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Permit 812 Cavalla Rd —I 'Jri,, CITY OF ATLANTIC BEACH PERMIT BUMI)ING/ZONING DE+]P NT APPLICATION '000 Seminole Road Atlantic Beach,Florida 32233 U �...��Jl0 (904)247-58300 (904)247-5845 Fax www.coab.us APPLICATION TRACKING FORM REQUI D DEPT: JJ rr�� N PLANNING Property Address, 8l U� Ca.v 0" �� �C z L.YIP1 BUILDING f n--� Y N' PUBLIC WORKS Applicant: c �. �1���1.�A 1 1 PUBLIC UTILITIES YFIRE DEPT. Project-. I.��'� �� YNN PUBLIC SAFETY N APPROVAL w vREQUIRED AGENCY: RECEIVED BY: INITIAL: DATE: w Y N D.E.P HUFSTETLER ¢� Y I+I S.J.R.W.M. CARPER i Y N ARMY CORPS of ENG CARPER O Y N HOTELS&RESAURANTS HUFSTETLER APPLICATION STATUS CIRCLE ONE: SITE BUILDING DAg AP REVIEWED BY: INITIAL: DATE' ® 1ST REV �� P e* U11Y UI­ NTIC BEACt BUILDING OFFICE EEB 2 9 2008 PLANNING BUILDING ® ® 2ND REV PUBLIC WORKS PUBLIC UTILITIES FIRE DEPT. PUBLIC SAFETY ® ® 3RD REV CITY OF ATLANTIC BEACH _ a4_#y 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 08 s OFFICE:(904)247-5826•FAX NO.:(904)247-5845 BUILDING-D E PT@ COAB.U S BUILDING PERMIT APPLICATION DUVAL COUNTY N ❑NEW BUILDING 13 DEMOLITION ESIDENTIAL LOT_BLOCK_SUB DIVISION ❑ADDITION ❑CONVERTING USE COMMERCIAL n P5lAERATION ❑ACCESSORY BLDG. REPAIR ❑POOL/SPA =NO N/A ���'l /ter✓ 13 MOVE 13 OTHER tl. .. ,.,bH.i;%, -^. 3 e l•.9,. d' rd o.;:,,, ,, „�,.." ',. p, �n „.,• . N,,. •'e k..� ��.e•.,.`r' 9.NAME L 15. PANY NAME: 23.COMPANY NAME: :i16.NA 24.LICENSEE NAME: vev A 10.ADDRESS: �!j ,J'�r r��1 17.SPTE OF FLORIDAL ENSE O.: 25.STATE OF FLORIDA LI ENSE NO.: IS I �6 18.AADDDRESSS, fY� 26.ADDRESS: 5 f c) 0Ari_r - 11A-t eo+/ P-D 3_w 11.OFFICE PHONE: 12.FAX NO.: 19._OFFICPHONE: 20. NQ.: 27.OFFICE PHONE: 28.FAX NO.: 13.CEL4 'JI 2117/CELL 5PHON�E':Z7/ /'��].� ,+^ 29.CELL PHONE: 14.EMAIL ADDRESS: 22.EMAIL DDRESS' 30.EMAIL ADDRESS: M e St' � U, z bU1 S, L1>YYVt 09 I�, r � 1 �; � �. a P . �. � ,` .(., d z'xfns. 01 31.NAME: 33.NAME: 35.NAME: 32.ADDRESS: 34.ADDRESS: 36.ADDRESS: 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 laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six (6)months, or if construction or work is suspended or abandoned for a period of six(6) months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks, 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. I will not occupy or use the referenced building or any part therof, until all inspections are finaled and prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law. 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. Vf a Signed: ate: Sig Date. Before me i a f 20 the county of Before met • vay of 20 the county of Duval,State of Florida,has personally appeared Duval,State of Florida,has personally appeared -TQq-:�c �k-f-A�TbL-V<4 herin by himself/herself and affirms that all statements and declarations are herin by himself/herself and affirms th t all statements and declarations are true and accurate. true and accurate. -�y Notary Public at Large,State of li County of Al/Q Notary Public at Large,State of County of ❑Personally Known !-- ❑Personally Known ❑Produced Identification- I U �J IV(� v✓ `-- ❑Produced Identification- Notary dentification-Notary Signa Notary Signature: K. CUNNINGHAM K. o�pY P`B`S Notary Public-State of Florida COAB FORM BL - •=My Commission Expires Feb 28,2010 `d.' Commission#DD 523638 ^^M;^'Onm df 9iD fiR{ i ;„�O:`' National Notary Assn. Bonded By CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 08- C OFFICE:(904)247-5826•FAX NO.:(904)247-5845 BUILDING-DEPT@COAB.US 'sfar>� PLUMBING PERMIT APPLICATION DUVAL COUNTY SS's r � , r i' d's :I- wz; ',n ,� V ill =,'�'t.. :• ''' F-=.E �Z Cava �(� �`� ❑No g- OYES PERMIT#: +t• ,�. V,;x �� .�wi� w,l e� ii��l�i�llidl D�rl !i,t+nli,kii 'ti�x�1"�i� i°a:'„i ^SPI OPERT1f^ "Nk' "iii k' il"+?"„~� +.r i "r'i;i� ��;',.i5 nail:i3^'.'w{�iil sN6ilP�i:w4'�.wrwr. (��.i+ ikl 4.NAME: 5.ADDRESS IF DIFFERENT FROM JOB ADDRESS: 6.PHONE: 'ti!h✓'^ii��ii PLUMEIIINGA.+ .+A 'R�W':.,.�w i �' .,`2+lil, 7.NA OF OMPANY: / 8.ADDRESS.: I � 7J�, Ie YVN /4�,I've? rR 9.STAT9 OF FLORIDA LICENSE NO: 10.CELL PHONE: 11.FAX NO.: 12.EMAIL ADDRESS: 13.OFFICE PHONE: 14. Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6) months,or if construction or work is suspended or abandoned for a period of six(6)months at any time after work is commenced. r CONTRACTORS SIGNATURE: "D�1a,%� 'ry u!' .4,:,,•• e• d. n� 1"N a i '"ii si' U ,r�,P J,I t;i �y-,, ” .WRREr�T, ❑ NEW 0'06 FLORIDA BUILDING CODE- E3 RE-PIPE PLUMBING d t�, t ❑OTHER: +� C':II'G" ( w", � �IAi"'tl;;� '!'i;�"^; 71 .i '� rd�.E ��i�l� �� ,'vk"! ' v ��7,,,roi Ii o.xrJ h ,,.,r1�9 ii�(k,�kx „9rw 43 ° BATH TUB SEWER CONNECTION BIDET SHOWERS DISH WASHER SHOWERS PANS DISPOSAL SINK DRINKING FOUNTAIN WATER CLOSET TANK FLOOR DRAIN / WATER CLOSET VALVE HOSE BIB v WASHING MACHINES ICE MAKER WATER CONNECTION INTERCEPTOR WATER HEATER LAVATORY URINALS LAUNDRY TRAY OTHER(SPECIFY): ROOF DRAIN ..� ' .% `i��� �V.F Yit1�tNptF["::.E +iu ii s'Sn•"Fi��ii�m'q�I 4 �t'i. „1.,.....nY 5 :""d f.. PERMIT ISSUING FEE: $35.00 TOTAL FIXTURES: x $7.00 (PER FIXTURE) + $35.00 O COAB FORM BLDG03:REVISED:1/10/2008 CITY OF ATLANTIC BEACH j 800 SEMINOLE ROAD =: ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 08-00000427 Date 4/02/08 Property Address . . . . . . 812 CAVALLA RD Application type description PLUMBING ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc 1 fixture ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ GREEN, JOHNNY ANYTIME PLUMBING BY DARRYL INC 812 CAVALLA ROAD 609 MANDALAY RD ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32216 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING PERMIT Additional desc . . Permit Fee . . . . 7 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 9/29/08 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ---------------- - ---------- ---------- ---------- ---------- Permit Fee Total 7 . 00 7 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 7 . 00 7 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. � CITY OF ATLANTIC BEACH r 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 INSPECTION EMAIL REQUEST: Building-dept(iDcoaKus Application Number . . . . . 08-00000275 Date 3/05/08 Property Address . . . . . . 812 CAVALLA RD Application type description FOUNDATI QLY�y�,yy� Property Zoning . . . . . . . TO B PDATED Application valuation . . . . 0 - ---------- -------- --- - -- --- - --- - - --- - - - - - -- ---- Application desc RECONSTRUCT SLAB Owner Contractor ------------- --- -- --- -- - --- --- --- - --- ---- --- - --- GREEN, JOHNNY BUILTMORE BUILDERS 812 CAVALLA ROAD 5150 PALM VALLEY RD ATLANTIC BEACH FL 32233 SUITE 210 PONTE VEDRA BCH FL 32082 (904) 962-7265 ------------------- --- -------------------------- --- -- - -- - --- -------- -- ----- - Permit . . . . . . FOUNDATION ONLY Additional desc . . Permit Fee . . . . 100 . 00 Plan Check Fee . 00 Issue Date Valuation . . . . 0 Expiration Date 3/05/08 ---------- ----- -- -------- ------------ ------- --- - --- --- --- - - - - - ------ - -- -- --- Fee summary Charged Paid Credited Due ------ --- - ---- - -- - -- ------- ---------- -- - --- - -- - --- ----- - - Permit Fee Total 100 . 00 100 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 100 . 00 100 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. NOTICE TO THE OWNER AND ALL PERSONS INTERESTED IN THE ATTACHED PROPERTY This property, to wit: -A ez located at: 11/.x-� ��x�ti S'�•��'G�'�' �-,� is improperly stored and is in violation of the Ordinance Code of the City of Atlantic Beach, Florida; Chapter 21, Article 11, Division 1, Section 21-24 (a) and must be removed within ten (10) days otherwise it shall be presumed to be abandoned property and may be removed and destroyed by order of the City of Atlantic Beach. If the property is a motor vehicle, the owner will be liable for the costs of removal and destruction. Dated: z/��/� 3 Signed: Code E orcement Officer City of Atlantic Beach 800 Seminole Road Atlantic Beach, Florida 32233 (904) 247-5826 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 08-00000435 Date 4/03/08 Property Address . . . . . . 812 CAVALLA RD Application type description ELECTRIC ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc WIRING FOR LAUNDRY ROOM ---------------------------------------------------------------------------- Owner Contractor - ------------------------ ----------------------- COVENANT ELECTRIC INC 1236 MCDUFF AVE STE 208 JACKSONVILLE FL 32205 ---------------------------------------------------------------------------- Permit . . . . . . ELECTRICAL PERMIT Additional desc . . Permit Fee . . . . 35 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 9/30/08 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 35 . 00 35 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 35 . 00 35 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CITY OF ATLANTIC BEACH BODSEiIiOIElWJ1D.ATLANTIC BEACH F132233 08m' OFFICE:"A47-W26 0 FAX NO.m(9M)2,V-W0 B I A W AG-DEPT@C.OAB.US s==i ELECTRICAL PERMIT APPLICATION DUVAL COUNTY p NO 13 YES PERMIT t. 4.NHIE: q j} ADDRESS IF DIFFERENT FROM JOB ADDRESS: PHOlaE: E CfRIGA1 S , 9'§ . OFNO: 10 CELL PHONE 11.FAX NO_ 12 EMAL ADDRESS: 13 OFFICE PHONE: 14. 15.Application is hereby made to obtain a pem*to do the work and kniallatioris as h&*W. I coTtiy that al work w6 be performed b meet the dWKIWft of al laws rspAmliM consisu tiom in this Misdiclion. This permit baoommes mull and void if work is rat comrnencad w*m sk(6) nxxIN.,or if consbuclion or work is suspended or abandoned for a period of six(6) s at7�%T— El tinhe after work is comwmenced. CONTRACTORS sx;rwTtA�:MULTI FAMILY-#OF UNITS: WRESIDENTIAL 0 SINGLE FAMILY O TEND SERVICE O COMMERCIAL 0 ADDITION O TRAILOR i ou"ZoIC,s IL Oyo"W CODEa O ALTERATION O SIGN 16 OLD O NEW O VS NATIONAL ELECTRICAL CODE O REPAIR 0 POOL/SPA O REWIRE O OTHER t.�'ML,R'.LEC'iTDLA1 20.TYPE OF SERVICE- 0 OVERHEAD 0 UNDERGROUND O UNDERGROUND UP POLE 21.NEW SERVICE: CONDUCTORS PER PHASE: 0 POWER IS ON 0 POWER IS OFF 22.SIZE OF CONDUCTOR: AMPACITY., OCOPPER O ALUMINUM 23.SWITCH OR BREAKER SIZE: AMPS: PH: W: VOLT: RACEWAY SIZE: 24.EXISTING SERVICE SIZE: AMPS: PH: W: VOLT.. RACEWAY SIZE: 25.FEEDERS- #OF AMPS: s OF AMPS: #OF AMPS: 28.LIGHTING FIXTURES- INCANDESCENT: FLUORESCENT&M.V.: 27.FIXED APPLIANCES: 0-30 AMPS: 31-100 AMPS: OVER 100 AMPS: 28.FIRE ALARM: O YES O NO 2931 DO NOT APPLY TO NEW 30GLE FAMILY, AWLY AND 29.SMOKE DETECTORS: NUMBER: 30.RECEPTACLES: 0-30 AMPS: 31-100 AMPS: OVER 100 AMPS: 31.SWITCHES: 0-30 AMPS: 31-100 AMPS: OVER 100 AMPS: 32.Allt C01041000 Ilk #OF UNITS: COMP.MOTOR HP RATING: AMPS: HEAT KW: #OF UNITS: COMP.MOTOR HP RATING: AMPS: HEAT KW: 33,MOTORS: NUMBER VOLTAGE: HP: KVA: NUMBER VOLTAGE: HP: KVA. , 34 TRANSFORMERS: UNDER 60OV: NUMBER: KVA: OVER 60OV: NUMBER: KVA 35.MSICELAMEOtlS M ASI& D SCRIBE IN DETAIL: COAG FORM BLOOM REVISED:1110MO6 i i CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 INSPECTION EMAIL REQUEST: Building-dotaegab.us Application Number . . . . . 08-00000293 Date 3/04/08 Property Address . . . . . . 812 CAVALLA RD Application type description MECHANICAL ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc 1 cu Owner Contractor ------------------------ ------------------------ I GREEN, JOHNNY MARCO HEATING & AIR 812 CAVALLA ROAD 720 MILL CREEK ROAD ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32211 (904) 74-3350 ---------------------------------------------------------------------------- Permit . . . . . . MECHANICAL PERMIT Additional desc . . Permit Fee . . . . 51 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 8/31/08 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 51 . 00 51 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 51 . 00 51 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. f �� CITY OF ATLANTIC BEACH Q_ 1 1 t 1 1 \.` �' �'i. 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 O V i • OFFICE:(904)247-5826•FAX NO.:(904)247-5845 BUILDING-DEPT@COAB.US y MECHANICAL PERMIT APPLICATION DUVAL COUNTY _1JO&A . ° _ ala-� lo� Ca /a Yrs r�I ❑YES PERMIT#: OWNER, DIFFEREN 4.NAME: .: ..ti 5.ADDRESS IFJOB T FROM JOO B ADDRESS: 6.PHONE: r M'CHANI0AL.. TOR: 7. AME OF COMPA Y: 8.ADDRESS.: " r h i t t l I I�P.e.� I' 9.STATE OF FLORIDA LICENSE NV 10.CELL PHO E: .�I^` 1.FAX NO.: C161 S 12. AIL ADDRESS: n 13.OFFICEPHONE: 'J'l/ �l.?t 14. M /lX1�l' yp_bp Application is hereby made to obtain a permit to do the(work and installations as indicated. I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6) months,or if construction or work is suspended or abandoned for a period of six(6)months at any time after work is commenced. CONTRACTORS SIGNATURE: ZZ, zlt4 VLA"'SS. .BUILOM* 17"SERVI 0 "C z,009. ❑NEW INSTALLATION ❑NEW KRESIDENTIAL 06 FLORIDA BUILDING CODE- REPLACEMENT OF EXISTING SYSTEM EXISTING ❑COMMERCIAL MECHANICAL ❑ALTERATION/ADDITION TO EXIST SYSTEM ❑REPAIR ❑OTHER META QUfP PENT TQ B6 fNSTALLEf 19.HEAT: ❑ SPACE ❑ RECESSED ACENTRAL ❑ FLOOR BURNERS: 20.AIR CONDITIONING: ❑ ROOM 77TENTRAL 21.DUCT SYSTEM: MATERIAL: THICKNESS: MAX CAPACITY: cfm 22. REFRIGERATION: MAX CAPACITY: cfm 23.COOLING TOWER: CAPACITY: gpm 24. FIRE SPRINKLER: NUMBER OF HEADS: 25.LIFT SYSTEM: ELEVATOR: MANLIFT: ESCALATOR: AUTOLIFT: 26.COMMERCIAL HOOD NUMBER: 27.FIREPLACE: PREFABRICATED: MASONRY: 28.IRRIGATION: ❑ PUMP ❑WELL ❑ PIPING 29.GAS PIPING: #OF OUTLETS: ❑GAS AHU: ❑GAS WATER HEATER: 30.OTHER-SPECIFY: SOLAR HEATING, BOILERS,UNFIRED PRESSURE VESSEL,HEAT EXCHANGER KNE UCTS ETC. VALUE FOR OTHER ITEMS: 31 COMM 43.EQ e u APPROVING DESCRIPTION MODEL# MANUFACTURER TONS AGENCY ser C ' a Iml a-,o [t 1, I� 2.HEATINf3 EQtlP1T NA nin CE I FI 1R ' A DESCRIPTION MODEL# MANUFACTURER BTU AGENCY GALLONS CONTAINED MANUFACTURER SERIAL# AGENCY COAB FORM BLDG04:REVISED:1/10/2008 CITY OF ATLANTIC MACH 08-._ L � I � I ON SEWN0"kay.ATLANTIC SLAW FL!272x{ OFFICE:MWP+>AMI•FAX NQ:(9atj�p•9ai6 aWLMNGAEPT*CG WV9 ' MECHANICAL PERMIT APPLICATION DUVAL COUNTY YES PEWNTIK t ! P� ►o(� i.NAME: tAD14,1FEt1EMr FROM JOB PNOFIE: 7 ME OR COMP i� `t i 1 ree� a-�-t I as TE ,. Ap WoWn is hereby made to abbtin a pm*to da the work and Instablions as indicated. I certify that ab work will be Perimmed to meet the standards or ON taws rspula&V CW*hcbon In INS j►uWkfion. This permit boonmea null and void if work ie not commenced withln sk(`) monft,or N owmi wclion or work k suspended or abet doped for a Period of six(6)MWM at any lane atter work is commertCed. IF©ONTRACTORS S�►tA'fWeE: a NEW INSTALLATION MAL APtT OF EXISTING SYSTEM EXISTING O COMMERCIAL MECHANICAL O ALTERATION t ADDITION TO EXIST SYSTEM O REPAIR all 111111 901 a a OTHER 19.HEAT: D SPACE O RECESSED CENTRAL D]FLOOR BURNERS: 20.ANk CONDfYKNOM: 13 ROOM ENTRAL 21.DUCT SYSTEM: MATERIAL: THICKNESS: MAX CAPACITY: dm 22.REFRN3MTK : MAX CAPACITY: Cfm 23.COOLING TOWSR: CAPACITY: ppm 24.FIRE SPPJNKLE L- NUMBER OF HEADS: 25.LIFT SYSTEM: ELEVATOR: MANLIFT: ESCALATOR: AUTOUFT: 26.COMIIERCLa mwD NUMBER: 27.FIREPLACE: PREFABRICATED: MASONRY: 26.IRRIGATION: 0 PUMP D WELL 0 PIPING 29.WIS PIPING: 0 OF OUTLETS: O GAS AHI: O GAS WATER HEATER: 30.OTIH ER-SPECIFY: SOLAR HAWN06 soREIm uN feo PRISM VE&W WAT E)O "3EA OR COR NI D1JGTa BTC. AWE FOR aTF1ER rTEA1$: APPROVIMI OF UIWTS DEscro"ON MODEL# MANt AcTvowm T AGENCY UG OF LON" DEKI40 ION MOOEL S MANUFAC UREtR BTUAMNCY NtJ1eER GALLONS CONT MANUFACTURER SERIAL e GOAD FORM KDOU;RoVIUM inOtr!OW 80/LO 39Vd DVAH DDbvW 6ESL668006 69:OT 800Z/00/£0 VEHICLE TOWING AND/OR NOTICE OF IMPOUNDMENT 1,VEH.YEAR 2.MAKE 3.MODEL 4.C.E.C.# REPORT dg��, &iv�� ATLANTIC BEACH CODE ENFORCEMENT 5.COLOR 6.TAG NUMBER STATE:1 ' YEAR 800 Seminole Road • 247-5800 16.WAS VEHICLE IMPOUNDED? T VEHICLE IDENTIFICATION NUMBER )"YES ❑ NO A," y� ,6/ , //' 3 3, THE OWNER HAS BEEN NOTIFIED OF THIS ACTION 8.OWNER'S NAME(LAST,FIRST,MIDDLE) IX YES ❑NO A NOTIFICATION BY PLACARD 9.OWNER'S ADDRESS CITY STATE NOTIFICATION BY PLACARD AND U.S.MAIL 10.DAY,DATE,TIME OF OCCURENCE v�� 3 67 17.ARTICLES TAKEN FROM VEHICLE(MUST BE PLACED IN PROPERTY ROOM) 11.LOCATION VEHICLE REMOVED FROM NUMBER 18.INVENTORY AND CONDITION OF VEHICLE 12.NAME OF WRECKER FIRM ry Si oRE' YES NO YES NO 13.ADDRESS VEHICLE REMOVED TO RADIO STRAIGHT WIRED V TAPE DECK KEYS IN LOCK 14.REASON VEHICLE TOWE TAPES( ) DOORS LOCKED C.B.RADIO TRUNK LOCKED SPARE TIRE Y VEHICLE DAMAGE TOOLS AREA OF DAMAGE ❑NA 15.RELEASE OF VEHICLE BATTERY �, ❑I HAVE PAID ALL CHARGES TO THE TOWING COMPANY AND REQUEST MY VEHICLE BE OTHER ITEMS RELEASED. CI I HAVE PAID ALL CHARGES TO THE TOWING COMPANY AND REQUEST A HEARING. ❑I HAVE NOT PAID CHARGES BUT REQUEST A HEARING AND UNDERSTAND THAT MY 19.THE INVENT RY OFT FS VC1iiCi E IS CORRECT VEHICLE WILL NOT BE RELEASED UNTIL THE CONCLUSION OF HEARING. DRIVER SIGNATUR AUTHORIZATION TO RELEASE VEHICLE 20.HEARING DATE TIME: Date: HEARING OFFICER FINDINGS: Code Enforcement Officer SIGNATURE OF HEARING OFFICER 21. IMPORTANT NOTICE TO OWNER- IMPOUNDED VEHICLES A. You are hqreby notified,that the above described vehicle is being impounded pursuant to Atlantic Beach City Ordinance Number . Towing and storage charges will be assessed against your vehicle. You may elect to: 1. Pay towing and storage charges to the towing company; 2. Request a hearing as to the propriety of the impoundment and as to the owner's liability for charges; 3. Pay the towing company and storage charges and then request a hearing as stated in #2. B. Failure by the owner to request a hearing within five(5)days after receipt of this notice may act as a waiver of his right to a hearing and may result in the placing of a lien against the motor vehicle for the towing and storage charges without a further notice to the owner. C. It will be necessary for the owner to obtain a vehicle release at the Atlantic Beach Code Enforcement Office before the vehicle can be claimed. Proof of ownership and payment of charges to the towing company must be presented at the time of the release. 22.OFFICER'S NAME 23.I.D.NUMBER 24.SUPERVISOR I.D.NUMBER ,00��Iz COPIES: White-Atlantic Beach Code Enforcement Department Canary-Release Copy-Wrecker Company Pink-Owner Copy Ak VEHICLE TOWING ANDfOR NOTICE OF IMPOUNDMENT 1.VEH.YEAR 2.MAKE a MODEL 4.cF_c.r REPORT 6>v'r ATLANTIC BEACH CODE ENFORCEMENT a COLOR s.TAG NUMBER STATE YEAR 800 Seminole Road • 247-5800 1t1.WAS VEHICLE IMPOUNDED? 7.VEHICLE IDENTIFICATION NUMB, ER ;if YES ❑NO 6 /05;1 "5M,7 THE OWNER HAS BEEN NOTIFIED OF THIS ACTION 8.OWNER'S NAME(LAST,FIRST,MIDDLE) qt YES ❑NO NOTIFICATION BY PLACARD 9.OWNER'S ADDRESS CITY STATE NOTIFICATION BY PLACARD AND U.S.MAIL 10.DAY,DATE,TIME OF OCCURENCE ... 17.ARTICLES TAKEN FROM VEHICLE(MUST BE PLACED IN PROPERTY ROOM) 11.LOCATION VF.HrAt REMOVED FROM NUMBER 'A 18.INVENTORY AND CONDITION OF VEHICLE 12.NAME r E&IRM YES NO- YES NO 13,ADDRESS Y r.E r0 RADIO STRAIGHT WIRED TAPE DECK KEYS N LO C ; 14.REASON.VEHICLE TOWED TAPES( ) DOORS LOCKED ;iA R zzr+>4✓"' C.B.RADIO TRUNK LOCKED SPARE TIRE VEHICLE DAMAGE TOOLS AREA OF DAMAGE ❑NA I&RELEASE OF VEHICLE 'r BARRY O 1 HAVE PAID ALL CHARGES To THE TOWING COMPANY AND REQUEST MY VEHICLE BE RELEASED. OTHER ITEMS O I HAVE PAID ALL CHARGES TO THE TOWING COMPANY AND REDDEST A HEARING. 0 1 HAVE NOT PAID CHARGES BUT REQUEST A HEARING AND UNDERSTAND THAT MY 18.THE INVENRY OF .0 E IS CORRECT VEHICLE WILL NOT BE RELEASED UNTIL THE CONCLUSION OF HEARING, r� pF�/EFt GWATU '" ' AUTHORIZATION TO RELEASE VEHICLE 20.HEARING DATE "TIME: Date: HEARING OFFICER FIN0008: Code Eniarcemsnt Officer SIGNATURE OF HEARING OFFICER 21. IMPORTANT NOTICE TO OWNER IMPOUNDED YEHICI0 A. You are h eby notifi d that the above described vehicle is being impounded pursuant to Atlantic Beach City Ordinance Number ` , Towing and storage charges will be assessed against your vehicle. You may elect to: 1. Pay towing and storage charges to the towing company; 2. Request a hearing as to the propriety of the impoundment and as to the owner's liability for charges; 3. Pay the towing company and storage charges and then request a hearing as stated in #2. B. Failure by the owner to request a hearing within five(5)days after receipt of this notice may act as a waiver of his right to a hearing and may result in the placing of a lien against the motor vehicle for the towing and storage charges without a further notice to the owner. C. it will be necessary for the owner to obtain a vehicle release at the Atiantic Beach Code Enforcement Office before the vehicle can be claimed. Proof of ownership and payment of charges to the towing company must be preewted at the time of the release. 22.OFFICER'S NAME2a I.D.NUMBER 24.SUPERVISOR I.D.NUMBER COPIES: White-Atlantic Beach Code Enforcement Department Canary-Release Copy-Wrecker Company Pink-Owner Copy,