address:731 t)Du/A S ' w�� f - . Ac (b1 4,1-1 City State Zip• 3)...L1 g
Office Phone Job Site/Contact Number -75; 9 8(7
State Certification/Registration# Cel, , -014499C E-Mail rex w't(1 �w.s 65Q3 r'u; L GDm
Architect Name & Phone#
Engineer's Name & Phone# Pony Jsh a34').-0A (A
Worker's Compensation
Exempt / Insurer I Lease Employees / Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced
prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating constructio in this jurisdiction.
This permit becomes null and void if ••rk 's not con me ed ithin six(6)months, or if construction orwork is suspender or abandoned for a
period of six(6)months at any time fie•w. k i corn e •ed/ understand that separate permits must be secured for Elect, al Work,Plumbing,
Signs, Wells,Pools,Furnaces,Bo ers, ,'te,:, Ta ks •nd, it Conditioners,etc.
Signature of Property Owne / Signature of Contractor: ,/ ,i,.,;_ _
Bef ee,,�
this(--L Day of tl Cl Before me this c' �a �f ��l Cv^��1 E�'+aC 1b
w•••., TON;!t:N E.PgRGER t ,
' Notary Public: A• [! -r4 GOUitilIIGItSF� ubitic: �.v‘, - \, w
if' n" EXPIRE:October 6,2019 I ,
........ Bonded Thru Notary Public U. •• -• _ _
I hereby certi that I have read and examined this(,.' --;----7----------.7--- --__'_.v "ue an ,,,� fp _ r.•r of laws and
ordinances governing this type o work will be co plied with whether specf e•.1 ''' '"•••no, rf , .r;' i� )e nit does not
presume to give authority to violate or cancel the provisions of any other.feder ; Brit lo it j►� . r`.; : str�rction or the
perfformance of construction. a", Sordid Thu
I
V.6