1757 W Park Ter RES20-0087 Int RemodelOWNER:ADDRESS:CITY:STATE:ZIP:
PETERSON BLAINE I 1757 PARK TER W ATLANTIC BEACH FL 32233-5611
COMPANY:ADDRESS:CITY:STATE:ZIP:
JAMES & SON BUILDERS,
INC 129 15TH AVENUE S JACKSONVILLE
BEACH FL 32250
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
172020 0378 SELVA MARINA UNIT 08
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
1757 W PARK TER
PRIVATE PROVIDER
INSPECTIONS ALTERATION
RESIDENTIAL
interior remodel - cabinets,
tile, drywall $125000.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $360.75
BUILDING PLAN CHECK 455-0000-322-1001 0 $180.38
STATE DBPR SURCHARGE 455-0000-208-0700 0 $8.12
STATE DCA SURCHARGE 455-0000-208-0600 0 $5.41
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: 8/13/2020
PERMIT NUMBER
RES20-0087
ISSUED: 8/13/2020
EXPIRES: 2/9/2021
PRIVATE PROVIDER INSPECTIONS
PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
TOTAL: $554.66
2 of 2Issued Date: 8/13/2020
PERMIT NUMBER
RES20-0087
ISSUED: 8/13/2020
EXPIRES: 2/9/2021
PRIVATE PROVIDER INSPECTIONS
PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $554.66
RES20-0087 Address: 1757 W PARK TER APN: 172020 0378 $554.66
BUILDING $360.75
BUILDING PERMIT 455-0000-322-1000 0 $360.75
BUILDING PLAN REVIEW $180.38
BUILDING PLAN CHECK 455-0000-322-1001 0 $180.38
STATE SURCHARGES $13.53
STATE DBPR SURCHARGE 455-0000-208-0700 0 $8.12
STATE DCA SURCHARGE 455-0000-208-0600 0 $5.41
TOTAL FEES PAID BY RECEIPT: R12777 $554.66
Printed: Thursday, August 13, 2020 2:11 PM
Date Paid: Thursday, August 13, 2020
Paid By: JAMES & SON BUILDERS, INC
Pay Method: CREDIT CARD 353007746
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R12777
UNIVERSAL ENGINEERING SCIENCE, INC.
5561 Florida Mining Blvd
Jacksonville, FL 32257
904-296-0757 -Fax: 904-296-0748
NOTICE TO BUILDING OFFICIAL -USE OF PRIVATE PROVIDER
Project Name:_J.)_·Oe-,,_~fr,--,· "'. v:si--""O"-,><.C\-' _______ _
Parcel Tax 1.D ____ 1'---2........,C._/')'-~2_'c .... )"___.=o'-'J"'_2_'_'_d"'_ __
Plans ReVieW .~Both
Circle one
Note: If the notice applies to either private plan review or private inspection services the Building Official may require , at his or her
discretion, the private provider to be used for both services pursuant to Section 553.791 (2) Florida Statute .
I, /7/~rJ~ &6?rS Cl.----\.
the fee oWner, affirm I have entered r"to a contract with the Private Provider Indicated below to conduct the services indicated above.
Private Provider Firm: ~;~~~~i~~L:~:~F~L~,~L~ice:n:se Registration or Certificate No. P.E. 38705 Private Provider:
Address : Phone : 904-296-0757 Fa x: 904-296-0746
I have elected to use one or more plivate providers to provide building code plans review and/or inspection services on the building that is the
subject of the enclosed permit application , as authorized by s.553. 791, Florida Statutes. I understand that the local building official may n ot
review the plans submitted or perform the required building inspections to detennine compliance with the applicable codes, except to the
extent specified in said law. Instead , plans review and /or required building inspections will be performed by licensed or certified personnel
identified in the application. The law requires minimum insurance requirements for such personnel , but I understand that I may require m ore
insurance to protect my interests. By executing this form , I acknowledge that I have made inquiry regarding the c ompetence of the licensed or
certified personnel and the level of their insurance and am satisfied that my interests are adequately protected. I agree to indemnify, defend,
and hold harmless the local government, the local building official , and their building code enforcement personnel from any and all claims
arising from my use of these licensed or certified personnel to perform building code inspection services wi th respect to the building that is the
subject of the enclosed permit application .
I understand the Building Official retains authority to review plans , make required inspections , and enforc e the applicable codes wit hin his or
her charge pursuant to the standards established by s.553.791 , Florida Statutes. If I make any changes to the listed private providers or the
services to be provided by those private providers, I shall, within 1 business day after any change, update this n otice to reflect such changes.
The building plans review and/or inspection services provided by the pri vate provider is limited to building c ode compliance and does not
include review for fire code land use environmen tal or other codes
INDIVIDUAL
Print Individual Name
By:
(signature)
Print
Name:
Address:
Telephone
No :
Please use appropriate notary block.
STATEOF,~======================= COUNTY OF
Individual
Before me, this ___ ---cc:-day of
~~~~~~~.20~~~ personally appeared who executed the foregoing
instrument, and acknowledged before me that
same was executed for the purposes therein
expressed .
Notary Public Stale of Florida
Lesa J NiJII:-Mack
My Commission GG 9440«
Expires 02112120204
cORPORATIOIiI A
::ntC ~/
.F
(Si9Lre)
Pont 5,' rr~ Name: COr J~
lis ' /1;' Address j''/.J7 W-{L 1t'/r'c.cF
,-"..' ,..",j
~~~Phon") tJ: C; -cJ 81 ~
Corporation
'7{)N-f.. Be~ this "':::::' day of
~\l < .20kQ.,a
Corporation, on behalf of the state
corporation who executed the foregoing
instrument, and acknowledged before me
that same was executed for the purposes
therein expressed .
PARTNERSHIP
Print Partnership Name
By:
(signature)
Print
Name:
its :
Address :
Telephone
No .:
Partnership
Before me , this da y of
,20
personally a ppeared Partner/agent o n
beh alf of, a partnership.
wh o exec uted the forego ing instrument,
and acknowledged before me that same
w as executed for the purposes therein
expre ssed.
ti on -+' ____ Ty pe of identification produced,--:-_______ _
<. ~ e~« T-Net Mode
Print Name
My commission expires : :z Ii 1. J 2.v 2.,~
7 7