685 Amberjack Ln 2013 roof repair window repaie elec CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00002630 Date 5/08/13
Property Address . . . . . . 685 AMBERJACK LN
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . Soo
----------------------------------------------------------------------------
Application desc
REPAIR LEAK AROUND CHIMNEY BOOT, SOME SHINGLES
----------------------------------------------------------------------------
Owner Contractor
------------------------
------------------------
HALL COY LEE BEACHES HABITAT
685 AMBERJACK LANE 1671 FRANCIS AVENUE
ATLANTIC BEACH FL 322334202 ATLANTIC BEACH FL 32233
(904) 241-1222
----------------------------------------------------------------------------
Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 55 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 500
Expiration Date . . 11/04/13
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 55 . 00 55 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 59 . 00 59 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
� M 9 � 0 T M ,
BUILDING PERMIT APPLICATION MAY 0 7 2013
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845 JBy_ <:Z\/,\
Job Address:685 Amber*ack Lane,Atlantic Beach,FL.32233 PermitNumber:
Legal Description:30-060-38-25-29E, Royal Palms Unit 1,Lot 6 Blk 5 Parcel V
#
Floor Area of Sq.Ft. S q.Ott
Valuation of Work$500.00 Proposed Work heated/cooled non-heate if ILE COPY I
Class of Work(circle one): New Addition Alteration Repair Move Demolition
window/door
Use of e�xi�ting/proposed structure(�) ircle one): Commercial Residential
If an existing structure,is a fire sprin=system installed?(Circle one): Yes No N/A
Florida Product Approval#
For multiple products use_p_r_odu_ct approval form
Describe in detail the type of work to be performed:Repair leak around chimney boot,replace
shin2les as needed
Proverty Owner Information: z
0
Name:Coy L.Hall z
Address:'685 Amber*ack Lane, 0
City:Atlantic Beach State:FL.Zip 32233 Phone:904-520-1872
Fli!-4 F�=
E-Mail or Fax#(Optional) " IE2
08
Contractor Information:
$4
Company Name:Beaches Habitat for Humanity Qualifying Agent:Robert Peterson;Construction Manage 0
Address: 1671 Francis Ave. Citv:Atlantic Beach State:Fla. Zin 32233
Office Phone:904-241-1222 Job Site/Contact Number:904-334-1202 Fax#:904-241-4310
State Certification/Registration#
I
Architect Name&Phone# r—. L&
Engineer's Name&Phone#
Fee Simple Title Holder Name and
Address
Bonding Company Name and
Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or inslallati�,n has
Commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws re ,"i,
,fu aing
S.
construction in this jurisdiction. This permit becomes null and void if work is not commenced within six mont s, or Tf
sus�eud or Veriod ofsLx(6)months at any time alter work is commencV. d
construction or work is e I understan
us, e ��orabandonedf
that separate permits in redfor Electrical ork,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks and
Air Conditioners,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE i&CORDING YOUR NOTICE OF COMMENCEMENT.
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions a la
,f ws and
ordinances governinj this type g work will be complied with whether specified herein or not. 7he granting ofapermit does not
presume to give out ority to via te or cancel the provisions of any otherfederal,state,or local law regulating construction or the
�erformance ofconstruction.
Signature of Owner &L,�, Signature of Contra r
Print Name ame
--------------------P-2............11 i ............------ Print N ................................................................................................................................
Sworn to and subscribed be ore me Sworn to and subscribed before me
this 28—LaDay of ff)" 20/3 this 2NA Day of MLI.4 20 13
A,
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V�i Tublic M blic
Reviseu 0177ru
JOYCE M.FREEMAN JOYCE M.FREEMAN
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Notary Public-State of Florida
Notary Public-State of Florida . �.. j
I Expires J My Comm.Expires Jun 10,2013
ZZ-F MY COMM.Expires Jun 10,2013 W,
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City of Atlantic Beach APPLiCATi0N NUMBER
Building Department
iobeal�signedbyiheBulillinOD6partment.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445
?
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us
City web-site: http://www.coab.us
APPLICATION REVIEW AN6 TRACKING FORM
1\
Property Address: pyY-0�r")6- _Doaartment review required--_yp�X0:1
Building\
Applicant: biffA0 )ItS VtCkIJ14��t =Pii_m�g&Zoning
Tr;-e Administrator
Projec�. CO— � qk'v__(C� Ch)�OM[2__A PublicWorks
Public Utilities
Public Safety
Fire Services
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: R�rApproved. FIDenied.
(Circle one.) Comments:
(B=UILDING
PLANNING&ZONING Reviewed by:
Date:_5
TREE ADMIN.
Second Review: FlApproved as revised. FIDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: [-]Approved as revised. FlDenied.
Comments:
Reviewed by: Date:
Revised 07127/10
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00002629 Date 5/08/13
Property Address . . . . . . 685 AMBERJACK LN
Application type description WINDOW AND/OR DOOR
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 1800
----------------------------------------------------------------------------
Application desc
REMOVE AND REPLACE 6 WINDOWS
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
HALL COY LEE BEACHES HABITAT
68S AMBERJACK LANE 1671 FRANCIS AVENUE
ATLANTIC BEACH FL 322334202 ATLANTIC BEACH FL 32233
(904) 241-1222
----------------------------------------------------------------------------
Permit . . . . . . WINDOW AND/OR DOOR PERMIT
Additional desc . .
Permit Fee . . . . 60 . 00 Plan Check Fee 30 . 00
Issue Date . . . . Valuation . . . . 1800
Expiration Date . . 11/04/13
----------------------------------------------------------------------------
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 MAY 0 7 2013
Job Address:685 Ambeflack Lane,Atlantic Beach,FL.32233 Permit Number:. 4��
Legal Description:30-060-38-25-29�1110 al Palms Unit 1 ot 6 Bilk 5 Parcel# By I J
oo_y7 ea of Nq.tL Sq.
Valuation of Work$1800.00 Proposed Work heated/cooled non-heate /cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
Florida Product proval#FL8114-RI
For multiple piogucts use product approval form
Describe in detail the type of work to be performed:Remove and RpPlace 6 old alumiam windows with 6 new
single hun ,double pane windows
Property Owner Information:Address:685 Ambereack Lane,
Name:Coy L.Hall FILE
City:Atlantic Beach State:FL.Zip 12233 Phone:904-520-1872
E-Mail or Fax#(Optional
Contractor Information:
Company Name:Beaches Habitat for Humanity-Q 51 Manaaer
Address: 1671 Francis Ave. A* nt.;n,&ach_ 9t,AF..LBa. Zip 32233
Office Phone:904-241-1222 Job Site/ 3 v fm A um COD E Ld E H M ft,ILAN C E
State Certification/Registration#
Architect Name&Phone# C114 OF ATLeMeMACTI
Engineer's Name&Phone# SEP PERMI'S FOR ADDff1ONAL
Fee Simple Title Holder Name and Address X 11"QU IREhMNTS AND C0
Bonding Company Name and Address
Mortgage Lender Name and Address 13Y: (1� T1 ATP
Application is hereby made to obtain a permit to do the work and mstattarlons as maimmm.-rimm""m F 9 q�so% r to the
issuance ofa permit and that all work will bepolbrmed to meet the standards of all laws regulating construction in thisjurisdiction. .4permcomey null
and id , rk is not commenced within six(6)months,or if construction yrrworkK isscaus e7dW or abandonedfor a eriod ofsixk)months at any time afier
0 E ectr P
Mork,
.0 -c L= red Plumbing,Signs, ells,Pools,
rk o . nced. I understand that separate permits must be secu In naces,Boilers.Heaters,
Tanks and Air Condidoners�eta
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 YOVk NOTICE OF
COMMENCEMENT.
I here,�,certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
? work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
prov.
isions of any otherfederal,state,or local law regulating construction or the performance ofconstruction.
Signature of Owner Signature of Contra r
Print Name PrintName 5i,�
_Q,0_�j................�.vaiv........................ ........................................... ............
Sworn to and subscribed before me Swom to and subscribed before me
this20-Dayof Opaq 20 1 this IDay of 1,_1�0- .2013
-M . (=d -W �taM,(,1,—
ic 50a
Vl-ublic
Revised 01.26.10
JOYC:EM.FREEMAN
S f
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Notary Public-State of Florida
S Jun 0 Ol JOYCE M.FREEMAN]
4F of
State of Florida
Zj My COMM.Expires Jun D10,2013 Notary Public
51 # 89 9 1 0 01
F commission#DO 897794 My COMM.Expires Jun 10 i 2013
89 9
Commission#DO 897794
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City of Atlantic Beach
ff
Building Department
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us
City web-site.- http://www.coab.us
APPLICATION REVIEW AN TRACKING FORM
Property Address: ��5 L artment review required Yes 'No
Iding
Applicant: -PMM1Yig&Zoning
Tree Administrator
Public Works
Project: F-�Vt, (CD ICk CL (D' ui d w 5 -
Public Utilities
Public Safety
Fire Services
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified
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: [F(Approved. FlDenled.
(Cirde one.) Comments:
PLANNING&ZONING Reviewed by: Date:
TREE ADMIN. Second Review: ElApproved as revised. [IDeni&W
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SER\ACES Third Review: DApproved as revised. E]Denied.
Comments:
Reviewed by: Date:
Fevised 07M7110
A
�ACH -
CITY OF ATLANTIC BE -
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00002643 Date 5/09/13
Property Address . . . . . . 685 AMBERJACK LN
Application type description ELECTRIC ONLY
Property zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0 --------------
--------------------------------------------------------------
Application desc
switches -lights ----------------------
-----------------------------------------------------
Owner Contractor
------------------------
KNIGHT ELECTRIC LLC
HALL COY LEE 910 11TH AVE S
685 AMBERJACK LANE FL 322SO
ATLANTIC BEACH FL 322334202 JACKSONVILLE BEACH
(904) 247-9884
-- -------------------------------------------------------------------------
Permit * * * . . . ELECTRICAL PERMIT
Additional desc - - Plan Check Fee . 00
Permit Fee . . . . 68 . 20 Valuation . . . . 0
Issue Date . . . .
Expiration Date . . 11/05/13 -----------------------
-----------------------------------------------------
Other Fees . . . . . . . . . STATE ELEC DCA SURCHARGE 2 . 00
STATE ELEC DBPR SURCHARGE 2 . 00
---------- -----------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 68 . 20 68 . 20 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 72 . 20 72 . 20 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
C m np.An,�*_"C BEA MI .
800 Seminole Rd,Atlantic Beacb,FL 32.233
Ph(904)247-5826 Fax(904)247-5845
4r,ktn1,TX le liaAe_ PERMIT#
JOB ADDRESS: G
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS PHASE
VALUE OF WORKS
NEW SERVICE El Overhead Underground, Underground up Pole
OResideutW(Main) Service
00-100 amps 0101-150amps 0 1 51-200amps amps of Meters
"Commercial (Main)Service
LJO-100 amps 0101-150amps 0 151-200amps 0 amps OCT Service amps
Conductor Type Size
E;Multi-Family(Main) Service
[10-100 amps f.-,101-150amps f]1517200amps 0 amps #of Unit Meters
LiTemporary Pole 0 ainps
SERVICE UPGRADE D amps E7 CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORi-&LKLICTURES,ETC.-
0100amps E1150amps E)200atnps 0 s . OCT Service amps
ADDITIONS,REMODELS,REPAIRS,HUILD-OUTS,ACCESSORY STRUC TURES,ETC.
Outlets/Switches: 0-30amps 31-100amps 101-200amps
Appliances: 0-30amps 3 1-1 00amps 10 1-200amps
A/C Circuits: 0-60amps 61-1 00amp.pl
Heat Circuits: # circuits
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS
El Swimming Pool 0 Sign 0 Smoke Detectors_Qt�. O-Traasf�rm. ers KVA f Motors h
P
FIRE ALARM SYSTEM (Requims 3 sets of plans)
Qty-volts/amps VAL UE OF WORK S
REPAIRS/MISCELLANEOUS
oReplace Bumt/Damaged Meter Can 0 Safety Inspection,..... -Q Panel Change DOH to UG
2&ar: Lq,17%�Je_S it- d [� t/�r
Permit becomes void if woric does not commence within a six month period or work is suspended or abandoned for six months. I her�by certify thait have
Tep.d this application and know the sarne to be trut an4,v)rre.&, Alf p-ivisimt of laws and crdirarce-s gov�-_qingcMs work will be complied with whether
6pwificd or not. Tbe permit does not give authority to violate the provj3ions,of any qi4erstate or Ifoww. mnstruction or the pertomAncc of
construction.
Property Owners Name Phone Number
Electrical Company �Vvl(kr OfficePhone V-99f* Fax 2'�74Y�)
Co- Address; 11 City 1,4/�_ -State F/ zip �?70
'Ucense Holder(Print):
'State cation/Registration# M�16(2�23
r_y_1
T\�btarized Signature of License Holder
Before me this 01/T ATXj
Z .1N
0 ..MY, 31 N. 95 0 JIL
Signature of Notary P _.: - rij
Omit uncerwri