487 ROYAL PALMS DR RES21-0072 Job site copies revision 9-20-21_1f;, Revision Request/Correction to Comments ALL INFORMATION
1 HIGHLIGHTED IN
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City of Atlantic Beach Building Department GRAY IS REQUIRED.
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V 800 Seminole Rd, Atlantic Beach, FL 32233
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Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: )222 -00-72.....
Iti/Revision to Issued Permit OR Corrections to Comments Date: 1 2.-i 7
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Project Address: L1 go-TA, h1 /j/1/l9 v .,
Contractor/Contact Name: MaA.Vre-e,"1
Contact Phone: /1° 715 Email: 11/‘ (a,4'rla rWq ((JU(id .C4 YI/l
Description of Proposed Revision/Corrections:
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IPLUdiree1/11411Na 4/ affirm the revision/correction to comments is inclusive of the proposed changes.
printed name)
Wil roposed revision/corrections add additional square footage to original submittal?
No Yes (additional s.f.to be added:
Will roposed revision/corrections add additio . increase in building value to original submittal?
o *Yes (additional increase in build' g M: ue: $ Contractor must sign if increase in valuation)
Signature of Contractor/Agent:
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0 fice Use Only)
Approved Denied Not Applicable to Department Permit Fee Due$
Revision/Plan Review Comments
Department Review Required:
Building
Planning&Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities
Public Safety Date
Fire Services Updated 10/17/18
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PRODUCT APPR VAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FLORIDA(*REQUIRED)
Project Address:
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1 V 1 'Rt-1-IVY);1\ Permit#: 12;e- 21 v°7 2,
Owner/Project Name: NctAA,r& l L i r r/2'y
As required by Florida Statute 553.842 and Florida Administrative Code Rule 61620-3,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
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
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Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
C.PANEL WALL
1.Siding
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 f i- A UO r2-4,
2.Underlayments M I ail lArAkt PL-106 'r—id,
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
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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 Na me): l 'a// ' Y *Contractor Signature 1 4//IA / /4 a4mi/
Company Name: (4 ' f t^l/( tet TJ J , "I 1('l.) C rJ-tn . .
Mailing dress:d I eh`W
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City: 404 fib /yt State:r li Zip Code:
Telephone Number: Il E-mail Address: Oill ICi.n l---'1 04- C609
Cell Phone Number: t4Iv l Fax Number:
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