238 PINE ST RES18-0405 DOOR PERMIT RESIDENTIAL PERMIT PERMIT NUMBER
-
CITY OF ATLANTIC BEACH RES18 04
05
800 SEMINOLE ROAD ISSUED:
ATLANTIC BEACH. FL 32233 EXPIRES:
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:
238 PINE ST RESIDENTIAL ALTERATION REPLACE DOOR $2211.00
RESIDENTIAL
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170554 0000 SALTAIR SEC 03
COMPANY: ADDRESS: CITY: STATE: ZIP:
LOWES HOME CENTERS 4948 TELSON PL ORLANDO FL 32812
INC
OWNER: ADDRESS: CITY: STATE: ZIP:
DOROTHY HAMM LIVING C/O DOROTHY HAMM & WAYNE ATLANTIC BEACH FL 32233
TRUST HOLLERAN
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 PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $65.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $32.50
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
Issued Date: 1 of 2
0LA.'.�- RESIDENTIAL PERMIT PERMIT NUMBER
JS ,'� RES18-0405
r f
CITY OF ATLANTIC BEACH
:51 v 800 SEMINOLE ROAD ISSUED:
�0j 59� EXPIRES:
ATLANTIC BEACH. FL 32233
TOTAL:$101.50
Issued Date: 2 of 2
Sii'ui f, City of Atlantic Beach APPLICATION NUMBER
i� >n� Building Department (To be assigned by the Building Department.)
f 800 Seminole Road
,, Atlantic Beach, Florida 32233 5445R -n4os
Phone(904)247-5826 • Fax(904)247-5845 /
l'40109'r• E-mail: building-dept@coab.us Date routed: 1 Z 1 Z ft
O
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Z SC___-, Pi, — c >(-- De artment review required Yes/ No
Buildin V
Applicant: 1
' —__[40WG—S °Mr—, ( ) Planning &Zoning
Tree Administrator
Project: ‘Thoop 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 44'
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: !r pproved. (Denied. (Not applicable
(Circle one.) Comments:
EILDIN
PLANNING &ZONING �/
Reviewed by: Date: /2'/ 9 '/ d
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
OFFICE COPY
1rCitBuilding Permit Application
Y
y of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
�'"'i~ Phone: (904)247-5826 Fax: (904) 247-5845
Job Address: ` &" Pi),lel '-j-1"' — Permit Number: R GS Ld _b 4
Legal Description 10-16 16-2S-29E SALTAIR SEC 3 LOT 521 RE# 170554-0000 w
U
Valuation of Work(Replacement Cost)$ .aZ I t • Oe, Heated/Cooled SF Non-Heated/Cooled Z N
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Windo oor i' = = J Z N
,, Q, Z 0
—
• Use of existing/proposed structure(s)(Circle one): Commercial esidentia > c 0
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No ® 0 m H Z N
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal 0 E O Q
Describe in detail the type of work to be performed: LJ I— 0
p 1LL0 : 3 iki , i( � ( f }-)-Yy dee 0 s
Approval u 14892.14 U F"' to t`
Florida Product
for multiple products use product appgvaktob Z NI
Property Owner Information L
cc
Name: IC i-4""•-4•11-4.,t •/1 t9JPi 2 ' 7 0 W
� � Address: �� C I ri L'_� .,,1 `I' �
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City� Gi.i'+�I f�': )"j G''.,�it a1 State!'/-- Zip .'I�. 3� Phone 4-Y0di -�/..�#--,.'j-r/L!� pi
E-Mail $
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Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) 5 cc w
Contractor Information f ' / ( W j
Name of Company: L—G I r_ ;' E-ic.n r4 Le::-!/•) ' `-, 1 L- alifying Agent: ±f e e.1--A-4.A.ver-
Address
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Address T'e ?3C '7 g•/-' 7.S City c'%r JA /re>c State f=L zip,9''.,Z'
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Office Phone c7 - "/-_5�'6-� i 7rte -r Job Site/Contact Number.U4rf 'I/-)i.-14-i G/(`•/ - 5.7,el--L+,f g9
State Certification/Registration if CGC1508417 E-Mail (/5 pe-}'/Herr+f-lr j4 plc)) ..e.,,-/1
Architect Name&Phone a N/A
Engineer's Name&Phone tt N/A
Workers Compensation WCO23102416 EXP: 04/0172018
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 PROP .*TY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATT n •r EY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
4t
(Signature otOvner or Agent including Contractor) (Signature of Contractor) �p
�S{}i�gne}fd and/nod Jsworn��to`�(/(or affirmed)before me this 2 day of Signed/a,�nddssworn tt�o(or affirmed)before me this // .day of
A0-417)44_J )(' 4&, 24 i■ 1 by -'I�,I�- -`i..,.-K i1 J by . Pere 1J
� (Signature of Notary)._ Si n to of Notary)
�,, ,IAM€SS GARDEN
e MY t:Ot7WISSION#GG135259 , ..,*::;:r'r""•., NATHAN BROOKS RYDER
I I Personally Known OR „„PIRES:AUG iii.2021 , ._ �''-: Nota:yPublit-Stzteof Florida
8 ,r;a Ih+ots ::ist Sta a in -an l{r)'Personally Known ORCommission a GG 094838
'Produced Identification) ( )Produced Identification I •?o , ' My Comm.Expires Apr 16,I021
Type of identification: t"t-5 G'C-- 1 ` .'°.`,:•'
/ "�/ -��9"� Type of Identification: ( [keeled through KatioralNctaryAssn.