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Permit Folder 550 Sherry Dr City of Atlantic Beach ` APPLICATION'NUMBER Building Department (To be assigned by the Building DeparlmenQ t1 800 Seminole Road • - " Atlantic Beach,Florida 32233-5445 U Phone(904)247-5826 - Fax(904)247-5845 E-mail: building-dept@coab.us13 Date routed: City web-site: http:Uwww.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: C r r t review required Y No Buildin Applicant: �l ; fps Planning&Zoning Tree Administrator Project: G Public Works Public Utififies Public Safety Fire Services Rv�ew fec�' - r DepSigna#ure ==4 - Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B Florida Dept of Environmental Protection Florida Dept of Transportation St Johns River Water Management District Amry Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other. APPLICATION STATUS Reviewing Department First Review: proved. ❑Denied. (Circle one.) Comments: BUILDtNG PLANNING&ZONING Reviewed by: Date: 3_d-1c) TREE ADMIN. Second Review: E]Approved as revised. QDenied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review. QApproved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/44/09 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 10-00000221 Date 3/04/10 Property Address . . . . . . 550 SHERRY DR Application type description WINDOW AND/OR DOOR Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 11379 ---------------------------------------------------------------------------- Application desc REPLACE 12 WINDOWS/ 1 DOOR ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ WHITEHEAD, MRS . L. D. PELLA WINDOW AND DOOR 550 SHERRY DRIVE Q/A:A DANIEL WOLFF, III ATLANTIC BEACH FL 32233 8174 BAYMEADOWS WAY W. JACKSONVILLE FL 32256 (904) 731-8330 ---------------------------------------------------------------------------- Permit . . . . . . WINDOW AND/OR DOOR PERMIT Additional desc . . Permit Fee . . . . 110 . 00 Plan Check Fee 55 . 00 Issue Date . . . . Valuation . . . . 11379 Expiration Date . . 8/31/10 ---------------------------------------------------------------------------- Special Notes and Comments *2007 FLORIDA BUILDING CODE W/ 105- 106 SUPPLEMENTS . 2007 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. WINDOW AND DOOR INSPECTION: *INSTALLATION INSTUCTIONS REQUIRED *ALL STICKERS ARE TO REMAIN ON THE WINDOWS *PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 110 . 00 110 . 00 . 00 . 00 Plan Check Total 55 . 00 55 . 00 . 00 . 00 Grand Total 165 . 00 165 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. t f CITY OF ATLANTIC BEACH 09- I I I I 1 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 �/ OFFICE:(904)247-5826•FAX NO.:(904)247-5845 BUILDING-DEPT@COAB.US BUILDING PERMIT APPLICATION DUVAL COUNTY K 3,A... a ❑NEW BUILDING ❑DEMOLITION ESIDENTIAL LOT_BLOCK_SUB DIVISION ❑ADDITION ❑CONVERTING USE ❑COMMERCIAL ❑ALTERATION ❑ACCESSORY BLDG. ".' s LJtIWCS t M ❑REPAIR ❑POOL/SPA ❑YES N/A 11 r ati7C Q„�-!(, Ota ❑MOVE OTHER ❑NO 77777,7777777 �NAM�� tj COMPANY 1 23.COMPANY NAME: ME:e416%ME: _'1 W ` 24.L ENSEE NAME: 10�^S 17.STATE OF FLORIDA LICSENSE N 25.STAT OF FLORIDA LICENSE NO.: C ZC Z3 F�—p, 18�DC ESyr mle,I►�Ct 1_ / 26.ADDRESS: ^11.OFFICE PHONE: 12.FAX NO.: 19.OFFICE PHONE: 20.FAX NO.: O 27.OFFICE PHONE: VAX IN ` 13.CELL PHONE: 21.CELL PHONE: 29.CELL PHONE: 14.EMAIL ADDRESS: 22.E IL ADDRESS: 30.EMAIL ADDRESS - L- z ,cc" IaSrJAW, r 31.NAME: 33.NAME: 35. ME 32.ADDRESS: 34.ADDRESS: 36.A RESS: 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 laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six (6) months, or if construction or work is suspended or abandoned for a period of six (6) months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks, Air Conditioners,etc. 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. I will not occupy or use the referenced building or any part therof, until all inspections are finaled and prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law. *** 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 CF COMM ENCEMEN 1. € "ONTi�Asa1 ESR '/ d�r g, r .: Qualjes L?1 y}, T Signe Date: �S �� Signed: _Date: Z" Iy Before me this f day of -a-�c-v 20CIon the county of Before 7�ZeofFlorida,,, day of u c,,r-A 2009 in the county of Duval,State of Florida,has personally appeared Duval,Sperso appeared__. Qxx r/.3 vim. 4 tea-G -f S C S herin by himself/herself and affirms that all statements and declarations are herin by himself/herself and affirms that all statements and declarations are true and accurate. C true and accurate. Notary Public at Large,State of � County of `Ju J rJ ry Public at Large,State of- County Elo Personally Known _ ersonally KI W © -4,�_ _ � Q 13 Produced Ida ficati in- E Produced Identification-� _ ---- J Notary Signati4re: r �ti_t Notary Signature. ` ' — 1 vw5 c� vel D FOR CODS ' lsslon 2177 Janice S. ave ITY OF A ommission DD602IC7 �.., s Janua 13,2011 zplres Janu ry 13,2011 SEE PERMITS FOR +D roy Fain-tnaurence.l .800,us-7019 ..11` sonaed Troy Fain-insuraInc eoa3ss-7t t EQUIREMENTS AND CONDITIONS. FILECOPY :: REVIEWED BY: DATE.• a�� ca�aaamuw,+v:v4<..4:.uw..;:.r.c.w..•aM�&w,+aroc,. NOTICE OF COMMENCEMENT (PREPARE IN DUPLICATE) '►�^ / Permit No. Tax Folio NR ' T v�1 F'� 00 1 State of 7�f t l�/i County of 4I,LLIA 1_ 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 this NOTICE OF COMMENCEMENT. ' I ^� C— A _ Legal description of property being improved: I ce — CY S ` e3,5 Gi Andre of pr pe Ing imprpved*, 3 r description ofimprovements: tZe ( �CO� 12— General W IVLGQt4c,�)S l►h/ C�� a .J v e,�I►� S Owner,b_k—.,,— e Address Owner's interest in site of the improvement Fee Simple Titleholder(if other than owner) I Name Address Contractor tea t� i�'c1L 1 Or r c i j)aU t a w ` 2 c7 / Address _ ZZJ Co Phone No. v S Fax No. Surety(if any) �I a Address Amount of bond$ Phone 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 of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may be served: Name 0)___X-- Address Phone 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. 6(tori_dp Statutes.(Fill In at O wner'sroption). NameeTqLA �� Address Phone 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 R igne . _ MAI GvAI �� t -ATE OS Beforeme this j C day of_ .�t�.._n_ tv in th Caunty Duval,State of Florida,has pe onally appeared �� herein by hi�erselt and affirms that all statements and d�e�alai2vons h Arein are true and acpurate :Qc ;3111tCe S. Havel Doc�2010046129,�;K�;�15166 Lage 25vu, � � � ,. �• Number l'ages: � N; * 'nmmission#DD602177 Recorded 02i26/201 o at 01:15 =M, - %;�•. ;:� Expires January 13,2011 P JIM FULLER CLERK CIRCUIT COURT DUV'a� `00%%` BondedTroyF n-Insurance.lnc 900-385.7018 --N-- COUNTY Notary Public at Large,Stae of County of _ ✓C RECORDING. $1 U CO My commission expires: Personally Known or Pr duced identification �I ,�� .1...•c. moi,(,' ���—_C� .�._�(�_,� ,? p c 0 m d o p C > A m ami II3i x g .O+ O O �U\ n (D O .. _. 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Search �1 Product Approval tt .USER:Public User Product Approval Menu>P_[4d_tLCt.4r Appl:lollpn_.S-U,rCh>Appli i n.U5-t>Application Detail FL# FL11914 Application Type New Code Version 2007 Application Status Approved Comments Archived Product Manufacturer Pella Corporation Address/Phone/Email 102 Main St. Pella,IA 50219 (641) 621-6096 pellaproductapproval@pelia.com Authorized Signature Joseph Hayden jahayden@pella.com Technical Representative Joseph Hayden Address/Phone/Email 102 Main Street Pella,IA 50219 (641)621-6096 jahayden@pella.com Quality Assurance Representative All Zarghami Address/Phone/Email 102 Main St Pella,IA 50219 (641) 621-1000 zarghamia@pelia.com Category Exterior Doors Subcategory Swinging Exterior Door Assemblies Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed Florida Professlonal Engineer Evaluation Report- Hardcopy Received Florida Engineer or Architect Name who Gordon Thomas developed the Evaluation Report Florida License PE-46718 Quality Assurance Entity Intertek Testing Services NA Inc Quality Assurance Contract Expiration Date 12/31/2010 Validated By James L. Buckner, P.E. at CBUCK,Inc. Validation Checklist- Hardcopy Received Certificate of Independence FL11914 RO COI Pella PE COI 1-09-signed.pdf Referenced Standard and Year(of Standard) Standard Year ASTM E330 2002 Equivalence of Product Standards Certified By http://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGE VXQwtDgsxYIeb4opOD... 2/25/2010 Florida Building Code Online Page 2 of 5 Sections from the Code Product Approval Method Method 1 Option D Date Submitted 12/23/2008 Date Validated 01/13/2009 Date Pending FBC Approval 02/18/2009 Date Approved 04/07/2009 Summary of Products !FL# IModel,Number or Name Description 11914.1 Pella Inswing Fiberglass Entry Clad Frame, Single Door, Full Lite, With Side Lite,6'8" Door Height, both Standard and Low Profile sill. Limits of Use Installation Instructions Approved for use in HVHZ: No FL..1_19.14_RO I.I.._40$Q2.5R2.-si_gne...d..p. df Approved for use outside HVHZ:Yes Verified By: Gordon Thomas Florida #46718 Impact Resistant: No Created by Independent Third Party: No Design Pressure: +35/-35 Evaluation Reports Other:Configurations of glass comply with ASTM FLi_1914_RO_AE_Pella__Evaluation.._Re.po..rt._P.2..008_-00.2...11...2_ E1300-04. signed_pdf Created by Independent Third Party: Yes 11914.2 L]Pella Inswing Fiberglass Entry Clad Frame, Single Door, Full Lite, With Side Lite,8'0" Door Height, both Standard and Low Profile sill. Limits of Use Installation Instructions 1 Approved for use In HVHZ: No FL11914 RO II 408027R2-signed.pd 3 j Approved for use outside HVHZ:Yes Verified By: Gordon Thomas Florida #46718 I Impact Resistant: No Created by Independent Third Party: No Design Pressure: +30/-30 Evaluation Reports Other: Configurations of glass comply with ASTM FL11914 RO AE Pella Evaluation Report P2008-002112- E1300-04. signed.pdf Created by Independent Third Party: Yes 11914.3 :::]Pella Inswing Fiberglass Entry Clad Frame, Single Door, Full Lite, 6'8"Height, both Door Standard and Low Profile sill. Limits of Use Installation Instructions Approved for use in HVHZ: No FL11914 RO II 408025R2si.gned.-pdf Approved for use outside HVHZ:Yes Verified By: Gordon Thomas Florida #46718 Impact Resistant: No Created by Independent Third Party: No Design Pressure: +35/-35 Evaluation Reports Other:Configurations of glass comply with ASTM FL.1...10.1..4_RO AE Pella_Evaluation Repo..rt_P2QjQ8-,002R2-. E1300-04. signed-pdf Created by Independent Third Party: Yes i 11914.4 Pella Inswing Fiberglass Entry Clad Frame, Single Door, Full Lite, 8'0"Height, both Door Standard and Low Profile sill. Limits of Use Installation Instructions Approved for use In HVHZ: No FL11914 RO II 408027112-sicined.pdf Approved for use outside HVHZ:Yes Verified By: Gordon Thomas Florida #46718 Impact Resistant: No Created by Independent Third Party: No I Design Pressure: +30/-30 Evaluation Reports Other: Configurations of glass comply with ASTM FL11914 RO AE Pella Evaluation Report P2008-002112- E1300-04. sioned.pdf Created by Independent Third Party: Yes 11914.5Pella Inswing Fiberglass Entry Clad Frame, Double Door, Full Lite, 6'8" Height, both =1Door Standard and Low Profile sill. Limits of Use Installation Instructions Approved for use in HVHZ: No F..L119_1.4_.RO_.I..I_40.8....0...2_5....R...2.-s...i.,gned..pdf Approved for use outside HVHZ:Yes Verified By: Gordon Thomas Florida #46718 Impact Resistant: No Created by Independent Third Party: No Design Pressure: +20/-20 Evaluation Reports Other:Configurations of glass comply with ASTM FL11914 RO AE Pella Evaluation Report P2008-002112- E1300-04. signed.pdf Created by Independent Third Party: Yes 11914.6 Pella Inswing Fiberglass Entry Clad Frame, Double Door, Full Lite,8'0" Height, both Door Standard and Low Profile sill. Limits of Use Installation Instructions Approved for use In HVHZ: No71 FL11914 RO II 408027112 signed.pdf http://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDgsxYIeb4opOD... 2/25/2010 Florida Building Code Online Page 3 of 5 Approved for use outside HVHZ:Yes Verified By: Gordon Thomas Florida #46718 Impact Resistant: No Created by Independent Third Party: No Design Pressure: +30/-30 Evaluation Reports Other:Configurations of glass comply with ASTM FL11914_RO_AE_Pella_.E.valuaton Report._P2008 002R.2.. E1300-04. siigned.pdf Created by Independent Third Party: Yes 11914.7 Pella Inswing Fiberglass Entry Clad Frame, Single Door, Non Glazed, 6'8" Height, both Door Standard and Low Profile sill. Limits of Use Installation Instructions Approved for use in HVHZ: No FL11914 RO II 408025112-signed.pdf Approved for use outside HVHZ:Yes Verified By: Gordon Thomas Florida #46718 Impact Resistant: No Created by Independent Third Party: No Design Pressure: +50/-50 Evaluation Reports Other: FL11914 RO AE Pella Evaluation Report P2008-002R2- signed.odf Created by Independent Third Party: Yes 11914.8 Pella Inswing Fiberglass Entry Clad Frame, Single Door, Non Glazed, 8'0"Height, both Door Standard and Low Profile sill. Limits of Use Installation Instructions Approved for use in HVHZ: No FL11914_.R...0_.I.I_408.0...27R2-si.gned,.p_d..f Approved for use outside HVHZ:Yes Verified By: Gordon Thomas Florida #46718 Impact Resistant: No Created by Independent Third Party: No j Design Pressure: +50/-50 Evaluation Reports Other: FL11914—RQ—AE_Pella_Eyaluation_Report.P2008-.0..02R2 sianed.pdf Created by Independent Third Party: Yes 11914.9 Pella Inswing Fiberglass Entry Clad Frame, Double Door, Non Glazed,6'8" Height, both ' Door Standard and Low Profile sill. Limits of Use Installation Instructions Approved for use In HVHZ: No FL11914 RO II 408025R2-signed.pdf Approved for use outside HVHZ:Yes Verified By: Gordon Thomas Florida #46718 Impact Resistant: No Created by Independent Third Party: No Design Pressure: +20/-20 Evaluation Reports Other: FL11914 RO AE Pella Evaluation Report P2008-002112- j sioned.pdf ! Created by Independent Third Party: Yes 11914.10 Pella Inswing Fiberglass Entry Clad Frame, Double Door, Non Glazed,8'0" Height, both Door Standard and Low Profile sill. Limits of Use Installation Instructions Approved for use In HVHZ: No F.L..11914_R..O_I..I_4...08..0..2...7R2-.s..g.ne..d...pd...f Approved for use outside HVHZ:Yes Verified By: Gordon Thomas Florida #46718 Impact Resistant: No Created by Independent Third Party: No Design Pressure: +30/-30 Evaluation Reports Other: FL119.14_RO_AE_..P..ella.._E_..v...al.u...ati.o..n_Report_P.2.0...0...8.-00..2.112. signed.pdf Created by Independent Third Party: Yes 11914.11 Pella Inswing Fiberglass Entry Wood Frame, Single Door, Full Lite,with Side Lite, 6'8" Door Height, both Standard and Low Profile sill. Limits of Use Installation Instructions Approved for use In HVHZ: No FL11914 RO II 408024R2-signed.pdf Approved for use outside HVHZ:Yes Verified By: Gordon Thomas Florida #46718 Impact Resistant: No Created by Independent Third Party: No Design Pressure: +40/-40 Evaluation Reports Other: Configurations of glass comply with ASTM FL11914 RO AE Pella Evaluation Report P2008-002112- E1300-04. sianed.p_df Created by Independent Third Party: Yes 11914.12 Pella Inswing Fiberglass Entry Wood Frame, Single Door, Full Lite,with Side Lite,8'0" Door Hei ht, both Standard and Low Profile sill. Limits of Use Installation Instructions Approved for use In HVHZ: No FL11914 RO II.._4.0..8.0..26_.R..2.-s...ign.ed..pdf Approved for use outside HVHZ:Yes Verified By: Gordon Thomas Florida #46718 Impact Resistant: No Created by Independent Third Party: No Design Pressure: +30/-30 Evaluation Reports Other:Configurations of glass comply with ASTM FLl_3914_RO AE_Peiia..Evaluaton Report._P2008-00211... i E1300-04. sianed.pdf Created by Independent Third Party: Yes 11914.13 ��]Pella Inswing Fiberglass Entry Wood Frame, Single Door, Full Lite,6'8" Height, both Door Standard and Low Profile sill. Limits of Use Installation Instructions Approved for use in HVHZ: No FL11914 RO II 408024R2-signed.pdf Approved for use outside HVHZ:Yes Verified By: Gordon Thomas Florida #46718 Impact Resistant: No Created by Independent Third Party: No http://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDgsxYIeb4opOD... 2/25/2010 Florida Building Code Online Page 4 of 5 Design Pressure: +40/-40 Evaluation Reports Other:Configurations of glass comply with ASTM F.L..1.19.14_.R...O_AE Pella._Eva..lu.a..tion_.Repo..Et._.P...2...008-Q.0.2_R...2. E1300-04. sianed.pdf I Created by Independent Third Party: Yes 11914.14 Pella Inswing Fiberglass Entry Wood Frame, Single Door, Full Lite,8'0" Height,both Door Standard and Low Profile sill, Limits of Use Installation Instructions Approved for use in HVHZ: No FL11914 RO II 408026R2-signed.pdf j Approved for use outside HVHZ:Yes Verified By: Gordon Thomas Florida #46718 Impact Resistant: No Created by Independent Third Party: No Design Pressure: +30/-30 Evaluation Reports Other: Configurations of glass comply with ASTM FL11914 RO AE Pella Evaluation Report P2008-002R2- i E1300-04. sianed.pdf Created by Independent Third Party:Yes 11914.15 Pella Inswing Fiberglass Entry Wood Frame, Double Door, Full Lite,with Side Lite, 8'0" Door IlHelght, both Standard and Low Profile sill. Limits of Use Installation Instructions Approved for use in HVHZ: No Approved for use outside HVHZ:Yes Verified By: Gordon Thomas Florida #46718 Impact Resistant: No Created by Independent Third Party: No Design Pressure: +30/-30 Evaluation Reports Other: Configurations of glass comply with ASTM F.I-11...914_R.O._AE_Pella_Eva.luation.._Repo..rt._P2..0..08...-002R2- E1300-04. sianed.pdf Created by Independent Third Party: Yes 11914.16 Pella Inswing Fiberglass Entry Wood Frame, Double Door, Full Lite, 6'8" Height, both Door Standard and Low Profile sill. Limits of Use Installation Instructions Approved for use in HVHZ: No FL11914 RO II 408024R2-sinned pdf Approved for use outside HVHZ:Yes Verified By: Gordon Thomas Florida #46718 Impact Resistant: No Created by Independent Third Party: No Design Pressure: +20/-20 Evaluation Reports Other: Configurations of glass comply with ASTM FL11914 RO AE Pella Evaluation Report P2008-002112- E1300-04. sianed.pdf I Created by Independent Third Party: Yes 11914.17Pella Inswing Fiberglass Entry Wood Frame, Single Door, Non Glazed,6'8" Height, both Door Standard and Low Profile sill. Limits of Use Installation Instructions Approved for use in HVHZ: No F1-119.14A0 II 40.8..0.2...482-si_g.ned pdf Approved for use outside HVHZ:Yes Verified By: Gordon Thomas Florida #46718 Impact Resistant: No Created by Independent Third Party: No Design Pressure: +55/-55 Evaluation Reports Other: F..1,119_14 RO AE_Pella_E...valuadwn..Report.-P200$-002112- sianed.pdf Created by Independent Third Party: Yes 11914.18 Pella Inswing Fiberglass Entry Wood Frame, Single Door, Non Glazed,8'0" Height, both Door Standard and Low Profile sill. I Limits of Use Installation Instructions Approved for use in HVHZ: No FL11914 RO II 408026R2-signed.pdf Approved for use outside HVHZ:Yes Verified By: Gordon Thomas Florida #46718 Impact Resistant: No Created by Independent Third Party: No Design Pressure: +50/-50 Evaluation Reports Other: FL11914 RO AE Pella Evaluation Report P2008-00282- sianed.pdf Created by Independent Third Party: Yes 11914.19 Pella Inswing Fiberglass Entry Wood Frame, Double Door, Non Glazed, 6'8" Height, Door both Standard and Low Profile sill. Limits of Use Installation Instructions Approved for use In HVHZ: No FL11914 RO II 40802482-signed.pdf Approved for use outside HVHZ:Yes Verified By: Gordon Thomas Florida #46718 Impact Resistant: No Created by Independent Third Party: No i Design Pressure: +20/-20 Evaluation Reports Other: FL11914 RO_A..E Pe.11a_Evaluatio_n Report_PZQ087002R2- sianed.pdf Created by Independent Third Party: Yes 11914.20 Pella Inswing Fiberglass Entry Wood Frame, Double Door, Non Glazed, 8'0" Height, :::IlDoor both Standard and Low Profile sill. I Limits of Use Installation Instructions Approved for use in HVHZ: No FL11914 RO II 408026R2-signed.pdf Approved for use outside HVHZ:Yes Verified By: Gordon Thomas Florida #46718 I Impact Resistant: No Created by Independent Third Party: No Design Pressure: +30/-30 Evaluation Reports Other: FL11914 RO AE Pella Evaluation Report P2008-002112- http://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDgsxYIeb4opOD... 2/25/2010 Florida Building Code Online Page 5 of 5 l� shee . df II� Crated by Independent�Third Party: Yes Back Next DCA Administration Department of Community Affairs Florida Building Code Online Codes and Standards 2555 Shumard Oak Boulevard Tallahassee,Florida 32399-2100 (850)487-1824,Fax(850)414-8436 p 2000-2010 The State of Florida.All rights reserved. Privacy Statement I Copyright Statement I Accessibility Statement I Plug-in Software I Customer Service Survey I Contact Us Product Approval Accepts: eChec,', MM V�riflyn Sieurra rr�rrr� http://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDgsxYIeb4opOD... 2/25/2010 =Florida Building Code Online Page 1 of 3 BCIS Home ( Log In User Registration j Hot Topics Submit Surcharge Stats&Facts Publications FBC Staff !. BCIS Site Map Links Search '.. Product Approval USER:Public User w Product Approval Menu>ProduSt_4r Appli.oatipn_S-eas_h>AppJiC0_VDnn.ig>Application Detail FL# FL5823-R4 Application Type Revision Code Version 2007 Application Status Approved k Comments Archived Product Manufacturer Custom Window Systems Inc. Address/Phone/Email 1900 SW 44th Avenue Ocala, FL 34474 (352) 368-6922 Ext 207 mlafevre@cws.cc Authorized Signature Michael La Fevre mlafevre@cws.cc Technical Representative Michael La Fevre ## Address/Phone/Email 1900 SW 44th Avenue Ocala, FL 34474 (352) 368-6922 Ext 207 MLaFevre@cws.cc Quality Assurance Representative Ralph Emminger## Address/Phone/Email 1900 SW 44th Avenue Custom Window Systems, Inc. Ocala, FL 34474 (352) 368-6922 Ext 208 Ralph@cws.cc Category Windows Subcategory Single Hung Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed Florida Professional Engineer Evaluation Report- Hardcopy Received Florida Engineer or Architect Name who Roberto Lomas developed the Evaluation Report Florida License PE-62514 Quality Assurance Entity Keystone Certifications,Inc. Quality Assurance Contract Expiration Date 12/31/2010 Validated By Steven M. Urich, PE Validation Checklist- Hardcopy Received Certificate of Independence FL5823 R4 COI 510484A(Eval Rep SH-8100 Impact).pd Referenced Standard and Year(of Standard) Standard Year AAMA/101/I.S.2-97 1997 AAMA/101/I.S.2/A440-05 2005 ASTM E1886-02 2002 http://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDgvMdF6zR4iHL... 2/25/2010 Florida Building Code Online Page 2 of 3 ASTM E1996-02 2002 PA/TAS 201/202/203 1994 Equivalence of Product Standards Certified By Sections from the Code Product Approval Method Method 1 Option D Date Submitted 12/19/2008 Date Validated 01/05/2009 Date Pending FBC Approval 01/09/2009 Date Approved 02/03/2009 -..._.... _..__...._._._.............._.............._...._.............._..__...._.............._..................... _...._....._...... ......_._..... .... ......_....................................._......... Summary of Products FL* Model,Number or Name Descri tion 5823.1 8100 Vinyl Single Hung 8100 Vinyl Single Hung (Impact Limits of Use Installation Instructions Approved for use in HVHZ:Yes FL5823 R4 II CWS-155A(SH-8100 Impact).pdf Approved for use outside HVHZ:Yes FL5823 R4 II DuPont PVB NOA 05-1208 02.pdf Impact Resistant:Yes FL5823 R4 II Mikron NOA 06-1220 01.pdf Design Pressure: +75/-75 Verified By: Roberto Lomas 62514 Other: Large Missile, 36x62 DP= +/- 75 psf. Created by Independent Third Party: Yes Evaluation Reports FL5823 R4 AE 510484A(Eval Rep SH-8100 Im.pa..ctl,pdf Created by Independent Third Party: Yes 5823.2 SH-8100 Vinyl Single Hung SH-8100 Vinyl Single Hung (Impact) 111 Limits of Use Installation Instructions Approved for use In HVHZ:YesF.L..5$23_R4_L.I_CWS.-1..5$A_(.SH-8100...L.mpact)..p-Cif Approved for use outside HVHZ:Yes FL5823 R4 II DuPont PVB NOA 05-1208 02.pdf Impact Resistant:Yes FL5823 R4 II Mikron NOA 06-1220 01.pdf Design Pressure: +67.5/-67.5 Verified By: Roberto Lomas 62514 Other: Large Missile, 53x76, DP+/-67.5 psf. Created by Independent Third Party: Yes Evaluation Reports FL5823 R4 AE 510484A(Eval Rep SH-8100 Impact).Ddf Created by Independent Third Party: Yes 5823.3 SH-8100 Vinyl Single Hung Heavy SH-8100 Vinyl Impact Single Hung w/Heavy Duty FMR { Duty Limits of Use Installation Instructions Approved for use in HVHZ:YesFL5$.2..3_R4 II_CWS-3..6...9(SH-8....1.00 Imp 52x72...100 Approved for use outside HVHZ:Yes DP). df Impact Resistant:Yes FL5823 R4 II DuPont SGP NOA 07-1116-04 pdf Design Pressure: +100/-100 FL5823 R4 II Mikron NOA 06-1220 01.pdf Other: Large Missile, 52"x 72", +/- 100 psf. Verified By: Roberto Lomas 62514 Created by Independent Third Party: Yes Evaluation Reports FL5823 R4 AE 510965 (Eval Rep SH-8100 Impact 100 DP).pdf I Created by Independent Third Party: Yes 5823.4SH-8100 Vinyl Single Hung Oriel SH-8100 Vinyl Single Hung Oriel Window w. HD FMR, 5 I11HI sash. i I Limits of Use Installation Instructions Approved for use in HVHZ:Yes FL5823 R4 II CWS-295 (SH-8100 Impact 52x96).pdf Approved for use outside HVHZ:Yes FL5823 R4 II DuPont PVB NOA 05-1208 02.pdf Impact Resistant:Yes FL5823 R4 II DuPont SGP NOA 07-1116-04.pdf Design Pressure: +67.5/-67.5 F..L5823_..R...4_I.I._...M...ikron_NOA_06.-122.0_01,pdf Other: Large Missile, 52"x 96"w/ 5 HI sash, +/-67.5 Verified By: Roberto Lomas 62514 psf. Created by Independent Third Party:Yes Evaluation Reports FL5823 R4 AE 510868(Eval Rep SH-8100 Impact 52x96).pdf Created by Independent Third Party: Yes I http://www.floridabuilding.org/pr/pr_app_dtl.aspx?param=wGEVXQwtDgvMdF6zR4iHL... 2/25/2010 Florida Building Code Online Page 3 of 3 Back Next DCA Administration Department of Community Affairs Florida Building Code Online Codes and Standards 2555 Shumard Oak Boulevard Tallahassee,Florida 32399-2100 (850)487-1824,Fax(850)414-8436 O 2000-2010 The State of Florida.All rights reserved. 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IV$ CA 021cm. ax0 Ci C A x ' cn - x 0� r ry , 0 3 m St bb co O CR eq W y m z m m DT - aZ le a m ^Li s $ zT R & cf) � � wuro -- S _CD t m t ,pT t a a o _ m a h 0) N S p n m 'D °� r4 rn 77 rn a r z a 03 r A V v gig f a ,� 6 a 8 S F Mr o Mr �o w a OHS � ►•►.• �m <� mei m� a �� fA O�� � '•?i♦' m„ �p �8 y ��+0 �i Fm s3� (pir m p i1i 1•► e y ym9 O8 m y W4 �1 to� ' ► ► •1► SL c �t�i � Z � p O N I ►►�i �• r SC rn W l < ,r►� � m .n OX • r L5 •• 37i •r �� T = i��> Zj mD .J. f '.. �c wm �x off m19 TDM �W N_ (p 7C Qzi1 IA x C r �7 v m � l •� �'" � m Y p2 qm �• ►• • yy A� �� v�v•v• m u m •V y gyp' � • • •� • �D �� �� ec ` v¢ •s' rn N � ° � o • � • y W c.: • 'n v r1p •v y mm o � I+T S``Sfi�QQ to ¢ 7TO0AOJJ F11 r' '• '+•�' a =� � i���5 m � m LL $ 58 MT <m m c < ao �m �F A PC '• r• f rr�i5• iQ< i7RLmf�. m � �� � ,•{ate, � �� Jt CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 � Jfl INSPECTION PHONE LINE 247-5826 Application Number Property Address 10-00000415 550 SHERRY DR Date 4/19/10 Application type description FENCE PERMIT Property Zoning Application valuation TO BE UPDATED ----------------------- 5498 Application desc ------------------------------------- 4FT_FENCE_REPLACEMENT __-- Owner------------------------ Contractor WHITEHEAD, MRS. L. D. ----------------------- 550 SHERRY DRIVE BEST FENCE CO OF JAX INC ATLANTIC BEACH886 AIA NORTH SUITE 5 FL 32233 PONTE VEDRA BCH (904) 543-7743----- - FL 32082 --------------------------- Permit - - --_____ Additional desc FENCE PERMIT ----------------- Permit Fee Issue Date 35 . 00 Plan Check Fee Expiration Date Valuation . 00 ----------------------------1/16/10--------------------------------------------- *2007 ----- _____ Special Notes and Co --------- ____ 0 *2007 FLORIDA BUILDINGCODEW/ , 05- ' 06 SUPPLEMENTS . 2007 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. *ALL FENCES OR ENCLOSURES OF LAND SHALL BE SUBSTANTIALLY CONSTRUCTED. *SCHEDULE FINAL INSPECTION ONCE FENCE HAS BEEN COMPLETED. PERMIT AND APPROVED SURVEY MUST BE AVAILABLE FOR FINAL INSPECTION. Roll off container company must be on City approved list --_-and-container_cannot-be_placed_on City_right-of-way. Fee summary Charged ---------- -- g Paid Credited _---_------- Permit Fee Total _ Due Plan Check Total 35 . 00 35 . 00 . 00 00 . 00 . 00 Grand Total 35 . 00 ' 00 . 00 35 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. �' •�IIr)knnl N,r ` m p ~ 5� 4� '`� Gil �Ca �' ( ��fP ��� _zi ; ti22 " o � +'I ni I, 9 n I � p zD -Pet?e e i;4 0 r 4GUPi �ior�/ I p. M N,�o <� I n` I r) z o (9) Al/ " '/6'Cr C J (,C•�GL` � l f� l 41�eja ti �" ,p j b�I i o QEtDEO To 7HE Cir OF g r���✓ric rr t- NJ 'O b C)�t"t S t S iI n r� L � O 2-0 nlb'r' .r'I G 6 \ City of Atlant Beach — z Planning and Zoni DepaM*M I his approval verifies com Usnoe with applkable Eroval ing, subdivision an Other local land d y z v°•° o elopment regulations, t does not COnetltute d, w o I Q Z i y r- for the issuance permits. Compliance 6 L o o Q. � kth Florida Building Code nd all other applicable "�' I 0 5 �+ —' �— cal, State Federal I;i p 1• 'o rJ , 0 ° �y J� a rmittin�req ulrementa „I w x �;� �, m ust be verifie by signatu of theof ^t„ y"",�: 5 3 0 each Buildin�;Off' ' I t0 d1f Atf#ntle z v c'6 0 2 t Building Per poi at (Approved By: ommun liwY4 z eva U d o _ — Date: S Y LY,�l� p?n,n nth Z ° '�'� o � n � ��.. iq� z O \/ O p ��yr �. rn d i T' <'Tj I I v O.`r�i r•:LC• n o '•'��,:•' A �_ _ �' /. -� m> _ a %D' 7f.D3 r�) � � � C VI �)n N p p Op •_r C-c� 431 ' �y''�fj'%t °•4"i i:.. ,5.:'; ";;S.:f�,v::,. ,�z LS) --i :Il \l nmn vi�o '�t, ° � ';;•��': 3RIcKfi FRA�Y :.''�: Sp � 71p A -1 7-- �•' :::•til :1: -;7 L, N 'q 2 niti p e :' .)';'ir:'.'159 ...it:i:.:;: •] _ ,\�j p ''RA 7 v�,• z �C�.3J :a:: "_' ;i::?..15.D''`:.• .� :,fr,;2�'s''?i''l (2�.5� _ .�� rrl zz -n 1 -� cJ R C O��rioo p I [➢ _ v h O v, .'C p y All00 d P < � D „I + U I nl D Ctl N I > ? t Vl y u y 1i �1 U 'J y a¢t°iic OCAmac, Vr l�1lL�IIII Illlllllllll�lll�Illlllil rn n._• ll1 t cn C C7 T�1 f\Vv b "1 _h?Ij, t� = Lo ,Srl, .--� RJrlvern�Q. tn5-ftz Il 111 15404 Race Track Rd...... ..........office(904)268-1638 t�`� Jacksonville FL 32259.,.......••.;_, K S f7 1 1' j St.Au Fax(904)230-2780 gustine................. TYPOffice(904)827-9088 E: ❑Gatc Op. hainlink �Vin 1 Lifetime Warranty on Vin f&Aluminum Fence Y ❑Aluminum 11 Wood FENCE HEIGHT: ❑ 3' tzf4• ❑ 4Y='0 5' ❑6• ❑8, ❑Transitions SIDENTIAL COhTRACT WALK GATE Z 4(' DRIVE GATES: �Zr Customer: r e POSTS: : ❑5' 216' ❑7' Q lo, , Address: 5 r ❑ t 0 9' ❑1..' / S r ' (]Even Q'Sligtt (]Ste t CLEARING r � � E- &S.9-3-3 U Bes ence I Customer Community. OLD FENCE: lirbast Fence ❑Customer Phone• GRADE: ❑Top Level 14OA/AR13: F01low Grade -(H) q�. q� t51UL4 ❑Best Fence ❑Customer —"–'-----(W) ❑APPROVAL RECEIVED DATE: ( )^ ( ) LUS+ N k[I Octe$ and ha VIT' tote- pnov -fo /'n5-al iD assi.-si with ?e(M(i Inez Notes: U4"54 4 1A)45 114 .��'� � a� LJ, z' - 7 , -mss. Customer must assume responsibility for placement of fence unless all appropriate survey pins(metal pipes)or concrete monuments are Total Feet d r Total Price uncovered prior to installation.Best Fence Co.,Inc.will assist owner in Sub Total e� locating pins if provided copy of survey.All materials will remain De sit Amount. 'L property of Best Fence Co.,Inc.until paid in full. ARB Fee J By signing,customer agrees to proposal indudtng materials, Date eb ,)utlined above.Any alteration or deviation from Above pnces,terms 6Imitation,as OPTION 1r executed only upon written order,and will become an exb diaipe voverrana above t02 he ll Balance Due -kP Arnate.An 2`l�� agreements contingent upon stn7ces,accidents,or delays beyond our control, OPTION "- last Fence Co.,Inc.is no" respcnslbl.for damage to undergrountl obstructions such as Pro sal is good for 3c� days ulitttes,sprinkler lines,pipes,etc.Returned checks are subject to a$25.00 service fee. Cancelled orders will be subject to a 50%restocking fee. Paymen arms: Job# ® �? BestDate: J Custome me : F.Nzg—?�'6 "310 313/ Ci.S-f - , 5 erg slq,U Lc.�r y �lz eft eftyf Atf € ffe l BUffdffig Ede partment $QO 'NUMSEP, RUad IQATfGH Atfanfic f3eacflTo be assigned by the Bttlldin j apartment) . ..: _ FloridaIai7da 3233-5 E Rona(904)947-5826 . t=ax(904j 247--5845 F"19 '. E-n,,if" buff Crn99-dept rt✓7r c,,b,.,s S Y web-si"e f�--11MWr coab.us Data routed: ' .9 �� - APPLICATIO-N REVIEW AND TRACK114G FORM '7FOPerty Address.- GSiTt,review M, € � o ing &zoni g _zz €Pu Utfr�ie- �l Public Saae Fra Se g mer Agency Review or Per€lft IRO: ked or i eIpt Flari€ia[)--Pt Of ETq¢nM8nfal Protection of Pere V6 ed Sy Date Florida Deli of TraFtsporiafioa. Si:Johns Piver water Management QlStriGt Ae€r. Corps Or Engineers •l kision of fi0faIs and Restauranfs Dh�ion tY€ co€ IIc Severaccres and—1 Obacm uEner evie ing QeParbment First Review, (Circle one.) PProwed. ElDenied. C �ae€a�s: T3UfLQfrI'�G am i-A�&ZON11fq Reviewed by: Qai:e; TREE ADMIN. Second€�evfe [�APProrred as revised_ QQenied_ PUBLIC WOP,KS Go ents_ :�UBL€C UTILITIES PUBLIC SAFE t Y Reviewed by: Date: FIRE SERVICES T€frd Review: CAPPraved as revised. OQer3led. RG viewed €y: DI=E-: C€€Y Of Atfantta Beach BUffdffig artmallt Agan eminofe Road SPL{ tic Bead?,Floridari32233--4445 by the-`- NUMBER l'�o be assign by fl:e Buiddin die Pfaone{804}X47_5828 - Fay i P�mait.) gj r E-mail. buffing-deP @coaE�.us )247-5885 City web-sue- hffP:Xrww eoab.us PrOPSOY Addres... MON REVIEW AND TRACKING FORM Applicant.- � L a e ��r��€�€mat yiss � ing&rani g u ' A0 er hg Pubk Pu U Ir ii ... .M�_ Baer Aggicy ReviL_w or Permit Required Revs Iry or a! - F[arieta DeM ofc� Purr it v'edffed By Date Er�rdronnzenfaf Protec€ion spO Florida die of Tranrfation St John Rhmr Water Management District Corps of Engineers "Mslan 2f KOtels and esfaur3n€s d�ierision�€AdecaFtoGc Beverages ancf Tobaccra C€iier_ AP ICA T ION STATUS '0V1e"'9 EaePartment Farst j;ev1e,,,: Prjcde one.) PProved. ElDenied. Comments: UdLf�dE� L Ali NING&ZONFING TREE ADMljq. Reviewed by: /77 Second Review: Date: y//3/—�_ PUBLIC WCR Comments: Date: as remised. ODenied- 'USLIC UTILITIES PUBLIC SAFETyF Reviewed by: FIRE SERVICES Third Review: Date: QAPPraved as revdsed. QQented. COMMe€�te: ed RevieWed b}f_ Date_ Atfian tic seep s sa. BGIt)Semtnofe Road • IC�,.TItGNiU It$I=R Aiifaniic Bea (E a be assigned b ch,Ffodcfa 32233-5 { , ,; y e u€ici�n ep n � P€1one(9114 J>1F E-mail. 7-582 - tax C��4)247-534S /► buffd,rB�aP'fgcoaf>.us U GFLY web-s"Le: ':'�-f/vavw-ccmb.us 1 a€e torted: ' APPLICATION REVIEW AND TRACKING FORM tpplicant int myeaw Paw;ted ing&Zorai g pt, Fire zservices OWNS Baer Agency Review or ftrEnft ire: .�e - �c�ad I�e�rg�et��>z< ea Ff"ida'pt-cf Envir anmen#ai Frote<iion e ed gY Ds F[odda DepL of Tmnsporfaton. S dofaras r Vtfatar to er€s 9 eraf i�is�� E4naTyr Cis of Engineers Dkisfon caf€ atafs and.Pes°taiaran€s DFWWon Of Afdoftciic Bevera Offaer- geld Tobacra APPLICATION STATtI, Wowing D90ar.-€tent First Review,t�. Approved. (Circle one.) ComM- efts: []Denied. BUILDING ANNING&ZONfiNG TREE ADMIN. SecoReviewed Second f�ate, '•UBLIC WGRKS Q�pproved as revised_ Qiaenied_ Cc�ents= UTiLi BLI Reviewed by: I SE (� Date: Es Third Review: QApProved as revised. []Denied. Comments: Rev awed b,. Dab--_ r- - 300 seminoie Rosd _ �3 Afantjc Bea Tt4Et f�.Li1L€ ER . ; �a be assign ci€ye�uildir� !fie a Phone(g34 'FlOn a 322. 3-5445 11! � � � t, i P r�entJ t , 7-5826 - s=ax('Q4)247LSaa- . E-mail.rstitbuilding-d,pt9Goa€%e..s BLY web-st'e: htf ; p flrr eb.us - _ - _ BaEe rrufeci: '} '7rG Address- (� A:erf- 1 Yes ing&Zani /9�b /j'l 447— U e r Pa E.i€�C�ie� /� D D 1,����-' (�h�7j public S�se Fire Sens Baer Ageacy Review ar ftrEnat Required €�ev¢�� Re�el� orcar Pereeed Bir Data ia'ida Dem car Etr�irannaenfal Pra�fe�ia€t 1=10fida Dept of Transporiairon St Johns RAmWater ganagament Dis_ Ambi'Cis cjr Engineers Dibcwc n of€-ibis and Restaurant3 DivWOn OfAfcohaiio Beverages aF�t#T�rsacc� Oilier VEL-Wing D9Parftn9nf First Review- (Circre one.) IrAppraved. ODenied. C€r�n'aer$rs: L BUILDING ANNING&ZCI�FING J TREE ADMIN. Reviewed by v Se-cond Review Dare: `UgLIC�'�r`( RKS ElApProved as revised. QDenied_ C>oa encs: i.JRLIC UTILITIES UUSUC SAFE Reviewed by: IRE SERVICES Thfrd Review: Dale: QAPProved as revised. QDenied. evfevved b,- j �eEe- °, rs CITY OF ATLANTIC B � EACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 ! 1 jDT INSPECTION PHONE LINE 247-5826 Application Number Property Address 10-00000422 Application type d 550 SHERRY DR Date 4/20/10 Zoning Property description RIGHT-OF-WAy PERMIT _--__ ----------Application valuation To BE UPDATED ------------- ----- _________ - --__----- -------- Application desc concrete forconcrete Owner --------------------------------------- _ Contractor WHITEHEAD, MRS. L. D. -- --------- ______ 550 SHERRY DRIVE OWNER ---- ATLANTIC BEACH FL 32233 Permit ------- . - . ----DRIVEWAY PERMIT ------------ __ Additional desc -------- Permit Fee Issue Date 35 . 00 Plan Check Fee Expiration DateValuation . 00 ----------------------- • 10/17/10 0 Special Notes and Comments-----------------------------------------___ Ensure all meter boxes, sewer cleanouts and valve cove and set to grade and visible . A sewer cleanout must i installed at the covers Cleanout must be covered with an Property metal lid. RT1 concrete box withe Roll off containeruoe set to grade and visible . and container cannot company must be on City approved list --------------------cannot---_placed-on City right-of-way. Fee summary Charged -------------- ---------- ----g Paid Credited ------------- Permit Fee Total --------- ---------- Due Plan Check Total 35 00 35 . 00 . 00 . 00 . 00 35 . 00 Grand Total ' 00 • 00 . 00 35 . 00 00 . 00 11t ll 1S kQp?'()N ➢ ONL'i 1N ACCORDANCE WIT" ALL CITY OF ATLANTIC BEACH ORDINANCES AND-TxE ELORmA 1ti0NO. R I I I L V) (� n ' t o o 0 0 0 INA �opG PIh V1 ut y arTI o ION h(hj yn0 fl V-- Z �yl �l+h 2 =06D Ab 1f/E C�r1i DF i47_G.4/✓7 � M L idol --- -, 0t Q1 O 00!�UnVi 10 C h n In't l p l ry(•j� CTt �f2on n Lr�i r (_ hI V�.'i r O O V fir$ h Ciu W 10Z P �.� L �quwmmf, oo1 ytiLU�1l $ 0On szW c)1 off, p2lytiGlh'' to t q?nl� I L' I ` O z v 0 q,h � n ZZ Y e y r rl )fq u,�l^ �oDtoA p �;� 1 it W �D,nr S � � � •6 ` r� o rte.,� �n Iwo ) y `�� �✓ _ _ �' 3.3i _ � — tl v n 1 a ;,as, url o�IM,044Q6 0 vim, - � 70• 74.ns' non, OT pU V VI m 2 S T• :.i::j;i;!''C`r•';,:(1^'Li � O yWUM H O !rt rnl Y NOW 0 04.$) Z v! ri •, X 5; t V a 3 p O b M b � - o ra y � _,I � r � Z • I z rt n D II I•rl 1 °fin� � � ?1 r� �bbO!'1M .'tl I�o�btA{y`a p m t fJ p 7 Vl In y b•a �'• Z � A 2 nIQ 1 D mil I �'z z o pEE/�ElJ To INE C/Ty OF fgTLAn/T/C > p1 1p O ieot �o a 61 h� I `-•o�r~u � 4t 1 O 1 U O vi �i.J ,P• hC m ti -'-1 A r p 1 Z , _-'i 4 Wj p LIti 17}� a o "1 - h � bvli�n�w os 1i QaV.0 O - \ 4 a �1 V z o ytiU ( h rj S Sy r hl ,1a; p�,•r Y � �� t 1 nlUz y c oz z Z �c,Ir�U<li�a m S c� /;C) 0.1 ry o uAA I: atigRu o �_ — m > �MQ�I�r•:LC o � � �� �� �1 � on. D O VI o FYI U)1 znv;Az noo OI.It� ' 0�1� Sp oog yj o 13\ `n ,,...,157 .'►... N -20'J 1' (2'T.U� ^ "i p mD ' Op o o ^n t— .N CIA r4. �n'b^n)t' r s AId,MU1 0 JJ n ld oO to - O O D Iq A1.1 461 o v 111201) o v n 1., 13 o . rn 4 A --d o 44 hi9A[` n / C < EoP v r ao y 0 r 1 O Cl Y b Z A Q N- U < hxuo° 1 ll-1 h 111 t .i01 11 1 ) A h11 hil 1"1 r) T 2"i0� V UI jz VIIzIl O XI SJ� V1 r' �°u =Ux� vl vi .Nll�nl� r no ni f'. 7. .�L '1 m J.. O CITY OF ATLANTIC BEACH CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS a ,_::•z'- 800 Seminole Road 904-247-5800 P1Atlantic Beach,Florida 32233-5445 Fax 904-247-5845 PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION. Date 4t I Ci 1 PERMIT# Job Address _ (^ r 1 I JP/ ISSUED BY THE CITY Permitee: Telephone# !aOL4- 341 —.53 1 D Permittee Address: CJS -)S YO Requesting Permission to Construct: "tnv� 1A Location: (Reference to Cross-Street) 1. Applicant declares that prior to filing this application he has ascertained. the location of all existing utilities, both aerial and underground and the accurate locations are shown on the sketches. A Letter of Notification was mailed to the following Utilities/Municipalities: Jacksonville Electric Authority Yes ( } No ( ) Date: Bell South Telephone Company Yes( ) No ( ) Date: Ferrell Gas Yes ( ) No ( ) Date: Comcast Yes ( ) No ( ) Date: 2. Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation, alteration or relocation of all, or any portion of said street or easement as determined by the Director of Public Works, any or all of said poles, wires, pipes, cables or other facilities and appurtenances authorized hereunder, shall be immediately removed from said street or easement or reset or' relocated hereon as required by the Director of Public Works, and at the expense of the Permittee unless reimbursement is authorized. 3. All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the supervision of DDUd_ICA 5 (�'un+e-v' (Contractor's Project Superintendent) located at --_' Telephone* 4. All materials and equipment shall be subject to inspection by the Director of Public Works or his designee. 5. All city property shall be restored to its original condition as far as practical, in keeping with city specifications and the manner satisfactory to the city. 6. A sketch of plans covering details of this installation, as well as, a copy of a recent survey shall be made a part of this permit. Calculations showing any increase in impervious area on owner's lot or in the city Right of Way are to be included with this application 7. This permittee shall commence actual construction in good faith with days. If the beginning date is more than 60 days from date of permit approval, then permittee must review the permit with the Director of Public Works to make sure no changes have occurred in the area that would affect the permitted construction. 8. It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right, title and interest in the land to be entered upon and used by the holder, and the Holder will, at all times, assume all risk of and indemnify, defend, and save harmless the City of Atlantic Beach from and against any and all loss, damage, and cost of expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges. 9. The Director of Public Works shall be notified twenty-four (24) hours prior to starting work and again immediately upon completion. OWNER ,.1"`,810"1% STEPHEN T. PUTNAM �e`�: Notary Public-Sh6s of Florida SignedAethis Date �� �, Before e' er day of)rj'tt;1u-i in the County of Duval, s;� 2D,2010 State Of Florida, has personally appeared .p ;,r; ey 57G196 4� 't �c '•,,;;,1t�•�� Bonded B National Notary Assn. Notary Public of Large,State of Florida, County of Duval. My commission expires: Personally Known: Produced Identification: R.O.W. Permit Attachment of for R.O.W.Permit# issued , 200_ Atlantic Beach,FL(32233 Owner's Name: AN2 Property Address: ,,siSn//�� ii r C.J 1-1+k-an+',c. -Bc'_k 32- 33 Subdivision: -5&1+C1 i r Sec.3 Lot#/Block#: R.E. #: REVOCABLE ENCROACHMENT PERMIT THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of , 200_, by Atlantic Beach, Florida, a municipal corporation organized and existing under the laws of the State of Florida, hereinafter referred to as "CITY" and of Atlantic Beach,Florida,hereinafter referred to as"USER". WITNESSETH: That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon the property of the City of Atlantic Beach for the purpose as described in the City of Atlantic Beach Right-of-Way/Easement permit numbers noted above (copies attached). This work is generally described as: Lak a I 13r P kms rwm RAI t-w7�6 r. Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to relocation or removal on thirty (30) days notice by CITY to the USER, said notice to USER shall be given by certified mail, return receipt requested, to the following address: The depositing of said notice of cancellation in the United States mail shall constitute the notice of cancellation and the burden is upon USER to keep the CITY inforaed of USER's proper address. The USER shall promptly make any and all necessary repairs to any facility erected or maintained in the exercise of the privilege herein granted and shall at all times maintain said facility in good and safe condition. In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter upon the above-described property of the CITY, the USER shall replace at the USER's sole expense, any and all material necessarily displaced during the action of maintaining, repairing, operating,replacing, or adding to of the utilities and facilities of the CITY or franchise utility provider. The facilities allowed by the pen-nit shall meet the current requirements of the City Code, Building Codes, Land Development Code, and all other land use and code requirements of the CITY, including City Code Section 19-7 (h) which states "Driveways that cross sidewalks: City sidewalks may not be replaced with other materials, but must be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks." Page 1 of 2 The USER, prior to making any changes from the approved plans and/or method, must obtain written approval from the City of Atlantic Beach, Public Works Department, for said change. The USER shall, at the discretion of the CITY, be requested to submit as-built drawings showing the change within thirty(3 0)days after the day of completion. This permit shall inure to the benefit of, and be binding upon, the USER and their respective successors and assigns. USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or specifications, to include utilities locate requirements and use limitations/requirements of public rights-of-way and other public land. USER further agrees that the CITY and its officers and employees shall be saved harmless by the USER from any of the work herein under the terms of this permit and that all of said liabilities are hereby assumed by the USER. DATED and SIGNED this % day of , 201P By: zl Property Owner (to be signed in presence of the Notary) STATE OF FLORIDA COUNTY O�DUVAL On this �1 day of2(.X, personally appeared before me, a Notary Public in and for said County and State, the property owner of SSS' •S1-e r<r /2yc,C1 Atlantic Beach, Florida, known to me to be the person(s) described in and who executed the foregoing instrument; who acknowledged to me that he or she executed the same freely and voluntarily and for the uses and purposes therein mentioned. Notary Public in for said County and State �. ����.,, STEPH�EtN T.PUT.N/A�My, =i yy111ln*sw Expim Jui 20,2010 CITY OF ATLANTIC BEACH, FLORIDA, a � ,,1111, r Commfasion#DD 576296 municipal corporation: '' tet`'`, Bonded By National Notary Assn. Approved: Ricky L. Carper,Public Works Director For Permits where city sidewalk is impacted, City Manager approval required: Jim Hanson, City Manager Page 2 of 2 r. City 0E Atlantic Seach �- Sung Depaftmant FPS: Tff3N NUMBER 80(]Seminole Road ? cla 6e essfgnecl by the Bui€dng Deparfinenf.) A.c�#anf3c Beach,Florida 333-544a/,�'¢-� Phone(904}2 7-58� - Fax(g r a < < , Fxl� E-mail" buffdm a M p€( coal us Dale rotd:ed. GLY web�-srfe: Ff€p:11mVW-eaab.us APPLICATIONREVIEW AND FORM �roperfy Address-, ��D S//, r25,, pe went review Yes . No p // f i]{Yitd6nr�. kpplicant — Q moi./• ��7'k'h7"z�r' (��G'_� Pfan ting&LOnincr isfrar C, Lt d y PUblic Safe-ty Fire Services ar•Agency Review OF Permit Re€ tired Review Or Receap Data cif•Perr�€�meed g� Florida DepL of Emftrunanfaf Pmfec€fon Florida Dep€of Transporlaffon S`l dof�res River water umageme t Dfsfdef 14t-nW Corps of Engfneem tgen of€dols and Resfauranfs ion of leaf clic Sevarages and Tobacco Mier evieWi€ag i3eparfinerrt F€rat Rev;ew: Ap?praVed. EJI)enied. (Circle one.) Comments.- BUILDING J2— °LAN SING&ZONFING Reviewed by. pate: y S C v TREE ADMIN- Second Review-- DApproved as revised- OCenied_ PUBLIC WORDS Co enfs: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: page: FIRE SERN/ICES T€frd Review: QAppraved as revised. ElDenfed. C€� €a€e€ts: Reviewed by- Date-- City of Atlantic Beach o APDL#QAT[GN NL1MBER Buifdi ng Departnent (To be assigned by the Bufdfng Department) 800 Serninofe Road D /i Atlantic Beach,Florida 32233-5445 _ - Phone(904)247-5826 - Fax(904)247-5$45 E-maif: buffdng-deptQcoa€s us Clams roomed: City web-site: hffp:flvrwtnr coab.us APPLICATION REVIEW AND T __- i FOR Property Address: � Sllgr r V De r€ ent raview required Yes No A/7 6nef-'l Building Applicant Q yI ,",,7-il- planning &Zoning T istrator rods : d7i CrJoR &01)rw T2- pr;a wit/ Public safaty Fire Services Other Agency Review or Permit Rewired Review or Receipt. Data of Permit Veriseed By Florida Dept of Environmental Protection Florida Dept of Transportation St Johns Pier Water Idanagement District Army Carps of Engineers Divimm of Hotels and Restaurants DivEmon of Alcoholic Beverages and Tobacco other_ APPLICATION STATUS ,eviewi€g.Department First Review. 'PApproved. QDenied. (CMe one.) Comments., BUILDING r�ING&ZONING � Reviewed by: Date: _� TREE ADMIN. Second Review: []Approved as revised. ODenied. !� QRKS Go rETY PUBLIC SReviewed by: Date: FERE SERVICES Third Review: ❑Approved as revised. QDenied. Comments: RevieEeied by: Data: