1921 SEMINOLE RD - BATHROOM REMODEL (..
,ti��„ CITY OF ATLANTIC BEACH
`°' 800 SEMINOLE ROAD
\,,,_
J v� ATLANTIC BEACH, FL 32233
013 a%' INSPECTION PHONE LINE 247-5814
RESIDENTIAL - ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES17-0321
Description: BATHROOM REMODEL
Estimated Value: 10000
Issue Date: 12/22/2017
Expiration Date: 6/20/2018
PROPERTY ADDRESS:
Address: 1921 SEMINOLE RD
RE Number: 169542 0530
PROPERTY OWNER:
Name: JONES RAYMOND E
Address: 1921 SEMINOLE RD
ATLANTIC BEACH, FL 32233-5903
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
,
Phone:
Name: R F CARTER CONTRUCTION, INC.
Address: 1872 BEACHSIDE CT
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$7,500.
'r Building Permit Application Updated 5/5/17
r �:, City of Atlantic Beach v K.. ' t . rtc.2.2,lel
800 Seminole Road, Atlantic Beach, FL 32233
-.on 9 Phone: (904) 247-5826 Fax: (904) 247-5845
Job Address: 1 ct Z \ V,,•is-lol:- VAL Permit Number: F E(7 0 32_ (
Legal Description -VL -(404f 2-5 2Z' �; ,E.74c4.-{'5 0` Loi VA .t 1 RE# 1(o9 S 4L O c 3 b
Valuation of Work(Replacement Cost)$ 10l 006 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New AdditionIteration1j Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial c&esidentia1)
• 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: Win;- r— 2.4 .,,, vv.aC(_t.. 12,Eec.A4ZC Et-t-51-1 Nc.,
(1.7-.) 7 grab it . US oi= E1.15r r or., Vi0w_birLrs •
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: .7--A-ti 0.,....,t, Jv/4E.. Address: \S 2-1 SEAN( y (2-4.
City 471.4-$11 t_ --F,«}cr} State FL Zip 3 Zzz�77 Phone No t) t - 'Mpg
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) C r€(Z-
Contractor Information
Name of Company: V F. �Ee-Cr,rig"1-12s%Gcl�ckQualifying Agent: 12-14;-J4i -9 C4wTeC-
Address 181 Z- A.CH-,►i�c, Cr f-J-iCity4Tt rttCt. ijc4cLtState F` Zip "3 2_2.-3Tj
Office Phone( .v'1) 1 Lk 2-- 1 4 7-c- Job Site/Contact Number LIRc A) 1A _-1 4-2-t,
State Certification/Registration#c-t? 044.114( E-Mail t--+fit-1A-¢-0 C.42Tc t2 ' Po ri-"7LA;--h- , 14&-i--
Architect
iArchitect Name&Phone#
Engineer's Name& Phone#
Workers Compensation E' Evv.Ar ti--i 2otct
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 NO E OF COMMENCEMENT.
p4047,74ex./ i (it,j,,,Q po=____
(Signature •i wner or Agent) (Signature of Contractor)
(including c. tractor)
Signed and sworn to(or affirm:t) •ef•re - this r day of Signed and sworn to(or affir ed) before me thisday o
r
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., , •.t. _ 'U , o (r by %6(16(1-0 �h
-i gaiiiiirAta`A ,
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v, JE NNETTE I. I BERRY (S'gnat r• otel#icHeryl�y
OPP
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. «;'commission#FF t 640 Notary Pubic
��:.:oc Expires July 15,20 (�• • State of Florida
pF Flf;C`° Bonded Tm„troy Fan Insurance eooaesao1e i► My Commission Expires 11130/2021
Commission
[t ersonally Known OR [ ]Personally Known OR No.GG 155172
[ ] Produced Identification [ oduced Identification
Type of Identification: Type of Identification: p(U)p_Ai5 L\__