552 PELICAN KEY - DOORS r\J\
' '` ' �S� CITY OF ATLANTIC BEACH
r "`""' J 800 SEMINOLE ROAD
.. , ....:. ,,�'� . �
. _ ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
J;319r
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-WIND-3710
Job Type: WINDOW AND/OR DOOR
Description: replace 2 doors
Estimated Value: $7,650.00
Issue Date: 4/12/2017
Expiration Date: 10/9/2017
PROPERTY ADDRESS:
Address: 552 PELICAN KEY
RE Number: 172027-5576
PROPERTY OWNER:
Name: FARRA, GABRIEL & ANN D, *
Address: 552 PELICAN KEY
GENERAL CONTRACTOR INFORMATION:
Name: PELLA WINDOW AND DOOR
, CBC046712
Address: 7818 PHILIPS HWY QA JAMES SAMUEL ROWLAND
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $44.13
BUILDING PERMIT FEE $88.25
STATE DBPR SURCHARGE $2.00
ISTATE DCA SURCHARGE $2.00
Total Payments: $136.38
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
i BUILDING CODES.
01.-Writ, City of Atlantic Beach APPLICATION NUMBER
a' lie 11%), Building Department (To be assigned by the Building Department.)
o
>•, 800 Seminole Road ,I- V) a-Al. __ aN)
2: Atlantic Beach, Florida 32233-5445 N
Phone(904)247-5826 • Fax(904)247-5845
Ao E-mV E-mail: building-dept@coab.us Date routed: ()Li I C I (-1-
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: SS Po/Lc an Y-- -q rtment review required Y No
Applicant: L I\cc W, n(Io w S A Dov(S Planning &Zoning
Tree Administrator
Project: ( LpACLLL a deo( 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: Eoved. ['Denied.
(Circle one.) Comments:
UILDIN-
PLANNING &ZONING �/�� 17'7 ./17
Reviewed by: //� ► Date:
TREE ADMIN. Second Review: ❑Approved as revised. ❑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
011111m for Pick Up 727-637.8400 BUILDING PERMIT APPLICATION
_CITY OF ATLANTIC BEACH "°' 1
800 Seminole Road, Atlantic Beach, FL 32233 ii rL� copy
Office (904) 247-5826 Fax (904) 247-5845
Job Address:53 Q.11_ v, \�`{ Permit Number: /7 W i /?/O — 32/0
Legal Description 9�-1 k 11•a S•a E Se l`'‘ 1-0.k.o Uft.1-a L61-90 Parcel # t--7 a.Qd7- 5-7-7 Co
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$ 7(E..3 - Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition A. - ;•:. Repair Move Demolition pool/s.< window/door
Use of existing/proposed structure(s) (circle one): Commercial CBssiskntiall
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to be performed: Q4wkii_. D. I4l.„) S 12.e.ckc- St-2e.-
Property Owner Information: p
Name: 'n FG. fit^ Address: .5—Sa \e._)\\e-so.l1 V
City r.
u .C.- State f Zip3�a-33 Phone 40`1-GI -la-iEr-
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: Pella��ows 8c Doors Qualifying Agent: �ic�,Y ,nn 4,,Ac►.v.,k-
350 Address: W 8hata ��' Q'� City State Zip
Office Phone Longwood.FL Yite/Contact Number Fax#
State Certification/Registration#0.6`-1(0-(1 -
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 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 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 lime after
work is commenced. I understand that separate permits must be secured for Electrical (Fork, Plumbing,Signs, Wells, Pools, Furnaces, Boilers, Heaters,
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 thisplication 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 specified 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�JV1 v u6 1.1 " NhZMi0 Signature of Contractor /4/-
g - .. g
Print Name Rm\. O,)w:)n �`I� Print Name`( 9 J�ar\14-
Swornand subs ibed before me Sworn Itland subscribed before me
t 1Ao ay of ,20 17 i l b` " Day of \1'\c_('Jr. ,20 17
Notary Public Notary Public
:k CHRISTINE Y Revised 01.26.10
,�:, ;__ MY COMMISSION I FF 087307
ai+?y''•. CHRISTINE O MALL EY
1:,���- EXPIRES:January29,201
?„i'^�d a Bonded
Thu Notary Public UndenTRen i .#.''''' MY COMMISSION I FF 087307
-:a= EXPIRES:January 29,.2018_
Doc # 2017074101, OR BK 17929 Page 1254, Number Pages: 1, Recorded
03/31/2017 at 09:27 AM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
•
Permit Number / 7— W //l/O '7/ 6
Parcel ID Number I 1 e)Oa.1 s3-1 CP
NOTICE OF COMMENCEMENT
State of Florida
County ofI\1"C 0.\
The undersigned hereby gives notice that the improvement(s)wit be made to certain real property,and in accordance with
Chapter 713,Florida Statutes,the following information is provided in this Notice of Commencement.
1. Description of prope({j/y'r�(lpgal description of the property,and street address if available)
Address_ d \Cr\\ __
Legal Description -I( 1-1-.-16 `at'
-ol • q Win. ' `
2. general descriptionimprovement(s)
3. Owner l formatio q t c
Name Y\ 4 r�rr°.. ?hone&Fax Number ` Q'
Address _ C'P)\e.Sk.N \<4.1
Interest in Property6i4-t2
4. Fee Simple Title older(if er than owner shown above) �-
Name \\!``� Phone&Fax Number
Address
5. Contractor Pella Windows&Doors .
Name Phone&Fax Number
Address 350 W Skirt,Road 43A
B. Surety(if any) Longwood.FL 32750
NameNIA Phone&Fax Number
Address"
7. Lender(if any)
NameNMA Phone&Fax Number _
Address"
8. Perscns with the State of Florida designated by Owner upon who notices or other documents may be served as
provided by 713.13(1)(a)),7,Fl Statutes.
Name < ttt Phone&Fax Number
Address
9. In addition to himself or herself,Owner designates the following to receive a ccpy of the Lienors Notice as provided in
13.13(1)(b),Florida Statutes
N ) n
Name �\\ �� Phone&Fax Number
Address
10. Expiration date of Notice of Commencement(the expiration date is one year from the date of recording unless a
different date is specified:
•
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA
STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO
OBTAIN FINANCING,CONSULT YOU LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE
OF COM CEM ..r '���p n c
11. tV11` �.�l1Vll I V� _ Nu\ awbn ref CA
Signature of Owners or Owners Author@ed Officer/DirectwJPajwor ar/Man Print Name {� �jr-
Sworn to(or affirmed)and subscribed before me this P:S. Vdaa`y of �-� 2p t r� by `h ON `'-''`VL' asf--°-Cr
\/.L %NAL.— (type of authority,e.g.officer,trustee,attorney in fact)for 5A-•\ ' (name of party on
be . Cof whom instrument was executed. personallr�k�rt,.n sauced
-, a as identification.
' \� •Ii yCOtMSSIO
APIF9 6
201
(�ggat1rvofNotary ` t4.L/ E p^ FlS3�f.JpNEnCua1ry1L2F9E7"A78
eondalhPaxanPeN4Undemrc
+s
,VNkeN1r-v,12--
Name)print
--AND-
Verification pursuant to Section 92.525,Florida Statutes. Under penalties of perjury,Declare that I have read the fpregoing and
that the facts stated are true to the best of my knowledge and belief. k� n�e\
S4ator.0 Natural Person Sgning On line e11)Above
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