2001 Park St RES19-0291 Window Replacement r,,... r%,,;, RESIDENTIAL PERMIT PERMIT NUMBER
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CITY OF ATLANTIC BEACHRES19-0291
�r ISSUED: 10/10/2019
800 SEMINOLE ROAD';' ATLANTIC BEACH, FL 32233 EXPIRES: 4/7/2020
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM 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.
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:
2001 PARK ST RESIDENTIAL ALTERATION WINDOW REPLACEMENT- $6000.00
RESIDENTIAL BLDG S-7
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172260 0000 DONNERS R/P NO 02
COMPANY: ADDRESS: CITY: STATE: ZIP:
KBT CONTRACTING CORP 5105 BLANDING BLVD JACKSONVILLE FL 32210
OWNER: ADDRESS: ° CITY: STATE: ZIP:
JACKSONVILLE HOUSING
AUTHORITY 1300 BROAD ST JACKSONVILLE FL 32202-3996
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 ACCOUNT QUANTITY PAID AMOUNT
1
BUILDING PERMIT 455-0000-322-1000 0 $85.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $42.50
STATE DBPR SURCHARGE 455-0000 208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$131.50
Issued Date. 10/10/2019 1 of 2
ri;..L.rf City of Atlantic Beach APPLICATION NUMBER
s' hcABuilding Department (To be assigned by theBuilding Department.)
r u 800 Seminole Road RE1SLCA lJ-Z
T.5. , x Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 Fax(904)247-5845ilali _
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� E-mail: building-dept@coab.us Date routed: -! /ZS IL 9
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Z(DC) P, PR_k vT Department review required Yes o
K
6�
wilding ) V
Applicant: C__0(\.)T2(�C`t'(/V� P nning &Zoning
Tree Administrator
Project: Vv IN)1CWS 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: roved. ❑Denied. I INot applicable
(Circle one.) Comments:
BUILD! ��/�
PLANNING &ZONING Reviewed by: /' /' '// Date: /0—E7q
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. I INot applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
;:ri`''r,:'� Building Permit Application OFFICE COPY
Updated 10/9/18
'"-,< t City of Atlantic Beach Building Department **ALL INFORMATION
J•? 'r
l � v 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
(- -on , IS REQUIRED.
ti Phone: (904 7-5826 Email: Building-Dept@coab.us
add` RES(Q -OZ�
‘O y0 WA S �7 /Loot • s 3 fh44 s` w &► , Permit Number:
O�4, Legal Description 2�-(eS -2s -l./q IE �p,1 § He Q k;t,I 6614, I RE#}'122,(02 °Doc)
'�j Valuation of Work(Replacement Cost)$ 11,0 t0 0 Heated/Cooled SF a 04 0 Non-Heated/Cooled 0
• Class of Work: ❑New EAddition ❑Alteration DRepair :Wove ❑Demo ❑Pool Window/Door
• Use of existing/proposed structure(s): ❑Commercialpa17Reside-ntitial
• If an existing structure, is a fire sprinkler system installed?: ❑Yes 'I]No W ''N
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Peiti Nr4 Cw,
Describe in detail the type of work to be performed: y,j t dOcs4 2Le u),(4.M i� .J c ‹ ' O
Cy LU. w
Florida Product Approval# F L\b' ODDC) - ^" for multiple products use product I pOv •
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Property Owner Information c F- cr z
Name �AhAcii'(li i t)SIN4 4011•IO(LZ.1 Address t1� pu (f t p '5'r2E-i%r 0 < 9O a
co
City .�.4 V Al vl'� � 34.4401_,State . Zip34.4401_, Phone 9,c —.tie(' —(e
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E-mail co M; & 0gX2h • c'r 0 2 I"
Owner or Age (If Agen , Power of Attorney�or Agency Letter Required) pay, Q. LI- OLI.-tcrur_ }
Contractor Information '> CI
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Name of Company X6,1, C.IJ�' -1114 L4f', Qualifying Agent T'� -411 %rAfy1Q*t w o W
Address 96 ce►L,�,y1' tdel gPotio, City - - Zip S ¢ w
Office Phone qo , G.4.-,_ '14 O Job Site Contact Number ..' 5
w
State Certification/ egistration# • aL bai,�OSSE-Mail • 4 0. ,_ _ cc
Architect Name& Phone# kid,
Engineer's Name& Phone# �,9A
Workers Compensation Insurer / Q J9y f-i t.1-17 _OR Exempt❑ Expiration Date $(2al ft0/...0
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
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: I u. i--_.-., 're 1 nts of this
permit, there may be additional restrictions applicable to this property that may be found in th• ., IiE r co.•. . t yjar
there may be additional permits required from other governmental entities such as water management districts;sat=a .-.r
federal agencies.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be dor lfoco'Nlia ?vith all
applicable laws regulating construction and zoning.
WARNING TO C NER: YOUR FAILURE TO RECORD A NOTICE OF CO �/�.N NT MAY
�trlC? : r ;ia;,r
RESULT IN Y r/UR ' A YING TWICE FOR IMPROVEMENTS TO YOUR IQ R, iY-„i,FAroL;: tpNf,D
TO OBT• FI 9tN s NG, CONSULT WITH YOUR LENDER OR AN Al •RNEY BEFORE
RECOR1 I fa U ' 1► • . OF COMMENCEMENT.
A, .-- -s >
(Signature of Owner or Agent) (Signature of Contractor)
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Si ned and sworn to(or affirmed) before me this /day of Signed a sworn to(or affir =.)b'f.re me 7-. day of
l.P ,,)611 , by �l t✓Cc.c/►e - le ic- r� CEG 2015(by . 1 �• . l IN11Nlp�.S
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LINDA SIMS i��°�e
o Y” : `�`. Notary Public-State of Florida
Notary Public-State of Florida I r l. .
lei:'.' Commission t GG 106242 Commission p GG 199162
1rsonally Known 0 < .
:N1111:i.. I Known OR orn� My Comm.Expires Apr 6,2022
�� o My Comm.Expires Jun IS,2021 ( j Personally
1 1 Produced Identificat. n '' P',F`.`. Non dedthroughNalionalNotaryAssn. I 1L]-Produced Identification Bonded through National Notary Assn.
Type of Identification: - - Type of Identification: Umilidi •