134 Pine RES18-0221 ?» CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL- NEW SINGLE FAMILY RESIDENCE
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES18-0221
Description: KITCHEN REMODEL
Estimated value: 300DO
Issue Date: 6/28/2018
Expiration Date: 12/25/2018
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: IREMODEL INC
Address: 4786 N SANDY RUN LN CHRISTOPHER BROCK NEVSETA
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.
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$7,500.
City of Atlantic Beach BER
Building Department E!M]
g Department)800 Seminole RoadzZ �Atlantic Beach,Florida 32233-5445
Phone(904)247-5826, Fax(904)247-5845
E-mail: building-deptecoab.us
City web-site: hep:1Nvww.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 13+ P) �F I De aliment review re aired Ye No
II uildin
Applicant: t �E(YIODE� I N� Planning&Zoning
PP Tree Administrator
Project: � ITn ,_rc- C) 1�,E411 ci,L C—�-- Public works
Public Utilities
Public Safety
Fire Services
Dept Signature M,
MReview or Receipt Date
13evemg—
Other,
gency Review or Permit Required of Permit Ver'died B
ept.of Environmental Protection
ept.of Transportation �r [yam
River Water Management District
rps of Engineers
f Hotels and Restaurants
of Alcoholic Bevemges and Tobago
APPLICATION STATUS
Reviewing Department First Review: Approved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDIN /V VCi
PLANNING &ZONING Reviewed by: Date: 02/-WP"
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. []Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY
Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/1912017
Building Permit Application Updated 1218/17
City of Atlantic Beach
BW Seminole Road,Atlantic Beach,FIL 32233
fl� Phone:(904)247-S826 Fax:(904)247-5845
Job Address: Permit Number: R E-s i F,-(D
Legal Description III '21-15-tlf X It MC. % 6!A 07' 070 RE#
Valuation of Work(Replacement Cost)$ 160 1 l Heated/Cooled SF-Non-Heated/Cooled_
• Class of Work(Circle one); New Adciition4S� Repair move Demo Pool Window/Door
• Use of existing/proposed tructure(,)(Circle one): Commercial 42�
• If an existing structure,is afire 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
t'r
"Ile r'r
x,aot fuorxy -r, Tlt-AI40. CAIWAIX
Florida Product Approval#�for multiple products use product approval form
Provering Owner Information
Name: CAAVT Address: r
M I
city AZLA91'= ACIIII State Ill zip
E-Mail LL-
Owner or Agent(if Agent,Power of Attorney or Agency Letter Required)
Contractor Informati on Qualifying Agent: 0
Name of Company,
Address city State zip 3%A&I4
Office Phone - Job Sifte/Cont
State Certification/ egist ation 4 E-Mal. ruxts e CIOM fA
Architect Name& hone# AIA � � Z
Engineer's Name&Phone# AtA -------- V
0
Workers Compensation murerj= ( is
Exempt/11 (. eEmpK� �l�-Plr,mn�
Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or inst t1a bsZ
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws replo's 00
construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK,PLU MBING, FM,< a
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc.NOTICE:In addition to the requirem s3 fjsz,
permit,there may be additional restrictions applicable to this property that may be found in the public records of this co torw
there may be additional permits required from other governmental entities such as water management districts,state a
federal agencies. U.
lance 1,191
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in com W
IC lo
applicable laws regulating construction and zoning. W n 0
tu
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEM 0
CC zu
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF I END E
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNE E
-.ORDING YOUR NOTICE OF COMMENCEMENT.
tLn
P'
ENT
YOU
BEFC,
R
L6;.
(Signature of Owner or Agent) (Signature of Contractor)
(including contractor)
ned and sworn to(of affilmined)before me thi;LP day of kigned and svvo��toor affir I oreAethisl da of� 0
i, by
by (%[I"! clollhLy
in
bur
f t.')
f ota a
(SignInture" f I
(Signiiture ofr)taw A
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a
Personally Known OR �'Per=K.wnOR
ro denfific I
Produced Identification antifi ato":FE, 0( -'�
Type of Identification: Type of Id "tion
1
NOTICE OF COMMENCEMENT
State of Tax Folio No.
County of
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: 10-16 11-25 '29£ SA6T4%x SAL 8 51/2 Lar 070
Address of property being improved: by Ps u1L $T
General description of improvements: /LYRNIF.A1 SZS.NeDLL
Owner: NARY A CL*dTZLR Address: 14)q PZAl& Sr a
Owner's interest in site of the improvement: A/4
Fee Simple Titleholder(if other than owner): AIA
0
Name: 0
n r
Contractor: WARL6 NV,VbLTA
0
rc
Address: 11784 SANDY RuN LA1 Al .. o-0
m �
Telephone No.: (10yoMGs'2369 Fax No: (toy) ATZ '1'S11/
Surety(if my) INA o 0 8
r o
Address: Amount of Bond$ w w
z
Telephone No: Fax No: a E w 0
Name and address of my person making a loan for the construction of the improvements s6 2 z 0
'
8 �00,
Name: I NA ozrcrcOW
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: —NA
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)(6),Florida Statues. (Fill in at Owner's option)
Name:—1 AfA.
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 OWNERy��
Signed: 1 v O-^ 6 lox- .il Dam: �a ji9 ID
Beforeme this ffi4k day o I unp m the County of Duval,Stam
�• n' JLNI M.)AWET Of Florida,has personally appeared law fA
' NMary Poblit-Stale dNwWa Notary Public at Large,State of Florida,Cou of Duval.
CemnlssbnrIMET 9s
MYComm.6pi.Ap15,2022 My commission expires:
Personally Known: ✓ or
Produced Identification: