1757 W Park Terr DEMO20-0003 Int Demo "`''ic., DEMO PERMIT PERMIT NUMBER
J-, ; CITY OF ATLANTIC BEACH DEMO20-0003
,r v~ 800 SEMINOLE ROAD ISSUED: 2/13/2020
4olti9r ATLANTIC BEACH, FL 32233 EXPIRES: 8/11/2020
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:
1757 W PARK TER DEMO INTERIOR ONLY INTERIOR DEMO $60000.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172020 0378 SELVA MARINA UNIT 08
COMPANY: ADDRESS: CITY: t` STATE: ' ZIP:
JAMES & SON BUILDERS, JACKSONVILLE
INC 129 15TH AVENUES BEACH FL 32250
OWNER: ADDRESS: CITY: STATE: ZIP:
GODFREY BESSIE 1757 PARK TER W ATLANTIC BEACH FL 32233-5611
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
DEMOLITION 455-0000-322-1000 0 $100.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$104.00
Issued Date: 2/13/2020 1 of 2
o' ' `'?' DEMO PERMIT PERMIT NUMBER
rS> = DEMO20-0003
CITY OF ATLANTIC BEACH
,�� 800 SEMINOLE ROAD ISSUED: 2/13/2020
�``1i3}�~ ATLANTIC BEACH. FL 32233 EXPIRES: 8/11/2020
Issued Date:2/13/2020 2 of 2
l
• rS- Building Permit Application b E.4A 0ff.-0CC-,3 Updated 10/9/18
h+ ! City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
cnti:;- IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Sc Iv0..//44- 'i3"G 0VIit 6
Job Address: 117—( 14----0(.- —1--c-`-vcc—t. -es-\-- Permit Number:
Legal Description s -pc•—v -7 3 c - 5o / z5 2 7. .: /��2RE# ! ?Z 20 -(`)7 r--71
Valuation of Work(Replacement Cost)$ ( /c)OC) Heated/Cooled SF RE-et'5"VED• Class of Work: ONew ❑Addition ❑Alteration ❑Repair ❑Mov *Dem' DPool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial f•Residentia
2020
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ONo FEB 1 1
• Will tree(s)be removed in association with proposed project? Cites(must submit separate Tree Removal Permit) _gNo
Describe in detail the type of work to be performed: v-ZtVLc„-e_ Ca-.v77-e-+ Ihiliteltilr��
-P-€.__vv.c, V *- - . r, L--cAJ•o 1 ,..•Q-4--S 1""--( \ d offft- °J? �-�
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Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name E\�‘b-•-e, -e--e_it-S:>.'N Address 1 1 S-1 -L -.%t- -1---eyraC.e_ s}-.
City Prlr-k 0...Vt r-cc.-- c c'- _ -1 State Ft-- Zip 3 2.2_3- Phone ' 'l c1/4.1• 1/4s 1/44`'l - 1SS
E-Mail z.,.=, S....).-1,--;c.•€ 6 to ., D n6 n. c-1ylil c•_ a r''•^'.
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information f
Name of Company_ 4 - ,S'cn-i /jug t elS Qualifying Agent S e•67r J-4,,,,,,,...s?
Address /es/ %S `- .y .S City )4.6rr,t-i State Fl Zip ,7 Z Z.rc'D
Office Phone ,/ _SU vi/Z _Job Site Cntact Number / ig ,..5-0`7 05%i.
State Certification/Registration# ( /0L----01/9/'!?T-Mail ,..-5(7,-.)(7-.7 .....--/A4-5..,/9L '6(. 6iiic4i/ i ,,,-12A-1
Architect Name&Phone#
0
Engineer's Name&Phone#
' Workers Compensation Insurer OR Exempt Expiration Date- • (0
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or install n has ,V
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regi. ing W N
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIS9,Z J Z
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE: In addition to the requirerneneofihri 2 ci,
permit, there may be additional restrictions applicable to this property that may be found in the public records of this count,60 a
there may be additional permits required from other governmental entities such as water management districts,state ager(Deal EZ a
federal agencies. W V Q U O
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance witpalt aC 2
applicable laws regulating construction and zoning. U Q 2 4
JJ N
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT Mt< w
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INVEt W w
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE W } a Q m
REG OUR NOTICE OF COMMENCEMENT. w V N Uj
0 W
�1;-�j7....--.,....
(Signature of Owner or Agent) (Signature of Contractor) `CC CC
Signed and sworn to(or affir -d)before me this J f day of Signed and sworn to(or affirmed)before me this!17~d'ay of
Feb .020#70, by • . Fe_12_,02D 20,by • 4A e-S__—
II._/�A� /. _ /-' I,_, .• -
(Sign. ure of Notary)
ir
(Si ature of o ary)
= i!�~�: ,: JENIFER A. MOTES
�:' - •: MY COMMISSION#GG145843
)(`, F.r. "1"--- JENIFER A. MOTES �= <
Personally Known OR Personally Known OR =,.;�• EXPIRES October 20.2021
, MY COMMISSION#GG14 Produced Identification
[ ]Produced Identification 4. $1
�'�?,'.• EXPIRES October 20.2021 Ta of Identification:
Type of Identification: '• . ,' ____ ___ p - - - -- - -- -
AMET American Integrity Insurance Company of Florida
1�1 �1 V 5426 Bay Center Drive, Suite 600
INTEGRITY Tampa, FL 33609
POLICY NUMBER: AGH0296841
HOMEOWNERS POLICY DECLARATIONS
POLICY FORM: HO3 x❑New Issue ❑Renewal ❑Change
IMPORTANT PHONE NUMBERS:
Your Agency: (904) 733-4634 Policy Effective Date: 02/07/2020
Customer Service: (866) 968-8390 Policy Expiration Date: 02/07/2021
Claims Reporting: (866)277-9871 12:01 a.m. STANDARD TIME at the residence premises
INSURED NAME AND MAIL ADDRESS: YOUR AMERICAN INTEGRITY AGENCY IS:
Blaine Peterson Insurance Wagon
Keri Peterson 2529 University Blvd W
1757 Park Ter W Jacksonville, FL 32217-2003
Atlantic Beach, FL 32233-5611
Residence Premises covered by this policy is:
1757 Park TER W, Atlantic Beach, FL 32233-5611
County: Duval
TOTAL ANNUAL POLICY PREMIUM: $2,158.00
The Hurricane portion of the premium is: $1,206.00
The non-Hurricane portion of the premium is: $830.00
Insurance is provided only with respect to the following coverages for which a limit of liability and/or premium is
specified, subject to all conditions of this policy. Based on the information available to us, the premium shown is
the lowest we offer for which you qualify.
SECTION I— PROPERTY COVERAGES LIMIT OF LIABILITY PREMIUM
Coverage A—Dwelling $298,000 $2,036.00
Coverage B—Other Structures $5,960 Included
Coverage C—Personal Property $149,000 Included
Coverage D—Loss of Use $29,800 Included
Ordinance or Law: 25% of Coverage A $74,500 Included
SECTION I — DEDUCTIBLES:
In case of a property loss, we only cover that part of the loss over the deductible(s) stated:
All Other Perils: $2,500
Windstorm or Hail (Other Than Hurricane) $2,500
HURRICANE: 2% of Coverage A $5,960
Sinkhole: Not Included
SECTION II—LIABILITY COVERAGES
Coverage E - Personal Liability $300,000 $30.00
Coverage F - Medical Payments to Others $5,000 $10.00
AIIC DEC 07 19 Print Date:01/30/2020 Page 1
Prepared By:
Gibraltar Title Services, LLC
4190 Belfort Rd., Suite 475
Jacksonville, FL 32216
Return To:
Gibraltar Title Services, LLC
4190 Belfort Road, Suite 475
Jacksonville, FL 32216
Order No.: GTS-2010075
Property Appraiser's Parcel I.D. (folio) Number:
172020-0378
WARRANTY DEED
THIS WARRANTY DEED dated February 7, 2020, by Bessie M. Godfrey, an unmarried woman, whose
post office address is 631 Selva Lakes Circle, Atlantic Beach, Florida 32233 (the "Grantor"), to Blaine I.
Peterson and Keri M. Peterson, husband and wife, whose post office address is 1757 Park Terrace West,
Atlantic Beach, Florida, 32233 (the "Grantee").
(Wherever used herein the terms "Grantor" and "Grantee" include all the parties to this instrument and the
heirs, legal representatives and assigns of individuals, and the successors and assigns of corporations)
WITNESSETH: That the Grantor, for and in consideration of the sum of Ten And No/100 Dollars ($10.00)
and other valuable consideration, receipt whereof is hereby acknowledged, hereby grants, bargains, sells,
aliens, remises, releases, conveys, and confirms unto the Grantee, all that certain land situated in County
of Duval, State of Florida, viz:
Lot 20, Block 12, SELVA MARINA UNIT NO. 8, according to a plat recorded in Plat Book 34, Page 85, of
the current public records of Duval County, Florida.
Subject to easements, restrictions, reservations and limitations of record, if any.
TOGETHER with all the tenements, hereditaments, and appurtenances thereto belonging or in anywise
appertaining
TO HAVE AND TO HOLD the same in Fee Simple forever.
AND the Grantor hereby covenants with said Grantee that the Grantor is lawfully seized of said land in fee
simple; that the Grantor has good right and lawful authority to sell and convey said land; that the Grantor
hereby fully warrants the title to said land and will defend the same against the lawful claims of all persons
whomsoever; and that said land is free of all encumbrances, except taxes accruing subsequent to: 2019.
IN WITNESS WHEREOF, the said Grantor has signed and sealed these presents the day and year first
above written.
Signed,sealed and delivered in presence of:
'�Z /2) 6%/r' fjy ',7/fl,�2y '1_ k_ Z,i.. r
Bessie M. Godfrey by Natalie Lyne White as her itness Signature
Attorney in Fact /9� /_gr J i) Vi cV(G1, OCtI1Cwr
i t^C rented Name of First ly,itness
J d-
�Wt Hess Signature
1 %>
Printed Name of Second Witness
State of FL
County of DUVAL
THE FOREGOING instrument was acknowledged before me by means of ( ✓,physical presence or (_)
online notarization, this 7 7`. _ day of February, 2020, by Natalie Lynne White as Attorney in Fact for
Bessie M. Godfrey, who is personally known to me or who ( ) produced 1 ,dac S G,N c
as identification.
-- _--Notary-P�lbtie -
My Commission Expire • , ,:,.Z_ =)-f' ?
[SEAL]
JAMES D ROGERS
�.' -.•.,.`_State of Florida-NotaryPublicii Pub
( �r-JCommission # GG 251869
My Commission Expires
_ August 23, 2022