2361 SEMINOLE RD WINDOWS I! -
CITY OF ATLANTIC BEACH
1 ' 800 SEMINOLE ROAD
Ky,,,_________/)
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: RES18-0291
Description: Replace 3 Windows
Estimated Value: 6400
Issue Date: 8/23/2018
Expiration Date: 2/19/2019
PROPERTY ADDRESS:
Address: 2361 SEMINOLE RD
RE Number: 168441 0052
PROPERTY OWNER:
Name: Joseph Arbona
Address: 2361 SEMINOLE RD
ATLANTIC BEACH, FL 32233-5971
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.
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.
01.AI.r,,,. City of Atlantic Beach APPLICATION NUMBER
JS it 1� Building Department (To be assigned by the Building Department.)
800 Seminole Road /(jam 02��
;� �� Atlantic Beach, Florida 32233 5445 Q V �+
Phone(904)247-5826 - Fax(904)247-5845 Date routed: 45121/O
!,o;; �? E-mail: building-dept@coab.us
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 23(ej StYufl 0% • _ • • ent review required Yierfslo
uildinq
Applicant: `"-"'! Planning &Zoning
2 Windows Tree Administrator
3 LA
Project: laLe indo dS 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 one.) Comments:
:UILDING
PLANNING &ZONING /ZZ/7( S
Reviewed by: Date:
TREE ADMIN. Second Review: El 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
t`'`+ Building Permit Application Updatedl2/8/17
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
(� Phone:(904)247-5826 Fax:(904)247-5845 /� /
Job Address: 6/ X/`t✓►okL ✓L2 . Permit Number: Es/g-- b2 1
11 vrrG
Legal Description 37 OS-c9 r , 7 1,GTowcf5 CoALaM tit ivM �w[II9 #(J �3� -01W 00 -d
Z-
Valuation of Work(Replacement Cost)$ 6 Y4:1) Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration R r Move Demo Po Window/Door 'm
COPY
• Use of existing/proposed structure(s) (Circle one): Commercial Residential (:
• 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:
Ce-PL.f e. 3 w'A .o s(24 $1-24,
Florida
r2 -
Florida Product Approval# for multiple products use product approval form
Property Owner Information Sem Name: -3-40. $i 4C‘Ono. Address: .Z3 ( SQM diotL(ZL
City State 1=t Zip 3 aa31 Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: kJ( ID w1 '14Ouff Qualifying Agent:
Address 3 S6 SR 411 W• City Low'.•. 1.. State A Zip 3123-1)
Office Phone ) 7- 7- e't A Job Site/Contact Number
State Certification/Registration# LgC0167/.2 E-Mail flf 's 6Mo.Ite./ 6,(eCcc t ar•Go/'+
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation
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. 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.
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 YO R NOJC OF COMMENCEMENT.
(Si: . ure of Owner or Agent)g ) (Signature of Contractor)
(including contractor)
Signed and sworn to(or affirmed)before me this l6 day of Signed and sworn to(or affirm before me this ' day of
4-v5v3r-, )o7Y ,bY - �
)°- 1+ 41C.L" yr , by ,/Alm-I /2o..arL
(Signature of Notary) (Signature of Notary)
s _
[ ]Personally Known OR 0•::,9:.yq'•, TIMOTHY R.O'MALLEY ]Personally Known OR rQ i::":; ;. TIMOTHY R.O'MALLEY
r ,° MY COMMISSION#GG 117135 ] - MY COMMISSION#GG 117135
[ ]Produced Identification ; ; r•� Produced Identification .; �'� ;,:
Type of Identification: • •_ ,� ype of Identification: ATS EXPIRES:August 7,2021
'br.:f:,.V Bonded Thru Notary Public Underwriters
.';w; Bonded Thru Notary Public Underwriters
Doc # 2018187667, OR BK 18486 Page 1674, Number Pages: 1,
Recorded 08/09/2018 12:22 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
Permit Number AS/S--
,S 9, �FICE COPY
Parcel ID Number /6,4fyf`005,2
NOTICE OF COMMENCEMENT
State of Flor``da
County of ))vve•
The undersigned hereby gives notice that the improvement(s)will be made to certain real property,and in accordance with
Chapter 713,Florida Statutes,the following information is provided in this Notice of Commencement.
1. Description property(legal descri tion of the property,and street address if available)
Address •tileILI
Legal Description 3'1J)S- � �}rjfw T L)ba.t�1 n a. f. TA,i • r nli n', O/Zgook 6V`(Q_
2. General de crlptlon of Improvement(s) 1,29f
IAA 41
3. Owner Information
Name Sit -11 " OxA Phone&Fax Number
Address • „ 3J231
Interest in Property own tr-
4. Fee Simple Title Holder(if other than owner shown above)
Name Phone&Fax Number
Address
5. Contra r `
Name`F2L(.., l o✓.)t DDa(S ++ Phone&Fax Number
Address 3,55 iR'12Y w, ���wwi F/ 3.27 Co
6. Surety(if any)
NamewA Phone&Fax Number
Add ressNiA
7. Lender(if any)
NamewA Phone&Fax Number
Add ressN/A
8. Persons with the State of Florida designated by Owner upon who notices or other documents may be served as
provided by 713.13(1)(a)7,Florida Statutes.
Name Phone&Fax Number
Address
9. In addition to himself or herself,Owner designates the following to receive a copy of the Lienors Notice as provided in
713.13(1)(b),Florida Statutes.
Name Phone&Fax Number
Address
10.Expiration date of Notice of Commencement(the expiration date is one year from the date of recording unless a
different date is specified:
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA
STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORD D AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO
OBTAIN FINANCING,CONS LT YO.' NDE: •r • •TFORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE
OF COMMENCEME, .
11 iNk.adak- ' i nskilk Arbr"—t—
—
re of owners or'ilirt :ner/Manage Print Name
Sworn to(or affirmed)and subscribed before me this—Phday of J u Iy ,20(® bk�I -/13, nr�f0as
1A-urneoWnR)— (type of authority,e.g.officer,trustee,attorney Inlfact)for (name of party on
half of whom instrument was executed. personally known to me or V.produced
tit C)r)wirs Cpr\ as identification.
Ignatory or nota ($„I NOWY Pubic Slay of rorio.
St, �} Valerie MexNz sari
�V1Q IV Q(�U zi T761O %4 MamnnYGG"ng7
Name 1printl
—AND--
Verification pursuant to Section 92.525,Florida Statutes. Under penalties of perjury,I declare tha ave r • g and
that the facts stated are true to the best of my knowledge and belief.
.tory of Natural•erson 5i:ni,: , -
PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH,FLORIDA
Project Name: 4chacq Permit # gEsl d ^cq f
Project Address: '233I `)e(►'Ivole ►`-V AI/ , t ic Sea ci , IC- 3.233 >,..
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
roduct approval may be obtained at:www,floridabuilding.org. LLi_
M
Category/Subcategory a u u I a c l u r r Product Description l Limitation of Use State# Local#
1 L
A. EXTERIOR DOORS Li_
1. Swinging `2.
2. Sliding
3. Sectional
4. Roll upIW
• CI—
5. Automatic Zz cn
6. Other cv
—I 5 Q R.
F,. QOR. (0'
B .WINDOWS 2 ui — n
00 — z f_9
1. Single hung W d 0 r 8 a d
o a
2.Horizontal slider ` D Z y
3. Casement 0
4. Double hung t G I Y6 71. V%S O q c
Pel COr P �X� Serie S
5. Fixed 1 U. wa C ,au w
6. Awning w >" a m
-- --. — -- __— — —- h 1.1.1p w
7. Pass-through w y w w
8. Projected 5cc al
9. Mullion ,RIt cafe 360 Ser,e.5 1 `/6 3 •ci ¢ °C
10. Wind breaker
,--,-
11.Dual action
2. Other >—
Category/Subcategory Manufacturer Product Description jLimitation of Use State# Local# J
H. NEW EXTERIOR
ENVELOPE PRODUCTS
1.
2.
iL
LL.
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: 4'( ldQ5 on G/ Docjr s
Mailing Address:3 (A) 5 10 Q d cf 3 q
city:LOG State: FE Zip Code:3 7-50
Telephone Number: ( ) Fax Number: ( )
Cell Phone Number: (77)C 3,.8 GO E-mail Address: T l r). 0,1 dile e(M14 . COM
csg)
OFFICE COPY