725 ATLANTIC BLVD UNIT 6 PPI24-0004 ATLANTIC COAST APPLIANCE BUILDOUTRE#171363-0000
building permit application I OTR INTERNAL OFFICE USE ONLYAtlanticBeachBuildingDepartmentPERMITtt
800 Seminole Road,Atlantic Beach,FL 32233 .»aii-*-7 .V **AIL information required to processPhone:(904)247-5826 Email:Buildlng-DeDt@coab.us I
Job Address 725-6 Atlantic Blvd.Atlantic Beach.PL 32233 RE#171363-0000
Legal Description 2 ROYAL PALMS UNIT A 3 LOTS 1,2,3(EX PT RECD 5294-36,4 5649-1182,PT IN R/W)BLK16
Valuation of Work (Replacement Cost)$75,000.00 Heated/Cooled SF 2381 Non-Heated/Cooled SF 0
•Class of Work:□New OAddition ISjAlteration UlRepalr DMove □Demo OPooI HHWindow/Door
•Use of existing/proposed structure(s):[x]Commercial OResidentlai •If existing structure,is a fire sprinkler system installed?:[I]Yes|X]No
•Will tree(s)be removed in association with proposed project?EH Yes (Must submit separate Tree Removal Permit)|x|No
Describe In detail the type of work to be performed:
THE PROJECT SCOPE IS TENANT BUILD-OUT FOR A RETAIL SPACE THAT IS A PART OF AN EXISTING UNIT.Tenant buildout for Atlantic Coast
Appliance.All interior atleration.
Florida Product Approval #NM
Property Owner Information Name atlantic-penman llc.
Address 500 S 3rd Street Ci
(For multiple products use Product Approval Information Sheet!
Phone 904-305-1370
icksonville Beach State FL Zip 32250
Phone 904-249-0698
Phone 904-249-0698
Address 500 S 3rd Street City Jacksonville Beach State FL Zip 32250
Email brittanyndriverl@gmail.com Owner or Agent (If Agent,Power of Attorney or Agency Letter Required)
Contractor Information Name of Company Dimension Construction Phone 904-249-6094
Address 1045 N Liberty Street City Jacksonville State FL Zip 32206
Ouallfying Agent Ramin Partow State Certification/Registration#CGC1S08799
Email ramin@dimensionconstruction.bi2 Job Site Contact Number Ramin Partow
Worker's Compensation Insurer Builder Insurance OR Exempt EH Expiration Date 12/31/2024
Architect's Name Craig Sommers Emailcsommers@dsae.net Phone 904-249-0698
Engineer's Name Caren Doherty Emallcsommers@dsae.net Phone 904-249-0698
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 befound inthepublicrecordsofthiscity/county,and there may be additional permits required from other governmental entities such as watermanagementdistricts,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 ail applicable
laws regulating construction and zoning.
♦♦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 SITE OF THE IMPROVEMENT BEFORE THE FIRST
INSPECTION.IF YOU INTfNOiRfOBTAIN FINANCING,CONSULT WITH YOU^ENDER OR ANATTQENe^FORE RECORDING YOUR NOTICE OF COMMENCEI#NT.
Signature of Notary —
[M^ersonally Known OFK []Produced Identification
Type of Identification:
BRITTANY FAYE DRIVER
Commission #HH 516773
Expkes April 28.2028
Signature of Notary[tf^rsonally Known OR
Type of Identification:
Produced Identification
BRIHANY FAYE DRIVER
**Commission ft HH 516773
ExplrMAprt28.2028
Form # 9B-3.053-2002-01
Notice to Building Official of
Use of Private Provider
Effective January 20, 2003
Project Name:
Parcel Tax ID:
Services to be provided: Plans Review Inspections
Note: If the notice applies to either private plan review or private inspection services the Building
Official may require, at his or her discretion, the private provider be used for both services pursuant to
Section 553.791(2) Florida Statute.
I____________________________________________________________________________________, the fee
owner, affirm I have entered into a contract with the Private Provider indicated below to conduct the services
indicated above.
Private Provider Firm:
Private Provider:
Address:
Telephone: Fax:
Email Address (Optional):
Florida License, Registration or Certificate #:
I have elected to use one or more private providers to provide building code plans review and/or inspection
services on the building that is the subject of the enclosed permit application, as authorized by s. 553.791, Florida
Statutes. I understand that the local building official may not review the plans submitted or perform the required
building inspections to determine compliance with the applicable codes, except to the extent specified in said law.
Instead, plans review and/or required building inspections will be performed by licensed or certified personnel
identified in the application. The law requires minimum insurance requirements for such personnel, but I
understand that I may require more insurance to protect my interests. By executing this form, I acknowledge that I
have made inquiry regarding the competence of the licensed or certified personnel and the level of their insurance
and am satisfied that my interests are adequately protected. I agree to indemnify, defend, and hold harmless the
local government, the local building official, and their building code enforcement personnel from any and all
claims arising from my use of these licensed or certified personnel to perform building code inspection services
with respect to the building that is the subject of the enclosed permit application.
I understand the Building Official retains authority to review plans, make required inspections, and enforce the
applicable codes within his or her charge pursuant to the standards established by s. 553.791, Florida Statutes. If I
make any changes to the listed private providers or the services to be provided by those private providers, I shall,
within 1 business day after any change, update this notice to reflect such changes. The building plans review
and/or inspection services provided by the private provider is limited to building code compliance and does not
include review for fire code, land use, environmental or other codes.
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The Barley Consulting Group, LLP
John M. Barley, II FAIA
4168 Oxford Avenue, Jacksonville, Florida 32210
904.387.5855 904.387.5330
john@barleygroup.org
AR-0005067
Tenant buildout for Atlantic Coast Appliance
171363-0000
Shahab Derazi