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645 MAYPORT RD - FOUNDATION REPAIR er j„`$1 4 CITY OF ATLANTIC BEACH s) 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 1;:toli 9%' INSPECTION PHONE LINE 247-5814 COMMERCIAL - ALTERATION COMMERCIAL MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: COMM17-0024 Description: FOUNDATION REPAIR Estimated Value: 39748 Issue Date: 11/3/2017 Expiration Date: 5/2/2018 PROPERTY ADDRESS: Address: 645 MAYPORT RD RE Number: 171797 0000 PROPERTY OWNER: Name: BRENT INTERNATIONAL INC Address: C/O AMERICAN MANAGEMENT GROUP645 MAYPORT RD ATLANTIC BEACH, FL 32233 GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Name: RAM JACK Address: 2075 S US HWY QA ERLEWINE A SCOTT RIDGEWAY, SC 29130 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. 01.m-fir, City of Atlantic Beach APPLICATION NUMBER Jsio Building Department (To be assigned by the Building Department.) 800 Seminole Road -7 iii �u, ��zs. Atlantic Beach, Florida 32233-5445 O r / - 0024. Phone(904)247-5826 • Fax(904)247-5845 / 0i1 �? IC,building-dept@coab.us Date routed: � ZS it 7 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 64 S ' Y cky pcg-T &-t-- Dei artment review required Yes No (Buildin� Applicant: (��rnJA.e `__--Plarrrring-&-Zoning Tree Administrator Project: P(jDtipPk-i(0/v Rpc ( [a Public Works Public Utilities Public Safety Fire Services Review fee $'_ , Dept Signature Other Agency Review or Permit Required Review or Receipt Date V of Permit Verified By 1� Florida Dept. of Environmental Protection •�C Florida Dept. of Transportation �! St. Johns River Water Management District V(� Army Corps of Engineers V" v Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: nApproved. ❑Denied. ❑Not applicabler (Circle one.) Comments:Sv pPo r 4 \Ora c Ice-h 4-0 lo-e. t o %p.e4 / �'T-chz_< BUILDING Golfer►'v.� PLANNING &ZONING Reviewed by: Date: /0-30-1 7 TREE ADMIN. Second Review: nApproved as revised. nDenied. nNot applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: nApproved as revised. ['Denied. fNot applicable Comments: Reviewed by: Date: Revised 05/19/2017 OFFICE COPY ��4 Building Permit Application Cityof Atlantic ,z�, Beach c�� 800 Seminole Road,Atlantic Beach,FL 32233 1`'f" Phone:(904)247-5826 Fax:(904)247-5845 Job Address: te.( 5-A4Al Pow r gogkO A-71-- ,3c'1-- Permit Number:0-0 AN N` 1 7 " 00 i4 Legal Description&J-13-P7- .5• iE thic•AC.,12eacotn Villa Ltf i-i a L I,Aa> ,a RE# 117 irn 1 -DO X) Valuation of Work(Replacement Cost)$2%740 . 00 Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): New Addition •Iteration Repair ove Demo Pool Window/Door •, Use of existing/proposed structure(s)(Cirtle one): omrrtercial :esidential ' • If an existing structure,is a fire sprinkler system instal ed?(Circle one): Yes No 49/0 • Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit o No Tree Removal Describe in detail the type of work to be performed: cO aGrk tor\ eA," TvWc.-0,..9 Wt cC.t.Q pi 1 e5. Florida Product Approval# for multiple products use product approval form Property Owner Information (p Nam • thesitata j ncriethem-Gybuc�efc k..1t4tddress: (Q45-MaiQ , City • Ciakie, h State P— Zip 3)x33 Phone -100,""4011 E-Mail Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) Contractor Information Name of Company: )1CArf"SoIC.t4- Po yylq}tOr lr k( Qualifying Agent:_ SC,i c CVA 600_ Address jytib�3 •� (y'ct 1 & City State Zip 3a al R Office Phone`ii- 7o 3(' Job Site/Contact Number iv-Jr'7-?-36S l State Certification/Registration#IiCijiQgdlo E-MallI ie� V—Se,czn,1 Architect Name&Phone# �� Engineer's Name&Phone# '1e1GtrItin -0- p 113, 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 RECORDING YOUR NOTICE OF COMMENCEMENT. 07(._ __itizt.,.., G(Signature of Owner or Agent Including Contractor) (Signature of Contractor) Signed and sworn to(or affirmed)before me this!.2 day of Signed and sworn to(or affirmed)before me this ICI day of 06SAh , •"/7 ,by �EFc ti. it/o TL -10-ju , r .Ot t7 ,by • C"\CIN,Ae- G t&c a ei A_.L 1.'_>411% . . t (Signature of Notary) (Signature of Notary) LISA A.BINDER NOTARY PUBLIC ASHLEE BURDEN -STATE OF FLORIDA ,�/ MY COMMISSION#FF914628 Personally Known OR Cort m#FF189043 [•J Y x� EXPIRES:Au 31,2019 • „_ , Personal) Known OR � � 8� [ )Produced Identification Expires 1/12/2019 [ 1 Produced Identification Type of Identification: Type of Identification: Doc # 2017236783, OR BK 18153 Page 727 , Number Pages : 1 , Recorded 10/16/2017 01 :25 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10. 00 OFFICE COPY pert,. �om ,v-, ! 7 - vagY NOTICE OF COMMENCEMENT State of FC.. _ _ Tax Folio No. 171797-0000 County of DUVAL 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: 31.1317.2S•29E ATLANTIC BEACH VILLA UNIT 2 LOTS 1,2,21,22 BLK 4 • .Address of property being improved: '10-S ' Mi eoff- '62'°4+0 Art-A-0-1-4- 1 " 4- (=G 5 Z7--: General description of improvements: FOUNDATION REPAIR owner: JEFF KLOTZ Address: 645 MAYPORT RD ATLANTIC BEACH FL 32233 Owner's interest in site of the improvement: Fee Simple Titleholder(if other than owner): _ __ Name: Contractor: RAM JACK Address: 14403 N MAIN ST JACKSONVILLE FL 32218 — Telephone No.:904-380-8488 Fax No: Surety(if any) Address: Amount of Bond S 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(2Xb),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: L Data: /�//�l�O/7 •y LISA A.BINDER Before me tis 12. day of ra 13Lr2 in the County of Duval,State NOTARY PUBLIC Of Florida,has personally appeared _rep-4g. Q. K/o T z- + =STATE OF FLORIDA Notary Public at Large,State of ///.24.20/9 lorida,county of Duval. �,. . C«,nn#FF189043 My commission expires: /.y o/9 91e Expires 1112/2019 Personally Known: iC — _or . Produced Identification: