1763 Seminole Rd 2015 Windows ' 'I SS\ CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
X ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-WIND-294
Job Type: WINDOW AND/OR DOOR
Description: DOOR REPLACEMENT
Estimated Value: $3,300.00
Issue Date: 2/13/2015
Expiration Date: 8/12/2015
PROPERTY ADDRESS:
Address: 1763 SEMINOLE RD
RE Number: 169636-0200
PROPERTY OWNER:
Name: SHADDEN, ELIZABETH B TRUST
Address: 1761 SEMINOLE RD
GENERAL CONTRACTOR INFORMATION:
Name: HOMERITE WINDOWS AND DOORS
Address: 4801 Executive Park CT N BLDG 200 STE 207
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $33.25
BUILDING PERMIT FEE $66.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $103.75
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
WIND - oaq�(
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD,ATLANTIC 13
OFFICE:(904)247-5826 0 FAX NO.:(9
BUILD BUILDING-DEPTCCOAB.US To
ING PERMIT APPLICA L COUNTY
? 2.VALUATION OF V
1,JOB ADDRESS: 9 a;I . I i, ,
/,71 134,L Gq4st 1 .3 3 L'I,f
5 CLASS OF WORK -Py- 6.USE PF STRUCTURE
4.LEGAL DESCRIPTION, -- 64A 0 JL 0 NEW Bt III nING 0 DEMOLITION 01R+DENML
LOT_BLOCK_ SU13 DIVISION 6309-1 Oe-tP-616V 0 ADDITION 0 CONVERTING USE 1!�,COMIMERCIAL
7.DESCRIPTION&F wbRK 0 ALTERATION El ACCESSORY BLDG 8.FIRE SPRINKLER:
0 REPAIR OPOOL/SPA 0 YES 11 N/A
D.,% f f/i 0 MOVE [ZOTHER 0 NO
CONTRACTOR: ARCHITECT/ENGINEER:
PROPERTY OVMF-K:
— 23.COMPANY NAME
9.NAME: 15 OMPANY NAME:
-c— -Ir vlk�-s 01,
16.NAME' 24.LICENSEE NAME:
17.r OF FLO 25.b I ATE OF FLORIDA LICENSE NO.:
10.ADDRESS: RIDA LICENSE NO.:
L tz I&APPRESS: -C i9a- 26.ADDRESS:
400% utc--
3 3 -TL,.t r- t A 14's 5L�tlrr,)4
11 FAX NO.: 19.OFFICE PHONE 20L FAX NO' 27.OFFICE PHONE: 2&FAX NO.:
11.OFFICE PHONE: 1 1 / .23�2
21.CXLL PHON -
I&C E: 29.CELL PHONE:
— Los, 2 5&, ->5 1 S-
14.EMAIL AMIRESS: 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
(if Agent Power of Attorney or Agency Letter Required) /`\ (QyaA-OA)
S C �Il(,C Date: SignevId
igned Q
-�;15- 2eWin the county of B ne this
-�bt5—,20QQ4RftcDuntyof
Before�m this day of Duval,State of rida,has persQngIIv ar)oeared----
Duval,State of &R21a202Jy.,ij&eared - -----
ROYAL G.DEAREN III
ROYAL G.DEAREN III
dec rations are enn himself Ws nei e c 11 tions are
herin by himsel . . . Z
NO y
pires ay e a accu Thru T Fain kwralce BOO-3W7019
true and accu T I rayFainil 800,385-70ig IN Mt
Notary Public a V11-
[:�Personally Known Eg'persona"y Known
0 Produced'denlifi.4-2
0 Produced IdentificabxW52 IL
Notary Signature:
BLDG01 Permit Application Bldg:REVISED:12/18/2008
NOTICE�q
.JF,�MQJD_ C -CERTIFICATION
FILE COPY
CERTIFICATION NO: N1010690.02
DATE: 01/16/2013
CERTIFICATION PROGRAM: Structural
COMPANY: Nan Ya
-1
CODE: 661
To verify that the"Notice of Product Certification"is valid,please visit www.NAMICertification.com to assure that the
product is active and currently listed.This certification represents product conformity to the applicable specification and
that certification criteria has been satisfied. A NAMI approved certification label must be applied to the product to claim
certification status. Please review and advise NAMI if any corrections are required to this document.
COMPANY NAME AND ADDRESS PRODUCT DESCRIPTION
Nan Ya Plastics Corporation USA Series "Out-Swing Entrance Door with
8989 North Loop East, Suite 800 Sidelites" Fiberglass Clad Entrance Door
Houston,TX 77029 Configuration: OXXO
Glazing:IG-Laminate(Interior)-1/8"Annealed
Glass/0.090"DuPont Butacite PVB/l/8"Annealed
Glass/(Exterior)-1/8"Tempered Glass
Frame: W-3703mm(145.75) H-2096mm(82.50")
Panel: W-895mm(35.25") H-2040mm(80.31")
Sidelite: W-875mm(34.50") H-2040mm(80.31")
SPECIFICATION PRODUCT RATING
ASTM E1886-05/EI996-05 Design Pressure:+70/-70 psf
Wind Zone 4-Missile Level D
Qualifies Configurations:O/X/ox/xo/OXX/XXO/OXO/OXXO
Product Tested By: Fenestration Testing Laboratory, Inc.
Report No: FTL 6492/W-1547
Expiration Date: April 30,2015
Administrator's Signature:
NATIONAL ACCREDITATION AND
MANAGEMENT INSTITUTE9 INC.
4794 George Washington Memorial Highway
Hayes,VA 23072
Tel: (804) 684-5124
Fax: (804) 684-5122
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NOTICE OF COMMENCEMENT11,L E
(PREPARE IN DUPLICATE)
Permit No.
State of /IV�1-1 � Tax Folio No.
To whom it may concern: County of
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:
Address of property being improved:
LC--
General description of improvements: '5- eDc-,c)
Owner 1\1
Address 4;1,3
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner) ---------
Name
Address
Contractor Q,,.r 4- D"
Addre ss 96 1 L
Phone No. 'qoLi- F ax N o. %L4 -j 1?/- -9 11;:, a
Surety (if any)
Address
mount 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 Lienor's Notice as provided in
Section 713-06 (2) (b), Florida Statutes. (Fill in at Owner's option).
Name
Address
Phone No. Fax No.
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
Date routed:
E-mail: building-dept@coab.us
W), Cityweb-site: http-://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: /7 4 3 4a _Qe t review req!�� Yes No
Building
Applicant: rjl_6 Zoning
free-Administrator
Project: Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Date
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:
APPLI'I�ATION STATUS
7-
ppro
Reviewing Department First Review: ;ApprovTedo FlDenied.
(Circle one.) Comments:
<:E�ED
PLANNING&ZONING Reviewed by: Date". C�
TREE ADMIN. ]Deni
Second Review: FApproved as revised. rF]Deni
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: -]Denied. Date:
FIRE SERVICES Third Review: F]Approved as revised.
Comments:
Reviewed by: Date:
Revised 07/27110