381 MAIN ST - INTERIOR REPAIR ,
-S�`v..l j�J
. -- s‘ CITY OF ATLANTIC BEACH
., .. s„ 800 SEMINOLE ROAD
J 111
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
0-
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-RAAR-3629
Job Type: RESIDENTIAL ALTERATION
Description: interior repair after water damage
Estimated Value: $80,000.00
Issue Date: 4/6/2017
Expiration Date: 10/3/2017
PROPERTY ADDRESS:
Address: 381 MAIN ST
RE Number: 170903-0000
PROPERTY OWNER:
Name: NOEL, MARGARET H
Address: 381 MAIN ST
GENERAL CONTRACTOR INFORMATION:
Name: THE DESIGN & BUILD GROUP, INC.
, CGC1505725
Address: 13412 PEREGRINE ST DAVID KIRSTEN
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $200.00
BUILDING PERMIT FEE $400.00
STATE DCA SURCHARGE $6.00
STATE DBPR SURCHARGE $6.00
Total Payments: $612.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
o.:vp,yf, City of Atlantic Beach APPLICATION NUMBER
tl '• Building Department
`� 6'� (To be assigned by the Building Department.)
800 Seminole Road
F,1 Atlantic Beach, Florida 32233-5445 1 — Q.q �— 3 L0a 5
Phone(904)247-5826 • Fax(904)247-5845 1 a,...s. >� E-mail: building-dept@coab.us Date routed: 3
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: U n Sk D nt review required Yes o
Building 1
Applicant: kkS� (�v) A- LA-,l A C-�(u P Planning &Zoning
1 ,, ' Tree Administrator
Project: \ f'�-1 ‘C..)( i L Cil; ( ck-N2,f W(l Public Works
C,*a M U Public Utilitiesfy
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: Approved. ❑Denied.
(Circle one.) Comments:
BUI DIN
PLANNING &ZONING �' Y1y
4(.6 !7
Reviewed by: Date:
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
:MVPs, Building Permit Application
•�,A ,
a City of Atlantic Beach OFFICE COPY
800 Seminole Road,Atlantic Beach, FL 32233
t 9r Phone: (904) 247-5826 Fax: (904)247-5845
Job Address: 38 r A 14/.c/ CJ? /07441,071-,G/5e/a Permit Number: I 1-A Ai2——3 (ofe-4
i
Legal Description RE#
c 6d
Valuation of Work(Replacement Cost)$O 0,e25Z5 Heated/Cooled SF /2 00 Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Ftp... i Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial V '
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes N 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 work to be,,performed: - NS,� _T//' O/off /,�,�5, (�Qo
R-' i a•f'4,Arra r [�Am/1 V aa6R-�, G1.4` � N
Florida Product Approval# 5- for multiple products use product approval form
Property Owner Information //,,//�- � - A �' (�
Name:0429A/2£"�" �Ofc/ Address: l• U, 'da' /32 /r�1�JA 2J�62b > V 20177
City State Zip Phones 2/ SU • 7D
E-Mail Al*4J, /1 o Z/, Cowl
l
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information /� // //���� // � ��,� L
Name of Company:£ ;a3! 17 0- 9w,W >.ioN o/Qualifying Agent: ,:.�A Viz) K'/K,9F/J
Address /3 34 /`�/ C7RSA �tQ- a® City j,Aaj_ State FL Zip .32225`
Office Phon 41 2-9'4/- 2304/ Job Site/Cont3ct Number SA/112
State Certification/Registration# /50 67 7.....5 E-Mail dCK I/2.5 SN Q 477. A/S '
Architect Name&Phone# .1/ 40
Engineer's Name&Phone# A/�ja '-- -------
Workers Compensation Szn, ' L ��{r _
Exempt/Insurer/Lease Empl�� /fxpiratio
Application is hereby made to obtain a permit to do the work and installatiori - indicated.I certify that no worq Or installation has
commenced prior to the issuance of a permit and that all work will be performed to mE4Ahe t�nd • •f all the laws regulationg
construction in this jurisdiction. I understand that a separate permit must be secured of-r ELECTR(CAirf •RK,PLUMBING,SIGNS,
WELLS, POOLS, FURNACES,BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,it__
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 CE OF COMMENCEMENT.
ture of Owner or Agent including Contr r) Sign ture of Contractor) }
Si d an
sworn to affirm d})before me thi ...2, day of Signed and sworn to(or affirmed)before me this�_1day of
Si
v".. 7,by �I�LY9i� (liar kCvCh , ao\l- , by
ARSELIA S S 0 ' _j ,, / -
Notary Public (Signature o Not. ) R4 M
NS ION
i,,Y ,a, t*s 1 r iM �4. •f•#GG 042984
Commonwealth of Virginia -.• EXPIRES:October 27,2020
Notary Registration Number: 7023877 ;' .• Bonded TMu Notary Public underwriters
�(� 31, 2018 401 `...q. ,_. _
MY y co r ,jkai ,nay [ ]Personally Known OR
oduced IdentificationIV L?4 Produced Identification
Type of Identification: .L,, �n Type of Identification: a(i\1 0.-(` '‘C-1--(1,Y1--
PeYkr% i4- # /7- oe AYL- 76 L9
NOTICE OF COMMENCEMENT OFFICE COPY
State of f 1 County of v V'c,_\ Tax Folio No.
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 Statutes,the following information is stat d in this NOTICE OF CO NCEMENT.
Legal Description of property being improved: /".-34/34' /7 2 5 -z $ ,c / 41/A.04/ - `r A
s ,6 lzr
Address of property being improved: 3 Si P\ K S\-re.`� A \\G_ \i L '1 Q FL 3 a a'3
General description of improvements: (7d01e/N7 i 4/54 47"0.,1/,, eVAyk4 1/, -7/ J y. nom/j✓�
Owner: M.Q-rya.r-c\ CA• Irl 0f.--1 Address: 3 &I PA.02,1-, Stt c. � \-\ GL nrL CC,
Owner's interest in site of the improvement: 1. a 0.7a
Fee Simple Titleholder(if other than owner):
Name:
Contractor: /h 2 rbe.,ci Sr d k.;, \ C- r OJ r ! /,JC 1
U
Address: /3 G 3 '/ Q'1 c o—rs c._. AuQ. )3Cr-C& unui\\4 'FL 3 g. oaa
Telephone No.4 ?alb Z- /-Z,3O4 Fax No: /V/g
Surety(if any)
Address: Amnuntof_Bond$
Telephone No: Fax No: jp L:., i( .._ L: I WL�--Name and address of any person making a loan for the construction of the improvements' :. ali
Name: j i j ! APR - 3 2017
Address: i I.!AAil
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
Fes-
served: Name: v L S t. 1.1�\n`2
Address: 9L �,cr--'f�L \ 0...1C IA` \`ti L 11 e c c L 3 ' : :j
Telephone No: q 6 t/ 3 3- 6 g S''D... 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
Signed �� 0..� Date: � � \\
Before e this day of /, /, a01 i/n/_th�e.County of State
Of�has personally appeare. 7 a tyaf'.. tha / ,1 to✓ 0u1V
Personally Known: J 1 or
Produced Identificatio 1f 3j . • 4 '
Doc#2017075768,OR BK 17931 Page 2404 Notary Public: ?, / • / / ;
Number Pages: 1 Y commLsieires: / ARSI+;LIA ()I,URIU
Recorded 04/03/2017 at 12:07 PM, ( Notary Public
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY Commonwealth of Virginia
RECORDING$10.00 Notary Registration Number: 7023877
My commission expires: May 31, 2018
OFFICE COPY
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