387 BELVEDERE ST - INTERIOR REMODEL LAN rjr,
.�� ' A CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
- �� ATLANTIC BEACH, FL 32233
0;3 v%' INSPECTION PHONE LINE 247-5814
RESIDENTIAL -ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES18-0034
Description: WINDOWS, DOOR AND INTERIOR REMODEL
Estimated Value: 18000
Issue Date: 2/8/2018
Expiration Date: 8/7/2018
PROPERTY ADDRESS:
Address: 387 BELVEDERE ST
RE Number: 170703 0274
PROPERTY OWNER:
Name: JOHNSON WILLIE NELL
Address: 387 BELVEDERE ST
ATLANTIC BEACH, FL 32233-4111
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: ANDESCO INC
Address: 7484 Scarlet Ibis LN
JACKSONVILLE, FL 32256
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.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions
applicable to this property that may be found in the public records of this county, and there may
be additional permits required from other governmental entities such as water management
districts, state agencies, or federal agencies.
* 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.
S,1-vp., City of Atlantic Beach APPLICATION NUMBER
�sS, Building Department (To be assigned by the Building Department.)
800 Seminole Road Est
8. fQ 03
.411:
0 Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
013 r)? E-mail: building-dept@coab.us Date routed: I /Z 4/I n
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 3 E3 7 4 . �,V c c c Department review required Yes No
fuildin
Applicant: )0E C00_0 t s Manning &Zoning
Tree Administrator
Project: V\J I N 0 0/0 s f-L c-.- ,n 2,S Public Works
/ Public Utilities
I13TE2l 02. R i 'p- r 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 -0.11/__17
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers \-;.,--,..V
Division of Hotels and Restaurants v
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: lj pproved. ['Denied. ['Not applicable
(Circle one.) Comments:‘..en/r4 c../4 jen. 14.4.64 /o PV T Al s L i C eats, it
uILDI o-ri 14 fp) zit f ioh .
PLANNING &ZONING Reviewed by: / / Date: Z -2 '02(318---
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
4 *1OFFICE COF uilding Permit Application Updated 12/8/17
City of Atlantic Beach
AMA"'
800 Seminole Road,Atlantic Beach,FL 32233
pp Phone:(904)247-5826 Fax:(904)247-5845
Job Address: 3 r & /lade c( S t 411G„114r 6:4,64 FL 322; 3Permit Number: R S I s 'OO
�. l< G �
Legal Description L,,+ 1, 61uci?, 5;�5 ;�ccv'J,,,'h "se c,/94.1 4i rtc 35�n F�°I , IREy#Lu;4 %-70 7 03 -0J-7(1
Valuation of Work(Replacement Cost)$ Heated/Cooled SF /5 gNon-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: 4.e e(c_Ce- (r12 r! w
FLtz :' S ( PL.,-.. r 9 bey IA I(
Florida Product Approval# giO'( ( FL I I-241 . S for multiple products use product approval form
Property Owner Information 6%6T. �`Z. lir 00,.✓S
Name: W�./L-,, i-h((S (LC Address: 222 / Ali is Lu
City A1-Iti„4,L State /-e- Zip 3 2 2 3 3 Phone (6D ) 3$
E-Mail k le 9 LA/rlhow4-culESC-Lte •+a ( • cv-�
Owner or Ager t(If Agent, Power of Attorney or Agency Letter Required) 4?16/21e
Contractor Information
Name of Company: iA £a 1.1 ••�l_1' • a Qualifying Agent: fro Cirt%Irt°XO
Address1L1 Sct i •`S ..r). City 7& Ck' CnNIIC State 1-t- Zip '1.7` %.J56
Office Phone 4(JI toe Cl . Job Site/Contact Number qc�d c yact%
State Certification/Registration# — 8.533 E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation A C -s t' trwp)cc y (- 1 1 Z
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. NOTICE: In addition to the requirements of this
permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and
there may be additional permits required from other governmental entities such as water management districts,state agencies,or
federal agencies.
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 BE ORE
RECORDING YOUR NOTICE OF COMMENCEMENT. 4 /
ignature ner or Agent) (Signature of Contractor)
(inclu ng contractor)
Signed and sworn to(or affirmed)before me t(lis 2Z- day of Signed and sworn to(or affirmed)before me this 2 a day of
,by k.11 C b:c U ��1,.,� , '7o lam,by
Tdr6iir:�'• LUZ ADRI t'''•°''• LUZ ADRIANA
., ((Siggnature of Notary) :t'•' '4= ( � Aibtary)
MY COMMISSION#GG091019 MY COMMISSION#GGO91o19
ES Ail 06,2021 ' r
[ Pt' y Knovlr pr [ ]Pers�o •wn OFEXPIRES April 06,2021
[ Produced Identification [ ]ProdwwrPd Identification . Z-
Type of Identification: t�— 'I Type of Identification:
t (�� I,ue eye
Perym-/- / 8'--°c)3 / s
NOTICE OF COMMENCEMENT
State of FIprida OFFICE COPYaxFolio No.
County of !J U V c+ I
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: L o f 1. / /?/vr,k 2 , Sr a s f., 1 a c Coed oi -fn -'h r uvi�f2 u' P 1a{ Awe(
os recori�d Ply „� 35 Poe(s) Gy laid 4/./9 S 7 c P'dl« ,,wrIi of Da, I (D,,7-) ; F/�,�✓ti .
Address of property being improved: 3 &.I ve ade Si- j4+14471,, /3 e,c4 / FL 3 a .2 3 3
General description of improvements: A I 1 c "71 o'`S
Owner: UV" kw TAMS LLC Address: 2221 14IILia Lh ,-/-L,A4 6,,AG4,PL 32233
Owner's interest in site of the improvement: 0(Ah'1C
Fee Simple Titleholder(if other than owner):
Name:
Contractor: P rI CO COnSbrUCtial �nC. `Q c,
Address: 11-4 2)t-i �4X S �.--t�3.Qi '�'a'1'd v t iC..��L. c3 0\61,C. ,
Telephone No.:tCY-4.Yael- /525 Fax No:
Surety(if any)
Address: Amount of Bond$
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(2)(b),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: `! Date: ''/ 6
- "4
Doc#2018018331,OR BK 18261 Page 411 Before me this 72 day o 3'" --'-7 per?, in the County of i val,State
Pages: 1 6, Of Florida,has personally appeared J'<I e b;c :�Y
Number
Recorded 01/24/2018 12:04 PM, Notary Public at Large,State of Florida,County of Duval.
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL My commission expires: 0"Z OG 2-1
COUNTY Personally Known: or
RECORDING $10.00 Produced Identificatin:: `•'4".RZ LANA SANTAMARIA
;`c MY COMMISSION# r' ' •
=°+' EXPIRES April 06,2021