1270 OCEAN BLVD RES18-0187 GARAGE DOOR PERM RESIDENTIAL PERMIT PERMIT NUMBER
r CITY OF ATLANTIC BEACH RES18-0187
800 SEMINOLE ROAD ISSUED: 3/25/2019
EXPIRES: 9/21/2019
ATLANTIC BEACH. FL 32233
MUST CALL INSPECTION • ! • 1 . BY 4 PM FOR + INSPECTION.
ALL • 'K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • ' D + 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:
1270 OCEAN BLVD RESIDENTIAL ALTERATION GARAGE DOOR $4170.00
RESIDENTIAL
TYPE OF
ZONING: :D •
• • GROUP:
171823 0000 MANDALAY
COMPANY: ADDRESS: CITY: STATE: ZIP:
GEORGE'S GARAGE DOOR
SERVICE, INC 870 MAIN ST ATLANTIC BEACH FL 32233
• + •D• '
STONE MITCHELL A 1270 OCEAN BLVD ATLANTIC BEACH FL 32233-5742
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 455-0000-322-1000 0 $75.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $37.50
STATE DBPR SURCHARGE 455-0000-208-0600 0 $2.00
STATE DCA SURCHARGE 45500002080700 0 $2.00
TOTAL: $116.50
Issued Date: 3/25/2019 1 of 2
rS1V1fCity of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road _S
�r Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-584 7
5
�J31>r E-mail: building-dept@coab.us Date routed: T( (0)
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1 G 7O �.�J(,1(� DNm4mgnt review required Yes No
uilding
Applicant: TrnQCcc� C ARMC Qp{� &Zoning
Tree Administrator
Project: A iZ�r C7p (�. Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ _ Dept Signature
Other Agency Review or Permit Required Review or Receiptof Permit Verified By
Date
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: Approved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
:BU:lLDING:D
PLANNING &ZONINGS' 3o f2ol
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 ApplicationRECE'VFQ7
OFFICE C 0 City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
a Phone:(904)247-5826 Fax:(904)247-5845 MAY 2 Q 20 \gyp
JobAddress: Permit Number:
Legal Descriptionit�g_bep�Jrlm�rt! rb
Valuation of Work(Replacement Cost)$ �I_)0 Heated/Cooled SF C n 8 M
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool ndow/Door Q 2 -J Z
VN
• Use of existing/proposed structure(s)(Circle one): Commercial Residential O- Q Z O
� WD
0
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A W H Z
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal V U O C Q
Describe in detail the type of work to be performed: UJH G
U � LL
Q-e- N
CC
Florida Product Approval# I l for multiple products use product zffr6�a o t
Property Owner Information LL 0 w W j:
Name :Address: 1 70 UleGr W n- CC M
City State F( Zip Phone Uhf W
E-Mail IJJ U W W W
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) > >
Contractor Information W
Name of Company: ccrnc.r,`CyAryl t_ '11r §ZfVQ Quali�fying Agent: az, pzae�
Address -7 0- MArIn 4 City JUI tate Zip
Office Phone aot+ 5 3 N (4 e°I Job Site/Contact Number UW, fr s
State Certification/Registration# A D 3 a- E-Mail 'UJ})(jty�e DwiS G IiL{ - l.,iw
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation ]-,
Exempt/Insurer/Lease Employees/Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or instal lation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg
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 �`ORNEY BEFORE
RECO D G OUR E OF COMMENCEMENT. xv�
/
(Signature of Owner or Agent) (Signature of Contractor)
(in clu ing cont actor) 1 U
Signed and sworn to( affi e ) fore me this day of Signed and sworn to(or affirmed)before me this��day of
VIAS 20 1� b t S�1 Pv f_ 470 IV k- W v V l c
OH ON
/IfY ............
t": - b1Y C NNIF 984
(Si nature of Notary) ?N MPIRES:0 ;V. e of otary)
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ALBERT MORENO °Ff
massiamm
Personally Known O ;MY
PR�°' l [ ]P
;a ; Notary Pubiic-State of F,oritla .[ ]Produced Identificat rs - [�J PYoduced IdentificationLQ �Commission#FF 239295 !>`Y `JSType of Identification: '� Qr Type of Identification:
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