Permit 141 Seminole Rd 12/2011 siding CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J ,aATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 11-00003036 Date 12/27/11
Property Address . . . . . . 141 SEMINOLE RD
Application type description SIDING PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 2500
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Application desc
new siding
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Owner Contractor
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AMOS, MICHAEL OWNER
141 SEMINOLE ROAD
ATLANTIC BEACH FL 32233
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Permit . . . . . . SIDING PERMIT
Additional desc . .
Permit Fee . . . . 65 . 00 Plan Check Fee 32 . 50
Issue Date . . . . Valuation . . . . 2500
Expiration Date . . 6/24/12
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Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONAL ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
* CALL FOR AN IN PROGRESS MIDWAY THROUGH YOUR SIDING
PROJECT AND THEN A FINAL INSPECTIONS WHEN PROJECT IS
COMPLETE. *
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 65 . 00 65 . 00 . 00 . 00
Plan Check Total 32 . 50 32 . 50 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 101 . 50 101 . 50 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALI, CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road /�. 43
Atlantic Beach, Florida 32233-5445
V Phone(904)247-5826 • Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: 2 ZZ /
City web-site: http://Www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: /T/ ��rn� 7�d�� �d D ment review required Ye No
Build'ng
Applicant: ��`7j �.� Planning &Zoning
(r� Tree Administrator
Project: /( &) �1 n Public Works
" Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
Florida Dept.of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: MApproved. ❑Denied.
(Circle one.) Comments:
UILDIN
PLANNING &ZONING Reviewed by: Date: A -2-7-1
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: [—]Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/94/09
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: ! ^' / E�/'� it, d �C�1 �l 43c-4rmit Number: //' 3C -Z!C
Legal Description Parcel#
Floor Area of Sq.Ft. sq.Ft
Valuation of Work$ ;Z s® Proposed Work heated/cooled non-heated/cooled /Z O e'
Class of Work(circle one): New Addition Alteration Re Gtr Move Demolition pool/spa window/door
Use of existing/pro osed structure(s)(circle one):" Commercial esidential�
If an existing structure,is a fire sprinkler system installed? (Circle one): es"�'No �A a
Florida Product Approval# $7 L 13 12 ' s.. .
For multiple products use product approval form ,
Describe in detail the type of work to be performed:
Nc.tc1L+ IG'.h / 1 C �rr1
Property Owner Informjation: i
Name: �NN+ e ` +M .5 Address: I V I P 1`
City 1't- k4yx \-e ea State_`CZip 3223 3Phone 9 ► 3 7 7%-1
E-Mail or Fax#(Optional)
Contractor Information: FILE 0 p
Company Name: Quali g Agent:
Address:
Office Phone Job Site/Contac
State Certification/Registration# OMPLIANCIVE
Architect Name&Phone# UMOKATIANTICBFAC
Engineer's Name&Phone# SEE P
Fee Simple Title Holder Name and Address REQJAREMENT.,AND C
Bonding Company Name and Address
Mortgage Lender Name and Address Jill DATE: - -
Application is hereby made to obtain a permi to do the work and install ons 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 Stan ards 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. !understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells, Pools, Furnaces, Boilers, Heaters,
Tanks and Air Conditioners,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
1 herebycertify that 1 have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type ofworkwill be complied with whether speci ted herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other ederal,stq;e1`5-r7CNl law regulating construction or the performance of construction.
Signature of Owner Signature of Contractor
Print Name V Y ` + c - 1. j Print Name
............................. .............................................
Swor o F o e Sworn to and subsc ' ed before me
this ay of Day of 20
SHIRLEY L GRAHAM
.�.PYA:= MY COMMISSION OD 957787
Nota ic1 EXPIRES:February 14,PNO)ta', e6lic
pf tyd' Bonded Thru Notary Public Underwriters
Revised 01.26.10