567 Selva Lakes Cir RES19-0152 9 Windows RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RES19-0152
ISSUED: 6/3/2019
800 SEMINOLE ROAD EXPIRES: 11/30/2019
ATLANTIC BEACH. FL 32233
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PIVI 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.
N E: add. . the requirements of this permit,there may be additional restrictions applicable to this property
OTC a in I.n"'".to u IRE r. or .. ' t On Y B
that may be found In the public records of this county,and there may be additional permits required from other
B s Is r
stNct',St. '8.RBR
F m y u P -nt districts,state agencies,or federal agencies.
g.v. t'I. t't."SO. as Rvat'r On ..gem Trt
governmental entities such as water manageme cl, te
JOB ADDRESS: PERMiTTYPE: DESCRIPTION: VALUEOFWORK:
RESIDENTIAL ALTERATION 9WINDOWS $12051.00
567 SELVA LAKES CIR RESIDENTIAL
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1720275526 SELVA LAKES UNIT02
COMPANY: ADDRESS: CITY: STATE: ZIP:
FHIA, ILE 3040 SW 42ND ST HOLLYWOOD FL 33312
OWNER: ADDRESS: CITY: STA I TE: ZIP:
HOZAJOANN 567 SELVA LAKES CIR ATLANTIC BEACH FL 32233-4375
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.
FEES
DESCRIPTION AUUUMNH
BUILDING PERMIT 455 CON)322 IWO 0
BUILDING PLAN CHECK 4 5 50003-322 1001 0 $57.50
52,59
STATE DBPR 5URCH A R.E 4SS ONO 208 07W 0
STATE DCA SURCHARGE 455 n $2.00
TOTAL:$177.09
Issued Date:6/3/2019 1of2
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road RES q C)t S 27—
Atlantic Beach,Florida 32233-5445
Phone(904)247-5825 Fax(904)247-5845 Date routed:
E ail: building-dept@wab.us
c,tyweb-site hftp/M"coabus
APPLICATION REVIEW AND TRACKING FORM
Property Address: o�,7u\m LaKes Awartwentreviewrequired Yes No
Building )
Applicant: EH I -B Ll Q Planning&Zoning
Tree Administrator
Project: IA Public Works
Public Utilities
Public Safety
Fire services
Review fee Dept Signature W
Review or Date
Other Agency Review or Permit Requ re of Permit Verifie PBy
Florida Dept.of Emaronmental protection
Fo—hd.Dept.of T.nsportation
St.Johns R!erWater Management District
Army Corps of Engineers
Division of H; Is�andRestaurants
Dii;ision of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: MK-P�Plved. E]Denied. EE]Not applicable
(Circle one.) Comments:
PLANNING&ZONING Reviewed by: Date:
V
1
.t Ica�
1,
TREE ADMIN. Second Review: DAPproved as reVised. ElDenied. [3Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:—
FIRE SERVICES Third Review: E]Approvecl as revised. [:]Denied. [:]Not applicable
Comments:
Reviewed by: Date:—
R.vi��d 0511912017
OFFICE COPY Updated 10/9/18
Building Permit Application --ALL INFORMATION
City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept2coab.us IS REQUIRED.
Job Aciclress:6615_, !�iL, Lr_Ken Permit Number: C� C)
Legal DescriptionLil'i-i I Lc:,4wc� RE#
Valuation of Work(Replacement Cost)5 )ZO 51 Heated/CooledSF_11ftre C,",r
• Classo(Work: ONew OAddition 0AIteration Oftepair OMove ODemo ElPool
• Use of existing/proposed structure(s): DCommercial DResidential
• if an existing structure,is a fire sprinkler system installed?: Dyes ONo 15 2019
IM in cc! ion Witt. 'must submit separate Tree Removal P rmit 11
Describe In detail the type of work to be performed: SuRdIng DeWrl
ti
r.1fir nf Aft
Florida Product Approval# Ae f,fL,.,I a yZ,%Z t for multiple products use product approval form
Property Owner I ormation
Name Address
City— 11, Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Informilition
Name of Company _LA Qualifying Agent tate zip
Aciclress5�4�14 1�) (4tav!s�- City 1
Office Phone RLIL-5- Job Site Contact N-UMDer Lit-
State Certification/Registration 4 E-MaIll m
Architect Name&Phone If At Z
Engineer's Name&Phone#
OR Exempt 0 Exptraffori Date
Workers Compensation lnsu,., I certify that no work or insiJI.tion has
Application is hereby made to obtain a permit to do the work and installations as indicated. (9gulating
commenced prior to the issuance of a permit and that ail work will be performed to meet the standards of all the laws
construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK,PLUM BIN 4gSIG NS, on
c. NOTICE:In addition to the require!�dn 91 5
I
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,et I i,1N
permit,there may be additional restrictions applicable to this property that may be found in the public records
there may be additional permits required from other governmental entities such as water management districts,state hio,IV
Da — Z
no
federal agencies. 0 0 0 U a
OVINER'S AFFIDAVIT:I certifythatall theforegoing information is accurate and that all workwill be done in complianoNvIlm a% a
Z D, Z
applicable laws regulating construction and zoning. 0 0 <
�A
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT
RESULT IN YOUR PAYING TWCE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU 0 W
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE u0J c. S; [0
RECORDING YOUR NgTIC;OF COMMENCEMENT. LU WW ir.
�41 dc W
(Signature of owner or AgenkV [Signature of Contoctor) LU
Signed and sworn to(or affir 5�fbelore me this day of
Signed and sworn to(or affirm I before me this_L day of 12u, /A b re
--&77 --T-- 7-4
nature fftapr ��au
Notary Public Notary"ic
Personally Known State ot Florida 144'personitily Kim State of Rorida
oli y 01"1 P uced tide at
A,0'11uuueu1.......... My Commission Expires 3/1 red J Ide
lip tific
Type of Identification: Gaffiffi,9.4,CM ii,cr_ pe of Iden
Coffirrission No. FF 970481
412312019 Property Appraiser-Proluerty Details
HOZA30ARN Primary Sim Acidness Official Record Book/Page Tile#
567 SELVA LAKES CIR 567 SELVA LAKES CIR 06438-02010 9417
ATLANTIC BEAQi,FL 32233-4375 Atlantic Beach FL 32233
567 SELVA LAKES CIR
tail Value So
172027-5526 FV—W.Di 2218—Um� 2019 In Programs
USD3 Value Method (AMA
Fraerar-uler 0100&;,,le Family Total Building Value $125,426,00 $128,050,00
#of Builifings I Extra Feature Value $1,711 W $1,656.00
For 1 11 legal de�nxoh ex, Und V Ina(market) $100,000,00 $125,001
Legal Done, -andulk Gegal�.telex, Land:alim(All $0,00 $0,00
subdivision N274 SELVA I-MES UNIT 02 Just(Harket)Value $227,137 00 $2�,706GD
Total Ande 34W Assistant Value $125,937 00 $128,329,00
The xd�of Mis pro,xurty may moilt in higher unarery,tomo.For make information go to!iave Cap Diff/Perloaddlit,Ann $101,200.00 j$0 W $126,377.00 j Sam
Cur Horm�and our P,,,,,I,_Tax Eximodhor.'In Prol mperty,valuei,examintors and Exemption $50,000 00 See ted.
on ftm�loge am not 0 the xxxxing,mr, Raw Be aoex In
Oange,Carried!values homal in the Value Summary am thime mattlead rh Conlon,but nor, Taxable Value $75,93700 see
induce any offil change,i made after certlicanion Learn leav ft Pro
�rmxs, It,-.
Taxable Values and Exemptions—In Progress
Ifthere am no lamentations applicable to a timing adoxhit,the Taxable Value is the same as late Assessual Value listed all in lure Value summer,box.
County/Municipal Taxable Value SIRWMD/FIND Taxable Value School Taxable Value
Maeoed Value $128,329.00 $128,329.00 /,exe�VWx, $128,329.00
. ............. ...................I...........----...... .... .... .... I 1 11 11 .11,1111,................
rommeauddi(rix) $25,00G.Ou H.6(HX) $25,00.00 Houl GHX) $25,000 GO
............................
(118) 000M EOmbng 1%.031(1)(W)pUn -$2i,�iT013 Taxable Value $103,329.
Taxable Value $78,329.00 Taxable Value $78,329.00
Sales History
Boadc/P., Sam,Data Priol Dood!Inutnument,True Co,m QualifieddyWilqualifiedl viviant/Improved
06438-02010 12/10/1987 $02,000.010 WD Wum, Deim! unqualifei Irawayid!
O74I&oD8,l2 91911992 still QC-Qot Q— UminhuflieJ biannual
07870,01334 QGI/Igg� $921000-00 M-Warrant,Di,,d Qmklhfm Imponed!
Extra Features
I LN Feature,Cause Foodderm panaiption Bldg. Length Width Total U.It; vidulk
11 FMW Final Firl 1 0 0 Ow, ssum
smeeh Inal a 0 1
2 SCFR2 72m $1,103.03
Land 8,Legal
Land
old ind a
l I causix usaneel stagor, I andi ke I two paderiptaid,
u= zaaw I ringrat Deven Tcatedial, Law units tar M
-T-
11 10103 RESUD3-7 FERAC —C, 13sm Iwoo common Jim cal r 43-11 11-i!;2
12 1 SELVA 2
3 Lines
Buildings
Building 1
Bidefing I She Addron, 1 El....t code, notail
567 SEIVA LAKES CIR
y0jamuc,Deach FIG 32D3 I Exted.,Wall 16 16 Frame Stoxec,
Roof Strud 3 3 Gable or Kip —j
010-rckwimclum Roofir,Coyi,, 3 3 MohmComp sling
Interior Wall 5 5�adl ad
up
guagaing Vegas Int Floomrg 8 18 Steer Vinyl
Int Fluour, 14 14 Carpot
Gards, labeled Enedd. Heatung Fm,I 4
T 11., 4 Eacer,
Year Aaa Ame Heatur,Tyro 4 4 Faread-Ducled!
Bee,And, 767 767 767 h,Ford 3 13 Central
flooded!(damage 417 0 2011
Rashed uppear 6M 6" 6M Element Code tend
sawl 51,11,1 2.000
Frethado,ar,
Ford, 0 21 BedroonV 2,OW
Tend IW4 14137 1632 Buthe i.
Rom.,/un� Idw
hdpS:Ilpaopropertys.a�.Mi.mUMsWOeWil.aspx?�=1720275526 112
412312019 Property Appraiser-Property Details
2018 Notice Of 1`110119sed Pro Ta -props Rolled Wilk
.Les I'M I NOUM)
as.
Taxing Distri Tatablelmag, Uatyater
7$75,937m $5WA7 $618.% $580.55
0
(]oA Be.di 117
Pukilic�:BY Stst�La- $125,937.00 00 $IDQ,937 W $416.70 $408.29 P103.88
$B "21_
BY Local Boad $125,937.00 $P221.08 SM.91 $214.28
ha,19"doi Di- $In,937m $71:937,00 $235 $2.43 $2.29
$.:M
ma:W
so so
$ .0
$1Is,qw.00 Mar) $N5.16 $229.72
Water Mgmt DuL SJRWM $1B,937.00 $50'stim $7S,937.00 $19.98 $19m $19.�
t;en�vatoo $1ngrm $Womm $M,937.W $Om $am so to
�tvvl Boad voted $125,937.00 $�,Ot000 $jBi $am $am $a..
ga
M,937.00 10.00 $am
Twel, $1 4..,.
Vn $aamom
Onset 000.00 $75,937.00
AqULTR _tV
JH-P—MlIff _gRM"LQLrd_("R ) Notices of Proposed Property Taxes CrPIM Notices)in
This RC refi�preperty details and values at the tirre of the original Miling of the
August.
preperty Buiscord Card(PRQ
The PRC amessed below reflects property details and values at the finte Of TaX Roll Certification in 0CtOb"Of the year listed.
2018
2017
2016
2015
2914
To obtain a hi=ric Property lt�rd Card(PP.Q front the Property Appraiser's Wee,sublit your request here:
Mom Information
orravt Us I Panoal Tax RKVd I SIS MP I NP Lha—w-GIBBIle`eP-I Q-LYE�—�
V2
haps:ilpaopmp"wamh.00j.neVBasicJD�aU.npx?RE=1720275526
Doc # 2019113630, OR BK 18793 Page 884 , Nunber Pages: 1,
Recorded 05/15/2019 01:42 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
1pey,M54 OFFICE COPY
NOTICE OF COMAIENCEMENT
State of-R-Irirkl TuFolioNo.
C."-f Tkwo—\
To Whom It May Consoesm: eefion 713 of
The undamigned hereby informs you that imPrOvealcids will be=do in certain real loolsity'and in anno' me
din Florida Starnes the following information is stated in this NOTICE OF COlMaMaENC
0 541110
Legal Desoription niproporty being finprowd: LrA—
Addross ofproperty being impruved:5Tol 5rAL& LC�&S Ct� "C'JAC &ar�, r-1 13am
Gmmldescdptionofi-pmv�u: \I���rinl�% Pd.pIrIC'e"11-4-
0.H= Zy- —
�,4 Address: se-Itra Lrkes.r��
o�a'sint�tinsiwoftlit�np�m=tC��i�9=
Fee Simple Titleholder(if other tban owner):
Name:
CDomactar: L
Address, 2bLIL4 SW 4D�rA 5�-
FaxNo:
Surety(if MY)
Address: A=wtofBmd$—
Telcpbm No: Fm No:
Name and address of my person making a inan far the of the improvements
Name:
Address:
Phons No: R.N.:
Name ofPsomr,within the Star,ofFlorids,orba,thmhima dasignated by owner upor,whom wtions or othm doorments my be
served: Nam:
Address:
Telephone,No: Faallo:
J, addition to homarK owner desigamos the fi)llowing p,,m to recarom a copy of the Lionar's Notice a prr�dcd S..tion
713.06(2)(b),Florida Stations. (Fill in 9 Owner's OPtim)
Name:
Address:
Tftbe No: FmNo: from the datz Of ranoording different date is
Expiration date of Notine,of Comanomement(the rapirostion date is one(1)year
specified):
THIS SPACE FORILIECORDER'S USE ONLY OWNER
pwit4alman �d ZCX -M4zZ—S---
4*y PubVic zth nally am=
SW Ot porida -?,thh.:pt2x-
------PubucatLary Save IF. conaryaDn"I.
Comdesion E018S My'..'Hylion�P;;i: or
CoMpOSSlon No.FF pn�d..d Idandflanion:
STATEDIFFILDRUIA
DUVALCOUNTY
L UNDERSIGNED Cleric dUm V�&Comel�wk Dunr-,
C.-(Y,"100 HERESY CEPH IN,within sa for...I,
-LJ—Pgn%0�. d woo� f 0, do Irril
It-PMr.,,,I.,,W..d Rik a tv O�.of fiI.C�d Cm
CwrW Cu�0 Du"I CoNty,fladda.
WffNESSwhMrrrd 10 d tc R&C."tC
"' "0,m?�.
w"NhwdkRm", 2d.,,
R 0 N N I E VFS S E CL
CWrk Watft.nd Coujoty Err"
AX8
OFFICE COPY
PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH.FLORIDA
Project Name: Pafterson, Loma Permit
Project Address: 567 Selva Lahes Cir, Atlantic Beach, FIL
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
rroduct approval may be obtained at::: floridabuildinla R.
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
AL EXTERIOR DOORS
1. Swinging
2. Sliding
3. Sectional
4.Roll up
5.Automatic
6.Other
B.WINDOWS
1. Single hung CWS 8100 SERIES FL4091 1T
2.Horizontal slider CWS 8200 SERIES FL4092.2
3. Casement
4.Double hung
5.Fixed CWS 8300 SERIES FL4093.1
6.Awning
7.Pass-through
8.Projected
9.Mullion
10.Wind breaker
11.Dual action
OFFICE COPY
2.Other
Category/Subcategory Manufacturer ProductDescription LimitationofUse State# Local
H.NEW EXTERIOR
ENVELOPEPRODUCTS
I
2.
In addition to completing the above list of manufacturers, product description and State approval number for the products used on this project, the
Contractor shall maintain on the job site and available to the Inspector, a legible copy of each matrufactmes printed specifications and installation
instructions along with this Product Approval Sheer.
I certify that this product approval list is true and correct to the best of my knowledge. I further cerfily,that use of different components other than the ones
listed in this document must be approved by the Building Official.
WAYNE THOMAS BURNETT
(Contractor Name) (Print Name) (Signature)
Company Name. FHIA, LLC
Mailing Address- 3044 SW 42nd ST
City: HOLLYWOOD state: FL zip Code: 33312
Telephone Number:(904)_101-4415 X 243 Feet Number:( 407 ) 4n-8380
Cell Phone Number: ( E-mail Address: LMARTINEZ@FHAPRODUCTS.COM
OFFICE COPY
FH I A D i agram Sh eet
M.
C�..evN.. I job N.b� PWP�M T� Exisdng Wind�
HQzA I &-WI-70
HS
713/4 x 47 1/4
(./-40)FL4092.2
11
2 3:7/a x 71 1/8
1 /_ /a x L 1/8
(-/-50):FL41D091I HS
35 5/8 x 35 1/2
(./-40) FL40922
HS
59 112 x 47 3/8
(-/-40)FL4092 2
HS
59 1/2 x 47 3/8
(+/-40)FL4092.2
HS
71 3/4 x 47 1'
(+/ 40)FL409
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Cash Register Receipt Receipt Number
City of Atlantic Beach R9778
DESCRIPTION ACCOUNT CITY PAID
PermitTRAK $55.00
RES19-0152 Address: 567 SELVA LAKES CIR APN: 172027 5526 $55.00
BUILDING FINAL"07/16/2019 RBE $55.00
BUILDING FINAL"07/16/2019 RBE 455-0000-322-1002 0 $55.00
TOTAL FEES PAID BY RECEIPT: R9778 $55.00
Date Paid: Tuesday, August 06, 2019
Paid By: FHIA, LLC
Cashier: CB
Pay Method: CREDIT CARD 4
Printed:Tuesday,August 06,2019 1:59 PIVI 1 of 1 or