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Home My Public Portal About11-0381 Russell_1of2City of . fnee Island • Community DeveloM.ient Dept. Inspection Report 403 Butler Ave. • P.O. Box 2749 • Tybee Island, GA 31328 Phone 912.786.4573 ext. 114 • Fax 912.786.9539 asnwit .--- INTERNATIONAL CODE CODNCIC MEMBER Permit No. -, 1- 0 3 o f Date Requested q- 1 1 1 Owner's Name kJ S 5 Q. 11 Date Needed 9- 2 -1 1 Gen. Contractor / Subcontractor i Contact Information 0 Q ( ci Project Address I OO L-L)reI 0 �; 70 Scope of Work " e_ ,J a -1-es 5 ' Inspector Date of Inspection Inspection re I n5 f2eL+ e (Q c . Inspection re i 5p .i . f1 ✓ Pass Pass F Fee s Inspection P j n,5 Q �_ - c h ff Pass Fai , Fee Inspection r c , A 5 ec� 7 r \o I Pass 4 z.; City of'._, aee Island • Community Develop.- _.ent Dept. Inspection Report 403 Butler Ave. • P.O. Box 2749 • Tybee Island, GA 31320 Phone 912.786.4573 ext. 114 Fax 9 12.786.9539 Permit No. J/- U / Owner's Narne Gen. Contractor Contact Inf r a Project Address Scope of Work Inspector ion Inspection Inspection Inspection Inspection Date Requested , g Date Needed Subcontractor / tom* INTERNATIONAL CODE COUNCIL MEMBER Wt.) U /40,7%1E-1 .mo .= ,d Date of Inspection Pass / /-771 "17:00 J/L 1f )/ a / 1 '2 / %/ Fait, Fee Pass ..QASS ( F to - /- 'C/'�i �..�— 113 e7U11�) • //'� Pass ❑ Fail CT 1- I z,' / `' • / j( i�r. SCIV5> Pass Fail Fee F4 City of , , Jee Island • Community Development Dept. Inspection Report 403 Butler Ave. • P.O. Box 2749 • Tybee Island, GA 31328 Phone 912.786.4573 ext. 114 • Fax 912.786.9539 MT k Writ INTERNATIONAL CODE COUNCIL` MEMBER Permit No. / / :.-? -' / Date Requested Owner's Name __ ; i Date N :`eased ," f Gen. Contractor Subcontractor Contact it or ation .1 -✓C `. . U, =1, _. ;)G> Project Address i ; (i-t.)Tr:44..L.. Scope of Work __;t to , 7,-. f_ >i -1--14-1 -_‘.. Inspector .711 Date of Inspection 'S r..r Inspection , t_. /. -7L- :,3 Pass Fail z. Fee ( /1) 1/ 3 ' S� Inspection -. Pass Fail Fee tt f Inspection Pass El Fail ® Fee Inspection Pass Fail Fee a City of Tydee Island • Community DeveloPJnt Dept. Inspection Report 403 Butler Ave. • P.O. Box 2749 • Tybee Island, GA 31328 Phone 912.786.4573 ext. 114 • Fax 912.786.9539 Permit No. 1/' ---7 Owner's Name Gen. Contractor Subcontractor Date Requested emoltik INTERNATIONAL CODE COUNCIL' MEMBER ate Needed — 0/41// ContactlInformation Project Address Scope of Work - Inspector / Date of Inspection • Inspection if i .-- f---/ ( ,\J/ .::?/-1 1 4 -. (}) '' ,-,1 a../-,;>6_s Pass Fee Inspection Pass U Fail \ /7/v( /`- 7 1/)).5 /471 A7 - L./7 (A1-,•(...::,,J-77- • \ ,67//' /--J-7••=1(A„)./0,-; Inspection /777 Pass e (10 Inspection 1:1 Fee Pass Fail Fee / A. - 0 1 J --)-7): f / 1 / 1 I.) ,, "• . City of,_ bee Island • Community Develoi —ient Dept. Inspection Report 403 Butler Ave. • P.O. Box 2749 • Tybee Island, GA 31328 Phone 912.786.4573 ext. 114 • Fax 912.786.9539 INTERNATIONAL CODE COUNCIL' MEMBER Permit No. 3 � / Date Requested 7- /q -ii 1 l Owner's Name J S.S / / r Date Needed Gen. Contractor 1113 dili E' ?G • Subcontractor Contact Information K Q r Project Address I U 3 3 Lo o r e! Ave Scope of Work 1, 4 c 1,D,/ i e n4 D c // / e c- • Inspector '1/ `7 Date of Inspection Inspection r � spe6 - er v: < 0 Pass E Fail Fee Inspection Pass ❑ Fail ❑ Fee Inspection Pass El Fail U Fee Inspection Pass ❑ Fail ❑ Fee IN Result Report P 1 07/19/2011 08:50 Serial No. CM35228060004 TC: 265777 Destination Start Time Time Prints Result Note Georgia Power 07 -19 08:50 00:00:42 001/001 OK Note MIX: Timer Original_TX11CALL:wMaanuaal1TX. Original Size gFWD:FForward Frame Erase RLY: Double-Sided y . : Confidential. : BUlletiinC1SIP rSIPnFax.FIPADR:FIP Address Fax. I -FAX: Internet Fax Result OK: Communication OK, S -OK: Stop Communication, PW -OFF: Power Switch OFF, TEL: RX from TEL, NG: Other Error, Cont: Continue, No Ans: No Answer, Refuse: Receipt Refused, Busy: Busy, M- Full:Memory Full, LOUR:Receiving length Over, POUER :Receiving page Over, FIL:File Error, DC:Decode Error, MDN:MDN Response Error, DSN:DSN Response Error. RELEASES FOR ELECTRIC SERVICE FROM TYBEE ISLAND - FAX TO: Lynn Bresnan 97 Pboae 912 G+(1 4%.t 3c � tow.a Q38�eorg:s i?ocrtr Location Address: 24116.4E- Lot # Release Date: Type of Release: Temporary ✓ Permanent Subd Name: Electrician: Gs %92%9E_ Electrician Phone Number: OwnerBuilder: Phone Number: Location Address: Type of Release: Temporary Permanent Subd Name: Electrician: Lot # Release Date: Owner/Builder: Electrician Phone Number: Phone Number: Location Address: Type of Release: Temporary Permanent Electrician: Owner/Builder: Lot # Release Date: Subd Name: Electrician Phone Number: Phone Number: RELEASES FOR ELECTRIC SERVICE FROM TYBEE ISLAND /FORS . FAX TO: Lynn Brennan =r- 4 -37 Phone 912= l< (/38�eorg ►at Pou r 3 0 40 . 2 c y� 3047 -2So r'°'3 ea-- 34- 2(023 Location Address: ) CO3 ZAtiZei satlit, Lot # Type of Release: Temporary .,--"Permanent Electrician: ktilCIPZ 24- [Z4,CL Electrician Phone Number: Release Date: Subd Name: Owner/Builder: Pgl1l/I Phone Number: -5:06 -AV -o, Ti Location Address: Type of Release: Temporary Permanent Subd Name: Electrician: Lot # Release Date: Owner/Builder: Electrician Phone Number: Phone Number: Location Address: Lot # Release Date: Type of Release: Temporary Permanent Subd Name: Electrician: Owner/Builder: Electrician Phone Number: Phone Number: Permit No. t r ' , City of Tybee Island • Community Development Dept. Inspection Report 403 Butler Ave. • P.O. Box 2749 • Tybee Island, GA 31328 Phone 912.786.4573 ext. 114 • Fax 912.786.9539 Owner's Name Gen. Contractor k'e Contact Information n Project Address Scope of Work Inspector O.3 I I 1003 Date Requested 0 r/ ` 1541 Date Needed 0i- Subcontractor 1/V Q Elec. Lr) o re.i Ave). trak mom gram INTERNATIONAL CODE COUNCIL' MEMBER e m O Inspection 7 t� r L)( Date of Inspection Pass El Fail VI Fee 1 _ Inspection ( \ C) Pass ❑ Fail Fee Inspection Inspection Pass Fail ❑ Fee Pass ❑ Fail Fee DATE ISSUED: 07 -6 -2011 WORK DESCRIPTION WORK LOCATION OWNER NAME ADDRESS CITY, ST, ZIP PHONE NUMBER CONTRACTOR NAME ADDRESS CITY STATE ZIP FLOOD ZONE BUILDING VALUATION SQUARE FOOTAGE OCCUPANCY TYPE TOTAL FEES CHARGED PROPERTY IDENTIFICATION # PROJECT VALUATION CITY OF TYBEE ISLAND BUILDING PERMIT KTCHN/BATH REMODEL; ELEC 1003 LAUREL AVE DAVID &MARIA RUSSELL 37 MOHAWK PATH BILLINGHAM MA 02019 -1221 508- 889 -6356 DAVID &MARIA RUSSELL 37 MOHAWK PATH BILLINGHAM MA 02019 -1221 P $ 165.00 $15,000.00 PERMIT #: 110381 TOTAL BALANCE DUE: $ 165.00 It is understood that if this permit is granted the builder will at all times comply with the zoning, subdivision, flood control, building, fire, soil and sedimentation, wetlands, marshlands protection and shore protection ordinances and codes whether local, state or federal, including all environmental laws and regulations when applicable, subsequent owners should be informed that any alterations to the property must be approved by the issuance of another building permit. Permit holder agrees to hold the City of Tybee Island harmless on any construction covered by this permit. This permit must be posted in a conspicuous location in the front of building and protected from the weather. If this permit is not posted work will be stopped. The building contractor will replace curb paving and gutter broken during construction. This permit will be voided unless work has begun within six months of the date of issuance. Signature of Building Inspector or Authorized Agent: P. 0. Box 2749 - 403 Butler Avenue, Tybee Island, Georgia 31328 (912) 786 -4573 - FAX (912) 786 -9539 www.cityoftybee.org 10,6& Location: CITY OF TYBEE ISLAND, GEORGIA APPLICATION FOR BUILDING PERMIT ((_ C 3 ) A C 3 LA J&EL AvE NAME ADDRESS PIN # TELEPHONE Owner l3AuE u sett, / co 3 LAtuRe& AVE 6bir -ag9 - (Q3S6c Architect or Engineer Building Contractor (Ch k all that apply) Q Repair ❑ Renovation ❑ Minor Addition ❑ Substantial Addition ❑ Other Details of Project: t ¢ l Residential ❑ Single Family ❑ Duplex ❑ Multi - Family ❑ Commercial ❑ Footprint Changes Rf/Discovery ❑ Demolition ee47 i , Rep ((tee_ 16. 84,nte00 / 14,It- 41--C k h j p. Estimated Cost of Construction: $ 4 t 7 J Dno - Construction Type (1) Wood Frame (2) Wood & Maso (3) Brick Veneer Proposed use: Remarks: (Enter appropriate n ber) (4) Masonry (5) Steel & Masonry (6) Other (please specify) ATTACH A COPY OF THE CER IED ' LEVATION SURVEY OF LOT and complete the following information based on the co ction drawings and site plan: # Units Bedroo •I s # Bathrooms Lot Area Living spac total sq. ft.) # Off - street parking spaces Trees located & listed on si plan Access: Driveway (. With culvert? With swale? Setbacks: Front Rear Sides (L) (R) # Stories Height Vertical distance measured from the average adjacent grade of the building to the extreme high point of the building, exclusive of chimneys, heating units, ventilation ducts, air conditioning units, elevators, and similar appurtances. During construction: On -site restroom facilities will be provided through €xt5h re5 e'- On -site waste and debris containers will be provided by 794/ Pi/A92 frri, Construction debris will be disposed by M Other by means of 7yly dwn,ty -f -md j6r' . I understand that I must comply with zoning, flood damage control, building, fire, shore protections and wetlands ordinances, FEMA regulations and all applicable codes and regulations. I understand that the lot must be staked out and that the stakes will be inspected to ensure that the setback requirements are met. I understand also that a certified plot plan showing elevation must be attached to this application and that an as -built elevation certification is due as soon as the habitable floor level is established. Drainage: I realize that I must ensure the adequacy of drainage of this property so that surrounding property is in no way adversely affected. I accept responsibility for any corrective action that may be necessary to restore drainage impaired by this permitted construction. Date: 4.7.70/ Signature of Applicant: Note: A permit normally takes 7 to 10 days to process. The following is to •e completed by City personnel: Zoning certification Approved rezoning/varia e? Street address and number: ew Is it in compliance with City .p? If not, has street name and /or nu fiber been reporte. o MPG? FEMA Certification attached State Energy Code Affidavit attached FIP Flood Zone Existing Utilities and Public Works: Describe any unusual finding(s) Access to building site Distance to water main tap si Distance to sewer stub site Water meter size Storm drainage Approvals: Zoning Administrator Code Enforcement Officer Water /Sewer Storm /Drainage Inspections City Manager Signature Date FEES Permit Inspections Water Tap Sewer Stub Aid to Const. TOTAL LEAD -BASED PAINT Adapted from http: / /www.epa.gov /lead /pubs /renovation.htm. Please use that site to access the following information. Information for Property Owners of Rental Housing, Child- Occupied Facilities Property owners who renovate, repair, or prepare surfaces for painting in pre -1978 rental housing or space rented by child -care facilities must, before beginning work, provide tenants with a copy of EPA's lead hazard information pamphlet Renovate Right: Important Lead Hazard Information for Families, Child Care Providers, and Schools. Owners of these rental properties must document compliance with this requirement. EPA's sample pre- renovation disclosure form may be used for this purpose. After April 22, 2010, property owners who perform these projects in pre -1978 rental housing or space rented by child -care facilities must be certified and follow the lead -safe work practices required by EPA's Renovation, Repair and Remodeling rule. To become certified, property owners must submit an application for firm certification and fee payment to EPA. The Agency has up to 90 days after receiving a complete request for certification to approve or disapprove the application. IF YOU'RE' NOT EAD-SAFE CERTIFIED, ISTURBING JUST SIX SQUARE FEET COULD COST YOU BIG TIM Property owners who perform renovation, repairs, and painting jobs in rental property should also: • Take training to learn how to perform lead -safe work practices. • Learn the lead laws that apply regarding certification and lead -safe work practices beginning in April 2010. • Keep records to demonstrate that you and your workers have been trained in lead -safe work practices and that you followed lea( safe work practices on the job. To make recordkeeping easier, you may use the sample recordkeeping checklist that EPA hz developed to help contractors comply with the renovation recordkeeping requirements that took effect April 2010. • Read about how to comply with EPA's rule in the EPA Small Entity Compliance Guide to Renovate Right. • Read about how to use lead -safe work practices in EPA's Steps to Lead Safe Renovation, Repair and Painting. Information for Homeowners Working at Home If you are a homeowner performing renovation, repair, or painting work in your own home, EPA's RRP rule does not cover your projec However, you have the ultimate responsibility for the safety of your family or children in your care. If you are living in a pre -1978 horr and planning to do painting or repairs, please read a copy of EPA's Renovate Right: Important Lead Hazard Information for Families, Chi Care Providers, and Schools lead hazard information pamphlet. You may also want to call the National Lead Information Center at 1 -80( 424 -LEAD (5323) and ask for more information on how to work safely in a home with lead -based paint. Information for Tenants and Families of Children under Age 6 in Child Care Facilities and Schools As a tenant or a parent or guardian of children in a child care facility or school, you should know your rights when a renovation job performed in your home, or in the child care facility or school that your child attends. • Before starting a renovation in residential buildings built before 1978, the contractor or property owner is required to have tenan sign a pre- renovation disclosure form, which indicates that the tenant received the Renovate Right lead hazard informatic pamphlet. • Beginning in December 2008, the contractor must also make renovation information available to the parents or guardians children under age six that attend child care facilities and schools, and to provide to owners and administrators of pre -1978 chi care facilities and schools to be renovated a copy of EPA's Renovate Right: Important Lead Hazard Information for Families, Chi Care Providers, and Schools lead hazard information pamphlet. Information for Contractors As a contractor, you play an important role in helping to prevent lead exposure. Ordinary renovation and maintenance activities can crew dust that contains lead. By following the lead -safe work practices, you can prevent lead hazards. Contractors who perform renovatioi repairs, and painting jobs in pre -1978 housing and child- occupied facilities must, before beginning work, provide owners, tenants, ar child -care facilities with a copy of EPA's lead hazard information pamphlet Renovate Right: Important Lead Hazard Information for Fami/ie Child Care Providers, and Schools. Contractors must document compliance with this requirement. EPA's pre- renovation disclosure form ME be used for this purpose. Understand that after April 22, 2010, federal law will require you to be certified and to use lead -safe woi practices. To become certified, renovation contractors must submit an application and fee payment to EPA. See: Application for fir certification. The Agency has up to 90 days after receiving a complete request for certification to approve or disapprove the application. Contractors who perform renovation, repairs, and painting jobs should also: • Take training to learn how to perform lead -safe work practices. • Find a training provider that has been accredited by EPA to provide training for renovators under EPA's Renovation, Repai and Painting (RRP) Program. Please note that if you previously completed an eligible renovation training course you mz take the 4 -hour refresher course instead of the 8 -hour initial course from an accredited training provider to become certified renovator. Click here for a list of eligible courses. • Provide a copy of your EPA or state lead training certificate to your client. • Tell your client what lead -safe methods you will use to perform the job. • Learn the lead laws that apply to you regarding certification and lead -safe work practices beginning in April 2010. • Ask your client to share the results of any previously conducted lead tests. • Provide your client with references from at least three recent jobs involving homes built before 1978. • Keep records to demonstrate that you and your workers have been trained in lead -safe work practices and that you followed lea( safe work practices on the job. To make recordkeeping easier, you may use the sample recordkeeping checklist that EPA hz developed to help contractors comply with the renovation recordkeeping requirements. • Read about how to comply with EPA's rule in the EPA Small Entity Compliance Guide to Renovate Right. • Read ate•' t ho to lead -safe work practices in EPA's Steps to Lead Safe Renovation, Repair and Painting. r Signa Printed Name 7 / /// Date Permit Acknowledgement of Asbestos /Environmental Notification to Georgia EPD for Projects Involving Demolition, Wrecking, or Renovation The undersigned hereby acknowledges that the issuance of this permit does not in any way grant permission to the owner, owner's representative, or permit holder to proceed with demolition, wrecking, or renovation of a structure prior to the filing of any required ten (10) day "Project Notification for Asbestos Renovation Encapsulation or Demolition" form in accordance with the Georgia Asbestos Rules. The Georgia Environmental Protection Division administers the rules. In most cases, the rules require both the owner and the involved contractors to assure the portion of the building involved in the project is thoroughly inspected by an Accredited Asbestos Inspector for materials that contain asbestos; and the removal of the asbestos before renovation, wrecking, or demolition begins almost without exemption. Georgia EPD requires a completed demolition notification from be submitted 10 workings days in advance even if no asbestos is present in the building. Further guidance for regulatory compliance and contact telephone numbers are provided by the brochures entitled Asbestos & Renovation and Asbestos and Demolition. Other environmental issues such as asbestos removal techniques, lead abatement, ground contamination, or unusual site conditions may have EPD regulations that could affect the project. 10/el/LA' Printed Name Date Office Use Only: Project Address: Permit Number: Chatham County Board of Asse - -)rs: 2011 Property Record Card 4 -002E `16 -010 Page 1 of 2 2011 Chatham County Board of Assessors Property Record Card 4- 0026 -06 -010 1003 LAUREL AVE TYBEE ISLAND ;APPRAISER LESTEPH LOTS 19 AND 20 BLOCK 5 GARDEN WA RD TYBEE LAST INSP 08/13/2010 'APPR ZONE 000008 YEOMANS CURTIS EUGENE; CAMA ASMT PO BOX 1648'211,000 211,000 LAND 2 TYBEE ISLAND GA 31328 -1648 55,100 55,100 BLDG 1 1,800 1,800 OBXF 2 1267,900 267,900 Cost - MS SALES BOOK / INS VI QU RSN PRICE PAGE 01 Aug 1987 I U UO 54,900 GRANTOR: GRANTEE: 01 Nov 1977 I Q QO 26,000 GRANTOR: GRANTEE: PERMITS TYPE DATE AMOUNT 090498 DM 13 Aug 2010 Insp 500 COMMENTS: 30 Dec 2010 TY11 HS REM PER COD FOR CURTIS 9/3/2010 27 Oct 2000 ADD CHG FORM 10 -27 -2000 SSB [Click for larger picture] CODES ;PROPERTY 0006 RESIDENTIAL USE UTA 0004 Tybee Island NBHD 020270.00 T270 TYBEE SCREVEN EXEMPTIONS HISTORY LAND IMPR TOTAL 2011 211,000 56,900 267,900 Cama , 2010 299,100 56,900 356,000 Cama 2009 299,000 116,500 415,500 Over 2008 299,000 116,500 415,500 Cama 2007 299,000 108,000 407,000 Cama 2006 314,000 73,500 387,500 Cama 2005 131,500 108,000 239,500 Cama 2004 91,000 96,000 187,000 Over 2003 91,000 96,000 187,000 Over 2002 187,000 A/C 2001 86,500 64,500 151,000 Cama 2000 68,000 57,500 125,500 Cama 1999 29,000 57,500 86,500 Cama 1998 29,000 56,500 85,500 Cama 1997 29,000 54,000 83,000 Cama 1996 17,000 43,420 60,420 Over 1995 17,000 43,420 60,420 Over 1994 17,000 43,420 60,420 Over 1993 17,000 43,420 60,420 Over 1992 17,000 43,420 60,420 Over EXTRA FEATURES ID# BLDG # SYSTEM DESC DIM 1 DIM 2 UNITS QL UNIT PRICE RCN AYB EYB DT ECON FUNC SP SP% RCNLD MKT VALUE 143049 87503 AVDetGarSid 15 24 360.00 A 22.54 8,114 1980 1980 2R 1,623 1,600 143050 87503 Solid Wall /SIabAV 7 4 28.00 A 38.09 1,067 1980 1980 2R 213 200 LAND ID# USE DESC FRONT DEPTH UNITS / TYPE PRICE ZONING LCTN TOPO OTHER ADJ1 ADJ2 ADJ3 ADJ4 MKT VALUE 112542 SINGLE FAMILY RES 0 0 7,000.00 -SF 42.00 RIB 197000 112543 SINGLE FAMILY RES 0 0 1,989.00 -SF 42.00 R1B SZ -75 14000 �J/ Ca LD x 507c, http: // boa. chathamcounty. org /DesktopModules /ChathamCounty /BoardofAssessors /Property... 7/1/2011 Chatham County Board of Asse -ors: 2011 Property Record Card 4 -0021 06 -010 Page 2 of 2 2011 Chatham County Board of Assessors 4- 0026 -06 -010 Property Record Card 1003 LAUREL AVE TYBEE ISLAND I BUILDING SECTION CONSTRUCTION TYPE RCN AYB EYB DEP TYPE PHYS ECON FUNC OBSV / % TOTAL DEP % RCNLD U.FACTOR MKT VAL 87503 -1 Residential 94,408 1954 1985 MS 27.00 0.00 0.00 0.00 27.00 68,918 55,100 15' 24' 24' •GDT Gunge (DA) 35 2 [Click for larger picture] SECTION TYPE 1 - Main AREA 1375 TYPE 1 - Single- family Residence FRAME 1 - Stud Frame STYLE 1 - One Story QUALITY 3.00 CONDITION 3.00 # UNITS 0 # OF BEDS / BATHS 3 / 2.00 COMPONENTS Units % QUAL R1 108 Frame, Siding, Wood 100.00 R2 208 Composition Shingle 100.00 R3 352 Heat Pump 100.00 R4 402 Automatic Floor Cover Allowance R6 601 Plumbing Fixtures ( #) 8.00 R6 602 Plumbing Rough -ins ( #) 1.00 R6 621 Slab on Grade (% or SF) 100.00 http: // boa. chathamcounty .org /DesktopModules /ChathamCounty /BoardofAssessors /Property... 7/1/2011 OWNER RECONSTRUCTION / IMPROVEMENT AFFI AVIT Name of Company Oalne.1 Contractor Address Name of Property Owner s %v 0 Telephone SW, , &8-7 Location of Property / D 0 43 J, Et_ 4-t' - I hereby attest to the fact that the attached itemized list of the Estimated Cost of Reconstruction and /or Improvements are all of the repairs and /or reconstruction and /or improvements proposed on the subject building for the attached Building Permit Application included with the estimate. Listed below are the date(s) and details of the last occurrence(s) of any repairs and /or reconstruction and /or additions and /or remodeling at this property: I understand that I am subject to enforcement action and /or penalties and /or fines if inspection of the property reveals repairs and /or reconstruction and /or improvements not included on the attached list of the Estimated Cost of Reconstruction and /or Improvements as well as the Building Permit Application as well as the list of the last occurrence(s) of any repairs and /or reconstruction and /or additions and /or remodeling. I understand that any Building Permit issued by the City of Tybee Island pursuant to this Affidavit does not authorize the repair and /or reconstruction and /or improvement and /or maintenance of any illegal additions, fences, sheds, or non - conforming uses or structures on the subject property. Total Labor & Materials $ / yi, 060 Overhead & Profit $ /UM— Total Cost $ / OVO STATE OF GEORGIA COUNTY OF CHATHAM Before me this day personally appeared who, by his /her signature below, states that the information provided on this Affidavit is correct and that he /she has read, un drstands, and agrees to comply with all the aforementioned conditions. Owner's Si nature Sworn to and subscribed before me this Signature of Notary Public My Commission expires day of , 20 City of ti_Aee Island • Community Develop, ent Dept. Inspection Report 403 Butler Ave. • P.O. Box 2749 • Tybee Island, GA 31326 Phone 912.786.4573 ext. /14 • Fax 912.786.9539 Permit No. Owner's `ae kV55�ri1 %� n_ Contractor Contact Information Da e Requested Cv /G // 77 Runk !!!::Cw INTERNATIONAL CODE COUNCIL MEMBER Date Needed Subcontractor Project Address O 00 3 (: -L) 72-E, ( /tzj Scope of Work Inspector '°? /q Date of Inspection /i Inspection U. ' ` >7 Inspection Pass Fee Pass Fail `"� Fee C' C! `� -- CU • Vic: Inspection t4 - , ,b ► 7 Pass ❑ 1530(141 - P1374"4. cir4 Inspection gDorb Fail l""°l Fee uoiit , -36 `K 4-12u6/1" Pass Fail 1 Fee Nio ce Nok (esb REIrES FOR ELECTRIC SERVICE FROM TYBEE ISLAND FOR c -W NN tr ET ECTRIC. FAX TO: Lynn Brennan X37 Phone 912= Fjeorg :a. 'Po coe r 3 o co - 2 4) L46 got,-23or C�u -�-tty 308- 2 czar Location Address: LSe SaCe IDO3 Lau rei Ave, Lot# Type of Rse. Temary Permnt Subd Mme. Electrician: wner a z or-c S 'Pr eS.e.in A- se Date: (2 — I Electrician Phone Number: uilder: Phone Number: Sods -d] (o (o - 3g0'I- Location Address: Type of Release: Temporary Permanent Subd Name: Electrician: Lot # Release Date: Owner/Builder: Electrician Phone Number: Phone Number: Location Address: Lot # Release Date: Type of Release: Temporary Permanent Subd Name: Electrician: Owner/Builder: Electrician Phone Number: Phone Number: rT TX Result Report P 1 06/17/2011 11:35 Serial No. CM35228060004 TC: 261550 Destination Start Time Time Prints Result Note Georgia Power 06 -17 11:35 00:00:33 001/001 OK Note TMR: Timer TX. POL: MIX: : Double- SidedaBindingA Direction. TX, SpecialSoriginal. Forward. : F- code, PC-Fax, Re -TX, RLY: Relay. MBX: Confidential. BUL: Bulletin. SIP: SIP Fax. IPADR: IP Address Fax, I -FAX: Internet Fax Result OK: Communication OK, S -OK: Stop Communication, PW -OFF: Power Switch OFF, TEL: RX from TEL, NG: Other Error, Cont: Continue, No Ans: No Answer, Refuse: Receipt Refused, Busy: Busy, M- Full:Memory Full, LOVR:Receiuing length Over, POVER:Receiving page Over, FIL:File Error, DC:Decode Error, MDN:MDN Response Error, DSN:DSN Response Error. RE SAES FOR ELECTRIC SERVICE FROM TYBEE ISLAND . FAX TO: Lynn Bresnan phone 912 0�oS- -a4. 34.41- Z bZr f_ -Po 410c 7- Location Address: saw I (.7-) 3 { _Q u c- L /-� ./ e. . Lot Type of 1g; Tem rary Ferin3,110 nt Electrician: udder: ^D c') , 5 <o_i Ca 2GiSMaS e Date: G2 — Electrician Phone Number: Phone Number: SOS' -`' ( Location Address: Type of Release: Temporary Permanent Subd Name: Electrician: Lot # Release Date: OwnerBuilder: Electrician Phone Number: Phone Number: Location Address: Type of Release: Temporary Permanent Electrician: Owner/Builder: Lot # Release Date: Subd Name: Electrician Phone Number: Phone Number_ T}{ Result Report P 1 06/17/2011 16:52 Serial No. CH35228060004 TC: 261597 Destination Start Time Time Prints Result Note Georgia Power 06 -17 16:51 00:00:41 001/001 OK Note TMR: rifler TX. POL: MIX: : Double- SidedaBindingA Direction. 5P: SpecialSoriglinal, Forward. : F -code, PC-Fax. Re -TX. RLY: Relay. MBX: Confidential. BUL: Bulletin. SIP: SIP Fax. IPADR: IP Address Fax. I -FAX: Internet Fax Result OK: Communication OK, S -OK: Stop Communication, Pw -OFF: Power Switch OFF, TEL: RX from TEL, NG: Other Error, Cont: Continue, No Ans: No Answer, Refuse: Receipt Refused, Busy: Busy, M -Full :Memory Full, LOVR:Receiving length Over, POVER:Receiving page Over, FIL:File Error, DC:Decode Error, MDN :MDN Response Error, DSN:DSN Response Error. MAYOR Jason Buelterman CITY COUNCIL Shirley Sessions, Mayor Pro Tern Wanda D_ Doyle Bill Garbutt Frank Schuman, Sr. Kathryn Williams Paul Wolff' Georgia Power PAX: 306 -2646 June 17, 2011 CITY OF TYBEE ISLAND PIease discontinue service to 1003 Laurel Avenue due to obvious life safety hazards. W /ck Ray Hord Building Official CI'T'Y lYIANAGER Diane Schleicher ACTING CLERK OF COUNCIL Jan LeViner P.O. Box 2749 - 403 Butler Avenue, Tybee Island, Georgia 31328-2749 (912) 786 -4573 - FAX (912) 786 -5737 www_eityoftybee.org CITY ATTORNEY Edward M. Hughes MAYOR • Jason Buelternian CITY COUNCIL Shirley Sessions, Mayor Pro Tem Wanda D. Doyle Bill Garbett Frank Schuman, Sr. Kathryn Williams Paul Wolff Georgia Power FAX: 306 -2646 June 17, 2011 CITY OF TYBEE ISLAND Please discontinue service to 1003 Laurel Avenue due to obvious life safety hazards. Ray Hord Building Official Aik „ CITY MANAGER Diane Schleicher ACTING CLERK OF COUNCIL Jan LeViner P.O. Box 2749 — 403 Butler Avenue, Tybee Island, Georgia 31328 -2749 (912) 786 -4573 — FAX (912) 786 -5737 www.cityoftybee.org CITY ATTORNEY Edward M. Hughes