707 Triton Rd (vault) A
CITY OF ATLANTIC BEACH
Ste' 800 SEMINOLE ROAD
ATLANTIC BEACH, FLORIDA 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 05-00030325 Date 5/13/05
Property Address . . . . . . 707 TRITON RD
Tenant nbr, name . . . . . . REPL 9 WINDOWS
Application description . . . RESIDENTIAL ADD/RENOVATE/ALTER
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 980
Owner Contractor
------------------------ ------------------------
JACKSON, VINCENT OWNER
707 TRITON ROAD
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
--------------------- ------------------------ -------------------------------
Permit BUILDING PERMIT
Additional desc
Permit Fee . . . . 35 . 00 Plan Check Fee 17 . 50
Issue Date . . . . Valuation . . . . 980
----------------------------------------------------------------------------
Special Notes and Comments
FBC 1707 .4 . 2 EXTERIOR WINDOWS & GLASS
DOOR SHALL BE TESTED BY AN APPROVED
INDEPENDENT TESTING LABORATORY & SHALL
BE LABELED WITH AN APPROVED LABEL
IDENTIFYING THE MANUFACTURER,
PERFORMANCE CHARACTERISTICS & TESTING
LABORATORY.
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 35 . 00 35 . 00 . 00 . 00
Plan Check Total 17 . 50 17 . 50 . 00 . 00
Grand Total 52 . 50 52 . 50 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING
CODES.
AIL
BUILD FF IAL
rj �lrf; CITY OF ATLANTIC BEACH Cc.
D. d--
' BUILDING / ZONING DEPARTMENT Higgins.
800 Seminole Road S. Doerr
Atlantic Beach,Florida 32233
JSSl>f (904)247-5800 R E s E I v E i]
(904)247-5845 Fax CITY OF ATLANTIC BEACH
www.coab.us BUILDING & ZONiK'G
PLAN REVIEW COMMENTS MAY 12 2005
Permit Application # C-,C� - --:1 C,3 25 BY:
Property Address: Com—] �� �L
Applicant: C l C."Sbt'-d� y/^I 1"J C-E!�T
Project: I2��L 9 �l�0b t�.f�
This permit application has been:
"proved
❑ Reviewed and the following items need attention:
1 W(L e E LA IC
re t U T
l�-o�. Z• F—'�T`2�2 w��.�o�s �cl.a�-�s deocz. ��w�-�,
L-A-kp o¢ --o 5 Iraq
a L 1
cln "CQ ��
L.ASve�-> v► i L. C—(�.f A L ►1
Please re-submit your application when these items have been completed.
Reviewed By: y Date:
Date Contractor Notified:
• RECEIVEC}
,l CITY OF ATLANTIC BEACH
BUILDING &ZONING CITY OF ATLANTIC BEACH
Y 1�WS, $IYLIGHTS, GARAGE DOORS,HURRICANE SHUTTERS
ff
Date: D 2-L vS
BY: '
Job Address: is i I�
Owner: ( j C,, A<-k- S,c. 7
Address: ::?n XD Phone: ��yo�� 17zy Z S
Legal Description: Block Number: Lot Number: Zoning District:
Contractor: z e ti State License Number:
Address: Phone:
City: State: Zip: Fax:
Describe proposed use and work to be done: IZ t�j LAec �1 wI►iD�: i
Present use of land or building(s): S-t
Valuation of proposed construction:
Is approval of Homeowner's Association or other private entity required? If yes,please submit with this
application.
Required Building Data:
Mean Roof Height (ft) Building Width (ft) Building Length (ft)
Roof Slope Window Height V.�(ft) Window Width ft)
Window Elevation from Grader,[iN(,,,ty-j(ft)
Measurement from corner of building to window (ft)
Number of windows being installed
Mean Roof Height
800 Seminole Road •Atlantic Beach,Florida 32233-5445
Phone: (904)247-5800 • Fax: (904)247-5845 • http://www.ci.atiantic-beach.fl.us
Page 1 Revised 1/27/03
Procedure: In order to expedite issuance of permits provide all information as appropriate. Incomplete applications may
result in delay in issuance of permit.
In addition to the building data,the following information is required:
1. Manufacturer's Test Report with Uniform Structural Load(psf)
2. Installation Procedures
3. Window Description/Type
4. Garage Door Description/Type
5. Skylights Description/Type
6. Hurricane Shutter Description/Type
7. Elevation View of Window Locations
I hereby certify that all information provided with this application is correct.
Signature of Owner: it. - JLLDate:
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of the laws and
ordinances governing this type of work will be complied with,whether specified herein or not. The granting of a permit does not presume to
give authority to violate or cancel the provisions of any federal,state or local rules,regulations,ordinances,or laws in any manner,including the
governing of construction or the performance of construction of the property. I understand that the issuance of this permit is contingent upon the
above information being true and correct and that the plans and supporting data have been or shall be provided as required.
Signature of Contractor. Date:
Address and contact information of person to receive all correspondence regarding this application(please print).
Name:
Mailing Address:
Telephone: Fax: E-Mail:
AS TO OWNER:
Sworn to and subscribed before me this (2"'G?'- day of m�/�}��`� ,20 0�
State of Florida,County of Duval
Notary's Signature �/� ^�
JENNIFER SCHLUETER
❑ Personally known
_.: MY COMMISSION N DD 121301 Produced identification
EXPIRES:May 27,2008
- gr;1 Bonded Thru Notary Public Underwriters Type of identification produced �5 C7 3C J
„ a
AS TO CONTRACTOR:
Sworn to and subscribed before me this day of ,20
State of Florida,County of Duval
Notary's Signature:
❑ Personally known
❑ Produced identification
Type of identification produced
800 Seminole Road Atlantic Beach,Florida 32233-5445
Phone: (904)247-5800 Fax: (904)247-5845 http://www.ei-atlantic-beach.fl.us
Page 2 Revised 1/27/03
pries 74o/.3740 74013740 Single Hu ' - 1/2" Flange Frame
FENESTRATION PRODUCT COMPLIES WITH THE
NEW FLORIDA BU l CODE
I FOR RESIDENTIAL BUILD
IN ITH A MEA ROOF
j HEIGHT OF 30 FT.OR LES -, EXPOSURE"B' (WHICH IS
INLAND OF A LINE THAT�'I 1500 FT. FR THE COAST),
AND'WALL ZONE'f`5"(INS LE R THE CORNER OF
THE BUILDING),
PER ASTM E1300,
THE CORRECT GLASS THICKNESS,
BASED ON THE NEGATIVE DESIGN PRESSURE (DP)
LISTED BELOW, HAS BEEN INSTALLED IN THIS UNIT.THE
GLASS THICKNESS IS BASED ON,ITS'WIDTH, HEIGHT,
AND ASPECT RATIO.
WIND ZONE: 140 MPH
DESIGN PRESSURE (DP): + 45.0 / -47.2
THIS PRODUCT MEETS THE REQUIREMENTS FOR '
I' STRUCTURAL LOADS,WATER AND AIR INFILTRATION PER
ATTACHED HAMA PERFORMANCE LABEL.BE ADVISED THAT
IF LOADS ARE PLACED UP TO OR EXCEEDING THE TESTED
LEVELS,THIS PRODUCT MAY BE ALTERED IN SUCH A WAY
THAT FUTURE,PERFORMANCE WILL BE REDUCED.
COMPLIANCE MUST INCLUDE INSTALLATION
ACCORDING TO MANUFACTURER'$ INSTRUCTIONS AND
FLORIDA CODE F�EQUIREMENTS.
BetterBilt, Division of Ma. Home Products
CPpRO
11yOFV ED
BHGUICDI
'D�E dEAOy
FFICE
MAY 12 2uU5 .
BY. 4
AADIA/NWWDA 101/I.S.2-97 -�
TEST REPORT SUMMARY
Rendered to:
NII HOME PRODUCTS,INC.
SERIES/MODEL:740/744/3740
TYPE: Aluminum Single Hung Window with Flange
Title of Test Results
Rating H-R45 52 x 71
Overall Design Pressure +45.0 psf
-47.2 psf
Operating Force 23 lb max.
Air Infiltration 0.10 c
Water Resistance . 5 P S
Structural Test Pressure +67.5 psf
-70.8 Psf
Deglazing Passed
Forced Entry Resistance 10
Reference should be made to Report No.01-40656.03 for complete test
specimen description and data.
For ARCHITECTURAL TESTING,INC.
Mark A.Hess,Technician
KAH.baw 22,V—h2002
600005991000 Item#0711
A0� tOv, �
t;IT r v.
BUILDING OFFICE
MAY 12 Mb
By:-
FPLOT PLAN
Royal
REPLAT OF FART UF Ru YAL PALki5
LOT . I , BLOCK —io UNIT 24
PLAT BOOK 31
PAGE (S) 16, 16A , 16L, , 16c & 16,),
CURRENT RECORDS , DUVAL COUNTY, FLORIDA
SCALE: I" = 20' A �
10' UTILITY EASEMENT ;!pTE : VERIFY I
SEWER ELEVATION
AND LOCATION -
INV - SEWER
i 93.01 ELEV . *4.0
12; tl II ,3 10.7
SWALE'
' - 11 .3
E- t fV I<- Il .g C
I ' SETBACK F" OF
ET
PLAN - H- 12
i Q
/ FIN . FL . ELEV .
�
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il�l0' 1 `' 1 �• 4r�
ca
tr
E- TT. _ c- I I.
F-i l I. ,c. F- 11 .5 —
i V
3' CON c• WALK
101. t `
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CONC `n
DRIVE
94.95,
10.4
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�o.20 R T O N �1-- ' Cu�s� c"
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RECEIVED
A i r1 0 2000
,
City of Atlantic Beach
CITY OF ATLANTIC OEACH EuMing and Zoning
PERMIT APPLICATION REMODEL, ADDITIONS, OR ALTERATIONS
MO/VENG., DEM�,O,/LMOONNS/1 Ks
Owner(s):�� f l ft 4f 4-4 r�/UL Vac, W 1
.lob Address : / D / / rj'-160n 7`d Phone :
I..at# Block or Unit# ;� Subdivision: t/wb4 1
Contractor: Jan.-;� & -&Lcostate License
Address : 1 • O • L� r Phone No;
L4
City State Zip Code log
Describe work to be done: RIX L41-ot
Present use of building: t/ 01,
Valuation of Proposed Construction: C�i Llt1�J
Proposed use:
Is this an addition? U yes, what are the dimension of the added
space : ft X ft. Will the added area be heated and
cooled.? New electrical (or increase)?
New plumbing fixtures ? New fimplace? New Heat/AC?
SUBMIT THREE(COMMERCIAL) TWO (RESIDENTIAL) COMPLETE SETS OF PLANS, INCLVDING
SITE PUN, SURVEY, ENMITY CODE FORMS, NOTICE OF COMbfENCL'MENT, AND
OWNERICONTRACTORS A ,DAVIT, IF OWNERS 1S C NTRACTORS.
Signature OWNER: U/ Date: e, ec
Signature CONTRAC Date: at-1 `
AS TO OWNER:
Sworn to and subscribed before me this o? da of + �oc3Ei
THOMAS HUGHES �, THOMAS HUGHES
Notary Public, State of Florida i -� rHAI , tate of Florida
My Comm. expires Sent. 3, %0U NOTARY PUBLIC My Comm. expires Sept. 3, 2001
Comm. No. CC 66i.j, Comm. No. CC665457
AS TO CONTRACTOR:
Sworn to and subscribed before me this- alG- day 0 AP + �U
e'' THOMAS HUGHES
Notary Public, State of Florida NOTARY PUBLIC
MY Comm. expires Sept. 3, 2001
Comm. No. CC 665451
CITY OF ATLANTIC BEACH
DEPARTMENT OF BUILDING
800 SEMINOLE ROAD-ATLANTIC BEACH, FL 32233-TEL: 247-5826-FAX: 247-5877
IIIIiI _-
Permit Number: 20087
Address: 707 TRITON ROAD
Permit Type: REMODELING ATLANTIC BEACH, FLORIDA 32233
Class of Work: REMODEL Township: 0 Range: 0 Book: 16
Proposed Use: SINGLE FAMILY Lot(s):1 Block: 10 Section: 0
Square Feet: Subdivision: ROYAL PALMS UNIT 2A
Est. Value: Parcel Number:
Improv. Cost: 10,000.00 —,_ 0 Q
Date Issued: 5/19/2000 Name: JACKSON VINCENT & LORRAINE
Total Fees: 90.00 Address: 707 TRITON ROAD
Amount Paid: 90.00 ATLANTIC BEACH, FL 32233
Date Paid: 5/19/2000 Phone: (000)000-0000
Work Desc: REPLACEMENT WINDOWS .z.r
SOUTHERN HOME PRODUCTS, INC- PE T90.00
� Pyr ia'} Y•, 4 3 T`
R
FINALBU1IL1FNW,zX11" T,
� k
.4yt
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.
$90.00 14
�LK Date: 5/26/00 01 Receipt: 0060622
CHECKS 3318
ATLANTIC BEACH UILDIN EPT. 00100003221000
This Warranty Deed Vali l o ?G1 201
Made this 11_91�1_ day of June A.D. 19 92 OFFICIAL RECORDS
by
Judith Ettlinger, unmarried
p. 0. Box 101
Day, Florida 32013-0101
hereinafter called the grantor, to
7incen�t Tyrone Jackson and Lorraine L. Jackson, his wife
o whose post office address is:
`v 707 Triton Road
Atlantic Beach, Florida 32233
`_ cn hereinafter called the grantee:
(Whenever used herein the term "grantor"and "grantee" include all the parties to this instrument and the
heirs,legal representatives and assigns of individuals,and the successors and assigns of corporations)
><
Witnesseth, that the grantor, for and in consideration of the sum of S Ten and 00/100 Dollars
oand other valuazlle considerations, receipt whereof is hereby acknowledged, hereby grants,bargains,sells, aliens, remises,
p n releases, c,aveys and confirms unto the grantee, all that certain land situate in Duval
@ County, Florida, viz: /
-' -'/
�t 1, Block 10, Replat of Part of Royal Palms, Unit
�16BA�16Ccand116Dtof
plat thereof recorded in Plat Book 31, pages ,
m the current public records of Duval County, Florida.
0
w
Q
a
i
Subject to covenants, restrictions and easements of record and taxes `
subsequent to 1991.
Together with all the tenements,hereditaments and appurtenances thereto belonging or in anywise appertaining.
To Have and to Hold, the same in fee simple forever.
And the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee simple;
jthat the grantor has good right and lawful authority to sell and convey said land; that the grantor hereby fully warrants
oche title to said land and will defend the same against the lawful claims of all persons whomsoever; and that said land is
u I"free of all encumbrances except taxes accruing subsequent to December 31, 19 91..
In Witness Whereof, the said grantor has signed and sealed these presents the day and year fust above
written.
{ -Signed, sealed and delivered in our presence:
W Y
C= 0 c
`_, 'amc ../ Ju Tttlinger
FEE
Carne .. �}
T:„� 1 /
C?)
DOCUMENTARY,� J1►a��1� tv.k i
poli amc. cv
GIN! v. R:.aEN
1 n f ....t.
5 Q
3_.____ �
State of Florid
-=o County of a°e
The foregoing instrument was acknowledged before me this ✓��ay of June
19 92
by Judith Ettlinger, unmarried
_cis'—
who iproduced personally known to me or who has 0�.* Le3�S- �3y as identification
and who 'did 4a take an oath.
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CITY OF
1'�actic �'eac! - �Gvciala
800 SEMINOLE ROAD
ATLANTIC BEACH,FLORIDA 32233-5445
TELEPHONE(904)247-5800
FAX(904)247-5805
September 28 . 1995
Mr . & Mrs . Vincent Jackson
707 Triton Road
Atlantic Beach, FL 32233
Dear Mr . and Mrs . Jackson:
Our records indicate that you are the occupant of the
following property in the City of Atlantic Beach, Florida :
707 Triton Road
a/k/a Lot 1 , Block 10 , Royal Palms 2A
RE#171392-0000
Investigation of this property discloses that I have found
and determined that you are in violation of City of Atlantic Beach
Ordinance Chapter 21 , Section 21-21-2 , i . e. , repair of motor
vehicle on City right-of-way.
You are hereby notified that unless the condition above
described is remedied within one (01) day from the date of your
receipt hereof , this case will be turned over to the Code
Enforcement Board .
Under Florida Statute 162 . 09 , the Code Enforcement Board may
impose fines of up to $250 .00 per day for a first violation and
$500 .00 per day for a repeat violation.
Sincerely ,
Karl W . Grunewald
Code Enforcement Officer
KWG/pah
cc : City Manager
CERTIFIED !TAIL
RETURN RECEIPT REQUESTED
5127
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
-- PERMIT INrURMA`FiUN - - LOCATION INFORMATION
:Iermit Number: 5127 Address: 707 TRITON ROAD
Permit Type: RE ROOF ATLANTIC BEACH, FLORIDA322 ,
o� Work: NEW
322;x:
-------- LEGAL DESCRIPTION -
Constr. Type: WOOD FRAME Lot: Block: Section:
Proposed Use: SINGLE FAMILY
Township: RNG: 0
Dwellings: 1 Code: O Subdivision:
Estimated Value: $0. 00
Improv. Cost : $0. 00
Total Fees: $22. 50
Amount`.* z $22. 50
ie .`vi c: ;�#•Ujl�I;.ATION ---- APPLICATION FEES ----
�i t MALAY REALTORS PERMIT $22. 5G
WATER IMPACT FEE. $0. 00
f, r "�0 TR-TQN ROAD
ATL,�,NTZC tjo, CH, FLORA.: SEWER IMPACT FEF
PhoT,,�: ( 9C t)24`2 31 1
WATER METER
RADON GAS-H. R. S. $0. 00
RADON GAS - 5% $0. 00
-- ------- t,;pNTt�AC'i'u�3 INFORMATION SO. 00
Name: DBA £SENHOWER ROOPI.NG WATER TAP
SEWER TAP $0. 00
�.Hdress : c12(-=, BELINDA CIRC:
JACKSONVILLE, FLOEt1E�A ��:�.. HYDRAULIC SHARE. $0, 00
RE-INSPECT FEE $0. 00
RC,01126590 Type: 7 SEC. H IMPACT FEE $0. 00
OTHER $0. 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 MECHANIBu' ILDINGIMPROVEMENTS.LIEN LAW CAN RESULT INPROPERTY OWNER PAYING TWICE FOR
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW.
ATLANTIC BEACH BUILDING DEPARTMENT
By:
v
CITY OF ATLANTIC BEACH
PERMIT APPLICATION ROOFING
'Owner(s):
Address: 12 �!/O� /�� Phone:
Lot # Block or Unit # Subdivision
Contractor:_
Address: Z,6 ��-,yol'� G,�. Phone:
State License No.�<-, Q0 �j'YcO
Describe work to be done:
Materials to be used:
Signature OWNER: ' Date:
Signature CONTRACTOR:
CITY OF
Office of Building Official
REQUEST FOR INSPECTION �73�
Date
Permit No.
Time A.M.
Received //�.� / P.M.
,?e,-7z
Job Address Locality
Owner's �p—
Name 17��Sd'/�' Contractor
BUILDINs
i� CONCRETEELECTRICA PLUMBING ECHII�1TCAtl�
Framing ❑ Footing ❑ Rough Wiring ❑ Rough ❑ Air Cond. & ❑
Re Roofing ❑ Slab ❑ Temp Pole ❑ Top Out ❑ Heating
Insulation ❑ Lintel ❑ Final ❑ Sewer ❑ Fire Place ❑
Pre Fab
READY FOR INSPECTION
A.M.
Mon. Tues. Wed. Thurs. �nda P.M.
Inspection Made
Inspector ' I Inspection
,y Certificate of Occupancy ❑
!1/' 5 �/✓ �///`� �� Date
PSR-W4 6663
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
----- PERMIT INFORMATION ------ -------- LOCATION INFORMATION -------- -
Permit Number : 6683 Address : 707 TRITON ROAD
Permit Type: MECHANICAL ATLANTIC BEACH , FLORIDA 32233
-lass of Work: ALTERATION ---------- LEGAL DESCRIPTION ----------
Constr . Type: WOOD FRAME Lot : Block : Section:
Proposed Use: SINGLE FAMILY Township : RNG: 0
Dwellings : 1 Code : 0 subdivision:
Estimated Value : $0 .00
Improv . Cost : $0 . 00
Total Fees : $27 .00
Amount Paid : $27 . 00
Date Paid: 4/26/93
Work Desc . : replacement of central heating system
---------- OWNER INFORMATION ------- ---- APPLICATION FEES -----
Name : MR. JACKSON PERMIT $27 .00
Address : 707 TRITON ROAD WATER IMPACT FEE $0 . 00
ATLANTIC BEACH , FLORIDA 32235 SEWER IMPACT FEE $0 .00
Phone : { WATER METER $0 . 00
RADON GAS-H . R. S . $0 . 00
------- CONTRACTOR INFORMATION ------ RADON GAS - 5% $0 . 00
Name: SOUTHERN HEATING & AIC CO IN WATER TAP $0 .00
Address : 10606 FORT CAROLINE ROAD SEWER TAP $0 . 00
JACKSONVILLE HYDRAULIC SHARE $0 .00
License : Type : 0 RE-INSPECT FEE $0 . 00
SEC .H IMPACT FEE $0 .00
NOTES:
C
NOTICE —ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING
PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE
BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE
CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER
"FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN
THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS."
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW.
"r-OC.gTMENT
BUILDING AND ZONING INSPECTION DIVISION
CITY OF ATLANTIC BEACH
ATLANTIC BEACH. FLORIDA 32233
APPLICATION FOR MECHANICAL, PERMIT CALL-IN NUMBER
IMPORTANT — Applicant to complete all items in sections I, II, III, and IV.
1. _ . _
LOCATION str.at Addrat: / /76/J
OF Intersecting Streatr: Daiwa@" r And-
Sul --
LDING ---------
Sub-division
I. IDENTIFICATION — To be completed by all applicants
In considorat;on of permit g;�sn for doing the work as described in the abcve ttafernent wa hereby agree to r0c'm sa•d .o•s a-: -:3a-:e.,tk the attached plant and specif cafions which are a part hereof and in accordance .itn the C.f of Jackson,.l'e old.
of good practice listed therein. y e ces a^a s e a as
Noma of Mackanical Contractors
Confractor (►ri"f) SOuTNt7zn/�(��' /�(� C(,._�/ r\ Master /
Nam* of
Property O."er wk. TitC
Signature of O.ner signature of _
w AwAerrsed Agent
Architect or Engineer
III. GENERAL INFORMATION
A. Type of ting fuel: E3. {
IS OTHER CONSTRUCTION BEING DONE'ON
Elect.c THIS BUILDING OR SITE I
❑ Gas—❑ LP ❑ Natural ❑ Central Utility
13 04 -
IF VES, GIVE NUMBER OF CONSTRUCTION
PERMIT
❑ Otts" — Specify
IV. WCHMIKAL EQUIPMENT TO RE INSTALLED
NATUf�OF WORK
(Provide complete 60 of cornporsenh on beth of this formr L3-'/Residential or ( I Commercial
"at ❑ Space ❑ Recessed 0 Contra) O Boor ❑lNN w Building
❑ Air Condrliowingo ❑ Room ❑ Central �L'J E�x ting Building
13pwct System: Materiel Tlicko*$L l7 Replacement of existing system
Maximum capacity GIT ❑ New Installation(No system previously installed)
❑ Re{r;99ret;o4 ❑ Extension or add-on to existing system
❑
❑ Other — Specify Goofing to.or: Capacity g•P.n+. ---
❑ Fire sprinkler: Number of head --
❑ Etovater ❑ Mari ❑ Escalator— _( mbar)
❑ GosoSM pumper (number) THIS SPACE poll OFFICE USE ONLY
�ReceMd)
O T*A. (number)
Refnarhs
O LM cOrtlaisers (aumbor)
❑ Uef'sred presstrr•vessot
❑ leis Permit Approved by pat.
❑ OAW — Specify Permit Foe _
I
LIST ALL EQUIPMENT
AM CONDITIONING AND REFRIGERATION EQUIPMENT
Number VaJtADescription Model Number Manufacturer jy �� roving
"/�`���
HEATING FURNACES, BOILERS, FIREPLACES -
Nusaber UWta Descsiptlon Model Number Manufacturer g�jy AaP+Agency
TANKS -
88vw I(any Notorinal Capacity
and Dtmentslaos 17Pe Liquid Name of Scrial Approving
Contained Manufacturer No. Agency
�; 7.1;v i
CITY OF ATLANTIC BEACH, FLORIDA
Approved by APPLICATION FOR ELECTRICAL. PERMIT
TO THE CHIEF ELECTRICAL INSPECTOR: DATE: V1 0z 19 `S
IMPORTANT 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 AND CITY OF
ATLANTIC BEACH ORDINANCES.
ELECTRICAL FIRMI:, MASTER ELECTRICIAN SIGNATURE JOURNEYMAN
NAME -f1��I�SON ADDRESS: 7o-7 �P: i %o, k GC —RFD—BOX—
BLDG.
FDBOXBLDG.SIZE BETWEEN:
RES. ) APT. ( ) COMM. ( ) PUBLIC ( ) INDUS. ( ) NEW( ! OLD (/14- REW. ( )
ADDITION ( ) TRAILER ( ) TEMP. ( ) SIGNS ( ) SO. FT.
SERVICE: NEW( ) INCREASE (\d REPAIR ( ) FEE
CONDUCTOR SIZE Q AMPS }�'� COPPER ( ) ALUM. A) / r
SWITCH OR BREAKER AMPS 1 PH W ;2 VOLT RACEWAY
EXIST.SERV.SIZE _ ���'� AMPS PH W �� VOLT 5`� RACEWAY
FEEDERS NO. SIZE NO. SIZE NO. SIZE
LIGHTING OUTLETS CONCEALED OPEN TOTAL
RECEPTACLES CONCEALED OPEN TOTAL
0.90 AMPS. 91.100 AMPS.
SWITCHES
INCANDESCENT
FLUORESCENT&M.V.
FIXED 0.100 AMPS. OVER
APPLIANCES BELL TRANSF.
AIR H.P. RATING H.P. RATING
CONDITIONING COMP.MOTOR OTHER MOTORS AMPS CEIL HEAT: KW-HEAT
0.1 OVER
MOTORS H.P. VOLTAGE PHS NO. 1 H.P. VOLTAGE PHS
MISCELLANEOUS
Q-�v
TRANSFORMERS: UNDER 600 V. OVER 600 V.
NO. KVA NO. IKVA
NO. NEON TRANSF. NO. VA. MA. MOTOR SIZE SWITCH FLASHER
EACH SIGN ---
FORWARDED
TOTAL FEES 3_?, ':�`d
I
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