1729 OCEAN GROVE DR - GARAGE DOOR ,jLJ i j
„ t
r� A CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
f-___,' r ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
30B INFORMATION:
Job ID: 17-WIND-3582
Job Type: WINDOW AND/OR DOOR
Description: replace garage door
Estimated Value: $800.00
Issue Date: 4/7/2017
Expiration Date: 10/4/2017
PROPERTY ADDRESS:
Address: 1729 OCEAN GROVE DR
RE Number: 1.69610-0000
PROPERTY OWNER:
Name: LALIBERTE, JOHN
Address: 14370 MANCHESTER DR
GENERAL CONTRACTOR INFORMATION:
Name: RADON PROFESSIONAL SERVICES
, CGC057793
Address: 336 14TH AVE QA WILLIAM TONY DAVENPORT
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $27.50
BUILDING PERMIT FEE $55.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $86.50
PERI11MI IS APPROVED ONLY IN ACCORDANCE \WITH ALL CITY OF ATLANTIC BEACII ORDINANCES AND THE FLORIDA
BUILDING CODES.
,i.ay- City of Atlantic Beach APPLICATION NUMBER
Js -4 • ed Building Department (To be assigned by the Building Department.)
r 800 Seminole Road l
7-5;IIIIP
�-s� Atlantic Beach, Florida 32233-5445 1 _ C'
Phone(904)247-5826 • Fax(904)247-5845 II``
'��;; E-mail: building-dept@coab.us Date routed: C 3 k4 I t4
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: \ a'6771 QLL&n �� ( OJ L De rtment review required Yes No
Building
Applicant: R--Cl&0 n 4(vers.1 Dr,(4 1 -( 4 Le-._S Planning &Zoning
Tree Administrator
Project: ( Lip 4t1_1--- k(aUJ-,Q._ O L f 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: roved. ['Denied.
(Circle one.) Comments:
____:)
c____UILDING
PLANNING &ZONING4f•N'/7
Reviewed by: Date:
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
ti
Building Permit Application
r '
' A 1.0City of Atlantic Beach OFFICE COPY
800 Seminole Road,Atlantic Beach, FL 32233
Ve Phone: (904)247-5826 Fax: (904)247-5845
Job Address: 172q CCe,4,. /'�/eot a Permit Number: 07-W/ n/tO — 35 81
Legal Description2D-26 o?- 2s -2?a Oc.,aa Gito 1v1/21 a7 ( S' RE# 4/0 - 0¢o0
Valuation of Work(Replacement Cost)$ Too Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool indow/Door
• Use of existing/proposed structure(s)(Circle one): Commercial esidentia
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes .►tom 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:
Re PLA-C a e - fF c l.) 0/2-
Florida
/ -Florida Product Approval / 4 2 . e 9 for multiple products use product approval form
Property Owner Informati ti
Name:T .,! L.4 L iye t7e " Address: /721 OC&4v4 GototJ a Q.
City A-nitr4 T e BPAL c4 State j L Zip_322 33 Phone
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: SQA,146,4 p,Ev f S eet telt.e Qualifying Agent: Lri�DA-de r)10047
Address 3.2 / '7/ fl,. N. City ,{7c-... 8Qn,'4 State /A/ Zip 32-2 67P
Office Phone 2..9 - $'Q 7o Job Site/Contact Number S-9/ /2/ e
State Certification/kegistration# (i'L' 4S 77 q 2 E-Mail R.4L id .OL' C.A..r
Architect Name&Phone# N///
Engineer's Name&Phone# N A
Workers Compensation A S5OCi/} e1 ,TA( /cT.ei<s A)1 ; # Z3/QO 1//f't'g
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
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS,FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
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. J
ignature of Owner or Agent including Contractor) (Signa ui-e of Contractor)
Signed and sworn to(or affirmed)before me this day of Signed and sworn to(or affirmed)before me this Z3 day of
YhA4c44 , 2017 ,by M ARG t4 , 20/7 ,by
1/11 (Signature of Notary) $72,11211HAFT
• • � NNory Public-Stale d Florida
,,4,,�ww STEPHEN HAFT ( Commitibe•FF 975623
:� * '� Notary PaMic-6toto 01 Florida ICOMM.fxpra Mit 5.2020
personally Known I€. .� . Commission i FF 975623 [�f ersonally Known OR � .:- e.
.: ��; I OoMod ttMoiph IIIIioell Nolary
ldentific i020 [ ]Produced Identification o� _
Produced � � MyComm.ConMn. � ►
[ ] �� Ewa
Type of Identification: '4i eondcdMa.NOM Notary Aso. Type of Identification: