2219 W Oceanforest Dr RES20-0007 Door/Sidelight RESIDENTIAL PERMIT PERMIT NUMBER
RES20-0007
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 1/21/2020
��'
�OiS"" ATLANTIC BEACH. FL 32233 EXPIRES: 7/19/2020
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:
2219 W OCEANFOREST DR RESIDENTIAL WINDOWS/DOORS DOOR AND SIDELIGHT $4000.00
TYPE OF REAL ESTATE j BUILDING USE
ZONING: SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169463 0574 OCEAN WALK UNIT 02
COMPANY: ADDRESS: CITY: STATE: ZIP:
DREAM DOORS, INC. 5220-201 SHAD RD JACKSONVILLE FL 32257
OWNER: ADDRESS: CITY: STATE: ZIP:
SIMS ROBERT L JR 2219 OCEANFOREST DR W ATLANTIC BEACH FL 32233-4569
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 $75.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $37.50
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $116.50
Issued Date: 1/21/2020 1 of 2
RESIDENTIAL PERMIT PERMIT NUMBER
JCITY OF ATLANTIC BEACH RES20-0007
,' 800 SEMINOLE ROAD ISSUED: 1/21/2020
�`S3 ATLANTIC BEACH. FL 32233 EXPIRES: 7/19/2020
Issued Date: 1/21/2020 2 of 2
0-44;y, City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
l - - 800 Seminole Road
Atlantic Beach, Florida 32233-5445 h E , 1 C T - 000 7
Phone(904)247-5826 • Fax(904)247-5845 I
E-mail: building-dept@coab.us Date routed: / 1 �j
City web-site: http://www.coab.us t(t
APPLICATION REVIEW AND TRACKING FORM
Or hi/
Property Address: a ` Ct CSC eats--Or-e,S r Department review required Ye No
Building
Applicant: F(`e Y\ 000 CS Planning &Zoning
Tree Administrator
Project: ,._ Sig& L kcr 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: V�Approved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING —�!�/-
Reviewed by: Date: d
TREE ADMIN. Second Review: ❑Approved as revised. ❑Deni d. ❑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
I
OFFICE COPY
0 Building Permit Application Updated 12/8/17
v City of Atlantic Beach
V800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845 �1
Job Address: 7 II 4 L l,.n ,n2.5� 6, (..J Permit Number:F65.0 - 0007
4 43 c -.a5v-a,t a9-f25-a�j&37-.25-a9h / /
Legal Description Oi of.- J__l i� t.&- (- .Q 3Le RE# /6 5'1 3 -OS 7`7'
Valuation of Work(Replacement Cost)$ yCOO.CO Heated/Cooled SF .2;20/ Non-Heated/Cooled 2L"7
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool /Vindow/Door
• Use of existing/proposed structure(s)(Circle one): Commercial •esidential
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No 42,
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type ppf work to-iibe performed• r f
R.A..tt OLA- wCI�i-t'. ...104)."--. l c...(-e_\:<,-Li- (�.�`-1 k eL vle.c.i
Florida Product Approval# J-L, /'7-34-7 / for multiple products use product approval form
Property Owner Information ,, 11 /` /
Name: iyv � �Jr,it t2e e.1 ,A Addressr 3/'7 tc� O S/ E , V .
.
City,-- 1e.n�ie_' C •� State i-L- Zip 3c 33 Phone i/i3 -9.3G -c5 VO
E-Mail r is i ry'r e cMG" 1 1, Ory
Owner or Agent(If kggnt,Por of Attorney or Agency Letter Required)
Contractor Information ( i
Name of Company: bt r-N 1�r� �5. ._L✓►c_ Qualifying Agent:{ ;CIl .,_ i L_. l6h� ei d _
Address5o2�O I S i 4a cityJa.e,k�,-1,7;(k^ State f`-L Zip.3acs7 _
Office Phone ' -(- C -7�7�7�,' Job Site/Contact Number 3J '/ "77 7
State Certification/Registration#C,�L:Ia5S 5 E-Mail r r-i;Ke 1,r e -,cars• -Yi
Architect Name&Phone#
Engineer's Name&Phone# /
Workers Compensation 4.6-56c+<lccJ, ,-,c./h7eSyL c �& . ' /O-/a-avacj
Exempt/Insurer/Lease Employees/Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or installatirazihas �`
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulatg N J'
construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGN = •aZ
WELLS,POOLS,FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc.NOTICE:In addition to the requirements(eV, Z O r
permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,21t 2 5
there may be additional permits required from other governmental entities such as water management districts,state agencie) 0r.
V V
federal agencies. p V
Ui
OWNER'S AFFIDAVIT:I certify that ail the foregoing information is accurate ana that ail work will be done in compliance with 41Bz 0: Z �•
applicable laws regulating construction and zoning. V 2 a
N
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAYD a z
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTENL w w
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE w a g
RECORDING YOUR NOTICE OF COMMENCEMENT. LIL
Lu V N ¢w [
:� _
W
(Signature of Owner or •:• t) Signature of Contractor) CC C
(including contrac
gned an swornt�j/( r affirmed)before rile this, day of Igned and sworn to(or affirmed)beforeffme this �.2 da .f
rlvG7 ,by d e/'•r1.. .�46.� -&C-rrfI C,?diei,by1'11i�.hc...�I L.6he-, ecJ
��!"11.f ._.... _r_/.,.t -_ ... --
.gnatu :n olL K JOSEPH KRIEGER,JR. n ature 9 F11@ �' FINGLAND
NOTARY Notary Public,State of Maryland '' `: My COMMISSION fF GG 156645
Personally Known OR Countyof Baltirra ovally Kno R i..•,;...!-1.,.n '`=
PUBLIC o; EXPIRES:Odober30,2021
I I Produced Identification 6.9 . My Commission Expires July1 1O1 iced Identification ''•rfodi�°p` Bonded TlxuNotary Public Underwrlters
Type of Identification: ��MpRCCe Type of Identification:
Doc # 2020005257, OR BK 19062 Page 710, Number Pages: 1 ,
Recorded 01/08/2020 04 :42 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10. 00
OFFICE COPY
Permit Number J do on 07 Tax Folio Number f 7/ - Q�CO
NOTICE OF COMMENCEMENT
STATE OF FLORIDA
COUNTY OF DUVAL
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property,
and in accordance with Chapter 713,Florida Statutes,the following information is provided in this
Notice of Commencement.
1. Description of property(Street address):7.I 4k.61 .• z ,j- ;30,-eaL
Legal Descrip❑tion�� 3 �/ a�- ,py i ` 1 J R/P
1_01-// �T�6� Lyins [rtL 7ut 4.R //GSr-
2. General description of improvement: .kap G Lt L'Lr
3. Owner information: -YuZ 2_c t I4 . / _
a. Name and Address: 707 �CaL�, f-rb.-�4- iP tic�c v, �} 3ac�Cv�••
b. Interest in property: /)L.,.),-) „,-
c.
2)L..)nic. Name and address of fee simple titleholder(other than owner): `
t-.a5./j e-/V
4.a.Contactors name and address: 4 tO1 � t- .I �E_ -, . t1' 1}-��L.� 5 7
b. Phone number '.4)4 Q-'77�� Fax number �10-J�, u-O-7'71-/
5. Surety Information:
a. Name and address:
b. Phone Number: Fax Number.
c. Amount of Bond:
6.a.Lender's name and address:
b. Phone Number:
7.a.Person within the State of Florida designated by Owner upon whom notices or other documents
may be served as provided by 713.12(1)(a)7.Florida Statutes.
a. Name and address:
b. Phone numbers of designated persons:
8.a.In addition to himself/herself,Owner designates of to
receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes.
b. Phone number of person or entity designated by owner:
9. Expiration date of notice of commencement(the expiration date is one(1)year from the date of
recording unless a different date is specified)
WARNING TO OWNER:ANY PAYMENTS MADE BY THE OWNERAFTER THE EXPIRATION OF
THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER
CHAPTER 713,PART I,SECTION 713.13,FLORIDA STATUTES,AND CAN 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 INTED TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER
OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF
COMMENCEMENT.
Signatur (Owners Auth. ized Officer/Director/Partner/Manager)
/wrl ' /
(Signatory's Title/Office)
The tregoinfl instrument was acknowledged before me this '' day of b'�.`1c 20
������V) ct LL_ N dp
by t}}{f�24L(1 as 0w^� _for o r
Q u�
ar
' F in t
Notaryw ,2 x c
rc._ c
z O
t�
Personally Known or Produced Identification �c Type of identification Produced:'C-1)1- r' o
u
m o > o
My commission expires:()AV') (z o'`.. u z 2 u
Under penalties of perjury,I declare that I have read the foregoing and that the facts stated ini . e1 1$.1)
it are true to the best of my knowledge and belief.
OFFICE COPY
PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH,FLORIDA
Project Name: „�; w�._S ((�� + i I Permit # tees op06107
Project Address:o� I�l �. �l_c�L"-► i z�r 2 S� . F—t4 L —I—t G�!- 117.C. 3 c
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.floridalmilding.org.
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
A.EXTERIOR DOORS
1.SwingingX51-0-7.) I,a;,: _' w r-/ L
<1e
2.Sliding
3.Sectional
4.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
OFFICE COPY
.. ...... . ... ...::.::.. ....:.:....::..... ..
. ......... .... ......
2.Other
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
H.NEW EXTERIOR
ENVELOPE PRODUCTS
1.
�__..... m.._... . ....:.......
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.
(Contractor Name) (Print Name) 0(1.t C�1C�� L . t'1 t T ' '`-(L( (Signature)
Company Name: 100r'S --�+�1 C_
Mailing Address: �5 ) d QZ O I le 1'' 3a S 7
City: L ! '1 J+ I ([ State: 1--
Zip Code:
Telephone Number:c70 /) V" 7 7-2 Fax Number: O' ) Sh6- 7-27 5{
Cell Phone Number:( ) E-mail Address: c./1 LA-( ) j "Q1�rv�41.30& co,1