10 10th ST #16 GLASS DOOR REPLAC PERM ,•j LAJJ J'!v
t';' f f _A CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
Olt > INSPECTION PHONE LINE 247-5814
RESIDENTIAL - ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES17-0277
Description: REPLACE 2 SLIDING GLASS DOORS
Estimated Value: 9400
Issue Date: 11/28/2017
Expiration Date: 5/27/2018
PROPERTY ADDRESS:
Address: 10 10TH ST Unit 16
RE Number: 170237 0044
PROPERTY OWNER:
Name: LEVIN JOAN L
Address: 2315 MILLER OAKS DR N
JACKSONVILLE, FL 32217-3507
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: HOMERITE WINDOWS AND DOORS
Address: 4801 Executive Park CT N BLDG 200 STE 207
JACKSONVILLE, FL 32216
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU 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.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500. For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
01-m-,..4_, City of Atlantic Beach APPLICATION NUMBER
Js 1 Building Department (To be assigned by the Building Department.)
• 800 Seminole Road
Atlantic Beach, Florida 32233-5445 { E S �7 ` O Z 7 7
Phone(904)247-5826 • Fax(904)247-5845
A.0;� 0. E-mail: building-dept@coab.us Date routed: I ( j ( S /C 7
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I v 1 — �(0 Department review required Yes/No
' + i B �
V
uildinq
Applicant: I`"1 Om,G-RCI VOt N00(0S £ boofz7 g&Zoning
Tree Administrator
Project: Z. S L.[(J(/\DG G Lass Dooe., Public Works
Public Utilities
Public Safety -
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review Receipt Date
of Permit or 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:
APPLICATIONLISTATUS
Reviewing Department First Review: ✓Approved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
UILDINt;
PLANNING &ZONING y 1� —��—�7
Reviewed b : �� Date:
TREE ADMIN. 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
moi..-��t,, ; \ita
BUILDING PERMIT APPLICATION
,_ s=
7_,)
CITY OF ATLANTIC BEACH OFFICE COPY
800 Seminole Road,Atlantic Beach FL 32233
u;tls)''/ 1 Cr, Office: (904)247-5826 • Fax: (904)247-5845 i[ €.s /7 _ v Z.77
V�tz LWl
Job Address: IC) 10 iiS 1- (4}Lc..-, '... t3‹,34,,.., til Permit Number:
Legal Description t(o--)___S - ZQ g '-f'--tfie C6 t54.9e-Co.t1�RE#
Valuation of Work(Replacement Cost) $ 9, yod o� Heated/Cooled lJSF��u ititer( Non-Heated/Cooled /6251-f
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool indow/Door
• Use of existing/proposed structure(s) (Circle one): Commercial eside •
• If an existing structure, is a fire sprinkler system installed?(Circle one): e.: N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Af .• • e ► e -e ' - : al
Describe inn detail the type of work to be performed: FL 2-0S38 , 6't
e, Qep4rk:trele- I~- • SS S1, A : Qav2 .
Florida Product Approval#_ for multiple products use product approval form
Property Owner Information
Name: SDA' j_ti Vi►-‘ Address: a 31 ITN: (l.e, (De ,k s O
City .0-4.4.4s�-V. .I( c. State H Zip 301 a.i ) Phone i•4 •08 3 - ('S'7.S
E-Mail
Owner or Agent (If Agent,Power of Attorney or Agency Letter Required)
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR A14,-ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
Contractor Information:
Name of Company:Uonr,4.ei 1-L WA-,looms 1- 000i ' Qualifying Agent: Mf(i-014-o (34)c.,
Address: 4ao( 'f.c tca,, l-'i£ 11-k 4,1- City..li:.cs,.:.v.•t I t State Zip 301. . 1 (o
Office Phone ' O'-1' a glo- a s 16- Job Site/Contact Number ri
State Certification/Registration# C.4 C151 2:17-1 E-Mail
Architect Name & Phone#
Engineer's Name & Phone#
Worker's Compensation Tw 35 q? Z 41) it/zOW
xempt / 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 installation has commenced
prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction.
This permit becomes null and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a
period of six(6)months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,
Signs, Wells,Pools,Furnaces,Boilers,Heaters, Tanks and Air Conditioners,etc.
Signature of Property Owner. &el,' �� .- Signature of Contractor &. I _
Befo e me
this 5' Day of v0 _-- Before me this Day of 04.../- 01.01"1
ROYAL GATES DEAREN III
Notary Public: i 1. �;' - . mission#F
_ F 19. 8Not. Public: i
__g
tairio •DEAREN!ii
E A Z,yl^•, Bonded T1uu Troy Fain Incurence 800-,785-7019 COttlmisslon#FF 190928
I hereby certify that I have read and examined this application an. know t ie same to be true and con: . ,U�,'•o>�j>� d+ 1:�O�t�d
ordinances governing this type ofspecified work will be complied with whether speced herein or not. Theo . - s i,,384044
presume to give authority to violte or cancel the provisions of any other federal, state, or local law regulating construction or 1-
performance of construction.
Rev. 3/14/16
Perymi 4/ .R 1' -0 277
NOTICE OF COMMENC1I NT
State of H v. i 1 County of 'b(414-... l Tax Folio No. t p .
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 C 0, t I CEMENT.
Legal Description ofproperty being improved: ,. - - f
1,
16w �. n I
Address ofproperty being improved: 10 10 4'''' S.I.._
I Lam I-(L. gY.d4-.L wl S.AA, 7 V/►; E'• t'- ,(.
General description of improvements: f2 a t-g,,.,.t.,L GI rs.s S S 1. Z..
Owner: .--TO A- Z Vi',•-• Address: /0 1614'S i.. /3 t=L C.,1-r4. A s�4-
Owner's interest in site of the improvement: Pe-s,,-,-.. 1.L...-.. Ft 3 as 33
(,�,,,,I✓ L ko
Fee Simple Titleholder(if other than owner):
Name:
Contractor: I•�✓►-L.(<l F� —
Address:• 4$6 l L xc g c FI V4. , t. • c, 15( , t(, ; l-
�{ Q( moo..
Telephone No.: �►'b�•l•��(� '� t S F ------ax No: rp��- .4(: . "
Surety(if any) —
Address: —
Amount of Bond$
Telephone No: - Fax No: — Q
Name and address of any person making a loan for the construction of the improvements -i1
Name: T1
Address: n
Phone No: Fax No: m
Name of person within the State of Florida, other than himself,'designated by owner upon whom notices or other documents may be Q
served: Name:
Address: ,------
Telephone No: Fax No: `'
In addition to himself; owner designates.the following person to receive a copy of the Lienor's Notice as provided in Section
713,06(2)(b),Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No:, _-- Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is
specified): Z -, 15" .. e:1 g
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Sign ,...„/ Date;///go J/ '?
Before me thi 34) day ofin th County of Duval,State
Of Florida,has personally appeared. %7�,V/N
, Personally Known:
Produced Identif : or
_ NotaryPublic: —" 'T�
Doc#2017261438,OR BK 18186 Page 1079,
Number Pages: 1 fission expires: /n/d7 ��
•=•.1451 2D, S
*.'iy•., III
Recorded 11/14/2017 10:05 AM, tat = ROYAL GATES DEAREN Commisslon#FF 190928
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
COUNTY %'€.i Expires May 20,2019
RECORDING $10.00 ''4,R„, BendadTMu'troy Uri inswame•masa+9
. OFFICE COPY
PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH FLORIDA
Project Name: .�"oA Z. ✓r Permit # Q S 7 0.27
Project Address: le) 1,04' 51- at-:i—r— .k.c.. 6 L- i}-L C&�, t. L • i G
As required by Florida Statute 553.842 and Florida Administrative Code RuleB-72,please provide the information and product approval number(s)
for the building components listed below as applicable to the building con tion project for the permit number listed above. You should contact
your product supplier if you do not know the product approval number for any bf the applicable listed products. Information regarding statewide
.roduct approval may be obtained at:www.floridabuildi .oig.
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
A.EXTERIOR DOORS 1
1. Swinging
• 2. Sliding ; C.W S 6/4.0- s/.1. - D4
3. Sectional {
4.Roll up 15:Automatic • al_
WINDOWS
1. Single hung •
. 2.Horizontal slider
3. Casement
111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
10.Wind breaker
11.Dual action
'
2. Other
Category/subcategory o `-- — J__._
g ry Manufacturer Product Description Limitation of Use State#
. .... Local# ._ . .. .
H.NEW EXTERIOR
ENVELOPE PRODUCTS
vL
1.
2.
In addition to completing the above list of manufacturers, product description and State approval number for the products used on thisr
ject, the
Contractor shall maintain on the job site and available to the Inspector, a legible copy of each manufacturer's printed specifications and installation
on
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.
;072sr ROYAL GATES DEAREN HI
Rr 41% ..: Commission#FF 190928
z��..%=.:a Expires May 20,2019
irAli '. Bonded Thiu Troy Fan Insurance 600385.7019
r
(Contractor Name) (Print Name) b.h Q D_ �jp� y�t> I I
V
(Signature) i41
Company Name: �` f� 5
l � v� � ►tic�v�s � Iri lr
Mailing Address: 4701 6.lLpet4}tv P`(.3-( S19 £.q J� 7.Z 7
City: 4. O'lc'1-,( til,(0
State: 6_ Zip Code: 3L2-(
Cg
Telephone Number: (fit f ) 7 Q(p,... 7.5(S- Fax Number: ( ) z.,Q6, ,y
25-- Z8"
Cell Phone Number: ( ) E-mail Address: f c (. e c