122 6th St RES19-0109 Repair Fireplace RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RES19-0109
800 SEMINOLE ROAD ISSUED:4/17/2019
ATLANTIC BEACH. FIL 32233 EXPIRES: 10/14/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT ISTH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPIMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
the requirements of this permit,there may be additional restrictions applicable to this property
the public records of this county,and there may be additional permits required I
i such as water management districts,state agencies,orfecleral agencies.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
122 STH ST RESIDENTIAL ALTERATION REPAIR WOOD ON $5000.00
RESIDENTIAL FIREPLACE
TYPE OF REALESTATE BUILDING USE
CONSTRUCTION: NUMBER: ZONING: GROUP: SUBDIVISION:
1701490000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
STYLES CONSTRUCTION 1537 PENMAN RD SUITE A JACKSONVILLE FL 32250
BEACH
OWNER: ADDRESS: CITY: STATE: ZIP:
HITE JEFFREY A 122 6TH ST ATLANTIC BEACH FL 32233-5316
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
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
RU IDINC IHMI kw02!H 1�22.2 2 $80co
$4000
STATE DBPR SURCHARGE 455 0000 208 07W 0 $2,00
STATE QCA SURCHARGE 455 0003 208 06W 0 $2.00
TOTAL:$124.GO
Issued Date:4/1712019 1 of 2
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Flonda 32233-5445 to
Phone(904)247-5826 Fax(904)247-5845
E-mail: building-dept@coalb.us Daterouted. 41SJi !�
City"b-sfte h"I/�.coab,us
APPLICATION REVIEW AND TRACKING FORM
Property Addresd: -T D! ment review required Y No
Buddl, 15
Applicant: -T 4.-/L-!E�4 Ci 0 M_�' _T Plannihg&Zoning
Tree Administrator
Project: cpn V\ ewn (N=&C— Public Works
p L_p,C�C Public Utilities
Public Safety
Fire Services
Review or Recei
Other Agency Review or Permit Required ofPem!tVerifiedpB'y Date
Florida Dept.of EmAronmental Protecbon
Florida Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division ot Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: g?Approved. E313enied. E]Not applicable
(Circle one.) Comments:
— 7'N
eT�v
PLANNING&ZONING Reviewed by: Date
TREE ADMIN. Second Review: E]Approved as revised. Denied. E]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: DApproved as revised. ElDenied. E]Nct applicable
Comments;
Reviewed by: Date:—
ReAsed 051IW2017
Building Permit Application OFFICE COPY uPd.wdj019118
City of Atlantic Beach Building Department "ALLINrORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Build ing-DeptCcDcoab.us IS REQUIRED.
Job Address: PermitNumber: —otoq
Legal Description RE#
Valuation of Work(Replacement Cost)$ Heated/Cooled SF—Non-Heatedi
• ClassofWork: []New OAddition DAlteration gill Ovinve C]Demo 0Po.I 1JWirdmv/DOO
• Use of existing/proposed structure(s): C]Commerdal Ar4sidential `4 2M,
• If an existing structure,is a Fire sprinkler system installed?: Dyes 01i
• Will treelsi be removed in association with maosed pro ect?Dyes(must submit separate Tree Removal Pernritl ONo
Describe in detail the type of work to be performed:
Florida Product Approval# for multiple products use product approval form
Property Owner Information
7
N J� Addrei,�,9
CJ7 Phone 9—
State Pe-- Zip_ Phone
L
M I � �Q
Owner or Agent(if Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Z�c, Qualifying Agent
15'13'7— State /5.7;. Zip
Address
Office Phone f,14' Job Site Contact Number
State Certfflc n/Registration# E-M a I 1 .0
Architect Name&Phone#
Engineerps Name&Phone If
sation Insurer /do-2-k OR Exempt o Expiration Dabe
Application is hereby made to obtain a perm t to do the work and instalfations as indicated.I certify that no work orinstaWion has
commenced priorto the issuance of a permit and that all work will be performed to meet the standards of all the laws rem3ating 0
construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICALWORK,PLUMBING,QII3X J, OZ
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE:In addition to the 0"Ltsq to sp
permit,there may be additional restrictions applicable to this property that may be found in the public records or this codit�
there may be additional permits req uired from other governmental entities such as water management districts,state ago CIA,ff 0Z
federal agencies. 0 C3 0 0
LU I CI
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in complianceQhZ W Z
'a 0 < r1tx
applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT folgt: Z
S yu
12
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU legbi W
� Le
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDE RAN ATTORNEY BEFORE LJLI � wm
wo
REC=DI YO!UTRTIOE OF COMMENCEMENT 0 ,
-fijam) (Signature of Contrador) ttl
(Signature of Owner or cc cc
Signed and sworn to for affirmed fore me this_�[_day of Si ed and sworn to(or affirmed)before me this dayof
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(ij�"uced Identification I Ptdo dinrliBirtRi o
Type of Identification: F� �, ., Ll I-% k-,LJInSe- Type of Identifflication:—