68 17th St RES19-0340 Door r RESIDENTIAL PERMIT PERMIT NUMBER
r S y ' RES19-0340
CITY OF ATLANTIC BEACH
" ISSUED: 11/25/2019
800 IC BEA LE ROAD EXPIRES: 5/23/2020
,,,_?..,44 cm �~ v ATLANTIC BEACH. FL 32233
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:
68 17TH STA RESIDENTIAL ALTERATION DOOR $2877.00
RESIDENTIAL
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169585 0000 OCEAN GROVE UNIT 01
COMPANY: ADDRESS: CITY: STATE: ZIP:
MIRACLE WINDOW AND
SUNROOMS 8933 WESTERN WAY APT 11 JACKSONVILLE FL 32256
OWNER: ADDRESS: CITY: STATE: ZIP:
PARISH WAYNE A 68 17TH ST ATLANTIC BEACH FL 32233-5810
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.
eirgip
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: 11/25/2019 1 of 2
(L.
i"�''' RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RES19-0340
800 SEMINOLE ROAD
ISSUED: 11/25/2019
���`''; >r ATLANTIC BEACH. FL 32233 EXPIRES: 5/23/2020
Issued Date: 11/25/2019 2 of 2
u iLAPPr , City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
*Altso 800 Seminole Road j> �
15,,,,, ,,:!!!� Atlantic Beach, Florida 32233-5445 �` _ _ V
Phone(904)247-5826 • Fax(904)247-5845
r5 E-mail: building-dept@coab.us Date routed: I t. I
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: (p L ' Department review required Yes No
i � 1
Building
Applicant: f \I\ \RN e.( .(_ Vv I ,� f..<� larm-mg &Zoning
Tree Administrator
Project: �> cc 12- 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 Ae/--Army Corps of Engineers \Li
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: Approved. I 'Denied. ❑Not applicable
(Circle one.) Comments:
BUILDIN
PLANNING &ZONING Reviewed by: � Date: //' 22 7-9
TREE ADMIN. Second Review: A roved as revised. /
❑ pp ❑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
1
•i' Building Permit Application OFFICEd `2/8/17
'V City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845
Job Address: 6I I1 S . Af6A.Ac Fac C D-2.1? `� (!cl 19 -OV, -
�� 3Permit Number:
Legal Description /5-.01 09-a5-c).9f OCeaic 9oye W't''4 LS/4D tLaf 7 RE# /1 9575-nc400
4.4?pc,tg
Valuation of Work(Replacement Cost)$ a8 77 1 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Residential
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed: Re fi ce._ / )door ‘,..66 ,fa 5:„
U:o------)
N
Florida Product Approv # 1OS5T for multiple products use product approiNl form N ty
Property Owner Information J I d O
Name: /!ares._ 13e;5I[a- Address:6 / - 1. d Ca .' i=
City A�Ca.�.-(,'c RCeCAL State 1( Zip 3,).D.)3 Phone '3011-/-114- `7385 � W O -
0 1,3 — I-
E-Mail9 o
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) v U " V a
Contractor Information C1 Z oc .70
Name of Company: Qualifying Agent: U a O U)
p Y: til:rac% CJ;�co,6r.c�s g Sr,t n fm..�s �� Qualif in /���YtC�—�•L�'K.e
Address Q933 acs-Ie/K.. t.Jdcj City,7-Ac/cSesW./(G State �L Zip.../2).. f•" ice.•, F"
Office Phone 90Y-53(- 5/?3 Job Site/Contact Number C7 .. S u
State Certification/Registration#e'RC/330 t/1 ' E-Mail a./.2t; .LC.: LL C w 2 CI
Architect Name& Phone# 4_,7;., W a 5 m
W
W
Engineer's Name&Phone# .r//,[l V N- 111-4i 5
Workers Compensation CC w
Exempt/Insurer/Lease Employees/Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or install�on has IA
cr
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg
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 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.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECOR NG YOUR TICE OF COMMENCEMENT. •
GC?`-- ,arte.z2Z- I , /
(Signature of Owner or Agent) Nature o .ntractor) �y�-
(including contractor) c7'
Signed and sworn to(or affirmed)p-fore me this day of Signed and sworn to(or affirme ).bbef re me this ` day of
. ___d___?0i_d iAi11L7!
f ' .i Sh NOV , l`1 ,by �`-U C(I iIiimikitik MILIENIIir . l-VIVA6 �
IP T til . -4./FFAMO
ioF:;;..,„,. LlSAf:^.. Jt\.�ASINO
• "•••• LISA M.TOMASINO
[ ]Personally Known •R' MY COMMISSION#GG 234015
...0-,:'•i •
•• �
, [ ]Personally Known OR �'
�L" EXPIRES:July 1,2.022 ;1.;_:;:•1,..V* MY COMMISSION#GG 234015
[ ]Produced Identificatio _"a•r ,c Produced Identificatio
s ��. [ ] EXPIRES:July 1,2022
Type of Identification: ____''' Bonded;hru dotary Putn :Jrdenvri. _ IS
Type of Identification: ,m r,4:,' Rnrdpd Thm Wtary Public:Undprviri
Doc # 2019260432 , OR BK 18999 Page 2190, Number Pages : 1 ,
Recorded 11/12/2019 11 :41 AM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
NOTICE OF COMMENCEMENT
(PREPARE IN DUPUCATE)
Tax Folio No /6`7'5-t32:,
Permit No. County of
State of L
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.
PC.Legal desorption of property Deng improved: ,5"
8a oR-2S - age i e. . .r. c ., " i
$� Ft f o{- 7 ,&0 4 3 S f k 8
Address of property being improved: • I .k St 41 ,t .. i . , 3
General description of improvements:_Fe Ptece. (!) doss r $•rG
tav S,cc
Owner K a rc.. 6. Pa r.s f.
Address 68 /1"` Se ,4EL;M"4.c 13taGI,-.I.( -' 3
Owner's interest in site of the improvement c5L 7 "V
i
Fee Simple Titleholder(if other than owner) ,�//Q
Name
Address
Contractor "0"...74 Ae. _L,J,K.o%i.,,t 8 ,S76.•(-roo"3,TGr!
Address. •=7 3 f,-)i-7 :(e,(14 i.)ay Sfe. /( j'atK.5,wv.', 3 5e
Phone No. //A
Fax No.
Surety(d any)
Address __ Amount of bond$
Phone No. _Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name s 1/74
Address
Phone No. Fax No.
Name of person within the State of Florida,other than himself or herself,designated by owner upon whom
notices or other documents may be served:
Name /"////b
Address
Phone No. Fax No.
In addition to himself or herself,owner designates the following person to receive a copy of the Lienor's Notice as
provided in Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option).
l
Name ,(''�
Address
Phone 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
DATE 1
{�Ca� ilnLQ.,f`moi Ul�`
7
•e me ice day of ° "� ase
county ca
herein by
himself/heyarAt end alma that as staternorea aid d.dwahans hefts
ere true ate -
'IT w urge. W' Y4l9ufa
my commission expires: ,� r_ _. - ;t
Personally Known liEr - r .. . .LRi.
PmdVGYO aensficauon 1 '•.c .:: '
6 __..:.�►
putstomer Name: Window# • Style Code
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DIAGRAM
OFFICE COPY
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