Permit 30 Ocean Blvd (vault) PERMIT WORKSHEET Certificate of occupancyl
Job Address: i5W Type Work: 7
Property Owner: Phone # C1 104�
Contractor: Phone # Aq
o V 1616 n &De's i E"'n-S
Permit#: 919 11 1-1 1 Date Issued:
Building Inspections: Footing
Slab
Tie Beam
Lintel
Nailing Sheathing VoA-�- �x�i p��
Framing Cover Up '7-
Insulation q,q-c)z,/
Final Building CA
Tree Permit# E- YES NO
Date / Copy to A D�
Electrical Permit# JEAF
I CA-
Temp, Pole Permit# Date /Copy to
I JEA
Temp. Power Letter Received: YES NO
Inspections: Rough Electric -q,Q�E Released to JEA
Temp, Power Released to JEA
Temp. Pole Released to JEA
Final Released to JEA
Mechanical Permit#
Inspections: Rough Final
Plumbing Permit# L�4-
Inspections: Rough Underslab Topout r7-'7-CA
Water Sewer Final
Drainage Inspection:
Pool Permit#
Inspections: Steel Final
Grounding Final
Roofing Permit#
Inspections: Nailing Sheathing Final
Fire Inspection:
Failed Inspections: Date Paid:
Date Paid:
JOB ADDRESS- 0 Ctkh, P�)W - TYPE WORK_ELB�-1�V- P&-Y-6 6
PROPERTY OWNE]k J Wow-, TELEPHONE004) MD -)-U3
CONTRACTO TELEPHONELqjij�Tgl - '60'�
PERMIT#- [-,Fqcq PY-Y-6-0� DATE
INSPECTIONS: FOOTING
SLAB
TIE BEAM
LINTEL
NAILINGJSHEATHING
FRAMING/COVERUP
INSULATION
FINAL WELDING
CERTIFICATE OF OCCUPANCY
ELECTRICAL PERMIT#
INSPECTIONS: ROUGH
FINAL
MECHANICAL PERMIT#
INSPECTIONS: ROUGH
FINAL
PLUMBING PERMIT#
INSPECTIONS: ROUGHlUNDER SLAB
TOPOUT
WATER/SEWER
FINAL.
NOTES:
ENERGY EFFICIENCY CODE FOR BUILDING CONSTRUCTION
Florida Department of Community Affairs
EnergyGauge FlaCom v1.22 FORM 40OA-2001
Whole Building Performance Method for Commercial Buildings
jurisdiction: ATLANTIC BEACH,DUVAL COUNTY,FL(261100)
Short Desc: Josephsc Project: Joseph's Cafe
Owner: Jimmy Jubran
Address: ---
30 Ocean Blvd.
City: Atlantic Beach
State: FL- PermitNo: 0--
Zip: 0 Storeys: I
Type: Restaurant GrossArea: 1564
Class: Renovation to existing building Net Area: 1564
Max Tonnage: 4(if different,write in)
Compliance Summary
Component Design Criteria Result
Gross Energy Use 88.78 100.00 PASSES
Other Envelope Requirements -A PASSES
LIGHTING CONTROLS PASSES
EXTERNAL LIGHTING PASSES
HVAC SYSTEM Celt_vt J PASSES
PLANT PASSES
WATER HEATING SYSTEMS PASSES
PIPING SYSTEMS PASSES
Met all required compliance from Check List? (9No/NA
TE:An input report Print-Out from EnergyGauge FlaCom of
this design building must be submitted along with this Compliance Report.
4/22/04 EnergyGauge FlaCom FLCCSB vl.22
COMPLIANCE CERTIFICATION:
I hereby certify that the plans and Review of the plans and specifications covered by this
specifications covered by this calculation are calculation indicates compliance with the Florida Energy
in compliance with the Florida Energy Code. Before construction is completed, this building will be
Efficiency Code. inspected for compliance in accordance with Section
553.908, F.S.
PREPARE BUILDING OFFI
D BY: CIAL:
DATE: LLQ'A DATE: 15
1 hereby certify that his uildi g mpliance
with the Florida En rgy fficii Code.
OWNER AGEN V- fufic�'
DATE: r)0' 0-t
1
If required by Florida law, I hereby certify that the system design is in
compliance with the Florida Energy Code. REGISTRATION
ARCHITECT : No.
ELECTRICAL SYSTEM DESIGNER: �6 7 3
LIGHTING SYSTEM DESIGNER: A& 46 7 3
MECHANICAL SYSTEM DESIGNER: A/e 4,(-7 3-
PLUMBING SYSTEM DESIGNER: 7
Signature is required where Florida Law requires design to be performed by registered design professionals.
Typed names and registration numbers may be used where all relevant information is contained on signed/sealed
plans.
4/22/04 EnergyGauge FlaCom FLCCSB v1.22 2
Project: Josephsc
Title:Joseph's Cafe
Type: Restaurant
Location:ATLANTIC BEACH,DUVAL COUNTY, FL(261100)
(WEA File: JACKSONVILLE.TMY)
Whole Building Compliance
Design Reference
Total 88.78 100.00
ELECTRICITY 88.78 100.00
AREA LIGHTS 27.97 28.01
MISC EQUIPMT 1.12 1.12
---- ------
SPACE COOL 35.70 39.61
SPACE HEAT 16.04 15.34
-----------
VENT FANS 7.94 15.92
Credits & Penalties (if any): Modified Points: 88.78 PASSES
Project:Josephsc
Title: Joseph's Cafe
Type: Restaurant
Location: ATLANTIC BEACH,DUVAL COUNTY,FL(261100)
(WEA File:JACKSONVILLE.TMY)
Other Envelope Requirements
Item Zone Description Design Limit Meet Req.
PrOZo I Rf2 PrOZo I Exterior Roof-Max Uo Limit 0.08 0.09 Yes
Meets Other Envelope Requirements
4/22/04 EnergyGauge FlaCom FLCCSB v1.22 3
External Lighting Compliance
Description Category Allowance Area or Length ELPA CLP
(W[Unit) or No. of Units (W) (W)
(Sqft or ft)
None
Project:Josephse
Title: Joseph's Cafe
Type: Restaurant
Location: ATLANTIC BEACH,DUVAL COUNTY,FL(261100)
(WEA File: JACKSONVILLE.TMY)
Lighting Controls Compliance
WNMWW.W.M�
Acronym Ashrae Description Area No.of Design Min Compli-
ID (sq.ft) Tasks CP CP ance
L
r
i
y
0
(W
0
e
e
pe
ca
EA
c
J
tiot*
0
R
n
FJ
s
e
i0
e
s
es
p
'a
Ah
I
cro ym
[rAn
PrOZolSpl 7 Food Service-Leisure Dining 1,564 1 7 3 PASSES
PASSES
Project: Josephsc
Title: Joseph's Cafe
Type: Restaurant
Location: ATLANTIC BEACH,DUVAL COUNTY,FL(261100)
(WEA File: JACKSONVILLE.TMY) __
System Report Compliance
PrOSyl System I Packaged Terminal Systems No.of Units
1
Component Category Capacity Design Eff Design IPLV Comp-
Eff Criteria IPLV Criteria liance
Cooling System PTAC > 15000 Btu/h 8.00 7.60 PASSES
(Cooling Mode)
Heating System Electric Furnace 1.00 1.00 PASSES
Air Handling Air Handler(Supply)- 0.40 0.80 PASSES
System-Supply Constant Volume
PASSES
4/22/04 EnergyGauge FlaCom FLCCSB v1.22 4
Plant Compliance
Description Installed Size Design Min Design Min Category Comp
No Eff Eff IPLV IPLV liance
None
Project:Josephsc
Title:Joseph's Cafe
Type: Restaurant 11
Location: ATLANTIC BEACH,DUVAL COUNTY,FL
(261100)
(WEA File: JACKSONVILLE.TMY)
Water Heater Compliance
Description Type Category Design Min Design Max Comp
Eff Eff Loss Loss liance
Water Heater I Storage Water Heater- < 100 Gal&> 0.82 0.78 2.34 PASSES
Gas 155000 [Btu/h]
PAS�
Piping System Compliance
Category Pipe Dia Is Operating Ins Cond Ins Req Ins Compliance
[inches] Runout? Temp IBtu-in/hr Thick[in] Thick[in]
IF] SF.FI
None
4/22/04 EnergyGaugeFlaCom FLCCSB v1.22 5
Project:Josephse
Title:Joseph's Cafe
Type: Restaurant
Location: ATLANTIC BEACH,DUVAL COUNTY,F
Other Required Compliance
Category Section Requirement(write N/A in box if not applicable) Check
Infiltration 406.1 Infiltration Criteria have been met
System 407.1 HVAC Load sizing has been performed
Ventilation 409.1 Ventilation criteria have been met
ADS 410.1 Duct sizing and Design have been performed
T&B 410.1 Testing and Balancing will be performed
Electrical 413.1 Metering criteria have been met
Motors 414.1 Motor efficiency criteria have been met
Lighting 415.1 Lighting criteria have been met E
O&M 102.1 Operation/maintenance manual will be provided to owner
Roof/Ceil 404.1 R-19 for Roof Deck with supply plenums beneath it
Report 101 Input Report Print-Out from EnergyGauge FlaCorn attached'?
r
4/22/04 EnergyGauge FlaCom FLCCSB v1.22 6
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FLORIDA 32233
-5826
INSPECTION PHONE LINE 247
Application Number . . . . . 04-00028187 Date 5/11/04
Property Address . . . . . . 30 OCSAIST BLVD
Tenant nbr, name . . . . . . CONVERSION EXIS .RESTAURAN
Application description . . . COMMERCIAL INTERIOR BUILD OUT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 73056
Owner Contractor
--- ---------------- ----- ------------------------
JUBRAN INVESTMENTS NU-VISION DESIGNS & CONST.
4541 ST AUGUSTINE RD 12276 SAN JOSE BLVD SUITE 111
JACKSONVILLE FL 32223 JACKSONVILLE FL 32223
(904) 241-9104 (904) 443-0008
----------------------------------------------------------------------------
Permit . . . . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 356 . 00 Plan Check Fee 178 . 00
Issue Date . . . . Valuation . . . . 73056
----------------- ------ ----------------------- -------------- ----------------
Other Fees . . . . . . . . . WATER CROSS CONNECTION 35 . 00
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 356 . 00 356 . 00 . 00 . 00
Plan Check Total 178 . 00 178 . 00 . 00 . 00
Other Fee Total 35 . 00 35 . 00 . 00 . 00
Grand Total 569 . 00 569 . 00 . 00 . 00
BUILDING MATERIAL,RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE CLEARED
UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER. "FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN
RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS" ISSUED ACCORDU-4G TO APPROVED PLANS
WHICH S PERMIT A PTO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW.
BUILDING OFFICIAL
Jun 02 03 02: 13p Information Stjstems 247-5645 p. 4
V
CITY OF ATLANTIC BEACH
BUILDING PERMIT APPLICATION
(FOR INTERJOR REMODEL)
Date: A-a-,
JobAddress:- OUA�Ln &�Awn4di -46A-�ir- tor C6
.r— W 3z 2
Owner of Property: J it-brean
Address: LA elephone: dqo�0 RL41— 9109'
Legal Description: Block Number: Lot NuT�nberc'
:_�rl Zoning District:
Contractor-. XAC, State License Number: C&CIS0.4z)n
Contractor's Address: 1221(o— I n
Telephone: (6JQ�QLAL43— �000'9 Fax: tQ C)�o LA q
Describe proposed use and work to be done: o e-q I f 0 _V-4-ULUL
S It aa1aLsA;.eo
Present use of land or building(s)-. Pj-.At�lrra rk
30
Valuation of proposed construction:
New electrical or increase in service? 1110-% New plumbing fixtures? QfljJ
New fireplace? No New heating/air conditioning? UkA)
Is approval of Homeowner's Association or other private entity required? AQ If yes,please submit with this
application.
Procedure: In order to expedite issuance of permits, please follow all steps and provide all information as appropriat
Incomplete applications may result in delay in issuance of permit.
Please submit Building Permit Application,Energy Code Forms,Notice of Commencement,Owrier/Contractor Affidavit if owner is contrdctor,
and two(2)complete sets of construction plans to the Building Department,which is located at the Atlantic Beach City Hall, 800 Seminole
Road.Atlantic Beach.FL 32233 Telephone-.(904)247-5926
in addition to construction and engineering detail,plans must contain the following information as appropriate for the type of work being
performed. Scale of drawings should be sufficient to depict all required information in a elm and legible manner.
n provid h
I hereby certi6,that all informatio this a lication is correct.
7'
Date:
Signature of Property Ownery— ql
I hereby certify that I have read and examined this application and know the same to be true and correct. Ah provisions of the laws and
ordinances goveming 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 federal,state or local rules,regulations,ordinances,or laws in any manner.including the
900 Seminole Read -Aflantic Reach,Florida 32233-5445
Telephone: (904)247-5800 -Fax: (904)247-5845 -http*//www.ei.atijintic-beach.ift.us
Page I RevisW 1115103
Ju,n 02 03 02: 13p Information S�jstems 247-5845 P. 5
c constru 'o
governing of construction or the perforrmancc 0,J n of(I property. I understand that the issuance of this permit is contingent upon the
above information being Qrue :dcor:rect and th the pi and s pporting I data have been or shall be provided as required.
Date: LA 12-0, rA
Signature of Contracton — I - — I
Address and contact inforniation of person to receive all correspondence regarding this application(please print).
Name: A,-1a(Ou')
Mailing Address: �Qn zbsr- Ec 3,:zDa3
Fax: E�Mail: Demo,--,&
AS TO OWNER:
Sworn to and subscribed before me this day of 20
State of Florida,County of Duval
PAMELA E.MORM Notary's Signature.
my Cmm ft.
OD 051149 Personally known
*M0 I Produced identification
Type of identification produced
AS TO CONTRACTOR:
Sworn to and subscribed before me this .2 day of 12004
State of Florida,County of Duval
Notary's Signature:
ersonally known
PAMlMA It 11101W &��
41AWN n Produced identification
1;051149 Type of identification produced
ow"Mo I I DOW ilk
800 Seminole Road -Atlantic Reach,Florid2 32233-5445
Telephone: (904)247-5800 -Fax: (904)247-5845 -http://www.ci.atiantic-beach.fl.us
Page 2 Revised 1/15/03
CITY OF ATLANTIC BEACH
PERMIT CALCULATION SHEET
Date:
Address 3 0 Ocr-A,0 6L V,0 2-�)7,CX,10vz�
Heated Square Footage
2 2- $ per sq ft = $
Garage Shed @$ per sq ft= $
Carport Porch @ $ per sq ft =
Deck (C5 @ $ per sq ft = $
Patio @ $ per sq ft = $
TOTAL VALUATION: 0 S-,(.
Total Valuation
ist $
Remaining Value $ per thousand
or portion thereof
CONSTRUCTION TYPE: 72:7 TOTAL BUILDING FEE $
ZONING: (!f G + V2 Filing Fee $
FLOOD ZONE: X ) Fireplaces@ $35.00 $
IMPERVIOUS SURFACE:
BUILDING PERMIT FEE $
WATERIMPACTFEE $
SEWER IMPACT FEE $
WATER METER/TAP $
CAPITAL IMPROVEMENT$
SEWER TAP $
C RADON HRS .0050 $
SECTION H PAVING ( ) $
CROSS CONNECTION $
ST( ) SURCHARGE S
OTHER $
GRAND TOTAL DUE: $
1/13/03
Address F ol IJ C V A IT il, 0/f AL Date
Minimum Requirements for Commercial Interior Remodel
hk9be,
UMED 00CUMENTS,"�
-..",,-MUSTIIIKSM�,TED;."A.T�.,,T]2".OF.P
I Job valuation. No N/A
Florida Energy Efficiency Forms:If mechanical equipment is being retrofitted,provide two(2)
2. complete sets of Form 400A,400B,400C,or 400D if applicable. All sheets shall contain the Yes No
signatures of the person who performed the calculations,owner/agent,architect,electrical,
mechanical,plumbing,and lighting designers. Provide two(2)copies of load calculations.
3. Fire Marshall plan review form shall be complete. MSDS shall be provided for storage of hazardous (:�e:s No N/A
materials in"H"occupancies.
4. Key plan showing the location of the tenant space and the type of occupancy of the adjacent tenant C—Ye—s—) No N/A
spaces. :Z�
5. Restaurants are required to submit two(2)copies of plans approved by Department of Business and (--y—R—) No N/A
Professional Regulation Division of Hotels and Restaurants.
Environmental Protection Commission(EPQ approval is required if any underground fuel
6. tanks/underground fuel piping,or underground oil separators are to be installed. Copy of EPC Yes No
approval is required prior to issuance of building permits. (813)272-5960. 1
U XM
Uca
Plans and specifications:Two(2)copies of drawings to scale(1/4" 1)with sufficient clarity and
detail to indicate the nature and scope of work. Such drawings shall contain information,in the form
of notes or otherwise,as to the quality of materials,where the quality is essential to conforming with
the technical codes of the 2001 Florida Building,Plumbing,Mechanical,Fuel Gas,Energy
1. Efficiency,Accessibility,1999 National Electrical Codes,and the 2000 NFPA 101 Life Safety Yei'-) No N/A
Code. Such information shall be specific,and the technical codes shall not be cited as a whole or in
part,nor shall the term"legal"or its equivalent be used as a substitute for specific information. All
drawings,specifications,and accompanying data shall bear the name and signature of the
person/persons responsible for the design. NOTE:All structural plans shall be signed and sealed
by a design professional.
2. Occupancy group and special occupancy shall be noted as determined by Chapter 3 and 4. No N/A
Y es`— No N/A
3. Minimum type of construction shall be noted as determined by Table 500.
Fire resistant construction requirements shall be shown and shall include the following components:
0 Fire resistant separations.
0 Fire resistant protection for type of construction.
0 Protection of openings and penetrations of rated walls. No N/A
4. �e
0 Listed assemblies of rated walls,floors/ceilings,and shaft enclosures.
0 Fire blocking and draftstopping.
0 Calculated fire resistance.
0 Door and window schedule and their listing.
Fire suppression systems:
0 Early warning.
5. 'Yes No N/A
0 Fire sprinklers.
0 Standpipes.
Life Safety systems shall be determined and shall include the following requirements:
0 Occupant load and egress capacities.
6. 0 Early warning. Yes No (ZA
0 Smoke control.
0 Stair pressurization.
0 Systems schematic.
Occupancy Load/Egress Requirements including the following:
0 Occupancy load gross and net.
7. 0 Means of egress,exit access,exits,and exit discharge. No N/A
0 Stair construction and protection.
0 Emergency lighting and exit signs.
0 Specific occupancy construction requirements and horizontal exiWexit passageways.
S. 5
(f.'�- '
CITY OF ATLANTIC BEACH �. Fod�
BUILDING / ZONING DEPARTMENT
800 Seminole Road Doerr
Atlantic Beach,Florida 32233
e.777 (904)247-5800
(904)247-5845 Fax
PLAN REVIEW COMMENTS
Permit Application # Clq
Property Address: cc-can
Applicant: No VJ'S' 10' r'%
Project:
This permit application has been:
D Approved
F7 Reviewed and the following items need attention:
Please re-submit your application when these items have been completed.
Reviewed By: Date:
STATE OF FLORIDA
DBPR- INESS AND PROFESSIONAL REGULATION
DEPARTMENT OF BUS
Jab Bush, Govemor
Diane Carr, Secretary
APRIL 22, 2004
SUSIE BATEH
30 OCEAN BLVD.
ATLANTIC BEACH, FL 32233
RE: DIVISION OF HOTELS AND RESTAURANTS PLAN REVIEW
LICENSE TYPE: 2010 PERMANENT FOOD SERVICE
APPLICATION NO. 100395
FILE NO. 183781 LOG NO. P5-04-490
TO WHOM IT MAY CONCERN:
THIS LETTER IS TO ADVISE YOU THAT THE PUBLIC FOOD SERVICE ESTABLISHMENT
PLANS SUBMITTED ON MARCH 29, 2004, FOR JOSEPH'S CAFE, 30 OCEAN BLVD., ATLANTIC
BEACH, FL 32233, HAVE BEEN APPROVED AS MEETING MINIMUM STANDARDS PER THE
INFORMATION GIVEN WITH THE FOLLOWING PROVISO(S):
1. MUST COMPLY WITH ITEM #4 ON SPECIFICATION WORKSHEET FOR CONSTRUCTION
FINISHES
2. INSTALL MOP SINK IN WAREWASHING AREA AS DISCUSSED 4122/04.
PLEASE HAVE THE ABOVE INFORMATION/PROOF READY FOR YOUR INSPECTOR AT THE
OPENING INSPECTION. BE SURE TO INCLUDE THE PLAN REVIEW LOG NUMBER ON ANY
DOCUMENTATION SUBMITTED. AN OPENING INSPECTION CANNOT BE COMPLETED
SATISFACTORILY UNLESS THE ABOVE INFORMATION/PROOF IS PROVIDED TO THE
INSPECTOR. IF ANY CHANGES OCCUR IN MENU, EQUIPMENT OR OPERATION, PLEASE
NOTIFY THE DISTRICT OFFICE IMMEDIATELY, AS YOUR PLANS ARE ONLY APPROVED AS
SHOWN. CERTAIN CHANGES MAY REQUIRE A NEW PLAN REVIEW AND CHANGES IN
PROPOSED OPERATIONAL PROCEDURES MAY REQUIRE ADDITIONAL EQUIPMENT.
IN ORDER FOR THE INSPECTOR TO CONDUCT THE OPENING/LICENSING INSPECTION, ALL
REQUIRED FINAL APPROVALS MUST BE ON SITE. PLEASE REFER TO THE ENCLOSED
"OPEN/LICENSING INSPECTION CHECKLIST". WHEN YOU ARE READY, CALL THE
CUSTOMER CONTACT CENTER AT 850.487.1395 AND INDICATE YOU WANT TO SCHEDULE
AN OPENING INSPECTION. BECAUSE RECORDS ARE IDENTIFIED BY THE LOG NUMBER AT
THE TOP OF THIS MEMO, PLEASE HAVE YOUR LOG NUMBER AVAILABLE WHEN CALLING
FOR YOUR INSPECTION. WITHOUT THIS NUMBER, THE OPENING INSPECTION MAY BE
DELAYED. PLEASE ALLOW AT LEAST THREE (3) WORKING DAYS RESPONSE TIME FOR AN
INSPECTOR TO RETURN YOUR CALL. AT SUCH TIME, YOU WILL THEN SET AN
APPOINTMENT WITH THE INSPECTOR FOR THE LICENSING INSPECTION.
Phone: 850.487.1395 7960 ARLINGTON EXPRESSWAY, SUITE 350 Internet:
Fax: 904.727.5558 JACKSONVILLE,FLORIDA 32211-7467 www.MyFlorida.com/dbpr
STATE OF FLORIDA
DBP� DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
Jeb Bush, Govemor
Diane Carr, Secretary 0"W"
IF THIS PROPOSED ESTABLISHMENT DOES NOT BECOME LICENSED WITHIN ONE (1) YEAR
OF THE DATE THE PLANS ARE APPROVED, THE APPROVAL BECOMES VOID AND YOU MAY
HAVE TO RESUBMIT FOR REVIEW WITH THE APPROPRIATE FEE.
IF YOU ARE NO LONGER THE RESPONSIBLE PARTY FOR THIS ESTABLISHMENT, PLEASE
FORWARD THIS LETTER TO THE APPROPRIATE PARTY.
SINCERELY,
PLAN REVIEWER
ENCLOSURE(S)
Phone: 850.487.1395 7960 ARLINGTON EXPRESSWAY, SUITE 350 Internet:
Fax: 904.727.5558 JACKSONVILLE,FLORIDA 32211-7467 www.MyFlorida.com/dbpr
z>Eaie oi r tui iucx
Department of Business and Professional Regulation
Division of Hotels and Restaurants
www.hospitalityeducation.org -P5
SPECIFICATION WORKSHEET. ..
--A(evv Page 1 of 2
Establishment Name:
BENT
-""MR V!
... 90"ILY- MEAN, �WONABSOA-
Floor* Wall Ceiling
"NeW construction
2),Conversion ood Preparation 22z:it�- FR P
F71 Remodeled Food Storage
EJ Closed at least one year
License Number: Wash Area
(if applicable)
Restrooms
ALL SURFACES MUST BE SMOOTH,NON-ABSORBENr
Worksheet Code Key Comments.
FREE OF CRACKS & CREVICES, SEALED AND EASILY
S Satisfactory CLEANABL�
U Unsatisfactory
M (��ortable extinguishers provided-as required by
NA - Not Applicable NFPA10 2A-10BC
E - Existing
C - Caution: Information inadequate M L---�ood automatic fire suppression system meets
6—FPA--9-6')ho mesh filters allowedAND MUST BE
or potential operational]violation, T=D, INSPECTED AND APPROVED.
I j
will be checked during inspection. Q---- Exit doors open outward(if required)for occupancy
greater than 49
..............
I'm OW
--..,,—Pubric access to exit does not go through kitchen,
Sanititing facilities provided storage rooms,or restrooms
[D",�Three compartment sink __.,�Qishmachine s: Public /
--'boards M Number of exit Employee Total
-,,�Lwash sinks v��drain
Number of compartm ei-nts�shown:'-:t4 F11 3 [:]2 M Square footage of establishment:
I gas appliances shall have a
—:�#qtv�o compartment food prop sinks M -L' A _n_afianaDy�1cognized
Number shown: testing laboratory seal such as(AGA or UL
# 14 IF FOODS COOKED THAT PRODUC
��31and sink(s)in food prop and food dispensing area(s) M comments:
S K FIRI
Number shown: GREASE LADEN VAPORS A CLAS
W---�Ll-land sink in dishwash area M=NGUISHER WILL REQUTRED AL
*Local fire department is the final authority having jurisdiction.
_�LTotal number of handwash sinks shown
7 7–—7—
�oticold ater supplied to all sinks where required
_r Approved local exhaust ventilation installed at or
Dishmachine sanitizer type: DChernical Fbot Final Rinse over all cooking units such as ranges,griddles,deep.
. CHEMICALLY SANITIZED DISHW SFERS fat frying units,and other units of equipment which
JU,,-�omments. release appreciable quantities of steam,odors,grease
'15t HAVE VISUAL/AUDIO ALARMS laden vapors,or smoke
C Restrooms ventilated or provided with windows
INSTALLED.
DBPR Form HR 5021-011 MyFlorida.com 2001 November,
Page 2 of 2
M C Outer openings protected Type of supply:
C Doors to exterior self-closing unless emergency exit [D*r&niclpa117Jt11fty 0 On-ske Well Other
�,2", Supplier Name:
7, ��j 10
ice machine installed in protected area and 0 Written approval for use issued by:
properlydrained MUST HAVE AN INDIRECT
WASTE LINE. I L_:., /�_
—il-6splayed food protected M Public well permit number:
Running water dipper well for bulk ice cream service W-1, tt��s L
Equipment to maintain proper food temperatures Type of system:
C Refri-cieration C Hottholding units [��nicipallUtilfty [I Package Plant 0 Septic Tank System
1 — /
L41-F & Below 140OF & Above IM System name:
aundry facilities properly protected
C Designated area(s)for employees'personal articles Written approval for use issued by:
) 1, 4
—C Designated storage area for maintenance and . :7 /+
cleaning equipment Septic Tank System permit number:
M C Adequate dry storage Tank size: —gallons Drainfield: ---square feet
C Mopiservice sink facility witikhot and colorunning
water drained to sanitary sewer Seating capacity as indicated by plan:
Location: M Plans approved without provisos
C
—Faucets with hose fittings and hose bibs protected by 31rians approved with noted provisos
11ICKI
M C Backslphonage/backfi if no air gap/break El Plans denied
04�ii� 6?1/["Tl /
M -LAefrigeration waste piping discharges ndirectl Plan Reviewer ate
into floor drain or other approved recapop� Provisoskomments: APPROVAL OF YOUR
El Adequate number of employee and/or public restrooms FOOD ESTABLISHMT,;t,1T PLAN WAS BASED
provided. Public restrooms accessible to customers UPON THE INFOMATTON SUPPLIED
without going through food preparation,food storage,
or warewashing areas WTT14 YOU ORIGINAT, RPQT7V..qrP_
water to all lavatories utilized by employees YOUR PLAN CHANGE, A REVISED PLAN FOR
APPROVAL WILL BE REQUESTED.
C Doo"(���-r constructed to ensure privacy DUMPSTER, AN I DIOR GREASE DRUM ARE REQU'
Comments: # 39 HOT WATER MUST REACH TO BE ON AKIMPERVIUOS SURFACE.
110OF AT EMPLOYEES HAND SINKS.
j
Waste container,grease receptacle,compactor,
recycle bins on nMonHh2LbjDt surfaces
Compactor areadrained to sanitary sewer Z,
Comments:
77
c
1A
W,
Light fixtures required to be shielded,coated,or covered where food
is stored,prepared,displayed,or where food is open or exposed. All items will be verified-during opening inspection
Plans released: �:�ailed to responsibie agent/contact person
50 foot candies: 20 foot candies: 10 foot candies:
food preparation self-service areas,inside reach-in or walk-in refrigerators,dry `7
areas under-counter refrigerators,hand- food storage areas,etc.
washing areas,warewashing areas, Signature ate
equipment and utensil storage,toilet
rooms Printed Name
DSPR Form HR 5021-011 MyFlofida.com 2001 November 14
DBPR HR-7005—Division of Hotels and Restaurants Application for Plan Review
A1.4-1--I STATE OF FLORIDA For Office Use Only
ere. DEPARTMENT OF BUSINESS AND PROFESSIONAL
_00""4
Rw* REGULATION rr Log#P J__CY_
W&NOwO&H 1940 North Monroe Street
. Tallahassee, FL 32399-01813
NOTE—This form must be submitted as pa o �an application
packet.Submit completed applications with plans.
If you have any questions or need assistance in completing this application, please contact the Department of Business
and Professional Regulation at your local district office, A district office address and contact information sheet can be
found on H&R's page of the DBPR web site at the link provided below.
www.MyFlorida.com
SECTION 1 —OFFICE USE I ONLY
—Date Received Initials $150 Plan Review Fee
Month Day Year Check#
Money Order# tl
SECTION 2—PLAN REVIEW TYPE
Please check the appropriate box. Reopen Food Service Conversion of Existing Extensive Remodeling of
New Construction(initial Establishment Closed Structure to Food Servicel E
Plan Review) 7 e Existing Food Service
At Least 1 Year (Initial Plan Revie Establishment
SECTION.1—'ESTABLISHMENT INFORMATION
Doing Business As (D/B/A) Name
Owner Name
• Name of Existing Public Food �� stablishment
• Division of Hotels and Restaurants' License Number
ESTABLISHMENT ADDRESS
Street Address 3a &,ean I 11-0(-r�
Zlp�Qtde +
oun
C it, 44 61 C 1 .4 - — b=�
Contact Name cc qFORMATION
[**V"4:4_" f6raaD
Primary Phone N6mber P 5'mary E-Mail Address
A�ernate
CJL.lone Number or Fax Number Altern te E-Ma`rAfdress
MAILING ADDRESS
Note, This address will.be designated as1h6"address bf.r6cord�',Jolr�purpose of official communication from the
Department. Please,ensure that the,name�of a�person:authoriz6d I'to accept thecommunicabons has been provided in
the Contact Information section of this form.
Street Address or Post Offi ,
coox
C state d
t_C I Z' C ptional) Cowatry
j�l A=� ��Lva"C
SECTION 4–TYPE OF SERVICE
Please check the appropriate box.
T---"Seating/Dine In El Take-out Only El Caterer AB&T SRX License
This form replaces DBPR Form HR 5021-010 Page 4 of 6
0BPR HR-7005-Division of Hotels and Restaurants Application for Plan Review
SECTION 5-GENERAL INFORMATION'
Number of Maximum Total Square Number of Exits
Seats Number of Footage of the
3L� _ Staff per Shift Establishment
Projected Start Date of Construction 14 Projected Completion Date of Construction
le-Li
Approved Plans are valid for one (1)year.
SECTION 6-'SUPPORTING'DOCUMENTS
Please enclose the following documents: A minimum of three (3) sets of scaled plans showing
• Proposed Menu (list of specific foods) equipment, plumbing, electrical, and mechanical ventilation. This
• Proof of Approved Water and Sewer office will retain two sets for our records. You may submit
• Equipment Specifications (if available) additional sets if required by local building or other local
authorities.
SECTION 7-FINISH SCHEDULE
Must indicate what type of material will be used in the following areas (i.e., quarry tile, stainless steel, etc.).
Construction,finlshes�must'be asity cleanable'and non-absorbent.
Floor Wall
Food Preparation Ceiling
Dining Area Can m i c- b-t V(zP
QJX& �m,�J,0_j
Food Storage M.C_ blu — I — ?Y� Li t1l
C. t I Q)t t4 L&A_�aI6,
Dishwashing Area QA,t- bak a P
Restrooms (�z kn t-A I OQ�nkd ;z -4 Ll ot AA 4S.2
* New or remodeled establishments are required to have curved and sealed cove �_ase at the floor/wali jun(;Jre except in
the dining area.
SECTION 8-WATER AND WASTEWATER APPROVAL
If using a municipal water and sewer system, a copy of your bill will suffice; otherwise, DBPR HR-701 1--Water and
Wastewater Approval, must be completed and submitted with plans. Grease traps must meet all local plumbing codes
and be located in easily accessible areas for cleaning purposes.
SECTION 9-FIRE SAFETY EQUIPMENT
Show location of fire extin2uishers on plans.
Types and number of Minimum 2A10BC K Class
each fire ex C�
Automatic Suppression System to R`rES F] NO Required when grease-laden vapors or
be Installed * smoke are produced.
Sprinkler System to be Installed YES Required if occupancy is 300 or more.
SECTION10—DISHWASHING FAcILITIES',_SHOW�ON PLANS
E] Manual (3-compartment sink with drainboards or equivalent) Er*m"echanical (Dishmachine)
Type of,Sanitization: 2-6-hemical - 0 Heat(High Temperature Final Rinse)
A warewashing machine that chemically sanitizes and was installed after January 1, 1998, must be equipped;With—a
.device that indicates audibly or visually when more chemical sanitizer needs to be added to the machine.
SECTION 11 -OTHER FACILITIES-SHOW ON PLANS
Number of Bathrooms Male I I Female ex --e Bathrooms
Only one (1) bathroom is required if the facility has 0-1-0 seats. Access to public bathrooms may not be through fdod
preparation, storage or warewashing areas.
Number of handwash sinks lNumber of prep sinks Mop�ink location
SECTION 12 7
.eSMATUJ=:
I hereby certify that the above information is correct. I underftand�hat fai re coftplete the application or submit
-required documentation will delay processing of this applicati�&
Print Name ELM CZ�� Ach�_ Signature Date
Approval of these'plans and specifTcations by the division does not indic ompliance with any-other codes, laws or regulations fhat may be
required. Further, approval does not constitute endorsement or acceptance of the completed establishment(structure and/or equipment).
An inspection of the establishment and equipment is required prior to licensing.
This form replaces DBPR Form HR 5021-010 Page 5 of 6
DBPR HR-7011 —Division of Hotels and Restaurants Water and Wastewater Approval
STATE OF FLORIDA For Office Use Only
Ica"- DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
1940 North Monroe Street Log #
RW ffe, Tallahassee, FL 32399-0183
&H
NOTE—This form must be submitted as part of a plan review application packet. A copy of the
KotNow- utility bill for the establishment address may be substituted for this form. Please return this form or
its equivalent with your plan review application to your local district office.
If you have any questions or need assistance in completing this form, please contact the Department of Business and
Professional Regulation at your local district office. A district office address and contact information sheet can be found on
H&R's page of the DBPR web site at the link provided below
www.MvFlorida.com
SECTION 1 —ESTABLISHMENT INFORMATION
Establishment Name h I P P
,�ris
Address
��c cc
city Cou ty p Code
�A �Mvlc' L-�Uua'k
SECTION 2—WATER
The above-named food service establishment uses the following water supely (choose one �tpe)i
EMunicipal Water Name of Supplier CITY OF ATLAN-1 IU btAL;rl
On-site Well System Permit No. Issued by
F-1 Establishment served by a 1 OD-4, FAC, liMiL'CU use public water system.
[I Establishment served by a Florida Safe Drinking Water Act(DEP regulated) public water system.
APPROVED OR DENIED?
F� Approved Comments
F� Denie�reason listed in Comments section)
Name Title
Agency CITY OF ATLANTIC BEACH U
Signature 7�
SECTION 3—WASTEWATER
The above-nanNied food service establishment uses the following wastewater disposal system (choose one type):
Municipal/Utili.ty Name of System CITY OF ATLANTIC BEACH
Septic Tank Permit No. Tank Size Drainfield Size
(gallons) (square feet)
Package Sewer Plant I Permit No. Issued By
1APPROVED OR DENIED?
Single Service Utensils Only Comments
Approved Number of Seats Permitted
Other Conditions (see comments)
F1 Denied
Name Title
-So 0�' 1,A
Agency CITY OF ATLANTIC BEACH
A
S Ig tu
Signature Date
4kit I ) T5' 61 a(o
U
This form replaces DBPR Form HR 5021-095 Page 6 of 6
BakedTasta speciaaies Sand-wiches
AN past.d-s Wud,y-d-. f �.p� led tfmift.caasa,).,.d ta--.dt S.*, AR w0wiches are wyed ork~d%oks of e44ft.nv.ho"wMade sub rall or pke Flat-11.
Pkide 1pm, -45 VA01e ndde�95 P*PPVWKWrl .65 Cmpj.79
%-d smed&.&H.-lype, f ftw-d.--W
TOPF-d-AS deein aid Wk.& S 1-95 Sala�r_ce be*0-wet.
v4seft""jmwm ;w
*,.w��;;;� wr,Skp�
Tppd-1th mWW
-whr- W)WmW,V-W bkd f d- -ph's
Spe..*.4 Mft- $7.95 meath.11------------------------- �4_25 $4.25
Pasta hikes Need *b ked.Wkd.. T-lt�d,mearball,-.d NWd�bkhan boast-omrd Wh Jose
arel hate.Twpd�Nh -.-rWL.d- mmorall. M.�94*-.
$4.50
d�_
C2.5 Pizza & Ita
T.ppW,ah .W s-e wel�1.d-- d .kw Han Restaurant
&.-*A Meet�wckwasa)._--- mear--d --.ft
Pu*d,�%MW wft bad m bcvpd vn*homemecle meri� -t ka"M ftmaftes Wee it
.W .ftW--fia d-. S-dr,.t-rite W *h ftmamide wom of w Hommade Coust"
S.1L............................ $4.25
we'd 7.95 *.A. .*-.and-I-
=wbm Wad-ON�d- we,awt�eref yme dchm od W..jed ftre--Oh-dftd EW-W F.1-esee......... $4.25
Tppd.A*nw-1Wbd-...db.6..1 --.dl.d-ne- Breaded qapfatt-ved-,th .*w
11.k.d P4peoi_.....................--------------------- --........ 7_95 R..tbd Hat r C.1d_.............. $4-25 newnara�Wee moxwelga theeee.
kKvaWgw pagaAh vw detfim cl(hwwn.&MEWN11 w SWIW moap��%,fth F.6 Akad beet im-,himaw If H�NwCakl._......... $4.25
ead mc-A.d-.
mwe-sel.&ardlad�
V Olicican 5�". $4.25 ppp...dW&f.4 .aftewas .d
9 W W F d.W.��;Z;_b .1�_%*h Ift".d..ft-
Pastak-IN LM"� &P=P&u se�.................... �425
Stwoked Lek"Imeat Wt w Caid S C2.5 peeep�i-ffh hm...&
Chceo Arty Farm S-ga,dute�lwt�.tomaw pi."-and .kdmunvila
Meet".j. - featcoccim - = - Spaghetti - UagWne W I-'a 7� d�
Horn&m&de Sasx:rs: .."ed p,.-Im.d-and
AN-9b Saac 57-95 he-1.- $695 -.d
V....F.,millaml .............WS4.75 $4.25
$ -W 1;;; kh
Aw.03W 04&Qk) &95 ~%...... 6'
C.t-wall P-dew .......$7.95 OW-wAgm ck-S_ $1196 deed Xeaildle d- mcwww�4b deem wt�t-e.
Ade P------ &95
5_Z5 P.Pp..,.w
taffi.d..Jft.
Add Y-feit�T.My Pasta Ham a1W Cheaea.HM w C034................ S4.25
[.a.. V 11.1.d h-A�&--I[.
.......... $4.00 a-mm..t-C..Ppp.,Odi
5 3.00 S 2LOO Tm Subnwitte............... 1;4 25 d,.jkq.
2 Afew"Ic ............................ f 7-ao ......... $ 2.00 T-d-ftc-ava-ei..kcs�
.95 4�"popperad..
st-11,ff-j.1................ $4-25
511ad steal�kftcw.tomat..
Beverages pepper-dni,-I*d-welleW,
F�WA Diet PapL 0,rqp-.O-V�741v 24;
1.d T. Ur..... ......... J1.20
c.ff"....... ...............
fpdaftwase,
A..O.We by**SL.'-d pod- Desserts
st'd 6", A-bert.& Mlc*Fob USKI Sea tw dessen sho�c-at ew fm-t ard.oce. N=qua FwAWes
lettred2w kwom w"dw wwww-w
Wiler Lit. Htinekvwt OLd..w O'Doh H-eemade C-00(A aradeeio.W lialart d.-rtj.-. .......... ............. $2.25 CA 705-on so arrairr faryaw-0 aftk
Bud-Light cam Ueefir Ptt�f Malian? aakt� (Mnft$Gwd 204 VISA mccepA me dwck rk-Y
,wimes I lipumcni Otakw ke $1.95
&I-We
Chwdmn.y VA,4e Brtf-dal nrantlaw(1121fore coffee�Iwr%Wth cuawd"ft and�;xNee 3,10 Fine Italian cuisinefor over 30 years
Ineelwcok CW..d Efte.Cellars MA" Homema*Qieesqcxkffi�
Lwfft-M 3.30
Ac0W411dewirW,%;1isw8daWe RkweallkYOUt�. $2.00 Plate Charge for ShMrig
18%Geverifity AAdded To Parties ot 8 or More I 7SUR Raien Once ojackw to FL 9MLVemedeadowilliAepollm
1111114111MM a FAX 111114/70149 10 swelf.sw a JrAx 04/44"M
it's 4M-
-At J0511P
wAIG I-
ro'eaw 0.,CSV
30010"o wo--A
Pep-W,
co:
rtado,
pizza W.-Oolpy
ialty Tory
., Cookedita
yes Coo�
.1
S�P ,
soup, 'rovyiAs
yetiz ers a?td .......... sic PPj?j8l
-AP
------ 'Ah vo�
Sold, St9s
.10$100 .6,.kiaco� maw ol
�wj
mod Mt*Wl 56-M
5,75
dom"
Of bo..".jw dooe-
YOM-
W41-W
W-ow". Spedi �*25 .10 aicfell
t;,."d P--Pl awl` is,00 melt". S9.9s
b�d .4�VWO f,.So -so
I,-*W S t,95 q.25 J14,
�Rwd ------ S12-W
it, S730 Cow
95 to-% SA6 25 j v15
$4, SIA.W
$6, S" SIOS
4. $ .......
-( b-qo 9.W 1.25 I.Is IA.IW--;:-OL��-W��. Wl�
NA 95 kd.,dtopo
S.-P................... jJ50 Oh.
Oldw t/2 1.50 WHO' 1wPe".bbck
S2-SO TZ5 j 100 1.25 S 42S V-'
W-d— P"A-- Tvo- .15 3.25 CA �Whwo
Cff� $9.95 $V-00 2.50 4,90 5 5,50 -veal
Z� 10 3-W S1350
'A"011e --------od.1,-�Mzv,eft
25 IfV.W S13-50
5Z MA cliw��SM-0 5195 -------
f,.*90WIP
OlAd O'nes CO,
,.Po, cafz ........
Sea d .........
SA.95
AL Sk.", 9S
.......... ....... ......
ff 1.95 f.d,
Clow V-9 S
S2.95
...............
-ow
.rA 56,9S
$5. SAW
25 AIN S*UM'
w.I............4,�� ............ ot 0
O—V ,,drf&tw4
gqgnu
$5.25 4L vrw- ROM.. ...........
wdcw� _........... Chi0y.9Wngsd P-—6 $450
F-W K-� iiolo .....
$1,95
W-d--,b.-
V F,.k .........
d"W*,0,&jbd
S6,75, 41S
............... Swo ................
C,jjP W dzrs S A-" -� ...........
4� ;m�
0-9 'Or
Sr '295
utd or e I ,
uIdl- it 2,95 14oll-0 #ft-
AJ2 ...........
2,q5
Frl-s cw $2,95 gov000,
$1.95 SO,*
A,r.ch—
As 0 cl,*,A� ...........
............... .45 530
sub 30
...............
saw we 510-01
16C-9 395 VIA
�to a
l low
w logod
ow ...........I--
c
ENERGY EFFICIENCY CODE FOR BUILDING CONSTRUCTION
Florida Department of Community Affairs
EnergyGauge FlaCom vl.22
INPUT DATA REPORT
Project Information
Project Name: Josephsc Orientation: North
Project Title: Joseph's Cafe Building Type: Restaurant
Address: 30 Ocean Blvd. Building Classification: Renovation to existing building
State- FL- No.of Storeys:
Zip: 0 GrossArea: 1564
Owner: Jimmy Jubran
Zones
No Acronym Description Type Load Profile Area Multiplier Total Area
1sq Isf]
I Prozol Zone I CONDITIONED FlaCom restaurant 1563.5 1 15615
building
4/22/04 EnergyGaugeFlaCom FLCCSB v1.22
Spaces
No Acronym Description Type Depth Width Height Multi TotalArea Total Volume
IN IN [ft] plier Isf] lef]
In Zone: PrOZol
I Pr0ZolSj)1 Zo0Sp1 Food Service-Leisure 53.00 29.50 9.00 1 1563.5 14071.5 El
Dining
Lighting
No Type Power Control Type No.of
[W] Ctrl pts
In Zone: PrOZol
In Space: Pr0Zo1Sp1
I Recessed Fluorescent-No vent 3900.00 Manual On/Off 7 El
Walls
No Description Type Width H(Effec) Multi Area DirectionConductance Heat Dens. R-Value
IN Ift] plier [sf] [Btu/hr.sf F] Capacity [lb/cf] lb.sf.F/Btul
[gtu/sf.Fl
In Zone: PrOZol
I PrOZolWal 0.75 in.stucco, 53.00 9.00 1 477.0 North 0.0838 11.2245 50.24 11.94 Ej
2"styro,8"CMU,1x2
x24"oc,airspace,
2 PrOZo I Wa2 0.75 in. stucco, 53.00 9.00 1 477.0 South 0.0838 11.2245 50.24 11.94
2"styro,8"CMU,lx2
x24"oc,airspace,
3 PrOZo I Wa3 0.75 in.stucco, 29.50 9.00 1 265.5 East 0.0838 11.2245 50.24 11.94
2"styro,8"CMU,lx2
x24"oc,airspace,
4 PrOZo I Wa4 0.75 in. stucco, 29.50 9.00 1 265.5 West 0.0838 11.2245 50.24 11.94
2"styro,8"CMU,lx2
x24"oc,airspace,
4/22/04 EnergyGauge FlaCom FLCCSB v1.22 2
Windows
No Description Type Shaded UCen SC Vis.Tr W H(Effec) Multi Total Art—
[Btu/hr sf F] IN ft] plier Isfl
In Zone: PrOZol
In Wall: PrOZo1Wa3
I PrOZolWa3Wil SINGLECLEAR No 1.0018 0.95 0.88 4.67 8.00 6 224.2
. Doors
No Description Type Shaded? Width H(Effec) Multi Area Cond. Dens. Heat Cap. R-Value
Ift] 1111 plier Isf] [Btu/hr.sf.F1 fib/cfl [Btu/sf,F1 jh.sff/BtuJ
In Zone: PrOZol
In Wall: PrOZo1Wa2
I PrOZolWa2l)rl Aluminumdoor, No 3.00 7.00 1 21.0 0.1919 43.67 0.53 5.21
1.25 in.
polystyrene
Roofs
No Description Type Width H(Effec) Multi Area Tilt Cond. Heat Cap Dens. R-Value
IN IN plier Isf] [degi lBtu/hr.Sf.F] [Btu/sf.F1 Ilb/cfl [b.sf.F/Btul
In Zone: PrOZol
I PrOZolRf2 Sngl 29.50 53.00 1 1563.5 0,00 0,0868 0.93 12.01 11.53
Ply/3"Iso/l/2"WD
Deck/WD Truss/Gyp
Br
Skylights
No Description Type UCen Shading Vis.Trans W H(Effec) Multiplier Area Total Area
jBtu/hr sf F] Coeff Ift] IN fSq fSfl
EnergyGauge FlaCom FLCCSB v1.22 3
In Zone:
In Roof.
Floors
No Description Type Width H(Effec) Multi Area Cond. Heat Cap. Dens. R-Value
IN Ift] plier jsfJ [Btu/hr.sL F1 [Btu/sL F1 jib/cfl jh.sff/Btuj
In Zone: PrOZol
I Pr0ZolFll Concrete floor, 29.50 53.00 1 1563.5 0,5987 9.33 140.00 1.67
carpet and rubber
pad
Systems
Prosyl System 1 Packaged Terminal Systems No.Of Units I
Component Category Capacity Efficiency IPLV
I Cooling System(PTAC > 15000 Btu/h(Cooling 48000.00 8,00
Mode))
2 Heating System(Electric Furnace) 17065.00 1.00
3 Air Handling System-Supply(Air Handler(Supply)- 1600.00 0.40
Constant Volume)
Plant
Equipment Category Size Inst.No Eff. IPLV
Water Heaters
W-Heater Description Capacit Cap.Unit I/P Rt. Efficiene Loss
I Storage Water Heater-Gas 91 Gal 199000 [Btu/h] 0.8200 [EF] [%/hr]
4/22/04 EnergyGauge FlaCom FLCCSB vl.22 4
EA-Lighting
Description Categories. Area/Len/No.of units Wattage
IsVft/NoI [w]
Piping
No Type Operating Insulation Nomonal pipe Insulation Is Runout?
Temperature Conductivity Diameter Thickness
IF] I Btu-in/h.stFj [in] [in]
If
Fenestration Used
Name Glass Type No.of Glass SC VLT Frame Frame
Panes Conductance Conductance Absorptance
[Btu/h.sf,FI [Btu/h.sf,FI
ApLbWndI SfNGLE CLEAR 1 1,0018 0.9500 0.8810 0.4340 0.7000 0 --JI
Materials Used
Mat No Acronym Description Only R-Value RValue Thickness Conductivity Density SpecificHeat
Used Ih.sf,F1BtuI IN [Btu/h.ft.Fl fib/cfl [Btu/Ib.Fl
18 Mat]18 2 in.Wood No 2.3857 0.1670 0.0700 37.00 0.3900
264 MatI264 ALUMINUM, 1/16 IN No 0.0002 0.0050 26.0000 480.00 0.1000 El
214 Mat1214 POLYSTYRENE,EXP., No 5,2100 0.1042 0.0200 1,80 0.2900 F1
1-1/41N,
EnergyGauge FlaCom FLCCSB vl.22 5
187 MatI187 GYP OR PLAS No 0.4533 0.0417 0.0920 50.00 0.2000
BOARD,1/21N
206 Mat1206 CELLULOSE,FILL,5.51N,R- No 20.8318 0.4583 0.0220 3.00 0.3300 ED
20
151 Matll5l CONC HW,DRD, 140LB, No 0.4403 0.3333 0.7570 140.00 0.2000 0
41N
178 Matl178 CARPET W/RUBBER PAD Yes 1.2300 F-1
265 Mat1265 Soil, I ft No 2.0000 1.0000 0.5000 100.00 0.2000 [--]
48 MatI48 6 in. Heavyweight concrete No 0.5000 0.5000 1.0000 140.00 0.2000 ED
123 Mat1123 CONC BLOCK No 1.7227 0.6667 0.3870 53.00 0.20oo El
MW,8fN,HOLLOW
159 Mat1159 CONC No 0.3202 0.3333 1.0410 140.00 0.2000 El
HW-UNDRD-140LB-41N
57 Mat157 3/4 in. Plaster or gypsum No 0.1488 0.0625 0.4200 100.00 0.2000
72 Mat172 AIR LAYER,3/41N OR Yes 0.9000
LESS,VERT. WALLS
267 Matt267 0.75"stucco No 0.1563 0.0625 0.4000 16.00 0.2000
266 MatI266 2x4@ 16"oc+RI I Batt No 8.3343 0.2917 0.0350 9.70 0.2000 El
215 MatI215 POLYSTYRENE,EXP., No 8.3350 0.1667 0.0200 1.80 0.2900 El
21N,
105 Matl105 CONC BLK HW, 81N, No 1.1002 0.6667 0.6060 69.00 0.2000 D
HOLLOW
256 MatI256 WOOD,SOFT, 1-1/21N No 1.8939 0.1250 0.0660 32.00 0.3300 0
86 Mat186 BRICK,COMMON,41N No 0.8012 0.3333 0.4160 120.00 0.2000 EJ
269 Mat1269 .75"ISO BTWN24"oc No 2.2321 0.0625 0.0280 4.19 0.3000 E-1
211 Matl2'I I POLYSTYRENE,EXP.,1/21 No 2.0850 0.0417 0.0200 1.80 0.2900 El
N,
12 MatI12 3 in. Insulation No 10.0000 0.2500 0.0250 2.00 0.2000 0
218 MatI218 POLYURETHANE,EXPJ/2 No 3.2077 0.0417 0.0130 1.50 0.3800 0
IN,
23 MatI23 6 in. Insulation No 20.0000 0.5000 0.0250 5.70 0.2000 ED
4 MatI4 Steel siding No 0.0002 0.0050 26.0000 480.00 0.1000 0
271 MatI271 2x4@24"oc+RI I Batt No 10.4179 0.2917 0.0280 7.11 0.2000
272 MatI272 Panel with 7/16"panels Yes 0.9044
273 Mat1273 Hollow core flush(1.375") Yes 1.2777
274 Mat1274 Solid core flush(1.375") Yes 1.7141
275 MatI275 Panel with 7/16"panels Yes 1.0019
(1.375")
276 MatI276 Hollow core flush(1.75") Yes 1.3239 EJ
4/22/04 EnergyGauge FlaCom FLCCSB v1.22 6
277 Mat1277 Panel with 1-1/8"panels Yes 1.7141 El
(1.75")
278 MaII278 Solid core flush(1.75") Yes 1.6500
279 Mat1279 Solid core flush(2.25") Yes 2.8537
280 MatI280 Fiberglass/Mineral wool core Yes 0.8167
281 MatI281 Paper Honeycomb core Yes 0.9357
282 Mat1282 Solid Urethane foam core Yes 1.6500
283 Mat1283 Solid mineral fiberboard core Yes 1.7816
284 MatI284 Polystyrene core(18 ga steel) Yes 2.0071 El
1
285 Mat1285 Polyurethane core(18 ga Yes 2.5983
steel)2
286 MatI286 Polyurethane core(24 ga Yes 2.5983
steel) 1
287 Mat1287 Polyurethane core(24 ga Yes 4.1500
steel)2
288 MatI288 Solid Urethane foam core Yes 4.1500 El
81 Matl8l ASPHALT-ROOFING, Yes 0.1500
ROLL
244 MatI244 PLYWOOD, 1/21N No 0.6318 0.0417 0.0660 34.00 0.2900
185 MatI185 CLAY TILE,PAVER,3/81N No 0.0301 0.0313 1.0410 120.00 0.2000
82 Mat182 ASPHALT-SHINGLE AND Yes 0.4400 E-1
SIDING
I I Mad 11 2 in. Insulation No 6.6800 0.1670 0.0250 2.00 0.2000 El
47 MatI47 2 in. Heavyweight concrete No 0.1670 0.1670 1.0000 140.00 0.2000 0
95 Mat195 CONC BLOCK No 0.7107 0.3333 0.4690 101.00 0.2000
HW-41N-HOLLOW
248 MatI248 ROOF GRAVEL OR No 0.0500 0.0417 0.8340 55.00 0.4000 ED
SLAGI/21N
94 Mat194 BUILT-UP ROOFING, No 0.3366 0.0313 0.0930 70.00 0.35oo El
3/81N
Constructs Used
4/22/04 EnergyGauge FlaCom FLCCSB v1.22 7
No Name Simple Massless Conductance Heat Capacity Density RValue
Construct Construct [Btu/h.stFl [Btu/sLF] [lb/cfl [h.sLF/Btul
1002 Aluminum door, 1.25 in.,polystyrene No No 0.19 - 0.53 43.67 5.2104 0
Layer Material Material Thickness Framing
No. IN Factor
1 264 ALUMINUM, 1/16 IN 0.0050 0.00 El
2 214 POLYSTYRENE,EXP., 1-1/41N, 0.1042 0.00 E]
3 264 ALUMINUM, 1/16 IN 0.0050 0.00 El
No Name Simple Massless Conductance Heat Capacity Density RValue
Construct Construct [Btulh.sf.Fl [Btu/sf.Fl [lb/cfl [h.sf.F/Btu]
1004 Concrete floor,carpet and rubber pad No No 0.60 9.33 140.00 1.6703
Layer Material Nfaterial Thickness Framing
No. Ift] Factor
1 151 CONC HW,DRD, 140LB,41N 0.3333 0.00 F-1
2 178 CARPET W/RUBBER PAD 0.00 El
No Name Simple Massless Conductance Heat Capacity Density RValue
Construct Construct [Btu/h.sLF] [Btu/sf.Fl [lb/cfl [h.sf.F/Btul
1010 0.75 in.stucco, No No 0.08 11.22 50.24 11.9386
2"styro,8"CMU,I x2x24"oc,airspace,0.5"gyp
Layer Material Material Thickness Framing
No. Ift] Factor
1 267 0.75"stucco 0.0625 0.00 El
2 187 GYP OR PLAS BOARD,1/21N 0.0417 0.00
3 215 POLYSTYRENE,EXP.,21N, 0.1667 0.00
4 10 5 CONC BLK HW,81N,HOLLOW 0.6667 0.00
5 256 WOOD,SOFT, 1-1/21N .0.1250 0.00
4/22/04 EnergyGauge FlaCom FLCCSB vl.22 8
No Name Simple Massless Conductance Heat Capacity Density RValue
Construct Construct [Btu/h.sf.Fj [Btu/sEF] [lb/cfl [h.sf.F/Btul
1042 Sngl Ply/3"Iso/l/2"WD Deck/WD Truss/Gyp No No 0.09 0.93 12.01 11.5251
Br
Layer Material Material Thickness Framing
No. IN Factor
1 82 ASPHALT-SHINGLE AND SIDING 0.00 ED
2 244 PLYWOOD, 1/21N 0.0417 0.00 E]
3 12 3 in. Insulation 0.2500 0.00 El
4 187 GYP OR PLAS BOARD,1/21N 0.0417 0.00
4/22/04, EnergyGauge FlaCom FLCCSB v1.22 9
CITY OF ATLANTIC BEACH
1P, 800 SEMINOLE ROAD
ATLANTIC BEACH, FLORIDA 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 04-00028187 Date 7/09/04
Property Address . . . . . . 30 OCEAN BLVD
Tenant nbr, name . . . . . . CONVERSION EXIS .RESTAURAN
Application description . . . COMMERCIAL INTERIOR BUILD OUT
Property zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 73056
Owner Contractor
------------------------ ------------------------
JUBRAN INVESTMENTS NU-VISION DESIGNS & CONST.
4541 ST AUGUSTINE RD 12276 SAN JOSE BLVD SUITE 111
JACKSONVILLE FL 32223 JACKSONVILLE FL 32223
(904) 241-9104 (904) 443-0008
----------------------------------------------------------------------------
Permit MECHANICAL PERMIT
Additional desc NEW HVAC
Sub Contractor STANDARD AIR INC
Permit Fee . . . . 87 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 87 . 00 87 . 00 . 00 . 00
Plan check Total . 00 . 00 . 00 . 00
Grand Total 87 . 00 87 . 00 . 00 . 00
PERNUT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING
CO
( 's lvw—k
BUILDING OFFICIAL
CITY OF ATLANTIC BEACH
MECHANICAL PERMIT APPLICATION
Date:
Property Address: :30 0 cea A led j &__gLi 6,e &A ,
Owner: 7a Uk J�S (-� j4 /V _27_ejtjrsT., Telephone #:
Contractor: Telephone#: 732-10,A3
Contractor Address: 6#k) c4
4)43Q,17-'- Air '-JA- v j�/7 Fax#: 72Y��a 6
In consideration of permit given for doing the work as described in the above statement,we hereby agree to perform said work in accordance
with the attached plans and specifications which are a part hereof and in accordance with the City of Atlantic Beach ordinances and standards of
good practice listed therein.
Type of Heating Fuel; If other construction is being done on this building
&-'Electric or site,list the building permit number:
• Gas: —LP —Nat" Central Utility F1
• Oil 1?7
• Other-Specify
MECHANICAL EQUIPMENT TO BE INSTALLED NATURE OF WORK
:��eat _Space _Recessed z,,<entral —Floor E, Residential
��ir Conditioning: —Room ��eentral
Duct System: Material&lvin44uss Thickness Commercial
• Refrigeration Maximum capac"Ity /7,C)n cfrn Q New Building
• Cooling Tower: Capacity —gpm W"� Existing Building
• Fire Sprinklers:Number of Heads
• Elevator: —- Manlift Escalator (Number) U Replacement of Existing System
• Gasoline Pumps Number)
L3 Tanks (Number) 2-_"New Installation
13 LPG Containers (Number) (No system previously installed)
L3 Unfired Pressure Vessel Q Extension or Add-on to Existing System
El Boilers
U Gas Piping L1 Other-Specify
C3 Other-Specify
LIST ALL EQUIPMENT
AIR CONDITIONING,REFRIGERATION EQUIPMENT&CONDENSORIS Approving
Number Units Description Model# Manufacturer Ton's Agency
/, jF/0A&"7_ OV 7,4;Offf I ofq-5j4w1e4n1 Y
*Oftr -
HEATING-FURNACES,BOILERS,FIREPLACES&AIR HANDLER'S Approving
Number Units Description Model# Manufacturer BTU's Agency
TANKS Nominal Capacity Type Liquid Serial Approving
How Many &Dimensions Contained Manufacturer No. Agency
800 Seminole Road-Atlantic Beach,Florida 32233-5445
Phone: (904)247-5800- Fax: (904)247-5845- http://www.ci.atlantic-beach.H.us
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FLORIDA 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 04-00028913 Date 8/30/04
Property Address . . . . . . 30 OCEAN BLVD
Tenant nbr, name . . . . . . RANGE HOOD
Application description . . . MECHANICAL ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
Owner Contractor
----- ---- - - ----- -------- ---- --------------------
JUBRAN INVESTMENTS QUALITY SHEET METAL SERVICES
1716 HARPER STREET
JACKSONVILLE FL 32204
(904) 354-5044
---------------------- ------------------------------------------------------
Permit . . . . . . MECHANICAL PERMIT
Additional desc . .
Permit Fee . . . . 65 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Fee summary Charged Paid Credited Due
-- -------- ------- ---------- ---------- ---------- ----------
Permit Fee Total 65 . 00 65 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 65 . 00 65 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORD[NANCES AND THE FLORIDA BUILDING
CODES.
OF IAL
Cc:
T CITY OF ATLANTIC BEACH
f--ff—Ford--)
BUILDING / ZONING DEPARTMENT S. Doerr
800 Seminole Road
Atlantic Beach,Florida 32233
(904)247-5800
r (904)247-5845 Fax
PLAN REVIEW COMMENTS
Permit Application # e:p+- zoc� 1,3
Property Address: C)C-Ep'�k 6, V-f--�
Applicant:
Project:
T pplication has been:
ved
viewed a944�e followi atten n:
1-5 5 -0
(7, 44 tZ
`31 2-3 OM -----:B�
Please re-submit your application when these items have been completed.
Reviewed By: Date:
'o
FROM : QUALITY SHEET MTL SVC INC PHONE NO. : 904 354 3669 Aug. 24 2004 04:36PM P2
Hug 2U U4 U4:38p Cittd 0-t Ptlartic Beach 9v 904-247-5e45 P. 1
C
CITY OF ATE-%NTIC BEACH
I ovid
BUILDING /ZONING DEPARTMENT ns
800 Scminok'Road 00aff
Man&Beach,FWida 12233
(904)247-5800
(904).147-5845 Fax
PLAN REVIEW COMMENTS
Permit Application 0 (fpk�- 763e:� 1.3
PropertyAddrs 8:
Applicant; CDC)A-L-1 Sir, e2l�tk
Project-.
This permdt application has been;
Approved
Reviewed and the following items need attention':
g./n r-> ��N
e5oo-'a
Pleme re-submit your Application wbeD these i1cm have been compleUdL
Reviewed By: Date:
FROM : QUALITY SHEET MTL SVC INC PHONE NO. : 904 354 3669 Aug. 24 2004 04:37PM P3
Awg 23 04 04: 38P Cittl or Rtlantic Beach BU 904-247-5045 p. 2
CITY OF ATLANTIC BEACH
PERMIT APPLICATION
MECHANICAL
Date: 1,
PropeM Address; 30 - QctA�� R)j�d
Owner. -:5LA)0r1A,�1aVFvr/,-r-,f-S Telephaae*
Contmctor, 2WNjj:1S4 S�tttrnpurzi CCACg5)(.t1.,Telephone#; 3S4-1r-9L(-) '210rl
Contractor Address: - �-I P)I J� Arf V- FIX 0: 30-01
!a Lonaidvratift of perrait given fmr doing dw work as dewribed in the above twoneft we h6mbY"Pen 0 001ban Mid in ficcordwe
wi*iho ow 4pXjfivjWeW which are a part hereof sad in accordance with the City of Aftntir&=h ordhanm ond swwg(ft of
pod practi=111:1 t. -] if other 6Ws—tmafian is"dorA on tiia WIdin8
TWp*Mtstieg Fuel: or ske.lis��#J��buiwmi W4ik numk�e;
a Electric
Q Gas., -LP __:Naturw Lkilit)
a oil
a 00W5m*--
MEMXIC JEWIPMENTTOSEIRTALLED KATM OF WORK
Cl Hea —Space —Recessed _Central _Flwr E3 jusided"
a Air Conditioning: _Room ceans]
a Duct System- Maierial Th icUncss . 8 c4numciat
Ratig"lon Maximum capac! -Cfm El Now Building
Cooling rower.,capa4ty SPM
C3 Fire Sprinklers:.Number of Heads
Elevato. SAICM
Gasoline Pumps (Number) New k3talladw
Tanis - (Number) (No syslem pre,,iously insmiled)
LPG Cantswers _(Number)
u Unfired Pressure Vessel 9 tvmsion or Add-on w Bminift System
Gasp, otvm-sper�
a Other-specify
AM-CON.VKTIONIKG�R&MGULA71ON W"ZNT&COND914MM'S App-Ang
Number Uld" Datripthm Aswicy
L
1O)PS 10/1
A S&AC I a 4,1
14-J
10AI]XV46—IMRMAC".901"W$.WIRIPLACT S st�AIR HANDLER'S AMMY4
Nambef UWN Deseription Age=
6v
uAks Nominal Cap& LIWid serial
how Mmv A amat§48 No, Anney
300 Seminole Rood*Atlantic 13409h,Florida 32233-5445
Phone:(904)247-MOO* Fuz: (904)247-5545. http;//www.eLatlsjntk4ben".us
is
CITY OF ATLANTIC BEACH
MECHANICAL PERMIT APPLICATION
oil Date:
Property Address: 30 Cc_eA,,, 9 J,)d
Owner: IS Telephone #: ?L11 -9)011
Contractor: r
'Itek It_,L4 �ee_t Me_-rA C"co-;X,�,W"Ielephone #: 3Sl-TOtt 1 (?19 696)
Contractor Address: (0 14,qS-P,f- st Fax#: 35cf-R,-0
I
In consideration of permit given for doing the work as described in the above statement,we hereby agree to perform said work in accordance
with the attached plans and specifications which are a part hereof and in accordance with the City of Atlantic Beach ordinances and standards of
good practice listed therein.
Type of Heating Fuel: If other construction is being done on this building
C3 Electric or site,list the building permit number:
• Gas: —LP —Natural —Central Utility
• Oil O'�- coo
L3 Other—Specify
MECHANICAL EQUIPMENT TO BE INSTALLED NATURE OF WORK
• Heat Space Recessed Central —Floor L3 Residential
• Air Con�_diitioning: Room Central
• Duct System: Material Thickness Commercial
L3 Refrigeration Maximum capacity_cfin L3 New Building
0 Cooling Tower: Capacity gpm Z$ Existing Building
L3 Fire Sprinklers:Number of Heads
L3 Elevator: —— Manlift—Escalator—(Number) Q Replacement of Existing System
Q Gasoline Pumps (Number)
C3 Tanks (Number) New Installation
Q LPG Containers (Number) (No system previously installed)
Ll Unfired Pressure Vessel Q Extension or Add-on to Existing System
a Boilers
L3 Gas Piping Ll Other-Specify
U Other—Specify--tilt C-L'_r,
LIST ALL EQUIPMENT
AIR CONDITIONING,REFRIGERATION EQUIPMENT&CONDENSOR'S Approving
Number Units Description Model# Manufitcturer 14P Agency
/\j F;()/�.A -,/, L e
I\JES /Q/1 3 il L
/-,j SP�_A 6 1
HEATING—FURNACES,BOILERS,FIREPLACES&AIR HANDLER'S Approving
Number Units Description Model# Manufacturer C_BT_U_k3 Agency
6.1-eise J44pod I -____ C�A4,rl L,e,4 Ir- T &t L
TANKS Nominal Capacity Type Liquid Serial Approving
How Many &Dimensions Contained Manufacturer No. Agency
800 Seminole Road *Atlantic Beach,Florida 32233-5445
Phone: (904)247-5800- Fax: (904)247-5845- http://www.ci.atiantic-beach.fl.us
PL.AN VIEW
NJ-WOFK IN-f5rAUM)PER
GOWrGrION OVEN NFPA 96
-OCA WAIJ- 4"0-VENr MAKf UP AV FOPP/ZZ4
oVtN Cry") P&7A OV-PN HOOD
14 (5,ld-V PIPE
ilc rL"�'H
")!Nc; oFf ICE
AUG 2 5 200.4
...........
By..
Olt-"W&J-
-ttc OD W/
UP,-ro MOF 0/"MAKf UP/X 18 OA UPM
AOWE X'OOF MAO UP 1W FM
JO-'5EP/I'-'5 CAFE
��o 0cfAiv OWL),
APPROVED
CITY OF ATLANT11C BEACH
157 A AUG 2 5 2004
m
L-.IqN VOW
(c, L-p-
ALL won fivf�rmjzv rrr co�
M GGNvrG;rloNovTm NFPA 96
T
zm
PLAOCKWAti- MAW UPAWFOPPUZA p
ovfN ff YF.4) PWA OVfN MOD
Typf 14"a4w rre -rypr N L4
CREA-5t HOOD (A
W
M
a)
ft=WA�-
ko
w Po JF" 140 ttow W/ 1B GA G?W
(FAN FOK PW OVrN "PAU 11)KE LuFp)W FMAO"CWOF t M W WIX rM
Wfi-l-of!.Zwo Grtf--p)
MW alrn) (GFtl=n)
13
OCiffAMPI-VO,
CITY OF ATLANTIC BEACH
S
800 SEMINOLE ROAD
ATLANTIC BEACH, FLORIDA 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 04-00028739 Date 8/16/04
Property Address . . . . . . 30 OCEAN BLVD
Tenant nbr, name . . . . . . 1-1/4"GAS SERVICE 3OPSIG
Application description . . . RIGHT OF WAY PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
Owner Contractor
------------------------ ----------- -------------
PEOPLES GAS COMPANY
P.O. BOX 10429
JACKSONVILLE FL 32247
----------------------------------------------------------------------------
Permit . . . . . . UTILITIES PERMIT
Additional desc . .
Permit Fee . . . . 35 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
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.
qvxak'
BUILDING OFFICIAL
DEPARTMENT OF PUBLIC WORKS
1200 SANDPIPER LANE
ATLANTIC BEACH,FLORIDA 32233-43 18
TELEPHONE:(904)247-5834
FAX: (904)247-5843
SUNCOM:852-5834
http://ci.atlantic-beach.fl.us
PLAN REVIEW COMMENTS FROM THE
PUBLIC WORKS DEPARTMENT
Permit Application # 6T-2 3��5
e-�
Applicant: /-9—(-,% - G(A-S
Address: elt"J,
Proj ect: (4� :�o ON a
F IV
u Your application is approved as noted by the Public Works Department.
Final application approval must come from the Building Department.
Your permit application has been reviewed by the Public Works Department and the
following items need attention:
Plan view shows location of proposed pipe with respect to
utilities (water, sewer, cable, buried electric) . Need
more information on boring procedure to avoid damage/impact
to City improvements, including decorative brick sidewalk.
(See attached picture) .
Please submit these requirements to the Public Works Department, 1200 Sandpiper Lane,
Atlantic Beach, FL 32233 in order that we can approve your application. If you have any
questions, please call (904) 247-5834.
R:;;;; P.E., Public Works Director
Date 4P141
Signature
Contractor Notified Date &KA�'010q
N 77
mom
DEPARTMENT OF PUBLIC WORKS
1200 SANDPIPER LANE
ATLANTIC BEACH,FLORIDA 32233-4318
C,
TELEPHONE:(904)247-5834
FAX:(904)247-5843
SUNCOM: 852-5834
http://ci.atiantic-beach.R.us
PLAN REVIEW COMMENTS FROM THE
PUBLIC UTILITIES DEPARTMENT
Permit Application # c,,44 - .2& 1,3�
Applicant: —/e co /Pea 1 0 1,C�s Cc-'�a,,,,
Address: 3V C,C
Proj ect: Or
94 rd �;C C y
�-j
Your application is approved as noted by the Public Utilities Department. Final
application approval must come from the Building Department.
u Your permit application has been reviewed by the Public Utilities Department and the
following items need attention:
adz A:1� at6�2�04�yz
Please submit these requirements to the Public Utilities Department, 1200 Sandpiper Lane,
Atlantic Beach, FL 32233 in order that we can approve your application. If you have any
questions please call (904) 247-5834.
Revi Donna Kaluzniak, Public Utilities Director
Date &e—
Signat-rre -7
Contractor Notified Date
IST
01�
AHERN
-------------
TO EXIST. SEA TURTLE INN
2' GAS SVC.
30 OCEAN BLVD.
1.11. K
UNOW 0012. "L6
ALLM % MINWWW
150'
EXISTING 2"-
GAS SERVICE
P
.m—pwv uw
ATLANTIC BLVD.
NK
011 AWIL
-4
ft- MIN. Peoples Gas System
PROPOSED 1-1/4* PE. GAS SVC.
FOR
DIW BORE DETAIL 30 OCEAN AVE.
10 39Vd SVEI S3-ldO3d 69ELEOP E0:01 vooz/9ZU0
Cour"y.-FAMAPS.D.M......
PC
TECOI Peoples Gas
4040 Phillips Highway
Jacksonville, FL 3220'
tel(904)739-4874
fax(904)443-7369 1""41�
Xt r a n s m i t f
to; City Of Atlantic Beach
fax 247-5800
from: Kermit Howell
date: 07-26-04
re: Gas service for 30 Ocean Blvd.
pages: , including this coversheet
NOTES: Gentlemen,
Attached please find TECO Peoples Gas' Right Of Way
construction pern-dt for installation of a 1-1?4" gas service
crossing Ocean Ave.Please process this infonnation and
correspond with me as necessary.
If you have any further questions or require any additional
inforrnation you may contact me at (904) 739-4874 (office) or
237-2046 (cell)
Thank you.
Kermit Howell
60 39Vd SV9 S31d03d 69ELCOO 60:01 V00Z/9z/L0
CITY OF ATLANTIC BEACH
CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
"I�ffir__
500 Seminole Road 904-247-5800
Atlantic Beach,Florida 32233-5445 FaX 904-247-5545
Date 07/14/04 PERmrr
JobAddress 300CEAN*aVE, _?5LVD �l 81 SUED BY THE C)TY
Permitee, TECO/PEOPLES GAS Telephone# Q04) 739-4874
Permittee Address: 4940 PHILIPS HWY. JAX. FL, 32207
Requesting Permission to Construct: A 3-1/4" GAS SERVICE 0, 30 PSIG
Location: (Reference to Cross-Street) CROSSING OCEAN AV�. a 125 FT NORTH OF ATLANTIC BLVD.
1. Applicant declares that prior to filing this application he has ascertained the location of all existing utilities,
both aerial and underground and the accurate locations are shown on the sketches.
A Letter of Notification was mailed to the following Utilities/Municipalities:
Jacksonville Electric Authority Yes(X No Date: 7/14/04
BeIJ South Telephone Company Yes(X No Date: 7/14/04
Ferrell Gas Yes(X No Date: 7114/04
Comcast Yes (X No Date: 7/14/04
2. Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation,
alteration or relocation of all, or any portion of said street or easement as determined by the Director of Public
Works, any or all of said poles, wires, pipes, cables or other facilities and appurtenances authorized
hereunder, shall be immediately removed from said street or easement or reset or relocated hereon as
required by the Director of Fublic Works, and at the expense of the Permittee unless reimbursement is
authorized,
3. All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be
performed under the supervision of CURT BROWN (Contractor's Project Superintendent)
located at 4040 PHILIPS HWY. JM. FL. Telephone (90$) 739A874
4. All materials and equipment shall be subject to inspection by the Director of Public Works or his designee.
5. All city property shall be restored to its original condition as far as practical, in keeping with city specifications
and the manner satisfactory to the city.
6. A sketch of plans covering details of this installation, as well as, a copy of a recent survey shall be made a
part of this permit
7. This permittee shall commence actual construction in good faith with 30 days. If the beginning date is
more than 60 days from date of permit approval, then permittee must review the permit with the Director of
Public Works to make sure no changes have occurred in the area that would affect the permitted construction.
8. It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the
City's right, title and interest in the land to be entered upon and used by the holder, and the Holder will, at all
times, assume all hsk of and indemnify, defend, and save harmless the City of Atlantic Beach from and
against any and all loss, damage, and cost of expenses arising in any manner of the exercise or attempted
exercises by the holder of the aforesaid rights and privileges.
9. The Director of Public Works shall be notified twenty-four (24) hours prior to starting work and again
immediately upon completion.
OWNER
Signed; Date:
Before me this day of in the County of Duval,
State Of Florida,has personally speared
Notary Public at Large,State of Florida,County of Duval.
My oormmls6ion expires:
Personally Known: or
Produced Ident1ficatlon;
ZO 30Vd SV9 S3-1d03d 69EZEPP E0:1211T t700Z/9Z/Z0
IST
isT
ERN
��ERN
0
AHFRM
-----------------
----------
ATLANTIC
DEPARTMENT OF PUBLIC WORKS
1200 SANDPIPER LANE
ATLANTIC BEACH,FLORIDA 32233-4318
TELEPHONE:(904)247-5834
FAX:(904)247-5843
SUNCOM: 852-5834
http://ci.atlantic-beach.fl.us
PLAN REVIEW COMMENTS FROM THE
PUBLIC UTILITIES DEPARTMENT
Permit Application # cA4
Applicant: -re-c,o /aa n I-Cs
Address: 30 nce-C, 0 J
Proj ect: r V I L r-
Your application is approved as noted by the Public Utilities Department. Final
application approval must come from the Building Department.
u Your permit application has been reviewed by the Public Utilities Department and the
following items need attention:
7'
4 -6 444
Please submit these requirements to the Public Utilities Department, 1200 Sandpiper Lane,
Atlantic Beach, FL 32233 in order that we can approve your application. If you have any
questions please call (904) 247-5834.
Revi Donna Kaluzniak, Public Utilities Director
Date 4
Signat-rre
Contractor Notified Date
DEPARTMENT OF PUBLIC WORKS
1200 SANDPIPER LANE
ATLANTIC BEA0-1,FLORIDA 32233-4318
TELEPHONE:(904)247-5834
FAX:(904)247-5843
lift SUNCOM:852-5834
http://ci.atlantic-beach.fl.us
PLAN REVIEW COMMENTS FROM THE
PUBLIC WORKS DEPARTMENT
Permit Application
Applicant:
Address:
Project: �10 V-S
V r V
/Your application is approved as noted by the Public Works Department.
final application approval must come from the Building Department.
Your permit application has been reviewed by the Public Works Department and the
following items need attention:
Plan view shows location of proposed pipe with respect to
, utilities (water, sewer, cable, buried electric) . Need
more information on boring procedure to avoid damage/impact
to City improvements, including decorative brick sidewalk.
(See attached picture) .
Please submit these requirements to the Public Works Department, 1200 Sandpiper Lane,
Atlantic Beach, FL 32233 in order that we can approve your application. If you have any-
questions,please call (904) 247-5834.
Reviewed Carper,P.E., Public Works Director D ate
Signature
Contractor Notified Date &6aZTkID,1-0q
-4r
7b?
".oi
Alt
,,IM
44
'I K
I _15
,lc'll
Ao,
10
5e
X
12
IN EAST COAST
P. 01
TRANSACTION REPORT
AUG-10-2004 TUE 07:42 AM
FOR: ATL, BCH. PUBLIC WORKS 904 247 5843
DATE START RECEIVER TX TIME PAGES TYPE NOTE M# DP
AUG-10 07:39 AM 94437369 2' 54" 3 SEND OK 972
TOTAL 2M 54S PAGES: 3
DEPARTMENT OF PUBLIC WORU
IMD SANDPIPER LANE
ATLANTIC BF ACK FLORIDA 32233-4318
TeLEplioNE,(904)247-5834
FAX(904)7,47-5843
suNC01vt 952,5834
hUp-,lici.adautic-beach-fl-US
lop
FAX TRANSMITTAL
DATE: /,o q_
g T—,
TO'. kez-m
er-O gnol
FAX
—9 r%--�v, im-hifflne, r.nvar Sheet: 15
P. 01
TRANSACTION REPORT
AUG-09-2004 MON 11:58 AM
FOR: ATL. BCH. PUBLIC WORKS 904 247 5843
DATE START RECEIVER TX TIME PAGES TYPE NOTE M# DP
AUG-09 11 :56 AM 94437369 2' 01" 4 SEND OK 967
TOTAL 2M IS PAGES: 4
DEPARTMINT OF PUBUC WORKS
12M SANDPIPER LANE
ATLANTIC BEACH,FWRMA 32233-4318
TELEPHONE(904)247-5834
FAX-(904)247-5843
SUNCOW 952-5934
http://ci,atlantic-boachl.us
limp
FAX TRANSMITTAL
DATE:
TO: it—)e
ecz,Z &Whcos
FAX#:
Teital Number of Paass. Includina Cover Shoot:
CITY OF ATLANTIC BEACH
CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
500 Seminole Road 004-247-5800
Atlantic Beach,Florida 32233-5"6 Fax 904-247-5545
Date 07/14/04 PERMIT 0
IS
JobAddress 300CEAN-aUt, SUED BY THE CITY
Perrnitee: TECO,/PEOPLES G6S Telephone#. L9041739-4874
Permittee Address: 404Q PHILIPS HWY, JAX. FL. 32207
Requesting Permission to Construct: A 1-1/4" GAS SERVICE 0, �O PSIG
Location: (Reference to Cross-Street) CROSSING OCEAN AV�, a 125 FT NORTH OF ATLANTIC BLVD.
1. Applicant declares that prior to filing this application he has ascertained the location of all existing utilities,
both aerial and underground and the accurate locations are shown on the sketches.
A Letter of Notification was mailed to the following Utilities/Municipalities:
Jacksonville Electric Authority Yes (X) No Date: 7/14/04
Bell South Telephone Company Yes (X ) No Date: 7/14/04
Ferrell Gas Yes (X ) No Date: 71 4/Q4
Comcast Yes (X ) No Date: 7/14104
2. Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation,
alteration or relocation of all, or any portion of said street or easement as determined by the Director of Public
Works, any or all of said poles, wires, pipes, cables or other facilities and appurtenances authorized
hereunder, shall be immediately removed from said street or easement or reset or relocated hereon as
required by the Director of Public Works, and at the expense of the Permittee unless reimbursement is
authorized,
3. AJI work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be
performed under the supervision of CURT BROWN -(Contractors Project Superintendent)
located at 4040 PHIUPS HWY. JAX, FL. elephone#: (90$) 7�94874
4. All materials and equipment shall be subject to inspection by the Director of Public Works or his designee.
5. All city property shall be restored to Its original condition as far as practical, in keeping with city specifications
and the manner satisfactory to the city.
6. A sketch of plans covering details of this installation, as well as, a copy of a recent survey shall be made a
part of this permit
7. This permittee shall commence actual construction in good faith with 30 days. If the beginning date is
more than 60 days from date of permit approval, then permittee must review the permit with the Director of
Public Works to make sure no changes have occurred in the area that would affect the permitted construction.
8, It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the
City's right, title and interest in the land to be entered upon and used by the holder, and the Holder will, at all
times, assume all hsk of and indemnify, defend, and save harmless the City of Atlantic Beach from and
against any and all loss, damage, and cost of expenses &rising In any manner of the exercise or attempted
exercises by the holder of the aforesaid rights and privileges.
9, 'the Director of Public Works shall be notified twenty-four (24) hours prior to starting work and again
immediately upon completion.
OWNER
Signed; Date:
Before me this —day of_in the County of Duval,
Slate Of Florida,has personally appeared
Notary Public at Large,StRe of Florida.County of Duval.
My commission expires:
Personally Known: or
Produced Ideftficatlon:
Z 0 30Vd SVE) S3-1d038 69ELEVO E0:01 l;100Z/9Z/L0
FXURP00C
TECOI Peoples Gas
4040 Phillips Highway
Jacksonville, FL 3220'
tel(904)739-4874
fax(904)443-7369
faxt r a n s m t
to: City Of Atlantic Beach
fax#: 247-5800
from Kermit Howell
date: 07-26-04
re: Gas service for 30 Ocean Blvd.
pages: 3, Including this cover sheet
NOTES: Gentlemen,
Attached please find TECO Peoples Gas' Right Of Way
construction pern-dt for installation of a 1-1?4" gas service
crossing Ocean Ave.Please process this information and
correspond with me as necessary.
If you have any further questions or require any additional
information you may contact me at (904) 739-4874 (office) or
237-2046 (cell)
Thank you.
Kermit Howell
C0 3DVd SVD 531d03d 69CLE0.0 EO:01 V00Z/9Z/L0
011 NVIXV
in
4
0
0
N-d3l4V
TO MST. SEA TURTLE INN
2 GAS SVC.
30 OCEAN BLVD.
90K PROP. 1-1/4' I.P. PC
UNDER E
AUAW VIM
36 MIMIX=6
150'
A EXISTING 2"
GAS SERVICE
ATLMTIC GLW.
VARES
MUS. AW4rL
hift Peoples Gas System
1-1/4- LP. PE SOMM PROPOSED 1-1/4' -PE, GAS SVC.
D/W BORE DErAJL FOR . i
-1 30 OCEAN AVE.
Tfl -
ATLANTIC
ERN AkiEPN
ATLANTIC
GENERAL NOTES
1. THE LOCATIONS AND SIZE OF EXISTING UTILITIES AS SHOWN ON THE PLANS ARE
APPROXIMATE ONLY. HOWEVER. THERE IS NO GUARANTEE THAT ALL EXISTING
FACILITIES NAVE SEEN FOUND OR SHOWN. THE CONTRACTOR IS FOREWARNED To
ASCERTAIN AND DETERMINE PRECISE LOCATIONS PREPARATORY TO EXCAVATING AND
ALSO FAMILIARIZE HIMSELF WITH ALL VOLTAGES CARRIED IN OVERHEAD OR
UNDERGROUND UTILITY SERVICES. NO CLAIM FOR EXTRA COST SHALL BE MADE
AGAINST THE OWNER OR ENGINEER AS A RESULT OF THE AFOREMENTiONEO
APPROXIMATIONS. THE CONTRACTOR SHALL LOCATE EXACTLY ALL UTILITIES THAT
CROSS THE PROPOSED UTILITIES PRIOR TO CONSTRUCTION.
2. THE CONTRACTOR SHALL NOTIFY ALL UTILITY COMPANIES AT LEAST 48 HOURS
BEFORE BEGINNING CONSTRUCTION.
CONTRACTOR SMALL -CALL SUNSHINE- 1-800-432-4770 A MINIMUM OF 2-DAYS
�4,wML4A C0`4 AND A MAXIMUM OF 5-DAYS PRIOR TO START OF CONSTRUCTION.
3. IT IS THE RESPONSIBILITY OF THE CONTRACTOR TO USE WHATEVER MEANS
NECESSARY TO CONTROL AND PREVENT EROSION AND TRANSPORT OF SEDIMENT
TO SURFACE DRAINS AND TO DITCHES DURING CONSTRUCTION.
4. THESE DRAWINGS 00 NOT INCLUDE NECESSARY COMPONENTS FOR CONSTRUCTION
SAFETY.
5. CONTRACTOR IS SOLELY RESPONSIBLE FOR CONSTRUCTION SAFETY. SPECIAL
PRECAUTIONS MAY BE REOUIREO IN THE VICINITY OF POWER LINES AND OTHER
UTILITIES.
6. ALL FEATURES ARE NOT SHOWN. THE FEATURES NOT SH0W?J INCLUDE-,. BUT ARE
NOT LIMITED TO. OVERHEAD UTILITIES. TRAFFIC CONTROL WIRING AND APPERTAIN-
ANCES, EXISTING UTILITY SERVICE LINES AND ROAD SIGNS. IT SHALL BE THE
CONTRACTOR'S RESPONSIBILITY TO LOCATE AND PROTECT THESE FACILITIES DURING
CONSTRUCTION. ANY DAMAGE CAUSED BY THE CONSTRUCTION SHALL BE REPAIRED
BY THE CONTRACTOR AT NO ADD1710NAL COST TO OWNER.
BRICK PAVERS
ASS
PARKING
mtl�ltmo,%,A
60' R/W
PARKING 1
C/L
GRASS
BRICK PAVERS
22'
1-114" PE
2" PE
STORM
Lu
REMOVE a REPLACE >-
BRICK PAVERS TO C3 FM 0
SAME OR BETTER ;w 0
CONDITION.
LPROP. 2- PE
GAS MAIN
ATLANTIC BLVD. CROSSING
NTS
-5-04 NORTH
r tl� PROPOSED 2" PLASTIC GAS MAIN
Fll9C3F-L-9E= 9--,Ak= ON OCEAN AVE. CROSSING
WRW 4040 PhlifID6 NtChWY ATLANTIC BLVD.
of 4 SCALE, _I* ._50' J00kaonville. Floricro 32207
BORE PROP 1-1/4"
'30 OCEANBLV�D
PE GAS S6VICE (0
.JOSFP14S
REST. LA
REMOVE & REPLACF
BRICK PAVERS TO
SAME OR BETTER
CONDITION.
z
BRICK PAVERS
GRASS GI
PARKING
BORE PROP.
ATLANTIC BOULEVARD ALJcw 4
S70RM -
PARK I NG
GRASS
BRICK PAVERS
WAT
LA TIE PROP.
TO EXIST.
DATE:
FILE:
JOSEPHs
OCEANBL
DRAWN S'
SHEET:
AHERN
0
ATLANTIC
TO EXIST. SEA TUR%E INN
2 GAS Svc.
30 OCEM BLVD.
EXIS'flNG 2"
GAS SERVICE
AIMM BLVO.
MUS *SPK
W mtm. Peoples Gas System
PROPOSED 1-1/4* PE. GGAS SVC.
FOR
D/W BORE DETAIL
30 OCEAN AVE.
TO 39Vd SV9 S3Id03d 69ELEOP EO:OT 170@Z/9Z/LO
AS
aA/
ATLANTIC
GENERAL NOTES
I. T14E LOCATIONS AND SIZE OF EXISTING UTILITIES AS SHOWN ON THE PLANS ARE
APPROXIMATE ONLY. HOWEVER. THERE IS NO GUARANTEE THAT ALL EXISTING
FACILITIES HAVE BEEN FOUND OR SHOWN. THE CONTRACTOR IS FOREWARNED TO
ASCERTAIN AND DETERMINE PRECISE LOCATIONS PREPARATORY TO EXCAVATING AND
ALSO FAMILIARIZE HIMSELF WITH ALL VOLTAGES CARRIED IN OVERHEAD OR
UNDERGROUND UTILITY SERVICES. NO CLAIM FOR EXTRA COST SHALL BE MADE
AGAINST THE OWNER OR ENGINEER AS A RESULT OF THE AFOREMENTIONED
APPROXIMATIONS. THE CONTRACTOR SHALL LOCATE EXACTLY ALL UTILITIES THAT
CROSS THE PROPOSED UTILITIES PRIOR TO CONSTRUCTION.
2. THE CONTRACTOR SHALL NOTIFY ALL UTILITY COMPANIES AT LEAST 48 HOURS
BEFORE BEGINNING CONSTRUCTION.
�4lWAAL)�A CO'�'6`2 CONTRACTOR SMALL 'CALL SUNSHINE' 1-800-432-4770 A MINIMUM OF 2-DAYS
AND A MAXIMUM OF S-OAYS PRIOR TO START OF CONSTRUCTION.
3. IT IS THE RESPONSIBILITY OF THE CONTRACTOR TO USE WHATEVER MEANS
NECESSARY TO CONTROL AND PREVENT EROSION AND TRANSPORT OF SEDIMENT
TO SURFACE DRAINS AND TO DITCHES DURING CONSTRUCTION.
4. THESE DRAWINGS 00 NOT INCLUDE NECESSARY COMPONENTS FOR CONSTRUCTION
SAFETY.
5- CONTRACTOR IS SOLELY RESPONSIBLE FORCONSTRUCTION SAFETY. SPECIAL
PRECAUTIONS MAY BE REOUIRED IN THE VICINITY OF POWER LINES AND OTHER
UTILITIES.
6. ALL FEATURES ARE NOT SHOWN. THE FEATURES NOT SHOWN INCLUDE.' BUT ARE
NOT LIMITED TO. OVERHEAD UTILITIES, TRAFFIC CONTROL WIRING AND APPERTAIN-
ANCES. EXISTING UTILITY SERVICE LINES AND ROAD SIGNS. IT SHALL BE THE
CONTRACTOR'S RESPONSIBILITY TO LOCATE AND PROTECT THESE FACILITIES DURING
CONSTRUCTION. ANY DAMAGE CAUSED BY THE CONSTRUCTION SHALL BE REPAIRED
I BY THE CONTRACTOR AT NO ADDITIONAL COST TO OWNER.
BRICK PAVERS
AASS
PARKING
60' R/W
PARKING 1
C/L
a:
GRASS
BRICK PAVERS
uj 22' V)
w
1-114" PE
2" PIE
REMOVE & REPLACE STORM
U'
BRICK PAVERS TO 8 0 FM 0
SAME OR BETTER
ICONDITION.
PROP. 2" PE
GAS MAIN
ATLANTI.Q BLVD. CROSSING
-5-04 NORTH
PROPOSED 2" PLASTIC GAS MAIN
ON OCEAN AVE. CROSSING
WRW 4040 Phil ATLANTIC BLVD.
2 Of 4 SCALE. 1" - 50' 1 ooksono I ie-'1Fp16orTdqQh712207
BORE PROP. 1-114"
30 OCtAt4 PE GAS SERVICE (0
S,pVjS ITALIAN
JO REST-
REMOVE & REPLACU
BRICK PAVERS TO
SAME OR BETTER
CONDITION.
BRICK PAVERS
GRASS G;
PARKING
BORE PROP.
ogrwz
ATLANTIC BOULEVARD
STORM
PARK I NG Fm
GRASS
BRICK PAVERS
19AI 3
TIE PROP.
TO EXIST.
VAT
LA
DATE:
FILE:
JOSEPHS
OCEANBL
DRAWN 8
SHEET:-
LAN
OR
OF
ADDITIONS or CORRECTIONSE
DO NOT REMOVE
JOB ADDRESS DATE
--L-0 6:�,COJA 9L14P ,2,CC/
THIS JOB HAS NOT BEEN COMPLETED
The following additions or corrections shall be made before
the job will be accepted
Pipoer-1 it, W4-5;�e_�L
A 1 0
Fq-$-t&00 REINSPECT FEE
It is unlawful for any Carpenter, Contractor, Builder or other
persons, to cover or cause to be covered, any part of the work
with flooring, lath, earth or other material, until the proper
inspector has had ample time to approve the installation.
After additions or corrections have been PLUMBINI:,LL
made, call 247-5826, Building Depart-
ment for an inspection. Field Inspectors ELEC
are in the office from 8:00 a.m.to 5:00
p.m. Monday through Friday, BLDG
LAN i 12�
(4)
Z
OR
OF
ADDITIONS or CORRECTIONS
DO NOT REMOVE
JOB ADDRESS o ATE
30 0C4,A10J__ (, ( . 0
THIS JOB HAS NOT BEEN COMPLETED
The following additions or corrections shall be made before
the job will be accepted
(2,
JON
[EF$15.00 REINSPECT FEE
It is unlawful for any Carpenter, Contractor, Builder or other
persons,to cover or cause to be covered, any part of the work
with flooring, lath, earth or other material, until the proper
inspector has had ample time to approve the installation.
After additions or corrections have been PLUMBING
made, call 247-5826, Building Depart-
ment for an inspection. Field Inspectors ELEC
are in the office-from 8:00 a.m. to 5:00
p.m. Monday through Friday. BLDG
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FLORIDA 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 04-00028187 Date 6/29/04
Property Address . . . . . . 30 OCEAN BLVD
Tenant nbr, name . . . . . . CONVERSION EXIS .RESTAURAN
Application description . . . COMMERCIAL INTERIOR BUILD OUT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 73056
Owner Contractor
------------------------ ------------------------
JUBRAN INVESTMENTS NU-VISION DESIGNS & CONST.
4541 ST AUGUSTINE RD 12276 SAN JOSE BLVD SUITE 111
JACKSONVILLE FL 32223 JACKSONVILLE FL 32223
(904) 241-9104 (904) 443-0008
--------------------------------------- -------------------------------------
Permit . . . . . . ELECTRICAL PERMIT
Additional desc 200AMP, lPH, 4W, 240V
Sub Contractor HOOVER & ASSOCIATES ELECTRIC
Permit Fee . . . . 175 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit . Fee Total 175 . 00 175 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 175 . 00 175 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING
BUILDING OFFICIAL
CITY OF ATLANTIC BEACH
ELECTRICAL PERMIT APPLICATION
Date: A,;
Property Address: -�rf) r
Owner: Telephone 4:
�n s A!,4. zj
Contractor: t�,j Telephone#: qoq -2 C,-R
Contractor Address:
In consideration of permit given for doing the work as described in the above statement, we hereby agree to perform said work in
accordance with the attached plans and specifications which are a part hereof and in accordance with the City of Atlantic Beach
ordinance and standards of good practice listed therein.
Building: Building Type: C3 Trailer Service: If other construction is
0 New El Residence El Temp. C3 New being done on this budding
Or site,list the building
-d'Old zr Commercial zi Signs U Increase Permit number:
El Re-wire U Addition Sq.Ft. ca Repair (12,C-1 2-2_1 1'E:7
Conductor Size: ANTS: Z-oc,,? C PPER AL
Switch or RACE
Breaker AMPS PH W VOLT WAY
Existing Service RACE
Size AMPS Z4f)n PH W VOLT WAY
Feeders: NO. SIZE NO SIZE NO SIZE
Lighting Outlets
CONCEALED OPEN
�AReceptacles 6ONCE LED� OPEN
PIR 11 100 AMPS
Switches
Incandescent
Fluorescent &
M.V.
Fixed 0.100 AMPS OVER BELL
Appliances TRANSFER.
Air H.P.RATING H.P.RATING CEILING KW-HEAT
Conditioning COMP.MOTOR OTHER MOTORS AMPS HEAT
Motors 0-1 H.P. VOLTAGE PH NO. OVER I H.P. PHS
UNDER600V OVE OOV
Transformers NO. KVA NO. KVA
No.Neon-Transf
Ea._Sign
Miscellaneous
800 Seminole Road-Atlantic Beach,Florida 32233-5445
Phone: (904)247-5800- Fax: (904)247-5845 * http://www.ci.atiantic-beach.fl.us
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FLORIDA 32233
INSPECTION PHONE LINE 247-5826
19)
Application Number . . . . . 04-00028187 Date 6/11/04
Property Address . . . . . . 30 OCEAN BLVD
Tenant nbr, name . . . . . . CONVERSION EXIS .RESTAURAN
Application description . . . COMMERCIAL INTERIOR BUILD OUT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 73056
Owner Contractor
------------------------ ----------------- -------
JUBRAN INVESTMENTS NU-VISION DESIGNS & CONST.
4541 ST AUGUSTINE RD 12276 SAN JOSE BLVD SUITE 111
JACKSONVILLE FL 32223 JACKSONVILLE FL 32223
(904) 241-9104 (904) 443-0008
----------------------------------------------------------------------------
Permit . . . . . . PLUM13ING PERMIT
Additional desc 10 FIXTURES
Sub Contractor PRECISION PIPEWORKS, INC.
Permit Fee . . . . 105 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 10S . 00 10S . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 105 . 00 105 . 00 . 00 . 00
PER S APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING
C�06�E'T"]�
�Q
BUILDING OFFICIAL
CITY OF ATLANTIC BEACH
PLUMBING PERMIT APPLICATION
Date: -7/0 q
Property Address: -3 0 Ocea rx S] vJ
Owner: 31"z�fz_A T2jjjesf Telephone#-. 211 1-9to fi(
Contractor: PkEkkslo�) Telephone #: a
Contractor Address: to �j n e g.6 A) Fax#:
In consideration of permit given for doing the work as described in the above statement,we hereby.agree to perform said work in
accordance with the attached plans and specifications which are a part hereof and in accordance with the City of Atlantic Beach
ordinance and standards of good practice listed therein.
Installation of plumbing and fixtures must be in accordance with the most recent edition of the Southern Standard Plumbing
Code.
Plumbing Type: If other construction is being done on this building or site,
El New list the building permit number:
L3 Re-Pipe 7
Number of Fixtures:
Bath Tubs Showers
Closets Shower Pans
Dishwashers Sinks
Disposals Urinals
Floor Drains Washing Machine
Lavatory Water
Sewer Water Heaters
Other
Fees
Permit Issuing Fee: $35.00
Total Fixtures: 10 X $7.00 + $35.00
800 Seminole Road-Atlantic Beach, Florida 32233-6446
Phone: (904) 247-5800 - Fax: (904) 247-5845- http:/twww.ci.atiantic-beach.fl.us
S CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FLORIDA 32233
INSPECTION PHONE LINE 247-5826
Application Number 04-00028206 Date 5/04/04
Property Address . . . . . . 30 OCEAN BLVD
Tenant nbr, name . . . . . . INTERIOR DEMO
Application description . . . DEMOLITION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
Owner Contractor
------- ----------------- ------------------------
NU-VISION DESIGNS & CONST.
12276 SAN JOSE BLVD SUITE 111
JACKSONVILLE FL 32223
(904) 443-0008
----------------------------------------------------------------------------
Permit . . . . . . DEMOLITION PERMIT
Additional desc . .
Permit Fee . . . . 100 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
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
BUILDING MATERIAL,RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE CLEARED
UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER. "FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN
RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS"ISSUED ACCORDING TO APPROVED PLANS
WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW.
Q, ) ( - qv�
BUILDING OFFICLAL
CITY OF ATLANTIC BEACH
DEMOLITION PERMIT APPLICATION
Date: �i ObA40Y
�-J
Job Address: (OL&,, 6adLJ-J � A4 la,I i, &,Lk FL, 322.33
Owner of Property: :Z 6ran T�)ve64moe\+�
Address: Lk5LA I &-t- a0q . FL 32.2CY1 Telephone: (904),RL41—q110L(
Legal Description: Block Ni 3S Lot Number: r-1 Zoning District:
Contractor: V I 601-V4, -A�Ic— State License Number: CG C, i ro q 3 19
Contractor's Address: -n;)fl U TIN San -TO-1, 601L.,4�J ; Xact=avillc F
-, C32V3
Telephone: (_50L.A) 4�J3 -0009 Fax: Cl 0 LI)k4t-4 00 Oq
De crib�proposed use and w toeone: C0)qe.--sjbp & &40,
- L-L±�, -�D �� Vf *4
1J -3
Present use of land or building(s): OnAdIAIrCLVI-A
Is approval of Homeowner's Association or other private entity required?�X If yes,please submit with this
application.
Will this-9ftJect involve changes in elevation,site grade or any use of fill material or the removal of any trees?
M'NO. Applicant certifies that no change in site grade or fill material will be used on this project.
F-1 YES. See Step 2 below. Approval of the Public Works Department is required prior to issuance of a Building
Permit.
2<000.0* Applicant certifies that no trees will be removed for this project.
YES. Removal of Trees will be required for this project. TREE REMOVAL PERMIT IS REQUIRED. Tree
Removal Permits to be reviewed by the Tree Conservation Board,which meets two times each month.
Procedure: In order to expedite issuance of permits, please follow all steps and provide all information as appropriate.
Incomplete applications may result in delay in issuance of permit.
STEP 1. Attach Tree Removal Application if trees are to be removed or relocated.
I hereby certify that all information provided with this application is correct.
Signature of Owner: C Date:
/ 7
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of the 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 federal,state or local rules,regulations,ordinances,or laws in any manner,including the
governing of construction or the performance of construction of the property. I understand that the issuance of this permit is contingent upon the
above information being true and correct and that the plans and supporting data have been or shall be provided as required.
800 Seminole Road -Atlantic Beach,Florida 32233-5445
Telephone: (904)247-5800 -Fax: (904)247-5845 -http://www.ci.atiantic-beach.fl.us
Page 1 Revised 1/14/03
Date: d
Signature of Contractor: // C71
Address and contact information of person to receive all correspondence regarding this application(/ease print).
Name: Uemtos Pan�ty� _
Mailing Address: ��R Q ri 6- It k IQ-6n ITOI�� PwaIAA_�� VAtJ rc 3X?23
Telephone: NoLO�AL43-0001i Fax: E-Mail: DA_on� Q cia"
L.0
AS TO OWNER:
Sworn to and subscribed before me this LA day of 20 OL4
State of Florida,County of Duval
poWAL Notary's Signature:
ewe to.IP
Mr-P'ersonally known
Produced identification
Type of identification produced
AS TO CONTRACTOR:
Sworn to and subscribed before me this L day of Maw 20 CM
State of Florida,County of Duval
Notary's Signature:
pAmELA L MOLAX
IAF Comm f*.&490 B?Ifersonally known
SQ0511" F-I Produced identification
"4;::qbM*1101wM Type of identification produced
800 Seminole Road -Atlantic Beach,Florida 32233-5445
Telephone: (904)247-5800 -Fax: (904)247-5845 -http://www.ei.atlantic-beach.fl.us
Page 2 Revised 1/14/03
Jun 02 03 02: 14P Information S�jstems 247-5845 F. G
PAt Ju Book- 11-780 page 592
NOTICE OF COMMENCEMENT
State of TaxFolioNoJ1r10121ar1 00
County of
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in accordance
with Sk�ction 713 of the Florida Statutes,the following information is stated in this NOTICE OF CON&M-NICEMENT.
Le i description o ro erty being improved: C�, 2-1- 25- 29C A4 La I iL.
f-s 'AT1 FT Lgi r7 Ai ir-A15� - -
, tA ng imp,
Address of pro ei roved C, n r,
F Lor,19aly 3�u 1-:��2>
General description of improvements:
Owner: L,he a- Nj L> tm(2,-%1-��
Address: tA 11 1
Owner's interest in site of the imppjro�vent, (OLA-�O" V-j,�cA LAne
Fee Simple Titleholder(if other than owner): ki
Name:
CoAddress: iru-r
ntractor: klu V" �� 'r 4
Address: I dar)L.���r, pt-�d' -Tqa::,�V, 1 ]32
Phone No: Ccic-si) q 2,—Cr-nS� Fax No:'(,,) L,LA c7n<;
rety(if any):
Address:' Amount of Bond
Phone No: Fax No:
Name and address of any pegon making a loan for the construction of the improvements.
Name:
Address:
Phone No: Fax No-
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other
documents may be served:
Name: �j iA
Address:
Phone No� Fax No:
In addition to himscl�owner designates the following person to receive a copy of the Licnor's Notice as provided in
Section 713.06(2)(b),Flori Statues. (Fill in at Owner's option).
Name: tift
Address;
Phone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a
different date is specified):
TfflS SPACE FOR RECORDER'S USE ONLY N E RmZ:7
. X Date:
1jilfore)ne this day of ;L,3 i the Ounry
ffDtl,StateTFIj ha*sly appeitred
it
Doc# 2004139674 te f
Book: 11780 ublic at Large,State of
Ntrr,7 P
pa e: 592 My commission expires- 49
Filed & Recorded Personally Known:
04/30/2004 04;12:46 PM Produced Identification:
JIM FULLER
CLERK CIRCUIT COURT
DUVAL COUNTY
RECORDING $ 5.00
TRUST FUND $ 1.00
CITY OF ATLANTIC BEACH
DEPARTMENT OF BUILDING
800 SEMINOLE ROAD-ATLANTIC BEACH,FL 32233-TEL: 247-5826-FAX: 247-5877
k-
:ft~ZM1T�&bf�M&�104, LOCATION INFORMA' IN
rPermit Number: 23241 Address: 30 OCEAN BOULEVARD
Permit Type: UTILITIES ATLANTIC BEACH, FL 32233
Class of Work: NEW Township: Range: Book:
Proposed Use: COMMERCIAL Lot(s): Block: Section:
Square Feet: Subdivision: ATLANTIC BEACH
Est. Value: Parcel Number:
OV: ------
Improv. Cost: �Atk fUF6RMATION__________,j
Date Issued: 12/31/2001 Name: JUBRAN
Total Fees: 525.00 Address: 60 OCEAN BLVD.
Amount Paid: 525,00
!MW ATLANTIC BEACH, FL 32233
--000-0000
Date Paid: 12/31/2001
i Work Desc: 3/4"
ON-
nAC
PUBLIC WORKS DEPARTM,
525.00
U,
t5ow',
4.
t
00� !M-N-1
�t' 4
lkl
F
.4r
NOTICE IOR T SPECTION
4
BUILDING MATERIAL, is ;,�WA�64& U TN I PUBLIC SPACE,AND
MUSTB W DUPA Ilk-
-7 7,�
"FA,ILURE TO COMPLY W SULT IN THE
S#1
PROPERTY OWNER PAYI G
THIS PERMIT AND SUBJECT TO REVOCATION
ISSUED ACCORDING TO APPROVED PLANS';��-
FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW:
FDTj
DEC 3 1 2001
AMa-FIC 6EACH BUILDING DEPT. 3149
3M
A AN
G2
RI
OF
ADDITIONS or CORRECTIONS-,
DO NOT REMOVE
JOB ADDRESS DATE
30 Oce-am B ral 5`1 -Ot
THIS JOB HAS NOT BEEN COMPLETED
The following additio-ns or corrections shall be made before
the job will be accepted
J
00h
(V
Cq) T_-fe en
4 6 rl<-
PAID
!!AY 2 2001
M of Allantic 13"",
$15.00 REINSPECT FEE
It is unlawful for any Carpenter, Contractor, Builder or other
persons, to cover or cause to be covered, any part of the work
with flooring, lath, earth or other material, until the proper
inspector has had ample time to approve the installation.
After additions or corrections have been
made, call 247-5826, Building Depart- PLUMBING
ment for an inspection. Field Inspectors ELEC
are in the office from 8:00 a.m. to 5:00
p.m. Monday through Friday.
CITY OF
4&4*t4C &44CA-0;&U444
Office of Building Official
REQUEST FOR INSPECTION
Date Permit No.
Time A.M.
Received (ribi
677
Job Address /�.Locality
Owner's 1-6
Name 41 Contractor
BUILDING CONCRETE PLUMBING MECHANICAL
Framing 0 Footing 11 Rough Wiring I-] Rough F1 Air Cond. & El
Re Roofing El Slab 0 Temp Pole F-1 Top Out L-1 Heating
Insulation 11 Lintel E Final F,1 Sewer D Fire Place El
Pre Fab
READY FOR INSPECTION
A.M.
Mon. Wed. Thurs. Friday-PM.
Inspection Made A.M.
—7! 1-plem
Inspector- Final Inspection El
g%O' Certificate of Occupancy Uj
Date !K /`7 7O—Z
OF ATLANTIC BEACH
D EpARTMENT OF BUILDING
800 Seminole Road Atlantic Beach, FI 32233 -Tel. (904) 247-5826
ROOFING PERMIT &M–k—TION
OUL D
101110T F...... Addres 0 UUr^jsj DuUL IDA 32233
P I TIC Rr-A CH, F
Pe it Number: 18907 ATLAN Range: 0 Book:
permit Type. RE-ROOF Township: 0 Block: section:0
Class of Work: REPAIR Lot(s)'
Proposed Use: Subdivision:
Square Feet: Parce! Number:
0 1 A i R E_k IN 06 R—M
Est. Value: 800.00 JUBRAN
Improv. Cost: 10/01/1999 Name- 40 OCEAN BOULEVARD
Address:
Date issued, 25-00 ATLANTIC BEACH, FLORIDA 32233
Total Fees: 25.00 "000 000-0000
Amount Paid: 10/01/`1999 Phone:
Date Paid: G VEL- ju -OU-%, .k
Work De-111 c: tEl ., OUAREST
25.00
NflR�A PERMI-I
ALL SOUTH ROUMNU CO.
Pq
Ct
NOTICE - INSPECTIONS MUST BE REQUESTED AT LEAST 24 HOURS PRIOR TO INSPECTION
BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND
MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER
"FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY
OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS11
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION
FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW.
__Q4r_ C
Date: 10/01/99 81 Receipt: 0806837
CITY 0 A LANTI EACH CHECKS 3793
Gal 0003221000
SEP-30-1999 11:03R FROM: 247-5845 TO:97778921 P:1/1
CITY OF ATLANTIC BEACH
ROOFING PERMIT APPLICATION
JOB LOCATION.,
-7 0
OWNER OF PROPERTY; TELEPHONE::
CONTRACTOR,
CONTRACTOR'S ADDRESS:
or
STATE LIC NSE NUMBER: ----TELEPHONE. 9�0
DESCRIBE WORK TO BE PERFORMED:—
VALUATION OF PROPOSED CONSTRUCTtON_
MATERIALS TO BE USED:_--
SIGNATURE OF OWNER:
SIGNATURE OF CONTRACTOR: �L,
SWORN TO AND SUBSCRIBED BE.F��"V"mw3O^ DAY OF
Q*My commission cr,720M3
"'DT
EWes Match 2,2==
AS TO OWNER-,
0
American Vectrical
contmaingt Im
PV'
Business office;2727 Clydo Road*ER001 5316*C0rP0r*t8 office:2515(
Mailing address: P.O. Box 4951, Jacksonville, Florida 32201-49
(904)737-7770
Fax:(-�04)737-4.0clo
April 18,2001
City of Atlantic Beach
-8Q0 SerTfinole Road
A tl a a—c Mwd&r,-R�2233
Electrical Dept.
Dear Sir.
We respectfully request that temporary pnv.-Pr tor the address listed below be cut on
for a period of thirty (30) days for testing purpose only, We accept responsibility for
anything that may occur due to the energizing of the service prior to the final
inspection, and the approval and completion of the job.
I
Job location: .30�ceaft
_�Yd
ftntic Beach, Fl
Sincerely,
Ead Frick
President
DEPARTMENT OF BUILDING FOR OFFICE USE ONLY
CITY OF ATLANTIC BEACH
FLORMA Dat
Applica Permit #/_.1.3_?4Fee
tioii�fOrPermit for Valuatio
'Miscellaneous Alterations, HOUSE
and Repairs �AiAgil;-ii-I�,
DESCRJB4:
(state if to repair, alter,
signs, e to or move building, er
Build-in : !�%V" 7 ect ax1rings,
V n: L t No, '
"No
0 'A 10!5;
Address 3S S b DIV_
0
wner l4tion S
BUILWDDI AND OCCU y
Resideh
f" What PlU;*bi49 work t 11 tial or B PIP
o be done?
i, Size, of 'present
Bldg.
ize 0
NO- Of stories now if Xtensio
Material �Of After altWed_,2L._MAter Lot Size
Present 'Buildin 0 roof
terial Of 83ctension._
P
iName of OIL R QK GASOI�XNZ EQUIPMENT
10*1 Burner Or Gasoline P
�Name and 'Address of Man%i UMP e Or Mode
.-In conae facturer �7�TyP
Ction herewith, applica,64.0n Is also
capac made to instal
ity taAMAY, R14de,'by
ground.
(Same of Manqfa meta
er At' AboveT cturer)
of Or Above)
no �j
PT;" I ng. F
;0 Ir- c 1�ui di
at rde�
S W, Furch- er
4 D: IqJCSG S
HOWING ENTIRE LAy0VT,
ON RE
THIS BT-%W VERSE SIDE or
ize
Classification
(State whe
#aterial of Construction 91 Ound roof, wa
# projec ng,,Banner)
,fllU*inatWZ__.Type 0
nat on
Dion
Over public property? Or re-on-7-
UBMIT, nuawrNGSHM,
NG CONSTRUCTION
SIGN AND METHOD
WAITP. 'ADD1TI6jjZ
(Pyor, X BEL9W
canvas awnings Provide dimenetn '10
reverse side)
i Ti
In consideration of Perm
the ab it given for doing the work as described
OvP1 statement, we here
a, _cord by, agree ,to perform
ance with the attached plans and spe said work in
hereOt and in &Ccordanice with the, c4f'catiOns, which are a
qtY Of Atlantic Beach. bUilding, regulations Of the
(South
0. tarA g C
Signature Build
er or Owner
es
one No.
FOR OFFICE USE ONLY
DEPARTMENT OF BUILDING �, j
Date
CITY OF ATLANTIC BEACH, FLORIDA Permit #At2,..C!ee $ ?S�!
Valuation $
2iZo/i
Application for Permit for
HOUSE
Miscellaneous Alterations,
k
Repairs
DESCRIAR.-
WOW �t)ob
(state if to repair, alter, add to or -move building, erect av*ings,
signs, etc.
Building on: Lot NO. ik Sub.Div.
-Lt,, 47-1 %1K 'Valuation
Address
Owner 'S Name raag,-k_tg� W I hk f;ht
No AND 6dCU ANCY
BUIWI
bUildi 0 ResidO iia or Busine
U- inq work t6'
se
What, 9 �M* done?-
Oize of', Present Bid ize, of, Extension
Lot, Size
at* roof
11" ko. of: ""Stot ies now alter 'Alt d riCl of
kiterii'll 'of present ildihq91Wtg, eriil of Extension
NECESSARY PLANS TO LZ S!LDMITTED HEREWITH,
OIL BURNER OR GASOLINE EQUIPMNT
Name of, Oil Burner or Gagoline Pump Type or Model
Name and Address of Manui*cturer
In conbection herewith, a gi on Is also made to install%
P'
i", gal. capacity tank(s) of 9 ietil
)ad
.,ou
ou
gr (Name of Manufacturer) 'Ur6.AT or Above)
(Under`� .or Above) 1��uijAi I
_n
o; building.' F
linside 5r torde)
FURNISH DRAWING SHOWING ENTIRE LAYOUT ON REVERSE SIDE OF
THIS BLANK
SIGNS
Classification
Size ther gr
t
(State whe roof, wall, projecEing, anner
Material of Construction
Illuaiq�ted�__Type of_)>4umination'
(SEREE whether Lamps or We-on)
Will sign be over pubric property?
SUBMIT DAM: ON, or 8 HOD a HANGING
EJR SMKO CONSTR 71 ION AND MET
HCO
WRITE ADDITIONAL INFORMATION LOW
(F
or :canvas awnings provide dimension wing o� reverse side)
COMP", 1
.. A -ft A
;JUL
IMP2BM NOTICE-,
y
In consideration of permit given for doing the work as described
in the above statement, we hereby. agree, to perform said work in
with the attached plans and specifications, which are a
e building regulations of the
and in accordance with th
city 6' cBeach. (S thorn Standard Building Co
f Signatur uner
a, of Buildar ,,09, 0
$to
4
Sional-urn of Rul ljd�p�,nir
CT I
LN
�7etl'
4, 10 4