1738 W Park Ter Kitchen, Bath Remodel Submittal f
'..,: '-''''%,, , Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
ig;
� 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
'UMW,' IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 1738 w PiO0.4G TE-i2-itiQG$ Permit Number:
Legal Description 3'4 Sr 09. Z•3 • 296, 3etvv ".is-..44 K.-.•t p 4-or X36 /0 RE# ‘72-02-6 -- 36y
Valuation of Work(Replacement Cost)$ !0/000• cie Heated/Cooled SF 214q4 Non-Heated/C
...v.1)
• Class of Work: ❑New ❑Addition Iteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Do MAY 2 7 1021
• Use of existing/proposed structure(s): ❑Commercial Residential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes ,1S-No BY:
• Will tree(s) be removed in association with proposed project? ❑Yes jmust submit separate Tree Removal Permit) ,IN- ,:;
Describe in detail the type of work to be performed: / ' cP "-1 z 7w 4c,,..fc'Z,.c, REPS
/N STAt..� / SL-..beg_ 67 AZ-0 72-
!tip.v,C7 o t,S F.Qo•✓7 - S .�-,c S'/Z� i 7 P c,-tr 2 '�4C.� a-' Do c LJ ii_6-,a 2-
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name JAMES P r2,/Esr"), Address /'738 /9404 `T' 4 t"J
City •i►Tdt AP-/7-IG ,$FrA�sd _ State F‘• Zip S:7—1. 3 Phone 844 • 5/78. 713
E-Mail r i es` 98 A '-• C-.-wl
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company , ,c,c-i.J GR-o"� "-' cQualifying Agent G``' '- 1 i°'`--/ .Q 'goo(- '<1
Address 20 1"--'11;"--1- B°°`a` L .) -st-te. City "'2o.1e PA A-14-- State GL Zip 320 4.!—
Office Phone l o c/• 2-/s- d a/4 Job Site Contact Number %41 - `/`{9 . 6,-1'3
State Certification/Registration# c-ac 132 G g2g E-Mail 67•co...s-/-/----c-/--.o.J Ae•L-. co4-.1
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt Expiration Date 5-b 4(2-S
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,SIGNS,
WELLS, POOLS,FURNACES,BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. 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.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
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 AN ATTORNEY BEFORE
RECO 1-NG Y.,. ' NOTICE F COMMENCEMENT. ��
i (Signature o ) . er or Agent) :.- . -of Contractor)
/ S /
Sii jned and sworn to(or affirmed efore me this day of Signed and sworn to(or affirmed)before me this �� day of
/e�3 .�v`� , bV'c�► iB- C. ,?O2- ,by Lj \'t a.m,''l3c.c�1 i 1A
CC! 1 ignature o tary) /f� (Signre of NocarYl
oi� g..
LARRY WALTER
a;"`" Notary Public-State of Florida
• : is is a Commission N GG 140597 viu4••a
[ I Perso art: = OR [ )P nally Known OR ;__z�}" •. ;JACK SCABAROZI
w c•, My Comm.Expires Sep 4,zoi l . :,•_Commission#GG 247125
[tr}'(srod e�l T�errti#ic i n _ [ roduced Identification
• ':7;...,...7..;:, Expires August 9,2022
Type of Identification: / i 1''t �4 Type of Identification: -' , •?•' •• • , • , -rice 800.385-7019
NOTICE OF COMMENCEMENT , /�
State of 4 /--4) .4 Tax Folio No. /7 20 2C 7
• G a` .
County of 4- VA £-
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to ertain real property, and in accordance with Section 713
of the Florida Statutes,the following information is stated in this NOTICE COMMENCEMENT.
Legal Description of property being improved: 3V- 23-r- d 9 • Z • 2`)F (S'E`vio 1�.t IfZ vtil d-
c. 7 i 3 a L.dc. /o
Address of property being improved: /7 a8 44./ ,0,4
General description of improvements: c. >c sf �,,/ arta "-ICD v�c—,e-
Owner: -"MA-1E-5- q,Al-4/6 /5 Address: /738 '1 IDAAir- 7114E
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor: 2.,=' C
Address: 7° /4"icl1 /sf7 aosc .7�.t /o L 4-4.L./9 /'Aft ' ' 3z-D6
Telephone No.: ?b` ' 2 i 5 e. Fax No: 9°4" 2-I t i lc
Surety(if any)
Address: Amount of Bond$
Telephone 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:
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):
✓ THIS SPACE FOR RECORDER'S USE ONLY OWNER
LARRY`iJALT[' /
Notary Public stat, //h.0.2.71�/
Doc#2021135347,OR BK 19742 Page 311, gned: 'u, '= omni 'u Clu
Number Pages: 1 afore m s l day of / Li, 6k1t'.,cpteuMty of Duval,State
Recorded 05/27/2021 01:11 PM, f Flori" has personally appeared .• _ •.i •• '
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL otar, Public at Large,State of Florid., .un y of Duval.
COUNTY ly commission expires: 6 #'"/ 2 01-/
RECORDING $10.00 srsonally Known: or
•oduced Identification: 2'/2,J l/ii"_ L-.('Geij t"
' PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FLORIDA (*REQUIRED)
*Project Address: /738 4.t-' 'ALA. "fe---ie-a-i4C Permit#:
*Owner/Project Name: -JAot—te 3 c . 2. /
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 Product Description Limitation of Use State# Local#
A.EXTERIOR DOORS
1.Swinging
2.Sliding Illi i 400 auk us;04 ) I6 /5 24 0 ( 2. 6
3.Sectional
4. Garage Roll-Up
5.Automatic
6. Other
B.WINDOWS
1.Single hung
2. Horizontal slider
3.Casement M i daor 0,2, , f 710 15 3 SO . l
4. Double hung
5. Fixed M i Acor AN4 w'aduto 3.c00 /8 b `f K . Z
6.Awning
7. Pass-through
8. Projected
9. Mullion
10.Wind breaker
11. Dual action
12.Other
Page 1 of 4 Updated 10/17/18
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
C. PANEL WALL
1.Siding
2.Soffits
3. EIFS
4.Storefronts
5.Curtain walls
6.Wall louvers
7.Glass block
8. Membrane
9.Greenhouse
10.Synthetic stucco
11.Other
D.ROOFING PRODUCTS
1.Asphalt shingles
2. Underlayments
3. Roofing fasteners
4. Nonstructural metal
roof
5. Built-up roofing
6. Modified bitumen
7.Single ply roofing
8. Roofing tiles
9. Roofing insulation
10.Waterproofing
11.Wood shingles/shakes
12. Roofing slate
13. Liquid applied roofing
14.Cement-adhesive
coats
15. Roof tile adhesive
16.Spray applied
polyurethane roof
17.Other
Page 2 of 4 Updated 10/17/18
fir
Cate. bcategory Manufacturer Product Description Limitation of Use State# Local#
E.SHUTTE
1.Accordion
2. Bahama
3.Storm panels Illi
4. Colonial
5. Roll-up
6. Equipment
7. Other rill
F.STRUCTURAL
COMPONENTS 111.
1.Wood
connector/anchor
2.Truss plates
3. Engineered lumber
4. Railing
5. Coolers-freezers
6. Concrete admixtures
7. Material
8. Insulation forms
9. Plastics
10. Deck-roof
11.Wall
12.Sheds
13. Other
G.SKYLIGHTS
1.Skylight
2.Other
H. NEW EXTERIOR
ENVELOPE PRODUCTS
1.
2.
Page 3 of 4 Updated 10/17/18
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.
bt
*Contractor NamePrint Name): W ('4'1 A- -. ) *Contractornature:�- "-- Si
� ) g
*Company Name: AA./c
*Mailing Address: �c a'ok ?419
*City: GL�l/Icj lSG-A 4) *State: L *Zip Code: S ZB o -4
*Telephone Number: pa c/. Z'S-• G,/0 *E-mail Address: '—•-/s Ao L . c-.4*�..
Cell Phone Number: 4 q• c/(9• L(ici 3 Fax Number: �a(71 • Z/cy
Page 4 of 4 Updated 10/17/18