2016 SELVA MADERA CT RES19-0008 GARAGE DOOR PERMIT RESIDENTIAL PERMIT PERMIT NUMBER
r CITY OF ATLANTIC BEACH RES19-0008
J' V~ 800 SEMINOLE ROAD ISSUED: 1/17/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 7/16/2019
MUST CALL INSPECTION • • • 1 BY / PM FOR • •
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • ' DA 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:
2016 SELVA MADERA CT RESIDENTIAL ALTERATION replace garage door $2097.00
RESIDENTIAL
TYPE OF
• :D •
• • GROUP:
169506 1636 SELVA NORTE UNIT 02
COMPANY: ADDRESS:
D & D GARAGE DOORS INC 9425 Phillips Hwy Jacksonville FL 32256
• ADDRESS:
GREENWALD JOHN R JR 2016 SELVA MADERA CT ATLANTIC BEACH FL 32233-4531
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 • . •
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
FEES
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 j 0 $2.00
TOTAL: $101.50
Issued Date: 1/17/2019 1 of 2
s-0irl. City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
U
r' Atlantic Beach, Florida 32233-5445S �f —Coo
Phone(904) 247-5826 Fax(904)247-5845 G `
E-mail: building-dept@coab.us Date routed: -1
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: � ` Cl l'���Q�4 ment review required Yes o
Building
Applicant: C��1'a wc�(S Planning &Zoning
U Tree Administrator
Project: e tv 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: ®proved. [-]Denied.
(Circle one.) Comments:
(!5�
PLANNING &ZONING Reviewed by: / / Date:-/—/6—/9
TREE ADMIN. Second Review:
[]Approved as revised. ❑Deni d.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: []Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
FFICE Y uilding Permit Application Updated 10/9/18
�iiby of Atlantic Beach Building Department "ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
s v? Phone: (904) 247-5826 Fax: (904) 247-5845 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: H2O I� S,P_\\J&' V ` k&P—m �Ovr+ Permit Number: e-G s 101—U00 F
t
Legal Description 40—M 0 — AS — o' G� ' Se,/(/q (iY1,► 1��-T_7A# 1 69 S C)6,1 6 36
Valuation of Work(Replacement Cost)$ PCU/7. ' Heated/Cooled SF Non-Heated/Cooled
• Class of Work: New ❑Addition ❑Alteration ❑Repair ❑Move []Demo ❑Pool AMindow/Door
• Use of existing/proposed structure(s): Commercial 00'Residential
• If an existing structure, is a fire sprinkler system installed?: []Yes E3No JAN — 9 2P9 �Q
• Will trees be removed in association with proposed project?[Ayes must submit separate Tree Removal P
Describe in detail the type of work
too be performed: OJ. U Z
0W O
❑
—7 i p m z H
Florida Product Approval # 107-
. 10 for multiple products use pro ictdpfolrm a
Property Owner information 13 � cc Z
Name �CXK CTe_-P AL✓a-i-k Address lI16 sem, Lxt 2r-k (A
City '� h i c. l��a State A_ Zip 3c9c�L$3 Phone d �
E-Mail
LL
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Na WFi
02
Contractor Information W }
Lu :3 ❑
Name of Company ��t"S Qualifying Agent A� l �C UJ
� U v �
Address S {1, III fDAS Vt City -J&C V� i UL 1(-.State�_Zip (,o W
Office Phone — — Job Site Contact Number ( _ ( --ct q I W
State Certification/Registration# cac J&5'Eao s E-Mail M Wl/ 5'u,-S Ldand Ar- a
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation Insurer '' ' OR Exempt❑ Expiration Date o/0-111,11
Application is hereby made to obtain a permit to d 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 ATTORNEY BEFORE
RECORDIN15 YOME OF CQI�IIMENCEMENT.
�
(Signature of Owner or Agent) Yignature of Contractor)
r�
wed and sworn to or affirmed) befor me his day of Si ned and sworn to (or affirmed before m ,this day of
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(SignatuW.f k.Vifllfi)rtaon eIQ &V`FUBLIC
NOTARY PUBLIC S STATE OF FLORIDA
Personally Known OR
STATE OF FLORIDA []'Plersonally Known OR - i Conn#GG272281
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