390 SKATE RD - INTERIOR RENO CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL - ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES17-0204
Description: INTERIOR RENOVATION
Estimated Value: 30000
Issue Date: 10/17/2017
Expiration Date: 4/15/2018
PROPERTY ADDRESS:
Address: 390 SKATE RD
RE Number: 171667 0000
PROPERTY OWNER:
Name: JACKSON DELORIES ET AL
Address: 8223 BRACKRIDE BLVD S
JACKSONVILLE, FL 32216
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: HAGERTY CONSTRUCTION AND
Address: 12850 WINTHROP COVE DR QA QUIN J HAGERTY
JACKSONVILLE, FL 32224
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.
City of Atlantic Beach APPLICATION NUMBER
.• Building Department (To be assigned by the Building Department.)
si 800 Seminole Road
�� Atlantic Beach, Florida 32233-5445 C-S `7 ' �-/ z
Phone(904)247-5826 • Fax(904) 247-5845
E-mail: building-dept@coab.us Date routed: 10 l �-
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 390 I<QA-e t C, Department q
e_ons-{
Deartment review reuired Yeso
BuildingApplicant: k E'(` Poop/AD g &Zoning
ee Administrator
Project: 1 (vC{Z(OG__T - RE Do\i f- - p1U 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:
APPLICATION STATUS
Reviewing Department First Review: roved. ❑Denied. I Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date: /0 /off -/7
TREE ADMIN. Second Review: Approved as revised. ❑Denied. ❑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
c.`�yj�: Building Permit Application OFFICE COPY
_ City of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
' Phone: (904) 247-5826 Fax: (904) 247-5845
,;(Skate Road RES 1 7- Q -O4
Job Address: Permit Number:
Legal Description Lot#23, Block#23, Royal Palms RE#
Valuation of Work(Replacement Cost)$ 30,000.00 Heated/Cooled SF 1,336 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:
interior renovation of bathrooms and kitchen, including flooring, no added plumbing or electrical fixtures
Florida Product Approval# N/A for multiple products use product approval form
Property Owner Information
Name: Dolfin Properties LLC Address: 1817 Twelve Oaks Lane W.
City Neptune Beach State FL. Zip 32266 Phone 904-536-1649
E-Mail scottwilliams@cbvf.com
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: Hagerty Construction&Roofing, Inc. Qualifying Agent: Quin J. Hagerty
Address 12850 Winthrop Cove Drive City Jacksonville State FL. Zip 32224
Office Phone 1-904-992-9960 Job Site/Contact Number 1-904-591-4354
State Certification/Registration# CGC 019551 E-Mail hagertyinc@yahoo.com
Architect Name&Phone# N/A
Engineer's Name&Phone# N/A
Workers Compensation Bridgefield Employers Insurance Company
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.
bt.1( A))1/ .-4(&44,0Jr_
(Signature of Owner or Agent including Contractor) �� (• :n. . ontractor)
Signed and sworn to(or affirmed)b-fore me this 10 day of Signed a • orn • 'r affir -d)before me this 10 day of
October , 2017 , biffi. • Williams Octobe V 7 , by Quin J. Ha•e
Ani _ /1
;571.7r•IOfJNblty o(Signature of' otary)
cpm:' w ``:. ,TARY PUBLIC #°` --1....(1, JAKE MILLENDER
ATE OF FLORIDA r • • MY COMMISSION940637
FF 940637
t
10;1 - in" EXPIRES:December 2,2019
., • omm#GG 119052 ,^+rip r0.1" Bonded thru Budget Notary Services
[x)Personally Known OR Expires 6/26/2021 [x]Personally Known OR
[ I Produced Identification [ 1 Produced Identification
Type of Identification: Type of Identification:
NOTICE OF COMMENCEMENT atteggiklil
�7 (PREPARE IN DUPLICATE)
Permit No.X�-S/ ` - ( o� Tax Folio No. 171667-0000
State of FLORIDA 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.
Lot#23, Block#23, Royal Palms
Legal description of property being improved. y
a.
Address of property being improved: Skate Road,Atlantic Beach,Florida,32233 Co)
w
General description of improvements: interior renovations C)
Li.
Owner Dolfin Properties,LLC LL
Address 1817 Twelve Oaks Lane W.,Neptune Beach,Florida,32266 0
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor061/
Hagerty Construction&Roofing,Inc.
Address 12850 Winthrop Cove Drive,Jacksonville,Florida,32224N.
Phone No. soa-992-ssso Fax No. 904-992-9961 ..,,
LU
Surety(if any) o N
Address Amount of bond$ Z N
Phone No. Fax No. Q = .-1 Z
_Joao d
aaoF-
Name and address of any person making a loan for the construction of the improvements. n w p
H
Name —0 U 8 V G
Address
Phone No. Fax No. d Z O a
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other 1, H 1--
documents may be served: O CC Q — w
LL �
Name u' cc 2
Ill
Address O a Q m
Phone No. Fax No. - W o W
W V N W
cc
In addition to himself,owner designates the following person to receive a copy of the Lienors Notice as provided in> W
W
Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option). CC
Name
Address
Phone 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! iL•kl— TE II).'fl.1/
Before me this day of in the
County of Duval,State of Florida,has personally appeared
F OR BK 18149 pay 2264, SCOTT WILLIAMS herein by
Doc#2017234258
Number Pages:1 are true and accurate I
Recorded 1011212017 10:58 AM, _opRYq� Quin J.Hag..
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL •
o� on NOTARY PUB ,N
COUNTY lir�Ci,i,:`t o STATE O'14 4.
RECORDING $10.00 .. '—
Notary Public at • :7--':.-..f FLORIDA o' r'. 'Ea
My commission expi—. expires 2612
Personally Known b oW IF
Produced Identification