831 Amberjack Ln RES19-0362 Replace 2 Windows RESIDENTIAL PERMIT PERMIT NUMBER
aCITY OF ATLANTIC BEACH RES19-0362
12/17/2019
YIP 800 SEMINOLE ROAD
EXPIRES: 6/14/2020
ATLANTIC BEACH. FL 32233
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:
831 AMBERJACK LN RESIDENTIAL ALTERATION replace 2 windows $1150.00
RESIDENTIAL
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171183 0000 ROYAL PALMS UNIT 01
COMPANY: ADDRESS: CITY: STATE: ZIP:
THE HOME DEPOT 9208 Florida Palm Drive TAMPA FL 33619
OWNER: ADDRESS: i CITY: STATE: ZIP:
RANDOLPH BASSEL L 831 AMBERJACK LN ATLANTIC BEACH FL 32233-4224
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.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $60.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $30.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $94.00
Issued Date: 12/17/2019 1 of 2
rSrs�''�'r%° RESIDENTIAL PERMIT PERMIT NUMBER
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` CITY OF ATLANTIC BEACH RES19-0362
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800 SEMINOLE ROAD ISSUED: 12/17/2019
-1,010)/ ATLANTIC BEACH, FL 32233 EXPIRES: 6/14/2020
Issued Date: 12/17/2019 2 of 2
r„.,-,11,-:!.../,,, City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
,,--t-,, - \ 800 Seminole Road rEC III—0 2 (p4,w - _ Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845 le'( ?0, (l5
".2:01119'''".2:01119''' E-mail: building-dept@coab.us Date routed: t
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 78 ( b.tt gc,LL . , De;. tment review required Ye No
--7 euildin
Applicant: l I�JI IY�, tip } Planning &Zoning
fn i Tree Administrator •
f
Project: 1 � 0—e-- '- (n�,!lb>03 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: [ pproved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: �/ Date: /4-I 7-1 9
b/
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
Call Tim for Fick Up 727-837-8400 i� r.-/ P/7
l0y -2 .'—
{ 'i, Building Permit Application Updated 10/9/18
_ is City of Atlantic Beach Building Department **ALL INFORMATION
t-# 800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Fax: (904) 247-5845 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: B31 Amberjack Lane Permit Number: F--LS 1 -D3(e,r).
Legal Description 30-60-17-2S-29E Royal Palms Unit 1 Lot 29 BIk 4 RE# 171183-0000
Valuation of Work(Replacement Cost) $ 1,150.00 Heated/Cooled SF Non-Heated/Cooled
•
• Class of Work: )New ❑Addition inAlteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): OCommercial ®Residential OFFICE COPY'
• If an existing structure, is a fire sprinkler system installed?: EYes ONo
• Will tree(s) be removed in association with proposed project?DYes(must submit separate Tree Removal Permit) no -
Describe in detail the type of work to be performed:
Replace 2 windows size for sizer, -fi iii-.. -,
Florida Product Apprdval # 1491 1.4 _ for multiple products use product approval form
Property Owner Information
Name Fredenca Randolph Address 831 Amberjack Lane
City Atlantic Beach State FL zip 32233 Phone (904) 329-0172
E-Mail : .
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) n/a
Contractor Information Z .
Name of Company The Home Depot Qualifying Agent Arthur Francis c(.
Address'9204 Florida Palm Dr City Tampa State FL Zip 33619 L)
Office Phone (727) 637-8400 • Job Site Contact Number LI i\
State Certification/Registration# CGC061641 E-Mail tim.omalley@expeditepermit.com. U .:: • ,
Architect Name& Phone# _ _ d x J Z I
Engineer's Name&Phone# 1 r N Q C)
Workers Compensation Insurer r2�^' /� !- R;t'Z'F-
P N �t�.�S)ti.re �,.y (,o OR Exempt o Expiration Date 3 t �c _, t'' 0 0
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installttjoL.Ji Z FI
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regtt� � 0
U ' L
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,S'I- a c •
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE: Inytl.p t6�t e' " mt!", •
permit,there may be additional restrictions applicable to this property that may be found in the.publlc-•ret&o..this ct u ,;,T_ > r
there may be additional permits required from other governmental entities such as water management districts,state a e I t$
federal agencies, g g 2 w
fnC�(�++
a ,...til- cc
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done`fit�bmplian a !x a
applicable laws regulating construction and zoning. — Iia u
W U N OWL u
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMIVIENCE1VTENT MYYr t LI
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU IMPEND' CX
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECQR,DING YOUR NOTIC •F COMMENCEMENT. \,..„.„&tivl
(Signature of Owner or Agent)— j (Signature of C ntractor
IV/ 3 ��
Signed a d sworn to (o affirmed)before me this / day of Signed and sworn to (or affirmed)before me this day of
/e)/•—•,.4,-- , d-al '/ ' - �� ` v-�
by /`-ice`- , 02.U[Q ,by�l r Wv[u• Fra.u5
NOTARY PUBLIC ' ;;0.1 •;', TIMOTHY R.O'MALLEY
fak •,: MY COMMISSION#GG 117135
.STATE OF FLORIDA - : Ge
PersonallyKnown C• � :,�•�� EXPIRES:August 7,2021 '
[ ] �•,. , Comm#GG229591 [ 1 Personally Known OR :Fo,; Bonded Th u Notary Public Underwriters
[ ] Produced Identificati."'•- ' Expires 6/18/2022 [ ]Produced Identification . "
-r.,........F LJ....+4i.-.44.....
OFFICE COPY
PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH,FLORIDA
Project Name: av1
Permit #0..C/9
Project Address: 83 t -141 a SCk
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: wwwfloridabuildirw.oro.
Category/Subcategory b . Manufacturer 4 Product Description J Limitation of Use State# Local #
A. EXTERIOR DOORS
1. Swinging
2. Sliding —
3. Sectional
4. Roll up
5. Automatic
_ 1
6.Other
B. WINDOWS
1. Single hung
2. Horizontal slider
3. Casement
4. Double hung
i
5. Fixed
6. Awning L_.____�_
7. Pass-through • � �----~---------� _
8. Projected ! r
9.Mullion 1
10. Wind breaker
11. Dual action d ---
1 ► 1
Other
Category/Subcategory Manufacturer Product Description imitation of Use State# Local#
H. NEW EXTERIOR
ENVELOPE PRODUCTS
2.
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.
cv-Q
(Contractor Name) (Print Name)
(SignaZ)
Company Name: - Vis_. d'Sr-
Mailing Address: 2
City: --TG---\D-Tc State: F--z- Zip Code: 33C t `1
Telephone Number: ( 'IJ��7) (9 3 7- e./ w
Fax Number: ( )
Cell Phone Number: ( ) E-mail Address:
OFFICE COPY
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