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Permit 440 Ocean Blvd (vault) Is CITY OF ATLANTIC BEACH a 1 800 SEMINOLE ROAD jy ATLANTIC BEACH, FLORIDA 32233 .kms INSPECTION PHONE LINE 247-5826 Application Number . . . . . 05-00029486 Date 1/27/05 Property Address . . . . . . 440 OCEAN BLVD Tenant nbr, name . . . . . . REPL WINDOW Application description . . . RESIDENTIAL ADD/RENOVATE/ALTER Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 840 Owner Contractor ------------------------ ------------------------ ZUCCHI, ELIZABETH INNOVATIVE BUILDERS 440 OCEAN BLVD. 569 HOPKINS ST. ATLANTIC BEACH FL 32233 NEPTUNE BEACH FL 32266 (904) 270-1117 ---------------------------------------------------------------------------- Permit . . . . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 70 . 00 Plan Check Fee 35 . 00 Issue Date . . . . Valuation . . . . 840 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 70 . 00 70 . 00 . 00 . 00 Plan Check Total 35 . 00 35 . 00 . 00 . 00 Grand Total 105 . 00 105 . 00 . 00 . 00 Y PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDING OFFICIAL M r"i3 F•"e. rak iy. 9� x>, .S tt�r Cc: CITY O F ATLANTIC BEACH k Wer BU 11,1)IN(A I ZONING DEPARTMENT s ;tt)U Seminole Road \tlaniiC 11CJch,Florida 32233 (904)247-5800 (904)247-5845 Fax �Ar 'T`Fx 5. PLAN REVIEW COMMENTS Permit Application # Property Address: t C F= ib L UTA Applicant: _ ..Five � LpIEE Project: i ' i ; 0M-W This permit application has been: � Approved Reviewed and the following items need attention: Please re-submit your application when these items have been completed. Reviewed By: Date: ' CO CITY OF ATLANTIC BEACH JS sa WINDOWS, SKYLIGHTS, GARAGE DOORS, HURRICANIF, S11UT"i'ERS Date: Job Address: l Owner: Address: 4Z�O C.%n �� r l ��r ►G E-1 e- L1 Phone: Legal Description: Block Nu �er: Lot Number: Zoning District: Contractor: E s a �t,rN tate icense umber: Address: Phone: City: r_e tate: _Zip: S Fax Describe proposed use and wo'r'k to be done: ( J c v-y-\uv F, A 0 4 V Present use of land or build4w: 0 o YVi f s +f n J 2 if !�S i _ t°iV ' f Valuation of proposed construction: 14 U1+6 Is approval of Homeowner's Association or other private entity required? &G If yes, please submit with this application. Required Building Data: Mean Roof Height (ft) Building Width (ft) Building Length___(ft) Roof Slope Window Height (ft) Window Width (ft) 0 Window Elevation from Grade 4 (ft) Measurement from corner of building to window �� (ft) Number of windows being installed Mean Roof Height it 800 Seminole Road •Atlantic Beach,Florida 32233-5445 Phone: (904)247-5800 • Fax: (904)247-5845 http://www.ci.atlantic-beach.fl.us Page 1 Revised 1j27/03 MAP SHOWING BOUNDARY SURVEY OF LOT 3 BLOCK 23 ACCORDING TO THE PLAT OF PLAN' NO, I SU BDEV ESCON kk %jw ATLANTEC BEACH, AS RECORDED IN PLAT BOOK 5 , PAGE(S) 69 OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. CERTIFIED TO: ELIZABETH McQUAID ZUCCIII, LUCA V. 7.UCCIII, S'TEWART TTTLE OF JACKSONVILLE, INC. o AND WATSON & OSBORNE TITLE SERVICES, INC, N II 4's V \.v f LOT 4, BLOCK 23 ` 115.00' � N11 I 112- x 2" x . 14 3.1' CONC. 1.2" . 0.6' . a C. 0.4 05, UN12 R 2.3' ---F " Roof 0.5' moo. ' asp- a. 19.9`. n . �. 12' 65.2' k N w _ LOT 3 Q �., BLOCK 23 \,jo� a 9.4 coNr, 0 �� o O p COV'O ------ - �c V 1 do 2-STORY FRAME DIRT _ o _ p ''� RESIDENCE Y O ° m O 2 POND O Q n W/2.5'EA WS C.OVO 7 R' 00 Q'� N y w p NO. 440 CONC. �\ 2 c� 1.4' QN w1 N d 0. „ 62.3' � 1.4' 22.9'cS *,-4I 94 03,44 r CDfYC, f i•,. o Qis' a 0.5' 0.8' 24.2 0.3' is:r ^ --o- RERAA 0.2' - 0.20.4' 0.3' 0.3' 0.2' 1.0 3' 1.11.3672 - 115.03' (M) 115.00' (RR) O LOT 2, BLOCK 23 Q CS v 0 r C7 (� f 1» FDII/RTH S TREET (40' 1?1GH7_-OF-WA Y� R V E Y 0 GENERAL NOTES. v 1. ANGLES ARE SHOWN FOR THIS SJRVEY. C 2.STRUCTURE N0. 440 SHOWN 4EREON LIES WIFIIN f1 001) IONS -x AS LIES A SsocIATED SURVEYORS INC. DETERMINED FROM F.E.M.A. FLOOD MAPS PANEL NO.___} DATEDo�_: ?q12_ 3.THIS IS A SURFACE SURVEY ONLY. THE EXTENT OF UNDERGROUND FOOTINGS, LAND do ENGINEERING SURVEYS PIPES AND UTILITIES, IF ANY, NOT DETERMINED. 4.JURISDICTIONAL AND ENVIRONMENTALLY SENSI HVE AREAS IF ANY, NOT 3846 BLANDING BOULEVARD LOCATED BY THIS SURVEY. a S JACKSONVILLE, FLORIDA 32210 5.THIS SURVEY BASED ON LEGAL DESCRIPTIONS I URNISI IED. THE PUBLIC i ? 904-771-6468 RECORDS WERE NOT SEARCHED BY THIS SURV[YOR FOR F.ASFMENTS, J TITLE, COVENANTS, RESTRICTIONS, CLOSURES, TAKINGS OR ORDINANCES, ETC, O S S V CERTIFICATE OF AUTHORIZATION N0. LB 0005488 THERE COULD BE OTHER MATTERS OF RECORD THAT AFFECT THIS PARCEL. 6.UNLESS OTHERWISE STATED ALL'IRON PIPES FOUND HAVE NO IDENTIFICATION- I HEREBY CERTIFY THIS SURVEY WAS DONE UNDER MY ��G1EPt';QlA�O��Eb1AVI01M� DIRECT SUPERVISION AND MEETS THE MINIMUM TECHNICAL SET IRON PIPE OR REBAR P.C. =POINT OF CURVL COV'D - COVERED STANDARDS FOR LAND SURVEYINGPURSUANTTO CHAPTER "ASSOC.SURVEY* OR L.8.5488P.T. =POINT OF TANGENCY E.B.=EtECTRIC BOX 61G17-6 L IDA ADMINISTRATION CODE, CAPT-, 47 F.S. 0 FOUND IRON PIN OR PIPE (IP) P.R.C.= POINT OF RLVFRSL CURVE ■ FOUND CONCRETE MONUMENT (C.M.) P.C.C. = POINT Of COMPOUND CURVE BY: _ X CROSS CUT OR DRILL HOLE C/L = CENTER FINE R/W- RIGHT OF WAY (R) =RECORD (M) - MEASURLD, CONC. = CONCRE T D.T. BUILDING TIE CH ES B. HATCHER FLORIDA CERTIF ATE N0. 3771 R. =RADIUS L.= ARC LENG'H A\C =AIR CONDITIONER (1-T.) = EAVE TIF,_ CHARLES L. STARLING FLORIDA CERTJFICATE NO. 4579 O.R.B.=OFFICIAL RECORD 1300K 50 =WATfR MF TCR -0,- UTILITY POLE RAYMOND J. SCHAEFER FLORIDA CERTWICATE N0, 6132 O.R.V. =OFFICIAL RECORD VOLUME REQ. =POOt EOUIPMENI ->- GUY ANCHOR P.R.M.=PERMANENT REFERENCE MONUMEW, -O.U.-=OVF:R HEAD UHI HIES CH - CFIORD JOB NO. 39622 DATE 02-06-2004 B.R.L =BUILDING RESTRICTION LINE X-X CHAIN I INK FENCE BEN. - BETWEEN SCALE: 1" = 20' DRAFTER J Z.NA E.T. =ELECTRIC TRANSFORMER & PAD W-W WIRE F"ENC[ FT--H WOOD FENCE J.E.A. -JACKSONVILLE ELECTRIC AMORfil'I C & R = COVENANIS & R STRCTIONS NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICEaISED SURVEYOR AND MAPPER ' 011.'05/2005 10:08 FAX 724 327 5 0890 PGIJ CORNING MARKETING cool MIAMI fN1LkNl-Dkl)E COUNTY, FCJKIDA METRO-DADE FLAGLF_-R[j!j'jj)(NG BUTLDING CODE COMPLIANCE OFFICE MMU-DADS FLACLLR BU'[L�JJIG 140 WEST FLAGEER STRETT,suITL 1603 MIAMI.FL(AUI)A 33130-15tH PRODUCT CONTROL NOTICE OF ACCEPTANCE (305)375.2901 i-,AX(3G5)375.2908 Pittsburgh Corning Corporation COINTRACroR 1,10ENSINC 8[,.'C7j0,4 800 Presque Isle Drive (305)37!-2527 F&N(305)115.2558 Pittsburgh PA 15239 MNTsLAcrowENFo?AcwxF,,rr I)INTSION (305)1373-2966 rAX(305)375.19uR PRODUCC CONTROI,131VINION Your application for Notice of Acceptance(NOA)of: (303)373-2.902 FAX(J05)372339 Vinyl Framed 2" Glass Block LightWise Window under Chapter 8 of the Code of Miami-Dade County governing the use of"Alternate Materials and Types of Construction, and completely described herein, has been recommended for acceptance by the Akarnl-Dade County Building Code Compliance Office(BCCO)under the conditions specified herein. This NCIA. shall not be valid after the expiration date stated below. BCCO reserves the right to secure this product or material at any time from a jobsite or manufa6turer's plant for quality control testing. If this product or material fails to perform in the approved manner, BCCO may revoke, modify, or suspend the use of such product or material inunediately. BCCO reserves the right to revoke this approval, if it Is determined by BCCO that this product or material fails to meet the requirements of the South Florida Building Code. The expense of such testing will be incurred by the manufacturer, ACCEPTANCE NO.: 9.1_-0410.14 EXPIRES: IV0112006 Raut Koangut.,z Chief Product Controt Division THIS 15 TELE CQV-E;RSHFET. SEE ADDITIONAL PAQ 174z PnDENERAL -C!QNDITIQNS BIJILIDING CQDE& PEQDUCI REVIEW COMN�JITTEEO This application for Product Approval has been reviewed by the BCCO and approved by the Building Code and Product Review Committee to be used in Miami-Dade County', Florida under the conditions set forth above. A P P R 0 V C E D CITY OF ATLAN-FiBEACH BUILDING OFFICE IJAN 0 6 2005 Francisco J.Quintana, K.A. By- Director Miami-Dade County APPROVED:. 11(0112001 Building Code Contpliancc Officc ) Post-RO Fax Note 7671 Date 777— /—j To j6�7— From)doe C0JDePL Co. P Phone# F no013 7 rx-*-'9 0 Z Fax# %04SMhpc20=qenv0atm%notk-_-acceptance cayer page.dot -Y-6 2 73r.? X 6, 3 3- Internet mail addrcw tiostmas(cr@buildingeodeontine.com qF Homelvage: h(til://W1yw.buitilingcf)deonlitic.coits 01110.5/200510:09 FAX 724 327 5890 PGH CORNING MARKETING 4L002 Pittsburgh Corning aCarnoration. ACCEPTANCE No.: 01-04JO.14 APPROVED: NOV "! EXPIRES: NOV 2006 NOTICE OF ACCEPTANCE: SPECIFIC CONDITIONS 1. SCOPE 1.1 This approves a glass block PVC fixed window as described in-Section 2 of this Notice of Acceptance,designed to comply with the South Florida Building Code,(Si'FIC), 1994 Edition for Miami-Dade County, for the locations where.,the pressure requirements,ns detetmired by SF13C Chapter 23,do not exceed the Design Pressure Rating values indicated in the -ipproved dral,4iin6f,. 2. PRODUCT DESC[UPTION The 2"LigbtWisc Window and its,components shall be constructed in sTrict comphai-tec with the following document: Drawing No.2LW-1,titled"2 LightWise Window,.--Nevv and Renovation Construction", Sheets I thru 2 of 2.dated 02/26/01,bearing the Miami-Dane Couaty Product Control approval stasnp with the Notice of Acceptance number and approval dare by the Nfiarni- Dade County Product Control Division. These documents shall hereinafter be referred to as the approved drawings. 3. LIMITATIONS 3.1 This approval applies to single unit applications of a glass block PVC rjxcd ,,w*itj,_,A,,as shown in the approved drawings. 4. INSTALLATION. 4.1 The glass block PVC fixed window and its coniporicnts shall be installed in strict compliance with the approved drawings. 4.2 Hurricane protection system(shutters): the installation of this unit will rcQuire a hurricane protection system. 5. LABELING 5.1 Each unit shall bear a permanent label with the manufacturer's name or iugu, city,stile and following statentent: "'Miami-Dade County Product Control Approved". 6. BUILDING PERMIT REQUIREMENTS , 6.1 Application for building permit shall be accompanied by two copies o1i'the folle,,ving: 6.1.1 This Notice of Acceptance. 6.1.2 Duplicate copies of the approved drawings, ns identified insect2 (jCthiS N40JCC Of Acceptance,clearly marked to show the components selected for thc proposed installation, 6.1-3 Any other documents required by the Building OlTicial or the South Flaricla[luilding Codc (SF3Q in order to properly evaluate the installation or this systern. Candido F Font PE. ,Sr. Product Control Exanlisic.- Product Control Division - 2 , 01„05!2005 10:1-6 FAX 724 327 5890 PGH CORNING MARKETING I A& Architectural Testing SAFETY GLAZING TEST REPORT Rendered to: PITTSBURGH CORNING CORPORATION 800 Presque Isle Drive Pittsburgh,Pennsylvania 15239-2799 Report No: 01-3"787S,02 Test:Date: (3912:55100 Report bate: 11/30/00 Product: Pittsburgh Corning LightWise*Window Description: 7-314" high by 7-314" wide by 2" deep block of glass fabricated from two halves oC annealed glass enclosing a vacuum center. Patterns: IceScapesTM(rninfinurn thickness 0.197") Glazing: The fixed lite utilized five blocks wide by 10 blocks high. Two beads (interior ani exterior) o,F cleat silicone sealant were utilized between all glass blocks. The glass block was i.nttr.rior glazed, batik bedded with clear silicone and held-in-place with extruded vinyl snap-dual durometex gi amag brads, Frame Construction: All frames were constructed of extruded vinyl and dual duronxeter virtyl. Ail corners were mitered and welded. Test Procedure: Five 40-1/2" wide by 79-1i2" high glass black window samples were tested in accordance with ANSI 297,1-1984, "American National Standard for Safety Giazinlg y,)aterials Used in Building — Safety Performance Specifications and Methods of Test" and "Comunacr Product `saf-ty Commission (16 CFP, Part 1201) Architectural Glazing Materials Proposed Testin- Pro 2rar;1 and Certifications Requirements". Test Results: Avg. Glass Impact Spec. Test Thickness, Distance, Resoles No. Standard inches inches Ser. Note #1 1 ANSI Z97.1-1984 0.2.85 12, 18, 48 No breakage_- 2 ANSI L97.1-1984 0.285 12, 18,48 No Brea!<age 3 ANSI Z97.1-1984 0.285 12, 18,48 No breacao 4 ANSI Z97.1-1984 0.285 12, 18,48 No breakate 5 16 CFR 1201 +0.285 48 No brcaka'; Note#1: The specimen met the performance criteria sat forth in the referenced specificatio`.. For ARCHITECTURAL TESTING, ' a,.ja 9q11, 11i1 fl f ha R I..ucken auoh Craig H. agner, RE -AZ , •�; Technician Senior Project Engineer ctu.:tjp , 0 ► 01-378783r, s 130 Derry Court I ,+ York, PA 17401-9405 phone:717.764.7760 1110"+'�tt1 tax:717.764 www.testati.:om I` sf1()d i PCH CU12Iv�y1�GM ARK Vt ot!,c5 2UUbNAY 724 327 5890 •. ,.t.. ns ,:: r�n }}i.9c' _ 7r'�.-j,�•u'kP ti 1, .�L ytirF 1.17 rfi4 rel d7i .t�rai�+�,cb�. � � 1 RPF4 � sS. i i 1 � i ii'!s#allatlQr) f r-d ruNd Optional Window Accessories Frame Colors double burr.'cf r r na�lit. gut � / PQSS!en5.rllu7temt 4� _ � t •, I} sill:nlleseafartjbr L – cuahnn t+i,x� Y ` neslherl'C5rsfancr Brichol w;tile f--hn fr'arnt J)itlt welded strrcturni intE, ly • ( '� r1rQltN YUlfI11'Nul fa'+';:.. ~•`•r.,ry. f -tt r f i ii P!t silt;:glr Cnrnut,q I ✓ _ �_ i_ y_ _.----______ ' $ '�rr•� I' .... ClaF6 Black ( ""' ; �}, ,�1,� ISveb+rotd aavriSMxe j-:',kdiuirl srtnrl>..mu ;Vl i ,,e s7 t„'o..c .Isr-�,ehunrr, rr ud t t,9�?gk Physical Properties and Parforrmanre Data ` rtirroum :nStalled Weight: 7.80 lb: (r- ' S' structural a ir. z r I sificaneserdanr Light Transtniss.orl: 75 r. 1 Tt � + �� ``• �( '? jbv vstititr Sound T'tansidssion: water end ASTM E-9C-97: C 3: z tS , g ruind barrier easy to dean, i AAMA 1503: CRE= ti �Sev scrakb•raYiar.ta o ow i ' _ AAMA 1;01.2 ; r NFRC-100-971Thermal Parformarice) • •,4.. &-Valuer UVAlua Window Sat GrlAa }, 7.62(t1A•iT'•f,RTU) 4SY!®IUJNN•tT.oP} 4p;n,:�68ivt, tivcidrnt.al ''�' f� 1000/.Real Glass Block From Pittsburgh Corning: The Wise Choice.Now More Than Ever. CANfCSA-A °-gyp Panel Wn Ade Tom We,1eYTest Wind Leal • MM dro 1`81PSnif*iAg Fa{t Sri+rating ie&PI{P`:Parurlag t^. LightWise`°Windows are a wise aux 14U(MY 5a) 711.91 Flim g>a t,s.tli as 4400':A&W C4 4�;-1+'•. e13 x 2032(32 x 10 15 il.ar) PtM tM 110,45} 8§ aAnu jtt1.s0) el choice when you want the beauty and durability of real glass block Dada Comity Tests(Protocol PA 202 9+1I PanalSits Air Tod WxWTast firrsiNnl�nd cornmertt_c with less installation hassle. Every 1111.1 IMP ip” Pqr, LightWise°1 Window starts with Real Pittsburgh ba x Tia 6.24 6.0 5`011 .,.v„e ur•°n.W: Corning Glass Black,which resists scratching and 32 x 04 d24 1.0 filtD w.oe eim r nepx will not bum or discolor like plastic.LighOX/iseo St x as ssa �,e dn.a w••n bu•.i.,.�, Windows offer a unique combination of features •q" you won't find in any other glass or plastic block Safety Glazing Test window. And now LightWise"Windows are even r1NS1291.1 P ssccl .Z',I` tct+.1 a ";icai•s lighter thanks to our new 2" thick glass block. CPSC-16-CFP, T'assed AAMA-101/1.5.2-97 Tests amcAMA Milo•.I,ah1...1y n..,i.d.:wmd— This new, lighter weight design means , MMA Alr7itat Wacar loss i.esiyn wa! LightWiseo Windows are even easier i' AAMA irli V4r 1 igIf L to install: just place in the opening ? F-a 61111x56 157 17 G! 60 ` F-11 be U x a 1.67 t2A0 60.0 P' and fwteIn along the built-In nailing � Nate:YWevniaaad"0'.11fe;wW ha—pned acv the ow"n',fie. •rva.wn.ra r6u J.ey,n wr•.a 1-C. firLi.LightWise Windows warranty a owe 57 PS1 < t details flYallilbie upon ,equest. 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' Daafgn Prof.urn R.Fnf trex DoejiarA' j -- -------i tr,$Y a,w,arSr` ar ze rd!?:,4540 jr..So- t!'A•sa'id l •h 60P8f W14V jft+Arta'40• er,rr raf9.•tjiIW wttr Ti rt in•1 PlewieNl Oil t.•,r mr.+ra• sr,t?' Isa.•t1w .r.,r rf'r:rs crr,kw Y! tNm r 2f4ji56%, dri7f �aV 31•ht R.71` 11+�tia'i.' RiSEfvdlt' �ipf,rdautl_ - a f.7Fr:4rtD n.c.LShcrav t1SIfI ll.'i a•. I 1 / 1 a'•'AaF SOUTH RJLyfA f$!i CODE ! l+: J ei M oFa sra f .� 7 a Mrtlow r 1� F"i ? y $ArE }EOY Ti_ I Gvas e`att y 137 �:• ,tai�n� ll '��essarsy ,dant r { rp J 1 (' ij � �1 ctylffllas fXl6E C24iie�irF Oi]]!E +Ae t•+ I ! 'rv^?'?�/!� ! 'l.�/ °.l� Aver;'t URcf#1 :l. .9 4 Detail B3 B F. r t. [ i ightM5_2f V%`NL DV S NEV41 ann REINOVAI_!' r CC N SI r'.1 t*WY.ti__ .T '� ' Do-!ail A-A E,I arVlew, n j L._._.-_ S. v �Fly A' rt ._ry"er) = krT r` ct: { .1 1 s :.E( tot".1� K sew e• �!1 y4 / } ( 2' U1/u7/GUUi7 LU:zl rAA IZ4 jz/ addu rtati UUK1Vl.Vti MAKKtAtNU Pittsburgh Corning Corporation 800 Presque Isle Drive Pittsburgh, PA 15239-2799•724-327-6 1 o EXTERIOR SIDE INTERIOR SIDE 1LALJ3 .- --- 750 o� (0,/ —t.25o .080 34 � � ��►y"-ley five CITY OF ATLANTIC BEACH 1800 SEMINOLE ROAD J ATLANTIC BEACH FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 04-00029267 Date 1,1/09f04 Property Address . . . . . . 440 OCEAN BLVD Tenant nbr, name . . . . . . 15 TOTAL FIXTURES Application description . . . PLUMBING ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 Owner Contractor ZUCCHI , ELIZABETH DAN BRYANT PLUMBING 440 OCEAN BOULEVARD P.O. BOX 331275 ATLANTIC BEACH FL 32233 ATLANTIC BEACH F'I, 32.233 (904) 242-9256 ------------------------------------------------ --- -------- - - - -- -- - - --- - - - - ----- Permit . . . . . . PLUMBING PERMIT Additional desc . . Permit Fee . . . . 140 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Fee summary Charged Paid Credited Due Permit Fee Total 140 . 00 140 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 140 . 00 140 . 00 . 00 . 00 PB=DIi ROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING 11L 0 lawk BUILDING OFFICIAL CITY OF ATLANTIC BERCI r PLUMBING PERMIT APPLICATION 'ix.tFUsky�an i IDS) Date: Property Address: OcGa! �Sly Owner: e Z v G Telephone#: _ j� Contractor: / / Telephone#: _= ` < Contractor Address: Fax p, 3312 G. Rch 7-1- In - -In consilieration of permit given for doing the work as described in the above statement,we hereby agree to perform said wor!:in accordance with the attached plans and specifications which are a part hereof and in accordance with the City of;'ttantic Beacti ordinance and standards of good practice listed therein. Installation of plumbing and fixtures must be in accordance with the most recent edition of the Southern Standard Plumbing Code. _ Plumbing Type: If other construction is being done on this building or site, ❑ New list the building permit number: Xt'e-Pipe I --- Number of Fixtures: Bath Tubs Showers _ Closets Shower Pans Dishwashers ! Sinks I Disposals Urinals 0 Floor Drains ! Washing Machine .3 Lavatory Water Sewer Water Heaters Other )64e Fees Permit Issuing Fee: $35.00 Total Fixtures: P9 X$7.00 + $35.00 = 800 Seminole Road - Atlantic Beach, Florida 32233-5445 Phone: (904) 247-5800 - Fax: (904) 247-5845- http://www.ci.atiantic-beach.fl.us Revised 1/0.3 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 04-00029448 Date 12/29/04 Property Address . . . . . . 440 OCEAN BLVD Tenant nbr, name . . . . . . REWIRE MASTER BATHROOM Application description . . . ELECTRIC ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 Owner Contractor ------------------------ -------------- ----- ----- ZUCCHI, LAURIE DUTCHER ELECTRIC INC 440 OCEAN BOULEVARD 1122 N. 3RD AVENUE ATLANTIC BEACH FL 32233 JAX BEACH FL 32250 (904) 241-4333 --- ----------------------------------------------------------- -------------- Permit . . . . . . ELECTRICAL PERMIT Additional desc . . Permit Fee . . . . 70 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Fee summary Charged Paid Credited Due ---------------- - ---------- --- ------- --------- - - --------- Permit Fee Total 70 . 00 70 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 70 . 00 70 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDING OFFICIAL 800 Seminole Road•Atlantic Beach,Florida 32233-3445 Phone:(904)247-5800. Fax: (904)247-5845. http://www.ci duatic-beack.fLus CITY OF 800 SEMINOLE ROAD ATLANTIC BEACH,FLORIDA 3223:3-5445 -- �'- TELEPHONE(904)247-5800 FAX(904)247-5805 9 i 997 SUNCOM 852-5800 GORDON OGBURN 440 OCEAN BOULEVARD ATLANTIC BEACH, FL 32233 RE: SECOND STORY DECK ADDITION AT 440 OCEAN BOULEVARD DEAR SIR: THE HOUSE AT 440 OCEAN BOULEVARD HAS HAD A SECOND STORY DECK ADDED TO THE WEST SIDE OF THE HOUSE. A CHECK OF OUR FILES DOES NOT REVEAL A PERMIT BEING ISSUED FOR THIS DECK. SECTION B. 104. 1 OF THE 1994 STANDARD BUILDING CODE AS ADOPTED BY THE CITY OF ATLANTIC BEACH, STATES "ANY OWNER, AUTHORIZED AGENT, OR CONTRACTOR WHO DESIRES TO CONSTRUCT, ENLARGE, ALTER, REPAIR, MOVE, DEMOLISH, OR CHANGE THE OCCUPANCY OF A BUILDING OR STRUCTURE, . . . . SHALL FIRST MAKE APPLICATION TO THE BUILDING OFFICIAL AND OBTAIN THE REQUIRED PERMIT FOR SUCH WORK." A COPY OF SECTIO B. 104. 1 IS ENCLOSED. BY THIS NOTICE YOU ARE REQUIRED TO MAKE APPLICATION FOR A PERMIT FOR THE DECK WITHIN FIFTEEN ( 1 5) DAYS OF THIS NOTICE OR BEFORE 5:00 P.M. APRIL 24, 1997. IF APPLICATION IS NOT MADE BY APRIL 24, 1997, THIS CASE WILL BE BROUGHT BEFORE THE CODE ENFORCEMENT BOARD. SINCERELY, DON C. FORD BUILDING OFFICIAL DCF/PAH ENCLOSURE CC: CITY MANAGER CODE ENFORCEMENT , VIA CERTIFIED MAIL RETURN RECEIPT REQUESTED B104 PERMITS B104.1 PERMIT APPLICATION B104 .1. 1 WHEN REQUIRED. Any owner, authorized agent, or contractor who desires to construct, enlarge, alter, repair, move, demolish, or change the occupancy of a building or structure, or to erect, install, enlarge, alter, repair, remove, convert or replace any electrical, gas, mechanical or plumbing system, the installation of which is regulated by the technical codes, or to cause any such work to be done, shall first make application to the building official and obtain the required permit for the work. EXCEPTION: Permits shall not be required for the following mechanical work: 1. any portable heating appliance; 2 . any portable ventilation equipment; 3 . any portable cooling unit; 4 . any steam, hot or chilled water piping within any heating or cooling equipment regulated by this code; 5 . replacement of any part which does not alter its approval or make it unsafe; 6 . any portable evaporative cooler; 7 . any self-contained refrigeration system containing 10 lb (4 .54 kg) or less of refrigerant and actuated by motors of 1 horsepower (746 W) or less . 5 }r A I I � l : � . DEPARTMENT SSP BtstLOfwG CITY OF ATLANTIC BEACH, A� I F II PE S` IN "CSX ' } - w.,.._� w Lid TION INP'Q�TICN i N b r: l 5 s Address: 9 40. t CE N 3 3C Pe rm t Ty ae .t�EC1 "` BFA�I", t oRIDA..322 ,3 C Aas tiWt , k:ADD TION, --------- fWtQAL DESCRIPTION Oars r. Ty :W4CJlJ +IE 8l rook ' + o ed tis : SCtI+ {? ubdsC� RAt» {} ;. I34ellira 3 subdivision tsi Value, ' v . Cott : 1, 40<00 ot t;4 fig F r, �� - '��.� AP 'S CATION FEES s _ %i PERMIt .i % Ad r 3r�1`'" :,.o.. E"}'+iR�j i.�yry u'��p@'p,47y,, i l,+ Lai i..h' ,cam ,`�''' ho t`€ qg YT e -0.+ � � ,k'�.r9un:f g. Nocsw..��.�.a�.m.�mnm<ma:,.-.....�er«�m..�iranw✓ `,� � �� A�" r> E k4 4 f { n S NOTIC -�A�.I,.C�?#4+��t�TE�1{I1$Ahlp FR}�3TINi3;S NIUffi'�'BE I�t�F+��'�'$#�$EFDRE POU two a : "PERMIT VOID 5{X MONTHS AFTER DATE OF IS$UE U{Lt31N(a MATE"{AL;R�Y�81SMl.d�ND gESRI$FROM THIS WORK MIDST NOT BE PI ED iN PUSL G SPACE,AND ST BE LEASED UP ANp HAULEp AWAY I EITHER CONTRACTOR OR OWNER t14 L R ;`C Ir 1 T Tl��+1►E MtE HAI I �' L»��i ;1 �11� t� IJ". 't" IN PAY'I Inc; 1C E � M f � . 1 r �fl 1t COR, ING TC APP00VL6PLAN$`WHICH�ARE PART CaF� CHIS PERMIT A SUBJECT T#"J`RE1l� G ATICM t,Ik,A PLICA 3LE F "t PUS OF LAW.. { CASR ALAiiTkGSAi*Izl�ltil�t?t ` EP�, MEtJC 11 �.x `t Y, =i ,u CITY OF ATLANTIC BEACH PERMIT CALCULATION SHEET Address /-/qo 0CEA-10 P. l Ar: A Dr r- Date Heated Square Footage �@ $ per sq ft = $ D Garage/Shed @ $ per sq ft = $ Carport/Porch ��@ $ per sq ft = $ Deck ,,ll5 @ $ per sq ft = $ Patio V 6� @ $ per sq ft = $ 00 TOTAL VALUATION : $ oQ �Q 0 / S. 00 $ Total Valuation 1st $ / 000 Foo 5--,06 $ S7 cc, Remaining Value $ per thousand o portion thereof TOTAL BUILDING FEE $ 2 O.d a + 1/2 Filing Fee $ �C).00 ( ) Fireplaces @ $15 . 00 $ BUILDING PERMIT FEE $ 3 WATER IMPACT FEE $ SEWER IMPACT FEE $ WATER METER/TAP $ CAPITAL IMPROVEMENT $ SEWER TAP $ ( ) RADON (HRS) . 0050 S SECTION H PAVING ( ) $ HYDRAULIC SHARES $ CROSS CONNECTION S ( ) SURCHARGE . 0050 $ OTHER $ GRAND TOTAL DUE $ 3 0.O p 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 APPLICATION REMODEL, ADDITIONS OR ALTERATIONS DEMOLITIONS r Owner(s) Address: �� Phone: Lot #_ Block or Unit # Subdivision: Contractor: State License # Address: f Phone No: , Describe work to be done• f ��...��-�C_, •mac: �� Present use of bui d'ng: Valuation of Proposed Construction: Proposed use: Is this an addition? If yes, what are the dimensions of the added space: ft. X ft. Will the added area be heated and cooled? New electrical (or increase) ? — New plumbing fixtures? (y�New fireplace? -- New Heat/AC? SUBMIT THREE (COMMERCIAL) TWO (RESIDENTIAL) COMPLETE SETS OF PLANS, INCLUDING SITE PLAN, SURVEY, ENERGY CODE FORMES, NOTICE OF Co"M7CEMENT, AND OWNER/CONTRACTOR AFFIDAVIT, IF OWNER IS CONTRACTOR. )- Signature OWNER " r '' Date: l� C Signat ureZ-E TRACTO9;- -- `. Date: License Supplied: Liability Insurance: I Worker's Compensation Insurance: RECEIVE® APR 2 4 1997 City Of Atlantic 13each BUilding and Zonine f r RECEIVED APR 2 4 1997 City of Atlantic Beach Building and Zoning CITY OF 800 SEXIINOLE ROAD ATLANTIC BEACH.FLORIDA:32133-:1445 TELEPHONE(904)247-5800 FAX(904)247-5805 SUNCOAI 852-5800 CHAPTER 489, FLORIDA STATUTES, PART I "CONSTRUCTION CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489. 1 03(7), FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS, YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU, AS THE OWNER OF YOUR PROPERTY, TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE - OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF $25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. ORDINANCES ALSO ALLOW AN OWNER TO IMPROVE THEIR OWN PROPERTY WHEN IT IS FOR PERSONAL OR FAMILY USE, AND LIKEWISE REQUIRE ALL WORK (EXCEPT MAINTENANCE UNDER $2,000) BE UNDER A BUILDING PERMIT AND PASS ALL NORMAL INSPECTIONS. THE ORDINANCE STATES OWNERS MAY PHYSICALLY DO WORK THEMSELVES; OR MAY HIRE UNLICENSED WORKERS PROVIDED SUCH WORKERS BE UNDER "DIRECT SUPERVISION OF THE OWNER, WHO MUST BE ON THE JOB AT ALL TIMES WHILE WORK IS IN PROGRESS BY UNLICENSED TRADES PEOPLE." THIS DOES NOT ALLOW USE OF UNLICENSED CONTRACTORS. SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKERS COMPENSATION INSURANCE BE PURCHASED UNDER THE HOMEOWNERS INSURANCE POLICY CLEARLY PROTECTS THE OWNER. OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1 099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 45'55-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT (247- 5826) IF IN DOUBT. I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. L-C U�, T / C� lJ�l�r PERTY N /BUILDER AD/DRESS TELEPHONE SWORN TO AND SUBSCRIBED BEFORE ME THIS `f DAY OF Jp�'� t. 19��•� N TAY PUBLIC NOTE: PHRASES UNDERLINED ABOVE MY CO *��•.� EXPIRE ARE EMPHASIZED BY THE BUILDING =o~/ +1n MAUREEN KING DEPARTMENT. Notary Public,State of Florida c4� My Comm, Exp. Mar.31, 1998 ole f Comm. No, CC 359683 MAP SHOWING SURVEY OF L_07 3, Bi'-OCK 23, PLAT No. 1, SUBDIVISION "A", ATLANTIC BEACH AS RECORDED IN PLAT BOOK 5, PAGE 69 OF THE CURRENT PUBLIC RE-CORDS OF DUVAL COUNTY, Fi ORIDA. I r> i LOT 4 W r'FOUN2' IRON 1'14.91' FIELD ) t 'v' P 1 f ty • FOUND 1/2* IRON --- PIPENO CAP ---- r: i ,-�_ CON TE WAU( --- -----_..� . 3,i�� N " iCONCRETE DRIVE AND WALK i CJP > STORY QY ' M G & l i 5.0' OPY F RAMF� p w LO j - � FrF SIi)F PJCr No 440O wc� STAIRS � O N Ja: < 2 _ Ls/ O .0'.-- < , Q rl �. --- - 62. ° �o icONCRETT (f; PA no 22.9' co CD SFr 1/2' IRON 6 FE CE PIPE, i B. 3872 89 48 S4" 115. <j rz FOUND 1/2' IRON t, PfPE, NO CAP a Z� 9. U W 0 4 ^ �O (1rr/j O O r ,I i NOTES �( '"HIS IS A BOUNDARY SURVEY. FOUND '/2' IRON I __ -- --- —.__ PIPE. ANGLES AS PER FIELD SIR VE Y. NO CAP No BullDNc REsrRlcrloN uNEs PER PLAT FOURTH STREET NORTH AS PER PLAT OF ATLANTIC BEACI TERRACE, FLAT BOOK 15, PAGE 34 40 FOOT RIGHT OF WAY, PAVED j Ti-1 PROPERTY SHOWN HEREON APPEARS TO LIE •N FLOOD ZONE "X" (AREA OUTSIDE 500 YEAR FLOOD PLAIN' AS WEi. L AS CAN BE L; ._ RA-rE MAP COMMUNITY PANEL No. 1200i5 0001 D, REVISED APRIL 1 , 1989 FOR THE THIS SURVEY WAS MADE FOR THE BENEFIT OF CITY OF ATLANTIC BEACH, FLORIDA. GORDON C. OGBURN AND IS IN COMPLIANCE W'TH THE MINIMUM TECHNICAL STANDARDS SET FORTH IN CHAPTER 61 G17-6 OF THE FLORIDA ADM NISTRATIVE CODE (REVISED 1996). UNLESS IT BEARS THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA DONN W. BOA'r*RIGHT, P.S. . LICENSED SURVEYOR AND MAPPER, ?HIS FLA, UC. SURVEYOR AND MAPPER No. 3295 MAP IS FOR INFORMATIONAL PURPOSES FLA. LIC, SURVEYING AND MAPPING BUSINESS No. 3672 ONLY AND IS NOT VALID. SCALE: 1`-_ 20'_ BOATWRIGHT LAND SURVEYORS, INC. DATE: NOV M R 26, 1996 DRAWN BY _-_ w�._ 1711 5th STREET SOUTH FILE e^_-_-_ ._� 739 JACKSONVILLE BEACH, FLORIDA 241-8550 SHEET_1_ OF _1 DISK 985-9 PSi DEPARTMENT OF 19UILoiNO CITY OF ATLANTIC S #bH } - '` 14 tAT Cts _.. LC3G T ON t 'C1F1�' t51 j �r i t ea bZitv x . P rmit 'hype:SIGN ATL" "1 ?IA�, 01 ass enatr. Typ�+ tWOOD F�RME rBlack: proposed Uar� Sections 0 Subd.: 3 subdivision"s, 3 Est . 'Va u�0 o loo mrov. Costs }4f1 s 10.00, ' ddr L" ARD Q y+ {� ai` w `yv v4 LORI DA p hwtTS -1� k�. l"h a u 2. Jaz " FTS T 4 s C r: ic NOTES; i NOTI 1!- ALL;CONCRETE f`b*#A$AND FOOTINGS 1NIUST,E E I1�ISPE L BEFORE.POU�#IMG ` }, P1:AMIT VOID SIX MONTHS AFTER GATE OF'1SSVE U1L.DING MATERIAL,RU$S1SH A1UO OtBRIS FROM THIS WORK MUST Nt3T.BE PLACED'"1N PUBLIC SPACE,ANO MUST BE LEAREO IJP"ANEW HAULED AWAY BY FITMERCONTRACTOR OR OWNER T® CE" M L.1f WITH THE MEC�1�4N10.7 ' . EN LAW ► RESTJN HE PROPERTY t�1�A t k SAYING TWICE IrC)R EIJII~1�1NG i �RC� IVI SSVEO ACCORO.ING TC.APRt OWED PLANS WHICH ARE PART"OF'THIS PERIuI1T"ANLS""SUBJECT TO FI VI.3CAT llC k AT1ON of APPLICAB{-E PI�QVMONS OF LAW. -ALPLUM;kill .. 4't`LANTIC SEAL BUILO0� PA. E APPLICATION FOR FENCE PERMIT r -� A� Owners name _ Phonetx`f'?'" U 15 Job Address Lot-°"___Block and/or Unit 013 Subdivision---P Contractor if different from own ------------------------------ - =------------------- s Corner nt..._... _._..___...,,,..�,.,,_._,� Valuation of fence S cta `f erior lot Type construction__L r Show location and height of fence as well as location of streetts) . Owner signature -'" AM � -` f Date ------------------ Contractor ------ --------- Contractor signature--------------` � ______Date CITY OF ATLANTIC BEACH DEPARTMENT OF BUILDING 800 Seminole Road - Atlantic Beach, FI 32233 - Tel. (904) 247-5826 ROOFING PERMIT _ PERMIT INFORMATION __LOCATION INFORMATION Permit Number: 17926_ Address : 440 OCEAN BOULEVARD Permit Type: RE-ROOF ATLANTIC BEACH, FLORIDA 32233 Class of Work: NEW Township: 0 Range: 0 Book: Proposed Use: i Lot(s): Block: Section: 0 Square Feet: Subdivision: Est. Value: _Parcel Number: Improv. Cost: 2,000.00 OWNER INFORMATION Date Issued: 3/18/1999 'Name: OGBURN Total Fees: 25.00 Address: 440 OCEAN BOULEVARD Amount Paid: 25.00 ATLANTIC BEACH, FLORIDA 32233 Date Paid: 3/18/1999 Phone: (0__00)00_0_-0000 Work Desc: REROOF W/25 YEAR ARCHITECT --- - CONTRACTOR(S) APPLICATION FEES PROPERTY OWNER RE-ROOF 25.00 Inspections Required NOT APPLICABLE - NOTICE - C 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 CQNSTRUCTION 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. I! f�5.88 14 _ Date: 3/18/99 81 Receipt: 8843894 CI OF AT TIC B CASH ae188883zz1ee8 Carr OF AT LXNTIC BEACH ROOFING PERMIT APFLICATION JOB LGCATION: Y" 3 OWNER OF PROPERTY' CCNTRACTOR: CONTRACTCR'S ADDRESS: ` QIP. STATE LICENSE NUMEER: n TELEP`-'CNE. DESCRIBE WORK TO 6E PERFORMED: VALUATION CF PRCFCS&D CCNSTRUCTnN 23n-a MATERIALS TO BE USED: SIGNATURE OF OWNER: SIGNATURE OF CONTRACTOR: SWORN TO AND SUE SCRIBED EE=ORE ME THIS AY OF C 19 NOTARY PUBLIC Liability Insurance Supplied ,; y PdftAmomb MY COMMISSION N MMI EXPKS August 27,MW Wcri<ers Ccmpensaticn Insurance Suppliec , eonawnrr�ma Contractor License Information Supplied Occupational License Infcrmadon Supplied BUILDING AND ZONING fNSPECTION DIVISION CITY OF ATLANTIC BEACH ATLANTIC BEACH, FLORIDA 32233 APPLICATION FOR MECHANICAL PERMIT CALL-IN NUMBER IMPORTANT — Applicant to complete all items in sections I, II, Ill, and IV. LOCATION Street Address: OF Intersecting Streets: Between And BUILDING Subdivision II. IDENTIFICATION — To be completed by all applicants . In consideration of permit given for doing the work as described in the above statement we hereby agree to perform said work in accordance with the attached plans and specifications which are a part hereof and in accordance with the City of Jacksonville ordinances and standards of good.practice listed therein. Name of Mechanical Contractors Contractor (Print) I!/ '` w-- Master Name of Property Owner Oq 4Jt!ve Ems/ Signature of Owner Signature of or Authorised Agent Architect or Engineer III. GENERAL INFORMATION A, Type of hosting fuel: B. IS OTHER CONSTRUCTION BEING DONE ON A Elecwc THIS BUILDING OR SITE? dA-- ❑ Gas—❑ LP ❑ Natural Central Utility IF YES, GIVE NUMBER OF CONSTRUCTION ❑ Oil PERMIT ❑ Other— Specify IV. MECHANICAL EQUIPMENT TO 8E INSTALLED NATURE OF WORK (hovide complete list of components on back of this form) A Residential or ❑ Commercial FHoot ❑ Space ❑ Recessed l Control O Floor ❑ New Building ❑ Air Conditioning: ❑ Room ❑ Control pg� Existing Building ❑ Duct System: Material Thickness ❑ Replacement of existing system Maximum capacity e.f.m. ❑ New Installation(No system previously installed) ❑ Refrigeration ❑ Extension or add-on to existing system Q Cooling lower: Capacity g.p.m. ❑ Other — Specify ❑ Fins sprinklers: Number of heads. ❑ Elevator ❑ Manlift ❑ Escalator (number) THIS SPACE FOR OFFICE USE ONLY ❑;Gasoline pumps (number) (Roftivod) ❑ Tanks (number) Remarks (3 LPG contain*K (number) ❑ Unfired pressure vessel ❑ •oilers Permit Approved by Dots — 0 Ofhor -- Specify Permit No LIST ALL EQUIPMENT AIR CONDITIONING AND REFRIGERATION EQUIPMENT Number Unita Description Model Number Manufacturer C('1 )Y Appy HEATING • FURNACES, BOILERS, FIREPLACES Capacity Aye Number Units Description Model Number Manutubirer t2itim) a1� Imo., CEJ qOd gMoy TANKS How Many Na final Capacity Type Liquid Nano M Serial Appproving and Dimensions Contained Maaufaeturer No. Agency 9747 d 7 AI IT DEPARTMONT OF.BUIL01MQ , r CITY�ATLANTIC aH G S P `i �" .I } 1 -__ LOCAT I IN " I s"R1 lfi i �? rmt numb : 6747 Addl:e!$t . r t1 L ' �ATLd,x c BEACH, LOIR DA ;3 2 1 C ' f� 1 ...._,. �.,..:,_ OCR I "to-not�� . WOOD PRMZ Lot 3 1;r � c . 1 FSubd �r aan. $0.00 00 S1.-6 s u $2411.66, ► + f 4t, 9.3" An . t k ' '. 1RR 3ATT 3 METER, r nF f 14I :..�': P IT IMPACT FEZ owl� 0101 9 �- . � .00 PONTto __..1..... RAUN, f3A $fI.tQ Iti m L OR DP 1R T TA, E 'TAP" 1 6 � PIF1s .'SAP RRA 4QO " Oto O " » A� 1. , 4 iiwsw I 4 � - r f 5. !t I s` NCTkC' -�qk.L CtlA1CIRETE FAROS AND'FOt�?TINt3$MUST BE 1NSP1rCTifl BEFORE POURING' PERMIT VO*SIX MONTHS AFT04 DATE 4f 1S;SUE { IL #Nth MAT1 . SAL,R11EiBISH AN[?DEAR#S FRtJM fM#S 1N(pRK MUST,NOT'B .PLACE0 IN PUBLIC SPACE,AND MUST BE.` ;EAAE0;1 P AN HAV,'LE 'AWAY E3Y'EITHER CONTRACTOROR OWNER ` I NJIC AIL. ;TC,� "G+QiIPi�Y 11ViTH THE ML IECNAS' i,. il,�.q►W +CAN RE;�u .T 1N C3 i1"1t` YLINi i PA' ii"+iG TWICE i= R BUILOIMG INIP 3Vi�iI�1EN S." w»"ACCdR ING TO'APPROVE© PLANS WHICH ARE PART Of 1141t PI FtM1 -AND T6 l� f A PLICA LE i Rt YI 1CIWS Qf t M A 1T BEACH U(LaING DEPA�iTMI�NT ` 4 x' ! pBpAW MENT OF BVILQMM' ` CITY OF ATLANTIC BEACH { ti jrbqkT ION INFORMATION pilIT > Cts 13I '" A dre !: 4 flC81 N "BOIJLEWAR , t MAI* FLORIDA .. . ..:».. � ;D ESCR I PT ICN - 5 t�Tcsrkt jiDDI 'ZJCAL Btio . ` -601 Code: C► S ibduis cn e Valu. $0,00 ,a $2:5", 00 i `4 , b A 3 }i ttry g F25.40 NIT L%VM t ' C`► .00 L ri FLC?NII3A $p ft3 4,T MSE. TIRE' » .00 AL3* 1.4'R�3 OAS, $0 .CC � .C rat Y y�( yyyyJr u� + i Ate 4 ` " 2t3 } .8 1I13CLBI�I3 . 0.00 rL "2250 #j'I�N�lt�Ia.IC# SRARI� ")"#Qt? CIN . z ye . gg OTfS., " } k Y� NE T1C -- ALL CONCR4Tt FOAMSAND FOOTINGS MUST 86 "SPIlEC"t50 BEFORE POURING PERMIT V©IC SIX K40NTHS AFTER MATE OF ISSUE , UII[?t#dG MATERIAL,RUBBISH AND DIES FROM THIS WORK MUST Nr BE P�ACE4#N PUBLIC SPACE,AND MUST BE { LE f3 URA ? HAUL Q AWA BY E#THER GQNTRAC TOR OR fl hMER ;FhttLtlR TQt CCIMPLY 11NITH THS MECHANICS' Ll LAW CAN REiU .T IN `I E PRSigfkTy p'lll!NRR A-ING TWICE FO BU i lII IGi Illll f'�t?Y AA I f`$ v E C©„ INGi TO APPRQVI 7.PLANS WHICH ARE PANT ©f= THIS PEFIMiI AND SUB,t�TQ RE SU A B} ��£X ►T d 1 t)F;° PPLICAaLE PAOVIS101 S C?F LAW.. AA -,F-,LA 600 NG DEPARTMENT k < SATE : �?---/-------- Fk:.-�EkVICE (DIVISION JACKSONVILLE ELECTRIC AUTHORITY 2s3 WEST DUVAL STREET JACK:_;UNVILLE, FLORIDA 32202 THE }FOLLOWING FINAL INSPECTIONS) HAVE BEEN MADE AND ARE .DATI�FACTOkY : 2C --------------------- -------------------------------------------- -------------------------------------------------- ------------------------------------------- ------------------------------------------------- Enclosed are the blue copies of the permits. SINCERELY, � BUILDING INSPECTION DIVISI.ON cc : FILE CITY OF ATLANTIC BEACH, FLORIDA �..�+r••� AmPI` "TION FOR RUCTRICA& PIRIAIT ATo TME CHIEF ELECTRICAL INSPECTOR: GATES' 1T.; IW04TANT NOTICE: IN CONSIDERATION OF PERMIT GIVEN FOR DOING THE., ORK AS-USCRIB9p, IN XHi FOLLOWING: ,OE HEREBY AGREE TO PERFORM SAID WORK IN ACCORDANCE WITH THE.ATTACHL4 PU�5 AND SPE�iFICJ1TI0 S. WHICH ARE A PART HEREOF, AND IN ACCORAANCE WITH-THE ELECTRICAL REGULATIONS; CODES AND CITY OF ATLANTIC BEACH no Pm,MAME ADORESi: 0--.•.�.�.�x...�..�. BLpp•SIZE _ .. .YiTWEEN: -' :• - ..... 1 RiiA".l 1 IJW&L 11 PLIC 1 1 IN"11 M W l l OLa• w.1 1 *AWTWN 1 1 TEM►. SHINS 1 - TNIIILEA 1 1 1 i 1..�.., SEAvICEI MEW{ 1 IMGAEJ1i;E 1 1 REPAIR -FEE- OWN" FE"Fl ., V. f FEE"" NO. S12R NO: - SIZE NO. SIZE- . LIGHTING OUTLETS CONCEALED OPEN TOTAL RECE/TAGLEi CONCEALED OPEN T:- �`•'��. "0 AMPS OWITCHKO PLUOREtCENT M.V. APPWAHG=s BELL TRAMP. AIR N.P.RATING H.P.,RATINO CONDIT100"NG COMP.MOTOR 07HER MOTORS' AMPS C&IL HEAT: KW41EAT ••1 OV14 MOTORS - H.P. VOLTAGE - PHS- -NO. i M.P. VOLTAGE PHS. Mi E LAN ' ' r TRANSFORMERS: UNDER 600 V. — --OVER 600 V. NO. KVA- - NO. KVA L&CHSO►GN � RAW. ' VA. AIA. MATOR SIZE WITCH IzLAEIIE .. FORW!lNQED • .. �. '• TOTAL FEES ' j CITY OF Office of Building Official REQUEST EOR INSPECTION Date_ Permit No. � Time Received _- P.M. ur Locality Owner's Name _ C�(JLf`✓' —Contrac BUILDING CONCRETEELE�-Ai PLUMBING MECHANICAL Framing 1:1 Footing Rough Wiring Rough L, Air Cond. & LI Re Roofing ❑ Slab - Temp Pole Top Out L Heating Insulation L Lintel Final Sewer L Fire Place L Pre Fab READY FOR INSPECTION A.M. Mon. Tues. Wed. Thurs. Friday A.M. Inspection Made —--- R RM. ---- - — -- fr:.s octoi Final Inspectio -- certificate of ccupa cy D;itc I CITY OF �! Office of Building Official REQUEST FOR INSPECTION Date --W_-. _ - Permit No. --Time A.M, A.M,. Received P.M. Jcbl/ ss n ality R Owner's BUILDING CONCRETEELECTPLUMBING MECHANICAL Framing Footing Rough Air Cond. & n, Re Roofing Slab - Temp Pole _ Top Out ❑ Heating Insulation Lintel Final Sewer Fire Place f Pre Fab READ R INSPECTION A.M. Mon. Tues Wed. Thurs. Friday—.-_— P.M. A.M. speeticn Made _- -- / Sy / -__. P.M. pc�cior_- Fina! Inspectio Certificate of Occupancy C_.a-lo" Da LATE: PRE-SERVICE DIVISION JACKSONVILLE: ELECTRIC AUTHORITY 2J,�l WEST DUVAL STREET JACKSONVILLE, FLORIDA 32202 , THE FOLLOWING FINAL INSPECTIONS) HAVE BEEN MADE AND ARE SATISFACTORY : 01) _ --------- -- , ------------- Enclosed are the blue copies of the permits. S`I�ILY, BUILDING INSPECTION DIVISION cc :FILE CITY OF ATLANTIC BEACH APPLICATION FOR SEWER CONNECTIONS PERMIT NO. - 42 - DATF,--,z- �/-?6 LOCATION 46�REET LOT NO. _ BLOCK NO. - 3 OWNER TYPE OF BUILDING ,MASTER PLUMBER ld-el- INSPECTED BY BILLED ACCOUNT NO. ,��„� x� APPLIC4TION FOR MATER CUT-IN TO TNR CITY OF ATLANTIC BEACH : APPlication is helrobwade lnr M ` 3l4 tap rater out-$" At th tollowieq 444rese for one unite. Cut-In ahArge of 85 . 00 plus 4 . 04 construction water T : street 44. 440 Ocean Boulevard { ? ` Lot 3 Plock 23 B/p i11R z Ordered by H. N. Ballentine" Owner Kenneth A. Heindel A Nailing Address 5716 Mi I)rty• mwb'' .. Account Mo. -- afaa . tooter Y t POO Installed i { y.. 3 FOR OFFICE USE ONLY Date........ '�t2 1 c�2...19.. .. Permit #----------•.............Fee$.,/•.✓...•....... CITY OF ATLANTIC BEACH Valuation $..-� � ' FLORIDA House # K7 ?_5'Y1J_ �--+.'--- ..................., APPLICATION FOR BUILDING PERMIT �/� -- .............*............*.....................**................... Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure described. This application is made in compliance and conformity with the Building Ordinance of the City of Atlantic Beach, Florida, and all provisions of the Laws of the State of Florida, all ordinances of the City of Atlantic Beach and all rules and regulations of the Building Department of the City of Atlantic Beach, shall be complied with, whether herein specified or not. The Contractor or Owner-Builder who has been issued a Building Permit is automatically responsible to ascertain that all sub- contractors engaged by him are duly licensed in the City of Atlantic Beach, Florida. To prevent delay or embarrasment regard- ing intermediate or final inspections it is suggested that a list of sub-contractors be submitted to this office so that licenses can be verified. -; y Date...................c,�U..f.... ��q x ................., 19.. Owner..�l.16V/,il/�1) --- •----A ��s. AId-Fk....------------------Address.�`71 ----111.41?A R-- Architect_------------------`------------•----•-------------------------------------••-------------------.Address,..........................................................Telephone No.--•--•-•---•---•------------ ContractorAddress .. .................... ./-c?.� .. -..Telephone TNo.----- � �6�azln� Lot No t4.�-------�-------------------------Block No.....----'t � ---Sub Division.._--!•'------------•-----------------------•-------•--,Zone---------....---- Lot No.------ --•-----.AJ,_V_AQ---------Street--- ln1�S7_Side Between------------1-----------•-----------_---.-_---and....---•--•-----....1.. -•---- Sts. Valuation $.3Y. ......For what purpose will building be used.-------- _.:...........Type of construction.........F-111 .M. Dimensions of Building.- + ----Dimensions of Lot. __..ZZ)v ..:..�./L.S................Size of Footings ��.��.....:-.. Size of Piers------------------------•----_--.... ,Siz..ee o-f Sills----------qq------------------.-_GTeat st 'll pan . ft...........................Type Roof..... Ai�l�'�Z..:�1 IAVA How will Building be Heated? ?X ..' '.. ill�ui dinln Solid or Filled Ground Y....._..c`31,C(. ............ r Size of Ceiling Joists......---2AA _..._------------- Distance on Centers............ .......L-41......... . -..e-.., Greatest Span...e3 ..... ... � �r f � Size of Floor Joists----- _. ._-------------------Distance on Centers__...._116.......�t.r-C.._r......., Greatest Span.._._/.4..." ...................... " . . r cr J Size of Rafters----------- L-X__ ------------ Distance on Centers. ... - -_....L�.C_._'._...., Greatest Span.-, :-Q..... qfi. _01 This rectangle is to represent the lot. Locate the building or buildings in the right position. Give distance in feet from all lot-lines and existing buildings. REAR LOT LINE Two copies of plans and specifications shall ' be submitted with application. Inspections required. �eyP, 1. When steel is in place and ready to pour footing. W W 2. When steel is in place and ready to pour columns and/or lintel. Z Z 3. When steel is in place and ready to pour beam. 4. When framing is completed. s r 92 5. When rough plumbing is completed,and ready to cover up. 6. When septic tank drain field or sewer is laid but before it is covered. Ak 7. Electrical inspection by City of Jacksonville. c L 8. Final inspection. Note: In case of any rejection,re-inspection MUST be called for after 0 corrections are made. 'V FRONT OF LOT In consideration of permit given for doing the work as described in the above statement, we hereby agree to perform said work in accordance with the attached plans and specifications, which are a part hereof, and in accordance with the building regulations of the City of Atlantic Beach. y Signature of Builder.- '/ 'r - * =sr,.!G�,�.....•--..--. Address._-/'.L_ ... Signatureof Owner.----- -------_-----------------------------------------d--------------_ Address.................................................................................................... CITY OF ATLANTIC BEACH ` + APPLICATION FOR FLUMBING PERMIT PERMIT NO. Date : �1 � o ~ 2& LOCATION0 Street LOT NO.. ,-3 —BLOCK No. '3 S/D_. r OWNER MASTER FLUMBER �a-- Bldg. BUILDER OR C04TRACTOR TYPE OF BUILDING SINKS LAVATORYL BATH TUBS URINALS (CLOSETS FLOOR DRAINS__LSHOWERSL_WATER HEATERS —DISH1,4A.SHERS DISPOSALS_r OTHER �„ �, e TOTAL FIXTURES "1 , 00 NO NORK MUST BE DONE UNTIL A PERMIT HAS BEEN FROCURED PLANS AND SPECIFICATIONS must show a plan and. description of the size-.and location of all the soil and vent pipes, and the numbor and loeation of all fixtures, (in accordance with 0r('-, lnanoe no. 188 of the City of Atlantic Beach, Flt)rida) must be sh w'n on ba^�k of appli- cation and be approved by the Plumbing Inspect- , DRA4 PLAN AND SkECIFICA.TION OF ABOVE PLUMBIN:_ ON BACK. Approved by_ Plumbing Inspector Date (FOR OFFICE USE ONLY ) ROUGH-IN INSPECTED REVARKS FINAL INSPECTION: CERTIFICATE ISSUED: CITY OF ATLANTIC BEACH, FLORIDA Apprcwd by APPLICATION FOR ELECTRICAL PERMIT TO THE CHIEF ELECTRICAL INSPECTOR: DATE: 20 January 19 76 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. Bill Thompson Electric Co. Inc. G�f/ ELECTRICAL FIRM: MASTER ELECTRICIAN StdWATURE H. M. Ballentine Ocean Blvd Lot 3 Block 23 NAME ADDRESS: RFD-BOX- BLDG. FD BOXBLDG.SIZE BETWEEN: RES.I ) AFT. ( ► comm.( i PUBLIC 1 1 INDUS. ( 1 NEW( 1 OLD( 1 REW.( I ADDITION 1 ) TRAILER ( TEMP.'I xK SIGNS ( ) SO. FT. SERVICE: NEW(xk INCREASE ( ► REPAIR 1 1 FEE CONDUCTOR SIZE 60 AMPS COPPER 1 x) ALUM. I ) SWITCH OR BREAKER 60 AMPS 1 PH 3 W 120 VOLT 1 RACEWAY EXIST.SERV.SIZE AMPS PH W VOLT RACEWAY FEEDERS NO. SIZE NO. SIZE NO. SIZE LIGHTING OUTLETS CONCEALED OPEN TOTAL RECEPTACLES CONCEALED OPEN TOTAL 0.90 AMPS. 91.100 AMPS SWITCHES INCANDESCENT FLUORESCENT&M.V. FIXED 0.100 AMPS, OVER APPUANCEs BELL TRANSF. AIR H.P.RATING H.P.RATING CONDITIONING COMP.MOTOR OTHER MOTORS AMPS CEIL HEAT: KW-HEAT 0.1 OVER MOTORS H.P. VOLTAGE PHS NO. 1 H.P. VOLTAGE PHS ISCELLANEOUS TRANSFORMERS: UNDER 600 V. OVER 600V. NO. I KVA 1.1 NO. 1KVA NO.NEON TRANSF. NO. VA. MA. MOTOR SIZE SWITCH FLASHER EACH SIGN FORWARDED S 2.00 TOTAL FEES $ r CITY OF rcti� teach - 9&W;d4 800 SEMINOLE ROAD ATLANTIC BEACH,FLORIDA 32233.5445 i � TELEPHONE(904)247-5800 FAX(904)247-5805 July 8, 1994 Gordon C. Ogburn P. 0. Box 51054 Jacksonville Beach, FL 32250 Re: Atlantic Beach RE#170171-0000 Dear Mr. Ogburn: It has come to our attention that a storage room has been constructed without a permit being issued by the City of Atlantic Beach. Permits are required for this type of structure. Please contact this office within thirty (30) days from your receipt of this letter to apply for a permit for this construction. If we do not hear from you within thirty (30) days this case will be turned over to the Code Enforcement Board. Under Florida Statute 162 .09, the Code Enforcement Board may impose fines of up to $250 .00 per day for a first violation and $500 .00 for a repeat violation. Sincerely, Q ,-'-C. Don C. For Building Official DCF/pah cc: City Manager VIA CERTIFIED MAIL RETURN RECEIPT REQUESTED ADDENDUM This plan approved subject to the following provisions being included in the building: In hollow masonry unit construction, each unit cell shall be reinforced with at least one No. 5 bar at all corners; poured and tamped with concrete; such reinforcing shall be properly tied into the footing and spandrel beam. All wood truss rafters---roof construction shall be securely fastened to the exterior walls with approved hurricane anchors or clips. Footings shall be continuous monolithic concrete under exterior walls, reinforced with two 5/8" deformed reinforcing rods for one-story buildings and three 5/8" deformed reinforcing rods for two,-story buildings. Reinforcing rods shall be placed in the lower one-third of the footings, properly placed and fastened on metal saddles with wire. Footings shall be 20" wide and 8" thick minimum. The undersigned hereby certifies that he has read the above and understands that this addendum takes precedence over any contrary details of the plans and specifications and agrees to comply with the intent of this addendum. BY: APPROVED Contractor/owner MIX Mt ATLAKM BEACH = - d Nowa co"ifnidion SCRt!' 004 OF MATERIALS, No .. _ Cro M iwserW irI 3.11 ee YAl. 0 Unskr Carrlhue ioef Property oddrw :.... .3..e . ,.? ..................................... 0ty -__ . . ....... ...... Side-, 1111441., mcwtgogar or Sponsor... . ....... .......•••. .... ........ ........, . ... ..... - ..., ♦N. (Neots) {AdAres) Contractor or Builder . e..B ,Ufrnt. aetfr.,.. lQRl. .t..r ptdlainl.. f►f o.•..PI.a IN11TRUCTIQNS 1. Pot addition! information on how this form is to be sabn►ithd.number miniusarn rquiremonts osnmof b•considered unless spseigeally ,des 4W. el oopipw, oft. a{ the instructions aporigable to the PWA Applica4ian hr „ Msrtsese.Iriwranos or VA Rgaesf'fen Defsraiinafion of Raeorabl{ Volvo. #. Include no o{1{enofos.'or phrases,w oentwdiatory itsras. (Corr` as#!p C{ii 0001100- Nduration of a +s"O for 0"Apte"Oe of fu6titute !male" of 2. ttessnike OR msterioM and { is raf Aer{by preeludsd.i tluipnrsaf to k{ used, whether « not.sheer+ o"11►e*&Wi*1tr1�rr�y tnwking an X in took opprol"As {h�boa and taferiot !i. Include $fpsaturss required of thr aced of f1sis fomes the irr1o"0trtion 2wd for in **A $pats. If $pest is inesiequate,enter "Sts ♦, The coostruefion " in 4a0eemnpp4tad in compliance WIA to alehd' muse."svW dawi6{larder item 27 or on an attached sheet. drowimas and tpesiloations,as mended dunes pro" The$ 3. wadi owlspsaill{olly deseribtd or A*" will net be Considered unless inefude this Destriplioa of Materials and 2.appZZe 14401im Corahsitliirn rgylrai, when ttiw mmsawn acceptable will be assumed. WoA excessil" Requiranents. I. UCAVATWNt _ Swing aail,type 104W-------------------------- --........--........... --........................................................-- -- 3. POYNOA..IONR: ---------------------------------•---------.._._...-....___._...._....__.._.__...------- -----_.._. ---•------..._.._-.._-----------• ------• rootings:Concrete mix-------- – -' - -- •---._..._... RelnforelnBll:rf .I?er_F 1. ._... ..... Foundation wall: Material -----Cgmr!#e.!__HUsk................... Reinforcing.- ___. _.___ _ __........_ ---•........... Interior foundation Beall: Material......................................... Party foundation wall --------- . .-_, ............ Columns: Material and size............. ----------------------------------- Piers: Material and reinforcing ._. ..__. _.. _.._-_ _.– ------ Girders: Material and sizes.......... . . ................................. Sills: Material ..____.._._-____._.. __.._._........___._...._........................... Basement entrance areaway__ ________________,.__........_... _ Window areaways.............................................. ..- Waterprooflng............... . . ............t.. .__. . _... ... ____.._ Footing drains ......................................... _..... n Termite protectio1 .1.. iMA,._�j..alAdtt .. tfOlti. N..iL1. _l1llA..jl�ia -K2AYtLr. c. itl.00i...». . Basementless space: Ground cover........................ Insulation............................... Foundation vents---------_.._.'w---------_— Specialfoundations ........................................................ -- ----•--- ••..................................................................... �. CNIhtNtT*:a----- ---- --------------------------------------------_-----•---------- -•------•-- ----------------- --•-- _. _. .�....... lftaterial Prefabricated ("soaks and site) Flue lining: Material .............-----------------------. Heater flue size ___.... Fireplace Sue size - Vents (owtorW and size): Gas or oil heater .--------- -------------------------------- -----: Water heater.............................. 4. NUPLACIIS: Type:❑Solid fuel;❑gas-burning; ❑circulator (make and rise) ---------------------------------- Ash dump and clean-out........ . Fireplace: Facing .. . -•------•----•--•--•_; lining •----_----;ih,.ea�rth -- -- -. -- ----. ---; mantel..._-•--._.._. . ...». S. tl>rTtR10R WALLS: --------------------------------------- ►ar: hRI•- -�!1"aaat�-P+7�*i�_____-_-- _ -------------- ---- ----------- -- -• . ..._,,..... Wood frame:Grade and ❑ Corner bracing. Building paper or felt__:1$.W.1414............ Sheathing------- -___.-__.___ ..; thickness --------- _; width ----------; p solid; ❑ spaced .............. o.c_; p diagonal; Siding.................... ----------;Fade type..............; size............... exposure------- ...;fattening ............... Shingles....................._......; grade .--- -----------*, type ; sin ;exposure ,fastening Stucco------------------- -- --------; thickness......-__.__ . Lath.......•..................._----------------------------------- weight :_... .__.....ib. MasonrY -. Sills Lintels ..................................... veneer --- •--------------••----•--•-----•---•-------•--•----- ---._.._..._....._._...._.�_..------- Masonry: Facing ----_----------------; backup -------------- thickness ._. _....•• . Bonding..................._____-______ Door sills COt4flYtt--------- Window sills ---_! ± ................................... Lintels__»KOOd........................ .............. . Interior surfaces: Dampproofing- -------- coats of---------------------------------- , furring .................... :. Exterior painting: Material Ot'1r �>! equal• Si>ti-transparent & iull-•------- --- s9at stains.......................,number oicoats Gable wail construction: ❑Same as main walls; [pother •-----_- ,............:..... .................................................... --•-•--•---------------•-------------- •_------ .....• ............................... S. FLOOR RAMl. Joists:Wood,grade and species•-_R_jVt.nws___.. -.-.,; other......_.......................; bridging W............; anchors Concrete slab: ❑ Basement floor;V first floor; A ground supported; ❑ self-supporting; mix ........;thickness_A_" reinforcing------6X6."j3J_=Ak___-__-; insulation ..--.-................................; membrane _.�.PT,�fA j? Fill under slab: Material ____ _ *3mus_eartk ---- _-•----; thickness .r+lr'las{" ........................................................ '_________________________________________________________________________ T. SUWLOORINQ: (Describe anderRoori s for special floors under item 21•) .�. Material:Grade and species--pl�iiad akie+►trhin�-#3'a-- -site 4X&!. ,type .ext.% Fir floor " law. lid:p sot 6�second floor;❑attic s9.,tt„ ❑dsallortlwl, :right g .�.rk..M. .a,.._�__.....»:............�»....»,.�.. JR MNISN FLOORING: (Wood cur/r, Descri aWker Knish foorinr under limn 21.) LocArsasr Rocas Gus armas TuicKNtes wmrx Bsato, PAM Mani Firstfloor ----- ............... ........ •----•--•-- ..... . .......... ............................... Secondfloor._ ...... -• .................... ...................................._. ..... - - Attic floor_ it 800THSID6 BLU"RINT SSRVICQ 1 DESCRIPTION OF MATMIUALS s. rA1�TITfoN rRAfsilNac ' ©ISCItM#E)1,f OF Studs: Wood,grade and species Ci t. s i '... ...... Sine and spacing .. Other .. .. ---- � . ...... -------------------�. ._. .._.._�...---.._ .. ._._,..-------- .--- _-............... . ,..».,.....�.,,w:...,,. 19. CEtNNa M AMI;W* Joists: Wood, Crude Spool se ....,��.::.St.�»._ ._ Other.........---__------– ___ 3lsid91ng........... ..._. ................................. ........... . ........................................................................ ... .- __..w ..:... 11. ROiEfi i�RAMrMa: Rafters: Wood, grade and species _..__._. _.,_. ..... Roof trusses ( detail): Grade acrd species ► . dr3.�... ........------w...... ...�..._ � It. 100111Nas Sheathing: Grade and species . .plxitasad..w3lftiL)L11 ......_;size Ax,3 ..; tnm...Axt.*.......; a soxlid; C 904".. ,•o.4. RooAne---Asphalt-i --------------- grade.. ... ..... .; weight or thickness-230; size fastening –mila-.. Stain or print _. ..................................................... . ... Underlay __.-_ :.1 lt.............. . ' ..... �.....;. Built-up roollzsg ,------------------------------------------------ ---------- --= number of plies........._..;surfacing material .. Fleshing: Material ...._.,��.aklli111s11tt�t.............................; gags or weight ---.)�. ...._ D gr'aveII stops; ❑-Snow guards .R�► --ta- - #, s- ...oCtxh1te-4&Ao1*r*---A-rid me IE. OMMS AND DOWNSPOUTS: Gutters: Material.......................................:gageor weight............;size_ _..._.....;shape ................... •,._.... ................. Downspouts: Material ........................ .;gage or woigbt---.........;else.......... ....;shape ..... ......_..._._.. .; number ....... Downspouts connected to: 0 Storm sewer; 0 sanitary sewer; p dry-w*h. p Splash blocks: Material and size............................ .....---•-.. ..... --------------------------- --- ------------------•----............-_--_--..._............................................................. 14. LATH AND PLASTER: Lath 0 walls,❑ceilings: Material ------------ ....;weight or thick ......._.__ Plaster Coats ..;finish................. Dry wall t walls, M ceilin Material R.i'R-E -thickness .;finish _;Joint.treatment t t AA....... a13 sri ..ri a, to i _sPra�►ad ,a.�ul.at.d as*uati .. IL DECORAtIN4: (Point, «rrlppco.ale.) flakes sprayed inti aNustio fieisk while wet, rtowe�i Www.p7x:639 MAfYUL A""PLICATION +OUXO Tris=s MA7=AL Aro A PP&MATIon Kitchen------------------ wall a11. 1rs. e. pe Ps "•gr Bath. .-----... - -�ialaFsi!xL. - .-:OR>;1+1'..� Il�t--_ _.. .. .._�...:_r ....... ethsrs all d �` g } : - ..... `.J?1f *---- - - -- - - .....__ --- ._ rall_trs brt_,paixtsd_2 _..at. -�+!!. .� .....AULit ...................................._...... Ik INTERIOR DOOR$ AND TRIM:- - - Doors: Type *these,.btglltm.ltrs!_&.191LTl2r±td.----.._; material tMA9kA.F N.. .................. thicksMsa.,1._.. f�tw Door trim: Type strtlk _... ..; material _ _AA10-------------- Be": Type .. b. ;material .923W------- • at". ` TIM1111 _.� .�.�1l . � !�!# +s ,a - Alu1Mt._11a1.d .................. . Other trim (item, type and lovaetisa) _ �i139..MAIL _. 1�..� }r't.. .1�_ t illSl. 71L_ ►�!a_�"El�.. .11Z"l114a.- ---- --•----- 17. WINDOWS: Windows: Type .# f..CAA4 make .AIA�.YN1,tlAAl't�},D_; material ..-A.IUXr............ .......: sash thickness. Glass: Grade SM............ .......; p sash weights; D balances,type ............. .; head flashing ................ . Trim: Type _�4?!W-OkI.............; material ---JRs_t, 3,_..4__d>"ywxl1-... Paint ........ ................ ... ......•_-._;number ants 'Weatherstripping; Type ..IM111VA�.�lU0.----_---------- _.........: material IOU,.................... Storm sash,number.. .., Screen$: p Full;$ halt; type ...Mars]"..!.A�--------- number•.-All....; screen clothmaterial _.-t'lbArjl". Basement windows: Type . ... .............___; material ........................; Q screens,number-__–_-; Q Storm sash,ntrtnbar_..L,,. Special windows _ .. _. Aa.then..aL.lr�at_Maar..._t4r_.ilxaui_ _.falt..a2.ut..tra�u►s._........................... . ._._ .•. ----------------- --- -- --------------------------------------- ------------------- -- ------------ .- 1E. RMTRAN.CRS ANd .RERiOR DETAIL- Main ..»... Main entrance door: Material ,1] 168;width.3.a-------;thicknen l-.3/.4. Frame: Material._pi" -:;thicknew w'I Other entrance doors: Material..]AR&--------------- width .2W.--; thickness L.311Y. Frame: Material..piss....;thickness Bead flashing .............................................. Weatherstripping: Type _,IanL__up..................... saddles .iRlltllls. Screen doors:Thickness...........;number._.........; screen cloth material----------------- Storm doors: Thieknees_......";number.,,..., Combination storm and screen doors: Thickness.........; number.......; screen cloth material _----._.-__............................................ Shutters: Q Hinged; Q Axed. Railings------------------------------------------------------ Louvers ..................................... ` Uterior millwork: Grade and species ..JRtASLLa..-OAl�tT .i x-_plCi! Paint _... seats . ..,. ._ .ale i_. I.�atia�_�t..ilk.'asXas.. �1.ba..�a�r rs�sl..xitb�.AIa E._. Lk.halcetd.-eras, _tinSalu................�...,.. it. CAEINRTS AND INTERIOR DETAIL: Kitchen cabinets,wall units: Material .Mild---------- ----------- .-_-.--------.-----_; lineal feet of shelves---pias.;Shelf WidtLIr— Base units: Material ....XOM&........................; counter top _1AnU&tAA.V.lx71.UA........ edging_AMM................. Back and and splash JAU1tiX&td&..P1AAtlA._ Finish of cabinets -----1A1[i"t&Aj), UlA_tA*tilf....;number coats._...,, Medicine cabinets: make . 31i1JElR_Ox._At)tUtl.;11.1 ., �..ltA1tM model ........-------------------------------------------_..........._... Other cabinets and built-in furniture-- - ----- --- --------------------- ------ .-_.- -----_ i>Aa......_-... ......-_ ... ........................... . - tQ. VA1RSt seen► Ts"as a ss$rxee HA RAWpersr t zrs �[atiasat "l'lNltawo I[at�r►d T4lekswa 1 +�liKiti $M� #p 1tW/MfY s>wle $ sema7tt-- --- _._._..... ......._........................................ ... ..... ... .. main— AM_ . .. ..... ............................... ..... .... .. . ....- ................i _...... ........ ... ................ ............... ...... �...._�...,.. DYsappeazlag: Make and model number ...... . a *-ij -tae- .4s--. 3 -lasata:. .. , ...,.... ............................I............................................................................ ......._ ....... ...,........ ....... BOUTHSIDE BLUEPRINT SERVICE 2 z > . iiwrl ft AIM WAW$CD't:' Ic L retell «`strip 3I ww'r:i* >wp00806 806M be 00 don i +r Lseasisu IIA csv.beask stem a &sora x ... ................ ...................... . -- . lei �atJl�. r�,t Sr eD _�Itl�k r 3.�kr.i l�il.�. ..8�►tt� . .. .�►i3..� t', ►t. 1a�ckd. _a #,a .7i lex ... a Loa►*« w►?WAL.C4t40.DD*bsa.GAP,BM=.aM.,test I mni of* !"0*~, .................... ___._. .:..-------------- ....... Bathraaea"coasorl"M Recessed;material. ....Al—"...... .; number s».; Q attached;Fnatesial .. -_-. ; number !L K11111111111143 -------- YMNNit . -.---- --------- -------- ---- ------------------------W-batit,,............................ ---- . ..... ................ lhN+uer Nunsss Laaasu,r HAse Mee's lixwas les MIX4Tnox No. � >Msa Heeae' .i�wer• LI kit, liR.St-�. .26.7 W/4117*�41i' 'r7alk.wfaln! lri.Plo 11E.VW.-.7u '---- .-Lavatory- -..- - . .... 79*9 ......... .. �!.�„ ..... ` Water closet .. - XA Bathtub......... -- .. .. _ Shower over tub*-.. . -- RU' ' ptsu , » r. tiRZ iLer� _1qi K.Ha---t _ U �.ra i' *. 'f+�uar r� • -- --------- ._... ._. ...� ._NA .... _ -ilk Std, r:. ._ _. .. ....__ neSiatxl :_`S :`r"iirl`fei' ------- Y,is .......- rtaia rod • !� i,r Cu .. .-.... �--._._. _. .. sse »_ Water supply: Q Public,al it s {{....,,., Bbwor witer► shy •x Z.aB, �� 1lidual (private}e� � P Sevare disposal: Cf Public; 0 community system;❑ individual (private) system. *SAew and describe individual system in complete detail in separate drawings and specifications according to requirements. House drain (inside): ❑ Cast iron; ❑tile;:0 other.41I&S- A- House sewer (outside): Q Cast iron; Q tile; IN othor.pustl&.. Water piping: QF Galvanized steel; O copper tubing; ❑ other......................................................... Sill cocks, number fbt Domaetit water heater: Type -------------; make and model 3AQtj:7-1!}~..0QU&1.......................................... rewftry .-----------------•-»- gph. 100' rise. Storage tank: Material tib9Irg1" _a. &*A........_.._...; capacity gano" Gas service: ❑ Utility company; CJ liq. pet.gas; Cl other------------------------------------------ Gas piping: Q Cooking; 0 house hsatiug. Footing drains connected to: 0 Storm sewer; Q sanitary sewer;❑ dry well. Sump pump - ----------------------------------------------,„.-..... ......... ........ •..................»_..... ._.......-•---_.... . ....._---..»......»..»_..........--._------- -................ ..,.«» n. INAflliA: Q Not water. O Steam Q Vapor. Q OvwPipe syabsaae. 0 Twwv*s sysUm Q Radiators, p Canreetors. ©lel aas»d radial+sn. >Ksb bad tMsdW.............. . ...........:.....:.....�_...K..-.......r..w,.....:,,:..• . Radiant panel: Q Floor; Q wall; ❑ceiling. Panel coil: Material...............................................». -- w--- _--- .. »,...__.. 0 Circulator. D Return pump. Make and model -------------•....._.»...-•------,___...._._....__......._._.._._ capacity ..........».. CPNL Boiler: Make and model _.....................................................- Output .................. Btuh.; net rating .._.. .... . .....Btah. War= air: O Gravity. :R)t_-Forted................................... Type of system Bii�p -------------»-----..__..w.-- -.---- •--- --- --•----•. - ---- Duet material: Supply .......; return_-_ 4&jq,e-.-_ Insulati0Af4AK, *j*o thickness __i!!.-_ Q Outside air intakes Furnace: hake and model -._ _ - --. --• Input Btub output Stuh _- -»vaarsa ,Eg�t#t fir_ iiaHdl�r WQl 'S_dc_Cae(nser_WAB..Jil # I{N *St�t;1s Q Space beater; ❑ door furnace; ❑ wall heater. Input --------------__».. Btuh - output... --».....__._. Btuh. number units......... � Make,model ................................................................_...............................................................»_......_............. Controls: Blake and types. Gst.eral Eleet tet.--•- --._.__....._. ---»._._._.._............................. .......... .. ...........................I.................................. Fuel: ❑Coal;0 oil; O gas; CI liq.pet.gas; Cl electric; Q other--------------- ---_».....»------- storage capacity .............. .. .... . . .................................................. ... . Fbing equipment furnished separately: ❑ Gas burner, conversiontype. Stokaer: CQHopper feed; ❑ bib feed. - ---_-~ ....... `Oil burner: p Pressure atomising; O vaporizing ............................................................................................... Makeand model ----------------------------------------------------------------------- Control ............................................................*.. Rlectric beating system: Type---------- ------------------------------- Inp - Input.....-._..watts; 0..�.»._...volts;output... .. ..... ... $� ,. .. .........................................•--------.. ------------------•---------•. ----•.............---•-...._.........---•......._....I.....--..».. Ventilating equipment: Attic fan, make and. model ------ ------ ------- --- _ ..... _.. _. ......... capacity...... Kitchen exhaust fan, make and model ---1>tia1kv ..9Nr-99N �A--Y[ ._p�...I:i 4 e.. .... Other beating, ventilating, or tooling equipment ........................... ....-. .. .-__-- ------....-___......_._...._._..._........_._...._. _ . .... ......».............................. .. ------... ---»..»...-----------..........._....»- ........ ... 34. RIMIC WIRING: Bervka:,❑ Overhead; m undergt+ourA Panel: O Fuse box; (Mcircuit-breaker ................. .....:...._.._ Number circuits .e ..� Wlr wt Q C nduit; 13 armored table; CAMometallie fable p knob and tube; Ci other ....................-1..... ... ... avood eutlrta:a Pump; la Water heater; taothert l'w.As+ tblif!! 11 * .r #`+R.�l►"M` _.+P�'! e . 91 Voorba& Z Chimes. Push-button locations A)'-Xt!r:a gat t s I*16e inel.wd id inn-e�bixl;'---All *tli r ._..... 2L UGWINS MX VUS: n ® e u r-nis led.B ie i�x. -ihiftat 1$i BT.:' se* plat 154 retail of Int1d reeMsaed) Total number of fttares Total allowance for Axtures,typica�.instal j Nontypiae:i installation _ 4+44 t�r,s +ta tier TkresiAa ©r equa....'t �_Wei-1`�2&U or R241W trio►. sa.. SOUIRSID& BLUEPRINT SERVICE 8 DESGRI4"[M OF MATE IALS ' _ 1eA7lsl� Trrr AlM1 yr0y00 sr�'IMefrl�t,iAlfilMi x 'rNicia+iMM �►, R .:r. .;+--..- ..+.w+.rr.»rlk»t.wN. i�,s,. ...•.Kw � ��../R[. �+•Al..hiLf7�i_,•„••.•...•....•M llt��'•�.� ilrw r,. �" p j • Wall........ ..r. ,._.... .-,..0.r..r•r.._,a..... .w.,................ , _u-..+«:.....wM....._.,•i«.e..•r••+•.,_..•.,.a•w.i•«.h}.. �Mf+..}w.4.. w�1•�,-1•• Floor ...... ................-..................................................... ._•..:........,__..,....,.:_....._.._... _. ._«�+. r.r.. .... . .. (Dssarof wpr sxafx dwstlisig mourials,.tgUip"*W.or constrwot"44M nota abeailb++e):. ........a...:«..«:«a.�...•. ... �...:...:.�. :». �:.�►1�.:3at�ar3s� .p�ei�[a1�.� �7�ti :.t�Mi►�.. ,,,let�..#.�.,l�e.�'r� ...�...� .�r�..�»......` ...: .w .a�.. .........».... w. faratNr, it.)t �+ir�dw:astsll:atust►alatl .sy►uttr�tr� rra, iL..# t1s.,ttaai�a ,ls.r.•..... ...,.*.�-,.�». .... ---_.. .. ._._.. .. ..... ...... .. . .. ... .r .. ... ..,. . r.«•... ..,. �"L,+ri:.gfl-.��.^�3��.......................................... ... . . .. ............................. ...w......,«». •.r._ ..•......................................................... ... ... . •>,.�.: -r-+:..*.�.'•" Aft `tsM�W,sad fiakh)........................................... ,w_ ...... .. ..•.,ryWs.y- ..... .................. .�i ••.�sM••}r�11 •i�.titl~,�il�• .-i+yli. :. ` il�t „i�M* '-y* .... ....... .. .._... .-• -{yrs a iii ZAi isalFei. ��4 lti -• F !3 - +r-�. .�.. „«a:,.:........,s:. SPOC1At RQW 01INTs (Sfeh ws vW or meta eel model.) Ve"sa,blinds .................................... Number ...w_..... Auton aUs w►asl>rr•..-il+ «it�1 p-. -. ....-.«-.------..,;..�.,....«: Kitreh*n range •8 assts iajE y��e-�• iat� c1+�ttis,�id u ......... ..� -a►r`- ,i+y �---�-�»- ltefrer#tor O~ --------------------- -- •-...... Ottawr«_ t”- iii !#+ . ....,.•.,..:.:«.:,...r.....,. Dial►+daeher-«--- ��,1rr1y-�* --arM lrs •'t:e•- I�rs�t-sMt st• "ptr�. «,�.:...• ... . ,.••,-;..:....,. ytedisposal unit --- ;.�. ....... — •---------------------- . -- .1.... .a. ............. .w.... a.r.. r•._. .W �r«r.....w..ray al0titillai° Litton s�iorewavo even r.« .. ........... . .........................«...«....... ...-,..,.:..._...:........«._....,....... •..�....,....., .............................................. .................. ......................................... .�.. .....•,,..r.•.......•i. ....rr.gi..._..•. _......«...... ....._.................................•......a.........._.»............I...r......N......................................,.•...•.a•'w..•w.•Niryp.N.».Y'•» -...#. ...................... ... .. .................... ., ............................'.._ .... .....��Yfrlr.YIMI�I.►►i.41plY t1iRRiR fi: Ixit&U evaerete slab vest nide of rear erOs �iasI2i 14# ♦ar.r.•a..+w.x.. .... .*...,.. .: a .. .. ,•y'.•.:-.+.:.•.-re,... .. ....i• .ww.,.. �aN`• :.....,..7w4t•i 1,_..:..tr........:......»...fw..s.ish?+»..r�..�iTi.....w.. i..+l�k't*a..atalM•.tner`..lke��. ,' ,� _.w. _ ,....w.w.........,-....... • ..... .. ..........................«r. ._.. ..............................«•..1..,.. .Nw..MMnYMP..r.4iY+1.WlMr`� 4A!lANiii � «... »_r_-- -Ui!••':A-fyiir�li}..-.ra .. ..............................„.• ..« .... ... .... ,•:..:.•.•a+►••.•�w.1"_ ... .. ..._N....a •_ero�+efa'erte •i r•. ..« a ._... •... .t.r. •... .... _...{♦ • .. .. •.Ff.MiM.{t•Y. ..M....�'YMIY�. .............. ------ sus s -• �:3�4tKe....................................... -. «..:.....:. .....................9 � r «mei-• wrz ri - r•�ritit-tens#au--tPt'' 5:.. .................... ....: «....�:,.. ., ...,„,«,�. ..... ............................................................... ......_...... _ . .. -, ..... _...................... .............IY:.. .a.. .kw . .M.M.p�'I MYir: WALK1 AND I*111liMA"t .Ilrivewray: Width.. .1,*4.- Base material -dtlrt .t thickness........_ fnrfadng Materisl F'ra*t walk:Width. material_... ...............:thiekneas.... ”. Seruiee walk: Widtb,&vt material, j t�i�te#e1w�...:' Steps: Idatsrial -------- ........................ treads . "; risers .... .......... Cheek walls ............... ..:::.... .«... Aiwa ) -tom-extend--fr+nt•#ielc1�►+est-"b�.1' ..sd�r"a - aat .*• ►t-rei#ry ...:,.. .«».,.... O�TNgR"ONftTt IMM�TtMgNldi (Spi,oily ell exterior_onsite isnprevoatoxis not descri6sd`elaswhers, indu&a 44MMS sulk°as i 06MW yradbto. d�u* rotaix ny walls,leans, roi i"s,OW aaoastory-struetures.) . . . ............. ...... ....-........_............. ...•.... ........ ............�....,..... ; . . «......................................... ........................... ........I.................................................................. .�:»..•„i,:..a ar..•r.....r••r.. ................. _ ..............- • .. _........................ ...... .M. ...•.... ..r ...M.•w�.N'. ,S . ..................................... _t...... ...........I........................ .ria .................. .»i.•q w . ............................. ......................................... .N. .� ••.rw•,•..••.r.RM.44wY•.�.IFbIN{,'' LAOSCAMO,+t'I,AI►"", An PHOR GRAOING: Oltfiex`♦ ... ........ ...... Fopiwii ,• thick: Q Froat yard,D side yards; [-gear Yard to fent behind mail"#►utidi .` Avw r (#seded,soddsd,or sprigged) 0 Front yard.................... [3 side yard$ .; Q.ranir Planting: C7 As specified and shown on drawing*; C],as follows; ._.. Shade tress, deciduous, . ......... .. caliper. .--....._ 1Cvdrgreen tsna, _...,. a' r ..•..i...«.;`$# ... t decid ' to ' > shriAba, ................ to... :: .......,. Iv a �. Low flowering trees, uous. ... ... M._. H ►-1Cr ►i shrub*,detidupus, .... to........' ....... .... ._._.. ,. . _».. ...,...: ,...�.. ..•, -Jl wi ahsllDe.d leiapu s. ' to ... .. .., ..,.. .............«. ,y.Y_r L�iv1r'! '�irvittg`,s ►rsby decid e► ''ta.. �, a..... ..., :. •.,,..4..'...«. «=.�, . .,Y•. «,. « .r...a»+� tvzvri ar`tOx.�--'Y e01bit slit die Identified by the signature of the tuildir,or F or tno a bar 4 i Is knows at the timer of application. Date_._:,v. .J_1�3t..� a..��..r1.. . ................... .. .,». Signature Signature.......r...... .r+.+«••w..w•«+•ra...�...i+.•Y..i�s'��"� ' $,OVTH81O2 i,IUIJBAiNT 861tVIGit