221 PINE ST - SIDING , SOFFIT REPAIR 0...,..,,,
d~ '' CITY OF ATLANTIC BEACH
s 800 SEMINOLE ROAD
-- ATLANTIC BEACH, FL 32233
o;3 c� INSPECTION PHONE LINE 247-5814
RESIDENTIAL OTHER -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: 17-SIDE-3598
Description: SIDING, SOFFIT & FASCIA
Estimated Value: 31000
Issue Date: 5/11/2017
Expiration Date: 11/7/2017
PROPERTY ADDRESS:
Address: 221 PINE ST
RE Number: 170564 0000
PROPERTY OWNER:
Name: Judith Sprague
Address: 221 Pine ST
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name:
Address:
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=-L`Jr City of Atlantic Beach
�� '" APPLICATION NUMBER
11i, Building Department
" - 1, 800 Seminole Road (To be assigned by the Building Department.)
•- r Atlantic Beach, Florida 32233-5445 - S 2 K
Phone(904)247-5826 • Fax(904)247-5845 I �� _J�
�ov E-mail: building-dept@coab.us Date routed: b 3 I(-9
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ' .a P` St . D rtment review required Yi7hlo
Building
Applicant: \I ‘ t-hn Ti, - ing &Zoning
a Tree Administrator
Project: S,. a, n G1 j StJ vc•, -k -A- u sc.:, (.1 Public Works
�1 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: Approved. ['Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date: y 447
TREE ADMIN. Second Review: QApproved as revised. ❑Denie .
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: QApproved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
.rta�r Building Permit Application � ^ 7
• A`towCity of Atlantic Beach iL.L.
�''j800 Seminole Road,Atlantic Beach, FL 32233
Phone: (904) 247-5826 Fax: (904) 247-5845
�{ 3 2—›-33S -?•51?Job Address: / Pl n e J • 44- �e 4.cC /2 Permit Number: /7 / 0� +
Legal Description RE#
Valuation of Work(Replacement Cost)$ 3 // 60 O Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition AlterationCMove Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial nti
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes 8 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:
jet / S 6 •r,
Florida Product Approval# j"L 170,3Z / R O for multiple products use product approval form
Property Owner Information
Name: v 04- 1/47 S�r& U Address: �-.2J P' n� &i' •
City 4-P/c..A i.- -G_cL • State /- Zip a 213 Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: jj i Y" u •7' 'C . QualijnAAent: 17o`' g. -1•- n cyf.wr •
Address /6.-7, 2 t7 cr L, GI.ic(S cry' State Jr-'-- Zip 3
Office Phone (7o Lj J rd 3 2> Job Site/Contact Number L90 y) (63- z 7 ) 7
State Certification/Registration#R `/DOOr 79 E-Mail V/r'��%t /�c G m.:-r / 6
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation
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 ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
(Signatu -of Ow t•r Ag-•t-ipcluding Contractor) U (Signature of Cof ractor)
neo and wor to(or a'irme.)b for a this day of Signed and sworn to(or affirmed)before me thisaR day of
2Qa,by ; IsAcucv� , a� "- ,by Sinn: OA A Stbn
52-1(L(Signa'fure o f, otary)
';iv�,�� TONI GINDLESPERGER
:,: ,u •�; MY COMMISSION October
#FF,24951
019 JENNIFER JOHNSTON
�•.� EXPIRES:October 6,20t9 �••••
'%?:p7 fld Bonded fire Notary Public Undenvrners 3}. •„N MY COMMISSION it GG 042984
[ ]Personally Known OR [ ]Personally Known OR W.,/,;6.4.„:4 EXPIRES:October 27.2020
[ ]Produced Identification (pjProduced Identification ''•.t p„ P' B,a+dadThruNotaryPubrclhdatwrk«'
N°
Type of Identification: Type of Identification: It( J tL Ill -
Pe r/Y?7 /- 47 /7 r S/ 1 — R31-9(" r - rirt7,7
NOTICE OF COMMENCEMENT �.
State of ' L County of �%,,,r,� Tax Folio No. 17 5 - v 00
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 Descrition of property being improved: ( C) 1 Co ( C -.z J - Z9 G.
Address of property being improved: f Pine 5---/- 1r¢4,:t_ /3¢.i-e.1-‘ V- L 3'2 t.33
General description of improvements: Sidi K 9
J
te Owner: -SAddress: oZ S
u�;ill ��Yc���-t a 1 r�� � �l•,�Yr-C�e�-�j l�1-,
��� Owner's interest in site of the improvement: X23
Fee Simple Titleholder(if other than owner):
Name: .
Contractor: \A \-(�.l,)\4' -A--n c •
Address: 2' cam, eY awe r Ar .IcI Souy SK fie I J 0 --...)0,x t 4--
Telephone No.: el(Pi-- 3 'a-T ) Fax No: , 15-G k-4;L. e (9.)..� 32.25-i›
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: l spiry., LA v___
Address: o1a )142.)142...) — A ~ S
Phone No: O t--3Z-'b- 1y7 VI Fax No: '9 04- $S -6$610
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):
Doc#2017069920,OR BK 17923 Page 2144, OWNER
Number Pages: 1 '
Recorded 03127:2017 at 03:12 PM, Signed: . I. 0 , - I Date: /c 120/7
Ronnie Fussell CLERK CIRCUIT COURT DUVAL Before m•t is M day oit I`. in the County of Duval,State
COUNTY
RECORDING$10.00 Of Florida, as personally appeared i,(eS
Personally Known: or
_ _ Produced Identification: 2.-4 33 -S7- d (O
-
Notary Public: 1,
FONT GINOLESPERGER Y commission expires: ( -)-- --
'. .• •‘''- MY COMMISSION#FF925951`'t EXPIRES:October 6,2019
8ondod firu Notary Pubk Underwriters .
„:;: :...vi-rj”. Cash Register Receipt Receipt Number
r oCity of Atlantic Beach 1:) }1 R1532
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $313.66
17-SIDE-3598 Address: 221 PINE ST APN: 170564 0000 $313.66
BUILDING PERMIT FEE $205.00
BUILDING PERMIT FEE *NONE* 1 $205.00
PLAN CHECK FEES $102.50
PLAN CHECK FEES *NONE* 1 $102.50
STATE DBPR SURCHARGE $3.08
I STATE DBPR SURCHARGE *NONE* 1 $3.08
STATE DCA SURCHARGE $3.08
STATE DCA SURCHARGE *NONE* 1 $3.08
TOTAL FEES PAID BY RECEIPT: R1532 $313.66
Date Paid: Thursday, May 11, 2017
Paid By: Judith Sprague
Cashier: CT
Pay Method: CREDIT CARD 011961
I
Printed:Thursday, May 11, 2017 2:51 PM 1 of 1 i
TIMET