2160 S Fairway Villas Submittal 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
on 6-)." IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: A I loo f .12 A...j w t Ikj r3 3 . Permit Number:
Legal Description T LtL
i . JL( V;11Q5 IILA}- 4, RE# 10'3'I ' IC)la
Valuation of Work(Replacement Cost)$cL .CX) Heated/Cooled SF 100.44 Non-Heated/Cooled OS C
• Class of Work: ❑New ❑Addition , (Alteration ❑Repair ❑Move [Memo ECEt
• Use of existing/proposed structure(s): ❑Commercial yResidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes XINo JUN 13 2021
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit karate Tree Removal rmit) bkNo
Describe in detail the type of work to be performed:
1 -v t"Cl 1 �'k,i 4t T r.(aC �`
1 Th o ke_cl rZ 41(x/ .'�bi(7_ k O<)✓l\
Florida Product Approval# 'J for multiple products use product approval form
Property Owner Information
Name C h i.-1S. Mt 0 S p lZL) 3h Address I ipa FCO'Yf l.�y \)t ticks L
City pi -1 -'ct c_ ad-) State Fl Zip 3a .3.3 Phone (9t )5.1 I i c.
E-Mail pr-r.3;.,hQrti a' y11tc;Ti', k -F
Owner or Agent (if Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company ' YY\Cit/ rile+-,]s r zr,� Qualifying Agent --Clan m }- yycy? -c•
Address Q 3 ,5 ,r City Ij State fl Zip 3a'1r-,
J
Office Phone O-4 to(,-.- 10 3 Job Site Contact Number Cit-.•,,A ( c2 t cic
State Certification/Registration# c'15(jT? -t Iv 1' E-Mail f"1c i fyy-t(c,;,t,-�{-0) t'�,{s re (c)MCC2,� - lL 'k.
Architect Name& Phone# � ri
Engineer's Name& Phone# i f'i / �}
Workers Compensation Insurer OR Exempt Jg1 Expiration Date l c :�(
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 F NCING, NSULT WITH YOUR LENDER OR AN ATTORNEYBEFORE
RECORDING YO , NO F MENCEMENT. C.i1_,
(Signature of Owner or Ag nt) (Signature of Contractor)
Signed and sworn to(or affirmed) before me this / 7 day of Sign d and sworn to(.r a ' med) before me this( day of
Itill
../q.-.); , '2,--,.2- 1 , by L c.,s' -,3%'tc M.\IS r_�x• r'' _ L. b AI— — t
PIMP
,.,, P SignatI otary) ( I". Wu! tirbt)Ron.:
°'1...ac ,per e.a J Nix Made
:- Am Commission#GG 326915 _ commlawn Go 944044
.;-7-:,:•;7*';;;.n1 Ex res April 29,2023
` . , (�; P � � xplres 02/12/2024
[ ] Personally Known OR r- r;ded Thru Troy Fain Insurance 800-385-7019 [ ersonally Known OR or w
[ duced Identificatio "' [ ] Produced ldentificatio
Type of Identification: 1—L r;�e : c�as� Type of Identification:
NOTICE OF COMMENCEMENT
State of Tax Folio No.
County of
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:
Fo:irway villa' L< ( ' , 39 c9c3 1��
Address of property being improved: o711a0 Fpiv w,•1 f<Jj IIaS t•-sl S Plickwev,r '6eac-h FF SAA'n
General description of improvements: "[Urn t1r,t 2Ki hg tray ._, b.rerpM
Owner: (A' y AAtllspA.051, Address: 9140 FA vWa.' (1iU& Lin5 i +Nfi�> t ' cac'h, i
Owner's interest in site of the improvement: cu vse,i
Fee Simple Titleholder(if other than owner):
Name:
Contractor: B&*-' v' rzwi-va.c.-+Dv5
Address: gssi `.74e$jty AveI SAX ?eac3.i, F1, 34).PSo
Telephone No.: (401> coy- R9o,- 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)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement (the expiration date is one(1)year from the ',ate of recor'ing unless a different date is
specified): _
THIS SPACE FOR RECORDER'S USE ONLY OWNER /I
Doc#2021139327, OR BK 19748 Page 1619, /I
Signed: Date: /'✓I / 7 1--
Number Pages0610 1 2-'2t in the County f Duval,State
Recorded 06IO2I2021 03:38 PM, Before me this j,7 dayof ,��y,
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL Of Florida,has personally appeared GI, s Le_r V\,11$ (4-0W,
COUNTY Notary Public at Large,State of Florida,County o
RECORDING $10.00
My commission expires: ��-. / 2'7 702 ,,,,.
' <9 . JOHN MARTIN
Personally Known: '•' �: or
Produced Identification: I-L r:vt}' •", �"101I�SiunOG32E945
L,,.ice
,,r•.�t, :�
Expires April 29,2023
Bonded Thru Troy Fain Insurance 800-385-7019
� T
PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FLORIDA(*REQUIRED)
/`cb D 1
*Project Address: c FcU k \ 1,}1'O?' Llj \ 5 , Permit#:
*Owner/Project Name: C h ri s ,,S
As required by Florida Statute 553.842 and Florida Administrative Code Rule 9B-72,please provide the information and product approval number(s)for
the building components listed below as applicable to the building construction project for the permit number listed above. You should contact your
product supplier if you do not know the product approval number for any of the applicable listed products. Information regarding statewide product
approval may be obtained at:www.floridabuilding.org.
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
A.EXTERIOR DOORS
1.Swinging SMC - DCLrAt .A.xy
2.Sliding
3.Sectional
4.Garage Roll-Up
5.Automatic
6.Other
B.WINDOWS
1.Single hung
2.Horizontal slider
3.Casement
•
4.Double hung
•
5.Fixed
6.Awning
7.Pass-through
8.Projected
9.Mullion
10.Wind breaker
11.Dual action
12.Other
Page 1 of 4 Updated 10/17/18
Category/Subcategory Manufacturer Product Description limitation of Use State# Local#
C.PANEL WALL
1.Siding iCN NkNiA PatAI.l 1 OC cti). c;
2.Soffits
3.EIFS
4.Storefronts
5.Curtain walls
6.Wall louvers
7.Glass block
8.Membrane
9.Greenhouse
10.Synthetic stucco
11.Other
D.ROOFING PRODUCTS
1.Asphalt shingles
2.Underlayments
3.Roofing fasteners
4.Nonstructural metal
roof
5.Built-up roofing
6.Modified bitumen
7.Single ply roofing
8.Roofing tiles
9.Roofing insulation
10.Waterproofing
11.Wood shingles/shakes
12.Roofing slate
13.Liquid applied roofing
14.Cement-adhesive
coats
15.Roof tile adhesive
16.Spray applied
polyurethane roof
17.Other
Page 2 d 4 Updated 10/17/18
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
E.SHUTTERS
1.Accordion
2.Bahama
3.Storm panels
4.Colonial
5.Roll-up
6.Equipment
7.Other
F.STRUCTURAL
COMPONENTS
1.Wood
connector/anchor
2.Truss plates
3.Engineered lumber
4.Railing
5.Coolers-freezers
6.Concrete admixtures
7.Material
8.Insulation forms
9.Plastics
10.Deck-roof
11.Wall
12.Sheds
13.Other
G.SKYLIGHTS
1.Skylight
2.Other
H.NEW EXTERIOR
ENVELOPE PRODUCTS
1.
2.
Page 3 of 4 Updated 10/17/18
In addition to completing the above list of manufacturers, product description and State approval number for the products used on this project,the
Contractor shall maintain on the job site and available to the Inspector, a legible copy of each manufacturer's printed specifications and installation
instructions along with this Product Approval Sheet.
I certify that this product approval list is true and correct to the best of my knowledge.I further certify that use of different components other than the
ones listed in this document must be approved by the Building Official.
*Contractor Name(Print Name):�V4.h {- *Contractor Signature: K)t..) 1)(.1 C�
*Company Name: YY>C,,( C,01-1"\ -r& c'C , r c 4
*Mailing Address: \ S\A-€ e( S 4 o
*City: -_)QX 1 _\,Th *State: r ( *Zip Code: 3a,�U
*Telephone Number: f\-\// *E-mail Address: b(_ CYT.(C c trc cc (5 6. Ck e'Y\CrG.'d.L)€
Cell Phone Number.9C y J L( Cj 0 3 Fax Number: IQ'
Page 4 of 4 Updated 10/17/18
l 934 Shetter Ave
•B E LMAR• Jacksonville Beach, FL, 32250
Lic. #CBC046774
CONTRACTORSS IN� email: belmarcontractors@comcast.net
phone: (904) 612-9903
SCOPE OF WORK
DETAIL OF WORK TO BE PERFORMED:
1. Form and pour concrete to level the garage floor to the same height as the existing
slab. Install new termite treatment and vapor barrier prior to pouring new concrete.
All concrete to be a 3500 psi fiber mix.
2. Remove the existing garage door and all garage door hardware. Install new framing
to allow for the installation of a new 6' double french door. Owner to provide door.
Install new Nichi board and batton siding as needed on the exterior wall to include
Nichi board casing around the new door. All new siding and trim to match the
existing trim.
3. Remove the existing door leading to the house and install a new 6 panel masonite
hollow core interior door. The swing of the door will be reversed from the existing
swing.
4. Electric: Add electric as per building code. Install (6) 6" recessed Led lights in the
ceiling. Install power for a new mini split unit. Install a new hookup for a generator.
5. Patch and repair drywall as needed throughout the room. Remove the existing
popcorn ceiling and slick the ceiling.
6. Remove the existing attic access and patch. Install a new wood attic ladder in the
new location.
7. Install a new 1.5 Ton Gree mini split unit.
8. Install approximately 400 sq. ft. of new LVP flooring throughout the room. Allowance
for the vinyl floors to be $2.50 sq. ft.
9. Install new baseboard, door casing, and shoe mould throughout the room.
10.Paint the new exterior trim installed around the new french door.
Note 1: Price includes all permits, labor, materials, and trash removal for the above
work unless otherwise stated above.
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