2235 OCEANFOREST DR W - INTERIOR REMODEL , .-5IAV:pv,
c' , ' ,s' CITY OF ATLANTIC BEACH
,iii
73, 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
lost L) INSPECTION PHONE LINE 247-5814
RESIDENTIAL -ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES17-0141
Description: INTERIOR REMODEL
Estimated Value: 10000
Issue Date: 9/1/2017
Expiration Date: 2/28/2018
PROPERTY ADDRESS:
Address: 2235 W OCEANFOREST DR
RE Number: 169463 0570
PROPERTY OWNER:
Name: PETERSON WILLIAM D
Address: 2235 OCEANFOREST DR W
ATLANTIC BEACH, FL 32233-4569
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: SIGNATURE HOMES & DEVELOPMENT
Address: 731 DUVAL STATION RD QA REX JONATHAN WILLIAMS
JACKSONVILLE, FL 32218
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.
;:sl 1,`1 City of Atlantic Beach APPLICATION NUMBER' Building Department (To be assigned by the Building Department.)
r `i 800 Seminole Road rr / /'�I I
Jam' "' Atlantic Beach, Florida 32233-5445 R C_5\ ` v`4- `
,,Ail �r
Phone(904)247 5826 Fax(904) 247 5845 C / f
0;ts>� E-mail: building-dept@coab.us Date routed: O ( 1 k' `
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
\\J
Property Address: Z Z3 S Ocesvo FoRiss-i- Department review required Yes No
ui in
Applicant: S 'k NTOORE, t'--6 „s Tanning &Zoning
Tree Administrator
Project: l ND TER-AC Z. R
-M Q c e (— 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:
APPLI ATION STATUS
Reviewing Department First Review: Approved. ❑Denied. [Not applicable
(Circle one.) Comments: 11) O
BUILDING
PLANNING & ZONING Date:Reviewed by: / k Z 311 7
TREE ADMIN. Second Review: Approved as revised. nDenie . Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. DDenied. nNot applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
er-Ank,. Building Permit Application Updated5/5/17
' f City of Atlantic Beach
K,:f 800 Seminole Road, Atlantic Beach, FL 32233
`r'';3, Phone: (904) 247-5826 Fax: (904) 247-5845
3ce�,v` . ro e r .s t" �S 17 O 14
Job Address: 5 Oi b i-, k) Permit Number:
Legal Description RE#
Valuation of Work(Replacement Cost)$ ( 0)00 J Heated/Cooled SF Non- Heated/Cooled
• Class of Work(Circle one): New Addition Iter atio Repair Move D Pool Window/Door
• Use of existing/proposed structure(s) (Circle one): Commercial Residential
• If an existing structure, is a fire sprinkler system installed?(Circle one . No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affl avit of No Tree Removal
Describe in detail the ype of work to be performed: \ In 1
'Re MOU� 0...,\,0...,\, '(-C.)'(-C.) 10„.ce Gxis�\ -(,',,,`,SVCS lv\ \C;n,ge.„(D I .(ectcic ccs v\e .1.
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Florida Product Approval# for multiple products use product approval form
Property Owner Information ((��
Name: 1, 'C,,, `t- kv.IA.,-ceS" PeAC►cS0 Address: g 5 Oceow, 1-oces*br. ,�City .�ilo,,,,, � , . Staten Zip 3)4\33 Phone
E-Mail J Pederson 4380 @ ,MQ-:. I . Cl,m
Owner or Agent(If Agent,Power of Attorney or Agency Letter quired
Contractor Information I
Name of Company: S, ,,\� ,�fe f`�AOW.e.c Qualifying Agent: e l, . �\ .u-.5
Address (tE-74- _ 3 S-�-ree City-0-'0,X_ B L State I� Zip 3x250
Office Phone 10 ik '7l4-n•")" Job Site/Contact Number /51 ,./17;6-I
State Certification/Registration# CgC •r)4+-599 6 E-Mail re.x t 5 i3 F\ ohneS f I .Cr�nr,
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 YOU PROPERTY. IF YOU INTEND
TO a :TAIN FINANCING, CONSULT WITH YOUR LENDER OR AN TORNEY BEFORE
RE OR r I G O ' .- IF COMMENCEMENT.
Illi �A /0 1 !
10 (Signatu COilv NDI (Signat -of Contractor)
ned an• sworn to or a ped be a thisl&day of d a • sworn to( r af' -�) before me th• kaday of
l IA �If ,b IS/ ---
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Signature o -�_ _ „�
'`y}"`••°v •; TON!GIM Rt-3--;:z---21 x �iONI GINDLESPERGE i
:,. `•v'_-• Poly COMMiSSIOR#FF 924951 j F`/?r _.: FM COMMISSIG�#FF 924851
=:;': EXPIRES:October 6,2019 " cy r ES'Oc1o5 r 6,2019
pitioC 6ordedThmRb:zryPub!icUnderx ters i Personal) Known OR ',?..-f' .errr:ers
[ I Personally Known OR L—. _ ----------
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[ )Produced Identification ] Produced Identification - "--'"'a `""""
Type of Identification: Type of Identification:
NOTICE OF COMMENCEMENT
State of F( County of ('VQ.--( Tax Folio No. /(e 'f(03 Or?0
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 sated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: /,...1) 3-7 t e.,)AC
/2., 32- as -,)- De ,tt_ L,w 1k t__67-- 39
Address of property being improved: ) OrRG.,n. OV e.5‘ \c-t \pJ.
General description of improvements:
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Ir•
Owner: tl/j l(x,vw 1-0 ev\A,sice;S V P Q,�('soh Address:
I __ a -t, Of e2 b Y
Owner's interest in site of the improvement: re e S1,i),,,fl C `1-'( 1e_ �0 .. (.5.
Fee Simple Titleholder(if other than owner): I
-:( Name:
le -ontractor: J)j.y. ock IN e: -i oYv. t-. veS-Tv+w 1
Address: /4-7 S 3 d 5+cr FL 3)-3-5D
Telephone No.: 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: <.4cd r (<- YY�S 'lit (1 , T'- c
Address: ILt--)1, d S', •• ST. 3-„/ , Y Jg., c}L e/. 3 z2-s--0
Telephone No: `�c411(--( - 0-2 4 -f Fax No: KCA l t� Si 5 VpN"eS-ri' C-51"---,
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) tt
Name: 5, v c
--+.%- , Eb- - s (c� v,-�-� 1 r11.G .
Address: ‘c-4 ' �. 3(�P S . 3`T- 1. --_,
+ 32,2.- -nn
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Telephone No:' -71--.01 c/`1 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 OWNit
1 a '
Signed: r Date: k) 7 3
Before me day of PrO in tie Co my of uval,State
l Doc#2017211330,OR BK 18117 Page 2418, Of Florida,!%.s perso I'y appeared ( (
Number Pages:1 Personally Known: or
Recorded 09/18/2017 at 01:42 PM, Produced Identification: 0 3 CD Z -44. 2. . - (oZ.3 U
Ronnie Fussell CLERK CIRCUIT COURT DUVAL Notary Public: C
COUNTY My commission expires: Ilk Iah,
RECORDING$10.00 ........+�. .c...:.. ----
te'4,',.147,,*:ru TONI GINDLESPEPGER
`.,,, MY COMMISSION d FF 924951 40IV„,. .�,,V EXPIRES:October 6,2019
%J�140. Banded Thru Notary Public Underwriters
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