390 5th - Alteration Garage and Side Door CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL -ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES17-0134
Description: alterations to garage door&side door
Estimated Value: 3300
Issue Date: 8/29/2017
Expiration Date: 2/25/2018
PROPERTY ADDRESS:
Address: 390 5TH ST
RE Number. 169850 0050
PROPERTY OWNER:
Name: HENDERSON FREDERICK JR
Address: 390 5TH ST
ATLANTIC BEACH, FL 32233-5346
GENERAL CONTRACTOR INFORMATION:
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.
* 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
s vlar, City of Atlantic Beach APPLICATION NUMBER
)� Building Department (ro be assigned by the Building Department.)
800 Seminole Road
J
Atlantic Beach, Florida 32233-5445 {-
Phone(904)247-5826 Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: 0
-- Cityweb-sile: hftp://www.wab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 3 cl S S� ' artment review required Yes No
tt.�r.. pp A� //���� C/ Building
Applicant: htr^ i- SlCS. py mcckQOENit Planning &Zoning
1. y Tree Administrator
Project: 611WA i1Do S 'tb !l b& I, Public Works
I Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required of RePeviewrmit Verged or ReceiptB Date
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. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed by: 2 SOS Dat -8 r'Z
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 0 511 912 01 7
1D mcgoyg
Building Permit ApplicatioAU0 1 0 2017 D
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845
!J-CLAN1/L SIL-%tGy" a'C _ Permit Number:Address: � Si
Legal Description f-6!- C ,TT E/7 to;?:: 37 &.4ex RE#M-/�,(SnVr,35
— OI3,-I
- 00-i 0
Valuatlon of Work(Replacement Cost)$ Heated/Cooled SF Non-Heated/Cooled
• Class of Work(circle one): New AdditionYaratier� Repair Move Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial
• If an existing structure,is a fire sprinkler system installed?(circle one): Yes [� 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: �G
91011"L�ii10W.4 a /45� 0b c 4041
Florida Product Approvalq --013 f• 0-2 for multiple products use product approval form
Property Ovmerinforma 'on
Name: Address: f/-
City -7lOyl/P/C 'L!/I- State Pe, . Zip ?L 7 73 Phone fir% -75-9i - �
E-Mail MISMOP14.0GrtAtL.CoM
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information L� /J ,/�
Name of Company:468'(.�C✓✓/c{S .4n /•Is � Qualifying Agent: /✓ aw"l ZL �• ��Ctat
Address '907 /Z City State_r-e- Zip 3ZLC-TJ
Office Phone U 2r// -;36Z< Job She/contact Number Oel PV/ 3/5'1
State Cenifwaticn/Registmtionq •2q//a3�1'x E-Mall AZ„-kL, G?heio' .Ann r-riw .Gown
Architect Name&Phone# Qdhu )- C.b.-
Engineers Name&Phone If /
Workers Compensation GU.Pn s'n5 CO -
Exenpt/Insvw/lease Employees/Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated.l 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.l 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:1 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 PROPPTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATT BEFORE
RECORDIN UR NOTICE OF COMMENCEMENT.
(Sig ureoro;�w or Agent including Contractor),. (Sig of coome"'ar) yN
Signed and swom to(or affirmed)befo nC hhis," day of Signed and swo to(or affirmed)before ma t is day of
OBr7.by f y •a
1ftt
�READERureofNotary)
E OF FLORIDA SEAN HARKENREADER
F080093 �, NDTCO MISSION#FF088893UBLIC-STATE OF IDA
ilea03109110 ,'1/ CDMM13310NY FF000093-Personally Known ORenscarally cedIdentification
Known OR +•.�% My Commission Expirea03109110
Produced Ideation FL, 11 1 e otlured Ideation:on
Type of identification:FL LLC6HSLa '24L 5-025-0 Typemldennfiwnon:
NOTICE OF PRODUCT CERTIFICATION
,5. CERTIFICATION NO: N1011906.01-R7
r"by DATE: 03/19/2014
CERTIFICATION PROGRAM: Structural
i C COMPANY: JELD-WEN
CODE: 1822-1
rN191\ S
REVISION DATE: 02/16/2017
To verify that the"Notice of Product Certification"is valid,please visit www.NAMICeftification.com to assure that the
product is activeandcurrently listed.This certification represents product conformity tothe applicable specification and
thatcenification criteria has been satisfied. ANAMI appmvedcertification label must be applied to the productto claim
certification status. Please review and advise NAMI if any corrections are required to this document.
COMPANY NAME AND ADDRESS PRODUCT DESCRIPTION
JELD-WEN JELD-WEN"Design Pro/Smooth Pro/Studio"
3737 Lakeport Boulevard Fiberglass Opaque
Klamath Falls,OR 97601 In-Swing or Out-Swing Side-Hinged Door
Configuration:X
IS Frame: W-952n*37.50") H-2487mm(97.93")
OS Frame:W-952mm(37.50") H-2466mm(97.12")
Panel: W-908mm(35.75") H-2419mm(95.25")
SPECIFICATION PRODUCT RATING
ASTM E283.04/E330-02 Design Pressure:+50/-50 psf
TAS 202-94 p.."11.C..namattua.:x
AAMA 1304-02
Product Tested By: National Certified Testing Laboratories
Report No: SJW2013-196/SJW2013-129/SJW2013-231/SJW2013-25I/S1W2013-252/SJW2013-
253/NCT4210-3925-03MCrL-210-3930-01 MCT4210-3930-02151 W 2014
066/SJ W 2014-076/SJ W 2014A70/SJ W 2014075/W-1660/W-1696/W 1783/W-1799
Expiration Date: March 30, 1026
Administrator's Signature:
NATIONAL ACCREDITATION AND
MANAGEMENT INSTITUTE, INC.
4794 George Washington Memorial Highway
Hayes,VA 23072
Tel: (804)684-5124
Fax:(804)684-5122
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