70 W 5th St RES19-0322 Siding/Doors RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RES19-0322
\�V �� 800 SEMINOLE ROAD ISSUED: 11/6/2019
�.213ia%- ATLANTIC BEACH. FL 32233 EXPIRES: 5/4/2020
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:
70 W 5TH ST RESIDENTIAL ALTERATION SIDING AND DOORS $14000.00
RESIDENTIAL
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170822 9600 ATLANTIC BEACH SEC H
COMPANY: ADDRESS: CITY: STATE: ZIP:
SIDING INDUSTRIES OF P 0 BOX 840292 ST.AUGUSTINE FL 32080
NORTHERN FLORIDA
OWNER: ADDRESS: CITY: STATE: ZIP:
CHAPPELL SALLY S ET AL 70 5TH ST W ATLANTIC BEACH FL 32233
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: 11/6/2019 1 of 2
�iL`rel RESIDENTIAL PERMIT PERMIT NUMBER
-- - RES19-0322
�',•,s .x_� s) CITY OF ATLANTIC BEACH
.,,,,,,v ISSUED: 11/6/2019
800 SEMINOLE ROAD
ATLANTIC BEACH. FL 32233 EXPIRES: 5/4/2020
Issued Date: 11/6/2019 2 of 2
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road ��� _�'��a z
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845 1 7
\ ���5 �:' E-mail: building-dept@coab.us Date routed: Of C�9 ii 9
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ! cD Department review required Yes o
, TBuildi
Applicant: 101 fO( (NOU R cE�S O c N p manning &Zoning
Tree Administrator
Project: to 1 ND r., 00 ja,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
rReviewing Department First Review: roved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: ' Date: /I"47419
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
r1- ' ` , Building Permit Application OFFICE COPY Updated 10/9/18
t7 City of Atlantic Beach Building Department **ALL INFORMATION
.#:_i 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
;t,),ii��� IS REQUIRED.
Phone: (904) 247-5826 Email:��ilBuilding-Dept@caab.us
Job Address: 70 ,J .57- Le-.7 /" "44-"Caelf 3"Permit Number: t'� \9 - 03Z--
/3 Z-'
Legal Description 19_34'38--2.5'-•2.-96—. //Z./10%d, , -A Xe Lai Q[.S Eti f 74,9.12-9(aLYJ
Valuation of Work(Replacement Cost)$ /"7'00 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New DAddition /Alteration ❑Repaid❑Move ❑Demo OPool VWitidoer/Door
• Use of existing/proposed structure(s): ❑Commercial dIResidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes I'No
• Will tree(s)be removed in association with proposed project?DYes(must submit separate Tree Removal Permit) to/No
Describe in detail the type of work to be performed: _Liu$-T 4. 1,I Fiber-C'efrt F, -r , i et_s .s
.jL y, „�..r p rio :Doo-e— j_ -)(.27a--K Jac
Florida Product Approval# for multiple products use product approval form
Property Owner Information/ / q�
Name Ce Sy rY Tr / (�/ '/ric"7' Address 7c7 .S.YAi /-71- M7Crf C 10:1" , 32233
City J'1,-hur?G /3 e,-,,C State /2- Zip 3 Z z 3- Phone a-5z•2-et, -/746
E-mail ir'.#t y. Pc/rfS�2 Z C /14 L - - Gviizr
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) ..w*
Contractor Information
Name of Company 6/d n?r ,r/p arr 74-5 f/f)JJ�L, ,‹ualifying Agent vKe Aeti tic kee— Ne
Address per Y ,� etc-0 zS'Z City ,$'r C:14.. .. State ,7-1---- Zip ,'2 7E3Z u)
Office Phone 91 V ce a tr4 7? 2,3 Job Site Contact Number 9UZ-3 0 A' 7Y a X JQ ZZ
State Certification/Registration if e'i C/3 2-74)3 VE-Mail Slnf"y,9 �o/4S rr-fit?C��YwL' 1r Air-, Z 0 N.
Architect Name&Phone# Q O -.
W Z uj
Engineer's Name&Phone# • m Q O F-
Workers Compensation Insurer OR Exempt/Expiration Date er 6 - ' in o 0
Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work.r insta latiortqa Z
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulatiioO Q c-Is
construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS() -3 N H
WELLS,POOLS, FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE:In addition to the requirements oWii4 F- Z
permit,there may be additional restrictions applicable to this property that may be found in the public records of this cowl)",aQl LL 2 L
there may be additional permits required from other governmental entities such as water management districts,state agerffciesrO w W �:
federal agencies. m
W n, CC
W 5cl
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance with al U h W 14
applicable laws regulating construction and zoning. SC W
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY c
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND - --
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORD G YOUR NO CE F COMMENCEMENT.
0 - _.. iiigiVil..,,- —
(Signature of Owner or Agent) IIIIP (Signature of Contractor) N.
ed d sworn to(or affirmed)before me this 1'J(day of ed a d sworn to( -ffir' ed)bio e me this7Iray of
t/ 7 e I ZC/�,by C,9J'� O Si(g5C ,ZcUl '7. .4 �, I I e-
Erna ure of Notary) "• -• P a '�
', ,. `�'` :.? MY COMMISSION#G,3 353178
ovally Known OR 1 �a"Pu`••. JOHN KELLEHER I Personally it" �Q<` EXPIRES:October b,2023
_° ': Notary Public-State of Florida [ } Known.pR•:FOF dC4. Bonded Thru p
[ j Produced Identification! Pte; Commission#GG 278000
I [ 1 Produced IdentifiC t --NOS Di:def*Tftars
Type of Identification: \os n. My Comm.Expires Mar 14,2023 I Type of Identification: �� iv e• — . — Z 0-�
Bonded through National Notary Assn. I
•
NOTICE OF COMMENCEMENT OFFICE COPY
('PREPARE MAI DUPLICATE)Permit No.Resig --
_ d 3L--' Tax Folio No:
et.a.t.of ___s c County of DWS
To encory,it may:.e.r»�ern:
The undersigt lad he9ref?y lrtltrmsyou that Improvements will be made to certain real property,and in
aceordar,rur with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF
CrSIItMFFe c^Mr.iy r.
d ion of property being improved:. S.`3 c�7 -29E- -7- /f / :A
Gec 1,., Sec tE L--o7 Z SLK '7‘
Address of properly being improved: "Ai LJ T (;c!
, )e,4dt ft 312-3./
General description of improvements: i• r, # J TD c
Owner ;Cd! .. .. )4,/i43S I .£ S.4IC4/ /1- ,
;d+nets
,r701.574 ..5-7- [1,-c„.1 - �TAtic:(�-7G 45r-- Z 3 zi 33
7„r.er's:'^serest In cite of the improvement ,fr ,-/P170/p `,P iritope...e--,Q .
Fee Sim;:i Tittehoirtnr(if other than owner) _ .
c_,
Name=
1dresss
coft
C4rltractor SKIING INDUSTRIES OF NORTHERN FLORIDA,INC
Address P 0 E3UX 840292 ST AUGUSTINE,Ft_32_08E
fl.k,.c Id-T923 .,
;i
ttena Ra _----- - Fax No.
Surety(if any) - — ---
tddress
Amount of bond
r?home .-- _Fax No.
Na:•,e and address of any person making a loan fbrthe construction of the improvements.
NerAe
ddi css
PhOrie No.- - - — -Fax Nc.
N.rwr^of rot-son r,vlfrin the State of Florida,other than himself or herself,designated by owner tipOE1':whom
noIt es or rlltre rocs nehts rttaY be Served:
Nerve
Address
Phone No. _ FaX Hit.
In:addition to himself of herself,owner designates the following person to receive a copy of the'Ltenors Notice as
prov de i is Section 713.08(2)(b),Florida Statutes.(Fin)in at Owner's option).
stddreeS
'bona No. Fax No.
Expi ation date of Notice Of Commencement(the expiration date is one(1)year from the date of recording unless a•
di^e-eat date is specified):
TH' &PACF;FOR RECORDER'S USE ONLY j OWNER 4_,4 � 1�i) r♦ I
154g..e mss. DATE /' g i \
Doc#2019248967,OR BK 18983 Page 2040, Berora ma s ,e day of 4.12/54,-- T-. ort n e ( ;;;°"1`.^1.,
Number Pages: 1 couu,ty $lewd ieest rzig, aerate by
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Recorded 10/29/2019 12:07 PM, , nrrnseliif eu ennd� that allstatements and decimations herein ( oc:\?:rra 7,
era ince and eo.urate '••.,
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL ( ` •A• '
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COUNTY Z
RECORDING $10.00 / ( g-n r+�^,
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OFFICE COPY
PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FLORIDA (*REQUIRED)
*Project Address: 7� -S / (-<.i Permit#: LL S /9-6) 3 2 Z
*Owner/Project Name: eageyi5 /, -,45g-// ..e' 64-
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 ,g 7-/ -/c:/7/4 5//C>!' 9/44S-5 OCt.17-- /(C,'2‘ • /
2. Sliding (10 ETL-3 .14/Scia
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 breaker
11. Dual action
12. Other
Page 1 of 4 Updated 10/17/18
OFFICE COPY
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
C. PANEL WALL /
1. Siding J 4 r L LfP S/cZ,-/ /3/
2. Soffits
3. EIFS
4. Storefronts
5. Curtain walls
6. Wall louvers
7. Glass block
8. Membrane
9. Greenhouse
10. Synthetic stucco
11. Other
D. ROOFING PRODUCTS
1. Asphalt shingles
2. Underlayments
3. Roofing fasteners
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. Liquid applied roofing
14. Cement-adhesive
coats
15. Roof tile adhesive
16. Spray applied
polyurethane roof
17. Other
Page 2 of 4 Updated 10/17/18
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.
OFFICE COP
*Contractor Name (Print Name): JO h v 2 ( keh e( *Contractor Signature:
*Company Name: ( c y �y�� _ N ?L
*Mailing Address: 1SG)(.- Lie O Z Z--
*City: ST a`41 *State: L *Zip Code: -Y2-0,:e�
*Telephone Number: 2O Y g/(7/- 772 3 *E-mail Address: ..n—.c34',/, .�S r'"63- �G `--'C4' J 'k`e✓
Cell Phone Number: Fax Number:
Page 4 of 4 Updated 10/17/18