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387 10TH ST - WINDOWS / DOORS f"---,, /Jj ,�I\ CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD `J 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-1418 Job Type: WINDOW AND/OR DOOR Description: REPLACE 4 SLIDERS Estimated Value: $8,707.00 Issue Date: 6/19/2015 Expiration Date: 12/16/2015 PROPERTY ADDRESS: Address: 387 10TH ST RE Number: 170093-0000 PROPERTY OWNER: Name: MUELLER, CONRAD Address: 387 10TH ST PERMIT INFORMATION: FEES: BUILDING PERMIT FEE $93.54 STATE DCA SURCHARGE $2.00 PLAN CHECK FEES $46.77 STATE DBPR SURCHARGE $2.00 Total Payments: $144.31 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACII ORDINANCES AND THE FLORIDA BUILDING CODES. City of Atlantic Beach eac APPLICATION NUMBER 44 Building Department (To be assigned by the Building Department.) A � 800 Seminole Road I j� Atlantic Beach, Florida 32233-5445 1 -- � N i_ 14 la Phone(904) 247-5826 • Fax(904)247-5845 / E-mail: building-dept @coab.us Date routed: Cp/( 7 / LS City web-site: http://www.coab.us I APPLICATION REVIEW AND TRACKING FORM Property Address: 3 8 .� I Q S-- . De artment review required Yes No Buildin Applicant: 0 W t\D _ anning &Zoning Tree Administrator Project: I - + . Public Works Public Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt 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: APPLICATION STATUS Reviewing Department First Review: E pproved. ❑Denied. (Circle one.) Comments: �) y BUILDING � " V PLANNING &ZONING Reviewed by: Date: 6 / 7'0?c)/5 TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 07/27/10 PBUILDING PERMIT APPLICATION D C) 17 FILE COPY CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 JU 7 - ____ Office (904)247-5826 Fax(904) 247-5845 3€'1 i clerk S/ Number:Job Address: Permit Number: /$—W j/VD—N/8 Legal Descriptions"14 /(o"c-S-igq 6 ATI‘k 4,71c, % Parcel# 17049 3 "O000 Floor Area of Sq.Ft. t Valuation of Work$ .0743ie Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa • 'I dow/door Use of existing/proposed structure(s)(circle one): Commercial esidential If an existing structure,is a fire sprinkler syste installed?(Circle one): N/A Florida Product Approval# 1L I'S o`�•� I r I For multiple products use product approva form p .1 ' LO Describe in detail the type of work to be perfo�ed: RI APIA C I- St/ 1))1V•6 1`'A i 0 1J Q O JU _. . . D Property Owner I ormation: l By Name'C..OY1V ��1( 347 Ia N kat C.. c� Address: 11 City 1 t, �j�l{1(i- S to ELZip ' Y") Phone ..ti I �f 7 $I • E-Mail or Fax#(Optional) PLI-l•-t- i(t e (3,(� p Vf , al y r Contractor Information: CONTRACTOR EMAIL ADDRESS: U1 SR A/a A .5C li c E5 aQ 7eA' y= l( Company Name:W 6�.4/ 'l✓P.1/i C j Qualifying Agent:ft. W r n/t/�l� Address: f�� G 130 2 pa._ City -ct b)( State 1' Zip 3y`7�S" Office Phone UV Y.3g 3 g.j Job Site/Contact Number 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 Application is hereby made to obtain a permit to do the work and installations as indicated. I cent&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 f work is not commenced within six(6)months, or if construction or work is suspended or abandoned for aperiod of six(6)months at any time after work is commenced. I understand that separate permits must be secured for Electrical'York,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 hereby certtbi that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether speci ied herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other federal,state, or local law regulating construction or the performance of construction. Signature of Owner Signature of Contractor Print Name Con 'NI M't 1 k l/ Print Name Befor= e Before me this D: .f II . 20 this Day of ,20• �� - � 'Dry Public Stets of Florida r riot. . Public Notary w iC 'F . . Expires Commission 18 008 or r,d' Expires 02/14/2018 Revised 01.26.10 • '... WINE / .BOIL-DER AFFIDAVIT FILE COPY, ...Air,..t.,,, I. FLORIDA STATUTES;UTES; CHAPTER 489, FLORIDA STATUTES, CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE El 7d-} PART I "CONSTRUCTION E LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES: 1ES: i STATE LAW SQUIRES CONSTRUCT 1 CON'1TA.CTORS. YOU HAVE , ION TO BE DONE BY LICENSED I LAW. THE EXEMPT/ON'ALLOWS YOU,AS TI-M OWNER OF YOUR PROPERTY.OPERTY.TO OA ,S YOUR OWN CONTRACTOR EVRN THOUGH l l'I,It1'Itil nit:L.1101..11<I-tt:'r ��ILIIZSI F YOU MAY BUILD OR LICENSE. 1 VU I 1 WO FAMILY RSIDENCE OR A FARM OUTBUILDING. YOU MAY IMPROVE A ONE-OR IMPROVE A CO.MItIBR.CL4L BUILDING AT A COST OF 525.000.00 OR LESS. T ALSO BUILD OR nIUST BP POPS YpUR Uq� OCCUPANCY. IT MAY NCI LF OR I NC BUILDING YOU HAVE BUILT YOURSELF WI SAL ;:,r,I.E,�A I AI l.L:R THE CONSTRUCTION IS COMPLETE, THE LAW WILL WITHIN ONE YEAR IT FOR SALE OR LEASLJ. WHICH IS IN �L PRESUME THAT YOU BUILT aflltr•_,�Id r Ir•II�J_'INSL;1'i J`I_Rtic.lN 1y tVIOLATION OF THIS E�)VIpTION: �,_�-I11 nl•11 nit)I I I%/1 r' ICI NSI I Lf -i t.t'ON1R-aCIt)1.�- YOUR CONSTRUC-I1ON MUST �'I'rl in m rJ n s1131U t T `BULLDIG CODES AND CZO-NINI .REGULATIONS. I f IN lit LI,I1_i.J.I' Q11tI.::L :'1 51.117= 1_,,kW AND I31' -�.:�_ II;11't_ )10.)t w.-1 1:1.. . , ���UNh ,�IU,wi:II�AI I Il'( fJ\IfJlr if. ir:.JURV 11,41:311_1(1- SIIVCE OWNERS MAY BE LIABLE FOR INJURIES TO WORT FpS IfJF1' 11;r I::(ilLf.)H�It • DEPARTMENT SUGGESTS WORKER'S �_ I11f,E t;11i-;/ ;i;'.•:.1.{I COMPENSATION IhI:;Uf:;1Nl'[ AE III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS ALSO EMPLOY ON THEIR IMPROVEMENT TRADES. THEY d�' I=ENALTV UNLICEf�Si_il CIRCUMSTANCES. OWNERS BEING SUBJECT"OTOb$5,000 PENALTY u---i _ORIf5A STATUTE CANNOT BE EMPLOYED ANY 1 UNDER -455-228(1). AN'OCCUPATIONAL LICENSE"IS NOT ADEQUATE. THE OWNER SHOULD I YSICAI LY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA CERTIFICATE TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. "COP BUILDING DEPARTMENT(247-5826) IF IN DOUBT. T ELEPHRACTOON� THE E V.ACKNOWLEDGEMENT;ED ,EMENT;I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE o STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. - ADJ+-ESS ..r — q t�� . J. I _ y i� PHONE NUMBER . 11 . 1111 ' 1 ‘ev.,, P' NAME 1 Y SIGNATU t(z b� 7— +5-in DATE Before me this f 3 day of __L 201 the county of Duval,State of Florida,has personally appealed herin by himself/herself and affirms that all statements and declarations are true.ry!accurate. Notary Public at Large, ate of_ +r _,County of ❑Personally Kn .11 ❑Produced t-ntif•^lion- - ,� Notary Public State Shirley L Grahamof r toriaa AP* MY Commission FF Notary r , 0 - Expires 02i/4/2018 08699p --.- - ' _ ' - - _ t fiiI_UG/Uwn_r-L'uitder AJtidnvir;REVISE ; =ha,• y� ._._-.... I' i CITY it `1I OF ATLANTIC BEACH AFFIDAVIT L FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE PART I "CONSTRUCTION DISCLOSURE STATEMENT FOR SECTION 459.103(1),FLORIDA STATUTES: • STATE LAW 'REQUIRES CONSTRUCTION TO BE DONE BY LICENSED I CONTRACTORS. YOU I LAVE APPLIED FOR A PERMIT UNDER AN EXEMPITON TO TITi1T I LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY.TO ACT AS I YOUR OW CONTRACTOR EVRN THOI.JGH YOU DO NOT HAVE A LICENSE. `1 C, _t::I'r !'.\►til Iln it.,rr 11;1.1<'Irt-,N lul.IliSF'I_I YOU MAY L I�1L1'I 1 WO FAMU_,Y RESJD NCE OR A FARM OUTBU2.DINGBUYOU R II�IPROVE A OI -OR. 1 IMPROVE A COMMERCIAL BUILDING AT A COST OF$25.000.00 OR LESS.LF THE BUILD MQ MUST BE FOR YGURUSEAND OCCUPANCY. IT MAY Nt:'T BE L+UILI rot{SALL' OR I IAS1 IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITI-)IN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEAS IS. WHICH IS IN VIOLATION OF THIS EXTIVIPTION. 'r(.rr.l r_I A.N. r.,y)1 rIIILI..,al.l_I r1I II_I:NSr;1'! f.'I:RSON_15 1•t7 .E.t.ON 7T<_at_Tt 11 . YOUR CONSTRUCTION UST BE DONE A •CORDNG TO THE BUILDING CODES AND ZONING .REGULATIONS. I 1 I:. rr1J iii r► sit n,tinIn.1; .l.t_l AI \ •:.r s,: ,- 1 It i-1J,yI I:I,•'' UI1:1::L RF .I.I1.1'( I l ill'L C rAmt(. rL) I;1 I J ,1 SJ 117__ L 11.AND HY t_UvNll 1,R , 1t,,1-1 fl.t1!_ I w }.,I.L�rb,:11:i:L_5'. _ ___ ----•-____---- .._ __.�_ 1��11�y1�'Ir. t_It`Ci�l: li!t, m �. it iP.t.JUR1' t_IAEII_IEY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO b __ _ .-1 I (I I:a n1_r 111( 1.1k=PAP.TIViENI SUGGESTS WORKER'S PE ON I RS TF)f 1' f f'� +'t_li:1 i Z:'.;J.i UrtrihI:�TIUhI Ihi:zktE::1fA:( ( .: a F., BIi. IRS WITHHOLDING; OWNERS HIRING WORKERS C3 2 N Z OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1R 99 REQUIREMENTS OYO N THrE WORKERS TI m z EMPLOY ON THEIR IMPROVEMENT TRADES. I'` t=Eid$t_Tl', i/r�rLlCEfti t_Ci {CONTRACTORS CANNOT CL = tCIRC;LIli4ST=1NCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE oscss • UNDER Il' 455-228(1). AN"OCCUPATIONAL LICENSE"IS NOT ADEQUATE. THE OWNER SHOULD PHYSICAJ s SEE THE COUN iY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CON T RACTO S CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE T;,_ BUILDING DEPARTMENT(247-5826)IF IN DOUBT. V ACKNOWLEDGEMENT;I HEREBY ACKNOWLEDGE THAT I HAVE READ T STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FORT HE�EI SUACELO OF AN OWNER-BUILDER PERMIT. • /�f 'IL . / J AD ESS 1i � �� �L.� l ��l� Id �� I L-6-' PHONE tfUMBER `(�' _ V V GNATUI. (./ � 1 /C i 1 DATE Before me this I� day of _ 4 i Q Duval,State of Florida,has personally rsonall �" 20L 'n'he county of 1 Pe Y%F'Pc-�ed herin by himself/herself and affirms that all statements and declarations are true n( aca,rate. — I iii, Notary Public at Large,.tale of +r _,County of v4d ❑Personally Kn .n .■ ❑Produced 1.entLS,^lion-_ — Y N. Notary 0 rY Public State of Flo � �,■ ,nor Shirley L Graham nda o«f:d My Commise.ion FF x86990 Notary a • , A / Expires 02/14/2018 ic). , F.1.iLfJG/0.ner-Bui,der Affzdnvir;REV/SE d/lo• tny9-- SC i Florida Building Code Online FLORIDA D&PAAYMtiYVT OF Business & Professional Regulation DBPR HOW ABOUT MDR DBPR DIVISIOh5 CONTACT 08PR Florida Depart rent°f BCIS Home I Log In User Registration Hot Topics! Submit Surcharge j Stats&Facts I Publications I FBC Staff i BCIS Site Map f Unks I Search Busines .? Professional I Product Approval �1 USER: Public REgUIatlo License efficiently.Regu'a;efairiy. L 0 Product Approval Menu>Product or Application Search>Application 1 id>Application Detail �J EMERGENCY P1 ` Cm II or MANAGEMENT FL# FL13241-R1 = O 0 A ►OFFICE OF THE Application Type Revision SECRETARY Code Version 2010 'IM' m Application Status Approved Comments (I) Z Archived 0 0 M m 'c^ Product Manufacturer Custom Window Systems Inc. cn Address/Phone/Email 1900 SW 44th Avenue O O f Ocala, FL 34474 03 (352) 368-6922 Ext 207 Z r mlafevre @cws.cc Authorized Signature Michael LaFevre mlafevre @cws.cc Technical Representative Brian Tenace Address/Phone/Email 1900 SW 44th Ave. Ocala, FL 34474 (352) 368-6922 Ext 291 btenace @cws.cc Quality Assurance Representative Jeff Thompson Address/Phone/Email 1900 SW 44th Ave. Ocala, FL 34474 (352) 368-6922 Ext 221 jhompson@cws.cc Category Exterior Doors Subcategory Sliding Exterior Door Assemblies Compliance Method Evaluation Report from a Florida Registered Architect or a Licensed Florida Professional Engineer 0 Evaluation Report- Hardcopy Received Florida Engineer or Architect Name who developed the Lucas A. Turner Evaluation Report Florida License PE-58201 Quality Assurance Entity Keystone Certifications, Inc. Quality Assurance Contract Expiration Date 03/01/2014 Validated By Steven M. Urich, PE 0 Validation Checklist - Hardcopy Received Certificate of Independence Fl 13241 R1 COI EvalReo CWS-496A(SGD-8900. NI).odf Referenced Standard and Year(of Standard) Standard Year r//floridabuilding.org/pr/pr_app_dd.aspx?param=wGEVXQwtDgvRk6bsvZ66FA9Q%2be33nyHnOoFoidno8Fgg%2fCpb4wIVJw%3dp/o3d[3/6/2012 3:34:24 PM] Florida Building Code Online AAMA/WDMA/CSA/101/I.S.2/A440-05 2005 ASTM E 1300-04 2004 PA TAS 202 1994 Equivalence of Product Standards Certified By Sections from the Code Product Approval Method Method 1 Option D Date Submitted 12/09/2011 Date Validated 12/12/2011 Date Pending FBC Approval 12/19/2011 Date Approved 01/31/2012 Summary of Products FL# Model,Number or Name Description 13241.1 SGD-8900 PVC Sliding Glass Door. SGD-8900, Sliding Glass Door, 16080, OXXO, Non-Impact. Limits of Use Installation Instructions Approved for use in HVHZ: Yes FL13241 R1 II CWS-496A(SGD-8900. NI).odf Approved for use outside HVHZ:Yes Verified By: Lucas A.Turner 58201 Impact Resistant: No Created by Independent Third Party: Yes Design Pressure: +N/A/-N/A Evaluation Reports Other:See Installation Dwgs.for DP, OXXO, OXO, OX, & XO, FL13241 RI AE EvalReo CWS-496A (SGD-8900. NI).o.f Max. size panels 4' x 8' nominal. Fl 13241 R1 AE Mikron NOA 11-0830 09.odf Created by Independent Third Party: Yes Contact Us::1940 North Monroe Street.Tallahassee FL 32399 Phone:850-487-1824 The State of Florida is an AA/EEO employer.Coovrioht 2007-2010 State of Florida,::Privacy Statement::Accessibility Statement::Refund Statement Under Florida law,e-mail addresses are public records.If you do not want your e-mail address released In response to a public-records request,do not send electronic mall to this entity.Instead,contact the office by phone or by traditional mail.If you have any questions regarding DBPR's ADA web accessibility,please contact our Web Master at webmaster8 dbnr.stat fl ,s. Product Approval Accepts: 07 la kte-cil 111 SCarei AFE 1://floridabuilding.org/pr/pr app_dd.aspx?param=wGEVXQwtDgvRk6bsvZ66FA9Q%2be33nyHnOoFoidnoBFge o2fCpb4wIVJw%3d%3d[3/6/2012 3:34:24 PM] (40/-(oci,: /.-ci._ R !). 1 sGb 4(0)690 ii , 6 6 c16)(S4' (...V 1 ‘,„.....-•' • i 1 1 I , 1 : . , : • i 1 . 1 : i i B As" FOA i . . . . ! ..._ 1 , L I 4.(,,o;- .; t.i.; : h 12117 : , r- (-, 12, , I 1 , 2 WD r-1-:(/'(:)I'L•• 1-'1 a re_ g..7 10.-(--, c72„ LcT i' L— _. 1 '3 Lucas A. Turner, P.E., MBA Evaluation Report 496A 2080 Mauve Terrace North Port,FL 34286 Ph. 941-380-1574 December 2, 2011 Product Description: Series 8900 PVC Sliding Glass Door,Non-Impact,4'x8' nominal panel size, 3/16 Tempered—Air—3/16 Tempered glass Manufacturer: Custom Window Systems,Inc. 1900 SW 44th Ave, Ocala,FL 34474 Statement of Compliance: This report evaluates the above-listed product per the requirements of FAC Product Approval Rule Chapter 9N-3.005 (4),using 9N-3.005 Method 1 option (d). This product complies with the requirements of the Florida Building Code including the High Velocity Hurricane Zone. The product testing standards performed are outlined below. Technical Documentation: 1) Approval drawing CWS-496A, signed and sealed by Lucas A. Turner,P.E. on 12/2/11. 2) Test Report NCTL-210-3614-3 and-3A,National Certified Testing Laboratories, Orlando,FL, with test completion date 06/15/2009 a. Testing Performed: TAS 202 1994(Full 202 performed on 3 identical specimens of 190_1/8"x 95_1/2"size OXXO with Design Pressure+/-60 psf) b. Testing Performed: AAMA/WDMA/CSA 101/I.S.2/A440-05 3) Supplemental Calculations to support CWS-496A,signed and sealed by Lucas A. Turner, P.E. on 12/2/11 Installation: Units must be installed according to approval document CWS-496A. Limitations of Use: This product: • May be used with door heights up to 95_1/2",with 45 5/8"max. panel widths and 41 1/2"x 85 7/8"max.glass DLO sizes • Achieves the design pressures shown in CWS-496A • Is non-impact resistant and requires the use of shutters in windborne debris regions • • May be used in the High Velocity Hurricane Zone • Requires 3/16 Tempered—Air—3/16 Tempered glass minimum • Requires Mikron rigid PVC frame extrusions per Miami-Dade N.O.A. 11-0830.09 Certification of Independence: I do not have,nor do I intend to acquire,nor will I acquire, a financial interest in Custom Window Systems or in any company manufacturing or distributing products for which this report is being issued. I do not have,nor do I intend to acquire,nor will I acquire, a financial interest in any other entity involved in the testing or approval process of this product. E ti� P • No 5$2Q 1 ':�1`)��' � *• # i* - 12/2/11 . �: STATE OF ; Lucas A. 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