90 OCEAN BLVD - STUCCO REPAIR ;'� r ,. ' 'sb CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
1.1v •
ATLANTIC BEACH, FL 32233
-r INSPECTION PHONE LINE 247-5814
RESIDENTIAL - NEW SINGLE FAMILY RESIDENCE
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES17-0106
Description: EVE DRIP AND STUCCO REPAIR
Estimated Value: 5000
Issue Date: 7/28/2017
Expiration Date: 1/24/2018
PROPERTY ADDRESS:
Address: 90 OCEAN BLVD
RE Number: 170225 0005
PROPERTY OWNER:
Name: ROY SASWATA
Address: 90 OCEAN BLVD
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: ELITE CUSTOM HOMES & RENOVATIONS INC
Address: 2304 Peach DR
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.
rS,a,yf City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
1—. 800 Seminole Road
Atlantic Beach, Florida 32233-5445 1 -ES 7- C7 1 OCC)
y Phone(904)247-5826 • Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: "7 i s it
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 9() Q PLV De artment review required Yes No
uildin)
Applicant: LiYE .r l 0 �brnes Planning &Zoning
Project: D [at p S RC
n Tree Administrator
7U oc o /'fl 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 BL_
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: U Approved. ❑Denied. ❑Not applicable
(Circle one.) Comments: ,/l „ O c_
I:UILDIN. ' U
PLANNING &ZONING Reviewed by: f' - (\d" Dater- 2. 617
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
OFFICE COPY
rt' Building Permit Application Updated5/S/17
ri
:-..,,; City of Atlantic Beach
41`
800 Seminole Road,Atlantic Beach, FL 32233
`''j;"~ V Phone: (904)247-5826 Fax:(904) 247-5845
Job Address: Q0 0`eatt) G I da Permit Nber/ RCS 1 7 0 (0�
Legal Description N//a Lab U ( 3V 569 Al a S _ g 1,RE?74l44.- '3e-4"7
Valuation of Work(Replacement Cost)$ OW 5 )'< Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial •esidential
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal 6V
Describe in detail the type of work to be performed: r
lue ,�^vr, Q'�„ 5-1� oc.C:O f li Pei.k,,)
� "\
Florida Product Approval# for multiple products use product approval form
Property Owner Information n S A S VV A TA
Name: A.N,4 ilk Al A- O y Address: cc) OC t3 . i3l u a
City 4 1-Icwf"-- / 'c e h State r/ Zip 742237 Phone_ 4'O9 — 2 ti N 8 ecce
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information " L a Q �/,�,�. 3'v� Z-4
/f r
Name of Co p ny: E/' e G,A�hM "q 41 o 11 Qualifying Agent: v 4 Y'f' 4,Ke/IV/
Addresses City SYi1fJ State / Zip 3 2 -1-
Office
1
Office Phone C�o1/-- 2r
4 130 Job Site/Contact Number 00' to J 4/ ce1
State Certification/Registration#earl.? t-i l E-Mail `T/(GQa-St•!'uvlflUu 6,1 • �
. #`�t-
Architect Name&Phone# y4Ji, J
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
RECORDIN YOUR N• ICE OF COMMENCEMENT. /71
// d►--0?/
Signature of# -r or gent) (Signature of Contractor)
(includi trac,.r) •/
nedand sworn to ffir a bef.r e t s' %•y of da5wo (oraffirm:.,efor
�to - m- t V day of
Si�O b 5 , .` t'b
Wr
--12) 11^- A --11M2 ' -
i:nature of Nota ) illik, (Signature o Notard
,$.,:tY'•"Y- ,,; TONI GINDLESPER ER V TONI GINDLESPERGER
a:.: 4 MY COMMISSION#FF 924951 MY COMMISSION#FF 924951moo;' EXPIRES:October 6,2019 ? "'
�+ Bonded Thru Nota Public Uraerwriters Personall Known OR 1t�":, 1" EXPIRES:October 6,2019
[ ]P onally Known OR •4„t Notary y �I'> Bonded ThuNotaryPubluUnderwriters
Produced Identification [ ]Produced Identification I�,.:.,t;
Type of Identification: Type of Identification:
NOTICE OF COMMENCEMENT
State of r`q County of DJ V a 1 Tax Folio No.
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of
the Florida Statutes,the following information is sta e in thisNOTICE OF C/O E E T. ,. /' (�' /_
Legal Description of property being improved: / c22 /0.1-- .b {J -- Co / �/ ��
0,q �' fOb Afkof-fr o' '/1
Address of property being improved: 90 0 C /}- W G`.1 A A fai / /3c It ?22 3
General description of improvements: Euc >7i`p cam- ci -5.1-00(A) 1 `ep'r (.3L-c Ks j
Owner:--�A- R O L Address: O O i /c3 A-A !Id fy)/a'/'� /36
Owner's interest in site of the improvement Q yh
Fee Simple Titleholder(if other than owner):
Name: r
Contractor: t—icl-e. 6(.) tvw-- (—I—mob 1 gevtDiJ6 bo"-5 .J-ln (--,
Address: 9 30
�,/�J '/ ?�'C,.C,�L1 0 d`' <v'`�ou( t//r f / 302-1/1
Telephone No.: ' 2 - 60` ti ) Fax No:
Surety(if any)
Address: Amount of Bond$
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
Signed: 6.L.--- i Date:
Before me this 17 day . it 0Zc,i� Z i 7 in the Co my of val,State
Doc#2017175909,OR BK 18067 Page 1385, Of Florida,has personally app�ared K N S
Number Pages: 1 Personally Known: or
Recorded 07128/2017 at 09:42 AM, '7O
Ronnie Fussell CLERK CIRCUIT COURT DUVAL Produced Identification: 0• . - •d OS-S 08
COUNTY Notary Public: a/ g
RECORDING$10.00 My commission expir- •
__ IF Imo..W
— ;.�f , TONI GINDLESPERa�W
0) " MY COMMISSION#FF 924951
IR.: ul EXPIRES:October 6,2019
f,(14 Bonded Thru Notary Public Underw dens