60 OCEAN BLVD DEMO22-0022 '`'',.' DEMO PERMIT PERMIT NUMBER
S; CITY OF ATLANTIC BEACH DEMO22-0022
�, 800 SEMINOLE ROAD ISSUED: 9/15/2022
-'`D'' �a ATLANTIC BEACH, FL 32233 EXPIRES: 3/14/2023
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.
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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
60 OCEAN BLVD (1-15) DEMO INTERIOR ONLY COMMERCIAL- DEMO ONLY $30000.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170227 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
KEN SARBU 3264 County RD MIDDLEBURG FL 32068
CONSTRUCTION CO INC.
OWNER: ADDRESS: CITY: ' STATE: ZIP:
60 OCEAN BOULEVARD LLC 4541 ST AUGUSTINE RD STE 1 JACKSONVILLE FL 32207
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT If\
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.
LIST OF CONDITIONS
Roll off container company must be on City approved list. Container cannot be placed on City right-of-way.
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:$104.00
Issued Date:9/15/2022 1 of 2
• ••1'- Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
t 9 IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us j�
Job Address: 60 (5(c .r t- We..--1,../l) Permit umber: bE McJ Z Z—C-)02 Z____
Legal Description /i 2.—S •— 01 51 /AC /QJI RE# / 7a Z -7,- -
Valuation of Work(R lacement Cost)$ Heated/Cooled SF Non-Heated/Cooled
�017 0//J_ Al/e. 5_ Wi
• Class of Work: ❑New ❑Addition ❑Alteration DRepair ❑Move jgVemo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ❑Residential
• If an existing structure,is a fire sprinkler system installed?: [Nes ❑No
• Will tree(s)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:
k / 1-'-_m 11141/ f 14 /362 0L7-- //- u.(
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name I w'140‘ J dit.al` / Address
City 7 State ii.---Zip Phone 49e)--- .•20,5>'
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) _.
Contractor Information
Name of Company f 2(—' ' Qualifying •gent
Address S Z Q �/y City h P L 44.. - ---:-L--Zip 5 c C)�nV
Office Phone et,, g- Qj 7 _Jab Site Contpct Number 42, —.1 _ 33
State Certification/Registration# ((. C�1 l`j E-Mail 5A-Xr�'(.. Cee -;'"-- 0 .. SPC _ , A_ (-
Architect Name& Phone# A r'' 1 •— e '44U:
Engineer's Name&Phone# E f 51 y -- g 3
Workers Compensation Insurer OR Exempt A.-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 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 PROPE'TY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER ORA A, • • l EY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
• .ILA._ J
(Signature of Owner or ATrt) (Signatu • of Contractor)
Signed and sworn to(or affirmed)before me this V day of Signed and sworn to(or affirmed)before me this 11.* day of
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`F Notary Public-State of Florida .• ry
Commission N HH 43737 4 � Commission#HH 43737
ersonall Known OR '� Personally PSep
Y ori`': My Comm.Expires Sep 17,202 Known OR ati,,: My Com,• xpires 7,2024
[ ]Produced Identification t 6.. • ded through National Notary Assn[ Produced Identification Bonded thr..gh ational Notary Assn.
Type of Identification: NiIiIIPAiamIlli/40'' se of Identification: \ /.../4.1011 '' iliI►