469 Atlantic Blvd Unit 8 2012 build out CITY' OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-CO001009 Date 8/08/12
Property Address . . . . . . 469 ATLANTIC BLVD
Application type description COMNERCIAL INTERIOR BUILD-OUT
Property Zoning . . . . . . . TO EE UPDATED
Application valuation . . . . 23000
---------------------------------------- ------------------------------------
Application desc
build out for dr office
---------------------------------------- ------------------------------------
Owner Contractor
------------------------ ------------------------
DIAMOND REAL ESTATE PROPERTIES MACK BROTHERS GENERAL CTRS.
6517 LOU DRIVE SOUTH 5521 BARKER STREET
JACKSONVILLE FL 32216 JACKSONVILLE FL 32207
(904) 237-0868
--- Structure Information 000 000 INTERIOR BUILD OUT
Construction Type . . . . . TYPE E -A
Occupancy Type . . . . . . BUSINESS
---------------------------------------- ------------------------------------
Permit . . . . . . COMMERCIAL ALIERATION/OTHER
Additional desc . .
Permit Fee . . . . 165 . 00 Plan Check Fee 82 . 50
Issue Date . . . . Valuation . . . . 23000
Expiration Date . . 2/04/13
---------------------------------------- ------------------------------------
Special Notes and Comments
per m griffin no fire review
2010 FLORIDA BUILDING CODE, FLORIDA FIRE PREVENTION CODE
2008 NATIONAL ELECTRIC CODE
---------------------------------------- ------------------------------------
Other Fees . . . . . . . . . STA9E DCA SURCHARGE 2 .48
STAIE DBPR SURCHARGE 2 .48
---------------------------------------- ------------------------------------
Fee summary Charged laid Credited Due
----------------- ---------- ---- ------ ---------- ----------
Permit Fee Total 165 . 00 165 . 00 . 00 . 00
Plan Check Total 82 . 50 82 . 50 . 00 . 00
Other Fee Total 4 . 96 4 . 96 . 00 . 00
Grand Total 252 .46 252 .46 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF i TLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT MPLICATION
CITY OF ATLANTIC BEACH FILE C 0 Y
i
800 Seminole Road,Atlantic 3each,FL 32233
'7�
Office(904)247-5826 Fax (904)247-5845
Job Address: 469 Atlantic Blvd. Ste 8 Permit Number:-Li _/0 0
Legal Description 10 - 16 21-2S-29E Saltair Sec 3 Parcel#
Floor Area ot Sq.Ft. Sq.Ft
Valuation of Work -Proposed Work heatedkooled 919 non-heated/cooled
Jf
Class of Work(circle one): New Addition Alteration Repaj r Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed?(Circle o le): Yes No N/A
Florida Product Approval#
For multiple products use product approval form
D e in detail the type of work to be performed:
61K 'WA--
"4&
�01
Property Owner Information:
Namc:Diamond R.E. Properties IV, LLCAddress: 6517 Lou Dr. S.
City Jacksonville -State FIZip 32216 P hone-
E-Mail or Fax#(Optional)
Contractor Information:
Company Name:Mack Brothers Bldg Cont. , Inc�Qualif ing Agent: Frederick W. Mack _T272�5
Address:1546 Girvin Rd. Unit 1 Citv Jacksonville State FL Zip
OfficePhone 220-2500 Job Site/Contact Num�er 0 8 6 8 Fax# 220-0520
State Certit-ication/RegistratiTn-#-C--B-CT-1 2 5 8 0 6 2
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is herebv,made to obtain a permit to do the ivork and installations as indic ted. I certili-that no ii,ork or installation has comniencedprior to the
issuance of a permit and that all ivoi-A-it-it/hepertbrined to ineet thestandards of till fait regulating construction in thisjyrisdiction. This permit becomes nuff
and void if work is not commenced ii,ithin six(6)months,or if construction or work,iss ended at-abandoned lot-a period of'six(6)months at anv time after
work is commenced. /understand that separate perinits must he secured - 1
,lot Electri Work,Plumbing,Signs, Wells,Pools,Furmiees,Hoileis,Heaters,
Tanks and Air Conditioners,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PA YING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO 01�TAIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFOR K RECORDING YOUR NOTICE OF
COMMENCEIV ENT.
I hereliv certitv that I have read and examined this qpplication and know the saine to he rue and correci. All provisions of I an ordi nces verni.ng,this
go
npe of worA ttvfl be complied with whether specified herein or not. Ae qranting at a permit does not presume to gi%, nth olat at' tic th
'action.
provi.sions ofatit,otherfederal,state,ot-locallaii,i-egiilatitkgcon.�t;,uctiott tn�thepe�jfbrqance ofconsti,14clion.
S4 nature of Co t
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Signature ofOwner nT:mw
F90M' 116
Print Name i2_1_C.±4/A R b F�A I A-T A Pri it Narne Aw. .4
........................................................................................................................ .. . .......................4.............00*_ -./.........................
Sworn to and subscribed before me SA-,)m to and subscribVd before me
thi '- D f --J—, 20 thi! 3C3 Day of- _T u it 20/c�
Notary PubliV Wi ary Public
Revised 0 1.26.10
PAM HRYNCEINICZ
COMMISSION#DO 961797
EXPIRES:March 2,2014 PAMELA HAYNCEWICZ
Bonded Thru NOWY PUbk Underwrit9m W COMMISSION#DD 961797
EXPIRES:March 2,2014
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City of Atlantic Eleach APPLICATION NUMBER
13ullding Deparbnent Cro be assigned by the BL"V Depeftot)
$00 Serninole Road 12 - 1, 0d 12
Atlantic Beach,Flonde 32233-5445
phone(904)247-SM - Fax(904)247-5845
te
E-mil: buNdkQ-dept@coab.us Da routed:
City ma"ife! ft-JhAAow.awb.ue
APPLICATION REVIEW AN TRACKING FORM
Property Address: A _QeMrtment mvkm required Yes No
*Ruildina*l
( r —
a:n1ni Zooft
& C
Applicant: T
Tree Adminisbator
Public Works
_7
Project: Public Utilities
7- fi4 -77 A-) Public Safety
Fire Services
Other Agency Review or Permit Required R or Recelpt Date
Of ft ve~By
Florida Dept.of Envirmnented Protection
Florkla Dq*of Transportation
St.Johns Rhw Water Management District
Affny Corps of Engineers
Division of Hotels and Restaurants
Nvision of Alcoholic:Beverages and Tobacco
Other
APPLICATION STkTUS
Reviewing D"wrtment Flmt Review: E�A'pproved. E]Denied.
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed by: Date:
TREE ADMIN. Second Review: [34proved as revised. F]Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed I py: Date:—
FIRE SERVICES Third Review.- E]Approved as revis Bd. ElDenied.
Comawnts:
Reviewed I y: Date:
Revisol 07WIM0
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assoied by the Sullang Depaftwt.)
800 Serninole Road
Afimnk Seex;h,Flondai 32233-5445 12 1
Phone(904)247-5826 - Fax(904)247-5845
E-mil: buildng-dept@coab.us Date routed: AZA&z-
City vmb-446! ft!JA~.W0b.u*
APPLICATION REVIEW AN TRACKING FORM
Property Address: 4N nt review required Y No
B Build
Applicant anning A Zogld"S
Tree AdminisMator
Project: 4 4 C'rY;7 I"kg:;77 q Public Works
Public Ublities
dl� 7- Public Safety
4J 644 Fire Services
Other Agency Review or Permit Required Re view or Receipt Date
of P annit Verified By
Fbrkla Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Ammy Corps of Engineers
Division of Hotels and Restaurants
Division of Ahu*wlic Beverages and Tobacco
Other
APPLICATION STATUS
Revioming DepartmeW Firat Review: EXP-proved. E]Denied.
(Circle one.) Comments:
PLANNING&ZONING Reviewed b,f: Date: &�-6-/Z-
TREE ADMIN. Second Review: [:]Approved as revised. F]Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed b1f: Date:
FIRE SERVICES Third Review: E34proved as revise j. FIDenied.
Comments:
Reviewed b): Date:
Revised 07)27110
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Foli No.
State of Florida County(of Duval
To whom It may concern:
The undersigned hereby Informs you that Improvemeni s will be made to certain real property, and In
accordance with Section 713 of the Florida Statutes,the following Information Is stated In this NOTICE OF
COMMENCEMENT.
Legal description of property being improved, 10-16 21-2S-29E Saltair Sec 3
Address of property being improved: 469:,Atlantic Bl-7d. Ste 8, Atlantic Beach, FL
32233 10
General description of improvements: 611AII&
Owner Diamond Real Estate Properties 117, LLC
Address 6S17 Lou Dr. S . , Jacksonville, FL 32216
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor, Mack Brothers Building Contract ors, Inc .
Address 1S46 Girvin Rd. Unit 1, Jacksonville, FL 32225
PhoneNo. 904-220-2SOO Fax No. 904-220-0520
urety(if any)
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the constrL ction of the improvements.
Name
Address
Phone No. Fax No.
Name of person within the State of Florida,other than himself, esignated by owner upon whom notices or other
documents may be served:
Name
Address
Phone No. Fax �o.
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in
Section 713.06(2)(b), Florida Statutes.(Fill in at Owner's optic n).
Name
Address
Phone No. Fax No.
Expiration date of Notice of Commencement(the expiration dat is one(1)year from the date of recording unless a
different date is specified):
---f—HIS-615—ACE �Uk RECOR—DE-Ri 'S USE ONLY _:qWNER
Signed: T=- DATE 2"�70
Before ir�W—this _670 day of -7-L.,/V �P- in the
County of Duva 1,State of Florida.has persdnaI6 appeared
herein t>y
himself/herself and affirms that all statements and declarations herein
are true and adurate
Doc#2012164893, OR BK 16022 Page 1794, <--
Number Pages:1
Recorded 08/03/2012 at 11:41 AM,
JIM FULLER CLERK CIRCUIT COURT DUVAL Notary P6611-ci'l StSte of Courft of Z7&-Z77;i--7-
COUNTY My commission expires: 2 OV41
RECORDING$10.00 Personally — L---- or
Produced Ide an
P
AMELA HRYNCEWICZ
MY COMMISSION#DD 961797
EXPIRES:March 2,2014
Bonded Thru Notary Public Und-ebm
JV
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12- )0001009 Date 8/16/12
Property Address . . . . . . 469 ATLANTIC BLVD
Tenant nbr, name . . . . . . 469 -8 UNIT 8 ATLANTIC BLVD
Application type description COMMERCIAL INTERIOR BUILD-OUT
Property Zoning . . . . . . . TO 13E UPDATED
Application valuation . . . . 23000
-----------------------------------------------------------------------------
Application desc
build out for dr office
--------------------------------------- ------------------------------------
Owner Contractor
------------------------ ------------------------
DIAMOND REAL ESTATE PROPERTIES MACK BROTHERS GENERAL CTRS .
6517 LOU DRIVE SOUTH 5521 BARKER STREET
JACKSONVILLE FL 32216 JACKSONVILLE FL 32207
(904) 237-0868
--- Structure Information 000 000 INTERIOR BUILD OUT
Construction Type . . . . . TYPE 5-A
Occupancy Type . . . . . . BUSINESS
---------------------------------------- ------------------------------------
Permit . . . . . . PLUMBING PERMIT
Additional desc INSTALL PLBG IOR COMM BUILDOUT
Sub Contractor ST JOHNS PLUMBING
Permit Fee . . . . 69 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 2/12/13 t
----------------------------------------41------------------------------------
Special Notes and Comments
per m griffin no fire review
2010 FLORIDA BUILDING CODE, FLOR DA FIRE PREVENTION CODE
2008 NATIONAL ELECTRIC CODE
--------------------------------------- ------------------------------------
Other Fees . . . . . . . . . STA E PLBG DCA SURCHARGE 2 . 00
STA E PLBG DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 69 . 00 69 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 73 . 00 73 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic �each, FL 32233
h(90�f2_47-5826 Fa (�'04) 247-5845
Aj X
JoB ADDRESS: 1,--f U,— PERMIT# 42
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FixTuRE QTY TYPE OF FixTURE QTY
Bathtub S,-ptic Tank& Pit
Clothes Washer S iower
Dishwasher S iower Pan
Drinking Fountain S op Sink
Floor Drain T iree Compartment Sink
Floor Sink T)ilet
Hose Bibs U rinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory ater Heater
RE-PIPE:Other Fixtures �ater Treating System
TYPE OF FixTURE QTY T rPE OF FixTuRE QTY
Bathtub Septic Tank&Pit
Clothes Washer Sl lower
Dishwasher Sl'ower Pan
Drinking Fountain SI)p Sink
Floor Drain TI iree Compartment Sink
Floor Sink Toilet
Hose Bibs U inal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
u Sewer Replacement o Back Flow Preventer E Grease Inte ceptor(Trap) gallons(Requires 3 sets of plans)
-Number of Heads E I Well
Fj Lawn Sprinkler System I
**SJRWD Well Completion Form. Completeil—form to be submitt d to the Building Department for final inspection."
1-1 Other
Permit becomes void if work does not commence within a six month period or work is s ispended or abandoned for six months.I hereby certify thTt I�haveread
this application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether specified
or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name Phone Number
Plumbing Company S-ri D Office Phone /Lo(-/ ) Fax
Co. Address: -LL G 0 IV)ArLe t I City JM State zip 1Z'7-\F?
License Holder(Print): Aoberr W' �Plp
I State Certification/Registration C ps
Notarized Signature of License Holder (r– tA)
DEBOW AMAWA Sworn
and subscribed before�ptp this day of 101-2—
My ComMWON 0 EE 349 2
W 1
067
15 J,
J:7
EXPIRES:May 21,2D
Bonded Thru N
owipwilmmAn Signature of Notary Public