1072 LITTLE CYPRESS KEY RES19-0063 siding permit RESIDENTIAL PERMIT PERMIT NUMBER
RES19-0063
CITY OF ATLANTIC BEACH ISSUED: 3/6/2019
800 SEMINOLE ROAD
F Di31�r ATLANTIC BEACH. FL 32233 EXPIRES: 9/2/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT • 1 OF •
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: PERMITTYPE:
I DESCRIPTION: VALUE OF WORK:
1072 LITTLE CYPRESS KEY RESIDENTIAL ALTERATIONRESIDENTIAL REPLACE T1-11 SIDING $16000.00
TYPE OF
ZONING: :D •
• • GROUP:
172027 5822 SELVA LAKES UNIT 03
COMPANY: ADDRESS:
SUPER SIDERS AND TRIM, 65 W. 9th Street Atlantic Beach FL 32233
INC
•
ADDRESS: CITY: STATE: ZIP:
SWANN STEPHEN C 332 3RD ST ATLANTIC BEACH FL 32233
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 $135.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $67.50
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.04
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.03
TOTAL:$207.57
Issued Date: 3/6/2019 1 of 2
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
ri 800 Seminole Road
�r
Atlantic Beach, Florida 32233-5445 a S
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: z-
City web-site: hftp://vvww.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I 07z- L17`1 , ,j 4Department review required Yes No
Applicant: ( ��� ���\ Zoning
_ Tree Administrator
Project: RF— 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 B C
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District �� V
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco 2
Other:
APPLICATION STATUS
Reviewing Department First Review: Vi&proved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by: Date:
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
ji
rt� 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
`Oj; IS REQUIRED.
Phone: (904) 247-5826 Email: Building(-/Dept@coab.us j�
Job Address: �i e �5S t`f' / Permit Number: ' `G � ( � —0o6 3
Legal Description S�I ou !4l« !/(
S 4l 3 �� < RE# /2Z-6 Z 7 — 575ZZ
Valuation of Work(Replacement Cost)$ �CD U l Heated/Cooled SF Non-Heated/Cooled-
• Class of Work: ❑New ❑Addition ICAlteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial Residential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes ❑No
• Will trees be removed in association with proposed roiect? ❑Yes must submit separate Tree Removal Permit ❑No
Describe in detail the type ofwork to be performed: C Gfh i
! Q .
�
//�/ � Ide4
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name f eje— rn, Address
City C / State Zip Phone
E-Mail
Owner or Agent(If Agent, Pow r of Attorney or Agency Letter Required)
Contractor Information 7�
0 4
Name of Company m f'I� �L°/� Gv>�l /�/ Qualifyn$ gent C'rr L + S
Address 41 City �7 n tate PL Zip 5:e7e 3
Office Phone Job Site Contact Number
dq
State Certification/Registration# t/1 5 S Z-!/ E-Mail �r-eiemif
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer �l.0✓l OR Exempt❑ Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work 6r 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 T PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDOR ATTORNEY BEFORE
RECORDIN UR OF COMMENCEMENT.
(Signature of Owner or Agent) (Signature of Contractor)
ftnecLand sworn to r of rm d)bef e me th's2(Dday of S[&Ded and sworn to or affi me )before me this�Sday of
�i b b S
ha it o f otary na r o I
TONI GINDLESPERGER
Personally Known OR MY COMMISSION#FF 924951 ersonally Known OR TONT GINDLESPERGER
.:
[ ]Produced Identificatio = EXPIRES:October 6,2019
[ ]Produced Identificatio ~ �;_ MYCOMMISSION#FF 924951
Type of Identifications „�` BondedThruNotarYPublicUnderwhters Type s'i
yp IBES:October 6,201
''!`•''� �` BcndedThruNotary rt�F