364 7TH ST RES18-0409 RES PERMIT RESIDENTIAL PERMIT PERMIT NUMBER
RES18-0409
sr, ; . CITY OF ATLANTIC BEACH ISSUED:
� 800 SEMINOLE ROAD
J'w~ 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:
364 7TH ST RESIDENTIAL NEW SINGLE BATHROOM REMODEL $4000.00
FAMILY RESIDENCE
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169901 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
TOM TROUT, INC. 5569 BOWDEN RD JACKSONVILLE FL 32216
OWNER: ADDRESS: CITY: STATE: ZIP:
NOVAK EMILY E 364 7TH ST ATLANTIC BEACH FL 32233-5434
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 $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: 1 of 2
-0,An-r,
sCity of Atlantic Beach APPLICATION NUMBER
''
'`4011 Building Department (To be assigned by the Building Department.)
`''v 800 icSeminolecRoad fj` Ed 1 � —0 O 9
5.,. r Atlantic Beach, Florida 32233-5445 0 � `1'
Phone(904)247-5826 - Fax(904)247-5845
�,it y? E-mail: building-dept@coab.us Date routed: I Z i 4 L 8
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 3(04 ( D nt review required Ye No
_ uildin V
Applicant: 1 0 M l R,00-7- &Zoning
Tree Administrator
QPublic Works
Project: ��r7" 64- I`C�Q � 1►'\C�.�L L .
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date t
of Permit Verified By
Florida Dept. of Environmental Protectionti
Florida Dept. of Transportation /i
St. Johns River Water Management District
Army Corps of Engineers API-
Division
of Hotels and Restaurants J \
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: I Jproved. 1 (2 ❑Denied. ❑Not applicable
(Circle one.) Comments: 0 C 'O 7- -P c.OYp� ,
BUILDING. / I�/
PLANNING &ZONING
Reviewed by: Date: lL`/9. ig
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
`S ' 3 Building Permit ApplicatiorpFFICE COPdd�d10/9/18
Ail IV CL` `:ui '�4 City of Atlantic Beach Building Department **ALL INFORMATION
JV 800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Fax: (904) 247-5845 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 3644 7 54-ree,4-, A.U. bd.,, P1... 32233 Permit Number: ' l ESt Q -- 0409
r 3/ock L
Legal Description 5-69 16-LS -2.9 6 ,Ail. ' .L,. t,J 3e1 Fr (-or L7, E30 Ft c orvi RE#
Valuation of Work(Replacement Cost)$ 4,(o Heated/Cooled SF 2.l lb Non-Heated/Cooled 730
• Class of Work: ❑New oAddition ❑Alterationtepair [Move [Demo ❑Pool ❑Window/Door
IL
• Use of existing/proposed structure(s): ❑Commercial ,Residential 0
• If an existing structure,is a fire sprinkler system installed?: ❑Yes JEI(No ❑N/A cC J Z
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal =IU z 0 N
Describe in detail the type of work to be performed: ie !DJ v t----.. Ili
I2e-M- -1‹.1,%.c.J'C( b �L,-, ....L 4- MA-1.1-er b,01-L, sewer o�'�- 3ec IEb o
W I- QO
Florida Product Approval# k.)/A for multiple products use product apRZef a
._i
Property Owner Information 0 Li- u, �'�
Name 6t.Ati /•-50 JAk.. Address Z '1� -c+ge.+ i ccZ H
Lisi
City 2M-tan 43,, "p�c,l„ State F . Zip 3Z23 3 Phone U.. a 2
E-Mail _ ' O U.1 W j:
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) N/A Il! 1.— 1i" 7 p
Contractor Information W U N w
Name of Company Ta,,.,,Tom,,•.-k• 1+.)c. . Qualifying Agent Tom Trow' r cc lala
Address SS1l9- \ czd.e. CL.d . City Jo.y:. State 'Fl.. Zip z24.1# 6, w
cc
Office Phone qpy• 737 • 54 1L Job Site Contact Number Q,Cc-I. 219 . 2-LB 1 CP o.......1)
State Certification/Registration# CU. Oib ixcl E-Mail kip.. A.Ta.-n.+rt .-4 u.]L. Co rv-
Architect Name&Phone#_. n)/4
Engineer's Name&Phone# A1/.d.
Workers Compensation Insurer FCe.2--.Z/I/.l102f9yQC.6 07. OR Exempt o Expiration Date c..242Y/42.6/9
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 regulating
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 ATTORN : • I;
RECOR OUR NOTICE OF COMMENCEMENT. -
(Signature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this /3 day of Signed and sworn to(or affirmed)before me this I/3 day of
`1 ee... , /OM> ,by Filart looVra.lL Xrig ,g2Ig , by7 4 2..M 901472F—
•
41I
(Signa e of Notary) (Sig ture of Notary)
• Kimmie Johnson Kimmie Johnson
e ' NOTARY PUBLIC `
�'` NOTARY PUBLIC
14 Personally Known OR 2_ STATE OF FLORIDA ]'Personally Known OR f� �STATE OF FLORIDA
[ ]Produced Identification .1i.�r.r43 Comm#GG097308 [ ]Produced Identification .1.043 Comm#GG097308
Type of Identification: ' ' A% Expires 4/24/2021 Type of Identification: /414 j9% Expires 4/2412021