1869 SEA OATS DR - FIREPLACE REMOVAL & DOOR PERMIT imm
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r* ` , CITY OF ATLANTIC BEACH
-- 800 SEMINOLE ROAD
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;� ATLANTIC BEACH, FL 32233
a INSPECTION PHONE LINE 247-5814
RESIDENTIAL -ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES17-0133
Description: REMOVE FIREPLACE/CHIMNEY AND ADD SLIDING DOOR
Estimated Value: 12000
Issue Date: 8/17/2017
Expiration Date: 2/13/2018
PROPERTY ADDRESS:
Address: 1869 SEA OATS DR
RE Number: 172020 0538
PROPERTY OWNER:
Name: KLEIN KARL M
Address: 1869 SEA OATS DR
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: MATHIEU BUILDERS
Address: 1778 OCEAN GROVE DR QA DUSTIN MATHIEU BROWN
ATLANTIC BEACH, FL 32233
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TORR TWICE RD A TICE C OF
COMMENCEMENT MAY RESULT IN YOU PICG
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE
COMMENCEMENT MUST BE RECORDED AND POSED ON THE JOB
SITE BEFORE THE FIRST INSPECTION. IF YOU
T AD TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER
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-=��i: City of Atlantic Beach APPLICATION NUMBER
's•r Building Department (To be assigned by the Building Department.)
J
r . ; ,v 800 Seminole Road �S� t r
3.�
l Atlantic Beach, Florida 32233-5445
\v Phone(904)247-5826 • Fax(904)247-5845 Q
�•�t>;sl�� E-mail: building-dept@coab.us
Date routed: PVL i i 7
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
p- . - + ent review required Ye No
Property Address: C�� SEP( 11trs t2`auildin•
M H IE--u � U ta>C--2_`C Planning &Zoning
Applicant: n Tree Administrator
REmovE_. ,� C tiIMNublic Works
Project: c R F Plr�' _ - ' Public Utilities
P P 4 0D L � N0,0�Public Safety
Fire Services
Review fee $ Dept Signature
Review or Receipt Date
Other Agency Review or Permit Required of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation (.....A,L....
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLIC TION STATUS
Reviewing Department First Review: pproved. ❑
Denied. ONot applicable
(Circle one.) Comments: /i ,�/
/"---- 11
I 11C�
PL•NNING &ZONING Reviewed by: ir\il y-16-- 0Dt
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. ❑Notapplicable
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
r' rr,, Building Permit Application OFFICE COPY
ill
City of Atlantic Beach
/ 800 Seminole Road, Atlantic Beach, FL 32233
''-94.1* Phone: (904) 247-5826 Fax: (904) 247-5845
/ /g , RC17- 0( 33
Job Address:/. C ! Se` Oa fs- Ur, v L _Permit Number:
Legal Description
Scl✓1 M n
1q ( /�.it, 17 !6f ( 9 5I/ r RE# /7Z0zo - O S3,,V
Valuation of Work(Replacement Cost)$ U/060 . 47° Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Ai ration Repair Move D o Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes Lflo7N/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: ( /
-----3
Q►titoJc -r;repIALe (C (itt,vtYte ( ) , , C( t n' � 145S both_
i, 7-2 1 s / for multiple products use product approval form
Florida Product Approval#_
Property Owner In o mation / /��� /__.
,( t _
Name: at,'/ It; 4 r Address:
l (/ /' !Jr
City1+ 4.11;c-- XCdtc'� State re.— Zip 3LG33 Phone yo f' £(33(
E-Mail_ .14MA- T I t AILrivv‘ a
Owner or Agent (If Agen , oiler of A to ney orAgency Let er Required)
Contractor Information Pi of Company: Mali) /e / ts /4c-- Qua rfYing A nt: t .SLl
n /5r•t/ /Address 3 : k 5-F- _City/Witt/1f;c-1eaLl-State 4 ..%-- Zip 3 Lam,
Office Phone °0 '/3 5 6 4 ) Job Site/Contact Number 9Q 54— 63/ - -f17/-S
State Certification/Registration# 1 Ii sq-5 Qi•/(06 E-Mail DOT( 1 j`�_ -rE v&V 1 L D t R S ,com
Architect Name&Phone# f icr a(S O r 17.t."ke.S 10V - q a 2-- C. S g
Engineer's Name&Phone# c,XMC 's. , Get / I _
Workers Compensation _ `` c — L S • a •• • -
�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 N TICE OF COMMENCEMENT.
i/LUTA,t,: tee - /
of Contractor)
(Signature of Owner or Agent including Contractor) (Signature �f� day of
Sigped and worn to(or affirmed)before me is / • day ofSigned and sworn to(or affirmed)before me this
,*U St- , aAct) ,by '. II41 i • GOA •g, a u t' , - '1 , by 1)uS-t;4 f5rowA
(-'2e4.4060- . lams- i 1J-14-1t1LA-"•121,1ir
A (Signature of Notary)
;;;; ` WENDY G.BRANDT
i' MY COMMISSION#FF 987713
ifli EXPIRES:May 1,2020 � ^ Heather Brown
r•uq` Notary Public State of Florida
':�• OS Bonded Thru Wary Public Underwrites \�
[ ersonally Known OR t� J Personally Known OR
My Commission FF 239144
[ )Produced Identificatio [ ) Produced Identification ?o, Expires 06/09/2019
Type of Identification: Type of Identification: . _ . _ _ .
/ NOTICE OF COMMENCEMENT
State of �ld, G(A- Tax Folio No. l 1"ZO ZOO _ D S 3 1-
County of 7)�.v q /
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 COMMENCEMEN .
Legal Description of property being improved: 3(Zp 07—,2,5' —c27 C e%aQ Mei as a„."--1 L
L-af (7 otic / S0. ire--Address of property being improved: 2 7 Oe fs Q r. I4 LI C4Ti,
/ G. 4ea % 6.--- 3 22-'3
General description of improvements: s"Wamp✓',9 T.re-p /ac.e. an el &ea/4 / 2 I S/, . j
3/aS 5 door// /� L
Owner: , e4,- / /� lC/n Address: (Od'7 Seo Qin�S bri ve /� 7 r„4,/,G/ash_.
Owner's interest in site of the improvement: e s 0 /.
Fee Simple Titleholder(if other than owner):
�2§§5 80
Name: /� 2i
Contractor: mit*� '-k 6 4e, (it r S 7h e_. r v Lr'B 7,gr o
r / Address: 3s ►n/ l 7`t St lat-1,'i er 4e..v 4 r c__ 3 2 2-33 c) -a, co
Telephone No.: Fax No: O m w
S x= 0
Surety(if any) x c, A]
1
Address: Amount of Bond S o N —
co
Telephone No: Fax No: 0 uul
Name and address of any person making a loan for the construction of the improvements o -u
Name: o 8
c
Address: D
r
Phone No: Fax No:
Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other documents maybe
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 A , I r
Signed: 6, S Date: $ 110 12-0(7
o�. "r�.•�ti WENDYG.BRANDT Before me this /Ot day of mit,
of Duval,State
: : ...mss MY COMMISSION0FF987713 Of Florida,has personally appeared F M Q / !(� It,S
"' ;.- EXPIRES:May 1,2020 Notary Public at Large,State of Florid.,County of Duval.
"r'`'i .F Bonded TAN Notify Public Underwdten
•ersonally Known: !► or
mei
Pro.1 -. .- " . ion: 0