354 19th St RES19-0313 Replace 17 Win "yvr RESIDENTIAL PERMIT PERMIT NUMBER
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CITY OF ATLANTIC BEACH RES19-0313
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a ' - 800 SEMINOLE ROAD ISSUED: 10/23/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 4/20/2020
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:
354 19TH ST RESIDENTIAL ALTERATION REPLACE 17 WINDOWS $17315.00
RESIDENTIAL
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172020 1236 SELVA MARINA UNIT
12A
COMPANY: ADDRESS: CITY: STATE: ZIP:
PELLA WINDOW AND 350 State Road 434 W LONGWOOD FL 32750
DOOR
OWNER: ADDRESS: CITY: STATE: ZIP:
SIMPKINS EDDIE L 354 19TH ST ATLANTIC BEACH FL 32233-4536
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
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
Issued Date: 10/23/2019 1 of 2
RESIDENTIAL PERMIT PERMIT NUMBER
RES19-0313
CITY OF ATLANTIC BEACH
ISSUED: 10/23/2019
800 SEMINOLE ROAD
n ATLANTIC BEACH. FL 32233 EXPIRES: 4/20/2020
TOTAL: $215.25
Issued Date: 10/23/2019 2 of 2
City Atlantic Beach APPLICATION NUMBER
Building
Department (To be assigned by the Building Department.)
800 Seminole Road 6��c I
Atlantic Beach, Florida 32233-5445 6 J
3
Phone(904)247-5826 - Fax(904)247-5845
bJg 9%' E-mail: building-dept@coab.us Date routed: IA
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
3S • l 9-I'L
S
Property Address:
T Department review required Ye No
P
.B4iildi L
Applicant: LLA V V IND( c)i,CA, Panning &Zoning
`"] ► n Tree Administrator
IProject: - V V1 I N) '(J O w 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 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: FKoproved. ❑Denied. I INot applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: ill Date:,d��5 "1,
TREE ADMIN. Second Review: Approved as revised. ❑Denied. L 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
Call Tim for Pick Up 727-637-8400 OFFICE COPY
4—E...,:o.,,,,i„,,
Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
Y 800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
'n;" Phone: (904)247-5826 Fax: (904)247-5845 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 3 S�1 9 7 S I Permit Number:
RESI9 - 03 I3
Legal Description 3r.-6,i 09- as -.21 E .th'c, twl,-o. u,:, I)-/4 /or 2. RE# I *70 002 0 —/236
Valuation of Work(Replacement Cost)$ (7 5/5- Heated/Cooled SF Non-Heated/Cooled _
• Class of Work: inNew ❑Addition ❑Alteration ❑Repair • ove ODemo OPool indow/Door
• Use of existing/proposed structure(s):. mmercial ril"esidential
• If an existing structure,is a fire sprinkler system installed?: Ft Yes rigNo
• Will tree(s)be removed in association with proposed proiect.f5es(must submit separate Tree Removal Perm't) I2io
Describe in detail the type of work to be performed: w
o� 5 -�.r S (2t co
Florida Product Approval# 1 k/)• / o2/•/O / /6�Og./ / /6 or multiple products use product approvaar-- Z O
Property Owner Information 3sy l9 S C' W — P.-
.-?..
u
Name Sit d.(e TTt"S1 M p Fes..-} Address G7 • al '-
City
City Al-1 eV . ►yco-GL, State 1^( Zip 1223? Phone •/cV' Er6�1 7733 U U
E-Mail ill — Q C
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) n/a 0 fi Oa a
Contractor Information n C) N H i-
Name of Company t(�. Imo•„ 0�-, tDct+f) Qualifying Agent Sates Ie...1'µZ Q z
Address fro s '1 5E1 w City A3 State P1 Zip ?Z7S"D d U.. -- '113
Office Phone Yd'' 937',1 k1fr Job Site Con act Number T 14 U a m
State Certification/Registration# C.-13C Oti(,?I.2 E-Mail ) to • 0 (�'t•�Llef� r,>e 12 ie-perMT•Gall } w 5 0
Architect Name&Phone# aW f3 W
ia
Engineer's Name&Phone# t"1 U N CC W
Workers Compensation Insurer 51 rJ �' GAS (d OR Exempt❑ Expiration Date Vt/o�v pi >
Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or installatiOrr has CWC
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: In addition to the requirements of this
permit,there may be additional restrictions applicable to this property that may be found in the public r:VT•• t is n ylaNd9
E D
there may be additional permits required from other governmental entities such as water management • st ' t i s,
federal agencies.
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning. OCT 9 2019
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTYSIFitittlyment
TO OBT IN FINANCING, CONSULT WItH YOUR LENDER OR AN ATTORNEfilEPErPrIalantic Beach, FL
R�E(CO / G YOUR TI OF COQ MEN MENT. /
/ ' (Signature Owner or ent) (Signature of Contractor)
Signed and sworn to(or affirme.)before me this j< day of Signed and sworn to(or affirmed)before me this /"day of
�, , Z 0/ t ,by ',- . 4 Oa g ,by —e+MIJ ip,./,2
49 t; .': gm:_ ,. i , . e of Florida (Signature of Notary)
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'`'(K Commission 8 GG 219590
;:orfsMy Comm.Expires May 20,2022 - - -
[ I Personally Known OR Bonded through National Notary Assn. Personally Known OR IzA1 "i ;. TIMOTHY R.O'MALLEY
j rProduced Identification [ I Produced Identification fai '-/` :,1 MY COMMISSION#GG 117135
Type of Identification: C 2 Type of Identification: k?;-�`--71 EXPIRES:August 7,2021
,P,;,jt Bonded Thru Notary Public Underwriters
OFFICE COPY
,- PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FLORIDA (*REQUIRED)
*Project Address: '1 1 014N-54--
Permit#: i2tS/ 9 -o )3
*Owner/Project Name: 5\r\c 5.'(•- k,,,_,
As required by Florida Statute 553.842 and Florida Administrative Code Rule 9B-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 .Ve\o` 0._r V
2. Horizontal slider Pesl c\ 21
6 Er -ap
3. Casement
4. Double hung
5. Fixed i.\\-°\ 2 3--U
6.Awning l� <<3
7. Pass-through _
8. Projected
9. Mullion
10.Wind breaker
11. Dual action -- ---
12.Other I — ------
Page 1 of 4 Updated 1 0/1 7/18
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 Road 434
*City: Longwood
*State: FL *Zip Code: 32750
*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
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Doc # 2019232081 , OR BK 18959 Page 2351 , Number Pages: 1 ,
Recorded 10/08/2019 01 :40 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10. 00
Permit Number
Parcel ID Number ' tJ �Z
NOTICE OF COMMENCEMENT
State of Florida
County of �.\\(G`
ChapterThe
d hereby
ives notice that
rovement(s)wil
713,Florida Statuttes,the following lnforrnation is p ovidedlfnt e made to certain real property,and In accordance with
h s Notice of Commencement.
P
1. Description of propertylege des`Crriptlon of the property,and street address if available)
Address 'I"
Legal Description i. ilk
01,2. General description �a \� n 1 - - !�'
p of ll _ Li
G.S\v\C9 W-)
3. Owner Inf.rmation ( L
Name 1. . .►• Asa: Cha .
Address -��� Phone&Fax Hum;
Interest in Property I"
+ \ty �'� 3
4. Fee Simple Title Holder(If other than owner shown above;
Name
Address Phone&Fax Number
5. Contractor PellO WindOWS&Doors •
Name 350 W State Road 434
Address Phone&Fax Number
'fie weAd,
6. Surety(Ifany)
NameH"
AddressPhone&Fax Number
7. Lender(If any;
NameN'A
AddresswA Phone&Fax Number
B. Persons with the State of Florida designated by Owner upon who notices or other documents may be served as
provided by 713.13(1)(a)7,Florida Statutes.
Name
Address Phone&Fax Number
9. In addltfon to himself or herself,Owner designates the following to receive a copy of the Llenors Notice as provided In
713.13(1)(b),Florida Statutes.
Name
Address
say, 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:
WARNING TO OWNER: 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
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFth1E THE FIRST INSPECTION.
OBTAIN FINAN tN 'CONSULT YOUR LENDER NOTICE OF
OF C FlNA M T. AN ATTORNEY BEFORE C t1MENCI CIION. IF YOU INTEND TO
11 �r,1� /� ., I ORKORltECgRD1NGYO�IR
CC //// ii NOTICE
ureaevraan or Baer r^ �J?I
a'marsAWp d l i! Tr :�-
r Of / rintNa ��`- �' ;s/ -
Print Name '_ _l l/,i
worn to for affirmed) subscribed before me thk/ :,�i / S11a,lre
W vVr- and(tys s edbeauthority, day of 'r,r,Lr!, 20L_by.
y 1;',.1"._,_,_&_/
behalf of whom e.g.officer,trustee,adorn In fact)for eas v�Y1�j0 h g
Instrument was executed. -- -�-1' (narrie of party on
---_LL� as identification. 1iirius: KEVIN AWRIGHi rr --�Iiloduced
r '//— — ',r=t.,-;,' Notary Public-State of Florida
5<)
s'a►?wrro}Nor„y "-I.} tl , Commission F GG 219590
sic'1 iE f f l7 - ?Orea1�1Y Cann.Expires May 20,2022
metwr WO / Bonded through National Notary Assn.
nk' --AND-
Verification pursuant to Section 92525,Florida Statutes. Under penalties offe that t e u ry I dh„
that the facts stated are true to the best of my knowledge and belief. readtl
th foregoing
P h , eJz irea�nt
- tSUnatore of Natural Pe �' �f-
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