331 7TH ST - WINDOW r \J�
y
CITY OF ATLANTIC BEACH
ti 800 SEMINOLE ROAD
J 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-2312
Job Type: WINDOW AND/OR DOOR
Description: exterior door
Estimated Value: $925.00
Issue Date: 10/14/2015
Expiration Date: 4/11/2016
PROPERTY ADDRESS:
Address: 331 7TH ST
RE Number: 169922-0000
PROPERTY OWNER:
Name: OSWALT, SUSAN M
Address: 4827 MAXWELL DR
GENERAL CONTRACTOR INFORMATION:
Name: BUTTERFIELD REMODELING LLC
Address: 4220 PLANTATION OAKS BLVD APT 1516 SIDING ONLY
Phone: - -
PERMIT INFORMATION:
FEES:
STATE DBPR SURCHARGE $2.00
BUILDING PERMIT FEE $55.00
STATE DCA SURCHARGE $2.00
PLAN CHECK FEES $27.50
Total Payments: $86.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
i> >ri\, City of Atlantic Beach APPLICATION NUMBER
S j r v - ,. Building Department (To be assigned by the Building Department.)
800 Seminole Road /� _ t„/�AM ?/�Atlantic Beach, Florida 32233 5445 !V !~•�\ Phone(904)247-5826 • Fax(904)247-5845
E-mail: building-dept @coab.us Date routed: AO ///5--
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 33. 1 7 TN Jr Department review required Yes No
(—Building
Applicant: Ar lc/ Eis o (31E Il l Planning &Zoning
Tree Administrator
Project: i ( eI 0 ,poor► 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: pproved. ❑Denied.
(Circle one.) Comments:
BUILDI
PLANNING &ZONING
Reviewed by: Date:A)`/O/.
TREE ADMIN. Second Review: ['Approved as revised. enied.
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
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233 ► , _ „.,, d - 3
Office (904)247-5826 Fax(904)247-5845
Job Address: 331 7th St. Atlantic Beach, Fl. 32233 Permit Number:/5'—ee/,4'D —)3/2
Legal Description 5-69 16-2S-29E ATLANTIC BEACH LOT 12 BLK 9 parcel ti 169922-0000
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$ 925.00 Proposed Work heated/cooled N/A non-heated/cooled N/A
Class of Work(circle one): New Addition Alteration Move Demolition pool/spa window/door
Use of existing/proposed struct e(s ( rcle one): Commercial sidentia
If an existing structure,is : fire sprit 7.•r system installed? (Circle one): Yes No (N /A)
Florida Product Approval " 13069.9
For multiple products use : o s - approva orm
Describe in detail the type of work to be performed: REPLACE EXTERIOR DOOR
Property Owner Information:
Name: JOHN OSWALT Address: 331 7TH ST.
City ATLANTIC BEACH State FL Zip 32233 Phone 513-502-4914
E-Mail or Fax#(Optional)__
Contractor Information:
Company Name: BUTTERFIELD REMODELING, LLC. Qualifying Agent: CLINT BUTTERFIELD
Address:4220 PLANTATION OAKS BLVD.#1516 City ORANGF PARK State Fl Zip 32065
Office Phone 904-333-8409 Job Site/Contact Number 904-333-8409 Fax#
State Certification/Registration# NS.S-14
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 L6)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 cert fy 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 specified 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�`, uction or the performance of construction.
/ /,/ r
Signature of Owner�� �Sig#7 Signature of Contractor ,- `rte / 4/ i a 'd/'A
Print Name /JOHN OSWALT Print Name CLINT BUTTERFIELD
Swo to and subscribed me Sworn to and subscribed .-fore m
this(err Day of 5 1' -6p l i ( ,20 1 ) this :._ Day of • _. • ..` ' " 2015 Acusor N otary Public N. Pit. is
_ Revised 01.26.10
ALEX N.POWERS i
.iY COMMISSION 4 FF 897944 """"�
XPIRES:July 12,2019 .:$A;, CAROL JEAN HUGHES
f; ed The t Public unae r$ °• u. .i. Commission s FF 171959
-::1"..%"' a Expires December 3,2018
'...:1-ps.1*. 8or ud TNu Troy Fa a Inuvence 8:�O.E5.701.4
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