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Permit Driveway 91 Dudley A 2011 "` , r,,, SI CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD j ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 Application Number 11- 00002440 Date 8/05/11 Property Address 91 DUDLEY ST A Application type description RIGHT -OF -WAY PERMIT Property Zoning TO BE UPDATED Application valuation . . . 0 Application desc repair concrete Owner Contractor JACKSONVILLE HOUSING AUTHORITY OWNER ATLANTIC BEACH FL 32233 Permit DRIVEWAY PERMIT Additional desc . Permit Fee . . . 35.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 2/01/12 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. All concrete driveway aprons must be 5 inches thick, 4000 psi, with fibermesh from the edge of pavement to the property line. Reinforcing rods or mesh are not allowed in the 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 STATE DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 35.00 35.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.0 4.00 .00 .00 r PERMIT IS pr D L IN ACCORDANCE WIT? 9 ALP ( hTY OF ATL1 f1� BEACH ORDINANCER 9 ND THE FLORIDA° ° BUILDING CODES. -- ~-------- 1 __-__�0,�ll�{ _ ____-___—_—____---_-- ti > ----------------------�-'--- - - - ------- / _________�-_____-_______- 0 `-__-__._-___�__'__-_-_____-______________-_--___-___�___'___--_-_________�-__ __-_______________-__-._-_-___---_-____--_ . ���������������������`����������������'������������`��`���� ' ---'-- ---------�-----------------------------------------�----- �- _ _ 1 l City of Atlantic Beach f % - j Building Department 4 APPLICATION NUMBER 9 p (To be assigned by the Buil in • Department.) 800 Seminole Road 6 Atlantic Beach, Florida 32233 -5445 410// * // - I Phone (904) 247 -5826 Fax (904) 247 -584 ' -mail: building - dept ©coab,us ' ; ., Date routed: J // City web -site: http: //www.coab.us ~` - / APPLICATION REVIEW AND TRACKING FORM Property Address: 9/ 2 J /i r Department review required Yes No Building Applicant: i, U (,rr. n 9 4,---H-, Planning & Zoning Tree Administrator Project: l f) , 0.6y, r0 f- ,/ -/ ill &/ tlicy__Vorts li Utilitie Public Safety Fire Services Re few f • ::' •. ' z - f*L .. Other Agency Review or Permit Required of Review Pe or Ve rified Receipt By Date 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: % l ' pproved. ['Denied. (Circle one.) Comments: �) ( - � BUILDING 4//0//.. PLANNING & ZONING c/` Reviewed by: Date: �/ �� TREE ADMIN. Second Review: DApproved 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: Revised 07/27110 r , .IL-t_ ! . City of Atlantic Beach 4. v. APPLICATION NUMBER -\ �\ Building Department ' }*� -r o (To be assigned by the Buil 'ng Department ) r - 800 Seminole Road f p �/(; /� - 7 Rj _' '� ' Atlantic Beach, Florida 32233 -5445 . rte, , - d I ► / `_ t'fi Phone (904) 247 -5826 - Fax (904) 247 -5845, 40 1/ / ` Z or3 s>%. E - mail: building - dept ©coab.us ~ Date routed: r1 / / / / / City web -site: http: //www.coab.us \� APPLICATION REVIEW AND T ' A CKING FORM L Property Address: 9 ✓ 2 /i .) / " T Department review required Yes No j j e Building • Applicant: ---;/ / t,.'; - t`1 � } 41-1,4:----1-7---) Planning & Zoning _ Tree Administrator Project ) /r} 1 . , ( 6) C / f' -. 1 - 1 v 1 y�)� y ub iic Utilities- • Public Safety Fire Services f evie'V fee : - a'+ r > -i ifj ! r1:- r , ' :st. .. . -7yze. 1: ; a Review or Receipt Other Agency Review or Permit Required Permit Verified By Date 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: APP ATION STATUS Reviewing Department First Review: proved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING & ZONING Reviewed b : 1� (i e Y � Date: ' TREE ADMIN. Second Review: ['Approved as revised. ['Denied. , • , ' ,� • � -r Comments: i i I 1 LI ES ` - Z PUB F C - ' FE Reviewed by: Date: FIRE SERVICES Third Review: []Approved as revised. ['Denied. Comments: Reviewed by: Date: Revised 07/27/10 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247 -5826 Fax (904) 247 -5845 Job Address: 91 0,)c.1 ) Permit Number: Legal Description Parcel # . Floor Area of Sq.Ft. Sq.Ft Valuation of Work $ 5 oc o Proposed Work heated/cooled non - heated /cooled Class of Work (circle one): New Addition Alteration Repair Move Demolition pool/spa window /door Use of existing /proposed structure(s) (circle one): Commercial esidenti If an existing structure, is a fire sprinkler system installed? (Circle one): s No N /A Florida Product Approval # For multiple products use product approval - form Describe in detail the type of work to be performed: C) 0 v , e. 0 c. <._ (AZ c rz_ e o (. ,7e_r.c ) c 0 2.-.J(..- Property Owner Information: f . Name: _l AV fh t-`�' in e T/ (� E1 /41 /< de t'ci c f Cu ST City State _ Zip Phone E -Mail or Fax # (Optional) Contractor Information: Company Name: (' n c r c k 0654 git) Qualifying Agent: Address: 065 5 (' t- 2 7.v City p'-r, o fl L-e --(6,, r 4,'y c _ State F- Zip 32o(--,9 Office Phone 901 2 - (3 1 5"c// Job Site/ Contact Number S 4 , ^-i c., V Fax # State Certification/Registration #/006 0 L i O 16 g Architect Name & Phone # Engineer's Name & Phone # Fee Simple Title Holder Name and Address 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 aperiod of At f6) months at any time after work is commenced. 1 understand that separate permits must be secured for Electrical ;York, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, 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. I hereby certify that 1 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. Signature of Owner Signature of Contractor '� Print Name hi'sCe L{ € ( _ < Print Name r . 61, , : -,� 4 L j • (; . 7 c . - , Sworn to and subs¢¢rrib d efore me Sworn to and subscrib d before me this 1,i ,bay of l ( u / / f , 20 I / / this / Day of tliy , 20 if q Notary ' ublic D L t" X1 218 Notary Public ., x Commission # EE ?" '` ' '' 9 Expire May 27, 201 Revised 01.26.10 N `:; 3 fY1S+M