330 10TH ST - CEDAR SHAKES REPAIR ,,,,J_\,,,,..
, ,-/r'l ,
j , CITY OF ATLANTIC BEACH
J800 SEMINOLE ROAD
.)11111 r ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
\JJ31�`
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-RAAR-1590
Job Type: RESIDENTIAL ALTERATION
Description: remove and replace cedar shakes, plywood, damaged
windows, and trim
Estimated Value: $10,000.00
Issue Date: 7/22/2016
Expiration Date: 1/18/2017
PROPERTY ADDRESS:
Address: 330 10TH ST
RE Number: 170035-0010 -
PROPERTY OWNER:
Name: BURNETTE JR,GEORGE M & KELLY G, *
Address: 330 10TH ST
GENERAL CONTRACTOR INFORMATION:
Name: SIGNATURE HOMES & DEVELOPMENT
Address: 731 DUVAL STATION RD QA REX JONATHAN
WILLIAMS
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $50.00
BUILDING PERMIT FEE $100.00
Total Payments: $150.00
PERMIT IS APPROVED ONLY IN ACCORDANCE wVITII ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
-s�:.�,�ir City of Atlantic Beach APPLICATION NUMBER
$r \ Building Department (To be assigned by the Building Department.)
r, 800 Seminole Road (� V-A _ t - 0
VI 0
75 Atlantic Beach, Florida 32233-5445 J , v
� Phone(904)247-5826 • Fax(904)247-5845 Date routed: I- 1 i y 1140
01119 E-mail: building-dept@coab.us
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 3? [0-0 5 ent review required Ye No
Buildin ✓/
Applicant: S►rOLAU,(L *IrLS btA). Planning &Zoning
Tree Administrator
Project: c2'mwl_kk ttp111C-2 CQ-6.al 5Natl.V Public Works
Q`\O.00) das8.a Wt ndo�S)a v,(.1) 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: roved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING l Reviewed by: ill Date: 7' 1 9' 1 6
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 05/14/09
I
FILE COPY
..5,..„.„,
,.. -----_------ $tJILDING PERMIT APPLICATION _ -
CITY OF ATLANTIC BEACH
J 800 Seminole Road,Atlantic Beach FL 32233
,'tl� Office: (904)247-5826 • Fax:(904)247-5845
f tV
Job Address: 330 IU S-cea- Permit Number:
Legal Description RE#
r
Valuation of Work(Replacement Cost)$ 1 0)0'0 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repa"• Move Demo Pool 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
• 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: l
' Vv\oUC i cA� Ce�c�,.r shv\kes- w�3 4, �J k„. 1,K 4---l n\-N
Florida Product Approval# L. 11635 for multiple products use product approval form
Property Owner Informati n
Name: -8 OY r.c Address: 30 (0 5-t�-e 6
City A? State\ Zip 3)..)Z3 Phone
E-Mail
Owner or Agent (If Agent,Power of Attorney or Agency Letter Required)
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.
Contractor Information:
Name of Compan ; .• v .ow•e3 , Qualifying Agent: R ,,._ (A.)i ( ,wv`-_,
Address: `73) V 0 It Ai 4, City j e,u State Zip 0 ?2) S
Office Phone Job Site/Contact Number 75c/ 9 86 1
State Certification/Registration# E-Mail ('6k/Vi 11c'w•c i c.-0 0l'-wi I s(:dn\
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 as commenced
Thrior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction ii, his jurisdiction.
is permit becomes null and void if work is not commenced within six(6)months, or if construction or work is suspended ., ,bandoned for a
period o six(6 months at any time after work is commenced. I understand that separate permits must be secured for Electri , ork,Plumbing,
Signs, Wells,Pools,Furnaces,Boilers,Heaters, Tanks and Air Conditioners,etc
0
Signature of Property Owner: A l ./ l_ Al4 . i4 i.- __ __ ... = e Contractor:, / i�_�;`a`,. •
Before a .' I ;':.:�y ., 70N!SINOIESPERGER r
this 1 lay of ..U i • _•. '4Y r. „I: PERG R me ii's—
Itk! ►�•/ �� r��
. J°.6L. : FIRES:October 6,2019 F
%f„p. ,.. .:J Thru Nota y Pubic Undery:ors
Notary Public: . _' —k i...r.. r ivvCCU y r :.ic — �ie• *'!n!MIMIC
' 1` MYEXPIRES:OcqqCOMMISSION ier FF6,92420 9 V�I
I hereby certsame that I have read and examined t is application and know the to ap '”::0-n,, .....144;404* f laws and
ordinances governing this type of work will be complied with whether specified he :.:_..:...._f._- -•--------- it does not
presume to give authority to violate or cancel the provisions of any other federal, s ate, or oca aw regulating construction or the
performance of construction.
Rev.3/14/16