1842 FORSYTH CT FIRE REPAIRS 2017 S ly
U�
a +++ CITY OF ATLANTIC BEACH
� . ,
'? 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
o INSPECTION PHONE LINE 247-5814
RESIDENTIAL -ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES17-0048
Description: repair/replace fire-damaged drywall, insulation, & paint
Estimated Value: 31000
Issue Date: 6/12/2017
Expiration Date: 12/9/2017
PROPERTY ADDRESS:
Address: 1842 FORSYTH CT
RE Number. 172097 9820
PROPERTY OWNER:
Name: BANOVSKI ANGELA JANE
Address: 1852 FORSYTH CT
ATLANTIC BEACH, FL 322334338
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: A-Team Petroleum &Tank, LLC DBA Petroleum Construction
Address: P.O. Box 9300
Fleming Island, FL 32006
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU 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 WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500.For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
s�1%i„•: City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
u
800 Seminole Road sj - 0f)1
Atlantic Beach,Florida 32233-5445 -r
Phone(904)247-5826 Fax(904)247-5845 Date routed: 0(d a I l T
E-mail: building-dept@coab.us
-- Cityweb-site'. httpfl M1 coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I LI a'
�DSYB
m
w Ye N
uildine
Applicant: Q (Y) ReJ'plQlAM Planning &Zoning
J, Tree Administrator
Project: f L Doc,( W L itce—_0.Q P'tLC Public Works
,t -` Public Utilities
Agw \mk\6�) T Q(A1 Public Safety
Fire Services
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
Florida Dept.of Environmental Protection
Florida Dept of Transportation
St.Johns River Water Management Distriq
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLI ATION STATUS
Reviewing Department First Review: pproved. ❑Denied. . ❑Not applicable
(Circle Comments: Nd P-8r vy"t t SS�eo� [/nfi I Cpr+f 4rcca}'ran
BUILDIN Or �¢f S+�af-f ( tcph r �QLorc�Epf oh t4ffAiC0+"J1tf
PLANNING &ZONING �F� Reviewed by: Date: 6 '7'l72
(V0(�.
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. . ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. . ❑Not applicable
Comments:
Reviewed by: Date:
Revised 0511912017
Q Building Permit Application Updated 515/17
n City of Atlantic Beach
- 800 Seminole Road,Atlantic Beach, FL 32233 OFFICE COPY
"a v'
Phone: (904)247-5826 Fax: (904)247-5845
�1 r1 1�pp-� nn
VL_ 3a>73
Job Address: f �n ` /' � iv` Cr�J'vHJ.�XwJ� Permit Number:
Legal Description ,\�$ �� SO- too a..i('f�d ac. Obo'}$ �F": RE# t't ao C( ? 9 80
Valuation of Work(Replacement Cost)$ 31 000 Heated/Cooled SF )t'1 U Non-Heated/Cooled 4 4
• Class of Work(Circle one): New Addition Alteration ED Move Demo Pool Window/Door
• Use ofexisting/proposed structure(s)(Circle one): Commercial sdentia
• If an existing structure,is afire sprinkler system installed?(Circle one): yes No <SjW
• 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:
&,M5x. r e,e,/ , Aq)nc_ �t9M+9+-C� C!'/ lJi� ♦ IJ�$�n KEi J/� ' t.
Florida Product AApproval# J for multiple products use product approval form
Property Owner Information
Name: fk.'}taw a.n$� Address: 1k43 Fo rf,�l�h L�
City AA-1 �, Dov- State r— zip 3:1-33 Phone
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information pBA' ped"k'^^' Cmnq,r Jci a, n
Name of Company: (a lLLa qualifying Agent: u+• k`� C mic=a `^
Address P (S-K 43 o u City Fl t State FL- Zip Z 1003
Office Phone Job Site/Contact Nunylrer cf Y-33Cs. t993
State Certification/R a -Maili^,y,^_•g, r+k'Ja ' ��
Architect Name& Ph e
Engineer's Name&P
Workers Compensati 1.3r. kxr v al;c S 1
Insurer/lease Empbyees/EVInition Date
Application is hereby a to obtain a permit to do rk and installations as indicated.I certify that no work or installation has
commenced prior to he is perm) an at all ork will be performed to meet the standards of all the laws regulationg
construction in this jurisdiction.I understand that a se ara a 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 0 A RNEY BEF
RECORDING, YOUR NOTICE OF COMMENCEMENT.
(Signature of3iiiner or k cN'j (Signat a of Contractor)
(Including contractor)
Signed and sworn to(or affirmed)before me this;24 day of Signed and sworn to(or affirmed)before me this S day of
2- A/7 .hy ITEM !' SJR+; Z•Ib by r P� FhJ
lilt enry Atkins,
tOCK (Signatu -rya u I
bpN jb"23,40�Sdos State of Florida
Faplannazs.zom
°if"/'""^""jpyunga800'°}'0" MY COMMISSION N0. FF 87720
[ ]Personally Known OR I ]Personally Known OR .[� !1018
Type of Identification:
/Produced Identification [�Foduced Identification T vPls January 30 G
�JpI DH APl kf U /4 Type of Identification: �"�
RCSc7 .- va4-Z'S
NOTICE OF COMMENCEMENT
•
State of F County of 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 stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: Re s (-�.(� ac a , t)(o 0 )
F lc r S
Cost • 1'1 _a - ac C . d . fe,.,�iS o�t�`C��ec l,3 `ltlLot I
c -
Address of property being improved: y �. �- rSyYL— C1- A+1 � �.�� � 3�a3 3 •
General description of improvements: 1:i • b tis L • (Z,e.„,• •
Owner: ri\c',rl mac` .S e T'c. Address: t 4 a- vors y,•kh
Owner's•interest in site of the improvement: (ov L
Fee Simple Titleholder(if other than owner):
Name:
Contractor: PC1r \ , et. A :
Address: Pa QJk q`3Uvea�i(n� LS��� rL 3 2va 3
ItS Telephone No.: Y 3 36- ( 3 9 3 Fax
No:
Surety(if any) •
Address: Amount of Bond$
Telephone No: Fax No:
•
Name and address of any person making a loan for the construction of the improvements
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 •
Doc#2017141623,OR BK 15020 Page 2324, Signed: "�4��- L� W� ->4 -U . Date: ,5 J2 / 7
Number Pages:1 Before me this 2 (3 day of 20/7 in the County of Duval,State
Recorded 06/16/2017 at 09:51 AM, Of Florida,has personally appeared��lL;7"q cYfAN-?WPC
Ronnie Fussell CLERK CIRCUIT COURT DUVAL Personally Known: ) • or
COUNTY Produced Identification: ^ , P I d ' vdtr FA 1. oS-!S•/S
RECORDING$10.00 Notary Public:! - / lwg c
My commission exff ri'es: ,�u�t1 r 2.3 2 i7 2O
,oS;fl';^ CRYSTAL BRADDOCK • 0
Commission#GG 005409