63 CORAL ST RES22-0054 revision 3-16-22 ALL
Revision Request/Correction to Comments **HIGHLI HIED I ON
s rt�y�rlr�. HIGHLIGHTED IN
: "' City of Atlantic Beach Building Department GRAY IS REQUIRED.
VIII:
800 Seminole Rd, Atlantic Beach, FL 32233 _
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: 52Z^ &)°5
_.„.4v2❑ Revision to Issued Permit OR Corrections to Comments Date:
Project Address: Gc 3 cc9,4( 9t
Contractor/Contact Name: TO —f1 CPAS�`�T' L1,6 G( o Tour G4-4SL
Contact Phone: CO 4 _ ��� I 7g Email: + 7' nJ`` a
Description of Proposed Revision/Corrections:
F''''`'IC 46"59c011 / -le 4
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I affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
• ill proposed revision/corrections add additional square footage to original submittal?
_...r144
o ❑ Yes (additional s.f.to be added: )
• ill proposed revision/corrections add additional increase in building value to original submittal?
..,Frit4
o ❑*Yes (additional increase in building value: $ ) (Contractor must sign if increase in valuation)
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*Signature of Contractor/Agent: i N
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4,1,9, lig-,A2A'Ff9,--)
(Office 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
C **AL''? Building Permit Application Updated 10/9/18
' City of Atlantic Beach Building Department
L INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
-�ws Pr IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 63 Coral Street Permit Number: R\ C z_ 0 054
Legal Description 15-82 09 2S-29E OCEAN GROVE UNIT NO 1 S/D PT LOT 7 E20FT LOT 17 BLK 8 RE# 169594-0170
Valuation of Work(Replacement Cost) $2.700.00 Heated/Cooled SF N/A Non- Heated/Cooled_
• Class of Work: ❑New ❑Addition VAlteration -Repair HMove II Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ElResidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s) be removed in association with proposed project? Lilies(must submit separate Tree Removal Permit) LiNo
Describe in detail the type of work to be performed: Remove and dispose existing firplace. Install finished opening for new Owner provided
electric fireplace. Install Owner provided wall tile for surround. Install TV Bracket. Re-route TV cables.
i-CU o-c e r 4 c . I pe
Florida Product Approval # for multiple products use product approval form
Property Owner Information
Name Peggy L Collins Address 63 Coral Street
City Atlantic Beach State Florida Zip 32233 Phone 904-372-3895
E-mail plc.atlanticbeach@gmail.corn
Owner or Agent (If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Tri-H Construction LLC Qualifying Agent Anton Harasz III
Address P.O. Box 331118 City Atlantic Beach State FLORIDA Zip 32233
Office Phone 904-545-9978 Job Site Contact Numb r 904-545-9978
State Certification/Registration# G O�ZZZC)( E-Mail -11).-1,�✓T"�i,Je •C@ 1.-'
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurer Exempt OR Exempt VI Expiration Date 3-22-2022
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 ATTORN Y BEFORE
REC• ' x 1G •UR NOTICE OF COMMENCEMENT. r(__ 7y '',, , ) %
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(Signature of Owner or Agent) (Signature of Contractor) '' //
Si ned and sworn to(or affir ed)before me this 11 day of S ned and sworn to(or of rmed)before me this(_ c9ay of
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Commission V GG 94325C
: Expires April 28,2024 [ ) Personally Know •r.a�" TONI GINDLESPERGER
(✓/1 Personally Known OR ,t,;;;‘,71.74:. ..r... Bonded Thru TroyFain Insurance 800-386-7019 :•• ••.. CO►,}titISSION#GG 353178
[ )Produced Identificatiot [ I Produced Identifi : ip ;r,,:
L T e of ldentificatio '.:'-•-ww.�.o,: t SPI October 6,2023
Type of Identification: i-' 51-141 "C YP .Y.1, .-
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