Permit Window 2337 Seminole 2011 w sl
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
►,.) - ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
4 J;31
Application Number 11- 00001811 Date 3/23/11
Property Address 2337 SEMINOLE RD UNIT ##A
Application type description WINDOW AND /OR DOOR
Property Zoning TO BE UPDATED
Application valuation . . . 400
Application desc
ONE NEW WINDOW IN KITCHEN
Owner Contractor
BOHR SARAH OWNER
ATLANTIC BEACH FL 32233
Permit WINDOW AND /OR DOOR PERMIT
Additional desc .
Permit Fee . . . 55.00 Plan Check Fee . . 27.50
Issue Date . . . Valuation . . . . 400
Expiration Date . 9/19/11
Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONALELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
WINDOW AND DOOR INSPECTION:
*INSTALLATION INSTUCTIONS REQUIRED
*ALL STICKERS ARE TO REMAIN ON THE WINDOWS
*PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS
* Fins shall be nailed at 7 inch o.c. *
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 55.00 55.00 .00 .00
Plan Check Total 27.50 27.50 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 86.50 86.50 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: `' 3 3 7 Se/1 ,s i p( ( , P.c Permit Number: ( g)1
Legal Description A Parcel # 9 15 2.
oor • rea o q. t. q . t
Valuation of Work $ '160 Proposed Work heated /cooled non - heated /cooled
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool /spa indow /dj
Use of existing /proposed structure(s) (circle one): Commercial r " s.i &-nti
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes ENO,; N /A
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to be performed: A dvr 4-
Property Owner Information:
Name: ' G t ca W. Par- Address: Z 3 3 2 5 e, ; 9)e P
Cit , (u 1 fi C gee.: State Ft-Zip 3 22.3 3 Phone 40c( 2C(G
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: Qualifying Agent:
Address: City State Zip
Office Phone Job Site/ Contact Number Fax #
State Certification /Registration #
Architect Name & Phone #
Engineer's Name & Phone #
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void if work is not commenced within six (6) months, or if construction or work is suspended or abandoned for aperiod of six (6) months at any time after
work is commenced. 1 understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters,
Tanks and Air Conditioners, etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereby certify that I have read and examined this pplication and know the same to be true and correct. All provisions of law ,a • 4 2E4 . p, ,ggye, t this
type of work will be complied with whether specified herein or not The granting of a permit does not presum : . >,° 6Lin the
provisions of any other federal, state, or local law regulating construction or the performance of construction. •
Signature of Owner Signature of Contractor;. F ILE C 0 P¥ t 1 _
7 /i
Print Name ..> � Print Name �ne -� --� � � ��� �• -��°
Sworn Vind subsc,�'jibed be� fo me �, DiOi COMPI LANCE I
this , Day of i`tiR- t�c�l.__ , 20 0 20
/ r I ' � "„ � '•�� �� C SEE P ITS FOR ADDITIONA
Notary Public 1 � EXPO 1, 884126 R13�d 1�il tSAND- 1,U1�ID1 .
156 0 -
- T i bNe U dnrtwtttrre
REVIEWED BY: ill DATE: Revised 01 ► 6.10
s
t
CITY OF ATLANTIC BEACH
®WNER / BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING" REQUIRES OWNER / BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT
LAW. THE EXEMPTION ALLOWS YOU, AS THE OWNER OF YOUR PROPERTY, TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST
SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE — OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST OF $25,000.00 OR LESS. THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER 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.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND /OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455- 228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT (247 -5826) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER- BUILDER PERMIT.
2 7ri! i/ro/ del 90/ 7- -55 5
ADDRESS / PHONE NUMBER
PRINT NAME
SIGNATURE 3 /Z� /�I
SI
DATE
Before me this day of 20 in the county of
Duval, State of Florida, has personally appeared herin by himself / herself and affirms that
all statements and declarations ar and accurate. p�
Notary Public at Large, State of , County of �' vt/ - G•-•��-
❑Personally Known "
`fGt Produced Identification - / ✓(// �� ti �''I�: D EBORA H A, y yI {I TE
/J r MY COM MISS I O N # DD 63 4126
Notary s !` / wed T, IR N a M P ue
Nota 21 un 2 a0 1 nvnt ers
Si natur:
F: /BLDG /Owner - Builder Affadavit; REVISED: 4/16/2009
Print Quote Page 1 of 2
More ,av More doing
Home Depot Store # 6365
12721 ATLANTIC BLVD
JACKSONVILLE, FL 32225
9042200822
DATE: 03/17/2011
CUSTOMER:
BOHR, SARAH
2337 SEMINOLE RD
ATLANTIC BEACH, FL 32233
9044726252
SALES ASSOCIATE: ROBERT
Thank you for shopping The Home Depot! We value your business!
UNIT TOTAL
ITEM FRAME SIZE LOCATION PRODUCT CODE DESCRIPTION PRICE QTY PR CE
0001 MANUFACTURER:JELD -WEN Windows & 1
Patio Doors - Venice
Frame Size = 47" W x 41" H Manufacturer: JELD -WEN Windows & Patio
Tip to Tip Size = 48" W x 42" H Doors - Venice
Product Design: Windows
Configuration: Single Hung
Frame Size Width: 47"
Frame Size Height: 41"
Exterior Finish: Builders Aluminum
Product Type: Single Hung
Impact Unit: No
Frame Type: Front Flange
Frame Color: White
Size Type: Standard and Custom Sizes
Sash Type: Equal Sash
Vent Height: 20 1/2"
Dade NOA: No
Florida Approval Number: 10970.2
Glass Rating: DP50
Glazing: Insulated
Inner Glass Thickness: DSB
Outer Glass Thickness: DSB
Glass Tint: Clear
Obscure Glass: No
LowE Glass: LowE 366
Tempered Glass: No
Insulated Glass Option: None
Grille Pattern: None
Screen: With Fiberglass Screen
Screen Type: Fixed Half Screen
Screen Color: Charcoal 18/16
Screen Installation: Installed
Hardware: Double Cam -Lock
Jamb Thickness: 2 11/16"
Egress: Does Not Meet Egress
Mull Prep: None
* *M20 Version Date: 10/27/10**
**M20 Catalog Version: 1.10.2**
Base Price for Single Hung: 4SH4842 $ 119.65
LowE 366 - Glass: $ 29.41
Insulated - Glass: $ 50.40
$ 199.46 $ 199.46
http: / /vendorapps. homedepot .com /usp /PrintQuote.jspx 3/17/2011
ty�r� City of Atlantic Beach APPLICATION NUMBER
a Building Department (To be assigned by the Building Department.)
v 800 Seminole Road
, Atlantic Beach, Florida 32233 -5445
Phone (904) 24,7 -5826 • Fax (904) 247 -5845
r;;IV' E -mail: building- dept @coab.us Date routed:
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Z37 De nt review required es No
u ding
Applicant: ping & Zoning
� Tree Administrator
Project: Public Works
Public Utilities
Public Safety
Fire Services
Reewf . _ ' �. 1 , �w DepS19.re X
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: [E1■■Pproved. [Denied.
(Circle one.) Comments:
/
BUILDIN
PLANNING & ZONING Reviewed by: Date:3
TREE ADMIN. Second Review:
Approved as revised. ❑Den ed.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09