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174 Jackson Rd 2014 level floor �j CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 14-00001387 Date 9/09/14 Property Address . . . . . . 174 JACKSON RD Application type description RESIDENTIAL ALTERATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 4SOO ------ ---------------------------------------------------------------------- Application desc level floor -- ------------------------------------------------------------------------- Owner Contractor-------------- ---------- ------------------------ BEACHES HABITAT OR HUMANITY MILLER, DANERI WILLIAMS 797 MAYPORT RD 174 JACKSON RD FL 32233 ATLANTIC BEACH FL 32233 ATLANTIC BEACH (904) 241-1222 --- Structure Information 000 000 LEVEL FLOOR occupancy Type . . . . . . RESIDENTIAL ---------- -------------- -------------------------------------------- ------ Permit . . . . . . RESIDENTIAL ALT/OTHER Additional desc . - Plan Check Fee 37 . SO Permit Fee . . . . 75 . 00 Valuation . . . . 4SOO Issue Date . . . . Expiration Date . . 3/08/1S -------------------------------- -------------------------------------------- Special Notes and Comments 2010 FLORIDA BUILDING CODE, 2008 NATIONAl ELECTRIC CODE *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. ----------------------- - -------------------------------------------------- GE 2 . 00 Other Fees . . . . . . . . . STATE DCA SURCHAR. STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited- Due--- ----------------- ---------- ---------- -------- --- Permit Fee Total 7S . 00 75 . 00 . 00 . 00 Plan Check Total 37 . SO 37 . SO . 00 . 00 other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 116 . SO 116 . SO . 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 406 800 Seminole Road, Atlantic Beach, FL 32233 '0 FILE COPY Office (904) 247-5826 Fax (904)247-5845 Job Address: 174 Jackson Rd. AB, 32233 Permit Number: Legal Description 8-4 17-2S-29E, Donners S/D PT Lot 15 RECD 10044-958 Parcel# Vloor Area of Sq.Ft. Sq.Ft Valuation of Work$ 4500.00 Proposed Work heated/cooled 1196 non-heated/cooled Class of Work(circle one): New Addition Alterati"nRe pair )CMove 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 Approval# For multiple products use product ap-p-r—ova-Morm Describe in detail the type of work to be performed: jack/shim/level floor, Eglace floor in bathroom (rotten), Property Owner Information: Name: Daneari Miller —Address: 174 Jackson Rd. City Atlantic Beach-State FL—Zip 32233 Phone : 904-610-8037 E-Mail or Fax#(Optional)- Contractor Information: Company Name: Beaches Habitat Qualifying Agent: Robert Peterson Address: 797 MMMort Rd. Citv Atlantic Beach State FL Zip 32233 Office Phone Job Site/Contact T�u`mber Fax# State Certification/Registration# Architect Name&Phone# Engineer's Name&Phone# Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and Address Ap I a, i h reb Tade ha a e7n, d th rk and a a ns a nil*ca 'erlify that no work or installation has commenced prior to the s s i I�'_s ' * h* ' * diction. 77as permit b�comes null �n �n e in t a d a a ng ction in t isjuns, i t wo s " t'o r ork ss or nedfor a Period ofsix(6)months at any time after l be e 0 ed to m I thet tan4 0� to 0 t p y d ha a I k L s or c ris s 't 0 is , r or P ic cei q a p it a t I woi� w p 6 th 7 f is not hi,s n t mi id k men ed-i i t 0 Plumbing,Signs, Wells, Pools,Furnaces, Boilers,Heaters, ", is co "c, rst t t Pin at,pem "s he secured OrE ec rica ,k d d and ha se 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 RECORDING Y61jR NOTICE OF COMMENCEMENT. Ihere cer!ify 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 Vwork will be cotnplied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancil the provisions ofany otherfederal,state,or local law regulating construction or the pe�formance of construction. & . cmd 0 Signature of Owner Vt� Signature of Contr<toZ2��.. Print Name .................................... ............. tq 'j 12 ............................................. Dan. ........ ..)Y_ Print Name Sworn to and subscribed befaire me Sworn to and subscribed before me this 91,15f Day of A U4 U6-t 20/Ll� this;QL5+Dayof 4u4az, 200 \j Nwbombla N ary Public E M.FREEMAN 1;46t_abj Public— my Pole-stme of FRWNW my C"K EX10"ja 10,nil Revised 01.26.10 set APPLICATION NUMBER City of Atlantic Beach Building Department (To be assigned b the Building Department-) 800 Seminole Road / V—' 134 Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: City web-site: http://vmw.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: J 7� rJACk-456A k4 Depgrtment review required Yes No (-Building__,) Applicant: 1,1-7tA'TAT 901`5iif�ing &Zoning Tree Administrator Project: A -FA Public Works Public Utilities LfVf11-'19 110404 Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review o Date of Permit Verified ety 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: [9'A—pproved. E]Denie,-'. (Circle one.) Comments: EE�) PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: DApproved as revised. F-]Denie(-,' PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: DApproved as revised. ElDenied. Comments: Reviewed by:_. Date: Revised 05/14109