170 8th St DEMO22-0019 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
BARDUSCH MARK C 170 8th ST ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
BOSCO BUILDING
CONTRACTORS 2158 MAYPORT RD ATLANTIC BEACH FL 32233
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
170326 0000 CLUB MANOR
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
170 8TH ST DEMO INTERIOR ONLY GARAGE INTERIOR DEMO $5000.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
DEMOLITION 455-0000-322-1000 0 $100.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $104.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property
that may be found in the public records of this county, and there may be additional permits required from other
governmental entities such as water management districts, state agencies, or federal agencies.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY 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
RECORDING YOUR NOTICE OF COMMENCEMENT.
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
1 of 2Issued Date: 8/9/2022
PERMIT NUMBER
DEMO22-0019
ISSUED: 8/9/2022
EXPIRES: 2/5/2023
DEMO PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
2 of 2Issued Date: 8/9/2022
PERMIT NUMBER
DEMO22-0019
ISSUED: 8/9/2022
EXPIRES: 2/5/2023
DEMO PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
t'--, Building Permit Application Updated 10/9/18
OiL City of Atlantic Beach Building Department ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
F:%;9r IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: / Y S ' QTL4iv G iC rmit Num ber:'•
Ef\v 2Z_ op 19
Legal Description 7-' (+ 2 Hp " )-S - AS'E - G>^k 6 A,144,A RE# ( 7 t73 X POde
LI-r t tiJ 2 l.q p.r Mr/s
Valuation of Work(Replacement Cost)$0o Heated/Cooled SF Non-Heated/Cooled
Class of Work: New Addition DAlteration DRepair Moveemo Pool Window/Door
Use of existing/proposed structure(s): Commercial i{JResidential
If an existing structure,is a fire sprinkler system installed?: Yes jZ'No
Will treels)be removed in association with proposed project? Yes(must submit separate Tree Removal Permit) No
Describe in detail the type of work to be performed: ael-
174 7- Jtioe fe Ad vAL )r=- 4 19G4, V-- fieok GZ4-s(J& e/i/ -
Florida Product Approval# vp for multiple products use product approval form
Property Owner Information
Name /`9A/- K iq,9 .P 14" / Address 7 70 s i '
City 4-17^fi/V-ri r•-- Pcif State FL Zip 3a-L.3 Phone 73.14-- 71G -D2-/,"
E-Mail /`7i4 41c 6 32,6.9 c & /Q / Z1C , .(o_/•(-
Owner
o/•fOwnerorAgent(If Agent, Power of Attorney or Agency Letter Required) f,•i Gd
Contractor Information
7• % L '(4 1'/•., 0 ( ,b 17'?/'C7ol s rco;' /yySCc
Name of Company Qualifying Agent
Address '../5—ci) r)NY PC(0- /0 CityfAersspy u'.'//° State Fes- Zip _ i...z,3P
Office Phone 70 ¢ A4-/-03?0 Job Site Contact Number 904. • .1-79-- a q 49.(--
State
9¢
State Certification/Registration# C'ff r • /A..rd A/2 E-Mail 71J7,4' /-3v'Sc4 CQ c • CC/f
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer ,/Y,17`2 x (s'ayRce. OR Exempt Expiration Date iL/l :7-1'2-3
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 regulating
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. NOTICE:In addition to the requirements of this
permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and
there may be additional permits required from other governmental entities such as water management districts,state agencies,or
federal agencies.
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 FINANCING • • SULT WITH YOUR LENDER OR AN ATTORNEY BEFORE tg
N
RECORDING YOU`N ENCEMENT. N -2
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Signature of Owner or Agent)Signature of Contractor) zo . .
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Signed and sworn to(or affirmed)before me this W''day of Signed and sworn to(or affirmed)before me this
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r.t(,,I'WILLIAM L.POPE PHy$/G44Gy ,4i°Si.:,i;;; g;,i°" '' r WILLIAM L.POPE -,04,r ,,'':MYCOMMISSION#GG 348645 )PersonallyKnown OR s'XI-Personally Known OR '* *:MY COMMISSION#GC
a. EXPIRES:October 19,2023 )Produced Identification s•iz; EXPIRES:October 1'Produced Identification Faoa; p;;BondedTAruNotaryPublicUnderwritern a of Identification: FaF °' Bonded rs:.Type of Identification:
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