123 Pine St RES20-0031 Windows/Doors (--;11.41.4..rk, RESIDENTIAL PERMIT PERMIT NUMBER
, % BEACH RES20-0031
• . .. ,..v, CITY OF ATLANTIC
.511$ 1
iii
800 SEMINOLE ROAD ISSUED: 2/11/2020 I
`4013 v� ATLANTIC BEACH. FL 32233 EXPIRES: 8/9/2020
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:
123 PINE ST RESIDENTIAL WINDOW AND DOORS $17577.00
WINDOWS/DOORS
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170636 0108 SALTAIR SEC 03
COMPANY: ADDRESS: CITY: STATE: ZIP:
Preservation Home 128 Seabury Or Ponte Vedra Beach FL 32082
Specialists
OWNER: ADDRESS: CITY: STATE: ZIP:
GARRETT KAREN S 123 PINE ST ATLANTIC BEACH FL 32233-4011
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.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $140.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $70.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.15
STATE DCA SURCHARGE 455-0000-208-0600 0 $2 10
TOTAL:$215.25
Issued Date: 2/11/2020 1 of 2
City of Atlantic Beach APPLICATION NUMBER
��s 1 ,� Building Department (To be assigned by the Building Department.)
..- 9 800 Seminole Road
r .- o c_sz c/3-r__3
j_,, . Atlantic Beach, Florida 32233-5445
\ Phone(904)247-5826 • Fax(904)247-5845
r it (
9- E-mail: building-dept@coab.us Date routed: �
CD
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1 Z 3 pi kx�. S - ent review required Ye o
r- �
140/A
Buildin
Applicant: LAR e suzockTI Q,� pE el AC sh_Planning &Zoning
Tree Administrator
Project: L ND 0 0c4... S > a 00 i2,S Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Review or Receipt
Other Agency Review or Permit Required of Permit Verified By Date
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 ,<.?cf
Other:
APPLICATION STATUS
Reviewing Department First Review: I 4proved. Denied. Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING n �a 0
Reviewed by: Date:
TREE ADMIN. Second Review: ❑Approved as revised. � �Denid. INot 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
f"4.
r ,,
Building Permit Application '
S Updated 10/9/18
',. ,,;.,.., CCity of Atlantic Beach Building Department **ALL INFORMATION
`, HIGHLIGHTED IN GRAY
\ :_ 800 Seminole Road, Atlantic Beach, FL 32233
,��;:;9r IS REQUIRED.
Phone:3 (904) 247-5826/�ZL Emaill: Building-Dept@coab.us
Job Address: / .3 f4 ire, 4Y Y . &dell Permit Number
: E�Z C()
c
Legal Description 10 -16 21 -2.3 -- Vie . 051 S i LTA-12 5e c 3 RE# 170 (i 360 '0/08
N//2 Lof &02-
Valuation of Work(Replacement Cost)$ (7 151-7,p0 Heated/Cooled SF I I a y Non-Heated/Cooled 5/U3
• Class of Work: ❑New ❑Addition ❑Alteration ❑RepaiSr� ❑Move ❑Demo ❑Pool Window/Door
• Use of existing/proposed structure(s): ❑Commercial faResidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes lifiNo
• Will tree(s)be removed in association with proposed project?❑Yes(must submit separate Tree Removal P� er_m-ith I%No
Describe in detail the type of work to be performed: M 8 A-11+ Fw((1/40 1- 0 bS CRL6
_R t_R _ 2. 5G i-- I O w i n d 0 w S ( F} 11 t Ed t rns) b6-14,(9-Q2_ Owl-el 1
140 S-(-rw c E• C kaM b ,'_- ''
Florida Product Approval# Priki24t. p Pc 1( %N i iv luAA2 56.11 for multiple products use product approval form
Property Owner Information
Name �f`�Q�adn S. C9aw -€ z3 Address lPine St .
City (4-+t 441c Bch State 9C( Zip 3ag-33 Phone 9'D+/ -/4 A. — (20 .2..O
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information // L
� �
Name of Company Pn wafim /Ivm.eSrJlCicc/ Is Qualifying Agent 141/1.../177- C �Gt�L isl r
Address 1$9.55 3 r +. N. City \J p er✓h State F/ Zip 3,P-.z(T0
Office Phone loci-563 -5107/q Job Site Contact Number0V-B.5 3 -5 7 r7 9.r 3/5'527-FX4 f
State Certification/Registration# KC( /3//378 ii"( E-Mail /Ka. _ 7? 'R 1rL/ ✓✓a/irnhS . Cc)'?? 1 7-71.Architect Name&Phone# i; . - C7 CI. i-
Engineer's Name&Phone# ;` iW' Z 1.ti.
Workers Compensation Insurer FI NK- (20/71 OR Exempt D Expiration Date /"/ - 2-4.5- U C
Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or installation s
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulatirz cc t,
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SI43S, 2 `C
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICEi-I a,¢diti.n-korthe requirf, ep •$ fir '12 C
permit,there may be additional restrictions applicable to this property that may be found it tlt public re&oYds of this iasi:) •', W
there may be additional permits required from other governmental entities such as water manag ent disi`ricts;state .I ' •rtiC z
L]
federal agencies. Lit ;+- u, W }
c" `Yccw9. o
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be dpEEin cor pl withal w C3 w
applicable laws regulating construction and zoning. JJ CCUUCCVV W co III
5 CC w
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OFC NINENCEMENT MM'
w
'Ir r t cc
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PRbF?tERtY. IF YOU INTEND
9, OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
_
' . O• DI • ' �� - ' NOTICE OF COMMENCEMENT.
s„ � m
? F i � Ik v act
"•1 ,(at e of Owner or Agent) (Signature of Contractor) c`'1<(;;)
x� D o LlJ 0(.9 0
c� •i '5 2. dayof Signed and sworn to(or affirmed)befo e me this da zin'� N v
a qq •.i• ed and sworn to(or affirmed)before me this /J g , y ' .N
SM `tI , Zo ,/, ,b / - �!' ,- ,- lJT , 44A- ,�w ,b ',UAX • a/ LQ.2Ec
''".z� I , i' II. ' ,� : ._L_. . a �_1. a Eci-,
N�o (Signature of Notary) ' (Signature of otary) =o U
o to Z
ImT • uu
p i.
c •, ]0ersonally Known OR ,(+y„Personally Known OR
'<I •roduced Identification 1- 94� [ ] Produced Identification ';__
.e of Identification: L ' h ''' 30 . Type of Identification: __ };,• ; I
NOTICE OF COMMENCEMENT OFFICE COPY
Perm)) - 2 o -- C)e'3/ QQ
State of F I Tax Folio No. [7 b(03 10 —0 ) O L?
County of 1 WV41 (---
To
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: f 0 - (in p 1 — 2.S - 2, cl E • 0 5 7 "574 urn-(12. SC 3
NJ (/ 2 1--0-t- 64 a 2 3 _
Address of property being improved: (�?) 4)I (�} - 5-1--- �i I be G1 P ( (-c7R3_3
General description of improvements: R w- V.. to u in flows 4- 2- S G `S
Owner: ren G k-r2 itetr Address: 12 3 Pf ne., Sf-- . II 41 ech Pi 3 3_
Owner's interest in site of the improvement:( /
Fee Simple Titleholder(if other than owner): L�-------
Name:
Contractor: P I/V(it (IVY) 4 YYVe S CL'all st-<, Sc c_ ( 3 i f Sf f3 ti 94
Address: I yd.6-I I — J
4G �
�' , .<1gG 3„1- -s--b
Telephone No.: q 0 `/-
S 5&7e] Fax No: 0
u> CC
Surety(if any) --- o
ai U
CD
Address: Amount of Bond$ c H
Telephone No: Fax No:
o? Q U
Name and address of any person making an for the construction of the improvements m o Y
ow
Name: - a: o(3 c
NJ
Address: a' o w
O o>C�S 2
Phone No: Fax No: a co o w
P -0 w>- c
Name of person within the State of Flori. other than himself,designated by owner upon whom notices or other documents may 4,'. o z z c
o n Ii)00u
be served: Name: azraoQ
Address:
Telephone No: Fax No:
In addition to himself, owner designates t e following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2) (b), Florida Statues. (Fill in at Own-r's option)
Name:
Address: E
Telephone No: �'/ Fax No:
Expiration date of Notice of Commencfinent(the expiration date is one (1)year from the date of recording unless a different date is
specified): \\ _
THIS SPACE FOR RECORDER'S USE ONLY OWNER /?o:;% Q
Signed: jC q ate: i 1 -rQ a-N -1
Before me is .2 a.,i, day of /rpa�M•'31-it thie Coup'of Duval, tate �-
Notary Pubic 6ta1s d Florida Of Florida,has personally appeared ,o.- wiz,....
'�'"`�^^ A`L
,118°4\ John C Meyers ,
My Cortxniafon " a
GG 336464 Notary Public at Large,State of Flo ,County of Duval.
co or Em 03/16(2023 My commission expires: t7 s--- R, z:)• ')
Personally Known: or
Produced Identification: 1 ... 2�t- CP•(o�0 ci i.'L-1.7etbC�
,z
, i ��..,. ...Y
PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH FLORIDA
Project Name: Q�t,(M Permit # V2 5020 — 'b3• t
Project Address: 19,3 •Pi P'-+ I ES ch PL 3 a-a 33
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 I Product Description Limitation of Use State# Local#
A. EXTERIOR DOORS
1. Swinging _ ...
.......... ..........
2. Sliding A rn Z if t!/ • • • ' tiU . off-- VµZ _F-L,.1232.30 1. 3. . 3/
3. Sectional
_
4.Roll up — —
5.Automatic
6. Other
B. WINDOWS —
1. Single hung
2.Horizontal slider
3. Casement
4.Double hung R-m.i 3 Do 0f • ���
U 72.0 .? N/4
5.Fixed
----
6.Awning --------
------ --_- ----i --- --
7.Pass-through
8.Projected
1 +
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
J
ENVELOPE PRODUCTS _ 1 -__ __
- - - -----------
1.
- -
2.
In addition to completing the above list of manufactui-rs, 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) (Signature)
Company Name: /� m - A-
�1K.�y v I�i..�<J ata/ /1111[ _ i
im
Mailing Address: ?-5- 3 2-dsh •
City: Tap c State: Zip Code: 3 2Zs-O
Telephone Number:
p (T0`l) $ J 3-5-6 Z 5 Fax Number: ( )
n hs
Cell Phone Number: (315) 5�7 -'85 g� E-mail Address: e � �"dv���� 'Cir)-am