363 ATLANTIC BLVD #13- REPAIR PERMIT (--- „ CITY OF ATLANTIC BEACH
�t ' s 800 SEMINOLE ROAD
,�� "r ATLANTIC BEACH, FL 32233
0.2 9, INSPECTION PHONE LINE 247-5814
COMMERCIAL - ALTERATION COMMERCIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: COMM17-0008
Description: REPAIR WALL DAMAGE, FRAME , DRYWALL &TILE
Estimated Value: 6500
Issue Date: 8/15/2017
Expiration Date: 2/11/2018
PROPERTY ADDRESS:
Address: 363 ATLANTIC BLVD 13
RE Number: 169730 0000
PROPERTY OWNER:
Name: MANDARIN EMPORIUM INC
Address: 2240 MAYPORT RD#7
1 ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: STYLES CONSTRUCTION, INC.
Address: 1537 PENMAN RD SUITE A QA DARRELL GLEN SMITH
JACKSONVILLE BEACH, FL 32250
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,.},vr City of Atlantic Beach APPLICATION NUMBER
�� (To be assigned by the Building Department.)
�- , �� Building Department
. :W \`� 800 Seminole Road NOA.M
r7.- VUv�jf Atlantic Beach, Florida 32233-5445
� j.:
Phone(904)247-5826 • Fax(904) 247-5845 `
, E-mail: building-dept@coab.us Date routed: 7/3 1 / ( 7
�01.141web-site: htt ://www.coab.us
City p
APPLICATION REVIEW AND TRACKING FORM
4/4 Property Address: 3 ( 3 F -1 L ikiv7l C. (3 De artment review required Yes/No
uilding (/
Applicant: S /Les C.0&DST arming &Zoning
Tree Administrator
Project: (, &..) RLL m ij � A �7 E Public Works
Public Utilities
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
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 I First Review: Approved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDIN
PLANNING &ZONINGReviewed by: AlDate:g"0 ' /7
TREE ADMIN. Second Review: ❑Approved as revised. DDenied. / ❑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
*1p�fy-,,,,,,, ,-
Building Permit Application OFFICE COPY
City of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
Phone: (904)247-5826 Fax: (904) 247-5845 + /
Job Address: 310 M1or 4- c -61v d . W I 3 Permit Number: C_Davy. 1 7- 000 8
Legal Description S-dyz/— 5'-294:-/,1rM1 ..,/1c lte, i /,715 7i ib RE# of.P /7,779 ,BL k /
Valuation of Work(Replacement Cost)$ r'''D' Heated/Cooled SF 7 ' 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): Residential
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes 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:
,fgierr 04so4.�ral j.J i/ 11 /
Florida Product Approval# /409 for multiple products use product approval form
Property Owner Information
Name: Mond CV(iY1 £mpOr.1Vr(\ • f' - • Address: PO BOX 3301-ILIE5
City E!•#'1c‘Yl}i L- TQO,C'\ StatePL- Zip 32233 Phone 909 Zc1 1- 115 1
E-Mail bgia,1 CCaf (.- p��-/r030,.`1._ C.. (\\
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information ,
Name of Company: 5'j/y/rs eie.,.,S/[ri,c.14/4.,14/a-✓ _T•dc. Qualifying Agent: /.)a r rC// 6, 5-*se/ .71Z
Address /S-37 .1,-.4....-,,,-, A1C' City ?coc ad. State ic%. Zip 3 z 7 Y a
Office Phone 1-9r- 9/0 74s Job Site/Contact Number S vx-- ,i•'-7
State Certification/Registration# C,6c/25-66 y E-Mail 1)4 rrc// WV ,a!oc//so"¢4 , N, )(—
Architect Name&Phone# J'.44, ZDA/a sir" b Yi' .$
Engineer's Name&Phone#
Workers Compensation G'if"d oi✓.✓cr 5
Exempt/Insurer/Lease Employees/Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated.I cert I!kat-Ro werk+etri st a
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. Wil. 7 2017
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. lent
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT %Eh. FL
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECO' ' ;= YOUR NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent including Contractor) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this_day of igned and sworn to(or affirmed)before me thisa4 day of
3ok\I ,7-01., \ C,by C1 LA\�Nc\-(3 cU1\k ,ZDct-i,byDCYY'eI T,1+).
\
,, . �•� n SALCAN
,�;Pa P�a�,,, (S' nature�,~`• 1,) (Sr na: • ��+tarNotary Public -State of Florida
-:• Ii".`'; Notary Public-State of Florida
r.•; _a, Commission # FF 229545 =• . 's' :•, Commission # FF 229545
•-•.. yin • :,,�.. „,. My Comm.Expires May 11,2019
j�'i3F WV My Comm.Expires May 11,2019 f • g -�,.�through National Notary Assn.
Bonded through National Notary Assn. )).(Personally Known OR
Personally Know' ' Y�
�[ I Produced Identification [ 1 Produced Identification
Type of Identification: Type of Identification:
fi m 17 of Doc#2017175345,OR BK 18066 Page 1726,
Pe rM ✓✓y Number Pages:1
Recorded 07/27/2017 at 01:45 PM,
NOTICE OF COMMENCEMENT Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING$10.00
State of . Tax Folio Nu.
County of ,Xi,.c/ OFFICE COPY
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of
the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: ,5"- 692/ --.ZS. ,2 9E' /. //c
`ofS -7 740 /8 PT Lof /9 ,rc.v., o`R /7 .779 AV /
Address of property being improved: 6 L ) I��_t O�l'�i C. 1 \.y c ,
General description of improvements: AL/4( oho res.5,, 1.Ja // �j c� vhe/s/ /)ap e
dr yid d
47,1
Owner: 'AC OVSn C11(1PcX i UIra 'AC-- Address: TO 31 350L-NS 350L-NSRkkar ii C ?:),2OO1 FL-.
Owner's interest in site of the improvement: ,cepa Jr p./o fry,„S<.,(
Fee Simple Titleholder(if other than owner): .151
Name:Name:
Contractor: 5.17 Cogs 7'rd c. ,
Address: /5-3 7 /1,4."7,047.." ,40/. " i)e g.Z /-'4' •
Telephone No.: 5-$/.5---9/D 7 Fax No:
Surety(if any) ,O9
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name: ////9
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: /f///7t
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: /-/A1
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): 7i4 x 7//7
THIS SPACE FOR RECORDER'S USE ONLY OWNER
•
_ _ d646-..
_ Signed: i Date: 342`i
, •.�aY, % B SALCAN Before • e th 'J' ►i day of 3 )1y in the Coun of D val,State
:`� Notary Public-State of Florida Of Florida,has personally appeared C,ry rS b rr i du,
3. ,_ Notary Public at Large,St e f Flor'd County of Duval.
4 Commission #FF 229545 4 a�
• "'{ • My commission expir s: 1 1 1 j L0
^,F °vc My Comm.Expires May 11,2019 Personally Known: or
'''% ,Y"° Bonded through National Notary Assn. P
Produced Identification: