1528 W Park Terr RES20-0012 Remodel Bathroom s%S'r''''r�c RESIDENTIAL PERMIT PERMIT NUMBER
�, RES20-0012
-, CITY OF ATLANTIC BEACH ISSUED: 1/24/2020
800 SEMINOLE ROAD
`0.;119r ATLANTIC BEACH. FL 32233 EXPIRES: 7/22/2020
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:
1528 W PARK TER RESIDENTIAL ALTERATION REMODEL BATHROOM $15000.00
RESIDENTIAL
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171939 0000 SELVA MARINA UNIT 02
COMPANY: ADDRESS: CITY: STATE: ZIP:
OSBORN BUILDERS LLC 2157 POINCIANA RD NEPTUNE BEACH FL 32266
OWNER: ADDRESS: CITY: STATE: ZIP:
GHIOTTO PHILIP M 1528 PARK TER W ATLANTIC BEACH FL 32233-5535
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.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $130.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $65.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.93
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $199.93
Issued Date: 1/24/2020 1 of 2
,`L.A,';:,,. RESIDENTIAL PERMIT PERMIT NUMBER
J-S D,
CITY OF ATLANTIC BEACH RES20-0012
800 SEMINOLE ROAD ISSUED: 1/24/2020
.A``''' '~ ATLANTIC BEACH, FL 32233 EXPIRES: 7/22/2020
Issued Date: 1/24/2020 2 of 2
/111-11/1-1--z,-A,\ City of Atlantic Beach APPLICATION NUMBER
P *AA, Building Department (To be assigned by the Building Department.)
A ):: 800 Seminole Road i�Es 20--Cao I _
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
_on y� E-mail: building-dept@coab.us Date routed: l I k 412-0
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
I 5 ZR P1R Department review requiredNo
Property Address: l� �E�(a. .
uilding
Applicant: 0 SBORK) 60(1.1)E--:(2-- &Zoning
Tree Administrator
Project: P1.1-k koorn I C,t\. 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
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: 1 Approved. ❑Denied. ❑Not applicable
(Circle one.) Comments: i f D�
D
UILING 'V
PLANNING &ZONING �/y�
Reviewed by: ! ' Date: /e/'a C)
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
Building Permitermit ApplicOCOPY� Updated 10/9/18
_ 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@coah.us IS REQUIRED.
Job Address: is 2,q py9?ZK �,� 1'✓ 4'lj.+¢/V7'/C&AFL 32233 Permit Number:
iNESZ --- CO ( Z
Legal Description c,2 7-4 1645-21E E „Sav4-M.¢ae:A UM 7---2 C-Drs BUC 3 RE# '14/4
Valuation of Work(Replacement Cost) $ /CI&Mel, Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition XAlteration ❑Repair CIMove ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial tResidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s) be removed in association with proposed project?❑Yes(must submit separate Tree Removal Permit)(No Q
Describe in detail the type of work to be performed: %►k,',v_0„lib. /464v ✓Ani{e./J��'� nd„—/q b a
v�,u.1t'• Choirujr'ntsho..�xIocw,}-;un. G
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Florida Product Approval# for multiple products use product appysivjft ti.i
Property Owner Information [a z0 z
Name PhiIJtp t' 4 + o Address /S28 p,41 )c7-064 W' t-) 0 C: cr 0
City 4724 7C/6E'kW State A— Zip 32233 Phone C1416 2f 9 -7179 to m o
E-Mail P(,I-1.1 orr0 9 1orro.co"A 0 o a
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) I-- H L
Contractor Information 0 LL z s
Name of Company (2 ;r3exex, 130/L.blE,25 1-1--C- Qualifying Agent f)//140 05$0Y—\) D 0 iii 111 ti. ft a
Address 2)57 ASO/A/Ue414441-02-O, CityNb-"i'Ve e-peg State Zip 32-226W 5 c
Office Phone CIOil)(2141-0-7 32_ Job Site Contact Number Ce Mg)$60 '/737 - V w u
State Certification/Registration# CC-12-585-0 6 E-Mail OE}.Vm 9 OSf,3Q2,..43 /_v_oZ5 .CDNi - cc 'u
Architect Name& Phone# tii u
Engineer's Name&Phone# ay,,,ii, Ct C
1-"I,HSvaa,?Li-60C/112-C'2.1
Workers Compensation Insurer eynOol2Gs ' c.-7I q 4,1 OR Exemptl� Expiration Date
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 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
RECORDING YOUR NOTICE OFF COMMENCEMENT. e �c�5-e
�%�
(Signature of Owner or Agent) (Sig -ture of Contractor)
Signed and sworn to or affirmed),bpfor me this ii ay of Signed and sworn to (oi a 'rme�)lb fore me this I�I day of
C/WOU— a.ZOL ,by ?t hl IA• .0 . �AW�r"R� �G� ” d 0 (3o2rJ
►i �.a�lll�.� ���t� � wc
-vitt :7 aryl (�Ji�AAl�rebf•Nethr�
;1rRY ptis-. ALBERT MORENO
+°��� Notary Public State of Florida
.0,xr p, Notary Public Stabs of Florida ;""r� ` Commission a GG 304875
[Personally Known OR e. r° Melissa J Hackman [ ] Personally Known OR E '`'.'orfs. My Comm.Expires Jun 9,2023 P
[ ] Produced Identification ;' a MyCommission t3C3091422 [Produced Identification -I Bonded through National Notary Assn.
"r, o Expires 04/08/2021 /
Type of Identification: °"` - - ii Type of Identification: r w✓t t
OFFICE COPY
Job Notes: Ghiotto Residence
1528 Park Terrace W
-construction dumpster will be off site and no materials stored outside
-there is ample parking at the home so there will be nobody parking on city right of way
Electric- Happy Cat Electric for electrical permit
Plumbing-Advantage plumbing for plumbing permit
Notes on scope:
-There are NO structural changes
-The shower location is changing on an off grade section of the home
3 ,, ,
David Osborn
Osborn Builders LLC
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