1969 BEACH AVE - SIDING & FRAMING REPAIR �ay7j,,�
6' , t CITY OF ATLANTIC BEACH
ss1
'_ 1.'` 800 SEMINOLE ROAD
15rr ATLANTIC BEACH, FL 32233
'"!,;1 S) INSPECTION PHONE LINE 247-5814
RESIDENTIAL - ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES17-0280
Description: SIDING REPAIR AND FRAMING AS NEEDED
Estimated Value: 1000
Issue Date: 11/28/2017
Expiration Date: 5/27/2018
PROPERTY ADDRESS:
Address: 1969 BEACH AVE
RE Number: 169698 0000
PROPERTY OWNER:
Name: GREIDER JACK L JR
Address: 1969 BEACH AVE
ATLANTIC BEACH, FL 32233-5936
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: SUNSHINE COAST CONSTRUCTION
Address: 513 VIKINGS LN QA JOSEPH MARTIN RUMANCIK
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.
01Jvt;74., City of Atlantic Beach APPLICATION NUMBER
Js Pr IA Building Department (To be assigned by the Building Department.)
800 Seminole Roado
e s� L CJ
u- �r Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
�? E-mail: building-dept@coab.us Date routed: L L l t C it 7
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I 1 e09 ERC L.( I-'C V e- Department review required Yer No
uilding V
Applicant: JUA:)SCnllf�6 ( l0 �S� cO/�ST nning &Zoning
Tree Administrator
Project: S t O I k G „ P A-(. 2 Public Works
(� Public Utilities
P.0") D 1 `EP LAC& 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: [1 Approved. ['Denied. ❑Not applicable
(Circle one.) Comments: iv
6 L.._
BUILDIN
PLANNING &ZONING by: /,,� 7/7
Reviewed �/ Date:
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
0 '• n Building Permit Application Updated5/5/17
City of Atlantic Beach OFFICE COPY
800 Seminole Road, Atlantic Beach, FL 32233
• n, Phone: (904) 247-5826 Fax: (904) 247-5845
Job Address: /1/6(1 I3t4cH /¢VEN"t Permit Number: R6I `-- OZ&O
LOiS ri Go
Legal Description /<-6 ? -LS — zit /U, kT.4�v;s' �;q<,4 I/N/T Aa; L RE# /6 y 61 g-OJOJ
Valuation of Work(Replacement Cost)$ 20,o.'.✓ Heated/Cooled SF Afir _Non-Heated/Cooled/`'off
• Class of Work(Circle one): New Addition Alteration Rep. r Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Corn ercial Residenti
• If an existing structure, is a fire sprinkler system installed?(Circle on . 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:
REP41,2 wG00 R0,411 R5/144711//v6S AfEOEO 4- f14in,N6)
Florida Product Approval# FL, J Z$ 7S j L sd&i4 ) for multiple products use product approval form
Property Owner Information p
Name: Da. JAck L &2E/OFG R. Address: /toy , EA(N ,4 (/E,vut
City /47CgNTI. , f4 c4 State FL. Zip 32—Z3i Phone yoy. 70C - 5'5T0
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) DR., JQc jc (. GRE/,OEC ,f/l.
Contractor Information
Name of Company: SV f'-fl+v( Co/fir CON774Cucr /Qualifying Agent: J°S,FPN M, /+s vMg tiC/,t
Address C13 frig/iv bs C 4"E City ,4 8 State G 1. Zip 32Z3/
Office Phone 'lo( . Zo3. /08 y Job Site/Contact Number 9qy. 208 . /084/
State Certification/Registration# CS 11 5"63'i E-Mail S tixiSh;i1ec-cei 5r/4C. Coni
Architect Name&Phone# /V
Engineer's Name& Phone#
Workers Compensation rR I GE.," /4/5 VgA/mac 6 SOC v j IOA'/ Gori ve (,441 E / 1/3c//$
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 ATTO' NEY BEFORE
RECORDING OUR NOTI, a F COMMENCEMM ► T.
A --'
(Signatur, •f Owner or Agent) (Signatur• of Contractor)
including contractor)
Signed and sworn to(or affirmed) before me thiis I S day of $igkedSi and sworn to(or affir a.)before me this day of
rJ OJ Lo,'o aon , by Utta- LI-6"d Cfi t&Qi.1(• 01 ,zo 17, bylA ..s d . e` k•
*�1. • - . ►. . Signatur : • otary)
[ `:? !a•, JENNIFER JOHNSTON
i <:•• •.�; r9.•a TONI GINDLESPERGER
1'
':+__ MY COMMISSION q FF 924951
=k_' ra, MY COMMISSION#GG 042984 EXPIRES:October 27,2020 '
j? G ,".•` Bonded Thru Notary Public Underwriters `y�•. vop EXPIRES:October 6,2019
[ ] Personally Known • [ ]Personally Known OR '•4.`,`;•`' 13ondedThruNotary Public Undenvriters
[)Produced Identifica i. [ ] Produced Identification
Type of Identification: F L dt,�9`S \;Li?1\SQ Type of Identification: I `
NOTICE OF COMMENCEMENT
•
State of t°4 I°4 County of 0 v oh. Tax Folio No. / 47 6 7 f - 0004)
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of
the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: IC- OC? 1 -L.5 -2.It 1/ n7G441/C. /gilt b (-11frir
itio 2 to T5 51/ (90 otg Rk S 6 7 yi —'id/ 610/ —790 •
I
Address of property being improved: IT CI t6f44 4ve44d. 117c47iJric /3t4c4/A't S'Z 2 51
General description of improvements: Cioliv& Rk"..4/
Owner: DR... JAc k L. 6i 1064 JR Address: //1/ ht" 4-u"'i-'1 4 8 il 3 ZZ 4
/
Owner's interest in site of the improvement: 0 wit/b.g
Fee Simple Titleholder(if other than owner): 11/fit'
Name:
jt
i\IC /b74
)pontractor: S vivi it pv L (o,hr c0,44/44,crwt- i pLic Jo 6 kum 4/1"(:-a
Address: ni Va/4/65. L 44/e /1/2j Ft, ;22 Li
Telephone No.: 10 4 • 241. JO 8 I Fax No:
Surety(if any)
Address: 4á/Kt Amount of Bond$ ./. ./1-.
Telephone No: ///4 Fax No:________
Name and address of any person making a loan for the construction of the improvements
Name: '7*
Address:
1
Phone No: Fax No:
Name of 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 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))at Owner's option)
Name:
Address:
74/47"
Telephone No: 1,1- ' Fax No:
Expiration date of Notice of C encement(the expiration date is one(1)year from the date of recording unless a different date i
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
/...40111
Signed:2( .-_,,,r-1 -,-/
Date:,...-- , Da 1,// 7
Before e l• day of NtiV4A4 Ablin ihe Count3of Duv State
Doc#2017272321,OR BK 18200 Page 1842, Of Florid. has personally appeared U 4-0-- U.Q-to-net 6.1fLY-4. 7 •
Number Pages:1 Personally Known: or
Recorded 11/28/20170314 PM, Produced Identificatio,: P '• kS 'Le-ns
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Notary Public: \ ' Iv
COUNTY My commission ex,res: - -
RECORDING $10.00 , -____ _. ;
JENNIFER JOHNSTON
,,,,•osiv-,.,4,',
•:':. '':% mY COMMISSION#GG 042984
EXPIRES:October 27,2020
"::e9,,,,-,71.0,V Bonded Thru Notary Public Underwriters
—1:— .--..--7--. —