857 Amberjack Ln 2014 window A CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 14-00000589 Date 4/21/14
Property Address . . . . . . 857 AMBERJACK LN
Application type description WINDOW AND/OR DOOR
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 10000 --------------
--------------------------------------------------------------
Application desc
WINDOW
---------------------------------------------
Owner Contractor
------------------------
TRI-H CONSTRUCTION LLC
KSN INVESTMENT CORP 11215 ST JOHNS INDUSTRIAL PKWY
9191 SKINNER PKWY STE S01
JACKSONVILLE FL 32256 UNIT 10
JACKSONVILLE FL 32246
(904) 545-9978
-- -------------------------------------------------------------------------
Permit . . . . . . WINDOW AND/OR DOOR PERMIT
Additional desc - - 100 . 00 Plan Check Fee SO . 00
Permit Fee . . . . Valuation . . . . 10000
Issue Date . . . .
Expiration Date . - 10/18/14 -----------------------
-------------------------------------------- --------
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
---------- --------------------------------------------------------2 . 00
Other Fees . . . . . . . . . STATE DCA SURCHARGE
STATE DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----- ----------- ---------- ---------- ---------- ----------
Permit Fee Total 100 . 00 100 . 00 . 00 . 00
Plan Check Total 50 . 00 50 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 154 . 00 154 . 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
311 .3 t
FILE COPY 800 Seminole Road, Atlantic Beach, FL 32233
0 ffice (904) 247-5826 Fax(904) 247-5845
Job Address: 857 Amberjack Lane, Atlantic beach, Fl 32233 Permit Number:
Legal Description 30-60 38-2S-29E Rqyal Palms Ufiit 1 Parcel# 171181-0000
Floor Area of Sq.Ft—.
Valuation of Work Proposed Work heated/cooled 1470 non-heated/cooledl 44
Class of Work(circle one): New Addition AEer:ationn� Repair Move Demolition pool/spa dow/door
Use of existing/proposed structure(s)(circle one): Commercial
If an existing structure,is a fire sprinkler system installed? (Circle one)- N/A
F I - A 4_,
lorida Product Approval 92 0151 ?, ff et" _ _
For multiple products use proTu—ct a pp—r—ov--al form
Describe in detail the type of work to be performed: W1,46A)5 - -Dooies latc
Property Owner Information:
Name: KSN Investment Corp. Address: 9191 Skinner pkwy Suite 501
City Jacksonville, State FLORIDA Zip 32256 Phone 904-710-2984
E-Maiil or Fax#(Optional) to%y
Contractor Information: lewed A
Company Name: Tri-H Construction LLC Qualifying Agent: Anton Harasz III (fel)
Address: P. 0. Box 331118 City Atlantic Beach State FLORIDA Zip 3223-
Office Phone 904-328-2228 ivr Job Sitet Contact Number 904-545-9978Fax#904-328-2224
State Certification/Registration# CBCO2201 AEV
Architect Name& Phone#n/a LIANC,
Engineer's Name&Phone# n/a 4 k Jik
Fee Simple Title Holder Name and Address SEE PERM.,-f --Df)1T10NAi.--
Bonding Company Name and Address REOUIREMEN AND.�-ONDMQNS-
Mortgage Lender Name and Address ;-r '4-19- (e of
Alb.--L-,1 0 17
A , at, he e ade ana e to do the work --ns—taVqMfis-as indi,,�d I c n has commencedpriorto Me
I rmit t to m o-work or installatio, _L b
t to o't r p b e ed ction in thisjurisdiction
su C 0 s in by md ha a k
r
form
hs, or I nedfor a period of six�6)Inonths at any time after
(6 mont
I PP ance 0 a per t an t wo w ep 'is pj�rmit ecoes null
and'Old work not c m e ed, n s
0,m nc Ith' ix Signs, Wells,Pools, tur a4ces,Boilei-s, Heafers,
f d f der tand that separate Pr_,ts
I
work s"m",ce s
T n s" r Con . 0 s, t,
a k dA, did ner e
WARNING TO OWNER: YOUR FAILURE TO RF('JU)IRD A NOTIC OF
COMMENCEMENT MAY RESULT IN YOUR PAYING T'�-`O`E FOR IMPR VEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING' CONS LT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
f herebl cerofy that I have read and examined this..anafication and know the same to be true and correct. All provisions oflaws and ances governing this
work will be coTplied with whether s eci e he n or not. Ae granting of a permit does not presume to give authority violate or cancel the
grovisions ofany other state, or lo a r g construction or the eiformance oj construction.
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I'll , P City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone (904)247-5826 - Fax(904)247-5845 LDate routed:
E-mail: building-dept@coab.us
City web-site: hftp://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
ev
iew required Ye 0
Property Address: Iferl r_'L *Dea rtme nt r,,.
I ing
anningg &Zoning
Applicant:
I ree Administrator
Project: `45 6 it)3 Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
— Review or Receipt Date
Other Agency Review or Permit Required 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: PrApproved. [:]Denied.
(Circle one.) Comments:
BUILDING
Date:
PLANNING &ZONING Reviewed by:
TREE ADMIN. ��ri []D ied.
Second Review: RApproved as revised.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: -Date:
FIRE SERVICES Third Review: nApproved as revised. []Denied.
Comments:
Reviewed by: -Date:
Revised 05/14/09