126 15TH ST - DOORS / WINDOWS �-L`J
rf i� �� CITY OF ATLANTIC BEACH
t1
`�i ? 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
0.; INSPECTION PHONE LINE 247-5814
RESIDENTIAL -ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES18-0125
Description: replace windows &doors
Estimated Value: 22572
Issue Date: 4/5/2018
Expiration Date: 10/2/2018
PROPERTY ADDRESS:
Address: 126 15TH ST
RE Number: 171864 0000
PROPERTY OWNER:
Name: JONES MAE THOMPSON LIFE ESTATE
Address: 126 15TH ST
ATLANTIC BEACH, FL 32233-5724
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: FLORIDA GEORGIA WINDOWS AND DOORS, INC.
Address: 11433 SAINTS RD QA KENNETH MICHAEL BRANHOLM
JACKSONVILLE, FL 32246
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.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions
applicable to this property that may be found in the public records of this county, and there may
be additional permits required from other governmental entities such as water management
districts, state agencies, or federal agencies.
* 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.
rS�L�'r. City of Atlantic Beach APPLICATION NUMBER
J� � � I Building Department (To be assigned by the Building Department.)
P,. 800 Seminole Road �/ O l
,,v Atlantic Beach, Florida 32233-5445 c
Phone(904)247-5826 • Fax(904)247-5845
o;tt. - E-mail: building-dept@coab.us Date routed: fact Ha
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
An ci
Property Address: ( c� `p (S - - De artment review required Ye o
1
Applicant: F ',cf R a c C&,Q-A(g�al Win des cllaws Planning Zoning
Tree Administrator
Project: c CUL L,,f .,(-N tC-t 4.ij y( S 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: RApproved. Denied. Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: / / ` Date: 11-2-720/f
i
TREE ADMIN. Second Review: roved as revised.
IApp ❑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
A FILE Y City of Atlantic Beach MAR 2 9 2018
COInvlJ v 800 Seminole Road,Atlantic Beach, FL 32233
Phone: (904)247-5826 Fax: (904) 247-5845
Job Address:12 , )514--1 S--- [q+10414 c.3c1-1 3 Zz3 3 Permit Number: 4 2 p(/ i 7 — C 10 S-
Legal Description I 0- 1) £o ZS-29 r andoJQ,_d wl,/0/II/ /7 )KRE# 17 1869
y
0r,
Valuation of Work(Replacement Cost)$aarS'?Z Heated/Cooled SF °Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool 'ndo /Doo
• Use of existing/proposed structure(s)(Circle one): Commercial 1 sidentia�
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No 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:
(Rep1a-C e n-i- r f- in,C /,),•-1d b c.JS - or5
Florida Product Approval# FL. 1II7 5 a.1 4 P L a 39,1 for multiple products use product approval form
Property Owner Information
Name: ma JonL 5 Address: I Z� 1S± S±r-e-e±*
City t9+-1(i')-)-CC C,h State e L Zip 3 ZZ3-2, Phone 2 LI 4-2(t.I LI
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company(Lk^i c ct GerC9,� Lt)inc(hay,Aka(S Qualifying Agent: 1;e4--‘ 12jir-r ho) m
Address )17:9 o Si-Tahns i,-J. pk" r)-e. ) City Jckx S State f'L. Zip 7ZZ '-I G.
Office Phone cl 01-1- ( 9 I-'-70!0 Job Site/Contact Number Sc` .e
State Certification/Registration#C2C_Oi.f 1 o t_t O E-Mail cigar_nn4-C ca-o(. CnrY-
Architect Name&Phone#
Engineer's Name&Phone# /J
Workers Compensation /`4(40 . - A.- S-cre C D.'_ 2 .//9
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 ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
)( — /
(Signature of Owner or Agent includi g Contractor) (Signature of Contractor) .,
Signed and sworn to(or firmed)befo a me this a i' day of Signed and sworn to(or affirmed) before me this=o day of
r)- Lt0J• , 7,01S .,bey ,,in _± •t"--)€--5 0-Vi-A1-1/1 , �_O I S , by Y rr Py-n� ..k o I.1/4_,
�. i .-'I .�,: • Florida (Signature of Notary)
k. MY Commission00097782 •
Or ExPkos o6/28f2021 2 Nobary Pubic State or Florida
• • RENEE L BRANHOLM
MY Co
salon 097782
[ ]Personally Known OR Personally Known OR 06/28/202121
1(]Produced Identification [ )Produced Identification -
Type of Identification: 1.1 'LOX\ Lt! Type of Identification:
~` /Permsf RtS1g'- 0/2S
NOTICE OF COMMENCEMENT OFFICE COPY
State of I-iO c 1 da. Tax Folio No. 11 ) 8 61-1
County of Du j aQ
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: )0- J ) 160-2S- 11 E rnnuThrialcait Leis /0) t 1/ 12
QIKo
Address of property being improved: I Z L4, )S 5--1- 3 ZZ.3 3
General description of improvements: Ian ,-N--N.e -1- ----4 m - L.0; &D u)S -41c..oirS
Owner: a Q JO '\a...5 Address: .Cli,,.�e ck_..s above)
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
C tractor: 0r 1 r ( ebr"Sr a_ ( l�'i ncbcUS oc c - r�C'
Address: It Z O S+ So hr,s ICI c�� S) I
a K
3 Z2
Telephone No.:9011-6,y)- 9 O)0 Fax No: 9 oLi- y Q- CI 1 s(43
Surety(if any)
Address: Amount of Bond$
Telephone 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:
Telephone 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 Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER Q
Signed: 71 d c4 It' illDate: *-Zio- /SBefore me this Z( .. day o /.-in the County of Duval,State
Doc#2018073220,OR BK 18331 Page 974, Of Florida,has personally appeared re-) t'1 eS
Number Pages:1 Notary Public at Large,State of Florida, of Duval. iiii
Recorded 03/29/2018 12:08 PM,
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL My commission expires: - .- .._•. ;. .",7—. _ •
Personally Known: r,r,a`�rI'"�.R,&.�'"sv--�°�Y- s- r
COUNTY
RECORDING $10.00 Produced Identification: 1 j s� ,' ,_>',;. RENEE mown/Pc=State el a ,
£.0RANHOLM
' ..i . + My Comraleacn GG 097782 '
p,�p,�' Expires 05/28/2021 7
OFFICE COPY
PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH,FLORIDA
Project Name: J o ^e—s ,^ 1 n Permit C)/.25
Project Address: 1 2(0 �4rE=3 )44-i 0-��i 0 l 0
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
7roduct approval may be obtained at:www.floridabuilding.o
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
A.EXTERIOR DOORS
1.Swinging IrisgrvY4- JRS41�r�c PL y 1.
2.Sliding
3.Sectional
4.Roll up
5.Automatic
6.Other
B.WINDOWS
1.Single hung PGT S 1 S�oC^�t"i cL7-S9.7
2.Horizontal slider
3.Casement
4.Double hung
5.Fixed
6.Awning
7.Pass-through
8.Projected
9.Mullion
10.Wind breaker
11.Dual action
OFFICE COPY
2.Other
Category/Subcategory Manufacturer Product 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:l-for; cL (encs i e i no,I2DLOS �' 002-
Mailing Address: 11 Z1 O SI--0;kv s �r cP. r �f2� I
City: 5ez 1 1 State: PL.. Zip Code: 3gZZy
Telephone Number:(901) lay I — )O 1 0 Fax Number:(9o4)_ 69 Z- l ISL
Cell Phone Number:( ) E-mail Address:- c AC,or . 4. C.o►-L�