81 5TH ST - GARAGE DOOR : $s CITY OF ATLANTIC BEACH
A ? 800 SEMINOLE ROAD
,141 ATLANTIC BEACH, FL 32233
JR c' INSPECTION PHONE LINE 247-5814
RESIDENTIAL -ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES17-0116
Description: NEW GARAGE DOOR
Estimated Value: 1600
Issue Date: 8/4/2017
Expiration Date: 1/31/2018
PROPERTY ADDRESS:
Address: 81 5TH ST
RE Number: 170151 0000
PROPERTY OWNER:
Name: SABATIER NADINE
Address: 108 OSPREY COVE LN
PONTE VEDRA BEACH, FL 32082
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: SURFSIDE HOMES, INC
Address: 108 Osprey Cove LN
PONTE VEDRA BEACH, FL 32082
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
i exceeds and estimated value of$7,500.
City of Atlantic Beach APPLICATION NUMBER
Jt Building Department (To be assigned by the Building Department.)
800 eaRoad
" � Atlantic Beach, Florida 32233-5445 F h S 1--7 1 ) r 1
Phone (904) 247-5826 • Fax(904)247-5845 Zs.
'
-0;09.- E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
De artment reviewrequired Y
e 7No
Property Address: n � 512- `�T1� -
uildin_g)
Applicant: UfZ,._FS(D rnE ng &Zoning
Tree Administrator
Project: Si S+ _Public Works
n Public Utilities
��/. tac-e j�-�t Y5 P QpO� Public Safety
�r�` 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 'Cit
•
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:,P' 3 -1 7
TREE ADMIN. Second Review: Approved as revised. ❑Denied ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: I (Approved as revised. I IDenied. I INot applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
OFFICE COPY
, '' %, Building Permit Application Updated5/S/17
rr,'" City of Atlantic Beach
�r
800 Seminole Road,Atlantic Beach, FL 32233
`""'% V Phone: (904) 247-5826 Fax: (904) 247-5845 1. ES`-7 0 1 ( Co
Job Address: I 5 1 S-t 1 Permit Number: 16 91/4-P00 ` kl-cp3
Legal Description
RE#
1
Valuation of Work(Replacement Cost)$ Cot0 0 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one):4110 Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): CommercialResidential
• 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:
ip.hl a c12 wt.19 ut sej, a-9e-2
Florida Product Approval# l 51 11 • for multiple products use product approval form
Property Owner Information -_ �p
Name: nN,_! a; , p, I I tS12 Address: el l 5A t)t fit
City A t... it • ! I. _ State ¶(r Zip '3 22 3 3 Phone
E-Mail In(Al t�P SQ Cit 02, F • U.)O b K1. Ka t-
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information In r� y,, v,G 1
Name of Company: V QK. SO o- 1. `U o �.c,S Qualifyi g'1Ageent: II)0 IS C .Sf I I
Address 10 0 fat_ ke L U.r2— City V V V State . Zip 3 Z01 I
Office Phone Q 04 5 PD -0 4- g i Job Site/Contact Number
State Certification/Registration# C13C, 04 B$ (o).. E-Mail Lot.)I SSQ lea ti e @ (oW.canfi. t. r
Architect Name&Phone#
Engineer's Name&Phone# S 4- ?� / d`-t-
Workers Compensation
xempt Insurer/Lease Employees/Expiration Date
Application is hereby made to obtain a permit to dot e 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.
ti, . SOt 6,.2.1 ill. ,S_0‘6(R/,a, ,
(Signature of Owner or Agent) (Signature o )
(includin• tractor) I / isk
Stigned nd sworn ttoo( a,fffir .efore e t i•1 ;day of Sig ed and sworn to(oor affirm-.)before me th' day of
y
_ / FAS. / � _
��a�S-An-
(Signature
(Signature of No .ry) (S=' ��KEVIN L.JOHNSON JR
sJa8 apunsgq^dtue;N,J41:apue, a„ •`�'t •�s Notary Public-State of Florida
6LOZ'9aagoto0:S3UidX3 - '`-�K- �_ •E Commission#`GG 051966
IS6�Z6 3a#NO193%6 1100 AIN •'. F; :; ,,Ir)
''",,St
My Comm.Expires JtM 2,2021
Personally Known O' 1J3933dSTIONID INC)" [ ] Personally Known OR ' S'F� Bonded through National Notary Assn.
[ ]Produced Identificat '�"""" """' '" ;Produced Identification F
Type of Identification: Type of Identification: 1,�