570 SAILFISH DR E - WINDOWS •i' ' y f.
,'' ' fs CITY OF ATLANTIC BEACH,,,„,_
`'' 800 SEMINOLE ROAD
,� �r ATLANTIC BEACH, FL 32233
"Zw;3 9'r INSPECTION PHONE LINE 247-5814
RESIDENTIAL - ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES17-0109
Description: replace windows
Estimated Value: 5126
Issue Date: 8/1/2017
Expiration Date: 1/28/2018
PROPERTY ADDRESS:
Address: 570 E SAILFISH DR
RE Number: 171274 0000
PROPERTY OWNER:
Name: ADAMS MARCUS N
Address: 570 SAILFISH DR E
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
,
Phone:
Name: FLORIDA GEORGIA CONTRACTORS
Address: 11433 SAINTS RD QA KENNETH MICHAEL BRANHOLM
JACKSONVILLE, FL 32246
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.
y, City of Atlantic Beach APPLICATION NUMBER
, ` � Building Department (To be assigned by the Building Department.)
800 Seminole Road ,p LSri-O i
11, , Atlantic Beach, Florida 32233-5445 Y�
\ Phone(904)247-5826 • Fax(904)247-5845
•`;•:.o:tl9/ E-mail: building-dept@coab.us Date routed: V-4-la
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: SIV £ . SQ,L S P(• Department review required Y >vNo
/1 ,,J uilc ing I/
Applicant: E tof;►a.(4 C,ttg�a Wi 1 YJt t Planning &Zoning
C Tree Administrator
Project: C U1L WctLin o.ok J 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: [pproved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDIN
PLANNING &ZONING
Reviewed by: Date: 7 6./7
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 05/19/2017
~
1 E C CO V LE -7
BuildingPermit Application j
i
'° ' OFFICE COPY City of Atlantic Beach p
JUL 212017
Fh 800 Seminole Road,Atlantic Beach, FL 32233 i
Phone: (904) 247-5826 Fax: (904)247-5845
Job Address: J9. 1
�nPermit Number: �G-�t"+ O 10 - .�
Legal Description—50-q4 12-2s-Ne Q_c AL YA IM ( 11-Z LOT 1 %l X n RE# 1'112_1-4 -OO
Valuation of Work(Replacement Cost)$�, !,Zia°--"-- Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move ool indow/Door
• Use of existing/proposed structure(s)(Circle one): Commercial RsideE n•
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
(aLACCRaS1 W(IAZ")5' 3 ua �,4-@,. I(ie5 I IR SI I3&LG c u uG 5
Florida Product Approval# for multiple products use product approval form
Property Owner Information "
Name: 0 1/(kI3 ' ► I k 5--//0 3 Address: c$p-j 1 IF s(- 1 .0-- C
City ;([_if • .rr II—. State _ Zip 32233 Phone CiDll •535 -0=t-DI
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Inform tion / 1. I -7 Sa114.01)4PA.OliOLK
Name of Companny:Ho IY1 G imga i 1O (LSA J,ric Qualifying Agent: G,
Address 112ab �I pS TpJD. ( ISu;d-C I City ClZSc�rl0‘ Ile_ State T �- Zip 3'2Z4(i
Office Phone �p -1,41.--11.3e I Job Site/Contact Number A-f4C
State Certification/Registration# Ute 0.14[o4'a E-Mail FLGi'rCD►sr p Aot-.CoA
Architect Name&Phone#
Engineer's Name&Phone# -
Workers Compensation q I l ( -
Exempt/Insurer/Lease Employs Expiration Date
Application is hereby made to obtain a permit to do the work and installation -ind' ed. 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 ATTOR FORE
RECORDING YOUR NOTICE OF COMMENCEMENT. /4.4....,..
g,c,L.Nz;C-1 .,0. 0A-CCOLYIk.
(Signature of Owner or Agent including Contrager) (Signatu of Contractor)
Signed and sworn to(or affirmed)before me this2 day of Signed and sworn to(or affirmed)before me hist day of
•
Notaryemit% Public state or Florida -UI -
3'/4 i�1/1 .0111 Notary Public State a FloridaKri /Sarah S Biggerstaff A� . SarahS /I
Brio els..
j UAy Commission FF 213814 s ignat e •f 0? ) d My Commiasion FF 213814it.,i71---':Ago .tars)
p Expires 03/25/2019 awd� Expiros 09/2512019 .
L ir
[ I Personally Known OR personally Known OR
[educed Identification DL- [ ]Produced Identification
Type of Identification: Type of Identification:
perm, 4_ R s/ 7 0/6
NOTICE OF COMMENCEMENT
State of CD(I-{ t Oc Folio No. 17-1234 -- v
County of DuVA� OFFICE COPD"
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: 30-q4 I? -2S'-2 9-
QO`lF4L PA -M (AN( Z Lbr I KIK
Address of property being improved: '" D A T Ltnm c. )1 t, rL 32233
General description of improvements: %4)1410,C;I4 - Lisi ncIDW5
Owner:. V : ' ►r) C 411 Address op op At SFS •R-. C i _:..a C
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor: c7 — L� A- W11\110/ C)- 690S/ LA,C .
Address: I C2 b �T -�r5 -�-t4fl. C. (�(�IA�'1✓ 1 —i-(its ' 1 S
1 I U� NUI �l, D. 3224(0
Telephone No.: 0Q-(0a' -�(l7 Faro: Qty 4- ((42- 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:
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):
Doc#2017158535,OR BK 18044 Page 1508,
Number Pages:1 OWNER
Recorded 07/07/2017 at 12:10 PM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL ;Signed.e ,_i. gj IP a' .4 Date: (C1 Z 1 17
COUNTY Before e this dayof
RECORDING$10.00 Zm� ii,pp the Co ty of Duval,State
Of Florida,has personally appeared U311N. ' /r'f j�
Notary Public at Large,State of 1 rids. _nty of Duval. �� '�/�
My commission expires: , 1Z S �/1s�„�!�I�
Personally Known: �f6 or
Produced Identification: (i ia,at, _'r'='',,o+xtWN
apMy Com 0nnfssion3/2512019 FF 213814
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