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395 12th St certificate of occupancy
CERTIFICATE OF OCCUPANCY #, v PERMANENT Issue Date: 02/23/2017 RE Number: 171922-0000 Address: 39512TH ST Zoning: RS-L Owner: FORSYTH V ALLISON W Contractor: MATHIEU BUILDERS (904) 813 - 3661 Application Number: 16-SFR-1250 Description of Work: NEW SINGLE FAMILY Construction Type: VB Occupancy Type: R-3 Approved: n Building O icff ial T VOID UNLESS SIGNED BY BUILDING OFFICIAL CITY OF ATLANTIC BEACH CERTIFICATE OF OCCUPANCY WORKSHEET Date Requested: eDa I Ib I II- Contractor Name: M a}h\F g V Ux 4 '�, Permit Property Address: a G S7 13-tl S} ' Legal Description: Improvements to the above-described property have been completed in accordance with the terms of the permit and are certified to be ready for occupancy as: Single-Family Residence F-1 Commercial E] Other: Lowest Floor Elevation: I'3 0Cl t Required As Built FFE The following must be colnpleted before issuing Cert{/icate of Occupancy: Department Date Notified Date Approved Approved By Fire Dept. — Public Works Public Utilities Building �i o2 aa1-7 Vj Zoning a; a311� D Tree Mitigation Satisfied Backflow Final Survey with FFE Yes No All Re-Inspect Fees Paid Yys No Termite Treatment Yes _ No Updated 9115116 z ( { m \ 7 \ )\ \ - 0w k ) V0 : E � v k \ / \ V \ ! � 0 § { ! ` « 2 y . \ 21-5 ! 45 \ ) § kj } ! k - a � ; A ! �® ` = V [ q J § ( k\ } � f22/)k \ \ \ { { ; {i ! ! $ !) \ . | ; ; % \7t � . kj � u AR { ! } | k � \ � \ � k k ■ { : } � \ ) / \ - \ ! k � # - a 5 £ m _ (\ ! � \ -/ 21 - \t ¥ | r ! � ) k ■ - F © � 2 \ mac ` k k / ( (m! 7 � § � �a f « ) ; t � .. ■ ! ! ! � ) ) {® : ! � : \ / ■ aaa C N E A 3 C � L 3 a � O a A m V j a � a n Y O O N C V CJC O V 3 CO _ L y T Q V V y C � 3 a E o_ C A W y N O � 3 v y m Q a W V m O O > o a v v E o d K a V L E � � L V O V u E to m y U L v d 3 ° v v E c a 0 o c m m E 0 O C V G m E 3 a = am a s c m Q V u n vNi ti r @J � C y > O O N p n W - Q N `o N j a Y@j U �p OM a a V a U ti a H a c O N N m C O0 ` Y E O V V am+ N a O LL t ML at O Y U u ry m o N E a .o- A w w n U = LL 0 c w Y, O 'tea W m 3r $ ODz00 A A a n O a) w o f0 3 m N o v w c o m O I— _ C C N0 U V C pq L o c X. ,`ate 3 ++ o ° = ^� S w 'N 'c AL e v L 0 CL > E «y3 > iy� 0 IL VI f V N d 6 N u 0 C N � E c 0 o N E J L W y' V1 d0 A O u m � d N d = V q V VC � V 3 c iA O v 3 w � v 3 � c o O q � Y � m d 0 J O O m m d E O N > d u L d V E c V 0 o w - E m ro U V N A d L 0 Y U C w ti A �D N N n G 0 t0 q J Y U V N 3 d d C O E q a o u Y E o q �iNki v v m u i J OlL O Y U � 2 O O Ed T a A C A V d J L O C W N J O j E O @J o J lEVu VI lO V N E O C N N d N J U L 4 2 .N i m c O C N O c c y` v u H C N 't 0 LL d N Ip N m N V W C xO ' � yN = � UU y « p C -„ E nen � (L o t o o O LL VI f V VI m IL N f 1' d N M r ' m U 7 . ..........._.. .. • J _ • 3E33E33E3E0.E3....On3M. 93':: 6E33:E39EE : 3 X3333 E .:•: ..... . ./ ..N.::::tl:.:t:N::::::.:.:.::.0 .:..:\�:.:.:O::.:t:t:t:�:•.::.:.:.:.::.::tl::N:.:.HHN ...tH . ... 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YY...t.tt. t....t.tt........t.t...t.....ttt.t...................t.t.....tt...../.........t....t....t...t.t..../ .t..t\........•..........t•tt.•.....t....\ttt..\.....\....t.t...t.....\t................../.t.....tt .t..t..t.....t.........t.t.t..ttt..t.....t....t..........t.\...tt.t......t......t...t..\......t.t.t. .•..t......tt...tt....t.t...t.t...•t.......t.tt.tt.t.tt.............t....t....t..:::•i:.t....tt.ttt: .......................\.............\........... t..........t.t..................t.t............t........•.:::/...:::...:....::..\....t.:::.......... ...\....t.t...\.t....t..........t...t.....t.ttt\•.t........t..........•............t.....t....t.t... ..t..t....../t.t..t.tt...t..•....•.•......•••••t............t...t.t....t..t.t..t......t.t....t...... t..\..\..\..t.t.........\......./.............t... ................•.............../.t...\.t....... t.t.tt....t....../..t.t.....t.t....\.t.....t..t.t............................t.....t................ ttt....... ..........................\...t....t.tt\ ..t......tt........................t...tt....\.. •..........•........••..••t.....t..\/...t...tt....t.........ONCE. ......t\\.../......t.........t\.... :t .tt...................t.•.t..••••N:.•.•/..........t.N.....t.:...:�.:t.N:..t.:::t.::: New Construction Subterranean Termite OMB Approval No.2502-0525 Service Record (exp.05/30/2018) This form is completed by the licensed Pest Control Company Public reporting burden for this collection of information is estimated to average 15 minutes per response,including the time for reviewing Instructions,searching existing data sources,gathering and maintaining the dam needed,and completing and reviewing the collection of information. This information is required to obtain benefits.HUD may not tolled this information,and you are not required to complete this form,unless it displays a currently valid OMB control number. Section 24 CFR 200.926d(b)(3)requires that the sites for HUD insured structures must be free of termite hazards.This information collection requires the builder to certify that an authorized Pest Control company performed all required treatment for termites,and that the buiider guarantees Me treated area against infestation for one year.guilders.past control cormanles,mortgage lenders,homebuyers,and HUD as a record of treatment for spec homes will use the information collected.The information is not considered confidential,therefore no assurance of confidentiality is provided. This report is submitted for informational purposes to the builder on proposed(new)construction cases when treatment for prevention of subterranean termite infestation is specified by Me builder,architect,or required by the tender.architect,FHA,or VA. All contracts for services are between the Pest Control company and builder,unless stated otherwise. Section 1:General Information(Pest Control Company Information) Company Name B&B Extemm:matino Co_Inc. Company Address 215 Oammia 5t City Jacksonville Stale FL Zip 32204-2623 Company Business License No. JB 178 Company Phone No. S(W389-M23 FHAIVA Case No.(if any) Section 2:Builder Information Company Name Phone No. Section 3:Property Information Location of Structure(s)Treated(Street Address or Legal Description,City,State and Zip) 38512TH ST.ATLANTIC BEACH,FL,3223&5537 Section 4:Treatment Intimation Date(s)of Sendcii 1W13/18 Type of Construction(Mom than one box may be checked) ❑Slab ❑Basement ❑Crawl ❑Other _ Check all that apply. ❑ A.Sail Applied Liquid Tertnitiride Brand Name of Termiticide: EPA Registration No. Approx.Dilution(%): Approx.Total Gallons Mix Applisd: Treatment completed on exterior:❑Yes❑No ® B.Wood Applied Liquid Terrnitiude Brand Name of EPA Registraton No. Temmuckle: RORACARF U405-1 Approx.Dilution(%): 1 1 Appmx.Total Gallons Mix Applied: 51 ❑ C.Bait system Installed Name of System: EPA Registration Number of Stations No. installed ❑ D.Physical Barrier System Installed Name of System: Attach installation information(required) Service Agreement Available? ®Yes ❑No Note:Some state laws require service agreements to be issued.This form does not preempt state law. Attachments(List) Comments Name of Applicator(s) IARFI IF HARPFR CertMWtion No.(R required by State law) JF 2275M The applicator has used a product in accordance with the product label and stale requirements. All materials and methods used comply with state and federal regulations. � rr11 Authorized Signature Data 10113118 wamtq:Hllovnu PmseammeaM4aMsaMsWton U. conic mymeauninmmr an0.brdvil Pe ft",(lou.b.c.teat,1010.1012:31u.s.c.3M,seo'!) forth HUD-HPI&A-9943(0812008)