298 13th St RES20-0221 Int RemodelOWNER:ADDRESS:CITY:STATE:ZIP:
GALLI DONALD N 298 13TH ST ATLANTIC BEACH FL 32233-5714
COMPANY:ADDRESS:CITY:STATE:ZIP:
SANDIFER DESIGN BUILD
REMODEL 4788 HODGES BLVD. B-102 JACKSONVILLE FL 32224
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
170370 0000 ATLANTIC BEACH
PRKWY #02
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
298 13TH ST RESIDENTIAL ALTERATION
RESIDENTIAL INTERIOR REMODEL $114000.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $522.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $261.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $11.75
STATE DCA SURCHARGE 455-0000-208-0600 0 $7.83
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: 8/20/2020
PERMIT NUMBER
RES20-0221
ISSUED: 8/20/2020
EXPIRES: 2/16/2021
RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
TOTAL: $802.58
2 of 2Issued Date: 8/20/2020
PERMIT NUMBER
RES20-0221
ISSUED: 8/20/2020
EXPIRES: 2/16/2021
RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $802.58
RES20-0221 Address: 298 13TH ST APN: 170370 0000 $802.58
BUILDING $522.00
BUILDING PERMIT 455-0000-322-1000 0 $522.00
BUILDING PLAN REVIEW $261.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $261.00
STATE SURCHARGES $19.58
STATE DBPR SURCHARGE 455-0000-208-0700 0 $11.75
STATE DCA SURCHARGE 455-0000-208-0600 0 $7.83
TOTAL FEES PAID BY RECEIPT: R12886 $802.58
Printed: Thursday, August 20, 2020 2:35 PM
Date Paid: Thursday, August 20, 2020
Paid By: SANDIFER DESIGN BUILD REMODEL
Pay Method: CREDIT CARD 354955322
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R12886
1111!! ·~ TRAKiT
RES20-0221
Building Permit Application
··· ~jt City of Atlantic Beach Building Department ,, z 800 Seminole Road, Atlantic Beach, FL 32233
,,.·d
Phone: {904) 247-5826 Email : Building-Dept@coab.us
Updated 10/9/18
**ALL INFORMATION
HIGHLIGHTED IN GRAY
IS REQUIRED.
Job Address: ,QC))>' \~ 9±reet" Permit Number: ..,..,,..,~---r"f""'r'::--.-==..__,,.-::--;
Y2 . c. .:._r. . _ o l\\l UPI.T fJ J-;;, LJT'3 (5C.E 4-
Legal Description \6-3;1 \l..t ·-.;l -.J,.. vrd": f\7 {J\ JJ\C..-, f2EOC!\ r W4(),lH1RE# ____ 1 ___ _
Valuation of Work (Replacement Cost) $ \ ll{'pDD . Do Heated/Cooled SF ____ Non-Heated/Cooled. ____ _
• Class of Work: □New □Addition □Alteration -~pair □Move □Demo □Pool □Window/Door
/
• Use of existing/proposed structure(s): □Commercial E;;!Residential
• If an existing structure, is a fire sprinkler system installed?: □Yes ~~
Describe in detail the type of work to be performed:
N µ u -t"c.-~'f~ C-PYB, ..,..l y"f'((" ~Pl--, PnJ ~
1
Pw .-..e , .r-=> G ~ ..I) ~e..--vt--·
Florida Product Approval # ___________________ for multiple products use product approval form
Propei:_ty Owner Information
Name t>o~\&:,\-I ~cl(,{ C:i Gl \\ ·,
City 1\~l\f't\.1
, <.. ~v~
Address o( q~ \ ~ Sh:Get
State (:==°L Zip ?> d'a:3 S Phone ___________ _
E-Mail ________________________________________ _
Owner or Agent (If Agent, Power of Attorney or Agency Letter Required) ___________________ _
Contractor I • ~ I
Name of C e! Qualifying Agent () \ ( bl 5'$ Sa, r--JJ:(?, ~
Address-'U:'-'---'CJ.J.l.'---,r.,~'-=-f",-L---1..,.L.1=:~4--1==-------City Y'--'f.:.s:im "' Ile,... State ~ Zip ?0-a;?'-l
Job Site Contact Numb~ ,
State Certifica-t-io.=:.n/L..:R::....eg:i.is-i.:tr;i..1.a..Ltio~n'--#.,.ll_,:?-.... ,:-,.,.-=--... ~:::-:.~::-=--=-E-Mail SP, 't<\Qo\--\.Af,09?v'!\A\fi:r$-es15'=: Y?0 1\ &-&furC
Architect Name & Phone# __________________________________ _
Engineer's Name & Phone# --n-r--.,----=---::-;-t----=:------------------,--,-t---:=,,--r-----
W or k er s Compensation Insurer /Q" L,e_ OR Exempt □ Expiration Date ---lL..:4-.,-L.....i..,.o=-c;;n..!...-_
Application is hereby made to obtain a permit to do the work and installations as indicated. I 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 OR AN ..... ~.,.
RECORDING YOUR ~TICE O~ COMMENCEMENT. c£, cx&t 'ii Cr,. tl { --,,.,,;----~-----
(signature of Owner or Agent) (Signature
RES20-0221
l~t\. .p ,,1
~
::,>
,J
,.::
Rev i sion Request/Co rrection to Comments
City of Atlantic Beach Building Department
800 Seminole Rd, Atlantic Beach, FL 32233
**ALL INFORMATION
HIGHLIGHTED IN
GRAY IS REQUIRED.
Phone : (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: _______ _
D Revision to Issued Permit OR ~rrections to Comments Date:_<i_-::-... \Y_--~--
Project Address: ----rr'J r--'. 9._~ ---+8'""'--tb, _ ___;:sti:......:...... _re.:_e+-+)---'--A-,1--J~~\ Q=..!-4-qt+-1-' ~C -'""'ft'--'-4"-=-°'-'-+1-I-F-L_---'---__
Contractor/Contact Name: _Q....._+-, ....:.;~Ccb""'+...,,,o"'--...:..~...>:.....:S:::;._ _ ___,_,,,5:::,<,>-Q'l.-l-h-""'J~·-.;._,k-'-=,a__---------------
Contact Phone: y'<v ([ le I °t 3 ~[~ Email : So® ,n,\-he\@ ~ ,nd)w r e,\fs ~5 "'bu ·, 'i M
Description of Proposed Revision / Corrections: ~;~~5(!~1 ~·~~~f ~ :a i :~~-. tlt~h \ DJs,
(printed name)
• Will proposed revision/corrections add additional square footage to original submittal?
0No 0 Yes (additional s.f. to be added: ____________ )
• \Ati,i,{r.opQ_sed revision~c_orrec~ions ad~ add'.ti~nal increase in building value to original submittal? g:t;:• Dv es (add1t1onal mer ease m build 1ng value: $ ~ ~ctor m"'"''" ifi,crea* ;a ~'"'"""i
*Signature of Contractor/ Agent: -,=<'-✓-~-----=--~---======z,::::.....=~------------
✓ (Office Use Only)
~Approved D Denied D Not Applicable to Department Permit Fee Due $ ------
Revision/Plan Review Comments ____________________________ _
Department Review Required:
Building
Planning & Zoning
Tree Administrator
Public Works
Public Utilities
Public Safety
Fire s·ervices
Reviewed By
Date
Update d 10/17/18
RES20-0221
NOTICE OF COMMENCEMENT
State of \-\ 0 (,dtL Tax Folio No. _____________ _
County of l)\ J ✓c"-\
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certa in real property, and in accordance with Section 713
of the Florida Statutes, the following information is stat__ed in ~his NOTICE OF COMM.ENh£MENT. _ "'."")
Legal Description of property being improved : \ s --i ◊ I ( 0 -.2 ,5 -a~ t::--tJ::\ Ll\Lrrtc.-> B t: f\.c__\-\-I A-fZK, 1,;,.J'A;y
DITT\ No a__ , G ~·
Address of property being improved: -~q--""-· _\ --,-.--,---=s c......,__r_e_;cc__~---'-\f\-:\---,-~_i"\-'-'-''--'c__:::.._\:..;.. =~=-qc_l-=---+-'F'--L_6)__::;)-3::...=.·-=.3_
Genera I descri ti?n of im provemitnts: _...;f\r t=u)::...,--+->s:'-+'-'t.,.,..__,__ _ __,._--'-"'a....;,,.L!...IC'-"--J=---+-'-"-'--Y-f,.L+-'-=-'-''-"-->.-i.~""----r------
J (\(\ ~ ~1"0 e_,
----,,,=~...L....>=='. n'-"J"""c;-'--(=J1-=-C\'-'-l\.1....:.·•----Address: _,i~q-'-<.L----+-'---...,,,~~~H--"'~--=--==-+.;:.>~"'--'+-'-
Owner's interest in site of the improvement: __ \_o_O_c!)~o ________________________ _
Fee Simple Titleholder (if other than owner): ------------------------------
Contractor:_+-.i...:..;'-"'-''--'-'-'--::::-'--""'----.r--re:::.::....:..:_n -r-'~-.,-.;--:-,,;:------==-----:--r--~--,.,.-----------+--
Address: _....__.'-=-'--'--'-:---"--''t---:------'-'-'....,__---'---"d"'-+-'--=')-=-~..::c...L=.:...--'--"':..:....:.,V"-'-;I -'( =e__'---+---'-~---=-l----"D"-=-="----
Telephone No.:--~~~~~---Fax No: ___________ _
Surety (if any) _______________________________________ _
Address: _______________________ Amount of Bond$ _________ _
Telephon e No : __________ _ Fax No: ------------
Name and address of any person making a loan for the construction of the improvements
Name: _______________________________________ _
Address:---------------------------------------
Phone No: ___________ _ Fax No: ___________ _
Name of person within the State of Florida other than hi!flself, designated by owner upon whom notices or other documents may
be served: Name: ---+-'--::7~-'f-.l....:="-=~-->-.r=::~-:'-'--'--=-----:-:--------;-.-----:::::::----=------,------
A d dress: ---'---PL=;,_--,'-'?~==~r-=-...LJ..:=-=--1--~c....:..:.=..:=.,_.z::..:....l\)-"'..!...:l.!.:..~"'-· t---~_L_~_:_~ _:),-.!L.-"-"'=-..J....... ___ _
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), Florid 1
Name:_-'-"-":'::-r"---i-=r--t--':::>~-"'"---.--,;,--+'--"'--'__._---"'-''-'-"=-'-'-:-t-__,_=--""-,,;-------------,----,----
Address: L 6ct
Fax No: ------------
Expiration date of Notice of Commencement (the expiration date is one (1) year from the date of recording unless a different date is
specified):------------------------------------------
THIS SPACE FOR RECORDER'S USE ONLY
---~~:t-~·••,,, SAMANTHA ~owns WEH
(!'~~--,, Notary Public• Statt! of Florid.a
',.1W~i Commi~sion # GG 255850 <1 o,f\.if·' My Comm. Expires St!p ,, 2022
........... Bondt!d throu~h N•tiontl Notilry Assn.
OWNER
Signed: c:2>l' dQt P _G, <J!)f}j__,. "Jate: &-f 3 -;;J.O-;u}
Before me this v3--$-: day of e:~• in the CountI,of Duval, State
Of FJ.arida, has personally appeared ~~ (2 i;7a l . ,
Nolary Pu~li~ at Lar~e, Stat~f Floridp, Cou nty of Duval.
y comm1ss1on expires:/_ ~,~ rid
ersonally Known: 1J' --t Ek-SW or
Produced Identification: ___________________ _
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