Permit SG Door Replacement 1946 Beach Ave 2012 ,ts - v "O,-.1
I, CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
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Application Number 12- 00000290 Date 3/21/12
Property Address 1946 BEACH AVE
Application type description WINDOW AND /OR DOOR
Property Zoning TO BE UPDATED
Application valuation . . . 1717
Application desc
replace sdg
Owner Contractor
MATHEWS DENNIS L LOWES HOME CENTERS INC
1946 BEACH AVE 4948 TELSON PLACE
ATLANTIC BEACH FL 32233 ORLANDO FL 32812
(904) 486 -4701
Permit WINDOW AND /OR DOOR PERMIT
Additional desc .
Permit Fee . . . 60.00 Plan Check Fee . . 30.00
Issue Date . . . Valuation . . . . 1717
Expiration Date . 9/17/12
Special Notes and Comments
2010 FLORIDA BUILDING CODE, 2008 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 60.00 60.00 .00 .00
Plan Check Total 30.00 30.00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 94.00 94.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: / '1 ' ( f ICC Permit Number:
Legal Description Parcel #
Valuation of Work $ J 77 q. 77
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool/spa window /• oor
Use of existing /proposed structures) ) (circle one): Commercial Residential
i
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /A
Florida Product Approval # FL l) V. k -
For multiple products use product approva orm
Describe in detail the type of work to be performed: LCd
Property Owner Information: /
Name: DE/1/4//S // S Address: /*% ,`/
City Lt'Z,La/yZe; al) ac6 State&2 Zip 32-2 3 Phone go{� ' — A / 7
E -Mail or Fax # (Optio
Contractor Information:
Company Name: Qualifying Agent:
Address: City State Zip
Office Phone Job Site/ Contact Number Fax #
State Certification/Registration #
Architect Name & Phone #
Engineer's Name & Phone #
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
4pplication 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
'ssuance 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
2nd void if work is not commenced within six (6) months, or if construction or work is suspended or abandoned for apertod of six 6) months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, F urnaces, Bo 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.
hereby certify that I have read and examined this goplication and know the same to be true and correct. All provisions of laws and . din, 'I es governing this
ype of work will be complied with whether specified her in or not. The granting of a permit does not presume to give author to date or cancel the
>rovisions of any other federal, state, or local law regulati construction or the performance of construction.
> ignature of Owner /)/74. y Signature of Contra,
'r int Name - o.,l.i `/i/ Print Name !�
,worn to and subscribed before me Swo • o ...d subscrib- • • efore e
his /O Day of ill ecA , 20 / L this 0 D . . . , . 20 /2-- tip • w
ROBERT C CURTIS ' , t , ! • • c • • • 0871944
, ._ . ._a..:
. otary Pub i
EXPIRES: q(p 1 Notary PubbC = Expires 3/18/2013
• Bonded through 1st Stab : �.y, � r Fbridallot tm. c 1 26.10
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03/15/2012 07:18 3524733167 KEYSTONE DOORS & ETC PAGE 03/15
YJ - IL II: (YU4) 4n-4(10 1699- INSTALLED SALES P 3/4
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FILE COPY FILE COPY
lAN -. City of Atlantic Beach APPLICATION NUMBER
F
Building Department (To be assigned by the Building Department.)
z / 800 Seminole Road 2
Atlantic Beach, Florida 32233 -5445
Phone (904) 247 -5826 • Fax (904) 247 -5845 !� ��
J,3 o' E -mail: building- dept @coab.us Date routed:
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: / Z cA eh AV. Department review required Ye v No
Building)
Applicant: / . a /,v 5 Planning & Zoning
Tree Administrator
Project: � C � Public Works
Public Utilities
Public Safety
Fire Services
flu.. Mti$ t r*:„
Other Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: proved. ❑Denied.
(Circle one.) Comments:
(13 NI G
PLANNING & ZONING 3-- Z,
/S'
Reviewed by: Date:
TREE ADMIN. Second Review: Approved as revised. ❑Denie
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
03/15/2012 07:18 3524733167 f KEYSTONE DOORS & ETC PAGE 02!15
1 13ulldin N6 rE .466_-_4710 APPL.I ION INSTALLED SALES P 2/4
CITY OF ATLANTIC REACE
800 Seminole Road, Aticuti,c Beach, FL 32233
Oflee (904) Z47 -5826 Fax (904) 247 -5845
Job Address: � Y 4' VeNe# Aveve4 Pe it Nrunher: J ',) ,a
1 Description • — /1 D7— 2S Pat c ! # / L 9 3 2 0 &.---.723 .
Valuation of Work $ /7r 7
Class of Work (circle floe): New Addition Alteration Repair Move Demolition pool /spa window /. np
Use of existing/proposed struetui ) (circle one): Commercial Residential
Ilan existing ertructure, is a fire sprer system ifl tailed? (Circle one): Yes No N /A
Florida'Produut Approved # L For For multiple products use produ a orm
Describe in detail the type of Work to be ptsr£ormed•_____ �� di� -,
____---
Lgjx_ty Ow n er 1'ntnrmatio M. TM
Nam: N //1 ,1 . . Address: ! dd i , 1 �, -
Ci ty or, S Zip .112.33 Phoi a goy : -- -_ /
F ( Optic a - .... 1 Y
[�nt1�lc�tt,r information: . - �� •. �
$ '
/
t:arnpany Ttamo• 04 t/1 Mdr 1 f A T _ , `.tea . �•.,,:, . ,u
Addre,4s:_P j Y Cit Stalo
offi Phone cI7 . ! 3 // / Job Site/ Coated [ N " J — - w
. �P l �
State Certification/Registration # — Ls 1 t. / • I - -
Ar ebitcct Name & Phone 1t I— • �,�,� I — C
Engineer's Name & Phone # ,.. .' C �
Fee Simple Title !folder Name and Address / 1 - ER R -- 'TONAL
Ronding Company Names Arid Address �i-�.— " @ C ONS. .
Mortgage Candor Name ..
and Address e - �� -.�. •..-
. 1
t pplirotiun is herdt(,y ew in obtain obtain a permit to the work and Installations as ' „rr,,
mime o a permit that all work will be per wed to meet the standard, of all law., regulating construction in due -
:outsold ,Twork is tint avmmenced v(hbt st7t (6 n onths, or tf c Lion or work is d or abandoned a ri�r d,dtc ��r, p , ti me
work z commenced ,f understand that reparde permits must �ccu d for ,Islecerlrk, Phi g,, w d ofb L mo any th rm% afier
Tau( = 4,11r Conditioners, do 's . Pob Bnif�ija,, I�I damdy'a,
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 FINANCIN CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMNT.
- hdrob y cerryy Ow I have rQwl and examined this pllrxdlon and knQ he same to be true and c rreet. ,111 provisions oflawe and • dfnanees - ouoroing this
ype of work will bdr complied with whether sp*c ed he or not P h a r f permit does not presume to give auth,rr to VIOL, or canes/ ehe
rovisforrs of any otheriederai state, or load 14W regu! C fr zwtf or t era o rrn ,car of' construction.
iigoature of Owner � Signore of Con
'riot Nt+me � � �•
..... ,.. iaz a,,.. �'7 Print Name - '7 - : ' . e)
;worn to and subscribed he fore me Sworn t -. d subscrih . efo - ,, u
his �[� nay of /T'Icie _ 20 / z - — D' o / 't. _.. . .._-_20 / a
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