2069 Beach AveCITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
Application Number 10-00000027 Date 1/08/10
Property Address 2069 BEACH AVE
Application type description MECHANICAL HVAC ONLY
Property Zoning TO BE UPDATED
Application valuation 0
----------------------------------------------------------------------------
Application desc
1CU lAHU
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
FERGUSON, LEE A. AIR ENGINEERS INC
2069 BEACH AVENUE 2815 ST JOHNS BLUFF
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32246
(904) 641-2333
----------------------------------------------------------------------------
Permit MECHANICAL HVAC PERMIT
Additional desc .
Permit Fee 91.00 Plan Check Fee .00
Issue Date Valuation 0
Expiration Date 7/07/10
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total
Plan Check Total
Grand Total
91.00 91.00 .00 .00
.00 .00 .00 .00
91.00 91.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
,f';rrT~ ~ CITY OF ATLANTIC BEACH
~~eAl` '' B00 SEMINOLE ROAD, ATLANTIC BEACH, FL 32233
~•,
t ~ ;.cc ~ I OFFICE: (904)247-5828 ~ FAX NO.:(904)247-5845
~~ _„,~- ) BUILDING-DEPT®COAB.US
~~-~'_c_~J~' I`IIECHAtr61CAL PERMIT APPLICATION
09- ..._.~ ,.-. ~. _~ ~
DUVALCOUNTY
1. JOB ADDRESS: 2. f5 TNIS A SUB PERMIT: 3. DATE:
~7Flo
h /
V tP ^ YES PERMIT #: ~ ~ _ O/ /~
V
PROPERTY OWNER:
4. NAME: 5. ADDRESS IF DIFFERENT FROM JOB ADDRESS: 6. PHONE:
e ~ /J
M ECHANICAL CONTRACTOR:
7. ME OF COMPANY: 8. DRESS.:
9. STA
TE OF FLORIDA LIC NSE NO: 10. CELL PHONE: 11. FAx NO.: ~~ . ~~/~ ~~~ ~,,
r
ll//'
12. EMAILADDRE
SS
: 13. OFFICE PHONE: 14.
(~~
J
~
=Cc ~
Appliption is hereby made to obtain a permit to do the work and installations as indicated. I certify 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 (ti)
work is suspended or abandoned for a period of six (6) months at any time after work is commenced.
ction
or
months, or if constr
u
11
~
j
7
CONTRACTORS SIGNATURE ~A/ B(fiOL..
15. CLASS OF WORK: i6. BUILDING: 17. SERVICE: 16. CURRENT CODE:
^ NEW INSTALLATION ^ NEW IDENTIAL ^ '07 FLORIDA BUILDING CODE-
,~-f21=PLACEMENT OF EXISTING SYSTEM Ja-@?CISTING ^ COMMERCIAL MECHANICAL
^ ALTERATION /ADDITION TO EXIST SYSTEM
^ REPAIR ^ OTHER
MECHANICAL EQUIPMENT TO BE INSTALLED:
19. HEAT: ^ SPACE ^ RECESSED .0-CENTRAL ^ FLOOR BURNERS:
20. AIR CONDITIONING: O ROOM NTRAL
21. DUCT SYSTEM: MATERIAL: THICKNESS: MAX CAPACITY: cfm
22. REFRIGERATION: MAX CAPACITY: cfm
23. COOLING TOWER: CAPACITY: gpm
24. FIRE SPRINKLER: NUMBER OF HEADS:
25. LIFT SYSTEM: ELEVATOR: MANLIFT: ESCALATOR: AUTOLIFT:
26. COMMERCIAL HOOD NUMBER:
27. FIREPLACE: PREFABRICATED: MASONRY:
28. IRRIGATION: ^ PUMP ^ WELL ^ PIPING
29. GAS PIPING: # OF OUTLETS: ^ GAS AHU: ^ GAS WATER HEATER:
30. OTHER -SPECIFY:
SOLAR HEATING, BOILERS, UNFIRED
PRESSURE VESSEL, HEAT EXCHANGER
OR COIL IN DUCTS ETC. VALUE FOR OTHER ITEMS:
31. COOLING EQUIPMENT:
AIR CO DITIONING REFRIGERATION E UIPMEN CONDENSORS ETC.
APPROVING
NUMBER
OF UNITS DESCRIPTION MODEL# MANUFACTURER TONS AGENCY
l o v / E' o ~
32. HEATING EQUIPMENT:
FURNACES BOILERS FIREPLACES IR HANDLERS ET .
IN
A
U DESCRIPTION MODEL# MANUFACTURER BTU AGENCY
OF UNITS
1 I D -~ Ni~d ~ - ~o
33. TANKS:
A
NUMBER GALLONS CONTAINED MANUFACTURER SERIAL# AGENCY
~Z 3~,<S6
BLDG04 Pertnk AppFcnton Mect,: REVISED: 1211 812 0 0 8
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
Application Number 09-00001250 Date 9/15/09
Property Address 2069 BEACH AVE
Application type description RESIDENTIAL ADDITION/ALTERATION
Property Zoning TO BE UPDATED
Application valuation 4000
----------------------------------------------------------------------------
Application desc
REBUILD PORCH
----------------------------------------------------------------------------
Owner
Contractor
------------------------ ------------------------
FERGUSON, LEE A. EASTERN SHORES CONSTRUCTION
2069 BEACH AVENUE 1015 ATLANTIC BOULEVARD
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 545-7878
--------------------- Structure Information 000 000 ----------------------
Construction Type TYPE 5-A
Occupancy Type RESIDENTIAL
Flood Zone ZONE X
----------------------------------------------------------------------------
Permit BUILDING PERMIT
Additional desc .
Permit Fee 50.00 Plan Check Fee 25.00
Issue Date Valuation 4000
Expiration Date 3/14/10
----------------------------------------------------------------------------
Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/'05-'06 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
Roll off container company must be on City approved list
and cannot be placed on City right-of-way.
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total
Plan Check Total
Grand Total
50.00 50.00 .00 .00
25.00 25.00 .00 .00
75.00 75.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Public Utilities Plan Re~~iew Comments
Date: q ~ I v~
Project 1'#Tame/Address: ~~~G~ ~eac~ ~~.
Initiials•
Application Permit.#: (~~ ~ ~ ~ 5~
.:Check $ox
Application Tracking !~om~nents to Kidd
Commen#
Avoid damage to underground water/sewer utilities. Verify vertical and horizontal
location of utilities. Hand dig if necessary. If field coordination is needed, call ^
247-5834.
Ensure all meter boxes, sewer cleanouts and valve covers are set to ,grade and ^
Vlslble.
A sewer cieanout must be installed at the property line. Cleanout must be covered ~
with an RTl concrete box with metal lid. Cleanout to be set to ade and visible.
A reduced pressure zone backElow preventer must be installed if irrigation will be
provided or if there is a private well on the property. Backflow preventer must be ^
tested by a certified tester and a co of the results sent to Public Utilities.
Plans note the building will be unsprinkled. If plans change, any fire line installed
must be metered with a Sensus touch-read meter ia3 a properly sized vault and an ^
appropriate backflow preventer installed. Backflow preventer must be tested by a
certified tester and a co y of the results sent to Public Utilities.
If fire sprinkler system is provided, contact Malcolm Clemons at 247-5$39 for
backflow requirements. At a minimum, will require .double check backflow ^
reventer.
Fire lines must be metered with a Sensus touch-read meter. Meters larger than 2" ^
must be installed in a vault as noted in JEA s ecifications.
^
___ _ ~
( , ~ ^
_ , :~~`~'''~f~_ CITY OF ATLANTIC BEACH
-~ ~~ 600 SEMINOLE ROAD, ATLANTIC BEACH, FL 32233
l^ r OFFICE: (904)247-5626 • FAX NO.:(904)247-5845
J ~ /" BUILDING-0EPT(~COAB.US
'`"=1r==~///-Y BUILDING PERIIAIT APPLICATION
09- ~ I i L _ _.I _. I
DUVALCOUNTY
1". JOB ADDRESS. _
_ 2. VALUATION OF WORK 3. SQt FT' UNDER ROOF
Zo~~
~,u.~t,. ,~N,c.,~~ e.~ ~y,oaa ~~
4. LEGALDESCRIPTION: 5. CLASS-0F WORK: 6. USE OF STRUCTURE:
^ NEW BUILDING ^ DEMOLITION ^ RESIDENTIAL
LOT_ BLOCK_ SUB DIVISION ADDITION ^ CONVERTING USE
^ ^ COMMERCIAL
Z DESCRIPTION OF WORK:.. J
Ii~S ALTERATION ^ ACCESSORY BLDG. 8. FIRE`SPRINKLER;
~` \ no ~.~ n O r_ ~
yU 1
J r ~ (
Q T " , ~~ ^ REPAIR ^ POOL /SPA ^ YES ^ N/A
t
~ ^ MOVE ^ OTHER ^ NO
PROPERTY OWNER: CONTR AQ OR: ' ARCHITECT /'ENGINEER:.
9. NAME: 15. COMPANY NAME:
~
~'
~
S ~-
~ 23. COMPANY NAME:
p
.
~t
,l
.z
,, ~' ~~
t~
ta
~ 0~
I.et- •(%ar ~
' S ~ ~ n ~
. ,.
~ s
G~ h
a tc, ,
~
,,
,
,
..
,
>
t
n c~,
I 16.~ ME: ~ ~t~~ ~f~ 24. LICE ~G1~FN ,'1 N
I
%/
`
/'
10, ADDRESS: q ~ 1
~ 17. STATE OF FLORIDA LICENSE NO.:
' N
S
E
NO.:
25. STATE OF• FL~RIDA LICE
(w+~
GCI T7'~-L C. G G O S ~o
I 3 3 ~'~l` •~ ~ Zed
titA ~ ~„ ` `~
~
~~~'i ~ 16. ADDRESS: (~ ~ S ~~~` ~~ V 26. ADDRESS: 1 fj ~ ~,~(, ~ J ~ ~ t S ,
`
'3223 ~ •
Or~~hc ~~L ~Fl,
e t ^~ ~h`•
F- 3 ~tio Z
siz ~
11. OFFICE PHONE: 12. FAX NO.: 19. OFFICE PHONE: 20.f~N0.: _ , 27. OFFICE PHO~ ~ 28. FAX NO.:
13. CELL PHONE: 21. CELL PHONE: 29. CELL PHONE:
/~
o _ S W S- "T ~e"l `a
14. EMAIL ADDRESS: 22. EMAIL ADDRESS: 30. EMAIL ADDRESS:
.„ ~'
FEE-SIMPLE TITLE HOLDER:
- (IF OTHER THAN OVV[JER) B NDING COMPANY: MORTGAGE LENDER:
-
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.
mot- WARNING TO OWNER: ~
YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
OWNER or'AGENT
" CONTRACTOR'
e , Powe Attorney or Agency Letter Requi
d)
(If
re (Qualifier Only)
/
')
•
/ ~ •
Signed
Date: Date:
Signed
Befor e this day of v` , 2009 in the county of ii
Before a this ~ day of ~T , 2009 in the county of
Duval, State of
Flori
da, has personally appeared Du
al, St
at
e
of
Florida,
h
as personally appeared
v
i
~
~•' ~ ~Q- ~Gj v `~O v-~ i
_
j
~
~
~,^
f
~
~
I~ JC..~ ~T ~ ~ l 1~1 L"~s~ ~/~fC~i~'
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. ~ \
f f ~•=
f ~4
N
t
bli
t L
t
C
t
P
St true and accurate.
of ~ `~-y ~- I
Count
Nota
Public at Lar
e
State of r ~'
. ,
o
ary
u
c a
arge,
a
e o
oun
y o
^ y
ry
g
,
,
L'J
l
PP rsonally Known ~ (~ ~~
5 ~ Personal
y Known
L7 Produced Identifi on -
1 ^ Produced Identificatio
n
-
Notary Signature: J ,ti '
A
'
Notary Signatur : v ~ ~- 1 ~ ~Zi(~~~
~. -~
~: :.; ~oN,y~
MV ~
H
~~
~°~~ pMM~SS;o
AMaV
~F Ft
~~ E~P~RES, N,p pd r
Sd, N
bun 'hru 9USt 49
yp
9
BLDG01 Permit Application Bldg: REVISED: a~
ub/r u
, ep ~
nv~fferS
.'~ti°ay:epo~. MICHEt~L~ L. WAI.Ur1 Q
:*, ~ *= Commission Cib ~687~
'•• es Expires June 25, ~,(d11
':~ of ~,°.~`~ Bonded thru Troy Faln InourapCe a7;1-ar;~`~81e
~;.5=''''1r~,;.~ CITY OF ATLANTIC BEACH
,~J ~Y 800 SEMINOLE ROAD, ATLANTIC BEACH, FL 32233
%- 7 OFFICE: (904)247-5826 ~ FAX NO.:(904)247-5845
~~ BUILDING-DEPT@COAB.US
-1,-,>>
~~'~ BUILDING PERMIT APPLICATION
09- L I_I
DUVAL COUNTY
1': JOB ADDRESSi 2. VALUATION OF WORK ` ` 3~ SQ: FT: UNDER ROOF
A _ '
ZD~~ ~ju,cl~• t"N~c..~J e.~ ~y~oea . oa
c 4. LEGAL DESCRIPTION: 5. CLASS OF WORK:;: 6. USE OF STRUCTURE
^ NEW BUILDING ^ DEMOLITION ^ RESIDENTIAL
SUB DIVISION
BLOCK
LOT pDDITION ^ CONVERTING USE
^ ^ COMMERCIAL
i
_
" 7
DESCRIPTION OF WORK. ' J
III ALTERATION ^ ACCESSORY BLDG. 8. FIRE SPRINKLER:
.
o_ D ~ ,, c ~
t ~
~~
~ ^ REPAIR ^ POOL /SPA ^ YES ^ N/A
~+G~ ~I
1 K+0 1~1 ~7
S ~ ^ MOVE ^ OTHER ^ NO
PROPERTY OWNER: CONTRAQ OR: ARCHITECT I ENGINEER:
9. NAME:
~ S s ~
C
~
I
C 15. COMPANY NAME:
~Q t ~Gv h s ~-a (tGo ~ n ~~ . 23. COMPANY NA E:
~ttJN CSI ~~.. PKa.~ ~' ~~'
.er
.
.
~ 16. NAME: ~
ALf~ ~f~ 24. LICE `~F~ ,'1 N
t
10. ADDRESS: 77. STATE OF FLORIDA LICENSE NO.: LICEN
O.:
25. STATE OF FL RID
A
Zo G CI ~C.G t.~ ~ ~ G G O S ro '13 3 ~
'
~
x-- d
~~h` ~ ~ 18. ADDRESS: (~~5 ~4n~c~ ~1,V 26. ADDRESS: ~f,q, ~~~ ~.atM{ ~ ~
''3u33 pt~,t,~,hc ~ P!,
; ~~ ~- 3~1oZ
~~'
sat ~
11. OFFICE PHONE: 12. FAX NO.: 19. OFFICE PHONE: 20 f~NO.: ~ ~
(J 0 27. OFFICE PHO~ ~~
~ ~ , 28. FAX NO.:
13. CELL PHONE: 21. CELL PHONE: 29. CELL PHONE
14. EMAIL ADDRESS: 22. EMAIL ADDRESS: 30. EMAIL ADDRESS:
FEE SIMPLE TITLE HOLDER: g DING COMPANY: MORTGAGE LENDER:
aF an+ER lfun ovurv~z>
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 offiaal, 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 OF COMMENCEMENT.
O ER olr'AGENT CONTRACTOR
re
d)
(11 a Powe AttomeyorAgencyLetterRequi (Qualifier Only):.
/
")
Sgned~ Date: v ~ Date: j
Signed
Befo a this day of ~7` , 2009 in the county of i ~~.,,~,
Befo a this I day of ~~ , 2009 in the county of
Duval, State of Florida, has personally appeared Duval, State of Florida, has personally appeared
~ ~Q~g ~~ ~-, R.~~~--~- L e t -~,~.--, v.~,~-
herin by himself / herseff and affirms that all statements and declarations are herin by himself / herseff and affirms that all statements and declarations are
true and accurate. '~ ^ ~, `
t
f '-^
~'~ a'\
C
'~ `~-'~ true and accurete. !--
County of D r'~'~V ~
State of 1- ~'
Public at Large
No
ta
oun
y o
-
,
Notary Public at Large, State of ,
,
'ry
~
ll
K
L~J P
^ PP ~O~ally Known _.~~ ~ nown
ersona
y
\
L' Produced Identifi n - ^ Produced Identificatlon -
Notary Signature: ~ Notary Signatu ~ ~~~A"
COMPLLA.NCE
C BEACH
REQUIREMENTS AND CONDITIONS.
REVIEWED BY:
DATE:
permit #
~~ J 5~'^ ' l Q ber(s)
Project l~Iame. ~ J wj " ~ d loduct approval num
to ~ t rovide the ~°nnation an p ~ you should contact
~j~ lease p en~nit number listed above. statewide
Project Address: ro ect for the p roducts. Information Tegarding
and Florida Adl~mstrative Ciod con t~Bion~p J e listed p
Florida Statute 553.$42 licable to the bull b $ for any of the appllcabl
A required by onents listed below as app royal num State # Local #
comp ow the product aPp -
forthe build'u~g lien if you do not kn tion ,Limitation of Use
roduct supp ~.floridabuildin 'orproduct Descrip
our p ed at: w`~'~
product approval may be obtain Manufacturer
Cate~o~'~Subcate~o~'
ox DooRs
A, EXTERI
1. Swinging _~~,,,_,.~-°
`r 2 Sliding
3, Sectional _
4. Roll up
5 ,Automatic
6, ether
B. W11~1,",._
~"' gle h~
2, Horizonte'
3. Casement
4, Double li
5. Fixed
b. Awning
9, 1Vlulliui1
,0. Wind breakf
1 D ac of n
fig
17.Other
CategoY'Yf Subcategory
E. ~ E~__._.....~
1. Accordion
?.Bahama
__
3. Storm panels
4. Colonial
5. Roll-up -.,.
6. Equipment
7.Other ~„~„~„~
T~Mpp~~NT
1, Wood connector/anchor
2. Truss plates
3 Btlgineered lumber ~~
4. Railing _
`°5, Coolers-freezers
6. Concrete admixtures
_ 7.1Vlaterial
g .Insulation forms
9. Plastic„
10. Deck-roof
11. W all
12. Sheds
13.Other
1. Skylight
Manufacturer
~M~~~~
product Description
State # Local #
of Use
12. Other
__
Category/Subcategory
-
Manufacturer
Product Description -- -
imitation of Use
State #
Local #
C. PANEL WALL
1. Siding
2. Soffits
3. EIFS -- - --- - -- - --
4. Storefronts
5. Curtaui walls
6. Wall louvers
-
7. Glass block _ --
8. Membrane
9. Greenhouse
10. Synthetic stucco
_._
-
1. Other
__
__
_
D. ROOFING PRODUCTS
1. Asphalt shingles
2. Underlayments
3. Roofing fasteners
-- - - -
4. Nonstructural metal roof
5. Built-up roofing
6. Modified bitumen
7. Single ply roofin
8. Roofing tiles
9. Roofing insulation
10. Waterproofing
11. Wood shingles/shakes
12. Roofing slate - - _ - - -
13. Liquid applied roofing
--
14. Cement-adhesive coats
15. Roof file adhesive
16. Spray applied polyurethane
roof
- -- __ __
- - -- -
2. Other - -
--
Manufacturer Product Description imitation of Use State # Local #
Category/Subcategory
H. NEW EXTERIOR
ENVELOPE PRODUCTS
1. _
2. - - --
the above list of manufacturers, product description and State approval number for the products used on this project, the
In addition to completing
Contractor shall maintain on the job site and available to the Inspector, a legible copy of each manufacturer's printed specifications and instal atron
instructions along with this Product Approval Sheet.
I certify that this product approval list is true and correct to the best of my knowledge. I further certify that use of different components other than the ones
listed in this document must be approved by the Building Official.
(Contractor Narne) (Print Name}
Company Name: ~ ~ ~ k ~ r ^
d r c~ "V
L~ c~ ~-~-
Mailing Address: 1 u ~ ~ ~~` ~''' ~ ~ ~,
~~ ~„ ~ ~~„ State: ~ Zip Code: 3 223 3
City:
Telephone Number: ('~o~O S ~' ~ $ ~ ~ Fax Number: ( )
Cell Phone Number:
E-mail Address:
L
~ r.
'''.,
-t''`'''~%~~~ City of Atlantic Beach
~S r '- r~~ Building Department
J ~ ~ 800 Seminole Road
;,., ~ Atlantic Beach, Florida 32233-5445
Phone (904) 247-5826 Fax (904) 247-5845
"'L~;; ~~ E-mail: building-dept@coab.us
City web-site: http://www.coab.us
APPLICATION. NUMBER
(To be assigned by the Building, Department.}
9-~ a
Date routed:
APPLICATION REVIEW AND TRACKING FORM
Property Address: ~D ~ ~ ~~~~ .~~
~NC.
Applicant: ~~~ ,~~~ ~,~~ m
Project: d~ od '-~
ent review re uired Ye No
Plannin Zonin
istrator
r
Public Utilitie
Pubic afety
Fire Services
Review fee $ Dept Signature _
Other Agency Review or Permit Required Review or Receipt
of Permit Verified B Date
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: dAp
proved. ^Denied.
(Circle Comments:
`'~
BUILDING
PLANNING & ZONING Reviewed by: Date: D
TREE ADMIN. Second Review: ^Approved as revised. ^ Hied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ^Approved as revised. ^Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
. ~:l~Ck~;~V~D
-i!:=L~rf City of Atlantic Beach
~~,.
JS~ ~ ~~~ Building Department ~~~ ~' 2 2009
Y ~, ;", ~ 800 Seminole Road
t~ , r Atlantic Beach, Florida 32233-5445 $Y;_~_-__~
Phone (904) 247-5826 Fax (904)
~ '~ -
~=~~;~~>r E-mail: building-dept@coab.us
City web-site: http://www.coab.us
APPLICATION NUMBER
(To be assigned by the Building Department.)
~9~ ~a~a
Date routed:
APPLICATION REVIEW AND TRACKING FORM
Property Address: or0 ~0 ! ~G~C ~f
~NC.
Applicant: ~[~~ pis ~-~ m
Project: a/E. av '~
Revtevv fee ~
ent review required Yes No
Plannin Zonin
istrator
or
Public Utilitie
Pubic afety
Fire Services
Dept Signature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified By Date
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: [Approved. ^Denied.
(Circle one.) Comments:
BUILDING ~ - ~~~~~ e~ ~!
PLANNING & ZONING
Reviewed by:
TREE ADMIN. Second Review: ^Approved as revised. ^Denied!
PUBLIC WORKS I Comments:
PUBLIC UTILITIES
PUBLIC SAFETY
FIRE SERVICES Third Review:
Comments:
Reviewed by:
^Approved as revised. ^Denied.
Reviewed by:
Date: ~/~
Date:
Date:
Revised 05/14/09
,, ,.5'-~''1 xis, CITY OF ATLANTIC BEACH
'-~ `~~~ 800 SEMINOLE ROAD, ATLANTIC BEACH, FL 32233
s~ OFFICE: (904)247-5826 ~ FAX NO.:(904)247-5845
t~' , BUILDING-DEPT~COAB.US
4 ~ ~ -_~~
J.;1:~'
_ ~, BUILDING PERMIT APPLICATION
DUVAL COUNTY
1,:)JOB ADDRESS: 2: VALUATION' OF WDRK 3: SO. FT; UNDER ROOF
AA_~ ,,
Z~~.CI ~ju.cl~. f'N,c~J ¢.1 ~~~ova , o~
4. LEGAL DESCRIPTION: 5: CLASS OF'WORK 6. USE OF STRUCTURE:
^ NEW BUILDING ^ DEMOLITION ^ RESIDENTIAL
SUB DIVISION
LOT
BLOCK ADDITION ^ CONVERTING USE
^ ^ COMMERCIAL
_
_
c 7; DESCRIPTION OF WORK: J
iI~ ALTERATION ^ ACCESSORY BLDG. 8. F1RE'SPRINKLER:
~//~- ` y//~ j~ ,, ~
~
~
~
~~ ^ REPAIR ^ POOL/SPA ^ YES ^ N/A
't ~+0 ^ l[t cS
w~
l
V \ ~ ^ MOVE ^ OTHER ^ NO
PROPERTY'OWNER: CONTRAG70R: "` ARCHITECT f ENGINEER:
9. NAME:
J S`~' ^
~
~
C 15. COMPANY NAME:
>~~i }Gr N S~D flm ~ 11 ~~ . r 23. COMPANY NAME: ~~ ~ ~~
~1C~11C~i1 ~J~
.¢lGI
,
. 16. NAME:
~ ~f-- 24. LICE EE NAME:
a~
~ ~,~
f
~~ .
,
10. ADDRESS: 17. STATE OF FLORIDA LICENSE NO.: 25. STATE OF FL RID~LICEN^ ^O.:
^Lp (~Cf ~jL,G t.~ t 1.J ~ G G O S ro '3 3 ~ •1+ (ivy
,~A ~ ~ ` 2, 1
~
`^'71 ~.r- 1B. ADDRESS: t O ~ 5 ~~~u ~~s 26. ADDRESS: ,~ ~, ~J~~. ~~~ M~
`
,2233 ~µhc (~t, ~!
i ~o ~~"~'~ ~' 3'~'1,oZ
, Saz
11. OFFICE PHONE: 12. FAX NO.: 19.OFFICE PHONE: 20. NO :
~~ - 2°l 0 1 27. OFFICE PHONE:
fr, - 1 ~ rJ'L 28. FAX NO.:
13. CELL PHONE: 21. CELL PHONE:
S-
~
~
S 29. CELL PHONE
1
e1
o -
y
14. EMAIL ADDRESS: 22. EMAIL ADDRESS: 30. EMAIL ADDRESS:
rl ~'
.FEE SIMPLE TITLE HQLDER: B LADING COMPANY: MORTGAGE LENDER:
pF OTHER THAN OWNER)
31. NAME: 33. NAME: 35. NAME:
32. ADDRESS: 34. ADDRESS: 36. ADDRESS:
Appligtion 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 wilt lie performed to meet the standards of all taws 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- t 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.
-**~k WARNING TO OWNER: ~-
YOURFAILURE 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.
O NER or AGENT CONTRACTOR
re
d)
(If e Powe Attorney or Agency Letter Requi {QualifieEbnly)
/
''
Signed Date: v ~ Date: / ~a T _
Signed•
Befor a this~~`^ day of v` , 2009 in the county of { _
Before a this I day of ~Jz'-~';` , 2009 in the county of
Duval, State of Florida, has personally appeared al, State of Florida, has personally appeared
Du
v
j
~
v tom-..
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. '[~ ~
County of ~ j ~~
of T `~-'~
St
t
bli
t L
t
P
N true and accurate.
ary Public at Large, State of ~ t" ,County of ~ `~V ~' i
ot
N
,
arge,
a
e
o
c a
ary
u ~
/
ll
K
fJ P
^ PP ~sonally Known
~~ ~ ~ y
nown
ersona
^ Produced Identifiption -
L9 Produced Identifi on -
\ '
~
~''~' ~" ~
~ '~
~ \
Notary Signature: Notary Signatu
:
-
~
Harr r ¢ r
r* :~'.
~ T • M ~P M~NSS N~'~BY
BLDG01 Permit Application Bldg: REV SED~ ` Bonded ~~ Nal ryupubttc ~ 2~ ~ 49
C9rWriterg
,L~y~,e IY41Wllk.k6.w m ~'fk+
; C01111111SSIdlI ~~ ~~~
~
:..
x
~;
•• ~a,'
~~ Expires Jung 25, ~~1 i
,
e of ~,°,~` q ,sR4.7P1~
Bonded hvu Troy raln (nOUlanp Ri!"d',
<<~,t!.;.L~1-r,~s City of Atlantic Beach
~- - ` - "s~ Building Department
_ _:.`~~ 800 Seminole Road
~~` s) Atlantic Beach, Florida 32233-5445
~.
~ .n Phone (904) 247-5826 Fax (904) 247-5845
"~r~;;~yr E-mail: building-dept@coab.us
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ~D ~0 ~' ~~~LC ,~j/~
/ ~NC.
Applicant:/~~~jQ1~5 6~7'w~•an
Project: ~ dlr. oU '7~
Review. fee $
ent review required Yes No
Plannin Zonin
T istrator
or
Public Utilitie
Pu lic afety
Fire Services
Dept,Signature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified B Date
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:
APPLICA
Reviewing Department First Review: L~proved
(Circle one.) Comments:
BUILDING
P ING & ZONI
TREE ADMIN.
PUBLIC WORKS
PUBLIC UTILITIES
PUBLIC SAFETY
FIRE SERVICES
^Denied.
Reviewed b •~% G`'~-
Y
Second Review: ^Approved as revised. ^Denied.
Comments:
Reviewed by:
Third Review: ^Approved as revised. ^Denied.
Comments:
Reviewed by:
APPLICATION NUMBER
(To be assigned by the Building Department.)
Date routed:
TATUS
q-oz-d
Date:
Date:
Revised 05/14/09
~''~~ 1' a,,,y , y r
-~ ~=
"'- ' ~~
y CITY OF ATLANTIC BEACH ____. .. ,_.
09- I I L I I
800 SEMINOLE ROAD, ATLANTIC BEACH, FL 32233
OFFICE: (904)247-5826 ~ FAX NO.:(904)247-5845
~,,. ~ BUILDING-DEPT(~iCOAB.US
~~~~~=~~~~<»= B UILDfNG PERMIT APPLICATION ouvaL couNT~r
" 1;-JOB ADDRESS:
_ 2: VALUATIONAF WDRK 3. SO. FT-UNDER ROOF
ZOGS
~,u.~,. ~N~.n~ ~ ~y,oea . o~
4: I:EGAL"DESCRIPTION:'. 5. CLASS OF,WORK 6. USE OF:STRUCTURE:
LOT-BLOCK SUB DIVISION ^ NEW BUILDING
^
pDDITION ^ DEMOLITION
^ CONVERTING USE ^ RESIDENTIAL
^ COMMERCIAL
7: DESCRIPTION OF WORK: J
iI~ALTERATION ^ ACCESSORY BLDG. B. FIRE'SPRINKLER:
~1N1~ J pO ~~ { LpO _
kI cS~ ^ REPAIR
^ MOVE ^ POOL /SPA
^ OTHER ^ YES ^ WA
^ NO
PROPERTY;OWNER: CONTR AG70R:" "ARCHITECT !'ENGINEER:'
9. NAME: /
~ S ~ /~
L
~
~ 15. COMPA1-NY NAME:
~~, i TGv n S ~-D f ~ ~ ~ ~~ , r 23. COMPANY NAME:
I~itlln <~ flJ~ ~~ ~ ^~~
,1/
~¢l [,,
. i
. tB.NAME:
i t n b,tt~-
l.P~ +~l.~J e~or"' 24.LICEy~t~F~ ,1 N
~~1lll .ly/~/•
10. ADDRESS:
ZO GC( ~G c~ ~ ~'•~ 17. STATE OF FLORIDA LICENSE NO.:
G G O S 4, '3 3 3 25. STATE OF FL RIDA LIC~.~E+NSE NO.:
.~ 1 ZGn
~~~` ;L,, `~ 18. ADDRESS: (d~s ~~J~` ~~s 26. ADDRESS: tJr1~, ,~<jj~ ~atM~ C
11. OFFICE PHONE: 12. FAX NO.: 19. OFFICE PHONE: 20.f~N0 : ^ ~ 1
ICJ, (/ o 27. OFFICE PHOe ~
f~~, ' ~ ~L 28. FAX NO.:
13. CELL PHONE: 21. CELL PHONE:
o _ S M S- ~t ~e'1 ~ 29. CELL PHONE:
14. EMAIL ADDRESS: 22. EMAIL ADDRESS:
~' 30. EMAIL ADDRESS:
FEE SIMPLE TITLE HOLDER:
(IF OTHER TITAN OWNER) g NDING COMPANY:
- MORTGAGE LENDER:
31. NAME: 33. NAME: 35. NAME:
32. ADDRESS: 34. ADDRESS: 36. ADORESS:
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 wilt be performed to meet the standards of al! 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, We{Is, Pools, Furnaces, t3oilers, 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 aft 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.
~k WARNING TO OWNER: ~
YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAVING 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.
/j O,-~yy'N~R or AGENT /' CONTRACTOR
nr arS r,( Rr,wau6R Annmeu nr Aoencv Letter Reauiredl 1. / (QualrCiec,Only)
Signed• ^^~~cc ~~y. Date: v ~ Y
Befo a 1his~''^ day of - v` , 2009 in the county of
Duval, State of Florida, has personalty appeared
herin by himself /herself and affirms that all statements and declarations are
true and accurate. '~
Notary Public at Large, State of '~ "-'~ ,County of ~ '~ c.1;
^ PP rsonaf{y Known _>r (~
L7 Produced Ident~ on - yJ -.,, , ~I
Notary Signature: ~ ~~'° _s J~.~~~~-~
BLDG01 Permit Application Bldg:
MYrr~M~NSaG, yA
s,a
}6 pd ;AI ~~NSora u9 s g~ ~ 3689
~YPub(tc Un~ga~2 ra
Signed' V Date:.
Before a this ~ day of ~..~-~4~_, 2009 in th/e co! unty~of
Duval, State of Florida, has personally appeared
~~ ~-~" ~ E-- ti In ~r.-1 VyCJ~jt'....~"'
herin by himself /herself and affirms that all statements and declarations are
true and accurate.
N.ot/ary Public at Large, State of ~ ~ ,County of ~~- `~ y ~" i
tJ Personally Known
^ Producetl Identficatiotn~-
Notary Signature' i1/ ~ ~-~1"~~~' ~~r~~~~~
Commission CAL? 6~Sf+
)rxpir~s Junk 25, ~~1 i
Bonded thru Troy Faln Ineuranca R?l~
-i±.:~1~y-r. .
~~ r' J~+
a .
< s)
J ~~
City of Atlantic Beach "`k"~`~°~•'~j u ~~'~~ APPLICATION NUMBER
Building Department ~ ~ ~ ~ ~ ZQ~~ (To be assigned by the Building Department.)
800 Seminole Road ~ ~}~ `~ ~~
Atlantic Beach, Florida 32233-5445 / `
Phone (904) 247-5826 Fax (904) 2 ----------.--__._
E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address:. 0~0 ~ / ~~tL~~i ~j/f
~i~C.
Applicant: ~ ~,~ ~,~-~ ~ ~(
Project: ~, a/E. av '-7~
ent review required Yes No
Plannin Zonin
istrator
or
Public Utilitie
Public afety
Fire Services
Review fee $ Dept Snignature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified By Date
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:
(Circle one.) Comments:
BUILDING
PLANNING & ZONING
TREE ADMI
PUBLIC O KS
PUBLIC T I
PUBLI AFETY
FIRE SERVICES
roved. ^Denied.
Reviewed by:
Second Review: ^Approved as revised. ^Denied.
Comments:
Reviewed by:
Third Review: ^Approved as revised. ^Denied.
Comments:
Date:
Reviewed by: Date:
Revised 05/14/09