Permit Doors 555 Selva Lakes Dr 2012 . !' � :7.
his
, CITY OF ATLANTIC BEACH
s) 800 SEMINOLE ROAD
,- , ATLANTIC BEACH, FL 32233
N i ' ''r` INSPECTION PHONE LINE 247 -5814
—ost 10
Application Number 12- 00000092 Date 1/25/12
Property Address 555 SELVA LAKES CIR
Application type description WINDOW AND /OR DOOR
Property Zoning TO BE UPDATED
Application valuation . . . 11200
Application desc
replace front and rear entry doors
Owner Contractor
CLAYTON THEODORE ET AL FISETTE CONSTRUCTION & REMODEL
555 SEVLA LAKES CIR. 2336 PINE ISLAND COURT
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32224
(904) 992 -4782
Permit WINDOW AND /OR DOOR PERMIT
Additional desc .
Permit Fee . . . 110.00 Plan Check Fee 55.00
Issue Date Valuation . 11200
Expiration Date . . 7/23/12
Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONA1 ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
WINDOW AND DOOR INSPECTION:
*INSTALLATION INSTUCTIONS REQUIRED
*ALL STICKERS ARE TO REMAIN ON THE WINDOWS
*PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 110.00 110.00 .00 .00
Plan Check Total 55.00 55.00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 169.00 169.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
7
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: 5.S fJVO.1 ' i, A (I 4 C &in 0,. , Permit Number: / — Oe n.
Legal Description ill' l' 6P e gPit/Ot I5 ArYN 4 7 Pi Sq 43 � s r � ' Parcel #
Floor ea of . Ft. ,Nt
Valuation of Work $.1 I ?i(�(7, 1 Proposed Work heated /cooled (25 non- heated /cooled AC
0
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool /spa window /door
Use of existing /proposed structure(s) (circle one): Commercial Residentia_
If an existing structure, is a fire sprinkler system installed? (Circle one): • es W • N /A
f ?
Florida Product Approval # rioot b,o e_#4,1 (, Weay b : FL,(
For multiple products use product approval form LL b
Describe in detail the type of work to be performed: (iZ, ; �6 0,Otbivie,h Goblet k+0 p itrilove,
S CAR,/ - Ltih`vilNd' i )4#4: 1 Ina, tovrtl &a✓ G ,✓S .
Property Owner Information:
Name: "xi a � dekilby, i1 T►4 , Address: 5.6 Seim L'.k s N
City A * ic %• t .. State r(,Zip , Phone (q04f) 2 - 3 52 7
E -Mail or Fax # (Optional)
Contractor Information:
.
Company Name: i : , ' _,;,L:y - . • A . t alder ' _ • Qualifying Agent: / S , /
Address: !69 • 4 S rt' City ' k3w4vr( Af._ , State Zip 2 Z7
Office Phone ti"-1 Zc j(, - 0501 Job Site/ Contact 't b
State Certification/Registration # 1 r • - 4
Architect Name & Phone # r i" "` =""•' 1'' Ld c ��• �••1.�►i M.►.c...., a
Engineer's Name & Phone # 1J 1 r l,J All V A: I'1 WNW
Fee Simple Title Holder Name . nd Address • +����Ky�u rallsor mi -
Bonding Company Name and Address ' • • • • • • • `
Mortgage Lender Name and Address .....
REVIEWED BY: — -
Application is hereby made to obtain a permit to do the work and instaltanons as tncttrarG t: trertl t
1411111111111 .1 , ',
at r ar lnsta - _ , - e , p f „
issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This pei ,` , •comes i
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 <:''. ' - .. t
work is commenced. 1 understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, . , ,.., - t Tanks and Air Conditioners, eta .
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVE -
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
1 hereby certify that 1 have read and examined this a plication and know the same to be true and correct. All provisions of 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 other federal. state, or local law regulating construction or the performance of construction.
4 ' .s inature Si nature of Owner % A - g > _ 1 Et i of Contr or
Print Name 1� AT.t e �,1. yam. Print Name t l / 4-e--
Sworn to and subscrt d before me
--� Sworn to and subscribed before me
this air Day of J4 _ , 20 i Z this e2 `-1 Day of , ,)& -tar , 20 l
S /�
QQ v
Pn �, i -ti WENDY FUCHS Notary u61ic t:tt.Y St t o SLAC o u c 4 e c
� AMil �Ypublic t•ot ry , = r 1 � •e , Notary Public - State of Florida
Commtssiot►i1EE9739Q - M Comm. Expires Dec 8 2014
ono!,
My comm. expires May 26, 2015 , i ' % g ; .t a ±4�p M�� k 4b0 M
( 4m,, Bonded Through National Notary Assn.
DO NOT WRITE BELOW - OFFICE USE ONLY
Applicable Codes: 2007 Florida Building Code w/ 2009 Revisions
Review Result (circle one):
Approved Disapproved Approved w/ Conditions
Review Initials /Date:
Development Size
Habitable Space Non - Habitable
Impervious area
Miscellaneous Information
Occupancy Group
Type of Construction
Number of Stories
Zoning District
Max. Occupancy Load
Fire Sprinklers Required
Flood Zone
Conditions /Comments:
Lav City of Atlantic Beach
d Building Department APPLICATION NUMBER
800 Seminole Road (To be assigned by the Building Department.)
1* Atlantic Beach, Florida 32233 -5445 /f� / 9Z
Phone (904) 247 -5826 • Fax (904) 247 -5845
`' E-mail: building- dept @coab.us
City web -site: http: / /www.coab.us Date routed: / c f % Z
-
APPLICATION REVIEW AND TRACKING FORM
Property Address: c5 l ��s Cy p ent review re '
uired Yes No
Building
Applicant: arming Zoning
Tree Administrator
Project: J 7"• sit /'
jp y � S Public Works
Public Utilities
Public Safety
Fire Services
e
Other Agency Review or Permit Required Review Re
of Permit or Ver ec ipt By Date
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: [Approved.
(Circle one.) Comments: ❑Denied.
BUILDIN
PLANNING & ZONING aa►►
Reviewed by: /77 Date: I -d $'' %
TREE ADMIN.
Second Review: []Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:
Date:
FIRE SERVICES Third Review: DApproved as revised. DDenied.
Comments:
Reviewed by: Date:
Revised 07/27/10