1175 Atlantic Blvd temp tralr 2015CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
r)
.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:
]Ob ID:
15-COTH-611
Job Type:
COMMERCIAL OTHER
Description:
CONSTRUCTION TRAILERS FOR URBAN FARMS
Estimated Value:
$5,000.00
Issue Date:
3/31/2015
Expiration Date:
9/27/2015
PROPERTY ADDRESS:
Address:
1175 ATLANTIC BLVD
RE Number:
170709-0000
PROPERTY OWNER:
Name:
Address:
ROBBINS NEST FARMS LLC,
1560 SELVA MARINA DR
GENERAL CONTRACTOR INFORMATION:
Name: CISSEL & COMPANY
Address: 2554 Philips HWY
Phone -904-759-4312
PERMIT INFORMATION:
FEES:
BUILDING PERMIT FEE $75.00
STATE DCA SURCHARGE $2.00
PLAN CHECK FEES $37.50
STATE DBPR SURCHARGE $2.00
Total Payments: $116.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC: BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
City of Atlantic Beach
Building Department
" �_ 800 Seminole Road
Of) Atlantic Beach, Florida 32233-5445
Phone (904) 247-5826 - Fax (904) 247-5845
E-mail: building-dept@coab.us
Cityweb-site: http://www.coab.us
APPLICATION NUMBER
(To be assigned by the Building Department.)
Date routed:
APPLICATION REVIEW AND TRACKING FORM
Property Address: - I --1s �fiCan�i "
Applicant: fil +— CLQ
Project: 4 T-cY»
{ Ckk %S
Review fee $
V
D ment review required Yes No
tanning &Zoning
Tre
Public Works
Public Utilities
Public Safety
Fire Services
Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
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 STATl1S
Revised 07/27/10
Reviewing Department
First Review:
[�pproved.
❑Denied.
(Circle one.)
Comments:
BUILDING
LZONING
Reviewed by'
Date:
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 07/27/10
City of Atlantic Beach
-; Building Department
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone (904) 247-5826 • Fax (904) 247-5845
�;si" 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
► I -�� ��C anti �I �°
PropertyAddress: rtment review required Yes No
11 Buildin
Applicant: CSSr/I +— C�� Planning Zoning
Project: L'}' -T-00? -� Public Works
C A Public Utilities
1 ` WV Public Safety
Fire Services
Review fee $
Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
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: �pproved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING
Reviewed by:
c
TREE ADMIN.
Second Review: ❑Approved as revised. [—]Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:
FIRE SERVICES Third Review: DApproved as revised. ❑Denied.
Comments:
Reviewed by:
Revised 07/27/10
Date:
Date:
i s -
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 4 T -Z-41,177 C B LYD
Legal Description 5u< ", /Z. 94 /3-rEcTo.,/ "/� 1""V D
Valuation of Work $ 5.000
Permit Number:
lvva t iivu vi �'•— -•
Proposed Work heated/cooled non-heated/cooled
Class of Work (circle one): New Addition Alteration Repair
Use of existing/proposed structure(s) (circle one): If anexisting structure, is a fire sprinkler system cos�C�omme�cia one):
Florida Product Approval #
For multiple products use product approva orm
7--PI-1,001e,49-y � T�1_Z1CJ
Move Demolition pool/spa window/door
Residential
Yes/A
Describe in detail the type of work to be
F, -)/Z /h/D 6;p&C.A 7 •oN S
Property Owner Information:
V) lCoalz �,fo ) eT Sy/ ( 8) ,CT
Name:9041 /S WIJ7 t4`�4N 4 • L • e• Address: 1960 SEL vA MgAII /,1 3 D2/ 4/
City 47ZAt,/77c- ekAg4 State/"'--LZip 3 -xi -33 Phone 9oS/ 694 7573
E -Mail or Fax # (Optional) L n /�
Contractor Information: S? e ✓-� Q 4,
Company Name: C155 E C �` tc�t�P�� y Qualifying Agent: S7PH1 �� C/SSE L
Address: 299`1` P6,/ � �✓4 Cit' ./4-cie- oWrI/1-c State �c Zip 3'A -'x-07
Office Phone 9,oY- 6 83 - SISSJ Job Site/ Contact Number qi?V - 7SY- Y 3 / _- Fax # 9oN- X39- -915Y
State Certification/Registration # C& C 010/73
Architect Name & Phone # Sco f F24St!'2 p690 y ,s 7/ • Z3 73 fht oo/ 3o p i
Engineer's Name & Phone # -✓RE LEE P6 ya y/ 3 ly 35/ 8
Fee Simple Title Holder Name and Address Avio /f ^/4.4- Av-f Z;4:4 1'5 60 .ftp✓� stiisrrt l�9 De. AT/ C1+- A
Bonding Company Name and Address
Mortgage Lender Name and Address N
Application is hereby made to obtain or
a permit to do the work and installations as indicaS.ted. 1 certify that no work or installation has commenced prior to the
issuance of a permit and that all wcto
ork will be perfoin rmed to meet the standards of all laws rpegulating construction in this jurisdiction(. This permit becomes null
work �s� omwork menced.ot I understand tii
hat separate permme ce its must bn ns
e secured for Electrical Workl Plumb ng or abaer
ndonSign , aWells, P ols,XFurnaces monthsBoilerat ys tHeaime iers,
Tanks and Air Conditioners etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE O
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPRO ENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CO6
WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR
ICE OF
COMMENCEMENT. ..
I here b certify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether sped ted herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal, state, or local law regulat^g construction or the performance of construction. / lI
A I
Signature of Owne1i ✓i dpi Signature of Contracto Y�
/i/,
ER J. ST iii
Print Name S.! CISS ��` � •••• �� Print Name S R • CtSSE..-
•O� 0t�ber 1J Fi o t
Sworn, to and subscribed befo me = �� �'o� �, : Sworn to and subscribe e
this Day of 100( Ir,tt^ = * 2� (� ; * = this _Ltp Day of
L
fj
FF 048870
AkkN tary Publ %C
�Ao\���`` Notary ubl
CI'T'Y OF ATLANTIC BEACH
OWNER / BUILDER AFFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING' REQUIRES OWNER / BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 4}{9.103(7), FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO 13E 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 ACr AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT RAVE 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
IMPROVE A COMMERCIAL BUILDING AT A COST OF 525,000.00 OR LESS, THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT 41AY NOT 13E 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. WHICII 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. TT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE FMPL DYED BY YOU HAVF,
I ICE,NSFS REQUIRED 13Y S'TA'1'F I AW AND BYC'OUNY OR MUNICIPAL. LICENSING
ORDINANCES.
11. 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.
//7S Arm-,.�T� c 3 �►�D
ADDRESS
PRINT NAM I
�,()y- 754- V312,
PHONE NUMBER
Befor me this day of 20 )4 in the county of
Duvat, br da, has personally appeared herin by h7msel` / herself and atf,rms that
all statements and declarations are true and accurate
Notary Public at Large. State of Ft- , County of 11►Vi:L
$a<�r,,,:ery Known
Cl Produced Ide hkabon --- __ __ _ — ___ RiN
tate of Florida
EE 677614
017
Notary &gnaturc:
QA
DATE /.
F.titD(M.nn-BwW.-r Altwta.u: REVISED 4,1t. -IM
�tr:ary.
�J 1 5 •
,. tl
� 'J
OWNER`S AUTHORIZATION FOR AGENT
is hereby authorized to ata on behalf of
C..C. L
I hes the owner(s) of those lands described
within the attached application ► as de cribed m the attached decd or other such proof of ownership ss may
an application related to a Development
be required, in applying to the - tty of Atlantic Beach, Florida, for
Permit or other action pursuan' 'I Amendment
❑
Zoning 'v,• 'nee
❑
❑
Comprehensive t an
Zoning Map Amendment
Use -by -E. option
❑
Plat, Replat or Lot Division
Building to{mit
❑
Tree Permit
❑
Sign Porn,
❑ Other
BY:
Signa
e of Owner
1 {
1
Print Name
Signature of ONvn,r _
Print Name
(, yZ, ,'g
Telephone Num Staic of �L C►_�s\�
County of-JDLa.�..l
>lh
i
Signed and swornbcfarc rr n this --- day of, 3olNotary Pewfic State of Flo
nda
,`,� app Kimberty A Billingsley
MyComrn" , t94t20
By 1 m��:C_1��� U
t a pd' E.M 1, 04, '2016
Identification vcrif►cd: _
No AOath sworn: --_ _- Yes •---""-.
Votary Signature - 0�
My Commission crpires: v� i �C
WEST 1 ST STREET
_ _ T --�
lii
AIL�� • I }(
PATH OF N'A R STECt _
rA�OID TREE ROOTS
JUSTED TO
i�
G ) x
k
I / / POND_
f fi GOG •�� t4�g , , CRUS+Eta i
STONE t
i �� '� �0�►P' SURFACE
P
TEMPORARY POWER
WELL HEAD 5'
PROPANE 8a TOILET i
A.
r. ( $TilBfYJT tH — �_�'•— — -----------n
G PLUG—E\
.tt Is T,^ A:1 v _ _ _
N , r �� _ IV ROLL—UF
r 1 -I 1 • . • DOOR
p, a
GATE VALVE -
j alers OFTemporary TrANES + 6' CLEANOUTZ
Construction
_ l�3 4 LOADING AREA
IJ
3 Storage & Operations
4ld0 b 1„ O (h
T-
CT.
TO LF STUBOUT 4-
VC FOR POSSIBLE `� w
FUTURE CONNECTION
i=
i
CRUSHED
5' SIDEWALK -
--- -STONE
i SURFACE
•
GREENHOUSE y
I ! OFF SITE PARKING
• CONSTRUCTION WORKERS
Cissel & Company AMER. LEGION WEST LOT
�i Certified General Contractor
904 759 4312 SECURITY ROLLING CXE (36 =T:) I �:
i TO BE OPEN DURING BUSINESS y
r' HOURS AND SHALL BE OPENED
' FROM THE ASIDE OF THE FACILITY
24 + F OF DOUBLE ---ter
YELLOW CENTERLINE t _
STUBOUT ARD ' SNit#:; GATE AT S i:F %$A
I AND PLUG
♦ i
1175 Atlantic Blvd
+ i:n3�Y 1 1� VMOGII-
NOTICE OF COMMENCEMENT
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, +
Florida Statutes, the following information is provide in this Notice of Commencement. 9
1. DESCRIPTION OF PROPERTY (Legal description of the property & street address, if a milable) TAX FOL IO NO.: 170709-0000 M
SUBDIVISION _Atlantic Beach BLOCK 11,12,13TRACr-Section"H: LOT____BLDG____UNIT
According to the Plat thereof, as recorded in Plat Book 18, Page 34 of the current public records of Duval County
J
2. GENERAL DESCRIPTION OF IMPROVEMENT: b
SQnstruction of 8,i}UO�l,rafe fooigteenhou;�;3�LasS4ciated suDRon_taCi(ity. ___
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPRO%'ENIEN?:
a. Name and address: Robins Nest Farm LLC, 1560 Selva Marina Drive, Atlantic Beach, Florida 32233
b. lntcmt in property: fee simple
C . Name and address of fee simple titleholder 1 i(diRcrem from Owner bsted above): Tracey Weser• 1560 Selva Marina Dr., Atlantic Beach, FL 32233
4. a. CONTRACTOR'S NAME: Atlantic Beach Urban Farm-LL-
Contractor's
armLLContractor's address + C
850 6th Ave. South Jacksonville Beach,FL 32250 b. Phone ntmtler 904-868-6957 w `�
_ h
5. SURETY (if applicable. a copy orthe payment bond is attached).
0
a. dame and address: N/A o
h Phone number. e. Amount of bond S
6. a. LENDER'S NAME: N/A
Lender's address: __ - -- _-- _____b. Phone number:_. .
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by
Section 713.13 (1) (a) 7., Florida Statutes: a
Name and address: SR Cissel, POB 1875, PVB.,FL 32004_
�., o
b. Phone numbers of designated persons: 904-759-4312
8. a. In addition to himself or herself, Owner designates Susan King of Atlantic Beach Urban Farms LLC ti o
to receive a copy of the Lienor's Notice as provided in Section 713.13 (1) (b), Florida Statutes. in a
904-868-6957 r in U
b. Phone number of person or entity designated by Owner: _ _ — ..— _ �
CD U
9. Expiration date of notice of commencement (the expiration date will be I year from the date of recording unless a different date is
0: m Y.
-T
specified): Juno 1 2015
O a: 8
, w
WARNING TO OWNER ANY PAYMENTS MADE BY THF OWNFR AFTFR
THE UPIRATION OF THE NOTICE OF COMMENCE%tETvT
AND CAN
U �'
r0 z
ARF CONSIDERED IMPROPER PAYMENTS UND1�R CHAPTER 713 PART
I SECTION 713 13 FLORIDA STATUTES,
A NOTICE OF COMMENCEMFNT MUST BE
a U_ > of
F
gFSULT IN YOUR PAYING TWICE FOR [MPROVFMNTS TO YOUR PROPERTY
RECORDED AND POSTED ON THE JOB SfrF BEFORE T}IF FIRST INSPECTION
IF YOU INTFND TO OBTAIN FINANCING CONSULT
` .2 a, z O
ar E v c Z U
oOw
WrM YOUR LENDER OR AN ATTORNEY BEFORE COMMFNCING WORK
OR RECORDING YOUR NOTICE OF COMMENCEMENT.
/
0 z(r_tYUtY
c—
Tracey Westbrook ;,,kee)
(Signa of Owner or ssee, or Owner's or Lessee's
Auto rized Officer/Director/Partner/Manager)
(Print M • s T�iie/ame and Provide Signato
State of Florida
County of Duval
s+
�
The foregoing instrument was acknowledged before me this __r ,
day of 20.1
by 1 rcwct�y w E S i G a (G, , as
M p.�+A-V-r tti bar•
(name of person)
(type of authority,...e.g. officer, trustee, attorney in fact)
1-
for Rep+rJ S At s+- FC%�" LV_ -_
(name of party on behalf of whom instrument was executed)
Personally Known X or Produced Identification
�� Notary Fabric State of Florida
Kimberly A Billingsley
+� pY My Ccmmission EE 194120
�1 jv,d Expires 04/302016
Type of Identification Produced
(Signature of otary lic
(Print, Type, or Stamp Commissioned Name of Notary Public)