393 4th St reso24-0015 COAB Permit Form with Conditions permitOWNER:ADDRESS:CITY:STATE:ZIP:
FaverGray Residential LLC 415 Pablo Avenue, Suite 200 Jacksonville Beach Fl 32250
COMPANY:ADDRESS:CITY:STATE:ZIP:
FLORIDA TURF COMPANY 210 Mayport Rd ATLANTIC BEACH FL 32233
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
169849 0000 ATLANTIC BEACH
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
393 4TH ST
RESIDENTIAL OTHER SINGLE OR
TWO FAMILY RESIDENTIAL
OTHER
ARTIFICIAL TURF in
DRIVEWAY AND WALKWAY $20000.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 PUBLIC WORKS DUMPSTERS/ROLL-OFF CONTAINERS INFORMATIONAL
Notes:
Dumpsters and roll-off containers must be used in compliance with Section 16-8 and must comply with all standards, per City code.
2 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration, including sod, is required.
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: 3/5/2024
PERMIT NUMBER
RESO24-0015
ISSUED: 3/5/2024
EXPIRES: 9/1/2024
RESIDENTIAL OTHER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 $100.00
TOTAL: $129.00
3 PUBLIC WORKS CONSTRUCTION SITE MANAGEMENT INFORMATIONAL
Notes:
Provide construction site management plan, including location of silt fence, dumpster, portable toilet. Right-of-Way Permit is required if using right-of-
way for construction parking.
4 PUBLIC WORKS GRASS INFORMATIONAL
Notes:
Full site to be grassed.
5 PUBLIC WORKS REVISION INFORMATIONAL
Notes:
Any plan change must be submitted as a Revision to the Building Department.
6 PUBLIC WORKS DEBRIS REMOVED INFORMATIONAL
Notes:
All construction debris must be removed from job site by Contractor.
7 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Contractor.
8 PUBLIC WORKS OTHER PUBLIC WORKS CONDITION INFORMATIONAL
Notes:
Use base material with <10% fines only. In-progress inspection is required. Must submit receipt of artificial turf material being used at final inspection.
9 PUBLIC WORKS OTHER PUBLIC WORKS CONDITION INFORMATIONAL
Notes:
No rock can be installed in right-of-way. No artificial turf can be installed in right-of-way.
2 of 2Issued Date: 3/5/2024
PERMIT NUMBER
RESO24-0015
ISSUED: 3/5/2024
EXPIRES: 9/1/2024
RESIDENTIAL OTHER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $129.00
RESO24-0015 Address: 393 4TH ST APN: 169849 0000 $129.00
PUBLIC WORKS PLAN REVIEW $25.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
ZONING PLAN REVIEW $100.00
ZONING REVIEW SINGLE AND TWO FAMILY
USES 001-0000-329-1003 0 $100.00
TOTAL FEES PAID BY RECEIPT: R26382 $129.00
Printed: Tuesday, March 5, 2024 8:26 AM
Date Paid: Monday, March 04, 2024
Paid By: FLORIDA TURF COMPANY
Pay Method: CHECK 1353
1 of 1
Cashier: JVS
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R26382
3 :
i-,; BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
City of Atlantic Beach Building Department PERMIT# F e oZ2( OCU
800 Seminole Road, Atlantic Beach, FL 32233 information required to process
f It 9 Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address Z,613 1?It St RE# / I Q`-j - 000 0
Legal Description IZ' S 3-1 U1vfl ?Flt Ac S- b9- 16 -2S _ ag E
Valuation of Work(Replacement Cost) a U f 0iO Heated/Cooled SF Non-Heated/Cooled SF
Class of Work: 51 New Addition Alteration Repair Move Demo Pool Window/Door
Use of existing/proposed structure(s): Commercial Residential • If existing structure, is a fire sprinkler system installed?:Yes No
Will tree(s)be removed in association with proposed project? Yes (Must submit separate Tree Removal Permit) RI No
Describe in detail the type of work to be performed:
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coo i ficlk( -104 jritciAti S1ri p3 ( soul On j -1,413h0 S itpS •
n).. yv Sy -F-f f f esti cut pk o
Florida Product Approval# For multiple products use Product Approval Information Sheet)
Property Owner Information Name r WLY (jr rq, 1401d LL-C Phone
Address L1tr Iut;k ,}tat. City Socbc,i ,Iji 111, State r(, Zip 3)R,5-1.)
Email Owner or Agent(If Agent, Power of Attorney1or Agency Letter Required)
Contractor Information Name of Company I,i d a ?Uv f" Coal)4/
iii
Phone `, j Th tgcn
Address IA fOt: jet IU City 44f6n ( • `GGt; State jet_ Zip 3 o 3)
Qualifying Agent A(‘ r,'-1-e1 State Certification/Registration#
Email a lc x Ff o'1 dk A r c o i'lp4,V ,L c,,t, Job Site Contact Number /—
Worker's Compensation Insurer 13 CLIC-' Mew/r n S OR Exempt Expiration Date
Architect's Name Email Phone
Engineer's Name Email Phone
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 city/county,and there may be additional permits requiredfrom 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 YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE SITE OF THE IMPROVEMENT BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF CO MENCEMEENNT.
a04/n
Signature of Owner or Agent) S' nature of Contractor)
Signed and sworn to(or affirmed)before me this I day of and sworn to(or affirmed)bef'or'e me this ,day of
RJB LAOS YL1 ,8 LI by ( D r(\ C YC•L 1b(VAC 1fd,L `by QA_Ci n cL x x-
Signature of Notary C (-tic,` t 0 '[S? J1 Signature of Notary•SCt-Q
ersonally Known OR [ ] Produced Identification Personally Known OR Produced Identification
Type of Identification:Type of Identification: 1)C t.Co 3 q 01-] '2 03-2 (
SUE ARENS--BRANDYt mak-•;• BRANDY SUE ARENS
1 NotaryPublic-State of Florida Notary Public•State of Florida I4, Commission I NN 233471 Commission I NN 233471
MY Comm.Expires Feb 27,2026
f ti. ay Comm.Expires Feb 27,2026
JOB COPY
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