535 Atlantic Boulevard UTIL18-0008 utility �� CITY OF ATLANTIC BEACH
ffab" �' 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
UTILITY SERVICE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: UTIL18-0008
Description: 2-inch potable & 1-inch irrigation meter request
Estimated Value: 0
Issue Date: 1/25/2018
Expiration Date: 7/24/2018
PROPERTY ADDRESS:
Address: 535 ATLANTIC BLVD 507
RE Number: 170684 0000
PROPERTY OWNER:
Name: GATE PETROLEUM COMPANY
Address: 9540 SAN JOSE BLVD
JACKSONVILLE, FL 32257
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: Scherer Construction of NEFL LLC
Address: 2926 Edison Avenue
Jacksonville, FL 32254
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
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 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.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500. For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
�Sy1,JjJ� City of Atlantic Beach APPLICATION NUMBER
Js Building Department (To be assigned by the Building Department.)
800 Seminole Road L0 _ D00¢
Atlantic Beach, Florida 32233-5445 (1 U
Phone(904)247-5826 • Fax(904)247-5845 f
E-mail: building-dept@coab.us Date routed: I 1
City web-site: http://vmw.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: S 3 lin L 6J - Department review required Yes No
Buildin
Applicant: C16(, �Q �1 U n'l in &Zoning
Tree Administrator
Project: �l` P0-\6(IrJ� -� ' �l \ i ' q Public Works
\p t D / Q � �1 blic Safety
�`-1 � l Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
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. PNot applicable
(Circle one.) Comments:
BUILDING
PLANNING & ZONING // �
Reviewed by: Date:
TREE ADMIN. Second Review: [-]Approved as revised. ❑Denied. ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: []Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
,sS!�Lir�JCity of Atlantic Beach APPLICATION NUMBER
Building Department j (To be assigned by the Building Department.)
i` 800 Seminole Road ,^�Q
Atlantic Beach, Florida 32233-5445 _I,. �- �- I V 000
Phone(904)247-5826 • Fax(904) 7-58AN 21
E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 3 S- I1 �Gi,fl l�N ' Department review required Yes No
Buildin
Applicant: C1kk-C- QQAfb`-V u nnin &Zoning
1 r i Tree Administrator
Project: Dl` 'A- 1 `l < < ',q cy) Public Works
p blic Utilities
-Wi 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:
APPLIgATION STATUS
Reviewing Department First Review: EApproved. []Denied. [-]Not applicable
(Circle one.) Comments:
BUILDING u
PLANNING &ZONING Reviewed by: Date: i Lz / I f
TREE ADMIN. Second Review: ❑Approved as revised. []Denied. ❑Not applicable
PWO S Comments:
LI I S
x- 22 -(
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. [-]Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
t '
4 I t � 11V'v F; ;rte'
el
' :. JAN 1 9 2018 City of Atlantic Beach
PUBLIC UTILITIES DEPARTMENT
902 Assisi Lane
Jacksonville, FL
LJ131�'. (904)247-5834 n *-►
71 -4
NEW WATER/SEWER TAP REQUEST �'y. 41
0�
Date Service Address _: • -'i. N"C 1 C
Number of Units�_ Commercial Residential Multi-Family
New Water Tap(s)&Meter(s) Meter Size(s) Z}14�,r-a13k-r-
New Irrigation Meter 1 Upgrade Existing Meter from to (size)
New Reclaim Water Meter 1_ Size New Connection to City Sewer
Applicant Name_ 1T1�T1 r 1'T�T1Lc�Lry fy\ G ,
Billing Address qS'A0
city .5 O'y", 'O14 V!C i F= State L zip
Phone CAOy
Email
IV i
Applicant Sign re -`
CITY STAFF USE ONLY
Application# ,S�Qr1 jcES cJtn E Esz iSi�wro,
Water System Development Charge $
Sewer System Development Charge $
Water Meter Only $
Reclaim Meter Only $
Water Meter Tap $
Sewer Tap $
Cross Connection $
Other $
TOTAL $_ Q!D (Notes)
APPROVED Kayle Moore, P.E. CGW\ -.Date
Pub!!c Utilities Director or Authorized Signature
ALL TAP REQUESTS MUST BE APPROVED BY THE PUBLIC UTILITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED
S'r1i1 f�r
yCash Register Receipt
City of Atlantic Beach�r
R4041
DESCRIPTION ACCOUNTQTY PAID
PermitTRAK $50.00
UTIL18-0008 Address: 535 ATLANTIC BLVD 507 APN: 170684 0000 $50.00
PUBLIC UTILITIES $50.00
CROSS CONNECTION 400-0000-343-3701 1 $50.00
TOTAL1 1 1 1
CITY OF ATLANTIC BEACH
800 SEMINOLE RD
ATLANTIC BEAC,FL 32233
01j251r2018 11:40;04
CREDIT CARD
VISA SALE
Card XXXXXMWXX2496
SEQ 6
Batch u; 529
INVOICE 1
Approval Code; 066603
Entry Method: Manual
Mode; Online
Tax Amount; $0.00
Cust Code:
Card Code: M
SALE AMOUNT $50,00
CUSTOMER COPY
Date Paid: Thursday, January 25, 2018
Paid By: GATE PETROLEUM COMPANY
Cashier: BA
Pay Method: CREDIT CARD 6
{
Printed:Thursday,January 25,2018 11:40 AM 1 of 1
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