712 Selva Lakes Cir - Replace T1-11 Siding r P 'L' r
r -
`� \ s v CITY OF ATLANTIC BEACH
` J 800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
RESIDENTIAL ALT /OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247 -5814
JOB INFORMATION:
Job ID: 16 -RAAR -362
Job Type: RESIDENTIAL ALTERATION
Description: REPLACE T1 -11 SIDING
Estimated Value: $1,600.00
Issue Date: 2/18/2016
Expiration Date: 8/16/2016
PROPERTY ADDRESS:
Address: 712 SELVA LAKES CIR
RE Number: 172027 -5838
PROPERTY OWNER:
Name: MCCAULEY, BEVERLY JANINE
Address: 712 SELVA LAKES CIR
GENERAL CONTRACTOR INFORMATION:
Name: FERGUSON BUILDERS
Address: 317 THIRD ST QA GREG FERGUSON
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $29.00
BUILDING PERMIT FEE $58.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $91.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
0,1
,,zo_A :r . City of Atlantic Beach
X , Building Department APPLICATION NUMBER
800 Seminole Road (To be assigned by the Building Department.)
. . -� Atlantic Beach, Florida 32233 -5445 _ Phone (904) 247 -5826 • Fax (904) 247 -5845 — ! � Email: buildin de t coab.us
g P @ Date r ® �
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 71 z S E OV A LIKS D ' I - I - ment review required Yes No
E Building
Applicant: Fs ; LSON 10I l.0 Plann • t : g
T Tree Administrator
Project: r ( t ( S (p t1'■._ (, Public Works
C PL � C Public Utilities
c, 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: pproved.
(Circle one. Comments:
Denied.
BUILDING
PLANNING & ZONING
Reviewed by: m Date: v // 91f 6
TREE ADMIN.
Second Review: I (Approved as revised. 1 IDeni .
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:
Date:
FIRE SERVICES Third Review: I 'Approved as revised. 1 !Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
1
1
BUILDING PERMIT APPLICATION n y
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845 1 (p -R p, AR-3 (0 7._
Job Address: 1( L t V G cdti 1 �L Permi Number:
Leal Description q 4 - ` £ \ l..„- i act t \YC', ` 0' V� - reel' 1 g P oor Area of 'q.Ft. Sq.Ft
Valuation of Work $ / C, DO . LO 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 installed? structure(s) (circle one): Commercial Residential
If an existing structure, is a fire sprinkler system nstalled? (Circle one): e s o
Florida Product Approval # -
For multiple products use product approval form
Describe in detail the type of work to be performed: /'�- eriv (i>= l c (e � 1-- cfil 0 r a/,,,
�� - %l i(-1dr,t� / ,fir. -•...r .r► 4-
Property Owner Information:
Ir /
Name: o n 'eaut�t ., Addre :� Q lVQ n '� S ^ c�_
City h Stat0 Zip 3D- hone Ou 1 -44'35 - '---)(
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: r4/✓ e Ge - 1/ Qualifying Agent: V SO
Address: 7(' — - V AA) � k
, # . City ', , ' 11- State -.... 4..„ Zips R 2 33
Office Phone ,` f • Job Site/ Contact Number Fax #
State Certification/Registration If G G d- D 2/ -1 ((3
Architect Name & Phone #
Engineer's Name & Phone # / /U /, C�
Fee Simple Title Holder Name and Address /40 of lru
Bonding Company Name and Address A/ p „J "Z-
Mortgage Lender Name and Address ,)(4 , J F !
Application is hereby made to obtain a permit to do the work and installations as indicated. I certf 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, Bo 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 certifi 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 w e r specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other fe. ' a , state, or 1, :1 law regulating construction or the performance of construction.
7 L t
Signature of O e ,),-- )
�p* � ( 4.4-z Sign of Cont racto � s° '
Print Name -__S ^A �Y--) C C a 0L Print Name -- .. -t.) 6"..1
Sworp to and subsesiibed before me Sworn to and subsetib�d before me
'1 Day of }- e_ k r u A r- .7 , 20 1 � , thi Day of -+--- r 20 I
—
I y
/ f l f i I/ o�� d� 1
y AMBER L HICKS t " otary `u. is ' MY COMMISSION #FF033216
Notary Public o` .
iii MY COMMISSION #FF033216 .."7-„9,,,,, o
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