1832 HICKORY LN RESIDENTIAL ALT PERMIT , J ' '' \ CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
Kly ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
\DF31>'r
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-RAAR-1406
Job Type: RESIDENTIAL ALTERATION
Description: REPLACE 200 SF CEDAR PLANK SIDING WITH CEDAR
SHINGLES
Estimated Value: $5,000.00
Issue Date: 6/24/2016
Expiration Date: 12/21/2016
PROPERTY ADDRESS:
Address: 1832 HICKORY LN
RE Number: 172020-1450
PROPERTY OWNER:
Name: DAVIDSON, RONALD L
Address: 1832 HICKORY LN
GENERAL CONTRACTOR INFORMATION:
Name: MARTIN HOME EXTERIORS
Address: 5749 HAVEN RD QA KENNETH BRIAN MARTIN
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $37.50
BUILDING PERMIT FEE $75.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $116.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Srvi-i-jJ, City of Atlantic Beach APPLICATION NUMBER
jS t' i* Building Department (To be assigned by the Building Department.)
r,• =" 800 Seminole Road
-6, - • tom.- Atlantic Beach, Florida 32233-5445 I G-R rata 2 14 O
Phone(904)247-5826 • Fax(904)247-5845 67-0
/ / _
��0;t 9%- E-mail: building-dept@coab.us Date routed: 670c (e,
City web-site: http://www.coab.us (((
APPLICATION REVIEW AND TRACKING FORM
Property Address: i 83Z 1— . I CkOt2L( L>v Department review required Yes No
,d3uildinci
Applicant: A AR n/N l—(om c Ri i 2(Oft Planning &Zoning
Tree Administrator
Project: ZOO,S-i-
c j i.C) (N.D(- 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: ti�Approved. ❑Denied.
(Circle one.) Comments: /� ' D c___ -7
(i**ZIL2\....? Iv{
PLANNING &ZONING
Reviewed by: /71 Date: 6'c),'/6
TREE ADMIN. Second Review: ❑Approved as revised. ❑De ied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
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: 1832 HICKORY LN Permit Number: 1p-i . Aa 2-(1-CG
Legal Description 37-29 09-2S-29E Parcel # 17086-02198
Soon Floor Area of Sq.Ft. Sq.rt
Valuation of Work$ 4)900 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 structures)(circle one): Commercial Residential
i
If an existing structure, s fire sprinkler system installed?(Circle one): Yes No N/A
For multiple products use product approval form
Describe in detail the type of work to be performed: Replace 200 sf cedar plank siding with cedar shingles. Paint all.
Property Owner Information:
Name:Anthony Arnao Address: 1832 HICKORY LN
City Atlantic Beach State FL Zip 32233 Phone
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: Martin Home Exteriors Qualifying Agent: Ken Martin Address: 5749 Haven Rd,
City Jacksonville State FL Zip 32216
Office Phone 9047375009 Job Site/Contact Number Fax#
State Certification/Registration# CRCO 57030
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(tperiod of six(6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical;York, 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 thisplication 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 feder I,state, or local law regulating construction or the performance of construction.
Signature of Owner Signature of Contractor
Print Name ry &0 Print Name '<ehvc \ Mar .I% •
SwornIo and subscrib before me Swo 'and subscribj before me
this Day o ,20169 this • D. : Juh ,20 it/
f� h& /' . . L I
No "public ' '"` - - —
P — — — — — — d — — EDWARD-L.RHODES
a`'0. °" Notary kO�lgE14it X1.26.10
EDWARD L. RHODES ;r Public-Stat
'r°.--1.'01 Notary Public-State of Florida ' •, My Comm.Expires Jul 9,2017
( • -- ... oma Commission#FF 034806
•. �• .•; My Comm. Expires Jul 9,2017
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"%;, .. �� Commission #FF 034806 � Bonded Through National Notary Assn.
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