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1843 Ocean Grove Dr RES19-0171 Roof Repair RESIDENTIAL PERMIT PERMIT NUMBER CITY OF ATLANTIC BEACH RES19-0171 J �r 800 SEMINOLE ROAD ISSUED: 6/19/2019 ATLANTIC BEACH, FL 32233 EXPIRES: 7/21/2020 MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION. ALL WORK • • ' TO THE CURRENT 6TH EDITION1 OF • ' ! + 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: RESIDENTIAL ALTERATION REINSTATED 1/21/2020- 1843 OCEAN GROVE DR RESIDENTIAL ROOF REPAIR w/SHINGLES $800.00 AND WOOD SIDING TYPE OF ZONING: :D • • • GROUP: 169598 0200 OCEAN GROVE UNIT 02 COMPANY: ADDRESS: • ADDRESS: MCLAUGHLIN MATTHEW 1843 OCEAN GROVE DR ATLANTIC BEACH FL 32233-5842 M 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 4S5-0000-322-1000 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: 6/19/2019 1 of 2 RESIDENTIAL PERMIT PERMIT NUMBER 011 CITY OF ATLANTIC BEACH r � ISSUED: 6/19/2019 800 SEMINOLE ROAD EXPIRES: 7/21/2020 ATLANTIC BEACH, FL 32233 Issued Date: 6/19/2019 2 of 2 rS' 'Vjr RESIDENTIAL PERMIT PERMIT NUMBER RES19-0171 CITY OF ATLANTIC BEACH ISSUED: 6/19/2019 800 SEMINOLE ROAD EXPIRES: 12/16/2019 `'—i 9Y ATLANTIC BEACH. FL 32233 MUST CALL INSPECTION • • • 1 BY 4 PM FORINSPECTION. ALL •RK MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • ' + BUILDING CODE, • AND OF ATLANTIC + CH 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. DESCRIPTION: VALUE OF WORK: JOB ADDRESS: PERMIT TYPE: RESIDENTIAL ALTERATION ROOF REPAIR w/ 1843 OCEAN GROVE DR RESIDENTIAL SHINGLESAND WOOD $800.00 SIDING TYPE OFBUILDING USE ZONING: ; . • • • GROUP: 169598 0200 OCEAN GROVE UNIT 02 • ADDRESS: CITY: STATE: • ADDRESS: ' MCLAUGHLIN MATTHEW 1843 OCEAN GROVE DR ATLANTIC BEACH FL 32233-5842 M 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. Roll off container company must be on City approved list. Container cannot be placed on City right-of-way. i 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 4S5-0000-208-0600 0 $2.00 TOTAL: $86.50 Issued Date: 6/19/2019 1 of 2 City of Atlantic Beach APPLICATION NUMBER f' 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 E-mail: building-dept@coab.us Date routed: c' to City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: C l rtment review required Y No wilding Applicant: NmTnw"Zoning Tree Administrator Project: Q('] S ( ©j tL' �1 Public Works Public Utilities (�C Public Safety r Fire Services Review fee $ Dept Signature - \v Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B Florida Dept. of Environmental Protection v 0 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: (BUILDING PLANNI G &ZONING 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 OFFICE COPY 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 IS REQUIRED. Phone: (9,f0�4) 247-5826 Email: Building-Dept@coab.us Job Address: 194 7 3 Cc 4o o 6tol t 1I r Permit Number: t \ C�s Legal Description DV?MY\ TOWN N0 MC RE#I(nCl 'S qZS Valuation of Work(Replacement Cost)$ iQ(7 '` Heated/Cooled SF 6 Non-Heated/Cooled _ • Class of Work: ❑New ❑Addition [--]Alteration �depair ❑Move ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial '7�esidential • If an existing structure,is a fire sprinkler system installed?: El Yes TAO • Will trees be removed in association with proposed ro'ect?❑Yes must submit separate Tree Removal Permit o Describe in detail the type of work to he performed:a e)e- y?<9 !'ec-lrm A �' ��� '�a a" slat rf,poir �oc� ,ncl>d�na-k ic�a �e F�r e 0 1AP Wood r ,n cI� .t � Florida Product Approval# for multiple products use product approval form PropertV Owner Information Name _WL-cjW -vi Address t, 4 Ce#ki ,h7L7r City l state L Zip ,�2ZPhone !?n L1 V7 t^ E-Mail Se rYt a Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) WContractor Information Name of Company S Q Qualifying Agent Z 0 \ Address City State Zip _ -J Z �\ Office Phone Job Site Contact Number U Z State Certification/Registration# E-Mail �Ui — p Architect Name&Phone# C) m p t- Engineer's Name&Phone# U o U D Workers Compensation Insurer OR Exempt xpiration Date n— Z CC Z Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation®as� 0 a commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulatirfs) N (a construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNSJX Q t= Z WELLS,POOLS, FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE: In addition to the requirements o& Cc 2 permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,asi O LU W there may be additional permits required from other governmental entities such as water management districts,state agencie upr>' w Q W Cc M federal agencies. W wUcnW OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with a15 W applicable laws regulating construction and zoning. fJJ W Cc Cc 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, NSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECARDING Y I OF COMMENCEMENT. ( ' re of Own r or Agent) (Signature of Contract / Signed and sworn to or affi me befor me this�day of Signed and sworn to(ora 'rmed)before me thi l9!day of 1 Ij�—, �,c� j by (,_J IlJ (S g ature of Notar ( ' n ture o Nota y) VIRGINIA ROSALES . Notary Public•State of Florida •A�? Comma�ICiT1no�G 9564 [ Personally Known OR ;20^"x'°`�;.,; VIRGINIA ROSALES F� :' ��Osim. �C�irefsa7 2021 �Produced Identification otar Public-State of Florida ro uce en i ica n y o i a n. (r pe of Identification: Co 59564 My Comm. Expires Jan 27,2021 OFFICECOPY "ALL INFORMATION Owner Builder Affidavit HIGHLIGHTED IN City of Atlantic Beach Building Department GRAY IS REQUIRED. 800 Seminole Rd, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: I. FLORIDA STATUTES;CHAPTER 489, FLORIDA STATUTES, PART 1"CONSTRUCTION CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF $25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. II. INJURY LIABILITY;SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. . 111. IRS WITHHOLDING;OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO$5,000 PENALTY UNDER FLORIDA STATUTE NO.455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY"CERTIFICATE OF COMPETENCY" OR THE FLORIDA"CONTRACTORS CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904- 247-5826 OR BUILDING-DEPT@COAB.US) IF IN DOUBT. V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALLTHE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. Job Address: A S� 3 �CQl�► C,, o r't (-1sin c Cauh , Owner Name: &J M �� (.a-� k I Phone Number: 1 OZ Mailing Address: C(ftlir, (S�M ✓4 'T) c City: i r, �X� State: Zip: :1 Z-2,3 Notarized Signature of Owner of e f egJi' i_n�trument was acknowledged before me this tlay of J G(yL� 20(�, in the State of Florida, County Signature of Notary Public +Ay ec= VIRGINIA:ROSADLES ] Personally Known OR Produced IdentificatioNotary Public-Commission My Comm. ExpirType of Identification: Ti—, RG HVM d�3 � �q Updated 10124118 OFFICE COPY about:blank NOTICE OF COMMENCEMENT State ofTax Folio No. County of To Whom It May Concern: The undersigned hereby informs you that improvements will be made to certain real property,and in accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT. Legal Description of property being improved: — Address of property being improved: 3 q3 ��L'F,Con_ General description of improvements: •+-)f" OL V, S) 0 r9 Pt D i rr"` Owner: !°1� ✓ Address: u ��I i (�irttrt Cwy a- t F_ Owners interest in site of the improvement: Fee Simple Titleholder(if other than owner): Name: — Contractor: �� ) — Address: Telephone No.: (�G-1 `t &ICK Fax No: Surety(if any) Aj/A Address: Amount of Bond$ — Telephone No: Fax No: Name and address of any person making a loan for the construction of the improvements Name: 1 "I Address: — Phone No: Fax No: Name of person within the State of�Florida,other than himself,designated by owner upon whom notices or other documents may NIA be served:Name: fy I A Address: Telephone No: Fax No: In addition to himself, owner designates the following person to receive a copy of the Lienors Notice as provided in Section 713.06(2)(b),Florida Statues. (Fill inners option) Name: N2 Address: Telephone No: Fax No: Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is specified): — THIS SPACE FOR RECORDER'S USE ONLY OWNER Q Signed: J Date: I Before rbe thisday o (W Rin the County of Duval,S to Of Florida,has personally appeared AATT�}M M �w 614(4 P Notary Public at Large,St Fof Duval. My commission ires:Stat of Personally Kno or _ Pro ced Id tification• � otr"`'�e;�., IRGINIA ROSA ES ' .°= Notary Public-Sta of Florida - " Commission#GG 059564 OF F.� My Comm. Expires Jan 27,2021 6/5/20 19 2:17 P1 about:blank OFFICE COPY PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FLORIDA(*REQUIRED) *Project Address: 1 �Ll � �/I/ Cw C`-,roV-t 7 Permit#: ksl — of-// *Owner/Project Name: G V CV h As required by Florida Statute 553.842 and Florida Administrative Code Rule 98-72,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.flaridabuilding.org. Category/Subcategory Manufacturer Product Description Limitation of Use State a Local 4 A.DqlOft DOORS 1.Swingt 2.Sliding 3.Sectional 4.Garage Roll-Up 5.Automatic 6.Other B.WINDOWS _ 1.Single hung 2.Horizontal slider 3.Casement 4.Double hung 5.Fixed 6.Awning 7.Pass-through 8.Projected 9.Mullion - 10.Wind bre 11.Du ion Other Page 1 of 4 Updated 10/17/18 1 _r d 6/5/2019 2:19 P OFFICEC0PY about:blank Ca ory/Subcategory Manufacturer Product Description Limitation of Use St Local# C.PANEL 1.Siding 2.Soffits 3.EIFS 4.Storefronts 5.Curtain walls 6.Wall louvers 7.Glass block 8.Membrane 9.Greenhouse 10.Synth ' ucco 1 . her D.ROOFING PRODUCES 1.Asphalt shinglesv l , h r `�J 2.Underlayments LJcerr b . .ti *3d Fc Trim -2Zb 3.Roofing fasteners ( 1. 4.Nonstructural metal roof 5.Built-up roofing 6.Modified bitumen 7.Single ply roofing 8.Roofing tiles 9.Roofing insulation 10.Waterproofing 11.Wood shingles/shakes 12.Roofing slate 13.Uquid applied roofing 14.Cement-adhesive coats 15.Roof the adhesive 16.Spray applied polyurethane roof _ 17.Other Page 2 of 4 Updated 10/17/18 I of A 6/5/2019 2:19 P1 0 F F I C E� COPY PY about:blank Category/Subcategory Manufacturer Product Description Umitation of Use e# Local# E.5 1.Accordio 2.Bahama 3.Storm panels 4.Colonial 5.Roll-up 6.E nt Other F.STRUCTURAL COMPONENTS 1.Wood connector/anchor 2.Truss plates 3.Engineered lumber 4.Railing _ 5.Coolers-freezers 6.Concrete admixtures 7.Material 8.Insulation forms 9.Plastics 10.Deck-roof I 2 16 11.Wall \ f5 52 - 12.Sheds 13.Other d"RTU—G—H—T—S7--- 1.Skylight H.NEW EXTERIOR ENVELOPE PRODUCTS 1. 2. Page 3 of 4 Updoted 10/17/18 3 of 4 6/5/2019 2:19 Pb about:blank 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. 7 *Contractor Name(Print Name`/ "n��6[AA'InLr.J �� contractor Signature: � *Company Name: . o- *Mailing Address: ��L�Q,� t=)1�✓� � � - *City:, 1 6w � 1'3 L�f,�L(►�fn "State: *Zip Code: + / *Telephone Number: �r)�f "1 (0 1 b*E-mail Address: e t ' 0 M� 1 @ hod ✓- /l Cell Phone Number: fax Number: Page 4 of 4 Updated 10/17/18 4 of 4 6/5/2019 2:19 PP