Permit Folder 2004 Beach Avenue CITY OF ATLANTIC BEACH
�? 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
.�� INSPECTION PHONE LINE 247-5826
Application Number -00000246 Date 3
Property Address 2004 BEACH AVE /05/10
Application type description SIDING PERMIT
Property Zoning . . . . . TO BE UPDATED
-----Application-valuation . 1500
Application desc
------------------------------------------------------
shake
--------------------------------
Owner Contractor
------------------------ ------------------------
CARPENTER, F.KENDALL OWNER
2004 BEACH AVENUE
ATLANTIC BEACH FL 32233
----------- Structure Information 000 000 ----------------------
Construction Type . . . . . TYPE 5-A
Occupancy Type . . . . . . RESIDENTIAL
Flood Zone . . . . . . . . ZONE X
-------------------------------------------------
Permit BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 60 . 00 Plan Check Fee 00
Issue Date Valuation 1500
Expiration Date . . 9/01/10
--------------------------------
--------------------
Fee summary Charged Paid Credited Due
----- ---------- ----------
Permit Fee Total 60 . 00 60 . 00
00 ------- . 00
. 00
Plan Check Total . 00 . 00 . 00
Grand Total 60 . 00 60 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904)247-5826 Fax(904) 247-5845
Job Address: 2-a�`� 02�4 Ar/q_ Permit Number:
Legal Description Parcel#
Valuation of Work
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of exkting/proposed structure(s)(circle one): Conunerc Residenti�
ilvv
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes N/A
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed:��1.
W i •�� GLA9 r�- t.,r.�.y..�.
Property Owner Information• _
Name: — A 67 z.-1'411__ Address:�_D
City .4 �tC- 10> f State!;t Zi
E-Mail or Fax#(Optional) P— 2?33Phone_�
Contractor Information:
Company Name: Qualifying Agent:
Address: City State Zip
Office Phone Job Site/Contact Number Fax#
State Certification/Registration#
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby�a�to obtain a permit to do the work and installations as indicated. I cert that no work or inhas commenced prior to the
issuance of a permit athat all work will be performed to meet the standards of all laws regulating construction in this jurisdiction This permit becomes null
and void f work is nommenced within six(6)months, or if construction or work is suspended or abandoned for a period of six16)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 and Air Cononers,etc
WARNING TO OWNER: YOUR FAILURE TO .RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUW NOTICE OF
COMMENCEMENT.
I hereb certify that I have read and examinedspthis plication and know the same to be true and correct. All provisions oflaws and ordinances governing this
provis"ions f a o � a1 state, ortlocrcr[law regulating constructa permancetofConst to give authority to violate or cancel the
Signature of Owner �� —
z Signature of Contractor
Print Name ('� - , Print Name
_.._..............._.
Swvh_gnd subscri befor me Sworn to and subscribed before me •,.F.-..ry"tl..
this Day of 201v this Day of
• 20
Notary Public My COMMISSION#DD 634121 Notary Public
AXPIAM May 2i,2011
4+,r®
/ Revised 01.26.10
CITY OF ATLANTIC BEACH
(OWNER / BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT
LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST
SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE—OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER TBE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. LOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES
If. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE
THE BUILDING DEPARTMFOR INJURIES TO WORKERS THEY HIRE,
PURCHASED. ENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO$5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN"OCCUPATIONAL LICENSE"IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826)IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
5 D
ADDRESS '� Ci r+ r-t✓� , g y - z yg —7-T41
PHONE NUMBER
1141NAM a
SI NAT L' � j.. 2.
DATE
Before me this day of 2a in the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are trW and accurate.
Notary Public at Large,State of ,County of
❑Personally Known
Produced Identification f ��E/VJ/� d Fc.
;;' r
DESMRaH
*� MY
COMMISSION
' "7C .�?P_ EXPNRNS;�212011 DD 126
Notary Signature: ( l "f-M Th�ryp blicunderwdters
PBLDG/Owner-Builder Affadavit,REVISED:4/16/2009
I11�
AI
CITY OF ATLANTIC BEACH
s) 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 09-00000735 Date 5/29/09
Property Address . . . . . . 2004 BEACH AVE
Application type description RESIDENTIAL OTHER
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 950
----------------------------------------------------------------------------
Application desc
garage door replacement
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
CARPENTER, F.KENDALL OVERHEAD DOOR CO. OF JAX
2004 BEACH AVENUE 6884 PHILIPS PARKWAY DR. N.
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32256
(904) 268-1627
----------------------------------------------------------------------------
Permit . . . . . . BUILDING PERMIT
Additional desc . . REPLACEMENT GARAGE DR
Permit Fee . . . 52 . 50 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 950
Expiration Date . . 11/25/09
----------------------------------------------------------------------------
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 52 . 50 52 . 50 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 52 . 50 52 . 50 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
s
i
J' CITY OF ATLANTIC BEACH O Q
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
13 .t?Iss
&I (?/l/ lAt"lantic Beach, FL 32233 ,G�
❑NEW BUILDING ❑DEMOLITION RESIDENTIAL
LOT BLOCK_SUB DIVISION ❑ADDITION ❑CONVERTING USE ❑COMMERCIAL
❑ALTERATION ❑ACCESSORY BLDG. =N/Al
REPAIR ❑POOL/SPA ❑YES 13MOVE ❑OTHER 11NO
' .: .....t11TtRAQTQRNKS a ,. .. ARRI TRCaT/l=NGINEE
9.NAME: / /� ) 15.COMPANY NAME: 23.COMPANY NAME:
�J/1�0(�[-t'ir2.I� Uh/��D6/Ur`�`+ UC-/G!`�Sjta'✓ l.�r�GY�- . C I�
16.NAME: 24.LICENSEE NAME:
10.ADDRESS: 17.STATE OF FLORIDA I iCENSE NO.. 25.STATE OF FLORIDA LICENSE NO.:
o(o e/ //,S��,e�r/l /�v �S JIM
18.ADDRESS: 28.ADDRESS:
e z,.0/• 2 L
11.OFFICE PHONE: 12.FAX NO.: 19.OFFICE PHONE: 20.FAX NO.: 27.OFFICE PHONE: 28.FAX NO.:
o Zls
;-17 U, 26� Z,*,
13.CELL PHONE: 21.CELL PH NE:_, 29.CELL PHONE:
14.EMAIL ADDRESS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS:
31.NAME: 33.NAME: 35.NAME:
32.ADDRESS: 34.ADDRESS: 36.ADDRESS:
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: k
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.
4. Q
/ _b
sign Date:�75 7-10U Ca9 S(gne ' l- •' Date
Before me thG �x'ffd of 208f in the county of Before me this ay of �7DB1 int county of
Duval,State of Flo a,has personally appeare Duval,State I a,hes persona ly appe
herin by himself/herself and affirms tha I s and declarations are herin b himself/herself and affirms that all statements and declarations are
true and accurate. ��x�```��A�r////�/ true and accurate.
Notary Public at Large,State of •• twgts Nota ublic at Large,State of Coty�
Personally Known •���e 18 y Personally Known �� •18,��.• y''+
Produced Identifloetion = 5 j = ❑Produced Identific n- O
Notary Signature:?• Notary 11 C-4
P s ,
cS',a CITY OFA LIAN •' ;+;�saa.
p/c,S It • �� SEE PERMITS FOR ADDITIONAL
F. e rannnt���� REMENTSANDCONDITIONS. /rnnm��a
0 L 1: I 1/8/2 7
REVMWED BY
�, .•dr: DATE:
8 w
M6 ao- �
Overhead Door Cornpany
Engineering Services
1900 Crown.-Drive
Farmers Branch,Texas 75234
Telephone: (972) 869-16136
Fax:(972) 869-1671
00C Jacksonville
6884 Phillips Parkway C rive North
Jacksonville, Florida 32256
'(904)268-1627
July 151 2003
T o*Vhom It May Conce•n:
The following Overhead Door Corporation residential windload doors have been designed and tested in
accordance with the Flor da Building Code and their respective windload pressures comply with the Florida
Building Code for Expost:re C, 120 mph. -
408950 Windload, 18012801381,37/55.5 psf,9'-0"max
409886 Windload; 18012811381,31/46.5 psf,16'-0"max Max Roof Height 15 feet
409341 Windload, 18012801381,37/55.5 psf,Post,16'-0"max
409888 Windload, 18012811381,31/46.5 psf,18'-0"max-Max Roof Height 15 feet
409337 W indload,180/2801381,37155.5 psf,Post,18'-0"max
408951 Windload,390,37155.5 psf,9'-0"max
409892 Windload,.3_8A-A ,&:psf�Afi'-0' max 'fft*,R00f�Height 15 feet
410026 W indload„ 7�55,5;psfY t� '0"max
'•09893 `WirYclli cf '390;31116:5 psf l$'-01�adx Nlaii ,uOf Height 15 feet
D9432 Windload,390,35.1/52.7 psf.Post, 1 S'-0"max
409977 Windload, 190/490,37155.5 psf,Post,10'-0"max
yr409960 Windload, 1901490,37/55.5 psf,Post,16'-0"max ,,.�..
409978 W indload, 190/490,37/55.5 psf,Post, 18'-0"max
Sincerely, Concur,
Mickey Womack LeRoy Krupke, P.E.
Project Engineer Registered—State of Florida
Overhead Door Corporation
4
City of Atlantic Beach APPLICATION NUMBER
i Building Department (To be assigned b t e Buildin Department.)
s 800 Seminole Road
t Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 Fax(904)247-5845 Q
E-mail: building-dept@coab.us Date routed: /
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: a?Q 7' ���tri /`�V rtment review required Yepe No
Building
Applicant: ayg�Q Yz ,b zoee Zoning
Tree Administrator
Project: Q�F QQ �,�ton 7 r Public Works
Public Utilities
Public Safety
Fire Services
k.
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
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: MApproved. ❑Denied.
(Circle one.) Comments:
BUILDIN
PLANNI G &ZONING Reviewed by: �
/77 Date: Z2&
TREE ADMIN. of
Second Review:
Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: QApproved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05114/09
CITY OF ATLANTIC BEACH AlUG c}
APPLICATION FOR POOL PERMIT Building and ZO
ning
Job Address C k=
Lot # 0�1
12T �, / 1CT #� 1.'AI�T _SubdivisionQQTH ��",CQ�I7Gj
Owner
Address 2oo4 vk:z-
Contractor �-
Address
License Number 003 2'9`-/
Valuation $ s 3 �S z-v Gallons _3 0
SITE PLAN
front
UI N
Di 03 APPROVED
(D �C��V'L" "/ N CITY OF ATLANTIC 13EAC 1
BUILDING OFFICE
Uy
rear
Date:�' ,.�
Signature Ownerl-- �-�.✓u-
Signature Contractor to
�w
ic.DING AND ZONING INSPECTION DIVISION o �
CITY Of ATL��SEACH;FLORIDA z -
a
ELEC RIU PERMIT-
- �#
Fee Permit No.
location
Between
:and
This is to certify that d
su
fEtectrlcof Contractor) (Master Electric+tin) ti
hos permission to install Electrical Construction as described herein in of
accordance with the provisions of the Electrical Code and regulations
of the City of Jacksonville, and subject to the information shown on the zW
application, drawings and specifications which ore made a part of this
permit.
for
Type of work: -714
SERVICE:1hoft I
Feeders:
Outlets:
Receptacles:
m
Switches:
Incandescent:
Fluorescent:
Appliances*.
Air.Condition'
Motors:
Transformers:
Signa.
Miscellaneous: 4"'ahwAst Stu web*"
IF NO WORK 1S DONE UNDER
THIS PERMIT DURING
f�NY SIX RUED BY:
MONTHS PERIOD, f�'ERMI dactricol Inspettpri Supsry
BECOMES VOID ��
ZBUILDING AND ZONING INSPECTION DIVISION
CITY OF ATLANTIC BEACH, FLORIDA i CIO
ELECTRICAL PERMIT
Date 0-U-n Fee $ 20.00 Permit No.
u
Location 2M 111148th AV*. 00
O
Between and Q
This is to certify th.,aa
rt
Mona" JuaCL2le Co. # W Y
(Electrical Contractor) (Master Electrician)
has permission to install Electrical Construction as described herein in of a
accordance with the provisions of the Electrical Code and regulations Z 01
of the City of Jacksonville, and subject to the information shown on the Lu e
application, drawings and specifications which are made a part of this 3
permit.
for
Lu
Type of work:—ft$-�: #ate..s::.jft G
SERVICE: So" . lit, M, J
230 tet 11
r a
4
Feeders: us
Outlets: O
v
Receptacles: m
Switches: H
Incandescent:
Fluorescent: _
Appliances:
Air Conditioning:
Motors:_
Transformers:
Signs: -
Miscellaneous:
salty Wi" all I,* "l
IF NO WORK IS DONE UNDER _
THIS PERMIT DURING ANY SIX ISSUED BY:
Electrical inspection Supervisor
MONTHS PERIOD, PERMIT
BECOMES VOID. _ "
CITY OF ATLANTIC BEACH, FLORIDA
Aaprowd by - APPLICATION FOR ELECTRICAL PERMIT
TO THE CHIEF ELECTRICAL INSPECTOR: DATE: 9/20 19 88
IMPORTANT NOTICE:
IN CONSIDERATION OF PERMIT GIVEN FOR DOING THE WORK AS DESCRIBED IN THE FOLLOWING, WE
HEREBY AGREE TO PERFORM SAID WORK IN ACCORDANCE WITH THE ATTACHED PLANS AND SPECIFICATIONS,
WHICH ARE A PART HEREOF, AND IN ACCORDANCE WITH THE ELECTRICAL REGULATIONS, CODES AND CITY OF
ATLANTIC BEACH ORDINANCES.
ER 0008818
ME 250
ELECTRICAL FIRM:McClure E c ER ELECTRIOJ&
Pat Kennedy Y ADDRESS: 2004 B!gach Avenue RFD-BOX
BLDG.SIZE BETWEEN:
RES.(A APT.( 1 COMM.! 1 PUBLIC( I INDUS:( 1 NEW'( ► OLD 110 REW.t 1
ADDITION{ ) TRAILER ( 1 TEMP.( 1 SIGNS ( ! SO.FT.
SERVICE: NEW( ) INCREASE( ) REPAIR ( ) FEE
CONDUCTOR SIZE AMPS COPPER f ALUM.
SWITCH OR BREAKER AMPS PH W VOLT RACEWAY
EXIST.SERV.SIZE 200 AMPS' 1 PH 3 W 230 VOLT 21, RACEWAY'
FEEDERS NO. SIZE IND. SIZE I NO. SIZE
LIGHTING OUTLETS CONCEALED OPEN TOTAL
RECEPTACLES CONCEALED OPEN TOTAL
0.90 AMP#, 31-100 AMPS
SWITCHES
INCANDESCENT
FLUORESCENT&M.V.
FIXED 0.100 AMPS. OVER
APPLIANCES BELL TRANSF.
AIR H.P.RATING H.P. RATING
CONDITIONING COMP.MOTOR OTHER MOTORS AMPS CELL HEAT: KW-HEAT
0-1 OVER
MOTORS H.P. VOLTAGE PHS NO. 1 fl.P. VOLTAGE PHS'
MISCELLANEOUS Groundand wire a l l spa Nel Med eauipm t
TRANSFORMERS! UNDER 600 V. OVER 600 V. T-1
A
,s rS /'Jv3
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FLORIDA 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 04-00029030 Date 9/23/04
Property Address . . . . . . 2004 BEACH AVE
Tenant nbr, name . . . . . . REPLACEMENT WINDOWS W/OSB
Application description . . . RESIDENTIAL ADD/RENOVATE/ALTER
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 11915
Owner Contractor
------------------------ ------------------------
CARPENTER, F.KENDALL AMERICAN WINDOW PRODUCTS
2004 BEACH AVENUE 2633 POWERS AVENUE
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32207
(904) 731-2247
----------------------------------------------------------------------------
Permit . . . . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 90 .00 Plan Check Fee 45.00
Issue Date . . . . Valuation . . . . 11915
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 90.00 90 .00 . 00 .00
Plan Check Total 45.00 45. 00 .00 .00
Grand Total 135.00 135.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING
CODE .
BUILDING OFFICIAL
-i rL`Irf,r
CITY OF ATLANTIC BEACH CD. Ford
BUILDING / ZONING DEPARTMENTHig ins
I _ �l 800 Seminole Road —S-.-Doerr
r Atlantic Beach,Florida 32233
(904)247-5800
(904)247-5845 Fax
PLAN REVIEW COMMENTS
Permit Application # 04 , 2 9 0 30
Property Address: 2 oo 4 "A Co Plt N V
Applicant: A MV R1 C A N w 1 N D0 W �RO D A C T 5 INC.
Project: WMtMINT 1N1 Na #5 W i1-1 V5B
This ermit application has been:
Approved
Rev' ed and t wing item ttention:
t1�tD
t Fu e- a
Please re-submit your application when these items have been completed.
Reviewed By: Date: l o �
PSC 2000 Series 2410 Log for
Personal Printer/Fax/Copier/Scanner City of Atlantic Beach Bui
904-247-5845
Sep 20 2004 2:13PM
Last Transaction
Date Time Tie. Identification Duration Pages Result
Sep 20 2:12PM Fax Sent 97318824 0:31 1 OK
J�:fys.l�ljFl i. (
CITY OF ATLANTIC BEACH
3 Sit
J sYS, SKYLIGHTS, GARAGE DOORS,HURRICANE SHUTTERS
SE: .
Date: Vly-h
t,r
Job Address: mf✓
Owner: en L( �
Address: ! hone• irZ7�
g_Z9
ga � 1otmber: aca Zponn Dct:scq ioBloctube
Contractor: AMERICAN WINDOW State License Number: C fJC Z� ZU
PRODUCTS,
Address: 1633 PpWFRfi AVE �
Phone: � l
City: JACKSONVILLE,FL 32207 State: Zip: Fax:
Describe proposed use and work to be done: �s
Present use of land or building(s): kp:��Ijwh Oj
Valuation of proposed construction:*I i Cl i�---
Is approval of Homeowner's Association or other private entity required? If yes,please submit with this
application.
Required Building Data: ^
Mean Roof Height 3 4 (ft) Building Width 3 L- (ft) Building Length 5,1 (ft)
Roof Slope G / 12 Window Height Z 3 (ft) Window Width 3640 52 (ft)
Window Elevation from Grade (ft)
Measurement from corner of building to window Z 6hb (ft)
g �
Number of windows being installed �,�D A4+o-cW
Mean Roof Height
800 Seminole Road •Atlantic Beach,Florida 32233-5445
Phone: (904)247-5800 Fax: (904)247-5845 • http://www.ei.atlantic-beach.1l.us
Page 1 Revised 1/27/03
Procedure: In order to expedite issuance of permits provide all information as appropriate. Incomplete applications may
result in delay in issuance of permit.
In addition to the building data,the following information is required:
, ►. 1. Manufacturer's Test Report with Uniform Structural Load(psf)
2. Installation Procedures
3. Window Description/Type
4. Garage Door Description/Type
5. Skylights Description/Type
6. Hurricane Shutter Description/Type
7. Elevation View of Window Locations
I hereby certify that all information provided with this application is correct.
q_ln y
Signature of Owner. Date:
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 not. The granting of a permit does not presume to
give authority to violate or cancel the provisions of any federal,state or local rules,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 of this permit is contingent upon the
above information being true and correct and that the plans and supporting
47A,,data have been or shall be provided as required.
Signature of Contractor.
�C W" Date: /'f' o L
Address and contact information of person to receive all correspondence regarding this application(please print).
Name:
Mailing Address:
Telephone: Fax: E-Mail:
AS TO OWNER: L� A
Sworn to and subscribed before me this / ( `� day of ,20
State of Florida,County of Duval
P
"S1 P&% BETTY FELDE? Notary's Signature: •�/((���L/
*M.'de*
MY COMMISS(ON#00 239510
NEXPIRES:December 7,2007 o ersonally known
Bonded Thro Budget Notary Services
Produced identification
Type of identification produced
AS TO CONTRACTOR:
Sworn to and subscribed before me this 1"7 ) day of ,20 y
State of Florida,County of Duval
aY P(j
�o��...,'k� BETTY FELOER Notary's Signature:
* MY COMMISSION t DD 235510
EXPIRES:Oacamber 7,2007 ('personally known
�l�rEOF $v*
Sonded Thru Budget NOM Srrvicos ❑
Produced identification
AOW Type of identification produced
800 Seminole Road Atlantic Beach,Florida 32233-5445
Phone: (904)247-5800 Fax: (904)247-5845 http://www.ci.atlantic-beach.fl.us
Page 2 Revised 1/27/03
NOTICE OF
COMMENCEMENT
PHONE r7 31_ N7
-Permit No.
Book ,iao41 Page 1761
State of Florida
- County of_ Tima,i
The`undersigned hereby gives notice that improvements will be made to certain real property, and in
accordance with section 713.13 of the Florida Statutes, the following information is provided in this
NOTICE OF COMMENCEMENT.
Legal des c 'ption of property(Include Stre A dress, If availab ). . -tW) 09-75- 296 N
uxu
Lo b 04 2111--Zo 82�
General des ription of Improvements WeP IOLU-MeA-
Owner
Address ? j -2-�
Owner's Interest in site of the Improvement
Fee Simple Title holder(if other than owner)
Name AMRV4C"w ;v
Address PRO,Puc_TS,INC. 7 3/- 2 2 5�7 ,
Contractor 2633 POWERS AVE.
Address JACK UNVILEE,FL 32207
Surety
Address Amount of bond $
Any person making a loan for the construction of the Improvements:
ti. Name
Address
Person within the State of Florida designated by owner upon whom notices or other documents may be
served as provided by Section 713.13(1)(a)7, Florida Statutes.
Name
Address
In addition to himself, owner designates
Of
to receivda copy of the Lienoes Notice as provided in Section 713.13 (1)(b), Florida Statutes.
Expiration.date of Notice of Commencement(the expiration date is one (1)year from the date of
recording unless a different date is specified)
Signature of Owner Printed Name of Owner
4 Notary Rubber Stamp Seal 1 I have relied upon•the followin&.1dentificatlon of the Affiant
BETTY FELDER� U
• �;•••;� Sworn to�and sub 'bed bef a me thisr_nz-�—
oc
20„�
# * MY COMMISSION t 00 239510
6 EXPIRES:December 7,2007 Booke209678
��t,,EOFFI�\�e BondldThruBudget Notary Serukes Notafj Signature
Page: 11761 d
Filed & Recorded Printe arae
09/16/2004 11:11:00 AN -
J JI14 FULLER
CLARK CIRCUIT COURT
DUVAL COUNTY
RECORDING .00 _
T FUND :# ` ' .08 F
FEE .. . 3 1.00 ' . . ,.
REC.,.ADDITIONAL 't 4.00 `
rt _:.:
Duval County Property Appraiser- Parcel Summary Page 1 of 2
i
site inrsx r,yniaseae
omdw 4titA37 # 0 dT J nVi�ie,
Pr r� r
Appraiser
Home> Departments > Proper Appraiser> Duval County Database Search
Parcel Information Printable Version 2004 Proposedyalue
Owner's Name: CARPENTER , F KENDALL Real Estate Number: 169702 0020
Secondary Name:
Property Address: 2004 BEACH AV Mailing Address: 2004 BEACH AVE
City: ATLANTIC BEACH ATLANTIC BEACH , FL
Zip: 32233
Unit Number: Zip: 32233-5935
2004 Exempt Value: $25,000.00
PARCEL DESCRIPTION
Property Use: 0100 SINGLE FAMILY ISale Date: 11/5/1991
Legal Description: 15-093 09-2S-29E N
ATLANTIC BEACH UNIT 3 PT LOT B RECD 0/R Sale Price: $191,000.00
BK 7214-2082 -
Neighborhood: 940907 BEACH AV
OWNHOMES
Section/Township/Range: 09- INo. Buildings: 1
Official Record Book and Page: 07214- Heated Area: 2506
2082
Map Panel: 553 4 Exterior Wall: TILE/WD STUCCO
VALUES AND TAXES FROM 2003 CERTIFIED TAX ROLL
Land Value: $178,524.00 Taxing Authority: USD3
Class Value: $0.00 County Tax: $1,212.79
Improvements: $203,684.00 School Tax: $1,581.47
Market Value: $382,208.00 IlDistrict Tax: $562.85
Assessed Value: $210,184.00 Other Tax: $92.69
Exempt Value: $25,000.00 Voted Tax: $94.63
http://apps2.coj.net/pao/RF-NO.asp?RENUM=169702+0020 9/15/2004
09/22/2004 12:07 9047318824 AMERICAN WINDOW PROD PAGE 02
c Of+
FILE COPY
APPROVED
CITY OF ATLANTIC BEACH
BUILDING OFFICE
SEP 2.3 2004
By: _ ..._
pp
>
DEPARTMENT OF BUILDING O O��}
Q
CITY OF ATLANTIC BEACH.FLORIDA PERMIT N
PERMIT TO BUILD .u,T
THIS PERMIT MUST BE POSTED ON JOB 514 1 A 8126113
Date August 25, 19 88 5553 1 n W261Q
Valuation$ 3,Soo.00 Fee$ 28.SO 1 �
This permit not valid until above fee has been paid to City Treasurer,and is
subject to revocation for violation of applicable provisions of law.
This is to certify that SURFSIDE POOLS
RP003299 321 Beach Ilvd
has permission to build wood deck with Spa
Classification Residential Zone
Owned by M' & Mrs Leland Kennedy
Lot Block S/D
House No. 2€104 BEACH AVEI+ItlE
According to approved plans which are part of this permit
t NOTICE—ALL CONCRETE FORMS
AND FOOTINGS MUST BE IN-
SPECTED BEFORE POURING.
PERMIT VOID SIX MONTHS
,t AFTER DATE OF ISSUE
4 No 00 O Building material, rubbish and debris
-zi from this work must not be placed
in public space, and must be cleared
t up ap# hauled away y either con-
a r 03PIOwner.
Building Official.
FOR OFFICE PERMIT DATE CONTRACTOR
USE ONLY NUMBER
PLUMBING
ELECTRICAL
SEWER
WATER
09/2.2/2004 12:07 9047318824 AMERICAN WINDOW PROD PAGE 03
t.
ot
3 � �
_ a
AMERICAN WINDOW PROD PAGE 04
09/22/2004 12:07 9047318824
t� UT
N
1
� 53�
/n 71 _
TV ��ni7 #dy- 29030
09/03/2003 21: 34 7244651894 GORELL ENTERPRISE PAGE= 01
Avnericen Test Lab of SoLdh Florida
6795 NW 17 Avenue Ft Lauclardele FI 33309
Rhona(9-W 973-0808 Fax(954)973-0823
Wab-www,witdxom E-Mail-inf�a51**l�-Coal
Pag,-, 1 of 6
ATI.Report#0910.02-02 DC Note#ATL 02057 Date: 9/30)'02
ATL Certificatj.on# 01-0516.16 fest Dates: 9/10, 9/:!1/02
Telt Requested By- Gorell Enterprises, Inc., 1380 Wayne Ave., Indiana, FES 15701
Phone (724)465-1839 Fax(724)465-1894
Tests CondMct DCOCCO PA 201-94,PA 202-94,PA 203-94, (with no deviations)
Qualifying: ASTM E 283, E 330,E 331, E 1996-02 and SBCCI SSTD 12-19.
9'9.
Desi o XMIgM -ev; + 50.0 psf,-50.0 psf
(1)DESCRIPI'JON OF UNIT:
Model Designtj' n: Model 5301 Vinyl Picture Window,as per drawing #s P5301D, t 8/
C000987 dated 3/25/94, 000099,dated 5/l/94, drawing'?5 1 D, :� :and
component drawings from Gorell Enterprises, Inc..
Oyerxll Size: 48"wide x 48"high x 3.446"deep.
CgUflizuration;. Fixed Window
(2)MATERIAL CHARACTERISTICS:
Frame Materi;jj: PVC
FrpMe Constniction: Jambs, head and sill consisted of a hollow section(drtwing# 10004A) (3,4467' x
2.304"x 0,065"typical wall thickness) and a channel cover section (drawing A12005.A.)(1.660"x(3.4-11"x
0.050"typical wall thickness). Jambs were welded to head and sill at each miter cut corner.
Glaziraa•
Note: Lawinat Dr's Dug(Permanent Identification)verified prior to testing.
IziMa Material: 0.717' OA,glass. 1/8" ann clear glass/0.218"Airspace with a spacer coil (2._'i nota)
around the perimeter of the glass, sealed to the glass and t4 frame with hot melt butyl sealant/ 1/8"ann clear
glass/0.090"Dupont rigid interlayer/ 1/8"ann clear glass, laminated by Guardian.
09/03/2003 21:34 7244651894 GORELL ENTERPRISE PAGE= 02
¢4 TLSF#0910.02-02
Page 2 of 6
Gazing Met1gh Exterior glazed with,PVC gla.4ug tape against interior perirraeter of glass. Biter o:ra glass
0.500". A PVC snap in Glazing,bead on exterior perimeter of glass(drawirl' ,# 12011 A)(0.844"x 0.225"x
0.065"typical wall thickness).
Ravtizht ORtnin : 43-1/4"wide x 43-1/4"high
Wext(rerstgNone
Ua� None
Weepholes: (4)__cut=s: (2)cutouts on each sill font side corner: (1)0.37°j' wide x 0.102"high, located
at 2-1/8"from jamb and at 0.98T'from sill,to center of cutou t and(1)0.500"widee x 0.125"
high,located at 2.080"from jamb and at 0,406'from sill,to renter of cutout.
(2 gmuts,0.500"x 0.250": (1)cutout on eacb sill top side cA)mer,located at 2.212"from
jamb and at 0.875"from back side of sill, to center of cutout.
Mgntins: None
Iteinforcemertt: None /
ant: Dov►Corning 1199 silicone sealant used between PVC ftme and'iuood test buck � Apand
heel beads. ,,4/
AddiihioaatDrMcri n: �, i
SpecimensA, B,C were installed in wood test bucks, and tested per the Impact d e e�ents of
DCBCCO Protocols PA 201 /203 -94.
Specimen D-was installed in a wood test buck;and tested per the Air Infiltration, at es' a tend
Static Air rNu irements of DCBCCO Protocol PA 202 -94.
(3)WSTAL,L ATION:
Ste.
#8 x 2"pan bbd phillips wood screws
Sill: 3 (1)at 7-1/2"from each jamb,(1)on center.
Header: 3 (1) at 7-1/2"from each jamb,(1)on center.
Jambs: 6 (1) at 9-1/2"from sill, 17-1/4", 15-1/2 . (3) screws per jamb
2
09/03/2003 21:34 7244651894 GORELL ENTERPRISE PAGE 03
A' F# �Q..
Page 3 of b
AIR INFII.TRA `ION
Aix Infiiluation Tests were conducted w accordance with DCBCCO PA 202 -94
Qualifying ASTM E 283
.Air at 1.57 psf Measured Allowable
Specimen D 0.00 CFWT 0.3 CF1,A/FT
STATIC AIR PREUM'QTS
Static Tests were conducted in accmd=ce wft DCBCCQ PA 202-94
Qualifying ASTM E 330
JA
1�
Design Loathe +50.0 Pa., •50.0 pst. Specimen D (� N
Positive leads time(sec.) psf load max. deft at"A"
1/2 Test 30 37.5
Desip 30 50.0 0.008"
Negative load.,
1/2 Test 30 37.5
Design 30 50.0 -0.003,1
Itegutts:Passed .
NAM.HUMTRATION TEST
lVater InfiiJUIWom Test was conducted in accordance with DCB'-,CO PA,202 -94
Qualifying ASTM E 331
Specimen D
Water @ 7.5 psf load for 15 minutes Result: Passed
No water pengUvtion over sill
3
09/03/2003 21:34 7244651894 GORELL ENTERPRISE PAGE 04
&1=#0910.02-02
Page 4 of 6
STATIC AIR JUSSIM TESTS
Static Tests were conducted in,woordsuce with DCBCC0 PA 202-94
Qualifying ASTM E 330
Design Loads +50.0 psf, -50.0 pst Specimen D
Positive loads titer Riff load V=- set at stv,
Test 30 75,0 0.002„
Negative load
Test 30 75.0 -0.0011,
PACT 3M-LARGE Mrbj" J'
Impact tests were conducted in accordance with DCBCCO PA 201 -94
Qualifying ASTM E 1996-02 and SBCCI SSTD 12-99.
v\
Yuen A imen B ;Specimen �\N
ti
Et
V- Let- 3j
SPEED FT/SEC. SPEED FT/SEC. SPEED FUSEC.
1). 50.2 2)_ 50.2 1). 50.2 2). 50.2 1). 50.2 2 '.50.2
13W 40d.a'0 of missile: #2 Southern Yellow Pine 2x4,Length approx, 89-5/16"&9 lb.
p ono specimens after impact test:
A. The firit impact was made in the center hated lite. The second impact was made in the lovnn right
corner of fixed bite. Now of the impacts penetrated the specimen and there was no separation of
glass£corm the glazing system.
Result P#aaed
B. The fir-t impact was made in the center fixed lite. The second impact was made in the iovres right
corner of fixed lite. Norse of the impacts penetrated the specimen and there was no separwioa of
glass from the glazing system.
Result Passed
4
09/03/2003 21:34 7244651894 GORELL ENTERPRISE PAGE 05
ATL5F#0910.4x»02
�YYrW WYWIr
.ft3e 5 of 6
C. The first impact was made in the center fled lite. The second impact was made in the lower richt
corner of fixed cite. None of the impacts penetrated the specimen and there was no separation of
glass tom the glazing system.
Result Passed
CYCLE, ,,
Cycle tests were conducted in accordance with DCBCCC PA 203-94
Qualifying ASTM E 1996-02 and SBCCI SSTD I' -99.
Design Loads +50.0 psf and-50.0 pif Spedmcas A►,B, C
Rw*e of test actual load psf #of cycles cycles/win
Positive loads
+ .2- ,5 10 25 3500 45 45 45
+ ,0- ,6 0 30 300 50 50 54
+ ,5 -,8 25 40 600 46 46 46
+ .3 - 1,0 15 50 100 25 25 25
Negative Loads V
- .3 - 1.0 15 50 50 25 25 25
-
.5 -,8 • 25 40 1050 58 58 58
- .0- .6 0 30 50 50 50 50
.2- .5 10 25 3350 57 57 57
9000 cycles completed
LW9*1LO—n of s =w-afer cy lc a test:
A,B, C: Specimens showed no resultant failure or duress after cycle test. No failure of-fasteners or
separation of grass from the aluminum spacer.
5
09/03/2003 21:34 7244651894 GORELL ENTERPRISE PAGE 06
ATLSF#4910 MUM
Pape 6 of 6
2 will polyethylene film was used on the cycle tests and it is the opinion of
the undersigned that they had no influence on the results of these tests.
Observers
William R. Mehuer-PE
Tony Swore,Jeremy Sivore-ATLSF
The PA 201-9,6,,P.A,202-94 and PA 203-94 tests reported have been performed in fall accordance to the
requirements of Dade County, with no deviations,
Dade CountyV Not pzesertt
Jo . Mir, Assistant or ,�-
American Test Lab of South Florida l
A11.Tests.CgWded and Witnessed by: Engineer Seal& Si
William R. Mehner
6795 N. W. 17 Avenue
Fort Lauderdale,FL 33309
State ol'Florida:
Registered E*neer P.E. #'7496
Drawing#s P5:3011),C00098, C00049,P53011), and component drawings from Gorell'Eaterprises,Inc. as
verified and mfuked with the ATLSF stamp are a part of this report.
Disclaimer This-,'est report was prepared by Amedcan Test Lab of South Mm ids(AT F), ibt the ew n We use of the above
naaaed client,it does not oozw�titute oe�of this prodtect. TIBC results are for that particular spmimon tested and dues not
imply the gmfity of similar or identical poducts mawdkUwDd or icor AMWd fMW spwiftatima i knfieal to the toned product.
A11,SF is a testing;lab and assumes that all h&mu ion provided by the cb Adis accurate a,*does dnot guarantee or warranty any
product tested or iastalled.
6
Keystone Certifications, Inc.
2545 Lori Drive, Suite 204,York, PA 17404. Phone (717) 764-6278 Fax (717) 764-3049
Notice of Product Certification Authorization
National Fenestration Rating Council Program
Issued to: Certification Number
Manufacturer: Gorell Enterprises 111
Address 1380 Wayne Avenue Product Line Number
Address Indiana, PA 15701 GOE-K-006
NFRC Code: GOE/602
Date: July 21, 1999
The following NFRC product line has been Authorized for Certification:
Model/Series: 5301 Picture Window
Operator Type: Fixed
Frame Type: Vinyl
Sash Type: Vinyl
Expiration Date: June 18, 2003
Ratings Authorized to Certify.
Rating Property Authorized
NFRC 100 U-factor Yes
NFRC 200 Solar Heat Gain Coefficient Yes
NFRC 200 Visible Light Yes
Conditions and Criteria for Product Certification Authorization:
Alanufacturer agrees to the following conditions and criteria per the NFRC PCP.
3.1A Products are marketed consistent to the simulated products.
3.IB Waiver requests shall be submitted to IA prior to marketing new products.
3.IC Only products with labels shall be considered Certified.
3.1D Only products authorized for certification shall be labeled.
3.1E Manufacturer shall designate individual responsible for proper labeling.
3.I F Manufacturer shall not use labels that are false,inaccurate or misleading.
3.IG No labels shall be attached to products that have not been authorized for certification.
3.2A Manufacturer shall maintain a documented in-plant quality control program.
3.2B Quality Control records shall be maintained for 4 years.
3.2C Manufacturer shall have staff to properly inspect and maintain Quality Control records.
3.3A Manufacturer shall have temporary labels approval prior to printing.
3.3B&C Ivlanufacturer agrees to the proper use of temporary and permanent labels.
3.5 Manufacturer agrees to obtain permission from NFRC to use NFRC certification mark.
Attached are the Certification Authorization Reports printed from the NFRC database.
You are authorized to label the options listed in the reports.
Please notifyKeystonewithin 10 days of receipt of any errors or omissions. G
-ninistrator's Signature: f/G2i'�i>!I� i�C. Date:
diligence was used in authorizing these products for certification. By accepting this report the licensee agrees to hold harmless and indemnify
Keystone Certifications, Inc.from all claims or liabilities which may arise out of or in any manner based on this certification authorization.
Certification authorization is based on NFRC program requirements and simulation and test reports from accredited laboratories.
■ An Independent Certification & Inspection Agency ■
Farabaugh Engineering and Testing, Inc.
CERTIFICIATION TEST REPORT
GORELL MODEL G5305
TILT DOUBLE HUNG WINDOW BUILDING PLANS EY.�t4'N' I
REVIEWED FOR
H-R55 CODE COA/1:PLYA.N(" ,.
(3'=8" X 5'-0") KEEP THIS PLAN ON JOB
FOR MAY 13 2003
Building&ZrA0101LI
ing iv-Jax., -L.
GORELL ENTERPRISES, INC
1380 WAYNE AVE Examiner Si ature
INDIANA, PA 15 701 License
Project No. T138-03
4/11/03
DANIEL G. FARABAUGH, P.E.
255 Saunders Station Rd.
Trafford, PA 15085
(412) 373-9238 1
Keystone Commons • 515 Braddock Avenue • Turtle Creek, PA 1 145
(412) 824-3316 FAX (412) 824-3367
S v3
Project No. T138-03
Report Date: April 11, 2003 Page 2 of 5
CERTIFICATION TEST REPORT
Manufacturer: GORELL ENTERPRISES, INC
1380 WAYNE AVE
INDIANA, PA 15701
Product Identification
Product Type: Double Hung Window
Series/3vlodel9: G5305
Specification: AANL4/NWWDA 101/I.S.2-97
Designation: H-R55 (44" X 60") AA1AINWWDA 101/I.S.2-97
GRADE 55
Test Reference: See Test Report ( FET Test Re ort T137-03) for any additional
information needed.
Product Description: Attached
Test Results: Attached
Test Equipment: FET
Testing Date: 3/20/03
Detailed assembly drawings showing wall thickness of all members, corner construction and
hardware application are on file and have been compared to the sample submitted. A copy of
this report and testt sample will be retained at FET for a period of 4 years. The results
obtained apply only to the specimen tested. No conclusions of any kind regarding the
adequacy or inadequacy of the glass in the test specimen may be drawn form this test.
The above results were secured by using the designated test methods and they indicate
compliance with the performance requirements of the referenced specification. This report
does not constitute certification of this product, which may only be granted by the
certification program administrator.
Prepared y: i Approved b
Paul G. F abaugh Patrick J. P aug E
Project No. T138-03 Page 3 of 5
Product Description
General:-
Test
eneral:Test sample was comprised of Gorell Model "G5305" (downsize)Tilt Double Hung Vinyl
Prime, one-over-one (tilt loading type) double hung window, with an overall master frame
size measuring 44" wide X 60" high X 3-1/4" wide. The bottom sash measured 40-1/8"
wide X 29-1/2" high overall. The top sash measured 39-1/4" wide X 28-5/8" high overall.
The frame corners were of welded mitered with one screw in bottom corners construction.
The sash corners were of welded mitered type corner construction. Bottom sash had an
aluminum exterior screen. Each sash had (2) foam chimney blocks located in the jambs near
the balances. One foam chimney block for each side of each sash. Each perimeter frame
member hollows were filled with stirrofoam pieces that measured to be 7/16" x 9/16". The
bottom rail of the bottom sash had a anti bow sway bar attached to the rail and when the
window would shut the bar would slide into an opening that was in the center of the sill
Weather-stripping:
N/fENIBER WEATHERSTIPPING QUAINTITY WIDTH X HEIGHT LOCATION
(INCHES)
Frame Header Insert Center Fin Pile Sdal 1 0.187" w x .23" ht side face
Frame Sill none 0 - none
Frame Jambs none 0 - none
Top sash—top rail Center Fin Pile Seal 1 0.187" w x .23" ht exterior face
Top sash—bot rail Center Fin Pile Seal 1 0.187" w x .23" lit intenor face
(keeper rail)
Bottom sash—top rail Center Fin Pile Seal 1 0.187" w x .23" ht exterior face
(meeting rail)
Bottom sash—bot rail Center Fin Pile Seal 1 0.187" w x .23" ht Bottom face
(lift rail) Foam Filled Bulb Vinyl 1 0.3125" Dia. Bottom face
with Fin
Top sash—jamb stiles Center Fin Pile Seal 1 0.187" w x .23" ht Exterior face
Center Fin Pile Seal 1 0.187" w x .23" ht Side face
Bottom sash—jamb 'stiles Center Fin Pile Seal 1 0.187" w x .23" ht Exterior face
Center Fin Pile Seal 1 0.187" w x .23" ht Side face
' Screen -too rail Pile Seal 1 0.187" w x .35" ht Interior face
Operators and Other Hardware:
Each sash had two sets of(4)constant force balance shoes, one per jamb. One cam-type
sweep lock was attached to the center of the bottom sash meeting rail with keeper on top
sash meeting rail. One plastic tilt latch with thumb actuator was housed at each end of the top
' rail and interior meeting rail of the bottom sash. One die-cast pivot bar was fastened with (1)
screw at each end of the bottom horizontal rails of the top and bottom sash. Each sash had a
Ilift rail with the top sash lift rail on the top rail and the bottom sash lift rail on the bottom rail.
i
Project No. T138-03 Page 4 of 5
Glazing System:
Each sash was exterior drop glazed with 7/8" thick insulated glass using double-sided foam
dazing tape. The sash utilized two (1/8") thick clear annealed glass lites with a 5/8"
continuous metal spac6r. An exterior snap-in single leaf dual durometer rigid vinyl-glazing
bead secured the glass.
Weep Holes:
Two (3/8" x 3/32") weep slots were located at the glazing track through the bottom of the
top sash bottom horizontal rail, one 4-1/8" from each end. Two (1/4" x 3/32") weep slots
were located at the glazing track of the bottom sash bottom horizontal rail, one 2" from each
end. One (3/8" x 3/16") weep slot were located just above each of the pivot bars on the ends
of the bottom sash rail of the both sashes. Two (1/2" x 1/8") baffled weep slots were located
on the exterior face of the sill, each one 1-7/8" from each end. Four (1/2" x 1/8") weep slots
were located on the inner chamber wall of the sill, two on very end of each side. Two (1/2''
x 3/16") weep slots were located on the interior of the sill, one 1-3/4" from each end. The
frame sill was a sloped sill. Three (3/8" diameter) baffled weep l�bes�ro�r�+1Y�a "� re
bottom rail of the screen, one weep in the center and one 5-3/4" fr .
com COM PTAANTC�°E
Sealant: KEEP THIS PLAN ON JOB
Silicone sealant was applied to all the following areas: MAY 13 2003
• Entire bottom of the sill to buck intersection..
• Screw heads hole openings used for anchorage of the fDddifigUa ng Ins�e�� U i civ J
• Exterior and interior of frame to buck intersection.
• A 1/4" wood Shim around the perimeter of the frame se'e FIX,
(tXY-th mne. —�
• Cover flange at the sill and header on the exterior of then me wasseat
frame/ .. tersection and the flange was also sealed to the buck/flange intersection.
nchorage:
A 'A" wood:shim was attached with silicone to the perimeter of the buck frame. wo
additional '/<" wood shim strips were attached at each jamb screw attachment to the wood
buck. The frame was attached to the buck using 2" long wood screws along with silicone at
the sill and on the e=*,or and intcrier perirneter of the framme to buck irtersecticns. Eac:,
jamb was attached with four sets of-2" long screws. The header was attached with two sets
of wood screws. Each set of screws consisted of a screw located on the interior jamb track
and one screw located on the exterior track of the frame. Each set of screws were attached
parallel to each other. The sill was secured using a built up of wood that was secured to the
buck and then the sill was attached with silicone to the wood. The exterior of the sill then
used a trim attachment and was secured to the frame sill and buck using silicone.
I
Id
. T138-03
Project No Page 5 of 5
GORELL "G5305 DOUBLE HUNG WINDOW
Test Results
Paragraph Test Title / Test Results Allowable
Referenced Test Method
See T137-03 (Full Size Test Window) for all Test Data on Gateway Minimum and
Specific Performance Window Requirements.
Optional Performance Results
4.3 Water Resistance Test
(ASTiVI E547-96)
@ 8.25 psf(w & wo screen) No penetration No penetration
4.4.2 Uniform Load Structural Test
(ASTM E-330-97) (P.4%xL)
@ 82.5 psf positive 0.044" * 0.157"
@ 82. psf negative 0.049" * 0.157"
@ 82. psf positive 0.020" * 0.118" (stile)
j @ 82. psf negative 0.022" * 0.160" (bot. rail)
* - vfaximum Deformations.
r° Ut �7�4(���ttGi�4 � From 11tiC_:�C•y r_aAe
Ca.rDept.t"ti t �C. co (,C5 -
t -,-- — NOTES,
CAULK & SECURE 1.) SHIM AS REQUIRED AT EACH INSTALiATION ANCHOR A�, --
BUCK TO MASONRY BEARING SHIM, AS DESIGNED BY OTHERS.
OPENING. AS DE– 2.) ANCHOR MUST BE OF SUFFICIENT LENGTH TO PROVIDE 1 1/4" EMBEDMLN,
SIGNED BY OTHERS. INTO BUCK, BY OTHERS.
ANCHOR 3.) CAULK BETWEEN WINDOW FLANGES A BUCK AND CAULK FULL PERIMETER
CONCRETE OR OF WINDOW.
MASONRY fl ANCHOR SPACING SHALL NOT EXCEED 16` OC.
OPENING. 5. GLASS THICKNESS WILL VARY WITH WINDOW SIZE & DESIGN LOAD, AND m
MUST COMPLY WITH ASTM–ET300. 0 C-) 0+
CONCRETE OR
6.) SEE APPLICABLE CHART FOR DESIGN LOAD DETAILS.
PERIMETER CAMASONRY OPENING.
CAU
, r
B1' OTHERS.UALSO, WOOD BUCK AND ANCHORS,DESIGNED 54" MAX ANCHOR Q ch
SHIM BY OTHERSS INSIO� DIMENSION C` c
BETWEEN FNGE 17-4- SHIM SHIM 1 4 SHIMS (3 REQ'D)
& BUCK. C C4
CAULKING e HEADER & JAMBS co � 4
w HEAD a INNERMOST t/4" WOOD SHIM ON INTERIOR OF FRAME.
M+ SECURED WITH SIUCONE TO
l THE FRAME PERIMETER. L__J
az
f ANCHORS IN PAIRS
s'u " = < 16` 0.C. (Uj
w Da_j JAMB
O
(A
SECURELY ANCHOR WINDOW UNIT TO 2 X 4 0
C1BUCK. ANCHOR EMBEDMENT MUST BE
A w i � 1 i . tS7 0 t.
USE SHEAR PADS 0 t�=n� � C3 0�
SILL, ANCHORS ARE Z
0NOT PERMISSAALE THRU - ANTI-BOW SWAY-B on ,� Q m
WINDOW FRAMES. o CAULK LANGE do BUCK z `
ANCHORS TO WITHIN p° �_ �,PER4M }C, 0 EXTERIOR. x�
Rs DIMENSION
OF FRAME CORNERS * A ' A
lG� R CAULK BETWEEN �2
a, BUCK & OPENING
SILL 1/4" SHIM A �_ A §MOTES TO ANCHOR)
c w ` MAX, STRUCTURAL TEST PRESSURE 82.5 CSF.
PERIMETER CAULK. f WOOD STOOL be 0 44 x 60
BY OTHERS. ANCHORAGE, BY A i5 Max STRUCTURAL TEST PRESSURE 45 PSF
OTHERS. ?< 0 54 X 77
Lo 4 A _ A
4 a A A GC1RELL EPUNTER -w. t , ' 1
m Xuur Ftlt1 a:cvPONS
DAn 3/27/02 v
A— - A t VSN
_
ORI;–CAST SILL �LIAODEI 5305 iNSTALLATtt1h1 o+a
CAULK BETWEEN FLANGE � PRE–CAST SILL. --
EXTERIOR LLEVATION h FASTENER DETAIL 5,305 IF
a
CITY OF ATLANTIC BEACH, FLORIDA
Approved by APPLICATION FOR ELECTRICAL PERMIT
TO THE CHIEF ELECTRICAL INSPECTOR: DATE: July 21 19 $$
IMPORTANT NOTICE:
IN CONSIDERATION OF PERMIT GIVEN FOR DOING,THE.WORK AS DESCRIBED IN THE FOLLOWING, WE
HEREBY AGREE TO PERFORM SAID WORK IN ACCORDANCE WITH THE ATTACHED PLANS AND SPECIFICATIONS,
WHICH ARE A PART HEREOF, AND IN ACCORDANCE WITH THE ELECTRICAL REGULATIONS, CODES AND CITY OF
ATLANTIC BEACH ORDINANCES.
e
ELECTRICAL FIRM: McClure Elec NaJWR ELECTRICIAN I URE JOURNEYMAN
NAME Frohwein Const.Co. ADDRESS: 2004 Beach Av _nm- RFD BOX
BLDG.SIZE BETWEEN:
RES.(X) APT.( ► Comm.( ) PUBLIC ( 1 INDUS.1 ► NEW(X► OLD( ! REW. l 1
ADDITION( ) TRAILER ( 1 TEMP.( ) SIGNS ( ) SO. FT.
SERVICE: NEW( ► INCREASE( 1 REPAIR ( ► FEE
CONDUCTOR SIZE AMPS COPPER f ALUM.
SWITCH OR BREAKER AMPS PH W VOLT RACEWAY
EXIST.SERV.SIZE 200 AMPS 1 PH 3 W 230 VOLT SEU RACEWAY
FEEDERS NO. SIZE IND. SIZE NO. SIZE
LIGHTING OUTLETS CONCEALED OPEN I TOTAL
RECEPTACLES CONCEALED OPEN I TOTAL
0.�0 AMPS. 91.100 AMPS.
SWITCHES
INCANDESCENT
FLUORESCENT&M.V.
FIXED 0.100 AMPS. OVER
APPLIANCES BELL TRANSF,
AIRH.P.RATING H.P.RATING
CONDITIONING COMP.MOTOR OTHER MOTORS AMPS CEIL HEAT: KW-HEAT
0.1 OVER
MOTORS H.P. VOLTAGE PHS NO. 1 H.P. VOLTAGEPHS
MISCELLANEOUS Install un eraround servicO lateral
CITY OF ATLANTIC BEACH, FLORIDA
J
APProwd by APPLICATION FOR ELECTRICAL PERMIT
TO THE CHIEF ELECTRICAL INSPECTOR: DATE: 19
IMPORTANT NOTICE:
IN CONSIDERATION OF PERMIT GIVEN FOR DOING THE WORK AS DESCRIBED IN THE FOLLOWING, WE
HEREBY AGREE TO PERFORM SAID WORK IN ACCORDANCE WITH THE ATTACHED PLANS AND SPECIFICATIONS,
WHICH ARE A PART HEREOF, AND IN ACCORDANCE WITH THE ELECTRICAL REGULATIONS, CODES AND CITYOF
ATLANTIC BEACH ORDINANCES.
Ga(
ELECTRICAL FIRM: TER ELECYRICIAN SIGNATURE
NAME= %_ .tet, Q—'fAO ADDRESS:_ RFD BOX
BLDG.SIZE BETWEEN:
RES.(x APT.( ► COMM.( 1 PUBLIC( 1 INDUS.1 ) NEW( ) OLD ( 1 REW. ( 1
ADDITION( ) TRAILER ( 1 TEMP. ( i SIGNS ( ) SO.FT.
SERVICE:. NEW( ) INCREASE( 1 REPAIR( 1 FEE
CONDUCTOR SIZE 1f O AMPS COPPER f ALUM.
SWITCH OR BREAKER 2-AC�o AMPS PH W VOLT RACEWAY
EXIST.SERV.SIZE AMPS PH W VOLT RACEWAY
FEEDERS NO. SIZE IND. SIZE NO. SIZE
LIGHTING OUTLETS CONCEALED OPEN TOTAL
RECEPTACLES CONCEALED OPEN TOTAL
O.30 AMPS, 91.100 AMPS.
SWITCHES
INCANDESCENT
FLUORESCENT&M.V.
FIXED 0.100 AMPS. OVER
APPLIANCES I I I BELL TRANSF.
AIR H.P.RATING H.P.RATING
CONDITIONING COMP.MOTOR OTHER MOTORS AMPS CEIL HEAT: KW-HEAT
0.1 OVER
MOTORS H.P. VOLTAGE PHS NO. 1 N.P. VOLTAGE _PHS
MISCELLANEOUS
lr�
CITY OF ATLANTIC BEACH
=�' y 800 SEMINOLE ROAD
r)
J ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
INSPECTION EMAIL REQUEST:
Building-dept2coab.us
Application Number . . . . . 07-00000971 Date 7/06/07
Property Address . . . . . . 2004 BEACH AVE
Application type description ELECTRIC ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
------------------------------------------------------------------ ----------
Application desc
200 AMPS 240 VOLT REPAIR
----------------------------------------------------------------------------
Owner Contractor
-
------------------------
-----------------------
CARPENTER, F.KENDALL BROOKS & LIMBAUGH ELECTRIC CO
2004 BEACH AVENUE Q/A BROOKS, CHRISTY
ATLANTIC BEACH FL 32233 42 WEST 8TH ST.
ATLANTIC BEACH FL 32233
(904) 241-9051
----------------------------------------------------------------------------
Permit . . . . . . ELECTRICAL PERMIT
Additional desc . .
Permit Fee . . . . 70 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 1/02/08
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 70 . 00 70 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 70 . 00 70 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ik
CITY OF ATLANTIC BEACH
ELECTRICAL PERMIT APPLICATION
Date:
Property Address:
Owner" Telephone#:
Contractor: le one# q(J5j
(!(
Contractor Address: Fax#•
Contractor Signature,
In consideration of permit given for do the w rk as in the above statement, we hereby agree to perform said work in
accordance with the attached plans and Spec iS ons w ch aro a part haoof and in accordance with the City of Atlantic Beach
ordinance and standards of good practice listed thereia
Building: Building Type: 0 Trailer Shrvice: If oma consau 6m is
❑ New f'Residence c i Temp. ❑ New be �on this buikfing
�bld the bujiding
❑ Commercial ❑ Signs ❑ Increase Permit numbs.
❑ Re-wire ❑ Addition Sq.Ft. woRepair
Conductor Size: AMPS: COPPER ALUNNUM
Switch or I i RACE
Breaker AMPS PH W VOLT WAY
Esistink: Service / 7
Size AMPS 908 PH J W > VOLT WAYMeter
��'b•
Number 6 ?66
Feeders: NO. SIZE NO f SM a a NO SIZE
Lighting Outlets
CONCEALED OPEN
Rete tacles CONCEALED OPEN
11 Inn AVPq I
Switches
Incandescent
Fluorescent &
M.V.
Fixed o.100 AMPS OVER BELL
Appliances TRANSFER-
Air
RANSFERAir H.P.RATING H.P.RATING CEILING KW-HEAT
Conditioning COMP.MOTOR OTHER MOTORS AMPS HEAT
Motors 0-1 H.P. JVOLTAGE PH NO. OVER 1 H.P. PHS
UNDE"V OVER600V
Transformers NO. KVA NO. KVA
No.Neon_Transf.
Ea. Si
Miscellaneous
800 Seminole Road•Atlantic Beach,Florida 32233-5445
Phone:(9q4)247-5800• Fax: (904)247-5845• b"tr//www.ci.atlantic-beach.fl.us
Revised 1/04
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 08-00001314 Date 9/22/08
Property Address . . . . . . 2004 BEACH AVE
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 5680
----------------------------------------------------------------------------
Application desc
reroof fl 1744 . 6
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
CARPENTER, F.KENDALL SHORE ROOFING COMPANY
2004 BEACH AVENUE 914 7TH AVENUE SOUTH
ATLANTIC BEACH FL 32233 JAX BEACH FL 32250
(904) 241-8842
----------------------------------------------------------------------------
Permit . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 58 . 40 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 5680
Expiration Date . . 3/21/09
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 58 .40 58 .40 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 58 .40 58 .40 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT ApmcATION
r J CITY OF ATLANTic BEACH
1 s�
}r 800 Seminole Road,Atlantic Beach FL 32233
ORI Office:(904)247-5826 • Fax:(904)247-5845
Job Address: 2cc Q >e Permit Number:
Legal Description h -(�'b 0 -'a,S q_r- K
Valuation of Work(Replacement Cost)S
■ Class of Work((Circle one): New Addition Alteration <. ve�-
• Use of existinglproposed Vis)�(Circle one,); Commercial ��
• If an existing structtm�is a fire sprj! 'systiem installed?(Circle one); Yes NoV11Ak• is approval of s assoerat�on or other private e�rty required?(Circle one);
Describe in detail the type of work to be performed:
Property Owner Information
t
Name: t-n �cr�r r Address: ` U
City 9.A t b c h State-2 Zipbla-b I'S-Phone 'J-,y 01 7�49_ _
Contractor Information:
Name of Company: ®.d. j f 2Xd�103, Qualif ng Agent;
Address: 1� �)kh e 5 jCity�( V State-�`Zip � n
Office Phone Job SitdContact Kimber 1 o 'a a coal,
State CertificationMegistration# CC — 8 l k Oise Fax#_?•q k 8 n:t�
Architect Name&Phone#
Engineer's Name&Phone#
Application is hereby made to obtain a permit to do the work and installations as indicated I certify that no wot
installation has commencedp-ior to the issuance ofapermitandMatallworkwillber edto meetMe standards(
laws regulating constrz�turn m this w1&*bion, TThhis permit becomes mill and void' work is not commenced within si
months, ar construction or wards suspended or abandoned for a period o�f six ((6) months at c time after wo
commenced I understand that sreponate must be secured for E i W Woik PlumbbW,Signs, Wells,P
Furnaces,Benders,Heaters, Tani&andAir
eom
WARMNG TO OWNRR:YOUR.FAILURE TO RECORD A NOTICE OF COMAE NCEMENT N
RESULT IN YOUR PAYING TWICE FOR DeROVFIVCENTS TO YOUR PROPERTY. IF '�
INTEND TO OBTAIN FINANCING CONSULT WITH YOUR LENDER OR AN ATT010
BEFORE RECORDING YOUR 90-KU OF COM MENCMENT.
thereby ce gifyy thatl have read and this kwon and know the same to be true and correct. All provisic
laws and oraTinawes this oPfl k be complied with whedier speci}le+d herein or not The jg;,n�
permit does not p�gove7 qty t+� violate or cautcel the provisions of any other federal, state, or loco
regulating construction or the perfonnanae of construction.
Signature of Property Owmr� Signature of Contractor: _
Sworn to and subscribed before m Sworn to and subscribed before me %
this_Ld Day of` }��
Notary Public• Notary Public: �� —�'
MARJORIE M.ARAMs-MARKUP MARJORIE MADAo"
. MS.."" �
r►t+�rTnT'+T 1%-v Air 623^IT O
r pia comnw 000{88
�1Q*/• 0 .`dp�Tp`r FSB•: r'OANIIM"w+ooVC3
at�,,,�;�4 z Exp
Bonded UnU(800)032-4254• `5 Bonded thru(aW)432.4254�
.. •. .,
.........Forida NOWryAesn.�hic
............ i... :
p
NOTICE OF COMMENCEMENT
Permit No.
Tax Folio No. Doc#2UO8241006,OR 6K 14644 Page 229,
i tOq��`�1'C`1J�� Number Pages: f
Recorded 09/19/2008 at 01:59 PM,
State of Florida JIM FULLER CLERK CIRCUIT COURT DUVAL
COUNTY
County of Duval RECORDING$10.00
THE UNDERSIGNED hereby give notice that the improvement wiliFie made fo certain real property in
accordance with Chapter 713, Florida Statutes,the following information is provided in this Notice of
Commencement.
1. Description of property (legal description of property and address if available):
(6 -69-6 3 &[x31 16ecn en �wL- •3�a3�
2. General Description of improvements:
7eoIc C)H- ofd 1(-kcc
3. Owner Information:
a)Name and Address&" �,r t�e�k_� r7,CX)� --)Pac)a AJ,-L AJ,-Lyza
b) Interest in property:�j�,�;,�,�
c)Name and address of simple titleholder(if other than owner):
4. Contractor(Name and Address):
Olk 5. Surety Informati .
a)Name and Address:
b)Phone Number:
c)Fax Number:
d)Amount of Bond:
6. Lender Information:
a)Name and Address:
b) Phone Number:
7. Person within the State of Florida designated by owner upon whom notices or other documents may be
served as provided by 713.12(1)(a),Florida Statutes.
a)Name and Address:
b)Phone Number:
c) Fax Number:
8. In addition to himself/herself,owner designates of
to receive a copy of the Lienor's Notice as provided in Section 713.12(1)(b),Florida Statutes.
9. Expiration date of Notice of Commencement(The expiration date is one(1)year from the date of
Recording unless a different date is specified:
Signature of Owner:~
Sworn and subscribed before me this 1`7 day of Cz
>p� ,20
❑ Known Personally ID Shown:
Signature of Notary:
My commission expires:
= MMUORM M AOJIMSFd4RRUP
Con W OOOIeHM
_ ;✓ fps 100MI. os
8«rtad 8ft($W$,'2.4254:
s.... Florida Notary AMn.�:nc. =
.IIIIIIP