571 SELVA LAKES CIR - REPAIRS frI \
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s: CITY OF ATLANTIC BEACH
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800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
''."1.Oil v� INSPECTION PHONE LINE 247-5814
RESIDENTIAL - ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES17-0278
Description: REPAIR TERMITE DAMAGE - LIKE FOR LIKE
Estimated Value: 2375
Issue Date: 11/22/2017
Expiration Date: 5/21/2018
PROPERTY ADDRESS:
Address: 571 SELVA LAKES CIR
RE Number: 172027 5528
PROPERTY OWNER:
Name: BLACKBURN LESLIE
Address: 571 SELVA LAKES CIR
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: FIELD RENOVATION SPECIALISTS LLC
Address: 2259 Forest BLVD
JACKSONVILLE, FL 32246
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.-W1-4.4. City of Atlantic Beach APPLICATION NUMBER
/t � Building Department (To be assigned by the Building Department.)
v 800 Seminole Road
s)
u -r Atlantic Beach, Florida 32233-5445 ` \ E 7 — v Z 7
Phone(904)247-5826 Fax(904)247-5845
Pion ty? E-mail: building-dept@coab.us Date routed: I ( (J i 7
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 5 / ( 3 as,p, EAK&, Ci , De artment review required Yes No
uildinc_)
Applicant: n E-1, 1) R .1\-)011 R}7t 0‘ -)SPe , Planning &Zoning
Tree Administrator
Project: R E.F t i -121-1A 1 r& okc� 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 �1
St. Johns River Water Management District 1110P—
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: ✓Approved. nDenied. ❑Not applicable
(Circle one.) Comments:
:UILDINf.
PLANNING &ZONING ���l6-�
Reviewed by: �� Date: 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: ❑Approved as revised. nDenied. nNot applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
S' Building Permit Application
OFFICE COPY
A )s City of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
s>"' Phone: (904) 247-5826 Fax: (904)247-5845 (�
Job Address: 571 SELVA LAKES CIRCLE ATLANTIC BEACH,FL 32233 Permit Number: t\E,S '7 - 0 Z 7g
Legal Description 43-11 17-2S-29E SELVA LAKES UNIT 2 LOT 66 RE#
Valuation of Work(Replacement Cost)$2,375.00 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:
REPAIR TERMITE DAMAGE LIKE FOR LIKE
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: LESLIE BLACKBURN Address: 571 SELVA LAKES CIRCLE
City ATLANTIC BEACH State FL Zip 32. 233 Phone 904-994-7471
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) OWNER
Contractor Information
Name of Company: FIELD RENOVATION SPECIALISTS LLC Qualifying Agent:
Address 2259 FOREST BLVD City JACKSONVILLE State FL Zip 32246
Office Phone 904-254-5058 Job Site/Contact Number 904-254-5058
State Certification/Registration# CBC059152 E-Mail fieldoffla@aol.com NOVArchitect Name&Phone# NA
Engineer's Name&Phone# NA
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
RECO DING YOUR NOTICE OF COMMENCEMENT
(Signature of wner or Agent including Contra tor) (Signatur- • Contractor)
Signed and sworn to(or affirmed)before me this LA day of Aned and sworn to or affir before"�e this day .f
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[ ]Personally renown UN [ ]Personally Known OR %F;::; Bonded Thru Notary Pubic Underwriters
()if-Produced Identification7 - [ 1 Produced Identification / / q
Type of Identification: rL£ -B�Z I "5Z I - 63--c 05_0 Type of Identification: F 43o -i7 -6 l��0 - S 1
OFFICE COPY
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OFFICE COPY
REVIEWED FOR CODE COMPLIANCE
CITY OF ATLANTIC BEACH
SEE PERMITS FOR ADDITIONAL
REQUIREMENTS AND CONDITIONS
REVIEWED BY: le_ DATE: a-/6-17