2133 Seminole Unit 1 RES18-0351 RESIDENTIAL PERMIT PERMIT NUMBER
RES18-0351
CITY OF ATLANTIC BEACH ISSUED: 10/26/2018
800 SEMINOLE ROAD EXPIRES:4/24/2019
ATLANTIC BEACH. FL 32233
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
XUL'Arlikl( rAYST CI?JFIRF*; T1 THE CWIRRENT fTH E1,ITI1;J (2117) 4LF TWE FLIRIIA 9UILDBJG�–,
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
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 aswater management districts,state agencies,orfecteral agencies. —
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
2133 SEMINOLE RD UNIT 1 RESIDENTIAL ALTERATION 5 Windows $2166 00
RESIDENTIAL
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1695150430 SECTION LAND
�COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
COOPER DIANNE 2133-1 SEMINOLE RD ATLANTIC BEACH FIL 32233
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR 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.
LIST OF CONDITIONS
Roll off container company must be on City approved list. Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAIDAMOUNT
BUILDING PERMIT 455 0 $65,00
BUILDING P�N CHECK $32.50
STATE DBPR SURCHARGE $2.0)
STATE EGA SURCHARGE 455-0000-208 0500 1 0 $2,00
TOTAL:$101.50
issued Date: 10/26/2018 1 of I
City of Atlantic Beach APPLICATION NUMBER
Building Department Cro be assigned by the Building Department.)
800 Seminole Road RES 19- 0351
Atlantic Beach,Florida 32233-5445
Phone(904)247-5826- Fax(904)247-5845 Date muted: 119
E-mail: building-dept@coalb.us
City web-site: hftp:/hvww.00ab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: no(e, �.egairtment review required Y No
gdg
Applicant: Planning&Zoning
Tree Administrator
Project: vi t'r\A 6 Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Reviow Date
Of Pemnit=pty
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: EJApproved. ElDenied. E]Not applicable
(Circle one.) Comments;
(E��
PLANNING &ZONING Reviewed by: Date: /0-
TREEADMIN. Second Review: F V a
]Approved as revised. E]Denied. EINct applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ElApproved as revised. ODenied. [-]Not applicable
Comments:
Reviewed by: Date:-
Rwised 0511912017
OFFICE COPY
Building Permit Application Updated 12/8/17
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fa.:(904)247-5845
ONIT Permit Numberp-E-Sil?-6351
Job Address: d S50i J4,0 1I
rLegal Description r3 I - � 5 ';t q t5, 13 7 L�+ RE# 4 SO
Valuation of Work(Replacement Cost)$4 1(66-0 0 Heated/CooledSF 1100 Non-Heated/Cooled_
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool 4jmdo-/D..1
id W
• Use ofexisting/proposed structure(s)(Circle one): Commercial E9;2�D 0
• If an existing structure,is afire sprinkler system installed?(Circle one): Yes (g N/A Z
• SubmitaTree Removal PernnitApplicaflon ifanytreesareto be removed orAfficlavitof NoTree Removal :5
Describe in detail the type of work to be performed: Z
R.PIR6.) 0
LL1 - 0
0 M 1= Z,
rj
Florida Product Approval# -for multiple products use product .arf
Property Owner Information M Z
`0 IA ri COO PE91L og- -11. 2
Name Address: ffil"400 P 4 NJ I
��17jp S11-33 Phone
Itai
W
�Opq, k1l 3��IQ
E I o d t It 3 RUO to��M
owner Or Ag!'t 11 rl�ent,Power of Attorney or Agency Letter Required)
Contractor Information 21
Name of C Qualifying Agent: W
ot(jeany: co - 3:
Address City_State Tip cc �2.
Office Phone Job Site/Contact Number- LIJI iu�
State Ceirtification/Registration E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation
Tin/linsu Eon�l. /expinition care
Application is hereby made to obtai n a permit to do the work=� rZ1,S
d insT. -d indicated.I certify that no work or installation has
commenced prior to the issuance of a permit and that al I work wi 11 be pe "4 meet th a da
a LEg
RIZAL=all the laws egulationg
construction in this jurisdiction.I understand that a separate permit must be--- -%r -- - K,PLUMBING,SIGNS,
IC . addition to the requirements of this
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc.-NOT't d t
P c c.r S of
permit,there may be additional restrictions applicable to this property that may be foundm t�hep c records of this county,and
e
_a g m
t I cts,
there may be additional permits required from other governmental entities such as water management tncts,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 YOUR NOTICE OF COMMENCEMENT.
<-�"Iul, &-�
(Slignature of Owner or Agent) (Signature of Contractor)
(including contractor)
Signed and sworn to(or affirme before this " dayof Signed and sworn to(or affirmed)before me this_day of
IT N
0_CT.IS1EC 2-al 8 by AN 9 COGUIL A by
(Signature of N.u(?0y) U7 (Signature of Notary)
I I P nally Known 0, nnwn OR
fn A., M e
.c. onfic.
r.d dIdent'' t i SW d t1firAivo
C-UT g
or
Type of ldentificati..: t� IL
OFFICE COPY
CITY OF ATLANTIC BEACH
(OWNER/ BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I 'CONSTRUCTION
CONTRACTING" REQUIRES OWNER I BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE By LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN E)MMPTioN To THAI
LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUSI
SUPERUSE TIM CONSTRUCTION YDURSELF. YOU MAY BUILD OR IMPROVE A ONE—OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BMDrN
MUSTBE FORY91MUSLAND OCCUPANCY. IT MAYNOTBE BUILT FOR SALE ORLEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLA-RON OF THIS EXEMI'nON. YOU MAY NO
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND By COUNTY OR MUNICIPAL LKENSING
IL INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WTHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES
IV. PENALTY; UNLICENSED CONTRAMRS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO$5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(l), AN�OCCUPATIONAL LICENSE'IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY 'CERTIFICATE OF COMPETENCY" UK INE FLORIDA 'CONTRACTORS
CERTIFICATE' TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT�247-5826)IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WTH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-SUILDER PERMIT.
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ADDRESS PHONE NUMBER
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PRINT NAME
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SIGNATURE I DATE
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CUSTOMER COPY EIVIIIIIHIM19/24/2018
LANSING QUOTATION #4000�967A Kevin Stakes
SOLD TO: SMP TO:
Laraing BP Cash Aect g BP Cash Amt
Kenn.Rd
0.,B.,
12740 Kermn Rd 0 Y
Jacksonville,Florida 3225sOFFICE C r:ki� Merida 32259
Phone:Pax: Phone:Fax:
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Dime Cooper Unassigned Project
mm"'m rymm
1 5050 Reflections Double Slider 58.25"X 46" $238.72 $238.72
RO: Operation=Left Opening-XO,Frarne=
Rcpl�ent,Ext.Color=White,Int Color
59.5 x 46.25 White,Glass Package=Standard Glass Options,
Rwm 11): ProSolarShadc Low E,Argon,Intercept,3/4"IGU,
N\A Glass Thickness= 1/8 in- 1/8 out DS,Left=
Annealed,Right=Annealed,Locks=2,White,
Cant,RoHm=Corrosion Resistant Rollex/Glide,
Sill Extender,Screw Coverage=11alf,Fiberglass,
Roll-Fornned,U-Factor=0.29,SHGC=0.2,VT= a
0.47, STC=05 Meets Energy Star Zones�North
SIMONTON Central, South Central, Southern,DP=30,AAMA,
------s-T TDI�WIN-1046,FloridaAppmval Code=5179
Initials:
1 5050 Reflections Double Hung 24-X 72" Operation $236.14 $236.14
RO: =Operating,Frame=Replacement,ExL Color= -
24.25 x 72.25 White,Int.Color=White,Glass Package=Standard
Glass Options,ProSolar Shade LowEArgon,
R...ED: Intercept,3/4"IGU, Glass Thickness= 1/8 in- 1/8
N\A out DS,Uppear=Annealed,Lower=Annealed,
Locks= 1,White,Camm,Air Latches=1,Sill
Extender,Screw Coverage=Half,Fiberglass,Roll-
FortruaJ,U-Factor=0.3 1,SHGC=0.21,VT=0.47,
STC=0,Mods Energy Star Zones=Southemn,DP
50,AAMA,TDI WIN-1213,Florida Approval
SIMO�TON Cc& 5167
-4
Initials:
Page I Of 2 Quote#* 400096
Diane Cooper Urooisigned Project
1 5050 Reflections Double Slider 60"X 47" S251.93 $251.93
RO: Operation=Left Opening-XO,Frame=
60.25 x 47.25 Replacement,Ext.Color=White,Int.Color
White,Glass Package=Standard Glass Options,
P�m 11): ProSolar Shade Low E,Argon,Intercept 3/4"IGU,
N\A Glass Thickness= 1/8 in- 1/8 out DS,Left=
Annealed,Right=Annealed,Locks=2,White,
Cam Rollers=Corrosion Resistant Rolla/Glide,
Sill Extender,Screat Coverage=Half,Fiberglass,
Roll-FornseJ,U-Factor=0.29,SHGC=0.2,VT=
0.47, STC=0,Meets Energy Star Zones=North
SUW,NTON Centrad,South Central,Southern,DP=3 0,AAMA,
TDI=WIN-1046,FloddaAppmvMCoft=5179
Initials:
2 550OReflmtiowFndV=tSlidalO9'X35.25� $649.17 $1,299.34
RO: Sash Split= 1/4- lf2- 1/4, Operation=End Vent
109.25 x 35.5 (XOX),Frame=Replacement,Ext.Color=White,
Int.Color=White,Glass Package=Standard Glass
Rownw; Options,ProSolar Shade Low E,Argon,Intercept,
N\A 3/4"IGU, Glass Thickness= 1/8 in- 1/8 out DS,
Annealed,Left=Annealed,Right=Annealed,
1,ocks=2,White,Cam,Rollers=Corrosion
Resistant Rolla/Glide,Sill Extender,Sawn
Coverage=Half,Fiberglass,Extruded,U-Factor
pply� 0.3,SHGC=0.19,VT=0.45, STC=0,Meets
SIWNToN Energy Star zones=North Central,South Central,
Southern,DP=25,AAMA,TDI WIN-1045,
Florida Approval Code 5179
Initials:
5 Total Oty Units 11111M� $2,025.13
100jffffKTffM $141.76
Comment: METURTWW" $0.00
NORTMOM $0.00
11117avirw7m ($0.00)
$2,166.89
($0.4at)
�nauug=M $2166.89
Submitted by; Accepted by; Date
Page 2 Of 2 Quote t. 400096
Frow Charles Butts ,urn
Subjec , Fwd: Cooper FL Paperwork EV Slider
Dat,,- Oct 10, 2018 at 3:51:45 PM
coopgoiden3@aol.com
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Begin forwarded message:
From: "Kevin Stokes (JXVL WNDWY <jXyLWn-d-�J-aosjngBP.c0m>
Subject: Cooper FL Paperwork EV Slider
Date: October 10, 2018 at 3:48:26 PM EDT
TO: Charles Butts<CbadQSbIdL'@YMa!AQM>
KEVINSTOKES
Win�'V&D—S�1311st
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