2133 SEMINOLE RD UNIT 1 - DOOR ,� '' s� CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
'2.01119%' INSPECTION PHONE LINE 247-5814
RESIDENTIAL - ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES17-0057
Description: ONE DOOR
Estimated Value: 1538
Issue Date: 6/19/2017
Expiration Date: 12/16/2017
PROPERTY ADDRESS:
Address: 2133 SEMINOLE RD UNIT 1
RE Number: 169515 0430
PROPERTY OWNER:
Name: COOPER DIANNE
Address: 2133-1 SEMINOLE RD
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: LOWES HOME CENTERS INC
Address: 4948 TELSON PL QA PETER ANTHONY CAFARO III
ORLANDO, FL 32812
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB
SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500. For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
4
r0y�.v�, City of Atlantic Beach APPLICATION NUMBER
t Building Department (To be assigned by the Building Department.)
Ir • z.-. 800 Seminole Road r
lir -- .- - Atlantic Beach, Florida 32233-5445 l��� • 1
Phone(904)247-5826 • Fax(904)247-5845
prilo'" V E-mail: building-dept@coab.us Date routed: •
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Z 133 Yhi1�X7L6 No 9 ' •- " - t review required YesV o
Building
Applicant:
LANE S L'-40mE-; (--- --AD7:G12--S-
\• . : Zoning
Tree Administrator
Project: ,1\_D"C R_LI DO 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: ✓Approved. I !Denied. . ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed by: Date: 6.IS-1'7
TREE ADMIN.
Second Review: Approved as revised. ['Den d. . Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: (Approved as revised. ❑Denied. . ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
n4,,l Building Permit Application OFFICE COPY
' v City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
▪ .fr Phone:(904) 247-5826 Fax:(904)247-5845
�.. � i_ C C
Job Address: ,...--2, I t s 5e!1"1 1 foie.i��.. L.L 1 J ) 1 R ES (7 ` 005 7
li
`C' Permit Number:
Legal Description 09-2S-29E.138 PT GOVT LOT 1 RECO O/R 17259-2325 RE# 169515-0430
III ?C
Valuation of Work(Replacement Cost)$ /,SM3£j'•L- Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteratio Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial (Residential
• if an existing structure, ,s a fire sprinkler system installed?(Circle one): Yes No( N/A 3
• 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:
/..6-'.!iii_1 r ; i l /e., ell-1i-y 4-1 -4.- i--
Florida Product Approval k 8228.7 for multiple products use product approval form
Property Owner Information
i Name: .yia_nw /•tz I
11 �' , �,���,���:f - Address: :� (•�_� ���,JYI J)"1Cr�tf..- ��(� l�l }-�
city A•• tiN i t'.... .t r--..e-i. e j! State 17:::::/--- Zip/- ?''-1 Phone tit'I-1 --'9-,).., -r L 1
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
i
Name o om ny:�-•0 ` ;`I" =.-C--C'11/ -9'�i L ..0 Qualifying Agent^.. .-e...._• -I..C.t Lc IC
Address Y/'' 7.-• 1 " I City C 1-lei r 1C State/ ---.1— Zip_... .Z6'� -"
,:J_
Office PhoneC — iJ.. .-‘1/4.,/ lob Site/Contact Number Con Srnar,(2647 535.3793
State Certification/Registration iY cGcisos4,7 E-Mail
Architect Name&Phone p
Engineer's Name&Phone p
Workers 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
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"anc 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 ATTO: EY zEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
(Signatu of Owner or Agent including Contractor) (Sig r., Contractor)
Signed and sworn to(or affirmed)before me this r day of Signed and sworn to(or affirmed)before me this 1 day of
vv"%e, , Z'C f '--- by June 2017 ,by Nathan Ryder
ROBERT e-e � a7`�
A ,
Qw'e of Notary)
• .�'r CommisSi0N , II-Etz ISi1 n3 uro of Notary)_
9-V• EXPIRES September 22.2017 •,•
4 ''; a''•". NATHAN BROOKS RYDER
, - :O13 Fioridallo{arYSoryceo.eom t ir, .., NotaryPublc-Stated Florida I
I I Personally Known•OR t'4'Personally Known OR n Commission#GGC l 838 '
j Productd identification 1 Wil- �' NIpCOmm.ExplresAprI6.2Q21
( I Produced Identification o�
Type of Identification: '11v15 /7E _ 4 "', 3'%- Type of Identification: , eor�ee n K#Nr owtscu,yum.