141 15TH ST - DOOR rt RESIDENTIAL PERMIT PERMIT NUMBER
Q� �� RES18-0378
j -,. v� CITY OF ATLANTIC BEACH ISSUED: 11/26/2018
�// 800 SEMINOLE ROAD
\4913"" ATLANTIC BEACH, FL 32233 EXPIRES: 5/25/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
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 as water management districts, state agencies, or federal agencies.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
141 15TH ST RESIDENTIAL ALTERATION replace door $4550.00
RESIDENTIAL
TYPE OF REAL ESTATE ZONING: 1 BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171870 0000 MANDALAY
COMPANY: ADDRESS: CITY: STATE: ZIP:
PELLA WINDOW AND 7818 PHILIPS HWY JACKSONVILLE FL 32256
DOOR
OWNER: ADDRESS: CITY: STATE: ZIP:
AMES WILLIAM H 141 15TH ST ATLANTIC BEACH FL 32233-5723
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.
.ro,w ,,
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $75.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $37.50
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $116.50
Issued Date: 11/26/2018 1 of 2
`: ,''`'f','` RESIDENTIAL PERMIT PERMIT NUMBER
` i-- CITY OF ATLANTIC BEACH RES18-0378
�� "�� 800 SEMINOLE ROAD" ISSUED: 11/26/2018
if.-.4.,.913I9*'' EXPIRES: 5/25/2019
ATLANTIC BEACH. FL 32233 I
Issued Date: 11/26/2018 2 of 2
ow-v.1/2,y, City of Atlantic Beach APPLICATION NUMBER
�s� b n+ Building Department (To be assigned by the Building Department.)
r) 800 Seminole Road LLS I c— 03
,�> Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
'„Dit E-mail: building-dept@coab.us Date routed: ( ( ( k e d i g
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I —1 t ( S 3-1 - tttent review required Ye No
Building
Applicant: 1 1C.. tc •c\ &( iS 4 UOL) S Planning &Zoning
Tree Administrator
Project: l L p(L L CO&[ Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Review or Receipt
Other Agency Review or Permit Required of Permit Verified By 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:
BUILDIN
PLANNING &ZONING Reviewed by: ^ Date: //.001Y—
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
u r r I V t U U f Y Call Tim for Pick Up 727-837-8400
0; Building Permit Application Updated=l2/k/37Ii
g> =j City of Atlantic Beach ('
''i 800 Seminole Road,Atlantic Beach,FL 32233 N O V 1 I 11
Phone:(904)247-5826 Fax:(904)247-5845 5 2018 l I r!
U/ f/y
Job Address: I 1 r /� S/ Permit Number: g. e_51 %---- 0 3 ')- '• it
Legal Description 60 -11 /6 2s--c)?0"
7" /11 i cL io of Al 7 y L IA- 63 RE# / 7/a-70-0006
Valuation of Work(Replacement Cost)$ I.53-1) Heated/Cooled SF Non-Heated/Cooled co
• Class of Work(Circle one): New Addition Alteration Repair Move •- .• Pool indow/Door W I
• Use of existing/proposed structure(s)(Circle one): Commercial •esiden .. 0
Z N
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No 4110 Q
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal a 0 Q 9 j
Describe in detail the type of work to be performed: 2 w - a
-t pLttte- I Jvr S(1I- -4( S /2.2 O Ca 8 Z ~
UVo oa
W -4 U D
Florida Product Approval# ` ( y 4 9. / for multiple products use product apprpgai rm 0
QProperty Owner Information _ O Q0
Name: Lt/I/OO&M t✓S Address: /Ni /5 . 5 r U N 0
Cit A. >< Zip 0 `f-aY7—/c 9 p Q E w
Y 7Id.-tr i. P�L� State • ( 3aa 3 3 Phone
E-Mail I.L. O W W j:
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) 0 a � m
Contractor Information W I-- w M 0
II n 0 w
Name of Company: Wi�l.JwS -f'boo 15 Qualifying Agent: -TaP+e_t (Zt _/ -, L IA VwLU W
Address 3,�d S ke.,tL.
K3 Y w City Lewyx-t,v l State f l Zip 3175 5
Office Phone ( - 7,27,637-- ktt I' Job Site/Contact Number _
iti
CC
State Certification/Registration# C a C O Y t 7/2 E-Mail `Ti M . 0/4-0.-Ilii Iolp r-7-0Per/LI fr. fail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation LC l•--7( - C a-S CV / 9/I//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.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 YOUR NOTICE OF COMMENCEMENT.
Z4 /"------
(Signature of Owner or Agent) (Signature of Contractor)
(including contractor)
•••Pd ate+ r.enap..-"e--si��y��ref�ore`me thisth2 V day of Signed and sworn to(or affirmed)before me this/ 7 day of
id,-_v . f �Wafro e n 44 `lam NU✓ , �1 h ,by J�'�'+�.s 'dror.L
o ary b 1 tate I�
ll�':' Commission:GG 219540
o. My Comm.Exoi,es may 7n,7077 v ��
. . Bonded through National Notart(9igna're of Notary (Signature of Notary)
- - - a
[ 1 Personally Known OR L)($ersonally Known OR .1;,111014;'•-., ; TIMOTHY R.O'MALLEY
[(J Produced Identification [ ]Produced Identificatio ,, !• i„=- MY COMMISSION#GG 117135
1�11
Type of Identification: L Type of Identification: ,��� ` EXPIRES:August 7,2021
'' ; Bonded Thru Notary Public Underwriters
Doc # 2018268390, OR BK 18596 Page 260, Number Pages: 1,
Recorded 11/14/2018 10: 13 AM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
PermltNumber qs- (J —0 3'7
Parcel ID Number f rlZv-QQ�
NOTICE OF COMMENCEMENT
Slate of Florida
County of �S v�`
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 Informa tkm Is provided In this Notice of Commencement.
1. Description of property(legal d ription of the property,and street address If available)
Address J� C� ,
Legal DescriptionL` -I I _ (e -.111 • .ti= 'A col C5 '" ' J( C43
2. General description of Improvemeni(s) GJ�rte_
3. Ownerinfor a Ion
• Name - G. one&Fax Num r
Address C•11 1 _ "1r �vt• `
Interest In Property El
4. Fee Simple Titlt�Toler If other than owner shown above)
Name \\ Phone Sr Fax Number
Address
5, Contractor P@poi Windows&Doors '
Name 360 w Stole Rood 434 Phone&Fax Number
Address
Longwood Ft. 327.1)
6. Surety{ffany)
NameNIA Phone&Fax Number
AddressN/A
7. Lender Of any)
NamewA Phone&Fax Number
Addressi
B. 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 tes.
Name N( Phone&Fax Number
Address
9, In addition to himself or herself,Owner designatethi a 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 dote 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 RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO
OBTAIN FINANCING,CONSULT YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE
OF C110EMEN — y f J /�
ue lured ownan erownetrAvrhortredornrerlorerter/Penn /ANmerr Print Wm* j
S(worrnn`tto( r
affirmed)and subscribed before me this a "Tayof (/}f A0 by as
(type of authority,e.g.officer,trustee,attorney In fact)for 1 3-Ename of party on
beh of whore Instrument was executed. personally known to me or 7,... -predtseed
as Identification.
•^;lei"• KEVIN A WRIGHT
orydrraary r Natary Public•State or cA rte,
Ql/y •
i Commission r GG 2 moo
Nam.(prim) ?O!n�� µy Comm.Expires May 10.20Z2
-A • bonded through National Notary Assn,
Verification pursuant to Section 92625,Florida Statutes,Under penalties of perjury, de r•t .• • . the foregoing and
that the facts stated are true to the best of my knowledge and belief. 42d14,
•/l /4
& aroryaHatoni PPetsoCnsenMa(in line/ Above
� PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FLORIDA (*REQUIRED)
*Project Address: 141 15th St Permit#: R310 — 0 57 4
*owner/Project Name: William & Rebecca Ames
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.floridabuilding.org.
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
A.EXTERIOR DOORS
1.Swinging
2.Sliding Pella Proline 11469.1
3.Sectional
4.Garage Roll-Up
5.Automatic
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
10.Wind breaker
11. Dual action
12. Other
Page 1 of 4 Updated 10/17/18
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 :James Rowland
*Contractor Signature:
*Company Name: Pella Window & Door
*Mailing Address: 350 W State Road 434
*City: Longwood *State: FL *Zip Code: 32750
*Telephone Number: d7- 637" .6-Y01
*E-mail Address: 1 M • Of21a I1 /(2 I � ) . ez"
[o" �"lrt.d i i P�Q1/K
Cell Phone Number: Fax Number:
Page 4 of 4 Updated 10/17/18
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