319 19TH ST - WINDOW . t rL‘Jr
CITY OF ATLANTIC BEACH
Jv 800 SEMINOLE ROAD
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-2851
Job Type: WINDOW AND/OR DOOR
Description: ONE WINDOW REPLACEMENT
Estimated Value: $240.00
Issue Date: 12/15/2015
Expiration Date: 6/12/2016
PROPERTY ADDRESS:
Address: 319 19TH ST
RE Number: 172020-0920
PROPERTY OWNER:
Name: SIROIS, STEPHEN
Address: 319 19TH ST
GENERAL CONTRACTOR INFORMATION:
Name: KOHN CONSTRUCTION LLC
Address: 15 Guana DR
Phone: 803-243-0395
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.
r5.1-A i4; City of Atlantic Beach
;;, Building Department APPLICATION NUMBER
800 Seminole Road (To be assigned by the Building Department)
+ `)~ Atlantic Beach, Florida 32233-5445
:.-6*-
a v' V Phone(904)247-5826 Fax(904)247-5845 � /V
7 S
- /
.on E-mail: building-dept@coab.us
City web-site: http://www.coab.us Date routed: dip /S
APPLICATION REVIEW AND TRACKING FORM
Property Address: 3 1��l '(", L: __,`ent review required n
•
i Buildin• -
Applicant: K0+{(0 _ `KD --rte f . 1 _ =anning &Zoning
Tree
Administrator
Project: ■ ■ •0 —0 • -- Public Works
Public Utilities _-
Public Safety --
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified B Date
Florida Dept. of Environmental Protection 11.111.01111111M1
Florida Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineers _
Division of Hotels and Restaurants
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Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: [/Approved.
(Circle one.) Comments:
nDenied.
BUILDIN
PLANNING &ZONING
Reviewed by: Date: ,.9 j
TREE ADMIN.
Second Review: []Approved as revised. ❑Den d.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:
Date:
FIRE SERVICES Third Review:
[Approved as revised. nDenied.
Comments:
Reviewed by: Date:
Revised 07/27/10
BUILDING PERMIT APPLICATION OFFICE COPY
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845 /
Job Address: 3/9 /9 Pi.*67e, A1/a, 4L,�r'ee.4/ FL J:173 Permit Number: /5_W//'{/D Dag-
Legal Description Lo f 8' /oA 3 Ile f// Parcel#
Floor Area of Sq.FL Sq.Ft
Valuation of Work S Proposed Work heated/cooled Si L) non-heated/cooled
ZOO cle-
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial e
If an existing structure,is a fire sprinkler system installed?(Circle one): es N/A
Florida Product Approval# l&p d C'r I
For multiple products use product approval form
Describe in detail the type of work to be performeA R E PL A C C w I i- Oo GO'y
Property Owner Information:
Name:,SfeDh'rl d-ICf s 5 bto/S Address: .?J7 /9 t9 J74
City Rf/arni,c, State&Zip,?.22.33 Phone 909 -4.1'96,
E-Mail or Fax#(Optional) see'ro y3'20/, CO Ali
Contractor Information: Y I
Company Name: N Jir bit. t*. QuaI}�y'ing Age t: G.A.AIV-•
Address:15 Grua /' City i't State (¢ Zip 77 0IS7i
Office Phone Job Site/C ntact Nu bet_ �A-nq c. Fax#
State Certification/Registration# e !LG 13 3 0 '�
Architect Name&Phone# Nit¢
Engineer's Name&Phone# "1/01
Fee Simple Title Holder Name and Address
Bonding Company Name and Address Al
Mortgage Lender Name and Address r
Application is hereby made to obtain a permit to do the work and installations as indicated /terrify that no work or installation has commenced prior to the
issuance ofa 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,rid rework is not commenced within six(6)months,or reconstruction or work is suspended or abandoned for as period of six 16)months at any time after
work is commenced. /understand that separate permits must be secured for Electrical;Fork,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Healers,
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/have read and examined this 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 cancel the
provisions of any other federal,state,or local law regulating construction or the performance of construction.
Signature of Owner t - ._Sty ,1 Signature of Con t:ctor I II
r�
Print Name 1��S �enC f s/iv i s Print Name I ( (/.
Sworn t and subscribed before rye Sworn to and subsc'bed before e
this Day of QQ f .. &• rmba r .20)' this 4/ ACLJ/ Day of - . 20
Notary Public Notas J
Revised 01.26.10
.0`; 4 BARBARA STEEt3
Notary Public-State of Florida ( BARBARA STEEG
}h r= y p
My Comm.Expires Jun 8,2018 =•;� �., � , Notary Public-State of Florida•
•:far. or Commission N FF 108182 "' •
MY Comm.Expires Jun 8,2011
•• C
Or;; '� ommission•
FF 108182