2265 Beachcomber Tr RES19-0217 Int Remodel PERMIT NUMBER
RESIDENTIAL PERMIT
RES19-0217
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED:
ATLANTIC BEACH. FL 32233 EXPIRES:
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 BUILDIN
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: PERMITTYPE: DESCRIPTION:
VALUE OF WORK:
2265 BEACHCOMBER TR RESIDENTIAL ALTERATION INTERIOR REMODEL $6000.00
RESIDENTIAL
TYPE OF REALESTATE BUILDING USE
ZONING- SUBDIVISION:
-CONSTRUCTION: NUMBER: GROUP:
1694630158 OCEANWALK U NIT 01
COMPANY: ADDRESS: CITY: STATE:1�
RJ VINAS CONSTRUCTION 2215 LAUGHING GULL CIR ATLANTIC BEACH FL 32233
OWNER: ADDRESS: CITY: STATE:
----------
KENNELLY BRADLEY JR 2265 BEACHCOMBER TRL ATLANTIC BEACH FL 32233-4567
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.
47
LIST OF CON DITIO NS
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 455-0000-322-1000 0 $85.00
BUILDING PLAN CHECK 4SS-0000-322-1001 0 $42.SO
STATE DBPR SURCHARGE 4SS-0000-208-0700 0 $4.84
STATE DCA SURCHARGE 4SS-0000-208-0600 0 $3.23
WORK WITHOUT PERMIT 4SS-0000-322-1000 0 $195.00
TOTAL: $330.57
Issued Date: 1 of 2
QDj___' City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
-7
800 Seminole Road
A (q - 21
tlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845 '7 CD/I
E-mail: building-dept@coab.us Date routed:
City web-site: hftp://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: geae��ccrn b pvDepartment review required Yes No
4-19-uilding
Applicant: &Zoning
Tree Administrator
Pro'ect: Public Works
R00 0 c)e L_
Public Utilities
Public Safety
F—Fire Services
Review fee Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
Florida Dept. of Environmental Protection of Permit Verified By
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: DApproved. ElDenied. E]Not applicable
(Circle one.) Comments:
BUILDING Was f"r-oyTN q STO
'01 P4
PLANNING &ZONING c)1210E?- . 0�jOvo r-e-e PVWI 10. a C/e eor
Reviewed by-.— t�v Date:
Oq
TREE ADMIN. Second Review: FlApproved as revised. F Deni V
ed. FINot applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: DApproved as revised. ElDenied. E]Not applicable
Comments:
Reviewed by: Date:
Revised 05/1912017
OFFICE (;Uijy
Building Permit Application Lpdutcd!019113
A City of Atlantic Beach Building Department "ALL INFORMATION
HIGHLIGHTED IN GRAY
800 Seminole Road, Atlantic Beach, FL 32233 IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@cclab.us
9 -7
Job Address: 6m-,L 4 s e C kA Permit Number: 7
Legal Description 4no 1- -22 1'_Ve_,,),, &e,11r-
—RE#
Valuation of Work(Replacement Cost)$ �, 00a Heated/cooled SF Non-Heated/Cooled
• ClassofWork: EINew ElAddition WAITt'eration E2�epair OMove E]Demo DPool DWinclow/Door
• Use of existing/proposed structure(s): ElCommercial OResidential
• If an existing structure,is a fire sprinkler system installed?: Dyes efNo
• Will tree(s)be removed in association with proposed prodect?E]Yes(must submit separate Tree Removal Permit) R11-0
Describe in detail the type of work to be performed:
14
6
Florida Product Approval# for multiple products use product approval form
PropertV!?wner Information
Name Address ;e7-2-Z;-Y
p 7 1
City ATTI,"t State t--�_ Zi Phone
E-Mail 14�15 J:42,f) /' , --
Owner or Agent(If Agent, Power of atorney or Agency Letter Required)
Contractor Information
Name of Company Qualifying iA it 4-i I 7e-J
ger _X
Address City
�2_c 5- e/ e'. 1-4 State zip-
Office Phone Y",/Z_ —Job Site Contact Number
State Certification/Registration# E-Mail g,411 ./-,liv
!rL A� 1 11) 4'
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer 'A"A Z11,117 OR Exempt Lj�'Expiration Date �Vc'
Application is hereby made to obtain a permit to d/o the work and installations as indicated.I certify that no work or installation s
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulatir*
X -J Z
C.) < 0
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNSO. Z P:
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WELLS,POOLS, FURNACES, BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE: In addition to the requirements OfAiju — C3
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permit,there may be additional restrictions applicable to this proWrty that may be found in the public records of this county, co Z 11,
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there may be additional permits required from other governmental entities such as water management districts,state agencieftrc.) a
federal agencies. <
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OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance with a < 0 .1
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applicable laws regulating construction and zoning. C/) li
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WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY LL
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RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND 0. cc cc
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE �; W :) C
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RECORDING YOUR NO-Tict6F COMMENCEMENT. CC
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(Signatureofo ��O'rAgent) (Signa f Contractor) Cc
igne and sworn to(or aff*(--'., t I /Oday of S)gned?nd sworn to(p rn`]E�d e e-rmne t day of
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(97ig—natu're-of Nota�y)� ignat.r.. NotNfL')
TONI GINDLESPERGER
My COMMISSION#FF 924951
Ober 6,2019
-yPiRES'OcIober 6,2019
F
wi� dertiribLirs
TTPersonally Known 0 v'� N1 13M)LESPERCER
Ppr,.�jom Kh0
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PF dii�CF wrt Produced Identificat!ion Fz, My COMMISSION#FF 924951
Type of Identificati n: 6-, OType of Identification: EXPIRES:October 6,2019
l3onded Thru Notary Public Underiji1iters
Pe r mv 12 Z-'-S / �- 02- 1
-OFFIC"
NOTICE OF COMMENCEMENT
State of op Tax Folio No. '9
County of az.,,
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 NUTICE OF COMMENCEMENT.-
Legal Description of property being improved: �2 oc-Q-Av,C"e- //c-
122-6S-
Address of property being improved: r 7-r
General description of improvements: 4-pvV77 /4e10-1We-i( CA G ;ek; J�L, 7� 1,
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Owner: LL-el7d?4 Address: ;?--Zber� Z 6,�— A34-,olc.,"A&#-
Owner's interest in site of the imprdvement:
Fee Simple Titleho Ider(if other than owner): e /-J�J,�-
Name:
Contractor: &C ",W- 1��,C
A d d r e s s: 6,A Fc
Telephone No.: qo (ee-s--yz_ 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 documentS7 m'ay
be served: Name:
Address:
LU 04
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 Sectio
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713,06(2)(b), Florida Statues. (Fill in at Owner's optio
Name: LU
C3 fl�
Address: Lu"I
Telephone No: Fax No:
.s
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different clatej,
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Doc#2019160516,OR BK 18858 Page 1006, Signed: Date: , ho
Before me this da of L".c in the County of DuJal,State
Number Pages:1
Recorded 07/10/2019 1132 AM, Of Florida,has per nally appe r d -7 c;,+�
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Notary Public at Large�-S�f horida,County�L�al.
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My Commission expires:
COUNTY or
RECORDING $10-00 Personally Known:
Produced Identification: K 4-0-
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