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Permits 1127 Atlantic BlvdCITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5826 Application Number 09-00001104 Date 8/21/09 Property Address 1127 ATLANTIC BLVD Application type description FENCE PERMIT Property Zoning TO BE UPDATED Application valuation 9400 ---------------------------------------------------------------------------- Application desc 6 FT WOOD FENCE ---------------------------------------------------------------------------- Owner ------------------------ 316, AMER. LEGION POST 1127 ATLANTIC BLVD. ATLANTIC BEACH FL 32233 Contractor CONCOR COMPANY JAMES LACOUR 14286-19 BEACH JAX BEACH (904) 219-3050 BLVD #335 FL 32250 ---------------------------------------------------------------------------- Permit FENCE PERMIT Additional desc . Permit Fee 35.00 Plan Check Fee .00 Issue Date Valuation 0 Expiration Date 2/17/10 ---------------------------------------------------------------------------- Special Notes and Comments *2007 FLORIDA BUILDING CODE W/'05-'06 SUPPLEMENTS. 2004 FLORIDA FIRE PREVENTION CODE 2005 NATIONAL ELECTRICAL CODE *ALL FENCES OR ENCLOSURES OF LAND SHALL BE SUBSTANTIALLY CONSTRUCTED. *SCHEDULE FINAL INSPECTION ONCE FENCE HAS BEEN COMPLETED. PERMIT AND APPROVED SURVEY MUST BE AVAILABLE FOR FINAL INSPECTION. Access to existing forcemain must be granted on a 24hr/day, 7dayjweek basis. Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 35.00 35.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 35.00 35.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. r~x''''''%'%,: CITY OF ATLANTIC BEACH =~ d' 800 SEMINOLE ROAD, ATLANTIC BEACH, FL 32233 N OFFICE: (904)247-5826 ~ FAX NO.:(904)247-5845 `.". ~; ~`r BUILDING-DEPT~COAB.US •. ~'~;,~,. ,!~ BUI LDING PERMIT APPLICATION 09- ~ I ~ ~ ~ DUVALCOUNTY _1;dOB ADDRESS: '2. VALUATION OF WORK 3x80. FT: UNDER ROOF ~Ia~' ~+~c'~(~'("rC ~nJO~Vc'jft71~ ~~~ oa 4: LEGAL DESCRIPTION: 5. CLASS'QF WORK 6: USE OF STRUCTURE: ~`f 115 y I ~; I ~ ~ I ~ 'S2 c'h a H LOT_ BLOCK ~ SUB DIVISION t= i~} ijoc K ; ~ ~ {-~ ' Q .>"'~ ^ NEW BUILDING ^ DEMOLITION ^ gDDITION ^ CONVERTING USE ^ RESIDENTIAL ~ COMMERCIAL " 7. DESCRIPTION-0F WORK: ^ ALTERATION ^ ACCESSORY BLDG. 8: FIRE`SPRINKLER: r 6 `NOO ~ r (_ N Ct I I'll 5 ~ ~/~ T1O 1~( ^ REPAIR ^ POOL! SPA ~ ^ YES ~d N!A ^ MOVE OTHER ^ NO PROPERTY OWNER: CONTRACTOR: ARCHITECT I ENGINEER: 9. NAME: Ama,riza,~ L.~gto~ I~O~~T 3it~ 15. COMPANY NAME: ~.aavGc~lS C~~, are 23.COMPANY NAME: N 18. NAME: ` ~ ~ 24. LICENSEE NAME: ~ YYI~ ~ U R a 10. ADDRESS: .y. ; ~ ~ ~ ~ 17. STATE OF FLORIDA LICENSE NO.: 25. STATE OF FLORIDA LICENSE NO.: J l l IG 17[> ~1/c~CC r ~'~'la I~ ~ ~ C:(aC Oe.l ~{~ ~- (( ~~ 11 1. L I C- ~'I'r~Ir111G 4}~C(~ 18. ADDRESS: I''{~~,Qi~i"(~~ ~.1~'-~C~ ~IvGt.~33~ 26. ADDRESS: / .~a~ks~~~til~ ~~ aaaKO 11. OFFICE PHONE: ~1~U- "~4s t 12. FAX NO_: 19. OFFICE PHONE: 3~3 i 13 t 20. FAX NO.: :~~3 X559 27. OFFICE PHONE: 28..FAX NO.: 13. CELL PHONE: ' 1 " 21. CELL PHONE: 29. CELL PHONE: ~ ~ ~ _ ~ ~ ~ t ~ O '~ 14. EMAIL ADDRESS: apa~h~~kL i~e~~5,;~}~ . ~le~- 22. EMAIL ADDRESS: atmL.Accv2 L CkllsG~fi~,.~c~- 30. EMAIL ADDRESS: FE StMP.LE TITLE HOLDER:" (IF OTHER THA)V OWNER) BONDING COMPANY: MORTGAGE LENDER: 31. NAME: ~~n ' t 33. NAME: ~ n 35. NAME: ~`'~ 32. ADDRESS: N ,r ~ 34. ADDRESS: E`~l ~ 36. ADDRESS: 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 (ti) months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Si ns, Wells, Pools, Furnaces, Boilers, Heaters, Tanks, Air Conditioners, etc. 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. I will not occupy or use the referenced building or any part therof, until all inspections are finaled and prior to obtaining a certificate of occupancy ar completion issued by the building official, as required by law. ~ WARNING TO OWNER: ~- YOURFAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE F{RST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. OWNER oir AGENT `CONTRACTOR (If Agent, Power of Attorney or Agency l.e4te(Required) (Quafifiar only) t~~ Signed: ~^ ~~ ~- Date: e~`J~f O G Si d '~ ~ ~ ~ D ~~ ~ gne : Date: i Before me th s , day of , 2009 in the county of Before met is day of , 2009 in the county of Duval, State of Florida, ~as~ pQerQso~n+a~lly appeared y ,^, ~-,t',r L puval, State o lorid~ ~ p sonatly ap ear ~ ( / / ~ r r YID L3y ( A Y ~ J ~,t t ! herin by hims e lf / Herself and affirms that all statements and declarations are herin by himself /herself and affirms that all statements and declarations are true and accurate. ~ ~ ~ true and accurate. / (]~ Notary Public at Large, State of _~~ .Cyr! , County of '`YG ~ ~ Notary Public at Large, State of I / , County of ~V ^ P sonally Known r,.' ~ ~ ~ ~ ~ , _ ^ Personally Known ~ roduced Identficatio 1 Q~roduced Ident~ca6on ~ ' Notary Signature: ~ Notary Signature: 1 ~tw.Yrei~m..~.u=$Are~Mybrr ttttye i~~4 =.At•' "~ys;-, MICHELLE B. BLOODWORTH ''`` r.' =^ MY COMMISSION # DD 82ti487 BLDGDi Permit Application B ~ gy. 2/18 ry„°„f,`,.•~` FIRES: Sept. 28, 2012 ttN°44 ~iq~M p~'^~£ MICHELLE B. BLOODWDRTH •K My COMMISSION # DD 826487 `%y,;;„;°:~~ EXPIRES: Sept, 28, 2012 17, elh~P~ i Cam- (' P~ Cst,,, ~~ l,~ ~ r~ "~i ~r R.O.W. Permit Attachment of R.O.W. Permit # issued 200 for II~~- Rtla~nt'~c ai~c~ Atlantic Beach, FL 32233 ~mec~ can I-eG~on i1~~ Atlan~~ Ui~d A} land-, c ~cc~ ~~ 3`di Owner's Name: Property Address: Subdivision: Lot # /Block #: R.E. #: $~ (< 14,E t 5~ 1 6 ,1 ~ 9 ~ $ `r7L'cPOn ~-f REVOCABLE ENCROACHMENT PERMIT THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of 200_, by Atlantic Beach, Florida, a municipal corporation organized and existing under the laws of the State of Florida, hereinafter referred to as "CITY" and ~imec~ cG,~ ~c~cn P©st 3t~ of Atlantic Beach, Florida, hereinafter refereed to as "USER". WITNESSETH: That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon the property of the City of Atlantic Beach far the purpose as described in the City of Atlantic Beach Right-of--Way/Easement permit numbers noted above (copies attached). This work is generally described as: !~e ma ~ a i o~ wood ~p rx~' a 5 heeo(ec~ +o C~CC~S'S Rr~al W1C711R"~t71/1 a4.~ ~'~tu~/1T' ~l7fCe 1'~i81r1 c~lOnr~ ~~1@ ~S~ ~(~~~,_ ~I nP s t ~~m~} ilumbeS Cannl~c~-{~vn~ ~~t 6 woo~1 -~Pnr~ i < <# d~ - llO~. Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to relocation or removal on thirty (30) days notice by CITY to the USER, said notice to USER shall be given by certifi d mail, return receipt re uested, to the following address: Ii~~ A4iay~-hc 3~~tey~rc~ A+1~3,~~L 3c>_~~h ~L The depositing of said notice of cancellation in the United States mail shall constitute the notice of cancellation and the burden is upon USER to keep the CITY informed of USER's proper address. The USER shall promptly make any and all necessary repairs to any facility erected or maintained in the exercise of the privilege herein granted and shall at all times maintain said facility in good and safe condition. In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter upon the above-described property of the CITY, the USER shall replace at the USER's sole expense, any and all material necessarily displaced during the action of maintaining, repairing, operating, replacing, or adding to of the utilities and facilities of the CITY or franchise utility provider. The facilities allowed by the permit shall meet the current requirements of the City Code, Building Codes, Land Development Code, and all other land use and code requirements of the CITY, including City Cade Section 19-7 (h) which states "Driveways that cross sidewalks: City sidewalks may not be replaced with other materials, but must be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks." Page 1 of 2 Public Utilities Plan Review Comments Date: $ 13)0 ~ Initials• Project NamelAddress: (~ a ~ ~t (,~„fi~ B(Vd Application Permit #: Q~ - ~'~ Cheek Box APplicatian Tracking Comments to Add Comment Avoid damage to underground water/sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is needed, call ~1 247-5834. Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and ^ visible. A sewer cleanout must be installed at the property line. Cleanout must be covered ^ with an RTl concrete box with metal lid. Cleanout to be set to ade and visible. A reduced pressure zone backflow preventer must be installed if irrigation will be provided or if there is a private well on the property. Backflow preventer must be ^ tested by a certified tester and a co y of the results sent to Public Utilities. Plans note the building will be unsprinkled. If plans change, any fire line installed must be metered with a Sensus touch-read meter in a properly sized vault and an appropriate backflow preventer installed. Backflow preventer must be tested by a ^ certified tester and a co y of the_results sent to Public Utilities. if fire sprinkler system is provided, contact Malcolm Clemons at 247-5839 for bacl~low requirements. At a minimum, will require double check backflow ^ reventer. Fire lines must be metered with a Sensus touch-read meter. Meters larger than 2" ^ must be installed in a vault as noted in JEA s ecifications. d ~ ~ - - - , `I T r ~ - ^ l ~ - f }Cce~s -fo ~ish~ ~~c-~.ra ~.~ rx use ,be g ~~ ~ ~ a~~~ ~ ~~vas %s ~ ^ ^ ^ ^ ~r Showman, Lisa To: jimlacour cQbeltsouth.net Cc: apachefk@bellsouth.net; Kalzuniak; Boyd, Nancy Subject; Building Permit Application for 6' fence lames: Public Utilities has denied permit application #09-1104 for the 6' wood fence at 1127 Atlantic Blvd. The following comment applies: "Fence must be kept out of the easement. There is a 24" effluent force main along the west property line that serves all three beach cities." Please submit revised plan to the Building Department at your earliest convenience. If you have any questions please call 247-5826. Thank you. Lisa Showman Administrative Assistant :~ d; •sc+~ 7 g. 6.82 » .7 _,_..._-- ..~---^"_"'. ~ » 11.65 ,_~_._...._._ .....\ ~ a t ' 10. ~ ~ti ~ o ~ ti - .. a~ 11 cat it `.- ~ ~ i,:8s ~. z ~ :« ~1 .., sci-fi' Sg=~+ ~ ~" 30'7 e -~ ti~ wns~ WA7~ +~ ~ 7op.laos ~ ~ _ ~? 12.0 1984 ~qg~ in o C? x ~~ °' a c1~aN It.`.~~ 11.3a` t;, 10. ~ ctE fp to.15 ,,, -t.tt ~, - ts.oo' -- tt1.TtP t-~ c~ 10 ~~ ~¢ .. - _ x e r.. to GYP= _ - - . -. _ W PL 1u ~:. ' - 1a2 N. ~ ~ c~ 1U.1 - ~~ W - .~ {7. ' ,~•3t is ~ IQ t J.M ~ 10.45 ~^ 10.22 13.54 _ - _ - a ~ x E _ ~~ ~. _. 'd e 1D.5`~ 9.72 8.72 ~ ~ ~-60.40 t0.22 •n tCl.T4 e . f2 f7 8. 2 y.6ti 1i. ~ ' o - ! ~a3 tf .4z r ~ - 11.69 11.61 9,39 ~ 10.48 11.60 9.88 pjjj M. - 11.21 pSptlpl.•7 . 980 _ 73 - - y o 70-a4"~--..lath 1O g ......-----"'`- J a _. a 9.23 8-TO ..------ ~s.:sr~;. City of Atlantic Beach ~~~ r .h : ,'.~'r~ Building Department ^' \'~ 800 Seminole Road j'`,, ' ~*'" ~' Atlantic Beach, Florida 32233-5445 ~_ ., Phone (904) 247-5826 Fax (904) 247-5845 ~~~~ ~;;~~%= E-mail: building-dept@coab.us City web-site: http://www.coab.us .APPLICATION NUMBER (To be assigned by the Building Department.) Date routed: APPLICATION REVIEW AND TRACKING FORM Property Address: `~2 7 ~~~~~ ~~/,b Applicant: ~ j~/~ CQ~. f~ Project: h/a~D ~ .. . _. Review fee $' ~ ~ - nt review required Yes o nning & Zoni Tree Administrator ublic Works ilities Public Safety Fire Services .....,~. Dept Signature ~•--. Other Agency Review or Permit Required Review or Receipt of Permit Verified By Date 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: Approved. ^Denied. (Circle one.) Comments: r. _._.._i_~ . BUILDIN PLANNING & ZONING Reviewed by: Date: r ~~ 4 TREE ADMIN. Second Review: ^Approved as revised. ^Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ^Approved as revised. ^Denied. Comments: Reviewed by: Date: Revised 05/14/09 -iy1P1:r r ~,,.. '.' . J ~. 'wOi;)Jr City of Atlantic Beach Building Department 800 Seminole Road Atlantic Beach, Florida 32233-5445 Phone (904) 247-5826 Fax (904) 247-5845 E-mail: building-dept@coab.us City web-site: http://www.coab.us Praperty Address: !~2 ? ~a~~-G ~ ~i/,d Applicant: 0.6/11 CQ~ Project: 1'1/od~ ~ Reviewed by APPLICATION- STATUS Reviewing Department First Review: (~(~oved (Circle one.) Comments: BUILDING LA ING & ZONIN ADMIN. PUBLIC WORKS PUBLIC UTILITIES PUBLIC SAFETY FIRE SERVICES APPLICATION REVIEVlI AND TRACKING FORM .APPLICATION NUMBER (To be assigned by the Building Department.) Date routed: nt review required Yes No anning & Zoni Tree Administrator ublic Works u ilities Public Safety Fire Services Review'fee $ __ _. __ .: Dept Signature .. , ^ .' Other Agency Review or Permit Required Review or Receipt of Permit Verified By Date 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: ^Denied. ~- Date: ~~`v,3 Second Review: ^Approved as revised. ^Denied. Comments: Reviewed by: Third Review: ^Approved as revised. ^Denied. Co~mmeu~ts: Reviewed by: Date: Date: Revised 05/14/09 jq/,,-.~~=•-"~'`'rr CITY OF ATLANTIC BEACH '~j r~ 3 ,. cd~ B00 SEMINOLE ROAD, ATLANTIC BEACH, FL 32233 - ` ~7 OFFICE: (904)247-5826 ~ FAX NO.:(904)247-5845 '"~ ~ BUILDING-DEPT~COAB.US -' °_~~=~~ BUILDING PERMIT APPLICATION 09- I l C I I DUVALCOUNTY 1:308 ADDRESS: ' 2. VALUATION OF WORK 3. SO: FT. UNDERROOF 4. LEGAL DESCRIPTION:' 5'. CLASS OF WORK: 6: USE OESTRUCTURE: ,/ ' H' 115 I I &, I ~ ~ I $ ~~ C'h a '1 H ~ ' ~ "'} ^ NEW BUILDING ^ DEMOLITION ^ RESIDENTIAL 'l~~ {~j,,, K t ;3 j~{ LOT_ BLOCK r! SUB DIVISION EtiY1 Q > ^ ADDITION ^ CONVERTING USE ~ COMMERCIAL T: DESCRIPTION OF WORK: ^ ALTERATION ^ ACCESSORY BLDG. 8: FIRE SPRINKLER: , 6 vVOU~ ~LNCir IriIST?~~T1VI\I ^ REPAIR ^ POOL! SPA ^MOVEOTHER ^ YES d WA ^NO PROPERTY OWNER: CONTRACTOR: ARCHITECT /ENGINEER: ' 9. NAME: T 3i~ I~o r L A 15. CDMPANY NAME: ~;o~1Gt7i' C 23. COMPANY NAME: ~ ~ ~g,o ~ m~+rt~a,~ am ate 1 16. NAME: 1~~5 h a ~U~ 24. LICENSEE NAME: 10. ADDRESS: p ~ ~ ` - 17. STATE OF FLORIDA LICENSE NO.: ` 25. STATE OF FLORIDA LICENSE NO.: r.~/ IG I ~V2tC~~i F j~ ~~ A'FI"~~'1 } C:C~C r7 i,1 ~~ /1+'.~n1_ C ~~~ I„~ }=L ~"l f~ 16. ADDRESS: I.t~C~i(~,. i'~'~ {?~~s~~~ ~)vC~.~33fj 26. ADDRESS: / J2ck 5c~u, 11~ (=L 3~~,rs0 11. OFFICE PHONE: ~,~U- "~4s t 12. FAX NO.: 19. OFFICE PHONE: ~a3 i 1~3 t 20. FAX NO.: '~`d3 ~S59 27. OFFICE PHONE: 28. FAX NO.: 13. CELL PHONE: ~ A~a~ _ f ~ ~l, a l? -[ 21. CELL PHO%N~E: ~~~ l ~~5~ 29. CELL PHONE: 14. EMAIL ADDRESS: apa ~ he f kL i~e(I~;.~}~, . Ines- 22. EMAIL ADDRESS: .~tm trA ccv2 @ ~I I~t:•~~~,.!~e~- 30. EMAIL ADDRESS: FEE SIMPLE TITLE HOLDER: QF OTHER THAN ONMER) BONDING COMPANY: - MORTGAGE LENDER`. 31. NAME: ~ ~~ 33. NAME: ~ ~ 35. NAME: ~}'~ 32. ADDRESS: N~~ 34. ADDRESS: N ~ 36. ADDRESS: 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, Si ns, Wells, Pools, Furnaces, Boilers, Heaters, Tanks, Air Conditioners, etc. OWNER'S AFFIDAVIT - 1 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. I will not occupy or use the referenced building or any part therof, until all inspections are finaled and prior to obtaining a certificate of occupancy or completion issued by the building official, as required by law. *~ WARNING TO OWNER: ~ YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR 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. OWNER or AGENT CONTRACTOR (If Agent, Poway of Attorney or Agency,Letter Required) (Qualifier Only) ,. Si ned: ~~ D te ~$ O "G ~ D ~(~ Si d g a : B f h ~~L" gne : Date: ore me t e is day of , 2009 in the county of Before met is day of , 2009 in the county of Duval, State Of Florida, as p ~onally appeared ` '- ' , p L ~ Duval, State o lorid~ I~as p~sonal(y ap ea / p , , l J , J / l ( ~ rs( r ~ j / S ~ J Y f / l ~ ( /1 ` , p / ` herin by hi lf erself and affir m e / h m s thatah statements and declarations are herin by himself / h e lf rse a nd a ffi r ms t h at all statements and declarations are true and accurate. ~ , true and accurate. / ~ / /~/~ Notary Public at Large, State of _~~ .~`_, County of V /`Vy ( ~ / / Notary Public at Large, State of I / ,County of ~17 4lY ^'~ P~~onally Known r,' ~ ~ ` ~ ^ Personally Known ~ I~roduced Ident~catio 1 O~oduced Ident~cation ~ ~ Notary Signature: ~ Notary Signature: / ..~ ~ .~ \µ\Iy,1 \\tl11yV ~~+ r r~ 4 1....., '•, 3 i1 i a$ 9,;,= MICHELLE B. BLOODWORTH +°`~ '"~{,:r~ MICHELLE B. BLOODWORTH sy'-'F MY COMMfSSION # OD 826487 ':e.e„'';. NIY COMMtSS10N # DD BLDG01 Permit Application B g. 2N8 % 826487 1,°„;; ,o` FIRES: Sept. 78, 2012 '%-.°~'~\0:~~ EXPIRES: Sept. 28, 2012 ,/q\N~ ~ -r ~~ -s~~,y;J~;: City of Atlantic Beach r ~FV~~ ~'-~~j Building Department At1G 8 ~ ~~~~ ^' -^"• ~ ~ 800 Seminole Road ~J ~r ^~' Atlantic Beach, Florida 32233-54 ,._ :, Phone (904) 247-5826 Fax (9 •~~~ ~;;~~r E-mail: building-dept@coab.us City web-site: http://www.coab.us .APPLICATION NUMBER (To be assigned by the Buildin Department.) ~~ _ ~~~ ~ Date routed: APPLICATION REVIEW AND TRACKING FORM Property Address: `~~ 7 ~a~~-~ ~l/,d Applicant: ,6,1V CQ~ Project: ~~djj ~ ~ rrr~nt review required Yes No Public Safety Fire Services nning & Zoni ~ Tree Administrator ublic Works __ fee $ De t Si Nature , _ _.._. Review Other Agency Review or Permit Required Review or Receipt of Permit Verified By Date 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: Reviewing Department First Review: (Circle one.) Comments: BUILDING PLANNING & ZONING TREE ADMIN. PUBLI OR S PUBLI U L S PUBLIC AFETY FIRE SERVICES Second Review: Comments: Third Review Ccmments: APPLICATION STATUS ^Approved. Denied. Reviewed by:/ i~~~ Date: pproved as revised. ^Denied. Reviewed (p ~f Date: ^Approved as revised. ^Denied. Reviewed hy: Date: Revised 05/14/09 rs~~,~~;. _. City of Atlantic Beach ~ ~ ~ "' '' ~,, . '"~°~~•,SS Building Department ~~~1G d 3 2049 ~~ 800 Seminole Road • ~`~'"' ~' Atlantic Beach, Florida 32233-544 ~.7 ,_ ., v Phone (904) 247-5826 Fax (90 - ----- ~•:` r~;;l,%' E-mail: building-dept@coab.us _ City web-site: http://www.coab.us .APPLICATION NUMBER (To be assigned by the Building Department.) Date routed: APPLICATION REVIE1nl AND TRACI~CING FORM Property Address: !~~ 7 ~a~~-~ ~I~,d Applicant: C,6~ CQ~ Project: 1'~0 dD ~ nt review required Yes No nning & Zoni Tree Administrator ublic Works ilities Public Safety Fire Services Revl~w fee $' _ ~ Dept Signature Other Agency Review or Permit Required Review or Receipt of Permit Verified By Date Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: Reviewing Department First Review: (Circle one.) Comments: BUILDING PLANNING & ZONING TREE ADMIN. PUBLIC WORKS PUBLIC UTILITIES PUBLIC SAFETY FIRE SERVICES APPLICATION STATUS Approved. ^Denied. ~, \ Wr.,~kewwte( t''~aw~,o~(, o ~t s ~ ~ 't-ed~CC ~ ,/~, , ~ ~~~~~ Reviewed by: - Date: Second Review: ^Approved as revised. ^Denied. Comments: Reviewed by: Date: Third Review: ^Approved as revised. ^Denied. Comments: Reviewed by: Date: Revised 05/14/09 s s-t~LJ'r,.,t CITY OF ATl~1NTIC BEACH ,r ~ - s ih'' 800 SEMINOLE ROAD, ATLANTIC BEACH, FL 32233 ';y' ~ ~ OFFICE: (904)247-5826 ~ FAX NO.:(904)247-5845 '~~ BUILDING-DEPT~COAB.US w~=~=1}>~ BUILDING PERMIT APPLICATION os- I I I I I DUVALCOUNTY 9.U06 ADDRESS: . 2: VALUATION OF WORK 3. SO. FT. UNDERROOF ~ i a(T ~ ~' ~ c~' iPl ~"1 C ~ n _/ ~ L° ~'' c'1 f L'1 i /O/S v a ~` (,/ 4. LEGAC DESCRIPTION:' _ 5: CLASS'OF WORK: __ 6. USE OF STRUCTURE: I'I' y 15 y I t~~ 1 ~} ~ f ~ ~~ ~~^r at1 I'I ~ ' ~ `~ ^ NEW BUILDING ^ DEMOLITION ^ RESIDENTIAL LOT_ BLOCK SUB DIVISION ~I'} (?js K i$ ~cir+=.F;=f^ ~ ~ ^ ADDITION ^ CONVERTING USE ~ COMMERCIAL 7: DESCRIPTION OF WORK ^ ALTERATION ^ ACCESSORY BLDG. 8. FIRE SPRINKLER: • 6 +/'~0~~ F`NCir II\iS~~nU1~( ^ REPAIR ^ POOL /SPA ^MOVE OTHER ^ YES \@i WA ^NO PROPERTY OWNERN' CONTRACTOR: ARCHITECT ! ENGINEER: 9. NAME: 1 /~mL~'yz3yt I...l?c~;ar1 I~-a.~T 31f~ 15. COMPANY NAME: Lat,ICc~i4 Gym are 23. COMPANY NAME: ~4 16. NAME: J~m~s La~Ui~ 24. LICENSEE NAME: 10. ADDRESS: ~ ~' ~ 17. STATE OF FLORIDA LICENSE NO.: ~ 25. STATE OF FLORfDA LICENSE NO.: Do~ ~ ~~/c7-CC I~~~ A'~ir'~Y1~1C I ~" CC~G O%.l~(~ L +i~v~-~c ~j=AC 1~ ! ~- 18. ADDRESS: l`I-~~ib„ ('~ ~.K-'~Cl~ Elvc~.~#335 26. ADDRESS: / -~ackSCnvyl-z FL 3'~~,50 11. OFFICE PHONE: X30- ~I-45 i 12. FAX NO.: 19. OFFICE PHONE: ~a3 i131 20. FAX NO.: ~`3~3 ~55`i 27. OFFICE PHONE: 28. FAX NO.: 13. CELL PHONE: ,~ ~~~- f ~ ~~ 21. CELL PHO!N~E: ~ 29. CELL PHONE: 14. EMAIL ADDRESS: }~ ef~s f k i h n ~- 22. EMAIL ADDRESS: }l -i' i (l @ 6 30. EMAIL ADDRESS: ,;.,, , ~ ~ app ~ ~ ~ ,.~c .J x~;, e m ~a cc~r~ FEE SIMPLE TITLE HOLDER: (IF OTHER THAN ONMER) BONDING COMPANY: MORTGAGE LENDER: 31. NAME: ~/~ 33. NAME: N n 35. NAME: n`'~ 32. ADDRESS: N J~ 34. ADDRESS: N ~ 36. ADDRESS: 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 (ti) months, or if construction or work is suspended or abandoned for a period of six (6) months at any time after work is wmmenced_ I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters, Tanks, Air Conditioners, etc. 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. I will not occupy or use the referenced building or any part therof, until all inspections are finaled and prior to obtaining a certificate of occupancy or completion issued by the building official, as required by law. ~r WARNING TO OWNER: ~r YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR 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. OWNER or AGENT CGNTRACTOR (If Agent, Power of Aitomey or Agency Let#er Required) (Qualifier On)y) ~- O ~ ~~ ~ ~ ~ Date: ~$ Signed: ~ Signed: ~ Date: s71<C L Before me th s ~~ day of ~, 2009 in the county of ~~ Before met is day of 2009 in the county of a, as personally appearedared Duval, State o lo~r/id f[F ~ Duval, State o lorid , q/n~a~As p~/oJnal ap ea d ~ ~~ / ~ ~ ~~ ~~ ~' ir•l 1~•V herin by himself ! herseff and affirms that all statements and declarations are herin by himself /herself and affirms that all statements and declarations are true and accurate. , Notary Public at Large, State of _~, County of V v ~VC true and accurate. ~ //~ (//~ Notary Public at Large, State of I / ,County of ~V VLV ,^ P rsonally Known '~ ~ ~ ~ ~ ~ ^ Personally Known ~ . LyProduced Identficatio I~~oduced Identification Notary Signature: ~ Notary Signature: ~ '`,;,. ``1\ tYi`i~ 4 •' "•5,;;•, MICHELLE B. Bl00DWORTH :~ MY COMMISSION # DD 821;487 BLDG01 Permit Application B gz • 2/18rz~IRES: Se 2 ~ ° nia~`~ pt. 8, 2012 Wry q"•'r •~~~ MICHELLE 8. BLOODWORTH ~• '=' '~ MY COMMISSION # DD 826487 '',,gn;; :'•~`` EXPIRES; Sept. 28, 2012 The USER, .prior to making any changes from the approved plans and/or method, must obtain written approval from the City of Atlantic Beach, Public Works Department, for said. change. The USER shall, at the discretion of the CITY, be requested to submit as-built drawings showing the change within thirty (30) days after the day of completion. This permit shall insure to the benefit of, and be binding upon, the USER and their respective successors and assigns. USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or specifications, to include utilities locate requirements and use limitations/requirements of public rights-of--way and other public land. USER further agrees that the CITY and its officers and employees shall be saved harmless by the USER from any of the work herein under the terms of this permit and that all of said liabilities aze hereby assumed by the USER. x DATED and SIGNED this ~2__ day of , 200~j. operty Owner (to be signed in presence of the Notary) STATE OF FLORIDA COUNTY OF DUVAL On this ~~ day of ~~- , 2~, personally appeared before me, a Notary Public in and for said C~~~C ii9l and State ~ -~~c~.c~ the roe owner of h' k~ ~ ! rtY '~~"~.C'c.~, ~1~~ +'~ ill- ~311~ ,Atlantic Beach, Florida, known to me to be the person(s) described in and ho executed the foregoing instrument; who acknowledged to me that he or she executed the same freely and voluntarily and for the uses and purposes therein mentioned. ~,,, ota Public in for said County and State Zia*""%~. JACQUELINE M. GAOOIS '' '= MY COMMISSION # DD 281141 CITY OF ATLANTIC BEACH, FLORIDA, a municipal corporation: Appro 0 Ricky L. arper, Public orks Director For Permits where city sidewalk is impacted, City Manager approval required: ~~ Jim Hanson, City an ~o': "'%'% :' EXPIRES: May 12, 2012 Page 2 of 2