1825 Live Oak Ln RES19-0342 Windows rS= % RESIDENTIAL PERMIT PERMIT NUMBER
,e'er m, RES19-0342
,� y� CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 12/4/2019
// EXPIRES: 6/1/2020
r_no `/ 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:
1825 LIVE OAK LN RESIDENTIAL ALTERATION WINDOWS $7742.00
RESIDENTIAL
TYPE OF 1 REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172020 0738 SELVA MARINA UNIT
10A
COMPANY: ADDRESS: CITY: STATE: 1 ZIP:
FLORIDA GEORGIA
WINDOWS AND DOORS, 11433 SAINTS RD JACKSONVILLE FL 32246
INC.
OWNER: ADDRESS: CITY: STATE: ZIP:
PENDLETON RONALD L 1825 LIVE OAK LN ATLANTIC BEACH FL 32233-4509
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.
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DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $90.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $45.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.03
Issued Date: 12/4/2019 1 of 2
- 0LA4. , RESIDENTIAL PERMIT PERMIT NUMBER
°� CITY OF ATLANTIC BEACH RES19-0342
uv f: ISSUED: 12/4/2019
800 SEMINOLE ROAD
ss ATLANTIC BEACH. FL 32233 EXPIRES: 6/1/2020
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $139.03
Issued Date: 12/4/2019 2 of 2
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
•�� 800 Seminole Road E c (9 _ O3 /I 7
0 Atlantic Beach, Florida 32233-5445 '\ J l,/ `-f Cr
\ Phone(904)247-5826 • Fax(904)247-5845
��';t�:' E-mail: building-dept@coab.us Date routed: 1 14
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: l Cdl3 LVE-_- C)c- c LP p_qpariment review required Yrlqo
uil"B din
Applicant: pLi- GA . W l ,DO,,,, { JpnQ,s Planning &Zoning
Tree Administrator
Project: V-\) ( N 1 .01/0- 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 c0
Florida Dept. of Transportation Q.7
St.Johns River Water Management District ! }C/�.�
Army Corps of Engineers .‘ Qj
Division of Hotels and Restaurants . ‘/
Division of Alcoholic Beverages and Tobacco C^'
Other:
APPLICATION STATUS
Reviewing Department First Review: 1 Approved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDINe
PLANNING &ZONING Reviewed by: 01 ...--- Date: /1'd w
TREE ADMIN. Second Review: ['Approved as revised. ❑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
:;---T1'"/.-4_, Building Permit Application Updated 10/9/18
PEKE COPY
City of Atlantic Beach Building Department 0 **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
'�?u,st'9�' IS REQUIRED.
Phone: (904) 247-5826/ Email: Building-Dept@coab.us CC (� �/�
Job Address: /L2.S� /A/15 avx `c frl/3c/ 22-23? Permit Number: RES) -1 - 0-347_
Legal Description /QL3 L O 3 7 UN 7L5 "es— 0E*.--.I;--7,4''x'Z•ac7- ; 3ES
Valuation of Work(Replacement Cost)$ 7 7 YL Heated/Cooled SF 'Non'=Heater#/Cooled '
• Class of Work: ❑New ❑Addition ❑Alteration DRepair DMove ❑Demo ❑Pool l Window/Door
• Use of existing/proposed structure(s): ❑Commercial -fftResidential NM/ 1 3 2019
• If an existing structure,is a fire sprinkler system installed?: DYes 1A-No
• Will tree(s)be removed in association with proposed project? DYes(must submit separate.TreeRemoval.PermitYfNt
Describe in detail the type of work to be performed: - •. , ,• l'. -- ', i-- •
Florida Prod ct Approval# /?239- 6 `Z 2YZ • for multiple products use product approval form
i
Pro s ert Ow - 'formation
Name fOrl,1"Ici- 1v L -• - Address /i?,c Z)/C alA
City jl fl th.242, ,aMt,/, State �ti Zip 4'2,3.3 Phone .Z5',G . ,s771/‘
E-Mail /94W j�C`�'jEr74,N COk-rLi4s A it CI"
Owner or Ag of(If Agent Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company//o �j2/titiL i 4- ot2f Qualifying�Agent fl?l/, /% 067/c, 41-vt
Address/(7 fO 5 t Jap] cy /v. JM' City zyc e-,' oi,-Lil/C State 16- Zip 322(-
Office Phone (,4/. 70/0 Job Site Contact Number Zi/l . .17 5':(
State Certification/Registration# t_ .I'l I Q l D E-Mail //pa caw r4 c .4-A( .C O N—
Architect Name&Phone#
Y�
Engineer's Name&Phone# CI
Workers Compensation Insurer _), to rcnALj OR Exempt D Expiration Date 3, /, 2-C6Application is hereby made to obtain a permit tondo the work and installations as indicated. I certify that no work or instal latiddi has y
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regula g'L ai Z CM
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGN, U Z
WELLS,POOLS, FURNACES, BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE:In addition to the requirements Sf iasi? p u
permit,there may be additional restrictions applicable to this property that may be found in the public records of this count-ro6 O Z F
�
there may be additional permits required from other governmental entities such as water management districts,state agenc�s,�} 0 U C
federal agencies. Q
ZCC O41
Z �
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance withgl J u.
applicable laws regulating construction and zoning. I- N I-
�pCa /- W
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MA11t. „ fx W
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEVD - °C a
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE H W a c
W 0U) w 3
RECQ,RI�I�NhG YOUR NO OF MENCEMENT. i —W u.
"CA �i t �-1 I u.
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(Sign of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this K day of Signed and sworn to(or affirmed)before me this day of
no v , • . by PC -r' ...,, e. s [b! z 0lam_ by r-- ei .. nl I
"TIOC: powwwir -__-- •.rte t 1'!."
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.11eRENEE L BRANHOLM yE �o�rtxrrlaslon p5/2812021
GG 097782
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app' ExQMes 21
[ ]Personally Known O' Personally Known OR
]Produced Identification [ ]Produced Identification
Type of Identification: ( i 0 L' -r-'-P Type of Identification:
NOTICE OF COMMENCEMENT
(PREPARE DUPLICATE) C
OFFICE OPS
Permit No. G S`q- 03Y2- Tax Folio No. 1 a(5 3 0:-)
COP'?
State of i= ' (-to_ County of C.).-.\-\r,4-1 i-. `
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. } t
Legal description of property being improved: !�- 5 t_ D ` 01",, Y-\C-
a �� - 2S " 29L .5e-104 i0 3
Address� ss- of� J property being improved: ' l \)(7_, 1.C.�Y� C�- Ct'
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General description of improvements: 4- C) �i( V Ut l01t/t
Owner kc& L, kit 1(a\Ou
Address 1g,z, ; fc\-\ein t e- d_9 k �=L r- -33
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor ` l ( �(Ark �. O(Y 1G. '• t06ADU S 1 `P'i _
Address 1Vc- ,1.I� ,s _( fl��f K.J` ll�A-h(A,� t' S 1+ i FL- ,` Dago
Phone No Q4--Y -(04 t '--)e)\0 Fax No.
Surety(if 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
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
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).
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
Signe. •`_ ur. .ATE gia J I-l
Befor-me this day of T�i11•f =��7 ' in the YY
=of Duval,Sate,•iFlori•-, as rson-II a••=-r-•
Doc ft 2019261770,OR BK 10001 Page 1827 •= i, herein by
Number Pages:1 himself/r r el d affir trr l ti n im witiN4tatio herein
Recorded 11/13/201912:29 PM, are true- d RENEE L BRANHOLM
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL - my Canrnisslon GG 027762
COUNTY Expires 05/28!2021
RECORDING $10.00 .id . =V;++ ;ti+�100
Notary Public at Large.State of •.County of 01/176 (Z
My commission expires: Z.,";,Z
Personally Known or
Produced Identification C_1 e 5Q-