128 Pine St RES19-0168 Door %i'�''''r�� RESIDENTIAL PERMIT PERMIT NUMBER
r � RES19-0168
CITY OF ATLANTIC BEACH ISSUED: 6/6/2019
800 SEMINOLE ROAD EXPIRES: 12/3/2019
ATLANTIC BEACH. FL 32233
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY4 PM FOR NEXT DAY INSPECTION.
ALL • 'K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • '
CODE, ' OF • 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:
128 PINE ST RESIDENTIAL ALTERATION DOOR $515.00
RESIDENTIAL
TYPE OF
• • GROUP:
170633 0000 SALTAIR SEC 03
ADDRESS:
BUTTERFIELD 4220 PLANTATION OAKS BLVD APT ORANGE PARK FL 32065
REMODELING LLC 1516
• ADDRESS:
SULLIVAN WILLIAM G 128 PINE ST ATLANTIC BEACH FL 32233
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 $55.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $27.50
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $86.50
Issued Date:6/6/2019 1 of 2
City of Atlantic Beach APPLICATION NUMBER
-'•r; Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845 Ls
E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1 Z � Pfro& S Department review required Ye No
uildin
Applicant: LJ0'"t'C--ki-_(ELD Rel"obeUPlanning &Zoning
Tree Administrator.
Project: _ (��� (� 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: MApproved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDI
PLANNING &ZONING
Reviewed by: Date: 'yq
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denie . ❑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
OFFICE COPY
Building Permit Application Updated 12/8/17
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845 !
Job Address: 128 PINE ST. ATLANTIC BEACH FL. 32233 Permit Number:
Legal Description 10-16 21-2S-29E SALTAIR SEC 3 LOT 671 RE# 170633-0000
Valuation of Work(Replacement Cost)$ 515.00 Heated/Cooled SF Non-Heated/Cooled 22
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door LU
• Use of existing/proposed structure(s)(Circle one): Commercial Residential U
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A ZN
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal J = Q O
Describe in detail the type of work to be performed: INSTALL EXTERIOR DOOR O ~
5631 — o
Omoo
U d U i
Florida Product Approval# FL#22363.1 for multiple products use product approval fo m F- Q 0
Property Owner Information ? 0 '�
Name: WILLIAM SULLIVAN Address: 128 PINE ST. U _J LL
O ;
CityATLANTIC BEACH state FL zip 32233 Phone 201-895-4197 L Q r z
E-Mail „ LLW
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) ,, 0 ui W j
o
Contractor Information W a. a ECF— C
Name of Company: BUTTFRFIFI D RFMC)DFI INC, I I C' Qualifying Agent: CI INT BUTTERFIELDcWn w u
Address 4220 PLANTATION OAKS RLVD_#151 S City nRANGE PARK State F_zip 32m5 S E_
Office Phone 904-333-8409 Job Site/Contact Number qn4_.1,1.,j_g4nq W
tl
State Certification/Registration# NSS-14 E-Mail IM HtIGHFS151.iA(,mAn (-nm cc
!7
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation
Exempt/Insurer/Lease Employees/Expiration Date C
Ea
/>►Application is hereby made to obtain a permit to do the work and installations as indicated.I certify th or o a
ED
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 o �
permit,there may be additional restrictions applicable to this property that may be found in the public records o co
there may be additional permits required from other governmental entities such as water management districts,state agencies,or
federal agencies. RR nea�a
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done irf tg ;QgebGRYt�d11'rtmentC
applicable laws regulating construction and zoning. Vii* N/A�aa4G beach, FL
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 ATTORNEY BEFORE1k.
RECORDING YOUR NOTI F CO MENC MENT. �. `
WILLIAM SULLIVAN� - CLINT BUTTERFIEL
(Signature of Owner or Agent) (Signa o Contractor)
(including contractor) `
Signed and sworn to(or affirmed)before me is-2ASrday of Signed and sworn to(or affirmed)before me thisQ_�e day of w
AA
�,by I1,UI (<Vh v�N � y w�
QVpp
ArA A
(Signature of Notary) (S� ture of Notary)
Personally Known OR pQ Personally Known OR _
[ ]Produced Ide [ I Produced Identification
Type of Identifica MARIANNE BRANSON Type of Identification:
Commission#GG1174097
Expires January 25,2022
Bonded Thru Troy Fain Insurance 800-3857019
OFFICE COPY
RE: 170633-0000
128/122 PINE ST.
ATLANTIC BEACH .
aF
itLYr ,
.�
OWNER PLEASE CIRCLE AN AREA ON THE
SKETCH TO SHOW WHERE YOUR NEW
DOORS ARE BEING INSTALLED. THANK
YOU .