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1767 Seminole Rd (vault) JOB ADDRESS 2-76 7 /��m G PROPERTY OWNER PERMIT NUMBER 17 V a / DATE INSPECTIONS: FOOTING SLAB TIE BEAM LINTEL NAILINGISHEATHING .3- FRAMING/COVER UP INSULATION FINAL BUILDING - 13-- CERTIFICATE OF OCCUPANCY ELECTRICAL PERMIT# / 7 573,1 INSPECTIONS ROUGH 3 - FINAL MECHANICAL PERMIT# hTSPECTIONS ROUGH FINAL PL U1VIBING PERMIT# Z -7 �� 3 INSPECTIONS ROUGHIUNDER SLAB TOPOUT 3- - WATERISEWER FINAL - 3-91 NOTES: -S--'LV- s s f CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 r'�JS31�r Application Number . . . . . 07-00000133 Date 2/13/07 Property Address . . . . . . 1767 SEMINOLE RD Application type description ROOF Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 16000 ----------------------------------- - - ------------- -------------------------- Application desc reroof fl 030528 . 08 ------ - ----------- ---- --------- ---- - ---- ----- ---------- - -------------------- Owner Contractor - ----------------------- ------------- --------- -- JERPBAK, DONALD HICKMAN METAL ROOFING 1767 SEMINOLE RD Q/C :HICKMAN, DONALD LAWERENCE ATLANTIC BEACH FL 32233 PO BOX 5515 (904) 242-0444 GAINESVILLE FL 32627 (904) 779-5786 -------------------- ------------------ -------------------------------------- Permit . . . . . . ROOF PERMIT Additional desc . . Permit Fee . . . . 110 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 16000 Expiration Date . . 8/12/07 ------------------------------- -------------------------- ------ ------------- Fee summary Charged Paid Credited Due Permit Fee Total 110 . 00 110 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 110 . 00 110 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. 110V It Ub 1 C: t ZJp H 1 t.KMHM UNb I K UU 35237 74656 P. 1 CITY OF ATLANTIC BEACH a ROOFING PERMIT APPLICATION Date: Job Address: Owner of Property: L RIC Address: `.��11 �.�.. Telephone: �� Siatc License Number: e e•eL> 8$ ._ Contractor nn —`—to im _ Contractor's Address:_off arJ K� L Telephone.��a - �G�� — Fat: S..%& � Scope of Work: '�e11., Deck Slope: _ Greater than 2:12_ lr•I.�_—Less than 2:12. . — Valuation of work- , _ Product Name(Example Timberline):_� Manufacturer(Example:GAF): _ na - ASTM Designation(s): �g - �-- Required Inspections: Sheathing and Final Signature of Owner Date: a � -o9 -- - Sibman re of Contractor: _ __- - AS TO OWNER_ �r Swann to and subscribed before me this— �/ day of i � 200() State of Florida,CWMfthTPTE OF FLO �� Tbiothy J. Vienss ry'S Signatu —— Commission#DDS28806 a PpAlonally known Expires: APR. 25, 2010 roduccd identification / �/ /J Bonded Thru Atlantic Bonding Co.,Inc. Type of identification produced n'I!/!/1 A5C�1L�� AS TO CONTRACTOR: Sworn to and subscribed before me this� day of State of Florida,County of Duval Notary's SlgilaAlrG: -- ,.4 �v, Terry O. Hunsinger Personally known Commission#DD402648 0 produced identification "M rr'-Expires April 10, 2009 Type oi'identifc:ation produced — i � Banded Troy Fein-Inwrance,lnc.800.38570/9 800 Seminole Road •Atlantic Beach,Florida 32233-5445 Page 3 Telephone: (904)247-5800 •Fa:: (904)247-5845 .http://,Aww.ci.itiant;c-be.ach.a.us nse Rcd 2F'1103 2006-11-17 13:19 HICKMAN METAL R 3523774656 Page 1 COUNTY OF DUVAL THE UNDERSIGNED hereby gives notice that improvement will be mad to certain real property, and in accordance with Chapter 713,Florida Statutes, the following information is provided in this Notice of Commencement. 1. Description of property: 2. General description of improvement: QZ A 3. Owner information: 1. Name and Address: A�- a ` i 2. Interest in property: 3. Name and address of a simple titleholder(other than owner): 4. Contactor's name and address: 1 L • 02 a. Phone number: � (opt M b. Fax number- Doc#2007053108,OR BK 13813 Page 2277, { Surety Number Pages:1 a. Name and address: Filed&Recorded 02/13/2007 at 02:02 PM, b. Phone Number: JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY c. Fax Number: RECORDING$10.00 d. Amount of Bond: 1 6. :Lender's name and address: a. Name and address: b. Phone Number: 7. Person within the State of Florida designated by owner upon whom notices or other documents maybe served as provided by 713.12(1)(a), Florida Statutes. a. Name and address: b. Phone number: c. Fax number: t 8. In addition to himself/herself, owner designates of to receive a copy of the Lienor's Notice as provided in Section 713.12(1)(b), Florida Statutes. 9. Expiration date of Notice of Commencement (the expiration date is one(1)year from the date of Recording unless a different date is specified) � � NOTARY PUBLIC-STATE OF FLORIDA Signature of Owner: gens Commission #PP528806 Sworn to and subs c ibed before me this � _ day of—`�'9 Expire�:2, fir, 2010 antic 9 ,ding Co.,Inc. Not Known personally/ID'shown: /nom►-GSv G�� S -/SG>!''u My commission expires: `SS, CITY OF ATLANTIC BEACH s 800 SEMINOLE ROAD ±) ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 ��r1Fi1>? INSPECTION EMAIL REQUEST: Buildin�deptkwab.us I Application Number . . . . . 07-00001555 Date 11/20/07 Property Address . . . . . . 1767 SEMINOLE RD Application type description RIGHT-OF-WAY PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 --------------- --- ---- --- -------------- - - -- - - --- - --- -- - - -------------------- Application desc driveway to pavers --------------------- --- ------ --- --------------- --- - - ----------------------- Owner Contractor ------------------------ ------------------------ JERPBAK, DONALD OWNER 1767 SEMINOLE RD ATLANTIC BEACH FL 32233 (904) 242-0444 ---------------------------------------------------- - ----------------------- Permit DRIVEWAY PERMIT Additional desc . . Permit Fee . . . . 35 . 00 Plan Check Fee . 00 Issue Date . . . . 11/19/07 Valuation . . . . 0 Expiration Date . . 5/17/08 ---------------------------------------------------------------------------- Special Notes and Comments Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible . Future disturbance of pavers for utility repair will require owner to repair pavers . City sidewalk must be plain concrete . Pavers not allowed. --------------------------------------------------------- ------------------- Fee summary Charged Paid Credited Due ----------- ------ --------- - ---------- ---------- ---------- Permit Fee Total 35 . 00 35 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 35 . 00 35 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. 4 j R.O.W.Permit Attachment of for R.O.W.Permit# issued , 200\ Atlantic Beach,FL 32233 Owner's Name: ID 6,N a I d i a Property Address: ) 7 G ? 5 0-,n :,v Subdivision: O G e_Z__7 6 f-o vc- Lot#/Block#: LoZ 4 -;t. R.E. #: REVOCABLE ENCROACHMENT PERMIT THIS REVOCABLE ENCROACHMENT PERMIT, issued on this jday of pie , 200 ,�by Atlantic Beach, Florida, a municipal corporation organized and existing under the laws of the State of Florida, hereinafter referred to as "CITY" and of Atlantic Beach, Florida, hereinafter referred to as"USER". WITNESSETH: That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon the property of the City of Atlantic Beach for the purpose as described in the City of Atlantic Beach Right-of-Way/Easement permit numbers noted above(copies attached). This work is generally described as: R%-�P 2 P C� '' 'c;.-eZ z""S d Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to relocation or removal on thirty (30) days notice by CITY to the USER, said notice to USER shall be given by certified mail, return receipt re uested, to the following address: 176 '7 S`ri ! ,va !e„ rRoad, A� Lonitc� ��a � FL 322:33 The depositing of said notice of cancellation in the United States mail shall constitute the notice of cancellation and the burden is upon USER to keep the CITY informed of USER's proper address. The USER shall promptly make any and all necessary repairs to any facility erected or maintained in the exercise of the privilege herein granted and shall at all times maintain said facility in good and safe condition. In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter upon the above-described property of the CITY, the USER shall replace at the USER's sole expense, any and all material necessarily displaced during the action of maintaining, repairing, operating, replacing, or adding to of the utilities and facilities of the CITY or franchise utility provider. The facilities allowed by the permit shall meet the current requirements of the City Code, Building Codes,Land Development Code, and all other land use and code requirements of the CITY. The USER, prior to making any changes from the approved plans and/or method, must obtain written approval from the City of Atlantic Beach, Public Works Department, for said change. The Page 1 of 2 y USER shall, at the discretion of the CITY, be requested to submit as-built drawings showing the change within thirty (30)days after the day of completion. This permit shall inure to the benefit of, and be binding upon, the USER and their respective successors and assigns. USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or specifications, to include utilities locate requirements and use limitations/requirements of public rights-of-way and other public land. USER further agrees that the CITY and its officers and employees shall be saved harmless by the USER from any of the work herein under the terms of this permit and that all of said liabilities are hereby assumed by the USER. DATED and SIGNED this day of vv�h� , 200 . CITY OF ATLANTIC BEACH,FLORIDA, By: CPA- a municipal corporation: Property Owner B Jim H I on, City Mang r Attest: i Rick C,4er, Public Works Director STATE OF FLORIDA COUNTY OF DUVAL 7 On this ./. • day of 0 v gym ✓ , 2 001'4 A personally appeared before me, a Notary Public in and for said County and State, , the property owner of 1 '7 6-2 Atlantic Beach, Florida, known to me to be the person(s) described in and who executed the foregoing instrument; who acknowledged to me that he or she executed the same freely and voluntarily and for the uses and purposes therein mentioned. By. J� No Publi d County and State Property Owner (to be signed in presence of the Notary) .., tNt3HAM ;�•!.''• K.CONN .•g Notary pubic-Stab of Florida •fly Co nrrrission Expires Feb 26.2010 Commission N DD 523638 Bonded By National Notary Assn. Page 2 of 2 .rs vL�I1'jv� �s, CITY OF ATLANTIC BEACH } 800 SEMINOLE ROAD jATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5826 INSPECTION EMAIL REQUEST: Building-dept(a,coab.us Application Number . . . . . 07-00001555 Date 11/19/07 Property Address . . . . . . 1767 SEMINOLE RD Application type description RIGHT-OF-WAY PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 --- ------------------------------------- -------------- - --------------------- Application desc driveway to pavers ---------------- --- ----------------- - -------------------------- ------------- Owner Contractor - ---------------- -------- -------------- - --- ----- JERPBAK, DONALD OWNER 1767 SEMINOLE RD ATLANTIC BEACH FL 32233 (904) 242-0444 ---------------------------------------------------------------------------- Permit . . . . . . DRIVEWAY PERMIT Additional desc . . Permit Fee . . . . 35 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 5/17/08 ----- --------- ------------------------ - ------------- - -------- --------------- Special Notes and Comments Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible . Future disturbance of pavers for utility repair will require owner to repair pavers . City sidewalk must be plain concrete . Pavers not allowed. -------------------- ------------------- ------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ------ ---- ---- ------ - --------- Permit Fee Total 35 . 00 35 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 35 . 00 35 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. MAR SHOWING BOUNDARY SURVEY OF LOT 42, OCEAN GROVE UNIT NO. 2, AS RECORDED IN PLAT BOOK 20, PAGE 20, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA- CERTIFIED TO: DONALD JERPBAK AND MARIANNE JERPBAK PHH MORTGAGE SERVICES — CHICAGO TITLE INSURANCE COMPANY BUSCHMAN, AHERN, PERSONS & BANKSTON N 0123'48" W 61.83` (CHORD\(PLAT) SEMINOLE BEACH ROAD N 01'22'18" W 61-48' (50-0' RICHT OF WAY) (CHORD)(MEASURED) FOUND 1 PSE FOUND PON TANGENCY iOUND 3j4PON PIPE FOUND 1/2"REW NO MENTIFlCATION 90 IDENTIFICATION R-5467.75 L=61-83' STAUM -PLS 4470` ---U S 01102`44" E . 61.90' (MEASURM) i S 00'5D'3w E 61.83• (PLAT) 20.2' �t f D �o x � pY' 2D.3' x- LEGEND: GARAGE �x 1.0. Z R RADIUS 7771x I � z L = LENGTH 10 20.2' � 3D x • � —x— FENCE OD 5j LII x Ata u O _ CONCRETE CONDITIONER ' 1 _ PAD � n 4 " x V M f*l I LOT 41 43 CA x � y LA 00 ul p ONE STORY a? FRAME x POSTED # 1767 D° > > M x to U)) 40.5 10.1` ;u 4.7 m m 5 ' - o x u k' a ){ W K ( s P O O L 1 LOT 42 _ 7'''"'"''"-MAS0rp1Y WALL O 6 l / i0.1ND 1/2WON PIPE NO mcmunCA 1ON FOR EASEMENT -- E(MEASURED) <�ID NAIL 4 S 03 5847" E 59.96 IN�"� 60-oo' (PLAT) (}3'46'42" E LOT 27 CITY OF ATLANTIC BEACH PERMIT BUILDING / ZONING DEPARTMENT APPLICATION � 800 Seminole Road `;; /�i►' _ -- - Atlantic Beach,Florida 32233 (904)247-5800 (904)247-5845 Fax www.coab.us goo, APPLICATION TRACKING FORM REQUIRED DEPT: Y N PLANNING Property Address, 60i-A, Rolz Y N BUILDING "/ = Y N PUBLIC WORKS Applicant: ��/I/ �� 0 Y N PUBLIC UTILITIES ,,pp Y N FIRE DEPT. Project: I V Jit �I/�l� Y N PUBLIC SAFETY 0 APPROVAL Ly v REQUIRED AGENCY: RECEIVED BY: INITIAL: DATE: Z or Y N D.E.P HUFSTETLER ¢D Cf Y S.J.R.W.M. CARPER Uw _ Y ARMY CORPS of ENG CARPER O Y N9 HOTELS&RESAURANTS HUFSTETLER APPLICATION STATUS CIRCLE ONE: SiBUILDING DA AP REVIEWED BY: INITIAL: DATE: ® 1ST REV ® FffT Ite— ////Y/" �\\e Noa oweC . PLANNING ® 2ND REV® BUILDING P B!0O,Ks PUBUTILITIES FIRE DEPT. PUBLIC SAFETY ® ® 3RD REV Return$Inas form to the Building Department once you have entered your comments into the AS400. Public Works Plan Review Comments �n Initials:Date:AAA_ ProjJect Name/Address: �0 I ` ApPlication/P ermit#: x` h�ctko { z C z t M" Aj tion uts Provide impervious surface calculations. Provide erosion and sediment control plans with installation details and maintenance ❑ schedule. ` Provide drainage plans'showing site topography (flow arrows, etc.) ❑ Provide construction site management plan,including Right-of-Way Permit if using ❑ right-of-way for construction parking. Provide a pre-construction topographic survey prepared by a Florida Licensed ❑ Professional Land Surveyor, showing l' contours. Section 24-66(b) of the Land Development Regulations requires on-site storage for increased runoff. Provide Delta volume calculations and on-site retention required per ❑ Section 24-66(b). (See attached info. Sheet) If on-site storage is required, a post construction topographic survey documenting proper ❑ construction will be required. A Right-of-Way Permit must be obtained. A Revocable Encroachment Permit must be obtained for ❑ Pool—Welipoint(if used)must discharge into vegetated area 10' minimum from street ❑ or drainage feature (swale or structure) All driveway aprons must be concrete, 5 inches thick,4000 psi,with fibermesh from the line.Reinforcing rods or mesh are not allowed in edge of the pavement to the property ❑ the ROW(Commercial driveways—6"thick). Any utility cuts in the road must be repaired using COS Standard Detail Case X and must be overlaid 10 feet in each direction fromithe center of the cut. Repair must be shown on the plans. ❑ CITY OF ATLANTIC BEACH CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS I� li i 800 Seminole Road 904-247-5800 i Atlantic Beach, Florida 32233-5445 Fax 904-247-5845 PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION. Date PERMIT# Job Address '7 7 a j0� n d ISSUED BY THE CITY Permitee: D G, a .7j } p L,a Telephone# -1 44 ;;k ` d Permittee Address: t 76 -7 c/,7 t�✓o fie. o a Requesting Permission to Construct: Location: (Reference to Cross-Street) t '� �`' f �'1" d Z' 1. Applicant declares that prior to filing this application he has ascertained the location of all existing utilities, both aerial and underground and the accurate locations are shown on the sketches. A Letter of Notification was mailed to the following Utilities/Municipalities: Jacksonville Electric Authority Yes ( ) No (?Q Date: Bell South Telephone Company Yes ( ) No Date.- Ferrell ate:Ferrell Gas Yes ( ) No (>Q Date: Comcast Yes ( ) No Date: 2. Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation, alteration or relocation of all, or any portion of said street or easement as determined by the Director of Public Works, any or all of said poles, wires, pipes, cables or other facilities and appurtenances authorized hereunder, shall be immediately removed from said street or easement or reset or relocated hereon as required by the Director of Public Works, and at the expense of the Permittee unless reimbursement is authorized. 3. All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the supervision of t-ZN% L- 5 1, (Contractor's Project Superintendent) located at S 5 � ) 1.N 0 c.i -;4- Telephone#: 4. All materials and equipment shall be subject to inspection by the Director of Public Works or his designee. 5. All city property shall be restored to its original condition as far as practical, in keeping with city specifications and the manner satisfactory to the city. 6. A sketch of plans covering details of this installation, as well as, a copy of a recent survey shall be made a part of this permit. Calculations showing any increase in impervious area on owner's lot or in the city Right of Way are to be included with this application. 7. This permittee shall commence actual construction in good faith with'-� days. If the beginning date is more than 60 days from date of permit approval, then permittee must review the permit with the Director of Public Works to make sure no changes have occurred in the area that would affect the permitted construction. 8. It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right, title and interest in the land to be entered upon and used by the holder, and the Holder will, at all times, assume all risk of and indemnify, defend, and save harmless the City of Atlantic Beach from and against any and all loss, damage, and cost of expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges. 9. The Director of Public Works shall be notified twenty-four (24) hours prior to starting work and again immediately upon completion. o ..�,t a N c c OWNERXb end o••� '2,,.• S, Date:) �•6-7 Before day of&10►/in the County o K. CUNNINGHAM State Of Florida, as personally appeared f iLl0. I �a*POB•,, Notary Public at Large,State of Florida,County of Duval. :r. _ Notary Public- State of Florida p �� Expires Feb 28,2010 My commission expires: - e J; �Commission#DD 523638 1Y1j pn��ir7.� DL Produced Id f Bonded By National Notary Assn. l fS�UTr�J. . CI'T'Y OF ATLANTIC BEACH PERMIT BUILDING / ZONING DEPARTW T APPLICATION# 800 Seminole Road Atlantic Beach,Florida 32233 (904)247-5800 (904)247-5845 Fax � www.coab.us APPLICATION TRACKING FORM REQUIRED DEPT: `�/-/� C�""" J Y N PLANNING Property Address. /! (��! d T�Wc�7!O�� /�Q Z Y N BUILDING Y N PUBLIC WORKS Applicant: W N ,'C�_ 0 Y N PUBLIC UTILITIES Y N FIRE DEPT. Project° b/aj�) ?,q vie S Y N PUBLIC SAFETY w APPROVAL 00 REQUIRED AGENCY: RECEIVED BY: INITIAL: DATE Z UJ Y N D.E.P HUFSTETLER Q D Y N S.J.R.W.M. CARPER _ Y N ARMY CORPS of ENG CARPER O Y N HOTELS&RESAURANTS HUFSTETLER APPLICATION STATUS CIRCLE ONE- SITE BUILDING DA AP REVIEWED Y: AL DATE: ® 1ST REV PLANNING ® ® 2ND REV BUILDING PU CW S P TIES FI DEPT. PUBLIC SAFETY Return this form to the But1dinb Department once you have entered your comments into the AS400. Impervious surface calculations % formula: " tae of- House foo ;. s `fes `'o ' , `' Find square footage footprint ' x 0 3 - Driveway Sidewalk A/C pads y� Detached garages or shed o Pool decking 3 >1 4 o = 7O Patios,etc. 1T J/2 Add the total square footage of the above then divide the sum by the total lot area. _ n, CITY OF ATLANTIC BEACH CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS 800 Seminole Road 904-247-5800 Atlantic Beach,Florida 32233-5445 Fax 904-247-5845 PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION. Date 7 PERMIT# Job Address 1 7 4 7 5`/"I 1 N a I e- P' o ZD c� ISSUED BY THE CITY Permitee: D a 'a Tc) T t- P a Telephone# Permittee Address: ) 76 -7 S c r-7 r/✓a 4 Requesting Permission to Construct R G p I A G e.. ct Y 1��w ►e/ Lot" L, p a v C, c—s Location: (Reference to Cross-Street) ��-`� '"`"4 ' / 7-� -a 2, 1. Applicant declares that prior to filing this application he has ascertained the location of all existing utilities, both aerial and underground and the accurate locations are shown on the sketches. A Letter of Notification was mailed to the following Utilities/Municipalities: Jacksonville Electric Authority Yes( ) No (?d Date: Bell South Telephone Company Yes( ) No 0�._J Date: Ferrell Gas Yes( ) No (?Q Date: Comcast Yes ( ) No N Date: 2. Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation, alteration or relocation of all, or any portion of said street or easement as determined by the Director of Public Works, any or all of said poles, wires, pipes, cables or other facilities and appurtenances authorized hereunder, shall be immediately removed from said street or easement or reset or relocated hereon as required by the Director of Public Works, and at the expense of the Permittee unless reimbursement is authorized. 3. All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the supervision of A L 5 1•, �p�+ r-v � (Contractor's Project_ Superintendent) located at 5' ' 3-- — Telephone 4. All materials and equipment shall be subject to inspection by the Director of Public Works or his designee. 5. All city property shall be restored to its original condition as far as practical, in keeping with city specifications and the manner satisfactory to the city. 6. A sketch of plans covering details of this installation, as well as, a copy of a recent survey shall be made a part of this permit. Calculations showing any increase in impervious area on owner's lot or in the city Right of Way are to be included with this application. 7. This permittee shall commence actual construction in good faith withi-✓ 4i5 days. If the beginning date is more than 60 days from date of permit approval, then permittee must review the permit with the Director of Public Works to make sure no changes have occurred in the area that would affect the permitted construction. 8. It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right, title and interest in the land to be entered upon and used by the holder, and the Holder will, at all times, assume all risk of and indemnify, defend, and save harmless the City of Atlantic Beach from and against any and all loss, damage, and cost of expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges. 9. The Director of Public Works shall be notified twenty-four (24) hours prior to starting work and again immediately upon completion. OWNER®-�-..,,c.�-moi. 1�---� �.{�..L. �._r-t c�•�ca•.,� �.-�,�- S, Date:)��•6� Before 7 day of,%I n lI/ in the County o ,r K. CUNNINGHAM State Of Florida, as personally appeared r0 loo., d'"•p6B'- Notary Pubic-State of Florida Notary Public at Large,State of Florida,County of Duval. =`,• My commission expires: O e o�, Expires Feb 28,2016 D� Produced Id „,., Commission#DD 523638 Bonded By National Notary Assn. R.O.W.Permit Attachment of _7 for R.O.W.Permit# issued .2o0 Atlantic each,FL 32233 Owner's Name: Z� ^' a i d e. F' k. Property Address: 1 7 6 7 5 Cin Subdivision: o C-�e- Lot#/Block#: R.E.#: REVOCABLE ENCROACHMENT PERMIT THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of , 200 ,'by Atlantic Beach, Florida, a municipal corporation organized and existing under the laws of the State of Florida, hereinafter referred to as"CITY" and of Atlantic Beach,Florida, hereinafter referred to as"USER". WITNESSETH: That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon the property of the City of Atlantic Beach for the purpose as described in the City of Atlantic Beach Right-of-Way/Easement permit numbers noted above(copies attached). This work is generally described as: R v,p 2.m. ,z- - Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to relocation or removal on thirty (30) days notice by CITY to the USER, said notice to USER shall be given by certified mail, return receipt r uested, to the following address: 1 7 G `1 Se a /ei R c),z d A-� L..ory tc> $ea� F L 3 �-— 3 3 The depositing of said notice of cancellation in the United States mail shall constitute the notice of cancellation and the burden is upon USER to keep the CITY informed of USER's proper address. The USER shall promptly make any and all necessary repairs to any facility erected or maintained in the exercise of the privilege herein granted and shall at all times maintain said facility in good and saf, ondition. In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter upon the above-described property of the CITY, the USER shall replace at the USER's sole expense, any and all material necessarily displaced during the action of maintaining, repairing, operating, replacing, or adding to of the utilities and facilities of the CITY or franchise utility provider. The facilities allowed by the permit shall meet the current requirements of the City Code, Building Codes,Land Development Code, and all other land use and code requirements of the CITY. The USER, prior to making any changes from the approved plans and/or method, must obtain written approval from the City of Atlantic Beach, Public Works Department, for said change. The Page 1 of 2 • t USER shall, at the discretion of the CITY, be requested to submit as-built drawings showing the change within thirty(30)days after the day of completion. This permit shall inure to the benefit of, and be binding upon, the USER and their respective successors and assigns. USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or specifications, to include utilities locate requirements and use limitations/requirements of public rights-of-way and other public land. USER further agrees that the CITY and its officers and employees shall be saved harmless by the USER from any of the work herein under the terms of this permit and that all of said liabilities are hereby assumed by the USER. DATED and SIGNED this day of .200k-? CITY OF ATLANTIC BEACH,FLORIDA, By a municipal corporation: Property Owner By: Jim Hanson, City Manager Attest: Rick Carper, Public Works Director STATE OF FLORIDA COUNTY OF DUVAL ? On this day of DYP—/n -✓ , 200N personally appeared before me, a Notary Public in and for said County and State, , the property owner of 1 .7 6.2 Sc,-7 t^ot>lc- IZaa4 ' Atlantic Beach, Florida, known to me to be the person(s) described in and who executed the foregoing instrument; who acknowledged to me that he or she executed the same finely and voluntarily and for the uses and purposes therein mentioned. i By. NoKPubli d County and State Property Owner (to be•signed in presence of the Notary) „ K. CUNNINDaA r P"°<i;-; Notary PubkC'S . qty Commission Expi ?' Commission# Bonded By Nation Page 2 of 2 low CITY OF ATLANTIC BEACH BUILDING DEPARTMENT INSPECTION REPORT JOB LOCATION PERMIT# SUBDIVISION ve OWNER NAME 1767 SEMINOLE ROAD PHONE 96 ATLANTIC BEACH, FLORIDA 32233 OCEANGROVE vw LEGAL DESC: LOT BLOCK SECTION PERMIT TYPE EVALYH DANCIGER CLA SR94b306-3633 CONTRACTOR PROPOSED USE 'w' 42 II BUILDING ADDITION WORK DESCRIPTINBRY DEVELOPMENT CO. SINGLE FAMILY INSPECTION REQUIRED INSPECTOR CONSTRUCT rR V I N DECK PER PLANS DATEINSPECTED BY 'L AflPROVEAt:] REJECTED LL COMMENTS t CITY OF ATLANTIC BEACH J 800 SEMINOLE ROAD ATLANTIC BEACH, FLORIDA 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 04-00028126 Date 4/21/04 Property Address . . . . . . 1767 SEMINOLE RD Tenant nbr, name . . . . . . SPRINKLER SYSTEM Application description . . . IRRIGATION/SPRINKLER Property Zoning . . . . . . . TO BE UPDATED Application valuation . . 0 Owner Contractor ----------------- ------- ---- -------------------- JERPBAK, DONALD HULIHAN TERRITORY 1767 SEMINOLE RD P.O. BOX 331268 ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233 (904) 242-0444 (904) 285-8505 ---------------------------------------------------------------------------- Permit PLUMBING PERMIT Additional desc . . Permit Fee . . . . 50 . 00 Plan Check Fee . 00 Issue Date . . Valuation . . . . 0 --------------------- --------------------- ----- ---------------- ------------- Special Notes and Comments OWNER MUST HIRE PLUMBER TO INSTALL BACKFLOW PREVENTER AND MAKE CONNECTION FROM THE PRIVATE PROPERTY Fee summary Charged Paid Credited Due ----------------- ------ ---- ---------- ---------- ---------- Permit Fee Total 50 . 00 50 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 50 . 00 50 . 00 . 00 . 00 r BUILDING MATERIAL,RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER. "FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS"ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. , , ( - 1J, BUILDING OFFICIAL �j"Lyrl�i s CITY OF ATLANTIC BEACH r, s� PLUMBING PERMIT APPLICATION Date: y- Job Address: V1 17 Owner of Property: Telephone: 44 a.- O w�-q- Plumbing Contractor: Contractor's Address: lV V7t; TtksJ- _ Telephone: a(g S - g 5p 5 Fax: �ka3 cs State License Number: _1: - 3'7 How many of the following fixtures (re-piped or new): Sinks Showers Water Lavatory Water Heaters Hose Bib Bathtubs Dishwashers Sewer Urinals Disposals Other Closets Washing Machine Shower Pans Floor Drains Re-Pipe (List fixtures being re-piped) Y1 n k-/e r I Total Fixtures: x $7.00 + $35.00 = (Minimum Permit Fee: $35.00) Signature of Contractor: — 4 Vz1_ Installation of plumbing and fixtures must be in accordance with the most recent edition of the Southern Standard Plumbing Code. Call a day ahead to schedule inspections: (904) 247-5826 800 Seminole Road• Atlantic Beach, Florida 32233-5445 Phone: (904)247-5800• Fax: (904)247-5845• http://www.ci.atlantic-beach.fl.us Revised 1/14/03 f i Cl CITY OF ATLANTIC BEACH s' S 800 SEMINOLE ROAD J ATLANTIC BEACH, FLORIDA 32233 -i~ INSPECTION PHONE LINE 247-5826 Application Number . . . . . 04-00028019 Date 4/01/04 Property Address . . . . . . 1767 SEMINOLE RD Tenant nbr, name 3/4 " IRRIG METER Application description . . . IRRIGATION/SPRINKLER Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 Owner Contractor ------------------- ----- ------------------------ JERPBAK, DONALD OWNER 1767 SEMINOLE RD ATLANTIC BEACH FL 32233 (904) 242-0444 --------------- -------- -------------- ----------- ---------------------------- Permit . . . . . . PLUMBING PERMIT Additional desc . . Permit Fee . . . . . 00 Plan Check Fee . 00 Issue Date . . . . 4/01/04 Valuation . . . . 0 Expiration Date . . 9/28/04 ----------------- ------------- ------------ --- ------------------------------- Special Notes and Comments OWNER MUST HIRE PLUMBER TO INSTALL A BACKFLOW PREVENTER AND MAKE THE CONNECTION TO THE PRIVATE PROPERTY. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . CAPITAL IMPROVEMENT 325 . 00 WATER CONNECT/TAP & METER 525 . 00 WATER CROSS CONNECTION 35 . 00 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total . 00 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 885 . 00 885 . 00 . 00 . 00 Grand Total 885 . 00 885 . 00 . 00 . 00 BUILDING MATERIAL,RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER. "FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS" ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. 4BDtING FFICIAL OF TIC CITY SEMINO CH ROAD ATLANTIC BEACH,FLORIDA 32233-5445 TELEPHONE: (904)247-5800 FAX: (904)247-5805 y ,r SUNCOM:852-5800 _J http://ci.atlantic-beach.fl.us Date: -l- 0 L+ Dear Property Owner: The costs to connect your building to the City sewer and/or water system are as follows: 3/4„ 1 Sewer Tap-Labor and materials to tap into sewer main $ Water Tap-Labor and materials to tap into water main $ 525.00 560.00 Water Meter-Cost of Meter $ Cross Connection Inspection-Inspection by Public Works to ensure backflow prevention $ 3)5.00 35.00 Sewer Impact Fees-Funds future expansion of the sewer plant $ Water Impact Fee-Funds future expansion of the water plants $ Capital Improvement-Funds for improvements, Expansion or replacement to water system $ 325.00 550.00 TOTAL COSTS $ 885.00 1145.00 If you have any questions concerning these charges, please call the building department at 247-5826. Sincerely, Don C. Ford Building Official You must supply your own backflow preventer. CITY OF ATLANTIC BEACH . 800 SEMINOLE ROAD r ATLANTIC BEACH, FLORIDA 32233 INSPECTION PHONE LINE 247-5826 !J13l�f' Application Number . . . . . 04-00027841 Date 3/05/04 Property Address . . . . . . 1767 SEMINOLE RD Tenant nbr, name . . . . . . CONNECT TO CITY SEWER Application description . . . PLUMBING ONLY Property, Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 Owner Contractor ------------------------ - ----------------------- JERPBAK, DONALD OWNER 1767 SEMINOLE RD ATLANTIC BEACH FL 32233 (904) 242-0444 -------------- --- ----- -------------- - --------------------------------------- Permit . . . . . . PLUMBING PERMIT Additional desc . . Permit Fee . . . . . 00 Plan Check Fee . 00 Issue Date 3/05/04 Valuation . . . . 0 Expiration Date 9/01/04 ------------------- ----- -------------------- -------------------------------- Other Fees . . . . . . . . . SEWER IMPACT FEES 1250 . 00 Fee summary Charged Paid Credited Due ---------- ------- ---------- ----- ----- ---- ------ ---------- Permit Fee Total . 00 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 1250 . 00 1250 . 00 . 00 . 00 Grand Total 1250 . 00 1250 . 00 . 00 . 00 BUILDING MATERIAL,RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER. "FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS"ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. C �n BUILDING OFFICIAL j � ao--owl PROPERTY OWNER NAME: SERVICE LOCATION 1 ADDRESS: 1 `7 6 -7 S c,rn I N l a s cJ A aNt /c-, Bea PROPERTY OWNER PHONE NUMBER: 17 O C_,� 1'1�_ el '�L — b Z4 CIZ C/ TENANT NAME: SERVICE NOW: ON CITY WATER 4 ON WELL❑ CONVERT FROM ON-SITE SEPTIC SYSTEM TO CITY SEWER: OPTION A: Customer hires own contractor and pays costs. OPTION B: Customer pays costs and hires contractor with City's assistance. OPTION C: Customer hires own contractor and finances costs through the City of Atlantic Beach. OPTION D: Turnkey Support. City assists with entire conversion. CUSTOMER SELECT OPTION PREFERRED: A Option A ❑ Option B ❑ Option C ❑ Option D OWNER'S SIGNATURE: Please return to: Gx_j DATE RECEIVED: 2 . f. W7/24/00 J,ItSSN CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FLORIDA 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 04-00027840 Date 3/05/04 Property Address . . . . . . 1767 SEMINOLE RD Tenant nbr, name . . . . . . CONNECT TO SEWER Application description . . . PLUMBING ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 Owner Contractor ------------------------ ------------------------ JERPBAK, DONALD DAVID GRAY PLUMBING INC. 1767 SEMINOLE ROAD 8850 CORPORATE SQUARE CT. ATLANTIC BEACH FL 32233-747 JACKSONVILLE FL 32216 (904) 242-0444 (904) 744-7255 ---------------------------------------------------------------------------- Permit PLUMBING PERMIT Additional desc . . Permit Fee . . . . 42 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 42 . 00 42 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 42 . 00 42 . 00 . 00 . 00 BUILDING MATERIAL,RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER. "FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS" ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. BUILDING OFFICIAL sSy�";r CITY OF ATLANTIC BEACH l PLUMBING PERMIT APPLICATION = BANK : Wachovia Check Number . Date: Property Address: Z-767 'f[ no d')G i rj Owner: r/,� ,$�� c�1� Telephone #: ,V" D`/yY Contractor: DAVID CRAY P1 11HRTNG. INi' Telephone #: 724-7211 Contractor Address: 8850 Corporate Square Ct . Fax #: 723-5668 Jacksonville E1 32216 In consideration of permit given for doing the work as described in the aN)ve statement,we hereby agree to perforin said:cork in accordance with the attached plans and specifications which are a part hereof and in accordance with the City of Atlantic Beach 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: ❑ Re-Pipe Number of Fixtures: _ Bath Tubs Showers Closets Shower Pans Dishwashers Sinks _ Disposals Urinals Floor Drains Washing Machine Lavatory Water Sewer Water Heaters 15W_4_1t_!' Other Fees Permit Issuing Fee: $35.00 Total Fixtures: X $7.00 + S35.00 = 800 Seminole Road • Atlantic Beach, Florida 32233-5445 Phone: (904) 247-5800 • Fax: (904) 247-5845 • http://www.ci.atlantic-beach.fl.us r6 39 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD j � ATLANTIC BEACH, FLORIDA 32233 xf INSPECTION PHONE LINE 247-5826 Application Number . . . . . 03-00027156 Date 10/28/03 Property Address . . . . . . 1767 SEMINOLE RD Tenant nbr, name . . . . . . REPL AIR HANDLER Application description . . . MECHANICAL ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 Owner Contractor ------------------------ ------------------------ JERPBAK, DON OCEAN STATE HEAT & AIR 11570 TYNDEL CREEK LN. 1476 ATLANTIC BLVD. ATLANTIC BEACH FL 32233-747 NEPTUNE BEACH FL 32266 (904) 249-8251 ----------------- ----------------------------------------------------------- Permit MECHANICAL PERMIT Additional desc . . Permit Fee . . . . 55 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Fee summary Charged Paid Credited Due ------------ ----- ---------- ---------- ---------- ---------- Permit Fee Total 55 . 00 55 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 55 . 00 55 . 00 . 00 . 00 BUILDING MATERIAL,RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER. "FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS"ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. BUILDING OFFICIAL Uct Ub UJ Ue: j3P Information Systems 247-5845 RP. 1 CITY OF ATLANTIC BEACH r�. MECHANICAL PERMIT APPLICATION =J81�r Date: 01AMer Of Property: Job Address: 19 V] 9eXn1 ?)Oacl At fi L &4LJIL Contractor:S r e. CSS O l�ulrl P�1� I I in consideration of permit given for doing the work as described in the above statement,we here6v agree to perform said work in ! accordance with the attached plans and specifications which are a part hereofand in accordance with the City of Atlantic Beach ordinances and standards of Rood practice listed therein. III. GEtiE AL INFORMATION A. ;?N of heating fuel: g_ Electric IS OTHER CONSTRUCT10,NOE1NG DONE ON THIS Gas: _LP _Natural _Central L'tdityBUILDI] OR SITE" tj �� ❑ Oil ❑ Other—Specifj' I IF YES,GIVE NUMBER OF CONSTRUCTION PERMIT IV. MECHANICAL EQliIPMENT TO BENATtiRE of WORK INSTALLED 51 Residential or Commercial ❑' New Building (Provide complete list of components o back of this form) Existing Building i Heat _Space _Recessed components _Floor ( ❑ Replacement of e..cisting system ❑ Air Conditioning: Room Central 1 ❑ New Ittslallation(No system previously installed) ❑ Duct Svsnem: Marerial Thickness ❑ Extension or add-on to existing system Maximum capacity cfin i ❑ Other-Specify i ❑ Refrigeration ❑ Cooling tower. Capacity gpm ❑ Fite sprinklers: Number of heads THIS SPACE FOR OFFICE USE ONLY -Z) Elevator: _ ManliR_Escalator (N umber) '' O Gasoline pumps (Dumber) (Received) ❑ Tanks (Number) :I LPG containers (Number) Remarks ZI Unfired pressure vessel Z Boilers Permit Approved by Date i C3Other—Specif.% Permit Fee I LIST ALL EQUIPMENT I AIR CONDITIONING AND REFRIGERATION EQUIPMENT t Number Units Description Model Number Manufacturer Capacity Approving j (Tons) Agency HEATING—FURNACES,BOILERS,FIREPLACES Number Units script Model Number M nufacturer Capacity Approving I ran e— (BTU) Agency TANKS How Many Nominal Capacity Type Liquid Name of Serial Approving And Dimensions Contained Manufacru= No. Agency 800 Seminole Road•Atlantic Beach,Florida 32233-5445 Phone:(904)247-5800•Fax:(904)247-5845• htip://www.cL.it3untic-benciLfi.tu 1/14/03 k,, Sts .., PSR-3844 11171 DEPARTMENT OF BUILDING CITY OF ATLANTIC BEACH Permit Number: 11171 Address : 1767 SEMINOLE ROAD Permit Type: PLUMBING ATLANTIC BEACH . FLORIDA 3223" Class of Work: ALTERATION ---------- LEGAL DESCRIPTION -------- - Constr . Tvpe: WOOD FRAME Lot : Block: Section: Proposed Use : SINGLE FAMILY Township: RNG: 0 Dwellings : 1 Code : 0 Subdivision: Estimated Value : 50 . 00 Improv . Cost : 50 .00 Total Fees : 525 .00 Amount Paid: 525 . 00 DateeR,aid 12/ 13/95 Nare -.. IT PERMIT 525 . 00 Address --",')LE ROAD WATER IMPACT FEE 50 . 00 Aii SACH : FLORII_ SEWER IMPACT FEE $0 . 00 Phone, '"' 'I -7 -04 WAT METER/TAP $0 . nn RA aser -- - CORACT01k INFORMATION ---- RADON CAB 5 A000 Na+r+e ABLE PLf $ING CAPITAL IMPROVE. $0 .00 Address 012 30381 "' STREET SEWER TAP $0 .00 JACOON V I LLE . FL .3 CROSS ,�QIUNECT:I�1 �0n. mw.9. LicensERF06-4 It8 Type: SEC H IMPACT FEE $0 . 00 CONST. SURCHARGE 50 . 00 SCHARGE/ATL.BCH. .�ftD 00 NOTES: NOTICE—ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE 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 MECHANIC'S LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYINGTWICE FORTHE BUILDING IMPROVEMENTS" ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. t GGGU CtUUCKtiKt() $25.0014 Date: V1 jjCPL; me 11171 ATLANTIC BEACH BUILDING DEPARTMENT CHECKS 00100QD3' lOQO By: CITY OF ATLANTIC BEACH !aPFLICATION FOR PLUMBING PERKi 10q n f&/Uy00z _TELEPHONE ' W MANY ok, THE FOLLOWING FIXTURES INSTALLED - SHOWERS .'_LtVATORY ----.:—WATER HEATERS DISHWASHERS --_---DISPOSALS 'ISETE WASHING MACHINE FLOOR DRAIN6 SHOW7 , FANS OT F"XTURES: MINIMUM PERMIT FEE - $25-00 SIGNATURE OF OWNER:__ SIGNATURE OF CONTRACTOR , ------ ---------------------- ---------- -------------- ---- ----- INSTALLATION OF PLUMBING AND FIXTURES MU6T BE IN ACCORDANCE WITH THE MOST RECENT EDITION OF THE SOUTHERN STANDARD PLUHBING -CODE. CAL;. DAY AHEAD TO SCHEDULE INSPECTIONS - ( 904) 247-5926 SEWER CONNECTIONS MUST HE CALLED INTO PUBLIC WORKS FOR INSPECTION PRIOR TO COVERING UP - ( 904) 247-5834 7" CITY OF ATLANTIC BEACH, FLORIDA Approval by APPLICATION FOR ELECTRICAL PERMIT TO THE CHIEF ELECTRICAL INSPECTOR: DATE: 19 IMP013TANT 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 AN CITY OF ATLANTIC BEACH ORDINANCES. ELECTRICAL FIRM: MASTER ELECTRICIAN $10— q TUBE JO NAME OA ��SG� ADDRESS:_ R BOX_ „ BLDG.SIZE BETWEEN: RES. !` APT.( ) COMM. ( ) PUBLIC ( ! INDUS. ( ! NEW( ! OLD V) REW. ! ADDITION ( ► TRAILER ( ► TEMP.( ► SIGNS ( ) SD. FT. SERVICE: NEW( ) INCREASE ( ) REPAIR FEE CONDUCTOR SIZE AMPS COPPER ALUM. SWITCH OR BREAKER AMPS PH W V T A W EXIST.SERV.SIZE AMPS PH VOLT RACEWAY FEEDERS NO. SIZE NO. SIZE NO. SIZE LIGHTING OUTLETS CONCEALED OPEN TOTAL RECEPTACLES CONCEALED o.ao AMPS. OPEN TOTAL SWITCHES 31.100 AMPS, INCANDESCENT FLUORESCENT&M.V. FIXED 0.100 AMPS. Oyu APPLIANCES AIRI H.P. RATINGELL TRANSF. CONDITIONING COMP,MOTOR H.P.• RATING OTHER MOTORS AMPS CEIL HEAT: KW-HEAT 0.1 MOTORS H. ), VOLTAGE PHS OVER NO. 1 N.P. VOLTAGE PHS MISCELLANEOUS �i mom TRANSFORMERS: UNDER 600 V. OVER BAo v 0002296 DEPARTMENT OF BUILDING CITY OF ATLANTIC BEACH _ - -- PERMIT INFORMATION _ LOCATION INFORMATION - Permit Number : 2296 Address: 1767 SEMINOLE ROAD Permit Type: BUILDING ATLANTIS.' BEACH, FLORIDA 32233 Class of Work% ADDITION ~- - - LEGAL DESCRIPTION - - ----- --- Constr. Type: WOOD Lot : 42 Block : Section: II Proposed Use: SINGLE FAMILY Township: RNG: 0 Dwellings: 0 Code: O Subdivision: OCEANGROVE Estimated Value: 53208. 50 Improv. Cost : $0. 00 Total Fees: $24. 00 Amount. Paid: $24. 00 A OWNER INFORMATION - _ ._ _ _ - ------ APPLICATION FEES -- -- -- Name: - -- - Name: EVALYN DANCIGER PERMIT $24. 00 Address: 1767 SEMINOLE ROAD WATER IMPACT FEE x+0. 00 ATLANTIC BEACH, FLORIDA 32-233 SEWER IMPACT FEE $0. 00 Phone: (904)246-3633 WATER METER $0. 00 RADON GAS--H. R. S. $0. 00 - - CONTRACTOR INFORMATION RADON GAS _ 5% $0. 00 Name: MABRY DEVELOPMENT CO. WATER TAP $0. 00 Address: 323 ATLANTIC BLVD. SEWER TAP $0. 00 ATLANTIC BEACH, FL. 32233 HYDRAULIC SHARE $0. 00 License: CGCO06748 Type: RE--INSPECT FEE $0. 00 ENGINEERING $0. 00 OTHER $0. 00 NOTES: 61 Tt '!T[ NOTICE —ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING I /gr ,rt PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE _9C 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 MECHANICS' 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 O'F LAW. ATLANTIC E CH BUILDING D PARTMENT By: d`Z;�� PLANS REVIEW CHECK LIST `1 Address _ Owner -- - - -- _ Lt2f-e�� --- --------- Legal Description.�� -----------Contractor_[:1 - ---- - ------ J ----------License Number License on Fil YES ; NO Section_ 24-101 ± Zoning Regulations d Zoning District1 Proposed Useo R Required Lot Size2-1 Actual Lot Size � .�/ Setbacks Required Provided Section 24_17 front _G__iL---- ---- CORNER LOT INTERIOR LOT ' rear _ -�f�- ) ----- `� � /�, Flood Zone side-1 - -- ----- n Required Elevation-------- side-2 -- 4 Max. Height Allowed__�3s-� Proposed Height��'�_l, � ,,PiY►ct. Section 24_82 * Minimum Lot Cov_er_agg N� Required Heated Area _ /g___ Proposed Area / _� __ Section 24_16_1 * Offstre_e_t Parking Number Spaces Required------- Spaces Provided_ Section 24182 * Duplicate Buildings Is there a similar building within 500' of proposed building?YES NO Utilities Water and sewer service is to be provided by: Buccaneer Utilities ----- City of Atlantic Beach Utilities Private Source SEPTIC TANK WELL Plans Reviewed by: ------------------------------Date ---------------- Building Permit #__-------- ISSUED DENIED Address 7 S / ` G t, f. 7 Fri�ti'o�F ! Heated Square Footage @ $ per.sq ft - $ Garage/Shed @ $ per sq ft - $ Carport/Fords @ $ ''I per sq ft - $ Deck @ $ y_per,sq ft - $ Patio @ $ per sq ft - $ -� TOTAL VALUATION t Tota a uaEl—m 1st $ �p Raiiaitider Valuation er thousand or , ' portion thereof `. nUDITIOt�At, PEtttil'TS Total Building Fee $ �� grid/or-F FUSS S RCQUIRRU "i + � Filing Fee. t4ediacttcal fireplaces @ 15.00 $ Fluibing BUILDING PERMIT � � S ov s_ ' Electric/New L------------------------------------------------ Septicx'az�lc BUILDING PERMIT WATER MCIER C1W=- $ Well . � � ' S`ihimlug Pool SEWER IMPACT 1TE $ Sign To ` : `: WATER IMPACT FEC $ Water Connection r' MISCELLANEOUS $ Sewer Cotinect:ion 1 Water meter Frlevat•ion Ccrtiric:au . GRAND..MM DUE , ----r----r------------rte•--rrrrr—rrrrr—�•--Y YYYYYYY rrr rrr�.—r—rr I CALCULAriONS and/or NUIES: • J .,1.;;iia z ,�•, AT f , • 'f f 1 1 14. i '.� t, �''' 1 . .l 1 f i I f Ili},�, �.�'Is ii {• J 1 ! • _ �,,ii•'J .r..it.}.,. . . . 1• .:uta ••4i. , :�•.��°l��ltll�.�*1'.�6:��L . CITY OF ATLANTIC BEACH DEPARTMENT OF BUILDING 800 SEMINOLE ROAD-ATLANTIC BEACH, FL 32233-TEL: 247-5826-FAX: 247-5877 I PERMIT INFORMATION f LOCATION INFORMATION Permit Number: 17901 Address: 1767 SEMINOLE ROAD Permit Type: REMODELING ATLANTIC BEACH, FLORIDA 32233 Class of Work: ALTERATION Township: 0 Range: 0 Book: Proposed Use: Lot(s): Block: Section: 0 Square Feet: Subdivision: Est. Value: Parcel Number: Improv. Cost: 12,000.00 OWNER INFORMATION Date Issued: 3/11/1999 Name. ROB RUSSELL Total Fees: 105.00 Address: 1767 SEMINOLE ROAD Amount Paid: 105.00 ATLANTIC BEACH, FLORIDA 32233 Date Paid: 3/10/1999 Phone: (904)241-9051 Work Desc: REPLACE DOORS AND WINDOWS PER PLANS CONTRACTOR(SL- -- APPLICATION FEES ARMSTRONG CONSTRUCTION PERMIT 10-5.-00---], i I I i I I I I i i I _ Inspections Required j iCOVER UP FRAMING INSULATION FINAL BUILDING j I j j NOTICE - INSPECTIONS MUST BE REQUESTED AT LEAST 24 HOURS PRIOR TO INSPECTION BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE. AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER "FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS" ISSUED AI.CORDING TO APPROVED PLAINS VVHiCH ARE PART OF THIS PERMIT AND SuBjEC T TO REVOCATION ION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. PAID MAA 1 5 1999 j I C4yd � Date: 3/15/99 81 Receipt: 41687 ATLANTIC BEACH BUILDING DEPT. CHECKS 2128 F111188883221888 �l�l�n�or'/T"gym%` ,tJro FLA „„ LAW, 5 RAIN. RETURN leo l st�� rs 713.13 PHQNE Z�11AMCo romm 409 ztfi.,r, jaf &vimtnrnrrmrnt 41-Nt►AR9 IN DurLICA7(1 `(�� fvljam it uut� rMtrent: iThe undersigned hereby informs all concerned that improvements will be made to certain real property, and in accordance with section 713.13 of the Florida Statutes, the following information m is stated in this NOTICE OF COMMENCEMENT. LL Descriptionof property.............^/ ,,, / � .. . � C...... ...... ................................ ....................................................... 0 ............................................................................»..._. »............................................................................................................................................... .......................................................... ........ 0 »............................................... 0 x ..............................................................»............................................................... General description of improvements.........�f+ 7 O,�'Uz�� ........ ..�K.................. ... ..........f.......... .FIG:�. ............ 1 ,� ... . .le, .. . . .. ............................»..........»»...................................I....... .. .................. ....................................... ..................................................... Owner........ T �p... � . d3� dfeSS r - Q-r'G ......................... ..................»»....»................... .... ......_........... .. Owner's interest in site of the improvement ................. fee Simple Title holder (if other than owner) Name...................................................... Address................................................... »........................................................... Contractor...... >% .......... ....... ................................................................................... Address.................JL ...1�........./..1....�`� ..................................................:.✓..,C�`'... /•,,,. 5-�......,.... CITY OF ATLANTIC BEACH PERMI`^ ,CALCULATION SHEET Address—/ �`t //U©L(z /'� ►`� ( f tJ �a��-S Date 3 — S -1 Heated Sauare Footage T@ $ per sq it = S 4 Garage/Shed �' @ $ per sq ft = S L Carport/Porch R n'P' @ S per sq ft = $_ Deck �� @ $ per sq ft = $ � J r� Patio Q v @ $ per sq ft = S TOTAL VALUATION: S 00 00 O d Cp /•�� a $ Total Valuation ist $ 't 1 1 , 000 �- S -r-)- Remaining Value i per thousand or portion thereof TOTAL BUILDING FEE $ -70 + 1/2 Filing Fee $ 3 ( ) Fireplaces @ $15 . 00 $ —0 - BUILDING PERMIT FEE $ WATER IMPACT FEE $� SEWER IMPACT FEE $ WATER METER/TAP $ CAPITAL IMPROVEMENT S SEWER TAP S 1 RADON (HRS) . 0050 S SECTION. H PAVING 1 j $ HYDRAULIC SHARES $ CROSS CONNECTION S SURCHARGE . 0050 $ OTHER $ GRAND TOTAL DUE Y O S� ADDITIONAL PERMITS OR FEES : Mechanical Plumbing Electric/New Electric/Temp ; SwimmingPool Septic Tank Well ; Sign_ Finish Floor Elevation Survey Other CALCULATIONS and/or NOTES : I RECEIVED CITY OF ATLANTIC BEACH FF19 2 2 1999 PERMIT APPLICATION REMODEL, ADDITIONS, OR 4ZqERA=W8Beach MOVING,DEMOLITIONS Building and Zoning � l- owner(s) : - G 1 r-1111 m . RU JJ P_ Job Address: 'Icrn 'nale Rc� Phone: V Lot #_:E/2 Block o711"z t # _ Subdivision: �� C�i'�T sem.( Contractor: /r/{ 72 41,Al 6 State License # Address: Phone No: L% 75<t1f City. /� State Zip Code _3.2.2 5' Describe work to be done: 65 / fed �-f�+L K�NNnll10 //fir �, � �/ � � Y/Ij•Ot/ ��//J/J � tyi' Present use of building: ~� tYfo.7f-ti7f�q.✓c-�. �,y rfr�. f✓A'1IS Valuation of Proposed Construction:_ %>7DD0 Proposed use: Is this an addition? L 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? New fireplace? New Heat/AC? SUBATT T)MT (C LAX) rwo (RSSIDXXTIAL) CCWI.>CT3s: SATs OF PLANS, INCLiJDX= SITr Pz", s'URD=T, IImnGr com Frma, zfoTxcx or AND Owr LIM/CONTRA.C'POR LAA7=, 1]?' 011NS'R CO2rXj ACTOR. Signature 09PNA: [� nno Date: — / �- j�_ C�C/ Signature CONTRACTOR: Date: 0�? AS TO OWNER: , —Y Sworn to a rQ" pet Vie& nRe th of 29�y >, t r.'�0 Public,State of Florida ' 'SOF fl�P M�ommss'On NO CC Comm1SS on EzP X504 08 loo 1.800-3-NoT,Xy-FILN r NOTARY PUBLIC i AS TO CONTRAC Sworn to and ubscribed before me this'�)-�_ of ,19 � s�Pfl,nU�� AIItl l ` 8adonna � I '_ - _3 1 Notatypublic,StateofFlorida TARY PUBLIC SOF FLOPS Comtpission No.CC 546330 MY Commission Expires Oq/08/Op < I-RW34NJOTARY.Fy v+Y Service k s - ,��i cov av-nccV, INS'(ALL 'x ° WIAI�OI�t/ APPROVED CITY .OF ATLANTIC BEACH BUILDING OFFICE MAR 0 9 19 9 i Q��A To RC C6VE�l�j�cg G�, P�1 //V�579�a6 RECEIVED FFR Z 2 1999 City of Atlantic Beach Building and Zoning o rn N o % �631a yeajV e City FFR Z 2 1999 o Building ainntic Beach d Zoning MAP SHOWING SURVEY OF LOT 42 BLOCK OCEA►.1 (. eOVE - Umi-r tjo. zor AS RECORDED IN PLAT BOOK 2 , PACE 20 OF THE CURRENT PUBLIC RECORDS OF Duk✓ 1 2 1999 COUNTY, FLORIDA I 05" WIDE c h LOT LOT OT Z-7 aLOCr WALL- Buildi. g and Zoningq (CHAW LINT FEWCE OU WAIL b 03' 4(, 4 E coo.00 LOT 2Co c< EASEMEtJ�ESEiLVE[D M W ooD FEN E 'IVI O.l 0.7 FouN� X Fovr.Ip KJAIL CUT IN Z F IUALL IN WALL z Z O ? UO C11 W n x /� Q Q H I-• J Q f X FQF h' Qi v Q � � u d 0 PooL ` Q F F O 3 z z ra - �oUc y " V u > a M M s7Al M M DE 04L') U T, DECK E. DEcIC cn In c:. a = a cam' DEcr lo.q E. O o a cov, x .] X w DESK = O SDI? ��'� I•STOQY EQ AME 9.4 I � Z Oa 8LL r RES �+ 19q ab/ rF-I O CUJ S o V) U 3 W E, N N Z 1( N W = a g Z = - 3LL Q w " LoT 41 I.o.1.� � w � F qac r/% Q7 35 (D = z ✓ 3:.: zFF M' x W 0 o,q 20.3 4.q x r X r M Zo. 3 x MX � (r F e A N1 E M o.5 000 'N bt h14 L IC 1.5 2 0.3 4.9 M'y^�' SET I�i M In ' t^ IRohl PIPE rh Y 4410 /� coNC i N E)rclvE o� Amc° Lcl. I 2EDA� 1 Paul OF 111 TAuc+EUGY ka. OI' Z9 48 W. GwC1 eC>: Q0 I. • --- � — 2- 54 1 -7 .7S O' 0'3914 A2c- Co1.83 S E M I Ki OLEfZ.OA p ( SEMIIQC>LE 6EACN ROAD 13Y PLAT loo' Q�w NOTES: J 1. This is a boundary survey. 2. Flood zone x as best ascertained from Flood Insurance Rate Map, community panel no.lzoo-75-ocxm.r dated 4•I,-89 RParinn r7a1-11m �n FAST I IL,C (,c . ,-- -- CITY OF 4&1 wa& /�ec�.�s-��i -��3 Office of Building Official REQUEST FOR INSPE ION Date 3 8 9 Per No. Time A.M. Received P.M. Job Add re Locality Owner's Name CONCRETE ELECTRIC PLUMBING MEC NICAL Framing Footing Rough Wiring El ❑ Air Cond. & ❑ Re Roofing L G Slab _ Temp Pole ❑ Top Out ❑ Heating Final ❑ Sewer Fire Place Insulation ❑ Lintel � Pre Fab Mo�'�- READY FOR INSPECTION Tues. Wed. Thurs. Friday A.M. Inspection Made 7 P.M. Final Inspection C Inspector Certificate of Occupancy ❑ Date FROM NADEEM ZEBOUNI PHONE NO. : 904 273 4254 Mar. 22 1999 06:05PM P2 RECEJV .- "*1k N �► ADEEM ZEBOUN1, P.E. � . Tel; M. (904)285 9880 AR 2 1999 �� Fax:(904)273-4254 FIELD OBSERVATION REPORT' City of Atlantic Beach Building and Zoning REPORT NO' 01 INSPECTION DATE- 3/22/99( 1 L•00 am) PROJECT>3t4. 8 _ :: REPORT DATE: 3/22/99(5'.00 PM) Atianuc Beach,Florida CONTRACTOR: Armstrong Construction WEATHER: Suuny CLIENT.• Shannon Armstrong YOUR REFERENCE: Truss Repair OBSERVED BY: Nadeem G.ZebOirni,P.E. OUR REFERENCE: 924 REASON FOR OBSERVATION: Evaluate truss load carrying capacity'to carry superimposed roof loads over the new 8%0"wide wall opening where a pocket door existed. PERSONS INVOLVED: Don Ford, Shannon Armstrong,and Nadeem Zebouni. rrEMS EXCHANGED: N/A OBSFRYATIONS AND DISCUSSLQIN5: A pocket door and a sliding glass door existed in the north wall of theto The f the 1 sliding removed, can he west ig the portion of the walLwas replaced with double doors and the eastern portion pocket door, The wall opening where the pocket door was is 8'-0"wide. The Building Official of the city of Atlantic Beach.Mr. Don Ford, requested to insure that the framing above the operung adequate o s ppo a the superimpoxd roof gravity loads. The owner does not want to place a header for supportprompted snuctural investigation covered in this report. A common roof truss exists over the wall openings in the north kitchen wall. The truss was observed from an attic access hole in the ceiling of a storage room west of the kitchen. The truss is supported at both ends and at its mid-span on the south end of a wall running in the north-south direction. Additional 2x dead wood members were observed between the truss members. A splice in the bottom chord of the truss was obscrvod immediately east of the interior support of the truss. A slight separation of the bottom chord was noticed at the splice location. The roof truss over the north wall of the kitchen caries a portion of the trussed roof on the south side and the conventionally framed roof on the north side of the truss. NCLUSIONS AN ECQMMENDATIONS- Based on my past experience,field observations,and the contents of this report,►t is my opinion that the existing roof truss is adequate. However,the following is recommended 1. Place a jack support and slightly raise the bottom chord of the prefabricated wood truss at the splice location until the bottom elevation of the bottom chord across the splice is in the same plane. 200 EXECUTIVE WAY, SUITE 216 • PONTE VEDRA BEACH, FLORIDA 32082 FROM,. : NADEEM ZEBOUNI PHONE NO. : 904 273 4254 Mar. 22 1999 06:06PM P3 2. Apply"APA" sheathing,7/16"minimum thickness,on the south side of the roof truss using 8d trails at 16"on centers along sheathing joints. The 4' x 8' sheathing may be cut to fit the size of the access opening in the ceiling. Reduce nail spacing to 4"on centers around the air conditioning duct opening. Extend the sheathing panels between the top and bottom chords of the truss and approximately 12"beyond the sides of the R'-0"wall opening below. 3. Remove the temporary jack shoring. implementation of the above recornmendations will insure that the thus will safely tarty the superimposed gravity loads in comee with current applicable building code criteria. fh ave y questions or if I can be of any further assistance,please let me know, 5ily,,r ii N 6 Z ni,P F. NG�:tjv Attachments cc Don Ford,Building Official CITY OF ATLANTIC BEACH j DEPARTMENT OF BUILDING 800 Seminole Road -Atlantic Beach, FL 32233- Tel: 247-5826 - Fax: 247-5877 ELECTRICAL PERMIT PERMIT INFORMATION LOCATION INFORMATION Permit Number: 17936 Address: 1767 SEMINOLE ROA i Permit Type: ELECTRICAL ATLANTIC BEACH, FLORIDA 32233 Class of Work: REMODEL I Township: 0 Range: 0 Book: Proposed Use: Lot(s): Block: Section: 0 Square Feet: Subdivision: Est. Value: Parcel Number: Improv. Cost: OWNER INFORMATION Date Issued: 3/19/1999 25:Maa�e s: 87067 S MINOLE ROAD � OB RUSSELL Total Fees: M 50.00 Amount Paid: ZiJM 50.00 ATLANTIC BEACH, FLORIDA 32233 Date Paid: 3/19/1999 Phone: (904)241-9051 Work Desc: RELOCATE RECEPTACLES AND REWIRE CONTRACTOR(S) APPLICATION'FEES BIVINS ELECTRIC CO. PERMIT 50.00 Permit Fee Doubled. Work Commenced Prior to Permitting Inspections Required ROUGH ELECTRIC FINAL ELECTRIC NOTICE- INSPECTIONS MUST BE REQUESTED AT LEAST 24 HOURS PRIOR TO INSPECTION BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE, AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER "FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS" ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. $50.0814 _ Date: 3/22/99 81 Receipt: 8843587 CHECKS 739 ATLANTIC BEACHBUILDI EPT. 881888832218W II CITY OF AT' ANTIC HACH, FLC ". `DA Approvsa by APPLICATION FOR ELECTRICAL PERMIT 1 TO THE CHIEF ELECTRICAL INSPECTOR: DATE: 1 19 l l IMPORTANT NOTICE: IN CONSIDERATION OF PERMIT GIVEN FOR DOING THE WORK AS DESCRIBED IN THE fOLLOVOING., WE HEREBY AGREE TO PERFORM SAID WOR ORDANCE WITH THE ATTACHED PLANS AND SPECIFICATIONS, WHICH ARE A PART HEREOF, AND IN CORDAN E WITH THE EV71CTRICAL REGULATIONS, CODES AND CITY w iAT�LECTRICAL NTIC BEACH ORDINANCES. FIRM: M T ELECTRI_C�I7- IGNATURf n JOURNEYMAN NAME S �_An4RESS- /G 7 sc-fnl."ocir KQ _ RFD BOX BLDG.SIZE BETWEEN: RES. AFT, ( I COMM.( ) PUBLIC( } INDUS. ( ) NEW( ) OLD REW.( 1 ADDITION ( ) TRAILER 1 ) TEMP. ( ) SIGNS ( ) SO. FT. SERVICE: NEW ( I INCREASE ( ) REPAIR ( 1 FEE CONDUCTOR SIZE AMPS COPPER i ALUM. i SWITCH OR BREAKER AMPS I PH I _WI VOLT f RACEWAY EXIST.SERV.SIZE 00 AMPS ( PH ' W ^OLT � l/ RACEWAY FEEDERS NO. SIZE NO. SIZE NO. SIZE LIGHTING OUTLETS CONCEALED OPEN TOTAL RECEPTACLES CONCEALED OPEN TOTAL SW ITCHES } INCANDESCENT FLUORESCENT&M. V. FIXED o-°O!MPrs r ovra APPLIANCES { BELLTRANSF. AIR H.P.RATING H.P. RATING i CONDITIONING COMP.MOTOR OTHER MOTORS AMPS !CEIL NEA": KW-HEAT � T � i I _ 0-1 fOV MOTORS H.P. VOLTAGE PHS NO. 1 H.P. VOLTAGE PHS MISCELLANEOUS -- 'tcy Vu TRANSFORMERS: UNDER 600 V. 44 OVER 6DO V. NO. I KVA I' I NO. KVA r NO.NEON TRANSF. INO. VA. MA. MOTOR SIZE ! SWITCH FLASHER CITY OF ATLANTIC BEACH DEPARTMENT OF BUILDING 800 Seminole Road - Atlantic Beach, FL 32233 - Tel: 247-5826 - Fax- 247-5877 PLUMBING PERMIT PERMIT_INFORMATION LOCATION INFORMATION Permit Number: 17953 Address: 1767 SEMINOLE ROAD Permit Type: PLUMBING ATLANTIC BEACH, FLORIDA 32233 Class of Work: ALTERATION Township: 0 Range: 0 Book: Proposed Use: Lot(s): Block: Section: 0 Square Feet: Subdivision: Est. Value: Parcel Number: Improv. Cost: OWNER INFORMATION Date Issued: 3/23/1999 Name: ROB RUSSELL Total Fees: 32.50 Address: 1767 SEMINOLE ROAD Amount Paid: 32.50 ATLANTIC BEACH, FLORIDA 32233 Date Paid: 3/23/1999 Phone: 904)241-9051 Work Desc: INSTALL PLUMBING CONTRACTOR(S) --- _APPLIC"ON FEES WILLIAM GOODLING PERMIT 32.50 _ nspe&ions Re ad _-- UNDER SLAB PLUMBING T ROUGH PLUMBING SEWER TOPOUT FINAL I NOTICE - INSPECTIONS MUST BE REQUESTED AT LEAST 24 HOURS PRIOR TO INSPECTION BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE, AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER "FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS" ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. C , c ATLANTIC BEACH BUILDING DEPT. i CITY OF ATLANTIC BEACH APPLICATION FOR PLUIKBING PERMIT JOB LOCATION: I-7(q'� Cp . OWNER OF PROPERTY: p uss l TELEPHONE NO. PLUMBING CONTRACTOR W tt� FZ) CONTRACTOR' S ADDRESS : S lCA 71tAd • S • S�:� j�cL___ STATE LICENSE NUMBER: (` ,F do (t(--)43 TELEPHONE : HOW MANY OF THE FOLLOWING FIXTURES INSTALLED SINKS SHOWERS 2_ LAVATORY WATER HEATERS BATH TUBS DISHWASHERS URINALS DISPOSALS Z CLOSETS WASHING MACHINE FLOOR DRAINS SHOWER PANS SEWER WATER REPIPE OTHER TOTAL FIXTURES : x $3 . 50 + $15 . 00 MINIMUM PERMIT FEE - $25 . 00 SIGNATURE OF OWNER: SIGNATURE OF CONTRACTOR: -----------------------------------------------=----------------- INSTALLATION OF PLUMBING AND FIXTURES MUST BE IN ACCORDANCE WITH THE MOST RECENT EDITION OF THE SOUTHERN STANDARD PLUMBING CODE . CALL A DAY AHEAD TO SCHEDULE INSPECTIONS - (904) 247-5826 SEWER CONNECTIONS MUST BE CALLED INTO PUBLIC WORKS FOR INSPECTION PRIOR TO COVERING UP - (904 ) 247-5834 _ BUILDING AND ZONING INSPECTION DIVISION CITY OF ATLANTIC BEACH 17106 ATLANTIC BEACH, FLORIDA 32233 APPLICATION FOR MECHANICAL PERMIT CALL-IN NUMBER IMPORTANT -- Applicant to complete all items in sections I, II, III, and IV. I. 1767 Seminole Road LOCATION Street Address: 17th Street And OF Intersecting Streets: Between BUILDING Sub-division tILIDENTIFICATION — To be completed by all applicants said work in accordance consideration of permit given f ficatio 9 whhichoakeaa partrlbed in the hereof and ain bcve acceby agr ordancenwith thet we n C ty ofeJacksonvillee to mordinnances and sta dards ith the attached plans and specf good practice listed therein. Contractors #190 ame of Mechanicalaster Contractor (Print) Huxham Heating & Air , Inc .Inc Name of Property Owner velyn Danciger Signature of Signature of Owner Architect or Engineer or Authorised Agent 0- 111. GENERAL IN RMATION B. A, Type of heating fuel: IS OTHER CONSTRUCTION BEING DONE ON THIS BUILDING OR SITE? IVO Cr Electric ❑ Gas—❑ LP ❑ Natural ❑ Central Utility IF YES, GIVE NUMBER OF CONSTRUCTION PERMIT ❑ Oil ❑ Other — Specify EQUIPMENT TO 1E INSTALLED NATURE OF WORK IV. b1ECHANI7.7U 1 Residential or ❑ Commercial (Provide cist of components on back of this form) ❑ New Building Heat ❑ Space ❑ Recessed EK Central O floor Z Existing Building ❑ Air Conditioning: ❑ Room b Central �] Replacement of existing system ❑ Duct System: Material PX i S t i n rr Thickness-- ❑ New installation(No system previously installed) Maximum capacity c.f.m. ❑ Extension or add-on to existing system ❑ Refrigeration ❑ Other — Specify ❑ Cooling tower: Capacity g.p m. ❑ Fire sprinklers: Number of head ❑ ❑ Menlift ❑ Esuletor_____ (number) THIS SPACE FOR OFFICE USE ONLY Elevator (Reeeived) ❑ Gasoline pum (number) ❑ Tonic (number) Remarks ❑ LPG container (number) ❑ Unfired pressure vessel Permit Approved by Date – ❑ Boilers Permit Fee ❑ Other •— Specify LIST ALL EQUIPMENT AIR CONDITIONING AND REFRIGERATION EQUIPMENT malty A > Deacrlption Model Number Manufacturer (TO") Number Unita t o n on erasing ural airier itan ler YAF030301 Carrier 2 1 2 ton J� \ ,.' i '�'� II �. � I (� �-_ I � -. � , �, � �: C � N ' � �, N_ . i..� ---� 3-0 c '� j ---1 �r --_ _ � 4 � I __ �s ' � II� � - � -- � � � -y i _ � o � — � —1 i I --------------- -L- � �� _ _ _ � � �� ----- m ; - R __ � i �_ ._f _- � � -� . : ^ � - - � f j , � - � - � - - ` o y —+—-—�— - I ---- t ---'---- _ -�.a �_.-- � � --` ' i � ` � 4 � F ^�,, --� � ,.' p' i X k � �� . -- x � � � � � , � s F F a W m 7 / ZW L/ Lnire N 4 > > < o a i --7 z S� W OJ W z � - 1LI��- a _ N I c +a I 4 4 i 1� \ t�E \ 2 \\ 1 \ �i i 1 1' s 1 f I � � 4 x f � i! ' !I , Q i i I 71� p � s 1W,RTY DESCRIPTION rfl'ozcda 716 OCEAN BOULEVARD P.0.BOX 26 f f AT BEACH,FLORIDA 32233 f Section -------- Lot -------;Block -------- TELEPIIONE(904)249-2396 Subdivision:----------------r - OF WORK DESCRIPTION Street Name )_7/ _ --- ---- or Address%_L 1O -If in a FLOOD HAZARD / BriefCj. t, area complete page S' Description:-------------- Flood Zone:-------------- _ <Nev Class of Work: f �-- (?� /Remodel/Addition) V rf fY,AR, 2 6 jyQn. Type of ��GLI A161 _ -------- : -- ZONING INFORMATION Construction Building and Zoning Value 5_ ��Do�- -'_ Proposed __ Estimated , Zoninict%------ -- Uae:_------------------- Distraterials% ----------------- M --------- ;xceptione or ---------------- Solid or Variances Granted%_____-- Filled ----- S�----- fD Roof% Ground%--- _� � - ------------------------------------------- -- hd of Heating%------------------ OWNER INFORMATION Met Phone%�7_1�- st-��-� owner%_�v�L��_Q�9N�L ---------------- Property - - -----------_--- Mailing r7jr J -C1 -- 3 22- 3-3- ---- Address__]_ W- ` Zips --- tin __ �--------------- CONTRACTOR INFORMATION .� Phone s��.1�_0796 - 9�� p ----------- Contractor,-- Mailing --rn� ---- Contractor:--�/ --- " Mailing �j � T�C.._.--�=-W�-------------- 3 z�3 3 Address%_�_/_�__- - =- l� / Zip%'------------�-- C -_17��-//- --`---------------------- Date%�to� Q ^ T License Number%_ __.. the work as described permit given for doing work in we hereby agree to perform said are In consideration of p s ecifications which the above statementf plans and p regulations with the attached p all rules and accordance and in accordance with a part hereof, $each- 1 ,j.v of the City of Atlantis J�*p• Dat --------- 1 ----------- Owner Signature ___-- -------- Date 3�z3.�9a nature_ -------- - _ ---- -- ¢ _ Contractor Sig MAP SHOWING -;,, .LJRVEY OF �-? BLOCK AS SHOWN ON MAP OF LOT O C EA1,J 67ROVE uN �-r rev. 2 -�--— -- - - AS RECORDED IN PLAT BOOK ?O _ PAGE____ 20___ _ __.OF PUBLIC RECORDS CF DUVAL CO FLA FOR _ EvELYN__ F _DAIJCIC-ER Lai Te � LOI 20 ' WIDE X 3.0 NIUN e�Pq� EASEMEIJ� ! RESERVED Q 0 APPROVED �0 S CITY OF ATLANTIC BEACH 1. PLANNING & ZONING OFFICE Yf $9 1990 �.► i � r W O 4 ,• L LP-1 4�i 1 y-roR;r v.oov s L0� AI I r VWELLINI' Ii NO• 1'1Co7 r a v < a• 3 I o tz � I � m E q I 1A, Qi0.7' q — w00D r' '701 r GARAGE r . � I" 10•T� � �' 3 m 1 .p c°' 1�•3'. �I.d' W N 3I E >� N c mcolic o � 4 •ti v Q• o � r � 6E�•CH ROAD t F i z aMu O �� INO�- 4 CITY OF ATLANTIC BEACH S, 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . 09-00000329 Date 3/11/09 Property Address . . . . . . 1767 SEMINOLE RD Application type description RESIDENTIAL ADDITION/ALTERATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 8000 ------------------------------------------------------------------- Application desc siding T1-11 ------------------------------------------------------------------- Owner Contractor - ------------------------ ----------------------- JERPBAK, DONALD A TO Z REMODELING & HOME 1767 SEMINOLE RD REPAIR INC. ATLANTIC BEACH FL 32233 230 VISTA GRANDE DRIVE (904) 242-0444 PONTE VEDRA BCH FL 32082 --------------------- Structure Information 000 000 ---------------------- Construction Type . . . . . TYPE 5-A Occupancy Type . . . . . . RESIDENTIAL Flood Zone . . . . . . . . ZONE X ----------------------------------------------------------- Permit . . . . . . BUILDING PERMIT Additional desc . . SIDING T-1 11 Permit Fee . . . . 70 . 00 Plan Check Fee 00 Issue Date . . . . Valuation . . . . 8000 Expiration Date . . 9/07/09 ------------------------------------------------------------ Special Notes and Comments *2004 FLROIDA BUILDING CODE W/ 105- 106 SUPPLEMENTS . 2004 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. ------------------------------------------------------------- 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. City of Atlantic Beach APPLICATION NUMBER J r Building Department (To be assigned by the Building Department.) 800 Seminole Road 06 -- ' '� Atlantic Beach, Florida 32233-5445 Vtl Phone (904)247-5826 - Fax(904)247-5845 a / O R E-mail: building-dept@coab.us Date routed;? / City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM LD nt review required Yes No 7 � Building Property Address: 1710 li �s Zoning Tree Administrator Applicant: /� Z �� al n9 i /!1 Public Works /� Public Utilities Project: (� Public Safety Fire Services Review or Receipt Date Other Agency Review or Permit Required 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: Approved. nDenied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: � Date: -� !I D TREE ADMIN. PUBLIC WORKS Second Review: ❑Approved as revised. ❑Denied. Comments: PUBLIC UTILITIES PUBLIC SAFETY FIRE SERVICES Reviewed by: Date: Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: CITY OF ATLANTIC BEACH oA- !i P7800 SECITY ROAD,ATLANTIC BEACH,FL 32233 £y �=� OFFICE:(904)247-5826•FAX NO.:(904)247-5845 ,u BUILDING-DEPT@COAB.US BUILDING PERMIT APPLICATION DUVAL COUNTY 1.JOB ADDRESS: 2.VALUATION OF WORK: 3.SQ.FT.UNDER ROOF 4.LEGAL DESCRIPTION: 5.CLASS OF WORK: 6.USE 21`STRUCTURE:: ❑NEW BUILDING ❑DEMOLITION RESIDENTIAL LOT_BLOCK_SUB DIVISION ❑/� ADD ION 11 CONVERTING USE 11 COMMERCIAL 7,DESCRIPTION OF WORK: ❑ RATION 11ACCESSORY BLDG. 8.FIRE SPRINKLER: �REPAIR 11 POOL%JPA I 1:1 YES Cr NIA f�/]�s if �IJ �%Df.✓L- •'o�'�' L��'1$i INL /'/l/ �'�{2a,% I❑MOVE ❑OTHER 10140 PROPERTY OWNER: CONTRACTOR: ARCHITECT/ENGINEER: 9.NAME: 15.COMPANY NAME: 23.COMPANY NAME: A!"r.Z !c/h: G. vl�N.v fr>F4 c ^ 16.NAME: 24.LICENSEE NAME: M,41t'Lu: 10.ADDRESS: 17.STATE OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.: G _ C Z "Z 7� ? �' � s �� 18.ADDRESS: 26.ADDRESS: i 3 1 5, D.✓7-a- ;/Z , 2z) .5,z- 11. 11.OFFICE PHONE: 12.FAX NO.: 19.OFFICE PHONE: 120.FAX NO.: 27.OFFICE PHONE: 28.FAX NO.: 3 -7�--LjL 13.CELL PHONE: 21.CELL PHONE: 29.CELL PHONE: 13 -(�'lc] Z 14.EMAIL ADDRESS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS: M o'/V r:1&• Citi! FEE SIMPLE TITLE HOLDER: BONDING COMPANY: MORTGAGE LENDER: (IF OTHER THAN OWNER) 31.NAME: 33.NAME: 35.NAME: 32.ADDRESS: 34,ADDRESS: 36.ADDRESS: Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six (6) months, or if construction or work is suspended or abandoned for a period of six (6) months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks, Air Conditioners,etc. OWNER'S AFFIDAVIT- I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. I will not occupy or use the referenced building or any part therof,until all inspections are finaled and prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law. t WARNING TO OWNER: r YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. OWNER or AGENT CONTRACTOR (If Agent,Power of Attorney or Agency Letter Required) (Q i er Only) ` SigjV-� Date: 3 1) Signed: Date: -?/�LO !�� Before me this-tb-day o (%C h 2009 in the county of Before me this 10 day of`)-\Q cc-<, 2009 in the county of Duval,State of Florida,has personally appeared Duval,State of Florida,has personally appeared I I � herin by himself/herself and affirms that all statements and declarations are herin by himself/herself and affirms that all statements and declarations are true and accurate. true and accurate. Notary Public at Large,State of `-,County of ,-a Notary Public at Large,State of d County of ❑Personally Known {� i Personally Known iq Produced Idenf on- 1X-l�Q(� �.A.`']L.El Produced IdentiiIe@tion- _- Notary Signature: N t� Do@ fee III MARJORlE M. I i I RUP. 000.e� OF ATLANTIC$ • _�� _ SEE PERMITS FOR ADDI I E j��e i fir' RE I°0D�'` UIREMENTS.AND CO tt� - eond d f^u c&X�-4�aI E BLDG01 Pemitl�pP.�fzt..,g...a.. � n. :� na FILE C Florida No A .... .......... ..i i ,,..„ ry aN1..Idc REVIEWED BY: K DATE:3 1 fU �• t:.�.�.;r�i�.ra.- i CITY OF ATLANTIC BEACH z f 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 J INSPECTION PHONE LINE 247-5826 Application Number . . . . . 09-00000967 Date 7/06/09 Property Address . . . . . . 1767 SEMINOLE RD Application type description MECHANICAL HVAC ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc 1 cu 1 ahu ---------------------------------------------------------------------------- Owner Contractor - ------------------------ ----------------------- JERPBAK, DONALD OCEAN STATE HEAT & AIR, INC. 1767 SEMINOLE RD 1476 ATLANTIC BLVD. ATLANTIC BEACH FL 32233 NEPTUNE BEACH FL 32266 (904) 242-0444 (904) 249-8251 ---------------------------------------------------------------------------- Permit . . . . . . MECHANICAL HVAC PERMIT Additional desc . . Permit Fee . . . . 75 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 1/02/10 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 75 . 00 75 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 75 . 00 75 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CITYATLANTIC BEACH R J-=� `�•.. 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 OFFICE:(904)247-5826•FAX NO.:(904)247-5845 �� D t1 - BUILDING-DEPT@COAB.US ............_ r MECHANICAL PERMIT APPLICATION D AL COUNTY 1,JOB ADDRESS: 2.'IS THIS A SUB PERMIT: 3.DATE: �_ NO 17 6 "7 s ev-'l L&Ol/6 �,GQ ❑YES PERMIT#: 7/-3/0 9 PROPERTY OWNER: 4.NAME. �,t,�� 5.ADDRESS IF DIFFERENT FROM JOB ADDRESS: 6.PHONE: ( � + Y `tsH 16LJ1�C. MECHANICAL CONTRACTOR: 7.NAME OF COMPANY: 8.ADDRESS.: CS4.4 "r /V7(0 9.STATE OF FLORIDA LICENSE NO: 10.CELL PHONE: 11 FAX O.: C Ll9 3/0 z�av- 12.EMAIL ADDRESS: 13.OFFICE HONE: 14. V- 2 Imo`-,'Z..T-_ Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null nd void if work is not commenced within six (6) months,or if construction or work is suspended or abandoned for a period of six ny Ime a er r Is d. CONTRACTORS SIGNAT E: 16.CLASS OF WORK: 16.BUILDING:' 1 ERVIGE: 18.CURRENT COQE: ❑NEW INSTALLATION ❑NEW R ENT L ❑'O6 FLORIDA BUILDING CODE- KREPLACEMENT OF EXISTING SYSTEM VEXISTING ❑COMMER MECHANICAL ❑ALTERATION/ADDITION TO EXIST SYSTEM ❑OTHER ❑ REPAIR MECHANICAL EQUIPMENT TO BE INSTALLED: 19. HEAT: ❑ SPACE ❑ RECESSED CENTRAL ❑ FLOOR BURNERS: 20.AIR CONDITIONING: ❑ ROOM CENTRAL 21.DUCT SYSTEM: MATERIAL: THICKNESS: MAX CAPACITY: cfm 22. REFRIGERATION: MAX CAPACITY: cfm 23.COOLING TOWER: CAPACITY: 9Pm 24. FIRE SPRINKLER: NUMBER OF HEADS: 25. LIFT SYSTEM: ELEVATOR: MANLIFT: ESCALATOR: AUTOLIFT 26.COMMERCIAL HOOD NUMBER: 27. FIREPLACE: PREFABRICATED: MASONRY: 28.IRRIGATION: ❑ PUMP ❑WELL ❑ PIPING 29.GAS PIPING: #OF OUTLETS: ❑GAS AHU: ❑GAS WATER HEATER: 30.OTHER-SPECIFY: SOLAR HEATING, BOILERS,UNFIRED PRESSURE VESSEL,HEAT EXCHANGER OR COIL IN DUCTS ETC VALUE FOR OTHER ITEMS: 31.COOLING,MQUIPMENT: AIR CONDITIONING REFRIGERATION"EQUIPMENT CONDENSORS ETC. APPROVING NUMBER OF UNITS DESCRIPTION MODEL# MANUFACTURER TONS AGENCY 7"- ? 32.HEATING IPM . FURNACES,BOILERS FIE2Ei?i ACE5 41R HANQLERS=ETC: APPROVING OFUNITS DESCRIPTION MODEL# MANUFACTURER BTU AGENCY t-3 I Yo 2. 33-TA MKS. - LIQUID A . NUMBER GALLONS CONTAINED MANUFACTURER SERIAL# AGENCY BLDG04 Permit Applicaton Mech:REVISED:12/1B/2008 07/03/2009 07:46 FAX 9042498949 OCEAN-STATE-A/C i ATLANTIC-BEACH toVVIIVVI ,�✓+ t4 fi CITY OF ATLANTIC BEACH OC,- P7 I I,_ •�.,„._I,•. 7 ;; s) 600 SEMINOLE ROAD,ATLANTIC BEACH.F6 32733 OFFICE'(904)217-5826•FAX NO,:(904)747.5615 9UiLoINa•oEPr®O0AS.U6 DWAL COUNTY PERMIT APPLICATION `1• OB'A B:' .,,1' � „'" OYES PERMIT w•. Q 7 /767 .�cwluo(� (�o ,.,.. ,,,}L,^•9%'.it ';�:�t.,Ail' t'.'i•;.::5 '4 t', „w+^L, F'1°rr•,c.• . :,1; S ADORE56 If pFFERENT'FROM JOB ADDRESS: 8.PHONE' 4.NAME (J �/ d� T Wit ;I,, „a:r,�: „r �:r :"• ^o„�'r• ;►.dt rw;:, 7,NAME OF COMPANY; Z r 76 c pFapx��wppp pn .STATE OF LORIDA LICE1a CEU.PHONE, v NSE NO: Z C 93 O 13,OFFIC HONE' 14 12,EMAIL ADDRESS: V Y”Z Imo:"B Z r Application is hereby made to obtain a permit to do the work and Installations as Indicated. I CertMy that all work will be performed to meet the standards of all laws regulating construction in this jurlBOlcoon. This permitbecomes null nd voice a rk isr et Commenced within slx(6) months,or If construction or work 16 suspended or abandoned for a period of-slx CONTRACTORS 5I0NAT '7.? C8.'�tlR '• "�iH �. ..tir A�t'.,:1�4, •:r:,.`n:4•t.9'JN•",,.' tl1I ��it , . C)NEW INSTALLATION ❑NEW PR ENT L f-1.06 FLORIDA BUILDING CODE- N"EXISTING ❑COMM MECHANICAL 'REPLACEMENT OF EXISTING SYSTEM C3 ALTERATION I ADDITION TO EXIST SYSTEM M OTHER O REPAIR 1 �r I:LTGVR'r t.: "' '• rt }a',I ',9 btT,:,.,�r D SPACE O RECESSED CENTRAL _ ❑ FLOOR BURNERS: 19,NEAT: 20.AIR CONDITIONING: D ROOM CENTRAL THICKNESS: MAX CAPACITY' Cfm 21.DUCT SYSTEM: MATERIAL: REFRIGERATION: MAX CAPAGTY: efm 23.COOLING TOWER: CAPACITY: 8pn' 24.FIRE SPRINKLER: NUMBSR OF HEADS: Au70UFT: 25, UFT SYS'rtIM� ELEVATOR: MANLIFT. ESCALATOR: 26.COMMERCIAL HOOD NUMBER: 27.FIREPLACE: PREFABRICATED: MASONRY: 28.IRRIGATION: D PUMP O WELL D PIPING 0 GAS WATER MrATER: 29.GAS PIPING: *OF OUTLETS, U GAS AHU: 30 ;'RED -SPECIFY: SOLAR HEATING, aoLERS.UNFIRED PRESSURE VESSEL.HEAT EXCHANGER VALUE FOR OTHER ITEMS: I,. g �+ OR COIL IN DUCTS ETC ',.r. w .�ir. i , `' "a`: .I ,r t;i ,.•�, Z .,y� L+^.•r•t ',?+`e+C° Y 5'= �•v;�d;RI^`'a.�:y.t .i, NSI', '�wM, ., ::,.7.7117 �5...'�;."'IIE'•'r;d;; : trig, APPROVING y;,' • NUMBER MODEL MANUFACTURER TONS AGENCY OF UNITS DESCRIPTION o � T 4.4 .°.F'IY•.•.11 �1:1f�MT i rc, :4�- ir.•.,u�r�;;y'^�;'t r,:�e1M1-41+„i r„��+1��'llft� ':y•,,h, DESCRIPTION MODELS MANUFACTURER STU AGENCY OF NI /� /� �''•3 ( T�'� ,•�, G+w�` oROVING :''S's/>)f',q' v ;H,,.I,„j;',i�• IRB?': ^,.•:.•ti;�o;..:';.,�'�ti.; ,t'r'w': I..'fs•.':.iG it�•,`�J .,;(Y: ;��.:'.� ti't'�r�'�a1'l,�r'...T"• �)�iu.:::',•rr.- NUMBER GALLONS CONTAINED MANUFACTURER SERIAL# A ENCY BLDG04 Permit APOK419n Mach:REVISED.12!16%006