640 PALM AVE - SIDING -j1,'-\11-f.
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CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
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ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
SIDING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-SIDE-1114
Job Type: SIDING PERMIT
Description: ADD SIDING OVER EXISTING
Estimated Value: $1,200.00
Issue Date: 5/19/2016
Expiration Date: 11/15/2016
PROPERTY ADDRESS:
Address: 640 PALM AVE
RE Number: 170439-0010
PROPERTY OWNER:
Name: WHALEN III ET AL, ALBERT G
Address: 640 PALM AVE 640 PALM AVE
GENERAL CONTRACTOR INFORMATION:
Name: PLUMBING BY JOSH
Address: 5677 FLORAL AVE QA THOMAS RALPH PORTER
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $28.00
BUILDING PERMIT FEE $56.00
STATE DCA SURCHARGE $2.00
4
STATE DBPR SURCHARGE $2.00
Total Payments: $88.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC I3EACII ORDINANCES AND THE FLORIDA
BUILDING CODES.
City of Atlantic Beach APPLICATION NUMBER
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� � Building Department (To be assigned by the Building Department.)
i, ) 800 Seminole Road ) _S `� I ` l /1
- — Atlantic Beach, Florida 32233-5445 l \ `t
Phone(904)247-5826 • Fax(904)247-5845
Date routed: '3 /`E-mail: `Co
�: 0109'' building-dept@coab.us l
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: C:�`-tCD PA -ui\ Department review required Yes No
(� Buildin
Applicant: ` on/1('>�t3ci 81/4-1 �S�l+ ing
Tree Administrator
Project: I 0 l toG 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: ILproved. ❑Denied.
(Circle one.) Comments:
:UILDING
PLANNING &ZONING Reviewed by: Date: 51g -16
TREE ADMIN. Second Review: ['Approved as revised. ElDenieV
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
7
_ BUILDING PERMIT APPLICATION
OFFICE COPY
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CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
-:?•(21il Office: (904)247-5826 • Fax: (904)247-5845
Ika -510E— Ikk4
Job Address: bLIO PAL wi Av Permit Number:
Legal Description RE# I —70 L1 3C( — 60 10
Valuation of Work(Replacement Cost) $ I • Heated/Cooled SF Ai,- Non-Heated/Cooled /�
r
• Class of Work(Circle one): New Addition Alteration .. Move Demo Pool Window/Door
• Use of existing/proposed structure(s) (Circle one): Commercial esi l ti
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed: Ak genr4t) V40.6)
Am iNG x}406.1 - .S.1.18(0(9--c) r r w N 6 luouel Sr.'WIU6 clisr C' VW11c-
Florida Product Approval# It- 1319 Z , I for multiple products use product approval form
Property Owner Informati t
is . r e .
Name: SA-Cr Ake— jv $ f lira— Address: 2 --(, —rder" l'rMt4
City �A1— 5c( State Zip 32zso Phone 'mg( '"1ai-t(. �E Th
E-Mail ®. ' &_ CO kik lU � i .
Owner or Agent (If Agent,Power of Attorney or Agency Letter Required)
MAT 1 3_201L
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTIC ( COM'�MENEN'1 AY
TORESULT IN OBTAIN YOUR
ONSULOR T WITH YOUR LENDERTS TO U4 R AN -ATTORNEY BEF(4 E
RECORDING YOUR NOTICE OF COMMENCEMENT.
\
Contractor Information:
Name of Company: (//i/16/2 XI juS&_V Qualifying Agent: ��D/'O I ,
Address: St 57 j-/v 1 4-vL City - ij ‘C Stat ZipJ?a 'I
Office Phone — Job Site/Contact Number -t.3,—.570b
State Certification/ egistration# CMLf aS 1090 1.. E-Mail .
Architect Name &Phone#
Engineer's Name&Phone#
Worker's Compensation
Exempt / Insurer / Lease Employees / Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has comment
prior to the issuance of a permit and that all work will he performed to meet the standards o all laws regulating construction in this jurisdicti i. Aa
This permit becomes null and void if work is not commenced within six(6 m. , . •r. •'struction or work is sus'ended or abandone.fora $
period oJ'six(6)months at any time afte work is commenced. I understand th• sep ateae its must be secured for .lectrical Wo k,PI r bi► e F
Signs, Wells,Pools,Furnaces,Bode , larders, Tanks id Air Co ditioners, c. j N
' o^ =u_a
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Signature of Property Owner: ..... S�g�atu f Contractor: L_ t F.
Before me o
a g
this IL Day of 1(h/ a-C)i i n is I I Day of� w a€ !
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Notary Public:/ k /OW Nogg'iii li.. // ,-4 1 4 . .
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I hereby certi that 1 have read and examined this application d kno, th ffij:- ' be true and correct. All provisions of laws at I
ordinances governing this type of work will be complied wit hether sp?'�,�ii n rein or not. The granting of a permit does n y
presume to give authority to violate or cancel the provisions of an) tl 'r. _ . ate, or local law regulating construction or it ' r
performance of construction. "ice-
Rev.3/14/16