70 W 13TH ST - SIDING (", LANr(1*iii ,,., CITY OF ATLANTIC BEACH
` s� 800 SEMINOLE ROAD
lily_ ATLANTIC BEACH, FL 32233L�;3 >%' INSPECTION PHONE LINE 247-5814
RESIDENTIAL - ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES17-0117
Description: NEW HARDI LAP SIDING
Estimated Value: 8994
Issue Date: 8/4/2017
Expiration Date: 1/31/2018
PROPERTY ADDRESS:
Address: 70 W 13TH ST
RE Number: 170805 0030
PROPERTY OWNER:
Name: ROTHE DANNY HOYONG
Address: 70 W 13TH ST
ATLANTIC BEACH, FL 32233-3418
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: A-Team Petroleum &Tank, LLC DBA Petrole
Address: P.O. Box 9300
Fleming Island, FL 32006
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$7,500.
I
4
r +yn,,i;.i' City of Atlantic Beach APPLICATION NUMBER
s\ Building Department (To be assigned by the Building Department.)
800 Seminole Road �~ S`�_ �� l t
AtlanticPhone (904)Beach247-5826, Florida 32233Fax(904)5445
1$ ,....,,
7
%i
247-5845 RC�0„19;• E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: '7O \Ai l 3-t-`--‘-- ( Department review required Yes •o
11ilding-
Applicant: ,a `-"TE•cam pe,TRC)L.uri\ Planning &Zoning
Tree Administrator
�` SProject: -7 0 W I
( Public Works
1 (� is Utilities
/�Z >/' 1`i-f)it- `J i ✓EJ Nce Gene/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
0 St.Johns River Water Management District
Army Corps of Engineers
0 Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department ¶ First Review: FlU{p roved. Denied. Not applicable
(Circle one.) Comments: f\10
BUILDING
PLANNING & ZONING
Reviewed by: 1/1Date: P...? 7
TREE ADMIN.
Second Review: ❑Approved as revised. applicable
❑Not
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: (Approved as revised. (Denied. I Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
Ab
t '1r BuildingPermit Application
,' AL;*A, Updated 5/5/17
A 1)
City of Atlantic Beach OFFICE COPY
800 Seminole Road,Atlantic Beach, FL 32233
�r Phone: (904) 247-5826 Fax: (904) 247-5845
Job Address: io lJ.&.sk \1 ..ScSPermit Number: R GS 17- 0 I. l 7
Legal Description 18- 14 - 3 t - as • 3 al E 0°I 2 AO t-‘,. 54.c, \i RE# t 7 U So S 003 0
-7°.CN L te i0 V 1opt'-\ 9\K58
Valuation of Work(Replacement Lost)> • g R city o Heated/Cooled SF 14 b 1 Non-Heated/Cooled 2 b
• Class of Work(Circle one): New Addition Iterati Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial esid'er1iiar --
• 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:
ci\a �\\C.� . 1 \ - \\ Sid'` e..s ,tr \-\ rc ' lam,r \D\cr\L- k(,,f S,- e;1 (4n4 e.At_ cx+c.f,.5r_
Florida Product Approval# %3 a!)3 • 1 for multiple products use product approval form
Property Owner Information
I Name: 1),,,..n y S1,`\\-.1 R ckL.tf Address: )o \?,0i" St AA 1 C .-L, cc. 1 D -3-3
City A-r\ lac �1r. State rc:._ Zip eka333 Phone 9 0 - 5---)Ca - 1 kS"�
E-Mail c \hcl.� <':> \ U,<)<-1,: 1 . c,,,�,
Owner or Agent(If Agent, Pow�'f of Attorney or Agency Letter Required)
Contractor Information 12 k .T,Ai_ u.‘-
Name of Company: p • p,..),/,‘‘,,-._ C a,..ir,J) a•, Qualifying Agent: Wit,-1ti Qe--0"LA
Address Pa 6:.)x. ci 3 00 City c1&A.As T<L..) State !:i- Zip :41 a)b (�
Office Phone cl0`1 iSR i iv 1 SS Job Site/Contact Numb 0 �*
State Certification/Registration# CP;(..1.).5 ) le D- E-Mail • to r.•A _ , h - . w eA- - Z , .
Architect Name& Phone#
..- 0 --I O A.
Engineer's Name& Phone# a. W O 0
Workers Compensation 1- t,.3 c---.34 A N t 1`S 1 k O m E z w
Exempt/Insurer/Lease Employees/Expiration Date V p o Q
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or 9s I�o4?has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the labia izubttng
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUM f�aliCSR RI
TA
POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. F- cn I-
CC Q /"" z
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in complieciyvi
applicable laws regulating construction and zoning. 0 0 wa LU m
W
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMERF8IIht aw
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF Y( J INT ID w
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFOR w
z
RECORDING YOUR NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) (Signature of Contractor)
(including contractor) ��77
Si ned and sworn to(or affirmed)before me this allay of Si ned and sworn to(or affirmed)before memisz jd y of
1/L ,c9O ,by �c r.'11/�y/4)i/el/ I L' .1 i 7 ,by ^( 44'\ Vue,,l 7 J `'`
Si:n.,/e of Notary) (St"gnature of Notary)
Ti,
SHELLEYE.ROTHE �nr.� SHELLEY E.R0j}{E
MYCORES:MAR ,201854 o MY COMMISSION*FF099154EXPk�ES:MAR O6,2018[ nally Known OR 0' Bonded through 1st State insurance kf Nersonally Known OR .; 4 r EXPIRES:MAR 06,2018
[ ]Produced Identification [ I Produced Identification Bonded through 1st Slate insurance
Type of Identification: Type of Identification: