134 PINE ST - SIDING ' ''S CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
r II INSPECTION PHONE LINE 247-5814
RESIDENTIAL -ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES18-0031
Description: install hardie lap siding over T1-11
Estimated Value: 11450
Issue Date: 2/6/2018
Expiration Date: 8/5/2018
PROPERTY ADDRESS:
Address: 134 PINE ST
RE Number: 170632 0100
PROPERTY OWNER:
Name: CLOUTIER MARY B
Address: 134 PINE ST
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: T H AGRAM, INC
Address: 3850 PACKARD DR
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.
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.
�i1.ar�, City of Atlantic Beach APPLICATION NUMBER
�'r s� Building Department (To be assigned by the Building Department.)
800 Seminole Road r, L S' --00.
1 0 I
- - ,; Atlantic Beach, Florida 32233-5445 1- �'
Phone(904)247-5826 • Fax(904) 247-5845 f g'
%%0109 E-mail: building-dept@coab.us Date routed: 1 /� `{ t
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 3k % (\,t, Si- • De ent review required Yes No
�AA Building I/
�`1 (a M L - Planning &Zoning
Applicant: �- � � � 1 9
, Tree Administrator
Project: t (1 Ski -t Q \00 of a u.ifij Public Works
Public Utilities
'It — ( k 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 77,,,,,---rti:T .........__.... ,
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: Approved. ['Denied. ['Not applicable
(Circle one.) Comments:
:UILDIN
PLANNING &ZONING
2-'2-'2-Coq--
Reviewed by: 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
\ L ..a
�_� i .x_14 [.I `1/ I. :_,
Building Permit Application ill F Updated 12/8/17
Naw
11
City of Atlantic Beach JAN 2 3 2018
800 Seminole Road,Atlantic Beach,FL 32233 A I
Phone:(904)247-5826 Fax:(904)247-5845 C
Job Address: /5 1 I)/7 E ST Permit Number: c6- I Yj— CO3 i
Legal Description/0-/6 2 /-25-Z 9 S7 / . C 3 RE# /7063Z — O/OO
Valuation of Work(Replacement Cost)$ II ) / 4 g Heated/Cooled SF 112. 4 Non-Heated/Cooled /7 Q 5-
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial •esidential
• 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:/NST/+'(,(„ 3/4A.A Di‘... L4./r S( .0/144 C/ 444.0
TAt" oVt R e-X 1ST /h 4 T t -Is / cA G44- to< ')' C
Florida Product Approval# F 1- 131 / 2- for multiple products use product approval form
Property Owner Information /e.... �Gy
Name: M X 47 .Lieg..0 o ? / Address: /3 4 `p/NGC l?� LA
City L N77 4- SeA cH State F Zip 3 L L�.? Phone 904.3 L'7, 4f O6 Z.
E-Mail ki2..1/ $ CLOLer/ rl 0 4/$10/4.. . Co"
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Informtion A
Name of rrom any: 77114, A 4j 4 AM/ /N G Qualifying Agent:7 /fL�v#O/'1/,47-/A/1/,47-/A/ C/C
9
Address-? O P4 G t.< A14DR.0 CityVA'cL(.fWl t!/!u'Stite F- Zip IL L 4.6
Office Phone 904 , 66 2. 7 3 7 Job Site/Contact Number 90 4. 6 47. 7727
State Certification/Registration# N sl '- c E-Mail r _ /Q 4 .r/O h • ' 90
Architect Name&Phone#
Engineer's Name&Phone# /
Workers Compensation 6.J( (,µl /T 0 / /O/ / Z.I 2.-
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 BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT. i
. -bewi-
N--Y)ttAl (Signature of Owner or Agent) fPntractor)
(including contractor)
Signed and sworn to(or affirmed) before me this I l*da of Signed and sworn to(or affirmed) before me this a.3 day of
% ,___al , by rncofcA Dti euantk , moi% , by _o LL. l { . Jhfirick
(Signature of Notary) . 111111011174:._
" JENNIFER JOHNSTON
4117.1!;;;i.,.. MICHELLE SOLOMON ?a' '``•: MY COMMISSION#GG 042984
Personally Known OR [ ]Personally Known „�� ,•. ,:
Commission#GG 088121 1" '''"'' EXPIRES:October 27,2020
[ ]Produced Identificati• °moi i„1, [Produced Identific. i�+»C�: B 4.-NN tg. Pali , meters
Type of Identification: `+:'�`'`�` Expires March 28,2021 Type
A�_
�.• T e of Identification: I "1 �' l�
OFFICE COPY NOTICE OF COMMENCEMENT
'
� (PREPARE IN DUPLICATE)
Permit No. t2es / d 00 3/ Tax Folio No. /10614 - 0/ 0o
State of +az- County of J�/a -
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. 1 I l
Legal description of property being improved: ! 0 " 6 2. / 2.s 2 9 6
5A LT14- 1 A 56 a % S 1 /2. Go 7 6 70
Address of property being improved 4 /'/A e Sr
PTc A N T/c.. e4 c i-✓, , E L... 1 2 211
General description of improvements: /•1 S7'fTGt'A7/Ox, 40/ ..- ��I d1E
StPin4 4-ND r < //k/
Owner /194/ 9 C G 061 77
Address P74 10I've Sr , ,TG,4/4Tic i asp c/t 322,33
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address 'J �1
�T
Contractor H, . ,'A. A�I /Ad C•
Address �j 6.S /AO rc KA' ,.0 Pie- / 3 C2-46
Phone No. `90 4. 6 6 2.7717 Fax No.
Surety(if any)
/
Address Amount of bond$
Phone 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
Phone 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 Statutes.(Fill in at Owner's option).
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: 4 I �' Gam - DATE /ill Lf
Before me this ' .ay of ' Ai . in a
County of Duval.State of Florida,has personally=ppeared
Doc#2018017171,OR BK 18259 Page 1287, herein by
Number Pages: 1 himsel nersei n(allirms t�ia'aRstalements andlec salons erein
aretru a MICHELLE SOLOMON
Recorded 01/23/2018 12:16 PM, 'Commission#GG 088121 t
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL ;i •. =
COUNTY ;.• . . Expires March 28,2021 • +'
RECORDING $10.00
4FP,;,; Bonded MN Troy Fain(wince 800.385.7019
Notary Public at Large.Ste:of '' , County of
Gmutfcsfires: ' ;1 451
P r ally Known -ry Pr1' or
roduca tion