160 11th St DEMO20-0034 Drywall 40• ,t DEMO PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH
DEM020-0034
800 SEMINOLE ROAD ISSUED: 12/1/2020
t v ATLANTIC BEACH. FL 32233 EXPIRES: 5/30/2021 I
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:
160 11TH ST DEMO INTERIOR ONLY DEMO - DRYWALL $0.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170256 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
PHILLIPS BUILDERS LLC 1250 SELVA MARINA CIR ATLANTIC BEACH FL 32233
OWNER: ADDRESS: CITY: STATE: ZIP:
MORRIS JONATHAN 160 11TH ST ATLANTIC BEACH FL 32233
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT If\
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: 12/1/2020 1 of 1
/'ems Cash Register Receipt Receipt Number
Y j
Si
City of Atlantic Beach R14245
__j -- - . „ _. _.
PermitTRAK $104.00
DEM020-0034 Address: 160 11TH ST APN: 170256 0000 $104.00
BUILDING $100.00
DEMOLITION 455-0000-322-1000 0 $100.00
STATE SURCHARGES $4.00
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:R14245 $104.00
Date Paid:Tuesday, December 01, 2020
Paid By: PHILLIPS BUILDERS LLC
Cashier: CG
Pay Method: EMV 1011251399937734
;
Printed:Tuesday, December 1, 2020 11:39 AM 1 of 1 1 CENTRALSQUARE
f-7'- . Building Permit Application Updated 10/9/18
_ City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: UpO II t - 51- 327-33 Permit Number: r lO Z(---)- 003 4
Legal Description (0-1 Ib-25- Zq6 AvIAM-c,C$EAc.N C feZ.5cT L S,6B(KkaRE# i 7c 2S(e COOO
Valuation of Work(Replacement Cost)$ I,OO9 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move*emo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial Residential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes 7410
• Will tree(s)be removed in association with proposed project? EYes(must submit separate Tree Removal Permit) rAo
Describe in detail the type of work to be performed:
LIT- PE-1-v") / 12e"eiQC DeA VJt \ Cg_ er4c-;,NEtc-
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name -5c,wart-l-01/41•1 MO eeA S Address Rao 1\t3N" 5'1--
City A, ,?j State F\ Zip -52_2-33 Phone 4,10 - 4105-(19-19
E-Mail UprA50Z.mo12-IziSE C-,r-,a.* t - co"-•
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Vi-t,\t,QS ?Duk\O SS Qualifying Agent F-2,AK6t2Ai-k,1\, 'S
Address 99.- O C.cN 31v0 City A.3 State 0 Zip 32-Z33
Office Phone 9QLf-31-1o1- 2`1161 Job Site Contact Number 1011 -755- 19'48
State Certification/Registration# C tic v2-5131(.1 E-Mail P1-1,11i PS 'Vsl DERS @ Cors-,CAST , f Lr
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR ExemptX Expiration Date
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 ATTORNEY BEFORE
REC RDING YOUR Ni. !�TICE OF COM ENCEMENT. , //
)4A44/(' (Signature. Owne •r ,:ent) (Signatu,•of Contractor)
Signed and sworn to(or . fir,led) ,e •• e me this rr,� day of ' ed and sworn to(or . ed) ,efore me •is / da of
r3o w` . Ir
1
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NM
_ s- g..-• ' otary
/;S�iv_aB.., 1 ALBERT MORENO
%=o•' -�4i Notary Public-State of Florida f
'a�'. o Commission a GG 304875 Irsonall Known OR
[ ]Personally Kn. � OR� '- '0F My Comm.Expires Jun 9,2023 y
oduced Identificati Bonded through National Notary Assn. ]Produced Identification
Type of Identification: �iff t`. �? --— 4•Type of Identification: ,''TixY.e6d:•. TONI GINDLESPERGER
'?' a. = MY COMMISSION#GG 353178
-1,;•••741.4:`,.. ` EXPIRES:October 6,2023
.if.r:f°`'' Bonded Thru Notary Public Underwriters