175 15th St RES22-0059 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
JOHNSON R MARK 175 15TH ST ATLANTIC BEACH FL 32233-5723
COMPANY:ADDRESS:CITY:STATE:ZIP:
COLLIER AND COLLIER 4552 BAY HARBOUR DR JACKSONVILLE FL 32225
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171869 0000 MANDALAY
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
175 15TH ST RESIDENTIAL ALTERATION
RESIDENTIAL
REPLACE BEAMS AND
FRENCH DOORS $49000.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BLDG 2ND PLAN REVIEW FEE 455-0000-322-1006 0 $50.00
BUILDING PERMIT 455-0000-322-1000 0 $300.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $150.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $7.50
STATE DCA SURCHARGE 455-0000-208-0600 0 $5.00
TOTAL: $512.50
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
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.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN 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.
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.
1 of 2Issued Date: 4/4/2022
PERMIT NUMBER
RES22-0059
ISSUED: 4/4/2022
EXPIRES: 10/1/2022
RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
2 of 2Issued Date: 4/4/2022
PERMIT NUMBER
RES22-0059
ISSUED: 4/4/2022
EXPIRES: 10/1/2022
RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
Revision Request/Correction to Comments ALL INFORMATION
HIGHLIGHTED IN
p 1' ' City of Atlantic Beach Building Department GRAY IS REQUIRED.
1/ 800 Seminole Rd, Atlantic Beach, FL 32233 RLs z z -cos9f• Jr Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
Revision to Issued Permit OR Corrections to Comments Date: t,2
Project Address: 1 7s
1Si/
h
ST
Contractor/Contact Name: tSv '- CO't 1 t. rf--*--,_
Contact Phone: CIO I( cYC2CC Email: C C-- (c( gCo n(1 &A ( CZ7 rY'
Description of Proposed Revision/Corrections:
I a c.c. ("24 I i Z— affirm the revision/correction to comments is inclusive of the proposed changes.
printed name)
NI-proposed revision/corrections add additional square footage to original submittal?
No Yes (additional s.f.to be added:
WjLl-proposed revision/corrections add additional increase in building value to original submittal?
17_1No *Yes (additional increase in building valu •$ Contractor must sign if increase in valuation)
Signature of Contractor/Agent: ':... . ...e...-az----
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
50.00
Qualifying agents name space on application is still incorrectly filled out.
By Mike Jones at 4:59 pm, Mar 10, 2022
A`jr4Building Permit Application Updated l0/9/18
n
City of Atlantic Beach Building Department ALL INFORMATION
p / 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
art
IS REQUIRED.
7S
IPhone: (
904) 247-5826aEmail: Building-Dept@coab.us
Job Address: 1 !5 /C111 -
1S % I'kiti7c en Ck fl--rN33 Permit Number: R ES 2. 2-Cja
Legal Description /4)7 3 131-)< ( Pl E MNO ALA' ) Cp I 7 (g
Valuation of Work(Replacement Cost)$ QVO Heated/Cooled SF 4`b4E Non-Heat . o0
Class of Work: New Addition Alteration KiRepair Move lifiDemo Pool (8Windo /Door
Use of existing/proposed structure(s): DCommercial giResidential
If an existing structure, is a fire sprinkler system installed?: OYes fiilNo
Will tree(s)be removes) in association with proposed protect? YesImu_st submit separate Tree Bernina'Permit) SQNo
Describe in detail the type of work to be performed: R(,f'l l(- N-----.?FIZt ' M p 5 ,
Florida Product Approval if for multiple products use product approval form
Property Owner Information
Name Il MAP( u j ri4Est;_ ,f 04A'.9:v.) Address 175 IS Ili "j I2/el
City °4Ti.AN --' t-'i:'(Ac'14 State rt_ Zip 33)-'x'-) Phone '01-/ oileA Ji-c)43 IF 7o y4.;jCyOsiE-Mail /'V) okin Sv-) ),a & vCYylr;}, L )"'1
Owner or hent(If Agent, Power offAttdorney or Agency Letter Required)
Contractor Inform•.tio f I P.
Ili
Name of ompany '
Cor (
i Qt l 1 l Ie - Quali ing Agent C 1 hi I b 8
Address a S" City :;% MA!1
Office Phone 0 ' - ( .Mt Job Site Contact Number 0
State Certification/Registration K 4' • a E-Mail . 4 C.. ikeriff rr,a t re+
Architect Name& Phone$$
Engineer's Name&Phone K SA130 l/t1 o-r tik/- 114=r—501 7 j 7,s'"--,;
Workers Compensation Insurer OR Exempt Er 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 FINAN ING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORD) c YO R OTICE OF COMMENCEMENT.
GPli
is a. n• of a net or Agent)
I--
Signature of Contractor) /
Sired and sworn to(o affirmed)before me this L Y0 day of Signed and sworn to(or affirmed)
Lbefore
me,this f - day of
1't a;`.1 t/, 2 L i 1 , by Oki• i `, .11'4,.. r 1•(./i f ;. / , 201 Z--,by 1 fp . I fi'+S5` -
i"L
J(
Sigrt ture of Notary) Li)(-"(gnat/re of No[[ry)
baja,.,-,..c. • - . ...
MELISSA;Cahn DAMS i o` . M;_SSA JOANN DAVIS
V1Personall Kn
4(
1`; Notary Dub':,c .State of Fiorlda x: ' Notary Public•State of FloridaPersonallyCommissionxGG956245j-Personally Known OR Commission I GG 956245
I I Produced Ide My Comm.Expires Feb 14.2024 I Produced Identificaho • •a My Comm.Expires Feb 14.2024 I
Type of Identifica n: Bonded tnrou h National Notary Asir Type of Identification: laded through National Notary As`* 1
CHRISTOPHER J SABOURIN STATE OF
FLORIDA, PROFESSIONAL ENGINEER,
LICENSE NO. 71461.
THIS DOCUMENT HAS BEEN
ELECTRONICALLY SIGNED AND
SEALED BY CHRISTOPHER J
SABOURIN, PE ON A SHA
AUTHENTICATION CODE.
PRINTED COPIES OF THIS DOCUMENT
ARE NOT CONSIDERED SIGNED AND
SEALED AND THE SHA
AUTHENTICATION CODE MUST BE
VERIFIED ON ANY ELECTRONIC
COPIES
02/24/2022
Christopher Sabourin
Christopher
Sabourin
I am approving
this document
2022.02.24
14:18:37-05'00'
By Toni Gindlesperger at 10:31 am, Feb 28, 2022
By Mike Jones at 12:50 pm, Mar 02, 2022