1986 W Sevilla Blvd RES19-0336 Interior Remodel S-`'----, RESIDENTIAL PERMIT PERMIT NUMBER
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800 SEMINOLE ROAD RES19-0336
�w';n,,. r, CITY OF ATLANTIC BEACH
V ISSUED: 11/20/2019
,
`�Dnt19r ATLANTIC BEACH. FL 32233 EXPIRES: 5/18/2020
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:
1986 W SEVILLA BLVD RESIDENTIAL ALTERATION INTERIOR REMODEL $11780.00
RESIDENTIAL
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169462 0400 SEVILLA GARDENS UNIT
02
COMPANY: ADDRESS: CITY: STATE: ZIP:
HOM SPACE 116 13TH AVE N ATLANTIC BEACH FL 32233
OWNER: ADDRESS: CITY: STATE: ZIP:
HANSEN NIELS 1986 SEVILLA BLVD W ATLANTIC BEACH FL 32233-4578
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 $110.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $55.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.48
•
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$169.48
Issued Date: 11/20/2019 1 of 2
6,;: ''`l,., RESIDENTIAL PERMIT PERMIT NUMBER
os CITY OF ATLANTIC BEACH
RES19-0336
off
800 SEMINOLE ROAD ISSUED: 11/20/2019
s: s.) ATLANTIC BEACH. FL 32233 EXPIRES: 5/18/2020
Issued Date: 11/20/2019 2 of 2
�S..L1i City of Atlantic Beach APPLICATION NUMBER
16 Building Department (To be assigned by the Building Department.)
1. 800 Seminole Road
c-•
' Atlantic Beach, Florida 32233-5445 RE,) ((-1 - 33 k�
Phone 26 -
�,;5 so, E-mail:(904)building47-582dept@coab.usFax(904)247-5845 Date routed: I S (
City web-site: http://www.coab.us '
APPLICATION REVIEW AND TRACKING FORM
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Property Address: 1' (
) (f.2 EU LLC Department review required Yes o
(Building
Applicant: Hum SPi`-\-D._, Planning &Zoning
Tree Administrator
Project: \ 1��(02 RE/T\COtY(_ 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:
BUILDING .
PLANNING &ZONING yy�
Reviewed by: / ' Date: //"/2-j9
TREE ADMIN. Second Review: A roved as revised.
❑ pp ❑Denied. ['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
srs'=lY..4.f Building Permit Application
U�dated70/9 18
i' City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
-o?'•i9`' IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us •
t
Job Address: I ® : A i�r� d,,.•, ` -3C'Prirri5 ber: { \CSl 9 -633(4, 1
Legal Description r ov'"' atoao Ut((e.aid'1S'-`eIFt14 2 i 54—Zel REit Wi4�tE'^', :40n,
Valuation of Work(Replacement Cost)$`''Ttr''' -_ Heated/Cooled SF Non-Heated/Cooled
• Class of Work: DNew DAddition l3Alteration 6: Repair__!!❑Move ❑Demo DPool DWindow/Door
• Use of existing/proposed structure(s): DCommerclal I2ftesldential
• If an existing structure,is a fire sprinkler system installed?: DYes RTIo
• Will tree(s)be n �
removed i association with proposed proiect?rlYes(must submit separate Tree Removal Permit) tet
Describe in detail the type of work to be performed
K(1cken CeVIA6-jeA CA1A4t -s 4, '0 1. , lbs 4- ••( c-t riaeJ .f` 1-tn^Fi G.(r �dort
Florida Product Approval# for'multiple products use product approval form w
Property Owner Information C.)
Name , LQ(4 —144� 3Q✓sAiVaSga`t ;.��:iAddress ?IqtFS6I _ L:]tlf * g5 ; RE
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L _
Cityliel .) Jc) te h Zip 00 i Phone l .6* 11 4at
E-Mailj!{4J1C? iliii_ �. ' . L : A:7-. . '.: : -. : - - ,
0
Owner or Agent(If Agent,Power of Attorney or A:- cy Letter Required)
Contractor Information
Name of Company i N' �
Address �e.e ` G ,w "�`t=om Qualifying Agent;.t i t l t.zi . 1h1 es(. Jr.
':' lt� e4�'�' v Q' iv. g5';` ' CityE .,6 nu.4{.eel,: State 'f.. . .Li �5c)�
Office PhoneROA-' 3a S q4.24:11.:67,,nniZ4Job Site Contact Number
State Certification/Registration It;CQG?SA-4ST' 'E-Mail l,vt ii4 aK1'46*-47442:t/ .:Gtait14y>•- W d•
Architect Name&Phone# U
Engineer's Name&Phone# N IN
riii OR Exempt rid Expiration Date'.:i.1 t/)Qzi::,2 � = Q O
that no work/or it/stat lation h U
ECE1VaE. .. :in a permit to do the work and installations as indicated.l certify t � Z � ..
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulating n65 0 a
construction in this Jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS, O pa Q O F
WELLS,POOLS,F RU, ciS,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE:In addition to the requirements of tl ii V ;,:l
permitt1i Vre m b nitional:restrictions applicable to:this property that`may be found in the public records of this county,and,1 Q0
there'may be additional'permits required from other governmental entities such as Water management districts,state;agencies,:O Z O Z
federal agencies. L- VI
4 9SgFI'fOYt'�fI tgrgat all the foregoing information is accurate and that all work will be done in compliance with all CC Q H Z
C LL 0 u. ¢ La
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY t- a cc m
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND., r' w p w
Lu TO OBT; IN FINANCING, CONSULT WITH YOUR LEND R N 1T ()Rid.'BEF� RE U ¢ w
RECO . GING YOU NOTICE OF COMMENCEMENT / . / IW w
`.` (Signature of Owner or Age3�t) (Signa . ont ctor)
Si peed and sworn to(or affirm- before` me this L, day of fined and sworn toAor affirmed) rrm
befoe,t is, it d yof
Ut _..a:. ,_ `G/ kt . 1 .. alt . N ;L) " ,Zoi ,b 1Gti..0,(1, -S I C'(-
p ��Il�atip)��\
,v�'!'P,,. 1" SDPHIE SKROBIALOWSKI • TOfdl GINDLESPERGER i`—..
..iA`r'r,, ,
- ' t Notuy Public•Stile of Florida ;*: r:, \• MY COMMISSION#GG 353178
[r7f Personally Knowr i �, Commistlon 0 FF 933669 ' .r ` nog,( (QjRES:October 6,2023
,,,� r My Comm.Expires Nov 16,2019 [
[ ]Produced!dent& ticffe, m [ yrrYi,i i �E-
4 i' Bonded through Netionsl Notify Assn,
Type of Identificatio , �� : _— -� type of Identification: u'J C) - - 'l --(e CO _. 74.7 • C.?
firm, -F - 2eS// 033C OFFICE COPY
NOTICE OF COMMENCEMENT
State of F/..- Tax Folio No.
County of a va,1
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: 45--1 °' -Z5 -21L-- S Puj lie. GGt c S
Address of property being improved: 0.'56 SeV I (k 'give) kl, p-i-k h}/L gcA /tz 3233 3
General description of improvements: k_I1GLPv. re_o-kccO Q.`
Owner: v
ids 14c-11Sevi Address: 1 1.5`.6 Sy(11G 21 IA w, 41-kil.lc eIA.1Z37i
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner): a
Name: D
O
41
Contractor: 1. sc SP" .e.. \KC— g j
Address: �14 03_4 N Q U V, CN
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Telephone No.: ''04- 47Z 364 Fax No: R 0
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Surety(if any) 03 <U
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Address: Amount of Bond$ o w
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Telephone No: Fax No: crci) 6csi; o
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Name and address of any person making a loan for the construction of the improvements N rn�U) 0
Name: oav,l ro
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Address: o 00 z o
oma000W
OZrrCCUrr
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 OWNER
_ _ _ Signed:f Az.ls Ak.,,,A,.. . Date: V t ' G . q 1
IlholloalikillbBefore me this day ofRile\ in the Count of Duval,State
ds'",T SOPHIE SKROBIALOWSKI y:° e`er., Notary Public -State of Florida Of Florida,has personally appearedtic it 114.5714
., Notary Public at Large,St e of Flo ida,County of Duval.
Commission i FF 933669
-�;,-I�"-p My Comm.Expires Nov 16,2019 ( Mycommission expires: 1`j 2,�Ot
1 ''''°� i"°s- Bonded through National Notary Assn. ( Personally Known: jiAlA ISW10 or
Produced Identification:
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�S t# CITY OF ATLANTIC BEACH BUILDING DEPARTMENT
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
CERTIFICATE OF COMPLETION
RES19-0336
RESIDENTIAL ALTERATION RESIDENTIAL
ISSUED: JOB ADDRESS: REAL ESTATE NUMBER: ; ZONING:
1986 W SEVILLA BLVD 169462 0400
DESCRIPTION OF WORK:
INTERIOR REMODEL
OWNER: CONTRACTOR:
HANSEN NIELS HOM SPACE
1986 SEVILLA BLVD W 116 13TH AVE N
ATLANTIC BEACH, FL 32233-4578 ATLANTIC BEACH, FL 32233
APPROVED: T �.I c cZ 4
CHIEF BUILDING OFFICIAL
VOID UNLESS SIGNED BY BUILDING OFFICIAL