820 14th Street West RES24-0088 BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
t`:'
:'2 City of Atlantic Beach Building DepartmentQ
PERMIT# RES ` b08C�
800 Seminole Road,Atlantic Beach, FL 32233
**ALL information required to process
P-','`)'. Phone: (904) 247-5826 Email: Building-DeptPcoab.us
Job Address 820 W 14th Street,Atlantic Beach, FL 32233 )(RE# 11 IQL('�-cDQQ d
X Legal Description /3 -3y 3' 5—2-7 € I Z , I ,4'+ c_ �e -k I 0+5 [ .Z. aJ IvZZZ
Valuation of Work(Replacement Cost) 17,000 Heated/Cooled SF 2278 Non-Heated/Cooled SF 296
•Class of Work: ❑ New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑X Window/Door
•Use of existing/proposed structure(s): ❑Commercial ❑X Residential •If existing structure, is a fire sprinkler system installed?:❑Yes❑X No
•Will tree(s)be removed in association with proposed project? ❑Yes (Must submit separate Tree Removal Permit) ❑X No
Describe in detail the type of work to be performed:
Window Replacement& Patio Door Replacement
Florida Product Approval# (For multiple products use Product Approval Information Sheet)
Property Owner Information Name Debbie Simmons C_ FskA Phone 904-626-5159
Address 820 E 14th Street City Atlantic Beach State FL Zip 32233
Email debbie@beachesbookkeeping corn Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information Name of Company Arrow Renovations and Design, LLC Phone (904)707-7762
Address 4276 Baltic Street City Jacksonville State FL Zip 32210
Qualifying Agent Samuel Evans State Certification/Registration# CRC1333910
Email gus@arrowigroup.com Job Site Contact Number
Worker's Compensation Insurer OR Exempt ❑X Expiration Date 3/30/25
Architect's Name NA Email Phone
Engineer's Name NA Email Phone
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 city/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. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE SITE OF THE IMPROVEMENT BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTI E O C• ' ENCEMEN
e
Aimr_�TAO
(Signature of Owner or Agent) nature of Contractor)
Signed and sworn to(or affirmed)before me this 15 day of Signed and worn to(or affirmed)befor- me this /.S day of
_jam
Signature otary Signature otary iCke
Personally Known OR ._--..• •••— ation [ ersonally Known OR 1 1 Prndrtrarl rae...rf ation
DENISE L.TAIT YP DENISE L.TAIT
Type of Identifi ia�Ayo�a'. Type of Identific
' MY2024 �' •. r • • • ::
EXPIRES:July 27, EXPIRES:July 27,2024
•"--- bvi.b Public Underwriters ;r 'oc
•'.E oP e�°;' Bonded Thru Notary Fc�,r�°P•' Bonded Thru Notary Public Underwriters
PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FLORIDA (*REQUIRED)
820 W 14th Street, Atlantic Beach, FL 32233
*Project Address: Permit#:
Debbie Simmons
*Owner/Project Name:
As required by Florida Statute 553.842 and Florida Administrative Code Rule 61G20-3, 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 BHI Doors 3-0 6-8 Prehung 15213.14
2.Sliding
3.Sectional
4.Garage Roll-Up
5.Automatic
6. Other
B.WINDOWS
1.Single hung MI Windows 3540 41866
2. Horizontal slider
3.Casement
4. Double hung
5. Fixed MI Windows 3540 18644
6.Awning
7. Pass-through
8. Projected
9. Mullion
10.Wind breaker
11. Dual action
12.Other
Page 1 of 4 Updated 06/21/21
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
2. Underlayments
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
Page 2 of 4 Updated 06/21/21
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
E.SHUTTERS
1.Accordion
2. Bahama
3.Storm panels
4.Colonial
5. Roll-up
6. Equipment
7.Other
F. STRUCTURAL
COMPONENTS
1. Wood
connector/anchor
2.Truss plates
3. Engineered lumber
4. Railing
5.Coolers-freezers
6.Concrete admixtures
7. Material
8. Insulation forms
9. Plastics
10. Deck-roof
11. Wall
12.Sheds
13. Other
G. SKYLIGHTS
1.Skylight
2.Other
H. NEW EXTERIOR
ENVELOPE PRODUCTS
1.
2.
Page 3 of 4 Updated 06/21/21
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.
Samuel Evans *
*Contractor Name (Print Name): *Contractor Signature: ;�- -� 1
Arrow Renovations and Design, LLC
*Company Name:
4276 Baltic Street
*Mailing Address:
*City: FL 32210
City: *State: *Zip Code:
us@arrowi .com
*Telephone Number: *E-mail Address: g grou p
9047077762
Cell Phone Number: Fax Number:
Page 4 of 4 Updated 06/21/21