725 ATLANTIC BLVD COMM22-0004 COAB Permit Form with Conditions CANVOS AWNINGOWNER:ADDRESS:CITY:STATE:ZIP:
ATLANTIC-PENMAN LLC 500 S 3RD ST JACKSONVILLE
BEACH FL 32250
COMPANY:ADDRESS:CITY:STATE:ZIP:
BOREE CANVAS
UNLIMITED, INC.4635 HIGHWAY AVE JACKSONVILLE FL 32254
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171363 0000 ROYAL PALMS UNIT 02A
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
725 ATLANTIC BLVD UNIT 9 COMMERCIAL ALTERATION
COMMERCIAL PATIO CANOPY $17195.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $140.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $70.00
FIRE DEPARTMENT FEE 45500002080800 0 $150.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.15
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: 4/5/2022
PERMIT NUMBER
COMM22-0004
ISSUED: 4/5/2022
EXPIRES: 10/2/2022
COMMERCIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.10
TOTAL: $365.25
2 of 2Issued Date: 4/5/2022
PERMIT NUMBER
COMM22-0004
ISSUED: 4/5/2022
EXPIRES: 10/2/2022
COMMERCIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
ji Y"`'''' ', Building Permit Application Updated 10/9/18
tiA
i City of Atlantic Beach Building Department ALL INFORMATION
j
014800SeminoleRoad, Atlantic Beach,-Ft-32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 E i1: Building-Dept@coab.us` LS REQUIRED,
Job Address: (1.q4-5--Mt -1-1C_ Permit Number: C1 M(h 2 Z 4
Legal Description 3/ - 1 LJ'?"' )- AC7., 3.95 r fl I `/Y1-S ;RE# i'7136,3 -cyjc6
Valuation of Work(Replacement Cost)$ /7 //-5--; 'i-leated/Cooled SF Non-Heated/Cooled
Class of Work: New DAddition OAlteration Repair LiMove Demo OPool Window/Door
Use of existing/proposed structure(s): ran mmercial Residential
If an existing structure,is a fire sprinkler system installed?: DYes No
Will tree(s)be removed in association with proposed project?DYes(must submit separate Tree Removal Permit) [7N°
Describe In detail the type of work to be performed:' T-. j (->/-I tUC120 r3, }
Florida Product Approval#pp for multiple products use product approval form
Property Owner Information
Name '\PosA - i In r i A)J LIL Address 3- .6t8
City ,\A i State - - -!Zip 55- Phone 746,---7602-)
E-Mail brl. tot"-Et ("'t+t.1 -1 r`C_t_nV ice:Criry
Owner or Agent(If Agent,Power of Attorney or Agency letter Required)
Contractor Information
Name of Company r Qualifying Agent `t"11a e1 .--,
Address-='-'4(-49- 4---- Al 1t Q City J NI. State rL.. :Zip : ,
Office Phone A /0 Job Site Contact Number "4)-7'
State Certification/Registration# Cf?f_ 1- E-Mail -t2 t'1 IXZS"r a eree fir,VO C'e,t r
Architect Name&Phone II
Engineer's Name&Phone# -11--k. ('‘ ,.. p t j- ,-- 9• ( - fl I - CSS()
sWorkersCompensationInsurer f OR Exempt a Expiration Date U l(11202-2_
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 CONDIFIONERS,etc. NOTICE:In addition to the requirements of thli
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 YO R PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIel' fi i NCING, CONSULT WITH YOUR LENDE• '.•RAN -TTORNEY BEFORE
RE • e i . • c, R NO d' E OF COMMENCEMENT.
Y Signature of Owner or Agent) Signature of Contractor)
Sig •d and sworn to(or affirmed before • this2. day of Signed and sworn to(or affirme )before me this /ay ofd , ZON .by i u. t/ ( ' I I,k+41m,i,'a z1 ,by a 4-_ .rkAe.....
moi,,._-7/,. . L..1/_
t f,, Signature of Notary)
TBRIT NY FAYE DRIVER
Personally
ISSIOri#GG2024 Personally Known OREXPIRES:April 28,2024 t'1 y KAREN MARIE BARR
1 Produced Identificat;. Produced Identification34 MYCOMMISSION#GG344841
Type of Identification: Type of Identification:i30 EXPIRES:July 09,2023
By Mike Jones at 9:21 am, Mar 01, 2022
REVIEWED FOR CODE COMPLIANCE
Doc # 2021289294 , OR BK 19989 Page 1381 , Number Pages: 1 ,
Recorded 11/02/2021 04 :23 PM, JODY PHILLIPS CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10. 00
NOTICE OF COMMENCEMENT
State of (er-tc\A. Tax Folio No. 1'11 5655- &coo
County of
655-
Countyof VUJ fir k..._.
To Whom It May Concern:
The undersigned hereby informs you that Improvements will be made to certain real property,and In accordance with Section 713
of the Florida Statutes,the following Information is stated In i is NOTICE OF COMMENCEMENT. •
Legal Description of property being Improved: _ ti - ‘ 15 ' Z ' 2 C 1"f1• a,'
1'11•S-vsA Io+r) I i :3 (.-e P-11(eQal
1
1 14-'3CN 5
1
9 -I/4 Pr f„ kya) el?i 16,
Address of property being Improved: 1 ) 4--4-lttk/1('_ 1
General description of improvements: C IT-t U l._,14-Nb ioL?
i
Owner:_i Ac IC' 1'C n Y J 1IAddress:
7•
jI. t 54GtJt1t
Ownees Interest In site of the Improvement: •
Fee Simple Titleholder(If other than owner):
Name:
ContractorContractorCS'r .S (-\-
4,(.0'
IN$V
1k: tAddress: v1- i' Q -,1i\`, 1 5l/.
tS%`l - 6 I79-Telephone No.: . VK'`7 u 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 ofperson 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 et Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date Is one(1)year from the date of recording unless a different date Is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER AkSigned: Date: /Q-2lo-202/
Before e . is Zit,. 2. in the opnw of Duval,State
Of Florf' i,•,has personalty appeared 1 !_,1
Notary
i
sionic
at targe,state of F ida,27'102ty of Du
a f" 4j • 4Mcommitslonexpires: 7 7 i z(_..•
Personalty Known: 0 . or
Produced Identification.
RI'ifITiAN,Y;RAYB DRIVER
yrkeommissio 460975700
y- H?:4Ril03'4911128,2A24
RF
Certificate of Flame ResistanceG5_ 4
CALter
FIRE
9+°-. ': Issued By:
oFRETP HERCULITE PRODUCTS INC
Registered Fabric ABERDEEN ROAD COMPANY
or Concern Number PO BOX 435 Date treated or manufactured:
F-06901 EMIGSVILLE, PA 19175-8310 11/02/2021
This is to certify that the materials described below have been treated with a flame-retardant chemical or are inherently
nonflammable.
FOR: Trivantage, LLC ADDRESS: 1831 North Park Ave.
CITY: Glen Raven STATE: NC 27217
Certification is hereby made that: (Check"a"or"b")
a) The articles described at the bottom of this Certificate have been treated with a flame-retardant chemical
approved and registered by the State Fire Marshal and the application of said chemical was done in conformance
with the laws of the State of California and the Rules and Regulations of the State Fire Marshal.
Name of chemical used: Chemical Registration#:
Method of application:
X (
b) The articles described the bottom of this Certificate are made from a flame-resistant fabric or material
registered and
approveat
d by the State Fire Marshal for such use.
Trade Name of flame-resistant
fabric or material used: REINFORCED VINYL Registration#: F-06901
The Flame-Retardant Process Used Will Not Be Removed By Washing
DONALD E. KAUFFMANN STEPHANIE MUMMERT, Q C MANAGER
Name of Applicator or Production Superintendent Title
RCNs# 00000000001138953091 CUSTOMER ORDER NO. 5272
00000000001138953183 CUSTOMER INVOICE NO. 3275891
YARDS OR QUANTITY 80.00
DESCRIPTION Weblon Coastline Plus #CP-2745
62" Pirate Black (Standard
Pack 50 Yards)
ITEM NUMBER 857245
We hereby certify the above to accurately reflect the information contained within a"CERTIFICATE OF FLAME RESISTANCE"issued toTrivantage, LLC from the registrant set forth above. A copy of the original Certificate of Flame Resistance is available upon
request to Trivantage, LLC and the registration information set forth above is on record with the California State Fire Marshal.
BOREE CANVAS UNLIMITED
MAILING ADDRESS
4635 HIGHWAY AVE
JACKSONVILLE, FL 32254-4123
TRIVANTAGE
11-02-2021
ORDER DONE.GOOD CAL,.
1831 North Park Avenue
Glen Raven, NC 27217-1100
www.trivantage.com
P: (336)227-6211
F: (336) 586-1394
BOREE CANVAS UNLIMITED
4635 HIGHWAY AVE
JACKSONVIL, FL 32254
US
CERTIFICATION OF COMPLIANCE
We hereby certify that 80.0 YD
Weblon Coastline Plus#CP-2745 62"Pirate Black(Standard Pack 50 Yards)
Item# 857245
shipped on 11-02-2021 against Purchase Order 5272
for use on Order No. WC_3597817 for RCN's
00000000001138953091,00000000001138953183
Customer Invoice 3275891 comply with specifications
CSFM REGISTERED#F-06901, NFPA-701,ASTM-E84-81A Class A
TRIVANTAGE, LLC
ge sz7
Bret Kelley
Vice President
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By Mike Jones at 9:25 am, Mar 01, 2022
18.75 FEET51.07 FEET