331 10TH ST - INTERIOR DEMO , ,
'ri 1 rJ,„
,�' ,at , CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
~!o;l a% INSPECTION PHONE LINE 247-5814
DEMO - INTERIOR ONLY
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: DEMO17-0027
Description: INTERIOR DEMO
Estimated Value: 0
Issue Date: 12/12/2017
Expiration Date: 6/10/2018
PROPERTY ADDRESS:
Address: 331 10TH ST
RE Number: 170073 0000
PROPERTY OWNER:
Name: DURHAM LAUREL
Address: 331 10TH ST N
ATLANTIC BEACH, FL 32233-5529
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: CORNELIUS CONSTRUCTION CO.
Address: 71 19TH ST QA MARGARET S. CORNELIUS
ATLANTIC BEACH, FL 32233
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$7,500.
r% Building Permit Application Updated 12/8/17
_y City of Atlantic Beach
,'�„v/ 800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845
Job Address: 33) late �' , tTt..$O4 Permit Number: t E-AA,Q I ! —ddZ.
Legal Description Aril" U. 131305 AeTS.. EAtcw Sec. A RE#
Valuation of Work(Replacement Cost)$ /2 ,DID 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 Residential
• 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:
.21JTERioR DEM D
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: ptx t,..—IADV DU(efIAM Address:331 IO"ST 46
City AT LA MT'C 3 C4 State f Zip 522,515 Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: (pP4SELA1,5 a,AID—re Qualifying Agent: IAApR6pkE-T Ll
Address ZI$ DAY .1-f CitymEe-ruMF ea State >FL Zip 32,Zto(,
Office Phone log • 244•g7C5 Co Job Site/Contact Number
State Certification/Registration# CBC0t(Fr9 VI E-Mail 'E6674 a cavi4E.L%0S ce 5 TRQCT10 11/41.00 in
Architect Name&Phone# —
Engineer's Name&Phone# —
Workers Compensation 1EXY1G'T
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. NOTICE: In addition to the requirements of this
permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and
there may be additional permits required from other governmental entities such as water management districts,state agencies,or
federal agencies.
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
RECORDINGGYOUR NOTICE OF COMMENCEMENT.
4
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/2,01- 1"6.4.
(Signature of Owner or Agent) ignature of Contractor)
(inclu•.•:contractor) J
ned and sworn to(or of •d) befo -- me this 1 �ay of Signed and sworn to(or affirmed)before me this 1 . day of
te, ZOI , b \o, it 1 • ck.I\. t ' ertbRC, 3D1•1- ,by k()-r Gtr Q k Cpl OP-V:44.S
vow
(Signa i - if' F. _nature o'No )
u n RG-
gip, ';,;i., MY COMMISSION•FF9 951
[ ]Personally Known OR ;L,. ,� EXPIRES:Octobe .,2019 j4Personally Known OR I: •o;•'�YP'-.;; JENNIFER JOHNSTON
° Donde°Thru Notary Publi U .- n „a% MY COMMISSION#GG 042984
[ ]Produced Identification .• [ ]Produced Identification •"'' �.;
EXPIRES:October 27,2020
Type of Identifications T 41F-7,—Ii"--- �� '"' Type of Identification: r' r j%,oZ' 0,,,,U.,tTh..N.taryft,bG.U.LUerwriters