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280 15TH ST - GARAGE DOOR i', yr d r* CITY OF ATLANTIC BEACH �'' sl 800 SEMINOLE ROAD ,� V ATLANTIC BEACH, FL 32233 1-o;3 �� INSPECTION PHONE LINE 247-5814 RESIDENTIAL -ALTERATION RESIDENTIAL MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 4 PERMIT INFORMATION: PERMIT NO: RES17-0112 Description: install garage door Estimated Value: 1045 Issue Date: 8/8/2017 Expiration Date: 2/4/2018 I PROPERTY ADDRESS: Address: 280 15TH ST RE Number: 170380 0000 PROPERTY OWNER: Name: ANDERSON ROBERT L Address: 280 15TH ST ATLANTIC BEACH, FL 32233-5726 GENERAL CONTRACTOR INFORMATION: II Name: Address: , Phone: Name: HOME SERVICES BY MCCUE OF NORTH FLORIDA Address: 981 11TH AVE S Jacksonville S JACKSONVILLE BEACH, FL 32250 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. I * 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 li exceeds and estimated value of$7,500. li 4 1 I, SCity of Atlantic Beach APPLICATION NUMBER f ,,: l...:- -. Building Department (To be assigned by the Building Department.) 800 Seminole Road p LS C ( � ,y Atlantic Beach, Florida 32233-5445 9-L Phone(904)247-5826 • Fax(904)247-5845 ( "Pto,t>>:` E-mail: building-dept@coab.us Date routed: 0,9- �� 1 1 9 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: b 1S 34 M . Department review required Yes o wilding' Applicant: L-? , `OA M(-Cut Planning &Zoning ill Tree Administrator Project: I () s ka t( at (tO I 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: APPLIJCATION STATUS Reviewing Department First Review: []"Approved. ❑Denied. [Not applicable (Circle one.) Comments: BUILDING c PLANNING &ZONING Reviewed by: Date: 6 '2-- ./"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: Approved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 Building Permit Application IP 12 © '''' '' °\\/Y IS-.---) 111 OFFICE COPY City of Atlantic Beach !! JUL 2 5 2017 iL ) 800 Seminole Road,Atlantic Beach, FL 32233 _ Phone: (904) 247-5826 Fax: (904) 247-5845 1 Job Address: 2F0 1541-' S-\--creek A-g 5l 3 Permit Number: ES (i_Ot. ( Legal Description /5- 73- IC-)S --01 e". 4hi64i2 ( ©/I✓,(I✓ue{ # / 7Oge 0000 A' 7.6-F7-. Lc j .S 6 )3/..4e_é Valuation of Work(Replacement Cost)$ r 1O4 S, Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): New Addition Alteration Repair 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: -;)54C4111A5 601-0510 d cf- 2X. G u%;v_S Florida Product Approval# S 30Z, 1 for multiple products use product approval form Property Owner Informationc SA -c'ober4- � Ad.e/SO1 Address: 2 (,) 15 STc e-G1-- 322 3 -� City ,A-2 State CC. Zip 3 L7.-'3? Phone 90`f- 1-'l7 -o593— E-Mail -6..) -, Y 1.Z54146,1.c0m Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) Contractor Information Name of Company: l tJSort/iC c S b l M C C U C. Qualifying Agent: Address Q%I ( , S _ City <lC.0 IsC.h. State c-71—. Zip 3 2-2-3 Office Phone 915.4- 1-I.', 1' 215 I Job Site/Contact Number 'o4-203- oo`i Z State Certification/Registration# E-Mail Architect Name&Phone# Engineer's Name&Phone# Workers Compensation GLx:4ra,t-e4 A IYISUC'c.✓t cc_ QFp 6 9(3of I"7 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 ATTORIIF Y BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. (Signature of Owner or Agent including Contractor /,/ t e of Contractor) 7f "Lied and sworn to(or affirmed)before me this day of Signe nd sworn to(or affirmed before me this f day of c... /../.__, 2'6 17, by L,,2/L '.1:x/ 1 2)7 , by ,)1 ' ° Z 8ll60/E0sa,ldx3uolsslwwoodyl �•,•;ii. „" ir t, i....„.____ " /"."-------- E68890jj#NOISSIW ' c [Si•natu;e.f No _.,(tignatrrra• 1 .o ry) yal8oiAd031d1S• d .A N HARKENREADER � °.� . ai. NC:?ARY PUBLIC•STATE OF FLORIDA .c SEAM HARKENREADER 2134 3lla v n Nd3S "^'ie -, 7COMMISSION#FF088893Wo NOTARY PUBLIC•STATE OF FLORIDA My Commission Expires 031 rE %`'o/ COMMISSION#FF088893 [ ]Personally Known OR AU Personally Known OR - My Commission Expires 03109/18 Produced Identificatiga-, �1 ��)) 7 [ 1 Produced Identification Type of Identification: re_ De, `f cJt 772 5-1 3'$o Type of Identification: w.. DRIVER LICENSE G ,SS L •3I536-772-51 .mi)-0 :ERT LES 4ERSON .2U ATLANTIC BLVD NEPTUNE BEACH,FL 32266-5252 DOB 08-25.1951 SEX M ISSUED 08-13-2014 HCT 5-11 EXPIRES 'x-25.2022 REST A 44.4n , EMDORS. SAFE DR r ER Own atom,of.mold..4.d.cot •. .•.ctxttwot to any•obrt.ty test r.putrod by Um