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Permits 61 Coral Street CITY OF ATLANTIC BEACH i1 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 10-00000792 Date 6/18/10 Property Address . . . . . . 61 CORAL ST Application type description MECHANICAL HVAC ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ------------------------------------------------------------------------ Application desc 1 CU 1 AHU -------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ ESPOSITO, JEFF BURLESON INC 1903 GREENLEAF LANE ATLANTIC BEACH FL 32233 LEESBURG FL 34748 (866) 344-4 156 ---------------------------------------------------------------------------- Permit . . . . . . MECHANICAL HVAC PERMIT Additional desc . . Permit Fee . . . . 87 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 12/15/10 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 87 . 00 87 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 87 . 00 87 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. 71A www.ahridirectory.org CERTIFIED,. certificate of Product Ratings AHRI Certified Reference Number: 3037318 Date: 6/18/2010 Product: Split System: Heat Pump with Remote Outdoor Unit-Air-Source Outdoor Unit Model Number: 25HCS318C30 Indoor Unit Model Number: FA4CN(F,C)024 Manufacturer: CARRIER AIR CONDITIONING Trade/Brand name: COASTAL 13 R22 HP Manufacturer responsible for the rating of this system combination is CARRIER AIR CONDITIONING Rated as follows in accordance with AHRI Standard 210/240-2006 for Unitary Air-Conditioning and Air-Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, independent,third party testing: Cooling Capacity(Btuh): 17000 EER Rating (Cooling): 10.80 SEER Rating (Cooling): 13.00 Heating Capacity(Btuh) @ 47 F: 17300 Region IV HSPF Rating (Heating): 7.70 Heating Capacity(Btuh) @ 17 F: 10600 A*following a rating indicates a voluntary rerate of previously published data,unless accompanied with a WAS which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s)listed on this Certificate and makes no representations,warranties or guarantees as to,and assumes no responsibility for, the product(s)listed on this Certificate.AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s),or the unauthorized alteration of data listed on this Certificate.Certified ratings are valid only for models and configurations listed in the directory at www.ahridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI.This Certificate shall only be used for individual,personal and confidential reference purposes.The contents of this Certificate may not,in whole or in part,be reproduced;copied;disseminated;entered into a computer database;or otherwise utilized,in any form or manner or by any means,except for the user's individual,personal and confidential reference. CERTIFICATE VERIFICATION A VloI Air-Conditioning, The information for the model cited on this certificate can be verified at www.ahridirecto or click on A. ■n-' Heating,and ry g, Refrigeration Institute "Verify Certificate"link and enter the AHRI Certified Reference Number and the date on which the certificate was issued,which is listed above,and the Certificate No.,which is listed below. 2009 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 129213508659545544 MECHANICAL PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph(904)247-5826 Fax(904)247-5845 JOB ADDRESS: �al PERwr# PROJECT TIAL UE $ NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION Air Conditioning: Unit Quantity Tons Per Unit Heat: Unit Quantity BTU's Per Unit Seer Rating /2 Duct Systems: Total CFM REQUIRED REPLACEMENT AIR CONDI'T'IONING & HEATING SYSTEM INSTALLATION ARI# 36 � 7 �i � Air Conditioning: Unit Quantity I Tons Per Unit 7,S- REQUIRED Heat: Unit Quantity i BTU's Per Unit S x w Seer Rating Duct Systems: Total CFM REQUIRED FIRE PREVENTION Fire Sprinkler System Quantity. (Requires 3 sets of plans) Fire Standpipe Quantity (Requires 3 sets of plans) Underground Fire Main Value (Requires 3 sets of plans) Fire Hose Cabinets Quantity (Requires 3 sets of plans) Commercial Hoods Quantity (Requires 3 sets of plans) Fire Suppression Systems Quantity (Requires 3 sets of plans) FIRE PLACES MISCELLANEOUS: Prefabricated Fireplace Qty Automobile Lifts Gas Piping Outlets Boilers BTU's Elevators/Escalators ALL OTHER GAS PIPING Heat Exchanger Quantity of Outlets Pumps #Vented Wall Furnaces Refrigerator Condenser BTU's #Water Heaters Solar Collection Systems Tanks (gallons) Wells OTHER: Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months.I hereby certify that I have read this application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether specified or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction. Property Owners Name ES P o S i 4c4, Phone Number E4/ Mechanical Company rIP c•n 1�rc_-r : _ Office Phone g�G-3zn-�N�bFax Co. Address: _1 03 �r��tle<<r 11w City -e, 6vp� StateZip3L1MF License Molder(Print): 6110rtw lGur Ic 3r State Certification/Registration# C/4c) SrI q&,�2 2 Notarized arized Signatu e of License 1-folder � Svae cribA before me this day of 20 Si of N lie' �(a0 0-9 CITY OF ATLANTIC BEACH s f 800 SEMINOLE ROAD j ATLANTIC BEACH, FLORIDA 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 04-00028842 Date 8/12/04 Property Address . . . . . . 61 CORAL ST Tenant nbr, name . . . . . . REPLACE 6 WINDOWS Application description . . . RESIDENTIAL ADD/RENOVATE/ALTER Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 4000 Owner Contractor - ------------------------ ----------------------- ESPOSITO, JEFF OWNER 61 CORAL STREET ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233 (904) --------------------------------------------------- ------------------------- Permit BUILDING PERMIT Additional desc . . Permit Fee . . . . 50 . 00 Plan Check Fee 25 . 00 Issue Date . . . . Valuation . . . . 4000 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 50 . 00 50 . 00 . 00 . 00 Plan Check Total 25 . 00 25 . 00 . 00 . 00 Grand Total 75 . 00 75 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDING OFFICIAL Cc: , NJ f CITY OF ATLANTIC BEACH D. Ford BUILDING / ZONING DEPARTMENTf - K" 800 Seminole Road S. Doerr j r Atlantic Beach,Florida 32233 (904)247-5800 (904)247-5845 Fax PLAN REVIEW COMMENTS Permit Application # - � `"� 2-- Property Address: Applicant: Project: � �! This p mit application has been: Approved Reviewed and the following items need attention: Please re-submit your application when these items have been completed. Reviewed By: ( ' Date: `6 j/ / 0 I OC( s CITY OF ATLANTIC BEACH WINDOWS",§Ky]�IG4 S, GARAGE DOORS,HURRICANE SHUTTERS Date: D or" 02— U T J Job Address: JEW Owner. Address: ary– Phone: Legal Description: Block Number: Lot Number: Zoning District: Contractor: (/ ' /J/ State License Number: Address: Phone: City: State: Zip: Fax: Describe proposed use and work to be done: -2!„iy J"74,ze 4, 141 Present use of land or building(s): Valuation of proposed construction: `7" 06 Is approval of Homeowner's Association or other private entity required?/Vo If yes,please submit with this application. Required Building Data: 1�/a V17-Com 0 Mean Roof Height (ft) Building Width Q (ft) Building Length 0(ft) Roof Slope ;2 Window Heightae dv(ft) Window Width&C ,d&IM (ft) Window Elevation from Grade (ft)/p 6 CA Measurement from corner of building to window (ft) 2 N Z V 7— %/Il 11��0197 Number of windows being installed_ C— U� fel/i!/�D ou+J-f' 7-14/ Mean Roof Height rj l 800 Seminole Road •Atlantic Beach,Florida 32233-5445 Phone: (904)247-5800 Fax: (904)247-5845 • http://www.ci.atlantic-beach.fl.us Page 1 Revised 1/27/03 CITY OF ATLANTIC BEACH s, BUILDING PERMIT APPLICATION (Alterations & Additions) Date: Job Address: Owner of Property: 0 -z 7 0 Address: � / ��,�, 1'T Telephone: Legal Description: Block Number: Lot Number: Zoning District: Contractor: Oe41 11 E4 ,gic 126 e.o State License Number: Contractor Address: Telephone: Fax: Describe proposed use and work to be done: ,� �Oe V C-6 CZ)10 141Zr/tDnZ,,Z.P s.&/ •t;;e n.r/ Present use of land or building(s)- Valuation of proposed construction: 00 Q .__-- 00 What are the dimensions of the added space: feet x feet Will the added area be heated and cooled? New electrical or increase in service? Add plumbing fixtures? Add fireplace? Add heating/air conditioning? Is approval of Homeowner's Association or other private entity required? _moo If yes, please submit with this application. Will this project involve changes in elevation,site grade or any use of fill material or the removal of any trees? M-NO. Applicant certifies that no change in site grade or fill material will be used on this project. ❑ YES. See Step 2 below. Approval of the Public Works Department is required prior to issuance of a Building Permit. �0. Applicant certifies that no trees will be removed for this project. ❑ YES. Removal of Trees will be required for this project. TREE REMOVAL PERMIT IS REQUIRED. Tree Removal Permits to be reviewed by the Tree Conservation Board,which meets two times each month. Procedure: In order to expedite issuance of permits, please follow all steps and provide all information as appropriate. Incomplete applications may result in delay in issuance of permit. STEP 1. Verify zoning designation and proper setbacks for the proposed construction. If you are unsure of this information, please contact the Planning and Zoning Department at 904-247-5826. In order to correctly verify zoning designation, please have Property Appraiser's Real Estate Number available. STEP 2. Contact the City of Atlantic Beach Department of Public Works to determine if a pre-construction or post-construction topographical survey or grading plan is required. (If not required, written verification must be provided with this application.) The Department of Public Works is located at: 1200 Sandpiper Lane,Atlantic Beach,FL 32233 Telephone:(904)247-5834 STEP 3. Submit Tree Removal Application if trees are to be removed or relocated. STEP 4. Please submit Building Permit Application, Energy Code Forms, Notice of Commencement, Owner/Contractor Affidavit if owner is contractor,and four(4)complete sets of construction plans to the Building Department,which is located at the Atlantic Beach City Hall,800 Seminole Road,Atlantic Beach,FL 32233 Telephone:(904)247-5826 800 Seminole Road •Atlantic Beach,Florida 32233-5445 Telephone: (904)247-5800 •Fax: (904)247-5845 •http://www.ei.atiantic-beach.fl.us Page 2 Revised 1/04 In addition to construction and engineering detail,plans must contain the following information as appropriate for the type of work being performed. Scale of drawings should be sufficient to depict all required information in a clear and legible manner. 1. Current survey showing the property boundary with bearings and distances and the legal description. 2. Location of all structures,temporary and permanent,including setbacks,building height,number of stories and square footage. Identify any existing structures and uses. 3. If required by the Department of Public Works,a pre-construction topographical survey. 4. Any significant environmental features,including any jurisdictional wetlands,CCCL,natural water bodies. 5. Impervious Surface area calculations: include driveways, sidewalks, patios and other Impervious Surfaces. Swimming pools may be excluded from total Impervious Surface. 6. Other information as may be appropriate for individual applications. I hereby certify that all inform A with is applicat n is correct. Signature of owner: Date: 8/4 I hereby certify that I have read and examined this /fication 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 data have been or shall be provided as required. Signature of Contractor: Date: 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: � Sworn to and subscribed before me this day of 6'11,f � ,20t(f State of Florida,County of Duval Y p;,,-----�•T..... Notary's Signature: � AINSLEYJ.CONNER .; MY COMMISSION#DD 158344 Personally known T = EXPIRES:November 11,2006 Bonded rhru Notary Public Underwriters Produced identification Type of identification produced AS TO CONTRACTOR: Sworn to and subscribed before me this day of ,20 State of Florida,County of Duval Notary's Signature: ❑ Personally known ❑ Produced identification Type of identification produced 800 Seminole Road •Atlantic Beach,Florida 32233-5445 Telephone: (904)247-5800 •Fax: (904)247-5845 •http://www.ei.atiantic-beach.fl.us Page 3 Revised 1/04 r f CITY OF ATLANTIC BEACH OWNER/BUILDER AFFIDAVIT Date:o&- 06 d Job Address: Z90,-f 9 L CHAPTER 489,FLORIDA STATUTES,PART I "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 THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU 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. ORDINANCES ALSO ALLOW AN OWNER TO IMPROVE THEIR OWN PROPERTY WHEN IT IS FOR PERSONAL OR FAMILY USE, AND LIKEWISE REQUIRE ALL WORK (EXCEPT MAINTENANCE UNDER$2,000)BE UNDER A BUILDING PERMIT AND PASS ALL NORMAL INSPECTIONS. THE ORDINANCE STATES OWNERS MAY PHYSICALLY DO WORK THEMSELVES; OR MAY HIRE UNLICENSED WORKERS PROVIDED SUCH WORKERS BE UNDER"DIRECT SUPERVISION OF THE OWNER,WHO MUST BE ON THE JOB AT ALL TIMES WHILE WORK IS IN PROGRESS BY UNLICENSED TRADES PEOPLE." THIS DOES NOT ALLOW USE OF UNLICENSED CONTRACTORS. SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS-WORKER'S COMPENSATION INSURANCE BE PURCHASED UNDER THE HOMEOWNERS INSURANCE POLICY TO CLEARLY PROTECT THE OWNER 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. 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. 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. AINSLEY J.CONNER *: r MY COMMISSION#DD 158344 EXPIRES:November 11,2006 PRO ER RBER •....� p,;rt.. Bonded Thru Notary public Underwriters SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY OF - 0d. NOTARY PUBLIC• MY COMMISSION EXPIRES: NOTE: PHRASES UNDERLINED ABOVE. 5 MIN. RETURN Book. 11977 mage 1519 PHONE# 669"70 DDookclE: O1 9 6982 Bo NOTICE OF COMMENCEMENT Page: 151'9 Filed & Recorded 48/09/2004 10:27:41 AN State of�_�� Tax Folio No. Tom,-FULLER County of_Zzdc CLERK CIRCUIT COURT DUVAL COMITY To Whom It May Concern: RECORING S 5.00 TRUST DFUND $ 1.00 REC ADDITION(, $ 4.00 The undersigned hereby informs you that improvements will be made to certain real property, an in accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT. Legal description of property being improved: Address of property being improved:/ 00 e!�.4 L General description of improvements:J i A C l G 1,-,"4t7d',Zr ()A/ Owner: ;3's,r'G cm.T 7o, Imo' Address: fol C.0RAL <- Fl,- STT 3 Owner's interest in site of the improvement: v/►y.c J)i F 7 Fee Simple Titleholder(' other than owner): Name: Address: Contractor: CZVAI — Address: Phone No: Fax No: Surety(if any): Address: Amount of Bond$ Phone No: Fax No: Name and address of any person making a loan for the constructs of the improvements. Name: Address: Phone No: Fax No: Name of person within the State of Florida,other than himself,designated by ner upon whom notices or other documents maybe served: Name: Address: Phone No: Fax No: In addition to himself,owner designates the following person to receive a copy of the Lienor's %ioe provided in -- Section 713.06(2)(b),Florida Statues. (Fill in at Owner's option). — Nam e: Address: Phone No: Fax No: Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is specified): THIS SPACE FOR RECORDER'S USE ONLYNER e Signed: nAA Date: Before me thi day of in the C unty of Duv tate of Florid s rsona11 appeared Notary Public at ge, tate of Florida,County of Duval. My commission expires: AINSLEY J.CONNER ' Personally Known: or MY COMMISSION#DD 158344 produced Identification: i EXPIRES:November 11,2006 Bonded Thru Notary Public Underwriters CITY OF JACKSONVILLE BEACH 2003 - 2004 OCCUPATIONAL LICENSE CITY CLERK'S OFFICE 11 NORTH THIRD STREET JACKSONVILLE BEACH, FL 32250 PH (904) 247-6250 FAX (904) 247-6256 License furnished pursuant to Jacksonville Beach Code of Ordinances, No. 95-7628, Chapter 15. Display conspicuously at place of business INESS NAME: FELCI CONSTRUCTION INC :.NSE-NUMBER 04-1-1853 - -. . FEE PENALTY - TRANSFER is 79 .20 $ 19 . 8 $ . 00 .SSIFICATION: 1761 ROOFING, SIDING & SHEET METAL WORK 7-ME RESTRICTIONS: TYPE I HMOC 03-00100645 SIDING INSTALL/OFFICE ONL 'D FROM OCTOBER 1, 2 0 0 3 TO SEPTEMBER 30, 2004 (ANAGER CITY CLERK LICENSE PEIALIST The City of Jacksonville Beach is Committed to the Citizen. First Class Service for First Coast Customers .NG ADDRESS BUSINESS ADDRESS 908 PATRICIA LN JACKSONVILLE BEACH FL 32250 CI CONSTRUCTION INC PATRICIA LN KSONVILLE BEACH FL 32250 !it-I��UHIVt,;C 04-22-2004 3ALLAGHER STATE OF FLORIDA 'NANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENS TIQN. **RE-ISSUANCE OF CONSTRUCTION INDUSTRY CE IFIC�TE OF EXEMPTION certificate exempts the Officer of the Corporation Fo" th �, ember of the Limited Liability Company below from the provision of Florida Workers' Cbm enation Law for the period indicated below . 'TIVE DATE: 04/15/2004 IRATION DATE: 06/30/2005 ORATE OFFICER/ AEMBER NAME: FELCIRICHARD 1418666 4ESS NAME ANDLC CONSTRUCTION INC 3ESS: 8� PATRICIA LANE ACKSONVILLE BEACH FL 32250 'E OF BUSINESS OR TRADE: SIDING RTANT: Pursuant to Chapter 440 . 0 5(14), F . S . , an officer of a corporation who elects .ption from this chapter by filing a certificate of election under this section may not recover Its or compensation under this chapter . QUESTIONS? (8501 488-1333 _-ISSUANCE OF CONSTRUCTION INDUSTRY CERTIFICATE OF EXEMPTION REVISED 11-03 cut out the card below and retain for inspection by any- partment of Financial Services representative while conducting work. 5 ')F FLORIDA IMPORTANT HENT OF FINANCIAL SERVICES I OF WORKERS' COMPENSATION F This certificate applies only to the corporate officer named on this certificate and ,ANCE OF CONSTRUCTION INDUSTRY CERTIFICATE OF EXEMPTION 'q� �,' Q applies only within the scope Of the business or trade listed hereon. tificate exempts the Officer of the Corporvi.n listed b low from L A copy of this card or the du licate above must be carried and available for ,ision of Florida Workers' Compensatior, aw for the period D i below. x inspection at all time while con ucting any construction work. NA 1VE DATE: 0411511004 ,� H Pursuant to chapter 440.051141, F.S., an officer of a corporation who elects TION DATE: O6l30F2t5 exemption from this chapter by filing a certificate of election under this section d � E may not recover benefits or compensation under this chapter. RATE OFFICER/ a ' R .MBER NA , FVC"CI RICHARD E Notices of election to be exempt and certificates of election to be exempt shall be r , 14-}866634 subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets SS NAM= A FELCI CONSTRUCTION INC the requirements of this section for issuance of a certificate. The department shall sS: 908 PATRICIA LANE revoke a certificate at any time for failure of the person named on the certificate JACKSONVILLE BEACH FL 31150 to meet the requirements of this section. OF BUSINESS OR TRADE:SIDING QUESTIONS? (850) 488-2333 CUT HERE -ISSUANCE OF CONSTRUCTION INDUSTRY CERTIFICATE OF EXEMPTION REVISED 11-03 ACORDIM CERTIFICATE OF LIABILITY INSURANCE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF IP INSURANCE CONCEPTS OF FLORIDA, INC. CONFERS NO RIGHT UPON THE SERTIFICATE110 14181 BEACH BOULEVARD, R5 DOES NOT AMEND,EXTEND OR ALTER THE COVI JACKSONVILLE, FL 32250 POLICIES BELOW. (904)223-4470 INSURERS AFFORDING COVI INSIIRfa) Richard Felci INSURER A: American Vehicle Insurance 908 Patricia Lane INSURER B: INSURER C: Jacksonville Beach, FL 32250 INSURER D: INSURER E: COVERAGE THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INC NOTHWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO k MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN INSR POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYY) DATE(MMIDD/YY) :ENF.R:YI,t.,1:1B1LITY [,A('I]OCCUItAN(T COMMIAWIAL(:I.NI;kAI.LIA13I1.1'I'Y IIRIS DAMAGII(AnV unr "I.AINIS AI;NDIQ O('('llit MFI)FXI'(Anq—,p.r.oi A 04302004FR_147980 04/30/2004 04/30/2005 11I:11SONAL AND ADV II I H�NIfItAI.AG(:ItGGA'll IIfN'IA(iGRll(;A I Ii I.IMl1'APITIIK 1114; PRODUCIN-UOMPrU1'. .S 1'(wIcY OI'ItoII.cI ❑I(R' \UTOMOBILE LIABILITY 'OMBINH)SIN(iLl(I IN ANY All'10 (ca n6d.nl) All OWNI;I)AI1'IOS BODILYINJURY SCI IP.Dt'I.Ii1)AI'TOS I'or.r'—) 111RFI)AU 10S BODILY INJURY NUN-UN'NFD AUTOS I'cr acciJcnl) I'ROI'I•:R'I'Y DAMA(d I'cr nccidcnO GARAGE LIABILITY AUjiO ONLY"FA ACCIt ANY AUTO )1'11FI "I'l1AN U'I'O ONLY: EXCESS LL"11LITY FACI I OC('UItAN(T D'I.AIMSMADI'. GGRUiGAIT 3ItIC11 DI(U UCI IIIIJ IN'IION ORKERS(XIMPENSATION AND CSTATU'l ORY' EMI'1.nY'F.RS LIABILITY LIMII'ti❑O'1'IILR E.L.LACII ACCIDENT 1..I..DISFASIS"I'.A LIMN) "1'11 F:R DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EX('LIJSIONS ADDED BY F.NDROUSMENT/SPECIAL PROVISIONS Installs Vinyl Siding Residential CF,RTIPI<'A'1'I?IIOLDF:R YDDI'rION.YL INSl1RED:INSURED LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELL ATE THEREOF,THE ISSUING INSURER WILL.ENDEAVOR TO MA O THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILI OBLIGATION ON LIABILITY OF ANY KIND UPON THE INSURER.11 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE , 0 to: ACCORD 26-S(7/97) A( 40-17 PW m Simonton Windows a P -C)Fi nish Contr c:tor- Pi-cture — Vinyl A JL j-- DS National Fenestration TSI �� ; {� Rating Council -' s 1-800—Simonton NFR(7 2001 ENERGY PERFORMANCE RATINGS U-Factor(U.&A-P) Solar Heat Gain Coefficient 0 . >1 0 . 62 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0 . 65 Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole product performance.NERC ratings are determined for a fixed set of environmental conditions and a specific product size.Consult manufacturer's literature for other product performance information. www.nfrc.org Jp i_I �� iNDt REIN OO/GLASS DS/F-R55 Dr . Testi Size; 60 x 48 "FROM :AMER,CAH WHOLESALE FA : H0. :904 519 1:x01 Rug. 09 20EW 03:2SPM F3 1 AUG9 2004 %ilk BY: nn ,AA,M,.AvNV4NA'DA 101/1.S.2-97 TEST REPORT SVMM-XRY �t.endereil in: SDIONTON WINDOWS SE R.IES11WODE1L: 40-06 'A'YPE: fl)tC.`Single Tung Window (with E9 R.dinforcement) e a Test Results �'xt� �7C 9 _ R ati; _ H-R 3 5 52 x 71 FILE Overall Desi Pressure 35 PSf �► Operatine;Force 25 lb max. Air Infiltration C.12 cfrn// Wattr Res;,,,>Umc-c �— W.25 Rsf StructLzal Test Pressure 52.5 2sf De lazvrig Passed Fo7-ced En Resistance Passed Me.renoLt should ix; made to Report No. 05-30170.01 for complete test s1?ecimea description, Tld data. For ARCHITECTT.11A ,TESTING,.INC. APPROVED CITY Or ATLAINTIC BEACH r� BUILDING OFFICE �Lr 10 20�� Lynn George, Project 1VSaaagex FROM AMER I CAN WHOLESALE FA": NO. :904 519 13CII Au�. �� 2004 07:ASPM P4 Architectural Testing TEST REPOk'T Rendexed ti,: SIIv(OTITCIN WSiDC)WS 011e Cochrme Avenue Per sboro, Wex Virginia 26415 I1_-porCNo: Q�-3U1?f1.01 Test Date: 05/221101 T2eport Date; 06/06/0]. Expira.tintl Date.: 015/22/015 Pro'ect Surnmary: Architectural Tcstin6, Inc. (,STI) was cuntract�d -y Simonton Wirdows to �vitaess perfornuuice.. tests on a. Series/Model 4(:)-06, PVC single lru.ng window at thei=r fa.rility'411 L enn1 t?orn, West V'i:rginiLa. The sainple .tested.snzccesa-fuily met the perfor auae r-equirement':; for �n'A-R35 52 " 71 ra'ti.�, 'T'es' speci.m.en descriptinr and results are repoi,tc-d herein 'Fest S'pecificatiort: The "test spec".1men was ev4iluat%d In ,.wc ordanee with 10LI:S,2-97 )'vlcrctcrr;r Si�ec rations for Alatntinunl, Jjirc��l (1'x`�.,i and PPNdavs crnci G1ass Dnc�rs. Test Specimen Description: Series/Model: 40-06 Type: PVC` SLi'gle Flung to/indow(witli E-9 rainforcet ienvt) Overall Sire: 4' 4" wide by S' 11" high Sash Size: 4' 1-13/16" wide. by 2' 10-5/8" high Daylight Opening Size: 3' 10-13/16•"wide by 2' 7-3/4" high Screen Size: 4' 0-1/16" wide by 2' 10"high Finish. All vinyl was white. 110 Carly'Court; York, PA 17402.9405 prone:717.764,7700 `ax: 717.764..4119 www.tesurt.com 15 FROM :AME-PICRN AHOLEGALP FAX NO. :904 519 1301 Pi..tq. 09 2004 03:26PH P Pau(,2 of Test Specimen Description: Continued) Glazing Details: The sash and fixed lite were glazed with 3/4" tllic-k, sealed insuiating. glass fabricated fi:o.m. two sheets of 3132" thic-L, annealed glass aiid a metal spacer sysu;in, The sash, was, exterior glazed using double-sided adhesivo tape and dual dutometer seep-in vinyl glazing beads. Tlae fixed lit-, was interior glazed using double-sided. adhc�;i-ve tape and snap-ill vinyl glazing beads. Weadierstripping: Quantin, Location 0.187" backt;d by 0.260" 1 Row Sill, and look rail high pile Arith center En 0.18T b@Qkced by 0,2,80" 2 P.owSash Stiles high pile Mfi th center fin 0.375" diarxietc-r, offset vinyl I Row Bottom rL'I jazktt/lhollow foam-filled bWb Frame C.'onstruction: Ifie,- PVC ftainet Nvas cr:,-IstrucV.i' ils.-Lne: 'naitcrcti and wc-lded cwa-,cr. rail was fi-Lstr-n�:d ic the jarnbs usl':ag. tii�e 9.8 by lag " lo -- construction. T-he fucod meeting 3 scre,A,s per end. Sash coustructikin. TI-le PV,', sash was, assembled utilizing .mitered and welded con.1-er Screen (Construction: TI-le screen was coastri-icted with roll-formed 2diumia-uni. he comers were square cut and secured using,plastic corner keys. The fiberglass m6sli screen clOth licid-iij-place with a Eexibla vinyl.spline. Hardware: Descnrtion Quantity Location Metal cam lock, and keeper 2 Lock rail, 8" in ftorn.each eud with, corrtsponding keepers at Exed rail Plastic tilt latch Lock rail at each end Metal pivot'oar Bottom rail at each end Consmu-a force balance 2 One per.jamb,three coils per balance Sash stop One per jzanb at tj-.tc head FROM AMER I CAN ,HOLE:=HLE Ff;X NO. :904 519 1301 Aug. 09 2004 ij_:26PM PG --- t,5-sUI70,0]. Pago_id'1' _ Test Specimen Description: (Continued) Drainage: Descriptio�n c1 n1- 1Ty I.oc,UOil 1-1116" wide by 1/8" High 2 Exterior.face of s01, wcepslat with fla).) one 4-1/8" iii from each end L-1/8" wide F+3r 1!2" deep 2Qtac at each end of, the sill/jamb Weepsl.ot in.tersect:ion 1" wide by 3/16" high } Silt intermediate leg weepslot 3116" di.ametex hole 2 Bottom rail glazLng 1�ocket, one 1-1!8" fiom each end 318" wide by 3,1.6" deep Bolton] rail, one at c ach and o wcc;plzcltt,h bottom pile Pocket 3/4" wide by leg lieiA= % One a'r each end nf,'the sill weepnotch screen irac.k Rebtfolrcemept: The lode rail, lixed nieetin,.g rail and bottom rail a custom shaped, steel reuntorcement ineasuring 0.863" ;, 0.567' x 0.090". (D.ra�z� ng Nc. V0931' The sash stiles contained a custom'shaped, steel reinRx-cam measuring 0.863" x 0.469" x 0.060" i Drawzlzo No. SIM 0925 —Siniontoil ('ode E9). Installation: The unit was installed in a2" x 10" wood bl.ick- collstrucwd'of Spruce-p1n?-7,ir construction lumber. The unit Uras securod to the buck through the nailing tilt using #8 x'1-1!4" drywall screws spaced approximately o,c. an.d.sealed wit:h ti sil:icone'sealant. FROM AMEPlCAN '.JHOLE ALE FA;-; HO. 904 519 1,71 Aug. 09 2004 0:1'—= F 05-30170,0; Pup 4 of 5 Test Results: The results are tabulated as follows: 1'ra-agranh lig-el of ThIst-Test Met�loil Results Allowed ?.2.1 6.1 Opera ing force Opening 25 lbs 30 ILs in-ax. Closing14 lias 30 lbs max. 2.1.2 Air In-filtration per ASTM E 283 (See Dote 41 fit, I,57 psf(25 mph) 0,12 cfirl/ft:- 0.3 cfi1.L/f2 ruax.. You ##l; The tested specimen Pleets (Or c,,,!e ids) the perfnrmcanee levels specified in .z.L11JI,JA1NPT7VDA 101.11 S:.2-o7_for stir tnfilrrution. I L3 Water Resistance per ASTM E 547 (with and without.,creed) V/`Tp=2.86 psf No leakage No teak xge 2.1.4.2 LJniforna..f_.oad Stiuctural Tier ASTM:r .330 (Measurenicats reported were taken on the ii.xed mc.etizg rail) {4 22.5 psf(extericr) 0,014" 0 197" @2?.5lost'(i teri.or) 0.004" 0,197 ni&,r, 2.2.1.6.: Deglaz'ii.g Test per ASTM C' 98? In operating directann at 70 lbs Lift Rall 0,12i"`2J,q. 0,500"'I OG°•1i IvIeeti.ng Rail 0.060"1'17"0 0,5*001111 00°-10 Ila remaining direction at 50 lbs "Left Stile 0.060"/12`i0 0.50Q"f100°11) Right Stile 0.06011/112% 0,310011/10011/10 .l.7 welded Comex Test Meets as stated. 1`vieets.as ,fated. 2.T.,8 ' Forced EntryResistance Tea,AAMA 1302.5-76 Test A NO entry Nes entry Test B No entry No entry Test C No entry NO entry Test D No entry No ent,1111 Test E No entry, No entry, Test F No ent 7y No entad' Test C No entry No ealtr-, Optional perfortndnce 4.3 Water Resistance per AST1vi E 547 (with mid without sameu) WTP at 5.25 psf No leakage i�To leakage - 4.4-2 Uniform Load Structural per ASTM E 330 (Measuremexits reported were taken on the fixed.meeting rail) @ 52_5 psf(ex-terior) 0.126" 0.197" max.. n 52.5 psf(interior) 0.066" 0.197" max, FFOM :HVERICPH I,JHOLEGALE FA); HO. !9-04 X19 1301 Aug. 09 20704 07:27PM F9 Ak 05t-30170,o1 Pztp 5 of 5 Detailed,dra-vAn' 9S, rc�resentfttive samples Of tl-'E, test Specimen, and a copy of this repolt Will be retained. by ATI for a period of foLx years_ The above results w= Secured by using the designated test methods and they indicate cDmpliaoce with the peiTciinance iequireanents of the s'vovc specificadoll. MS rt-.port does not constitute cetftiflUlion Of this product which may only be granted by the certification progrmi administrator. For ARC=EC7URAL TESTING, DIC: .4. Lynn George i Scott A. Warner Project N-Janager Executive 'Vice Preside.,at TAj G! P FFOtl "AMER 104-1 ,.HQLE'SALE FkH0. 904 519 1301 RL19. 09 2004 03:24Pt"l P2 on :4 x C5 J. Q Ph p . N -7 2.O R 3 ro go ANCHORING CROSS SECTIONS Septan ?l Simonton W(ndowig FOR IX SJCK to MASONRY Ir �i I One Cochrone Avenue Floridq P. E No 14 m 195 p SINGLE HUNG Pennsbaro, WV 26415 PH. 800-425.2242 05 Franck Lo VINYL WINDOW Lutz, FL 335 CITY OF ATLANTIC BEACH DEPARTMENT OF BUILDING 800 Seminole Road -Atlantic Beach, FL 32233 - Tel: 247-5826 - Fax: 247-5877 PLUMBING PERMIT :PERMIT°INFORM i4TIOfV'; , '. LOCATION" NFORMAT,ION Permit Number: 20963 Address: 61 CORAL STREET Permit Type: PLUMBING ATLANTIC BEACH, FLORIDA 32233 Class of Work: NEW Township: 0 Range: 0 Book: Proposed Use: Lot(s): Block: Section:0 Square Feet: Subdivision: Est. Value: Parcel Number: Improv. Cost: OWNER:INFORMATION , . , „ .' Date Issued: 11/09/2000 Name: HOLLINGSWORTH Total Fees: 25.00 Address: 61 CORAL STREET Amount Paid: 25.00 ATLANTIC BEACH, FLORIDA 32233 Date Paid: 11/09/2000 Phone: 000)000-0000 Work Desc: CONNECT TO CITY SEWER :CONTRafTOR'°S JAX PLUMBING & SEPTIC TANK PERMIT 25.00 FINAL ecfilotts;'Re W �� NOTICE - INSPECTIONS MUST BE REQUESTED AT LEAST 24 HOURS PRIOR TO INSPECTION 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 CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. Q) Dite:CHECKS 81 Receipt!2881�9889 139 4 A' NTICBE,ACH bUILDING DEPT. 88198884 ien 13488 �/ ,, CITY OF 4&6odwBeadt-44?fQ.ii Office of Building Official REQUEST FOR INSPECTION l2 02- ;z0�� Date Permit No. Time A.M. Received P.M. Job d ocality -7,04 43 rp Owner's Namf NameC tractor BUILDING CONCRE ELECTRICAL BI MECHANICAL Framing ❑ Footing ❑ Rough Wiring D oug ❑ Air gond. & ❑ Re Roofing ❑ Slab ❑ Temp Pole ❑ Top Out ❑ Heating Insulation ❑ Lintel ❑ Final ❑ Sewer Fire Place ❑ .� READY FOR INSPECTION Pre Fab Mon. Tues. Wed. Thurs. Friday A.M. Inspection Made P.M. Inspector a-- Final Inspection Certificate of ccupancy❑ Date CITY OF ATLANTIC BEACH, FLORIDA UTILITY PAYMENT PLAN AGREEMENT PROPERTY DESCRIPTION: OWNER: Presley O. Hollingsworth 61 Coral Street Atlantic Beach,,Florida 32233 RE# 1695-940-140 LEGAL DESCRIPTION 15-82 09-2S-29E Ocean Grove Unit No 1 S/D PT Lot 7 W 20 FT Lot 16 Blk 8 TOTAL AMOUNT OF AGREEMENT: $3,122.30 This document shall serve as an extended payment agreement between you and the City of Atlantic Beach, Florida for the above listed total amount and for which said amount will be filed as a lien with the Court of the Circuit Court for Duval County, Florida until the entire balance is paid. CHARGES: Sewer Impact Fee $1,250.00 Sewer Tap 496.00 Contractor 1,375.00 TOTAL CHARGES: $3,121.00 Less 10%Down Payment 312.10 Payment of lien filing fee 19.50 TOTAL DOWN PAYMENT: $331.60 TOTAL AMOUNT FINANCED $2,808.90 TOTAL AMOUNT OF LIEN $3,122.30 TERMS: Number of Monthly Payments 36 Due Date: Due monthly with your utility bill Billing Included on utility bill Late Charges 10% Failure to pay all charges will result in the water services being cut-off. Payment Amount $86.73 per month Total Interest over term of loan $313.40 LIEN: A lien in the amount of the TOTAL AGREEMENT above shall be executed and recorded against the above referenced property. The owner hereby agrees to pay all recording fees and costs involved with the execution of the lien. Upon payment being made in full, the lien shall be released of record. Please indicate your acceptance of the provisions of this agreement by signing in the place indicated. Your signature signifies your agreement to indemnify and hold harmless the City of Atlantic Beach, Fl., from any and all damages resulting from your failure to timely make the above payments, including reasonable attorneys fees and court costs. The City of Atlantic Beach looks forward to cooperating with you under this agreement. PROPE TY OWNER By:71 Date: Presley O. Hollingsworth City of Atlantic Beach �• Date: 00 Jim Hanson, City Manager Prepared by and return to: Maureen King, City Clerk City of Atlantic Beach 800 Seminole Road Atlantic Beach, FL 32233 REAL PROPERTY LIEN The parties have agreed that this LIEN be filed against the real property owned by Presley O. Hollingsworth, and shall be recorded in the official public records of Duval County, Florida. This LIEN is for financed costs associated with the conversion of a private septic system to public sewer system and including sewer impact fees on the following real property located in Duval County, Florida, more particularly described as follows: RE#: 1695940140 LEGAL DESCRIPTION: 15-82 09-2S-29E Ocean Grove Unit No 1 S/D PT Lot 7 W 20 FT Lot 16 Blk 8 OWNER NAME & PROPERTY ADDRESS: Presley O. Hollingsworth 61 Coral Street Atlantic Beach, Florida, 32233 This LIEN is to secure payment from Presley O. Hollingsworth to the City of Atlantic Beach in the amount of$ 3,122.30 pursuant to Utility Payment Plan Agreement attached. Alt Witness (Sign NameY OWNER: resley O. Ho ingsworth Witness (Print Name) r _ CITY OF ATLANTIC BEACH WYness (Sign Name) By JLL11 e M. Vro n d t Maureen King Witness(Print dame) Certified Municipal Clerk Page 1 of 2 Hollingsworth Lien STATE OF FLORIDA COUNTY OF DUVAL Sworn to and subscribed before me this day of 6�- , 2000, by who are personally known to me or produced as identification, and who did/did not take an oath. Notary Public, State of Florida at Large My Commission expires: "'" Patricia Amonette ;.=MY COMMISSION# CC947012 EXPIRES August 27,2004 BONDED THRU TROY FAIN INSURANCE,WG Page 2 of 2 Hollingsworth Lien -- 2 pj' Or f'7 rl CUSTOMER NAME: N--a ,nT-�tx SERVICE LOCATION ADDRESS: 62 C CUSTOMER PHONE NUMBER: PROPERTY OWNER NAME: SERVICE NOW: ON CITY WATER 0 ON WELL U CONVERT FROM ON-SITE SEPTIC SYSTEM TO CITY SEWER: OPTION A: Customer to hire own contractor and pays costs. OPTION it: Customer pays costs and hires contractor with City-s assistance; QPTIQ N C: Customer to hire own contractor and finance cost through the City ofAtlantic Beach. OfMON D: rnkey Support 0ty assists with entire conversion. CUS'1:OER SELECT OOPTION PREFER=: 0 Option A O Option B U Option C O Option D OWNER'S SIGNAT F: Please return to: DO NOT COMPLETE BELOW: REAL ESTATE NUMBER: LEGAL DESCRIPTION: PRICE QUOTE: CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD AT TELEP ONE: 904)24IC BEACH, 7-5800 3-5445 47-5800 FAX:(904)247-5805 ,' S) SUNCOM: 852-5800 http://ci.atiantic-beach.fl.us �v 1 9 L� S Dare-.--_-L.-7=Q 1-------Pam--Z--------------- To.• ----------------fax, --------------------- �o ------------------------------------------ R ----------------------------------------- i��u-tri• .,., 7. . ,,++��,��//6 a1��c nn // CITY OF 494m,4 Office of Building Official REQUEST FOR INSPECTION � 0 � Date Permit No. Time A.M. Received P.M. i Jozazdd (—Z!9ja-k�cl- LocalityOwner's Name tractor BUILDING CONCRET ELECTRICAL BI MECHANICAL Framing ❑ Footing ❑ Rough Wiring ❑ ouR`g i ❑ Air Cond. & ❑ Re Roofing ❑ Slab ❑ temp Pole ❑ Top Out ❑ Heating Insulation ❑ Lintel ❑ Final ❑ Sewer Fire Place ❑ Pre Fab READY FOR INSPECTION Mon. Tues. Wed. Thurs. Friday [/ Q Inspection Made ` T i A.M.A.M Inspector v-� Final Inspectixcc-p-ncy Certificate of ❑ Date I CITY OF 4&4a4-c Beu A-49&vd* 4 Office of Building Official REQUEST FOR INSPECTION �} L Date `^ ( '—Z/ 1� Permit No. 00 `- Time A.M. Received P. Jo cldress Locality Owner's Name Contractor BUILDING NCRETE ELECTRICALMECHANICAL PLUM Framing ❑ Footing ❑ Rough Wiring ❑ ❑ Air Cond. & ❑ Re Roofing ❑ Slab Cl Temp Pole ❑ Top Out �❑,} Heating Insulation 11 Lintel ❑ Final ❑ Sewer r Fire Place ❑ _pre Fab READY FOR INSPECTION A.M.~_ Mon. Tues. Wed. Thurs. Friday ._P.M. A Inspection Made 5 + / M. i Inspector Final Inspection Certificate of Occupancy ❑ Date CITY OF ATLANTIC BEACH DEPARTMENT OF BUILDING 800 Seminole Road -Atlantic Beach, FL 32233 - Tel: 247-5826 - Fax: 247-5877 PLUMBING PERMIT PERMkT INFORMATION`) ;, kY �OCATION'INFORMATIOP� .", ".: _. .. Permit Number: 20962 Address: 59 CORAL STREET Permit Type: PLUMBING ATLANTIC BEACH, FL 32233 Class of Work: NEW Township: Range: Book: Proposed Use: SINGLE FAMILY Lot(s): Block: Section: Square Feet: Subdivision: OCEAN GROVE Est. Value: Parcel Number: Improv. Cost: °:OWNER°INFORMATIONQ:. s . Date Issued: 11/09/2000 Name: HOLLINGSWORTH Total Fees: 25.00 Address 59 CORAL STREET Amount Paid: 25.00 ATLANTIC BEACH, FL 32233 Date Paid: 11/09/2000 Phone: ` 904)353-1304 Work Desc: CONNECT TO CITY SEWER QONTRACOR 5 P .F PPfO FEES; " $. f . JAX PLUMBING & SEPTIC TANK PERMIT 25.00 e sections Riilie , a FINAL NOTICE - INSPECTIONS MUST BE REQUESTED AT LEAST 24 HOURS PRIOR TO INSPECTION 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 CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS" ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. $25.8814 Date: 12/19/88 81 Receipt: MM39 c CHECKS 15488 ATLA TIC BEA H ILDING DEPT. 88188883221888 Aug-29-00 07 : 4SA City Atlantic Beach 904247SBOS P . Ol CITY OF ATLANTIC BEAM APPLICATION FOR PLUMBING PERMIT JOB LOCATION: S_ l Cu. ('at I J�' OWNER OF PROPERTY: �' v f! �► v �'i' TELEPHONE NO.21 / J/� PLUMBING CONTRACTOR J AK f_/UAi1 /'r79t— J c 7'1'C TC, C CONTRACTOR' S ADDRESS : i 76C �� , r fly �\ A f F/ STATE LICENSE NUMBER: 6F6 0.2 is Y Y TELEPHONE : 7 HOW MANY OF THE FOLLOWING FIXTURES INSTALLED SINKS SHOWERS LAVATORY WATER HEATERS BATH TUBS DISHWASHERS URINALS DISPOSALS CLOSETS WASHING MACHINE FLOOR DRAINS SHOWER PANS _ SEWER WATER REPIPE OTHER TOTAL FIXTURES: x $3 . 50 + $15 . 00 MINIMUM PERMIT FEE - $25 . 30 SIGNATURE OF OWNER: SIGNATURE OF CCNTRACTOR: INSTALLATION OF PLUMBING AND FIXTURES MUST BE IN ACCORDANCE WITH THE MOST RECENT EDITION OF THE SOUTHERN STANDARD PLUMBING CODE. CALL A DAY AHEAD TO SCHEDULE INSPECTIONS - (904) 247-5826 SEWER CONNECTIONS MUST BE CALLED INTO PUBLIC WORKS FOR INSPECTION PRIOR TO COVERING UP - ( 904 ) 247-5834 Aug-29-00 07 : 45A City Atlantic Beach 9042.475805 P _ O1 CITY OF ATLANTIC BEACH APPLICATION FOR PLUMSING PERMIT JOB LOCATION: _ C o! l / 9`r' OWNER OF PROPERTY : r, f 7 / 1, ,� yJ V r�' 6TELEPHONE NO .J S3 X30 y PLUMBING CONTRACTOR d 61 k u Yh r f7 'f- Sc 7�i'C l G 17/: .L A1C . CONTRACTOR' S ADDRESS : 176 c 31� r r J� , lam( 32 22 STATE LICENSE NUMBER: C.,. Coa )Is--y TELEPHONE : 7VG"13 VU HOW MANY OF THE FOLLOWING FIXTURES INSTALLED SINKS SHOWERS LAVATORY WATER HEATERS BATH TUBS DISHWASHERS URINALS DISPOSALS CLOSETS WASHING MACHINE FLOOR DRAINS SHOWER PANS SEWER WATER REPIPE OTHER TOTAL FIXTURES: x $3 . 50 + $15 .00 MINIMUM PERMIT FEE - $25 . 00 SIGNATURE OF OWNER: C SIGNATURE OF CONTRACTOR: ------------------------------------------------------------ INSTALLATION OF PLUMBING AND FIXTURES MUST BE IN ACCORDANCE WITH THE MOST RECENT EDITION OF THE SOUTHERN STANDARD PLUMBING CODE. CALL A DAY AHEAD TO SCHEDULE INSPECTIONS - (904 ) 247-5326 SEWER CONNECTIONS MUST BE CALLED INTO PUBLIC WORKS FOR INSPECTION PRIOR TO COVERING UP - ( 904 ) 247-5834 CITY OF ATLANTIC BEACH, FLORIDA UTILITY PAYMENT PLAN AGREEMENT PROPERTY DESCRIPTION: OWNER: James N. Bowen 59 Coral Street Atlantic Beach, Florida 32233 RE# 1695940150 LEGAL DESCRIPTION----I5-82 09-2S-29E Ocean Grove Unit No 1 S!D PT Lot 7 E 30.3 FT Lot 16 Blk 8 TOTAL AMOUNT OF AGREEMENT: $4,131.07 This document shall serve as an extended payment agreement between you and the City of Atlantic Beach, Florida for the above listed total amount and for which said amount will be filed as a lien with the Court of the Circuit Court for Duval County, Florida until the entire balance is paid. CHARGES: Sewer Impact Fee $1,250.00 Sewer Tap 496.00 Contractor 1,375.00 TOTAL CHARGES: $3,121.00 Less 5% Down Payment 156.05 Payment of lien filing fee 19.50 TOTAL DOWN PAYMENT: $175.55 TOTAL AMOUNT FINANCED $2,964.95 TOTAL AMOUNT OF LIEN $4,131.07 TERMS: Number of Monthly Payments 120 Due Date: Due monthly with your utility bill Billing Included on utility bill Late Charges 10% Failure to pay all charges will result in the water services being cut-off. Payment Amount $34.43 per month Total Interest over term of loan $1,166.12 LIEN: A lien in the amount of the TOTAL AGREEMENT above shall be executed and recorded against the above referenced property The owner hereby agrees to pay all recording fees and costs involved with the execution of the lien. Upon payment being made in full, the lien shall be released of record. Please indicate your acceptance of the provisions of this agreement by signing in the place indicated. Your signature signifies your agreement to indemnify and hold harmless the City of Atlantic Beach, Fl., from any and all damages resulting from your failure to timely make the above payments, including reasonable attorneys fees and court costs. The City of Atlantic Beach looks forward to cooperating with you under this agreement. PROPERTY OWNER By: Date: es N. Bowen City of Atlantic Beach Date: Jim Hanson, City Manager a Prepared by and return to: Maureen King, City Clerk City of Atlantic Beach 800 Seminole Road Atlantic Beach, FL 32233 REAL PROPERTY LIEN The parties have agreed that this LIEN be filed against the real property owned by James N. Bowen, and shall be recorded in the official public records of Duval County, Florida. This LIEN is for financed costs associated with the conversion of a private septic system to public sewer system and including sewer impact fees on the following real property located in Duval County, Florida, more particularly described as follows: RE* 1695940150 LEGAL DESCRIPTION: 15-82 09-2S-29E Ocean Grove Unit No 1 S/D PT Lot 7 E 30.3 FT Lot 16 Blk 8 OWNER NAME& PROPERTY ADDRESS: James N. Bowen 59 Coral Street Atlantic Beach, Florida, 32233 This LIEN is to secure payment from James N. Bowen to the City of Atlantic Beach in the amount of$4,131.07 pursuant to Utility Payment Plan Agreement attached. Witness (Sign Name) �WNER: James . Bowen Witness (Print Name) CITY OF ATLANTIC BEACH Witness (Sign Nam ) By J; Gu Maureen King Witness (Print Ni.me) Certified Municipal Clerk Page 1 of 2 Bowen Lien STATE OF FLORIDA COUNTY OF DUVAL Swornto and subscribed before me this 3Z qday of �&1,&} 2000, by ..ZAm c S k/, &QW6:tl who are personally known tome or produced r-_r)L as identification, and who did/did not take an oath. MAUREEN KING Notary Public, Stat4 o orida at Large Notary Public-state of Florida My Commission expire W Commission Expires Mar 31,2001 Commission#CC720781 Page 2 of 2 Bowen Lien CUSTOMER NAME: (�>Q Li o SERVICE LOCATION ADDRESS: CUSTOMER PHONE NUMBER: PROPERTY OWNER NAME: SERVICE NOW: ON CITY WATER 0 ON WELL 0 CONVERT FROM ON-SITE SEPTIC SYSTEM TO CITY SEWER: QP.TI4IY.A; Castower to hire own contractor and pays costa. QMQN B: Customer pays costs and hires contractor wick Cky's assistance: OPT : Customer to hire own contractor and flnance coat through the City of Atlantic Beach. OPUQB I(,*. Turnkey Support. atsista with entire conversion. Culmmu 8111-ECT O_XMQH=]MR=: .. 0 Option A O Option S 0 Option C 0 Option D QWNER19 SIGNATURE: Please return to: DO NOT COMPLETE BELOW: REAL ESTATE NUMBER: LEGAL DESCRIPTION: PRICE QUOTE: r 758 DEPARTMENT Of BUILDING CITY OF ATLANTIC�B AC.H PERN"I T INFORMATION �. ,. ..._ - -- LOCATION INFORMATION erxit NU ery 7592 Address . 61 CORAL STREET { ertiVt Type. MEt�HANICAL ATLANTIC BEACH, FLORII?A 3223 . - --- .--- LEGAL DESCRIPTION pTI N __ .- 10fm' bkkwALTERATIOT C r, . Type. N/A t: Block. section*. roposod Use. ' SINGLE FAMILY Township. RNG., d Code. Q bdivi idn' r of imaf4d va I cane $0 .00 Ilra ,rciv. cost • 0 .0o Total Feed ' 0 a 00 Amount Pa . ,x. x"43.00 Date � � 4/93 I oak DesI rig A/C: system k i "TION ^.` APPLICATION FEES -_~ - Name H RMT E43 .+ £ rear , ET MATER IMPACT FEE $0.00 FLORIDA �3 � SSE FACT` E � 4.0G� ORMATION RADON QAS 5% $0.00 Name. A N E ING. CAPITAL IMPROVE. ��,�C 47 R BLVD.: , �. �.,".,:. . ... 00 - ,x"K* 5 vweHPDR CLIC SHARE C' .00,t?C cense* MHAR- 6 Type: 0 CROS CONNECTION S0.40 �, SEC..,H IMPACT FEECON".SC -OTHER i MOTES, NOTICE ALL CONCRETE FORMS AND FOOTINGS MU$T BE INSPECTED BEFORE POURING PERMITVOID SIX MONTHS AFTER DATE+JFISSUE BUILDING MATERIAL,RUBBISH AND DEBRIS FROM THIS WORK MUST NOT.gE PLACED IN PUBLIC SPACE,AND MUST BE CLEARED UP AND HAULED AWAIT BY EITHER CONTRACTOR OR OWNER " `.`FAI'LURE T4 COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN THE PRflPE'RTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS. -ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART.OF THIS PERMIT AND SUBJECT TO`REVOCATION FGR VIOLATION Of APPLICABLE PROVISIONS OF LAW. TLNTICBA£HBUILDING DEPARTMENT # atrs CR'dtl t LI l }10, 4 Tota .{ 35 BUILDING AND ZONING INSPECTION DIVISION CITY OF ATLANTIC BEACH ATLANTIC BEACH, FLORIDA 32233. APPLICATION FOR MECHANICAL PERMIT CALL-IN NUMBER IMPORTANT — Applicant to complete all items in sections I, II, III, and IV. 1. LOCATION Street Address: Q OF Intersecting Streets: Betwee + And n..J�} 1\N1 BUILDING Sub-division II. IDENTIFICATION - To be completed by all applicants . In consideration 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 are a part hereof and in accordance with the City of Jacksonville ordinances and standards of good--practice listed therein. Name of Mechanical Contractors Contractor (Print) Master Name of ProPerty Owner Signatua of Owner Signature of or Authorised Agent ` Architect or Engineer .- 111. GENERAL INFORMATION A, Type of heating fuel: B' IS OTHER CONSTRUCTION BEING ON£ON M-c THIS BUILDING OR SITE?_IN O Gas—❑ LP ❑ Natural ❑ Central Utility / IF YES, GIVE NUMBER OF CONSTRUCTION Q Oil PERMIT / Q Other Specify IV. MICMANICAL EQUIPMENT TO SE INSTALLED NATURE OF WORK (Provide complete list of components on back of this forum) 2 Residential or ❑ Commercial ffo'Host ❑ Space ❑ Recessed aCwMal O Roof ❑ New Building Air Conditioning: ❑ Room ErControl ' 4�TExisting Building ❑ Duct System: Material Thickness 2000'Replacement of existing system Maximum capacity cf.m. 0 New installation(No system previously Installed) �O ❑ Extension or add-on to existing system 13 Il efrigeation ❑ Other — Specify [j Cooling fowen Capacity 9•p•m• ❑ Fire sprinklers: Number of head 0 'Elevator D Maalift ❑ Escalator (number) THIS SPACE FOR OFFICE USE ONLY ❑_ Gasoline pumps (number) (Reeeiwd) 13. Tarte■ (number) Remarks 0 LPG contains (number) Q Unfired pressure vesNt O Meilen Permit Approved by Date Other -Specify Permit Fee LIST-ALL EQUIPMENT AIR CONDITIONING AND REFRIGERATION EQUIPMENT Capacity I► er p Number Units Dercriptio>B Model NumberManufacturer (Zbns) A s CITY OF ATLANTIC BEACH APPLICATION FOR PLUMBING PERMIT s JOB. LOCATION:__; -� / 9 :OWNER OF PROPERTY: �. 7�1�r)1 `� err t-y'I :PLUMBING CONTRACTOR: Ilarl 63z's I!Iil b- ng Tn�" 'CONTRACTOR'S AD3DRESS: 3552' St, Augustine Road. Jax FL 32207 k ` STATE LICENSE NUMBER: CF ,5§ZO2 TELEPHONE: 448-2040 HOW M OF THE FOLLOWING FIXTURES INSTALLED SINKS SHOWERS LAVATOfIES WATER HEATERS BATA TUBS _r__J_DISHWASHERS URINALS DISPOSALS i CLOSETS, WASHING MACHINES FLOOR DRAINS SHOWER PANS I OTHER TOTAL FIXTURES: X3.50 + $15.00 NK NIMUM PERMIT FEE = $25.00' is ! 9ZGNATURE OF OWNER: SIGNATURE OF CON:tRACTOR: INSTALLATION OF PLUMBING AND `FIXTURES MUST BE IN ACCORDANCE WITH THE! 1904: STANDARD PLUMBING CODE. CALL A DAY AHEAD TO SCHEDULE ;INSPECTIONS — (904) 247-5826 f ' SEVER CONNECTIONS MUST BE CALLED IN TO PUBLIC WORKS FOR INSPECTION PRIOR i TO 'COVERING UP — (1904) 247-5834. f PSR-3844 16524 DEPARTMENT OF,BUILDING I CITY OF ATLANTIC BEACH 1 PERMIT INFORMATION - - LOCATION INFORMATION' - rmit Number : 15524, Ai idress 61 CORAL STREET Permit Type:PLUME.ING ATI.AINT C BEACH r FLORIDA 32233 j ens f c rk:P,LT tATZt?1N LEOAL DESCRIPTION 1 jV }Lom fiT�}Spi s ��NCR TE Block: Lot: '' ' Twp., {ors tr. T`po: Jeryjio0 Nulvi� Rn,gaLse {{ Dvel 1 i cgs > 1 subdivision. s. on Est: sue: o .ar Improv. Cost : 0 ,00 Tot.aI Fees ;,, 25 .001 Amount P2 5 00 i Date Padt 991, cork nq , ' �y�: ERI;f ' . 2 -U � r i y� UET kEAQ lILOR I DA 322 3 3 � ane. � � t3 � ; P { t fr t 5 f - 9S 4 9 PP' =4 �' b "6w, , COH" TO I GMAT ION . ,. Carie 17 Ad?L l� ` S P-toms I R`+ 11'IC , dr,*, 15,52 ,,.5T' A000STINE ROAD' JACKSOIVV'IL► ;,. FL 32207 :Lic. Exp j NOTES: i I� I NOTICE-INSPECTIONS MUST BE REQUESTED AT LEAS?24 NtIUR$ PRIOR TO INSPECTION I i BUILDING MATERIAL,RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE CLEARED UP AND HAULED AWAY BY EITHERCONTRACTOR OR OWNER f 4iFAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN � THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS." ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS'PERMIT AND,SUBJECT TO REVOrw Y ON FOR ;VIOLATION OF-APPLICABLE PROVISIONS OF LAIN. JA TLANTf EACH BUILDING PEPARTMENT 99II8BB 2794 BY. ,_ . .. ` . CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD J -� ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 fb �� INSPECTION EMAIL REQUEST: Building deptgcoab.us Application Number . . . . . 07-00000804 Date 6/11/07 Property Address . . . . . . 61 CORAL ST Application type description PLUMBING ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc 13 FIXTURES ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ ESPOSITO, JEFF DAVID GRAY PLUMBING INC. 8850 CORPORATE SQUARE CT. ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32216 (904) 744-7255 ------------------------------------------------------- --------------------- Permit . . . . . . PLUMBING PERMIT Additional desc . . Permit Fee . . . . 126 . 00 Plan Check Fee . 00 Issue Date . . . Valuation . . . . 0 Expiration Date . . 12/08/07 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 126 . 00 126 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 126 . 00 126 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CITY OF ATLANTIC BEACH PLUMBING PERMIT APPLICATION Date: Property Address: �0I drl.4L 7— Owner: Owner: ��,r-i n�i�rs iA�Ie-C z Telephone#: Contractor: David Gray Plumbing, Inc. Telephone#• 9850 bFporata SquaTe Court Contractor Address: jacksorville. Florida 32216 Fax#: _7,13-5tlo6a .pp Contractor Signature: Avg CFC 022586 In consideration of permit given for doing the work as described in the above statement;we hereby 00'perform said work in accordance with the attached plans and specifications which are a part hereof and in accordance with the City of Atlantic Beach ordinance and standards of good practice listed therein. Installation of plumbing and fixtures must be in accordance with the most recent edition of the Southern Standard Plumbing Code. Plumbing Type: If other construction is being done on this building or site, ❑ New list the building permit number: Re-Pipe Number of Fixtures: Bath Tubs / Showers _ Closets Shower Pans Dishwashers Sinks Disposals Urinals Floor Drains Washing Machine Lavatory Water Sewer / Water Heaters Sprinkler System Other Fees Permit Issuing Fee: $35.00 t1� Total Fixtures: 1 X$7.00 + $35.00 800 Seminole Road -Atlantic Beach, Florida 32233-5445 Phone: (904) 247-5800 - Fax: (904)247-5845- http:/lv nAm.ci.atiantic-beach.fl.us Revised 1/04 Jun 11 07 09:25a DAVID GRAY PLUMBING 904 723 5668 P.1 CITY OF ATLANTIC BEACH y� PLUMBING PERMIT APPLICATION Date: w ,... N Property Address: 'G i�rc,r ?"' :�• is Owner:��s-�.«✓.��a sl1s,� T%: Telephone#: ..��(, ;�4 Contractor: bevid Gray Plumbing, Inc. Telephone#: 7y5'"S SM orporate SquaFe Court Contractor Address: Ja^kE nYiI!.Q, Roorida 32216 Fax#: ��l�Sft68 Contractor Signature: tf :�� =Z CFC $225$6 Ir:consideration of permit given for doing the work as described in the above statement,we hereby perform said woTk ir. wcor(hwoc with the attached plans and specifications,wwt%Wn are a part hereof said m accordanex,%ith the City of Atlantic Beach ordinance and standards of.good practice listed therein. lrstallation of plumbing and ;fir=es must be in accordance with the most recant edition of foe Southern Standard Plumbing Code. Plumbing Type: If other construction is being done on this building or site, I Q New list the building perntit number. epr Re-Pipe Number of Fixtures: ` j Bath Tubs % Showers Closets Shower Pans Dishwashers S inks Disposals Urinals Floor Drains Washing Machine Lavatory Water Sewer / Water Heaters Sprinkler System Other Fees Permit Issuing Fee: S35-00 Total Fixtures: 1 X S7.00 + $35.00= U - Soo Seminole Road•Atlantic Beach,Florida 32233-5445 Phone:(9")247-5800• Fax: (904)247-5845• htt p:lharww.c l.atiantic heaeh.fl.us Revised L04