1155 Atlantic Blvd 2014 DEMOCITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 14-00000596 Date 4/22/14
Property Address . . . . . . 1155 ATLANTIC BLVD
Application type description DEMOLITION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
DEMO EXISTING STRUCTURE
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Owner Contractor
REEVES ET AL, CECIL E OWNER
C/O THOMAS E REEVES, SR
7147 TONGA DR
JACKSONVILLE FL 32216
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Permit . . . . . . DEMOLITION PERMIT
Additional desc . .
Permit Fee . . . . 100.00 Plan Check Fee
.00
Issue Date . . . . Valuation . . . .
0
Expiration Date . . 10/19/14
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Special Notes and Comments
Roll off container company must be on City approved list
and container cannot be placed on City Right-of-way.
(Approved: Advanced Disposal, Realco, Shappelle's and Waste
Management.)
Full erosion control measures must be installed and
approved prior to beginning any earth disturbing
activities. Contact Public Works (247-5834) for Erosion
and Sediment Control Inspection prior to start of
construction.
Silt fence must be properly installed on Atlantic Blvd. and
West 1st St. frontage, and must be inspected by Public
Works. Call 247-5834 for inspection.
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Other Fees . . . . . . . . . STATE DCA SURCHARGE
2.00
STATE DBPR SURCHARGE
2.00
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Fee summary Charged Paid Credited Due
------------------------------
---------------------------
Permit Fee Total 100.00 100.00 .00
.00
Plan Check Total .00 .00 .00
.00
Other Fee Total 4.00 4.00 .00
.00
Grand Total 104.00 104.00 .00
.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
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$% 1 . City of Atlantic Beach
Js� Building Department RCF�VED'
r 800 Seminole Road
Atlantic Beach, Florida 32233-5445 hPD 2014
Phone (904) 247-5826 - Fax (904) 2 -584
E-mail: building-dept@coab.us
City web -site: http://www.coab.L�@)L
APPLICATION NUMBER
(To be assigned by the Build!N Depai
Date routed:
APPLICATION REVIEW AND TRACKING FORM
Property Address: &�2h_70_46
Applicant: 4 a)-"-�7 � 4
Project:o (16nak
X mi, iss�
Department review required Yes No
Building
Planning & Zoning
Tree Administrator
ubl* orks
Public Utilities
Public Safety
Fire Services
Review fee $ aDept Signature ��
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
Florida Dept. of Environmental Protection
Florida Dept. of Transportation Arc
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
6 , s
APPLICATION STATUS
pY
Reviewing Department
First Review:(�JApproved. ❑Denied.,o�'r
(Circle one.)
BUILDING
Comments: /
C V%i
/-��*
L� O� -JZ�-rT r C
fir. - "
.
j �' Y
PLANNING & ZONING
r ,�
i / Revitefby:
Dat y_
Second Review: ❑Approved as revised. Denie
TREE ADMIN.
PUBLIC WORKS
Comments:
PUBLIC UTILITIES
PUBLIC SAFETY
Reviewed by:
Date:
Third Review: ❑Approved as revised. []Denied.
FIRE SERVICES
Comments:
Reviewed by:
Date:
Revised 05/14/09
,_,uii_jl,llvly rEmVil'I' APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, Fl- 32233
Office (904) 247-5826 Fax (904)24.7-5845
Job Address: �� S.s 5 .474AN-71c C1•• _ Permit Number:
Legal Description Parcel #
Floor Area o q. t. q. t
Valuation of Work $ Proposed Work heated/cooled non-heated/cooled
Class of Work (circle one): New Addition Alteration Repair Move Demolit' pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial Residential
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /A
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to be performed:
Property Owner Information:
Name:
Citv
E -Mail or Fax # (Optional
Address:
State _Zip Phone
«17.11
Company Name: Qualifying Agent:
Address: City
Office Phone Job Site/ Contact ber
State Certification/Registration #
Architect Name & Phone #
Engineer's Name & Phone #
Fee Simple Title Holder Name and Addres
Bonding Company Name and Address
Mortgage Lender Name and Addres
Jo -
Fax # 4Yl -
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 cert 1; ?o work or installati has commenced prior to the
issuance of a permit and that all work will be performed to meet the standards of all laws regulating co,. ction in thisiTurisdic 'on. This permit becomes nu!l
and void f work is not commenced within six (6) months, or if construction or work is suspended or abc; used for a_period of (6) months at any time after
work is commenced. 1 understand that separate permits must be secured for Electrical work, P/umh. g, signs, Wells, Poo/ Furnaces, Boilers, Heaters,
Tanks and Air Conditioners, etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOd CE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IM ROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING C NSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR OTICE OF
COMMENCEMENT.
'hereby certify that I have read and examined this application and know the same to be true and correct; All provisions oflaws d ordinances governing this
ype of work will be complied with whether specified herein or not. The granting of a permit does not presume to give nut rity to violate or cancel the
wovisions of any other federal, state, or local law regylating, construction or the performance of construction.
signature of Owner
Signature of Coni ..ctor
Tint Name _�... E_.y.......W..�.. �i`� .b.� l X..............I........... Print Name
;efore me n / Before me
tis L Day of this Day of
ESSIE MERRITT
r1' Notary Public -State of Florida
taffy Public ; •i My Comm. Expires e X17 Notary Public
'0' Commission # EE 872959
�' .°,`„t �• Bonded Through National Notary AIM.
01.26.10
CITY OF ATLANTIC BEACH
(OWNER 0 BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING" REQUIRES OWNER / BUILDER TO ACKNOWLEDGE THE LAW.
DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT
LAW. THE EXEMPTION ALLOWS YOU, AS THE OWNER OF YOUR PROPERTY. TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST
SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE — OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
MROVE A COMMERCIAL BUILDING AT A COST OF $25,000.00 OR LESS. THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO,
455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA 'CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT (247-5826) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER -BUILDER PERMIT.
�_ Wi) (v--" - 3-523
PHONE NRJMBER
DATE
Before me this — day of '?-Vq 1 20!_1 in the county of
Duval, State of Florida, has personal y appeared herin by himself/ herself and affirms that
all statements and declarations are true and accurate.
'
Notary P id at Large, State of �(p `/ r a � County of
4.Y Pie, ESSIE MERRITT
ersonaily Known ;.yijfflj�j ' Notary public • State of Florida
❑Produced Identification - My Comm. Expires Feb 10, 2017
IP
= Commission k EE 872959
IfRSI:i:►6l1- ��ii!'�t�C/IL/IlrifMali
F:BLDG/Ownu-Builder Affadavit; REVISED: 4/1612009
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
OWNER ASBESTOS NOTIFICATION STATEMENT
Date: —VI1
Building Permit #
Site Address: /j % / ` �_ cl
Street
City
3zz,=Z3
State Zip
104.4.4 Asbestos removal. Moving, removal or disposal of asbestos -containing materials on a residential
building where the owner occupies the building, the building is not for sale o- lease, and the work is performed
according to the owner -builder limitations provided in this paragraph. To qualify for exemption,' under this
paragraph, an owner must personally appear and sign the building permit application. The permitting
agency shall provide the person with a disclosure statement in substantially the following form:
Disclosure Statement
State law requires asbestos abatement to be done by licensed contractors. You have applied for a permit
under an exemption to that law. The exemption allows you, as the owne-• of your property, to act as
your own asbestos abatement contractor even though you do not have °i license. You must supervise
the construction yourself. You may move, remove or dispose of asbestos -containing materials on a
residential building where you occupy the building and the building is not for sale or lease, or the
building is a farm outbuilding on your property. If you sell or lease such L <ailding within 1 year after the
asbestos abatement is complete, the law will presume that you intended, v sell or lease the property at
the time the work was done, which is a violation of this exemption. Y, may not hire an unlicensed
person as your contractor. Your work must be done according to all lou -I!, state and federal laws and
regulations which apply to asbestos abatement projects. It is your responsibility to make sure that people
employed by you have licenses requi dby state law and by county or municipal licensing ordinances.
Prope er'sSignature
j ( t,� „.d/ personally appeared
Subscribed and sworn to before me this �-�—day of ��' y pp
f)17 who is personally known to me or
as identification, and who did/did not
produced
take an oath. ESSIE MER T7
""JAY P: .
°r° •�•. Notary Public - Stat' of Florida
?•� •= My Comm. Expires Fib 10, 2017
Seal �r Commission # EE!872959
Notary Public Sig ature �•';;a� Bonded Through NationalNotary Assn.
FORM: ASsoWN
FORM DATE 10.01 .2006