1209 Beach Ave RES20-0092 Win/Door City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
r800 Seminole Road {� ` / Z
Atlantic Beach, Florida 32233-5445 1 \�JV w�
Phone(904)247-5826 • Fax(904)247-5845
n )•r E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ' ZO` A COAG-1 Av a artment review required Yry No
Buildin�
Applicant: (::Rt0ER,, 01L7S arming &Zoning
Tree Administrator
Project: LiD (,Q2 c)(A £ cc) Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date N.3€.1
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: (proved. Denied. ❑Not applicable
I' <<
(Circle one.) Comments:
\�a lva � v r` o 1 -e blank.
BUILDIN
PLANNING &ZONING Reviewed by: Date:11'471-4PC)
TREE ADMIN. Second Review:
'Approved as revised. I (Denied. I 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
rrt,' -''% Building Permit Application Updated 10/9/18
s,` OFFICE COPS
`�4 ' City of Atlantic Beach Building Department **ALL INFORMATION
\ 800�r 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Lust IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
\
pt@coab.us �*`
Job Address: /,.?09 d�/1C2. i / Lm Tr( Re--/q-cis Permit Number: ESZV "•" /w9
Legal Description 6 -I e b - S - ,29 6 /9'3 Loll /, ,,.),3 �,?L,'S6 RE#
Valuation of Work(Replacement Cost)$ Heated/Cooled SF Non- Heated/Cooled
• Class of Work: ❑New ❑Addition EAlteration ❑Repair LIMove ❑Demo ❑Pool I Vindow/Door
• Use of existing/proposed structure(s): ECommercial lecesidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes Ktivo
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit)XNo
Describe in detail the type of work to be performed:
f
ecootoi r /e,h as l PA",..240c eric a 7 S
Florida Product Approval# S0 C5.4040rei for multiple products use product approval form
Property Owner Information ))
Name —ILA 6 i i t S. . eel u at vi e r 01UOc146I1I4-•y1Address /e2 0 c1 82 I C L 6/
City /`7-1- -r,itt ,8E•ia t I. State r/ Zip 3 2 3,3 Phone 9 o v '/C "-1 y 'L
E-Mail J.SBCH-LA r Ce' (i91N i?. / 1
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor InformationtiI _
Name of Company c.�7I4 i' Cpl171 24,,,e- Qualifying Agent‘//�
Address p?p$ 1/7 h . ,(/6 4 CI" City Ail�C/� State HCl Zip 3,2) 33
Office Phone 37 2' 71 4SJob Site Contac Number
State Certification/Registration #CJRG /321329,5" E-Mail- G"/_r +j ��r d/.7"
Architect Name& Phone# 4/#
Engineer's Name& Phone# i..„
Workers Compensation Insurer OR Exempt, Expiration Date Z tD
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or instattnt' j
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws re laiig '-
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, F ,i7: 2 H
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE: In addition to the requiremotskgft00 Qn
permit,there may be additional restrictions applicable to this property that may be found in the public records of this coitutvM 0
there may be additional permits required from other governmental entities such as water management districts,state agoc�,ora
federal agencies. V J u. to
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance thief! t: Z
applicable laws regulating construction and zoning. VLi. LL cc n
maw m
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT IV r LU 5 m
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU II''gfid oow w
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER O' AN ATTORN Y BEF RE E w
REC RDINGrIAR NOTICE OF COMMENCEMENT. °C
cti G Es%/ nt)
`f/l
(Signature of Owne (Signature of Contractor)
Signed and sworn to(or affirmed) before me this day/of Signed and sworn to(or affirm-0) before me this2- day of
... _ , by 5)d I-l - €GJ L,ei" IARfC ' , .',i •y A A a ,-S%
21/(sr.. , XPi rop_.„.
,(. nature df tttab V O'CONNOR
MARISSALORDA ,'....."-.1\...--,' Notary Public-State of Florida
..,:6.',;;,,,,p, -
l • Commission#GG 177533
'4• ••• = MY COMMISSION#GG 228145
��� "''+�i i 4.7/MyComm.Expires Jan 22,2022
[ ] Personally Known OR T"4�•.P EXPIRES:June 12,2022 ,, ] ?e r s o n a I I y Known OR dog,dod:Irou,�hNtaimnalNotary Assn
•fi[A/Produced Identification
",f.iffc;4•' Bonded ThruNotary Public Underwriters Produced Identification
Type of Identification: dck�LC� t_. ��C�
Type of Identification: t�f <,i P!� 1 C c✓�( YP S
OFFICE COPY JOB COPS
�_ PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FLORIDA (*REQUIRED)
*Project Address:_ILO -` 3Egcm_41/z= Permit#: O2 C So-, --cog 2-
*Owner/Project Name: )3 edt.V,10or
As required by Florida Statute 553.842 and Florida Administrative Code Rule 96-72, 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 i ManufacturerIProduct Description Limitation of Use State# I �T Local it
A.EXTERIOR DOORS � 1
1.Swinging _ Aileigk__ - v - 1 i/1 la 1
2.Sliding W 'L
3.Sectional I Z il
i - = �
4. Garage Roll Up l - _ - az
_ Q •
- 5.Automatic { -- - CL W o o
•
6.Other --- - - - -- O m E z lij
a
B.WINDOWS I -f- - - --- -- E Z < Z
1.Single hung - -__-_t - O 4 C
- - a
2. Horizontal slider - - U F- N f-
3.Casement I ¢ iu
t
4. Double hung ..i el545 /7 e !) _ 1 Z 1 _ L a cc -03
5. Fixed - d���r>�1 - Pi /631 -1::,-191_-
6.Awning - - - - - - w O cn w
7. Pass-through w
--CCw
8. Projected ------ ----- - - - ----- cc
9. Mullion ./146rA _ i. . , f /01.1•3
10.Wind breaker
11.Dual action
12.Other
Page 1 of 4 Updated 10/17/18
4 OFFICE COPY JOB COPY
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 /) *Contractor Signature:
Name (Print Name):67:try �fg G�
*Company Name: 6f)).er (04 .7J 1 V th Z4c
*Mailing Address: a OS- /I4 �e Gr
*City: "74/0:071—;C. ,��=f 322&3
*State: � *Zip Code:
*Telephone Number: ``" — 3 7 '. 7/41_5" *E-mail Address:�f,1AI"CCoti6Y dl/./i�' IX .COON
Cell Phone Number: Fax Number: _
Page 4 of 4 Updated 10/17/18