812 OCEAN BLVD RES21-0158 revision 8-31-21 Revision Request/Correction to Comments *"ALL INFORMATION
HIGHLIGHTED IN
�' City of Atlantic Beach Building Department GRAY IS REQUIRED.
iY
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Buildin -Det coab.us PERMIT#: �� --)C i -0t
i; p @
ERevision to Issued Permit OR6l 3 i /2-®Corrections to Comments Date:
Project Address: - ' , c'c '\ CSitic(. ' A -44A L..4/c___ ( <
Contractor/Contact Name: Co-)‘. . tc , LZ C.--
Contact
Contact Phone: q0471- Ife--( ( -(/y/ Email: ( Ki i)g'S e vt serve2_ 4—Coli
Description of Proposed Revision/Corrections:
l'_,- the revision/correction to comments is inclusive of the proposed changes.
(printed name)
• Will proposed revision/corrections add additional square footage to original submittal?
No Yes (additional s.f. to be added: )
• A ill proposed revision/corrections add additional increase in building value to original submittal?
E' o El*yes (additional increase in building value: $ ) (Contractor must sign if increase in valuation)
*Signature of Contractor/Agent:
(Office Use Only)
J Approved ] Denied — Not Applicable to Department Permit Fee Due $
Revision/Plan Review Comments
Department Review Required:
Building
Planning &Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities
Public Safety Date
Fire Services Updated10/17/18
`% PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FLORIDA(*REQUIRED)
*Project Address: Si Z OCC4vx 61 v1-1 Permit#: KFS 2(—01 S8
*Owner/Project Name: liav‘C\ R CC,&
As required by Florida Statute 553.842 and Florida Administrative Code Rule 61G20-3,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 Daiwa. Cr..j-tcr 1-L 16S5-6
1.Swinging Ikr;MLA- 1ry b."0 ir,PwC� FL•c 9%,5-
2.Slidingi�l-1T n.c
�7 1' c,e J
— ',Y1 cL.-2r I .10
3.Sectional \-7
C'
4.Garage Roll-Up I4T \G\1t'\ 'o a C- t'L IS-017..- 5
5.Automatic
6.Other
B.WINDOWS
1.Single hung
2.Horizontal slider
3.Casement
4.Double hung VT - -ri,p&AA—V nil C1.•2`jrot-1 t
5.Fixed
6.Awning
7.Pass-through
8.Projected
9.Mullion
10.Wind breaker
11.Dual action
12.Other
Page 1 of 4 Updated 06/21/21
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
C.PANEL WALL
1.Siding s 1-6ra Sig r- Jxi (.e.0,0f* FLi0477 1
2.Soffits �•r '� 1{i r2�'� t.6 ; Sc k FL, 13 .65, l
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 jY\ tk-Ahec eA?trlt StIck F 17461 i
3.Roofing fasteners
4.Nonstructural metal ► 5- 'MuAN:Au :n £)J FL 21423-2_
roof ►S'�1`1�o.ct
Sv;.la�� Y�'1ct�\s cDx
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 06/21/21
Category/Subcategory Manufacturer Product Description Limitation of Use State* Local#
E.SHUTTERS
1.Accordion
2.Bahama
3.Storm panels
4.Colonial
5.Roll-up
6.Equipment
7.Other
F.STRUCTURAL
COMPONENTS
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 06/21/21
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): ChCS- ,, (1,Y�C 5 *Contractor Signature: Ci s y 1 t S
*Company Name: C (\� E,V e l
*Mailing Address: O 60 Vcseck . ;A S
*City: '.W *State: r (b ;c1h *Zip Code: 1221 t
*Telephone Number: V9rA\\) '`f L\LA— It-1 *E-mail Address: C •S C,c„"N-Sc.C'i(LI
( twv
Cell Phone Number:`_`)'A\ 1-)6* I `1 Fax Number:
Page 4 of 4 Updated 06/21/21
NOTICE OF COMMENCEMENT
State of Flor'A D.. Tax Folio No. 170335-00.00
County of Dkwa\
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:
15-60 ) (o-29-29 C 46 'Pack Tccro.e.e A Sit) P 1 Lok 1
Address of property being improved: R 17. O Ceram b l sA . ��i I�w`�;�. ��eQe�f F)c r:r (x. 32 233
General description of improvements: New kn e Ce,nskr t,t_i;Dv\
Owner: Dov;c� \Cer� Address: 1019 Es `(j,,^;c\cJes i FL, 37,2 it
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor: C n n5 e.c'v c�) L•LC
Address: 50 (-,O Pc,.re* ea S._ ekshsw;l l+' F t . '12 7-1
Telephone No.: 9 0‘..\- L+`(4-l (N t Fax No:
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 t i;104f,„! 1,"="1:71iR te is
specified): r•,RE:, ..
'- `�•;� EXPIS:October 6,2023
THIS SPACE FOR RECORDER'S USE ONLY OWNERBondedThru NotaryPublic Underwriters
Doc#2021227978,OR BK 19890 Page 1365, Signed: c, I Date: BM
Number Pages:1 Befo this •ay of C in the Coun of Du ;I,State
Recorded 08/31/2021 03:05 PM, Of Florida,has personally appeared -VA
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL Notary Public at Large Stat T Florida, ntji of Duv .
COUNTY
RECORDING $10.00 My commission expires:
Personally Known: C%}__ _ �• or
Produced Identification: