Permit 630-632 Main St (vault) BUILDING, PLANNING AND ZONING INSPECTION DEPARTMENT
CITY OF A TLANTIC BF,4 CH, FLORIDA
CERTIFICATE OF OCCUPANCY
WORKSHEET
Date Requested: 3/4/97
Building Contractor: Dean Russell
Building Permit Number: 12756-57
Address: 630-632 Main street
Legal Description: Lot 4/5, BLock 132, H
improvements to the above described property have been completed
in accordance with the terms of the permit and is certified to be
ready for occupancy as
duplex
Lowest Floor Elevation: /0 3-
required as built
BEFORE ISSUING CERTIFICA TE OF OCCUPANCY THE FOLLOWING MUST BE COMPLETE
DEPARTMENT DATE NOTIFIED DATE APPROVED BY
Fire n/a
Public Works 3/3/97 3/4/97 PN
2
3/4/97
Planning
Building
ADDRESS
BUILDING PERMIT NUMBER
TNSPECTIONS: FOOTING
UNDER SLAB PLUMBING
SLAB
FRAMING -9 7,
COVER-UP- 7
INSULATION
FINAL BUILDING 3
CERTIFICATE OF OCCUPANCY -�� -
31ol
ELECTRICAL PERMIT #
ij --7
INSPECTIONS ROUGH /3 -7
7
FINAL
MECHANICAL PERMIT #
PLUMBING PERMIT # 15 3
NOTES :
DEPARTMENT OF PUBLIC WORKS
1200 SANDPIPER LANE
ATLANTIC BEACH, FLORIDA 32233-4318
TELEPHONE: (904)247-5834
FAX: (904)247-5843
SUNCOM: 852-5834
http://ci.atlantic-beach.fl.us
PLAN REVIEW COMMENTS FROM THE
PUBLIC WORKS DEPARTMENT
Permit Application # — 0"�-3 - )LSS> 56'
Applicant: '1 0, &( t4da 0-0 -S
Address: 7�-5 i2� M 0- 1 n '!�>-� -
Proj ect: I yt( 112a Lj"
e
XYour application is approved as noted by the Public Works Department. Final
application approval must come from the Building Department.
cj Your pen-nit application has been reviewed by the Public Works Department and the
following items need attention:
4.,
.417240
Please submit these requirements to the Public Works Department, 1200 Sandpiper Lane,
Atlantic Beach, FL 32233 in order that we can approve your application. If you have any
questions please call (904) 247-5834.
Reviewed by Robert S. Kosoy, P.E., Director of Public Works
Date 1,64 O`Z
Signature
C ontractor Noti fi ed D ate M a ed q /-7 lo,3
CITY OF ATLANTIC BEACH CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
DATE PERMIT NO.
ISSUED BY THE CITY
JOB ADDRESS VALUATION $
'�`,12? 3-
PERmrrrEE k-
PERMM-EE ADDRESS
TELEPHONE NO.
ReoUESTING PERMISSION FROM THE CITY OF ATLANTIC BEACH TO CONSTRUCT 4A/i Q7-r 2,;q�t,
LOCATIONS: (REAEReNcE To CROSS-STRIEET)
I APPLICANT DECLARES THAT PRIOR TO FILING THIS APPLICATION HE HAS ASCERTAINEDTHM L6,CATIQ�ttlF ALL
EXISTING UTILITIES, BOTH AERIAL AND UNDERGROUND AND THE ACCURATE LOCATIONS ARE SHOWN ON THE
SKETCHES.
A LETTER OF NOTIFICATION WAS MAI—D TO THE FOLLOWING UTILITIES/MUNICIPAUTIES:
JAcKsoNvi— ELECTRIC AUTHORITY YES (V/) No ( ) DATF: jzAAPRb3
BELL SOUTH TELEPHONE COMPANY Yes (A No ( ) DATE:
FERRELL GAS Yes (vl) No ( ) DATE: (2>(R A f1Z 0 3
MEDIA ONE CABLE TV YES (,/) No ( ) DATE:
2. WHF-74EVF-R NECESSARY FOR THE CONSTRUCTION, REPAIR, IMPROVEMENT, MAINTENANCE, SAFE AND EFFICIENT
OPERATION, ALTERATION OR RELOCAT`ION OF ALL. OR ANY PORTION OF SAID STREET OR EASEMENT AS
DL-rE:RmiNFD BY THE DIRECTOR OF PUBLIC WORKS, A14Y OR ALL OF SAID POLES, WIRES, PIPES, CABLES OR
OTHER FACIUTIES AND APPURTENANCES AUTHORIZED HEREUNDER, SHALL BE IMMEDIATELY REMOVED FROM
SAID STREET OR CASEMENT OR RESET OR RELOCATED HEREON AS RE(:)UIRED BY THE DIRECTOR OF PUBLIC
WORKS, AND AT THE EXPENSE: OF THE PERMiTTEE UNLESS REIMBURSEMENT IS AUTHORIZED.
3. ALL WORK SHALL MEET CITY OF ATLANTIC BEACH OR FLORIDA DFPARTME14T OF TRANSPIRAT`ION STANDARDS
AND BE PERFORMED UNDER THE SUPERVISION OF MR, L)�4LE- 8je,0\-JNJ (CONTRACTOR'S
PROJECT SUPERINTENDENT) LOCATED AT TE:LFPHoNE: No.
4. ALL MATERIALS AND FOUIPMENT SHALL BE SUBJECT TO INSPECTION BY THE DIRECTOR OF PUBLIC WORKS OR
HIS DESIGNEE.
5. Au CITY PROPERTY SHALL BE RESTORED TO ITS ORIGINAL CONDITION AS FAR AS PRACTICAL, IN KEEPING WITH
CITY SPECIFICATIONS AND THE MANNER SATISFACTORY TO THE CITY.
A SKETCH OR PLANS COVERING De-rAji-s OF THIS INSTALLATION SHALL BE MADE A PART OF THIS PERMIT,
7. THIS PERmiTrEe SHALL COMMENCE ACTUAL CONSTRUCTION IN C;OOn FAITH WITHIN DAYS FROM THE DAY
OF SAID PERMIT APPROVAL AND SHALL BE COMPLETED WITHIN 7_ DAYS. IF THE BEGINNING DATE IS
MORE THAN r3O DAYS FROM DATE OF PERMIT APPROVAL, THEN PERMITTEE MUST REVIEW THE PERMIT WITH THE
DIRECTOR OF PUBLIC WORKS TO MAKE SURE: NO CHANGES HAVE OCCURRED IN THE AREA THAT WOULD
AFFECT THE PERMITTED CONSTRUCTION.
a. IT IS UNDERSTOOD AND AGREED THAT THE: RIGHTS AND PRIVILEGES HEREIN SET OUT ARE GRANTED ONLY To
THE EXTENT OF THE CITY'S RIGHT, TITLE AND INTEREST IN THE LAND TO BE ENTERED UPON AND USED 13Y THE
HOLDER, AND THE HOLDER WILL, AT ALL TIMES, ASSUME ALL RISK OF AND INDEMNIFY, DEFEND, AND SAVE
HARMLESS THE CITY OF ATLANTIC BEACH FROM AND AGAINST ANY AND ALL LOSS, DAMAGE:, AND COST OF
EXPENSES ARISING IN ANY MANNER OF THE EXERCISE OR ATTEMPTED EXERCISES BY THE HOLDER OF THE
AFORESAID RIGHTS AND PRIVILEGES.
9� THE DIRECTOR OF PUBLIC WORKS SHALL BE NOTIFIED TWENTY-FOUR (24) HOURS PRIOR TO STARTING WORK
AND AGAIN IMMEDIATELY UPON CO LIETION.
SUBMITTED BY: (PLACE CORPORATE SEAL IF APPLICABLE)
DAY OF -x
J=9
SWORN TO AND SUBSCRIBED BEFORE ME is
JENNIFER SCHLUETER N rA PUBLA&K,-C,�
.'i*l M�COMMISSION#DD 121301
v--
EXPIRES:May 27,2W6
Bonded Thru Notary Public Underwriters
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FLORIDA 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 03-00025856 Date 4/22/03
Property Address . . . . . . 632 MAIN ST
Tenant nbr, name . . . . . . NEW DRIVEWAY
Application description . . . RIGHT OF WAY PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
Owner Contractor
------------------------ - ----------------------
JARVIS, TISHA &: ADAM OWNER
632 MAIN ST.
ATLANTIC BEACH FL 32233
(904) 249-0260
----------------------------------------------------------------------------
Permit . . . . . . DRIVEWAY PERMIT
Additional desc . .
Permit Fee . . . . 35 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 35. 00 35. 00 . 00 . 00
Plan Check Total .00 . 00 . 00 . 00
Grand Total 35. 00 35. 00 . 00 . 00
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.
BUILDING OFFICIAL
DEPARTMENT OF PUBLIC WORKS
1200 SANDPIPER LANE
ATLANTIC BEACH,FLORIDA 32233-4319
TELEPHONE:(904)247-5834
FAX:(904)247-5843
SUNCOM:852-5834
http://ci.atiantic-beach.R.us
PLAN REVIEW COMMENTS FROM THE
PUBLIC UTILITIES DEPARTMENT
Permit Application # 03 — CC
Applicant: a
Address:
Project: Do" ak�
Your application is approved as noted by the Public Utilities Department. Final
application approval must come from the Building Department.
u Your permit application has been reviewed by the Public Utilities Department and the
following items need attention:
Please submit these requirements to the Public Utilities Department, 1200 Sandpiper Lane,
Atlantic Beach, FL 32233 in order that we can approve your application. If you have any
questions please call (904) 247-5834.
Reviewed by Donna Ka niak,Public Utilities Director
D
.�? '4 n ate
Signature
Contractor Notified Date Mj;�4 21/0�3
r
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FLORIDA 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 03-00025909 Date 5/06/03
Property Address . . . . . . 630 MAIN ST
Tenant nbr, name . . . . . . DRIVEWAY
Application description . . . RIGHT OF WAY PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
Owner Contractor
------------------- ------------------------
DEAN RUSSELL CONSTRUCTION ROBERT LAW
1415 SOUTH THIRD STREET
JAX BEACH FL 32250
----------------------------------------------------------------------------
Permit . . . . . . DRIVEWAY PERMIT
Additional desc . .
Permit Fee . . . . 35 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 35 . 00 35 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 35 . 00 35 . 00 . 00 . 00
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.
BUILDING OFFICIAL
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FLORIDA 32233-5445
P". TELEPHONE: (904)247-5800
FAX:(904)247-5805
SUNCOM:852-5800
C http://ci.atlantic-beach.fl.us
PLAN REVIEW COMMENTS
Permit Application # 0,--5- Z a 9 02
f2
Applicant: _)r
Address:� Z50 H
Project: 1 12a t u c--- U\-)
our application is approved
Your permit application has been reviewed and the following items need
attention:
LA-1 k4f k" Aq
Z e.Lo CA-1 r_— 1-7 T
0 T- L I-r E�3
-54 E M e-T FO 01i+yj 'z>TAv --r4QZ-C A-3 L)o
&)E A-fQF t4
11411:" —%L
P,4.t/- 7Z k�t-- 64" PA—%-aV-r V-41
( ,Vz ej-3
�'�Vpz7s
Please re-submit your application when these items have been completed.
Reviewed by
Signed
Contractor Notified Date
CITY OF ATLAN71C BEACH CONSTRUCTION PERMIT'WITHIN CITY RIGHTS OFWAY AND EASEMENTS
DATE.q:lq'-03 PERMIT NO.
ISSUED BY THE CITY
I f� I ; , 0 ij�
JOB ADDRESS 0?)0 Mffi(�,:�hee± DA46114 I —VALU�,TIO N $
PERMITTEE
PERMITTIZE ADDRESS k 7)5tnvul �P�E NO. T44-a 241,041 1
Mhl TELEPHO
REQUESTING PERMISSION FROM THE CITY OF ATLANTIC BEACH TO CONSTRUCT
LOCATIONS: (REFERENCE TO CROSS-STREL-r) �ym claci CnA�in,
I . APPLICANT DECLARES THAT PRIOR TO FILING THIS APPLICATION HE HAS ASCERTAINED THE LOCATION OF ALL
EXISTING UTILITIES, BOTH AERIAL AND UNDERGROUND AND THE ACCURATE LOCATIONS ARE SHOWN ON THE
SKETCHES.
A LETTER OF NOTIFICATION WAS MAILED TO THE FOLLOWING UTiUTIF-S/MUNICIP LITIES
JAcKsoNviLLF- ELECTRIC AUTHORITY YES (vll No ( ) DATF--.--4.
BELL SOUTH TELEPHONE COMPANY YES (v-1) No ( ) DATE:
FERRELL GAS YES (v) No ( ) DATE:
MEDIA ONE CABLE TV YES (�/) No ( ) DATE:
2. WHENEVER NECESSARY FOR THE CONSTRUCTION, REPAIR, IMPROVEMENT, MAINTENANCE, SAFE AND EFFICIENT
OPERATION, ALTERATION OR RELOCAT10N OF ALL, OR ANY PORTION OF SAID STREET OR EASEMENT AS
DETERMINED BY THE DIRECTOR OF PUBLIC WORKS, ANY OR ALL Or SAID POI E-5, WIRES, PIPES, CABLES OR
OTHER FACILITIES AND APPURTENANCES AUTHORIZED HEREUNDER, SHALL BE IMMEDIATELY REMOVED FROM
SAID STREET OR EASEMENT OR RESET OR RELOCATED HEREON AS REQUIRED BY THE DIRECTOR OF PUBLIC
WORKS, AND AT THE EXPENSE OF THE PERMITTEE UNLESS REIMBURSEMENT IS AUTHORIZED.
3. ALL WORK SHALL MEET CITY OF ATLANTIC BEACH OR FLORIDA DEPAJ15ITMENT OF TAANSPIRATION STANDARDS
AND BE PERFORMED UNDER THE SUPERVISION OF (CONTRACTO!3 I S
PROJECT SUPERINTENDENT) LOCATED ATA 13 OL- M r,\-i(Inc:.�= =74- A70 TELEPHONE No.-66L-t55;33
3PBLM
4, ALL MATERIALS AV40 EQUIPMENT SHALL BE SUBJECT TO INSPECT70N BY THE DIRECTOR OF PUBLIC WORKS OR
HIS DESIGNEE�
5, Au CITY PROPERTY SHALL 13E RESTORED TO ITS ORIGINAL CONDITION As FAR AS PRACTICAL, IN KEEPING WITH
CITY SPECIFICATIONS AND THE MANNER SATISFACTORY TO THE CITY.
155. A SKETCH OR PLANS COVERING DETAILS OF THIS INSTALLATION SHALL BE MADE A PART OF THIS PERMIT.
7. THIS PERmrrrEE SHALL COMMENCE ACTUAL CONSTRUCTION IN GOOD FAITH WITHIN DAYS FROM THE DAY
OF SAID PERMIT APPROVAL AND SHALL BE COMPLETED WITHIN DAYS� IF THE BEGINNING DATE IS
MORE THAN 60 DAYS FROM DATE OF PERMIT APPROVAL, THEN PERMITTEE MUST REVIEW THE PERMIT WITH THE
DIRECTOR OF PUBLIC WORKS TO MAKE: SURE: NO CHANGES HAVE OCCURRED IN THE AREA THAT WOULD
AFFECT THE PERMITTED CONSTRUCTION.
a. IT IS UNDERSTOOD AND AGREED THAT THE RIGHTS AND PRIVILEGES HEREIN SET OUT ARE GRANTED ONLY TO
THE: EXTENT OF THE CITY'S RIGHT, TITLE AND INTEREST IN THE LAND TO BE ENTERED UPON AND USED BY THE
HOLDER, AND THE HOLDER WILL, AT ALL TIMES, ASSUME ALL RISK OF AND INDEMNIFY, DEFEND, AND SAVE
HARMLESS THE CITY OF ATLANTIC BEACH FROM AND AGAINST ANY AND ALL LOSS, DAMAGE, AND COST OF
EXPENSES ARISING IN ANY MANNER OF THE EXERCISE OR ATTEMPTED EXERCISES BY THE HOLDER OF THE
AFORESAID RIGHTS AND PRIVILEGES.
9. THE DIRECTOR OF PUBLIC WORKS SHALL BE NOTIFIED TWENTY-FOUR (24) HOURS PRIOR TO STARTING WORK
AND AGAIN IMMEDIATELY UPON 99MPLF-TION.
SUBMITTED BY: A (PLACE CORPORATE SEAL IF APPLICABLE)
SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY
NOTARY PUBLIC
MAP SHOWLIM BOUNDARY SURVEY OF7,-4w Ajjjoo,9elrrip4
000loFLOT BLOCK 5 2 AS SHOWN ON MAP OF
ASRECORDED IN PLAT BOOK /8 PAGES 34 OF THE PUBLIC RECORDS OF DUVAL COUN7-Y, FLORIDA
CER 77FIED FOR: a?g/,gAj A. qAqt_,prj-e-_ szaidjAg-r 7-1-rz,,r G444,C,4AJ25� &Q,�Z .47A257
ALLLZiaA,jec-n- AAAJK RIC,41,4)W42 -r- t24P�_=14EAf_:> R-A.
/<
A.A 0/ 2 Z' eO 9/ 4W.00'
N
Oka.
\j
IN
IL
4m
*lie
THE PROPERTY SHOW HEREON APPEARS TO LIE W7HIN.FLOOO HAZARD ZONE x AS SCALED FROM FLOOD
NOE RATE MAP_-L— FOR ME CITY OF FL ORIDA, DA D e4-17- 51
TE AND
IS SHOW AS A C0UR7ESY ONLY AND DOES NOT CONSMUTE A CER77MAnON OF SAME.
TRI-STATE LAND SURVEYORS.. INC.
8411 BAMEADOWS WAY SU17F #2, JACKSONWLLE, FLORIDA .32256 (904) 731-7235
BEARINGS BASED ON R ZIJ LINE AS SHOW.
0 com AM
0 ow cat THIS SURVEY DOES NOT REFLECT OR DEMERMINE OWERSHIP.
(Rr WIN W i LS 4144) NOT VAUD WTHOUT ME WGNA7URE AND IHE ORIGINAL RAISED SEAL
mw OF A FLORIDA LICENSED SURVEYOR AND MAPPER.
0 Am on Mom)
0 awn my
a&L x4ow fimmmm Lw LARRY G. EDDY, P.L.S. No. 4144
OUT Osaowr GLENN M. BROADS T, P. 5814
" MMF4F-WAY
CM WOO MEA SCALE-
wnvKm
AA A*COWM"PAO REEN7ERED SURVEMIR AND MAPPER,
M mum awma DATE. STAX 0- FLORIDA (LB 14921)
73MMpa_7357 ORDER No. e3-z--_,q4o!
55
C
ITY OF ATLANTIC BEACH
800 SEAMOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
will INSPECTION EMAIL REQUEST:
Building-dept oab.us
Application Number . . . . . 07-00001491 Date 11/13/07
Property Address . . . . . . 630 MAIN ST
Application type description FENCE PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 125
----------------------------------------------------------------------------
Application desc
INSTALL 41 FENCE FRONT YARD
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
KELLER, MATTHEW OWNER
ATLANTIC BEACH FL 32233
----------------------------------------------------------------------------
Permit . . . . . . FENCE PERMIT
Additional desc . .
Permit Fee . . . . 35 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 5/11/08
----------------------------------------------------------------------------
Special Notes and Comments
*ALL FENCES OR ENCLOSURES OF LAND SHALL BE SUBSTANTIALLY
CONSTRUCTED.
*SCHEDULE FINAL INSPECTION ONCE FENCE HAS BEEN COMPLETED.
PERMIT AND APPROVED SURVEY MUST BE AVAILABLE FOR FINAL
INSPECTION.
*EMAIL INSPECTION REQUESTS TO BUILDING-DEPT@COAB,US
Fence must be constructed on owner' s property, not in City
right-of-way.
----------------------------------------------------------- ----------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 35 . 00 35 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 35 .00 35 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
CITY OF ATLANTIC BEACH PERMIT
BUIL]DING ZONING DEPARTAIENT APPLICATION#
800 Sendnode Road
Atlantic Beach,Flofl&32233
(904)247-58M
(904)247-5845 Fax
www.coab.us
APPLICATION TRACKING FORM
REQUIRED DEPT.
Y N PLANNING
Property Address: 0 e4- z y ti BUILDING
Y N PUBLIC WORKS
Applicant: hfu) k-r I if r Y N PUBLIC UTILITIES
y N FIRE DEPT.
Project: Y N PUBLIC SAFETY
TT- 6/14yarot
-APPROVAL
LU
0 REQUIRED AGENCY: RECEIVED BY: INITIAL DATE-
z ga,
W w Y N D.E.P HUFSTETLER
�5
Y N S.J.R.W.M. CARPER
UJ Y N ARMY CORPS of ENG
CARPER
0 Y N HOTELS&RESAURANTS HUFSTETLER
APPLICATION STATUS
CIRCLE ONE: SITE BUILDING DA AP �,�ED BY: INITIAL. DATE:
0 0 1STREV 0 Rf ',vz�
P NNING
2ND REV 1 ,0 1
IWLDING
PUBLICWORKS
PUBLIC UTILITIES
FIRE DEPT.
PUBLIC SAFETY
3RD REV
Retu M this form to the Building Department once you have entered your comments into the AS400.
CITY OF ATLANnC BEACH 07-F
800 SEMINOLE ROAD,ATLANTIC WEACH,FL
OFFICE:(W4)2a-&M 0 FAX NO.:(W4)2,V-8W
suiLDING-DEPTOCOM.Us
BUILDING PERMIT APPLICATION DUVAL COUNTY
Atlantic Beach, FL 32233
AAG��
77
NON,
11 New autwo 0 DRODUT" R.RESIDENTIAL
LOT BLOCK WSION 13mxmvN 13 cowA-mm usE COMMMCIAL.
13 ALTERATION 0 ACCESSORY s=. JUFRE
REPAIR 0 POOL I SPA 0 YES Cl MA
Fe-6 Yar'b u.MOVE 0 No
.74 777]OEM 9�E
9�NAME I&COMPANY NAME: Z3.COMPANY WAAE:
ATr1A evJ 1&NAME. 24.LICENSEE NAME.
10.ADDRESS: 17.STATE OF FLORIDA LICENSE NO.: 26.STATE OF FLORIDA LICENSE NO.:
I&ADDRESS. 26.ADDRESS:
ATLA[Iffkc '�*A UA 3TZ33
12-FAX NO.: 11 OFFICE PHONE: 20.FAX NO.: -7FAX NO:
11.OFFICE PHONE: 27 OFFICE PHONE:
joy-942 ;7z —,2Q-�Ja 1
13,CELL PHONE 21.CELL PHONE: 29.CELL PHONE:
1�0 ff- -1 1 d-Z
14.EMAIL ADDREN: 22 EVAL ADDRESS: 30.EMAIL ADDRESS:
Z4
4
alp
0,IM
*2 i VA
NOW
31,NAME: 33.NAME X NAME:
32.ADDRESS- 34.ADDRESS: 36.ADDRESS.
Application Is hereby made to obtain a permit to do the work and roMations as indicated. I certily that no work or Installation has
commenced prior to the issuance of a permit and dud all work wig be perforrned to mest the standarft of all twos regulating construction in this
jurisdiction. This permit becomes null and void if work is not commenced within 9&(6)months, or if construction or work is suspended or
abandoned for a period of six(6)rnonths at any time aftr work Is commainced. I understand that separate permits must be secured for
Electrical Work,Plumbing,Weils,Fuirnaces,Bollem.Heatem Tanks, Air Condftkmm eltic.
OWNEWS AFFIDAM-I cattilly that all the foregoing inibimation Is accurate and that all work will be dorm in compliance with all applicable
Lwa regulating construction and zoning.I wig not occupy or use the referenced building or any part therof.until all inspections are finaled and
prior to obtaining a carfificate of occupancy or completion issued by the building official,as requitod by law.
222 WARNING TO OWNER: 222
YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
-ovy" j,
1 R
a
Am ,-FA
Vot
Signed- Dale. 2,5 OC? p7 Swle& Data.
Before me We alThday or X=E 2007 In the cour*of Before me#ft day of 2007 In the county of
Duval,State of Flodda, Dtival,State of Florida,has personally aMeared
herin by hirnself I tierself and affirms tiat all statements and declarations are hedn by trimself I herself and affimns Orat all statements and declarations we
true and accurate. true and accurate.
Notary Public at Large,State of County of DI Notary Pubfic at Large,State of County of
0 Pwsonally Known 13 Pw3ww*Known
xroduced ident4kmfion- 4----t— lot, 13 Proajoad wwturionuon-
P
Notary Signatum -2
Notary Pubk-SW of Fbft
CIIIIImisgion Exom Fab 28,2DIO
COAS FORM BLDWGBi Cwwriesion#DO 5=311
Bonded By Nab"Willy ANII.
W "Q
4k
A
tit
I�N) l,
43 4k
46 k 4C k k ALQ�Cc
E ' T
800
CITY OF ATLAN-T K;
4-0 00' BUILDING & ZOWN(i
k
APR 10 2003
1�:V)
BY:
City otAtlantic Beach
Planning and ZorAV Depaftwt
This approval verMias 4011VIlst"wfth applicable
subdivision and other local land
zoning,
-egulations
development r , but does not constitute
approval for the issuance of permits, Compliance
with Florida Building Code and all other applicable
local, State and Federal permitting requirements
must be verified by signature of this City of Atlantic
Beach Building 0"l prior to the is uonce of a
uildWg
A4
troved By.—Communl�LDsveloWent
24 — 0-7
7.S5' Date:
Pr)
aD
7;n
CITY OF ATLANTIC BEACH PERMIT
BUILDING / ZONING DEPARTMENT APPLICATION #
7� 800 Seminole Road
Aflantic l3each,Florida 32233
(904)247-5-00
0
(904)247-5845 Fax
www.coab.us
APPLICATION TRACKING FORM
REQUIRED DEPT:
OY N PLANNING
lu .
Y
Property Address: o 52-ul-x mam 5kir-r-e* z N, BUILDING
Y PUBLICWORKS
AppReant: a) kf i try- tYN PUBLIC UTILITIES
fn&14 0
Y N FIRE DEPT.
Project: Y PUBLIC SAFET Y
TYOfl4yaret,
C/) APPROVAL
REQUIRED AGENCY: RECEIVED BY: INITIAL: DATE:
z ai
LU Y N D.E.P HUFSTETLER
< N S.J.R.W.M. CARPER
LU
Y N ARMY CORPS of ENG CARPER
�U-i t.-I I I
0 Y N HOTELS&RESAURANTS HUFSTETLER
APPLICATION STATUS
CIRCLE ONE: SITE BUILDING DA AP ,�REVIEWED BY: INIT�W AT/
E] E] 1 ST REV
r
PLANNING F] 2ND REV
BUILDIN:/
PUBLIC WORKS
PUBLIC UTILITIES
FIRE DEPT.
PUBLIC SAFETY 3RDREV
Retu rn this form to the Building Department once you have entered your comments into the AS400.
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 07
OFFICE:(904)247-5826 0 FAX NO.:(904)247-5W
-DEPT@COAB.US
BUILDING
BUILDING PERMIT APPLICATION DUVAL COUNTY
, 1 11 1- I I I I I&AiNgla 11
HH012
Atlantic Beach, FL 32233
4A
11 NEW BUILDING 0 DEMOLITION 5LRESIDENTIAL
LOT_BLOCK_SUB DIVISION 0 ADDITION 0 CONVERTING USE 11 COMMERCIAL
K, HIMINN"ON 08"0101400`91111111111111111�i 11 ALTERATION 13 ACCESSORY BLDG. Rt-"sp MOW"%W
q 1 11 REPAIR 0 POOL/SPA 0 YES 13 N/A
Fe'b , 13 MOVE OLOTHER 13 NO
PEP,
,T,X,0WNE
w.,w-umpT lRill
iijli� " --
9.NAME: 15.COMPANY NAME: 23.COMPANY NAME:
ATT0 evJ 16.NAME: 24.LICENSEE NAME:
10.ADDRESS: 17.STATE OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.:
�3c) Jq\0r%N
1 S.ADDRESS: 26.ADDRESS:
AT(-At,JT\(- A- 3-rz,33
11.OFFICE PHONE: T12 FA7NO: 19.OFFICE PHONE: 20.FAX NO.: 27.OFFICE PHONE: 28.FAX NO.:
qcii-i42 —Zt-Z 19.q—-?-27- —*2Q�'�0 1 1
13.CELL PHONE: 21.CELL PHONE: 29.CELL PHONE:
1�4 Lit- I L Z-'Z I Q-Z
14.EMAIL ADDRESS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS:
aCr.�JN'�r
1, 0"t"i 'IT
Pi
PAN M., NOR
31,NAME: 33.NAME: 35.NAME:
32.ADDRESS: 34.ADDRESS: 36.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 a period of six (6) months at any time after work is commenced. I understand that separate permits must be secured for
Electrical Work,Plumbing,Wells,Furnaces,Boilers,Heaters,Tanks, Air Conditioners,etc.
OWNER'S AFFIDAVIT- I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construction and zoning. I will not occupy or use the referenced building or any part therof, until all inspections are finaled and
prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law.
222 WARNING TO OWNER: 222
YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
ON.
Signed: Date: ';Z5 cc?'9�7 Signed: Date:
Before me;hiscRA51hday of 2007 in the county of Before me this_day of —2007 in the county of
Duval,State of Florida,has person ly appe4red Duval,State of Florida,has personally appeared
MYW Ze/xr —
herin by himself/herself and affirms that all statements and declarations are herin by himself/herself and affirms that all statements and declarations are
true and accurate. true and accurate.
Notary Public at Large,State of County of Notary Public at Large,State of County of
11 Personally Known 0 Personally Known
)(Produced Identification- 10 It, 11 Produced Identification-
Notary Signature: Notary Signature:
CUMMONAM
pW*-Sim d Fbft
Cwm*sw Exphu Feb 28,2010
COAB FORM BLDG01 007 Comn*sW#DO 52MM
Bonded By Natimal Notary Ann.
1 .%J-Jr:i CITY OF ATLANTIC BEACH PERMIT
BUnDING /ZONING DEPARTMENT APPLICATION
800 Seminole Road
Aflantic Beach,Florida 32233
(904)247-58M
(904)247-5845 Fax 007
VT".coab.us
APPLICATION TRACKING FORM
-REQUIRED DEPT-
Y N PLANNING
y N BUILDING
Property Address: too"-u-,,% ffat�3 5�ff-r-e*
y N PUBLIC WORKS
Applicant: fn-v4 fn) k-r- i irr 0 Y N PUBLIC UTILITIES
w
Y N FIRE DEPT.
Project: F(nCE Y N PUBLICWETY
�Fro/14yar,(/t
-APPROVAL
LU REQUIRED AGENCY: RECEIVED BY: INMAL: DATE_
0
z cw,
UJ 0: Y N D.E.P HUFSTETLER
5
0 Y N S.J.R.W.M. CARPER
W
UJ it
Y N ARMY CORPS of ENG CARPER
y N HOTELS&RESAURANTS HUFSTETLER
APPLICATION STATUS
CIRCI F ONE- SITE BUILDING DA AP REVIEWEDBY: ,-1NMAL: DATE:
1ST REV 10 1C. W/
PLANNING
BUILDING 0 1 0 12NDREV 10 10 1
PUBL
�P U S
U S
FIRE DEPT.
PUBLIC SAFETY
0 1 3RD REV
Retu rn this form to the Building Department once you have entered your comments into the AS400.
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD.ATLANTIC BEACK FL W= 07-1 --
OFFICE M4)2.0-.NM 0 FAX NO.:M4)24'1-M*
WLDWG-Mff@CQWUS
BUILDING PERMIT APPLICATION DUVAL COUNTY
Ob
Atlantic Beach, FL 32233
o
13 NEw BuILOING
LOT BLOCK SUB DIVISION %DENTIAL
13 ADDITION E)CONWRTM USE 13 G2MbWr
13 ALTERATION 0 ACCESSORY BLDr. -01" 41AL
.9 S—P—RD-09MW4�5--hy
11 REPAIR 0 POOL I SPA E3 YES 13 wA
E3 MOVE QIOTHER E3 No
9.NAME: I&COMPANY NAME-- 23.COMPANY NAM:
AAJ--r,A f,,3 16.NAME-'—::� 24.LICENSEE NAME:
10.ADDRESS: V.STATE OF FLORIDA LICENSE NO.: STATE OF FLORIDA LICENSE NO.:
�3o tA*,%,N
I&ADDRESS: 26,ADDRESS,
7FL-
ATLA,JT%c- 'V�fA co a33
Ii.OFFICE P14ONE 112.FAX 19.OFFICE PHONE:- 2(k FAX NO.: 27.OFFICE PHONE. 28.FAX NO.:
lof-icz -77Z I I
13.CELL 21.CELL PHONE: 29.CELL PHONE-
9%q'- 4 6 7---Z I U-Z
U.EMAIL ADDRESS: 22 EMAIL ADDRESS: X EMAIL ADDRESS.
31.NAME U NAME: X MAW-
32.ADORES& 34.ADDRESS- 36.ADDRESS:
APPlicstim 0 hereby made to obtain 8 permit to do the Work and mstallefions as indicated. I car* that no wo* or Installation has
commenced prior to the Issuance of a permit WW that all work will be performed to ffmW V*MandardS of all laws regulating construction in this
jurisdiction. This permit becomes null and void N work is not commenced within six(6)months, or N consbuction or work is suspended or
abandoned for a period of six (6)months at any*m after work is commenced. I undonftnd that separate permits must be secured for
ElectrIcal Work,Plumbing,Wells,Furnaces,Bollars,Healam Twft, Air Conclitknn,aw.
OWNERS AMDAVIT-I car*OW all the foregolng inkfflubm Is accurate and that all work will be done in oomplil3noe with all applicable
111019 mgUhlft construction mid zoning.I will tot occupy or use the referenced building or any part therof,until all inspections am finaW and
Prior to obtaining a cartlificate of occupsncy or completion issued by ft buMkV ormigli.as mquimd by law.
222 WARNING TO OWNER: 222
YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECO ING YOUR NOTICE OF COMMENCEMENT.
L!
Signed: Elate- 2 -7
* 5 ocil 3P Sll;ned: DaW.
2007 in Ihe c=*of
Before rne Oft a day Of X=E — Before n-a tIft day of 2DO7 In the county of
Duval,State of Florida,has I Pyappeared Duval.State of Flodda,has pwwnaRy appeared
MIrw T. _rf 1xr
herin by t*TWW I herself and aft=1W all stalerneft and declaralJons are herin by t*TtSBIf f IMmeff and affIrm#W all slaternents and dech-waftu are
true and accurcft. true and accurate.
Notwy Pubhc at Large.SWe of-F—L—CW*0f,ZU Y12) Notary Publir,at Lame,State Of_county Of
E3 PmsonalIy Known 13 perswony Known
)(Pro,k-W klen0cation- 0 Proftmd IdenfificMion-
NotB(y Signature. Notiny SIgnatunx.
6-4C CUNNINGMM
6try public-SM of POW
-bg�C4mlniason E*m Fab 26,2010
COAB FORM BffiLDGMD1 Cmdssion III DD 5MM
I asSIX.." sonded By Nalknal Notary Assn.
le
5TO a\K Fa A j��
and .5iTucco
7.5' 1 B.R.L, 4-o.-7,
REVISk
00
E SOU T�i 10.0' FEET OF LOT 5, BLOCK 132 UN SARIT KARS THE S
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SAL
MY OF AIIANTIC BEACH PERMIT
"AUNT
BUILDING /ZONING DEPARI APPLICATION
800 S=iaole Road
4q
Aflanfic Beack Florkla 32233
(904)247-5900
-5845 Fax
(904)247
www.coab.us
APPLICATION TRACKING FORM
REQUIRED DEPT.
Y N PLANNING
0
Property Address: mavi z y K BUILDING
Y N PUBUCWORKS
M
Applic=t: M(L-TT kf r- 0 Y N PUBLIC UTILITIES
Project: anCZ Y N FIRE DEPT.
.!Ln-;:qzfa,114 Y N PUBLIC SAFETY
-APPROVAL
REQUIRED AGENCY: RECENIED BY: INITIAL DATE:
z Ull
LU i% y N D.E.P HUFSTETLER
05
y S.J.R.W.M. CARPER
LU ARMY CORPS of ENG CARPER
L 0 Y N HOTELS&RESAURA14TS HUFSTETLER
APPLICATION STATUS
CIRCLE ONE- SU BUILDING DA AP REVIEWEDBY: INITIAL DATE:
.] 11 1 1ST REV I []TaT - I /4-__ N f ?
16(WU. A&%A$)r' I/f_ G A) 0k)FTk r
f4olWY1 Al-)T- lel C")-X 4�k-Lol"" L-'&/ '.
PLANNING 0 2ND REV JJ3. 1 0 1
BUILDING
ZC�WORKS
PUBLIC UTILITIES
FIRE DEPT.
PUBLIC SAFETY
3RD REV
Retu rn this form to the BuMng Department once you have entered your comments into the ASMO.
CITY OF ATLANTIC BEACH 07-F- -J—F—F-1
800 SEMMOLE R01110,ATLANTIC WEACH,FLX= T
OFFICE 0 FAX N0..(W4)247-58*
BUILDING PERMIT APPLICATION DUVAL COUNTY
z
0L Atlantic Beach, FL 32233
OU
E3 NEW BUILDING rI DEMD�I
LOT BLOCK sue DIVISM RLRESIDEWnAL
13 ADDITION El COWERTING USE E3 q2NKRC
13 ALTERATION E3 Acassm BLDG. Am wl!R
El REPAIR El POOL I SPA DYES INA
49-owf fw(4 4 ' yar ,b &OTHER No
9,NAME: IrL COMPANY NAME: 23.COMPANY NAME:
IS.NAME: 24.LICENSEE NAME.
10.ADDRESS., V.STATE OF FLORIDA LICENSE NO.: 26.STATE OF FLORIDA LICENSE NO.:
%,N
18.ADDRESS: 26.ADDREW
ATLPJtIJTIIC- %—AC017F(— 3TZ33
11.OFFICE PHONE: 12.FAX NO.: 19.OFFICE PHONE 20.FAX NO.: 27.OFFICE PHONE 28.'FAXNO.:
lot-942 -Z(QQ- ?a if-37Z I I
13.CELL fome 21.CELL PHONE. 29.CELL PHOW
14.EMAIL AODRM: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS:
v-7��CQ)A1C,-,S�, Aft
"M fie.
:*, ,
31.14AME: 33.NAME. 3ffL NAME.
37-ADDRESS- 34.ADDRESS: 3S.ADDRESS*
Application is hereby made to obtain a permit to do the work and installiations; as Indicated. I OK* that no work or installation im
wmmm;Gd prior to the issuance Of a Permit and that all work will be performed to ffxmd On standards of all Wm regulatirg construcfion in this
jurisdiction. This permit becomes null and void It wo* is not commenced within sbc(6)months, or if construction or work is suspended or
abandoned for a period of sb((6) months at any time after work Is comnimmed. I undeirstand that separate perrift must be secured for
Electrical Work,PlumblM WeRs,Funums,BWbris,Heater%Tanlks, Air CondWoners,str-
OWNE"AFFMVIT-I c0irfily'that all the ftWoing information is accurate and that all work will be done in compliance with all applicable
him regulaft constritmboln and zonft.I VAR not occupy or use the referenced buNdN or any part thorof,until all inspections are finaled and
prior to obbwwv a cartilicate of occupancy or completion Issued by the buil&V official.as mquirilid by hm.
222 RNING TO OWNER: 222
YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
L'ENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
g aw
V
g&'� E=16 E
hKKNW
Slgried: Date.
Dew 2
_ 5 7
Before me Cjj�hday of .2DO7 In ft county of Before me Ws day of 2007 In the wunly of
Duval,State of Florida,has perSone.11y Duval,State of Florida.has personagy appearW
M-eo r(71r'
herin by hinAW I hersell'and affIrm Viat all staterrmft and declaratIom are herin by hirnsell I tiersell'mid affIrm Vial all statements and declarations are
true and acmwide. true and aomirate
Notary Pub#c at Large,Stele of. County Of DI VOJ Notary Public at Large,State of_County of
E3 Personally Known 13 PersonnRy Known
)(Produced idertffication- 0 Produced idenimcmion
Notary Signature:- Notary.SigrkiftW
Z--
64('WNW4GHAM
Nolary Pubk-SW of Floft
-ft cwm*l*n Expires Fab 28,20110
COAS FORM BLOW: Corarnission#DO 5"M
W rgl
DXK*d By NaftW Notary Man.
5T 0�Z%-r P A ?,.,I 1�
and 15;Tucco 7.4-'
C)
4-o.-7,
7 5' B.R.L.
REV15,6
/wv. 9
00
SOUTH 10.0' ffET OF LOT 5, BLOCK 132 �t�SS 17 DEARS THE S
QR MAP Ilt FOR IM
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CITY OF ATLANTIC BEACH
DEPARTMENT OF BUILDING
800 Seminole Road -Atlantic Beach, FL 32233-Tel: 247-5826- Fax: 247-5877
ELECTRICAL PERMIT
---------- ------
10CA
T1Qk11NFORNAT1ON----._
Number: .'23613 632 MAIN STREET
Permit Type: ELECTRICAL ATLANTIC BEACH, FL 32233
Class of Work: ALTERATION Township. Range: Book:
Proposed Use: SINGLE FAMILY . Lot(s):4 Block: 132 Section:
Square Feet:
Subdivision: SECTION H
Est. Value:
Parcel Number:
Improv. Cost:
OWNER )RRA N
Date Issued: 3/12/2002 Name: JARVIS, TISHA
Total Fees: 25.00 A I d1dress, 632 MAIIN STREET
Amount Paid: 25,00 ATLANTICBEACH, FL 32233
Date Paid: . .,3/12/2002 Phone: 0 -0000
.1 00)000
Work Desc: WIRE FOR REMODEL
APPL ,Ji�
—CONT ------
AT-9--CLEECTRIC, 177�-C`
PERMIT, '00
W
NOTICE�L'�:
BUILDING MAT
MUST BE CLEAR
"FAILURE TO HE-
PROPERTY OWN
.IS8UED ACCORDING TO
TO REVOCATION
FOR VIOLATION OP APPLI
Pr
OpOr: CHERYLE . Typ
e: OC 1MOT*
Date� 3/12/02 81 Receipt no:. 41926
A $25.08
-A- 14 PERNITS-BUILDIN5.
ATLANTIC BtACH BUILDING, DEPT. Trans-number:
CHECKS. 3389
Trans iatew: -3/12/02 Time- 16.33.11
CITY OF ATLANTIC BEACH, FLORIDA
Apprw�� APPLICATION FOR ELECTRICAL PERMIT
TO THE CHIEF ELECTRICAL INSPECTOR: DATE. 19
IMPORTANT NOTICE:
IN CONSIDERATION OF PERMIT GIVEN FOR DOING THE WORK AS DESCRIBED IN THE FOLLOWING, WE
HEREBY AGREE TO PERFORM SAID WORK IN ACCORDANCE WITH THE ATTACHED PLANS AND SPECIFICATIONS,
WHICH ARE A PART HEREOF, AND IN-ACCORDANCE WITH THE ELECTRICAL REGULATIONS, CODES AND CITY OF
ATLANTIC BEACH ORDINANCES.
fle
ELECTRICAL FIRM: MASTER ELECTRICIAN SIGNATURE JOURNEYMAN
NAME TWi, ADDRESS: RFD—BOX
SLOG.SIZE BETWEEN:
RES. APT. COMM.( PUBLIC( INDUS. NEW( OLD ( REW.I J
ADDITION (,<) TRAILER I TEMP.( SIGNS I ) 57') —SCL Fr.
SERVICE. NEW( INCREASE( REPAIR ( FEE
CONDUCTOR SIZE AMPS COPPER ( ALUM. (
SWITCH OR BREAKER AMPS PH I Wl VOLTI RACEWAY
DUST.SERV.SIZE AMPS PH I Wl VOLTI RACEWAY
FEEDERS NO. SIZE IND. SIZE NO. SIZE
LIGHTING OUTLM 3 CONCEALED OPEN TOTAL
RECEPTACLES CONCEALED OPEN TOTAL
0-30 AMPS. 31-100 AMPS.
SWITCHES
INCANDESCENT
FLUORESCENT&M.V. It)
FIXED 13,11113AIA", ovXR
APPLIANCES BELL TRANSF.
AIR H.P.RATING H.P.RATING
CONDITIONING COMP.MOTOR OTHER MOTORS AMPS CEIL HEAT: KW-HEAT
ov
MOTORS H.P. VOLTAGE PHS NO. 1 VOLTAGE PHS
MISCELLANEOUS
TRANSFORMERS: UNDER 600 V. OVER 600 V.
NO. KVA I I NO. lKVA
NO.NEON TRANSF. NG. VA. MA. MOTOR SIZE SWITCH FLASHER
EACH SIGN I I
FORWARDED
CITY OF
4&4M4-c Be4C.4-
Office of Building icial
REQUEST FOR INS ON
Dlt.— ;g/ P mit No. �q
Time A,M,
Received — PM,
Job Address Locality
r
Owner" -AAq(4 S7.
Name r1l Contractor
,effUILDIN-q CONCRETE ELECTRICAL PWMBING MECHANICAL
\ZF"n"-n-q 0 Footing El Rough Wiring E, Rough E Air Cond.& Ej
Re Roofing El Slab E, Temp Pole 0 Top Out E) Heating
Insulation 11 Lintel 0 Final El Sewer 0 Fire Place 0
0411 Pre Fab
READY FOR INSPECTION
Mon. Tues. Wed, Thor& tr�Fndy
A,M.
Inspection Made RK
Inspector Final Inspection 0
Certificate of Occupancy 0
Date
189v—py
BUILDING
11. IDENTIFICATION To be completed by all applicani-6 .
In consideration of potrWt q!vam fop doing the wort as dascre6od In, Ih* #bova staft.-moril "a bere6y sq,** to pterform sokl work in atowdonc
w ith the #114c�d piont, snJ 4po6fications wbi-.h off a part hveof an$ in 6.x0fdor-cir W;Th the City of jortsonydit ordinances and itimclard,
019004 P!40;ts tilted therGIA.
Name *f Mochaivital Contractors
ce"Iffolor jorlat) A T P Y-
,I.FW-, nF F1 ngTnA - -IN Mallet
Name of
Propor4y 0whor CAC058757 - KENNETH ERIC CAVENDER
$11noture of OwIlet Signature of
ell,
or Autherh*4 Alan# Architect or Efill"or-i
III. MARAL INFORMATION
IV14 of Imating fuel. 19 OTHRR CONSTAUCTION BRING DONE ON
C) (4ciric THIS BUILDING Oft SITE?
C3 066 C) V (3 Netut6l [3 Ce,aftel Utility
CITY OF ATLANTIC BEACH
MECHANICAL PERMIT
800 SEMINOLE ROAD-ATLANTIC BEACH, FL 32233-TEL: 247-5826-FAX: 247-5877
WEE W FRID
Permit Number: ZJb[0 ress: bJZ MAIN 5 1 Klmt I
Permit Type: MECHANICAL ATLANTIC BEACH, FL 32233
Class of Work: ADDITION Township: Range: Book:
Proposed Use: SINGLE FAMILY Lot(s):4 Block: 132 Section:
Square Feet: Subdivision: SECTION H
Est. Value: Parce-I Number:
Improv. Cost:
Date Issued: 3/18/2002 Name: JAKVIZ5, I IZ5
Total Fees: 25.00 Address: 632 MAIIN STREET
Amount Paid: 25-00 ATLANTIC BEACH, FL 32233
Date Paid: 3/18/2002 Phone: (000)000-0000
Work sci--2 SUPPLY VIEN I S
AIR bYZ5 I tMZ5 I
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.
Oper: DOYLE Type: OC Drawer: I
Date: 3/18/92 61 Receipt no: 4W7
14 PERNITS-BUILDING I M.06
Trans nueber: 797282
4ATNTIICEACH QBUILD G DWEPT. CK DIECKS 12% $25.06
1 lians date: 3718782 lise: 13:38:99
CITY OF ATLANTIC BEACH PERMIT CALCULATION SHEET
Address Al S71- 2,2/' 72 0 Q
Date
Heated Square Footage 2- @ $ per sq ft = $
Garage/Shed @ $_per sq ft = $
Carport/Porch @ $_per sq ft = $
Deck @ $—Per sq ft = $
Patio @ $—Per sq ft = $
TOTAL VALUATION: $
S-4f C — /r - $
Total Valuation 1st $ /00 0
�Z �S__OF C_ - Z:.4 6 $
Remaining Value $s- per thousand
or portion thereof
TOTAL BUILDING FEE s-
+ 1/2 Filing Fee $
( ) Fireplaces @ $15 . 00 $ -6 -
BUILDING PERMIT FEE $ Y_3
WATER IMPACT FEE $
SEWER IMPACT FEE
WATER METER/TAP
CAPITAL IMPROVEMENT $
SEWER TAP $_
) RADON (HRS) .0050 $
SECTION H PAVING ( $
HYDRAULIC SHARES $
CROSS CONNECTION $
) SURCHARGE .0050 $
OTHER
GRAND TOTAL DUE $
ADDITIONAL PERMITS OR FEES: Mechanical—; Plumbing
Electric/New Electric/Temp_; SwimmingPool
Septic Tank_ Well Sign Finish Floor Elevation
Survey ; Other-
CALCULATIONS and/or NOTES:
pmc VED
PROPERTY DESCRIPTION
2 15 "IjOi
Lot # Block #13.),- Section #
Subdivision:
Street Name DESCRIPTION OF WORK
or Address: sy/-.
(If in a FLOOD HAZARD
Flood Zone: -14A rea complete page 3)
Brief Description IV'
fo atc
Class of Work: (New/
Remodel/Addition:-
ZONING INFORMATION Type of Construction: Altd 11 If 1/4
Zoning Proposed
District: Use: Estimated Value $ qffvo _06
f
Exceptions or Varian Materials: wooce—
Granted:
Solid or Filled
Ground: -Roof-.
Method of Heating: -e I"I
OWNER INFORMATION
Property Owner: r"ak J-ovk� Phone:
Mailing Address- 3722 F L
zip:
CONTRACTOR INFOR14ATION
Contractor: e��,,j -Phone:
Mailing Address: AV-e, __�) -
3 - Zip:
Expiration
STATE LICENSE NO: 67/0/" Date:_ 2 z
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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.
Owner Signature,, DATE
Contractor Signature DATE 42 7'/
SWORN TO AND SUBSCRIBED BEFORE ME BY 'Peo, Aloejfell THIS DAY
OF
,10, Clayton 3.Waugh)00
CC7355 _EXPIU,
MY COMMISSION#
April 20,2002
NOTAXY PUBIrdIC
BONDED THRU TROY FAIN INSURANCE,INC
FLOODPLAIN DEVELOPMENT INFO
Location::
Type of Development:
Flood Zone: Z�-O n e
Required Lowest Floor Elevation: I'la�C J,
If building is located within a flood hazard zone, 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 Me with the Building Department.
COMNIENTS:
Applicant Acknowledgment: 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 affecting the proposed development.
Date Z41,� ?
4,g Applicant's Signature
Department Use:
Required Lowest Floor Elevation
As Built Lowest Floor Elevation
Survey Filed with Building Department
Building Department Representative
FLORIDA ENERGY EFFICIENCY CODE FOR BUILDING CONSTRUCTION
FORM 60OC-97 Residential Limited Applications Prescriptive Method C NORTH 1 2 3
Small Additions,Renovations&Building Systems .Department of Community Affairs I
Compliance with Method C of Chapter 6 of the Florida Energy Efficiency Code may be demonstrated by the use of Form 60OC-97 for additions of 600 sWare feet or lessi site-installed components
of manufactured homes,and renovations to single and multifamily resideras. Alternative methtxIs are provided for additions by use of Form 6ODS-97 or 600A-97.
PROJECT NAME: BUILDER: .be-, ACceile 4, &,C/
AND ADDRESS: ('22 z-72,ki-p? ff- PERMITTING CLIMATE
I A�1A, 6e.r,�" r-I , OFFICE: de4rxC4� ZONE: 1112F�3 2-
OWNER: A" -ra i PERMIT NO.1 I I I I = JURISDICnON NO.: T�
1 - 14) A-Ad 1-t W&I y I I I I I I
SMALL ADDITIONS TO EXISTING RESIDENCES(600 Square feet or less of conditioned area). Prescriptive requirements in Tables 6C-1,6C-2 and 6C-3 apply only to the
components of the addition,not to the existing building. Space heating,cooling,and water heating equipment efficiency levels must be met only when equipment is installed
specifically to serve the addition or is being Installed In conjunction with the addition construction. Components separating unconditioned spaces from conditioned spaces must
meet the prescribed minimum insulation levels. RENOVATIONS(Residential buildings undergoing renovations costing more than 30%of the assessed value of the building).
Prescriptive requirements In Tables 6C-1 and 6C-2 apply only to the components and equipment being renovated or replaced. MANUFACTURED HOMES AND BUILDINGS.Only site-
installed components and features are covered by this form.BUILDING SYSTEMS Comply when complete new system Is installed. Please Print CK
1. Renovation, Addition, New System or Manufactured Home 1. L,
2. Single family detached or Multifamily attached 2. 1;_�le r1LLt-*4_
3. If Multifamily-No. of units covered by this submission 3.
4. Conditioned floor area (sq. ft.) 4.
5. Predominant eave overhang (ft.) 5.
6. Glass area and type: Single Pane D ouble Pane
a. Clear glass 6a. sq. ft. � '�7 sq.ft.
b. Tint,film or solar screen 6b. sq. ft. -sq.ft.
7. Percentage of glass to floor area 7. %
8. Floor type and insulation:
a. Slab-on-grade (R-value) 8a. R= [in. 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 and insulation:
a. Exterior:
1. Masonry (insulation R-value) 9a-1 R= sq. ft.
2. Wood frame (Insulation R-value) gla-2 R= sq. ft.
b. Adjacent:
1. Masonry (Insulation R-value) 9b-1 R= sq. ft.
2. Wood frame (insulation R-value) 9b-2 R= sq. ft.
c. Marriage Walls of Multiple Units* (Yes/No) 9C
10. Ceiling type and insulation:
a. Under attic (Insulation R-value) 10a. R= sq. ft.
b. Single assembly (Insulation R-value) 10b. R= sq. ft.
11. Cooling system*
(Types:centrat, room unit,package terminal A.C.,gas,existing, none) 11. Type: 71;'�5
SEER/EER:
12. Heating systerl (Types:heat pump,elec.strip,natural gas,L.P.gas, 12. Type:
gas h.p.,room or PTAC,existing,none) HSPF/COP/AFUE:
13. Air Distribution System*:
a. Backf low-damper or single package systems* (Yes/No) 13a.
b. Ducts on marriage walls adequately sealed* (Yes/No) 13b. e x,7
14. Hot water system: 14. Type:
(Types:elec.,natural gas,other,existing,none) EF:
Pertains to manufactured homes with site installed components.
I hereby certify that the plans and specifications covered by the calculation are in Review of plans and specifications covered by this calculation indicates compliance
compliance with the�l rida Energy Code. with the Florida Energy Code. Before construction is competed,this building will be
PREPAREQ Se 7e_e1#' 1AI&elk inspected for compliance in accordance with Section 553.908,F.S.
DATE: lel
I hereby certify s in F rida Energy Co&. BUILDING OFFICIAL,
OWNER AGENT: DATE: DATE:
Revised 1998
01/09/02 WED 14:29 FAX 10002
Aug 07 01 08:41a Building Department 904-247-5805 P. 1
�Dook 10293 Page 1763
1763
.114d I Recorded
01/02/2M 01.20:32 ph
NOTICE OF: CCNIMENCEMENT JIN FULLER
CLERK CMMT Millit
DUVAL Cam
TRUST FWD 1.00
TO VVH-'QM IT MAY, CONCERN: COPY FEE 1.00
CERTIFY 1.00
,heLndersr -c hereby inforin-5 all concemed that imprcve Fin e to
�_nL AMIN I u 4, iiwir.
real PrOC I
pe!tj, Fnd in accordancz-, �-yith Se,=ion 713.13 of the i��onda Statutes. U,:a following
inforimazion is st2ted j,-. t,-,is OF COMMENCEMENT,
Cescript,ion of Property
General Description of irrprcvernemsm_�� S,F Aj
Owner 7-1'r�a a
Owm*ei interest in site of improvernertz:
Fee Simple Title Holder ather than owner)
Name
Address
Contrac.-Or Del. t&well )23 el
Address J" M-e �rl 60A., FZ 3
Surety (if any)
Address Amount of Bond
Name ofperspri wiUlin u-,& State of Florida cesigrared by owner L;pcn whnrn-rotices or cther
documents may be senieo.-
Name
Address
In addition to himself, owner �eziqnates the foilowirg person to-receive a copy of:he I.Ainor`3
Nodce as provided in Sec�ion 713.13(1)(5). Florida Statutes. (RI iii at Owner's opton).
Name
Addresa,
CWner
Sworn to and'acbsc:ted before ne this 7NxMWq&y of ix=1
% CkWM.1 ftugh
_MYC0MMM0N*CC735MSMS
a
No wary F
Apr#2q 2002
Aug 07 01 00: 41a Building Department 904-247-5805 P. 1
Book 10293 Page 1763
10
P49e: 1763
Filed & Recorded
01/02/2002 01:20:32 PN
NOTICE OF COMMENCEMENT Jim FILLER
CLERK CIRCUIT COURT
DUVAL COUNTY
TRUST FUND $ 1.00
TO W,'-,'OM IT MAY CONCERN: COPY FEE ll 1.00
CERTIFY $ 1.00
-1e Lndersignec hereby in(cf-ins -311 ccncamed that irn IFNI -be rn.-Ce to :X#Wir
real property, Znd �n accordance. with Sec--;cn 7131.13 of the Flarida Statutes, U--e 1011CvA19
information is stated Ir tnis iNCTICE CF COMilvlENCENIENT.
Ces&.Pt.ion Proper-/ lj1'-3q _�f - � . &�' /�`�/"'/`-
General Oescription of Irripmvernerrts F,
e
Ckner
a kid 1416
Address-- - NwHo,�,�, ee.-� 23
Owner's intereat in site of improvements:
Fee Simple Title Holder(.t otl�ler thar, owner)
Name
Address
J23 4/
Contr2c�or
Address Fl- 3-�-Zs&l
Surety (rf any)
Address Amount of BGna
Name oF 'oerson wiLhin the S'kzt-2 of Florida cesigrated by owner i-pcn -whorn-rcbces or cthe,
document.5 may be se�,ieo.-
Name
Address
In additicn to himself, owner designates the foilcwirg person to receive a -opy of :he Lainces
Nadce as provided in Section 713.1 2(1)(F), Florida Statutes. (Fill in* at Owner's opton).
Name
Address:
C4�
Cwner
Swcrn to and scbzcribed before rne this ay or
27Zr4 P i"i
Clayton 3.Waugh
Ow�N.",
MY COMMISSION#CC735528 EXPIRES
ry
A No utlic
pril 20,2002
BONDED No TROY INN INSURANC&INC
'tera-fificate of Mrcltpancu�
Mtu of
Atlantic Ncac4 — Nloriba
10tvartmtnt of Nuiffing Inspation
This Certificate issued.pursuant to the requirements of Section 1018 of the Southern Standard
Building Code certifying that at the time of issuance this structure was in compliance with the
various ordinances regulating building construction or use For the following.
Use Classification Bldg.Permit No. 12 7 5 6
Group-3�.f rame Type Constructiond—u21—ex Fire District Atlantic Beach
384 15th Ave. S.
Owner of Building Dean Russell Address � -- --I a —H
0
ingmd,0.630 Main
qStreet Locality AtlanticleDacr
�,IL2 k2
DOBC. FORD
By
Building Official Date:
POST IN A CONSPICUOUS PLACE
Tirtifiratt of Mccuptinq)
(titV of
Atlantic jgtar4 — Nloriba
ftartmtnt of Nitilbing Inspatt'Lln
This�Certiftcate issued pursuant to the requirements of Section 103.8 of the Southern Standard
Building Code certifying that at the time of issuance this structure was in compliance with the
various ordinances regulating building construction or use- For the following.
Use Classification Duvii�x Residence Bidg.permitNo. 12757
Group'��--fraMe Type Construction ONRI—eX Fire Distr
Owner of Building Dean Russell Address k-sonville Seach, EL-32250
BuddingAddress 632 )Iaintstreet Locality Atlantic Beach, FL 32233
By: DON C. FORD
Building Official Date:
POST IN A CONSPICUOUS PLACE
IWPN�Aw=afqralr�Gl�
CITY OF
4&4^4-C B"
Office of Building Official t3
f IV/13�oe - t1,E-
REQUEST FOR INSPEt= 13 o9V— FS/�-7
7
Date Permit N.�
Time A.M.
Received R.M.
3 0—t—63,
V Locality
Job ddress
Owner's
Name Contractor
L
CONCRET
-ffU—ILDWG E
--------- t ugh
Ro
Framing Footing C ough Wiring
Re Rooting C] Slab F- Temp Pole Top Out E Heating
Insulation E Lintel C Final C Sewer 0 Fire Place
Pre Fab
READY FOR INSPECTION
Mon. Tues. Wed. Thurs. Friday
CTUI)---�
—M
rispection Made '112 - �'\
Spector— Aff— ipecti;--�K
�allns, n
7
7 upancy
Date
&K building As locat" wAthAn a S&q" howard sm a survmy' ovLot
be ilade, AFTCR Tom SLANk XAB SM P"CDO wortAsty"W that th%�
LOWEBT FLOOR WAVATZON AS WqM&A ts, or ab~ the base glood
elevation eatub4laked ger that amm.
No final Inapeetleft will be amdo mw as o&r%4Sj**t& og occup6ncy
Vill be AW&UWd mOtAl the WWWMY AS 00 SA:" WAtk the Xm&ldAnV
Department,
CORMCUTSI
Applicant A*know&*d@*vmmt* I UnderatsmW that the AWNUence of
thle permit to vm*tjLovq� L upeft tjbW &bo" Aft9ormetton b*Lno
corrodt and that the p4ame mW a --- "to how* bees, or shell
be provided as required* X "Pee to sespAr WAth a&& oppAtcoble
provisions of r 16ft 28-7-99 smd *91 other Aows or
ordt.nancew m9fecting the, propose -de"Aepment,
oat* / 0-/
Department Use
fte,quired Lowest fteor XlewstAen
^a Built Lowest oplow ISAWWO46104
Survey Filed i6th XmA&dUW D"bertommt
BuLlding D;p,a�ro-t-W-nt ftr&m'mtfttIv&
Polue 3
"Illy
LU LC
7
0
Ca
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0 E C IE� Q)
LL
0) W
0
Co
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LIJ cc
a cc
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4S 0 C
0
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ZINk
1,3
M IN "iPTPE
rn I
CITY OF
1*&o4z Ve4d 9&Ud4
800 SEMINOLE ROAD
ATLANTIC BEACH,FLORIDA 32233-5445
TELEPHONE(904)247-5800
FAX(904)247-5805
NOTICE
TO: Water Department
FROM: Building Department
DATE: -7
Please be advised that the final building inspection has been
completed on each of the following addresses and construction water
is no longer needed:
Permit Number Address
4, -3
hL
Sincerely
Buildi- n4 Department
-7
DATE. (
PRE-SERVICE DIVISION
JACKSONVILLE ELECTRIC AUTHORITY
233 WEST DUVAL STREET
JACKSONVILLE, FLORIDA 32202
THE FOLLOWING FINAL INSPECTION(S) HAVE BEEN MADE AND ARE
SATISFACTORY:
t
--------------------
---------------------------
-------------------------------------------------
-------------------------------------------------
-------------------------------------------------
Enclosed are the blue copies of the permits.
S I NAZER E
BUILDING INSPECTION DIVISION
cc:FILE
CITY OF
Office oi Building Official
REQUEST FOR INSPECTIO
61 Per t No. J-
Date
Time A.V,
Received RM,
eg- 0
Job Address Locality
Owner's
Name Contractor
BUILDING �O�NC Et ELECTRICAL PLUMBING MECHANICAL
Framing tjo Rough Wiring Rough 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
A.M.
Inspection Made PM.
Final Inspection
Certificate of Occupancy
Dat6
CITY OF
Office of Building Official
REQUEST FOR INSPECTION
Date Permit No.
Time A,V:
Received —--——— P M
3
Job Ad,,�,ess Locality
Owner's
Name 7) "1 /,<Q r( —
Contractor �1 ,1 i
rBUILDING-) CONCREit) ELECTRICAL PLUMBING MECHANICAL
R,ugh Wiring Rough Air Cond. &
Re Rooting Slai, Temp Pole t.--
Top Out Heating
Insulation Untei --f-Tnal Sewer Fire Place
Pre Fab
READY FOR INSPECTION
Mon. Tues Wed. Thurs. Cnd,�)—�
A.M.
PM.
Inspectior. kladE
Final Inspection E
Certificate of Occupancy
Date
tort'
061�j��c`c
,�Ola
-3�Z-
30
Good,
ed GOO '��e
?\ac
ob
"es's-
101?
5ovolA V-0
611kel \Ned f\Cl
Moo
0�\09 �'J�Aa\\(159 occopa
or,
cor,OAde
,.;2 CITY OF
Office of Building Official
REQUEST FOR INSPECTION 7s-7�
Date------ Permit No.
Time AM
P.M,
Received
jo ocall Y–)
Owner's
C
ontractor
CONCRETE ELECTRICAL PLUMBING MECHANICAL
F,sa,�-,wg Footing Pouch,Wining Rough Air Cond. &
poofin,� Slab Tic—,p Poie Top Out Healing
lnsulation L i nt e; Fina, Sewer Fire Place
Pre Fab
READY FOP, INSPECTION
1,vlor� Tue� Wco. (TTI�-,!—) Friday-----PM
AM.
A qe— Rlvll.
Final In8pection
Cer*!flcate of Occupancy,
("atc
CITY OF
office Of Building ffi ial R53- 4z
REQUEST FOR INS
Date CTION -3L'':�z
Time Permit No.
Ived
Rec,
pm
Job Address
Owner's Locality
Name
UILDI cQntr, r
'�'un r
CONCRETE �ELL E
F,a inj ing Footing ��CTR�ICA
e m IC Q NICALY
F Slab 9 Wit,
R R ing
Insulation r-
Lintel Temp Pole Rough
Top Out Air Cond. &
Final E7 Sewer Heating
Fire Place
READY FOR INSPECTION Pre Fab
Tues- Wed. Thurs. Friday A.M�
IsPection Made A.M.
Spector P.M.Final Inspection [1i
Certificate Of Occupancy
Date
TRANSMITTAL DOCUMENT FOR JEA
DATE:
The following permits have passed "rough" inspection:
Permit No. Address
ERxzbmexlx)aEex)o=xX*xlme*x3=td)esxofx)ddagxpeaumd*u. Please update
your records accordingly.
Than
BUIL "'IN Lt��K-
CITY OF ATLANTIC BEACH
/vcb
CITY OF ATLA' NTIC BEACH, FLORID
b
APVrw.,wdi_v _—_] APPLICATION MR lUtTRi4CV, PtItMIT
TO THE CHIEF ELECTRICAL INSPECTOA:
iWORTANT NOTICE-.
IN CONSIDERATION OF PERMIT G,IVEN FOR r,�.'�vC.,RISF0 IN THE FOLLOWING, WE
HEREBY AGREE TO PERFORM SA;D WORK `4
t'H D P�AN$AND SPECIFICATIONS#
WHICH ARE A PART HEREOF, AND IN ACCOiia.NCE lev�`; l T�;,C S;r*��, r1r,01ATIONS, CODEN' AND CITY Of
ATLANTIC BEACH ORDINANCES.
LL ALI-LL
tLECTRIM Fift-
NAME ADDRFSS-_��,
BLDO.SIZE
R U COMM. t i PV6LIC INUU3, NEW ", LD REW.
ADDITION ( TRAILER TEMP SIGN�i 1 $0, FT
uptvlcfi: NEW i-T___�"NCREASE I AEPAIR i FEE
AMPS COPPER i
CQNOWTOR SIZE .-A ......
"�40
MMTCH QB
EXIST,SERY.fAZE AMPS W VOLT RACEWAY
FEEDERS NO. size NO. SIZE NO. size
LIGKTING OUTLETS CONCEALED OPEN
TOTAL
RECE"ACLES CONCEALED OPEN TOTAL
1 0.80^moo* 81.100 Amps.
SWITCHItS
IWCAADESCIENT
FLUORESCENT&M.V.
FIXED Q.100 AMOI:�j gy 9x__
APPLIANCES BELL TRANSF.
AIR H.P. RATING H.p.,RATINT__"_
CONDITIONING COMP.MOTOR OTHER MOTORS AMPS 'CEIL HEAT.! KW-HEAT
OVER
MOTORS H.P, VOLTAGE PHS NO. I N.p� VOLTAGE PHS
UIMLLAN��
TRANSFORMERS: UNPSR 600 V. OVEA6WV,,.—,,—
NO. KVA NO. LKV A
NO.N[ON TRANSF. -[VA. j_M_A.__j' TOR
EACH SIGN
FORWARDED
TOTALFEES
CITY OF ATLANTIC BEA(�H. FLORIDA 1�xjlmj
16DJ75 -7
Approv*dT;----,-] APPLICATION FOR ILECTPICVI� PERMIT'
TO THE CHIEF ELECTRICAL INSPECTOR: DATE,
IMPORTANT NOTICE;
0 ow WE
IN CONSIDERATION OF FIERM�T CjiVCN Kirt n' r IN THE F U ING,
_D P!ANS AND SPECIFICATIONS,
HEREBY AGREE TO PERFORM SM0 YYORK �`i
lFC01 AllONS, CODE$ AND CIT� OF
WHI�H ARE A PART HEREOF, AND IN ACCONW.-NCE Vl,'fl T;-�L
ATLANTIC BEACH ORDINANCES.
11LECTRICO"FIBM- fZT8j!;!,4&.Sig N A
NAME L-0 L
a wa.size
R m I COMMA i PV6LW ;NDUS -NEw OLD( Rew.
AODITION 11 TRAILEA I TEMP I 1 60, FT -------
URVICE: NEW i INCREASE i AEPAIR I FEE
CONDUCTOR SIZE 100 AMPS WppEfU
VfflTCHQ5§5EA
9XIlT,SERV,f4ZE AM VOLT
FEEDERS NO. size NO. SIZE ___fN0. size
LIGKTING OUTLETS CONCEALED OPEN
RECE"ACLES CONCEALED OPEN TOTAL
1 0-80 okml%
SWITCHES
110CANDESCINY
FLUORESCENT&M.V.
Fixto ^mr
APPLIANCES- BELL TRANSF.
AIR H.P. RATING H.P.AATING
CONDITIONING COMP.MOTOR OTH9ft MOTORS EAT. XW.HEAT
0-1 OVIR
MOTORS KIP, VOLTAGE PH$ NO. I H.P. VOLTAGE PHS
MIMCILLAN��__
TRANSFORMERk UNDER 600 V KVA OVER 6W V,
NO. NO. lKVA
NO.NEON TRANSF, M MOTOR SIZF
EACH SIGN
FORWARDED
LTOTAL FEES
`757-
Oil 111111
7,
M u
P
OF auujxt4
ICBEACH'
'NT
A*4w
---- --- MCATION , INVOR"
"r�`l XrORNAT 11 09
*r Add
P,
r sa s 43, 2 max
kIDA' 3 i�
permit",
cl;lss of lWork., U 014
L - *11PT ,
Constr. Vyp*,.,,'WOOD IPRAXX B I ock 1
Sect
two ll"Jagta 0 Subdivit 'iSZOTt
zbtl�-�,:Valuet,
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FOR RECORDER
THIS INSTRUMENT PREPARED BY:
Barbara J.Lamb Book 8463 PU 1107
WA73ON&OSBORNE,P.A_
208 Ponte Vedra Park Drive,Suite 101
Pouts Vedra Reach,Florida 32092 Bk: 8463
Pas 1107
Doc# 962e1512
RFCORD AND RETURN TO: Filed & Recorded
10/21/96
Oli4044 P.M.
HENRY W. COOK
�0 fN I Ft ro CLERK CIRCUIT COURT
DUVAL COUNTY, FL
REC. 6.0o
NOTICE OF COMMENCEMENT
(PREPARE IN DUP11CATE)
The undersigned hereby gives notice that in?provement will be made to certain real property, and in accordance
with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
Descri tioa of property-. The South 40 feet of Lot 4 and the North 40 feet of Lot S, Block 132, Section 'HI, ATLANTIC
BEAC according to plat thereof as recorded In Plat Book 19, page 34 of the current public records of Duval County,
Florida.
General description of improvements-, Construction of a multi-family unit consisting of two single family residential
dwellings
Owner(6): Dean Russell Construction Inc.
Address:394 lSth Avenue S.,Jacksonville Beach,FL 32250
Owner's interest in site of the improvement: Fee Simple
Fee Sinjoe Title Holder(if other than Owner):
Name:Some as Owner
Address:
Contractor: Dean Russell Construction Inc.
Address:394 15th Avenue S,Jacksonville Beach,FL 322SO
Surety,kif any):N/A
Address:N/A
Amov at of bond:$0.00
Lender:Peoples First Community Bank
Address:2305 HWY 77, P.O.Box 29SS,Panama City,Florida 32402
Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided
by Section 713.13(1)(a)7.,Florida Statutes:
Rame:Peoples First community Bank
Address:230S HWY 77,P.O.Box 2955,Panama City,Florida 32402
In addition to himself, owner designates the following person to receive a copy of the Lienoes Notice as provided in Section
713.13�1) (b),Florida Statutes.
Name: eoples First Community BAnk
Address: 110 AIA North,Ponte Vedra Beach,FL 32092
Expiration Date of Notice of Commencement is day of 19
Dean Ril ell Construcd-o-a-S—c.
29'. &=2f�
Dean RusseL4 President
STATE OF FLORIDA
COUNTY OF ST.JOHNS
The foregoing instrument was acknowledged me his lSth day of October, 19% by N�P'o P_LLSSO
Col
Deap as 1zhalf or me corporauon. f1c./Sho is personaLly
known to me or has procluced NSE— as identification.
ubl' ate al County Afo
Notary P!��'
00,
Notap7t*-atufr. (Title or Rank)
BARBARA J., LAM13
Notary Printed Sigmature (Senal No.,it any)
BARBARA J. LAMN
I CC 373618
COMMISSION
EXpIRj!8 JUN 20,1998
DONDEOTHAU
A.TLANTIC BONDING CO.,INC.
Pap I Feim lloftwbm byAwlems%d R4A 16ims SpWw,lee. 94TOW
7M,
OFFMDWQ�
Twfi
'ClTy
It'�*A u vim AV,,
w , IC BEACH-
OF ATLANT
.. ........
7i"
FORMAT ------- CA* -10?0
�630 -MAIN, $T$tXLET,,
r: 12, 5i6 Address,
e
P, i
't T� ATLANTIC BEACH, IrtIL4 DA 3 1
Or Ltx
Ape,:
(71 1 a's s of"*ork:NZW --------- LEGAL DISCRIPTI
Cons t r type:WOOD 'PP Block-. 132
Lot.1 4/5 PTS IkTwp
'10
Proposed useltopl-Ex Section: �O subd.
Dwel I ings i: Subdi vi's,ioni'sZOTION H
Est". 00
Improv tJw
Totall TO' 3,ii3 4$
Amou t
42
W e"Mal=
IDENCE PER P r — 126641
On CATII ON rZIU;- --------
T 435.10
' Ad WATER 114 112 396.:,
I �3
of SAM
ph*,,
')I RAD014 G "d
6.b
7RADON CAS -Sit
%PITAL IMP
'Name t N N CO.
C 3 5.
CROSS
IMPACT. "APItt'
Li c'* SEC H 6 00
r72CONSTI.
-0
NOTEV.
1��A":00010ftft**AWAWQ MUST 6p."pvdti 0 W.FMIft0000,
I - p
ir� 1 0
Sl)(MONTHS AFTER D,
Or
MA, E 4- *')wJtI4 THIS RK C
N-MACTOR O: R OWNER
MUST N?Sft?�" PUBLI $FAO4j AND M"S I
'T NIV
E:MECH-A
kv
FA
THE FORTHE,
N WK, -nON
to R fOCA
E 4N$'WMIW ARE PART OFTHIS P SUBJECT F
Ol
V1
t4s�144
t
m
T
VrWEN
ATLA
'By:,
77 M17
7--� 7,77
j
-0
0000@@@@@@@@@V@ TEL �Io . 2475805 Oct 13 , 96 9 :00 No -001 P -03
CITY OF ATLANTIC BEACH PERMIT CALCULATION SRZ8T
Address
Date 10-
Heated square Footage ;t $ Per sq
air --per sq f t z $
per sq f t = $ 23.
Carporta�i;��)
Deck @ $ per aq ft 2 S 0 --
Patio 6 @ s —per sq ft. $ 0
TOTAL VALUATION: $
Total'Valuition lot $ T3, 060
Ll �c & - A& -00
Remaining Value !f.00per thousandf
portion thereo
TOTAL BUILDING FEE - 75 1�0�
+ 1/2 Filing Fee $ 4 mi.00
( 1 ) Fireplaces 0 $IS .00 $ –L.-0 6
BUILDING PERMIT FEE s �31.00
WATER IMPACT FEE
SEWER IMPACT FEE $– fro%�an
WATER METERITAP
CAPITAL IMPROVEMENT
SEWER TAP
RADON (HRS) .0050 $ I z",32.
&
SECTION H PAVING ( 'fop
HYDRAULIC SHARES
CROSS CONNECTION 110
Q.140) SURCHARGE .0050 .1; S"", 7 Q 4 &3
OTHER
GY"D TOTA14 DUE
ADDITIONAL PERMITS OR FEES; Mechanical_: Plumbing
Electric/N*w Electric/Temp_;SwimmingPool
Septic Tank— Well sign Finish Floor Elevation
Survey ; other_
CALCULATIONS and/6r NOTiS:
V/
Of
A�
6r
%3x 3
0'13
J�6
0(�k POO
�-\Je
G 9
po\e
0
\\�V�JAG C'vP
\3 poA
,,�03
4,2
'P.0
W"\\,0
-10 G �%%
lei
DATE:
PRE-SERVICE DIVISION
JACKSONVILLE ELECTRIC AUTHORITY
233 WEST DUVAL STREET
JACKSONVILLE, FLORIDA 32202
THE FOLLOWING FINAL INSPECTION(S) HAVE BEEN MADE AND ARE
SATISFACTORY:
------ ----------- ---------
11 C,
------ - ---------------------------
--------------------------
1A
-------------------------------------------------
Enclosed are the blue copies of the permits.
I N C�E)E L Y
13UILDING INSPECTION DIVISION
c;: FI L E
CITY OF ATLANTIC BEACH, FLORIDA
Approved by APPLICATION FOR ELECTRICAL PERMIT
TO THE CHIEF ELECTRICAL INSPECTOR: DATE: it)I LZ
IMPORTANT NOTICE:
IN CONSIDERATION OF PERMIT GIVEN FOR DOING THE WORK AS DESCRIBED IN THE FOLLOWING, WE
HEREBY AGREE TO PERFORM SAID WORK IN ACCORDANCE WITH THE ATTACHED PLANS AND SPECIFICATIONS,
WHICH ARE A PART HEREOF, AND IN'ACCORDANCE WITH THE ELECTRICAL REGULATIONS, CODES AND CITY OF
ATLANTIC BEACH ORDINANCES.
8ILL THOMPSON ELECTRIC Co., INC.
P. 0. BOX 330150
ATLANTIC BEACH,FL 32233,0150 /*�X 172 -05��
ELECTRICAL FIRM: MASTER �CECTRICIAN SIGNATURE JOURNEYMAN
NAME-!"0 ADDRESS: L6Z MAW SL TELO —RFD—BOX—
BLDG.SIZE BETWEEN:
RES. ( ) AFT. COMM. ( PUBLIC INDUS. NEW( OLD ( REW.
ADDITION ( ) TRAILER ( TEMP.J/j SIGNS ( ) SQ. FT.
SERVICE: NEW( INCREASE ( REPAIR FEE
CONDUCTOR SIZE , -?q-- AMPS COPPER ALUM. Wj
SWITCH OR BREAKER AMPS PH 3 W VOLT RACEWAY
EXIST.SERV.SIZE AMPS PH W VOLT RACEWAY
FEEDERS - NO. SIZE IND. SIZE NO. SIZE
LIGHTING OUTLETS CONCEALEDI OPEN I
RECEPTACLES CONCEALED] OPEN ITOTAL
0 AMPS. 31-100 AMPS.
SWITCHES
INCANDESCENT
FLUORESCENT&M.V.
FIXED 1 0.100 AMPS. ov" BELLTRANSF.
APPLIANCES I I
AIR H.P. RATING H.P. RATING
CONDITIONING COMP.MOTOR OTHER MOTORS AMPS CEIL HEAT: KW-HEAT
0-1 OVER
MOTORS H.-P. I VOLTAGE PHS NO. I H.P. VOLTAGE PHS-1
MISCELLANEOUS
TRANSFORMERS: UNDER 600 V. OVER 600 V.
–NO-.�O KVA INO. lKVA---[ FLASHER
NO.NEON TRANSF. VA. MA. MOTOR SIZE SWITCH
EACH SIGN
FORWARDED
s
TOTAL FEES
Ar
NT OF EIU"WG
CITY OF ATLANTIC BEACH
--- PERMIT PjaTION -------
------- LOCATIOR INFORMATION
12",7
Pi, rmit Nuh�ber: _4,6,Z'
Address 630- 632 14AIN,,S
TAUT
`�'P e rmi t TYIWFOUNDATION ONLY
C
_j, ATLANTIC BRACIR, PLORIDA, 32233
NEW
'_a'SS of W6r
tk. --------- LWAL DESCRIPTOR -- ---------
onstr. TYWWOOD FRAME Block
rOPOsed Tlie-DUPLXX Lot': 4/5 Twp: 0
Section: �O
T Subd Rng: 0
Dwel I ingfs: 2 Subd v on:,StCTION H
-Value:, 0.00
Eis t
"I f7pprov. Cost: ""0.00
e, 21 zo
Total F 0
."Amount
E(A Aml
ION APPLICATION FEES -----------
TIF
f&I T 25.00
Addr: 3
8, SOUTH
ro MAT! ------
N' DE �ONRST*U Co.
L
JACK$ "m
BEACH, FL 32250
L rxp :
Foomas M
Not
ram' ----
for _4 J6 Aa u223.1ft
C, tsS 0 S U
ter
VOID SIX MO"
NG MATEFM, RUSSISH AM DEBRIs FROM THIS WO MUSTNOT LA0f P 14 P
AND f, RK BE f�
USLIC SPACE,AND MUST BE
AWAY 1"e4
COWRACTORr OR OWNER
0
URIE�Tq,
HE MECHANICS,LIEN LAW
'CANAESULTIN
PAWNGTMCE FORTHE SUILDWO"PROVEME?0%
ED ACIOR APPROVED,PLANS-WHICH ARE PART OF THISPERMIT AND SUBJECTTO REVOCATJW.(p
pp
DVI$IONr>OF LAW.
OM47
91 ReOipt.,
LAI' W
AtLANTIC k BUiL
4
Q61 —————————
CITY OF A�ANTIC$EACH.
PZRMIt INFORMATION
FORMATION"
6
it
LOOATION IN
p 3A NufAbo"r t 12$: Addiess
MAIN lftzptl.�
llermi t TYpe P4
-16 233,
URI$jN0 ATL TIC, BEA61 `jL
Ok W 12
-------- LEGAL DESOUPTION
of mbr
k
--------- -
�st r �Tyjoe:14�ft FRAME . ''Lot:4/s 'PTS Twp
Blockwla2
I Wl -oposod 'U* fjp�L'XX
7 , I � **0 Secti4l 0 b
'we
I Sit d.
Subdivision.
as t Vil,
0.00
*,prov Co sit 0'.00
Tot I Fe 53.1150
��l no f
No'!
APPLICATION Paz$
----------
100
A^ 53. 50
a, SO I T, T
cm PL 32
.3
r
C
aAc"Of SCH PIPL J2240-1558
41
flot=
AWOMPSM Poo*,,AND F0
OT114GS WW'109,11M06CM �'QRE POUR04
ftf;
'PEfWIT VOID SIX MONTHS AFTER DATE OF ISSUf
%*fNG MATERIAL,AUM$H AND,DF.SRiS FROM THIS WORK muslr N&EIE pLA
6Et)114 PUBLIC SPACE,AND,MUST BE , ,
It �k)N#Y
Up,AND HA( NTRACTO OR OWNER
S*t"E01 CO R
Y WITH "S'llEN, LAW CAN"R
THE IC-
M F�
IIAN ESULT �JN� .
fAYING THEIBU NO Allinm,
9ME
FID11140 TO APP,
-ROVED PLANS WHICH ARE PART OF THI$'PERMIT�AND SUBjF
A, PAPf CT-to REVOCATION FOR
kICASM PAWISIONS OF LAW.
-Q4
2
NT
5 �
CITY OF ATLANTIC BEACH
APPLICATION FOR PLUMBING PERMIT
6 7 o
JOB LOCATION :
OWNER OF PROPERTY: , DEAN gijs,�Elli CONSTRUCTToN
PLUMBING CONTRACTOR - F- w- pATg pT,fjmjgTNr. c()-
CONTRACTOR' S ADDRESS : p- o- BOX 51558, Jacksonville Beach, Fl. 32240-1558
STATE LICENSE NUMBER:- g,p ()()37so3 TE I LEPHONE: 204-241-7191
HOW MANY OF THE FOLLOWING FIXTURES INSTALLED
1 —SINKS SHOWERS
2 LAVATORY 1 WATER HEATERS
2 BATH TUBS 1 _DISHWASHERS
URINALS 1 DISPOSALS
2 CLOSETS 1 WASHING MACHINE
FLOOR DRAINS SHOWER PANS
OTHER
TOTAL FIXTURES:— 11 x $3 . 50 + $15 .00
MINIMUM PERMIT FEE - $25 .00
SIGNATURE OF OWNER: K\ J1 A
I'--
SIGNATURE OF CONTRACTOR:----
-----------------------------------------------------------------
INSTALLATION OF PLUMBING AND FIXTURES MUST BE IN ACCORDANCE WITH
THE MOST RECENT EDITION OF THE SOUTHERN STANDARD PLUMBING CODE.
CALL A DAY AHEAD TO SCHEDULE INSPECTIONS - (904) 247-5826
SEWER CONNECTIONS MUST BE CALLED INTO PUBLIC WORKS FOR INSPECTION
PRIOR TO COVERING UP - ( 904) 247-5834
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
p
ERMIT INFORMATION ------- LOCATIONINFORMATION ---
pl 12154
Oftit Numb
Address MAIN STREET ,
I,: exmi t, T *PLUM$TNG
C I-, ATLANTIC� BZACH, FLORIDA �32233
�-Ass,, of Work:Nt*, --------- LEGAL DZSC
I ' RIPTION ----------
dimsir. Type:WOOD, 'FRAMZ 0
Bl ' ck,.13, 2, Lot--30'2Wi Twp,. 0
i6,-*,p,,0se&,Vie DUPLEX Sectidn: 0 -Subd n
R 0
We
D 11,1 h qz
SubdivislonfSECTION H
"' Est . Value:
-0,.'00
p
'peov. c s��,'t 0.00
To, tal re 53 50
tQunt
ud-�T N MEN
ON APPLICATION FEES ----------
T
�T
53.50 -
r: , 3 SOV
TH
'CH FL
L
P
4 40 F.
",ING C
C PL, '32240-1558
T
ALL CONCftTtfOR#A$AND FO0TfNQ$MUST SE MpE
CTIED99FOREPOURING,
PERMIT V611D SIX MONTHS AFTER DATF-OF ISS
UE
Bu40NQ mATF.AtAL,,RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE
AND)*XE'D AWAY BY EffHEA CONTRACTOR OR OWNER
'S UIEN LAW CA
dOMPLYWI
J!� 'A JURE V
R 11L, TWTHEMKHANIC RRESULT IN "
'p
OWWA PAYINGTWICE FOATHESUILDING 14PIAMEMENTS
ED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS'PERMIT AND,SMECT TOREVOCATION FOR'
APPLICABLE PAWISION$`OF LAW.
031�54 14
I pAttz 114,1446 at ttygaigu wa-2-
"ATLAN71C SEACH B
vkoiw PARTMENT
CITY OF ATLANTIC BEACH
APPLICATION FOR PLU!MfING PERMIT
t � L,
JOB LOCATION :
OWNER OF PROPERTY: DEAN auSSELT, C0NqTRTl(--TT0N-
PLUMBING CONTRACTOR F- W- FAIR PT,TlM'RTNG CO
CONTRACTOR' S ADDRESS :p- 0- BOX 51558. Jacksonville Beach, Fl. 32240-1558
STATE LICENSE NUMBER: Rp on37503 TELEPHONE: 9-04-241-7191
HOW MANY OF THE FOLLOWING FIXTURES INSTALLED
1 _SINKS -SHOWERS
2 LAVATORY WATER HEATERS
2 BATH TUBS 1 _DISHWASHERS
URINALS I _DISPOSALS
2 CLOSETS I WASHING MACHINE
FLOOR DRAINS SHOWER PANS
OTHER
TOTAL FIXTURES:_ 11 x $3 . 50 + $15 .00
MINIMUM PERMIT FEE - $25 .00
SIGNATURE OF OWNER:
STGNATURE 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) 247-5826
SEWER CONNECTIONS MUST BE CALLED INTO PUBLIC WORKS FOR INSPECTION
PRIOR TO COVERING UP ( 904) 247-5834
0000@@@@@@@@@@ TEL No . 2475805 Oct 13 ,96 9 :00 No . 001 P .04
.................
CITY OF ATL"TIC BEACH PZRXIT CALCULATION BRENT
Address—A-3 :2-- L5
Date 5 - q.k
Heated Square Footage $ 37-00 per sq ft z
-32
(.Gara
per sq f t x $ 2
Carportsfoi��fl) s-13-06 per sq ft z
Deck @ per sq f t = 5 0
Patio 6 -@ per sq ft = $
TOTAL VALUATION:
Total"Valultion ist $ S60 60.2
4." -4c- fe - Am' I bo 0
Remaining Value $ .00per thousand
X 0 portion theroof
TOTAL BUILDING FEE
+ 1/2 Filing Fee �00
( I ) Fireplaces @ $15 .Oo $=:ii 5:El =
BUILDING PERMIT PEE 141.31700
WATZR IMPACT FEE Ok 04CIQ
SEWER IMPACT FEE Cn-an
WATER METER/TAP ecvb
CAPITAL IMPROVEMENT bb
SEWER TAP
(1,*G) RADON (HRS) .0050
SECTION H PAVING
HYDRAULIC SHARES S
CROSS CONNECTION sp on
Q)L4G) SURCHARGE . 0050 S -C- 70441
OTHER
01tAND TOTAL DUE
ADDITIONAL PERMITS OR FEES: Mechanical_; Plumbing
Electric/New Electric/Temp_;SwimmingPool
Septic Tank Sign_Finish Floor Elevation
Survey other_
CALCULATIONS and/or NOTES:
CITY OF ATLANTIC BEACH PERMIT CALCULATION SHEET
Address M
Date Jc -
Heated Square Footage
Q � @ $ per sqft =
G a-r a 4e�0§h e4 ;QV� @ $- I F.00 per sq f t = S
Carport '--' -- '7 f @ $ per sq f t = $
Deck @ $ per sq ft = $
Patio @ $—6per sq f t = $
TOTAL VALUATION: $
$
ist $ 500000
Ain' .0c) — $
Remaining Value $ obper thousand
�� portion thereof
TOTAL BUILDING FEE $
+ 1/2 Filing Fee $ VA-60
( 1 ) Fireplaces @ $15 . 00 $ 1 /15-.00
BUILDING PERMIT FEE $ 3S-00
WATER IMPACT FEE $ 3eio-00
SEWER IMPACT FEE $ C-A to
WATER METER/TAP $
CAPITAL IMPROVEMENT $ :—L
SEWER TAP $ _--n
( Q&6) RADON (HRS) . 00-50 S e7 :�; ,
SECTION H PAVING $
HYDRAULIC SHARES $
CROSS CONNECTION $ on
q146) SURCHARGE . 0050 $ Z-, 70r4 &3
OTHER $
GRAND TOTAL DUE $ 3 1 3 2- , 46
ADDITIONAL PERMITS OR FEES: Mechanical_; Plumbing
Electric/New Electric/Temp_; SwimmingPool
Septic Tank Well__; Sign Finish Floor Elevation
Survey Other
CALCULATIONS and/or NOTES:
CITY OF ATLANTIC BEACH PERMIT CALCULATION SHEET
Address— eo 3 tj
Date 0� �
Heated Square Footage @ $ per sq ft =
/'G--a r a-jje�Yj h @ $ I per sq ft = $
C a r p o r t '�o-r-c- h)' '7 f @ $ per sq f t = $
Deck @ $ per sq ft = $
Patio @ $ 6 per sq ft = $
TOTAL VALUATION : $ !S-Ll .574
$ 12
fo—t—a-1-7 V a 1 u
,j�tion ist $
-5 'Ic $
Remaining Value $ .0f)per thousand
�� portion thereof
TOTAL BUILDING FEE $
+ 1/2 Filing Fee $
( 1 ) Fireplaces @ $15 . 00 $ 0 0
BUILDING PERMIT FEE $ 3rOc)
WATER IMPACT FEE $---34io.to
SEWER IMPACT FEE $ C-D (0
WATER METER/TAP $ OD
CAPITAL IMPROVEMENT $
SEWER TAP $
( 1)64) RADON (HRS) .0050 $ 2-
SECTION H PAVING 00-�
HYDRAULIC SHARES
CROSS CONNECTION $
(1.746) SURCHARGE . 0050 $ Z 7 0 L 3
OTHER $
GRAND TOTAL DUE $ 2-
ADDITIONAL PERMITS OR FEES: Mechanical_; Plumbing
Electric/New Electric/Temp_; SwimmingPool
Septic Tank Well Sign_Finish Floor Elevation
Survey Other
CALCULATIONS and/or NOTES:
TEL 11110 . 24758015 Sep 7 ,95, 1 2 :20 No .009 P .02
CITY OF
;I i ,q
Building and Zoairtg so SCHWOLA 00"
ATLARM MCH,nOLM%=W,"U
PROPERTY DESCRIPTION TEUMNS("4)204M
TAX me 247-M
L t #�L,`, Block #Jf�� Section #L
,or
SUb ivision:
t'4 t,,7�t� ,,, _-, 5 --1 ��,A 40 rk, L.O�T_q
Street Name DESCRIPTION' OF WORK
or Address:-- rh6dr--(
If in a FLOOD HAZARD
Flood Zone;-C.Larea, complete page 3. Brief D*scriptio
Class of Work: (N*w/
Remodel/Addition: F—Y4
ZONING INFORMATION T- of Const C_,L Fz-
,Ype ruction:_
Zoning 3;-k Proposed
District-&�� use: I-Lao ' Estimated Val $ 0 C)
L[��Rn 7r Art, U* A
Exceptions or Variances Materials:
Granted: -
Solid or Filled
Grounda-.4�xt Roof :�-29trrCnL,&
Method of Heating: UE&M: _3�:urv\3>
OWNER INFORMATION
Property Owner: L&= hone.. LIA -zol -
Mailing
Address
?7"1
CONTRACTOR INFORMATION
Contractor%
Phone: -Ze-1 3
Mailing L
Address:-
-\,4-w- zip:
Expiration
License Number : Cl�� - CL M 6 —Date#.
I HEREBY CERTIFY TH4T I HAVE READ AND EXAMINED THIS APPLICATION 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 HE EIN
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, Olt LAWS IN ANY MANNER, INCLUDING THE COVERNING OF
CONSTRUCTION OR THE PERFORMANCE OF C70NSTRUCTION OP THE PROPERTY. I
UNDERSTAND THAT THE ISSUXN(�. jr THIS PERHtT IS CONTINQtNT UPON THE ABOVE
INFORMATION BEING TRUE AND CORRECT AND THAT THE PLANS AND SUPPORTINO DATA
HAVE BEEN OR SHALL BE PROVIDED AS REQUIRED.
Owner Signature jo_�e_ Date Z&
CITY OF ATLANTIC BEACH
Fixture Unit Worksheet for Water Impact Fee
FIXTURE UNITS ARE ESTABLISHED AS THE NZASURZMM OF'WATER DEHAND FOR
ZACK WATER FIXTURZ UNIT INSTALLED AND CONNECTED TO THE CITY WATER
SYSTEM. THE WATER SUPPLY CHARGE IS N M BY FIXED AT TWENTY DOLLARS
PER FIXTURE UNIT CONNECTED TO THE CITY WATER SYSTEM.
I 1--ZATHROOM GROUP CONSISTING OF SERVICE .SINK TRAP STAND
WATER CLOSET, LAVATORY & BATH
TUB OR SHOWER STALL (6) / ;I_
1 WATER CLOSET
_�_WATER CLOSET. TANK OPERATED (4) 1 VALVE OPERATED (8)
BATUTUB/SHOWER (2) 'URINAL WALL LIP (4)
_�__SHOWZX GROUP PER READ (3) DRAIN (1)
SHOWER STALL DOMESTIC (2) LAUNDRY TRAY (2)
LAVATORY (1) +—COMBINATION SINK AND TRAY (3)
WASHING MACHINE (3) '3 POT, SCULLERY SINK (4)
DISHWASHER (2) 2-- WASH SINK EACH SET OF
FAUCETS (2)
___L_KITCHEN SINK (2) 4 DENTAL LAVATORY (1)
KITCHEN SINK WITR WASTE DENTAL UNIT OR CUSPIDOR (1)
GRINDER (3)
BIDET URINAL STALL, WASHOUT (4)
COMBINATION SINK AND TRAY WITH
,._nvSgl= KIM SINK (6)
FOOD DISPOS. (4)
URINAL, PZD9STALo SYPHON JET DRINKING FOUNTAIN (112)
31,0WOUT (2)
LAVATORY, BARBER/SlAUTY ICE MAKER (1/2)
SHOP (2)
SURGEONS SINK (3) LAVATORY. SURGEONS (2)
JACUZZI (2) URINAL STALL. WASHOUT (4)
TOTAL FIXTURE UNITS
4 $20.00 EACH $
JOB INFORMATION
+904-241-2028 DEAN RUSSELL �--OH'73T 41,713 P021 OCT 17 '96 08:56
IFAN INUM 1191=8071111,INC.
384 15th Avenue South
Jackmi-ville Beach.FL.32250
Phonc 241-3334
Fax 241-2028
October 16, 1996
City of Allantic Beach
800 Seminole Road
Building Dept.
Atlantic Beach, FL. 32233
Dear Dor�
This letter s to certify that all truss systems associated with duplex models AB,C, & D on
Main Street in Atlantic Beach meet or exceed the 100 NPH wind loading requirements as
specified by the S.B.C.C.I.
Tha��you,
x,U, It 4��W
DiEn Russell
DWR/ww
�uluoj pup
tulplIng
t
E
– CITY OF ATLANTIC BEACH
Fixture Unit Workshoet fat Water Impact Fee
FIXTURE UNITS ARE ESTABLISHED AS THE MEASUREMENT OF'WATER DEMAND FOR
EACH WATER FIXTURE UNIT INSTALLED AND CONNECTED TO THE CITY WATER
SYSTEM. THE WATER SUPPLY CHARGE IS HEREBY FIXED AT TWENTY DOLLARS
PER FIXTURE UNIT CONNECTED TO THE CITY WATER SYSTEM.
2. BATHROOM GROUP CONSISTING OF SERVICE -SINK TRAP STAND
WATER CLOSET, LAVATORY 4 BATH (8)
TUN OR SHOWER STALL (6) 1 ;z_
WATER CLOSET
__�_WATZR CLOSETo TANK OPERATED (4) VALVE OPERATED (8)
,—BATNTUB/SHOWER (2) URINAL WALL LIP (4)
_.�._SHOWU GROUP PER HEAD (3) FLOOR DRAIN (1)
i SHOWER STALL DOMESTIC (2) LAUNDRY TRAY (2)
_�.�LAVATORY (1) COMBINATION SINK AND TRAY (3)
WASHING MACHINE (3) POT, SCULLERY SINK (4)
DISHWASHER (2) WASH SINK EACH SET OF
FAUCETS (2)
KITCHEN SINK (2) DENTAL LAVATORY (1)
KITCHEN SINK WITH WASTE DENTAL UNIT OR CUSPIDOR (1)
GRI14DER (3) 7
URINAL STALL. WASHOUT (4)
BIDET
COMBINATION SINK AND TRAY WITH
FLUSNING RIM SINK (4) FOOD DISPOS. (4)
URINAL, PEDESTAL, SYPNON JET DRINKtNG FOUNTAIN (112)
SLA)WOUT (2)
LAVATORY* AARBER/BZAUTY t -ICE MAKER (1/2) 1
SHOP (2)
SURGEONS SINK (3) LAVATORY, SURGEONS (2)
JACUZZI (2) URINAL STALL, WASHOUT (4)
TOTAL FIXTURE UNITS__1 A $20.00 EACH $
JOB INFORMATION '30 1 A/
~ /� i�`� �./�`{-93 Reszdential Cumpunent �`resc� ��tive �a�hoJ A NJ�T�i
.' .(`��CT NAhE: .����� DUPLEX � BUILDER. DEAN RUSSEL
| PERM ITTING 1CLTHAT E
1OFFICE: iZONE: 1 / j 2 | _| 3 | _|
OwNER: � PERMI � �O. | JURISDICTION NO.
� ^
1. New construction or addition 1. New Constructioo� ____
2. Single family detached or Multifamily attached 2. Single-Family
3. If Multifamily-No. of units 3. � _........
_
4. If Multifamily , is this a worst case (yes/no) 4.
5. Conditioned floor area (sq. ft, � 5. 1258. 00
6. Predominant eave overhang (ft. > 6. 1. 33 .................
T. Porch overhang length (ft. ) T. 0. O0 .................
G. Glass area and type: Single Pane Double Pane
a. Clear Glass 8a. O. Osqft 131. 00sqft
b. tint , film or solar screen 8b.
9. Floor type and insulation:
a. slab on qrade (R-value, perimeter) 9a. K= O. 00 , �4�. 0O ft .... ........
1O. Net Wall type area and insulations
a. Exterior: 2. Wood frame ( Insulation R-value) 10a-2 R=i1 . SO, 863. 00sqft____
a. Adjacent: 2. Wood frame ( Insulation R-value) 10a-2 R=11. O0, 102. 00sqft____
11. Ceiling type area and insulations
a. UnJer attic ( Insulation R-value) 11a. R=19. 0� , 140. 00sq1t____
a. Under attic ( Insulation R-value) 11a. R=30. 00 , 1274^ 00sqft____
12. Air distribution systems
a. Ducts ( Insulation + Location) 12a. R= 6. 00 , uncond
13. Cooling system 13. Type: Central A/C
SEER: 10. 00
14. Heating System: 14. Type: Heat Pump
15. Hot water system: 15. Type: Electric
EF : ('. 93
16. Hot Water Credits: (HR-Heat Recovery, 16.
DHP-Dedicated Heat Pump)
1T. Infiltration practice: 1 , 2 or 3 1T.
18. 4VAC Credits (CF-Ceiling Fan , CV-Cross vent, 18.
HF-Whole house fan, RB-Attic radiant
barrier , MZ-Multizone)
19. EPI (must not exceed 100 points) 19. 97. 98
a. tuba ! As__Bui lt points 19a. 249 ]5. 88
b. Total Base points
- ----_ ----_--........ ... ..........._ ........--_---...._......._-----....-........-- ........--..................
-__--___--'-_--- ---_---
.......... ............... ._������������ � ��� ��_��� �� �
l kereby certify that the plans aEd 1 Revzew of the plans arh spec zficatioos
specificatzons covered by this calcu- 1 covered by this calculation indicates
iatzon are :�.n compliance with the | compliance with the F�/ ruda Energy
Fl-nzda E�ergy Code Code. Before construction is comp �eted
this buildingwill b t d f
w e znspec e cr
PREPARED DY: / 1 compliance in accoroance with Sectio',
DAM:______________{���.�_�,����_�`����__ ____ | 553. 9O8 F. S.
'
I hereby certi�y that this build104 is i
in compliance with the Florida Energy | '
Coue. |
JWNEE � �UILDI�G OFFIC
^ --
---- - '-
............
- ----- -_-'----'
��
�
ION PRACTICE COMPLIANCE CHECKLIST **
REQUIREMENTS FOR EACH PRACTICE CHECK
' 606^1 COMPLY WITH ALL INFILTRATION PRESCRIPTIVES.
---���..............z-._-_----------------------_-----_-----_'_---__----------_--
i Maximum of 0. 34 FM per linear *foot of operable vash
crack ( includes sliding glass doors)
areac solid
606YI Maximum of 0. 5 CFM per sq. ft. of door
dare, wood panel, insulated or glass d9ars only.
----------------------------
" :QTa be caulked, gasketed, weather-stnipped or other
F. ".02, 606�L COMPLY WITH PRACTICE H1 AND THE FOLLOWING,:
1111IS 60611 �Top plate penetrations sealed. Infiltration batrier
installed. Sole plate/floor 'joint caulked or sealed.
6001 Penetrations, joints and cracks on interior surface
.606:1. DuctWork in unconditioned space must be sealed.
606,4 EQuipped with. outside combustion air, doors and flw'-�
`
606. 1.A. 2.
-----------------------------------------------------------------------
CombVdt-i on 606.1 Combustion space and water heating systems provided
with outside combustion air, except direct vent
---------------------------------------
N, QJE$qR1ry4VgQMEASURE8 (must be met or emceeded by all residences. )
- - ------------------------------------------------------
6 1"2 T - C6mply - with efficiency requirements in Table 6-11.,
Switch. or clearly marked circuithreaker (electric)
or cutoff (gas) must be provided.. Emternal or built
in heat trap required.,
ASW 61211 Spas and heated pools must have covers (emcept solar
Gas- spa & pool heaters must have a minimum thermal.
efficiency of 78 percent.
--------------------------
Water flow must be restricted to no more than 3 gal
Ions par minute at 80 PSIG.
ff-L EP tribution . 6104X All ducts, fittings, mechanical equipment and plenum
ay" chambers shall be mechanically attached , sealed ins
ulated and installed in accordance with the criteria
of Section 610, Ducts in Unconditioned attics mus
be insulated to a minimum of R-6. Air handlers shall.
not, ba installed in attics unless in mechanical.
'-tQfmostat +or each system.
6001 Wilings minimum R-19. Common Walls Frame R-11 or
. 602. 1 CBS R-3 both sides. Common ceiling floors R-10
_
...............
;�,. :::� i�`,O 1 NOR 1 T VIF E SC JR1011 Akjo-,�
............ ........... ........ ................................... ...........
ME 10. 00 65. 8 658. 0 1 DBL. CLfv G. 0 57. 7 . 80 SNA
E 61. 00 65. 8 4013. 8 1 DBL GLR E 17. 0 79. 7 . 89 120&
D i..",L, t:",I i:,.! i��s 24. 0 79. 7 ya 1804,
1:�.,-i i:�'. i� 7 � 05 1513.
SE 1000 65. 8 65& 0 f DBL. Clio SE 1 K TA 1 Ws 6 8 2.
- 42 1.
9': < 2 1 DBL. CIA S 9. 0 66. 2 . 7i
,.,j �1-1 00 S 2697. 0 1 DBL. CO it A) 25. 0 7AY � ?S 1 A 4
L. -C.*:LJ:�! TKO 75. 7 . % A00_
................ .......... .......................................................................................... ............................. . ...... .......
f::fftiiD:�f i::tic 1 Ef ADINTS to 1 1q FS I KKKI I i:
................................... ............................. ...................., ...............-,............. .... ...
. 15 1 258. G:,; 131. 00 440 to,6 140. so i2,416. 46 1
.....................
..................... .................................................................................................................................-................................................................ .......................................................................
... ..... .................................................... i
Ext 863. 0 . 9 776. 7 1 Ext Wood Frame 11� 0 86SO 1. 70 1461. 1
Adj 102. 0 . 7 71. 4 1 Adj Wood Frame 11. 0 102. 0 � 70 71. 4 ,
'00 ..............................................I................
Ext 20. 0 6. 1 122. 0 1 Ext invulatwA 20. 0 4. 10 al. ;:�
Adi is. 0 :2. 4 43. 2 f Adj Insulated 18. 0 1. 60 23A..
ZVO 730. 0 � 60 �50.
1 Under Attic 30. 0 524. 0 � 60
1 Under Attv-:: 19- 0 140. 0 1. 10
......................................................
Sib 145. 0 -37. 0 -5365. 0 1 S lab-on-Grad lo5. 0 -41. 20 -5074.
!NFILTRATION-----------
pronvice 12%. 0 G. Ov 1 cc
56
C.'_OOLING 1 TOTAL v CAP x NA! x SYSTEM x CREDIT
i::tGI1QT&j 1 G13NFIAM VKHTJ PULT pul-T PRA.T KI
............................ .....................1.......... ............................................. ................ .................................................................__...I
iewes. 56 . 37 69906. 92 1 15, 747. 59 1. 00 1. 070 . 340 1� 000 5, 72a. 0%
...........
1::'01AMB 1 TYPE SC M 1 Eli (ARM K)INK.",
............................. .........................................................--1-............... ............ ................................................................................... ...............................................
o-iE� :1. i,-,0 -10,6 -106. 0 i DDL CLFQ ME 10. 0 4. 6 1. 29 59. 1
E 61. 00 -10. 6 -646. 6 1 DBL i�-": 17. 0 -9. 2 . 7o 10 9�-X."
1 *D Y:��i Ci k! i��: 24. 0 -9. 2 . 83 18 3.
i ).')"I"...;i i i��m 20. 0 -9. 2 . 85 15 6.
S E 10. 00 --T& 40 --106. 0 1 DBL. CM SE 1NO -22. 7 . 86 19 5.
('.,j 0 10, 6 -95. 4 ! DBL 13M S 00. 0 -28. 4 . 81 -206.-1�
6i 41. 00 -10. 6 -434. 6 1 DSL CM W 21. 0 -9. 2 . 79 -18 1
�."I,*Y-'.�,�... -*-,.'�,*� `V�i 16. 0 -% 2 . 63 -9 2.
........... .......................... .................................................................. .................. ........................................................................... ..............................
i: �GNKQ K)1 of TO i V&A JA TV,
................. .......................... .................. ...........................................................................................................................I............................................. ............................
" 15 1 ,258. 0,,--'- MKOO 1� 440 -1 ,3%. 60 -2,000. 22 1 1 ,0 b 6. 3
................................................................................................................................... ............. ...........................................................................
... .......--............. .....................
ENt 863. 0 2. 12 1898. 6 1 Ext Wood Frame 11. 0 a6310 3. 70 319S. I
Adj 102. 0 3. 6 067. it f Ohl i Wood Frame 11M 102. 0 3. 60 267.2
DOORS-------------------
Ext 20. (',', 12�, 4 6. 0 1 Ext insulated 20. 0 8. 40 168. 0
Ad j 18, 0 1115 207. 0 i Adj insulate,:.! 1& 0 G. 00 14 4.
1. 2 1509. 6 1 Dndep Atob:::
1 Mder 114tic 30. 0 524. 0 1. 20 6 2 8
1 Under AM,:: 19. 0 140. 0 2. 00 280. 0
............. ............................................
Sin 145. 0 to, 91 1290. 5 1 Slab-on-Gvade 10 145. 0 18. 80 2 7 2 6.
jNFILTRATION------------
"". 4 9109. 2 1 Practice i.20S, 3 7, 45 150� Zi
MAL WINTER FTMM�;
12,%Vee 16,649. K:
Eli - INATINKA 1 TONAL. M!" PLAN it SYMEN x CREDIT - HEAT! N--.:.'-
wily! PAZ rVi L.T POINAM 1 CCANION Q0 f 1 F: VA&T rum_T p I h! IS.,.
............................................................................................................................ .1. -� . -1.1-.......................-- -........... ...........
12,027. ea . 55 71035. 33 1 16,649. 99 1. 00 �. 070 � 0�2 1� 000 8,400. 0.
MMKOUTshn KA K44 AK kk4K,%%%A Ann&n 4�������������`���������
NUM OF x MULT = lOTAL | TANK VOLUr<E EF TANK x nULT it CREDIT = TOTAL
BEDRMFAA[IO PRA-1'
-------------------------------------------------------------------------------
3 3803. 0 11 ,409. 00 | 40 . 93 1. 000 3599. 3 1. 00 1O, T98. O0
****************who************************************************************
SUMMARY
*******************************************************************************
COOLING HEATING HOT WAT[R TOTAL | COOLING H�ATING HOT MATER TOTAL
POINTS + POIN1S + POINTS = POINTS 1 PCINTS + PUI/1TS + POINTS = POINTS
---............--....------...................---......................---........................------........... --- - ---'-----...........-----------........--
6986. 9 7055. 3 11409. 0 25,451. 25 | 5729. 0 5�38. 9 10798. 0 24 ,935. 88
*****************
* EPI = 97. 98 *
*****************
_
Fo' �etuz �e`� informatio��
of t/e [ FI rati��g �^�aber
or frn any. ITEM listed ,
�ask your Builder forEPA-
DCA Form 60OA-93
or Form 6OOB-93
O 10 20 30 40 50 60 T0 80 90 100
� ........---............-----......--........ ....................------------....''X- |
The maximum allowable EPI is 100. The lower the EPI the more efficient the home
RESIDENTIAL ENERGY PERFORMANCE RATING SWET
ITEM HOME VALUE Low Efficiency High Efficiency
SINSL CLT! DBL TINT
WINDOWS. . . . . . . . . . . . . . . . . . . . . Dour) in" Clear ---------X------- |
INSULATION. . . . . . . . . . . . . . . . . .
R-10 R-3O
Ceiling R-Value. . . . . . . . . 22. 9 ------------------X__ !
Wall R-Value. . . . . . . . . 11. 0 --------------------X |
A-� R-1�
O � X |
Floor R-Value. . . . . . . . . . 0 --------------------
AIR CONDITIONEV . . . . . . . . . . . .
1O. 0 SEER 1T. O
SEER/EER. . . . . . . . . . . . . . . . . . 1O. O | X--------------------|
9. 7 EER 16. O
HEATING SYSTEM. . . . . . . . . . . . . .
6. B HSPF 12. 0
Electric COP/HSPF. . . . . . . . 7. 2 | -X------------------- |
0. T8 AFUE O. 9O
Gas AFUE. . . . . . . . . . . . 0. O0 � --------------------- |
WATER HEATER. " . . ^ . . . . . . . . . . .
0. 88 0. 96
Electric EF. . . . . . . . . . . . . . 0. 93 | ------------X-------- |
0. 54 O. 90
GasEF. . . . . . . . . . . . . . O. 00 ' --------------------- |
/), 40 0. 80
' -' _' _---_- |
Solar EF. . . . . . . . . . . . . . ----�---- -'
OTHER FEATURES. . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
I certify that these energy saving features required for the Florida
Energy Code have been installed in this house.
Builder
� �v~
Address: __�� _---{}ignatur �_��_
City/Zip~,�������f-z��-_-'������--
Florida Energy Code for Building Construction
Florida Department of Community Affairs FL-EPL CARD93
_
^ File name:
Jou #: 1258 Mg Clg
For: DEAN RUSSEL Outside db 32 94
ATLANTIC BEACH Inside db 70 75
1258: DUPLEX Design TD 38 19
Daily Range - M
Inside Humid. - 50
By: Air Flow Designs Grains Water - 49
5615 St. Augustine Road Method Simplified
Jacksonville FL 3220T ' Const. qlty Average
(904) 398-5866 FirePlaces 1
HEATING EQUIPMENT CDDLING EQUIPMENT
Make CARRIER Make CARRIER
Model O. 00 kW Model
Type elec Type ashp
Efficiency A
Heating Input 0 Btuh Sensible Cooling 197o0 Btuh
Heating Output O Btuh Latent Cooling 8v60 BIM '
Heating Temp Rise O Deg F Total Coolinq 28200 Btuh
Actual Heating Fan 1000 CFM Actual Cooling Fan 100O CFI
Htg Air Flow Factor 0. 042 CFM/Btuh Mg Air Flow Factor 0. 065 CFM/Btuh
Space Thermostat Load Sensible Heat Ratio S0
============================================================================
ROOM NAME | AREA | HTG | CUB | HTG 1 CL[�
| SQ. FT. 1 BTUH | BTUH 1 CFM | CFM
GREAT ROM | 261 1 5446 1 352^
LAUWDRY | 55 | 1631 556 | 68 | 36
BEDROOM 150 1 2129 | 851 | 89 | 56
BATH 2/BEDR0011 3 1 270 | 2618 | 1144 1 109 | 75
MASTER BEDROOM | 185 { 4570 | 3197 | 190 1 209
KITCHEN | 247 | 5994 1 4945 { 250 | 324
MASTER BATH | 9O | 1616 | MT5 | 67 1 T0
============================================================================
Entire House di 1258 | 240u^ 1 15287 | 1000 1 1000
Ventilation Air | | 8444 1756 | |
Equip. @ 1. 00 RSM 17042 | �
LMent Cooling 6519
TOTALS | 1258 | 32448 | 23561 | 1000 | 10 0O
UANUAL JV2. 12
+904-241-2028 DEAN RUSSELL CONST 704 PO4 DEC 03 '96 17:00
-MR RgMRFR-
TM INSTRLIMENT PMARED BY:
Barbare J.L41mb Book 6463 PU 1107
WATSW&0990ME.PA.
M poett Vedra Park Drive,Smite 101 Bk: 8463
Ponte Vebm Be**Florida 32M Pol 1107
Doc# 96221512
Filed & Recorded
A Frr)�W AND PMURN TO; 10/21/96
WiA1044 P.M.
HENRY k. COOK
t\0 IN fo CLERK CIRCUIT COURT
DUVAL COUNTY, FL
vr,-13- V REC. * 6.00
NOTICE OF COMMENCEMENT
(PP"AM IN DUPUCAW)
7U undersigned horoby gives notico that improvement will be made to certain teal property, and in aic=rdance
with Chapter 7M 1%rWa &jtutes, ths fam* information is provided in N6 Rotice of Commencement.
Descipuion of pmerty- Mw South 40 fed ot Lot 4 and the North 40 fftt of Loot 5, Block 132, S"V091 111-, ATLANMC
BEAch, accer&4 to plat thavor as recorM In Plat Book 19, pp 34 of the cunvnt public rccur4a of Duval County,
Florida.
Gentral description of improvements: Constroctim d a multi-ftmily unit consisting of two single family residential
owncx<t.).Dm RwWl Co"truflon Inc.
Addrew 384 IS&A"ma S.,jaclumville,Reach,FL 32250
ow"es int"at in she of the improvement Fat Simple
ree simple Tkic Holdar(if other than Owner)t
Nam&"we"O"W
Addraic
c4latradw Dean Ra"011 Co"hwetim Inc
Ad&w&.314 150 A"aw 9,Jacksonville Beadk.FL 32250
S=ur5y N=12:N/A
of boa&$0.0
Leader.p"pW Vim Commmity Bank
A,d&cm jW R"77,pa.8"1955,Nuaw Ciq,Florida 32402
Fersom wkbin the State or Fkwida designated by owwr upon whom natices or other documents may be served as provided
Socdm 70.13(1) a ,Florida Statutec
Imm ftopies Fkjt --"-Bank
Addrear 2W H%W 77,PAh 309 ZM,PRASIM&City,F101`149 32402
In additkm to" .61f, owner dtsig;nates the Wowing person to xeceive a copy of the Lienor's Notice as provided in Section
71113 CI)(b),R=W StOutes.
hoplas ftit Commeaft BAs*
Ad&ow-110 AIA No*Pontg Vadre Deac*FL 32092
EViration Date of Notice of Commencement is day of 19
t5e a-Muell Constructio-5-13—c
11— MEW,frisidont
STATE OF TWRMA
COLINIT OF Slr.JOHNS
7%0 foregoing WOMC01 Wag ackniowledged bgjar-%mo " ISth day or October, 1996 by N�Po
DtijAr"JW C� Im WjAjj*ha1f of the corporauou. Ho/bbo
As
ki�'v-m to a@ or Lu =d oe' ide on
Natm P!��e 0,4 County
(Tiffe&Rank)
BARBARA I LAMB
Survy MR SOW" (SFnal No.,it anyl
J, LAM$
r
V;%--00MMjS$j0N 0 1'r
so"060 THAU
.4 Gototma CO.,
PWIN IN fta Laft h",1-o"Wtus "TUWC
"S�
+904--241-2028 DEAN RUSSELL coNs-r ?04 P05 DEC 0-�) 196 17:01
if
TWS VjSMj;MLWr MPARED BY: Doak 8463 Pq 1102
Barbara I Laub
WATSON&05302M,PA.
2W Peaft VC&S Pwk Drim Sake 101 ks &463
Poste vedm%0*rmids 32M gs 1102
cIc* 96221510
iled A Recorded
1 10/21/96
RswRD AND RETURN TO: 01z44z44 P.M.
OE E"RK' &RCCU'Iff COURT
Ito A16 ZUVAL COUHTY, FL
F'j- F EC. 6.00
J'aar-M—
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
7U undcffjpcd hereby givu notice that improvenient Will be made to cataw real prpperty, and in accordaace
with Chapta M Florida StatWC4 the Mowing i2kf*tmAti0G is provided in thiis Notice of CoiInmencement.
'Criptim 4V property- Tin &mtb jo reet at Lot 5 and all of W 6, Block 132, SECT70N 'H' ATLANnC BEACK
accordIft Ito pi" thet"t" reewded in Plat Book 19, PW 34 of the currant public records of Duval. County, Mart&
General description of improvements. Cousbrattlon of a multijamny unit consisting of two sftigle family residential
dwellings
Ow=r(s):Dm R=mfi Coastructloo lac.
Addrcsk 384 Ift A"*=S.,Jackwavillf Bmk,FL 322SO
Owmes intuest in dk of thei improvement,Fee Simpk
Foe Simple 1rdle HoWer(d otbcr dian Owwr)-
Name:Saw as Owner
Adikew
COM&Ador DM RMW comaractim Inc.
Addres&3X4 Ift Avemn Sqg*jacksonvilk Bewh,Fl,322SO
Surely(if N/A
Addr m N LA
Amount of .$040
Lendes:Poop]=Fiat Cmnuuk SO&
Ajdrm&-230 HWY 77,PD.Box 29A fta"w City,Florida 32402
person within the Stato of Fkw1h dc4aaW4 by Owner upon whom notices or other documents may bc,srmd as provided
by Sectimi 713.13(1)Ca)7.,Florida Statutew
Name:110,1110111 MOA cummok B"k
Addruc 23M HWV 77.P.M Doi 2"S,Pusan City,Floridit 32402
in addition to himeg owner dedpgu he following person to receivc a cM of the Utuor's Notice as provided in sectiou
713.13(1)(bX FW"St4u1z&
pow"Fbit c4=20111111ty Bank
&JAI AU Nardi.,Powit Vedm Beack FL 32092
E,xpitation ]Date of Nodee of Commencement is day o( 19
VeanMumll Constructio-FTF—c
XJL
IX-a-nRussall,President
STATE OF FLORIDA
COUNTY OF ST.JOHNS
Tbc for bmtrunuml was &&uowl d nit this 151h day of October 1996 by Dean Russell, President of Dean
ROOM of ation, He/She is personally iZZ to me or has produced
-RO ;- as iden0cation.
Notary nUtAw and Cmugy al
edge belosr
Title or Rw*)
IBYSARA J. LAMB a No.,if a0y)
NoWy PrMa Mpature
BA1111ARA j. LAMB
100 373618
COMMISSION I
kXpIAESjUN2$v1906
SoNoto T14W
INC.
ATLANTIC BONDING CO
POO I bVAVWM4%4 RW 40110%*V966100,INIF,1460606-t IN NUM5
PSR- 4
13094 ,
DEPARTMENT OF BUILDIM0
CITY OF ATLANTIC BEACH
PERMIT INFORMATION, ------ --- LOCATION YNFORMAT I on
Pi�rmit Numbtr: Address : 630 MAIN STREET,
Tyie.'MECHANICAL ATLANTIC , BEACH PLORIDA 32233
� Clats of ,WoIrk:NZW -------
LZOAL DESCRIPTION
Oonstr, Type:WOOID rRAME
Block-,132 Lot! 4/5 PTS Twp: 0
Otoposed U$e:DUPLEX n*
Sectio 0 Subd: Rng, 0
Dwtl.li
Subdivision.-SECTION H
Est Valuet 0 .00
i,zprov.
0 01.00 t
47 .00
jAmount __,�47 .00
496,
Q
�jr- ��FORI HOME ,
ION ----
A-PPLICATION IPEES ----------
PERMIT,
47 .00
A4dr.
,ow
SOUTH
4",
4
L CH, FL 31212
N 4
C, RA ORMATT
N"OR0,11, AIR_Slf�'S,
Addr: 2815 SIT........ S BLUFF
144 w FLOR
IDA, 32216
v, g�m!t�zj w
T i ," 0
NOTES:
NOTICE ALL CONCRETE FOAMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING
PERMIT VOID SIX MONTHS AFTER DATE OF ISSUV'1
1BLULDING MATERIAL,RUBBISH AND DEBRIS FROM THIS WORK MUST NOTAE PLACED IN PUBLIC SPACE,AND MUST BE
E ARED UP AND-HAULED AWAY BY EITHER CONTRACTOR OR OWNER
LURE TO COMPLY WITH THE MECHANICS' LIEWLA AN RE LT IN
W SU
tt �; O-PE OWNE�Rl-PAYING TWICE 4ROVE ENTS
A "vR
T, RTY FOABUILDING I
—*ft*'�Wf",4AN$'WHICH ARE PART OF THIS PERMIT AND,SU10JE 7oowv
Or, 00
-MIi
qj
'077
Fll�`�`
' 'Wt.
BUILDING AND ZONING INSPECTION DIVISION
CITY OF ATLANTIC BEACH
ATLANTIC IIXACH. FLORIDA 32233
APPLICATIO-N FOR MECHANICAL PERMIT CALL-IN NUMBER
IMPORTANT — Applicant to complete all items in sections 1, 11. 111, and IV.
013cl Aft 1�7? , S� —
Street Address:
I.00ATION
OF Intersecting Street$$ Between_ Ez 012'e" A&V And z ;04
BUILDING
sub-dIvIsIon
11. IDENTIFICATION —To be completed by all applicants ,
In consideration of permit given for 'doing the work at detcr4bed in the above statement we hereby agree to perform said work in accordance
with the oftechpd plan$ and specification$ which at* a part hereof and in accordance with the C;fy of Jacksonville ordinances and standards
of good proctico listed therein.
Name of Mechanical Contractors
Contractor (Frint) Matter
Name of
property Owner YV
Lff-A
Signature of 40wher SI &fur@ of
w Authorized Agent V.11ted or Engineer
Ill. GENERAL INFORMATION
A' Typo of koating fuels 13�
IS OTHER CONSTRUCTION BEING DONE ON
4.
X.::
Electric THIS BUILDING tit SITET
P
C] Gas E3 L? C1 Natural 0 Central Ulililh/
IF YES, GIVE N DER QF ONSTRUCTION,
0 Ol PERMIT 4"175
El Other — specify
IV. WWN�NICAL SQUIPMRIT TO 86 INSTALLED NATURE OF WORK
(Frov;do complete list of components on beck of this forml Residential or C3 Commercial
Rest 0 4ats, C3 Recoil" 14b Central 0 Floor Now Building
0) Air Conditionings [3 Room /Id Central 0 Existing Building
r, Material AAeja)_4_,_S Thickile., 0 Replacement of'existing system
)JM Duct Systems
NOW InstallatI06,1N6 system previously Installed)
Maximum capecil.
0 Extension or add-on to existing system
13 Refrigeration
0 Other— Specify
P C401182 towers capacity g.pjv6
(3 Fin spriftlilont Number of head-
0 Elevator 0 Monlift E3 bcalsto (number) THIS SfACE 001t OFFICS USE ONLY
(3.G4sollaa,pu Im (Aurniter)
L
t� 13, TOO (number) Remarks
.13 IN confelsom --
13 UaW P""ure vessel
Parmil Approved by Do
AA
I.T 13 Sollon
IV Permit
Othv spw
LtST ALL EQUIPMENT
AIR C0=1nON*(; ANID REFRIGERATION EQULPb1ENT
Ca aelty ArprovW9
NumberlInIts Deacriptlon Model Number Manufacturer ASMOY
�7
IMATING - FURNACES, BOILERS, FIREPLACES
capadty ApprovIn
HumberUnIts DeattopuOu Model Number Manufacturer (UM) Agmay
&
TANKS
NOW X0AjY XaMbW Cgpadty TYP4 LkUld Name of serw Approving
IlAd DinmAdons Corit&tned Manufacturer No. Alloncy
k
PSA43W
1309S
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
PER1417 INFOIM�ION ------ --------
LOCATION ,INFORKATION
Po,,rmit Numbir: 13055 Address: $32 MAIN STREET
MECHA14 I CAL
ermit Type ATLANTIC BEACH, FLORIDA 32233
----------
C J�A s s of Wor-k:,NEW --------- LZOAL�DESCR I PIT 1 ON
donstr. Ty'0e:WOOD p1wz B I ock:1312, ', Lot**4/5 PTS Twp* 0
oposed U0e:DUPLEX . S*ction: 0" . Subd: Rnq: 0
Dwel.lixiq� s: 0 SubdivisiontStCTION H
Est . Val(te:
0.100
-,inprov Cost 0 .00
Total FA�4411-1 47 .CrO
47 .00
','�,,Amount 1�3
-!Vvt
at
111,Iff
ION ---- APPLICATION FEES ----------
47 .00
PE"IT owrl
AP",
"I'll '*' " 'y'
dr: A i 1
SOUTH e
ew
r"x! 4
,"v A
L 01 r, PL 3 21
c 'RA -ORMATI - - ------
KA Alk-'sy
NS
2815 $T BLUrt
j N
FLORIDA 32216
Exp:
MR
T
NOTES:
RETE FORMSAND FOOTINGS MUST SIE 09FORE POURING
NOTICE ALL CONC INspEcTeD
PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE
UILDING,M E
ATEOIAL,R U 13 B ISH AN D DEBRIS FROM TH I S WO R K MUST NOT BE PLACED I N PU BLIC SPACE,AND M UST B
atARED1JP AND HAULED AWAY BYEITHER CONTRACTOR OR OWNER
,'.'FAILURE,TO COMPLY''WITH THE MECHANICS' LIEN LAW CAN RESULT 'IN
THE: PROPERTY QW40APAYING TWICE FOR BUILDING IMPROVEMENTS.
"UED ACCORDING TO APPROVEOPLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT To REVO
ION Of APPLICABLE PROVI$
VJOLAT ioNs OF LAW.
7�-774"
''ATLANTIC BEACH-SUIL)IN EPAFt ENT
"J
-F,
BUILDING AND ZONING INSPECTION DIVISION
CITY OF ATLANTIC BEACH
ATLANTIC NZACK, FLOMDA 3Z13*
APPLICATION FOR MECHANICAL PERMIT CALL-IN NUMBER
IMPORTANT— Applicant to complete all items in sections 1, 11, 111, and IV.
Street Address: to/
LOCATION 1A
OF Intersecting Stroolle Between And
BUILDING
II. IDENTIFICATION —To be completed by all applicants.
In consideration of permit given for 'doing the work as described in the aboye staternent we hereby agree to perform said work in accordance
with the atteclipci plans and specifications which are a part hereof and in accordance with the City of Jacksonville ordinances and standardt
of good practice listed therein.
Name of Mechanical onfratters
Missfer 4�7A
Coakaefor -5 C
Name of
Property Owner iejal
Signature of 6w"er Signaluto of
11w Aulhorlsed Agent \A Architect or Engineer
Ill. GENERAL INFOiMATIO'N
Typo of hosting fuels IS OTHER CONSTRUCTION BEING DQN6 ON
THIS BUILDING bit SITE?
r
I.,-,-
1*3 Off me E 3 L Is 0 Natural E3 Control Utility
If YES. GIVE NUMBER OF CONSTRUCTION,
13 09 PERMIT
13 Other — Specify
IV. MECH�MICAL SqUIPMENT TO if INSTAUED NATURE OF WORK
(provide complete IM of compo"ash on back of this form) /F Residential or C1 Commercial
Heat 13 Sp4co G Itscsssiid )a central 0 Flow e�q New Building
Air Coadslionings E3 Room Central 0 Existing Building
Duct Systems Material) Thickness 0 Replacement of'existing system
Masimuns capacity. c1m. OP Now lnstallatlo&.tho* system previously Installed)
0 Extension or add-on to existing system
ff. 13 Refrigeration
V 0 Other—Specify
C] Cooling towort Capacity
13 Rro WAnklerss Number of hea.s__
(.3 flevghw (3 Mar-lift 0 Escalate Inumber) THIS SPACE �Olt OFFICE USE ONLY
G48011"pu P4 —(number) (Rocelvesl)
13. TA-L. (number) Remarks
-,(number)
13 "confainem—
C] UAW pro"ure vousl
Pormli App ad by— Do
C3 godw.
13 Other L- SpWly Permit ILL0
1119T ALL EQUIPMENT
AM CONDITIONiNG AND REFRIGERATION EQUIPMENT
Ca &city Approving
NumberUnIts Description Model Number Manufacturer Xne) Agmer
�2 0 k 4- Q 4:;� 4 ev
1->C-1 7,0 ,V
v
HEATING - FURNACES, SOMERS, F*IREPLACES
ca"dty Approving
NumberUnIts IDWrIPUoRk 3CC441 Number Manufacturer (BTU) AgetW
44CA_ :2 4
L-4,7/ 0, clk 'r
TANKS
Now Many Notmind Capacity Typ4 Uquid X0,1126 Of Strid Approvin1l;
"a DLULOACUS Manut"turer No. Agency
k
I
j2::D.4F'l,'- PTL SCH t-_ITII' HALL P. i
P'V
CITY OF ATLANTIC BlEAC W .4
TREE REMOVAL APPLI CAT&!.-, 1996
bu;,Iding and Zoning
All applIQWioaLWust bo recalged by § P_.M. on ft MQNDAY 12=tg th-q.W dW
be @-4
meefing in gWer tQ beslamd on the agenda fQr conalderation--INCOMELETE
MELICATIONE WILL N-01-BE PROCESSEQ.
D-F.At-A, ZLffiau�-
APPLICANT NAME ADDRESS TELEPHONE
M017 1 -)�-T. L,�L� --2-L
:�,� qc) =k . qc L--�, gc�z-
ADDRESS OR LEGAL DESCRIPTION OF PROPOSED TREE REMOVAL
ti
H
3. DESCRIBE PURPOSE OF TREE REMOVAL-7-6 &L C-,Qfftg��
4. SPECIFY TREES PROPOSED FOR REMOVAL AS FOLLOWS:
NUMBER SPECIES DIAMETER (DBH) CONDITION
-QAQ-. -, co-,I -- L I
OA \e- I-\ %,,) -7
04\4- L iur� q !f
At\t- I C) ,l (3
A kl--
5, TOTAL NUMBER OF TREES TO BE REMOVED:
6. TOTAL NUMBER OF INCHES OF TREES TO BE REMOVED:
7. SPECIFY PROPOSED REPLACEMENT TREES AS FOLLOWS:
NUMBER SPECIES DIAM ETER (OBH)
L\
Lk C)A-14 15
.�PJG 2E '96 PTL -BCH CITY HALL F.
8. AT7ACH SITE PLAN INDICATING THE FOLLOWING:
a) Site topography, including proposed grade changes
b) Existing and proposed buildings and other improvements vAth dimensions and
required setbacks
c) Tree protection zones as applicable
d) Location, DSH and species of all trees Wth a DSH of six inches or greater
e) Location, DBH and species of all trees vAth DBH of less then six inches
proposed to be used for mitigation
f) Specify trees of unique or"clal character
g) Each tree proposed for removal clearly marked Wth a 'LX�
h) All existing and new trees proposed to be used for mitigation clearly marked
vAth brackets "( r
1) Location of utilities, easements and material storage areas
9. ALL TREES PROPOSED FOR REMOVAL M BE CLEARLY MARKED ON SITE
BYJMQ SURVEYORS RIBBON.
10. ALL EXISTING TREES PROPOSED TO BE USED FOR MITIGATION MU151 BE
CLEARLY MARKED ON SITE BY SURVEYORS RIBBON.
1. -INQQMPLF.TE- APP-LICATIM WILL NOTSEP—RO-CMED,
I HEREBY AGREE TO COMPLY WITH ALL PROVISIONS OF CHAPTER 23, ARTICLE
11, TREE PROTECTION, AND ALL OTHER APPLICABLE CODES AND ORDINANCES
OF THE CITY OF ATLANTIC BEACH.,
J11, 41�
L q/1 .3 A(,
;�PNLICANTS SIGNATURE DATE
LL-- &2::i�� -C),L-
-5WNERS SIGNATURE DATE
APPROVED -.
TREE CONSERVATION BOARD CHAIRMAN DATE