305 AHERN ST RES17-0264 (2) oid-v f City of Atlantic Beach APPLICATION NUMBER
�S . Building Department (To be assigned by the Building Department.)
l� --- 800 Seminole Road �5tl _ D4)�
�. �r Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845 '1 l�S Ill
j;ttg E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: OS AA-A n Si • Department review required Yes No
Csuildi a
Applicant: . ,('0 0.-(1 1)a,i-AN.-{,s s (I.IC{i Manning &Zonin
Tree Administrator
Project: 'f\ e.),) 'kvv rk h10 Cions-Vi.L( icr C` is Works
CPubH Utilitietiee
Public Safety
(—Tire 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: Approved. Denied. Not applicable
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed by: Date:
TREE ADMIN. Second Review: Approved as revised. I 'Denied. I INot 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
4,.,:11-• ,',,, Building Permit Application
City of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
j
Phone: (904) 247-5826 Fax: (904)247-5845
Job Address: 3c ,n.►-,P.r-r, sr-.A+-''-''— (3e ,1 p Permit Number: 9_ s l } ~ 03' y
Legal Description See Attached RE# 169742-000, 169737-0000,169737-0010
Valuation of Work(Replacement Cost)$ 200,000.00Heated/Cooled SF 1836 Non Heated/Cooled 658
• Class of Work(Circle one : New ddition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): :ommerc :I Residential
• If an existing structure,is a fire sprinkler system installed? Circle one): Yes No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
New Townhome Construction
Florida Product Approval# See Attached for multiple products use product approval form
Property Owner Information
Name: Ahern Project TH LLC Address: 830-13 A1A North#170
City Ponte Vedra Beach State FL Zip 32082 Phone (904)219-5003
E-mail rjohnston.mec@gmail.com
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: Urban Partners Construction Qualifying Agent: Edmundo Gonzalez
Address 3236 Beach Blvd. City Jacksonville State FL Zip 32207
Office Phone (904)270-2225 Job Site/Contact Number (904)591-7929
State Certification/Registration# CGC 1518379 E-mail eg@urbanpartnersgroup.com
Architect Name& Phone# Mark Macco(904)249-2724
Engineer's Name&Phone# Bradford Davis(904)739-3655
Workers Compensation Builder Mutual Insurance Co.WCP 104191601 _
Exempt/Insurer/Lease Employees/Expiration Date
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 the laws regulationg
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS, FURNACES, BOILERS, HEATERS,TANKS, and 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.
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 NANCIN , CO SULT WITH YOUR LEND • of AN ATTO• I EY BEFORE
RECORD;'G U), • /TIC OF COMMENCEMENT. i/
/4-
...k......
(Signatu of Owner or Age ' uding Contractor) - ('ignature of Cy tractor)
Signed and swo n to(or affirmed)before me thislo day of Signed and sworn o or affirmed) •efore me this (....o day of
I I .F .4----/ ,by R.'c:.K Jor)n�-+cr-'1 I I ` , by Cdrni.+r-,dGo c?r'1 )e-'
r
(Signature of Notary) (Signature of Notary)
�(, TALIADAHLKE ,Personal) Known OR 'p'P
XY ••P;�
Personally Known OF ;F''• ' .;�'i Y ;•�t :� •.
��� :,. MY COMMISSION#GG 094490 :?o,.• . • ,: TALIA DAHLKE
[ ]Produced Identificati�g;: 2— [ ]Produced Identification ,', •-• -: MY COMMISSION#GG 094490
:,.��.,; EXPIRES:Apri116,2021 :L: M:
Type of Identification: i _ Type of Identification: Vr�2�:< EXPIRES.April 16.2021
"'F0;•;'' • Bonded Thm Notary Public Underwriters
Legal Description:
A Replat of Lots 2, 4, 6, 8, 10 and 12, Block 2, Plat No. 1 Subdivision "A"
Atlantic Beach, as Recorded in Plat Book 5, Page 69 of the Current Public Records of
the City of Jacksonville, City of Atlantic Beach, Duval County, Florida.
Address RE#:
542 EAST COAST DR RE# 169742-0000
329 AHERN STREET RE# 169737-0000
331 AHERN STREET RE# 169737-0010
OACES
AHIE1 TOWNH � j Subdivision. "A"
,;2, 4s 6. 8.10 10 and 12, Block- p-0 Plat No
A Replat of Lots p e d f
4 Book 5, Page 139 'Ot the C`ur"Ut Ublic R cot a 0
At
'Beach, as Recorded i: I PIOLt
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