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1021 Atlantic Blvd # 1013 comm build out J 1S1 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD J ;r ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 COMMERICAL ALTERATION/OTHER MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 14-CINT-354 Job Type: COMMERCIAL INTERIOR BUILD-OUT Description: Estimated Value: $12,500.00 Issue Date: 11/26/2014 Expiration Date: 5/25/2015 PROPERTY ADDRESS: Address: 1021 ATLANTIC BLVD RE Number: 177602-0040 PROPERTY OWNER: Name: EQUITY ONE ATLANTIC VILLAGE, Address: 16 NE MIAMI GARDENS DR ATTN: TREASURY DEPT GENERAL CONTRACTOR INFORMATION: Name: KC PETROLEUM INC. Address: 533 17TH AVE QA SCOTT M LAMBERSON Phone: - - PERMIT INFORMATION: FEES: PLAN CHECK FEES $56.25 BUILDING PERMIT FEE $112.50 STATE DCA SURCHARGE $2.00 STATE DBPR SURCHARGE $2.00 Total Payments: $172.75 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. rr-h & 9W � m1 3 BUILDING PERMIT APPLICATION �7 O CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach,FL 32233 / r� Office(904)247-5826 Fax(904)247-5845 rr' Job Address: 3 I s Permit Number: •mD Legal Description�%—2 5 W ZA E dL ,l Q—Z Z -7Parcel# la D Z CC)4 0 [C= Floor Area o q. t. q. t r Valuation of Work$ 17-1 c!17&: Proposed Work heated/cooled l non-heated/cooled O/ Class of Work(circle one): New AdditionIteration Repair Move Demolition pooVspa window/door Use of existing/proposed structure(s)(circle one): Commercia Residential If an existing structure,is a fire sprinkler system insta irc a one): Yes to N/A Florida Product Approval# For multiple products use product approva orm t_- ` L Describe in detail the type of work to be performed: M 1 V%0 f Gf141INg0 ex l S`+►11! TZhC(V -svace , Property Owner Information: i Name:CJa� 14' (, City 1 L tate Zip l Phone E-Mail or Fax#( ptional) Contractor Information: Company ame: AA QualifyingA ent: E V o r M e�� Address: A Y i State FL Zip Office Phone C "�% Job Site/Contact N ber Fax# 'Z q:j�40 State Certification/Registratior< �. Z Architect Name&Phone# Engineer's Name&Phone# V WA Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and Address AZZA 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 pe ormed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void tf work is not commenced within. (6�months,or if construction or work is suspended or abandoned for a penod ofsizp6)months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs,Wills,Pools, urnaces,BaAers,Heaters, Tanks and Air Conditioners,etc. 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 RECORDING YOUR NOTICE OF COMMENCEMENT. I hercertify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type o!work will be complied with whether speci ed herein or not. The granting of a permit does not presume to give authority to violate or cancel t provisions of any other federal,state,or local law regulating construction or the performance of construction. Signature of Owner 1*0 Signature of Contractor Print Name Ty. //mak S O LA Print Name Revj n CorM ler Sworn to and subscribed before meSworn to and subscribe before me this ay of mar " .20�'IL this V—Da of 20 Notartplblic Notaubhc Revised 01.26.10 JO ANN RUOGIERO my cm*A=I01'10 BE43856 Explins:Deomober06.2014 iPa °ref% LINDA A. EVANS t My PLNowyMonet AmmC1a. _'_�' '. Notary Public State of Florida 1` My Comm.Expires Mar 10,2015 Commission #EE 72706 Jackson ville Fire and Rescue Department FIRE PREVENTION DIVISION ' PROJECT NAME: Sunrise Smoothie IdI3 ADDRESS: 1013 Atlantic Bv. REVIEWED BY: RE DATE: 11/7/2014 A er ini al review,the following excep ons were noted in your construc on plans submi ed to this o ce as part of the building/mechanical permit process: 1. 1) Please provide an itemized type written summary, with revised clouded plans. 2) Provide exit door tacfrle signage (Braille) per N.F.P.A. 101,7. 10.1.3. 2. 3) Provide light-frame truss-type construcrcon iden7t cafton signage per F �.,C'69A-60.0081 or wri"n veri�',caTon that such structure does not meet the definiTion of 69A-60.00; :!. 3. 4) Provide portable tyre ext,nguisher protec7ion per N.F.P.A. 10. 4. At-v loft —'1 c � V 214 N HOGAN ST. PHONE: (904)255 8560 JACKSONVILLE, FLORIDA 32202 FAX: (904)255-8559 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) ti 800 Seminole Road l _ /jr 3, Atlantic Beach, Florida 322:33-5445 / (� Phone(904)247-5826 • Fax(904)247-5845 City web-site: http://www.coab.us Date routed: APPLICATION REVIEW AND TRACKING FORM 4#' io I3 Property Address: LPZ I Deparmldent review required fifes o uildi Applicant: _ Q —� Planning &Zoning Tree Adrninistrator Project: �lL� d r / �� �, Public Works Public Utilities Public Safety ire Services Review fee $ Dept Signature CONTRACTOR EMAIL ADDRESS CONTRACTOR CONTACT # APPLICATION STATUS Reviewing Department First Review: Approved. ❑Denier_ (Circle one.) Comments: /BUILDING PLANNING &ZONING Reviewed by:--'---"---�"�— Date:—L I—>0 TREE ADMIN. Second Review: A roved as revised. ❑ Pp ❑Denie PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Revievtff []Approved as revised. []Denied. Comments: Reviewed by: Date: REVISED 09252014 City of Atlantic Beach APPLICATION NUMBER s` Building Departmen': (To be assigned by the Building Department.) 800 Seminole Road / t' , �c_'' Atlantic Beach, Florida 322:33-5445 /V 7 Phone(904)247-5826 • Fax(904)247-5845 i f,t City web-site: http://wvinw.,�oab.us Date routed: h lid APPLICATION REVIEW AND TRAC° ,ING FOR Property Address: OZ I � �/ Depar nt review required Yes No Applicant: � A120 — Plannin Zoning Tree G -istrator Project: !-�/� Ole & i.�d ` Public s Public Utilities Public Safety Ire Services Review fee $ Dept Signature vONTRACTOR EMAIL ADDRESS CONTRACTOR CONTACT # APPLICATION STATUS Reviewing Department First Review: ❑Approved. Deniz (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: W45 _ Date: �l 7 TREE ADMIN. Second Review: ❑Approved as revised. ❑Denioc PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Revievtr. ❑Approved as revised. ❑Denie Comments: Reviewed by: Date: REVISED 092520141 I� CITY OF ATLANTIC BEACH J r� 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 oil I sr ELECTRICAL PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 14-ELEC-613 Job Type: ELECTRIC ONLY Description: 5 outlets unit 1013 Estimated Value: Issue Date: 12/9/2014 Expiration Date: 6/7/2015 — PROPERTY ADDRESS: Address: 1021 ATLANTIC BLVD MAIN RE Number: None GENERAL CONTRACTOR INFORMATION: Name: EAGLE ELECTRIC INC. Address: P O BOX 6266 QA STEPHEN N. BRANNEN Phone: - - — FEES: State Elec DBPR Surcharge $2.00 State Elec DCA Surcharge $2.00 Switch Outlets $3.00 Trade Permit Base Fee $55.00 Total Payments: $62.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. ELECTRICAL PERMIT APPLICATION \� CITY OF ATLANTIC BEACH v` 800 Seminole Rd,Atlantic Beach,FL 32233 Ph(904) 247-5826 Fax(904) 247-5845 .TOB ADDRESS: l©Q I 6A�a y)�l C & A R P� I'1'7�o Oa— n�y C� PERMIT# JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS PHASE VA UE OF WORK$f CM , NEW SERVICE ❑ Overhead ❑ Underground ❑T Underground up Pole []Residential(Main) Service ❑0-100 amps [110 1-I 50amps ❑151-200amps []______amps #of Meters []Commercial(Main)Service ❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps 0 C Service amps Conductor Type Size ❑Multi-Family(Main)Service ❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Unit Meters []Temporary Pole ❑ amps SERVICE UPGRADE ❑ amps ❑ CT Service amps NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.) ❑100 amps ❑150amps ❑200amps ❑ amps ❑CT Service amps ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC. Outlets/Switches: 4_0-30amps 31-100amps 101-200amps Appliances: 0-30amps 31-100amps 101-200amps A/C Circuits: 0-60amps 61-100amps Heat Circuits: # circuits @ kw Number of Lighting Outlets, Including Fixtures: OTHER ELECTRICAL PROJECTS ❑Swimming Pool ❑ Sign ❑Smoke Detectors_Qty ❑Transformers KV A ❑Motors hp FIRE ALARM SYSTEM (Requires 3 sets of plans) Qty volts/amps VALUE OF WORK S REPAIRS/MISCELLANEOUS ❑Replace Burnt/Damaged Meter Can []Safety Inspection []Panel Change ❑OH to UG ❑Other: Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. I hereby certify that I have read this application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether specified or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction. Property Owners Name cit Phone Number Electrical Company F ale E�eC�r is c�F TCL C KS Orly►II p Office Phone 90 y 196-6 V7 Fax�O�l'r$�o-y�g Co. Address: 1 A9 Q n_&t W-) SSC-re--A S. City yAV i ll e State �_Zip 3,qa5q License Holder(Print): tate Certification/Registration# �00000toIq Notarized Signature of License Holder Sworn and subscribed before me this ?+h day of _20A4 UARLEBd M.HEAB6ll50rt �.�� * lilt CO M1ISSION t EE 1100 Signature of Notary Public p�lA r n (�LYVb EXPIRES:August 1,2015 0 8aded TAN�l Nalary Services t�aFa�• Nov 26 1411:40a P•1 ��s c ]NOTICE OF COMMENCEMENT i� State of Florida County of SL Johns J ;ter �� - G �- 3Gq ' Permit No. r. M 40� Tax Folio Igo- 1-1-1(go2 00 4 V flR1 THE UNDERSIGNED HEREW CIVETS NOTICETRAT L►ipROVEMENT WELL BE NADF TO CERTAIN REAL PROPERTY,AND rN ACCORDANC€W[T6 CRA PTER7I3,FLORIDA STATUTES,THE FOLLO%MZG INFORMATION IS PROVIDED IN THIS NOTICE OF CDNf4ENCEMEyT. Expiration Date of Notice of Commencement(the expiration date is I year from the Date of recording unless a different date is specified Owner's name(print)EiV 1 4' t Owner's addressw' t t e e Is r j s s Oner's interest in property Le Legal dcseription of property` — Propertyaddress A4man , ' "' W► General description of improvement Q. Fee simple title holder,if other than owner(print) Address // r 1/- Z 317�.�{-� V Phone( gJ i'�,Ly Lr' Contrado//r'sp^tianer(print) .•� u 1i•ri i f,'1— `� �� 1 1:L :10 & IIZ�i fi Fax `1 Address v I,-tt Y Surety's name,if any(print) [ Airiount of band S Address Phone(—JFax L� Lcioder's us me(print) Pbone(_, Lender's address Fax PERSONS WITHIN THE STATE OF FLORIDA DESIC19ATED BY ONVN£R upnw»vsr^"win rrr�cc no n rutcv tlnr r Mr VTC Mev as SERVED AS PROVIDED BY SECTION 713.13(1)(A)7,FLORIDA STATUMS: Dc-:,#21014267476,O R BK 16988 Page 250, ) Number Pages:1 Nang eat Recorded 11+262014 at-39:48 AM, Address Ronnie Fussell CLERK CIRCUIT COURT OUVAL COUNTY LYAIIIIITIONTommsELFORRERsELF,OWNER DESICNixes REC0RUM3 510.00 OF To RECEIVE A COPY OF THE LIENOWS NO11 PHONE NCMHER OF PERSON OR ENTITY DESIGNATED BY OWNER WARNING TO OWNER: ATN'PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART L SECTION 713.13, FLORIDA STATUTES, AND CAN 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 COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING AND THAT THE FACTS STATED IN IT ARE TRUE TO THE BES F MY KNOWLEDGE AND BELIEF_ Signature of Owner or Lessee,or Owner's or Lessee's Autborized OfficerMireetorlPartnerhNanager Date Signed c P1 In County Flamed Of State Print Nae of Person signing Above Name STATE OF FLORIDA COUNTY OF ST.JOHNS A The foregoing instrumcat'`was acknowledged before me this ...—day of '^ ,20 �� A ANso✓N as o R - Print Nrof Persoo Type of auth _officer,trstee, ey in fact 7N for •�� ' I Name of Party on Bebatf of Wham Instrument was Executed Notary Public Sisnatnre / O Area n R(Atm2. • r'D Known Persoriallp V Or Identification Name or rotary Ty Printed Type afldetstMcation Commission Number and Expiration Date(stamp or seal): JO ANN RUOQiYO WCOM aBUory>leseIIIlss