2262 Beachcomber Tr RES19-0173 window permit RESIDENTIAL PERMIT PERMIT NUMBER
r '� CITY OF ATLANTIC BEACH RES19-0173
800 SEMINOLE ROAD ISSUED: 6/14/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 12/11/2019
INSPECTIONMUST CALL • • 14) 247-5814 BY 4 PM FORINSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • '
CODE, • OF BEACH CODEOF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASEREADCAREFULLY.
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:--
2262 BEACHCOMBER TR RESIDENTIAL ALTERATION 16 WINDOWS $17700.00
RESIDENTIAL
TYPE OF
ZONING: : • •
• • GROUP:
169463 0062 OCEANWALK UNIT 01
COMPANY: ADDRESS:
PELLA WINDOW AND 350 State Road 434 W LONGWOOD FL 32750
DOOR
• ADDRESS:
MULLIS JERRY W JR 2262 BEACHCOMBER TRL ATLANTIC BEACH FL 32233-4566
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.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $140.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $70.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.15
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.10
TOTAL:$215.25
Issued Date: 6/14/2019 1 of 2
s
RESIDENTIAL PERMIT PERMIT NUMBER
r; CITY OF ATLANTIC BEACH RES19-0173
v~ 800 SEMINOLE ROAD ISSUED: 6/14/2019
r ATLANTIC BEACH, FL 32233 EXPIRES: 12/11/2019
Issued Date: 6/14/2019 2 of 2
;.
'1 City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
r� Atlantic Beach, Florida 32233-5445 REal
3
Phone(904)247-5826 • Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: C22 IL9
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Z ��(�C�-(C�(p a ment review required Ye No
i din
Applicant: -L�l � A ) t rt 0CSS oning
1 n Tree Administrator
Project: (n IN O�S 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 B
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:
BUILDING
PLANNING &ZONING Reviewed by: Date: 6 -42
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
OFFICECOPY call rm for Pick Up 727-637-8400
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 Fax: (904)247-5845 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: ,y2a 6 a2 99 .c� `Tr ILv
Permit Number: 1�Sk 9 Q [ '73
Legal Description 3,2- �2S - 029 C- o , .--%.I k Vn-k-j 1 /-17"Z9 RE# �6 q y6 3-006.2
Valuation of Work(Replacement Cost)$ l ??civ Heated/Cooled SF Non-Heated/Cooled
• Class of Work: tNew ❑Addition ❑Alteration ❑Repair Ove ❑Demo ❑Po �
• Use of existing/proposed structure(s): ZCommerciaResidentiia�t
• If an existing structure,is a fire sprinkler system instalied?Azlyes FZNo
• Will trees be removed in association with proposed roiect? s must submit separate Tree Removal Permit No
DescribeeDdin detail the type of work to be performed:
l �Ia (Q ,�j ��nGoMS S f-76 -fJ< S1-74
Florida Product Approval# for multiple products use product approval form
Property Owner Information /
Name_ l_0,V row M.. I I IS Address aab,2
City 4:-;-(",C-,,L Gec CL State Zip 3.7 33 Phone 900 - ,S(,b--0YV1
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) n/a
Contractor Information
Name of Company Q I.- UOof S QualifyingAgent ,�o.MPS �,a•-ion
Address__ SO s� C(�'1 t--, City 1/043&-uj� State Zip 7.2750
Office Phone Job Site Contact Number
State Certification/Registration# C C 0-Y9-2 1-2. E-Mail Tri_ DMo l(0°( W_j i—,8 kZin • (vr^
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer NtM CAA cy OR Exempt ❑ Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulating? �r
construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS f N
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE: In addition to the requirements o�isC Q 0
permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,q& 0 Z
there may be additional permits required from other governmental entities such as water management districts,state agencie�ru - p
federal agencies. 0 m O fw.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with al(u V Q U
applicable laws regulating construction and zoning. D Z OC Z
0oa
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAYO '
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEI 'Q g UZi
U.
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER O AN ATTORNEY BEFORE p 0 a W m
RECO DING YOU NOTICE OF COMMENCEMENT. W _ w o
Lu U N C 3LIJ.
(Signature of Owner or Agent) (Signature of Contractor) } w
lW W
Signed and sworn to(or affirmed)before me this 29 day of Signed and sworn to(or affirmed)beforee this dayfgf
frl 0/9 by LOW S1, tn'1v �/,s D/f by artiCj-fe3a
o�-/a-�
ISig nature of Notary) (Signature of Notary)
LE,
TIMOTHY R.O'MALLEY ;zo n:': c TIMOTHY R.O'MALLEY
, MY COMMISSION#GG 117135Personally Known OR personally Known OR Alt:__ MYCOMMISSION#GG 117135
' EXPIRES:August 7,2021 ]Produced IdentificationEXPIRES:August 7,2021
Producedldentificatio BondedThruI'` bonded Thru Notary Public Underwriters Notary Public Underwriters
Type of Identification: ype of Identification:
Doc # 2019125261, OR BK 18808 Page 2142, Number Pages: 1,
Recorded 05/30/2019 01:18 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
OFFICE COPY
Permit Number / ^v/7 ✓
Parcel ID Number
NOTICE OF COMMENCEMENT
State of Florida
County of
The undersigned hereby gives notice that the improvement(s)will be made to certain real Property,and in accordance with
Chapter 713,Florida Statutes,the following information is providee in this Notice of Commencement.
1. Description of rope (legal escriptionotheproperty rid Street address If available)
Address W )L -'�'��
Legal Description
�KMf0. ✓`
• 2. General description of improvement($)
_ 3. Owner nformation (� `
Name Pho(�e&F X Nurser
Address e1 tyC C. Ytt e- C1 tr1�1ti
Interest in Property_
4. Fee Simple Title Hoer(if other than owner shown above)
Name_ 1 Phone R Fax Number
Addresz
S. Contractor Pella Wu1doWS&Doors
•
Name— 359
434
Address Phone Sil]IP Phone&Fax Number
iOf1
6. Surety(if any) W
NamewA
AddressWA (hone&Fax Number
7. Lender(if any) --
NamewA
AddressN/A Phone&Fax Number
• 8, Persons with the State of Florida designated by Owner upon who notices or other documents may be served as
Provided by713.13(1)(a)7,Florida Statutes.
Name
Address Phone R:Fax Number
9. In addition to himself or herself,Owner designates;he following to receive a c
713.13(1)(b).Florida Statutes. \V^ ' oPV of the Lienors Notice as provided In
Name
Address Phone&Fax Number
•
• 10.Expiration date of Notice of Commencement(the expiration date is one year from the date of recording unless a
different date is specified:
WARNINGTOOWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA
STATUTES, AND CAN 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 FINA ING,CONSULT YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE
_ OF COMMEN E^NT^,n ++�� < 1' r
11.Jr`� �(j V��A7
S� _ 1 ��
- PON,*downers or Owners authorised Oe°—/Dior/PriMana
rectaw/
, 8� OrintNama
Sworn to(or affirmed)and subscribed before me this/q/sdayof �l C
7CJr 20 f
(type of authority,e.g.officer,trustee,attor eY in fac)for by
L/
4
4-aof a� as
hehal of whom instrument was executed. Personally known t �CpPoduety on
ne as identification.
i
slenmoryofucta, a� ANDREW BREED
/� r� ,p (Sea)) e/�I�y' State of Florida_NDrary public
• ��+9/Or..,J�fNCG(. ,�jp�/o;• Commission/GG 245933
• Name(print) Y''✓c My Commi59iDn Expires
August OB•2022
Verification pursuant to Section 92525,Florida Statutes. Under Penalties of
that the facts stated are true to the best of D perjury,I deet a that I have Pea the foregoing and
• my knowledge and belief.
r
S18notory of Natural Person signing fin line 4111 Above
OFFICE COPY r
PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH FLORIDA (*REQUIRED)
*Project Address: 2262 Beachcomber Tri Permit#:_X&V1 —017.3
*Owner/Project Name: Laura MUIIIS
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 product
approval may be obtained at: www.floridabuilding.org.
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
A. EXTERIOR DOORS
1.Swinging
2. Sliding
3. Sectional
4.Garage Roll-Up
5.Automatic
6. Other
B.WINDOWS
1.Single hung
2. Horizontal slider Pella 250 16809.5
3. Casement
4. Double hung Pella 250 16813.4/.11
5. Fixed Pella 250 16811.1 / .3
6.Awning
7. Pass-through
8. Projected
9. Mullion Pella Mull 17464.1
10.Wind breaker
11. Dual action
12. Other
'
Pagel of 4 Updated 10117118
OFFICE COPY
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 manufacturer's printed specifications and installation
instructions along with this Product Approval Sheet.
I certify that this product approval list is true and correct to the best of my knowledge. I further certify that use of different components other than the
ones listed in this document must be approved by the Building Official.
*Contractor Name (Print Name):James Rowland *Contractor Signature:
*Company Name: Pella Windows and Doors
*Mailing Address: 350 W State Rd 434
y Longwood * 32750
*City: 9 FL
State: *Zip Code:
*Telephone Number: (727) 637-8400 *E-mail Address. tim.omalley@expeditepermit.com
Cell Phone Number: Fax Number:
Page 4 of 4 Updated 10/17/18
OFFICE COPY
7-1
F'sp,
BAS
FGR
Is
• eceipt Number
' sh • ister Receipt
• • - •29
DESCRIPTION • CITY PAID
PermitTRAK $55.00
RES19-0173 Address: 2262 BEACHCOMBER TR APN: 169463 0062 $55.00
BUILDING WINDOW DOOR INSTALL 07/10/2019 RBE $55.00
BUILDING WINDOW DOOR INSTALL 455-0000-322-1002 0 $55.00
07/10/2019 RBE
TOTALR9629 $55.00
Date Paid: Friday,July 19, 2019
Paid By: PELLA WINDOW AND DOOR
Cashier: CT
Pay Method: CREDIT CARD 019745
Printed: Friday,July 19,2019 4:49 PM 1 of 1
s J-fim
yReceipt
DESCRIPTIONCity of Atlantic Beach R10471
• QTY PAID
PermitTRAK $55.00
RES19-0173 Address: 2262 BEACHCOMBER TR APN: 169463 0062 $55.00
BUILDING FINAL"09/24/2019 RBE $55.00
BUILDING FINAL"09/24/2019 RBE 455-0000-322-1002 0 $55.00
TOTALBY 1 , 11
Date Paid: Wednesday, September 25, 2019
Paid By: PELLA WINDOW AND DOOR
Cashier: CB
Pay Method: CREDIT CARD 5
oft
Printed:Wednesday,September 25,2019 10:52 AM 1 of 1