158 Poinsettia St RES20-0148 Siding, Fascia, SoffitOWNER:ADDRESS:CITY:STATE:ZIP:
STELZMANN ANDREW A 184 POINSETTIA ST ATLANTIC BEACH FL 32233-4018
COMPANY:ADDRESS:CITY:STATE:ZIP:
HOME REMODELING &
MAINTENANCE, INC 10471 DOCKSIDE DR W JACKSONVILLE FL 32257
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
170639 0010 SALTAIR SEC 03
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
158 POINSETTIA ST RESIDENTIAL SIDING SIDING, FASCIA AND SOFFIT $3145.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $70.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $35.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $109.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
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.
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.
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.
1 of 2Issued Date: 6/15/2020
PERMIT NUMBER
RES20-0148
ISSUED: 6/15/2020
EXPIRES: 12/12/2020
RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
2 of 2Issued Date: 6/15/2020
PERMIT NUMBER
RES20-0148
ISSUED: 6/15/2020
EXPIRES: 12/12/2020
RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $113.00
RES20-0148 Address: 158 POINSETTIA ST APN: 170639 0010 $113.00
BUILDING $70.00
BUILDING PERMIT 455-0000-322-1000 0 $70.00
BUILDING PLAN REVIEW $35.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $35.00
STATE SURCHARGES $8.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R12110 $113.00
Printed: Monday, June 15, 2020 2:35 PM
Date Paid: Monday, June 15, 2020
Paid By: HOME REMODELING & MAINTENANCE, INC
Pay Method: CHECK 824
1 of 1
Cashier: CT
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R12110
@ Building Permit Application i r. City of Atlantic Beach Building Department
,,·,.ul! '.J" 800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Updat~d 10/9/18
••ALL INFORMATION
HIGHLIGHTED IN GRAY
IS REQUIRED.
JobAddress: /58 ~{KJ~ E77/1',-SI,. PermitNumber: ________ _
Legal Description lo -ti 2-,t -2..5 -..2. fl E:-SftL.:Tf'r-1 R $13:-C ::) RE#_;._ ______ _
Valuation of Work (Replacement Cost)$ / l1z S Heated/Cooled SF ____ Non-Heated/Cooled, ____ _
• dass of Work: ~Repair
• Use of existing/proposed structure(s): ~esidential
• If an existing structure, is a fire sprinkler system installed?: t!fNo
• ·1 r b o a 10 't u a
Describe in detail the type ofworls_ to be perfo~ed: ~~•r~IP.::JC!<.~,Q,. n 1-101~~r-e 10o,..r0, er~· v..,/"'\ J, n '?}...llo.... o
l-(f'tR..f)1e--.Lp,'P otb i'NC-(<;;. f e~. (/) -LL , L s~ I 'Af-.J •
Florida Product Approval# I~ 1 2 .l.z 2 for J.-1\--p i:A.~'ltt/ for multiple products use product approval form
Property ~ner lnfcp:matio.n _ ' -
Name z. MA }J1J ft~.[,ly?_6~ Address -_158 PotN.::xE 'r7/-/J 5 I.
City IL 7 ft State L Zip ,3 2.2 3 3 Phone @07 } Z 7 --17g
E-Mail Clfl lj Ce 42. nza I}/) Y/J'J?,,,t' -("O CLf > ,
Owner or Agent(lf Agent, Power of Attorney or Agency Letter Required) _________________ _
Contractor Information t)(~ l-1 h_. 'N]v\£.
NameofCompany Jl04e ~f)Wc-ll(J IS' , QualifyingAgent JAtotno l P.o<::i)k?z/70 a~
Address (0471 Qj r l)~k:}_Jt. ~u .. City O l'--/r, State PL Zip 3c 2-S?
Office Phone C9o0 5/IJ -:1 rf 5:C Job Site Contact Number -Z rf6
State Certification/R~lstration #1-P-~ ~r§>:i.£11\f¢.Z. E-Mail /1(00'70~ 6,iaii-or,ve A) \i<ihc:>'b . ('
Architect Name & Phone # __..... Engineer's Name & Phone# __ ...;.._/...,_,,....-.---------------------------
Workers Compensation Insurer ______________ OR Exempt~ Expiration Date /~ µ q
Application is hereby made to obtain a permit to do the work and installations as indicated. l 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~~ TTORNEY BEFORE
RECORDIN YJl-R NOTI E OF COMMENCEMENT. ¥ k ,
--~:...:.....,c...:;.,#--,,:.-~.:..._~=;__------..:__
Signature of Contractor)
Signed and sworn to (or affirmed) before me this a.L,_ day of Jt1,c , ~:;w by fJtJIJll./fw STC l-Zll"lpu,,.,V
.
orn to (or affirmed) before me this / ~ Y of '2.0)() by M o ~-.«o.~~~\C.
MA
of Florida
jlJ-Personally Known OR 64132 [ 1 Pysonally Known OR
[ ] Produced Identification [J-f'roduced Identification
T~ of Identification: _:~~~~~~~~~;;;:;;:;;;f Type of Identification: B-9'-f>'2. "S'\ ':JJC) C.. "=f )'=f, t
)
)
NOTICE OF COMMENCEMENT
State of ___________ _ Tax Folio No. _______________ _
County of __________ _
To Whom It Mav 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 J_lilted :'this NOTICE 0£ c.,QMMENC#v1~T. _......
legalDescriptionofpropertybeingimproved: /V -rr._ Z./ -'I.::> -2':Jb-S A L 1 fl-1e 6 z;:. C
.kJ /2-LoT <oo' l
Add~s;tqopertybeingimproved: / 5 0/{)J E 0 /
~neral~;&i~on of improvements: S
A-TL A-f/v-= ( L_ I;
µAk-o/e /AP ,
,~"1)¥ (h '@-L L (J..€_ ,s 1 h o.,q
fi)O!IJ6c7711: ST II-IL. (3.
Owner's interest in site of the improvement: _...;/1:....;o=--rc:>~/_· ____________________ _
Fee Simple Titleholder (if other than owner): __ _,:;_ ______________________ _
,,>·. Name: __________________________________ _
Contractor: t/-lom e ~<?IP<_od eol-l /) 'I ,' -te J?C\
' 10
Address: /0 t-, 7 0, d r--. .[)A-X PL, 3ecS 7
Telephone No ... \-9;:;._-"-="-"-....L..---'""-":...:::.~ Fax No: ___ .7 __ ' _____ _ >· 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
Y,
be served: Name: ___ ,,, _____ -,--~-------,--,--------,r------------
Address: ____ / __ , ______________ "T'-_____________ _
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 . (fi!J in at Owner's option)
Name: /'
Address=-------->oc--------------,---------------
Telephone No: _______ , __ _
Expiration date of Notice of Commencement (the expiration date is one (1) year fr ecord ~n 1'1f e ~n date is
specified): a
THIS SPACE FOR RECORDER'S USE ONLY
Doc # 2020105700, OR BK 19215 Page 2248,
Nwnber Pages 1
RecordedOS/26/202010 :51 AM,
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING $10 .00
' '
OWNER
Signed: _£~Z!f~~~~~:=:::=:::::__ Date: 5"">) ti!,(}
Before ~.,___,_ """"'~-==.:::_-In the County of Duval, State
Of Flori d u 7ti<-,Z.#t4N&,} 1
e, State of Florida, County of Duval.
es: / -Jr).• dlf~/
Pr&'11.10~mrnri?-::::;:-=:n::------------------or --------------
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