2069 SELVA MARINA DR DOORS PERMIT • T'S',.I,�`Jr��) RESIDENTIAL PERMIT PERMIT NUMBER
Jp1
CITY OF ATLANTIC BEACH RES19-0022
J 800 SEMINOLE ROAD ISSUED: 2/5/2019
ATLANTIC BEACH, FL 32233 EXPIRES: 8/4/2019
MUST CALL INSPECTION • . 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.
E'OTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property
be found in the public records of this county,and there may be additional permits required from other
ental entities such as water management districts, state agencies, or federal agencies.
JOB ADD• ---------PERMIT • • OF • •
2069 SELVA MARINA DR RESIDENTIAL ALTERATION REPLACE 3 DOORS $11200.00
RESIDENTIAL
TYPE OF
• :D •
CONSTRUCTION: • •
169506 1070 SELVA NORTE UNIT 01
COMPANY: ADDRESS: CITY: STATE: zip:
PELLA WINDOW AND 7818 PHILIPS HWY JACKSONVILLE FL 32256
DOOR
OWNER: ADDRESS: STATE: ZIP:
� i • ■
WHITE DONALD BATES 2069 SELVA MARINA DR ATLANTIC BEACH FL 32233-4554
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.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $110.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $55.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $248
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$169.48
Issued Date: 2/5/2019 1 of 2
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
J 800 Seminole Road
Atlantic Beach, Florida 32233-5445 vv
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: z
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: -zc)(, ( S GLVrA II r `{'P( e artment review required Yes o
Q(Building
Applicant: �G(,C,,q A , l lU bac QZop fanning &Zoning
Tree Administrator
Project: (�n cp _ 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: la4proved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUTLDIN
PLANNING &ZONINGel—�
Reviewed by: Dater '-'
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
Cal!Mm for Pk*Up 727-W?-UOO OFFICE COPY
Vr Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department "ALL INFORMATION
800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
r;''te Phone: (904) 247-5826 Fax: (904) 247-5845 Email: Building-Dept@` 1
coab.us IS REQUIRED.
Job Address: 20G pq 3,Q,61� rle�r;�n.. � `
f p ( Permit Number: � GS 1 /
Legal Description 3 / b b` ' 'a r F >4(Vo, /VOCT4t ✓A%i Oat, 107- RE# 6 9 bb "/D 70
Valuation of Work(Replacement Cost)$ 0a Heated/Cooled SF Non-Heated/Cooled
• Class of Work: 4}fdew ❑Addition ❑Alteration ORepair-IlMove ❑Demo ❑Pool WIndOW/Door
• Use of existing/proposed structure(s): cerciCIResidential
• If an existing structure,is a fire sprinkler system installed?: Yes ®No
• Will trees be removed in association with proposed ro'ect? es must submit separate Tree Removal Permi N
Describe in detail the type of work to be performed:
Ce-plkCk 3 V00 Srit-4.r 51ze,
Florida Product Approval# for multiple products use product approval form
Property Owner Information
NameJ/1A�G N,I�L Address Se("L Parr-o, br
City State 1 Zip -JAUT Phone 90 y�(/�-V2 7?9
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) n/a
Contractor Information n
Name of Company ft K.. VV, �v) -t'boo 4-5 Qualifying Agent
Address 3 5b S x(3'1 LV City Un9w0v State )-*r Zip IJ 7-5-31
Office Phone Job Site Contact Number
State Certification/Registration# G$c 0 Y 71;_ E-Mail 7fiN • 0im-[t ey • 60^
Architect Name&Phone# LU
Engineer's Name&Phone#
Workers Compensation Insurer t 'c ra 337 OR Exempt❑ Expiration Date / J Z i
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or instalEgiM4
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws reE:EaIgg p
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W
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,�I'� Q 0 Q
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS, and AIR CONDITIONERS, etc. NOTICE: In addition to the requireme9sb_3ttas1,
permit,there may be additional restrictions applicable to this property that may be found in the public records of this co*11L
r9 2
there may be additional permits required from other governmental entities such as water management districts,state aged0 afederal agencies. U
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance •= W
applicable laws regulating construction and zoning. LL LL Cc 2
LU
in 0- M
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT N!4t ui 5 o
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU lydEFA& w
¢ w
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE W >
RECORDING Y=/ T1 - MENCEMENT.
(Signature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affir ed)befo a me this �� day of Signed and sworn to(or affirmed) before me this day of
X 19 ,by Punw( f Wk Vic.. ��i 9 by
aigriature of�Notota� (Signature of Notary
TIMOTHY R.O'MALLEY-, ;;°a�?�:,. TIMOTHY R.O'MALLEY
MY COMMISSION#GG 117135 PAY CO110MISSION#GG 117135
[ ]Personally Known OR P ersonally Known OR
, EXPIRES:August 7,2021 �%� EXPIRES:August 7,2021
WJ Produced Identification ,� „°•° gondedThruNotaryPublicUnderwrite� roduced Identification
Bonded TtiruNotary Public Underwriters
iF F,
Type of Identification: -- —— — -V of Identification:
OFFICE COPY
Doc # 2019005066, OR BK 18651 Page 1012, Number Pages: 1,
Recorded 01/08/2019 09:47 AM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
Permit Number �`/ I ocj2 Z
Parcel ID Number
NOTICE OF COMMENCEMENT
State of Florida V�
Countyof dJ
The undersigned hereby gives notice that the improvement(s)will be made to certain real property,and in accordance with
Chapter 7t3,Rorida Statutes,the following information is provided in this Notice of Commencement.
L Description of ro(�JertyC(le g}al desui,�jQo-n of the property,and street address if available)
Address v�� \V Y" Iry ytp�p r•
Legal Descriptiopy,_94-
2. General description ofimprovement(s)
�dOKJ
3. Dwnefio"aon
one&FaK Numbperty�V\N r
4. Fee Simple title of r(if other than owner shown above)
Name Phone&Fax Number
Address
S. Contractor Pel)Q VI(II1dOWS&DOOM '
Name Phone&Fax Number
Address
S. Surety(ifany) Longwood,FL $2750
NameNIA
AddrnsWp Phone&Fax Number
7. tender(if any)
NameNA
AddressNA Phone&Fax Number
8. 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,Florldp statutes.
Name ( /y
Address Phone&Fax Number
9. In addition to himself or herself,Owner designates the following to receive a copy of the Uenofs Notice as provided in
713.13(1)(b),Florida Statutes.
Name
Address Phone&Fax Number.
'
10.Expiration date of Notice of Comme
different date isspecified: ncement(the expiration date is one year from the date of recording unless a
WARNINGTOOWNER. ANY PAYMCNTS 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,CONSULTYOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR YOUR NOTICE
OFCOM CEMEN . �U
1LSgutweorOwnersOfU tnAtabodzedo/nceroinector —' �+re\�`s W Y`' `�
/ 11's-w-nager Amt Nam¢ /
Sworn to(or a(firmed)and subscribed before me this,,day of�J 20 t by gyt 1r
(type of authority,e.g•officer,trustee,attorney In fact)for�_\" P� as
behalf gL whoinstrument was executed. _personally known to me or (nam¢c�� rty on
as identification. duced
Signatory of h ANDREW BREED
(Seal) , i�Stete of Fiorida•Notery Publi
Name(pAr,U Commission a GG 245933
MY Com mission Expires
Au ust O8,2022
Verification pursuant to Section 92.525,Florida Statutes, Under penalties of Perjury,I declare that 1 have read the foregoing and
p P 1 N.
that the facts stated are true to the bort of my knowledge and belief.
Slgytory of NaMel Fart pn nne Y33)Above
OFFICE COPY
PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH FLORIDA (*REQUIRED)
*Project address: 2069 Selva Marina Dr Permit#: ES��j—c�a22-
*Owner/Project Name: Donald White
As required by Florida Statute 553.842 and Florida Administrative Code Rule 96-72, 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 Pella Architect Series 14896.17
2.Sliding Pella 350 Series 14010.3
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
OFFICE COPY
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 Windows and Doors
*Mailing Address: 350 SR 434 W
*City: Longwood *State: FL *zip code; 32750
*Telephone Number: (407) 937-2848 *E-mail Address: Tim.OMalley@Expeditepermit.com
Cell Phone Number: Fax Number:
Page 4 of 4 Updated 10/17/18
OFFICE COPY
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\' Permit Inspections
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f Atlantic Beach
'`�LDI4 9r
Permit Number: RES19-0022 Description: REPLACE 3 DOORS
Applied: 1/24/2019 Approved: 2/4/2019 Site Address: 2069 SELVA MARINA DR
Issued: 2/5/2019 Finaled:3/12/2019 City,State Zip Code:Atlantic Beach, FI 32233
Status: FINALED Applicant:<NONE>
Parent Permit: Owner:WHITE DONALD BATES
Parent Project: Contractor: <NONE>
Details:
LIST OF INSPECTIONS
SEQ SCHEDULED DATE COMPLETED DATE TYPE INSPECTOR RESULT REMARKS
ID
BUILDING Universal
2/11/2019 2/11/2019 WINDOW DOOR Engineering CANCELLED
INSTALL
Notes:
I
PM inspection
407-937-2848
PHONED IN
BUILDING PARTIALLY
3/11/2019 3/11/2019 WINDOW DOOR Mike Jones PASSED
INSTALL
Notes:
SHANA 407-937-2834
Will inspect exteriors at final.
BUILDING
3/12/2019 3/12/2019 WINDOW DOOR Mike Jones PASSED
FINAL"
Notes:
407-937-2848
late PM inspection requested
s
Printed:Tuesday, 27 August, 2019 1 of 1 1