1745 OCEAN GROVE DR - WINDOWS (--
,
. �s� CITY OF ATLANTIC BEACH
•
r - - 800 SEMINOLE ROAD
+9 �". ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-WIND-3610
Job Type: WINDOW AND/OR DOOR
Description: replace 16 windows
Estimated Value: $14,535.00
Issue Date: 4/7/2017
Expiration Date: 10/4/2017 _
PROPERTY ADDRESS:
Address: 1745 OCEAN GROVE DR
RE Number: 169607-0055
PROPERTY OWNER:
Name: TORMOLLEN, SALLY
Address:
GENERAL CONTRACTOR INFORMATION:
Name: PELLA WINDOW AND DOOR
, CBC046712
Address: 7818 PHILIPS HWY QA JAMES SAMUEL ROWLAND
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $61.34
BUILDING PERMIT FEE $122.68
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $188.02
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALI, CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
0.1.-v.r , City of Atlantic Beach APPLICATION NUMBER
Building Department
(To be assigned
_ 1
by the`Building Department.)
800 Seminole Road
4I Atlantic Beach, Florida 32233-5445 ,Vw 6 - 3k) ( Li
Phone(904)247-5826 • Fax(904)247-5845 j��i
011 !� I
E-mail: building-dept@coab.us Date routed: D3 III
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: a1S ocean n D ent review required Ye No
� a ` l Buildin
Applicant: �� n LA.)S Dob(S anning &Zoning
f ` I,, Tree Administrator
Project: U t4 ttL L ` �O w t ( LL)vJ S Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
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: proved. ❑Denied.
(Circle one.) Comments:
:UILDIIVe
PLANNING &ZONING �i�,,
Reviewed by: / Date: '1'S 17
TREE ADMIN. Second Review: A roved as revised.
❑ pp ❑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
ealltr"tor Pk*upW-4137.8400 BUILDING PERMIT APPLICATION •t
CITY OF ATLANTIC BEACH r ._—.d1 '.4.4 `.✓d ii .
800 Seminole Road, Atlantic Beach, FL 32233
Office(904) 247-5826 Fax (904) 247-5845
Job Address: /-793- bCe,04Q.v."1_ ( Permit Number: 1 - W--A-M 6-3(0 It)
Legal Description��-av c i-As -ac c aklAv►O �ovu•• — l'Parcel #/GI 0-7-00 3-s-
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$/y, 5-- 5---- Proposed Work heated/cooled non-heated/cooled_
Class of Work(circle one): New AdditionC. . epair Move Demolition pool/sp 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
Florida Product Approval # Se /4-na.•c1l •
For multiple products use product approval form
Describe in detail the type of work to be performed: ` l(Iz L vAo ma_ S s t �.-2 -
I, !
Property Owner Information: r r y}
Name:c&,`\,fe.. -\""ti-c'0-‘4\\.(D\ Address: I?y-r C`PPoVIG rI I k 8 2017
_ILCity ‘V\-\.0,-v•-11-‘C.. -VN Statez--Zip 3 .:):1-- Phone ct04-is-J--1 I xtz)
E-Mail or Fax#(Optional)
Contractor Information: (2-14'4'-'^'1_
Company Name: . Pella Windows&Doors Qualifying Agent: - -b
Address: 350 W State Road 434 City State Zip
Office PhoneFL 32
Longwoi� Site/Contact Number -id.7-C3T-b'`(S'- Fax#
�d,
State Certification/Registration CAC-O`-F.(o—1 t�-
Architect Name&Phone#
Engineer's Name& Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do Bre 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 construction in this jurisdiction. This permit becomes null
and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six(6)months at any time after
work is commenced. I understand that separate pernrits must be secured for ElectricaT'York, Plumbing, Signs, Wells, Pools, Furnaces, Boilers,Healers,
Tanks and Air Conditioners,etc
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.
I hereby certify that I have read and examined this plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether speci red herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,state,or local law regulating construction or the performance of construction.
Signature of Owner .5 ,, ✓ Signature of Contractor (2-k
''
Print Name �1,\,;e_.-v,.c. ,0,,kAll-k. Print Name --- :),,,A, `W w\c,.VI.L—
Sworn o and subs ibed before me Swot�pp and subs ibed before me
s '' r_n Day of �� '�, hi 'CADay of V,Nct,rtAN 0 17
Fly:......= CHRISTINEO'IAALLEY e+
r , :.- MY COMMISSION t FF 087307 ;,ti;;:*.ei;;k; CHRISTINE O'MALLEY
+: r..r . '- EXPIRES.January 29,2018 • ay coMMISSIOW t FF 087307
Notary Public I'' p„a Bonded Thru Notary PublicUnderwriters Notary Public -.k..--. r1 EXPIRES:January 29,2018
�...
f •,?.. 1•� Bonded Thru Notary Pubk Undenynters
Doc # 2017067155, OR BK 17920 Page 907, Number Pages: 1, Recorded 03/23/2017
at 12:35 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00
AFrt„'i Rccnt:nrvc_RETURN To. Pella Windows&350 State Rood°oors -
OFFICE COPY
Longwood,FL 32750 .
?ER..fff NUMBER:/7 11/f ,VO— ,?6/6
NOTICE OF COMMENCEMENT
The undersigned hereby gives notice;hat improvement will be made to certain real property,and in accordance with Chapter 713,
Fonda Statutes,the following information is provided in this Notice of Commencement.
I. DESCRIPTION OF PROPERTY(Levi descriptive Of the property&strut adorer,if Svail3ble)TAX FOLIO NO.:
/
SUBDIVISION 2ta V1 ' BLOCK TRACT LOT I0,- BLDG (RIR .�
a�•�� pq- -S e 17 esAyt tar:.GENERAL DESCRIPTION OF IMPROVEMENT:
0.C.13, W�,tiClS s,
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR'f33k:IMPROVEMENT:
a.Nameand seeress: SQ,\ Q.-7-(YrN..0\\LNA. (74{1 Qtt,O.vtG rS1/41-4.1Z1.4( f1— ,CA t ICA.
b.Interest in P:cpety•6wv..v---
e.Nano end address or fee simple ducbdder(If Crum from Owoo'lined aboycti
Pella Windows&Doors
4. a.CONTRACTOR'S NAME:
300 w State Road 434
Contntsor's address: b.Phone nuober.
Longwood,FL 32750 .
S. SURETY(if appleable,a copy or the paymea:bond is=clod).
o,NamoaM address:
b.Phone number. o Aseoo tt ofboad:S
6.3.I,Ir^7DER'S NAME: �4 \tl‘`
Lender's addresr ` S.none number.
7. Persons within one State of Florida designated by Owner upon whom notices or other documents may be served as provided by
Section 713.13(1)(a)7..Florida Saltness 11
a.Name and address:
b Phone our,.ben of desicmied persaru l`
S.a.In addition to himself or herself.Owner designates of
to receive a copy of the Lienor's Notice as provided in Sedan 713.13(1)(b),Florida Statutes.
b.Phone oamber otperson or=sky do<Sated by Owner.
S. Expiration date of otiee of commencement(the expiration date will be I year from the date of recording unless a different date is
speciSed): ,20_
WARNING TO OWNER;ANY PAVMF_*7TS MA4E RV THF OAR AFTER THP_EXPIRATION OP THE NOTTCF,OF COMMENCFM.Fhrr.
ARE CONSIDERED IMPROPER 3AYMFNTS iINDFR CHAPTER 7)3 PART 1.SFC, TON 713.1FLORIDA STATUTES.AND CAN
RESULT IN YOUR PAY?NG TWICE FOR PAPROVF,MEN7S TO YOUR PROPERTY A NOTICE OF COMMENCFVUCT MUST$P
gECORDFD AND POSTED ON THF)OB SITE BFFORE.T71F,MT NCPECTION IF YOU INTEND TO OBTAIN FINANCING,.CONSULT
wry.;Vol FR:,Fn'QF.R OR AN ATTORNEY BEFORE COMMFNCTNO WORK OR RECORDTNO YOUR sTOT!C=OF COMMENCENNNT
V TCN er r wake h
(Signature of Owner or Lessee,or Owner's or Lessee's (Print Name and Provide Signatory's Tide/Office)
Authorized Officcr/Director/ParteerMaaarer)
State of Ft tsc
County of"Du vuk _ C� M
The foregoing instrument was acknowledged before me this ` day of \' •O`n'e ?0
by ;zN\\- "Tts'C moi`\tkr‘ ,as O V,31,N VL__
(name of person) (type of authority,...e.g.officer,trustee,attorney in fact)
for �-F.\-
(name of pan'on behalf of whom instrument was executed)
Personally Known_or Produced Identification Type of Identification Pro
iii?tx,F1NF:0'idN1EY
AiY COMMISSIO�'1 N FF 087307
(Signature of Notary Public)
EXPIRES:January 29,2018 (Print Type.or SCnp Commissioned Name of Notary Public)
Bonded'Nu Notary FcNe Under:Mars
Rev.10,13-11
I
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