1969 BRISTA DE MAR CIR - WINDOWS �� " `'' CITY OF ATLANTIC BEACH
id
a.:-
�' , y 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
"!�____�3 >%' INSPECTION PHONE LINE 247-5814
RESIDENTIAL - ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES17-0298
Description: replace 24 windows
Estimated Value: 21661
Issue Date: 12/20/2017
Expiration Date: 6/18/2018
PROPERTY ADDRESS:
Address: 1969 BRISTA DE MAR CIR
RE Number: 169506 1670
PROPERTY OWNER:
Name: KANE PHILIP B
Address: 1969 BRISTA DE MAR CIR
ATLANTIC BEACH, FL 32233-4525
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
,
Phone:
Name: PELLA WINDOW AND DOOR
Address: 7818 PHILIPS HWY QA JAMES SAMUEL ROWLAND
JACKSONVILLE, FL 32256
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.
�� ,' , } CITY OF ATLANTIC BEACH
' -'.'' 0 800 SEMINOLE ROAD
,V �� ATLANTIC BEACH, FL 32233
r;it
J;; v% INSPECTION PHONE LINE 247-5814
RESIDENTIAL -ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES17-0298
Description: replace 24 windows
Estimated Value: 21661
Issue Date:
Expiration Date:
PROPERTY ADDRESS:
Address: 1969 BRISTA DE MAR CIR
RE Number: 169506 1670
PROPERTY OWNER:
Name: KANE PHILIP B
Address: 1969 BRISTA DE MAR CIR
ATLANTIC BEACH, FL 32233-4525
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: PELLA WINDOW AND DOOR
Address: 7818 PHILIPS HWY QA JAMES SAMUEL ROWLAND
JACKSONVILLE, FL 32256
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.
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. 169506-1670
State of Florida County of Duval
To whom it may concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in
accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: 40-37 09-2S-29E SELVA NORTE UNIT TWO LOT 90
Address of property being improved: 1969 BRISTA DE MAR CIR,ATLANTIC BEACH, FL 32233
General description of improvements: siding, windows or screen room
Owner Philip/Kathleen Kane
Address 1969 BRISTA DE MAR CIR,ATLANTIC BEACH,FL 32233
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Martin Home Exteriors,Inc.
Address 5715 Haven Road,Jacksonville,FL 32216
Phone No. 904-737-5009Fax No. 904-594-3064
Surety(if any)
Address Amount of bond S
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name
Address
Phone No. Fax No.
Name of person within the State of Florida.other than himself,designated by owner upon whom notices or other
documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself.owner designates the following person to receive a copy of the Lienor's Notice as provided in
Section 713.06(2)(b), Florida Statutes. (Fill in at Owner's option).
Name
Address
Phone No. Fax No.
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a '
311
different date is specified): ),,,•,,,.•;c?,`
•r b,r•
THIS SPACE FOR RECORDER'S USE ONLY O NER ,m
Signed, LL �� DTE 11/301/ �.p n
Before me f is 5 day of ` 7�7►► 4 -0 Z"I I in the = y0 p
County of al.S a-of Floridy has personally appeared 2 70 ..0
L wt Ate"'L herein by n{mA Th.„,fn
Doc#2017278047,OR BK 18209 Page 88, himself,'herself and affirms hat all statements- d declarations hereinrn
Number Pages:1 are true and ac rate/ j § Z =
Recorded 12/06/2017 10:22 AM, it» V
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL I - o -0
II oPa Z3m
RECORDING $10.00
N• 'ubli - l •
'at arge.State o County of f 7C
My commission expires: & • I 11
Personally Kno:,nrLD L or
Produced Identification
Vii"�'`pri., City of Atlantic Beach APPLICATION NUMBER
Js �y Building Department (To be assigned by the Building Department.)
800 Seminole Road 1?- C}
s) Atlantic Beach, Florida 32233-5445 D
B r
til
. � Phone(904)247-5826 • Fax(904)247-5845 � f„
x.... �r Email: building dept@coab.us Date routed: Y�
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: O et �
MAO i SA-A Of )44 Ci, De a review required Yes No
Building
Applicant: N,A,G� W t (\tto vJ S cal bO( Planning &Zoning
\ Tree Administrator
Project: c L lO_L L g w k i\4_0, \ 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. ❑Denied. ['Not applicable
(Circle e.) Comments:
BUILDING
PLANNING &ZONING Kr1
Reviewed by: Date:/2'/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
Cel Tun for Pick Up 727.83741400 CITY OF ATLANTIC BEACH 1(1_7. L `
OFFICE C0PY 800 Seminole Road, Atlantic Beach, FL 32233 DEC - 6
Office(904) 247-5826 Fax(904) 247-5845 2017
Job Address: I61604 Rrts}a Qt ffl r £ r• Permit Number`:w -S"i
Legal Description 40.31 04.5-994 SScitista O(k 140-Tiob toii0 Parcel # I(9 4404,40°
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$ r lWar- Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Residential
If an existing structure,is a fire sprinklerinstalled?system (Circle one): Yes No N/A
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed: (\e1)10,GG 2 V Jvt.jo id) s rat -Pe 5t
Property Owner Information:
Name: a,lti� Addr s: q(,di Jewish, e.mai ern
City f'I viHdt i&t State a_Zip 3223 Phone
E-Mail or Fax#(Optional)
Contractor Information: n nn
Company Name: pt:1Ia.Gtq c�lnoJ) S 04 ®ooIS Qualifying Agent: 3A nec Ro6,J1Attd,
Address: 350 k) sp-q34 City /Ong w'c•o oL State 1=Z Zip 32 7C 0
Office Phone 1107-$31-'01o00 Job Site/Contact Number Fax#
State Certification/Registration# COCO Li is,1?—
Architect
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
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 peormed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for openod of six 16)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing, Signs, Wells,Pools, Furnaces,Boilers,Heaters,
Tanks and Air Conditioners,etc
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.
I herebycertify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
type owork will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,state,or local taw regulating construction or the performance of construction.
Signature of Own:- Signature of Contractor
Print Name Print Name
Sworn to and subscribed bef.re meSworn to and subscribed •efore me
this MP Day of o✓ 20 V-7 this (9 Da • ' a t/ ,20 r7
- Jonathon Thomas
•_ .c Q ` 'T;'T-Y PUBLIC
?STATE OF FLORIDA. �i
o
_STATE OF FLORIDA
s y;�0Comm*GG141189
?Comm#GG141189 Revised 01.26.10
�
NCE 10lExpires 9/18/2021 SINCE 191 Expires 9/18/2021
KANE PHILIP B Primary Site Address Official Record Book/Page Tile#
1969 BRISTA DE MAR CIR 1969 BRISTA DE MAR CIR 06021-00273 9409
ATLANTIC BEACH, FL 32233-4525 Atlantic Beach FL 32233 OFFICE C 0 PY
KANE KATHLEEN T
1969 BRISTA DE MAR CIR
Property Detail Value Summary
RE# 169506-1670 2017 Certified 2018 In Progress
Tax District USD3 — Value Method CAMA CAMA
,._._..__""" `— '""",__ Total Building Value $246,816.00 $244,632.00
property Use 0100 Single Family
#___f..Build_.__.._ Extra Feature Value ,$946.00 $840.00
of Buildings 1
description Land Value(Market) 5:80,000.00 $180,000.00
Legal Desc. For full legal description see
Land&Legal section below Land Value fAgric,) 50.00 $0.00
Subdivision 03958 SELVA NORTE UNIT 02 ]ust(Market)Value $427,762.00 $425,472.00
Total Area 12615 Assessed Value $239,159.00 $239,159.00
The sale of this property may result in higher property taxes.For more information go to Save Cap Diff/Portability Amt 5188,603.00/$0.00 $186,313.00/$0.00
Our Homes and our Property Tax Estimator.'In Progress'property values,exemptions and Exemptions `$50,000.00 See below
other supporting information on this page are part of the working tax roll and are subject to
change.Certified values listed in the Value Summary are those certified in October,but may Taxable Value I$189,159.00 See below
indude any official changes made after certification Learn how the Property Appraiser's Office
values property.
Taxable Values and Exemptions—In Progress.,
If there are no exemptions applicable to a taxing authority,the Taxable Value is the same as the Assessed Value listed above in the Value Summary box.
County/Municipal Taxable Value SJRWMD/FIND Taxable Value School Taxable Value
Assessed Value $239,159.00 Assessed Value $239,159.00 Assessed Value $239,159.00
Homestead(HX) -$25,000.00 Homestead(HX) -$25,000.00 Homestead(HX) -$25,000.01
Homestead Banding 19A31(1)(b)(HB) :.$25,000.00 Homestead Banding 196.031(1)(b)(HB) -$25,000.00 Taxable Value $214,159.00
Taxable Value $189,159.00 Taxable Value $189,159.00
Sales History
Book/Page 1 Sale Date I Sale Price Deed Instrument Type Code !Qualified/Unqualified 3 Vacant/Improved
06021-00273 19/26/1985 $59,000.00 WD-Warranty DeedI Unqualified }Vacant
06673-02357 3/15/1989 l$53,000.00 WD-Warranty Deed Unqualified i Improved
07213-02222 110/31/1991 I$161,000.00 i WD-Warranty Deed I Qualified Improved
+
Extra Features
LN Feature Code Feature Description Bldg. Length !Width Total Units Value
1 I FPPR7 Fireplace Prefab 1 ,0 I 0 1.00 '$840.00
Land&Legal _
Landj Legal
LN Code Use Description 1 Zoning Front Depth Category Land Units Land Type Land Value I [LN I I Legal Description
1 ' 0100 ' RES LD 3-7 UNITS PER AC `;:ARS-1 1 105.001 120.00 i Common 1.00 Lot i$180,000.00 I 1 1 40-37 09-2S-29E 1
2 I SELVA NORTE UNIT TWO I
13 I LOT 90 I
Buildings
Building 1
Building 1 Site Addressi r---,+-1
1969 BRISTA DE MAR CIR Element Code I Detail
Atlantic Beach FL 32233 I Exterior Wall 12 1 12 Cedar/Redwood F'� _
€Roof Struct 3 l 3 Gable or Hip I
Building Type 10101-SFR 1 STORY I Roofing Cover 3 13 Asph/Comp Shng I
Year Built €1989 Interior Wall 5 5 Drywall I RAS r
Building Value $244,632.00 Int mooring 11 11 Cer Clay Tile I
jl
Int Flooring 12 1 12 Hardwood ] L, {
Gross Heated €Effective Heating Fuel 4 1 4 Electric I
'RNArea i Area ,Area Heating Type 4 14 Forced-Ducted Ir FCA
Base Area 2338 `2338 12338 I Air Cond 3 13 Central I L
Finished Garage € 546 1
0 273
Finished End315 0 189 i €Element t Code 1
Porch
Total 3199 i 2338 2800 I #Stories 1.000
€Bedrooms i 3.000
Baths €2.000
Rooms/Units i 1.000 I I
017 Notice of Proposed Property Taxes Notice(TRIM Notice) OFFICE C0PY
,
Taxing District I Assessed Value Exemptions Taxable Value Last Year Proposed Rolled-back
Gen Govt Beaches $239,159.00 $50,000.00 $189,159.00 $1,501.78 I$1,541.87 1$1,462.65
Public Schools: By State Law $239,159.00 $25,000.00 $214,159.00 1$952.88 $907.39 i$924.85
I By Local Board $239,159.00 # $25,000.00 I$214,159.00 i$470.37 1$481.43 1$456.54
I FL Inland Navigation Dist. I$239,159.00 1$50,000.00 $189,159.00 I$5.90 $6.05 1$5.67
I Atlantic Beach 1$239,159.00 $50,000.00 $189,159.00 I$594.82 $610.70 F I$580.38
Water Mgmt Dist.SIRWMD 1$239,159.00 $50,000.00 $189,159.00 I$53.15 $51.53 $51.53
Gen Gov Voted $239,159.00 i$50,000.00 $189,159.00 I$0.00 $0.00 $0.00
School Board Voted I$239,159.00 $25,000.00 $214,159.00 I$0.00 $0.00 $0.00
Urban Service Dist3 1$239,159.00 $50,000.00 $189,159.00 ?$0.00 $0.00 E$0.00
Totals 1$3,578.90 $3,598.97 I$3,481.62 I
Just Value I Assessed Value Exemptions 3 Taxable Value
Last Year <$412,634.00 ?$234,240.00 $50,000.00 $184,240.00
Current Year]$427,762.00 I$239,159.00 }$50 000.00 $189,159.00
2017 TRIM Property Record Card (PRC)
This PRC reflects property details and values at the time of the original mailing of the Notices of Proposed Property Taxes(TRIM Notices)in
August.
Property Record Card (PRC)
The PRC accessed below reflects property details and values at the time of Tax Roll Certification in October of the year listed.
2017
2016
2015
2014
•To obtain a historic Property Record Card (PRC)from the Property Appraiser's Office,submit your request here: 4.—
More
More Information
ontact Us I Parcel Tax Record I GIS Map I Map this property on Google Maps I City Fees Record
Doc # 2017275783, OR BK 18205 Page 1992, Number Pages: 1 ,
Recorded 12/04/2017 08:00 AM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00 OFFICE COPY
4F171.RECORTNNel-iFr':0;TO; Pella Windows&Doom
350 W State Rood 434
/ Longwood,pFL 32750
?ER ACT NLILIEFE: t ^/
NOTICE OF COMMENCEMENT
7I,cnndasi8nedhrby gives notion that impcovt ncotwill be maie,tocertoin real property,and in aeeordon=with Chaptr 711t.
Flusids 5a.1:tcs.the following information is provided in this Notice of Cnmm un res
L p CO
DESCRIPTION OF PROPERTY(Lep)derrick=of the p o,ety,.b street addr�.,if csoibblc (a
)TAX FOIAOPIO.: / l'�` ' 'p 7 v
SUBDrviS14.11N S C''l'S latlf-� BLOCK TRACT LOT C?V ZLDC MUT •
y0-37-C` - aS-act I�i(eq 6 � f\1t..r
7.C.F71ER DESCRA'i1ON1 OF LMWROVEY:?:AT:
X OWT'FA LVFORatAT1ON OR L1:SSC1E LNFOt.7MATION D'THE LESSEE CONl'RACrED FOR IRE IMPROVIMIX c
a.Naze ad nddress: P 't.\\� 1Lav-Q_ � (e. v-C,4-Vl \'1CN•Y' C\(___ C .(�(,V� 1
rtss apcopet)- 3 a a 3 3
e.Nnreeand bete.effir a rale tieebelde of O.•naBrodt: -
Pella Windows Doof5 '
a a.cY)NTRACTOR'sYAME:
a etaaa's ad oar:_._ h hem nabs:
tangWOod.FL .52/50
sxArty(fcw,s:ioeU:an any of le Wya'a'n bow:isttc eq:
a.Nu=andaddresc ,`
b.Pbcx>r�bor ../V e.,lmara n
of been6.
6.e.LENDER'S NAME:
Lexdr.?:.aeldrW; Jv b.Plmc:umber:•
7.Freston within the State of Flai a desitmsted by O.vnaapon witom notices ea other deem:tents may be Scr.•ed en presided by
Section 70.13(1)(a)7„Florida Statutes:
a.Yule and
b.Plna<amorous
rs or o:ele»ed per=u t^ „
S.a.:n addition to himself or hersclf.Ovmcr des:go3a of
torcce ve a eopy of the Liana's Notice as provided in Section 71.13(1)(b).Florida Statutes.
h nose reicher nfpxor.a w7 detiEmxe:by;NT=_..
9.Expiration dote ofnotioa of oommeaccmont(the expiration dolt will bc ycnr from the dote of rcau-Jiag unless u differutt date is
specified)' .20
WAUrNS"T)rrzyN'2 Aa Y tAY?t,..NTS MADE AY D-i OWNF i AFrFF 7T•PiT XFIrA"7O\(`.F"=F,VOTFC.F•O=r..O1AVtt:.XC:F,T.!F\T
A.R2.OONSI7 LFD TACDROPF,R PAYMENTS i i1c1?R CHAPTER T.2.'PAW" SECTION 713,t;?(CAUDA M'ATtTFS.AND CAN
REct F.T IN'Mirk FAYTV(:--cul yOR'x.mikr L•uEN-rs TO YO:?t P40PlR y A Nfl rT=OF cr1\.N.u.Kr:-1.(fi\T),AT'.tT RF
RRr(TPF..PA'NT)PotT.i)f)lN-F:/ORst'Ty a.soRF.-7.7.FIRST'N.CPF.CTIO\ IFyou'1`,T.tt->-nORTAINFDIATCTIO rrrtc:r7
W7TT-T 1,OiiR I ND=4 OR AN ATTORxRY Fri7ORE t"DyA�tFhf"NO WORT::OR RRCORnrir-Vol:r lOTOF:(X=c NrTR-Ft r r
.fes f\A-\\e
e• r orllxvec,Or Ovmer's or Les
(SI see's (Print Name an Provide Signatory's Trdel0fliec)
• •O,tccr/Di1ctor/Partacr/Manoger)
Stataof J=-l1/4VY\,h
County of \.5 NI sal
The foregoing instrument wen acknowledged before me this l day of C3
by Qh.\.\ \& r-e_
t_ (atone&person) (tppc of euthaity,...n e.ofScnr,tru..tee.attorney in foot)
for di
(nom:of party on behalf o: ma:
whom iacmtent was eceecd) '
Persoeaily Known or Produced IdmstiScaam k Type den' odea Produced
I,,�'�.''•"•!'g1'rk,. CHR.iStINEOMILLEY
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,• y ,•. EXPIRES:,eaouury292018 (S•nafvs•ofNotaryPubfic)
„r •'e Bonded Thru Notify Pu):c-Mdarmiters
(Prim.Type,or StralpCAmmisioned\amt of Notary Public)
Ren'.1 a4 S-12
OFFICE COPY
PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH,FLORIDA
Project Name: y\\.\,, �C► v� Q-- Permit # RFS /7- 0 a 9 k
Project Address: (cal, S\c,..r-
As required by Florida Statute 553.842 and Florida Administrative Code Rule 9B-72,please provide the information and product approval number(s)
for the building components listed below as applicable to the building construction project for the permit number listed above. You should contact
your product supplier if you do not know the product approval number for any of the applicable listed products. Information regarding statewide
product approval may be obtained at:www.floridabuilclint.org.
Category/Subcategory Manufacturer Product Description I Limitation of Use State# Local# J
A.EXTERIOR DOORS
1. Swinging
REVIEWED FOR BODE cUmrL1ANCE
2. Sliding. CITY OF ATLANTIC BEACH
FIR ADDITIONAL
3. Sectional
PFOUIREMEWS AND CONDITIONS
4.Roll up
5.Automatic REVIEWED dY:
GABS:
6.Other
B.WINDOWS
1. Single hung
2.Horizontal slider
3. Casement --
4.Double hung
5.Fixed
6. Awning
7. Pass-through
8.Projected
9. Mullion \\� V�`
10.Wind breaker
11.Dual action
OFFICE COPY
2.Other
Category/Subcategory Manufacturer l'roduct Description Limitation of Use State # Local#
H. NEW EXTERIOR
ENVELOPE PRODUCTS
1.
2.
In addition to completing the above list of manufacturers, product description and State approval number for the products used on this project, the
Contractor shall maintain on the job site and available to the Inspector, a legible copy of each manufacturer's printed specifications and installation
instructions along with this Product Approval Sheet.
I certify that this product approval list is true and correct to the best of my knowledge. I further certify that use of different components other than the ones
listed in this document must be approved by the Building Official.
(Contractor Name) (Print Name) (Signature)
Company Name:
Pelta Windows&Doors •
Mailing Address: 350 W State Road 434
Longwood, FL 32750
City: State: Zip Code:
Telephone Number: CP-7 ) C 3 7-c5f�!Q v Fax Number: ( )
Cell Phone Number: ( ) E-mail Address:
1sy „, Ma— . L �_ OFFICE COPY
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