84 W 9th St RES19-0361 Replace Garage Door • rlL'I-Jr)"` RESIDENTIAL PERMIT PERMIT NUMBER
�w CITY OF ATLANTIC BEACH RES19-0361
�'� ISSUED: 12/20/2019
` �� 800 SEMINOLE ROAD
44`_r3iv� ATLANTIC BEACH. FL 32233 EXPIRES: 6/17/2020
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:
84 W 9TH ST RESIDENTIAL ALTERATION replace garage door $1412.40
RESIDENTIAL
TYPE OF REAL ESTATE ZONING: 1 BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170814 0084 ATLANTIC BEACH SEC H
COMPANY: ADDRESS: CITY: STATE: ZIP:
PRECISION DOOR SERVICE 6676 COLUMBIA PARK DR S JACKSONVILLE FL 32258
OF N FL JASO
OWNER: ADDRESS: CITY: STATE: ZIP:
SLOCUM MATTHEW A 13073 BIRCH BARK CT N JACKSONVILLE FL 32246-7026
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.
u LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1
1 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: 12/20/2019 1 of 2
51'llnr 0 RESIDENTIAL PERMIT PERMIT NUMBER
-
CITY OF ATLANTIC BEACH RES19-0361
v%
800 SEMINOLE ROAD ISSUED: 12/20/2019
0.i»� ATLANTIC BEACH. FL 32233 EXPIRES: 6/17/2020
Issued Date: 12/20/2019 2 of 2
(iy_,A4r, City of Atlantic Beach APPLICATION NUMBER
40:40rn Building Department (To be assigned by the Building Department.)
800 Seminole Road Q �� lQ ._O 30
0 Atlantic Beach, Florida 32233-5445
\J� Phone(904)247-5826 • Fax(904)247-5845 C 1 `r�'i llJ `1 l c1
!"."-/ • 19%- E-mail: building-dept@coab.us Date routed: rt
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: U4 ,ent review required Ye No
Buildin {
Applicant: 01 LL-1 belo I Planning &Zoning
Tree Administrator
Project: (LO4.L.L a�� do 1( Public Works
�J Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date " 61V
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: i Approved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDIN6)
PLANNING &ZONING
Reviewed by: Date: /� — a a y
TREE ADMIN. Second Review: A roved as revised.
❑ pp Den d. ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: I 'Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
i.,-''-''''''''''-.., Building Permit Application OFFICE COPY
Updated 10/9/18
:5 ),! City of Atlantic Beach Building Department **ALL INFORMATION
.-!!' on 9? 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: (2 1 V v CV" CJ\. . Permit Number: 9A-37i t~` — °V0
Legal Description \9A \--1 ' 2S-- ")..AE. , c)cq RE# \-1 09)\2\- �7A
Valuation of Work(Replacement Cost)$ \\\f/ AO Heated/Cooled SF Non-Heated/Cooled 51_r)
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool Window/Door
• Use of existing/proposed structure(s): ❑Commercial 1esidential F ----,
• If an existing structure,is a fire sprinkler system installed?: ❑Yes �JVo
110� s~ r-,' rp.1
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ❑No £ i1
Describe in detail the type of work to be performed: DEC - 9 2019
r Q\c\ce 96 - it, k eov I. ; k - _w• ,
Florida Product Approva • 5( G2 for multiple products use product approval form
Property Owner Information / 'L<MC\\
Name N\0 A 1 CJ\cC\m Address 0 V lc‘C e�` "•
City `l(ci. State F L_ Zip ' U. Phone *OA- lc • - '
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company•r r' & 110I, _ :N\ ' lif F Qualifying Agent J Q\3On c..40 :c)pc,;c 1
Address(0t0j ( \u \C1 CO- 1 S. City T �Q� State �l _Zip -'27 SR
Office Phone q p -\o , �- Job Site Contact Number I, ''
State Certification/Registration# 'QQ,1NIx7A E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer. ` ''• '''n' '-'''-?9. > . ;`?';/OR Exempt❑ Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or install tin has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regiUing (�
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SI*S, Uf
WELLS, POOLS,FURNACES,BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE:In addition to the requirements-Jo 4 Z t
pettnit,,there MObe additional restrictions applicable tdthis property that relay be found in the public records of this count,. Z E
'there May be additional permits required from other governmental entities such as water management districts,state ager9,Ler� Z
federal agencies, 0 m o 0 Q
V V 0U 0
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance witllillll� G p
applicable laws regulating construction and zoning. O ZCCO G
QJ u. N
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT M, t- 0 z
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPER Y. IF YOU INT' 2 la
cc
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTO EY BE ORE p O wa. w m
RECORDING Y UR NOTICE OF COMMENCEMENT. uu i� w 5 o
WVN ¢ w
(Signature of Owner or Agent) ( ignature of Contractor) W W
EC cc
Signed and sworn to(or affirmed)before me this 11), day of Signed and sworn to(or affirmed)before me this J2 da of
OC.tn( Ot ,21) \ ,by MC\\'\ew c- 0, Ii 06MW, 0 ' . L .r 6,t t�/'(c
1! '- IPS..,7. IL, Wa MW lam'
(SigriAJfl �f ,1444r,1:4'6.`4,.---.,4NotaryPubiic a� by lorida Y p�, MICHELLE VAN V N
Commission p GG 203561 ;•;., k
' o' Comm.Expires Jul 29,2022 Z'3 i Notary Public-State of Florida
?pof ry; My lin
Commission#GG 203567
[ ]Personally Known 0 gonded through National Notary Assn. [ ]Personally Known O' `+�-oFfl3 ' My Comm.Expires Jul 29,2022
[ ]Produced Identifica • [ ]Produced Identifica 'n'""''Bonded through National Notary Assn.
Type of Identification: Type of Identification: