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Permit 748 Amberjack Lane~ ~~ CITY OF ATLANTIC BEACH -=~ 840 SEMINOLE ROAD j ~ ATLANTIC BEACH, FL 32233 ~ INSPECTION PHQNE LINE 247-5826 INSPECTION EMAIL REQUEST: Buildin -debt~coab.us Application Number 07-00001701 Date 12/27/07 Property Address . 748 AMBERJACK LN Application type description RIGHT-OF-WAY PERMIT Property Zoning TO BE UPDATED Application valuation 0 ---------------------------------------------------------------------------- Application desc DRIVEWAY ADDITION Owner Contractor THOMPSON, JOHN OWNER 748 AMBERJACK LANE ATLANTIC BEACH FL 32233 Permit DRIVEWAY PERMIT Additional desc . Permit Fee , 35.00 Plan Check Fee . .00 Issue Date Valuation 0 Expiration Date 6/24/08 Special Notes and Comments CONCRETE MUST BE S" THICK 4000 PSI COMPRESSIVE STRENGTH Fee summary Charged Paid Credited Due Permit Fee Total 35.00 35.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 35.00 35.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. J" , . ° .w'' - ~ ~ ~ 8.J 9L.R~~~..LY ~tsr ~ ~r® ~' ~~r~ J~ l~'~L~el"Y J _, 'r o00 Seminole Road ~~"F '=~ ~ ~ Ailantic Beach, Florida 32233 ~'~~ Jii1,r (90~) 247-Jo00 ~go4~z~~-s~~s Fax ~.1~:~'~:+.'~~TFD .~a~.~ d~c ~ ~ zaar ~~~~~~.llnte J b~ Vi n ^T~,o ~EI~I~IT P.PF'LICAYI~1~9 7- ~ aj REQU DEPT: V PLANNING ~ BUILD6NG j N PUBLIC WDRKS ~ V PUBLIC UTILITIE5 G!9 FIRE DEPT. PUBLIC SAFE T Y t..i ~ APPROVAL ua REQUIRED AGENCY: RECEIVED BY: !NlTIAL: DATE: w ~ Y N D.E.P 1-iUFSTETLER _ ¢~ ~ Y G~ S.J.R.W.M. GARPER _ ~ Y N ARMY GORPS of ENG CARPER O Y N HOTELS ~ RESAURANTS FIUFSTETLE ~ R~ APPLICr~TI~I~ STa1TIJS CIRCLE CNE: SIT BUILDING DA AP REVIEWED BY: INITIAL: ATE: ® 1ST REV ® /ZC_. ~~, ~ ) P- c~.c~e ~ ,~,~- ~ ~„ T1~~~, yr~v r f<~ G I PLANP N BUILDING ® ® 2ND REV .~ , PUBLIG WORPC i' ~, ~ "> ~~ :.:~ - , PUBLIC UTILITIES FIRE DEPT, U LIC SAFETY P B ® ® 3RD REV ~ ~' °. >7 ~~~, ~ ~- ~ ~ j ~~tan~~ $~ f®n t® tl~® ~~alala~~ l~r~~~a°tt~~;~t ~~a~~ ~~~a fln~w~ ~;~~>rc~d g~~~a~ ~®~a~c~~$~ l~t® tlace A~~®~e rS~~~,~,y," CITY OF ATLANTIC BEACH l '~~ `' CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS liii~ _ :, yr 800 Seminole Road 904-247-5800 ~~'! nsi~%' Atlantic Beach, Florida 32233-5445 Fax 904-247-5845 ~ „~ PLEAS"'E~S~UBMIT (3) COMPLETE SETS OF PLANS WITH APPLICATION. Date ~JQ.~„t~„rv1~e.1~ ~~+ a~i7~~7 PERMIT# ~~ j,_ ~ ISSUED BY THE CITY Job Address 11 ~1'Yl pl'1 •• ~1 Permiee: ~'~~tni ~ ~llry'~OS"Byy Telephone # ~6~ ~~ ~ `4 Permittee Address: SAme, c~S` Q4~c~t~c~. Requesting Permission to Construct: ~ nJ ye kr~-~, ~c~c~ [~l O~ Location: (Reference to Cross-Street) 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 (~/y Date: Bell South Telephone Company Yes (• y No (,/) Date: Ferrell Gas Yes (/ No ( ) Date: 3 1 ~ .160 n Comcast Yes ~ No O~ ( ) ( ) 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 S~ k~ ~ ~o raps o w (Contractor's Project Superintendent) located at S A m ~ 4s cab o ~; Q Telephone #: ~ ~ G, ~ (~S~ 4. All materials and equipment shall be subject to inspection by the Director of Public Works or his designee. 5. Alf 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 cif 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 Signed: Date: Before me this day of in the County of Duval, State Of Florida, has personally appeared Notary Public at Large, State of Florida, County of Duval. My commission expires: Personally Known: Produced Identification: a Impervious surface caiculatiou °~~ formula; Find square footage of -House footprint Driveway Sidewalk ~ ~~ ~, , AIC pads 3 Detached garages or shed Pool decking Patios, etc. Add the total square footage of the above then divide the sum by the total lot area ; ~ f ~ ~ ~~ Y ~~~. to-bo~-~ ~.~n~.,;1 ~ S ~4-t~,,~ ~ c~ ~~r~ ~ ou s ~u ~ r~c~ i C~ , (Q Z i~1 ~ C~ ~~ ill `'~ C ti p~~c (~~ ~1`~'f°~ l~C~.~7t.~,(,~'~cJ~ ~1'~ , r p"~'~ ~- ~ ~~~ d ~'" -~~~Q Y~ ~~QcX Y~12er1 Public ~~orks Plan review Comments Date: ~ '~. -~ `1: O ~ IrLitlal5: ~~.~ Project Name/Address: ~ `~ ~ ~~v~- )~~ ~-- ~' Application/Permit #: 0~]--~~d/ t~/2~cx~,.~1~ .~ a r-: ~iChec'k:~o~ .~.pplicatzon T~ac;I:in~T Comments i 'To ~~dd - ~ ,g ~. ,i ~ , Provide impervious surface calculations. ^ Provide erosion and sediment control plans with installation details and maintenance ~ schedule. Provide drainage plans~showing site topography (flow arrows, etc.) ~ ^ Provide construction site management plan, includingRight-of--Way P erniit if using ^ right-of--way for construction parking. Provide apre-construction topographic survey prepared by a Florida Licensed - ^ Professional Land Surveyor, showing 1' COIlt0urs. . Section 24-b6(b) of the Land Development Regulations requires on-site storage for increased runoff. Provide Delta volume calculations and on-site retention required per ^ Section 24-66(b). (See attached info. Sheet) I~f on-site storage is required, a post construction topographic survey documenting proper ^ construction will be required. A Right-of--Way Permit must be obtained. - ^ A Revocable Encroachment Permit must be obtained for ^ Pool - Wellpoint (if used) must discharge into vegetated area 10' minimum. from street ^ or drainage feature (swale or structure) - All driveway aprons must be concrete, 5 inches thick, 4000 psi, with fibermesh from the edge of the pavement to the property line. Reinforcing rods or mesh are not allowed in the ROW (Commercial driveways - 6" thick). Any utility cuts in the road must be repaired using CO7 Standard Detail Case X and must be overlaid.l0 feet in each direction from~the center of the cut. Repair must be shown on ~] the plans.. . y-'~~4-x 'w~ ~1f[.. o ~ ~1/1.~/~~Ny w~tt~y La~-t' Gltt/ ~ ~ -. ^ ~oB ADDRESS ~ ~~ ~r ~~ TYPE WD.Rg PItDPERTY OWNER ~ ~.~~~ om ~~~~ TF'7'.RP~7DNE CONTR4CTOR y'F.7.F'~4'ONE PE1~~IT NiTMBER DATE IIYSPECTIDNS.• FDOTTNG_ SZAB TIE BEAM i.,INTF_7_ NAILING~.ATHING FRA~VGr~CDYER DP ~lSUI.AI70N FII~TAL BIfILDLYG CERT~'rCATE OF OCCUPANCY F7.FCIRIGlL P~~ r7 ~ ` k INSPECTIONS ROaGE S r~• ; r ~ / • ? S~ ~ G FIN.A.L MEC~3AIVICAL PERMTI# INSPECTIONS ROUGH FINAL P~UMl3INGPERMII# / S~'7 / ~ ~SPECTIONS ROZIGH/t11YDER BLAB TOPODT FINAL NOT~.~ X943 ~.~., DEPARTMENT OF BWLDING ~ ~ CITY OF ATLANTIC BEACH -- -.PERMIT zNFORMATZON -~-____ ____---- LQCATION INFORMATION ------___ pw~~~.~ IvVtii~n~,er.: ~9~3 Ac~dres~ ; ?4~+ AMBERJAi~K LANE ~~r»it Tyke: RE-R04F ATLANTIC BEACH, FLORIDA 3233 '~~~a~s .pf Flock: NEW __.________ LEDAL DESCRIPTION _______..__ ~~oi~~t~; . 'TyP~:: W~7r'+Z? FRAME I.,oi:: Hlook: Section: ~'r{:a~±oSed CTSa: STNOI,E FAMIi~~ 'j'j:}Tn'r1:~~'1~,>"?' R~ic~: Lwe~ ~. in~~ : l Code ; J Su}~div i~ ~ ~~n : Rt~~AL PALMS Estz~t~ate~i Val ~.te : D . nrl .~11~~=:~~an*. Faicl ~ S~~' . r~~ ~ ~ n I>. T '~ ~ __- - QWNER ZNFORMA.TION _..____ --- APPLICATION FEES -____ ~I~tFil~'.` LESTIWR JEl~KIN~, RF.PiLT~.R-. rPEFtMTT $22.r~ A~cl~c~ws : ? 4'3 Ak~iBER 7A~"K LANE WATER... IMPACT FEE ~C' . ~?~-' ._r. "` kTI.A~T1~' I3~~~H, FL~?TtILA ~2~' SEi~ER ,IM~'A~'T. FEE ~-G C~~. FhC~~i~: ~`~'~~?3``~'~r~~,~ WA`t''EI't 'M`E~:'ER ~~~t;) ___ _ ~. _ - CD]~TRAGTOR ' ~~IFORMAT i ~Jhi - ~. -- - - RAD«N t;~'iS - 5~ ~~ . ~ 0 ?dame : T. ~" HALL WATER TAP $0 . ~4 Addr~~~ : 534 WFiLBASI'i $~i7LEVAR~ SEWER TAP ~0 ~ ~~' JA.~K~~?NVILLE, FL~R?I~A ~~2~4 HYI3RAi3LI~' SHARE 4_~0 L,icen~e`. RL~~`''4815 TYF~w: ? CAPITAL IMPROVE. S~.C'0 _ , SEC , H IMPACT FEE ~n , ~''~ '.. 'v?THER ;~~ »Ut~' NOTES: NOTICE -ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WOflK MUST NOT BE PLACED IN PUBLIC SPACE, AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER "FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS." ilk: it~l-~~~~t~t ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SI~~CT TO REVOCIQII~ FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. rR.ttr ~`'s'''~'~ F^ 4Et~I#~I tdl~ER; ~'~1837 ATLANTiCjBEACH BUILDING DEPARTMENT { CITY OF t~1'PI.AN'i'IC: HI.ACIi PERMIT APPLTCATIUN ROC)FTNG r Owner(s) : 1- L°S 1 E~O~___~_~~-~_ ~'j ~ l~l~ J~'E' ~ .~~~_,-- - - Address:_~Lf ~ _ )'YI L~~~ /~ .~.4 e ~L ~;Phone:__._._..._..._------- __..~~._ __._ Lot # Block ar Unit # Subdivision Contractor: % ~ . ~--~~~ Address:~2 f~-~~~S~i ~'~~sPhone:_1~'.~:..~~'~.~f~ State License No.~~ ~'C~ ~~~~ Describe work to be done:_J~ y_1 y~ l4aterials to be used:~~~~V_`~^y?~ _,.._.__~__._~.- __...._ ,~ Signature OWNE;bt-~ _~-~~_ Date: Signature CONTRACTOR~~ , C= _ .~ ~~~ CITY OF r~a~ctic ~~~i - ~~vrida Uj, l S00 SEMINOLE ROAD ___.._____..._____._ ATLANTIC BEACH, FLORIDA 32233-5445 TELEPHONE (904) 245800 ~~ FAX (904) 24'~SS05 f~; . ?' . ;~ ! ?, tote>rl .. .- , '..' a.:.r _• r:° ~:r c! t. a. si c! z r~. rr t r.y d. it ~a is y ca a e::r~~ r=' t. 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Last Name First Name _.~~._ ADDRESS ; ~, ~ ~ CITY/STATEJ2IP: __._ _._______~ _.._~.___----.--._~._~._.__.____..__...__._.__. ___ s _. ° _..-..__.___.._.._.__..___~_~..__ TELEPHONE: (~~) _M,-- ___. _ i COMPLAINT; ~1~~,..~_... lc_.._.~.~.s_...~__~~!' ~ ~.~.:,5~-___._._.______.._~_.___. ~Q ~" S~~.~~~~' tom- r1 ~ ~`' ~17/,:? s' ~~o~~ro - r' LOCATION : /7' d'-' ff/~j~~-~' S PROPERTX OWNERS PHONE: (~ -• PROPERTY OWNERS NAME:` , DEPARTMENT FORWARDED TO: COMPLAINT TAKE23 BY: _~ DATE/TIME: `____----_.___-__v__ UFFICE USE ONLY ~~ ~._~-.~ .~ INVESTIGATED: (date/time) _ ASSIGNED DEPT./~DIVI,SION: PRIORITY: INVESTIGATOR: ~ ~ --~~ .~ -_ CONDITIONS FOUND: ACTION TAKEN: COMPLIANCE: •- NOTES: ~I~,~S~.f3b~2i ~d Y ~~.~&i N2Y11Z3~ 'II`t+~ Q3t~iI~2~t3~ @'I!t ~d/::,:~ xaa~t~~~ -~ua~aa.zo~ug apoa i p Z ~Ma~/nz~ ° ~y ~ x~ ' x ja.zaouig •aou~s~nu ;~zjgnd ~ a~n~t~.suoa you saap uot~tpuoa pa~.s-cj anoq~ auk. ~pu~ hcctMOus ~o asod:cnd aq~ .zap 'xpoq ~~~t~ a~zo~aq...-,6ut.zeau u ~o~ uo~sag ~z~u~~~y }o ~~z~ au~} ~a uozssa~uuzaa ~-~Y~ at{~ o} ~sanba~ ua~~itcl a:{eui ~C~ut non ' ~oa~zaq a~~p at~~ woad sbpp (5T) uaa~aT~ izTu'~?b~ •1C:}zado.td at{~ uo ~xa~rj ~ s~ pa~sod aq ~jtM 's~so:a butsz~.aanpe snjd ~unowr~ aozontxt au~~, `buzj~~q ~o ~dzeoaa za~~~ sR~p (p£) ~~.zzq~ utt.~~Trn pt~d ~.ou ~T •~u~dnooo zo zaurao X~~ado~d auk passassu aq ~ j gzcn ua-ct~M 'sasuadxa an ~~~.z~s-curu~p~ ~~z~ zanoa o-~. ~.zar~ act;} 30 ~sov aq~ ~o z~ppT o:} tanba afa~cu~{:~ e snjci ~gzoM auk ~o ~soo ~ ~u uaz~zpuao s~u~ Rpatuax ~~zea A~i~ ar~~. '~cra~at.~ a~~p aq~ tuoz~ sAep C.ST) uaa~3t~ u~cu~.~r~ pa~pau~az sz ~~agt~osap anage uot~tpuoa aq=~ ssalun ~~c~-} paT~°~~.ou a~ga.xar;~ axs riot • (ss~.zb pug spaa~x c~~iYu) T.~osa~~ az~uej~~ ~o apa~ auk ~o £-T--ZT uox~aag ~o uot~~jozn ~ a~n~~z-}suo:~ o~ s~ uoa~at~~ s~stxa aou~sTnu a~rjgnd ~ ~uu~ patztu(~a~ap putt puno~ an~ck I ~eq~ sasojostp h~zada~d szu~ ~o uo-~~sb-~~.sanu~ u~ 9-0000- TL.T~32t ~~#~:'~~ l f ~ ! E t~ ~iutl s~izi~-~ '~ oIg 5 ~~'I :~pz.xoj,~ 'ua~ag o~~u~j~~ 3o x~=~ aq~ ui ~~.zadoxd buIMO j job auk ~q xauMO ac{:~ axe noR ~~Lj~ a~.~a~cpu°c sp~ooax .xn~ £56T ' ZZ ~-rzd~ S~S-Lht (Y06) Xt'3 008S-it'~ (tt)6) 340Hd"3"13.I. :~r,-££ZZf lQ1F~0'I3 `H~N~fl :?LI.4d"6~t~ ~ </A~ ~1 r ~~ ~. :.zxg ~~aQ ££Z~£ `I3 'ua~ag ~z~u~~(~~' au~rI ~~:~1?C:~agwFl 8~1 Cd X131 ~-~ ~ ~ " ~ ' ?~ ~ -x W 4~': • . ~. UNITED STATES POSTAL SERVICE Official Business PENALTY FOR PRIVATE USE Tp AVOID PAYMENT ' OF POSTAGE, $300 f Print your n me, address and ZIP Code here ;~~r~ CITY OF LANTIC BEACH - $00 SEMINOLE ROAD ATLANTIC BEACH, ~L 32233-544 ~7.~'a.- b ~ ~ b tb Q DEPARTMENT OF BUILDING Ft7R OFFICE US_E ONLY CITY. t}F ATLANTIC BEACH, FI,Q3R.IDA Date ~' a'S~ 19~ ~~I Permit # .~ Fee 8 p~ V~tluatian ~ Application for Permit for ~~~`.~!.~,,,-•.. HOUSE # 71L' ' ~ j Miscellaneous Alterations, -----r- and Repairs. ,.~`' ;~''- ~~ DESCRIBE: ~ .~ da (State if o repair alter, a d t or move uilding, er dt a~ri.ngB, signs, ~, tc.) -Building an• Lot No. Bik No.~~~Sub.Div. Address ~ 7 S' Valuation 8 0'~ f,r Owner ` s Name BUILDINGS AND OCCUPANCY Building. Use -Residential or Business What Plumbing work to be done? Size of Present Bldg. Size of Extension Lot Sixe bio, of > stor ies now after altered Material. of roof Material of Present Building. Material. of Extension NECESSARY PLANS TO 8E SUBMITTED HEREWITH OIL ``BUR*?L`~ OR C~QL~,NE EQUIPMENT Name of ©il Burner or Gasoline Pump Type or Model Name and Addres of Manufacturer In connection herewith, application i~ ~.lso made to installs gal, capacity tank (s} made by of gagge metes ~,:3,~r;. ,,~„ ground: (Na*nP of Ms.nufactuxer} +Ci±^c~•a~ or Above) (Under. car Above of bud, ldinc,~ . ~~' or ns a or u s a ':acne o urc seer j . FURNISH DRAWING SHOWIP~G ENTIRE; LAYC3T,J'~' ON REVERSE SIDE 4F THIS.. BLANK SIGNS ~.___, Size Classification (State. whet eFi^ r. rc~u~c'~,`r aa~:, ~-a pro ec nq, anner~ Material of Cflnstruction I l uminated? Type o€ i 1.lt~i;-~ lion Late w e er amps or eon Will sign }~ over public, .property.? SUBMIT DRAWING SHOWING ^C?"_'~il?'Uri3;~ri Q~ rIGt3 AND ME OD OF HANGING' .WRITE ADDITIQNAL ID?~`O'~.MPT~CON BEL `--' (Far canvas awnings ,provide dimens~amec~ drawing on arse side) PLETEI3 F to IMs~URTANT NOTICES In eonsideratioA of .permit given for .doing,. the work as described in the above statement, we hereby: agree to` perform said work in accordance with the attached plans and specifications, which art: a part hereof, ' and in accordance with the building regulations of t1~e' City of Atlantic Beach. '.::(Southern St,.a,~rndard Building Code] Signature of Builder or thrner ~ ast.~-t~ ~~ ~O . , Addres& ~ Phone No. ~_ L ~ , ~Q~pP~.'1J 't~'sQOS,~aL `L'f `~ ~~~¢`~ ~~~~ ~~ P ~srreg' '~ i~~ (,ode re~~ ~ /,' .~a~ a Z~Q o~~`c ara a~e5s t nape ad `rt y°v ` G ~~~ C~~ oa s ~~~ ~~'~ ''' .~.~- ~ ~,~.~, t CITY OF r~aatic ~'ea cli - ~~v~ida 800 SEMINOLE ROAD -- --- --- ATLANTIC BEACH, FLORIDA 32133-5~5 TELEPHONE (904) 2475800 ~~ FAX (904) 2475805 October 20, 1995 Jeffrey & Anne Camarda 1520 River Road Orange Park, FL 32073-4917 Dear Mr. and Mrs. Camarda: Our records indicate that you are the owner of the following property in the City of Atlantic Beach, Florida: 748 Amberjack Lane a/k/a Lot 5, Block 2, Royal Palms ~1 RE#171129-0000 Investigation of this property discloses that I have found and determined that you are in violation of City of Atlantic Beach ordinance Chapter 12, Section 12-1-(7) i.e., open storage of refrigerators and other items. FL S.S. 823.07 requires the removal of doors from all white goods (refrigeragors, stoves, washing machines). You are hereby notified that unless the condition above described is remedied within five (5) days from the date of your receipt hereof, this. case will be turned over to the Code Enforcement Board. Under Florida Statute 162.09, the Code Enforcement Board may impose fines of up to $250.00 per day for a first violation and 5500.00 per day for ,a repeat violation. sincerely, ~~ K~/arl W. Grunewald Code Enforcement Officer "' KWG/pah cc: City Manager CERTIFIED MAIL RETURN RECEIPT REQUESTED ~ ~e ~ PSR3844 DEPARTMENT OF BUILDING CITY OF ATLANTIC BEACH ._.. _. _._ pERM?:'T ?I~Ff.~RMATI0~1 -__~ .- .__ _.- I,OO~,T?,ON ?NF~?R.MATION -._.__.___ _ P~rr~i.~ ~dum~et:: i~,71° A~~re~~s: "~dS A1~BER~7ACK DANE Petrrt~ ~ TyFe: FLI~MBIN~' ATisP,FdTT^ BEACH , FI,u~RIDA 3223 "` "lass ~~~ 4~ark:REPAiR _......-___.__ LEGAL LES~'T~gPTION - 1 ~c~n~tr. TvP~;4~Gt'~t~ FRAME E1ack: L~,~.; Twp` ~ p~:~~P~~e~fi t7s~.SiT~I~~LF FAiyiiZLY Lubd.~.~.ri~ion:RJYAL PALMS ~ta~llin~s: Est . Va.u~: „,+~t1 Frn~;rc~v_ ~~st: r,encJ ~, r~ ~~ ~'~~tal Fps : . u ~.mn~cnt Paid : 2 ~ . Bats Paid:12~2~1179'? f _.~~.-~:~-}: L'e~~;REPLAt_'F !~EG~IEFt E r _-._.--_-- _ ___~.- APpLi~"ATi'!?N F~~S -_._.___ _. ._ - ....._ . _ -_ OW ~I Eft i Y~i 1= ~~ R~" AT I ._, H ~- - - 2~.C~~, ~~ta~r~~ ~ MI'~fiAEL ANG>~LO PI?CiFERTIES P~RMI7' <~ct,3 ? +1 >3 A.M. f3 EP. 3 Ar'K AN E ATLA?dTI~^ EEAOkE. FLORIDA 37.23_'. _ ... ,. _ ~. ~`;~NTF.AGTCF. ~<IyFORMAT I ~5N - - _ ._ ... _. p;am~ _ ~ ~'~; ~ ~~I~'TRATING SERVi~wES ;~~.~~': c,g2~a ATZ.1~1"iTiC fiGULEZ~ARD !, -~A~"KS~3N~1~-i,E , FLC~RIOA LiF~: rF:~r;gA~32~ E~~: / ~ ;, NOTES: i I NOTICE -INSPECTIONS MUST BE REflUESTED AT LEAST 24 HOURS PRIOR TO INSPECTION F l BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE, AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER "FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAVI/ CAN RESUT tN THE .PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMEN S ISSUED ACCORDING TO APPROVED PLANTS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. i~'S.~ 14 CIIECY~S 311 1~1888~3'c18~ ATLANTI BEACH BUILDIN DEPARTMENT - By: i CITY OF ATLANTIC BBACK APPL I C1-T I ON P"OR PLUMB I NO pERlt I T JOB LOCATION: _ ~~O .~`i•'~~~~,~~~'C-/rE` ,; r~- ONNBR OP' PROPERTt : ~/i~ /,~ r'9~ ~ ~~i,~~GG `~`ri~2 T/~~ - - BVILDINa CONTRACTOR: P LUMH I 1iU CONTRACTOR Ado Z ~~1 i n~ ~i S~8'-~ 9 ~ r~.A~7`i C ~ L y_O AND ADDRE88• T6LQk'IiONE NUM86R s .~~ , ,r; 9~a ~ ,~,,, ~ _~~ STJ~TE L I CEN 8E NO : ~f~ ~~'-~ ~ TYFE O! gUILDINO: s%+sC~c~ rrrrn. nr ~~ h.Qi~itc~ ~fS. r • ^r ~.~.-.-~- TYPC Or NORK: S~'~r--- ~ff~~C~'~'~sy NON MANY OF THE FOLL0~1INGt lIXTURES INSTAY.LSD 8INx8 BNOWaRs L1~V11TORY BATH TU88 nRINALB ~CLOBSTs WATER HdAT8R8 DIBHi~ASHER8 DISPOSALS W]'-8N I NO MUCH INE FLOOR DRAINS SNOKER PArS - OTHER St ~ ~/~- rOT2-G EIYTURE COUNT: x $3.50 + 615.00 = $ rrr.. .. -r~-r-..~~-w..rrrrw-rrr.wwrr~.~.w..r..~w~-rr.r ... ..w-r~w~w-~.~..wrr..- IN$TALLIITION OF PLpMBINp AND FIXTURICB MVBT' Hlt ~ IN ACCORDANCE WITH THE MOST RECENT EDITION 0! TNL SOUTHERN BTANDARD~PLUMBINd CODE. CALL A DAY l~HB•~1D TO SCliBDULE INSPECTIORS r (904) 247-5826 SEfilCR CONNIiCTION8 NRBT Bs Cl~LL!!D INTC! BUBLIC NORKS !OR INI3PECTION BSP'ORB COYSRINa VI' - (904) 247-5834 r~ o ~ ~ ~~ ay =$ rJC~~ , . ~ Y m y `~°~Mp a~ C ~,~ ~$ ,7 J O b ~. Q (1~, ' C~ '~U h ~'. O Z 1 ~~ a~'' ~ IJ ~ ~ ~~ .Q ~ ~ .,. ~ D ~c r oa ~ ~ ~,b m ~ ~~ ~°~ b C ~G~ j O ~S f ~ JO kJ d ~ 2 "? ~ ~ ~o ~• ~ / !~ pl t JV r .,~ ,a o '~ , y`. c~O 2 o~ ~ ~. ~~ y J Y ~~ O n ~ '~ '~.. / n.. ``~` t W ~ e 4~ w _,__ ,v'qE_- i __ CITY OF ATLANTIC BEACH ~ DEPARTMENT OF BUILDING 800 Seminole Road -Atlantic Beach, FL 32233 - Te{: 247-5826 -Fax: 247-5877 ELECTRICAL PERMIT _ - ~ - - PERMIT INFORMATION i-_---_- ___ _____ _ LOCATION INFORMATION _ ___ - _- Permit~Number: _- 23328 - ~ Address: 748 AMBERJACK LANE Permit Type: ELECTRICAL ATLANTIC BEACH, FL 32233 Book: Class of Work: INCREASE Y Township: Range: Lot(s): Block: Section: Proposed Use: SINGLE FAMIL Subdivision: ROYAL PALMS Square Feet: Est. Value: Parcel Number: _ __ _ - - Improv. Cost: __ _ - _OWNEFZ IN_FORMATION_ ___ ___ _ . ~_ Date Issued: 1!16/2002 Name: THOMPSON, DUANE Total Fees: 40.00 Address: 748 AMBERJACK LANE Amount Paid: 40.00 ATLANTIC BEACH, FL 32233 P 'd• t 1/16/2002 Phone: {000)000-0000_ _ _ o _ Da ai . NVork Desc: 100AMPS - 200AMPS 1 P - - -- - CO_NTRACTORjS~ _ _. - BEACHES ELECTRICAL SERVIC - .tiY~ ~p ~~ ~~ ~ ~~ - ^4 x 4 ~ ~~'` ~` ~ ~l~ ~~ ' ~~f : K * •R`" ,~~ F 1?rr'` ~ ~ a~ t: L~ y k ~t3 ~~~3~ \ F'af~ ix [T~.nS-. 4 PLICATION FEES _. -.~, -- ~ ~w ~' ~_~ ~ ``~~. ~`> `~~ x. ~ ~ - c-- Y,-. ~~ ~ m Vin. ~ ~ ~-~ ~ _ - -- ---- 40.00 ~ FINAL ELECTRI ~ ~~~ ~~,, . ~ ~~ t ~~'~ ~~ ~ F f 9 ~ .~. J +~ ~ ~:~ ~ ~ .. -_'Y-..~ arA ~ ;p~S- ~3vC: 'Sys ~~. _ ~ _ ~ _ , _ ~tt ~ a. 1 #; ~ ~. "'; T4 '~ NOTICE -. IN GTIOi~ TEE #~EI~I~~ST'~D AT i-~~'_2~ }-lflt.}R~- !OR TC} SPECTION ---~ BUILDING MATERIAL, 131SH A~~7EBRI~ Ff~DitlF'F'f~tfS: W©RK ~' NOrt ~ CE©il~E' BLIC SPACE, AND MUST BE CLEARED UP'~ I~1kiAULE `~tVAY BY IT -~S~ttTRACTOR OR ER - ~; "FAILURE TO COMPLY ' M ~. ~ ON` N I' TIN THE PROPERTY OWNER PAYI VIC ISSUED ACCORDING TO APPROVED _ P IT AND SUBJECT TO REVOCATION F_OR VIOLATION'OF APPLICABLE PROVtS10 _ _ - -- i ~, Jr ~ ATLANTIC BEACH BUILDING DEPT. nEacs 1/ib/R2 01 Re~si~ta 1ti CITY OF ATLANTIC BEACH, FLORIDA APO. sr - APPLICATION FOR ELECTRICAL PERIIAIT ~~~ Z TO THE CHIEF ELECTRICAL INSPECTOR: -DATE: 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 HEREDF, AND IN'ACCORDANCE WITH THE ELECTRICAL REGULATIONS, CODES AND CITY OF ATLANTIC BEACH ORDINANCES. ~. \~ C . ~`) ~ C._ ~ ,rte C.. e. NAME~1~~'n t~ h~1"~~' ~~ ADDRESS: ~ ~ ~ / ih~ ~r ~C ~l L..~ -RFD BOX / BLDG. S..1..2E ` ~' ~ ~ ~ ~ ~ BETWEEN: i" ~ ('4 2 C%~ /~ ~ % c~..~ ~ `'~ (~"` RES. (j~-~ APT. ( ) COMM. 1 1 PUBLIC ( ) INDUS. 1 1 NEW ( 1 OLJ~(~ REW, AODITIIION ( 1 TRAILER ( ) TEMP. ( 1 SIGNS ( 1 SO. FT. `- SERVICE: NEW 1 1 INCREASE (~j~ REPAIR ( 1 ~/~ FEE Cl]NI'fllf_Tf]R RI7F `7 /a ~OMPS ~~ ~ CAPPER ( 1 OLL1M_ -C~A 51AlITCH OR BREAKEA ~~ AMPS PH ~ ~V1/OLT ~ 1 RACEWAY EXIST. SERV. S12E ~~ AMPS ii 1 PH ~ W z ~`i/OlT 2 t yRACEWAY FEEDERS NO. SIZE NO. SIZE NO. SIZE LIGHTING OUTLETS CONCEALED OPEN TOTAL RECEPTACLES CONCEALED OPEN TOTAL 0.30 AMP4. ] t- I00 AMP9. swITCHEs INCANDESCENT FLUORESCENT & M. V. FIXED O-f00 AMP 4. OVtR APPLIANCES BELL TRANSF. AIR CONDITIONING H.P. RATING COMP. MOTOR H.P. AATiNG ' OTHER MOTORS AMPS CELL HEAT: KW-HEAT MOTORS 0.1 H.P. VOLTAGE PHS NO, OVER 1 H.P. VOLTAGE PHS MISCELLANEOUS TRANSFORMERS: UNDER 600 V, OVER 600 V, NO. KVA NO. KVA NO, NEON TRANSF, NO. VA, MA. MOTOR SIZE SWITCH FLASHE EACH SIGN FORWARDED ~ S TOTAL FEES °,....-. CITY OF ~~a~tic ~eacl - ~~CVUdu 800 SEMINOLE ROAD ATLANTIC BEACH, FLORIDA 32233-5445 TELEPHONE (904) 247-5800 FAX (904) 247-5805 SUNCOM 852-5800 DATE !` ~_ ~.~ a. ~ .. JEA Construction & Maintenance 2325 Emerson Street Jacksonville, FL 32207 Attention: Connie Re: Final Electrical Inspections Dear Connie: Final inspections on the following locations have been completed and approved: PERMIT NO. .-~ l; ~. ~ _~ ~ ti:: .'~~ _j ADDRESS Please call me at 904-247-5826 if you have any questions. Sincerely, ATLANTIC BEACH BUILDING DEPARTMENT } "`'~ ~ f 1 R1K ~# i~ 6 . l'~ Y~ t' ,C ~~•. ~ ~ " ~ ~ CITY of ATLANnc BEACH DEPARTMENT OF BUILDING 800 Seminole Road - Atlantic Beach, FL 32233 -Tel: 2~ ELECTRICAL PERMIT ~~~~ ~~~ - Fax: 247-5877 ~~.> ~.~ PERIWIT INFORMATION LOCATION INF T10N Permit Number: 23013 Address: 748 AMBERJACK LANE Permit Type: ELECTRICAL ATLANTIC BEACH, FL 32233 Class of Work: REPAIR Township: Range: Book: Proposed Use: SINGLE FAMILY Lot(s): Block: Section: .Square Feet: Subdivision: ROYAL PALMS Est. Value: - Pan~1 Number: Improv. Cost: t}WNER INFORMATf N Date Issued: 11/13/2001 Name: THOMPSON, DUANE Total Fees: 25.00 Address: 748 AMBERJACK LANE Amount Paid: 25.00 ATLANTIC BEACH, FL 32233 Date Paid: 11/13/2001 • . 000 000-000p Work Desc: REPLACE LINE SID -~OAIDUGT T -CAN -100AMPS '1 PH3W 240V CO TRACTOR ._ . . ', - :' -" ~_~.. ~,,, CATION FEE BEACHES ELECTRICAL SER ,~~ i~,,r ~ ~ - ~ `G ~~- . _ ' 25.00 Y ,, , ~ ~ ~~ ~~ A } * "~. ~ :. ~ ~ .._, ~- x ~~ ~ _ ~ ~3 ~ ~~ `~ ~ '4 ,~.4&~s•+- ~ ~ 1~ may' ^,~ ..B': ~~2G"i~,J ~'.~ ~. ~ ~ v` ~ to s '1 X~ ~_ r b - m - _- -..:~4 - ~~~. ~ ill 9.~~~~ - - % _ . FINAL ELECTR ~, - ~ ~~x~.. =~t f ~ y~ _ ~~ 1~ .~; ~ ~ ~ . ~.~ #E ~~~ _ F ' S. d i .C...' i ~.' - .I.rya' ~ a ,,:1 '1` ~. " 19p-iyy~~ . . ~~: 1 _, .-, _ - NOTICE -INS, I~CTiONS.x 7 __ ~-~~i~1~~5'~D-~T_k.R~-~'f ~4 H+C3U#~ IOR ? SPEGTION BUILDING MATERIAL, ~: BIS~ AN . l BRiS FROM THi.:3 WORK MUST NOT PLAOED UBLIC SPACE, AND MUST BE CLEARED UP ~A~IwED , ~ ~- '~-'~~NED~3#~ItACTOR R" ~_ _. ~~- - _ ` "FAILURE TO COMPLY ~ ; . ~ LT IN THE ~ _ PROPERTY OWNER PAYIN . y : .. >a - t. ISSUED ACCORDING TO APPROVED PLA ERMIT AND SUBJECT TO REVOCATION - ..:... FOR VIOLATION OF APPLICABLE PROVISIONS O - - - ; _.~ ~Z~~ . ATLAN IC BEACH BUILDING DEPT. ~`'~. p" ~ s CITY OF ATLANTIC BEACH, FLORIDA Apps e. APPLIGTION FOit EL>:CTRIGAL PERINIT TO THE CHIEF ELECTRICAL INSPECTOR: -DATE: ~ 1 U~ 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 5PECIFICAT10N4, WHICH ARE A PART HEREOF, AND IN~ACCORDANCE WITH THE ELECTRICAL REGULATIONS, CODES AND CfT'( OF ATLANTIC BEACH ORDINANCES. ~ecZcS.~.e s ~-~~c~t' ~ cc,~ S e.c-~~G~ ~_~C , `~ ~~--f~' NAME i iV~~ t~ 1Y~~MPS~ ADDRESS: ~7 ~ ~lvrhL'("c/G7c~ LQ,. RFD BOX BLDG. S12E ~~ S BETWEEN: ~~ 1g- Z ~' ~ ~~/r~~ RES. ( 1 APT. ( ) COMM.( ) PUBLIC ( ) INDUS. ( 1 NEW ( ) OLD 1-~1~~ REW, ( ) ADDITION ( ) TRAILER ( ) TEMP. ( I SIGNS ( i SQ. FT. SERVICE: NEW ( ) CONDUCTOR Sl2E ~ Z -- // INCREASE ( ) REPAIR (y' AMPS I ~~ CnPPFR 1 ReP l~~ e ~ ~ he ~I~ 1 Al I1M_ (/Y. f ~'^tJ`v.. C~'he r S ~,~~ ~~Iv SWITCH OR BREAKER C)~ AMPS ~ PH W ~~~VOLT ~ ~ RACEWAY EXIST. SERV. SIZE <]~ AMPS PH 3 W 2 Y~OLT ~ G 2 t RACEWAY FEEDERS ND. SIZE NO. SIZE NO. SIZE LIGHTING OUTLETS CONCEALED OPEN TOTAL RECEPTACLES CONCEALED OPEN TOTAL 0.90 AMPS. ]1-100 AMPS. B W ITCIi E5 INCANDESCENT FLUORESCENT & M. V. FIXED o.10o AMP S, ovrn APPLIANCES BELL TRANSF. AIR CONDITIONING H.P, RATING COMP. MOTOR H,P. RATING ' OTHER MOTORS AMPS CE1L HEAT: KW-HEAT MOTORS a1 H.P. VOLTAGE PHS NO. ov~ll 1 H.P. VOLTAGE PHS MISCELLANEO US TRANSFORMERS; UNDER 600 V. OVER 600 V, NO. KVA NO, KVA NO, NEON TAANSF, NO. VA. MA. MOTOR SIZE SWITCH FLASHE EACH SIGN • FORWARDED i S TOTAL FEES ~~ _. ,. /1~ `¢ ~ ~ , - -- MIT tNFORMA DEPARTMENT OF BU1LDlNG 800 Seminole Road -Atlantic Beach, FL 32233 -Tel: 247-5828 - F ELECTRICAL PERMIT Permit Number: 23013 Permit Type: ELECTRICAL Class of Work: REPAIR Proposed Use:. Square Feet: Est. Value: Improv. Cost: Date Issued: 11/13!2001 Total Fees: 25.00 Amount Paid: 25.00 Date Paid: 11J13/2001 Work Desc: REPLACE LINE F 25.00 ION SPACE, AND "FAILURE TO COMPL1~11~tfTH~"H~~~tNSi~RUCTtON LI_lwi~`'~1E~1,~1 ~tET IN THE PROPERTY OWNER PAY3..~4~:E ~'OR IT`i~"~1~P ISSUED ACCORDING TO APPROVED~"#~i~"~IUMi; H~E~'Af~T ~' ~~ P,. -' IT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVIS~>`I~~3~~~LAW'~` ~'`'_ ~ ~,,,'~ - . ,. ~ ~ i.2, > /,~ i 247-5877 I ~RMATION __ - -~, _ - -- -.- __ _ Address: 76 AMBERJACK LAN AT TIC BEACH, FLORIDA 32233 Townshi Range: 0 Book: Lot(s): Block: Section:0 Subdivision: ROYAL PALMS Parcel Number: _ OWNER INFORMATION __ Name: JOHNSON, DARLENE Address: 0 AMBERJACK LANE At TIC BEACH, FLORIDA 32233 Phone: (9Q4) 3-3585 X25.00 14 ATLANTIC BEACH BUILDING DEPT. Date: 11114181 8i Receipt: 08110$0 _ ------ - --_- - ----- CA5H 08180003221080 i ^.e. -- - ~ ~ _ CITY OF ATLANTIC BEACH -- MECHANICAL PERMIT 800 SEMINOLE ROAD - ATLANTIC BEACH, FL 32233 -TEL: 247.5826 -FAX: 247-5877 ._ - PERINIIT INFORMATION i _ _. --- - --- - - - --~- _-- _ _._-. LOCATION_IIVFORMATI(~N ;Permit Number: 23307 ___ ___-__ - .- _-- Address: 748 AMBERJACK LANE - - ~~" Permit Type: MECHANICAL ATLANTIC BEACH, FL 32233 Class of Work: ALTERATION Township: Range: Book: Proposed Use: SINGLE FAMILY Lot(s): Block: Section: Square Feet: Subdivision: ROYAL PALMS Est. Value: Parcel Number: Improv. Cost: - - - - - _ _ Date Issued: 1!11/2002 ~ - -- -- - OWNER INFORMATION - `~ Name: THQMPSON, DUANE Total Fees: 37.00 Address: 748 AMBERJACK LANE Amount Paid: 37.00 a ~,~,,,, _ ~e.~ ATLANTIC BEACH, FL 32233 '_ Date Paid: 1/1112002 _ _..M~ ~ ~ ~ ~ ~Ia00)000-0000 C _ Wark Desc: REPLACE HVAC -~~` _ ~ ~ ~ ~ - -- ---------. " ~ - - _ CONTRACTOR ~ ~; ~,_ '-,~.-_,.~~ATIQN FEES - _ _~ __ -, OCEAN STATE HEAT & AIR, ,~ ;,~ ~ }~~ t ~ ~/~,. v "~'.~~~ ~ ~ ~ `` 37.00 ~, ~= ~ ~° I S Y ~ ~ ~-.~. ~ 'H r S wr .K ~_ ~g ~~ _~r F~ `K ~ , ~ mot' ~ ` ~ S't ,~. ~ _ ~ a r -~ ~~`' nSL~'[a"~ j c ~~. ,~ r ni* ~ Via- { i ,~lY X3n1 A 1 a yE ^ .: r ~ ~ ~ > ~-.:- ~ ' ~i~rya ~'-~£'~' i R r. _. .ti ~ ,, ~ ~` : _ FINAL _ ~ ~ ~ , _ ~ ~~ ~.~~~ ~--~. - ~ - _ _ - _ , t ,, ~ _ ~ ~ ~ ~ 1 i r n _ g . -. - _ - _ ? r ------ ` ' .~ NOTICE - II~SPECTlO ~tI>3S!~" Bf= RI~QUES~'ED AT LEAST 24 HOURS ~IC~R TD 14PECTION BUILDING MATERIAL, f2C.~B8iSH AND BRJS FROM 'i~iS V11fii~_MUST NO~~ P#.ACED"PUBLIC SPACE, AND __ _.___ MUST BE C.I.EARED UP A _ NAULED~ , ~(~YE1TFiER ~C~`~7~0.CT~ aWNI^R ~' "FAILURE TO COMPLY Wi~~rH~ (~'INg ~ " ~Er~1 SULT IN THE PROPERTY OWNER PAYING~tC'~..Ql~ B L N~ II~{p {, 5" ISSUED ACCORDING TO APPROVED PLANS _ tS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. - .- _ --- __ - -.,-- _ _---_ --_ I ATLANTIC BEACH BUILDING DEPT. f~7.88 14 Date: i/11/8 81 Receipt: 8r32:;~47 ~NECISS __- 1691 8818s1883z21888 ---- - «. _ BUILDING AND ZONING INSPECTION DIVISION CITY OF ATLANTIC BEACN ATLANTIC efACN, FLORIDA aaaaa APPLICATION FOR MECHANICAL PERMIT CALL•INNUMSER IMPORTANT - Applicont to complete all items in sections 1, II, III, and IV. . LOCATION Sfnef Addhuc ^' <~ `~ M • OF le}eneeflnq Sheele Between L A 2 A And 6cN z T,a, 21~. euILDIN~ Sub.dlv6(en II. IDENTIFICATION - To be completed by oil eppliconts . (n tonridentioe of permit given for doing the wwk a dncribed In the ebova defemenl we hereby egrea fo perform wid work (n eeeordenee with the etfeelyd plem end rpatiliufione which are a pare Mreo( end o- good.pncfke tided Ihenin. in ecewdance with the Cify of Jaekwnril4 ordineneer end denderde Nerve of Meeheekel CenMacferr Gekeefer ~Irlnfl - - q.." Mubr `A r (~ 31t} Nerve of _ w..._,._...,,...„._,. _ .. ~ Signefvn w '- Signafun e( a Ae1hw qen} Arehilae} or Engineer 111. CEN L tNFOR J A' Type of hating c . ~ }~ I S OTHER CONSTRUCTION BEINO OON[ ON ' t e TNIS 9UILOING OA SITET /l1 ( ~ Q 60-^ V ^ Ne}enl Q GnfnlUfilip Q Qu ~ IF YES, GIVE NUMBER OF CONSTRUCTION PERMIT ^ OMer - Spedfy IV. iM~G1A,TINSAl ~UIIMWT TO it INSTALLED NATURE OF WORK I-eOride ewnplNe ild e1 eemparenM en beet of this fenrr~ ~ Resldentlsl or ^ Commercial Hut ^ Spea Q Reeneed J~ Gnhel <7 floor ^ New 8ulldlnp Air Geddke61q: ^ Roem ~ Gnln) Existing BulldlnQ ~ ^ Orct SytNm; Meferiet TM1~a..a . /' a9+ Replacement of sxlellnp system Mnlmwn apdfy ~~ ^ New installation (No system previously Installed) ^ R~frlgeroHw ^ Extension or add-on to exletinp system Q Gellaq ~~ Gp•dfy q~ ^ Other - Speclly ^ Hro e'einUeru Number eF hest Q Ebrsler ^ Msn11N ^ Eeulefer (eruaMr~ TNIS SPACE POR OIFICE YSiE ONLT ^ . f3sallu pearpe (number! (bwNeei~ Q. Tam (nureber) Remerka ^ l!C anMlw (nrmber~ O Usibed prweuro r...l ^ Iellen -ermif Approved by 6ea. Q OMs, ~•Spedk hnnil I:- LIST ALL EQUIPMENT A11t CONDI'iZONINC AND AEirR1G13RA'[ION CQUIFNENT Number Valta ])eeerlptlep Yodel Ntmlbee Hanulaotuerr tr w~ T1 f tffiATING • AUANACFS, SOII.ER3, l?IRP.PLACES r Nusober VadL Dseorfpttan 3iode12tum1fer ][ansstaatunr (g'1'I7) F1 i TANR'S Aolr IEan~ XeQtoai Ce~yealtT 17rye Llqutd Xaaoe o! Serial Ap orb sod Dlmeoelau Contalnea ][a nDteettovr No. ~1