196 & 198 POINSETTIA - DEMO City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road cGIr OZO_ y /)
Atlantic Beach, Florida 32233-5445 V Vt�J`—t
Phone(904)247-5826 Fax(904)247-5845 /
OThIl �T E-mail: building-dept@coab.us Date routed: Zit /Z-
City
ZCity web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: P i cP P0( osel 0. Department review required Yes No
(uildingJ--)
Applicant: L_�� 8 Lf�f�[� EILLEPc4AXPlanning &Zoning
Tree Administrator
Project: l '1QOSC ublic Worms
ublic ti i iee')
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: I 'Approved. ['Denied. ['Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date:
TREE ADMIN.
Second Review: ❑Approved as revised. ❑Denied. [Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: I 'Approved as revised. ❑Denied. Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
Building Permit Application Of lorp,j,o/a/re
ti4,E.,
,,., City of Atlantic Beach Building Department ••ALLLIFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
(� 1i• DErnoa°- C�0°4
Job Address: 1,4 rev /.. .4glcirP01115e—t'r f Q Permit Number:
:r- tts Z1-z5 -Vie. 5At.rAtvt- 6Ce- lt'o4roN4 t`TDV3t.e G510
Legal Desorption___164:1_ ,__44.040‘).,(,.-7.4,y • _RE#y (oltkt a'� D C]
Valuzliun of Work(Replacement Cost)91 .LLD I4eated/Cooled sr .,.,." -.1. Non-heated/Coaled_- -.
• Class of Work: ONew ❑Addition ❑Alteration ❑Repair ❑Move #memo OPool OWindow/Door
• Use of existing/proposed structure(s): ❑Commercialsidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ( 'Nt
• Will trees be removed in association with ro.• -. .r.':,1 I:4 • • __ __•_•_ .__•__ - c3itN
Describe in detail the type of work to be performedri. I t4 tOf'► bf--•Q t re.- U.e. Liirt
; (ErYOt,Jut t AiVzai- � 9tf1G4ree tocarled eQ5+ 3irte Choc ,
Florida Product Approval# --. "•' _...for multiple products use product approval form
Property Owner Information
Name Uoe\\51I Address I 2.5D5 - bk-rt L 1-kr,PAC CQ 4.3
City NQS cnorile StateZip 5032$ Phone 5I rJ -39'6 - a�
E-Mail bi 1r`,A-. (ti . 5C'tiCi ri=,' .__ _..c.:-----77.7.-...-,..1.0 . i Csiy-%
Owner or Agent,If Agent,Power of Attorney or A;,::ncy Leder Requited)
Contractor Information
Name of Company ELM .�Y()CU;I�e=L'L' 11k,ttif.11-2-L Ai Qualifying Agent /jt,.r � EA,,lit; riAt,•LE
I. F.,
Address 7116 pi..n 2.A J City ATI--.1,V,—Te Pr4c}t State rL Zip 3"._2-3 3
Office Phone Qo(• z7-2.1 I7fr6j Job Site Contact Number 4-3 2Y x 24. 17('1
State Certification/Registration 41 `C.;C..I'.-)2';:>313 E-Mail t E.Noci El-Fi ( .TAX c(o./11
Architect Name&Phone# ,y'•
Engineer's Name&Phone fi ,'A�___
Workers Compensation Insurer L'Le/s:rA/3t,tA}bJL CO OR Exempt Expiration Date 1/1/ 2.0:I
Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or int tallation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws -egulating
construction in this jurisdiction.i understai,d that a separate permit must be secured for ELECTRICAL WORK, PLUMBIN 3,SIGNS,
WELLS,POOLS, FURNACES,b3ILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE:In addition to the require=rents of this
permit,there mai J.4dditioital restrictions applicable to this property that may be found in the public records of this i aunty,and
there may be additional permits required from other governmentui entities such as water management districts,state agencies,or
federal agencies.
OWNERS AFFIDAVIT:I cert'fy that at i .a foreboing:r ccrmatio:is accurate anti:hat all work will be done i.-:cornplian:?with all
applicable:laws regulating construction and zoning.
WARNING TO OWNER:YOtY ILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN V. I R PAYING T ICE OR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN i �T�' ' CIN , CetNSU WITH YOUR LENDER OR AN ATTORNEY BEFORE
`fr it iC: 0- OMMENCEMENT. s- _ ,'
RECORDlfJ� � -
- /.... )
1,�� - ---
f . • .re ofOwncr • ',zer,;) (Signature of Contractor)
0.54-led and svirn to(or affix • c1 or-ore.-• thir'&day of Signed and sworn to(or affirmed)before me this..5_day of
fa _ __ -- -—_. _ . by t i ?r=�t
-: `';::tyt; G
ir : : 711.11P'143i.. i tSiBnnt:.:o ofl3r_tary
Iplit
'I'r PNM.!1.A THEI3L JR
JOANNE BASSI ersonznyKnownOR AhfOfJ�f't lONM00?7�iPP
NOTARY AUBLIC pF NE . E 1, Deorftr i,MI
in r j froduce8 identification S.
W JERSEY - ; t --np":!trpirtk
?v i : ,., .. COrpfp_. 2436?'83 __ Type of Identifications - -- � .
""iSSI0f1 EXpir.PS 7/30/202q,
PJ3TiCE OF COMMENCEMENT
State of FW rsio Tax Folio No.
County of b4LV-A1,,... —.
To Whom It May Concern:
The under sit,ned hereby informs you that improvements will be made to certain real property,and in accordance wii h Section 713
of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: LL' ').L4 (f p-2 t SAacria. ;;,,.. . 3 _
5 tl C ao` .
Address of property being improved: t CIU '�0 ling/A.4{a
General description of improvements:T 1f r c I s c,.r
Ov:ner:� }S:'ii siA� C _. Adu:ess.
Owner's inlet est in site of the improvement: t_ ..t,t\. ■
Fee Simple Titleholder(if other than owner): _
Name:
Contractor:
Address:
Telephone No.: Fax No:
Surety(if any)
Address: Amount of Bond$
Telephone No: Fax No:
Name ani address of any person making a loan fol the construction of the improvements
.erne:
Phone No: Fox No:
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other docs ments may
be sec ved: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 proviced it Section
713.06(2)(b),Florida Statues. (Fill in at Owner's option)
Name:
Address:
"Iel sphone No: _-_ Fax No:
Expir,rt'o..date of Notice of Commencement(the expiration date is one(1)y r from the date,recording unless a di ferent date is
sp:cifiedi
THIS SPACE FOR RECORDER'S USE ON_Y ervercr•It lOt t /
Signed: _ (late:z!?�w
Before me tills jay of 1 the uum,c0$pr4.State
Of Ni ,has personally appeared
.Notary Public at Large,State f fCounty of l a..0,..
My commission expires: IMO ___ __
Personally Know.): 41)� ...4111111 IOror
- dicedtdrntif,.,aic �• _
0 NEW JERSEY
Apr •• .omm.# 2436793
MY ommiasion Exr lre 7M 2023
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p..vi Ci City of Atlantic Beach APPLICATION NUMBER
'jib Building Department (To be assigned by the Building Department.)
. 800 Seminole Road DE rnO ' _0 OU5
jo„ f Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845 77
fir;;
\ t>:_,,y
_.E-mail:Email: building-dept@coab.us routed: o
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: [ S Pu t t\S� ( c Department review required Yes No
f
_ I j `- j ,iBtOirdin )
Applicant: E' qV LQ„,t_ fi111R'
t— Planning &Zoning
Tree Administrator
Project: HO � cWow
ublic 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 Reviewed by: Date:
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. I 'Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
Building Permit Application ur.dared 10/9/J8
City of Atlantic Beach Building Department '•ALLI<dFORNIATION'
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept( lcoab.us IS REQUIRED.
Job Address:C • /I q13 CL. Permit Number: r 1® -000'5
...ttE 21-Z5
-29C 5A4;rAtiti 6t;C. 3 l.crr• (,5' r1o(. L. C) c�
Legal Description "gc.�tsr 'd•s''t.V Y7 rt _RE#
Valurl.ivri of Work(Replacement Cost)$ '+i•at Neated/Cooled SF " -Y* Non-Ideated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move Bo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): DCommercial i3Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes [9f$U
• Will trees be removed in association with ro.osed •ro•ect?L(es _ ••• - 4 '-rsiit ❑No
Describe in detail the type of work to be performed7D l Y')S] 4 t Orm, d F t re- L. LAirc
(eef loyal 04- snorauf6tAX,, pt,nt,NC'ee, to cat- d e q + 3,C t row ,
Florida Product Approval# __==..""w for multiple products use product approval form
Property Owner Information
Name 1„..08.11-5 -Qri ] Address 1r 2303 - b 4 4 140ene. Ca 4,3
city cnotit't State. Zip 50326 Phone 515 -39$ - ' MO
E-Maililia 1: \ . :":; ---
Owner or Agent(If Agent,Power of Attorney orAeency Leiter Requr ed)
Contractor Information 1 n
Name of Company ELCV(? L ip CLFitic`•4'l !>�•s1�!.1.i- Qualifying Agent r-)EA) , T l E '�fLIe.
Address j` :7 pL-A ZA Lt,i, City ATI--14r1-4 Ri=4 f State rt._ Zip 3%_ZS
Office Phone t ;'-77-11' Job Site Contact Number gok 62'- !7%e1
State Certification/Registration ..6;L1:7283173 E-Mail G/Vct)ELFV$ TAX cGC.lt)
Architect Name&Phone# !tf•
Engineer's Name&Phone# ,' A- •G__-' f
Workers Compensation Insurer L ' . i2Ai t P.AA,f Ll= 1 O OR Exempt c] I Expiration Date /t,/ 2.0Z/
Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or int tallation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws -egulating
construction in this jurisdiction.i understand chat a separate permit must be secured for ELECTRICAL WORK, PLUMBIN 3,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE:In addition to the require-tents of this
permit,there ma/Pe sdditioaai restrictions applicable to this property that may be found in the public records of this r aunty,and
there may be additional permits requited from other gavernmenttl entities such as water management districts,state igen cies,or
federal agencies.
OWNER'S AFFIDAVI :I certify that al i'-..e foregoing:Herniation is accurate and:hat all work will be done in complian: with all
applicable lavrs regulating construction and zoning.
WARNING TO OWNER:YOU ILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN Y. V R PAYING T ICE OR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN ' ` CiiN , CI'NSU WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDIN,S II ' IC. O- OMMENCEMENT. J _
;-rr . .re of Owner Azei ii} (Signature of Contractor)
^,ed and sL r.s to(or affix �c) ore • this&day of Signed and sworn to(or affirmed)before this day of
r - '_ a:- _- ., ).,;:; fi
,by :e3,z
�•
(sian9r:.:C•or laca,ry
'.1.1 , PHILII.A.THEi30,JRr
JOANNE BASSI ersonztl Known OR AIYC 11!r,•lON Ga
y y drs OrS411 ►1rS0p
r,.o+,r r^"_=' NOTARY PUgL1C OF NE ; )Produced Identification:
1'r Lidr:Led ido,, ' s: W JERSEY eec.= Tt _ ___
Type of iciPnti;i�2ii r, COmrll _-24� 7g3 Type of identification!nmmfSSiOl1 EXpirGS 7/30/2073
NOTICE OF COMMENCEMENT
rl � — —
State of r. r.-t,�'1.t-( Tax Folio No.
County of i fidVA"l._
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in accordance wit-i Section 713
of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: IQ-At-it 2I—ZS -pct G CM'1IC2. 5 . •
Address of property being improved: l 9i n se4 Q
Genera!description of improvements:_ 1(`1\ O t t-4-1 cp.
Owner:.1I`- -- . ' .•t _- Address: ____
Owner's interest in site of tine improvement: lit ,0 f
Fee Simple Titleholder(if other than owner): "" "
Name•
Contractor:
Address:
Tt'lephone No.: _ Fax No:
Surety(if tiny).Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for me construction of the improvements
Name:
Pi.one Nu: Fax No:
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other docu nents may
be served:Name:
Address:
Telephone No: Fax No: -
In
In addition to h msetf, owner designates the following person to receive a copy of the Lienor's Notice as prov;d 'd in Section
713.06(2:(b).Florida Statues. (Fill_in at Owner's uptiun)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1)y•ar from the date.ecording unless a dif'erent date is
specified):._
THIS SPACE FOR RECORDER'S USE ONLY '6W �/jfJER n 6' en \
� 2/71e4
Signed: _ Date:
Before me this.2A-
_day of_ "�i,l ,.,• in the Cptfrtvoi• QOj3tate
Of /0 ,has personally appeared : . . •i. ,rLl u. _ _
Notary Public at Large,State 9f /f ,County of�'0TI1f
My commission expires:_7 __
l'ersonat v Known: _-ivor;
_�____- —�- - -- __ _dr
l' ndusetl l:Jrutification:
_ pu_;f -;Asst -- --
•TA• PUBLIC OF NEW RSE1
omm.# 2436793
My Commission Expires 7/30/2023