760 REDFIN DR - SHED j rL`J\.,_.________.....,fy
P .JJ4
r-': 1i ' 4'' �1 CITY OF ATLANTIC BEACH
9
800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
SHED PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-SHED-2529
Job Type: SHED PERMIT
Description: SHED - WOOD FRAME 12' x 16'
Estimated Value: $1,700.00
Issue Date: 12/9/2015
Expiration Date: 6/6/2016
PROPERTY ADDRESS:
Address: 760 REDFIN DR
RE Number: 171310-0000
PROPERTY OWNER:
Name: WOJNAROWICZ, KRZYSTOF P & EWA. *
Address: 760 REDFIN DR
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $29.25
BUILDING PERMIT FEE $58.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $91.75
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH OFFICE COPY
800 Seminole Road,Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 1(a RIED Y I NA DI ' Permit Number:/s-Vied-0751;
Legal Description Parcel#
Valuation of Work$ 2 30o Prop Proposed Work he ted/cooled t
� 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 Residential
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A
Florida Product Approval#
For multiple products use product approva orm
Describe in detail the type of work to be performed: $t til t.t> HN4
walk R001:1We- SIMMr%-e-s
Property Owner Information:
Name: K(tai .P. W O-rNI ,R,,O Wl C Address: 140 (tEflFI 4 DR.. _
City OfTLAKTt C ZE.ON. State 31,Zip_aanzrhone 1.54 2111 ')o' 3
E-Mail or Fax#(Optional) K,lMS c t._.4 Q"
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: Qualifying Agent:
Address: City State
Office Phone Job Site/Contact Number Zip
State Certification/Registration# Fax#
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 certib 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 a period of six_(6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical IFork,Plumbing,Signs, Wells, Pools,Furnaces,Boilers,Heatters,
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 ordinances governing this
type ofwork 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 construction or the performance of construction.
Signature of Owner__ —�` . Signature of Contractor
Print Name Kg'S , erg ��- Print Name
Befor: /� Before me
thi IF, Da of 20 this Day of
art
y ,20 AIL ink. __
y �' _ orida
vO ry �� 7 Shirley L Graham otary Public
` +fat My Commission FP 088990
4'd'1. ' Expires 02/14/2018
A.A A. Revised 01 6 1 n
•
S!AIV
? '� �;� CITY OF ATLANTIC BEACH
800 Se minole
Road j Atl antic Beach,Florida 32233',' -� ,`y ! OFFICE COPY j0 = � v
Telephone(904)247-5800
��J j j FAX(904)247-5845
REVISION REQUEST SHEET S ��� .ZS�q
Date: b 1 Received by: /
Penn it Number
Resubmitted:
Original Plans Examiner:
Project Address: Project Name: slfv
Contractor: IC l c ,e_r szz a.?
Contact Phone : 90 j� Contact Name:
Revision/Plan Check/Permit Fee(s)Due: $ ton act a-mail: ,YRIp p� G M•t4J� •
M>�
Descri tion of Pro.osed Revision to Existin. Permit:
�'11T , ,,-/VS 04
Additional Increase in Building Value: $ 51•0 Site Plan Revised: Additional S.F.
Public W/U Approval:
By signing below.I(print name)
is inclusive of the proposed changes. affirm that the above revision
•
_P
Signature Cot actor/Age t(Contractor must sign if increase in valuation) �' `O !
Date
Office Use Only
Date: Approved:
Rejected: Notified by:
Plan Review Comments:
rk ECIEOVED
iii 'I 10
'
w
Department review required Yes No
6_ Idin.
Il an Zonin;1111111111111111111-
Tree A.minis rator _-
,blic Works _- Plans Examiner
t 'ublic Utilities
blic a e y _-
Fire Services
Date Crewed 8/20/15 Rev.2
u CITY OF ATLANTIC BEACH OFFICE COPY
71 4. IJ%WNER / BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT
LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST
SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE-OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU I-LAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826)IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
-1 o e_t-.0 r 1 r y K t- n G r A C,4- 'o4 51 t 3'L f l
ADDRESS PL .3�J _PHONE NUMBER
k<,R,kS ,R 1a o`x\r(P�(�w I, Z L?��
PRINT NAME
SIGNATURE DATE 3)._____
Before me this y of Q ,20 tthe county of
Duval,State of Florida,has personally appeared herin by himself I herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of 1 ( ,County of £v'IA-
❑Personally Known II
roduced Identification- ` a
�� �• TONI GINDIESPERGER
/ :--4 �-: MY DNI%SION t FF 924951
i ▪ . .t EXPIRES:October 6,2019
Notary Signature: _71 �.�1 t+: `- pubkUndaneMrs
f• oih BondedThnlNotary
F./BL.DG(Gwncr-Builder Afradavit,REVISED:4/162009
/ " r N L r,4 L.IN/)' VAl./ T 7—!e■ 0
AS RECORDED IN PLAT BOOK 3d PAGES 94 .944 OF THE PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA
C E R T I F I E D F O R: 1 -C-Z y c.Z.TO F P ,f & V4 I,✓O J A1.4/2_, k\// CZ_ : E-,0 s r&R-A/ Mo g.Tc4C
(_o le.-P. ; /17-7-D2n 6,Y5' TITLE- /,J5. FC/ 10,' f IC. ; 120r.I.1
o/3R-/SIC &,Z.- ; /38--,474.04__E-y, DE-c..4A/,D/o s' SNAh/
OFFICE COPY
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•` ° L ■ FAc.c.5 /n/
NJ B S o 37 • z " F&/\/. Po ST
7 � W 80. !05'
q
8
7
THE PROPERTY SHOWN HEREON APPEARS TO LIE WITHIN FLOOD HAZARD ZONE X AS SCALED FROM FLOOD
INSURANCE RATE WPM() I FOR THE CITY OF 4 T L, /3C 11, FLORIDA, DATED 4• I )-$9 . AND
IS SHOWN AS A COURTESY ONLY AND DOES NOT CONSTITUTE A CER77FCATTON OF SAME.
TRI-STATE LAND SURVEYORS, INC. •
8411 BA YMEADO WS WAY SUITE #2, JACKSONVILLE, FLORIDA 32256 (904) 731-7235
SKU#382-407
GAF
PRODUCT APPROVAL
v Roofing Shingles
Underlayment(Synthetics) FL 10124
FL15487
•
Underlayment (Liberty Base, Ruberoid SA Base/Ply, Storm guard)
Everguard 7P0 (SA & Fleece) Roof Systems 8 ) FL 1006262
6
FL 5293 OFFICE COPY
Roof Ventilation
FL 6267
960 Static Roof Louver
FL 5027
CERTAINTEED
PRODUCT APPROVAL
Roof Shingles FL 5444
Underlayments (Torch, Flintlastic, SA, etc.) FL 11288
Modified Bitumen Roof System FL 2533
OWENS CORNING
PRODUCT APPROVAL
Roof Shingles FL 10674
Roof Shingles(Supreme& Classic) FL 16638
Underlayment FL 9777
TAMKO PRODUCT APPROVAL
Roof Shingles
FL 1956
ATLAS
PRODUCT APPROVAL
Roof Shingles FL09792
Underlayment
FL 11915
MIDSTATES
PRODUCT APPROVAL
Quick-Stick Ice and Water-sanded FL 13857.4
WOODLAND
PRODUCT APPROVAL
15#Felt D226
V30#Felt D226 FL 1814
15# D4869 FL 1814
30# D4869 FL 1814
FL 1814
STAMPCO
PRODUCT APPROVAL
Off Ridge Vents FL 16160
LOMANCO
PRODUCT APPROVAL
750 Vent FL 3792
•
Omni Roll
FL 2847
Roofing Supply Group I 3333 Canal Street- Unit 1 I Jacksonville, FL 32209
09/25/97 THU 13:59 FAX 904 354 0077 BROWN OBRINGER Qu02
MAP SHOWING BOUNDARY SURVEY OF
LOT 15. BLOCK 9• ROYAL PALMS UNIT TWO, AS RECOP.DE'D IN PLAT 800K 30, PAGES 94 AND 94A,
OF THE CURRENT PUBLIC RECORDS Of DJVAL COUNTY, FLORIDA.
ill CERTIFIED TO:
JOHN ONOR,-.JICK.A
BANK OF ST. AUGUSTINE Z ��'
LAWYERS TI IlE INSURANCE FUND. INC. FIL
DALE BEARD5I.EY, P.A. OP Y
•
REDFIN DRIVE
(6C 0' RIGHT of VIAY)
+
F0UND 1/2"1HCN PIE S 85'37'27" E 80.65' — X —
ze..s:' 4 No roENTTICADON
I ✓ ..'a. ' roues ,Ron rIPE
'' ar_ 50 cer+nnc&u
FI
COP
*\ •'.. .?i
-J \ . • •- . , !
b rya.E 1r 0LJ 24.5' - as 8
1 ON STORY
D~ i n.3• MASONRY 2
I )t I POSTED 760 1 i
LOT 14 !. o _
tAs BLOCK 9 : d LOCK•M I I , F_• 17
I 1'il fV
2 :� + pi
o 1 s
27 4' w
Y.
I'
di di LOT 15
16� 6LOCf: 9
d4^• I � .O' ..•Y 1 �- • �.• 1NAGE ANC UPUTY EMD EN:�`... i G4'
iv•-- y _ . \\
V0 rout&1/: i nt+1.1P"iva 0nI��t•AE F.•' .3 i �%» W 80.65 No IDWflCATWn•- " , - - __. .. — �
P�a\-Nc. r LOT 8
Qe P.0,, p1 I BLOCK 9 I
G�y�' �
gy` �t ✓
1 , FiLl COPY
, - _
,o,c 4W TED SY'
LEGEND: _ _
CCRETE _.I
NOTES: �y _...__�.��___�.. .....�..��_�.�.____�_ .,
%. 8EARtNCS ARE BASED ON WE _ PLR7 5;i/ek• ; or .....?,.P5.3:'.27" L, Awmo ywc F2EY]�iOly�
SOUTHERLY RIGHT OF w,,Y LINE OF Kali UR:v:' DA���� DES.FS'r)i.
2. DY GRAPHIC PLOTflNC CNLY 114E CAPTIONED LANDS LIE WrIHI.N FLOOD ZONE X AS S:IO'W ON THE
NATIONAL FLOOD INSURANCE MAP DATED APRIL 17, MO, C04AULN1r, NuuBEF. 1200/5. F'P.N L 1 n , _.
. -.._ ...,.r ._.,... ... ■ .rc„ntTe A•Pirw'M nr e+AY AR Prn RE•a?/:tD r...Y t/OR 11TLE COAOA,11JENT
!It- •
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904)247-5845 1 5-SR 60- 2S
Job Address: 16) 'Q;o„b.t. I% i* - ��
�tiflc. cvc-e.. Permit Number:
Legal Description Parcel#
Valuation of Work$ t�Oo,�Proposed Work he ted/cooled t
•�t.t� non-heated/cooled 1,4,0
Class of Work(circle one): Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial :esidentia
If an existing structure ,is a fire sprinkler system installed? (Circle one): • - 44:11b. N/A
Florida Product Approval#
For multiple products use product approva
Describe in detail the type of work to be performed: 9 AliC,t t,> 1\(m.w L,,g Go \ S lk C
ION GAba 6 X 12, \K L3l.,.cbt- \icskil-�
Property Owner Information: Q 15 w 0 C71►w
Name: &1g • R, 'h94`,�l W t t,L - ,•4
City �"R.d+4�L'C IC. $�..i�{yF, Address: '7fp Rt�,p'EwPp �(2l.,
E-Mail or Fax#(Optional) State ,7ip '�j22hone eSo� �.��, bt
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: Qualifying Agent:
Address: City State Zip
Office Phone 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 cert(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 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
r
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.
T hereby ert 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 specs red 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 \ X- Signature of Contractor
V--'rint Name f—'' :71..1�� .... Print Name
lefore m Aft
us I�. • of .T.a_R r 20 Before me
'S this Day of 20
_
4;411/77:"_ TONI GINDIFSPERGER
iota Pu.—ic ; '!- . M` ssION►FF924S61
�' ,; M.
.•4k - EXPIRES:October 6,2019 Notary Public
S A,f:.!':.• Bonded Thru Notary Pubk Underwriters -
Revised 01.26.10
1
(rp.m.,74b
CITY OF ATLANTIC BEACH
u*WNER/ BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT
LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST
SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE—OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUN IY OR MUNICIPAL LICENSING
ORDINANCES.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN'OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY 'CERTIFICATE OF COMPETENCY" OR THE FLORIDA 'CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
-160 Q.��r, Iy �('�, , 32.(,1
ADDRESS i . PHONE NUMBER
PRINT NAME
' QX SIGNATURE DATE
Before me this p 61e-Pay of �C2 ,20 the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of 1 ,County of t_ J(-:)■f R L
❑Personally Known
roduced Identification- `
TONI GINDIE$PER GER
' MY COMMISSION FF 924951
• •� �'=
Notary Signature: _ • Bon PMu IKE SNoaY: p icU20et
s 19
F:IBLDG'Owncr-Buildcr Affidavit;REVISED:4/16/2009
/2-. 0y4 L. P L.cv S (J,.// 7- 7J o
AS RECORDED IN PLAT BOOK 54 PAGES 94 .944 OF THE PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA
CERTIFIED FOR: /Gc.ZVCzTOP P evA I.\/oJf\ -ov✓/ cZ- ' ES7-6-2.x./ Mo/..T 4 &
Co g-P. t _ TTO/z &/S TITz-&- /"15. Fvnl0 c . • 2_z,
D 5 -/A/Cf&-/2- ; f t E--,4/L 0 L yi D E-C A n/0/D 5' S NAhI
ia �- F / A/ ID s- •
f Z$9.6,z
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9
8 -7
THE PROPERTY SHOWN HEREON APPEARS TO LIE W17H/N FLOOD HAZARD ZONE X AS SCALED FROM FLOOD
INSURANCE RATE MAP MO I FOR THE CITY OF 4-r c. /i c y/ FLORIDA, DATED. dr-• I-1 - 5 9 . AND
IS SHOWN AS A COURTESY ONLY AND DOES NOT CONSTITUTE A CER71FCA770N OF SAME.
TRI—STATE LAND SURVEYORS, INC.
8411 BA YMEADOWS WAY SUITE #2, JACKSONVILLE, FLORIDA 32256 (904) 731-7235
���,, I 1
L 'NEW tZxVox
2
3 EIA"t-" 911)4 9%X t #yti_
t 5400,7- 1- 2_u G ",‹ I 1 --�- �Jl -- sg
0 MIL. Rrfzaw-o TLAR -ES
-1-W0 WI w7 Two x(010
Special Order Roofing
SKU# 382-407
GAF PRODUCT APPROVAL
VRoofing Shingles FL 10124
Underlayment (Synthetics) FL15487
Underlayment (Liberty Base, Ruberoid SA Base/Ply, Stormguard) FL 10626
Everguard TPO (SA& Fleece) Roof Systems FL 5293
Roof Ventilation FL 6267
960 Static Roof Louver FL 5027
CERTAINTEED PRODUCT APPROVAL
Roof Shingles FL 5444
Underlayments (Torch, Flintlastic, SA, etc.) FL 11288
Modified Bitumen Roof System FL 2533
OWENS CORNING PRODUCT APPROVAL
Roof Shingles FL 10674
Roof Shingles (Supreme & Classic) FL 16638
Underlayment FL 9777
TAMKO PRODUCT APPROVAL
Roof Shingles FL 1956
ATLAS PRODUCT APPROVAL
Roof Shingles FL09792
Underlayment FL 11915
MIDSTATES PRODUCT APPROVAL
Quick-Stick Ice and Water-sanded FL 13857.4
WOODLAND PRODUCT APPROVAL
15# Felt D226 FL 1814
✓30#Felt D226 FL 1814
15# D4869 FL 1814
30# D4869 FL 1814
STAMPCO PRODUCT APPROVAL
Off Ridge Vents FL 16160
LOMANCO PRODUCT APPROVAL
750 Vent FL 3792
Omni Roll FL 2847
Roofing Supply Group 1 3333 Canal Street- Unit 1 I Jacksonville, FL 32209
..q kills.
r CITY OF ATLANTIC BEACH
�' ' S f 800 Seminole Road
0
Atlantic Beach,Florida 32233
Telephone(904)247-5800
FAX(904)247-5845
1.-tJi319 r S " s heo -ZS
•
REVISION REQUEST SHEET /
Date: 11 . to 1 c Received by:
Permit Number: Resubmitted:
Original Plans Examiner: Project Name: 5141)
Project Address: -
;� i t SIC C.�a
Contractor: Contact Name:
Contact Phone : %pit 57/ 3 2 6/ Contact e-mail:
Revision/Plan Check/Permit Fee(s)Due: $ kg/51�✓o�'/r► (� `' /v�,t}��' �o M
Description of Proposed Revision to Existing Permit:
r Ill/T 'LAW$ eie.
Additional Increase in Building Value: $ 5100 Additional S.F.
Site Plan Revised: Public W/U Approval:
By signing below.I(print name) affirm that the above revision
is inclusive of the proposed changes.
`P I1► 10 , 1s--
Signature Coi actor/Age t(Contractor must sign if increase in valuation) Date
Office Use Only
Date: Approved: Rejected:
Notified by
•
Plan Review Comments: � 2 �n n 2
D15 LS Vt5
•
Nov 1 0 mis
•
Department review required Yes No -
6_ :uildinq
IP a- ing &Zonin•
Tree A.minis rator
. -ubli Works
Plans Examiner
r 'ublic Utilities
bic aey
Fire Services Date
Created 8/20/15 Rev.2
■
■
sir±;�i, City of Atlantic Beach
:4 . APPLICATION NUMBER
i .& Building Department (To be assigned by the Building Department.
h �� 800 Seminole Road /�r�� —Lr''' r� Atlantic Beach, Florida 32233-5445 Z
v�� Vr Phone(904)247-5826 - Fax(904)247-5845 7
`�;t ov- E-mail: building-dept @coab.us Date routed: /� �J j. i
City web-site: http://www coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 76 0 4--b-,14.,, De•attment review required Yes No
4-Building
Applicant: Q ,I' arming &Zoning
/6_ rator
Project: -- -- x /Z i i i is Works ___
► diiil till ies_
' 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: 'Approved. [Lenied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by:,04../, v‘-----_ Date: i lic/),f
TREE ADMIN. Second Review: R roved as revised.
pp nDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:/��,,., C,'—‘--------- Date: OM-
•
FIRE SERVICES Third Review: [Approved as revised. nDenied.
Comments:
Reviewed by: Date:
evised 07/27/10
o!.:>:,9;,;,, City of Atlantic Beach
Building Department APPLICATION NUMBER
` 800 Seminole Road (To be assigned by the Building Department.)
e, Atlantic Beach, Florida 32233 5445 IS — St-I0—t✓ ZS Z9
• Phone(904)247-5826 • Fax(904)247-5845
�.,.o;; >% E-mail: building-dept@coab.us Date routed
Z6::, ZOO
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 0 R O I !v UR_ Departent review required Yes No
',f I owner C Buildin•
Applicant: Kr-m S'`I-O-f -tannin &Zoning
Y �p���rowt S� g g
Project: S KE[ - AJ o0 ( FR f M€ Public Works
, Public Utilities
1 X (L/O Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified By Date
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: ❑Approved. ['Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING
Reviewed by: Date:
TREE ADMIN. Second Review: QApproved 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
I
1
0ii. ,;, City of Atlantic Beach APPLICATION NUMBER
c•F .,. Building Department
d� 9 p (To be assigned by the Building Department.
-':� i.,k- ',1 .- 800 Seminole Road (�/�' /////� /A, Z`y/,
,s� Atlantic Beach, Honda 32233 5445
Phone(904)247-5826 • Fax(904) 247-5845
1).“10'1. E-mail: building-dept @coab.us Date routed: /� 1..! /3--.
City web-site: http://www coab.us 1
APPLICATION REVIEW AND TRACKING FORM
Property Address: 7 6 0 "i.b-i
.'y] De ent review required Yes o
Building
Applicant: D Gt) "7') E 4 anning &Zoning
--..-�� X Z h�� rator
Project: _ _ / is Works ____
Public Safety_
Fire Services
Review fee $ Dept Signature
Review or Receipt
Other Agency Review or Permit Required of Permit Verified By Date
Ili 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: Approved. I 'Denied.
!i (Circle one.) Comments:
:UILDIN
PLANNING & ZONING /�v,' Date: /l-fl./ S
Reviewed by: f � �
TREE ADMIN.
Second Review: nApproved as revised. nDe ' d.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: nApproved as revised. (Denied.
Comments:
Reviewed by: Date:
evised 07/27/10
-isvv-f City of Atlantic Beach /ii y�. l APPLICATION NUMBER
�s .�� Building Department NOD (To be assigned by the Building Department.
r I 800 Seminole Road V
a - ,. Atlantic Beach, Florida 32233-544 � 3 2015 / Sr
Phone(904)247-5826 • Fax(904)24.7 :45 7
01; g:' E-mail: building-dept @coab.us Date routed: /1 J /'3"--4
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 76 0 ..'Y] De• . • 1 ent review required Yes No
di-building
Applicant: D f 4 PP' anning &Zonin•
4 _ • rator
'•• is Works
Project: /6 X /1 S/igsk `.
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:
APPLIC 'TION STATUS
Reviewing Department First Review: la Approved. ❑Denied.
(Circle one.) Comments: if
BUILDING
elf
PLANNING & ZONING Reviewed by:A/I ate: /3 /` i,.r'
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
{i:r►;,./;: City of Atlantic Beach C APPLICATION NUMBER
,'• % Building Department j . �� D (To be assigned by the Building Department.
-• .,. k= •• ' 800 Seminole Road
"--`4 ,: * .yN ' NOV j 0 i —S� ,d - 26)"
,, Atlantic Beach, Florida 32233-5445/
l' Phone(904)247-5826 •• Fax(904 ,�. p845 �15 7
&.9;110- E-mail: building-dept @coab.us _ Date routed: /� �J ��
City web-site: http://www coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 76 0 ii-b-7 ''Y] De•attment review required Yes No
Building
Applicant: Q W E 4 anning &Zoning
/6 X /� £VJ
Project: lc Works
hies
Public Safety
Fire Services
Review fee $ Dept Signature j(.•-•\
Review or Receipt
Other Agency Review or Permit Required of Permit Verified By Date
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: 1VApproved. Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: � t–...—.. Date: il/ i t/(
TREE ADMIN. Second Review:
A pp roved as revised.
['Denied./�eC WORK' Comments:-� ,.
r r/,. - J
0/BLI UT L IES...1
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: (Approved as revised. (Denied.
Comments:
Reviewed by: Date:
2evised 07/27/10