1826 Tierra Verde Dr RES19-0268 Replace Door RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RES19-0268
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800 SEMINOLE ROAD ISSUED: 9/13/2019
'sW119ATLANTIC BEACH. FL 32233 EXPIRES: 3/11/2020
MUST CALL INSPECTION • ! • 1 i PM FOR • •
ALL WORK MUST CONFORMTO THE CURRENT6TH EDITION (2017) OF THE FLORIDA
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:
1826 TIERRA VERDE DR RESIDENTIAL ALTERATION replace door $2900.00
RESIDENTIAL
TYPE OF
• :D •
• • GROUP:
169542 5054 SELVA TIERRA
• z ADDRESS:
PELLA WINDOW AND 350 State Road 434 W LONGWOOD FL 32750
DOOR
• ADDRESS:
FREEMAN WILLIAM 1826 TIERRA VERDE DR JACKSONVILLE FL 32233-4527
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 • •
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
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DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $65.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $32.50
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $101.50
Issued Date: 9/13/2019 1 of 2
r1!:Lyr,. City of Atlantic Beach APPLICATION NUMBER
�S } Building Department (To be 1 assigned by the Building Department.)
— V 0 800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 Fax(904)247-5845
Oil qr E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Oa Vl T ���G1y�G� pr • De ment review required Yes o
Applicant: Q �lu W11 R 46,J Planning &Zoning
1 Tree Administrator
Project: y- �c�� Public Works
Public Utilities
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
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:
PLANNING &ZONING
Reviewed by: Date: �l
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. V ❑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
OFFICE COPY
�A Budding 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: 1826 j i'Grro�_-VerdG 17'C,` Permit Number: Q('ES �/�l—I/ c�(10X
Legal Description Se\V(,\ t (Y O� 0�`21 RE# ��UM9I 2-- SOL)
Valuation of Work(Replacement Cost)$ 2_q00 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: inNew ❑Addition ❑Alteration ❑Repair []Move ❑Demo ❑Pool #Indow/Door
• Use of existing/proposed structure(s): Commercial esidential
• If an existing structure,is afire sprinkler system installed?: / Yes ®No
• Will trees be removed in association with proposed ro'ect? es must submit separate Tree Removal Permit o
Describe'in detail the type of work to be performed:
'he, 1 a,cl!, I d00K size 4�� s i 2,
Florida Product Approval# 21y 7J for multiple products use product approval form
Property Owner Information
Name\t1c\Vi am FrGetna�n Address lb 2(p Tf Cr Yo,- V evel f `r
City State_ Zip ��22'0'5 Phone gay-2 y9-27 2 3
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) n/a
Contractor Information
1
Name of Company \ d Q DCx�S Qualifying Agent Q,;M Pte$ 01A f�a
Addressmo W s`R 4,6qCity 1Qng W0601 State ' FL_ zip 32750
Office Phone 4 01" Q 3�- Z 6 y9 Job Site Contact Number
State Certification/Registration# CW 4(v 117- E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer —OR Exempt❑ Expiration Date LL1
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installatiorMas
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commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulatiLt = J Z
construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGN0 Z 0
N
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS, and AIR CONDITIONERS,etc. NOTICE: In addition to the requirements drthg 0 0
permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,Od W ZZ a
there may additional permits required from other governmental entities such as water management districts,state agencie , 00 ❑ V G
federal agencies. ® Z Z
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance with aQ Q 0 Q
applicable laws regulating construction and zoning. vV JI.... rA H
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WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAYO u. 5 g
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEpl�
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TO OBTAIN FINANCING, SULT WITH YOUR LENDER O N ATTORNEY BEFORE 3: V N W
REMN"gUR NO IC FF COMMEN�C�EMENT. W�� W
(Signature of Owner or Agent) — (Signature of Contractor) is
Signed and sworn to(or affirmed) before me this Zl� day of Signed and sworn to(or affirmed) before me his 26 day of
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Doc # 2019185627, OR BK 18893 Page 1992, Number Pages : 1 ,
Recorded 08/09/2019 12 : 01 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
Pr Number
Number
S� 9— �a 6 OFFICE COPY
Parcel ID Number
NOTICE OF COMMENCEMENT
state of Fior7dav Yom\
Courtly of
The undersigned hereby gives notice that the improvements)will be made to certain real property,and In accordance with
Chapter 713,Florida Statutes,the following Information Is provided In this Notice of Commencement.
i, Descriptio of proper legal descrl tion o(the operl
Addresy,and street address If avallabie)
s '�r �V, tf
Legal0-01ptbn
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2, Genaraldescription of Improvements)
3. Ovmerinformation
Name O.v'1
Address hone&FaxNumbcr
Interestin roperty `��
4. Fee Slmpla Title Holder(If other thin owner shown above)
Name
Address Phone&Fax Number
S. Contractor Pella WlndowS&Doors
Name out til Ctn+o Rnr^+ Phone&fax Number
Address
B. Surety(iFany) ongw
Name WA
Address'- Phone&Fax Number
7, Lendor(It any)
NamewA
AddreSSIVA Phone&FaxNumber
S. Persons with the State*of Florida designated by Owner upon who notices or other documents may be served as
Provided by 713,13(1)(a)7,Florida StatVtes.
Name
Address Phone&Fax Number
9. In addition to himself or herself,Owner desi ales the following to receive
713,13(1)(b) a wpy o(tha tlenor s Notice as provlJed In
,fiorlda Statutes.
Name Phone&Fax Numbor
Address
10,Expiration date of Notice of Commencement(the expiration date Is one year from the date of recording unless a
ellfferent date Is specified;
WARNING TO OWNER; • ANY PAYMENTS MADE DY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA
STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A N071 CE OF
COMMENCEMENT MUST BE RECORDED AND)?OSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION, 1,F-YOU INTEND TO
odTAIN FINANtI C;CONSULT YOUR LENDER#AN ATTORNEY BEFORE COMMENCING WORK OR RECORdItPG YOUR NOTICE
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