162 CAMELIA ST 15-WIND-1717 GARAGE DOOR CITY OF ATLANTIC BEACH
s f 800 SEMINOLE ROAD
} y - ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
1.-t JSiI>?'
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-WIND-1717
Job Type: WINDOW AND/OR DOOR
Description: GARAGE DOOR
Estimated Value: $600.00
Issue Date: 7/21/2015
Expiration Date: 1/17/2016
PROPERTY ADDRESS:
Address: 162 CAMELIA ST
RE Number: 170846-0025
PROPERTY OWNER:
Name: WINDLEY JR ET AL, JOHN S
Address: 162 CAMELIA ST 162 CAMELIA ST
GENERAL CONTRACTOR INFORMATION:
Name: ADVANTAGE DOORS INC
Address: 10752 S DEERWOOD PK BLVD ARTIMUS WALKER
Phone: --
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $27.50
BUILDING PERMIT FEE $55.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $86.50
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 CO n 1'1
800 Seminole Road, Atlantic Beach, FL 32233 :..�. 6 :.,
Office (904) 247-5826 Fax (904) 247-5845
/i2- eel rye I C f r )7 nf,'c, r — GtriM Dl7!lob Address: Permit Number: �� 7
Legal Description /3-. I.7 -2 S-2,5 r Parcel# 1 70 w `OQ 1-3
pp Floor Area of Sq.Ft. q.Ft
Valuation of Work S (p DO — Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial 'esidential
If an existing structure,is a fire sprinkler system installed?(Circle one): - `o N /A
Florida Product Approval # 530 Z
For multiple products use product approval form
Describe in detail the type of work to be performed: gAt A6 _ 6008
Property Owner Information: /
Name: .0 GA /I/t �, fcA11L / 1d14 Address: 75(3 PC,i)P' `44-v y
City c U< w 11? StatePLZip 322.- Phone 9' I X77-4777
E-Mail or Fax#(Optional)
Contractor information: CONTRACTOR EMAIL ADDRESS:
Company Name: dGlv4hl' ,ors ZnIc Qualifying Agent: 7/ Q'•i (,/GLk
Address: VS-2—f-4 . / -..1i1( 1(A• City c ✓ State / Zip 3-2g'7
Office Phone 430K (94M Z</cs Job Site/Contact Number Fax#
State Certification/Registration# "0- 3E
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 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 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 certify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordin'' ' .•overning this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority . violate or cancel the
provisions of any other federa ate, or local law regulating construction or the performance of construction.
Signature of Owner Signature of Contractor
Print Name GZwt_ 4( Print Name C(�.�,5 (...1,,,A9(--442.7
ii�
Before me Before me ��
this .�Da of •,JJ , 20 I< this Ai Day of -J U I.. ,20 15
1I r — J
Nota �''l:lic ,, ` "''t MATTHEW A.MEN „Sr.n tijw
.? r -'
:.r ��� ..: MY COMMISSION t FF 139444 _= MY 0..AUSSIQN a FF 139444 Revised 012610
�� ,. EXPIRES:September 8,2018 �'
'•'. , •' Bonded TM„Notary Polk EXPIRES:September 8,
$______.1—ry— Underwrders 1 8 mded TMs see Pudic Uncle
( ,\ City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned b the Building Department.)
800 Seminole Road / /, f/ /] "7/ 7
Atlantic Beach, Florida 32233-5445 f'v i(/
Phone(904)247-5826 • Fax(904)247-5845 --�
� ;�f• E-mail: building-dept @coab.us Date routed: 7/1 7 45.,
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 16 Z £C! 4___ `- . , •ment review required Yieyfgo
Building
Applicant: A d Q ees - - - • : Zoning
Tree Administrator
Project: q62,2‘t_9 g, Q es- 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: loved. ❑Denied.
(Circle one.) Comments:
BUILDI
PLANNING&ZONING Reviewed by: Date?.20-/.�
TREE ADMIN. Second Review:
❑Approved as revised. ❑Deni
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