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36 Jackson Rd RES19-0306 Replace Doors, Drywall, Insulation :-S'-`,'f�., RESIDENTIAL PERMIT PERMIT NUMBER :1" 'iJ RES19-0306 , CITY OF ATLANTIC BEACH \'� 800 SEMINOLE ROAD ISSUED: 10/14/2019 <'71-0119'' ATLANTIC BEACH. FL 32233 EXPIRES:4/11/2020 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: 36 JACKSON RD RESIDENTIAL ALTERATION replace doors, drywall, $14000.00 RESIDENTIAL insulation TYPE OF REAL ESTATEZONING: 3 BUILDING USE SUBDIVISION: CONSTRUCTION: NUMBER: GROUP: 172087 0000 SECTION LAND COMPANY: ADDRESS: CITY: STATE: ZIP: SLSCO LTD. P.O. Box 17017 Galveston TX 77552 OWNER: ADDRESS: CITY: STATE: # ZIP: • WATERS LOUIS 36 JACKSON RD ATLANTIC BEACH FL 32233-4320 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. DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT BUILDING PERMIT 455-0000-322-1000 0 $125.00 BUILDING PLAN CHECK 455-0000-322-1001 0 $62.50 STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.81 STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00 TOTAL: $192.31 Issued Date: 10/14/2019 1 of 2 ,;.1Li VJr%, RESIDENTIAL PERMIT PERMIT NUMBER '„ CITY OF ATLANTIC BEACH RES19-0306 Alf ISSUED: 10/14/2019 800 SEMINOLE ROAD `.,3;119',' ATLANTIC BEACH. FL 32233 EXPIRES:4/11/2020 Issued Date: 10/14/2019 2 of 2 City of Atlantic Beach APPLICATION NUMBER #-it. Building Department (To be assigned by the Building Department.) 'v 800 Seminole Road V/_ [J S`� -030( " ri Atlantic Beach, Florida 32233-5445 G 1 Phone(904)247-5826 • Fax(904)247-5845 r; E-mail: building-dept@coab.us Date routed: D I Li 1 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: to itctcd on Q41 • D ment review required Yes No BuildingApplicant: S .. 1:1- 0 D - PlannitT&Zoning 1 Tree Administrator Project: ( 6-00(S l w!(t� Public Works Y 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: Ltproved. I (Denied. ❑Not applicable (Circle one.) Comments: BUILDING fl)D- PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: ❑Approved as revised. nDenied. 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 Building Permit Application OFFICE COPY Updated 10/9/18 City of Atlantic Beach Building Department **ALL INFORMATION 44. �� V 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED. Job Address: 'i(c -3-Nek5611 WA-, Al•ii.c1,c�&e Permit Number: (?.E S ( 9 -03 010 Legal Description P L. (cnv r 6 f 3 3 Ik- /1/TD D- Y6. 7 RE# R'"o ca-: ^a Valuation of Work(Replacement Cost)$ /4/, 0 Uv FHacJeI Heated/Cooled SFI • Class of Work: ❑New ❑Addition ❑Alteration 1ARepair ❑Move ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial ❑Residential OCT 4 2019 • If an existing structure,is a fire sprinkler system installed?: ❑Yes I.No • Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) )?9No Describe in detail the type of work to be performed: Building Department af (� L ^� f p (� ) (Li f AtlaritiC Beach, FL pto.tc +C:v�. .-DrCL t DXy4.c-iii t3-i�1.5( uil, b,4 °'gtk e,.glglkze- t '` Florida Product Approval# /c..3(-C-70. / for multiple products use product approval form Property Owner Information Name Pri A%U IIcs- I-tM ( f Address 3C9 f[Ltk604 City 0104441C, 1X r.h. State pi- Zip 3aa3J Phone 90`/ ' -73,6''c9r/b0 E-Mail a 47C,kl(?awteast. ( t- Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) Contractor Information /I /' Name of Company SIS ea li-T.b Qualifying Agent CIin'l 'ter i," -f db/'t. Address 77. 0- 130& 1 70/ 7 City 64/1/CsTOn State 71( Zip 77.5-1.5-. Office Phone 7/3- gkD 9f S , B *tib Site Contact Number 5/3. 5/ss -/(0 96, *- State Certification/Registration# C(`-- C Ic Cil- E-Mail (-4(//44 0... g Isar) . 0-0 pry? Architect Name&Phone# Engineer's Name&Phone# Workers Compensation Insurer 1 L't&ctS M LAA-''rct OR Exempt❑ Expiration Date ,SI a(a/a-D,-cO Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation Las t commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulatirr construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS.? ..y. J 2 t WELLS,POOLS, FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE:In addition to the requirements of this) Q 0 Si permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and i' z h- 4 O — there may be additional permits required from other governmental entities such as water management districts,state agencies,or J E 0 a federal agencies. o C] 88 F OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance with a8 E- G 0 applicable laws regulating construction and zoning. n Z Q a WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY � � � z RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND;;_ 2 TO OBTAIN FINANCING, CONSULT WITH YOUR LENDE OR AN TT RNEY BEFORE cl © a w Er_ m RECORDING YOUR NOTICE OF COMMENCEMENT. W f- w 0 0 l,/Ju c, ,� paw U cn w uj of Owner or Agent) W cc uJ (Signature (Signature of Contractor) > '/ CC W Signed and sworn to(or affirmed)before me this 3 day of Signed and sworn to(or affirmed)before me this 7 dayof cc eictra ,, 19 by t ' cCi)(Gi_ . 7ba OCi2. , 2019 ,by fh42yo PAl I ! - / ,,,,,,i, L ' - i t Signature of o .s ,. G{R!STOK ER GARY RUNT i �N :" TANGELA JEUDY % ,,, = MY COMMISSION M GG° f, ' MY COMMISSION%GG 913686 [ ]Personally Known OR :.i :* { ]Personally Known OR �, :o: EXPIRES:MY M,N. '4 ���;o EXPIRES:September 16,2023 '` ‹roduced Identificatio +,�o!or;; ga�dedTtvuNpt✓MNPubp6tM n [v1 Produced Identification '-FyF ;°.� 8� � icU it 'Type of Identification: _ ----- Type of Identification: L rvCrs lee-44-5c <rot�R� A��v��s��C8v5�