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296 Royal Plams Dr build out 2011 H ULSBERG ENGINEERING Residential and Commercial Structural Engineers May 19, 2011 City of Atlantic Beach Building Dept. 800 Seminole Road Atlantic Beach, Florida 32233 Re: North Florida Builders 296 Royal Palms Drive Permit No. "Y--,20V60' To Whom It May Concern: On the subject project we offer the following: • The slab or fill may be placed over the existing asphalt. • Termite poison is not required. If you have any further questions, please feel free to contact me. Sincerely, M William J. Di ry, PE FL PE 490 . 11481 Old St. Augustine Rd., Suite 202, Jacksonville, Florida 32258 Phone (904) 886 -2401, Fax (904) 260 -4367, FL CA No. 25846 A .16:440N CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD r ATLANTIC BEACH, FL 32233 it INSPECTION PHONE LINE 247 -5814 Application Number 11- 00002046 Date 5/17/11 Property Address 296 ROYAL PALMS DR Application type description COMMERCIAL ALTERATION Property Zoning TO BE UPDATED Application valuation . 10000 Application desc BUILD OUT AND NEW CONCRETE SLAB Owner Contractor KLOTZ JEFFREY DAVID AR COLLEY CONSTRUCTION INC P.O. BOX 330833 512 18TH ST N ATLANTIC BEACH FL 32233 JAX BEACH FL 32250 (904) 866 -1165 Permit COMMERCIAL ALTERATION /OTHER Additional desc . Permit Fee . . . 100.00 Plan Check Fee . . 50.00 Issue Date . . . Valuation . . . . 10000 Expiration Date . 11/13/11 Special Notes and Comments Avoid damage to underground water /sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is needed, call 247 -5834. Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible. A sewer cleanout must be installed at the property line. Cleanout must be covered with an RT1 concrete box with metal lid. Cleanout to be set to grade and visible. Roll off container company must be on City approved list and container cannot be placed on City right -of -way. Roll off container company must be on City approved list and container cannot be placed on City right -of -way. Other Fees STATE DCA SURCHARGE 2.00 DEV REVIEW - PUBLIC /INSTITU 25.00 ENG REV COMMERCIAL BLDG 25.00 STATE DBPR SURCHARGE 2.00 UTIL REV PRE APP >3 HRS 25.00 Fee summary Charged Paid Credited Due Permit Fee Total 100.00 100.00 .00 .00 Plan Check Total 50.00 50.00 .00 .00 PERMIT IS XPVPIZ ED 1 �C RDANCE WITI ALL° PITY OF ATLAAtC n n ACH ORDINANCEQ ciND THE FLORIDA° 0 BUILDING CODES. CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD J ATLANTIC BEACH, FL 32233 \se ' INSPECTION PHONE LINE 247 -5814 '401.1 �lf Page 2 Application Number 11- 00002046 Date 5/17/11 Grand Total 229.00 229.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. - .7f /4e91.2 I- a -- 7 2 /4 ielt A7, r:TviENT "" E IViANr1 1.-- „''..','''',`,-.'".•••.,:,-.:,,.:,...*".",;.',,,,., A.; i 223 ENDURA® GR ENDU____ __ - - • ,,,S 0 - ' :•°!n= t ,,, m 7, .mns,,r; .4F.,,',,' , 1 • : eere -'- ngin , ' Y ... r1,.-4,,,, ' ''' '''''''yti ■+''' '1 041,1 .',\O''...'"''' '' , 1 it',71 '' ' ' r 1 .' ''',. i 7: 4 40 'tig+, ' ' ':11`, ! eit.,4' ' t 44:1 ,1,Y ;VI 40#,,L,,,,t I ' '' .,,,,,'1.4 ■14 '''' '''''''' '',, 1,4',"11 1 ,-, .^ ',,?), ".." ..4 - ' ' ' %,,,..? ,r ` , 61', ..17,4HI " .:, '''. ''.4* 1 ''''' ntr, ',',■^1( l'C' 1 i The 1 4 . 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',; ,,• ther[44 ..pialciff.'L Fi xibilit of installation ,,, e...$f......,..„:„. 1 - ,... ,c,„;-, °. • .'..i. z, ,.....,.... „..,.•,...,,,,, ___,''...,,,:,, irk AptrinIcW,,7,, .,- • _ .e - floor or , ,,• 4 .' 4 .• ,,,, ,tff..- ,:' ! „.- ,....2'.,ne::....i.,, ' . jfIkEttoilltft111454 'Itr,,PF y f - ca •I',74;1,,,i;,," a nd " in s tal led in-floor, on -floor, .t..4',"•14.!:,A,.tt'''','",‘,•,•.,..• ,,...',.1.,u'.•.,,,',..''.‘•''' •' • .. " ',.1,,I.4e„bet vallie4“ ) '-'4',i ' ;'1:1 : , ' ' '' ' ' 11'014 " : '-.....-..L.L'''' , • • 4:-•il'''''•;'-'.':• '''-'1•.-,' • ''''..ifil';',"140%4,',.Ptii.trikpgs' ' ta lir' an r operator 4 ..- .,. ii'L sem i-recessed ..,•',,,..,.s.'4,4F4'...„,0-',„.-4.,..,,ii,.;.1.!0:: ----: -..,hittl;settut v.v. ,4,,171, , , i....".....,,,..44.,‘ , , .1 , :i' . ',.., - ,,..`' ,•lit,,z,... .,:•,,, , . ....,,..., ..„.•?.,t,-,,,..;,,,...,7 ,, -'.. „;- 7 ,-,, ,, ,, t- . &"1";' .- ";,'-'", ;. .'' ,,, ,q,"; 4 - ' ';,,, ‘ ', . ,,', r' ,I, • ., 1 'y , ,,,, , , isiottb. iotr,ttxlzt)t.,,,.,:,i,'j4A;:.;"fil'",.,,'.,';' :if*MIYALY .,., ,, - m ,-, . - 44..,V -- '1, 4 giiii' '''''', ' off.t.. 1 011 $11'4 , i4 ,1 1"t' , '''"=1"' L " r ' ' .• "' d' ,,` 7` ',t .k '''' 4 ' 1 '/- , IN 7" 'Iv.' 7, '. ill -1-p '' Mil ap1)10 4, w e , ,...,.. ASME 112.14.3 _.:. pAEA160- 6 e 6 S441 444"0 00.E W W • nduraintercepto,or.cAoliamxis comp- dis ° 8 Si3ip S < �a r a $ap F 1 ��, s ,� a $ q a 1 I" ii a 8. ` `` I L R Grease Interceptor Contractor shall install a Canplas Endura° Grease Interceptor, Part No. 39S 0 A 03 (fill in). A flow control with a rate of S0 gpm will also be installed in accordance % * Diffuser to manufacturer's instructions. The unit shall be comprised of engineered thermoplastics to withstand ...4..:.;:::::::::::.:::::: ..,, { 1 baffle only operational temperatures up to 220 °F (104 °C) and incorporate a lid with the capability of supporting ? I s‘; t „ used in 35 440 lbs. (200 Kgs). The unit will be supported by a 10 year manufacturer's extended warranty. The grease �/ ' an models GPM interceptor shall be certified to the current version of the PDI- G101standard and where locally applicable ` to ASME112.14.3 orhave UPC listing. Contractorshall provide mechanical connectors to connect the grease L i ce . i interceptor. " TANK DIMENSIONS `- 1 � GPM/Ibs 15 /30 20/40 25/50' LO 25/50 35/70 50/100 E � ) I,, Y ,! t ; • A 23.6" (600mm) 23.6" (600mm) 31.0" (787mm) 23.6 "(600mm) 31.0 "(787mm) 31.0" (787mm) 11 1 l 1, � ;, ',;�` 1 1 f B 17.5 "(444mm) 17.5 "(444mm) 23.5" (597mm) 17.5 "(444mm) 233" (597mm) 23.5" (597mm) ' `I hl ti'I i ill !;, ; 1 ' C 3.5" (89mm) 3.5" (89mm) 4" (102mm) 4.1 "(104mm) 5.0"(127mm) 5.0" (127mm) ■ r , ,. 1 1 l 1 I li D 12.8" (325mm) 12.8" (325mm) 7" (178mm) 12.2 "(310mm) 12.5 "(318mm) 18.5" (469.9mm) A III \ j E 16.3" (414mm) 16.3" (414mm) 11" (279mm) 16.3 "(414mm) 17.5 "(444mm) 233" (596.9mm) FLOW CONTROL DIMENSIONS AIR INTAKE DIMENSIONS FLOW CONTROL AIR INTAKE TEE Connection 2 "h xh 3 "hxh 4 "hxh 2 "spg 3 " spgxh; 4 "spgxh Iron Pipe Size (Solvent weld)'_ <C A 3.0" 4.23" 6.13" 2.91" 2.67" 3.19" .-- - (76.2mm) (107.4mm) (155.7mm) (73.9mm) (67.8mm) (81mm) B ' 8 3.84" 5.93" 6.84" 2.71" 4.01" 5.04" B (97.Smm) (151mm) (173.7mm) (68.8mm) (101.9mm) (128mm) ' to �! C - - - 2.24" 2.27" 2.72" IA- A->j IA A->I (56mm) (57.7mm) (69.1mm) 3" VERSION ILLUSTRATED CAPACITIES LIS Gallons Per Minute (GPM) 15 20 25 LO 25 35 50 CAPACITY - Pounds 30 40 50 50 70 100 Litres Per Second (LPS) 0.94 1.26 1.6 1.6 2.2 3.2 CAPACITY - Kilograms 13.6 18.1 22.68 22.7 31.8 45.4 Average Efficiency % (ASME 112.4.3) 97.1% 95.4% 97.1% 92.5% 98.6% 93.9% Part Number 3915A02 3920A02 3925A0210 3925A02 (2") 3935A03 (3 ") 3950A03 (3") 3925A03 ") 3935A04 (4") 3950A04 " Grease Capacity Ibs (Kg) actual 65 (29,5) 76.4 (34.65) 53.4 (24.22) 74 (33,6)* 138.5 (62.8) 122 (55.3) * Operating Temperature Capabilities 220°F (104°C) 220 °1(104`C) 220 °F (104 °C) 2201 (104 °C) 220°F (104 °C) 220°F (104"0 Surface Load Capacity 440 Ibs (200 kgs) 440 Ibs (200 kgs) 440 Ibs (200 kgs) 440 Ibs (200 kgs) 440 Ibs (200 kgs) 440 Ibs (200 kgs) Unit Weight (Empty) 23 Ibs (10.4 kgs) 23 Ibs (10.4 kgs) 23.9, lbs (10.85 kgs) 13 Ibs (10,4 kgs) 45 lbs (20.4 kgs) 60 Ibs (27.2 kgs) Liquid Capacity 21.6 gat (81.8 L) 21.6 gal (81.8 L) 18.9 gal (71.541) 21.6 gal (81.8 L) 39.4 gal (149.1 l) 52.0 gal (197 1) Connection size (mechanical) 2" 2" 2" 2" (3925A02) 3 "(3935A03) 3 "'(3950A03) (110 mm available on request) 3 "(3925A03) 4 "(3935A04) 4 "(3950A04) * Max capacity calculated based on data at PDI G101 test approval. All other models /data quote figures at ASME 112.14.3 Breakdown. Canplas Industries Ltd. Canplas LLC -'{.moo P.O. Box 1800, 500 Veterans Drive 11402 East 53rd Ave. Mixed Sources Barrie, Ontario, Canada L4M 4V3 Suite 200, Denver, CO, U.S.A. 80239 haarrtge.p Ymawti . Tel: (705) 726 - 3361 Tel: (303) 373 - 1918 t.. a.tna< "m"u.a.w,a. Toll Free: 1- 800 - 461 -5300 Toll Free: 1- 888- 461 -5307 FSC e,z17m2s „c. °.1 Fax: (705) 726 -2186 Fax: (303) 373 -1923 CO nPiCiS GD- 000205- EN -02 -10 PRINTED IN CANADA on OAliax;s comosny Page 1 of 1 Measure your sinks. (Note: include freestanding, wall and mop sinks in this section) Length Width Depth Cubic Capacity Volume (inches) (inches) (inches) (inches) (US gallons) Sink 1 Compartment /Bowl 1 24 24 12 6912 Compartment/Bowl 2 24 24 1 12 6912 Compartment/Bowl 3 24 24 12 6912 Sub Total - Sink 1 20736 89.766 Gallons Sink 2 Compartment /Bowl1 10 12 8 960 Compartment /bowl 2 10 12 8 960 Compartment/Bowl 3 10 12 8 960 Sub Total Sink 2 2880 12.468 Gallons Sink 3 Compartment/Bowl 1 0 0 0 0 Compartment/Bowl 2 0 0 0 0 1 Compartment/Bowl 3 0 0 0 0 Sub Total - Sink 3 0 0 Gallons Maximum Discharge 102.234 Gallons Drainage Load A (Max Discharge x 0.75) 76.676 Gallons 2. Select a '1' or '2' minute drain period. Note: where possible it is recommended to design based on a 1 minute drain period Formula assumes a 1 minute drain period - For 2 minute enter '2' 2 Minute Actual Drainage Load 38.338 Gallons /Minute (GPM) 3. Add any additional appliances. Note: Dishwashers can be connected to a GI only if allowed by local code. Each dishwasher will require a seperate GI. For floor drains /sinks take the volume of water produced by the number of hose bibs (i.e. 1.5 -2.0 GPM per 3/4 inch faucet) Floor Sink 1 /Other Appliance 2 GPM Floor Sink 2 /Other Appliance ! 0 GPM Floor Sink 3 /Other Appliance 0 GPM Additional Discharge 2 GPM Your Endura Grease Interceptor TOTAL Actual Drainage Load 40.338 GPM Grease Interceptor Capacity Required 50 GPM If the above cell displays "Flow Rating Exceeded" consider using a 2 minute drain period. If still showing "Flow Rating Exceeded" contact your national Canplas Customer Service location for assistance. These are listed below for your convenience. This application requires a Canplas Endura - Part Code 3950A03 Canplas Customer Service Canada: 1- 800 - 461 -5300 U.S. A.: A.: 1- 888 - 461 -5307 httn' / /tznanu ra nr,iaor,I„rn /T -TTAAT /,,...1, . ,.« ..t. t. a. l c is tnn, X1201.) fr.t SAL S i 1 E f I-- ti 1 6 t.. Q y 4 � 2 �1 111 �1 � 1 1 1 � 1 `` � r. r ,.,\4 .' \ 1 0 g ut) it \ t \ I ...MlfY . ,ik ,— iaKA. A t`. \ , j� .(w( r�r7y R r,�, rt, ∎, e \. r1 I t�V A I.: t . { 1 ''' • e.'?/- �r ( ";' ' ` r E17 " ) . - r r I i , ).\\ ! � � \ I�ISPtnA4- r - 1 .� r 11,1.. rc 0 J �.: c r t it •.. • -,/ • rte ' fr �"• f - ` .r` . .4 , aL .:\ ai= m • ■ ~ \ e 0. 1",,, ` ( {r d � \ JJ ti. a t t l ', •.4 I,l IS t __ ._S./ � '.. IY IATYo 1h�tfd% r l � t � \ . \ ri .. i ce —Adf .4P It 1.41'1u6 • . »_. .i... . ....vs./6 ■eom;, AV.e \ w �- /,u..•r -... • j.'" .r _ _ " _ _ - .. 146. 4i _r , D1.( ?wt....._ f 4 s },.h_..n !... / Uoc # aui 1 I U0/4b, UR 6K i =93 Page 3O y NOTICE OF COMMENCEMENT Number Pages: 1 Recorded 05/0612011 at 11 05 AM. ��LL/ • JIM FULLER CLERK CIRCUIT COURT DUV.AL / - 07v 7t ry — RECORDING Permit No. RECORD SNG $10.00 Tax Folio No. /77 6 /3- X00 THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Section 713.13 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT. 1.Description of property (legal description): 38 .- . 7 7€. 56 8 DE _ 0Asneo YF " trt c e es j — a) Street (job) Address: 294 &VAC . eA.M..2.____biZi MG 2.General description of improvements: _=aVyXe'eO't.__ -&UML do c _- 3.Owner Information ------ - - - - -- - - -- - - -- - - - - -- �^ a) Name and address: zE F_k,pTZ 7.•D. 3 3 0x'33 Q724'v77 2 L32233 b) Name and address of fee simple titleholder (if other than own r) c) Interest in property _ 4.Contractor Information a) Name and address: ?0•04f � J 1Q. 3��T 1?1 b) Telephone No.: 90 — 4 fa__ l /(, _ Fax No. (Opt.) (i0 "0170 - clap �ryt� 5.Surety lnformation -- - - -- -- - Y `,/ } a Na Telepho me and address: b) Amount of Bond: c) Telephone No.: -- - - - - - ax'No. (Opt.j ", ` W"`"`.... ... �.,..~....-W- Y--- ..�.�.....- - 6.L.ender _.— z _ a) Name and address: ' ,. Phon 7. identity of person within the State of Florida designated by owner upon tit F f . documents may be served: a) Name and address: ;r b) Telephone No _ _ + Fax ;. 0 t.)_ 8.In addition to himself, owner designates the following person to receive aicopy ' e M .tire as t j,pn ' 713.1 3(1)(b), Florida Statutes:* °:v* ' a) Name and address: b) Telephone No -- - - — Fa: r. an Tit( 9.Expiration date of Notice of Commencement (the expiration date is one year ro or e e • " dac . cling ul!!..ss a t i _y....� �.�,.,_..�...,....... _ 6 specified): WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN 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 YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. STATE OF FLORIDA ¢ 1 '. (OI NTY O F 1,!RS DUV AL+ f - / Signature of Owie or )wner's A r rite. Oftic 1 !Di , 'etor /Partner /Manager Print Name The foregoing instrument was acknowledged before me this frtL day of_ 2 011 , by ■'e 1+ l/ .r, as AI /WALL i_''k -___ , < E _____ (type of authority, e.g. officer, trustee, attorney in fact) for - -_ (name of party on behalf of whom instrument was executed). Personally Known ) OR Produced Identification __ _ Notary Signature died ' / 4 _•, ., f, - -r., - =o + °I. Notary Public State of Florida Type of Identification Produced Natne (print) �o /-}! L ' 7 T Gail Testa — -- M, Gunmission WYtleu61 OR 7o A0 Expires 06!07/2014 Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I _ .. , • . _ _ • . .. the facts stated in it are true to the best of my knowledge and belief P l .l FORNIS,'VOC.nsa?uifio ... %. Signa r (Natural P.r)n Signing (' line • 10.) Above VP City of Atlantic Beach r P * L, C TION NUMBER : , Building Department }(To be �� assigned ' b ty pe Building Department } `' � -..z " 800 Seminole Road 1::7 cx t ry# ° r o Atlantic Beach, Florida 32233 -5445 : ,,:.0 .. f'1 Phone (904) 247 -5826 • Fax (904) 247 - 5845_. E -mail: building- dept @coab.us . Date routed City web -site: http: //www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 9(,, ?yi De rtment review re. uired Yes No , .. Applicant: £ 4,//,ij en,,,,Trkay7 try) .: • • g Tree Administrator Project: AA id t k 7' (- 7 ,1 ekiti ; hi 6 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: QApproved. enied. (Circle one.) Comments: 6 a.ei —.e — BUILDING PLANNING & ZONING Reviewed by: Date: / (� � 5 TREE ADMIN. Second Review: Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. ['Denied. omments: Reviewed by: Date: 2evised 05114/09 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247 -5826 Fax (904) 247 -5845 Job Address: 494 e?c,v4e. t ?aCOIS 12211 Permit Number: // 5/6 Legal Description 38 - .25'e.796 --- . sho 3 vE d Ya�az Parcel # / 774,1 3-0660 Floor Area of Sq.rt. 4 Q T q•Ft Valuation of Work $ 10 000 — Proposed Work heated /cooled 4 .1.. � O non - heated /cooled 460 Class of Work (circle one): New Addition (Alteration_) Repair Move Demolition pool/spa window /door Use of existing/proposed structure(s) (circle one): ommercial Residential If an existing structure, is a fire sprinkler system insta • r : - c e one): Yes No N /A Florida Product Approval # For multiple products use product approval orm / 47 &- -'o '-- Describe in detail the type of work to be 1 e p 3vt t b eb.c. i ' � 2 t /.iS S M w 1( iChe:IA( NV- Property Owner Information: Name: — c G Ie-LOT Z Address: 1 -14, 71//121) SP% P-043, 3 3 O Z33 City •' ., 1 1.... c ?,,f 1 StateZip„5a733 Phone qtr - -e27ft_- s s4 E -Mail or Fax # (Optional) Contractor Information: / Company Name: 1. • dews . /..; _1, Qualifying Agent: 1/If�4CTc .8) z • Address: 5?( 1? '_ sr ' • City --- "A- C • /4'. Stat • J Zipr3JaSZ) Office Phone ga} t244, - 3 Job Site/ Contact Number q0(- g(p, / //ps' Fax # c ,05 1. -:.„1"7 -0920 State Certification/Registration # 410.e__ 1 7 /$/i(L. Architect Name & Phone # Engineer's Name & Phone # guts beY9 L //lee12.otkFG, T • /qv- 2 - 2 Fee Simple Title Holder Name and Addre s / Bonding Company Name and Address Mortgage Lender Name and Address Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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 ElectricalWork, Plumbing, Signs, Wells, Pools, F urnaces, Bo Heaters, Tanks and Air Conditioners, etc. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE F • '. MINIS, TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCI 1,1 - ,',Z.-:.- YOUR LENDER OR AN ATTORNEY BEFORE RECORDING 1- ‘ T COMMENCEMENT. 4. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisio . ,. , n • type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give. authority.Er, aria or wRncei4lte provisions of any other federal, state, or local law regulating construction or the performance of construction. ignature of Owner A I �,� Signature of Contractor ,r �/� : (Print Name L® .z._ Print Name l! Acte. �, ' 0 & AO , Swo i to and subset • - d before me Sworn to and subscribed before me this4 t / Da of _ _ 20 / this < Day of di. t , , 20 1/ If i , ` , , J. 0, ""i Notary Public State of Florida — • S ` c� y. Notary Pub is w _ . ' ; M y conxnission D0999061 No +, ' " : - • • - , , ,,o xpres 06/07/2014 Expires �` - ` Notsty Pttblk, 26.10 ,, t My comm. exPkes Dec. 16, 2014 Doc # 2011100746, OR BK 15593 Page 359, NOTICE OF COMMENCEMENT Number Pages: 1 Recorded 05/0672011 at 11:05 AM, JIM FULLER CLERK CIRCUIT COURT DUVAL Permit No. f f 020 446 COUNTY RECORDING $10.00 Tax Folio No. / 6 l 3 — 00c5 THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Section 713.13 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT. 1.Description of property (legal description): 38"cPS'al €. 56 8 DE )'P A' e €. 7 a) Street (job) Address: Z.94 N0YsK. P4C 1V../U6 2.General description of improvements: wrs iOw; sO /c.. etcf 3.Owner Information a) Name and address: z -F QTZ 7.0 . 3 3 O 73 3 4 ' en 7ZA 2 ,Q 32233 b) Name and address of fee simple titleholder (if other than own r) c) Interest in property 4.Contractor Information / a) Name and address: Af ad „l z , F , A . _ . _ , • 342j6 / b) Telephone No.: 9 — , 6 / /( ( Fax No. (Opt.) 4 "O a – . 0 \ ,, �`/} 5 .Surety Information a) Name and address: b) Amount of Bond: c) Telephone No.: Fax No. (Opt.) 6.Lender a) Name and address: Phone No. 7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served: a) Name and address: b) Telephone No.: Fax No. (Opt.) 8.In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes: a) Name and address: b) Telephone No.: Fax No. (Opt.) 9.Expiration date of Notice of Commencement (the expiration date is one year from the date of recording unless a different date is specified): WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN 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 YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. STATE OF FLORIDA COUNTY OF4.114ret.AS DUAL. Signature of Owne •Owner's A r orize Offic /Di ctor /Partner /Manager E ,� ° a rm' Print Name The foregoing instrument was acknowledged before me this Lott) day of , 20 f / , by 7 Pf . 4' Zel rZ as /Y1 AlYAAtnfA Al Eni ea-to (type of authority, e.g. officer, trustee, attorney in fact) for (name of party on behalf of whom instrument was executed). / Personally Known Y OR Produced identification __ Notary Signature A fa i J. — „ - o � �Y "L. Notary Public State of Florida Type of Identification Produced _ Name (print) c$ E}1 L r = i A Gail Testa OR 1'01 A o''' Expires 06/07/2014 Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that 1 ' . ,: .:: -. _ • _ ., • . the facts stated in it are true to the best of my knowledge and belief. 4 ! '7 FORMSMOC.n sd20IO Jai Signa„0 fNatural Iron Signing ( line • 10 .) Above r --L`1r City of Atlantic Beach '` r A PLI CATION NUMBER �= Building Department � • " i � ' � ,, 9 p � �• -� (To be assigne th l3wld Department z - �e 800 Seminole Road 617. *O�� ce -517: r Atlantic Beach, Florida 32233 -5445 Phone (904) 247 -5826 • Fax (904) 247 -58 �< * ��`�' oi✓ E - mail: building- dept @coab.us .�� Date outed y - +' `� •' r 4 �" City web -site: http: //www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: �-, C �Y p �cg ep L De • artment review re • uired Yes No � l/n� ,[ 1 r � Applicant: ,� 4 `/f / (7Tk07% w • • g Tree Administrator Project: , { / Id L1 A r 4- (1 77 7hhCof - • - �� .. :, Mg i frr", M 3.. P Pt - +e' 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. (Circle one.) Comments: BUILDING �) PLANNING & ZONING Reviewed by: (/ Date: cC'9 --f/ TREE •MIN. Second Review: A roved as revised. n pp ❑Denied. P "ORKS C. ments: ( P UTUTES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: (Approved as revised. ❑Denied. Comments: Reviewed by: Date: evised 05/14/09 City of Atlantic Beach r } �?I�CQtTION NUMBER Building Department F ' a sS� (To be assigned the Building Department ) r - - 800 Seminole Road t } a T Atlantic Beach 5 , Florida 32233 -544 ry a s Phone (904) 247 -5826 Fax (904) 247 -5845 F, f�5ys E -mail: building- dept@coab.us Date routed + a City web -site: http: //www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: �> 9 De • artment review re • uired Yes No l ? yi - Applicant: £ �n //i &,'Tk •nnin• - • • g / Tree Administrator _ Project: { i LcI © A T 4-71 77. 1L) �rz, ter€ l�i� e rF 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: APPLI ATION STATUS Reviewing Department First Review: Approved. ❑Denied. (Circle one.) Comments: BUILDING 3 e- W • -. P_L.�F G &ZONING a „ i �raAA�Q�sIC. Reviewed by:J Date. TR ADMtid. Second Review: QApproved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: (Approved as revised. ❑Denied. Comments: Reviewed by: Date: Zevised 05114109 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247 -5826 Fax (904) 247 -5845 Job Address: .294 ZbYAG 24.0,15 1)7211 Permit Number: Legal Description 3S-.25-102(16-1 S6 8 i)E 0 Y .. Parcel # / 7741 3 —coca Floor Area of Sq.Iit. C712 101T Sq.Ft Valuation of Work $ /0 ) 000 — Proposed Work heated/cooled c ,1., V-0 non - heated /cooled 4 Class of Work (circle one): New Addition CAlferati& Repair Move Demolition pool/spa window /door Use of existing /proposed structure(s) ((circle one): ommercial Residential If an existing structure, is a fire sprinl' insta system nsta • r : - e one): Yes No N /A Florida Product Approval # / For multiple products use product approval orm /4 / - - ) - i!0 t ---- Describe in detail the type of work to be performed: Bvt Our ,.2 W p m/ ' AIc S >ic w/ 0 ic-A eg `7 ,t/- 6 , 6 4 - :--1 (- - 4:.'..._ Z/1 Property Owner Information: Name: C F T Z- Address: 4 T/rzl) sr:: So / -0• L3 ye 3 3 O X33 City /flL N d_. State Zip?& 3 Phone ei0, --,.2l yt• S 34 E -Mail or Fax # (Optional) Contractor Information: // Company Name: 1. • ______I cows '-1 . 2:4 Qualifying Agent: Vi/r4 7?J2 d4 ,., Z - Q • Address: 37i / 8' - ST. ' • City • r�1 )C • 1 . State • Zip Office Phone 90 ,244 - 8,96 Job Site/ Contact Number 90y- g("/ - / /bs Fax #9034 09,0 State Certification/Registration # age__ l57/BGQ. Architect Name & Phone # Engineer's Name & Phone # egc.is ievg i'- elf/ /!c!wzoteG, T. • /q,'_ Y64 - 2 Fee Simple Title Holder Name and Addre s Bonding Company Name and Address Mortgage Lender Name and Address Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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 f6) months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Bo Heaters, Tanks and Air Conditioners, etc. • 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 CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. 1 hereby cer that I have read and examined this a placation and know the same to be true and correct. All provisions of laws and ordinances governing this type of wtify work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other federal, state, or local law regulating construction or the performance of construction. l' ' r: 41; fl ignature of Owner t 'j ` � Signature of Contractor���/l'� r. 1 - �' Print Name l 'err / 7 Le 7 , Print Name �,!�ll lZ a C� i Sworn to and subscribed before me Sworn to and subscribed before me this( (1. Day of / /dd 20 I this °" �� Day of 'Ji�,_; f C-". i , 20 4 / i i t k, r m , , ,.. v ° 4i y Notary Public State of Florida 71 i/rr n k l� ,a. Notary Pub is S o c. 0 1-717 ag i My cornmissior, 00999051 No ,. ,. ' , - ., , ,,,o Expires 06/07/2014 NotavY Pubic, `' • iliV 1 26.10 MY comfn• expires Dec. 16, 2014 +4 td r l�.Ly ;y City of Atlantic Beac q�?IG N UMBER s 'ma y Budding Department 1114 y ,:sro be assignedrbxthe Bwlding. Department) T i 800 Seminole Road v f a ,5-t- e7 ^". �" i `� • u Atlantic Beach, Florida 32233- • - 1"*. • 41 F s � : y a7 T Phone (904) 247 -5826 • • Fax (904) 24 , ` K `-_ L ate{ E -mail: building - dept @coab.us fi, Date • ,� � City web -site: http: //www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address:, J(, A L //n5 J r - De • artment review re. uired Yes No Applicant: o 4'i'///-'V 4 . 117'14, � ✓ j tr7) ' nnin• . • • g - / Tree Administrator Project: b1,4 !cal I t ' . ri 72 i) tlt f e e / , / i 6 P . • afety rxt x +-s d ra+. 0. f 7.� - ' li w 4 - r t r Reu ev ee .$ _ , 1 � pe i Sign r � ; ,i °,4 . � ti : 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: QApproved. Denied. (Circle one.) Comments: ti-4 t � BUILDING PLANNING & ZONING Reviewed by: Date: &74 /J) TREE ADMIN. Second Review: Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: -( 1? FIRE SERVICES Third Review: (Approved as revised. ❑Denied. Comments: Reviewed by: Date: Zevised 05/14/09 6 I V "12.(:0 S�. -r City of Atlantic Beach APPLICATION NUMBER $.1t Building Department z (To be assigned by tuilding Department ) s1 � {E -�, he B 800 Seminole Road " ems ` �' , r - ` �, �- � t f � y Atlantic Beach, Florida 32233 -5445 � � { x E b E l - � , Phone (904) 247 -5826 • Fax (904) 247 -5845 f-. a r ^x sr E -mail: building- dept @coab.us Dafe routed; f ' E _ City web -site: http: //www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: ) g(, - 1()/A L. / 'P/m5 De • artment review re • uired No v . Applicant: 1 ///tV &m%tr,'2 - •' g / Tree Administrator Project: lcI 6 A )1-7h-:/ i0 dIECIZEZWAYEVEfill �'�'�;�' =°©'mss �,r .0 F `�' Reuievufeei$. ,,.,� W eview or Permit Required Review or Receipt Date gpU � Q Verified By F � ironmental Protection of Permit Veri i o 'r'eS Isportation �1 s% t il r Management District 3ers Restaurants averages and Tobacco APPLICATION STATUS Reviewing Department First Review: Approved ['Denied. (Circle one.) Comments: BUILDING PLANNING & ZONING Date: Reviewed by: 5' 9 � � TREE ADMIN. Second Review: ['Approved as revised. ❑D ied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 G KS0NVi z FIRE 442 1 , 9F SCUE O' FIRE PREVENTION DIVISION OFFICE OF PLAN REVIEW May 9, 2011 TO: Atlantic Beach Building Department FROM: Captain Bob Ratliff SUBJECT: Plan Review for Village Wine & Cheese 296 Royal Palms Drive The following discrepancies are noted on the plans as submitted: 1. Comply with FAC 69A- 60.0081 Notice Required for Structures With Light -frame Truss -type Construction. 2. NFPA 1- 11.1.7.1* Means shall be provided for the fire department to disconnect the electrical service to a building, structure, or facility when the electrical installation is covered under the scope of NFPA 70. 11.1.7.2 The disconnecting means shall be maintained accessible to the fire department. 11.1.7.3 Identification of Disconnecting Means. 11.1.7.3.1 Each disconnecting means shall be legibly marked to indicate its purpose unless located and arranged so the purpose is evident. 11.1.7.3.2 The marking shall be of sufficient durability to withstand the environment involved. 3. NFPA 101 - 7.10.1.3 Provide Tactile Signage at each door requiring an Exit sign. Signage to be mounted on latch side of door, 60" AFF. 4. Provide Code Summary indicating codes utilized for design of occupancy, Occupancy Type and Occupant Load. 5. NFPA 101 - 7.2.2.4.1.1 Stairs and ramps shall have handrails on both sides, unless otherwise permitted in 7.2.2.4.1.5 or 7.2.2.4.1.6. ig a .-t1 Where Floeida Begin.. 214 N. Hogan Street I Jacksonville, FL 32202 -4128 I Phone: 904 - 255 -8320 I Fax: 904 - 255 -85591 bratliff @coj.net 6. NFPA 101 - 7.2.5 Ramps. 7.2.5.1 General. Every ramp used as a component in a means of egress shall conform to the general requirements of Section 7.1 and to the special requirements of 7.2.5. Provide detail of egress ramp 7. NFPA 101 - 7.9.1.1* Emergency lighting facilities for means of egress shall be provided in accordance with Section 7.9 for the following: (1) Buildings or structures where required in Chapter 11 through Chapter 42 ... Provide Emergency Lighting in required areas. 8. Answer all comments in written summary with revised / clouded plans. • G Where Florida Be ,s. 214 N. Hogan Street I Jacksonville, FL 32202 -4128 I Phone: 904 - 255 -8320 I Fax: 904 - 255 -8559 1 bratliff @coj.net May 11,2011 Tgiul SUMMARY OF PLAN CHANGES MAY 12 2011 SUBJECT: PLAN REVIEW FOR VILLAGE WINE & CHEESE 296 ROYAL 1. THIS BUILDING IS CONSTRUCTED WITH 16" RIGID STEEL TRUSS ATTACHED TO I -BEAM IN CENTER — SEE ATTACHED CLOUDED ARCHITECTURAL DRAWING. 2. A KNOX BOX WILL BE INSTALLED AT THE CLOSEST ENTRY DOOR TO THE ELECTRICAL PANEL — SEE CLOUDED PLAN — KEY #31 3. TACTILE SIGNS WILL BE INSTALLED AT ALL EXITS — SEE CLOUDED PLAN - KEY #33 4. 2007 FLORIDA BUILDING CODE, 2009 SUPPLEMENT - CHAPTER 3, SECTION 303.1 — ASSEMBLY GROUP A -2 - FOOD AND DRINK RESTAURANT - ASSEMBLY GROUP A OCCUPANCY INCLUDES, AMONG OTHERS, THE USE OF A BUILDING OR STRUCTURE, OR A PORTION THEREOF, FOR THE GATHERING OF PERSONS FOR PURPOSES SUCH AS CIVIC, SOCIAL OR RELIGIOUS FUNCTIONS; RECREATION, FOOD OR DRINK CONSUMPTION; OR AWAITING TRANSPORTATION. TOTAL BUILDING SQ. FT. = 4232 —1532 UNUSABLE SQ. FT. = 2700 USABLE SQ. FT. / 15 SQ. FT. PER PERSON = 180 PERSON OCCUPANCY LOAD. 5. RAMP IN FRONT OF BUILDING HAS FRONT & SIDE SLOPES OF 1:12 AND BACK RAMP ALSO 1:12 SLOPE WILL HAVE HAND RAILS ON BOTH SIDES - SEE CLOUDED PLAN AND ATTACHED CLOUDED ELEVATION DRAWING. 6. SEE CLOUDED PLAN AND ATTACHED CLOUDED ELEVATION DRAWING. 7. SEE CLOUDED PLAN KEY #32,34,35 8. ALL CONSTRUCTION AND OR ALTERATIONS WILL ADHERE TO ALL CURRENT AND SUPPLEMENTAL FLORIDA BUILDING CODES, INCLUDING BUT NOT LIMITED TO THE FOLLOWING: a. NFPA 101 LIFE SAFETY CODES AND CHAPTER 69A -60 THE FLORIDA FIRE PREVENTION CODE. b. BUILDING CODES - 2007 FLORIDA BUILDING CODE, 2009 SUPPLEMENT— CHAPTER 6, SECTION 601 — CHAPTER 7, SECTION 705 — CHAPTER 9, SECTIONS 901 - 912 c. ELECTRICAL CODES — CHAPTER 27 AND NFPA 70 & 110 d. EGRESS— CHAPTER 10, SECTIONS 1001 -1029 & 1035 e. ACCESSIBILITY - CHAPTER 11, PART A, SECTION 11 -5 1/4s8 •Nvidos 4 f p - - , 4 1 _ 46:1' Z Gk. p _. y �- `„ t , , t' �1 ...,j a - }# �� n F 1! 1 ,,, / ® t ..;> . :: p '5�� ' 1 I _, - ■gi 1 t :..' .,i { • n■rl .,. I i t ' _ �■ t 1 Y __ ■■ ■ ■■ 0 . I E.7C� ®r +�t�'�r1[sts,rt. t p � , ` � .�t '• ':Li ' -1-1- . ~f-- ' - I F - t - 111111 1 __,_;-. 4_1. rill ..L_1 i __ 1 ., IIIMF1,1111111111111 ; _J.- - 1 ,•I ; til iptAlu..4 : 11. 1_2,._ .InIEgimi i- ,i_r_.: . ,... _ - por„-• �� ; . r .i tl a►, L rF � �Glie-� ,p,!� -; N IL t� d f _ �^ , ,_ NI,F-,,,,„ -1 , tal l .. r t ' rt - ? .' �, ; ,- -i 1� � , G . , i _. ii _ i r 1 -.' R '', '-_'� .4 � . — 7r _.- __ 1 ,___4__ t I 1 '10 likly r 4 _ l ,' ' ' ' ' : ,' ,- .'. . I .' [3 tt� i • ; ' tl . - r a t � :: ■ids' ' tai - i M ., . i .. . I I i 2. � �, p ■i I ] • ham, 1 _r 1 IT � 1 >. Arta t~ �� < „ 0 , i I --a' -- - - l 4 - - __,__,_,___.,,,..,, _ ' 1 t ._...I_ te ` app .. . i _ a , l ily i ••' • 7_ b. ' i ,, , • : }-1-1- i ---q .4 ', .-'[- II A , m ,,,, w , . r . ,_ ., ;14 i , , , ii , ii 4 _ la ' ., , --t , , 3 - ± } an00 1 t _ I r 1 1 �� . I :, P -^+o ff - - • 1- - 1 1 Graham Shirley From: Ratliff, Bob [BRatliff @coj.net] Sent: Monday, May 16, 2011 3:31 PM To: Ratliff, Bob; Graham Shirley Cc: White, Debbie; Griffin, Michael Subject: RE: 296 Royal Palms Dr Attachments: DOC.PDF Shirley, The approved plans for 296 Royal Palms Drive are attached. Please make sure the owner understands that he should not move anything into the store or begin operations until a Fire Safety Final is conducted at the location. This will need to be coordinated with Mike as well. Thanks, eaptaitt i3C5 3icttliff CFPS Jacksonville Fire & Rescue Department Fire Prevention Division Office of Plans Review 214 N. Hogan Street Room 281 Jacksonville, FL 32202 (904) 255 -8320 Office (904) 255 -8559 Fax CONFIDENTIALITY NOTICE: Please note that under Florida's very broad public records law, e-mail communications to and from city officials are subject to public disclosure. From: Ratliff, Bob Sent: Thursday, May 12, 2011 9:00 AM To: 'Graham Shirley' Cc: White, Debbie; Griffin, Michael Subject: RE: 296 Royal Palms Dr You can scan them if you like but I will also need to see the original if they are approved. Thanks, Captain 301 :Ratliff' CFPS Jacksonville Fire & Rescue Department Fire Prevention Division Office of Plans Review 214 N. Hogan Street Room 281 Jacksonville, FL 32202 (904) 255 -8320 Office (904) 255 -8559 Fax 1 CONFIDENTIALITY NOTICE: Please note that under Florida's very broad public records law, e-mail communications to and from city officials are subject to public disclosure. From: Graham Shirley jmailto:sgrahamOcoab.usl „ . Sent: Thursday, May 12, 2011 8:58 AM To: Ratliff, Bob Cc: White, Debbie; Griffin, Michael Subject: RE: 296 Royal Palms Dr Good morning, I have the revisions for the village wine and cheese at 296 Royal Palms Dr, I can scan these and email them if you prefer, just let me know! Shirley From: Ratliff, Bob jmailto:BRatliffOcoj.net] Sent: Friday, May 06, 2011 11:15 AM To: Graham Shirley Cc: White, Debbie; Griffin, Michael; Jones, Mike Subject: RE: 296 Royal Palms Dr My current plan is to leave my office around 3:00 this afternoon to make it to you by around 3:30 or so. Hopefully I will be able to get both of these plans taken care of today. See you soon, Cap tain B05 ERcatiff CFPS Jacksonville Fire & Rescue Department Fire Prevention Division Office of Plans Review 214 N. Hogan Street Room 281 Jacksonville, FL 32202 (904) 255 -8320 Office (904) 255 -8559 Fax CONFIDENTIALITY NOTICE: Please note that under Florida's very broad public records law, e-mail communications to and from city officials are subject to public disclosure. From: Graham Shirley [mailtoagrahamOcoab.us] Sent: Friday, May 06, 2011 11:13 AM To: Ratliff, Bob Cc: White, Debbie; Griffin, Michael; Jones, Mike Subject: 296 Royal Palms Dr We have another set of plans for your review at 296 Royal Palms Dr Shirley Graham Building Department 800 Seminole Rd 2 z /7 "22 -: ,.. .,.--- a A A.._ - 1 ' 7 -- - — .... 7 ... ,...• ., / 04 , 2„......... /4}/ 4 ' , , E . ,.. , . 0 t I.— I V I I I i NIT 1 - -1 i\AENT .„,. :,........„....1.........,,,,,.....4.4,, U G 11"1. 46 I\ 1 jak END RA Cf- F A • , . . .... , . ' - - 4.qt..: . :9": ,A o : ii` . .., ., . Th e 4. - - ,,,,,,,, '. " ■ . ._„rt, .,.... 4., ,„.,... 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ASME 112,14.3 . r W C ® . or c rnpoi.4, m'EA160.0..1' ww.enduratnterceptoo,r.)CAOliaMxis a a S x 8 Y X BS d o0.. 'i.10 3 9 4 .fa 8 X8d B 3 -. � ° € : �, . 8 8 8 �. r '% Grease Interceptor Contractor shall install a Canplas Endura• Grease Interceptor, Part No. 39S 0 q 0 .3 A flow control with a rate of S O (fi a in nce ). . * Diffuser to manufacturer's instructions. The unit shall be comprised of engineered n ered l thermoplastics it accord :::.'. i. baffle only operational temperatures up to 220 °F (104 °C) and incorporate a lid with the capability of supporting " 6 .`.-:1:::•::• \ used in 35 440 lbs. (200 Kgs). The unit will be supported by a 10 year manufacturer's extended warranty. The grease ! �! I 4 f , and 50 GPM interceptor shall be certified to the current version of the PDI- G101standard and where locally applicable models toASME112. 14. 3or have UPC listing. Contractor shall provide mechanicalconnectorstoconnectthe grease interceptor. g - s3 � a <j \ j TANK DIMENSIONS t ■ r. " GPM /Ibs 4 -`� C L ` �. 15/30 20/40 25/50 LO �' 25/50 35/70 50/100 l I' t h A 23.6" (600mm) 23.6" (600mm) 31.0" (787mm) 23.6 "(600mm) 31.0 "(787mm) 31.0" 787mm ) ' I i � 1 @@� i �I "•° - 411 B 17.5 "(444mm) 17.5 "(444mm) 23.5" (597mm) 17.5 "(444mm) 23.5 "(597mm) 23.5" (597mm) l i t i ti C 3.5" (89mm) 3.5" (89mm) 4" (102mm) 4.1 "(104mm) S.0 "(127mm) 5.0" (127mm) A a 11 D 12.8" (325mm) 12.8" (325mm) 7" (178mm) 12 2 "(310mm 12 " E 16.3" (414mm) 16.3" (414mm) 11" (279mm) 16.3 "(414mm) 175 "(444mm) 23.5" (596.9 mm) FLOW CONTROL DIMENSIONS AIR INTAKE DIMENSIONS Connection 2 "h x h 3 "h x h 4 "h x h 2 "spg x h 3 "spg x h 4 "sp xh FLOW CONTROL AIR INTAKE TEE Iron Pipe Size (Solvent weld) 11(C >I A 3.0" 4.23" 6.13" 2.91" 2.67" 3.19" _ (76.2mm) (107.4mm) (155.7mm) (73.9mm) (67.8mm) (81mm) B B 3.84" 5:93" 6.84" 2.71" 4.01" 5.04" ! I B (97.5mm) (151mm) (173.7mrn) (68.8mm) (101.9mm) (128mm) Y I C - - 2.24" 2.27" 2.72" (56mm) (57.7mm) (69.1mm) IA- A --,.I +rA >I CAPACITIES 3 " VERSION ILLUSTRATED 4/ US Gallons Per Minute (GPM) 15 20 2510 25 35 I 50 CAPACITY - Pounds I 30 I 40 50 50 I 70 I 100 Litres Per Second (LPS) 0.94 f 1. 1.6 26 1.6 2.2 3.I CAPACITY' - Kilograms 13.6 18.1 22.68 22.7 31.8 45.4 Average Efficiency %(ASME 112.4.3) 97.1% 95.4% 97.1% 92.5% 98.6% 93.9% Part Number 3915A02 3920A02 3925A0210 3925A02 (2") 3935A03 (3") 3950A03 (3") 3925A03 (3 1 3935A04 (4 ") 3950A04 (4 1 Grease Capacity Ibs (Kg) actual 65 (29.5) 76.4 (34.65) 53.4 (24.22) 74 (33.6) * 138.5 (62.8) 122 (55.3)* Operating Temperature Capabilities 220°F (104°C) 220°F (104X) 220'F (104°C) 220'F(104 *C) 221 104 °C) 220'F {) Surface toad Capacity 440 Ibs (200 kgs) 440 Ibs (200 kgs) 440 lbs (200 kgs) 440 Ibs (200 kgs) 440 Ibs (200 kgs) 440 Ibs (200 kgs) Unit Weight (Empty) 23 Ibs (10.4 kgs) 23 Ibs (10.4 kgs) 23.9 Ibs (10.85 kgs) 23 Ibs (10.4 kgs) 45 Ibs (20.4 kgs) 60 Ibs (27.2 kgs) Liquid Capacity 21.6 gal (81.81) 21.6 gal (81.81) 18.9 gal (71.541) 21.6 gal (81.8 L) 39.4 gal (149.1 L) 52.0 gal (1971) Connection size (mechanical) 2" 2" 2" ;770 mmavailableonrequest) 2 "(3925A02) 3 "(3935A03) 3 " (3950A03) 3 " (3925A03) 4 " (3935A04) 4"(3950A04) * Max capacity calculated based on data at PDI G101 test approval. All other models/data quote figures at ASME 112.14.3 Breakdown. Canplas Industries Ltd. Canplas LLC 4 o P.O. Box 1800, 500 Veterans Drive 11402 East 53rd Ave. T411Xt?d Sources Barrie, Ontario, Canada L4M 4V3 Suite 200, Denver, CO, U.SA.80239 i „ „i „�Amtir °<o"�` �",'„ Tel: (705) 726-3361 Tel: (303) 373-1918 FSC .�..tcw Ce.t"sSGYC Toll Free: 1-800-461-5300 Toll Free: 1 -888- 461 -5307 ever, "..< se.w.�.w;.,a Fax: (705) 726 -2186 Fax: (303)373 -1923 GD 000205 -EN -0 2-10 PRINTED IN CANADA il .m Y an OAIhaxis compony Page 1 of 1 1 Measure your sinks. (Note: include freestanding, wall and mop sinks in this section) Length Width Depth Cubic Capacity Volume (inches) (inches) (inches) (inches) (US gallons) Sink 1 Compartment /Bowl i 24 24 12 6912 Compartment/Bowl 2 24 24 12 6912 Compartment /Bowl 3 24 24 , 12 i Sub Total - Sink 1 1 20736 Sink 2 _ 89.766 Gallons Compartment /Bowl 1 10 - -- -- 12 8 960 Compartment /Bowl 2 12 8 960 . Compartment /Bowl 3 10 12 8 960 Sub Total - Sink 2 Sink 3 2880 ' 12.468 Gallons Compartment /Bowl 1 • 0 0 0 Compartment /Bowl2 0 0 0 0 0 Compartment /Bowl 3 0 Sub Total - Sink 3 Maximum Discharge 0 0 Gallons Drainage Load A 102.234 (Max Discharge x 0.75) 76.676 Gallons 2. Select a '1' or '2' minute drain period. Note: where possible it is recommended to design based on a 1 minute drain period Formula assumes a 1 minute drain period - For 2 minute enter '2' , :2 - -- _— Minute Actual Drainage Load � ------------ ,.-- .____. 3. Add any additional appliances. 38.338 Gallons /Minute (GPM) Note: Dishwashers can be connected to a GI only if allowed by local code. Each dishwasher will require a seperate GI. For floor drains /sinks take the volume of water produced by the number of hose bibs (i.e. 1.5 -2.0 GPM per 3/4 inch faucet) Floor Sink 1 /Other Appliance 2 GPM Floor Sink 2 /Other Appliance 0 GPM Floor Sink 3 /Other Appliance i 0 'GPM Additional Discharge 2 GPM Your Endura Grease Interceptor TOTAL Actual Drainage Load ------- - - - -__ _.___ 40.338 GPM Grease Interceptor Capacity Required 50 GPM If the above cell displays "Flow Rating Exceeded" consider using a 2 minute drain period. If still showing "Flow Rating Exceeded" contact your national Canplas Customer Service location for assistance. These are listed below for your convenience. This application requires a Canplas Endura - Part Code 3950A03 Canplas Customer Service Canada: 1 800 - 461 -5300 U.S.A.: 1 888 - 461 -5307 httn //unznx, ranniaeninmk;nn ..nrn/LTTA /,....,.i,.. :.., «,. ..1.....a 1.4....1 c is rnn, 1 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247 -5826 Fax (904) 247 -5845 Job Address: c99 .WoY/�C &ens j)ui' Permit Number: Legal Description 38 Si 8 t)E ( � rae_ Parcel # / 7<'/ 3 —° fib . Floor Area of Sq. Ft. q.Ft Valuation of Work $ 10� 000 Proposed Work heated /cooled y -0 non - heated/cooled 4 Class of Work (circle one): New Addition ' Iteration Repair Move Demolition pool/spa window /door Use of existing/proposed structure(s) (circle one): mo mercial Residential If an existing structure, is a fire sprinkler system insta • • : - e one): Yes No N /A Florida Product Approval # For multiple products use product approval form /,7 7 ) - v / i. Describe in detail the type of work to be performed: .&.'t L b oc ' Gat W/AIS S rbR L 1.4i r fC h cig '- /Vii -- 1 L: ; r .L (f7 Property Owner Information: Name: C•�FG 41-PI Z Address: Il/& 71/fie,A SA7, So ,/ -DZ,• 3 3o Z33 City /xT 1 L $E379c7I State, ,12,233 Phone 49 — .273,t— S' 34 E -Mail or Fax # (Optional) Contractor Information: �y � // Company Name: 1, . _ ( ,:„,„..4_,,_4.1,,, r , Qualifying Agent: 11//1€7.2 4 / ) zIe • Address: 5a / 8 S7 ' . City' 14X . aii . State • Zip,404 Office Phone 9bY a? - g " Job Site/ Contact Number 9jot- g-6,4,_ / /l, Fax #9 - State Certification/Registration # (re._ iswak,,Q. Architect Name & Phone # Engineer's Name & Phone # 'kiS be 9 L 79//?QQi22,W , -.✓ec . /q.jt- ,764 - ay-of Fee Simple Title Holder Name and Addre3's / Bonding Company Name and Address Mortgage Lender Name and 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 aperiod of six 6) months at any time after work is commenced. I understand that separate permits must be secured for ElectricalWork, Plumbing, Signs, Wells, Pools, F urnaces, Bo Heaters, Tanks and Air Conditioners, etc. 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 CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. 1 hereby certify that I have read and examined thisplication and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other federal, state, or local law regulating construction or the performance of construction. A' ignature of Owner , i (/ ii =t Print Name Signature of Contractor��f ; L - '' , "` y ° r {{ ' r f e± 7 Pr int Name �� J/,,�yy a A . Ota. r • Swornn to and subscribed before me Sworn to and subscribed before me '' € this, • 1 Day of / 4,' 201 this '' Day of Cl i� t / , 20 Ij Mr J /"_ k .' - 2, �. °% Notary Public Stab Of Fbrida ' " „i . ' ( - A O Notary Pub is ; ; _ , i My commission Duseeoa1 No 1- 7 r „pc Expires 08/07/2014 ,.• ..�, � I Notety ,' � ,' i 26.10 ,,..,, ConNnl MY comm• exPMes Dec. it 2014 CITY OF ATLANTIC BEACH I J 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 Application Number 11- 00002046 Date 5/25/11 Property Address 296 ROYAL PALMS DR Application type description COMMERCIAL ALTERATION Property Zoning TO BE UPDATED Application valuation . . . 10000 Application desc BUILD OUT AND NEW CONCRETE SLAB Owner Contractor KLOTZ JEFFREY DAVID AR COLLEY CONSTRUCTION INC P.O. BOX 330833 512 18TH ST N ATLANTIC BEACH FL 32233 JAX BEACH FL 32250 (904) 866 -1165 Permit ELECTRICAL PERMIT Additional desc . Sub Contractor . MKM ELECTRICAL CONTRACTOR, INC Permit Fee . . . 78.60 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 11/21/11 Special Notes and Comments Avoid damage to underground water /sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is needed, call 247 -5834. Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible. A sewer cleanout must be installed at the property line. Cleanout must be covered with an RT1 concrete box with metal lid. Cleanout to be set to grade and visible. Roll off container company must be on City approved list and container cannot be placed on City right -of -way. Roll off container company must be on City approved list and container cannot be placed on City right -of -way. Other Fees STATE ELEC DCA SURCHARGE 2.00 STATE ELEC DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 78.60 78.60 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 82.60 82.60 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. ELECTRICAL PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd, Atlantic Beach, FL 32233 Ph (904) 247 -5826 Fax (904) 247 -5845 !!11 �1 JOB ADDRESS: / KOX �. / e4 /,� Pr PERMIT # /1 - �.7 JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS PHASE VALUE OF WORK $ NEW SERVICE ❑ Overhead ❑ Underground ❑J Underground up Pole ❑ Residential (Main) Service 00 -100 amps ❑ 101- 150amps ❑ 151- 200amps ❑ amps # of Meters ❑ Commercial (Main) Service 00 -100 amps ❑ 101- 150amps ❑ 151- 200amps ❑ amps OCT Service amps Conductor Type Size ❑ Multi- Family (Main) Service 00 -100 amps ❑ 101- 150amps ❑ 151- 200amps ❑ amps # of Unit Meters ❑ Temporary Pole ❑ amps SERVICE UPGRADE ❑ amps ❑ CT Service amps NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.) ❑ 100 amps ❑ 150amps ❑ 200amps ❑ amps ❑ CT Service amps ADDITIONS, REMODELS, REPAIRS, BUILD -OUTS, ACCESSORY STRUCTURES, ETC. Outlets /Switches: 1 L. 0- 30amps / 31- 100amps 101- 200amps Appliances: 4- 0- 30amps 31- 100amps 101- 200amps A/C Circuits: o_ 0- 60amps 61- 100amps Heat Circuits: d,.- # circuits @ kw Number of Lighting Outlets, Including Fixtures: 1 4 OTHER ELECTRICAL PROJECTS ❑Swimming Pool ❑ Sign ❑ Smoke Detectors Qty ❑Transformers KVA ❑Motors hp FIRE ALARM SYSTEM (Requires 3 sets of plans & Fire Alarm Checklist) Qty volts /amps VALUE OF WORK $ REPAIRS/MISCELLANEOUS ❑ Replace Burnt/Damaged Meter Can ❑ Safety Inspection ❑ Panel Change ❑ OH to UG ❑ Other: Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. I hereby certify that I have read this application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether specified or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction. Property Owners Name '-' elq 1 i Q t Z. Phone Number Electrical Company 7)2k 471i21/,' ci, 1 Office Phone 35 /,2// Fax Co. Address: /©,ij c 11 e , -,y 5f City J1 k SGT, 'o,7 /' State ,% Zip 3.7,9cJ License Holder (Print): ," i / 4, _ ' // C 1 • ✓ i I State Certification/Registration # b2 c'© /y// 9 Notarize, , T : ri i ; ,� f rte r , .i T i 7 " J'. ✓..,,,.. / _ 41�i 5 Ai __ , Li/ ' 1 , : �''c:_ �., ' ;,: MY COMMISSION # DD 634126 1 il / rte-.: a ;_ EXPIRES: May 21, zoo t S . rn and subscribed before ,) e this � day of �,� ,� 20 ' k "_ Bonded Thru Notary Public Underwriters I / , / ! ature of Notary Publi• 4/" DL ma3) -----. N ° � `f, CITY OF ATLANTIC BEACH g x = • j 8 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5826 Application Number . . . . . 11- 00001912 Date 4/11/11 Property Address 296 ROYAL PALMS DR Application type description MECHANICAL HVAC ONLY Property Zoning TO BE UPDATED Application valuation . . . 0 Application desc 1 cu 1 ahu Owner Contractor OCCUPANT B & B HEATING AND AIR CONDITN 296 ROYAL PALMS DRIVE 4603 LAMBING RD ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32210 (904) 219 -7291 Permit MECHANICAL HVAC PERMIT Additional desc . Permit Fee . . . 155.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 10/08/11 Other Fees STATE MECH DCA SURCHARGE 2.33 STATE MECH DBPR SURCHARGE 2.33 Fee summary Charged Paid Credited Due Permit Fee Total 155.00 155.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.66 4.66 .00 .00 Grand Total 159.66 159.66 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. MECHANICAL PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph (904) 247 -5826 Fax (904) 247 -5845 JOB ADDRESS: 0994 w ?oy a f £%s L2r PERMIT # PROJECT VALUE $ 740 ,o NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION Air Conditioning: Unit Quantity / Tons Per Unit S.7r7r1 r Heat: Unit Quantity / BTU's Per Unit Seer Rating / -7 Duct Systems: Total CFM REQUIRED REPLACEMENT AIR CONDITIONING & HEATING SYSTEM INSTAL AYJ I li ARI# J0'bj' Air Conditioning: Unit Quantity / Tons Per Unit 574 r REQUIRE i Heat: Unit Quantity BTU's Per Unit Seer Rating /3 Duct Systems: Total CFM REQUIRED FIRE PREVENTION Fire Sprinkler System Quantity (Requires 3 sets of plans) Fire Standpipe Quantity (Requires 3 sets of plans) Underground Fire Main Value (Requires 3 sets of plans) Fire Hose Cabinets Quantity (Requires 3 sets of plans) Commercial Hoods Quantity (Requires 3 sets of plans) Fire Suppression Systems Quantity (Requires 3 sets of plans) FIRE PLACES MISCELLANEOUS: Prefabricated Fireplace Qty Automobile Lifts Gas Piping Outlets Boilers BTU's Elevators /Escalators ALL OTHER GAS PIPING Heat Exchanger Quantity of Outlets Pumps # Vented Wall Furnaces Refrigerator Condenser BTU's # Water Heaters Solar Collection Systems Tanks (gallons) Wells OTHER: Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. I hereby certify that I have read this application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether specified or not. The permit does not give authority to violate the provisions o any other state or local law regulation construction or the performance of construction. ri Property Owners Name e - Pc K 10 Z Phone Number a/a- 5331/ Mechanical Company P 1i A , , • i J2 t r - . Office Phone A19 Fax clo f6 'J 'b Co. Address: j 03 / aiiL) iN c k ' City TyC, . State Zip cad v�° License Holder (Print): / t t , c Xd Stat Certification/Registration # (.CI 81359 Notarized Signature o License Holder , �� ,u ' g f �' a / , S _-_•:-.-.: 0.a. b,_. ' , - . > I this / c y f , r i I 20/1 R: .. SHIRLEY L. G AM (� f 5 o. ,a; r oflN�'lR@ l � �' ;,� EX R ES : ebruary 14, 20 1 % Rf 1 � °: Bonds Th ru Notary Public Unden -4 1#144 CITY OF ATLANTIC BEACH ,, - 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 Application Number 11- 00002046 Date 5/24/11 Property Address 296 ROYAL PALMS DR Application type description COMMERCIAL ALTERATION Property Zoning TO BE UPDATED Application valuation . . . 10000 Application desc BUILD OUT AND NEW CONCRETE SLAB Owner Contractor KLOTZ JEFFREY DAVID AR COLLEY CONSTRUCTION INC P.O. BOX 330833 512 18TH ST N ATLANTIC BEACH FL 32233 JAX BEACH FL 32250 (904) 866 -1165 Permit PLUMBING PERMIT Additional desc . INSTALL 7 NEW FIXTURES Sub Contractor . B & G PLUMBING Permit Fee . 104.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 11/20/11 Special Notes and Comments Avoid damage to underground water /sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is needed, call 247 -5834. Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible. A sewer cleanout must be installed at the property line. Cleanout must be covered with an RT1 concrete box with metal lid. Cleanout to be set to grade and visible. Roll off container company must be on City approved list and container cannot be placed on City right -of -way. Roll off container company must be on City approved list and container cannot be placed on City right -of -way. Other Fees STATE PLBG DCA SURCHARGE 2.00 STATE PLBG DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 104.00 104.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 108.00 108.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH _ 800 Seminole Rd Atlantic Beach, FL 32233 Ph (904) 24782 6 Fax (904) 247 -5845 [,� JOB ADDRESS: "1 ld V.Okict_.1 i4 ►,,,r S 1, ,.r PERI IIT # II— J 0 T (, NEW OR REPLACEMENT INSTALLATION: Project Value $ TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY Bathtub Septic Tank & Pit Clothes Washer Shower Dishwasher Shower Pan Drinking Fountain Slop Sink Floor Drain `. Three Compartment Sink Floor Sink Q. Toilet Hose Bibs Urinal Kitchen Sink Vacuum Breakers Laundry Tray Water Connected Appliances Lavatory 3.. Water Heater Other Fixtures _1__ Water Treating System RE -PIPE: TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY Bathtub Septic Tank & Pit ( Clothes Washer Shower Dishwasher Shower Pan Drinking Fountain Slop Sink Floor Drain Three Compartment Sink Floor Sink Toilet Hose Bibs Urinal Kitchen Sink Vacuum Breakers .0 Laundry Tray Water Connected Appliances Lavatory . Water Heater Other Fixtures . Water Treating System MISCELLANEOUS: ❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans) ❑ Lawn Sprinkler System - Number of Heads ❑ Well * * ** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection. ** ❑ Other Permit becomes void if work does not commence within a six month period or work is suspenlled or abandoned for six months. I hereby certify that I have read this application and know the same to be true and correct. All provisions of laws and ordinances goveming this work will be complied with whether specified or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction. Property Owners Name Phone Number Plumbing Company . 6 4-G- PL) t , ,,,, n Office Phone 413 -3 S 8 5 Fax D-43---1 Co. Address: X331 c� w�-}�. 3 6 City T 5c+..sccf k State r(. Zip 3 �lb P � License Holder (Print): a e . . -. ko If � State Certification/Re # e'-t R " 0 3 Notarized Signature of License e e�lclea• - Sworn and subscribed before us a`l day of oo / . 20 /l oom Pot, Notary Public State of Florida = . /_ I Lori S Nordgren Signature of Notary Public ((( _ • c My Commission DD766611 7 4o FFV Oa Expires 03/10/2012