1840 SELVA GRANDE DR RES19-0068 GARAGE DOOR RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RES19-0068
ISSUED: 3/20/2019
800 SEMINOLE ROAD
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 CONFORMTO THE CURRENT 6TH EDITION1 OF • '
CODE ' OF BEACH CODEOF • '
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:
1840 SELVA GRANDE DR RESIDENTIAL ALTERATION GARAGE DOOR $1936.00
RESIDENTIAL
TYPE OF
• • • •
169542 5014 SELVA TIERRA
COMPANY: ADDRESS:
PRECISION DOOR SERVICE 11323 Business Park BLVD JACKSONVILLE FL 32256
OF N FL JASO
• ADDRESS:
HUEHN KELVIN W 1840 SELVA GRANDE DR ATLANTIC BEACH FL 32233-4526
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 $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: 3/20/2019 1 of 2
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road _O
Atlantic Beach, Florida 32233-5445 RE:��
Phone(904)247-5826 Fax(904)247-5845
r r,; E-mail: building-dept@coab.us Date routed: 7, / ZSZ19
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ` c�`'t� S E LVA C� � Department review required Yes o
juildin
Applicant: `� R EL I ON 6n ((?� oning
Tree Administrator
Project: P P P G& co e 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: [E'Approved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
DIN
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
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
Phone: (904) 247-5826 Email: Building-Dept@coab.us QIS REQUIRED.
Job Address: `�d S�\�1C� �CUN f' �( Permit Number: 1 J�
Legal Description ` RE#
Valuation of Work(Replacement Cost)$ 1rv` )�114 --M Heated/Cooled SF Non-J8e e4ACQal
•.tYn p
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pohl l
• Use of existing/proposed structure(s): ❑Commercial Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No FFR 2 6 2M
• Will trees be removed in association with proposed ro ect? ❑Yes must submit separate Tree Removal Permit ❑No
Describe in detail the type of work to be performed:
Ut tF?ding Departm tat %/ A
Florida Product Approval# j�V `7 for multiple products use product appeal forgtN 06
Property Owner Information _I R O
Name K&JkrA Address \��� S d >�= d o ~ M
city State V�_ Zip 2, Phone gOla-to k O c�3 g� M1 ~' Z H
E-Mail l� W _ Q U O
Owner or Agent(If Agent, Power Attorney or Agency Letter Required) _ H o
Contractor Information Q Li Q O a
Name of Company 1��f-,QV'ANY-\nOiCIC C)e-TN\C_t qualifying Agent ' f) V 'J Cn
Address f 'D , City 5o'* State -zip Z
Office Phone Job Site Contact Number u- g
State Certification/Registration# E-Mail ahr h�M ' VC ' 0,Mia, �C,NN o w M m
Architect Name& Phone# Am ICY
Engineer's Name&Phone# w W W
Workers Compensation Insurer � .� �\V\C-a� OR Exempt 0 Expiration Date ' X w
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or instal ion has w
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws re Mating cc
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 PROPER YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATT E BEf ORE
RECORDING YO NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) (Signature of Contractor)
i
Signed and sworn to(or affirmed)before me this 2.L3 day of Signed and sworn to(or affirmed)before me this 25day of
byMIL" LLI �U,N
�e of Lary)
Notary Public• e o onda :arprw�•., MICHELLE VAN WREN
e Commission p GG 203567 :° Notary Public State of Florida
or n My Comm.Expires Jul 29,2022 a" �° Commission p GG 203567
Persothrough National Notary Assn. Personally Known OR ' �`'`
[ ] of r•..` My Comm.Expires Jul 29,2022
Tyroduced Identification [ ]Produced Identificati Bonded through National Notary Assn.
pe of Identification: t 'C,� Type of Identification: