161 SEMINOLE RD RES19-0085 WDO REP RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RES19-0085
800 SEMINOLE ROAD ISSUED: 3/21/2019
ATLANTIC BEACH. FIL 32233 EXPIRES: 9/17/2019
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 .
A LL 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:
161 SEMINOLE RD RESIDENTIAL ALTERATION wood-destroying organism $1100.00
RESIDENTIAL repairs under house
TYPE OF REALESTATE BUILDING USE
ZONING: SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1706080000 SALTAIR SEC 01
COMPANY: ADDRESS: CITY: STATE: ZIP:
A.M. Construction and 242 Stokes Landing Rd St. Augustine FL 32095
Property Services
OWNER: ADDRESS: CITY: STATE: ZIP:
BROWNING ARTHUR W JR 7622 HUNTERS GROVE RD JACKSONVILLE FL 32256-7241
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 4SS-0000-322-1000 0 $60.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $30.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $94.00
Issued Date: 3/21/2019 1 of 2
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
L-S L
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845 Date routed: L
E-mail: building-dept@coab.us
Cityweb-site: hftp://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: IV Su�,Ro�t Dqp_artnient review required Ye,%,*' No
'Buildin��
Applicant: M—anning &Zoning
Tree Administrator
Project: Wo ts��b_j -k'qf-1 0(ja tj�S Vy)_ Public Works
1%J Public Utilities
V1 L"',ty"_ 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: [�rApproved. E]Denied. [:]Not applicable
"C' Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date: '3)/ 112-N
TREE ADM IN. Second Review: FlApproved as revised. F _]Not applicable
]Denied. F
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ElApproved as revised. DDenied. [:]Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/20117
Building Permit Application Updated 1019118
City of Atlantic Beach Building DepartmentOFFICE COPY "ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: UZI Permit Number:
Legal Description RE# 17 19 6 6 _00 0 0
Valuation of Work(Replacement Cost)$ Heated/Cooled SIP Non-Heated/Cooled
Class of Work: ONew DAddition DAlteration XRepair 13move E]Demo E]Pool []Window/Door
Use of existing/proposed structure(s): OCommercial *esidential
If an existing structure,is a fire sprinkler system installed?: Dyes �91\lo MAR 1 3 2019
Will tree(s)be removed in association with proposed pro*ect? E]Yes(must submit separate Tree Removal Permit) 160
Describe in detail the type of work to be performed:
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name t\�tl� 0 &C 1:!�) Tr Address 161 R-A
City q(C"CV, State -rL Zip 1�_0_3_� Phone 2�q _763 .-7511
E-Mail C) M�, i-I-) 0 !,V, ,C Z P—
Owner or Agent(if Agent, Power of1ttorney or Agency Letter Required)
Contractor Information
Name of Company lPi �3 Qualifying Agent RQt'a, W mzt,��v,,-,
Address city 15;—, V��C- State- Ft.- Zip '5:1("A 13
Office Phone 904- 'Scl k- Job Site Contact Number
State Certification/Registration# E-Mail 6LVII e-cv-,4vu(_4 Ic Y)
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurer OR ExemptX 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 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
RECORRkNG YOUR NOTICE OF COMMENCEMENT.
�2aj.a� r ' t) �J I �
6�K_ 4_1 U'.), M,
(SigRature of Ov��er o�JAgent) (Signat&e of Contractor)
orn to(or affirmed)Wore me this- day of. Signed and sworn to.( affirmed)before m �this y of
by LJ )rbi,4AI�ilr. M� CkYt by 6LV
1-1-VI 111-7>1 __J (:�, ,Y)-\ -
o
(Si�a �ta ry) (SignatKeNf N t$
RNANDEZ
IE�RNANDEZ MY COMMISSION#FF 934117
Personally Known OR MY COMMISSION#FF 934117 Personally Known OR EXPIRE&November 27,2019
Produced Identification EXPIRES:November 27,2019 Produced Identification Bonded Thru Budget Notary Seryhs
Type of Identification: Bonded Thru Budget Notary Seftn Type of Identification: