1763 Seminole Rd RES19-0365 2 Windows/1 Door ' ,' .. `` RESIDENTIAL PERMIT PERMIT NUMBER
r ' �,6 19-0365
CITY OF ATLANTIC BEACH RES
19-0365
ISSUED: 12/20/2019
800 SEMINOLE ROAD
.ti- EXPIRES: 6/17/2020
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:
1763 SEMINOLE RD RESIDENTIAL WINDOWS/DOORS 2 WINDOWS AND ONE $7845.00
DOOR
TYPE OF I REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169636 0200 OCEAN GROVE UNIT 02
COMPANY: ADDRESS: CITY: STATE: ZIP:
HOMERITE WINDOWS AND 4801 Executive Park CT N JACKSONVILLE FL 32216
DOORS
OWNER: ADDRESS: CITY: STATE: ZIP:
SHADDEN JOHN WILLIAM 1763 SEMINOLE RD 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 $90.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $45.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.03
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $139.03
Issued Date: 12/20/2019 1 of 2
.,:l'-''''r,� RESIDENTIAL PERMIT PERMIT NUMBER
f' CITY OF ATLANTIC BEACH RES19-0365
''�! �" ISSUED: 12/20/2019
vJr3 ,r 800 SEMINOLE ROAD EXPIRES: 6/17/2020
ATLANTIC BEACH. FL 32233
Issued Date: 12/20/2019 2 of 2
rt�l,/, City of Atlantic Beach APPLICATION NUMBER
�' ' ,1 Building Department (To be assigned by the Building Department.)
r 800 Seminole Road - VMBE R
,5 . Atlantic Beach, Florida 32233-5445 � � V ttCV�
Phone(904)247-5826 • Fax(904)247-5845 / IL9^p; >% E-mail: building dept@coab.us Date routed: I 2- ft I
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: L 7(0 .3 ve1f flopLe KID De artment review required Ye No
ilc_2_ Building ,}
Vining &ZoningApplicant: �' 0 rY\e�(TG (A). iLpr-)06)- .
Tree Administrator
Project: 2 W I/OWc vs ONDC-- `)OCA ft 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: 4proved. ❑Denied. ['Not applicable
(Circle one.) Comments:
BUIL G
PLANNING &ZONING /� !�
Reviewed by: / y Date:/d• -/7-1 9
TREE ADMIN. ki
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
..�s'�'"ir-�. Building Permit Application Updated 10/9/18
'Y.?,'City of Atlantic Beach Building Department OFFICE COPT
INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 lr HIGHLIGHTED IN GRAY
jcitv
oit U' IS REQUIRED.
Phone: (904) 247-5826/Email:: Building-Dept@coab.us r ( (,,
Job Address: ( 1(01 SO Ga 00/!..12 ted• Permit Number: ��ESl 9 `--) 3`"'" 5
Legal Descri tion 4 6-F)& 9'-ZS._2-9A1()Co:ik. ` . - / •.r• put
Valuation of Work(Replacement Cost)$ `le9c--ec- Heated/Cooled SF &J A- Non-Heated/Cooled ,,OA
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool HWindow—H/ /Door CW.I \.
���� 1
• Use of existing/proposed structure(s): ❑Commercial I�'Kesidential Z y ,
• If an existing structure,is a fire sprinkler system installed?: - ❑Yes IRNo ...I Q _0
• Will tree(s)be removed in association with proposed project?❑Yes must submit separate Tree Removal Permit oc Q H
Describe in detail the type of work to be performed: O m 1= Q
CI?
A i, W V Q 0
Florida Product Approval . '-' -- -. Q 1,- /0 for multiple products use product appro vfwn0 a
I---j
(n
Property Owner Inform-Don y,,,,,,,a,,2 ( h IN,. I—
Name '441,4;k_ £AUdt? �.o rt. Address / `7(c 3 S,�2rti(�N,e.)(D 1(4)- I, 5 w •City A-t-t ofccr-C 6.etc State ��, Zip .j Z z 3 J. Phone 04-( -4/5'_,6 f/. 0 . W
E-Mail ' , ..j r , 1 ) , ti CC m
Owner or Agent(If Agent,Power of Atto ney or Agency Letter Required) Al A- $ =tgl-rw p W
Contractor Information W ) cn CC W
` ( (') �J,--(a-._ W
Name of Company `14A)l+vi 4 tK tef� �_ ex�� Qualifying Agent J2 f vl �� C`/� w
Address '�$U( L�yC1j L t'1C, ff - •-- t� `r City ' 7 -Ituca1 State KJ_ Zip 'zzzi;, w
Office Phone q Z 2,5 4.5-- Job Site Contact Number
State Certification/Registration# CC/C_ ZS(1-7 41 E-Mail e (.1(1y£41 Pvt- (g i OA,/Q fi`-L O IA41, (
Architect Name&Phone# —
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt o Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or installation has
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,.S GN
WELLS, POOLS,FURNACES, BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE: In addition to the requirementso a#i
permit, s[)
there maybe additional restrictions applicable to this property that may be found in the public records of this county,aftd' '
there may be additional permits required from other governmental entities such as water management districts,state agencies,or
federal agencies.
DEC( 11 3019
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compiance wit a
applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY. 4,
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND?, -.'
TO OBTAIN FINANCING, CONSULT WITH ui L NDER OR AN ATTORNEY BEFORE
RECORDING.a YOUR OTIC OF CO ME � n4-1 a(2-1-1 i r)--"...'.. . -
Qj - --
(Sig ature of Owner or Agent) 4 1 i 1 I I# (Signature of Contractor)
Signed and sworn to(or affirme before me t'•s day of Signed and sworn to(or affirmed)), fore me this day of
A , 7&( ? ,by •; .� . .1)6, jL3/;_ .by `( ,(e-
4FIrgt ) _-� .f cry)
49 N Notary PuWlc State of Florida r° wry Pubic State of Florida
PMet T Ruvarac ��,�
Peter T Ruvarac
[ ]Personally Known OR j My Commission GG 1079e2 ltf Personally Known OR 14aM1 �Y Commission GO 107902
[ ]Produced Identificati. orttidF Exp" :s n.r2 4/2021 1 1 Produced Identification 05/24/20ti
Type of Identification: '''$'." Type of Identification: -
NOTICE OF COMMENCEMENT OFFICE COPY
L� / n,,��r
(PREPARE IN DUPLICATE)
Permit No. �'Sl! (9 % S Tax Folio No. j(v T"(/;) - (97
State of Florida County of Duval
To whom it may concern:
The undersigned hereby informs you that Improvements will be made to certain real property,and In
accordance with Section 713 of the Florida Statutes,the following Information is stated in this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: 2-0 07-.S – ) QL
� aLnc- A VV 2- A.) /z- 1/444
Address of property being improved: ! 7( j. S 2 f ( iP 2
4i7,/d.t f �[iC (C- 1/2.?3
General description of improvements: Replacing windows doors. Size for size.
Owner n�Y 'c i i i( cc 2.A
Address (1 s So�. i ( t: r• ' . _ -Le_f
Owner's interest in site of the improvement Primary residence
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Homerite Windows and Doors
Address 4801 Executive Park Court BIdg.200 Suite 200 Jacksonville,FL 32216
Phone No.904-296-2515 Fax No.904-296-2528
Surety(if any)
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name
Address
Phone No. Fax No.
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other
documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in .)'s"kO
Vmuir
Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option).
Name mc-oz z
Address c�a a
Phone No. Fax No. N qq
A M i k
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a N cn
different date is specified): "'0
THIS SPACE FOR RECORDER'S USE ONLY4.1,kiretOWNEa7�1 �/ sSig DATE___ _-t-1"'. I 14 n
Before me this day of ` 0 ` u.l r rn ria l 1
Doc#2019282582,OR BK 19033 Page 291, :minty of Duval,State o Florida.h. • al appeared s
Number Pages: 1 l , a herein by
g iimsetti herself and affi th- a l statements a declarations herein
Recorded 12/11/2019 08:46 AM, ire true and accurate
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
COUNTY `
RECORDING $10.00 •
j
Notary Public at .'•_,=I•=.e o AV . County of
My commission-••res: I
Personally Known ' 2-1 or
Produced Identification urn
OFFICE 'COPY
PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH,FLORIDA
Project Name: ^5- Vid(0. t .Q0.
Permit #21$/9--oar 36S
Project Address: n L
As required by Florida Statute 553.842 and Florida Administrative Code Rule 9B-72,please provide the information and product approval
for the building components listed below as applicable to the building construction project for the permit number listed above. You should cont(c)
tact
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.or•.
Category/Subcategory
Manufacturer Product Description Limitation of Use State#- U
A.EXTERIOR DOORS Local)0, NotyCi
1. swinging
_ . .I �f
2. Sliding . 4r •
3. Sectional
4.Roll up
5..Automatic _
B. WINDOWS
1. Single hung
2. • • •- r i
3. Casement
4.Double hung
5.Fixed
6.Awning
7.Pass-through
, 8.Projected .111111.1111111111111111111.11111 I
, 9.Mullion
10.Wind breaker
11.Dual action
OFFICE dopy -
2. Other
'; Category/Subcategory -
Manufacturer
Product Description 'Limitation of Use
H•NEW EXTERIOR State# Local#
ENVELOPE PRODUCTS
In addition to completing the above list of manufacturers, product description and
ector, ale legible co State approval number for the products used on this project, the
Contractor shall maintain on the job site and available to the Ins p g copy of each manufacturers 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 certifythat use o
listed in this document must be approved by the Building Official. f different components other than the ones
(Contractor Name) (Print Name)
_:'(Signature) ii
Company Name: . -._: s., ‘ , 0 1 i/
Mailing Address: , p ; op a : C
'z
J a C
City: Ce_______________
I( e
State: Zip Code: ,.r�
Telephone Number: ( r ) l
Fax Number: ( �(Ly4,) # rCell Phone Number: J �`
((L H ) 7 E-mail Address: