2041 BEACH AVE - DOOR & WINDOW 'Is CITY OF ATLANTIC BEACH
/ ' l INOLE ROAD
- 800 SEMINOLE
*tax ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
-r. /___.0.F0911"
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-WIND-3559
Job Type: WINDOW AND/OR DOOR
Description: REPLACE 3 DOORS AND ONE WINDOW, REPAIR
STUCCO
Estimated Value: $25,000.00
Issue Date: 4/4/2017
Expiration Date: 10/1/2017
PROPERTY ADDRESS:
Address: 2041 BEACH AVE
RE Number: 169711-0000
PROPERTY OWNER:
Name: BROTMAN SOLOMON G & LESLIE G, *
Address: 2041 BEACH AVE
GENERAL CONTRACTOR INFORMATION:
Name: JONATHAN DAVID SMITH INC.
, RG 291103904
Address: 66 W 14TH ST
Phone: 904-762-7285
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $87.50
BUILDING PERMIT FEE $175.00
STATE DCA SURCHARGE $2.63
STATE DBPR SURCHARGE $2.63
Total Payments: $267.76
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
i BUILDING CODES.
01 - City of Atlantic Beach APPLICATION NUMBER
�. Building Department (To be assigned by the Building Department.)
r ,. 4 '�`� 800 Seminole Road �,_W ' �O c Q
.,� - Atlantic Beach, Florida 32233-5445 J 1
\\ ' I Phone(904)247-5826 • Fax(904)247-5845
o;ti9' E-mail: building-dept@coab.us Date routed: _W=2,41_46)____
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Z01 ( ae_clek Rv e _ _Department review required Ye�/No
Ruilriing- �/
AN i V' A Plannin &Zoning
Applicant: JC7N�TH (� � STk , C
Tree Administrator
Project: 3 t c',o R QfV E L liLUQOtk) Public Works
Public Utilities
l O CG O REPc t 1 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: liKoproved. ['Denied.
(Circle one.) Comments:
BUILDING ?
PLANNING &ZONING Reviewed by: Date: ✓ Z 7
TREE ADMIN. Second Review: Approved as revised. ❑Deni
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
0
Revised 05/14/09
FP
Building Permit Application �L Il�/ a
6. , �
.. �, City of Atlantic Beach
800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Fax: (904) 247-5845 IS
7 W 11\3 3 59
Job Address: 2041 Beach Ave Atlantic Beach,FL 32233 Permit Number:
Legal Description LOT 71,North Atlantic Beach Unit#3 PT RE# 169711-0000
Valuation of Work(Replacement Cost)$$25,000.00 Heated/Cooled SF 3748 Non-Heated/Cooled 1114
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool indow/Door
• Use of existing/proposed structure(s) (Circle one): Commercial esidentiJ
• 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 work to be performed:
Replace 3 doors and 1 window on the East facing side of home with impact rated doors and windows and repair ancillary stucco around the windows and doors being replaced.
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: Soloman G.Brotman and Leslie Brotman Address: 2041 Beach Ave.
City Atlantic Beach State FL Zip 32233 Phone 904-716-4091
E-Mail sgbrotman@prodigy.net
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) N/A
Contractor Information
Name of Company: Jonathan David Smith Inc. Qualifying Agent: Jonathan D.Smith
Address 66 W 14th St City Atlantic Beach State FL Zip 32233
Office Phone 904-782.7285 Job Site/Contact Number 904-762-7285
State Certification/Registration# RG#291103904 E-Mail Jsmith@onathandavidsmithmc.com
Architect Name&Phone# N/A
Engineer's Name&Phone# N/A
Workers Compensation Exempt _
Exempt/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 ATT•RNE REFIRE
RECO' DING YOUR NOTICE OF COMMENCEMENT. /
, L1142d2finceek---
(Signature of Owner or Agent including Contractor) (Signature of Contractor)
gn d a sworn to(or affirmed) before m;this,/ day of Signe. ndsworn to(or affirmed)before me this 2'2-day of
of Z,by /�tO1S/s' ' r M U--/ �" , 2-0(7 , by Jol, srn�J`►
Igna re of Not y) Sao
*.oa y. Wirt WNW
JONATHAN D.SMITH ( 1P'' `�k. Way Mlle• N Florida
Pori,'_ Notary Public-State of Florida .tom, .gNpps�
• e My Comm.Expires Aug 24,2018 ' COMM.El�I/M f> 14,2020
aersonally Know [ ] Personally Known OR +
do Commission#�FF 153956 ''{>iAr 'Wad MOM A%[ ]Produced Identifi tYgjt? QS�� [ ]Produced Identification
Bonded through National Notary Assn.
Type of Identificatio Type of Identification:
NOTICE OF(PREPARE COMMENCEMENT FL2 CO .. i
IN DUPLICATE)
Permit No. /7'w/wn 33-`5/ Tax Folio No. 169711-0000
State of Fbrila County of Duval
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 stated in this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: ,LOT 71 N o rth A tlan tic B each Un it#3 PT
Address of property being improved: 2041 Beach Ave.,A tlan tic Beach,FL 32233-5934
General description of improvements: Rep lacem entof3 doors and 1 window on the East facing side
of the hom eon the first floor level.Repair of ancillary Stucco around the doors and w indow to be replaced.
Owner So tom on B rotm an
Address 2041 Beach Ave.AtlanticBeach,FL 32233
Owner's interest in site of the improvement 100%
Fee Simple Titleholder(if other than owner)
Name N/A
Address
Contractor Jonathan David Sm ith Inc.
Address 66 W 14th St.AtlanticBeach,FL 32233
Phone No. 904-762-7285 Fax No.
Surety(if any)N IA
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name N/A
Address
Phone No. Fax No.
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other
idocuments may be served:
Name N/A
Address
Phone No. Fax No.
In addition to himself,owner designates the following person to receive a copy of the Lienors Notice as provided in
Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option).
Name N/A
Address
Phone 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 ( OW R
a _..1•6_ All ..11•..
Signed: V�/,` DATE 0.3/2-02 0
I. Before me thisk' day ofv-f. -- In the
,a'"""n PAUL FO R B E S County of Duval.State of FI ride,has personally appeared
a°4�v Puerc% Notary Public-State of F! r ', �cstb Mme- C OTf'rl�/'^� heroin by
hlmself/herself and affirms that all statements and declarations herein
• •� •e My Comm.Expires Sep 22.
' are true and accurate .
=;', %�� 0-4 Commission#FF 161974
i>-://14........,............„/
°'''°''''''' Bonded thrcugt National Notary Asc.
No yry Public at Large.State of f"- _ County of Z4 •-‘
My commission expires: -)1 -•d
Personally Known or
Produced Identification
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