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1869 SEA OATS DR SOLR23-0008 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP: KLEIN KARL M 1869 SEA OATS DR ATLANTIC BEACH FL 32233 COMPANY:ADDRESS:CITY:STATE:ZIP: Lumio HX Inc 1550 W. Digital Drive Suite 500 Lehi UT 84043 TYPE OF CONSTRUCTION: REAL ESTATE NUMBER:ZONING:BUILDING USE GROUP:SUBDIVISION: 172020 0538 SELVA MARINA UNIT 09 JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK: 1869 SEA OATS DR ELECTRICAL SOLAR PANEL PV Solar Panel Installation Roof Mounted $30377.95 FEES DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.00 SOLAR COLLECTOR SYSTEM 455-0000-322-1000 0 $30.00 STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00 STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00 TOTAL: $89.00 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: 11/9/2023 PERMIT NUMBER SOLR23-0008 ISSUED: 11/9/2023 EXPIRES: 5/7/2024 ELECTRICAL SOLAR PANEL PERMIT CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 2 of 2Issued Date: 11/9/2023 PERMIT NUMBER SOLR23-0008 ISSUED: 11/9/2023 EXPIRES: 5/7/2024 ELECTRICAL SOLAR PANEL PERMIT CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 BUILDING PERMIT APPLICATION City of Atlantic Beach Building Department 800 Seminole Road, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email:Building-Dept@coab.us Name PhoneProperty Owner Information (Signature of Owner or Agent) Job Address Legal Description RE# Valuation of Work (Replacement Cost) - Class of Work: New Addition Alteration Repair Move Demo Pool Window/Door - Use of existing/proposed structure(s): Commercial Residential - If an existing structure, is a fire sprinkler system installed?: Yes No - Will tree(s) be removed in association with proposed project? Yes (Must submit separate Tree Removal Permit) No Heated/Cooled SF Non-Heated/Cooled SF Describe in detail the type of work to be performed: Florida Product Approval #(For multiple products use Product Approval Information Sheet) Address City State Zip Email Owner or Agent (If Agent, Power of Attorney or Agency Letter Required) State Certification/Registration# ZipStateCityAddress PhoneName of CompanyContractor Information 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 YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. Job Site Contact NumberEmail Qualifying Agent Signed and sworn to (or affirmed) before me this ________ day of ________________, _________ by __________________________ Signature of Notary ______________________________________ [ ] Personally Known OR [ ] Produced Identification Type of Identification: ____________________________________ Worker's Compensation Insurer OR Exempt Expiration Date PhoneArchitect's Name Engineer's Name FOR INTERNAL OFFICE USE ONLY PERMIT # ____________________ **ALL information required to process Email PhoneEmail (Signature of Contractor) Signed and sworn to (or affirmed) before me this ________ day of ________________, _________ by __________________________ Signature of Notary ______________________________________ [ ] Personally Known OR [ ] Produced Identification Type of Identification: ____________________________________ PV SOLAR PANEL INSTALLATION ROOF MOUNTED /SOLAR PANELS LUMIO HX INC 407-819-4000 1550 W DIGITAL DRIVE #500 LEHI UT 84043 CODY ORAM EC13006740 floridapermits@lumio.com 407-819-4000 Trumbull Insurance Company 11/7/2024 1869 SEA OATS DR Atlantic Beach FL 32233 36-20 09-2S-29E SELVA MARINA UNIT 9 LOT 19 BLK 1 $30,377.95 KLEIN KARL M (904) 386-0206 1869 SEA OATS DR ATLANTIC BEACH FL 32233 emmaa7jm@gmail.com 9th 2023October KARL%martin%KLEIN_______________by _________________________ _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ] DRIVER%LICENSE Notarized%online%using%audio-video%communication 07 NOVEMBER 2023 CODY ORAM 172020-0538 SOLR23-0008 JOB COPY JOB COPY JOB COPY DESCRIPTION ACCOUNT QTY PAID PermitTRAK $89.00 SOLR23-0008 Address: 1869 SEA OATS DR APN: 172020 0538 $89.00 ELECTRICAL $55.00 ELECTRICAL BASE FEE 455-0000-322-1000 0 $55.00 MECHANICAL $30.00 SOLAR COLLECTOR SYSTEM 455-0000-322-1000 0 $30.00 STATE SURCHARGES $4.00 STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00 STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00 TOTAL FEES PAID BY RECEIPT: R25446 $89.00 Printed: Thursday, November 9, 2023 8:12 AM Date Paid: Thursday, November 09, 2023 Paid By: Lumio HX Inc Pay Method: CREDIT CARD 10115846733 1 of 1 Cashier: TG Cash Register Receipt City of Atlantic Beach Receipt Number R25446