451 INLAND WAY RES ALT PERM RESIDENTIAL PERMIT PERMIT NUMBER
RES19-0030
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 2/11/2019
ATLANTIC BEACH. FIL 32233 EXPIRES: 8/10/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
451 INLAND WAY RESIDENTIAL ALTERATION convert loft to bedroom $4000.00
RESIDENTIAL
TYPE OF REALESTATE BUILDING USE SUBDIVISION:
ZONING.
CONSTRUCTION: NUMBER: GROUP:
169463 1532 OCEANWALK UNIT 04
----- ---I
COMPANY: ADDRESS: CITY: STATE: ZIP:
BOSCO BUILDING 2158 MAYPORT RD ATLANTIC BEACH FL 32233
CONTRACTORS
OWNER: ADDRESS: CITY: STATE: ZIP:
LEVY DERRICK S 451 INLAND WAY ATLANTIC BEACH FL 32233-4682
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR 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.
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 4SS-0000-322-1000 0 $7S.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $37.50
STATE DBPR SURCHARGE 4SS-0000-208-0700 0 $2.001
STATE DCA SURCHARGE 45S-0000-208-0600 0 $2.001
TOTAL: $116.50
Issued Date: 2/11/2019 1 of 2
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road L -0 0 _,3
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed:
City web-site: http://vmw.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: L� S y��a P
Q&p.artment review required Yes -No
gilding_�)i
PI
Applicant: 6D,_�C Planning &Zoning
Tr
I ree Administrator
Project: n� )--q Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Review or Receipt
Other Agency Review or Permit Required of Permit Verified By Date
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:
APPLI-CATION STATUS
Reviewing Department First Review: MeApproved. ElDenied. E]Not applicable
(Circle one.) Comments:
(HD::JN� r'
PLANNING &ZONING Reviewed by: Date-.,d-7-c90/7___
TREE ADMIN. Second Review: FlApproved as revised. F]Denied.V F]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ElApproved as revised. OlDenied. E]Not applicable
Comments:
Reviewed by: Date:
Revised 05/1912017
NOTICE OF COMMENCEMENT
State of El-ottvoA OFFICE copyraxFolioNo.
County of pt4 vfti-
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: + F-
co r-MAI k/
Address of property being improved:
- / I-VA- -fZq4,T 1,e I IF # Z,3 3
General description of improvements:— &04,1Vd12 rf 1,0; )-OF7' 7-0 j9j5oRo0.,,j
Owner: P-459RICkS 4-- (fHR1-(Ty 1,0VY Address: 4-5�'f .140y 1011w) -:3;X -3
Owner's interest in site of the improvement: 'VeA r-
Fee Simple Titleholder(if other than owner):
Name:
Contractor: 06)av Oal4ow,�' 1AIr -7-61�919 1:jWec,
0p6TAddress: Y'som,'r R a - rwe"-low"
e ephone No.: %6 �1-4-/- &,T:9-6 Fax No: 5�,9
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 OWN
Signed: Date:
d o 6rX
da
Before me th11— I ay of r in the County of Duval,State
P
Of Flor7ida,has personally appeared 1C*- 'L 4e%J!I
Doc#2019025851,OR BK 186T7 Page 2160, Notary Public at Large,State of Florida,County of Duval.
Number Pages:I My commission" ires:
Recorded 02101/2019 11:18 AM, Personally Known-:-"'�Z' or
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Produced Identification: -(L Detfise A.EMS
COUNTY qyA.- NOTARY PUBLIL;
RECORDING $10.00 STATE OF FLORIDA
Comm#FF966426
E I Expires 3/11/2020
Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department
"ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233
HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Fax: (904) 247-5845 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 4-5 10,011'.0 Wd y R77, dell', Y-2,X Permit Number: 0-b
Legal Description -J�-f f3 7 RE#
Valuation of Work (Replacement Cost)$ (90 Heated/Cooled SIP Non-Heated/Cooled
OFFIC E GGPY
Class of Work: ONew OAddition *Iteration E]Repair ElMove []Demo E]Pool OWinclow/Pralor
Use of exi sti ng/pro posed structure(s): OCommercial MResidential
If an existing structure, is a fire sprinkler system installed?: E:]Yes MNo FFB 2019
Will tree(s) be removed in association with proposed pro*ect?P]Yes(must submit separate Tree Removal Permit) 0No
ribe in detail the type of work to be performed:
C4/v-r-e rt,�/ r -ro J3 0-
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name 1 6 cj�w��ry k�7v y Address 4-S-1 1414-11,VI2 Lj)&-y
city ffcly- State I-E,1- Zip -TJL,;-.2-7 —Phone �Vf - 013 r- 17
E-Mail V0- L12:V11
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) n/a
Contractor Information
Name of Company flepsco 13U/1-014"'iF C,40,,/7;,�Ucr/7/fdo/ael)i/fy(ing Agent 7&�Ig 46
70-F--1c),
Address Z1,ejy1'P,<7- kfo City %ate t'��4- Zip--3,Z�-33
Office Phone �Ip sL- >-4-1 -en-3-x Job Site Contact Number_ 9V4- - a--3-?-k)1v74
State Certification/Registration# e(?C,
E-Mail -FeOp a- /3'aS-CC C�1.�?c
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurer i��4 L ew(144 OR Exempt Ei Expiration Date lrll-rl�I?
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 regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBIN6,SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE: In adchtion to the requi�ements 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 A ORNEY BE ORE
RECORDI"VR NOTICE OF COMMENCEMENT.
15179nature;oOwner or gent) (Signature of Contractor)
Signed and sworn to(or affirmed) before me this day of Si ?ed and sworn to (or affirmed) before me this day of
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NOTARY PUBLIC NOTARY PUBLIC
Personally Known OR STATE OF FLORIDA Personally Known OR STATE OF FLORIDA
Produced identification Cornm#FF966426 Produced Identification Comm#FF966426
Type of Identification: Expires 3/1/2020 Type of Identification: Expires 3/1/2o2o