Beach Ave 1766 D. Is exterior wall finish,shown? Yes 00 NIA 15. Does bedroom open directly into garage? Yes No L,/1-VA
E. Is interior wall finish shown? Yes�No N/A 16. Does the number of bedrooms shown an plans match the number
F. Is minimum clearance between wood siding and finished of bedrooms shown on the application? Yes v"No NIA
grade shown? (FBC 23041.5) Yes�/Nri N/A
G. Are shear wall segments shown? Yes, No N/A 17. Is Designer's name and address shown on plans? Yr. --No N/A
A. Type of hold-downs shown? Yes�Ao N/A is. Do egress doors and landings comply with FBC 1012.1.3
9. Are ceiling heights shown? (FBC 1202.2) Yes /'No N/A and FBC 10 12.1.5? Yes ,'No N/A
0. Are all hurricane anchorage and hold-downs specified and labeled? Yes�/�o N/A 19. Are habitable room$shown with the minirnum light and ventilation
f' is ceiling type shown,drywall thickness? Yes v/No N/A requirements of FBC 1203.1? Yesvl"No N/A
12. RoofFraming 20. Are garage doors,windows and other openings shown as meeting
A. Are engineered trusses shown? Yes VNo N/A wind load requirements for components and cladding per FBC 16067 Yes 0 NIA
B. Are conventional fiame rafters used? Yes No NIA v1 21. Does floor plan show fireplace? Yes�4o NIA
1. Rafter size shown? Yes No N/A 22. Are stair details shown? Yes No N/A.",
2. Species of lumber shown? Yes No N/A A. Is minimum stair width shown? (FBC Table IM4) Yes No N/A
3. Grade of lumber shown? Yes No N/A B. Are tread and riser sizes shown? (FBC 1007.3) Yes No N/A
C. Type oftoofshecting shown7 Yes ,, No NIA C. Do spiral stairways comply with FBC 1007.8.2? Yes No N/A
1. Thickness of roof sheeting shown? Yes :,"No N/A D. Are required landing shown? (FBC 1007.4)? Yes No N/A I-'
2. Grade of roof sheeting shown? Yes%j��Nri N/A E. Is required headroom clearance!shown? (FBC 1007.4) Yes No NIA
3. Nailing pattern of roof sheeting shown? Yes �No N/A 23. If floor plan shows mixed construction,are mixed
(FBC Table 2306.1) Construction details shown? (May require engineering.) Yes No N/A W-�'
D. Weight of Dry-In felt shown? yes 0 N/A 24. If required,are tenant separations shown? Yes No N/A
E. Type of roof cover shown? Yes��4ri NIA A. Duplex (FBC Table 704.1)
I Attachment asphalt/fiberglass shingles shown? B. Townhouse (FBC 704.4)
(FBC 1507.3.7) Yes VINo NIA 25. Are all columns and beams shown for porches and lanais? Yes VI�No N/A
2. Attachment of tile roof shown7 Yes No N/A V' A. Are column type,size and anchorage shown? Yes V No NIA
(FBC 1507.3.7) B. Are beam type,size,span and anchorage shown? Yes V-5No N/A
3. Other mof covering and attachments shown? Yes N/A 26. Are all lintel and beam details shown? Yes%oo"�io NIA
F. Length of roof overhang shown? Yes No N/A 27. Are engineering details provided for but[glass? Yes %,^o NIA
0. Type of soffit and fascia shown? Yes v/>o N/A
H. Attic ventilation shown? Yes V,'No N/A
1. Location,type and thickness of flashing shown? VII. Truss/Rafter Plan.
(FBC 1503.2.1 and FBC 1507.3.9) Yes Ve"No N/A 1. Are engineered truss plans provided showing loads,uplifts and
1. Type and Raug of cave metal shown? Yes ��No N/A required connections? Yes V"N, NIA
2. Are all headem,beams,girders and interior bearing walls shown? Yes W. NIA
3. Framed roof.
V1. Floor Plan. A. Is rafter plan shown,including size,spacing species,
I. Does square footage on plan match square footage show on grade of lumber,span and connections? Yes No NIA
application? Yes V"No NIA B. Is ceiling joist plan shown,including size,spacing,
2. Are all room dimensions shown? Yest,,,"No N/A species,grade of lumber,span and connections? Yes No N/A
3. Are all door and window sizes shown? Yes <No NIA C. Are collar ties shown,including size,spacing,species,
4. Are all emergency egress openings shown? Ye.Z--'No N/A grade of lumber and connections? Yes No N/A
5. Is required tempered glass shown at all hazardous locations? D. Is ridge beam shown,including size,species and grade
(FBC 2405.2) Yes, No N/A of lumber? Yes No NIA V--'
6. Are all vertical reinforcements shown? YesV�'No N/A 4. Is roofshecting indicated,showing type,thickness and nailing
7. Are all shear wall segments shown? Yes /,No NIA pattern? YesV11"N'(3 N/A
Are all hold-downs and hurricane anchorages shown? Yes ,"No NIA
9. Is required attic access shown7 Yes /No N/A
M Are all plumbing fixtures shown? Yes�40 N/A VIII. Floor Framing.
It, Are all electrical fixtures shown? Yes �A. N/A I. Is engineered floor truss plan provided,showing loads,
12, Are all mechanical fixtures shown? Yes�;<No N/A uplifts and connections? Yes No N/A,,.-
A. Is air handler and condensor location shown? Yes V/No N/A 2. Is joist plan provided,showing size,spacing,span,species,
B. Are exhaust fans shown? Yes N/A grade of lumber and connections? Yes No N/A V-
13. Are all smoke detectors shown? (FBC 905.2) Yes N/A 3. Is floor sheeting indicated,showing type,thickness and
14. Does one(1)bathroom on the first habitable floor level nailing pattern? Yes No N/A
Have a 29"net clear door opening and handicap accessible
route? (FBCII-11) Yes:"-N/. NIA
fit. Energy Code Information:
1. Is the current energy code form completed properly and signed;
RESIDENTLAI CHECKLIST FOR ONE&TWO FAMILY DWELLINGS correct climate zone and correct jurisdiction? (FBC 13-600) Yes L/N. NIA
2. Does conditioned square feet area on plans match square feet
NOTE: DRAWINGS REQUIRED TO BE DRAWN TO SCALE WITH SUFFICIENT CLARITY shown on energy forms? Yes -'/No N/A
AND DETAIL-(FBC 104.2.1) 3. Is the"R"value between common walls shown? Yes No N/A,,-"'
(FBC 13-602.I.A]3C.1.1)
4 1
I:the::R!value for added insulation on exterior walls shown? Yes -,Yo N/A
PLANS EXAMINER: DATE: 5' the R"value for ceilings shown? (FBC 13-604.I.ABC.1) Ye:v"kJo N/A
Co 6 Is the"It"value for raised floors shown? (FBC 13-605) Y. VNo N/A
OWNER: P,4,1 JOBADDPESS:-Fqo llev)tlt$�7 ?* Are Energy Credits Claimed? Yes w-_'No N/A
A. Attic Radiant Barrier Credit (FBC 13-607.I.A.4) Yes/No N/A
CONTRACTOR: A Co"Sr PHONE NUMBER: C( B. White Roof Credit (FBC 13-607.1.A.5) Yes -�Vo N/A
C. Programmable Thermostat (FBC 13-600.2.A.3.5) Yes No N/A
(CIRCLE)
1. Survey: IV Foundation Plan:
I. Is a specific purpose survey submitted? Yes V/No N/A I. Are all footings shown,including interior bearing walls,
2. Is correct Flood Zone shown? Yes No NIA Column pads and concentrated loads? Yes �/No N/A
3. Are existing grade elevations shown for structures located 2. Are all locations of vertical reinforcement and anchor bolts shown? Yes 6"No N/A
in an"A"or"V"zone? Yes No N/A 3. Are all elevation changes in slab shown? Yes �/No N/A
4. On lots in multiple flood zones,are flood zone lines indicated? Yes No N/A 4. Is minimum concrete PSI shown? Yes ol No N/A
5. Is property in a flood way? Yes No N/A 5. Is slab reinforcement shown? Yesw,�No N/A
6. Is flood way line shown? Yes No N/A A. Wire mesh size and gauge? Yes No NIA."'
B. Fibermesh reinforcement? Yes ,*%o N/A
II. Structure Code Compliance: 6. Is vapor barrier,minimum 6 mill.shown? (FBC 1909.2) Yes%,-'No N/A
7. Is minimum slab on grade thickness shown?(FBC 1909.1) Yes �4N. N/A
1. Are plans scaled by architect or engineer? Yes No V-"NIA 8. Is type of soil treatment for termites shown?(FBC 1816) Yes V,�No N/A
A. Are structural calculations submitted? Yes,_,'No NIA
2. Is correct wind speed shown? (FBC Figure 1606) 1 9. Do plans show concrete footings have a specified compressive
Yes',/NO NIA Strength of not less than 2500 PSI at 28 days? (FBC 1804.5.1) Yes V.-'Ro N/A
3. Is exposure category shown7 (FBC 1606.1.8) Yes 5�,No N/A 10. Ifpile foundation shown,is Scaled Soils Report submitted?
4. Is Importance Factor shown per FBC Table 1606? Yes No N/A (FBC 1805.1) Yes No N/A I-'
5. Are pressures for wind loading on components and cladding
Shown per FBC 1606.2.5? Yes ,"No N/A
6. Are pressures for wind loading on components and cladding Yes W"', V. Typical Wall Section:
Shown per FBC 1606.2.5? No N/A I. Is finished grade shown? Yes
7. Does structure meet requirements of FBC Table 500 for number of ,No N/A
2. Is minimum floor elevation shown? Yes-'yo N/A
stories and allowable area? Yes �,./No N/A A. Minimum 8"above adjacent grade? Yes%.�NO NIA
a. Does structure meet Fire Resistance Ratings ofFBC Table 600 1 B. Flood protection elevation? Yes .e"'No N/A
for structural elements? Yes --"No NIA C. Base flood elevation? Yes No N/A
9. Are plans designed per SSTD 10-99? Yes No N/A 3. Is minimum footing depth beneath finished grade shown? Yes\,,,,No N/A
A. Are all appropriate charts and tables shown? Yes No N/A (FBC 1804.1.3)
B. Are all appropriate requirements circled or highlighted? Yes No N/A 4. Are all footing sizes shown? Yes ,No N/A
10. Are plans designed per"Guide to Concrete Masonry Residential 5. Are all horizontal reinforcements shown? Yes o�W N/A
Construction in High Wind Areas"? Yes No N/A� 6. Is vertical reinforcement shown? Yes-,,r No N/A
A. Are all appropriate charts and tables shown? Yes No NIA 7. Masonry construction.
B. Are all appropriate requirements circled or highlighted? Yes No N/A A. Is exterior wall finish shown? Yes No N/A
11. Are plans designed per"WPPC Guide to Wood Construction in B. Is interior furring shown? Yes No N/A
High Wind Areas? Yes-`�No N/A C. Is exterior wall insulation shown? Yes No N/A
A. Are all appropriate charts and tables showm? Yes --"No N/A D. Is exterior wall finish shown? Yes No N/A
B. Are all appropriate requirements circled or highlighted? Yes LNo N/A 8. Wood Frame Construction
12. Are plans designed per"AF&PA Wood Frame Construction A. Is stud size,spacing,grade and lumber species shown? Yes\.,IN. N/A
Manual for One-and Two-Family Dwellings,High Wind Edition"? Yes No N/A B. Is exterior sheathing(type and thickness)shown? Yes%,/No N/A
A. Are all appropriate charts and tables shown? Yes No N/A C. Are nailing requirements(size and spacing)shown? Yes-No N/A
B. Are all appropriate requirements circled or highlighted? Yes No NIA (FBC Table 2306.1)
HL Energy Code Information:
I Is the current energy code form completed properly and signed;
RESIDENTIAL CHECKLIST FOR ONE&TWO FAMILY DWELLINGS correct climate zone and con ect jurisdiction? (FBC 13-600) Yes No N/A
2. Does conditioned square feet area on plans match square feet
NOTE: DRAWINGS REQUIRED TO BE DRAWN TO SCALE WITH SUFFICIENT CLARITY shown on energy forms? Yes No N/A
AND DETAIL-(FBC 104.2.1) 3. Is the"W'value between common walls shown? Yes No N/A
(FBC 13-602.1.ABC.1.1)
4. 1:the:'R"value for cadded insulation on exterior walls shown? Yes No N/A
PLANS EXAMINER: DATE: 5. 1 the V'va ue for eilings shown? (FBC 13-604.IABC.1) Yes No N/A
6. Is the"It"value for raised floors shown? (FBC 13-605) Yes No N/A
OWNER: JOB ADDRESS: 7. Are Energy Credits Claimed? Yes No N/A
A. Attic Radiant Barrier Credit (FBC 13-607.I.A.4) Yes No N/A
CONTRACTOR: PHONE NUMBER: B. White Roof Credit (FBC 13-607.1.A.5) Yes No N/A
C. Programmable Thermostat (FBC 13-600.2.A.3.5) Yes No N/A
(CIRCLE)
1. Survey: IV Foundation Plan:
I. Is a specific purpose survey submitted? Yes No N/A 1. Are all footings shown,including interior bearing walls,
2. Is correct Flood Zone shown? Yes No N/A Column pads and concentrated loads? Yes No N/A
3. Are existing grade elevations shown for structures located 2. Are all locations of vertical reinforcement and anchor bolts shown? Yes No N/A
in an"A"or"V"zone? Yes No N/A 3. Are all elevation changes in slab shown? Yes No N/A
4. On lots in multiple flood zones,are flood zone lines indicated? Yes No N/A 4. Is minimum concrete PSI shown? Yes No N/A
5. Is property in a flood way? Yes No N/A 5. Is slab reinforcement shown? Yes No N/A
6. Is flood way line shown? Yes No N/A A. Wire mesh size and gauge? Yes No N/A
B. Fibermesh reinforcement? Yes No N/A
11. Structure Code Compliance: 6. Is vapor barrier,minimurn 6 mil.shown? (FBC 1909.2) Yes No N/A
7. Is minimum slab on grade thickness shown?(FBC 1909.1) Yes No N/A
I. Are plans sealed by architect or engincer7 Yes No N/A 8. Is type of soil treatment for termites shown?(FBC 1816) Yes No N/A
A. Are structural calculations submitted? Yes No N/A 9. Do plans show concrete footings have a specified compressive
2. Is correct wind speed showm? (FBC Figure 1606) Yes No N/A Strength ofnot less than 2500 PSI at 28 days? (FBC 1804.5.1) Yes No N/A
3. Is exposure category shown? (FBC 1606.1.8) Yes No N/A 10. If pile foundation shown,is Sealed Soils Report submitted?
4, Is Importance Factor shown per FBC Table 1606? Yes No N/A (FBC 1805.1) Yes No N/A
5. Are pressures for wind loading on components and cladding
Shown per FBC 1606.2.5? Yes No N/A
6. Are pressures for wind loading on components and cladding V. Typical Wall Section:
Shown per FBC 1606.2,5? Yes No N/A I. Is finished grade shown? Yes No N/A
7. Does structure meet requirements of FBC Table 500 for number of 2. Is minimum floor elevation shown? Yes No N/A
stories and allowable area? Yes No NIA A. Minimum 8"above adjacent grade? Yes No N/A
8. Does structure meet Fire Resistance Ratings of FBC Table 600 B. Flood protection elevation? Yes No N/A
for structural elements? Yes No NIA C. Base flood elevation? Yes No N/A
Yes No NIA 3. Is minimum footing depth beneath finished grade shown?
9. Are plans designed per SSTD 10-99? Yes No N/A
A. Are all appropriate charts and tables shown? Yes No N/A (FBC 1804.1.3)
B. Are all appropriate requirements circled or highlighted? Yes No N/A 4. Are all footing sizes shown? Yes No N/A
10. Are plans designed per"Guide to Concrete Masonry Residential 5. Are all horizontal reinforcements shown? Yes No N/A
Construction in High Wind Areas"? Yes No N/A 6. Is vertical reinforcement shown? Yes No N/A
A. Are all appropriate charts and tables shown? Yes No NIA 7. Masonry construction.
B. Are all appropriate requirements circled or highlighted7 Yes No N/A A. Is exterior wall finish shown? Yes No N/A
it. Are plans designed per"WPPC Guide to Wood Construction in B. Is interior furring shown? Yes No N/A
High Wind Areas? Yes No N/A C. Is exterior wall insulation shown? Yes No N/A
A. Are all appropriate charts and tables showit? Yes No N/A D. Is exterior wall finish shown? Yes No N/A
B. Art,all appropriate requirements circled or highlighted7 Yes No N/A 8. Wood Frame Construction
12. Are plans designed per"AF&PA Wood Frame Construction A. Is stud size,spacing,grade and lumber species shown? Yes No N/A
Manual for One-and Two-Family Dwellings,High Wind Edition"? Yes No N/A B., Is exterior sheathing(type and thickness)shown? Yes No N/A
A. Are all appropriate charts and tables shown? Yes No N/A C. Are nailing requirements(size and spacing)shown? Yes No N/A
B. Are all appropriate requirements circled or Mghlighted7 Yes No N/A (FBC Table 2306.1)
WATER IMPACT FEE WORKSHEET
ADDRESS: FIt 0 IS 4!�'0Aj e r- "oe C'-) -.15,
DRAINAGE
FIXTURE UNIT
FIXTURE TYPE VALUE AS LOAD FIXTURES UNITS
Automatic clothes washers,commercial 3
Automatic clothes washers, residential 2
Bathroom group consisting of water closet lavatory,
Bidet, and bathtub or shower 6
Bathtub(with or without overhead shower or whirlpool
allachments) 2
Bidet 2
Combination sink and tray 2
Dental lavatory 1
Dishwashing machine,domestic 2 2--
-Drinking fountA C_ccemajke:rj) Y2
Floor drains 2
Hose bib 1
Kitchen sink, domestic 2
Kitchen sink, dorresfic with food waste grinder andfor
dishwasher 2
Laundry tray(1 or 2 compartments) 2
Lavatory
Shower compartment domestic 2
Sink 2
Urinal 4
Udnal, 1 gallon per flush or less 2
Wash sink(circular or multiple)each set of faucets 2
Water closet flushorneter tank, public or private 4
Water close�private installation 4
Water closet public installation 6
TOTAL NUMBER OF UNITS--
I muL-nPUED X 20
ITOTAL$ L110 I
In addition to construction and engineering detail,plans must contain the following information as appropriate for the type of work being
performed. Scale of drawings should be sufficient to depict all required information in a clear and legible manner.
1. Current survey showing the property boundary with bearings and distances and the legal description.
2. Location of all structures,temporary and permartent,including setbacks,building height,number of stories and square footage. Identify
any existing structures and uses.
3. If required by the Department of Public Works,a pre-construction topographical survey.
4. Any significant environmental features,including any jurisdictional wetlands,CCCL,natural water bodies.
5. Impervious Surface area calculationL Include driveways,sidewalks,patios and other Impervious Surf2ceL Swimming Pools
may be excluded from total Impervious Surface.
6. Other information as may be appropriate for individual applications.
I hereby certify that all p ided with licatio s c rrrec
%-1 IC6
Signature of owneer: tr Date: &t�jo—!-4
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of the laws and
ordinances governing this type of work will be complied with,whether specified herein or mt. The gianting of a permit does not presume to
give authority to violate or cancel the provisions of any federal,state or local mles,regulations,ordinances,or laws in any manner,including the
governing of construction or the performance of construction of the property. I understand that the issuance ofthis permit is contingent upon the
above information being that the plans and supporting data have been or shall be provided as required.
SignatumofContmctor._Ti'�,/�,;�.
V,W- L7 I
Address and contact information ofperson to receive all correspondence regarding this application(please print).
Name:
Mailing Address:
Phone: Fax: E-Mail:
AS TO OWNER:
Sworn to and subscribed before me this day of _Aj� 20 0 J'.
7
State of Florida,County ofDuval
to y SHARON D,STARLING i Notary's Signatu
My COMMISSION#DD 190702
EXPIRES:March 21,2007 Personally known
Bm"i Thru Notary PtINIC UnderwrIters Produced identification
Type ofidentification produced
AS TO CONTRACTOR:
Sworn to and subscribed before me this day of xL, 20 ep
State of Florida,County of I)uval
Notary's Signaturk.-----,,:� "en,
SHARON D.STARLING
MY COMMISSION#DD 19076
-n2 Personally known
EXPIRES:March 21,2007
W V- ,V BMW Th.Notairy P&I.Urdewft..
Produced identification
Type of identification produced
800 Seminole Road -Atlantic Beach,Florida 32233-5445
Phone: (904)247-5800 - Fax: (904)247-5845 - http://www.ci.atiantic-beach.fl.us
Page 2 Revised 1/14/03
A,
CITY OF ATLANTIC BEACH
BUILDING PERMIT APPLICATION
(FOR NEW SINGLE FAMILY RESIDENCE AND
DUPLEX CONSTRUCTION)
0-yd k 3�, Date:
�J
JobAddress: Lm-t- t , 61oc-k-- 1qq ,W�7�?q34
Owner's Name:
Address: b 81� AA Phone:
Legal Description: BlockNumber: Lot Number: Zoning District:
Contractor: HP+A (2 E5*n .TtA t.State License Number: 0,0=k
Address: (o(4 Phone: c>-LJJ— '-4(P19
city: a 1,0- 4OLe-LN StateJ--L- Zip: 33Q7�?�Fax:
Describe proposed use and work to be done: Cn n tt�r J� C160 0-F A) V".al'o im" 1,J
fe,�flfckwop ;V% L1L-1n1(Ja-V-,C1- &�J" 111�
Present use of land or building(s): �/oC-CL%&' ltr�-
Valuation of proposed construction: 't I --iq I 01D C3
Is approval of Homeowner's Association or other private entity required? K\rn If yes,please submit with this
application.
Will this project involve changes in elevation,site grade or any use of fill material or the removal of any trees?
CINO. Applicant certifies that no change in site grade or fill material will be used on this project.
[9/M. See Step 2 below. Approval of the Public Works Department is required prior to issuance of a Building
Permit
0 NO. Applicant certifies that no trees will be removed for this project.
ED/
i(ES. Removal of Trees will be required for this project. TREE REMOVAL PERMIT IS REQUIRED. Tree
Removal Permits to be reviewed by the Tree Conservation Board,which meets two times each month.
Procedure: In order to expedite issuance of permits, please follow all steps and provide all information as appropriate
Incomplete applications may result in delay in issuance of permit.
STEP L Verify zoning designation and proper setbacks for the proposed construction. If you are unsure of this information,please
comact the Planning and Zoning Department at 904-247-5826. in order to correctly verify zoning designation,please have
Property Appraiser's Real Estate Number available.
STEP 2. Contact the City of Atlantic Beach Department of Public Works to determine if a pre-construction or post-construction
topographical survey or grading plan is required. (if not required,written verification must be provided with this application.)
11c Department of Public Works is located at: 1200 Sandpiper Lane,Atlantic Beach,FL 32233 Telephone:(904)247-5834
STEP 3. Submit Tree Removal Application if trees are to be removed or relocated.
STEP 4. Please aibmit Building Permit Application, Energy Code Forms, Notice of Commencement, Owner/Contractor Affidavit if
owner is contractor,and four(4)complete sets of construction plans to the Building Department,which is located at the Atlantic
Beach City Hall,800 Seminole Road,Atlantic Beach,FL 32233 Telephone:(904)247-5826
800 Seminole Road -Atlantic Beach,Florida 32233-5445
Page I Phone: (904)247-5800 - Fax: (904)247-5845 - http://www.ci.atiantic-beach.fl.us Revised 1/14/03
CITY OF ATLANTIC BEACH
PERMIT CALCULATION SHEET
Date: 2
Address 0 k 1� C,0 j
Heated Square Footage V-3� @ per sq ft =
Garage / Shed 6 0 L/O per sq ft=
Carpo#7f-Pg h (TI per sq ft =
Deck
per sq ft =
Patio per sq ft = $
$
TOTAL VALUATION:
Total Valuation
ist
Remaining Value perthousand.
or portion thereof
CONSTRUCTION TYPE: TOTAL BUILDING FEE
ZONING: fi (o + 1/2 Filing Fee
FLOOD ZONE: (I) Fireplaces @ $35.00 $ -7-57 0 C)
IMPERVIOUS SURFACE:,;�!
BUILDING PERMIT FEE $
WATER INTACT FEE $ 4110
SEWER IMPACT FEE $ 1:7,J-6
WATER METER/TAP $
CAPITAL IMPROVEMENT$
SEWER TAP $ -0-
C q�se) RADON HRS .0050 $
SECTION H PAVING ( ) $ 6 -
CROSS CONNECTION $
ST(j,?2Y) SURCHARGE
OTHER
GRAND TOTAL DUE:
1/13/03