1633 Beach Ave 2014 2nd story CITY OF ATLANTIC BEACH
r sl 800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
�� 13
Application Number . . . . . 14-00000479 Date 9/04/14
Property Address . . . . . . 1633 BEACH AVE
Application type description RESIDENTIAL ADDITION
Property Zoning . . . . . . . RES SF DISTRICT
Application valuation . . . . 180000
----------------------------------------------------------------------------
Application desc
2nd story no adl sq ftg
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
FARR, JAY AND MARY HOME SWEET ACCESSIBLE HOME
1633 BEACH AVE 2121 FOREST HOLLOW WAY
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32259
(904) 545-4649
--- Structure Information 000 000 2ND STORY ADDITION
Construction Type . . . . . TYPE 5-B
Occupancy Type . . . . . . RESIDENTIAL
Flood Zone . . . . . . . . ZONE X
----------------------------------------------------------------------------
Permit . . . . . . RESIDENTIAL ADDITION
Additional desc . .
Permit Fee . . . . 720 . 00 Plan Check Fee 360 . 00
Issue Date . . . . Valuation . . . . 180000
Expiration Date . . 3/03/15
----------------------------------------------------------------------------
Special Notes and Comments
2010 FLORIDA BUILDING CODE, 2008 NATIONAL 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 10 . 80
STATE DBPR SURCHARGE 10 . 80
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 720 . 00 720 . 00 . 00 . 00
Plan Check Total 360 . 00 360 . 00 . 00 . 00
Other Fee Total 21 . 60 21 . 60 . 00 . 00
Grand Total 1101 . 60 1101 . 60 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION r
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233 , U
T ffice (904) 247-5826 Fax (904) 247-5845 44 �'� . 8 ?014
Job Address: J hEAC-A Aviv 14 J,:230 Permit Number:
Legal Description 6-1& LW-,�';.t_�F /N Alt,, kMz-6&6h 1.1117 W 1 i%Parcel# 11-usl -o ado
Floor Area of 9q--.Ft. ' 1 t
Valuation of Work$ D60 Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Iteration Repair Move Demolition pool/sp v�jadQW4.40or r
Use of existing/proposed structure(s) (t ircle one): Commercial
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes o N/
Florida Product Approval # x L COPY
For multiple products use product appirWa orm
Describe in detail the type of work to be performed: 6✓metle77DAj OF 2 SFeo�p`S7 g � � "�q -fir
j,0, # &YAC A7-Wro 5.,,Oe ,6�!r'b 1V0) Aj?5, s doy4- tx1�,oct ANG r�A�na�r�
Property Owner Information: Q
Name jA y�R(Z Address: 143a v6""N Av>r
City �QTL.'hgzl-,AC>W 1 AA tai _Zip��z33 Phone ��
E-Mail or Fax#(Optional)
Contractor Information: CONT _ 1LCTOR EMAIL ADDRESS:
Company Name:_ �k y Qualifying Agent:
Address: A&1100V City c7" State Zip
Office Phone 6Y-3`,1-11W _.1b Site/Contact NumbergD���y -►�t.Ly g Fax#_ft*_1A
State Certification/Registration# 4RC
Architect Name&Phone# cTA rXCe' ,.+REX 2 aye-?D7os
Engineer's Name&Phone 7 --
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 1 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 and Air Conditioners,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY ?, ULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF • U INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN /- TTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereb certify that I have read and examined this lication and know the same to be true and correct. All provisions of laws and ordinances governing this
type ovork will be cotnpliej with whether specifi, herein or not. The granting of a permit does not presume to give authority t violate or cancel the
provisions of any other federa tate, o local law rt-ulating construction or the performance of construction.
Signature of Owner Signature of Contractor
Print Name �ti� t t Print Name . r /�.........'��..
Before me Before me
this t Day of .M64 Li 20 IL( this I Day of /Flare 1 20 IH
;aY'a CHRi :-�.: l'HER B.MILLER ��•°' TOPHER B.MILLER
- Commission#EE 003466
Commission 003466 =* Revised 01.26.10
Expires July 2'1
, "14 P Expires June 23,2014
% e a p ......r-_..r_.. a n ooa>mn •'•�F•.Af F.Q.• Bonded Thru Troy Fain Insurance 800-385-7019
FLORIDA DEPARTMENT OF
ENVIRONMENTAL PROTECTION-Z- k
Division of Water Resource Manageniodt L
f10 A , 2600 Blair Stone Road,Mail Station 3t4 FILE C
Tallahassee,Florida 32399-2400
Telephone(850)488-7708
GENERAL PERMIT NOTICE TO PROCEED
Permittee Name: Permit Number: DU-458 GP
Jay and Mary Farr Permit Expires: November 15, 2015
c/o Kevin Partel, President
Coastal Consulting&Restoration, P.A.
4230 Myrtle Street
St. Augustine,Florida 32084
You are hereby granted final authorization to proceed with construction or activities authorized by this
notice. Authorized work must conform to the project description, approved plans, all the conditions of
Section 62B-34.050, Florida Administrative Code, and any preconstruction requirements.
Project Description: Construction of a second-story addition over existing first floor room with
replacement of an existing elevated wooden east side deck. Modification of an existing foundation to
support a new second-story addition.
Project Location: Between approximately 140 feet and 190 feet south of the Department of
Environmental Protection's reference monument R-46, in Duval County. Project Address: 1633 Beach
Avenue Atlantic Beach.
Special Instructions: A preconstruction conference is required. Contact Trey Hatch at (904) 655-
1765 to schedule a conference. The permittee shall comply with all general permit conditions.
Questions regarding t is notice should ected to the undersigned at the above address.
Davie/,Permit Manager l5ate
1�9,q _Uh2A�� J/11,5_10_)01a
'I*ZICMerlk Date
KLD/dw
cc: Permit File
Permit Information Center
Trey Hatch/Michael Savage, Field Inspector
Jay and Mary Farr, Property Owners
City of Atlantic Beach, Building Official
. , Post Conspicuously on the Site
DEP Form 73-102(Updated 9/05)
tt� City of Atlantic Beach Building and Zoning Department
800 Seminole Road
Atlantic Beach Florida 32233 �� f
Telephone(904)247-5800
Fax(904)247-5805 f : FILE C
www.coab.us
November 14, 2013
Ms. Valerie Jones
3900 Commonwealth Boulevard,
Tallahassee, FL 32399
Re: Renovation of single family dwelling at 1633 Beach Avenue
Dear Ms Jones:
The proposed renovations as shown on plans dated 10-28-13 stamped and sealed by James W.
Dupree, Architect does not contravene local setback requirements or zoning codes and is
consistent with the City of Atlantic Beach's Comprehensive Plan.
Sincerely,
)Vt«�4
Michael Griffi CBO, CFM
Director, Building and Zoning
City of Atlantic Beach
APPLICATION NUMBER
Building Department
800 Seminole Road i o be assigned by the Building Department.)
Atlantic Beach, Florida 32233-5445 » Q �7 G)
J „r / J
Phone(904)247-5826 • Fax(904) 247-5845
E-mail: building-dept@coab.us Date routed: pOld
City web-site: http://www.coab.us
fo
APPLICATION REVIEW AND TRACING FORM
Property Address: 14QA:5 0&1 Cy /W D nt review required Yes No
Buildinu
Applicant: jj/y�� �jJj�TL1 � Lin &Zonin
�2 � � /�•! Tree Administrator
Project: ��/�Q/V Public Works
i7a—
Public Utilities
Public Safety
/ Fire Services
,Review fee $ '-
Dept Signature --
Other Agency Review or Permit Required Review or ReceiF
Florida Dept. of Environmental Protection of Permit Verified F Date
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:
APPLJCATIPtN STATUS
Reviewing Department First Review: pproved. []Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by: 4e..Date:
TREE ADMIN.
J/7
Second Review: DApproved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:
Date:
FIRE SERVICES Third Review: OApproved as revised. ODenied.
Comments:
Reviewed by: Date:
wised 05/14/09
City of Atlantic Beach
�a F7Daterouted:
PLICATION NUMBER
_ � Building Department
gned by the Building Department.)
P 800 Seminole Road O
r� Atlantic Beach, Florida 32233-5445 �7 G>)
Phone(904)247-5826 - Fax(904) 247-5845 I ,/
r p )� E-mail: building-dept@coab.us p7(�
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: /0 � �C Q Cy WD ment review required Yes No
Buildin
Applicant: /y�� �jT �� � � � in _,Zonin
n(�
M / Tree Administrator
Project: 2 Jn 1-77Q/V I Public Works
,� o �� L
)�_A � Public Ut!_ties
/1/ q Public Safety
/ Fire Services
;Review fee $ _ - _ .. _
Dept Signature
Other Agency Review or Permit Required Review or Recei�
of Permit Verified F Date
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 DepartmentFFirs,teview: Qpproved. [Denied.(Circle one.) Coments: P l o d vc � oq 1' � 'd L, � IQ.,V,__k_\
S� ���' P Y►t�il-.� I��'P Pf r m��^ �o p y I
PLANNING &ZONING
TREE ADMIN.
Reviewed by: Date:
'
Second Review: DApproved as revised. DD nied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:
Date:
FIRE SERVICES Third Review: DApproved as revised. DDenied.
Comments:
Reviewed by: Date:
vised 05/14/09
CITY OF ATLANTIC BEACH
Building Department
800 Seminole Road
Atlantic Beach,Florida 32233
(904)247-5800
PLAN REVIEW COAUMNTS
Permit Application # /4l- Y79
Property Address: Z
Applicant: <�o, r-e Sw PE, ccrss� ✓le l�
Project:
This permit application has been:
0 Approved
0 Reviewed and the following items need attention:
I. S " P'o ac ?! rov4/ 1 / /
S � b 46h , r
Please re-submit your application when these items have been completed.
Reviewed By: . Date:
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH lJ
FILECOPY
� 800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845 ?8 2014
Job Address: _� Rk=k Na ,4`IL,a�„�,,,��<N Y` • Q�
—T .2�� Permit Number:
Legal Description i5-1b, o`I F /N fy parcel# LS4,51 -o 004
Ioor Area o q. t. �t
Valuation of Work$ fa 1>60 Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Iteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes o N/A
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to be performed: (,�Ry4VDAj df 2 SE<o ,ST�Rk Ar�0171 s� bm grjFAfT
Sisk' 0: &WA7 k)XV 54PZ kr'h A&D Vg*S A W 60~4 al&i ,.46-
Property Owner Information•
Name A -FA PF, Address: /433 AUC
S.
c. / 091-k Stat _Zip3�3 Phone ? -J9�3y
E-Mail or Fax#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: l� � �C�' & ,�j� //4*f APV— Qualifying Agent:
Address: f,6�//1atJ L,6�/ City c7" r State Zip9
Office Phone 1W Job Site/Contact Number�bZ 7 J5*y -► Ly 9 Fax#�f-.A a �f tT
State Certification/Registration# e--Re-- Qn5t25
Architect Name &Phone# 3-4 rX&s /?EE 2 O't _701�6
Engineer's Name&Phone# cu Pb&AA 5,. :
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 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 or Electrical Work, 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 RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereb 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
type o71 work will be compliej with whether sped ied herein or not. The granting of a permit does i
ume to give authority t violate or cancel the
provisions of any other federa tate, or local law regulating construction or the performance of constru
Signature of Owner Signature of Cor
Print Name ................Y_a� �� tl Print Name .
........... ................................................................................
Before me Before me
this_M Day of MW G)k 20 1 y this 11 Day of 20 114
:"s CHRi�: 'HER B.MILLER :"°: TOPHER B.MILLER
Commission# :c 003466 .;AT., Commission#EE 003466
Expires June 23,2014 Expires June 23,2014 Revised 01.26.10
• pF H�'`` Bonded Tnru hoy Fein i:u-+:rw��SOOJ85-7019 ''%�P p;°p��• B.Ad T�Troy Fain Insurance 800-385-7019
DO NOT WRITE BELOW- OFFICE USE ONLY
Appheable Codes: 2010 FLORIDA BUILDING CODE
Revi esult circle one):
Approved Disapproved Approved w/ Conditions
Review Initials/Date: f'n e-1-11-!
Development Size
Habitable Space ?'I/ s F Non-Habitable
Impervious area
Miscellaneous Information
Occupancy Group 2 - 3
Type of Construction V- 6
Number of Stories 2
Zoning District J?G- -M
Max. Occupancy Load
Fire Sprinklers Required
Flood Zone fv'A"
Conditions/Comments:
NOTICE OF COMMENCEMENT FILE COPY
(PREPARE IN DUPLICATE) Lz
Permit No. 0 Tax Folio No.
State of County of (l t. L-
To whom it may concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in
accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: /5-10 09-Cq,5—p2 qE
Address of property being improve( 'fN3 >dE�� -AVE 47Z,4A&.'<
General description of improvements: eyiy,.//
Owner_ 9A F'AP,A
Addressfaj__-e3AGQAjy/- 44.-_R F' 2"2M
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor_��fY/Fi'
Address ,9/ � C +�!/qGJ _7 / 32-2-5
Phone No. Fax No.
Surety(if any)
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name
Address
Phone No. Fax No.
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other
documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself,owner designates the following person to receive a copy of the Lienors Notice as provided in
Section 713.06(2)(b),Florida Statutes-(Fill in at Owner's option).
Name
Address
Phone No. Fax No.
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
X
Signed: `' _ DATE .3 (I IfI
Before me thisay of in the
County of D}jval, tate of Florida,hes personalty appeared
'T o-A A (r i;✓C herein by
Doc#2014069156,OR BK 16733 Page 274, himself/-fierseIf and affirms thaW&WIg4nts and declarations herein
g are true and accurate
u Yer,.
Number Pages: 1 CHRISTOPHER B.MILLER
Recorded 03/28/2014 at 03:20 PM, =k; COn1IpISSIOn#EE 003466
Ronnie Fussell CLERK CIRCUIT COURT DUVAL _+ ;.. o Expires June 23,2014
COUNTY r C''
•i.,t�" &,ndad Th 385-7019
RECORDING$10.00 Notary Public at Large,State
My commission expires:�u.✓-r '
Personally Known or
Produced Identification t=L C(v0(J t( I(d'i 6510
FLORIDA DEPARTMENT OF
ENVIRONMENTAL PROTECTION
t Division of Water Resource Management
FL0RM A k 2600 Blair Stone Road,Mail Station 3522 t
Tallahassee,Florida 32399-2400
Telephone(850)488-7708 F ILE COPY
GENERAL PERMIT NOTICE TO PROCEED
Permittee Name: Permit Number: DU-458 GP
Jay and Mary Farr
Permit Expires: November 15, 2015
c/a Kevin Partel, President
Coastal Consulting& Restoration, P.A.
4230 Myrtle Street
St. Augustine, Florida 32084
You are hereby granted final authorization to proceed with construction or activities authorized by this
notice. Authorized work must conform to the project description, approved plans, all the conditions of
Section 62B-34.050, Florida Administrative Code, and any preconstruction requirements.
Project Description: Construction of a second-story addition over existing first floor room with
replacement of an existing elevated wooden east side deck. Modification of an existing foundation to
support a new second-story addition.
Project Location: Between approximately 140 feet and 190 feet south of the Department of
Environmental Protection's reference monument R46, in Duval County. Project Address: 1633 Beach
Avenue Atlantic Beach.
Special Instructions: A preconstruction conference is required. Contact Trey Hatch at (904) 655-
1765 to schedule a conference. The permittee shall comply with all general permit conditions.
Questions regarding t is notice should be.directed to the undersigned at the above address.
Davie;Permit Manager Date
u y erk Date
KLD/dw
cc: Permit File
Permit Information Center
Trey Hatch/Michael Savage, Field Inspector
.Jay and Mary Farr, Property Owners
City of Atlantic Beach, Building Official
. , Post Conspicuously on the Site
DEP Form 73-102(Updated 9/05)
City of Atlantic Beach Building and Zoning Department FILE C
800 Seminole Road
Atlantic Beach, Florida 32233
;v�i3y�r Telephone(904)247-5800
Fax(904)247-5805
www.coab.us
November 14, 2013
Ms. Valerie Jones
3900 Commonwealth Boulevard,
Tallahassee, FL 32399
Re: Renovation of single family dwelling at 1633 Beach Avenue
Dear Ms Jones:
The proposed renovations as shown on plans dated 10-28-13 stamped and sealed by James W.
Dupree, Architect does not contravene local setback requirements or zoning codes and is
consistent with the City of Atlantic Beach's Comprehensive Plan.
Sincerely,
LEA
"A �
Michael Griffi CBO, CFM
Director, Building and Zoning
FORM 405-10
FLORIDA ENERGY EFFICIENCY CODE FOR BUILDING CONSTRUCTION
Florida Department of Business and Professional Regulation - Residential Performance Method
Project Name: FARR RESIDENCE Builder Name:
Street: 1633 BEACH AVENUE Permit Office: ATLANTIC BEACH FILE COPY , q
City, State,Zip: ATLANTIC BEACH , FL, 32233- Permit Number.
Owner: Jurisdiction:
Design Location: FL,Jacksonville
1. New construction or existing New(From Plans) 9. Wall Types(3484.5 sqft.) Insulation Area
2. Single family or multiple family Single-family a. Frame-Wood, Exterior R=19.0 3484.50 ft2
b. N/A R= ft2
3. Number of units, if multiple family 1 c. N/A R= ft2
4. Number of Bedrooms 3 d. N/A R= ft2
10.Ceiling Types (1938.0 sqft.) Insulation Area
5. Is this a worst case? No a. Under Attic(Vented) R=30.0 1938.00 ft2
6. Conditioned floor area above grade(ft2) 3755 b. N/A R= ft2
c. R= ft2
11. Duuctct
Conditioned floor area below grade(ft2) 0 s R ft2
7. Windows(636.2 sqft.) Description Area a. Sup: 1st Floor, Ret: 1st Floor, AH: 1st Floor 6 474
a. U-Factor: Dbl, U=0.47 636.22 ft2 b. Sup: 2nd Floor, Ret:2nd Floor,AH:2nd Floor 6 464
SHGC: SHGC=0.31
b. U-Factor: N/A ft2 12.Cooling systems kBtu/hr Efficiency
a.Central Unit 30.0 SEER:13.00
SHGC: b.Central Unit 42.0 SEER:13.00
c. U-Factor: N/A ft2
SHGC: 13. Heating systems kBtu/hr Efficiency
d. U-Factor: N/A ft2 a. Electric Heat Pump 30.0 HSPF:7.70
SHGC: b. Electric Heat Pump 42.0 HSPF:7.70
Area Weighted Average Overhang Depth: 2.000 ft.
Area Weighted Average SHGC: 0.310 14. Hot water systems
a. Electric Cap:50 gallons
8. Floor Types (3754.0 sqft.) Insulation Area EF:0.940
a. Slab-On-Grade Edge Insulation R=0.0 1898.00 ft2 b. Conservation features
b. Floor Over Other Space R=0.0 1856.00 ft2 None
c. N/A R= ft2 15.Credits Pstat
Total Proposed Modified Loads: 48.20 PASS
Glass/Floor Area: 0.169 Total Standard Reference Loads: 68.11
1 hereby certify that the plans and specifications covered by Review of the plans and OI'CHE ST,gT,
this calculation are in com lian_cg/ with the Florida Energy specifications covered by this
Code. Jv �2(�j�CEZ calculation indicates compliance
with the Florida Energy Code. nr,,, '. --.` '.•` O
PREPARED Y: Before construction is completed
DATE: this building will be inspected for a
compliance with Section 553.908
I hereby certify that this building, as designed, is in compliance Florida Statutes.
with the Florida Energy Code. COO WE
OWNER/AGENT: BUILDING OFFICIAL:
DATE: DATE:
- Compliance requires completion of a Florida Air Barrier and Insulation Inspection Checklist
12/19/2013 8:25 AM EnergyGauge®USA-FlaRes2010 Section 405.4.1 Compliant Software Page 1 of 6
a
PROJECT
Title: FARR RESIDENCE Bedrooms: 3 Address Type: Street Address
Building Type: User Conditioned Area: 3755 Lot#
Owner: Total Stories: 2 Block/SubDivision:
#of Units: 1 Worst Case: No PlatBook:
Builder Name: Rotate Angle: 0 Street: 1633 BEACH AVENUE
Permit Office: ATLANTIC BEACH Cross Ventilation: County: Duval
Jurisdiction: Whole House Fan: City, State,Zip: ATLANTIC BEACH ,
Family Type: Single-family FL, 32233-
New/Existing: New(From Plans)
Comment:
CLIMATE
/ IECC Design Temp Int Design Temp Heating Design Daily Temp
V Design Location TMY Site Zone 97.5% 2.5% Winter Summer Degree Days Moisture Range
FL,Jacksonville FL—JACKSONVILLE—INT 2 32 93 70 75 1281 49 Medium
BLOCKS
Number Name Area Volume
1 Blocks 1898 17082
2 Block2 1857 16713
SPACES
Number Name Area Volume Kitchen Occupants Bedrooms InfilID Finished Cooled Heated
1 1st Floor 1898 17082 Yes 1 1 Yes Yes Yes I
2 2nd Floor 1857 16713 No 2 3 1 Yes Yes Yes
FLOORS
# Floor Type Space Perimeter Perimeter R-Value Area Joist R-Value Tile Wood Carpet
1 Slab-On-Grade Edge Insulatio 1st Floor 192.7 ft 0 1898 ftz ---- 0 0 1
2 Floor Over Other Space 2nd Floor ---- ---- 1856 ftz 0 0 0 1
ROOF
Roof Gable Roof Solar SA Emitt Emitt Deck Pitch
# Type Materials Area Area Color Absor. Tested Tested Insul. (deg)
1 Gable or shed Composition shingles 2099 ft' 404 ft2 Medium 0.96 No 0.9 No 0 22.6
ATTIC
V # Type Ventilation Vent Ratio(1 in) Area RBS IRCC
1 Full attic Vented 300 1938 ftz N N
12/19/2013 8:25 AM EnergyGauge®USA-FlaRes2010 Section 405.4.1 Compliant Software Page 2 of 6
CEILING
# Ceiling Type Space R-Value Area Framing Frac Truss Type
1 Under Attic(Vented) 1st Floor 30 81 ft2 0.11 Wood
2 Under Attic(Vented) 2nd Floor 30 1857 ft2 0.11 Wood
WALLS
Adjacent Ca
Space vity Width Height Sheathing Framing Solar Belowo
F1 In Ft In Area R-Vahle Fcactnn AhSnr
1 N Exterior Frame-Wood 1st Floor 19 59 9 531.0 ft2 0.23 0.75 0
2 E Exterior Frame-Wood 1st Floor 19 37 4 9 336.0 ft2 0.23 0.75 0
3 S Exterior Frame-Wood 1 st Floor 19 59 9 531.0 ft2 0.23 0.75 0
4 W Exterior Frame-Wood 1st Floor 19 37 4 9 336.0 ft2 0.23 0.75 0
5 N Exterior Frame-Wood 2nd Floor 19 60 1 9 540.8 ft2 0.23 0.75 0
6 E Exterior Frame-Wood 2nd Floor 19 37 2 9 334.5 ft2 0.23 0.75 0
7 S Exterior Frame-Wood 2nd Floor 19 60 1 9 540.8 ft2 0.23 0.75 0
8 W Exterior Frame-Wood 2nd Floor 19 37 2 9 334.5 ft2 0.23 0.75 0
WINDOWS
Orientation shown is the entered, Proposed orientation.
Wall Overhang
V # Ornt ID Frame Panes NFRC U-Factor SHGC Area Depth Separation Int Shade Screening
1 N 1 Wood Low-E Double Yes 0.47 0.31 12.0 ft2 2 ft 0 in 6 ft 0 in Drapes/blinds None
2 N 1 Wood Low-E Double Yes 0.47 0.31 30.0 ft2 2 ft 0 in 6 ft 0 in Drapes/blinds None
3 E 2 Wood Low-E Double Yes 0.47 0.31 84.0 ft2 2 ft 0 in 8 ft 0 in Drapes/blinds None
4 E 2 Wood Low-E Double Yes 0.47 0.31 84.0 ft2 2 ft 0 in 8 ft 0 in Drapes/blinds None
5 S 3 Wood Low-E Double Yes 0.47 0.31 36.0 ft2 2 ft 0 in 6 ft 0 in Drapes/blinds None
6 S 3 Wood Low-E Double Yes 0.47 0.31 8.0 ft2 2 ft 0 in 6 ft 0 in Drapes/blinds None
7 S 3 Wood Low-E Double Yes 0.47 0.31 30.0 ft2 2 ft 0 in 6 ft 0 in Drapes/blinds None
8 W 4 Wood Low-E Double Yes 0.47 0.31 24.0 ft2 2 ft 0 in 6 ft 0 in Drapes/blinds None
9 N 5 Wood Low-E Double Yes 0.47 0.31 5.3 ft2 2 ft 0 in 6 ft 0 in Drapes/blinds None
10 N 5 Wood Low-E Double Yes 0.47 0.31 24.0 ft2 2 ft 0 in 6 ft 0 in Drapes/blinds None
11 N 5 Wood Low-E Double Yes 0.47 0.31 36.0 ft2 2 ft 0 in 6 ft 0 in Drapes/blinds None
12 E 6 Wood Low-E Double Yes 0.47 0.31 13.8 ft2 2 ft 0 in 6 ft 0 in Drapes/blinds None
13 E 6 Wood Low-E Double Yes 0.47 0.31 126.0 ft2 2 ft 0 in 8 ft 0 in Drapes/blinds None
14 S 7 Wood Low-E Double Yes 0.47 0.31 10.7 ft2 2 ft 0 in 4 ft 0 in Drapes/blinds None
15 S 7 Wood Low-E Double Yes 0.47 0.31 24.0 ft2 2 ft 0 in 6 ft 0 in Drapes/blinds None
16 S 7 Wood Low-E Double Yes 0.47 0.31 36.0 ft2 2 ft 0 in 6 ft 0 in Drapes/blinds None
17 W 8 Wood Low-E Double Yes 0.47 0.31 5.3 ft2 2 ft 0 in 4 ft 0 in Drapes/blinds None
18 W 8 Wood Low-E Double Yes 0.47 0.31 24.0 ft2 2 ft 0 in 6 ft 0 in Drapes/blinds None
19 W 8 Wood Low-E Double Yes 0.47 0.31 23.1 ft2 2 ft 0 in 6 ft 0 in Drapes/blinds None
12/19/2013 8:25 AM EnergyGaugeO USA-FlaRes2010 Section 405.4.1 Compliant Software Page 3 of 6
INFILTRATION
# Scope Method SLA CFM 50 ELA Eq LA ACH ACH 50
1 Wholehouse Best Guess .0005 4924.7 270.36 508.45 .474 8.7434
HEATING SYSTEM
# System Type Subtype Efficiency Capacity Block Ducts
1 Electric Heat Pump None HSPF:7.7 30 kBtu/hr 1 sys#1
2 Electric Heat Pump None HSPF:7.7 42 kBtu/hr 2 sys#2
COOLING SYSTEM
# System Type Subtype Efficiency Capacity Air Flow SHR Block Ducts
1 Central Unit None SEER: 13 30 kBtu/hr 900 cfm 0.75 1 sys#1
2 Central Unit None SEER: 13 42 kBtu/hr 1260 cfm 0.75 2 sys#2
HOT WATER SYSTEM
# System Type SubType Location EF Cap Use SetPnt Conservation
1 Electric None 1st Floor 0.94 50 gal 60 gal 120 deg None
SOLAR HOT WATER SYSTEM
FSEC Collector Storage
Cert # Company Name System Model# Collector Model# Area Volume FEF
None None ft2
DUCTS
/ ----Supply---- ----Return---- Air CFM 25 CFM25 HVAC#
V # Location R-Value Area Location Area Leakage Type Handler TOT OUT QN RLF Heat Cool
1 1st Floor 6 474 ft2 1st Floor 94 ft2 Default Leakage 1st Floor (Default) (Default) 1 1
2 2nd Floor 6 464 ft2 2nd Floor 92 ft2 Default Leakage 2nd Floor (Default) (Default) 2 2
TEMPERATURES
Programable Thermostat: Y Ceiling Fans:
Cooling Jan Feb Jan Feb Mar Apr Ma X Jun X Jul X Au X Se Oct (`�Nov Dec
VentinHeating Jan Feb lx�Mar �X�Apr May Jun Jul AuMar A Jun Ju g Sep �X�Oct lOct el Nov Dec
12/19/2013 8:25 AM EnergyGaugeO USA-FlaRes2010 Section 405.4.1 Compliant Software Page 4 of 6
Thermostat Schedule: HERS 2006 Reference Hours
Schedule Type 1 2 3 4 5 6 7 8 9 10 11 12
Cooling(WD) AM 78 78 78 78 78 78 78 78 80 80 80 80
PM 80 80 78 78 78 78 78 78 78 78 78 78
Cooling(WEH) AM 78 78 78 78 78 78 78 78 78 78 78 78
PM 78 78 78 78 78 78 78 78 78 78 78 78
Heating(WD) AM 66 66 66 66 66 68 68 68 68 68 68 68
PM 68 68 68 68 68 68 68 68 68 68 66 66
Heating (WEH) AM 66 66 66 66 66 68 68 68 68 68 68 68
PM 68 68 68 68 68 68 68 68 68 68 66 66
12/19/2013 825 AM EnergyGauge®USA-FlaRes2010 Section 405.4.1 Compliant Software Page 5 of 6
FORM 405-10
Florida Code Compliance Checklist
Florida Department of Business and Professional Regulations
Residential Whole Building Performance Method
ADDRESS: 1633 BEACH AVENUE PERMIT#:
ATLANTIC BEACH, FL, 32233-
MANDATORY REQUIREMENTS SUMMARY- See individual code sections for full details.
COMPONENT SECTION SUMMARY OF REQUIREMENT(S) CHECK
Air leakage 402.4 To be caulked, gasketed, weatherstripped or otherwise sealed.
Recessed lighting IC-rated as meeting ASTM E 283. Windows and
doors= 0.30 cfm/sq.ft. Testing or visual inspection required. Fireplaces:
gasketed doors& outdoor combustion air. Must complete envelope
leakage report or visually verify Table 402.4.2.
Thermostat& 403.1 At least one thermostat shall be provided for each separate heating and
controls cooling system. Where forced-air furnace is primary system,
programmable thermostat is required. Heat pumps with supplemental
electric heat must prevent supplemental heat when compressor can
meet the load.
Ducts 403.2.2 All ducts, air handlers, filter boxes and building cavities which form the
primary air containment passageways for air distribution systems shall
be considered ducts or plenum chambers, shall be constructed and
sealed in accordance with Section 503.2.7.2 of this code.
403.3.3 Building framing cavities shall not be used as supply ducts.
Water heaters 403.4 Heat trap required for vertical pipe risers. Comply with efficiencies in
Table 403.4.3.2. Provide switch or clearly marked circuit breaker
(electric) or shutoff(gas). Circulating system pipes insulated to= R-2
+ accessible manual OFF switch.
Mechanical 403.5 Homes designed to operate at positive pressure or with mechanical
ventilation ventilation systems shall not exceed the minimum ASHRAE 62 level.
No make-up air from attics, crawispaces, garages or outdoors adjacent
to pools or spas.
Swimming Pools 403.9 Pool pumps and pool pump motors with a total horsepower (HP) of= 1
& Spas HP shall have the capability of operating at two or more speeds. Spas
and heated pools must have vapor-retardant covers or a liquid cover or
other means proven to reduce heat loss except if 70%of heat from
site-recovered energy. Off/timer switch required. Gas heaters minimum
thermal efficiency=78% (82% after 4/16/13). Heat pump pool heaters
minimum COP= 4.0.
Cooling/heating 403.6 Sizing calculation performed & attached. Minimum efficiencies per
Tables 503.2.3. Equipment efficiency verification required. Special
equipment occasion cooling or heating capacity requires separate system or
variable capacity system. Electric heat>10kW must be divided into two
or more stages.
Ceilings/knee walls 405.2.1 R-19 space permitting.
12/19/2013 8:25 AM EnergyGauge®USA-FlaRes2010 Section 405.4.1 Compliant Software Page 6 of 6
ENERGY PERFORMANCE LEVEL (EPL)
DISPLAY CARD
ESTIMATED ENERGY PERFORMANCE INDEX* = 71
The lower the EnergyPerformance Index, the more efficient the home.
1633 BEACH AVENUE, ATLANTIC BEACH, FL, 32233-
1. New construction or existing New(From Plans) 9. Wall Types Insulation Area
2. Single family or multiple family Single-family a. Frame-Wood, Exterior R=19.0 3484.50 ft2
b. N/A R= ft
3. Number of units, if multiple family 1 c. N/A R= ft2
4. Number of Bedrooms 3 d. N/A R= ft2
10.Ceiling Types Insulation Area
5. Is this a worst case? No a. Under Attic(Vented) R=30.0 1938.00 ft2
6. Conditioned floor area(ft2) 3755 b. N/A R= ft2
c. N/A R= ft2
7. Windows" Description Area 2
a. U-Factor: Dbl, U=0.47 636.22 ft2 11. Ducts R ft
a. Sup: 1st Floor, Ret: 1st Floor,AH: 1 st Floor 6 474
SHGC: SHGC=0.31 b. Sup: 2nd Floor, Ret:2nd Floor, AH:2nd Floor 6 464
b. U-Factor: N/A ft2
SHGC: 12.Cooling systems kBtu/hr Efficiency
c. U-Factor: N/A ft2 a.Central Unit 30.0 SEER:13.00
SHGC: b.Central Unit 42.0 SEER:13.00
d. U-Factor: N/A ft2 13. Heating systems kBtu/hr Efficiency
SHGC: a. Electric Heat Pump 30.0 HSPF:7.70
Area Weighted Average Overhang Depth: 2.000 ft. b. Electric Heat Pump 42.0 HSPF:7.70
Area Weighted Average SHGC: 0.310
8. Floor Types Insulation Area 14. Hot water systems Cap:50 gallons
a. Slab-On-Grade Edge Insulation R=0.0 1898.00 ft2 a. Electric
EF:0.94
b. Floor Over Other Space R=0.0 1856.00 ft2 b. Conservation features
c. N/A R= ft2 None
15.Credits Pstat
I certify that this home has complied with the Florida Energy Efficiency Code for Building -(HE ST
Construction through the above energy saving features which will be installed (or exceeded) `,0� ATEo
in this home before final inspection. Otherwise, a new EPL Display Card will be completed
based on installed Code compliant features.
Builder Signature: Date: -boo_0 a
Address of New Home: City/FL Zip: *jticoD WIE
Note: This is not a Building Energy Rating. If your Index is below 70, your home may qualify for energy efficient
mortgage (EEM) incentives if you obtain a Florida EnergyGauge Rating. Contact the EnergyGauge Hotline at(321)
638-1492 or see the EnergyGauge web site at energygauge.com for information and a list of certified Raters. For
information about the Florida Building Code, Energy Conservation, contact the Florida Building Commission's support
staff.
"`Label required by Section 303.1.3 of the Florida Building Code, Energy Conservation, if not DEFAULT.
EnergyGauge®USA-FlaRes2010 Section 405.4.1 Compliant Software
Project Summar Job: 121813
RODRI�UEZ 1 Y Date: Dec 18,2013
energy Consuiting (Rest of House) By: ERIN RODRIGUEZ
Proiect Information
For: FARR HOUSE
1633 BEACH AVENUE, ATLANTIC BEACH, FL 32233
Notes:
Design Information
Weather: Jacksonville Mayport Naval, FL, US
Winter Design Conditions Summer Design Conditions
Outside db 39 °F Outside db 92 °F
Inside db 68 °F Inside db 74 °F
Design TD 29 °F Design TD 18 °F
Daily range L
Relative humidity 50 %
Moisture difference 60 gr/Ib
Heating Summary Sensible Cooling Equipment Load Sizing
Structure 15278 Btuh Structure 12961 Btuh
Ducts 3929 Btuh Ducts 5518 Btuh
Central vent(0 cfm) 0 Btuh Central vent(0 cfm) 0 Btuh
Humidification 0 Btuh Blower 0 Btuh
Piping 0 Btuh
Equipment load 19207 Btuh Use manufacturer's data n
Rate/swing multiplier 0.97
Infiltration Equipment sensible load 17924 Btuh
Method Simplified Latent Cooling Equipment Load Sizing
Construction quality Average
Fireplaces 0 Structure 1532 Btuh
Ducts 1359 Btuh
Heating Cooling Central vent(0 cfm) 0 Btuh
Area(ft2) 1898 1898 Equipment latent load 2891 Btuh
Volume (ft') 15185 15185
Air changes/hour 0.28 0.15 Equipment total load 20815 Btuh
Equiv. AVF(cfm) 70 37 Req. total capacity at 0.70 SHR 2.1 ton
Heating Equipment Summary Cooling Equipment Summary
Make Make
Trade Trade
Model Cond
AHRI ref Coil
AHRI ref
Efficiency 80 AFUE Efficiency 0 SEER
Heating input 0 MBtuh Sensible cooling 0 Btuh
Heating output 0 Btuh Latent cooling 0 Btuh
Temperature rise 0 °F Total cooling 0 Btuh
Actual air flow 803 cfm Actual air flow 803 cfm
Air flow factor 0.042 cfm/Btuh Air flow factor 0.043 cfm/Btuh
Static pressure 0 in H2O Static pressure 0 in H2O
Space thermostat Load sensible heat ratio 0.86
Calculations approved by ACCA to meet all requirements of Manual J 8th Ed.
W rl htsoft
2014-Mar-06 13:age59 2
9 Right-Suite®Universa1201212.1.08RSU01508 page2
'CCJ�l ._rin\Documents\Wrightsoft HVAC\Template\FARR.rup Calc=MA Front Door faces E
RODRIGUEZ Project Summary Date: D 121813 1 ,2013
energy consulting 2ND FLOOR By: ERIN RODRIGUEZ
Proiect Information
For: FARR HOUSE
1633 BEACH AVENUE, ATLANTIC BEACH, FL 32233
Notes:
Design Information
Weather: Jacksonville Mayport Naval, FL, US
Winter Design Conditions Summer Design Conditions
Outside db 39 °F Outside db 92 °F
Inside db 68 °F Inside db 74 °F
Design TD 29 °F Design TD 18 °F
Daily range L
Relative humidity 50 %
Moisture difference 60 gr/Ib
Heating Summary Sensible Cooling Equipment Load Sizing
Structure 11914 Btuh Structure 16599 Btuh
Ducts 5073 Btuh Ducts 7244 Btuh
Central vent(0 cfm) 0 Btuh Central vent(0 cfm) 0 Btuh
Humidification 0 Btuh Blower 0 Btuh
Piping 0 Btuh
Equipment load 16987 Btuh Use manufacturer's data n
Rate/swing multiplier 0.97
Infiltration Equipment sensible load 23127 Btuh
Method Simplified Latent Cooling Equipment Load Sizing
Construction quality Average
Fireplaces 0 Structure 1546 Btuh
Ducts 1806 Btuh
Heating Cooling Central vent(0 cfm) 0 Btuh
Area(ftz) 1857 1857 Equipment latent load 3353 Btuh
Volume (ft') 14857 14857
Air changes/hour 0.28 0.15 Equipment total load 26480 Btuh
Equiv. AVF (cfm) 70 38 Req. total capacity at 0.70 SHR 2.8 ton
Heating Equipment Summary Cooling Equipment Summary
Make Make
Trade Trade
Model Cond
AHRI ref Coil
AHRI ref
Efficiency 80 AFUE Efficiency 0 SEER
Heating input 0 MBtuh Sensible cooling 0 Btuh
Heating output 0 Btuh Latent cooling 0 Btuh
Temperature rise 0 °F Total cooling 0 Btuh
Actual air flow 1031 cfm Actual air flow 1031 cfm
Air flow factor 0.061 cfm/Btuh Air flow factor 0.043 cfm/Btuh
Static pressure 0 in H2O Static pressure 0 in H2O
Space thermostat Load sensible heat ratio 0.88
Calculations approved by ACCA to meet all requirements of Manual J 8th Ed.
2014-Mar-06 13:59 06
AC ' +�+ wrightsoft Right-Suite®Universal 2012 12.1.08 RSU01508 Page 3
..rin\Documents\Wrightsoft HVAC\Template\FARR.rup Calc=MJ8 Front Door faces E
CD CD 0 0
`- -' 5 a
``CD —
` ` p, ?;
`b � 3 '� Pt ° w a N trJ e�
CD a `� o x � C
v C n
_ � b � eD
b qq d �
�• .. Zo CD
CD
CD
C CD CDa
O
CDCD
a
�( A
CD
CD
0 O O rami
CCD CCD p
m 7J Co cdD
z CD CD
CD
`� CD
W
U4 CD �.
CD o
CD
CD
p �
.�
CD
CD
� c
C
o
CDaeD
CD
CD
CD A
CD to
r..+
O ¢'
"t —.'0
O
n
� O
CD
CD
V ll. 11
o� t!i w N •-- p p 0o J 9*, P" w N A
o •� ° .n ° o °o °o � o °o ¢ x ° cirri ¢
CD CD CD
N it W uq
" � OCD D CaQ,
CD CD 0 W CD
.O �'. Q (DCD
b4 r � N Q n O
CD
o �
0a
CD
�s
A
d
H
O
2 � K
■'h
y
CD
r
0
A
� O
n
f7 r r (n D DS r S 2 S S D
C� D -� W W 46 C N CLnNin cn N OD N Z
Z
rn � O OD rn O N Irl
N �
0
T1
V �
Z N N (p CA W N
v WXO ODLn O0 0 0 L" OD 0) Ln O O O
0C � 0 OO O O Cr O O
(n
y �
� r ^
-D !
r 0 -
CAzOJD ODD O OD v m
0 D 0 O p 00 0 o 0 O O O O � Z
W 0 1 O a a I� � N I co W I -P'
1 --- --' z
OD � N a 9 O O O a I a i I O O O a OD
0 0 a O a. a a
C- a O a a a a e: a a s a j j m X m
O m v v 0 0 0 0 X 0 -r rn D D N N D ^'_ U1 m
m nx �_ �_ cn D cn D 8 � -� � z p m D n O Z
O O { N N O -� m O C O C v D m
It D - I I m -4 cn -*� m m O
CD m rn rn � \ z p v U)
a a m CO
D
O
L�
Ln OD 46 CAW Ln co �p W OD 00
coW O
N N c0 cp ()t O N N N O W
W ;m O) N N OD .0► W W W W 46
W
m�IL I
s
- :� t
i 3
o �
W d
wo
d �1
U a •� � � � 1j 1�1 �
rA
w �
CC N
W U
x 6,
E-�
E•r � � � u
U U 4r
d �, ° � a �
Q dC � '�3 4.
U
d V ooh
M
a cd o a4
U Q w � a,
0
�4)' 00 0� o
e4
0
a
w
0
-44
o
A
v
b
0
a
1
y
V
COO
Q
� J
U �
cd N
Con
U Sy" - 44 0 ICQ 79
-
0 O Q m V] U W O a H W U U 4 4 Q M r VI
bA �y
r 00 C1 O --+- � M- cn --
U W fi; C7
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
PLUMBING PERMIT INSPECTION PHONE LINE 247-5814
_"%J1 CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 14-PLBG-155
Job Type: PLUMBING ONLY
Description: INSTALL 5 FIXTURES
Estimated Value:
Issue Date: 10/7/2014
Expiration Date: 4/5/2015
PROPERTY ADDRESS:
Address: 1633 BEACH AVE
RE Number: 169651-0000
PROPERTY OWNER:
Name: FARR, JAY AND MARY,
Address: 1633 BEACH AVE
GENERAL CONTRACTOR INFORMATION:
Name: ADVANTAGE PLUMBING
Address:
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $35.00
Trade Permit Base Fee $55.00
Total Payments: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904) 247-5826 Fax(904)247-5845
.TOB ADDRESS: Ilo AeP�CSE PERMIT# y d 9
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE of FIXTURE QTY TYPE of FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower t
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet �—
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater T—
Other Fixtures Water Treating System
RE-PIPE:
TYPE of FIXTURE QTY TYPE of FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well **
**SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
❑ Other
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months.I hereby certify that I have read
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
or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name Phone Number
Plumbing Company lli9 AJ%f _Office Phone�A V 7 7'
Co.Address: City il IL-, 1; -�— State la Zip 3-1.2_J
License Holder(Print): C,ri(-aEate Certification/Registration# CF'
Notarized Signature of License Ho er
worn and sub scri ed before me this day of c� _20
ai?`•�Y° ME YOtINa CFIRiSTY
MY COMMISSION#FF 005505 ignature of Notary Public
' EXPIRES JWy 21 2017
f3ull�id i1Mu Nomy pudic lMdemiters