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467 Whiting Ln (vault) CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 INSPECTION EMAIL REQUEST: Building-dept@coab.qs Application Number . . . . . 08-00000132 Date 1/29/08 Property Address . . . . . . 467 WHITING LN Application type description MECHANICAL ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc INSTALL 1 CU & 1 AHU & 1 HS ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ ADALIA COOL CLIMATE HEATING & A/C 467 WHITING LANE 3653 REGENT BLVD EAST PARK ATLANTIC BEACH FL 32233 UNIT 307 JACKSONVILLE FL 32246 (904) 509-3062 ---------------------------------------------------------------------------- Permit . . . . . . MECHANICAL PERMIT Additional desc . . Permit Fee . . . . 89 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 7/27/08 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 89 . 00 89. 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 89 . 00 89 . 00 . 00 . 00 PERmrr is APPRovED ONLY IN ACCORDANCE wrrH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CITY bF ATLANTIC BEACH 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 08 OFFICE:(904)247-5826*FAX NO.:(9G4)247-5845 BUILDING-DEPT@COAB.US MECHAN CAL PERMIT APPLICATION DUVAL COUNTY 1.JOB ADDRESS: 12.IS THIS A SUB PERMIT: 3.DATE: E3 NO 0 YES PERMIT#: Atlantic Beach, FL 32233 PROPERTY OWNER: 4.NAME: 5 ADDRESS IF DIFFERENT FROM JOB ADDRESS 6.PHONE. --r-)-Z L/ MECHANICAL CONTRACTOR: 7.NAME OF COMPANY: 8.ADDRESS.. cc.,C)I C 1 1,"'k, 3 (�, 5-3 RI-- C 9.STATE OF FLORIDA LICENSE NO: 10.CELL PHONE: 11.FAX NO.: A-c- 67 o L( 3 c��, 2- 4 12.EMAIL ADDRESS: 13.OFFICE PHONE: 14. r C.>I^,/(-j, -,,c-/--t !i()L�-6 (-(/ - 9 3 Application is hereby made to obtain a permit to do the work and installations as indicated. I certify 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. CONTRACTORS SIGNATURE: 15.CLASS OF WORK: 16.BUILDING: 17.SERVICE: 18.CURRENT CODE: 11 NEW INSTALLATION 0 NEW -ffr'RESIDENTIAL 0'06 FLORIDA BUILDING CODF7 O-REITLACEMENT OF EXISTING SYSTEM O-EXISTING 0 COMMERCIAL MECHANICAL •ALTERATION/ADDITION TO EXIST SYSTEM •REPAIR 0 OTHER MECHANICAL EQUIPMENT TO BE INSTALLED: 19. HEAT: 0 SPACE ORECESSED (P-C-ENTRAL 0 FLOOR BURNERS: 20.AIR CONDITIONING: 11 ROOM Aa-CENTRAL 21. DUCT SYSTEM: MATERIAL: /,* _5,,',,-ftHICKNESS:L MAX CAPACITY: �,D vct P cfm 22. REFRIGERATION: MAX CAPACITY: cfm 23. COOLING TOWER: CAPACITY: 9pIT1 24.FIRE SPRINKLER: NUMBER OF HEADS: 25. LIFT SYSTEM: ELEVATOR: MANLIFT: ESCALATOR: AUTOLIFT: 26. COMMERCIAL HOOD NUMBER: 27. FIREPLACE: PREFABRICATED: MASONRY: 28. IRRIGATION: 0 PUMP 0 WELL 0 PIPING 29.GAS PIPING: #OF OUTLETS: 0 GAS AHU: 0 GAS WATER HEATER: 30.OTHER-SPECIFY: SOLAR HEATING, BOILERS,UNFIRED PRESSURE VESSEL,HEAT EXCHANGER OR COIL IN DUCTS ETC. VALUE FOR OTHER TEM& 31.COOLING EQUIPMENT: AIR CONDITIONING.R RIGERATI EQUIPMENT,CONDENSORS,ETC. NUMBER APPROVING OF UNITS DESCRIPTION MODEL# MANUFACTURER TONS AGENCY -�1_t�c 3 QJP;� -;?-Vz- e--- - L/ 32.HEATING EQUIPMENT: FURNACES,BOILERS,FIREPLACES,AIR HANDLERS ETC. N APPROVING OF UNITS DESCRIPTION MODEL# MANUFACTURER BTU AGENCY 33.TANKS: YPE LIQUID APPROVING NUMBER GALLONS CONTAINED MANUFACTURER SERIAL -----AGENCY COAB FORM BLDG04:REVISED:1/8/2008 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 INSPECTION EMAIL REQUEST: Bui1ding-dept@coqb.us Application Number . . . . . 08-00000182 Date 2/08/08 Property Address . . . . . . 467 WHITING LN Application type description ROOF PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 1200 ----------------- -------- ----- ----- - ---------- ----- - - ----------- ------------ Application desc REROOF FL 183 FL 196 . 4 ---- ----------- --- ---- --- - ------ ----- - --- - ------ ---- -- - - - - -- --- ---- --------- Owner Contractor ---------------------- - - - - ---- - - -- -- -- - - - - ---- -- ADALIA OWNER 467 WHITING LANE ATLANTIC BEACH FL 32233 ------------------------------ ------ ----- ------ ------ - ---- ------------------ Permit . . . . . . ROOF PERMIT Additional desc . . Permit Fee . . . . 40 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 1200 Expiration Date . . 8/06/08 ----------------------------------------------------- - ---------------------- Fee summary Charged Paid Credited Due ----------------- ------ ---- -- -------- ---- ------ ---------- Permit Fee Total 40 . 00 40 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 40 . 00 40 . 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 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 08- OFFICE:(904)247-5826 0 FAX NO.:(904)247-5845 BUILDING-DEPT@COAB.US TY BUILDING PERMIT APPLICATION DUVAL COLIN 1.JOB ADDRESS: 2.VALUATION OF WORK: 13.SQ.FT.UNDER ROOF -4.LEGAL DESCRIPTION: 5.CLASS OF WORK: 6.USE OF STRUCTURE* 11 NEW BUILDING El DEMOLITION 11 RESIDENTIAL LOT-BLOCK-SUB DIVISION G ADDITION 0 CONVERTING USE 11 COMMERCIAL 7.DESCRIPTION OF WORK: 0 ALTERATION 13 ACCESSORY BLDG. 8.FIRE SPRINKLER: 11 REPAIR OPOOL/SPA 11 YES 0 N/A t�Z le - I t- 11 MOVE 11 OTHER 11 NO PROPERTY OWNER: CONMACTOR: ARCHITECT i ENGINEER: 9.NAMEiF� A,,4 L * 15.COMPANY NAME: 23.COMPANY NAME: 16.NAME: 24.LICENSEE NAME: 10 ADDRESS, 17.STATE OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.: 18.ADDRESS: 26.ADDRESS: rM 11.OFFICE PHONE: 12.FAX NO.: 19.OFFICE PHONE: 20.FAX NO.: 27.OFFICE PHONE: 28.FAX NO.: 13.C5LPIONE: . 21.CELL PHONE: 29.CELL PHONE: "14- 1 -lls'13 14.EMAIL ADDRESS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS: 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. I 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. WARNING TO OWNER: 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 (IfAgent,Power of Attorney or Agency Letter Required) (Qualifier Only) SigneV Date: !P,- 7-451 Signed: Date: Before me this day of 44PZ -20011in the county of Before me this_day of 2007 in the county of Duval,State of Flo has p 11 p;ed Duval,State of Florida,has personally appeared r . & y a4 (L I I 4_0 herin by himself/herself and affirms that all statements and declarations are herinbyhimself I herself and affirms that all statements and declarations are true and accurate. T%V4 true and accurate. Notary Public at Large,State of 4L County of Notary Public at Large,State of-,County of ;[3 VPonally Known ' U e-ICA 0 Personally Known rod We I rodlu d I ti [I Produced Identification- LNote ignature: Notary Signature: P TIMOTHY A.BYRD Notary Public,State of Florida MY comm.expires Mar. 15,2008 COAB F6Rm. 1:R ISED:1/420W 300520 CITY OF ATLANTIC BEACH OWNER / BUILDER AFFIDAVIT 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING'REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE—OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR fMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000-00 OR LESS. TH-E BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COM[PLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR- YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. 11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED UNDER THE HOMEOWNERS INSURANCE POLICY TO CLEARLY PROTECT THE OWNER. 111. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO$5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(l). AN-OCCUPATIONAL LICENSE- IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826)IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. z1 3 cj� C4_ PHONE NUMBER ADDRESS fi- C , 77E, _ SIGNATURE DATE Before me this I day of 20(&?in the county of Duval,Stateof Florida,has personally appeared herin by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of County of 11MOTHY k B D 0 Personally Known A-6 19 Notary PtIblic,S'tate of Florida 3q0- T Orrin expifreS Mar. 15,2008 gef�oillticed idritfication- My C No.DD 300520 Notary COAD FORM OLDG07;P EVISED: 8114r2M SS CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD 0 _7 77- ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 INSPECTION EMAIL REQUEST: Building-deptna,coab.us Application Number . . . . . 07-00000549 Date 4/23/07 Property Address . . . . . . 467 WHITING LN Application type description PLUMBING ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc re-pipe ---------------------------------------------------------------------------- - Owner Contractor ------------------------ ------------------------ ADALIA, FE ADVANTAGE PLUMBING 467 WHITING LANE GREG GAUSE INC. (DBA) ATLANTIC BEACH FL 32233 941 11TH AVE S JAX BEACH FL 32250 (904) 247-9848 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING PERMIT Additional desc . . Permit Fee . . . . 42 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 10/20/07 ---------------------------------------------------------------------------- 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 PERMIT IS "PROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CITY OF ATLANTIC BEACH PLUMBING PERMIT APPLICATION Date: 2 3 707 Property Address: " Owner: ,a Telephone#: Telephone#: e�2 9 7 VS I/ Contractor: mm �ZL�— Alum Contractor Address: rk,,,P, /y Fax#: Contractor Signature: In consideration of permit given for doing th as described in the above statement,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 City of Atlantic Beach ordinance and standards of good practice listed therein. Installation of plumbing and ffictures 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, U New list the building permit number: X_Re-Pipe Number of Fixtures: - ,4,0 Bath Tubs Showers Closets Shower Pans Dishwashers Sinks Disposals Urinals Floor Drains Washing Machine Lavatory Water Sewer Water Heaters Sprinkler System Other *See attached sheet see For LcOow and Irrigation procedures Fees Permit Issuing Fee: $35.00 Total Fixtures: X$7.00 + $35.00 800 Seminole Road -Atlantic Beach, Florida 32233-5445 Phone: (904) 247-5800 - Fax: (904)247-5845- http://www.ei.atlantic-beach.fl.us Revised 9/06 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 INSPECTION EMAIL REQUEST: Building-deptnaxoab.us Application Number . . . . . 08-00000346 Date 3/20 08 Property Address . . . . . . 467 WHITING LN Application type description SIDING PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 500 .T1 ---------- ----- --- --- -- -- ----- - -- - -- -- -- -------- --- ------------------r Application desc REPLACE SIDING --------------- ------------------------- ----------- --- --- -------- ----------- Owner Contractor ------------------------ --- --------------------- ADALIA OWNER 467 WHITING LANE ATLANTIC BEACH FL 32233 - ---- ------- -- -- - ----- -- --------------------------------- ------------------- Permit . . . . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 35 . 00 Plan Check Fee 17 .50 Issue Date . . . . Valuation . . . . 500 Expiration Date . . 9/16/08 --------------- ------ --------------------------- --------- - ------ ------- Special Notes and Comments *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDIN ' DEPARTMENT IMMEDIATELY. *2004 FLROIDA BUILDING CODE W/ 105- 106 SUPPLEMENTS . 2004 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. ----- -------- ------ - ---------- -------- -- ---- --- - ------ ----------------- - ---- - 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 E FLORIDA BUILDING CODES. F7 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 08 1 OFFICE:(904)247-5826 0 FAX NO.:(904)247-5845 BUILDING-DEPT@COAB.US BUILDING PERMIT APPLICATION DUVAL COUNTY 1.JOB ADDRESS: 2.VALUAT10N OF WORK: 13.SO,FT.UNDER ROOF -1.t -7 Uhr4ifia ;_5� 4.LEGAL DESCRIPTION: 5.CLASS OF WORK: 16.USE OF STRUCTURE: NEW BUILDING 11 DEMOLITION 0 RESIDENTIAL LOT BLOCK SUB DIVISION 13 ADDITION 0 CONVERT11'G USE 0 COMMERCIAL 7.DESCRIPTION OF WORK: El ALTERATION 0 ACCESSORY BLDG. 8.=FIRE SPRINKLER: 0 y S REPAIR 0 POOL/SPA EIYES El N/A �C13MOVE OOTHER I El No PROPERTY OWNER: CONTRACTOR: ARCHITECT/ENGINEER: 9.NAME: 15.COMPANY NAME: 23.COMPANY NAME: 16.NAIIF_\ 24.LICENSEE NAME: 0-/1 10.ADDRESS Z 17.STATE ON�<RIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.: 6717e 14 J7 �J-Ze�/ ?16 _ _ 26.ADDRESS: j 18.ADDRESS: an�t("1 4� E I;c /-It 11.OFFICE PHONE: 12.FAX NO.: 19.OFFICE PHONE: X-FXNO.: 27.OFFICE PHONE: -T-FAX NO.: 13.CELL PHONE: 21.CELL PHONE: A 29.CELL PHONE: 14.EMAIL ADDRESS: 22.EMAIL ADDRESS: / \ 30.EMAIL ADDRESS: FEE SIMPLE TITLE HOLDER: BON#NG COMPANY: MORTGAGE LENDER: (IF OTHER THAN OWNER) 35.NAME: 31.NAME: 33.NAME: 32-ADDRESS: 34.TIDDRES 36.ADDRESS: Application is hereby made to obtain a permit to do kfIe work and installations as indicated. I 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. WARNING TO OWNER: 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 Adomey or Agency Lader Required) (Qualifier Only) Signed: 4V el OeWALi-Date-e_:� Signed: Date:- Before me this I i& day of YY\0,AJ-\ ,200&the county of Before me this day of 2007 in the county of Duval,State of Florida,has personally appeared Duval,State of Florida,has personally appeared Ef 42A#e) p4n ADAtIA 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. '�7 L 0 UV k L. true and accurate. Notary Public at Large,State of County of Notary Public at Large,State of_,County of_ 0 Personally Known 1 11 Personally Known GrProduced Identification- FLOCAOA A,ILAD ZtA_5 Lk(D 0 0 Produced Identification- Notary Signature: Z�l 11!:�!� REv1Ewk;1) jvvm C-766E eompt Crff OF ATLkNTIC BEACH SUSAN SPEAKS GORM ITS FOR ADDITIONAL AK GORMAN C PE 0 SD366 SEE PERM [ISSI N#DD64 = 5, 011 -:Feb 2 2 MY COMMISSION#DD6436 REQUIREMENTS AND CONDITIONS. COAS FORM BLDG01 V" e1j12WIPES:Febnmy25,201 -NUT y Ms.C. .f ^0 T Fl.Notary DLkq=".t A-Co. DATE:._J212L6L- REVIEViTJ!'011'[111 11111 '1611,1111 1- 11 If 110 OF ATLANTIC BEACH 17 '"ER BUILDER AFFIDAVIT 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IM[PROVE A ONE—OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR INTROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF TTHS EXENOTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR- YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EWLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. 11. INJURY UABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED UNDER THE HOMEOWNERS INSURANCE POLICY TO CLEARLY PROTECT THE OWNER. III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN-OCCUPATIONAL LICENSE- IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826)IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. C2" Le to ADDRESS PHZ)NE NUMBER Ile z2 0 14 o'q P�TE SIGNATURE DATE Before me this day of 200IDn the county of Tio—n Duval,Stateof da,has personally appeared herin by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of County of D k-x\) A L_ 0 Personally Known i;KmducedidenUfication- r—Lj)e-tote.sL.icc#�isL AsLi Notary Signature: SUSAN SPEAKS GORMAN My COMMISSION#DD643668 EXPIRES:February 25,2011 1C0ABF0PMBLDG07;REVISED:9/14/2007 1-80WO-3-NOTA Y Fl.Notary Discount Assoc.Co. (QC CITY OF ATLANTIC BEACH PERMIT BUILDING / Z01"4LNG DEH PARTAT-11KNT APPLICAT�ON 'DOD Stmiaolp Road Atlantic Bcach,Florida 32233 (904)247-58100 (904)247-5945 Fax www.coabms APPUCA70N TRACKNG FORM R E Q U I PF�q DEPT: PLANNING Property Addrem, Atol Wni�b wA Lam) ( Y_,�A BUILDING y(1-5p, PUBLIC WORKS AppUemft- 0 Y INA PUBLIC UTILITIES v y FIRE DEPT. Project-. ace, Y( N) PU 6 LIC SAFET Y -APPROVAL c_) REQU D AGENCY: RECEIVED BY: INITIAL: DATE. Z Lu N D.E.P HUFSTETLER <CY Y N SJR.W.m. CARPER a�UJ LU Y NN ARMY CORPS of ENG CARPER 0 N N HOTELS&RESAURANTS HUFSTETLER APPLICATION STATUS CIRCLE ONE: SITE BUILDING DA AP ,:E�IEWED BY: INITIAL: DATE: I ST REV �rl 1 0 (HING 2ND REV El 0 PUBLIC WORKS PUBLIC U TILITIES FIRE DEPT. PUBLIC SAFETY 3RD REV PSR-3844 12353 DEPARTMENT OF BUILDING CITY OF ATLANTIC BEACH PERMIT INFORMATION ------- LOCATION INFORMATION Permit Number : 12353 Address : 467 WHITING LANE Permit Type :RE-ROOF ATLANTIC BEACH , FLORIDA 32233 'lass of Work :NEW --------- LEGAL DESCRIPTION --------- Constr . Type :WOOD FRAME Block : Lot : Twp: Proposed Use: SINGLE FAMILY Section: 0 Subd: Rng' Dwellings ! 0 Subdivision:ROYAL PALMS Est . Value: 0100 Improv- Cost : 2 ,000 . 00 Total Feqt.,, * 25 . 00 1-4� 25 . 00 -11WNEP INFORMATION APPLICATION FEES N T ame., FE GRUPEF, I T Ad-ir* 4 , 4' WHiT7NG LANE '�TIJUWok, B&AC*,4'- FLORIDA 122- - OPMZTTM TJ i")R F Name : PROPERTY�--OWNER L i Exp , T V 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 IMPROVEMENTS95 $25.00 14 8/01/96 01 Rcpt: 0015,18S ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND�-95�JECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. 00100093221000 ATLANTIC BEACH BUILDING DEPARTMENT By: CITY OF ALANTIC BEACH ROOFING PERMIT APPLICATION owner(s) : �r"07 Address:--�/-6 _Phone: 2Y 7 - 2 Lot #_, Block or Univ# Subdivision: Contractor: Oujvl �- P-- Address : City, State and Zip Phone State License # Describe work to be performed: Ic— Valuation of Proposed Construction: 4 ;7, 000 ,17 fiev Materials to be used: 7e-/- ,P A�' Signature of Owner; Signature of Contra�/Or: Liability Insurance Supplied Workers Compensation Insurance Supplied License Information f 1 14:11,1)ING,:- 1.0,r: Il-U",h I N G Mi-'�CIJAN I CAL: ELFCTRI CAL: BUILDING PERAIT WOR'KSHEET HEATED SQUARE FOOTAGE: @ s per sq. ft. GARAGE (PRIVATE/SHED) : @ $ per sq. ft. CARPORT: @ $ per sq. ft. PORCHES: @ per sq. ft. DECK: @ $ per sq. ft. PATIO: @ $ per sq. ft. TOTAL VALUATION: PERMIT FEES 33�,0 4) Z/ $ �&/9-06 TOTAIC VALUATION DATA Ist 00 $ Q- 50 REMAINDER VALUATION @ $ q.5Z) Per thousand or portion thereof TOTAL BUILDING PERNlIT FEE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SZ) PLUS 11 THE BUILDING PERMIT FOR PLAN FILING FEE. . . . . ... . . . .$ o?S-. 7!r TOTAL FEE DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . .$ -7-7 ----------------------------------------------------------------------------------------------- PLUMBING PERMIT FEE: $ M�ECHANICAL PERMIT FEE: $ ELECTRICAL RESIDENTIAL: $ ELECTRICAL TEMPORARY: $ WATER 'IMETER, SIZE: FEE: $ SEWER CONNECTION CHARGE: SQUARE FOOTAGE: FEE $ WATER CONNECTION CF-ARGE: FIXTURE U'NITS $10.00 PER UNIT: ACCOUNT NO. : APPROVED BY: TOTAL BUILDING/PLAN FILING FEES: $-- -7 P R 0 E: D TOTAL WATER METER CHARGE: $ 'N'11C BEACH DING OFFCE TOTAL WATER CONNECTION CHARGE: $ 2 TOTAL SEWER CONNECTION CHARGE: GRA-ND TOTAL DUE: FOR OFFICE USE ONLY Date .................................19 ...... CITY OF ATLANTIC BEACH Permit *........................Fee$........................ Valuation $...................................................... FLORIDAHouse #........................................................... ............................................................................ APPLICATION FOR BUILDING PERMIT --------------*-----------------------------------*------------------------ Application is hereby made for the -approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure described. This application is made in compliance and conformity with the Building Ordinance of the City of Atlantic Beach, Florida, and all provisions of the Laws of the State of Florida, all ordinances of the City of Atlantic Beach and all rules and regulations of the Building Department of the City of Atlantic Beach, shall be complied with, whether herein specified or not. The Contractor or Owner-Builder who has been issued a Building Permit is automatically responsible to ascertain that all sub- contractors engaged by hirn are duly licensed in the City of Atlantic Beach, Florida. To prevent delay or embarrasment regard- ing intermediate or final inspections it is suggested that a list of sub-contractors be submitted to this office so that licenses can be verified. ) Date,.......M2..... ........... -------------------------------- Owner...... V'� ..41.. ....... --------------------------Address..... Telephone Nw��J..................X_ ........... --- .......... Architect..........................I................... ..............................Addres&................ Telephone No........ ............. Contractor Builder--H.44/. 4 Z ---_ 1//1 *�;L N........Telephone No..2-0 .'�t .. .......................... ..................Address......... ..................................... .............. /5;) Lot No..........Lla..................................Block No_.....H.......... ....Sub Division--P, 10 A I)* V 44i A?_-04�7 ..........................................................—one............ .......................................................----Street------- ........ ---Side Between......................................... qn ..................................................... Valuation $_J0,aP.0-------For what purpose will building be used..*./,.64Ar_1%J./.......Type 'of construction.....J—Ri9tilen ................................. Dimensions of Building.- ...77-7-----------Dimensions of Lot_$.0441.5....V-.q.4....... ----- ---Size of Footings... ...........W, *----------- Size of Piers.----- - ---------- -----Size of Sills.. ... .. --- .. .....Greatest Sill Span in ft------------ ----Type Roof.................. ... How will Building be Hpated?... ........... ...............-Will Building be on Solid or Filled Ground 9------------------/ . .................. .......................... Size of Ceiling Joists--..-..z--x--(......................... Distance on Centers--- ........................... Greatest Span---------- ...... --- ... ..... Size of Floor Joists--------------Z&A�...................... Distance on Centers ... ... . ............................. Greatest Span--------_........ ........ Size of Rafters..........?-x 1� Z y st Span........./0 ..............................---_-------- Distance on Centers ..... .................................. Greate ................................ This rectangle is to represent the lot. T41 C-A -�i 0 40 F_ Locate the building or buildings in the right position. Give distance in feet from all lot-lines and existing buildings. REAR LOT LINE Two copies of plans and specifications shall be submitted with application. APPROVED Inspections required. GiTY OF �,_N;NTIC BEACH BUILDiNG C)Fz:cE 1. When steel is in place and ready to pour footing. W , W 2. When steel is in place and ready to pour columns and/or lintel. Z Z 3. When steel is in place and ready to pour beam. 4. When framing is completed. 5. When rough plumbing is completed,and ready to cover up. 6. When septic tank drain field or sewer is laid but before it is cover P 7. Electrical inspection by City of Jacksor.ville. 8. Final inspection. Note: In case of any rejection,re-inspection MUST be called for after corrections are made. FRONT OF LOT In consideration of permit given for doing the work as described in the above statement, we hereby agree to perform said work in accordance with the attached plans a4id specifications, which are a part hereof, and in accordance with the building regulations of the City of k antic Bea Ict // *ZZ-nd Signature of Builder... _. ......&K- ---_1_-- ------------_------------- Address---------------------------------------..............................9.e.n"l...... YLD . ........ .............. Signatureof Owner.... ....... --- ------_--------J ------ ----------------------- Address.................................___------------------------------------------------------------ ))!.I E i-)'I I'E ON ADD) I CO':'11:RCI AL 1-.*j 01, ADD)JESS Ef. --A Pl�-R-CrV-E-D p) L,2se print CITY rjF 1,TL;.NTIC BEACH BUILDING OFFICE OCCU--eA'j1O*,':Aj, LICEN'SE NO. E (_j:kj3F) CA] E NO. L14 D_;'F. cc.. - - -- - - - - - -- - -- - - - - - --- - - - - - --------------------- ---------- -------- --- -- --- --- - -- -- S-1*'_K S ? 0 i�y BAT)i j_GBS URIN.-LS bF_AI.',S C!C"S E T S S': p s VAJEP E-�:_;�EPS DjS!'k"'SALS "__CH3NE 07'iER TOTAL F uFLE COUNT L j_A 13 O,,� (jj -D FI) TURES IST A2' ACCC:--_*.!2'.CE TfE ",C)ST I.ECENT HDI TI ON ,1!%'G CODE. :k - OR ErltC , l.'_-'-_ER Fly-Ti:KE 1-11"IT t7.-j S S T 3 L 2 S-H E D A S 7 B E ��A S U E�'i N T 0 -'A 71 Tjjr i-.):-::'D AT .' TER SL7..,pLy C,�_*_RGr IS __'D C0'.-CJED TO TAE CITY Y"ATER S"YS-i —EM. D -]IT C0'-- ECT';:D TO T,3E Clyy !R Sy S i:-Y,. SEC. 27-3 (c) S ?TR F 1 X LFAE 1:1% C-!'C)_U_P CC)"SISTING OF y LIE (l-.-!OR W/O OVER GN 1 TS) S T I C (2 L' F: C r I S E T -10 R Y 6 7-S 1,T F, H—D (2 TUB OR S--'CWER STj_A_lL (6 UNITS) BID�ZT (3 'ONITS) ip'Ay CO'�-IB1NATION SI'Nl: & 1P-ky AVATORY (2 U-;I TS) (3 UNITS) UlNIT) KITCPEN SINT. co"BiNA1101' SINT, & TRAY W1 P-1HENTAL OR CUSPI- (2 U-N!TS) FOOD DIS_ (4 17NITS) DOR (I Kl7'CjiEN SIN DR1,NKING FOUNTAIN (If LTNIT) DlSh-�:t.SliER (2 UNITS) WASTE GRI'l-DER FLOOR DRAINS (I UNIT) I-AXATORY (I bNIT) LAVATORY, E-Ably PA7�i_OR i-L.VATORY, SURGEONS (2 UN I TS) SHO-"T_RS C-,-'O-U-P PEER P F_kD -1 TS) SURGEONS SINK (3 UNITS) (3 UNITS) (2 ION POT, SCULL-ERY FLUSHI-NG RIM SIKK (8 UNITS) SERVICE SIN-1, '!P--"-p SINK (4 UNITS URINAL, PEDESTAL, SYPBON JET ST��--%D (3 U-N-ITS) _t:,R_!1.'.kL STALL, A "AL I.AcIlio'liT (4 Ul; BLU...-OUT (8 U I', WALL LIP (4 UNITS) URINAL T_'_.O_oGp EACH 2' .ZjS- - "Asp SIN-l'. EA qlNG "-ACr'lj;-=' RES- SECTION (2 UNITS) (3 UNI TS) Or FAUCETS— E'WTS' VALVE p CLeSiTs' (2 17.3 TS) .-.)T-p CLOS -1 TS) 10 _.;TED (4 L7;1. 6 -11 T' _ UA z le av ti) Its 4:1 LA 4-- 00 147- po ca 00 7-o 6 e rm a up- /�P ? RoVED GITY OF 'r.,j-;;74TIC BEACH BuILOj;4G OFFICE CITY OF ATLANTIC BEACH, FLORIDA prov*d by APPLICATION FOR ELECTRICAL PERMIT TO THE CHIEF ELECTRICAL INSPECTOR: DATE: May 2. 19 83 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 ELkTRICAL REGULATIONS, CODES AND CITY OF ATLANTIC BEACH ORDINANCES. A8252 'Rivins, JOURNEYMAN ELECTRICAL FIRM: EMJ 15 E37 M04ASTERVELU�;T IANSIGNATURE. NAME H. Wilson Sutton—ADDRESS: 467 Whiting Lane RFD_BOX_ BLDG.SIZE- BETWEEN: RES.fK4 APTA comm. ( PUBLIC INDUS. NEW ( I OLDJA REW. ADDITION (x) TRAILER I TEMP. SIGNS —SQ. FT. FEE SERVICE: NEW ( I INCREASE k)J REPAIR ( CONDUCTOR SIZE 3 7 /0 AMPS COPPER ALUM. (x ) 25.00 SWITCH OR BREAKER J-5 AMPS PH W 240 VOLT cab[e RACEWAY EXIST.SERV.SIZE 6 AMPS i PH 3—W VOLT _Cabl_e___ RACEWAY FEEDERS NO. SIZE NO. SIZE NO. SIZE LIGHTING OUTLETS CONCEALED OPEN 2.40 RECEPTACLES CONCEALED OPEN TOTAL 2.10 -7 31.100 AMPS. 0.30 AMPS. 1.80 SWITCHES INCANDESCENT FLUORESCENT&M.V. — 0.100 AMPS. OVER FIXED ELL TRANSF. 3.00 APPLIANCES AIR H.P. RATING H.P. RATING CONDITIONING COMP.MOTOR OTHER MOTORS AMPS CEIL HEAT: KW-HEAT 60 10 2.50 1,00 0-1 OVER MOTORS H.P. VOLTAGE PHS NO. I H.P. VOLTAGE PHS 171-SCELLANEOUS TRANSFORMERS: UNDER 600 V. OVER 600 V. NO. KVA NO.--- -- - - KVA NO.NEON TRA F. NO. VA. MA. MOTOR SIZE SWITCH FLASHER EACH SIGN FORWARDED -T TAL FEES 37.80 c I -T), CF A I j I C r 0'J FC-R F11.1 I t3j.l.,.3 -.1.11 DAI E C'4 PL I I- F I �-M I'-'.Sl LR PLLJ ':-'F-R - :,'j-Y (,-C�J�ATI Llcz�"S� CI I — " , STATE CL'R-f IF) CAJE J .PE OF aJIl-DJN'G___ D*11.1 rE PIS t ky PH Tuas —D I S ERS URI' 1�f%!-s D) SF'OSALS cj-c;co!-: Is —FL C--R I N'S FIJ�jl2z- C:-iT4T N'STALLAJI ON C.F PLU-31 NG ANID FI KFURES s*-'-'JST BE I SN ACC'S*:Ra-'J.'C--:7 III -CH F.:-:CENT L-D) TI ON OF -PHE S9JT'X-_"r—uN STl;--J,'-D�LRD PLL-I%-Bl NG DD-DE. VC) SHOWAING SURVEY OF 17 —14 R 11)F -4 300K F I -I') It PLAT U _ PAGIE.Z.�_ ..d. �_OF PUBLIC RECORDS OF DUVt �,2 g? 4 1 n 7 00 L ot X I HEREBY CERTIFY THAT THE --WAS SURVILYED MY LEGEND, CONCOWTC M F AND THAT ------ IS LOCATED UPON SAME AS SMOWN AND THAT THEP] /E ARE 0 Kt4cp kfHrmTS UPON X.X Ilt"ca REG CHARLES W DfOROVS. JW 573 VERA DRIVIL JACKSON'VILLE, FL,0RtD^ 32210 X A L f. REG,STIERV0 SURVEYOR NO #71 F' MEMBER: r s s okmo 'k C.0 M TMENT 0fr i3UILDING PERM IT No. 5—9-51— DEPAR BFAC�4,FLORIDA CITY OF ATLANTIC f)FRMIT -to BUILD MUSI 13�pOSTED ON jOB TH�S PERMI Date 10 2,0.50 Fee 3109 Vali'lation City Treasurer,and is This Pelolit not valid until above�,,has been Paid to $ions Of 13w' "Voc3t.Ion for violation 0�applicable PrOv' ullcl subject to p-LLTtIBING ,This is to certifY t1lat S U111 VID t 0 T has permission to Zone -PS�11 #2 Classification PoyAl BANK GRUBFR 11 S/V Owned'by :::�� Block Lot-------- _T1111-ING 1,1��NB Vii - 7 —AkL–]�L� this permit ouse No Vhich are part of IN- 14 OTIC–E—ALL cONMErE 'OP'MS approved 'Plan' 1� FOOTiNGS MUST BE According to pND PIE pOURING. SpEC,rED BEFO -IS PEPMlr VOID SIX MON"I DATE OF 'SSIJE AFTEP- na debris ,te ubbish a A 101 Building 11 ,j,l,r, t be place– fotu thi, work 1"ust no St be cleared i. Public space, arld '" con- up and mauled away by either 0 Owner. tt ::y Building Officia" CONTRACTOR pERTAIT DATE ----— FOR OFFI E NUMBER USE ONLY PLUMBING ELECTRICAL SF\NER WATER 16 DEPARTMENT OF BUILDING 7680 PERMIT NO..--- C T �'�i L TY��ANTIC BEACH,FLORIDA CI Y OF ATL I PERMIT TO BUILD 5. 0 T 2628 1A 4/29/8 THIS PEPMIT MUST BE POSTED ON JOB 900CA 8 April 29 IQ86 7680 Date __�"— M 26id8 Valuation$__LA LD -75—STFee$ 7.50 10010 This permit not valid until above fee has been paid to City Treasurer, and is subject to revocation for violation of applicable provisions of law. Hank Cruber This is to certify that__� ered porch per plans on front of house has permission to build cov RES 1 re s i dent ii I Zone Classification Hank Gruber Owned by Block Lot 467 Whiting Lane House No. According to approved plans which are part of this permit NOTICE—ALL CONCRETE FORMS FAND FOOTINGS MUST BE IN- SPECTED BEFORE POURING. S PERMIT VOID SIX MONTH AFTER DATE OF ISSUE sh and debris mo Building material, rubbi z from this work must not be placed ill, public space, and must be cleared up and hauled away by either con- t aor Or ,-w_';:,- ra or o owner. t �� L g Official PERMIT DATE CONTRACTOR FOR OFFICE NUMBER USE ONLY PLUMBING ELECTRICAL SEWER WATER "NOW CITY OF ATLANTIC BEACH APPLICATION TO MAKE ADDITIONS OR ALTERATIONS A Owner t-16vu le 0 L)R C(2- Addresso��zv�,Yj phone2tig -.12 q Architect--Se I Address Phone Contractor SO Address Phone Contractors License/Certification Numbers Expiration Date Property Address�1?L)k i �iA' t Zoning Lot # Blcok or Unit # Subdivision Pq lo4 Valuation of Cons truction. $ 2,1)0. 6 0 Type of Construction uj 00 Describe Work to be Performed Materials to be Used Present Use of Buil Proposed Use of Building, Flood Zone Dimensions of New Area: HEATED N�A C.ARAGE OR STORAGE tt-(A CARPOI;9 OR PORCH k, �g( Y DECK PATIO 'YES NO NUMBER Will there be an increase in numberof units? Will there be a decrease in number of units? Any additional pluubing fixtures? Any new fireplaces? SUB= M Ca�TLETE SETS OF PLANS INCLUDING SITE PLAN Signature OWNEF 'A" Date t Signature CONERACTOR Date Address Heated Square Footage @ $ _____per sq ft = $ Garage/Shed @ per sq ft = $ Carport/Porch @ $ 0 per sq ft = $ Ll I C). Deck @ $ __per sq ft = $ Patio @ $ __per sq ft = $ TOTAL VALUATION: $ Total Val�tion�� lst $ C)c Remainder Valuation Per thousand or $ portion thereof -------------------------------------------- Total Building Fee ADDITIONAL PERMITS and/or FEES REQUIRED + 1, Filing Fee $ 09 50 Mechanical Fireplaces @ 15.00 $ Pluibing BUILDING,I PERMIT FEE 8 's C) Electric/New Electric/Temp Septic Tank BUILDING PERNIT $ Well WATER METER CHARGE $ swimidng Pool SEWER IMPACT FEE $ Sign WATER IMPACT FEE $ Water Connection ]MISCELLANEOUS $ Sewer Connection $ Water Meter $ Elevation Certificate GRAND TOTAL DUE $ ---------------------------------------------------------------------------------------------- CALCULATIONS and/or NOTES LA Z I An -AA Ob.p., 5q. PAR "Op i4!"'W-�JPVI'8111 ;h*.lumt MR, Pik I ullb,".."ll 11 INKA 1 w If ww rl .,p mr�pq�w M'N N1,14'11' A4 a�4 ig Mg sN "Warl, K 4 5" kji. Ux Igo - ------------- ......- �"p t v;,o,3iL I I -. igt 0 Alrwl, I m �Ab TV !!f fit m low. ?:;'i� V! t!;llilpll'L�X-i�� it L-0-1 tTlall dw 'W 4M 114z gg 2 Jll IF, 'RM �VNa� — i jr.,z.'. I :" %A.P. VOW," Vt ,j; .mqN jkfr ORK4 -.1 g4g; 15,llu;" tl If J�i .1, N I Xi qg!.fyzjl P'lElft j, i ....... ... 0.1", id T, Y, It L U 4m .1 , W, pia. ;N JOL 77 4ww'i, VA R, jjj..... ........ `f t bii L I . .