108 Seminole Rd RES20-0047 Int Remodel " RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RES20-0047
°lair800 SEMINOLE ROAD •
l 9' ATLANTIC BEACH. FL 32233 EXPIRES: 8/29/2020
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:
108 SEMINOLE RD RESIDENTIAL ALTERATION interior remodel - replace $28000.00
RESIDENTIAL cabinets
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170590 0140 SALTAIR SEC 01
COMPANY: ADDRESS: CITY: STATE: ZIP:
HOM SPACE 116 13TH AVE N JACKSONVILLE FL 32250
BEACH
OWNER: ADDRESS: CITY: STATE: ZIP:
RODNEY AND LINDA 1349 GOLDENROD HILLSBORO KS 67063
PETERS REVOCABLE TRUST
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 `;
o r �.� A• s = ter:
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $195.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $97.50
STATE DBPR SURCHARGE 455-0000-208-0700 0 $4.39
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.93
Issued Date:3/2/2020 1 of 2
RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RES20-0047
.4 800 SEMINOLE ROAD ISSUED: 3/2/2020
..—... �r ATLANTIC BEACH. FL 32233 EXPIRES: 8/29/2020
TOTAL:$299.82
Issued Date:3/2/2020 2 of 2
y, City of Atlantic Beach APPLICATION NUMBER
js Building Department (To be assigned by the Building Department.)
:. ` 800 Seminole Road Q ��a O 11-
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826• Fax(904)247-5845 '1 l l \U
401110- E-mail: building-dept@coab.us Date routed: �C a �,\
V
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: t C St" tnOLL Q , ment review required ys/No
wilding
Applicant: ttOM SOLL- L-' Planning &Zoning
Tree Administrator
Project: F R kf-1 )1 I g\v ctiLl_ (WALL_ Public Works
LA b Nt—i3 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: Approved. Denied. Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date: 312/
TREE ADMIN. Second Review: (Approved as revised. ❑Deni . ❑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
-1'=''' Building Permit Application ���ICE COPY Updated 10/9/18
• i��
City of Atlantic Beach Building Department **ALL INFORMATION
W/IVv 800 Seminole Road, Atlantic Beach, FL 32233
HIGHLIGHTED IN GRAY
it si? IS REQUIRED.
Phone: (904) 247-58264Email: Building-Dept@coab.us
Job Address: WS ' P 1A.Il.tt P la 4414-14/C.,fi ft, 3ZZ Permit Number: fp
— •"'S �0 0 c,49-
Legal Description I0-8 11�2-S''2.95: . O7 S 4 t-r ec- 10 9
Valuation of Work(Replacement Cost)$ 2 ca ant, Heated/Cooled SF RI*1.1- I4' 1 )
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair El Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ❑Residential FEB 1 9 2020
• 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 se rate Tree Removal Permit) ❑No
Describe in detain the type of work to be performed: (testi°v«.1 a.?- amsV-ivy 41,1 �.t - s _ R
t K S , , o�-?_lOK ?" V A CAI°I vi.2_4-ry ,o- �[t�,l^E✓(. , A ryd A c "f' C :Kill''s(_ o
re..vv,Ll vt +i-e___ sc.: e-.
Florida Product Approval# for multiple products use product approval form
Property Owner Information n n
Name 6,1„,i e_r Qrr Address IO S�.M1,4.c:4_
tacit
City / el —tG AD
+ State Ct. Zip '3 7.,....-7_ 3 Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company 40(.4.% S(�.Ge. 1 tAG- Qualifying Agent L)6P S (,.It 11.;0..---1,3 e's( Jr.
Address 1(4 (3+ AVP Ai • o City c6-ddSbhvtlle (&l State P1... Zip 32,Zs C'
Office Phone 'I'04 472 -36'( g Job Site Contact Number
State Certification/Registration#r_ec. I a 5 4' 5 I E-Mail 110449' egO4 ' 5wn-G._1 I I CO✓1n
Architect Name& Phone#
Engineer's Name&Phone# -
Workers Compensation Insurer OR Exempt/Expiration Date 10 0
Application is hereby made to obtain a pe mit to do the work and installations as indicated. I certify that no wo or nstal la o ash Z N4
commenced prior to the issuance of a pef snit and that all work will be performed to meet the standards of all the laws regtEti 4 0 '\
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SON*.:C O
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE:In addition to the requiremer5 c ltii2 H
permit,there may be additional restrictions applicable to this property that may be found in the public records of this courtly,mdn U O
&
there may be additional permits required from other governmental entities such as water management districts,state ageogitpo
federal agencies. CI 7 Ir cx a
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance wt)a4UJ 11. U)
applicable laws regulating construction and zoning. CC Q II- Z
o g
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAYA w
� W
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU Ir EPIE�,, 5 o
:a -- uQ w
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORN BEFORE Lu O cn W
REC IN YOUR ylC OF COMMENCEMENT. 5
111
CC w
IA.....4. cc
nature of Owner or Agent) ir! J Y' (Signat 'ntractor)
Signed and sworn to(or affirmed)before me this!'1 &day of Si; ed and sworn to(or affirmed)before me this I 9 day of
rebras,ry , °10,20 ,b o614e ,Ae4-0-E5 ¢P�0l1„t ( , )(0,:o , by 10.r&&S W•11..0.1+11 u41kit(Z1 •
,(Signature of Notary) . -sv-i : a ur • ' J INSTON
.FpY P�.pr
`.• ,� 'f = MY COMMISSION 4 GG 042984
KIRBY SMITH It'.. EXPIRES:October 27,2020
bd Personally Known OR .. NOTARY PUBLIC "''"''
[ ]Pers \ally Known OR ;;o,•�op. Bonded Thru Notary Public Underwriters
i. STATE OF KANSAS oduced Identificatio' •
[ ]Produced Identificatit r; IlF{�R't:n::`•. 1 tg � [ ,-7:- t ,
Type of Identification: My Appt.Exp. (r I Type of Identification: !l 4: L
- 00 /'7 OFFICE COPY
NOTICE OF COMMENCEMENT
State of F1 or'►�, Tax Folio No.
County of 11,1/44a,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.
Legal Description of property being improved: 1®-a ri -Z g - . 07 gA.1 ir Sec-1
NI/2 L04-
Address of property being improved: j( g Stp IA4 i t d1QVcQ A1-1 I ,� e� 3 2 2 33
General description of improvements: Ill�Gh@� r��OAC- A 01
Owner: k0lif1Py P? J r 4-1444.4.-
Address: dl® iWil.?fit
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor: "��as� � e„ A KC-. *�
Address: )14 (34-k 402, �• d� ck ' ui ((e f3 L . PL. 1ZZ50
Telephone No.: ?O4 472- -34,5Z Fax No:
Surety(if any)
Address: Amount of Bond$
Telephone 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,designated by owner upon whom notices or other documents may
be served: 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 provided in Section
713.06(2)(b), Florida Statues. (Fill in at Owner's option) Doc#2020039064,OR BK 19109 Page 3327-
Name: Number Pages: 1
Recorded 02/19/2020 01:18 PM,
Address: RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
COUNTY
Telephone No: Fax No:_ RECORDING $10.00
Expiration date of Notice of Commencement(the expiration date is one
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER -�
Signed: •_/ �"- Date: Z//4/2aZo
Before me this 1944 day of Fehr y 202° in the Cou ty -BdaeF,•-Stete
@ -Ffertda,has personally appeared
1464,1 sNotar Public at Large, 5{-s{ -e 4 4,,,,5a5 co./al/Van;
KIRBY SMITFMy com'. fission expires:
NOTARY PUBLI�rsona I y Known: I o%(�e� Ap
;?1 or
STATE OF NSiAlS duce'. Identification:
it fll!ilfl mi3,"'• My APPt,Exp. a
OFFICE COPY
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