Permit 78 Forrestal Circle South (3) CITY OF ATLANTIC BEAQi ��
0 " APPLICATION FOR BUILDING PERMIT
Owner And. and &of f Sli r" 'Address 78" S Fo rrc sta. I C i rc k zip 3.),4.3 3 Phone .W1.5(097
Architect — Address zip Phone
Contractor Address zip Phone
Contractor's License Number Expiration Date Copy on File
Lot I[ 4 Block or Section # O. Subdivision Zoning
Street , r/ / Between and side
Valuation $ /5 Type of Construction % Gkl
Purpose of Building /74/,ae, Eitnsio r , Number of Units / Fireplaces -
Utility Service: Water Sewer —
If the City if providing water or sewer service, do we need to make taps?
Dimensions: Building Lot Size Footings a k /n
Sz. Piers Sz. Sills Greatest Span Sills
Sz. Ceiling Joists _ Distance on Centers ' ait' Greatest Span
Sz. Floor Joists /4; Distance on Centers le," Greatest Span
Sz. Rafters 2 ' ' 6" Distance on Centers /6, Greatest Span
Method of Heating tZi -ic ex,'st,41 Solid- Filled Ground Roof 5X;,
Flood Zone C. If located within a FLOOD HAZARD complete page 2
SUBMIT: Two complete sets of plans, including a detailed site plan.
Florida Energy Efficiency Code Sheets
Recent Survey
pections Required:
A.
When steel is in place and ready to pour footings.
2. When steel is in place and ready to pour columns /lintel.
3. When steel is in place and ready to pour beam.
,/4. When framing, mechanical, plumbing, electrical, fireplace, is completed and ready
to cover up.
V 5. Final inspection.
SETBACKS
NO INSPECTION WILL BE MADE IF BUILDING CARD IS NOT POSTED ON JOB.
In case of rejection, reinspection MUST be called for after Lot Line
corrections are made.
4.11. ,,
In consideration of permit given for doing the
work as described in the above statement, we on
hereby agree to perform said work in accordance 0
a
with the attached plans and specifications, are a part hereof, and in accordance r `4" 13 6
rt
with the building regulations of Atlantic Beach,
Signature ner
4Z �' 7,Gce
Signature Contractor
33' 30 ,
'
ron • ine . •
w FLOODPLAIN DEVELOPMENT INFORMATION
Type of Development: New Building
t,-/ Alterations to Existing Building
(7 /
Flood Zone
Required Floor Elevation /1/6(-----
Actual (as built)Lowest Floor Elevation
,
If located within a flood hazard zone (zone A) a survey must be
made after the slab has been poured, certifying that the "lowest
•
floor elevation" is equal to or above the base flood elevation
established for that zone.
No Final Inspection will be made and No Certificate of Occupancy
will be issued until the survey is on file with the Building Department.
COMMENTS
Applicant acknowledgement: I understand that the issuance of this
permit is contingent upon the above information being correct and
that the plans and supporting data have been or shall be provided
as required. I agree to comply with all applicable provisions of
Ordinance No. 25 -7 -11 and all other laws or ordinances effecting
the proposed developemnt.
Date 5/021// g`9 Applicant's Signature L� C'- ,Pi��.f
Department Use
Survey filed with the Building Department on
Certified Lowest Floor Elevation
Required Lowest Floor Elevation
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f\ I 'N ' \ 5 0 i „_„, ' . &2
Building Department Representative i ,.;
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A -O
Address S(
Heated Square Footage V 36) o @ $ p . per sq ft = $ / ; /3,
00
Garage /Shed @ $ per sq ft = $
Carport /Porch @ $ per sq ft = $
Deck @ $ per sq ft = $
Patio @ $ per sq ft = $
T O T A L VALUATION: S i t e / / 33, 0 °
Total valuation 1st $/5 60 0
$/ v
Remainder Valuation .pper thousand or
Portion thereof
Total Building Fee $ � 0c)
ADDITIONAL PERMITS and /or FEES REQUIRED
+ z Filing Fee $
Mechanical Fireplaces @ 15.00 $
Plumbing BUILDING'PERMIT FEE $ /, d c)
Electric /Neva
Electric /Temp $ ?�, Q r1
Septic Tank BUILDING PERMIT c..
Well WATER METER CHARGE $
Swimming Pool SEWER IMPACT FEE $}
Si WATER IMPACT FEE $0
Water Connection MISCELLANEOUS $
Sewer Connection "•�`�,° $ � ,(g-
Water Meter
Elevation Certificate
��
GRAND TOTAL DUE $
CALCULATIONS and /or NOTES
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I APPROVED
CITY OF ATLANTIC BEACid Ok S" 4•7
BUILDING OFFICE
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MAR 2 5 1989 , •
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Building and Zoning
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APPROVED
CITY OF ATLANTIC BEACH
BUILDING QFF10E
MAR 2 .; 1989
By ��.' ....�.
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APPROV
CITY OF ATLANTIC BEACI1
BUILDING OFFICE
MAR 2 .3 t ?8°
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- CITY OF
• r4t€adrtie f�eae4 - wuel
800 SEMINOLE ROAD
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ATLANTIC BEACH, FLORIDA 32233 -5445
TELEPHONE (904) 247 -5800
'IN
FAX (904) 852-5800
��% SUNCOM 852 -5800 0
INCOME VERIFICATION FORM
PART 1. To be filled out by Applicant/Employee:
Applicant /Employee Name: All R a, • —h l V E �2R
Address: r ig r= 0pie$ 7i L.- C 1 RCLE �U n? % L• aC.H. OTC.. 3 as 33
Social Security Number: In_ 4.6 -- /(3A
1 hereby authorize release of my income information to the City of Atlantic Beach, Florida.
Applicant/Employee Signature �"
Date -8
PART 2. To be filled out by Social Security Administration, HRS or the Employer:
S.S. Administration, HRS or Employer: Please complete the following and return the requested
information to the Director of Community Development, 800 Seminole Road, Atlantic Beach, Fl.,
32233.
Applicant/Employee's name:
Gross amount of income paid monthly:
Employment to be continued? Yes No . If no, please explain
Employer Signature: Title:
Employer Telephone Number: Date:
* ** REC 0098273 0151202 H7170CE0 nfe5 CIPQYA7 PQA7 (F -nfe ) * **
SOCIAL SECURITY ADMINISTRATION
Date: September 30, 1998
Claim Number: 183- 46 -1132A
183- 46- 1132DI
Name: ANA RIVERA
ANA C RIVERA
78 FORRESTAL CIRCLE S
ATLANTIC BEACH FL 32233 -3326
You asked us for information from your record. The :information that you
requested is shown below. If you want anyone else to have this information, you
may send them this letter.
Information About Current Social Security Benefits
Beginning December 1997, the full monthly
Social Security benefit before any deductions is $ 264.00
We deduct $0.00 for medical insurance premiums each month.
The regular monthly Social Security payment is $ 264.00
(We must round down to the whole dollar.)
Social Security benefits for a given month are paid the following month. (For
example, Social Security benefits for March are paid in April.)
Your Social Security benefits are paid on or about the third of each month.
Information About Supplemental Security Income Payments
Beginning January 1998, the current
Supplemental Security Income payment is $ 250.00
This payment amount may change from month to month if income or
living situation changes.
Supplemental Security Income Payments are paid the month they are due. (For
example, Supplemental Security Income Payments for March are paid in March.)