1989 BRISTA DE MAR CIR RES19-0087 REPL 11 WIND RESIDENTIAL PERMIT PERMIT NUMBER
RES19-0087
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 3/20/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 9/16/2019
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 .
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:
1989 BRISTA DE MAR CIR RESIDENTIAL ALTERATION REPLACE 11 WINDOWS SIZE $13592.00
RESIDENTIAL FOR SIZE
TYPE OF REALESTATE BUILDING USE
CONSTRUCTION: NUMBER: ZONING: GROUP: SUBDIVISION:
1695061678 SELVA NORTE UNIT 02
COMPANY: ADDRESS: CITY: STATE: ZIP:
PELLA WINDOW AND 7818 PHILIPS HWY JACKSONVILLE FL 32256
DOOR
OWNER: ADDRESS: CITY: STATE: ZIP:
BROMMER BRUCE A 1989 BRISTA DE MAR CIR ATLANTIC BEACH FL 32233-4525
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 $120.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $60.00
STATE DBPR SURCHARGE 4SS-0000-208-0700 0 $2.70
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $184.70
Issued Date: 3/20/2019 1 of 2
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
I P 800 Seminole Road
-00('�>_7
tlantic Beach, Florida 32233-5445 C)
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us L__�ate routed:
City web-site: hftp://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: C - rtment review required Yes -No
1"building p -7
Applicant: nc�CD P'Fd'n—ning &Zoning
Tree Administrator
Project: k10 I AD L 0 1,� 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: EY/Approved. E]Denied. E]Not applicable
(Circle one.) Comments:
PLANNING &ZONING Reviewed by: Date:
TREE ADMIN. Second Review: ElApproved as revised. E]Denief ONot applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ElApproved as revised. [:]Denied. [-]Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
OFFICE COPY
TIM for ftk Up M-W-Woo
Building Permit Application Updated 1019118
'I City of Atlantic Beach Building Department "ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
JobAddress: 120 gr(OL' D4 6,- Ccr PermitNumber: Rcsn —00F_�)
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Lega I Descri pti on YC 0 2 S K SO-I",, /1/�ri C-L'--71 2 11:17 9 RE4 lil� 6 — 7
Valuation of Work(Replacement Cost)$ ns-�'� Heated/Cooled SF Non-Heated/Cooled
• ClassofWork: ONew OAddition DAIteration DRepair DMove ODemo OPool 2IWindow/Door
• Use of existing/proposed structure(s): OCommercial AResidential
• If an existing structure,is a fire sprinkler system installed?: Dyes f%No
• Will tree(s)be removed in association with proposed project?E--)Yes(must submit separate Tree Removal Permit) E]No
Describe in detail the type of work to be performed:
Florida Product Approval# see +_TJ&tktL Jor multiple products use product approval form
PropertV Owner Information
Name &(--a Address /9�-F 94r��— �e ft-' 6(
City State ec Zip- Phone F-0-y-
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Qualifying Agent '3_&'6Ne.S (�014'2
Address�_�-o 5 a '(J� I'/ City I'Aqkjw� State FE Z,p 3,27-5-6
Office Phone L(4 Job Site Contact Number
State Certification/Registration#C--YC 0 Y��71 E-Mail o Mzk�e� 6,ePR
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer �A> (0,.ppy OR Exempt o Expiration Date-7
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Application is hereby made to obtain a p�rmit to do the w�rk and installations as indicated.I certify that no work or installatio as En
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commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulati < 0
construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNU 0
WELLS,POOLS,FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE: In addition to the requirements 0
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permit,there may be additional restrictions applicable to this property that may be found in the public records of this county, C13
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there may be additional permits required from other governmental entities such as water management districts,state agencie ftu 0 0
federal agencies. W
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OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with a
applicable laws regulating construction and zoning.
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WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAYO — 2 ul
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RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTENDO Ui
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TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER 0 AN ATTORNEY BEFORE to
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RECORDING YOLIR NOTT&� OF COMMENCEMENT. W U) Lu
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ner or Agent) W
S' atuweo-- (Signature of Contractor) cc
Signed and swor-i to(or affirmed)before me this a f SijCd and sworn to(or affirm is
(A � b 0)befl me th' I day of
X'CA �019 by Vr,,�f, f3rwe,- y_
or
(Signature of Notary) (Signature of Notary)
TIMOTHY R.OMALLEY TIMOTHY R.O'MALLEY
Personally Known G 11713K rsonally Known
0 R My COMMISSION#GG 11713K OR
OR MY COMMISSION#GG 117135
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Vq Produced Identific EXPIRES:August 7,2021 oduced Identification EXPIRES:August 7,2D21
onded Thru Notary Public underwril" of Identificatio
Type of Identification B n:
OFFICE COPY
Doc # 2019046680, OR EK 18704 Page 975, Number Pages: 1,
Recorded 03/01/2019 09:01 AM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
PeirmitNumber REV?
Parcel ID Number 1��-TrS
NOTICE OF COMMENCEMENT
Stat f F1 "d
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Co. ty of
The undersigned hereby g1ves notice that the improvement(s)will be trade to certain real property,and in accordance with
Chapter 713,Florida Statutes,the following informationis provided in this NoUoe ofCommencement.
1. Descnpt-o t rtV(le at de on tio of he p erty,and street address if available)
Adcine�'I Wqp�gc"5 z� !,t^ I
Cfk),L�>-7-0 q-,-)-L3 - , � �f Z,
Legal Description is )z
2. General descr)ptior of irnprovement(3)
ton'112 ton
bq�
Address -5 Xei-33
nttre;t in Prcpe
4. Fee SImple Title Holder(if other than owner shown above)
Na"y*—l; �4 Phorte&Fax Number
Address t-1 \44-
S' Contractor . Pello Windows&Dom
Nmr" Phone S,Fax Number
Address =WSIuluR0ad454
6. Surety(If any) Longwood FL 32750
Nar,i Phorte&Fax Number
AddressNIA
7. Lenter(If any)
Name"'A Phone&Fax Number
AddressIl(A
S. Persons With the State of Florida designated by Owner upon he neces or other documents may be served as
provided by 713.13(1)(a)7,Florida Statutes,
Name Phone&Fax Number
Address
9. In addition to hirmelf or herself,Owner designates the following to receive a copy of the Liencir's Notice as provided in
713.13(l)(b),Florida Statutes.
Name Phone&Fax Number
Address
10.Expiration date of Notice of Commencement(the expiration date is one year from tie date of recording umless a
different date Is specified:
WARNINGTOOWNER; ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIFATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 715, PART 1, SECTION 713.13, FIORIDA
STATVTES� AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY, A NOTICE OF
COMMENCEM"INIT MUST BE RECORDED AND POSTIED ON THE JOE SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO
OBTAIN FINAN ORNIV BEFORE COM VFNICINC WORK OR RECORDING YOUR NOTICE
.r�JNS�U R LENDER ORAN A717
OFCUM
SvZ�0--Z�erl A�thC,r4ld PA�N...
Sworn to(or iiffirmed)and subscribed before me this X1 day of 20 \c�. by1('-,tL
(4n—4,, (type cf suil-iorly,e-g.officer,trustee,artomey in fac4)for 4�-t (name f party ort
�chalf of whom In5trtiment W55 executed. —personally knowri to me or
-_L__jxoduced
- - - - - - - - - - - -
5'% t.Yol'Nofiry (Seal) k Eli
cwwio'ww r9567
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Verification pursvant to Section 92.575,Florida Statites. Under perulties of pertury,I de la ��r the foregoing and
that the IaLts stated are true to the best of my knii and belief /V�' --
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PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FLORIDA (*REQUIRED)
CL e
C) *Project Address: 1989 Brista De Mar Circle
C) Permit#: 60ff 7
Bruce Brommer
L!�,] *Owner/Project Name:
As required by Florida Statute 553.842 and Florida Administrative Code Rule 913-72, 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 D
A.EXTERIOR DOORS Wscf'Ption Umitation of Use State# Local#
1.Swinging
2.Sliding
3.Sectional
4. Garage Roll-Up
5.Automatic
6.Other
B.WINDOWS
1.Single hung -Pei 250 16812.1
2. Horizontal slider
3.Casement Pella 250 26533.2 / .4
4. Double hung
-Fixed Pella 250
6. �w n i_ng 16811.3
7. Pass-through
8. Projected
9. Mullio I Pella Mull 1652W.-1 174-64.1
10.Wind breaker
11. Dual action
12.Other
Page I of 4 Updated 10/17118
>_ In addition to completing the above list of manufacturers, product description and State approval number for the products used on this project, the
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a Contractor shall maintain on the job site and available to the inspector, a legible copy of each manufacturer's printed specifications and installation
C—) instructions along with this Product Approval Sheet.
Lk I 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
U ones listed in this document must be approved by the Building Official.
LL-
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*Contractor Name(Print Name):James Rowland *Contractor Signature: A4'��
*Company Name: Pella Windows and Doors
*Mailing Address: 350 W State Road 434
*City: Longwood *State: FL —*Zip Code: 32750
*Telephone Number: (727) 637-8400 *E-mail Address: tim.omalley@expeditepermit.com
Cell Phone Number: Fax Number:
Page 4 of 4 Updated 10/17118
OFFICE COPY
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