2251 BAREFOOT TRAC -BATHROOM REVO. I-S x\1..17
j j `'' 'J`s CITY OF ATLANTIC BEACH
i:',' j 800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
„,..,_____j
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-RAAR-3494
Job Type: RESIDENTIAL ALTERATION
Description: RENOVATE TWO BATHROOMS
Estimated Value: $75,000.00
Issue Date: 3/24/2017
Expiration Date: 9/20/2017
PROPERTY ADDRESS:
Address: 2251 BAREFOOT TRAC
RE Number: 169463-0632
PROPERTY OWNER:
Name: HAGAN,KENNETH DALE & CATHRYN A, *
Address: 2251 BAREFOOT TRAC
GENERAL CONTRACTOR INFORMATION:
Name: CORNELIUS CONSTRUCTION CO.
, CBC048967
Address: 71 19TH ST QA MARGARET S. CORNELIUS
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $190.00
BUILDING PERMIT FEE $380.00
STATE DCA SURCHARGE $5.70
STATE DBPR SURCHARGE $5.70
Total Payments: $581.40
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
i (jCity of Atlantic Beach APPLICATION NUMBER
/' r,��,�pr'.:,\ Building Department
To be assigned by the Building Department.)
J
2 800 Seminole Road }d
Ai ')_.r �r Atlantic Beach, Florida 32233-5445 1_3- R(aft R - -�4 ` 1
\ ` Phone (904) 247-5826 • Fax(904) 247-5845 [r7
'��,tl�%' E-mail: building-dept@coab.us
Date routed: l 1 v
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
I Department reviewrequired Y
es No
Property Address: ZZ5 ( 1�►�R�FC�C�( I -P
Building
Applicant: 0 RN E L( OS e0(—S'C alining &Zoning
(__,
�
Tree Administrator
j
Project: ,J rAy e_( R00,/, R C On CS Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Review or Receipt
Other Agency Review or Permit Required 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:
UILDIN�
PLANNING & ZONING3/07V/i7Reviewed by: � Date:
TREE ADMIN. Second Review: I lApproved as revised. I IDenie .
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
om'. Building Permit Application
is City of Atlantic Beach OFFICE COPY
800 Seminole Road,Atlantic Beach, FL 32233
Phone: (904)247-5826 Fax: (904)247-5845 17 - R(ARK -34 cizi
Job Address: 2251 EARFOOT TipRCE Permit Number:
Legal Description LOT to S. l)tT 2 OCEAIJWA-LK RE#
Valuation of Work(Replacement Cost)$ '1610 00 00 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 draal
• 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: RETI,OVATE MFtSTF--R 5AT(-I- 1-{Al-t- BATH
m0P-TN - NE4J T Ug/S•Howezi-iai I /vAo my/ Tl L -
ItAU-(3A-DA - Nt 5}10492Jt, re)tL eIT JAN lN/ T1LE--
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name:KF f r.r - t-1 1-\AC-1c Address: 2 9 51 BAP_E FOOT TR1\c -
City A-TLcL TIC F3(.0 State 322 3 Zip FL Phone (a7 0 2L-71:3 ' I')
E-mail (}.i A C-r 4JJ N F I=DU
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: 6)Ri_VE1.XiS ( okiST2lXTI O N Qualifying Agent: MEET �osIJvI.-10.5
Address 218 RAY ST City 19E9TO KSF FC+-i State Fi_- Zip 3 22!010
Office Phone a04. 2464 •G`7'oto Job Site/Contact Number qpu • 249 •1700
State Certification/Registration# -'RC 0 (I P (07 E-Mail 47l:CIL-,'I N izi3 EL-IUS cp k\STROC (0(4, COM
Architect Name&Phone#
Engineer's Name&Phone# --
Workers Compensation
(t2Ml Insurer/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 the laws regulationg
construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc.
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
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.
4ya C
(Signature of Owne\or •:ent inclu . Contractor) (Signature of Contractor)
gned and sworn to(or a r es befo me this day of d andsworn to(or affirmeAlt•fore m• this d of
0 .AL S by f Oki .� SimQ fe a 20 I 7by IAA
do( Q� _ 1111=
(Signature of Notary) Sig re o Notary)
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g.ot4 MN; ,r
TON GIRDLE t ti-3EA FF 924951
l`I�Rersonally Known OR p� uY �4YCCVNi :TION FF 92=951 [ )personally Known OR EXFlr;E` CY.Io!e;u,2019 bUnder
Produced Identification II EXP!RL .(k.taber 6,2019 ,?y „.�� • n,�n:zry p�
OProduced Identi >; wrters
I ^�ndeditr,tvo. y.u.kci,r6ermters ficatio
Type of Identification: ,,,,�, Type of Identification:
NOTICE OF COMMENCEMENT OFFICE COPY
State of rt-DR 1 P14 Tax Folio No.
County of p I)VAL
To Whom It May Concern: 7 / 7_R igA/Z— 3 9y
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 NOTICE OF COMMENCEMENT.
Legal Description of property being improved: jj T (45 ofd IT 2 OcEti.WW1 Ll
Address of property being improved: 2251 Ro4 eE4700T T1 -AC 1 JClrugt iTlclT C$-J .) 1=)..• sz2.33
General description of improvements: JZ>=N J 0j\/Are_ B PT -1 OO MS
Owner: kFA AJ E_N 1-1A-6.7 A t4 IL I■ 1 address: 22 5-i 13 RE roar TRX10E
Owner's interest in site of the improvement: r . 164" x x x z o
m0o c
Fee Simple Titleholder(if other than owner): Z a
Name: C) a m o
czi gaig
Contractor: CO fR3V lam)-1US CD 1•1 s-IR U C T 1 p f1/4-( `0 -°' "
Address: 21 g 13/4 V 6 T . f\)1 f' J i J E__ B G M . ) PI- �Z Z o 4' S p3,1 p
Telephone No.: 90 L( • 21.F q • G{ 20 CP Fax No: o x
Surety(if any)— oD
51
Address: —
Amount of Bond$ o i
xi
Telephone No:— Fax No: -I
o
c m
Name and address of any person making a loan for the construction of the improvements < °'
D
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 SPACE FOR RECORDER'S USE ONLY OWNER Q
Signed: / '`,//
Date: 2.O ( 7
Before me this ,� 'ay of ak 4 I k. in the County o uv I S to
?'>!; _ ToNI GIND SSL PE ERGER Of Florida,has personally appeared ' T �}�
_:`' -, .. MY COMMISSION#FP 92435 Notary Public at Large,State of Florida,Co ty f Duv�
r'.' , EXPIRES:October 6,2019 My commission expires:
or__:.: Personally Known:
R,a`P Banded ThN Notary Pubic Undenvrlers
or
Produced Identification: �/, air%
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