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Permit Add 1959 Selva Marina 2011 , , CITY OF ATLANTIC BEACH f, b s 800 SEMINOLE ROAD J �: ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5826 Application Number 11- 00001889 Date 4/13/11 Property Address 1959 SELVA MARINA DR Application type description RESIDENTIAL ADDITION Property Zoning TO BE UPDATED Application valuation . . . 27560 Application desc CONVERT PORCH TO BEDROOM ADDL SQ FGT Owner Contractor ROBBINS THIS OLD BEACH HOUSE INC 1959 SELVA MARINA DR. 3869 GRANDE BLVD ATLANTIC BEACH FL 32233 JAX BEACH FL 32250 (904) 249 -2904 Structure Information 000 000 Construction Type TYPE 5 -A Occupancy Type RESIDENTIAL Flood Zone ZONE X Permit RESIDENTIAL ADDITION Additional desc . Permit Fee . . . 190.00 Plan Check Fee . . 95.00 Issue Date . . . Valuation . . . . 27560 Expiration Date . 10 /10 /11 Special Notes and Comments *2007 FLORIDA BUILDING CODE W/2009 REVISIONS NATIONALELECTRIC CODE *SUBMIT "CERTIFICATE OF COMPLIANCE" BY A LICENSED PEST CONTROL COMPANY PRIOR TO C.O. *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. WINDOW AND DOOR INSPECTION: *INSTALLATION INSTUCTIONS REQUIRED *ALL STICKERS ARE TO REMAIN ON THE WINDOWS *PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS Roll off container company must be on City approved list and container cannot be placec on City right -of -way. Other Fees STATE DCA SURCHARGE 2.85 DEV REVIEW - SINGLE & 2 -FAM 25.00 ENG REV PRE APP > 3 HRS 25.00 STATE DBPR SURCHARGE 2.85 UTIL REV PRE APP >3 HRS 25.00 PERMIT I APPR -- QNLY IN ACCORDANCENFI ff LL CITY OF A` L P Z7R IC BEACH 214Ctg AND THE FielieDA BUILDING CODES. ` ' *s CITY OF ATLANTIC BEACH . a , '� zy 800 SEMINOLE ROAD . Z. ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5826 ,,may f:),131 9" Page 2 Application Number 11- 00001889 Date 4/13/11 Permit Fee Total 190.00 190.00 .00 .00 Plan Check Total 95.00 95.00 .00 .00 Other Fee Total 80.70 80.70 .00 .00 Grand Total 365.70 365.70 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. ' 4 , - , , .• , ,,I . ' • • , %....! bK :::,b0 -age ;4,:Dd ' NOTICE ' OF COMMENCEMENT Number Pages ! ....; - Recorded 6406 2011 at 09 Am jiM FULLER CLERK CiRCH1T (DOURT DUVAL COUNTY • . RECORDVNG $10 00 • 2_-_ H . ''...13 .i..?!''',1CiNI hereby gives notice that improvements will be made to certain real property, and in accordance with Section tiorida Statutes. the following information is provided in this NOTICE OF COMMENCEMENT. _ . • i -, -,•+ i , i ,1 7,' fiego/ , i description): .L. , 1 . - ,. _ r ( r . ', ,‘.. - .,..L - 1 19 E ..5 L.., i' t \-I c>i2. i.. 3 4 ddress: A :9'5'1 ,, --. ' t P , P. k..._. ([ >1?,., /4-71-APj-ric..., sc. 14, .EL , 2,133 • ,,,. .-., ,i,--,:::cmt,,,,:)t improvements: _ ____,,,,.., F.- e . 4 .2 43:...r2 t ,--, - 1 - i:, 5E0' 9.„,,.:4,,, , ,4J q0C)F ot/Eg I>5..c.- f,t and address: 1 ' 56 0- 5 7_ .. , . 1„et,....4,?, hrt.. 5.r.,4, .--.• I-- - - ' , . .f -; f - I V •C‘ (LI ±1,..-- '1 :nld address of fee simple titleholder (if other than owner) t in property _ A 1 7,7 - , .... :, } ' and address: ii izn , . C-1c2t ; t C— .4. , -- - , , i::-, prione No.: Fa.x No. (Opt.) (- 0 5 ZA`l ,,,,, H;.:,,uat.,r!n _ rici, ar.iclie›s. rst iiiiii i it Hone: •„.leonone No.: Fax No. t Opt.) . .. .•, -.,:a!“., 1.n.c.i :.v..iiiress: 1'1) _ Phone No. „._. . . person within the State of Florida designated by owner upon whom notices or other documents may he served: and address: _ NI it . _ uoramc No.: Fax No. Opt.) . .i :. ii. nursed', owner designates the following person to receive a copy of the I.ienor's Notice as provided in Section lorida Statutes: Name and address: isi.„(0.1-‘ic _____ to : ,r.lephoile No.: • Fax No. (Opt.] •,iare of Notice of Commencement (the expiration date is one year from the date of recording unless a different date .. ,e1-iii.-ii)! '10 OWNFR: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF EME NT AKE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, IL TES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. cOotivlENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST If YOU. INTEND TO OBTAIN FINANCING. CONSULT YOUR LENDER OR AN ATTORNEY BEFORE 0 kit t .:( I.Nit.; WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. / . , ,.. .) i [ O. a... ' i I. 1 , ... SignAure of Owner or Ovine - s A mind Officer/Director/Partner/Manager 10°goCe-:- ...._ Print Name -,- ., i•:•., i it:. idstrurnent 1V as acknowledged before me this - day of (..I,.' p../1,1-0_ , 20 i 1. by . . as i i_. h%. LI (type of authority, e.g. officer, trustee, f ' i .r•,„'i',e-+, in faci; tor 1-- i 1 KJ.. 7.4-(.1.--).--' (name of party on behalf of whom instrument was executed). • L.. '.k, Avn 7 OR Produced Identification Notary Signature _41-11.4..., i,?'). L k- ZL t /--- , i•i, r , th..•ntitkatiott Produced —_ Name (print) ,- ..Wt /-)i. F.- ((),I ('-f ',,,,: OR ptifRtiant, to Section 92.525. Florida Statutes. Under penalties of perjury. 1 declare that I have read the foregoing and that in it are true to the best of m knowled e and belief. - -----. JANE B. WILCOX (.71,,, MY COMMISSION # DD 934790 EXPIRES: February 20, 2014 Signature ot Natural Person Signing • (in line # 10 ) Above - ''' , 7 . " , •'•ef Bonded Thru Notary Public Underwriters BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247 -5826 Fax (904) 247 -5845 // 0 Job Address: \ckn 5E1V VIA2trJA D Permit Number: / — 5ELv r( tE Legal Description 3 t 0 r3 7 S — ' U S . E T ( Lc T 1 Parcel # I' ° I 50 C9 100 2. d oor Area of Sq.I"t• o n- heated/cooled L( y Valuation of Work $ 2-'1 5(0C) Proposed Work heated/cooled ,3`i Z non-heated/cooled — (lass of Work (circle one): New 5jjj Alteration Repair Move Demolition pool/spa window /door Use of existing /proposed structures) (circle one): Commercial ' esidentii. 1 Ilan existing structure, is a fire sprinkler system installed? (Circle one): ' es ' • N /A Florida Product Approval # For multiple products use product approval form 1)escribe in detail the type of work to be performed: ( riyr�R, - 1 EXt.t-2Tt r-t& r av lZeto i li . c,= 1 (t 13 DRc� r'1, C.otsiver r E/ct S - Vr-1Cot/Ea •c 1 C...i.c Ta (wt) (2. .i> Property Owner Informat Narne:_.___ 1 R u t,.� iZo t,-} 5 Address: ( "IS ci _SE LVq i''l Ase\r_tc) a. Cit., _JA NT tr., sC StateFLZip 72233 Phone X1 L4 Z\ L Mail or Fax # (Optional) Contractor information: Company Name: �e OL o Ge15 c\ov'SE, [I-' c - • Qualifying Agent: tc- 1ca>:L GO tc-t_ Address: H 1_0 - A U C. Ec_x..A 'Au F City --1 A.,x Sc■+ State F L . Z, „ U Off ice Phone C2 3 5- 2 t<, DC,- Job Site/ i --- - . -. � .1 4, = a. Fax # , S �, , State Certification /Registration # G I i i i f r� o ti '. 1. Architect Name & Phone # V.F • t . ,( �i r���i-� i ir� ) X 1 ►/ - ► _ �i� ; E ngineer's Name & Phone # (�) Y 11`l1� : Y : _L Y as ° -. -�,, tee Simple Title Holder Name and Address 11 1 r 1 ��1N��t!l1�Y�i : a r s r . Ian � -1 Bonding Company Name and Address 1 y • UIREMENTS 4 OD • ■I• Mu .. tR -I ' Mortgage I ,ender Name and Address 1 L j ,- . . i: r►� /�Iq:1V for a . / r LriJ • r DATE: „ itu,tication is hereby made to obtain a permit to do the wor , • .7-'7-7-- • , s + zerouk•i +« • • : menced ri ` . , the ssuance al a permit and that all work will be performed to meet the standards of a aws r egu • a t • - i ' ie • null Ind t, Void d I u ork is not commenced within six (6) months, or if construction or work is suspended or abandoned for a period Po f ls six / 6 F . • finis , t r t e i er � wo i.s commenced. 1 understand that separate permits must be secured for Electric Work, Plumbing, Signs, Wells, Tanks and Air Conditioners, eic. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE e - --- - - 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 BEFOR ERECORDING YOUR NOTICE OF 1 r r , ,1' c,.rt iJv that 1 have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this ttlrc of work will he complied with whether spec: led herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of cozy other federal, state, or local law regulator construction or the performance of construction. i Signature ot'()wner � Signature of Contractor � / '" 1 xe "6 Print Name 1 Print Name ........... ._ f. � ..F.1_,... ...._ � .. Aj...LG..K., Sworn to and subscribed before me Sworn . and . ; cri. d before r e this 5 Day of C L p n c P , 20 L i this , . . of • 1 Lrr 4 20 ry Publ►c k JANE B.WILCOX , ''ir t; R , o . t w • O,. r 1! ers ° 'Ip „ P ` AND 54e OF ME CURRENT FUBLtC RECORDS OF DUVAL COUNTY, FLORIDA. I I L ori/ Fe tpt 339 ' t `-O 3 5. 07 ° 35 1 ° " . .. • . t h4 71 339 ; . t • 4, I, j Cit o ` D g %r /7. 2' 9 4 6 1 1, tor.. i *.rt ;f p., a ed i a,c 4 .; f T 1' rn (\ # •••## S Q (, G � .. 1 a. it ,.,. T b d. 3 Vs . A, 41..11641. ; Z - 1 4 .„.' - k � - aAME f 6n�c� /. , s 414 !-SroR k1F,<a fNc • L o y N Nilk 15.4' ., 7 .i L 9.95 , - '!J '{( Q ;$ . p 4 an f9r '""fir fr� la : w ` J 4 4 W q ��.1' r6 h �� - . w 1 4m r ©�a 4 ' (QUrde Faund /a�.r9a>Ar g-. d iti t ► ms s 95.101 u'' tor 44 i'� NOTES (forr j da' R 6A ' BEARINGS ARC BASED ON THE NORTH UNE OF LOT I THis PROP `="' LIES IN FLOOD ZONE "X" SY FLOOD MAPS AS BEING N.99'C8'46 "E. BY PLAT, REVISED 4/17/tik139. COMMUNITY PANEL NO. 120O75 00010. NO BUILD /NG RESTRICTION LINE BY PLAT, BUT THERE MAY BE RESTRICTION LINES OR EASEMENTS THAT AFFECT THIS PROPERTY BY ZONA() OR RECORDED IN THE PUBLIC RECORDS I ! HERE Y CERTIFY TO: TOM 8 QLIYE I4. BRUGGEMAM OF THIS CODUTf THAT ARE NOT SHOWN ON THIS SURVEY. NA ONSBAPS( OF f L ;D4 : '"e0e644.0,4444-0-,4.4.77. 1�TL,e<- /. ' .r. ,r400r 1 0,A , e; -+•s 4.6..s...e .47-7},-.„.4-. , APPENDIX 13 -D EtTective March 1, 2009 1 FLORIDA ENERGY EFFICIENCY CODE FOR BUILDING CONSTRUCTION ALL CLIMATE ZONES FORM 11008 -08 Residential Component Prescriptive Method 8 Compliance with Method 8 of Chapter 11 of the Florida Building Code, Residential or Subchapter 13 -6 of the Florida Building Code, Building, may be demonstrated by the use of Form 11008 for single -and multiple - family residences of three stories or less in height, additions to existing residential buildings, renovations to existing residential buildings, new heating, cooling, and water heating systems in existing buildings, and site -added components of manufactured homes and manufactured buildings.To comply, a building must meet or exceed all of the energy efficiency requirements on Table 118 -1 and all applicable mandatory requirements summarized in Table 11B-2 of this form. If a building does not comply with this method, it may still comply under Method A of Chapter 11 orSubchapter 1 of the applicable code. • ! BUILDER: 1` C)L. V G k} PROJECT NAME: - © � `t r "' , AND ADDRESS: t J J c ^ P. PERMITTING _ . , j,, r ` / 5 OFFICE: ,. ' _ ii u OWNER: PERMIT NO.: ©r t apir JURISDICTION NO.: ! J 1 . New construction including additions which incorporate any of the following features cannot comply using this method: skylights or othernonvertiral roof glass, glass areas in excess of 16 percent of conditioned floor area, and electric resistance heat (See Notes to Table 110-1 on page 2). 2. Fill in all the applicable spaces of the "To Be Installed" column on "Table 118 -1 with the information requested. All "To Be Installed" values must be equal to or more efficient than the required levels. 3. Complete page 1 based on the "To Be Installed" column information. 4. Read "Minimum Requirements for All Packages ", Table 118-2 and check each box to indicate your intent to comply with all applicable items. 5. Read, sign and date the "Prepared By" certification statement at the bottom of page 1. The owner or owner's agent must also sign and date the form. Please Print CK 1. New construction, addition, or existing building 1. / ,&A-e t - +1 C ) 2. Single - family detached or multiple - family attached 2. - c---; 4--- 3. If multiple - family -No. of units covered by this submission 3 . 4. Is this a worst case? (yes/no) 4. A 5. Conditioned floor area (sq. ft.) 5. 6. Glass type and area: 6a. + a. U b. SHGC 6c. ! sq. ft. c. Glass area 7. Percentage of glass to floor area 7. - % 8. Floor type, area or perimeter, and insulation: R. a. Slab -on -grade (R- value) 8a . R - Iin.ft. b. Wood, raised (R- value) 8b. R = sq. ft. c. Wood, common (R- value) 8c. R. sq.ft. d. Concrete, raised (R- value) 8d. R. sq.ft. e. Concrete, common (R value) 8e. R. sq.ft. 9. Wall type, area and insulation: a. Exterior: 1. Masonry (Insulation R- value) 9a - R= sq.ft. 2. Wood frame (Insulation R- value) 9a - R = 1 3 20 sq. ft. _ b. Adjacent: 1. Masonry (insulation R - value) 9b R. sq.ft. 2. Wood frame (Insulation R value) 9b R. .. sq.ft. __ _, 10. Ceiling type, area and insulation: //^�� a. Under attic (Insulation R- value) 10a. R.. 30 sq. ft. V b. Single assembly (Insulation R- value) 10b. R= sq.ft. 11. Air distribution system: Duct insulation, location .. 11a. R= Test report required if duct in unconditioned space ?, �`- 11 b.Test repo ttached? Yes € 12. Cooling system: 12b. SEER/EER: / 410 (Types: central ackage terminal A.C., gas. none) r 12c. Capacity: T EEM 13. Heating system: 13a T ' ��� - - (Types: heat pump, elec. strip, nat. gas, LP -Gas, gas h.p I{ir►N' .r ' C, n on e)• 13b. HSPF /COP /AFU : 13c. Capacity: ' tlre1 14. Programmable thermostat installed on HVAC systems: r _ 14. Yes No of 15. Hot water system: 15a. Type: i (Types: elec., nat. gas. LP -gas, solar, heat rec., ded. heat pump, otter, none) 15b. EF: <4) Ai , i hereby certify that the , - ns a ■ .. di . „ covered by the calculation are in mpiance with ' Review of plans and specifications covered by this calculation indicates compliance with the Florida the Florida Energy Co . / Energy Code. Before construction is completed, this building will be inspected lon compliance in a , // accordance with Section 553.908, F.S. PREPAR' 4/ .11 L DA : I BUILDING OFFICIAL I hereby certify the thi u'idigp is i oiai � 1 i re the Florida Energy Code: /j �I' DATE: 9 6 - /1 OWNER AGENT: / DATE: 10 2007 FLORIDA BUILDING CODE - BUILDING 13 -0.23 Y APPENDIX 13 -D * TABLE 11B -1 MINIMUM REQUIREMENTS (See Note 1) All Climate Zones BUILDING COMPONENT PERFORMANCE CRITERIA INSTALLED VALUES: I U- Factor = 0.65 U- Factor = , G, S" 1 Windows (see Note 2): SHGC = 0.35 SHGC = , 3 % of CFA <T16% % of CFA = _ s_L_.�?._._ ____ Exterior door type_ Wood or insulated ^._ __ Type: _ —. ......._. ' Walls - Ext and Adj. (see Note 3): Framo R -13 R -Value = ) Mass (see Note 3) Interior of wall: - R-6 R -Value = R -value - �._. Exterior of woe: .- -- -_-- -- ....__._ _._..__ —..— ..—. ___T . eat__ Note 10) ._._ Not allowed Electric resistance hoot (See Note 10) —.-- Ceilings (see Notes 3 & 4) ,_, R =30 _,.R-Value = 3(-7 . -.__ 1 Floors: Slab -on -grade No requirement R -Value = a • I_ Over unconditioned spaces (see Note 3) ( R -13 .. Hot water systems (storage typo) Electric (see Nato 5): 40 gal: EF = 0.92 Gallons = 40 gal: EF = 0.50 EF I 6.x• . r Gas fired (sea Note 6): 40 gal: EF = 0.59 Gallons = ' 50 gal: EF = 0.58 EF= _ _ it conditioning systems (sae Note 7) SEER = 13.0 _ _ _ SEER = 1"5 Heat pump systems (see Note a) SEER = 13.0 SEER = -- HSPF= 7.7 - HSPF = l . 7 ... _ - I Gas tumaces AFUE = 78% AFUE = __— ! 1 Oil tumaces AFUE 6 78% AFUE = 1 Programmable thermostat (see Note 10) Must be installed on all HVAC systems. Instafed7 Yes No ! Ductwork: (see Note 9) Location: Unconditioned space' R-6, TESTED , ` Unconditioned space Conditioned space NA • / Wj1..C.i R- Value= Unventetl attic assembly per R806.4 with Insulation et the root plane R-4.2 C Test report: Conditioned space R -Value - (No test repo required) Air Handler location: Unconditioned attic' or garage Requires test snort Location: Conditioned space or 1 '"� Test report: Unvented attic assembly per R806.4 with Insulation at the roof •:an - du o ct test required__ (1) Each component present in the As -Built home must meet or exceed e. . i • • ..li . • .. . ' ance criteria in order to comply with this code using this method; oth- erwise Method A compliance must be used. (2) Windows and doors qualifying as glazed fenestration areas must comply with both the maximum U- Factor and the maximum SHGC (Solar Heat Gain Coefficient) criteria and have a maximum total window area equal to or less than 16% of the conditioned floor area (CFA), otherwise Method A must be used for compliance. Exceptions: 1. Ad- ditions of 600 square feet (56 m or less may have maximum glass to CFA of 50 percent. 2. Renovations with new windows under z 2 foot overhang whose lower edge does not extend further than 8 feet from the overhang may have tinted glazing or double -pane clear glazing, Replacement skylights instated in renovations shall be doublepaned or single paned with a diffuser. (3) R- Values are tor insulation material only as applied In accordance with manufacturers' installation instructions. For mass walls, the "interior of wall" requirement (R -6) must be met except it at least 50% of the R-4 insulation value required for the "exterior of wall" Is installed exterior of, or integral to, the wall. (4) Attic knee walls shall be insulated to same level as ceilings and shall have a positive means of maintaining insulation In place. Such means may include rigid insulation board or air barrier sheet materials adequately fastened to the attic sides of knee wall framing materials. (5) For other electric storage volumes, minimum EF = 0.97 - (0.00132 " volume). (6) For other natural gas storage volumes, minimum EF = 0.67 - (0.0019 * volume). (7) For all•conventionai units with capacities greater than 30,000 Btu /hc For Small -Duct, High - Velocity units, Space Constrained units, and units with capacities less than 30,000 Btu /hr see Table 13- 607.AB.3.2A of the Florida Building Code, Building or Table 141107.AB.3.2A of the Florida Building Code, Residential. (8) For all conventional units with capacities greater than 30,000 Btu /hr. For Small -Duct, High - Velocity units, Space Constrained units, and units with capacities less than 30,000 Btu/hr see Table 13- 607.AB.3.2B of the Florida Building Code, Building, or Table N1107.AB.3.28 of the Florida Building Code, Residential. (9) All ducts and air handlers shall be either located in conditioned space or tested by a Class 1 BERS rater to be "substantially" leak free. "Substantially leak free" shall mean distribution system air leakage to outdoors no greater than 3 ctm per 100 square feet of conditioned floor area at a pressure differential of 25 Pascal (0.10 in. wc.) across the entire air distribution system, including the manufacturer's air handler enclosure. Exception: New or replacement ducts installed onto an existing air distribution system as part of an addition or renovation. Such ducts shall either be insulated to R -6 or be installed in conditioned space. 10) The prohibition on electric resistance heat and the requirement for programmable thermostats do not apply to additions. renovations, and new heating systems installed in existing buildings. TABLE 110 -2 MINIMUM REQUIREMENTS FOR ALL PACKAGES COMPONENTS _.__, SECTION REQUIREMENTS �— __ CHECKK Exterior Joints & Cracks N1106.AB.1.2 To be caulked. gesketed, weather - stripped or otherwise sealed. ✓ 1 Exterior Windows & Doors 141106.AB.1.1 Max .3 cfm/sq.ft. window area; .5 drNsq.tt. door area. _ Sole & Top Plates _ Nt 106.AB.1.2.1 Sole plates and penetrations through t� plates of exterior walls must be sealed. _ ....r _Recessed Lighting N1106.A8.1.2.4 Typo IC rated with no penetrations Ltwo altemativos mowed). . -___ __._.._._.— .-•••"'"' _ Multistory Houses _ N1106.AB.1.2.5 Air banter on perimeter of floor cavity between floors, _ / Exhaust Fans N1106 .A8.1.3 Exhaust fans vented to unconditioned space shall have dampers, oxcept for combustion devices with integral exhaust ductwork. Water Heaters N1112.AB.3 .__. Comply with efficiency requirements in Table 141112.AB :3. Switch or clearly marked circuit breaker electric or cutoff �..- __ (gas) must be provided. External or built -in heat trap required for vertical pipe risers. ___ Spas & heated pools must have covers (except =tar heated). Noncommercial pools must have a pump timer. Gas Swimming Pools & Spas Nt 112.AB.2.3.4 spa & pool heaters must have minimum thermal efficiency o178 %. Heat pump pool heaters shall have a minimum i/) �, COP of 4.0. I (f/� Hot Water Pipes N1112.AB.5 Insuaton Is required for hot water circulating systems (Including heat recovery units). Shower Heads N1112.AB.2.4 Water flow must be restricted to no more than 2.5 pallons per minute at Bo psig. �, HVAC Duct Construction, All ducts, fittings, mechanical equipment and plenum chambers shall be mechanically attached, sealed, insulated ... /""-'- Insulation &Installation /41110.AB and installed In accordance with the criteria of Section N1110.AB. Ducts in attics must be insulated to a minimum of HVACControls 41107.AB.2 Separate readily accessible manual or automatic thermostat for each system. 13 -D.24 2007 FLORIDA BUILDING CODE — BUILDING e O ` O Po v w N t W 1 ON '-^ w N ---• 1---J eD = « � T i r p ' e CJ 4 o > g n x 0 Y xi cn 4 c� 0 �O D rt 51 0 5 9 co, m o c� c' o B' A: O Cr >✓ as `� y r 8 r* o a E as 1 ,.� 0 0 CD O c + 'CI r ''d (D 0 rt v. . H 0.. � Q., w ill or ec 44 is '11 G + ; N T 1- I C1 r C b CO N O N 2 O CI a (D N ■ E4 a a ;� 1 DD , o Y " A w W f� :11 c� M 0 L-4 as cD cD 0 r (°, 0- �C .c O as E CD a 0 I Oa FA !al W N i.- ~ Oo :1 01 th ? ■'--. Xi , G \p 00 J a1 (.h , .P W N .111171t N ' O r O O O O O 0 Q c4 0 4 C) , C� cA tr1 O C/1 i 0 O °, s o o o° o o a y o - b kg 8 cD g a: 4 5, 'v o vo ti' `'o °ra CDo o '0 va y n - o g 6- c o � ' 1 = cr o tz iD ro 5 ' 5_ .r 0 S c a q a ` R . 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City of Atlantic Beach APPLICATION NUMBER J ;? ../V -L..., Department e b the Buildin artment ; - i (To asst 9 ned .. 9 De P ) At' A 800 Seminole Road 1 a r Atlantic Beach, Florida 32233-5445 NI d g �' 11 / a T k '" ° . Phone (904) 247 -5826 • Fax (904) . 845 �, *:,k F ,, i' - %. > f3 , E -mail: building- dept @coab.us , Date routed ai-is + T ma x} -_ City web -site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: / 96 Silt/ et. /heir I n a- . - • • - nt review required Yes No U I Buildine_ ./1111111111111111111111 Applicant: -1/f - .S ad &aeAA A c�Z 4 P nning & Zoning -- •dministrator -- Project: a)r)VI2 ro rch a dro j& rublicWorks_ _- io 54—,1 0- cv V i% - NO - / D � # w Fire Services _— " `�'" ""�' q ,k f } L .i t-r a .��z�r ire. n T.Idd •t+. aY 7ij'" ..-r 9 t ! iaa N v f " evlewGfee$ 614 .';01 f NTS18ignat c , a "44:7; ., ; •- -. ",s 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: ❑Approved. ¥Denied. (Circle one.) Comments: p Ste_ Qi BUILDING PLANNING & ZONING Reviewed by: Date: // // TREE ADMIN. Second Review: ri:, • pproved as revised. rlDenied. 41 PUBLIC WORKS Comments: PUBLIC UTILITIES � 0/1 PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: nApproved as revised. (Denied. Comments: Reviewed by: Date: Revised 05/14/09 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247 -5826 Fax (904) 247 -5845 Job Address: \`t5`t SE1tc.'A MAC irJA D� Permit Number: 5 ELva r.(oQTE Legal Description 3 `{ P Sf 01 7 5 -2._ E U r-1 T ( L oT 1 Parcel # ) (? '1 50 (0- 10 01.. 'Ioor Area of Sq.Pt. Sq.Ft Valuation of Work $ V 1 5 Proposed Work heated/cooled �`i L non - heated/cooled 1 Class of Work (circle one): New Additio 1 Alteration Repair Move Demolition pool /spa window /door Use of existing /proposed structures) (circle one): Commercial ' esidenti. If an existing structure, is a fire sprinkler system installed? (Circle one): ' es fa0 N /A Florida Product Approval # For multiple products use product approval form G✓ Describe in detail the type of work to be perform „ performed: C �ivER.`T , EX G� IZ t p-1 i (7 - 'ce tf� l . Jr:, Jr:, ,` I i, LJ I� R Dot rt, CO Lrd� � - r� t S Ti ir∎I � V o g - 1 - 1> - 1 - 1> t�atl c> 7 5c-K EfLE [, �c D C. g-- Property Owner Information: Name: 3 (z u 1' 1z o 6C% t t-15 Address: l 9 5 `l _'E Lvq H Ace. % ,..i q a City A i LA1. tC. 'Q C N State FL-Zip 7223 Phone G, f L4 10 E -Mail or Fax # (Optional) Contractor Information: r( Company Name: �,�c4 O� � !� ouS� lrJ c-. Qualifying Agent: Ht C-14 AFL- GO IC- K— Address: L( 7.0 • A OS t, C 'i A A,, 5 City .. -..1 qx 5 ct+ State f L Zip 322 -D Office Phone 6,135- Z 6 nG Job Site/ Contact Number 1 `l r i /�, s ( - %oo Fax # (B 2A State Certification /Registration # Cr"ri G- /5779 5 3 Architect Name & Phone # V-_ERt -1Pfy A Rr. I-I frEr - r5 zL((o• 1150 Engineer's Name & Phone # Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and Address ,44pplication is hereby made to obtain a permit to do the work and installations as indicated 1 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 sus ended or abandoned for a�period of six (6) months at any time after work is commenced I understand that separate permits must be secured for Electrical 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. 1 hereby certify that 1 have read and examined this a plication and know the same to be true and correct. All provisions o laws and ordinances governing this type q / - work will be complied with whether speci ied herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other federal, state, or local law regulatin • construction or the performance of construction. t :to 4i� , .signature of Owner / - a Signature of Contractor Print Name 1 ��uce A- , - "OAP /NS Print Name �, Sworn to and subscribed before me Sworn m and .:,crib d before ► e tins J Day of j 20 11 this >r of 4 . Li 1 , 20 .�=,, .fir' -- -�. !-'>---- ' ` - --- --- �'�aC: t y Public u JANE B .WILCOX 1 * . o' Ds' et `�, t r , �•� r MY COMMISSION N DD 934790 �,��: o_ EXPIRES: February 14, 14,014 1 d:' Bonded T hru Notary Public Underwriters .. � EXPIRES: February , pr Revised 01.26.10 °'� mow`- ibi ERES Fua 20 2014 , . or id:`' Bonded Thru Notary Public Underwriters ,istY:"-v.:1;/, City of Atlantic Beach ,.. - _ = APPLICATION NUMBER ` ? " 1 Building Department (To be assigned by the Building Department) ' v 800 Seminole Road a o- , ) Atlantic Beach, Florida 32233 -5445 APR 0 Jr.) a j Ph on e (904) 247 -5826 • • Fax (904) 845 9 Q ` - . --DR fi r. E -mail: building- dept @coab.us _ � µ Date routed - a 1" , f/ �j{ i APPLI CATION City web -site: http: / /www.coab.us APPLICATION REVIE W AND TR CKING FORM Property Address: ! 96 Sc/i/A, /hQ' nt review required Yes No Buildin Applicant: - fill S Did ,Efine 7 A asz lin & Zoning Ti 6e7Xdministrator Project: CO t V 7 7 t eh d ro 0 ublic Works Tres ,b tc n C v C/ - Pfo 4- - - Ti tic =@ofet ODvWiQ Fire Services 9 x� gg a � � � +�. �t ,'�- iy�5�+ 1����+� -� +`gym � �6 K ;�'v �e}� r�. �� �,�,��C q"� i�.t �i evlewrfee $ 4.,,:if,I _ , .t � �� 6, gat `� �- ;', 26., ;_ �,x,.at i._�:.tid 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 I Reviewing Department First Review: Approved. EDenied. (Circle one.) Comments: BUILDING PLANNING & ZONING Reviewed by: Date: 7�/t TREE ADMIN. Second Review: ['Approved as revised. nDenied. P 'i WORKS o ments: Jt: i S PUB IC A FETY Reviewed by: Date: FIRE SERVICES Third Review: (Approved as revised. I Denied. Comments: Reviewed by: Date: Revised 05/14/09 Graham Shirley From: Doerr, Sonya Sent: Tuesday, April 12, 2011 4:03 PM To: Graham Shirley Subject: RE: 1959 selva Marina Rd Good to go on my end. Sonya From: Graham Shirley Sent: Tuesday, April 12, 2011 2:37 PM To: Doerr, Sonya Subject: FW: 1959 selva Marina Rd Permit 114889 covert porch to bedroom and cover existing deck From: Graham Shirley Sent: Tuesday, April 12, 2011 1:31 PM To: Doerr, Sonya Subject: 1959 selva Marina Rd Sonya Do you have an issue with these plans ? The contractor is asking about his permit . Shirley Graham Building Department 800 Seminole Rd Atlantic Beach, Fl 32233 904 247 5800 1 City of Atlantic Beach APPLICATION NUMBER - jt +� Building Department (T be assigned by the Building D epartment.) ' - t 'i SSS a` <� 800 Seminole Road f Atlantic Beach, Florida 32233 -5445 _ / 1 - O Phone (904) 247 -5826 • Fax (904) 247-5845 r E-mail: building-dept@coab.us Date routed City web -site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: /96--9 Sth, it r' i .et ' - nt review required No Buildin•_ • Applicant: S �Cd fah ( 5z r'"- � nning & Zoning 11111111111111 App �/1� - - • dministrator _- Project: (ivir p eh 7 - z , l'0 0 A— blic Works _ __- Qov ei p Fire Services _- ` , " �"" aka "_`. z i t . N yL �-m��+."r"' r� n� tax a k {' ' .nl a '2a 3 k"3 'FS. b '7 r u'4"',1 °70, I h c + z°u ��JA r Revlew re : _7� 41 � , DeptSlgnature 1 4: ri .:. }� s 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: IPPDproved. ['Denied. (Circle one.) Comments: BUIL ING PLANNING & ZONING Reviewed by: ,1 Date: TREE ADMIN. Second Review: Approved as revised. _jD ied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: (Approved as revised. (Denied. Comments: Reviewed by: Date: Revised 05114109 !: L s j''4 11 .0 y , �'� CITY OF ATLANTIC BEACH r .r s y 1 800 SEMINOLE ROAD J Vi 4 .. =` ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5826 Application Number 11- 00001889 Date 4/14/11 Property Address 1959 SELVA MARINA DR Application type description RESIDENTIAL ADDITION Property Zoning TO BE UPDATED Application valuation . . . 27560 Application desc CONVERT PORCH TO BEDROOM ADDL SQ FGT Owner Contractor ROBBINS THIS OLD BEACH HOUSE INC 1959 SELVA MARINA DR. 3869 GRANDE BLVD ATLANTIC BEACH FL 32233 JAX BEACH FL 32250 (904) 249 -2904 Structure Information 000 000 Construction Type TYPE 5 -A Occupancy Type RESIDENTIAL Flood Zone ZONE X Permit PLUMBING PERMIT Additional desc . Sub Contractor . ADVANTAGE PLUMBING Permit Fee . . . 76.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 10 /11 /11 Special Notes and Comments *2007 FLORIDA BUILDING CODE W/2009 REVISIONS NATIONALELECTRIC CODE *SUBMIT "CERTIFICATE OF COMPLIANCE" BY A LICENSED PEST CONTROL COMPANY PRIOR TO C.O. *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. WINDOW AND DOOR INSPECTION: *INSTALLATION INSTUCTIONS REQUIRED *ALL STICKERS ARE TO REMAIN ON THE WINDOWS *PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS Roll off container company must be on City approved list and container cannot be placec on City right -of -way. Other Fees STATE PLBG DCA SURCHARGE 2.00 STATE PLBG DBPR SURCHARGE 2.00 Fee summary ��77++ tt Charged nn Paid Credited Due A PERMIT IS PYKUYED t 01ER' �C DANCE WITH QITY OF ATLA p � BEACH ORDINANQI Q%ND THE FLORIDk 0 BUILDING CODES. -f— - f , s ` A CITY OF ATLANTIC BEACH ��� '�� ) 800 SEMINOLE ROAD J ' ATLANTIC BEACH, FL 32233 F. INSPECTION PHONE LINE 247 -5826 1319' Page 2 Application Number 11- 00001889 Date 4/14/11 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 80.00 80.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph (904) 247 -5826 Fax (904) 247 -5845 LOB ADDRESS: \ k Th 3€.lu \'‘ i '1100 r'> PERMIT # \ \ --1 f STEW OR REPLACEMENT INSTALLATION: Project Value $ 3e'), an TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY Bathtub Septic Tank & Pit Clothes Washer Shower 1 Dishwasher Shower Pan Drinking Fountain Slop Sink Floor Drain Three Compartment Sink Floor Sink Toilet ___L__ Hose Bibs Urinal Kitchen Sink Vacuum Breakers Laundry Tray Water Connected Appliances Lavatory i Water Heater Other Fixtures Water Treating System RE -PIPE: TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY Bathtub Septic Tank & Pit Clothes Washer Shower Dishwasher Shower Pan Drinking Fountain Slop Sink Floor Drain Three Compartment Sink Floor Sink Toilet Hose Bibs Urinal Kitchen Sink Vacuum Breakers Laundry Tray Water Connected Appliances Lavatory Water Heater Other Fixtures Water Treating System MISCELLANEOUS: ❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans) ❑ Lawn Sprinkler System - Number of Heads ❑ Well * * ** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection. ** ❑ 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 Phone Number Plumbing Company 2' c.,_ A . _.l• . ii. 1W Office Phone 24' Fax Z I u Co. Address: t Q 1 2,...._:::\ It.)e.k._ ‘,..N -3/4-V City xx to Om State' ` Zip License Holder (Print): r r► 1s__ y t _ State CertificationlRegistration # C_`FC Iy2 94 Notarized Signature of License Holder i ai • °' ;; MICHELLE L CREWS 'Sworn and subscri ed before me this ty day of Pyr t, 201 I ' ": .; ; *: MY COMMISSION # EE037670 p \ * -t EXPIRES October 26, 2014 s of Notary Public St C.3■Q (407) 398.0183 FlorldallotaryService.com r rs� City of Atlantic Beach APPLICATION NUMBER Building Department ment) f 800 Seminole Road j t ' Atlantic Beach, Florida 32233 -5445 4 • t`• Phone (904) 247-5826 • Fax (904) 247-5845 k {: -G x 013 ) s E - mail: building- dept @coab.us Date routed 1,1 City web -site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: ! C / C 9 S i� ` Orrin a ' - • - • - nt review required Yes No Buildin•_ Applicant: /f � .Ot d &/ u CZ 4 . ' - nning & Zoning _� -- administrator Project: 06/7V607 () /7V& 7 7 r eh a cJ re, 0 - ratio Work _ O oV tQ Fire Services �Si. �'§ `� '�X t Asa F�,�'ti'��•`�q, �.. � 0716 Dep i?-s t S 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: APPLI ATION STATUS Reviewing Department First Review: pproved. ❑Denied. (Circle one.) Comments: BUILDING l PLANNING & ZONING Reviewed by: Date: TREE ADMIN. Second Review: EApproved as revised. [Denied. 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 } s `''' s , CITY OF ATLANTIC BEACH .�, 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 Application Number . 11- 00001889 Date 5/12/11 Property Address 1959 SELVA MARINA DR Application type description RESIDENTIAL ADDITION Property Zoning TO BE UPDATED Application valuation . . . • 27560 Application desc CONVERT PORCH TO BEDROOM ADDL SQ FGT Owner Contractor ROBBINS THIS OLD BEACH HOUSE INC 1959 SELVA MARINA DR. 3869 GRANDE BLVD ATLANTIC BEACH FL 32233 JAX BEACH FL 32250 (904) 249 -2904 Structure Information 000 000 Construction Type TYPE 5 -A Occupancy Type RESIDENTIAL Flood Zone ZONE X Permit ELECTRICAL PERMIT Additional desc . Sub Contractor . KNIGHT ELECTRIC LLC Plan Check Fee .00 Permit Fee . . . 70.60 0 Issue Date . . . Valuation . . . . Expiration Date . 11/08/11 Special Notes and Comments *2007 FLORIDA BUILDING CODE W/2009 REVISIONS NATIONALELECTRIC CODE *SUBMIT "CERTIFICATE OF COMPLIANCE" BY A LICENSED PEST CONTROL COMPANY PRIOR TO C.O. *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. WINDOW AND DOOR INSPECTION: *INSTALLATION INSTUCTIONS REQUIRED *ALL STICKERS ARE TO REMAIN ON THE WINDOWS *PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS Roll off container company must be on City approved list and container cannot be placec on City right -of -way. Other Fees STATE ELEC DCA SURCHARGE 2.00 STATE ELEC DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due PERMIT IS AYYxC'YC'I'D els9V IW9 RDANCE WITi 91Lf'ITY OF ATUarIC(PEACH ORDINANC€ ( AND THE FLORIDA° 0 BUILDING CODES. r 4. lel 7 . � CITY OF ATLANTIC BEAC H ?� 800 SEMINOL ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 Page 2 i1- 00001889 Date 5/12/11 Application Number Plan Check Total .00 .00 .00 .00 .00 .00 Other Fee Total 4.00 .00 .00 Grand Total 74.60 74.60 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. r ELECTRICAL PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd, Atlantic Beach, FL 32233 Ph (904) 247 -5826 Fax (904) 247 -5845 � , «`8,� JOB ADDRESS: C VI C( w� PERMrr # / 0 NEW SERVICE ❑ Overhead 7 Underground 7 Underground up Pole ❑Residential (Main) Service am s of ?deters 00 -100 amps 101- 150amps 0151 200amps P ❑ Commercial (Main) Service • T Service amps 00.100 amps 0101- 150amps 0151- 200amps amps T. Conductor Type Size OMulti- Family (Main) Service _ amps = o Unit Meters EO -100 amps `101- 150amps - , 151- 200arnps - ❑Temporary Pole D amps CT Service SERVICE UPGRADE ❑ amps NEW FEEDER (ADDIT'IONS, ACCESSORY STRUCTURES ETC.) 0100 ar ps 0150amps D200am _ ps amps _ CT Seri i :e _ amps ADDITIONS, REMODEL REPAIRS, BUILD-OUTS, ACCESSORY STRUCTURES ETC. Outlets/Switches: / rn 0- 30arnps 31- 100aps -- _ 0 Appliances: 0- 30amps 31- 100arnps A/C Circuits: 0- 60amps _ 61.100arrps 7. Heat Circuits: # circuits C � cL k � , — Number of Lighting Outlets, Including Fixtures: OTHER ELECTRICAL PROJECTS _ Mot.: rs _ OSwiFnming Pool 0 Sign =Smoke Detectors Qty = fransforrners hp FIRE ALARM SYSTEM (Requires 3 sets of plans & Fire Alarm Cliecldist) Qty volts/amps VALUE OF WORK 5 REPAIRS/MISCELLANEOUS - F? UC ❑Replace Burnt/Dama edMeter Can :Safety Ir.spection _Panel Cba ze El Other: roc'/IN lknbf FAXED rj-? sip no- : :xz^:• xr � 7.. , ;a • c Permit becomes void if work does not coa mence within a six month period or work i< s.s . naked :r aba-. ' � 1 � _��. vad this application and know the same to be true and c w orre =t. All provisions cf laws and )rdinanc go` d tLS °'z.r w Y ;pacified or not The permit does not give authority' to violate the ploy t sitms of any ether Aa±e >� I law mgutau an : x5trx*}!a _x -rr. = ;onstrucdon. Vtlone `.ur_be r Property Owners Name 21f - }�1 Umce Pt c>ue 2 1 _ 9 1k� Fax Nlectrical Company l ''..' An ' e l C L C- 1 � Comte zit; ?ZZ {U SI N S C',r TM- r Co. Address: / 57- KM 'k( State Certifcaiic,aRe;-..ion -aon - License Holder (Print): Op; Votarized Signature of License Holder :,) fl Sworn and subscrib before rr l da , o < f� (3"4AN ' gnats re of Notary Public _� ►��; )7 957760 • .e 14, 2014 ..1:f. underwriters