360 1st St RES19-0319 Kitchen Remodel s"'' RESIDENTIAL PERMIT PERMIT NUMBER
:J 1 . e
j CITY OF ATLANTIC BEACH RES19-0319
ISSUED: 10/24/2019
KV 800 SEMINOLE ROAD" ATLANTIC BEACH. FL 32233 EXPIRES: 4/21/2020
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:
360 1ST ST RESIDENTIAL ALTERATION KITCHEN REMODEL $25000.00
RESIDENTIAL
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169750 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
SUNSHINE COAST
CONSTRUCTION 513 VIKINGS LN ATLANTIC BEACH FL 32233
OWNER: ADDRESS: CITY: STATE: ZIP:
DAVID W NEWMAN
REVOCABLE TRUST 360 1ST ST ATLANTIC BEACH FL 32233-5347
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.
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 $180.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $90.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $4.05
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.70
Issued Date: 10/24/2019 1 of 2
i
0s? „" r RESIDENTIAL PERMIT PERMIT NUMBER
-.L CITY OF ATLANTIC BEACH RES19-0319
DV :" ISSUED: 10/24/2019 I
r ` 800 SEMINOLE ROAD
'u'3 � EXPIRES: 4/21/2020 ATLANTIC BEACH. FL 32233
TOTAL: $276.75
Issued Date: 10/24/2019 2 of 2
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
-^_ 800 Seminole Road 9
' Atlantic Beach, Florida 32233-5445 GS �.
Phone(904)247-5826 Fax(904)247-5845
n ;t 9),, E-mail: building-dept@coab.us Date routed: /CD / / ( 7
City web-site: http://www.coab.us LLL
APPLICATION REVIEW AND TRACKING FORM
Property Address: 36 vDepartment review required Yes No_
wilding _ _?
Applicant: OADSklt1/4.DC C C)145 t'�iJ� Planning&Zoning
Tree Administrator
Project: K 7.-El=i (\o Q F( 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:
APPLICATION STATUS
Reviewing Department First Review: proved. ❑Denied. 1Not applicable
(Circle one.) Comments: NO G
:UILDING
PLANNING &ZONING Reviewed by: / //may,� Date:/0 22-ac/g
TREE ADMIN. Second Review: ❑Approved as revised. ❑Den . ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: I /Approved as revised. ['Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
rs"—All4,� Building Permit Application OFFICE COPY Updated10/9/18
i~ City of Atlantic Beach Building Department **ALL INFORMATION
U7800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
on SP' IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 3 b 0 1 71 57x117 Permit Number: • GS l 9
Legal Description 5.--61 LI-i5 Z`Ie, 2 /�7c•ttitic /�fkli 12(Cot 13 Rf�O 170R#} lu i f 9? - 00//00
Valuation of Work Replacement�Cost)$ 2_ ,/ you Heated/Cooled SF 17't Non-Heated/Cooled s'��
• Class of Work: ❑New DAddition tAteration ❑RepairpMove ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial C1dResidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes LI No
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) No
Describe in detail the type of work to be performed: /4Ma✓f E,r,s r/,vd X iTCN£N (r4i/Nf r S/ CU✓N7tRs
AA,D /ZEPLAcE IA., t r,nic/A LuLATrd.M, ltiEaio,,F XI '7)NG DEck I3OA05 /I fD A/P1-1`4
Vv ii N JJ 1'+' JJECIC /3oA2Of,
Florida Product Approval# /V/4 _ _for multiple products use product approval form
Property Owner Information 5 RfEr
Name 0AvE P/EwAr/l'✓ Address 3 ta0
City ATLAtLT,t 6E404 State CC Zip 32233 Phone 76y 60g, 'r'67
E-Mail d wA yg a Inde . C.a M
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) 61.,,,t4
Contractor Information a
vC
Name of Company 5v N51114/1 CoA I7 c0A,5i//CT"/ Qualifying Agent J°SE1 N /Yj "Gp1AA'4-//r p
Address /3 i//KjNVS L-AtiE City AI State it Zip 3 22 1011 1
Office Phone_ fj 61 f, ZDg. l6'ti Job Site Contact Number /0`/. 24, %p�l'y 0 cl
State Certification/Registration# CPC 1Z St 3' r E-Mail Joe c SVASh;4Q C a1 5 t 1 4 C. CO, 1 N r`1
Architect Name&Phone# A'14 4 = J Z `
Engineer's Name&Phone# /4/i/fiCJ___U `„L 2 N
Workers Compensation Insurer CaN✓ek6ftic6 OR Exempt❑ Expiration Date /0///ZUrtLu 2
Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or installati s a 0 a
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regul inU Q U C
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIG ,I”' 2
WELLS, POOLS, FURNACES, BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE: In addition to the requirementfpfiso 4
permit,there may be additional restrictions applicable to this property that may be found in the public records of this count a cn fp_
theremay be additional permits required from other governmental entities such as water management districts,state agentsx(Y F Z
federal agencies. LA- LI. El S
OwUJ
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance witl$11 a [C m
applicable laws regulating construction and zoning. : 7.- W Q W
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAX CO cc W
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTth
ID w
cc
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN..AT7te 'NEY BEFORE
REC YOUR NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) (Si; ature of Contractor)
Si�n d and sworn to(o affirmed)before me this (1 day of Signed and sworn to(or . fir, ed)befo • me is da_y of
, ? 1) .b DCM(,l Ne,vJw h O( 7or�F2, 20 K , J Jo5,�:/c= c _
Signature of Notary) �- 0 Sign.tur- of N�.ry) —
�pp MARY BRANHAM
r+ -P`
� � Notary Public,State of Florida
R „�;, " C ssionq 238078 4
:i�,I].,ry Ologne rig 9.24,2022 �,(i]icrsonally Known OR , ,;;r•,,,
Pra ce I en ificatinny� [ ]Produced Identification iI''' % TONI GINDLESPERGER
*d ;* MYCOMMISSION#
Type of Identification: J/v Type of Identification: GG _. ,
n�RVSMI( yP ,
NOTICE OF COMMENCEMENT
State of �LU21 Q Tax Folio No. 4/17 7 - 0000
County of OV✓A 1.-
To
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. s-�
Legal Description of property being improved: C- 61 21 - �5 - Z tiE, I .1 /�}Ttatir'€ /SEA( N .a1 Lou r �r
Recp 17416 - Y1 ? E -T/2 Cor /y )3L4 2 -
Address of property being improved: `(?
15f ST/f7- 4 i LA4-rrc (3E4c !// AL 1223 f
General description of improvements: ALt/h06,6 EX,sr) rU 6 IC IT(NIA" CA6,,4 ITS / CUv^'7. /{'t'o
AfptAcF I/+/ S1/n1011z LoiAiuiv, /2eAioVf /,Y,5Tlit'6 deck 804RO 4ti0 R1,01(1 %.4/.ZTN
/] tit w.
0
Owner: AV I6 N e w/44N Address: 3 G O 1 5 r S fi2.e`T A B,f t 3 2 2 71
Owner's interest in site of the improvement: 0 c"'A,l&
Fee Simple Titleholder(if other than owner): /47
Name: tv74
Contractor: Su Ni to 14,6 CUASi C0rt.1i1vi.,,U/4-' 0 .fn'c . - ( -1ba[P,1 M. iet,m4N4.lk) ..
Address: > l3 V/t,Nt3 LAu1 Ai LA^-Trc ,314 N/ IL 3 2251
Telephone No.: ,�i%Oy, 200 . /08y Fax No: 14"%4Surety(if any) s//7A
Address: ,g1 Amount of Bond$ /jam —
Telephone No: ///4 Fax No: �j4
Name and address of any person makingg�a loan for the construction of the improvements
Name: �/(/i
Address: 1 "-/A
Phone No: /1`/'f Fax No:
Name of person within the State of Florida,lo/�� other than himself,designated by owner upon whom notices or other documents may
be served:Name: /'v74
Address: /1/ A
Telephone No: !/ '�f� Fax No:
/7/1
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 pption)
Name:
��//// // '' —
Address: 7//A"
A
Telephone No: /' /4 Fax No: /717
Expiration date of Notice of 2mp�encement(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
eG4- '7lI
Signed: �, Date: i
Doc#2019240482,OR BK 18972 Page 500,
Number Pages: 1 Before me this jlett day of J( /_' Aro in the County of Duval,State
Recorded 10/17/2019 03:51 PM, Of Florida,has personally appeared 1 i ' WOU"1
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Notary Public at Large,Stale of Florida,County of Duval.
COUNTY My commission expires: t,t.D�US 1 02� • LR 6 a•- -.RECORDING $10.00 Personally Known: JJ or
Produced Identification: Dl.i MARY BRANHAM
/� 2�`fi -Pit Notary Public,State of Florida
... If U V ,f�/c l Aavt ...
'..._f,
Commission#pire Aug.G238078
���' My comm.expires Au24,2022