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390 Main St RES19-0324 Replace 5 Windows RESIDENTIAL PERMIT PERMIT NUMBER CITY OF ATLANTIC BEACH RES19-0324 �. � 800 SEMINOLE ROAD ISSUED: 11/6/2019 ATLANTIC BEACH. FL 32233 EXPIRES: 5/4/2020 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: 390 MAIN ST RESIDENTIAL ALTERATION REPLACE 5 WINDOWS $2800.00 RESIDENTIAL TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION: CONSTRUCTION: NUMBER: GROUP: 170900 0600 ATLANTIC BEACH SEC H COMPANY: ADDRESS: CITY: STATE: ZIP: BIG D BUILDING CENTERS 1325 WEST BEAVER STREET PL JACKSONVILLE FL 32260 OWNER: , ADDRESS: I CITY: STATE: . ZIP: WEST GROUP 623 MAIN ST ATLANTIC BEACH FL 32233-2530 ACQUISITIONS LLC 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 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: 11/6/2019 1 of 2 rtlAi'rci ,410. ,' RESIDENTIAL PERMIT PERMIT NUMBER ii: r S RES19-0324 CITY OF ATLANTIC BEACH Dv 800 SEMINOLE ROAD ISSUED: 11/6/2019 A'`-.CM :, ATLANTIC BEACH. FL 32233 EXPIRES: 5/4/2020 Issued Date: 11/6/2019 2 of 2 rtrLJ/�r. City of Atlantic Beach APPLICATION NUMBER 6 Building Department (To be assigned by the Building Department.) '' 80aBeaRoad I\ Csi� - 0314 - rf Atlantictic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845 Date routed: ( ( � • E-mail: building-dept@coab.us City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: .S90 T Department review required Ylerslo C. Build ( OCLP �Applicant: l� Planning &ZoningTree Administrator c Project: � �� 11u � Gw�.' 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 G/7 Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: F Approved. Denied. ❑Not applicable (Circle one.) Comments: ILII PLANNING &ZONING Reviewed by: // "1/* / l Date: TREE ADMIN. Second Review: ❑Approved as revised. ❑Denie . ❑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 Building Permit Application OFFICE COPY - pp Updated 10%9/18 (E City of Atlantic Beach Building Department **ALL INFORMATION 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY Phone: (904) 247-5826 Email: Building-Dept(@)coab.us IS REQUIRED. Job Address:'" lei Mek\v\ -J\ , V\\\C\C..0,,\. .t �1 Ct_ic 1 Permit Number: R- t - O3-z4 Legal Description. 3I'-‘ \-' ea),' ,t l ti \\ t V.We \\At_,V:;11.6.0 A c�RE �` `t + 4' �L \. �� Valuation of Work(Replacement Cost)$ ai.CC Heated/Cooled SF Non-Heated/Cooled • Class of Work: ONew ❑Addition ❑Alteration ❑Repair ❑Move CDemo OPool Window/Door r • Use of existing/proposed structure(s): ❑Commercial DResidential _.'*' V\ • If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No V • Will tree(s)be removed in association with proposed project?Oyes(must submit separate Tree Removal Permit) to f/f Describe in detail the type of work to be performed: J U Q U CU Florida Product Approval# \--- li-\ls , \ for multiple products use product approEj fC7,,''p8 ma_ Property Owner Information LW 17: a 0 Name\13L,\ `1(17.A.) 18."Vx\'„\t�..4 \ Address . "\t..! �, c.+ 0 Z CC City V V \c% - "i,. ' t%c Ni State (L. Zip 21:.Z al?j'j Phone 0` G - c rr. U. y E-Mail \j'k-1 c,\�, (t1 4--,•c \t„►.\A,ry � ct, , t..., Le I- I-.Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) 0 g — la cc 2 Contractor Information i ,, � 0 liJW 5: Name of Company. Ij Y�.+:�\/�t<ir()PS-LA a CC m , il`.- Qualifying Agent Mv\.,r V_ \, ,.�1 W 5 fa Address\21,,/c3 W �ecylu r :� . City t\' ♦r,\%....8_ State -1 Zip...:-.1:),.... 0a lV N 0 IU Office Phone Com\, F ti. iii • _ Job Site Contact Number It UI State Certification/Registration t1(", ` .O c•,if.i•171 E-Mai} f.j .k• i, bnAY1..A.\‘c'e. (• ,Jr;, L. ,.Z E Architect Name&Phone 14 _ Lt CC Engineer's Name&Phone# ETl Ft I Q Workers Compensation InsureiQ'V.c• c .t.c� ,s \rv.i• .w&i.. OR Exempt❑ Expiration Date \at?„\ ' n 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,PLUMBING,SIGNS, WELLS,POOLS,FURNACES, BOILERS,HEATERS,TANKS, and AIR CONDITIONERS,etc. NOTICE:In additiona ui his permit,there may be additional restrictions applicable to this property that may be found in the public re s s cot ,jn / there may be additional permits required from other governmental entities such as water management dktri a g federal agencies. OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compli3r with all 2 �9 applicable laws regulating construction and zoning. U 33 J WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.WRcibgeE'mDrtrnent TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY4401ftettlaftie Beach, FL RECO O R NOTICE OF COMMENCEMENT. (Signature of Owner or Agent) de (Signature of Contractor) Signed and sworn to(or affirmed)before me this w T1ay of Signed an• oro to(or affirmed)before me this l,4day of c * bec—, , C3'. ,by'$cz r4•e> �e 'c..n +u do ' ,; 14k.t,by 1 Your lc 4.,, 1 , ''L•••-,=� CI., t I/ •, „I -l_.c - , csl-.���%w , -7C C7�/LCyIIOk' AN, .�ISic nab iJof.Lnrar — — '. (Signature of Notary) •"""''j JUDITH BEALL LAYLAND ;,---v t; Notary Public-State of Florida %.1116411641 I )Personalty Known OR • ' ,•• ••; Commission # FF 9b,s408 .1 :Personally Known OR I ,,,,;,ag'os, JUDITH BEALL LAPLAND Produced Identification `e,,,-A-'o;.� My Comm.Expires May 4,202d Produced Identification 1 ta't `s': Notary Public •Stale of Florida I ',,Far F,�', - Commission# FF 91,:408Type of Identification: ''n,,,',•'' _ Boneathrough National Notary AssnT .e of Identification: •• , ,,, � ,$ "My uomm Expires May 4.2020 LF t ?t''"° Bonded through National Notary Assn. P 0, • Doc # 2019249519, OR BK 18984 Page 1844 , Number Pages : 1 , Recorded 10/29/2019 04 : 17 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10 . 00 01,•• E COPY NOTICE OF COMMENCEMENT b LrkF Iry C.iF. 2erm ,L,t No Iii` Si ! — a y -ax Folio No -- State of II — — — County of DUVAI To whom it may concern: The undersigned hereby informs you that improvements will be made to cetteln real property and in accordance with Section 113 of the Florida Statutes.the following information is stated in this NOTICE OF COMMENCEMENT Legal description ol property berng improved 18-34 17-25-l4)l:.I 17 All ANI 11 IWA('N SI'C II .QT C.bid.124 _- Address of property being improved 390 MAIN ST Al 1.AN'I1C MACli.FL 32233 General tlescnp6on o)•mprovements REMOVE AND INSTALL 5 NEW MI WINDOWS Owner WEST(;ROUI'AQIIISITI(IN Address 390 MAIN ST ATLANTIC IiFAC UI H.32233 O,ner s interest el site of the improvement RENO1 ATICON Fee S,rspre Tit eholcer or other than o.vner, _ Name Address Contractor I11G 1)Isl0Ll)1Nt,:I S fI:R Address 132511 BfA1'I'KS1 IACNNUN111-I.I FI t_,;119 Phone No 904 330.6600 Far No !I:14 Surety(d any) —^ Address Amount of bond S Phone No .- Fax Nc __..-._....._—_..._.-. Name and address of any person maturg a loan fel the construct on of tie marc.erients Name Address Phone No Fax No Name or person within the State of Florida other than h,mse't or he,scli dosigr,a:ea G;pxier upon whirr nohces or ether documents may be served Name Address ----.--._— Phone No Fax No .n addrhon to himself or herself owner designates the to-lowing person t:receive a copy of the Lir'o•'s Notice as provided n Section 7t3 05 121 ioi Ftor ca Statutes (Fie in a:Owner s opt on) Name Address Phone Na Fax No Exp,rat ui date of Notice of Comn-.encerneit(the exp rat.un Cate,s Die(1i year Iron':ie date or recording unless a different date Is s,etdIed: THIS SPACE FOR RECORDER'S USE ONLY �\ OWNER { p�� a. r= a i�i ' 1 s,_..y=aY01. 1,4rck)@ . ala rima :v.•u..a r�taw,ctFFnOa • ce'sx-a,atter,e �(' �,1�.��7•_ r.E;t•ntly het s•O !'t, r aria err.-.s,«•t• s,a!e-r-•s a,:14-c era.,rns+.bre,n !re Nut baa ace U'ate .- I JUDITH BEALL LAYLAND .?.sp - Notary Public-State of Florida t.; N irT ^'� ,1__ ft.., Commission 8 FF 96J408 c cartrpe Slate.f :,-".11 III!! Comm.Expires May 4,2020 ,ss¢ �a�• ►M '4;ntt> y •. ., Ft*servo-, . nr � ,,,„,,c, Bonded through NabionZ Notary Assn. xt4iice i-.eni 6,al.• . OFFICE COPY DAWKI-1 OP ID: LM ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `..►� 12/27/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 904-565-1952 CONTACT NAME: Lea McKinney,CISR, CRIS Brown&Brown of Florida,Inc. PHONE 904-565-1952 I FAX 904-565-2440 Building 100,Suite 100 (A/c,No,Ext): (A1C,No): 10151 Deerwood Park Blvd E-MAIL Jacksonville, FL 32256 ADDRESS: Jim Parrish INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Ohio Security Insurance Co. INSURED Dawkins,Inc. INSURER B:Auto Owners Insurance 18988 1325 W.Beaver Street Ohio Casualty Insurance Com an 24074 Jacksonville,FL 32209 INSURERC: `7 Comp an D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POUCY EXP LIMITS LTR INSD WVD IMM/DD/YYYY1,IMMIDDMNYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR BLS5842303712/31/2018 12/31/2019 DAMAGE TO RENTED 300,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY _ $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY yEa LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY (Ea accciiden SINGLE LIMIT $ 1,000,000 ANY AUTO 4248908600 12/31/2018 12/31/2019 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSRE� ONLY X AUUTNOpSyyN BODILY� INJURY(Per accident) $ X AUTOS ONLY X AUTOS ONLY (Parr acddent�AMAGE $ C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE US058423037 12/31/2018 12/31/2019 AGGREGATE $ 2,000,000 DED X RETENTION$ 10000 A WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE ER OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N XWS58423037 01/01/2019 01/01/2020 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A 500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION ATLA-05 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Atlantic Beach 800 Seminole Road Atlantic Beach, FL 32233 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD