The URL can be used to link to this page

18 5th St (vault) x CITY OF ATLANTIC BEACH Department of Community Development 800 Seminole Road Atlantic Beach, FL 32233 Phone-(904)247-5800 Fax:(904)247-5845 Internet- www.coab.us r TREE REMOVAL PERMIT FILE COPY Application Number . . . . . 09-00101154 Date 9/04/09 Property Address . . . . . . 333 5TH ST Application type description TREE PERMIT Property Zoning . . . . . . . RESIDENTIAL SINGLE FAMILY Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc Residential addition/driveway & carport ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ KILCULLEN, MATTHEW F, JR & M J RBC HOMES, LLC 333 5TH ST LARRY RICE ATLANTIC BEACH FL 32233 12 PONTE VEDRA CIRCLE PONTE VEDRA BCH FL 32082 (904) 591-0360 ---------------------------------------------------------------------------- Permit . . . . . . TREE PERMIT Additional desc . . SF/DRIVEWAY & CARPORT ADDN Permit Fee . . . . 125.00 Plan Check Fee . 00 Issue Date . . . . 9/03/09 Valuation . . . . 0 Expiration Date . . 9/03/10 ---------------------------------------------------------------------------- Special Notes and Comments T/S: 09/03/2009 09: 03 AM EHALL ------------------------- EXTERIOR ZONE: Approved to remove one (1) -8" palm, regulated (>6") ; mitigation is 1:2, or 4". T/S: 09/03/2009 09: 07 AM EHALL ------------------------- INTERIOR ZONE: Approved to remove one (1) -8" palm and two (2) -10" palms; All are non-regulated (<20") ; no mitigation required. T/S: 09/03/2009 09: 08 AM EHALL ------------------------- MITIGATION CALCULATION: Total mitigation due for approved tree removals (notes 1 & 2, above) is 4"; however, the applicant has demonstrated a total of 95" of existing trees to be preserved onsite, leaving a NET of 91"; thus no additional plantings are required at this time. ---------------------------------------------------------------------------- Fee summary Charged- Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 125. 00 125. 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 125. 00 125. 00 . 00 . 00 APPROVAL IS IN ACCORDANCE WITH THE CITY OF ATLANTIC BEACH CODE OF ORDINANCES IN EFFECT AT TIME OF ISSUANCE. DATE: 9/03/09 PLAN REVIEW CORRECTIONS REPORT PAGE 1 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH FL 32233 ------------------------------------------------------------------------------ APPLICATION NBR . - : 09-00101154 ADDRESS . . . . . . : 333 5TH ST APPLICATION DATE 8/31/09 FILE CffY APPLICATION TYPE TREE PERMIT ------------------------------------------------------------------------------ OWNER . . . . . . . KILCULLEN, MATTHEW F, JR & M J 333 5TH ST ATLANTIC BEACH FL 32233 CONTRACTOR . . . . . RBC HOMES, LLC LARRY RICE 12 PONTE VEDRA CIRCLE PONTE VEDRA BCH FL 32082 ------------------------------------------------------------------------------ AGENCY NAME : PLANNING & ZONING DATE ACTION ACTION BY ------------------------------------------------------------------------------ 9/03/09 APPROVED ERIKA HALL J.TIS : 09/03/2009 09 : 03 AM EHALL ------------------------- EXTERIOR ZONE: Approved to remove one (1) -81' palm, regulated (>6" ) ; mitigation is 1 : 2 , or 4" . T/S : 09/03/2009 09 : 07 AM EHALL ------------------------- 2.INTERIOR ZONE: Approved to remove one (1) -8" palm and two (2 ) -10" palms; All are non-regulated (<20") ; no mitigation required. T/S : 09/03/2009 09 : 08 AM EHALL ------------------------- .51-MITIGATION CALCULATION: Total mitigation due for approved tree removals (notes 1 & 2 , above) is 4"; however, the applicant has demonstrated a total of 95" of existing trees to be preserved onsite, leaving a NET of 91" ; thus no additional plantings are required at this time . CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 E 247-5826 INSPECTION PHONE LIN Application Number . . . . . 09-00001245 Date 9/09/09 Property Address . . . . . . 333 5TH ST Application type description FENCE PERMIT Property Zoning . . . . . . . RESIDENTIAL SINGLE FAMILY Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc 4ft AND 6ft FENCING ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ BRYANT RBC HOMES, LLC 333 5TH STREET LARRY RICE ATLANTIC BEACH FL 32233 12 PONTE VEDRA CIRCLE PONTE VEDRA BCH FL 32082 (904) 591-0360 ---------------------------------------------------------------------------- Permit . . . . . . FENCE PERMIT Additional desc . . Permit Fee . . . . 35 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 3/08/10 ---------------------------------------------------------------------------- Special Notes and Comments *2007 FLORIDA BUILDING CODE W/ 105- 106 SUPPLEMENTS . 2007 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. *ALL FENCES OR ENCLOSURES OF LAND SHALL BE SUBSTANTIALLY CONSTRUCTED. *SCHEDULE FINAL INSPECTION ONCE FENCE HAS BEEN COMPLETED. PERMIT AND APPROVED SURVEY MUST BE AVAILABLE FOR FINAL INSPECTION. ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 35 . 00 35 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 35 . 00 35 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CITY OF ATLANTIC BEACH 09- 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 OFFICE:(904)247-5826 e FAX NO.:(904)247-5a45 BUILDING-DEPTQCOAB.US BUILDING PERMIT APPLICATION DUVAL COUNTY 3- WPRK; 2--VALL16TIPO�CIF �;6:,�! LLiqFA5PR2sqT-7.7- DES�CRIPT IE6AL -USE.OFSTR -,'j" .OR 6.T OCT I .6.CLASS CFW 0 NEW BUIL DING 1:1 DEMOLITION KRESIDENTAL LOTg BLOCK -7SUB DIVISION 0 ADDITION 11 CONVERTING USE Q-COMMERCIAL w K 11 ACCESSORY BLDG. S;FIRE S .,,.,�,.7,'.;�PESr,RIF-nONQF,,�� OR El ALTERA-FION 11 REPAIR OPOOL/SPA [I YES 13 NIA "F,P-ir\t-<', 0 MOVE CKOTHER sirNO TRA T1E1!JqlNEgR. !�ARCHITEC PROPERTY CON , CTOR._ -, , NAME: COMPANY NAME: 23.COMPANY NAME: PiLLM %Ylkw- '-- Pb L V4 0&V4 L L-C- (3 P-�AIQ`12 A 24.LICENSEE NAME: ADDRESS: U—rSTATE OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.: C. 3*33 TADDRESS: %2- 26.ADDRESS: -P,-�LAt4l!C 9 vis ip 1 37-0002- (r).OFFICE PHONE: FAX NO.: 19.OFFICE PHONE: 20.FAX NO.: 27.OFFICE PHONE: 28.FAX NO.: N N P. NA apo -wwq 12'4�7) ---0 (),4 0 CELL PHOIJE: 21.CELL PHONE: 29.CELL PHONE: 01 EMAIL ADDRESS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS: �,YFEE SIMPLP:TIT NDING COMPANY' B (IF OTHER J �E R 6 .,,,.i;'M0RTGA ELEN*M--.L 6 NAME: 33.NAME: NAME: ADDRESS: 34.ADDRESS: 45ADDRESS: Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six(6) months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks, Air Conditioners,etc. OWNEITS AFFIDAVIT-I certify that all the foregoing information is accurate and that all work will be done in compliance With all applicable laws regulating construction and zoning. I will not occupy or use the referenced building or any part therof,until all inspections are finaled and prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, MNSULI WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NO NICE OE CQMULN C NE :'O 'AGENT" 'r _� r.- I L- - I� " , � r9f-9m A r qf At�pmeYpf-ftency Letter Required) V f LII'V\J 1111I.—Ir 'N' '0 Date: Signed: Will! sock W%,Patq;.L Before me this day of 20A4 ttli(county of —dalof I MIS Before thi Duval,State of Florida,has personally Eippeared Duval,State of Florida,haE personoNred ��V'a'-� k \-A f y-k'<p ' J013 SIT herin by himself/herse�`ancl affirms that all statements and declarations are herin by himself/herself a d affigm t1at k%TJ a true and accurate. true and accurate. CAUNINSPECTI N Notary Public at Large,State of County of Notary Public at Larg Prs,u,nally Known 11 Personally Known Pro, '.ad Iden E3 Produced Identifica 7e: L, Notary Signature: E co eobj: CE CITY OF ATLANTIC BEACH DONNA SEE PERMITS FOR ADDITIONAL M13Y My COM ISSIO DD 783649 REQUIREMENTS AND CONDITIONS. . PIRES: ug"s 29,2012 BLDG01 Permit Application Bld R I 'h'u No 'y PubliG Undany I djers REVIEWED By:';0P';7a-- DATE:. LOT 17 LOT 15, BLOCK 7 LOT 13, BLOCK 7 LOT 11 BLOCK 7 00.00' (R) BLOCK 7 100.09, (Y) 1/2 1.8'- REB11 1.2' 1.1' 4."' 4.6'--,, 1/2" 0. A A(-0.4' 1" 0.-'� 3/+- 306 0- 0.8 u --2 5- D 0.9, -2.8' U.uu 212- 5 0. (M) ' " 11 FRAME 0.1" 90'14,35 UILDING 1/2 0.1 3/4- Y 0119' S 0.12' N . 1)'Ao 21.3' 15.. 0 r 1.00' E PA'no 0- 0.52' E 4.: . STONES -j CONC.. CO C. DO 3.0' LOT 14 POOL BLOCK 7 REMAINS OF oc PARTIALLY BURIED CONC. PATIO (NOT SHOWN) STONES- PA 10 -Cok. STO ES 11.4'lr-��-,. 13.4' 4111 9.9, 5.4' 0 '.' .0 10.7' 0 COV'D , , 1. 1 1�' 0.2'- WOOD DECK 0 3'. CONIC. M I::.:'6�:1,�:; lu M Qt IZ5 0 Izz Oi 1.0 C13 cu 0 W >z 0 0 z rn m r;z rn 71 A/C --4 PAD P. M =J Z z M M M M rn z rrl M M 7:E > rn> -< COV'D :E CONC. 5 11 -< 60.0' co 4.8" 18.2� cri 12.3' . ........r L4 STEPS CONC. p 10. Ln 5 �4 2.0' 1/2- 51 50 00' R) RAT0 50*13' (M) -ON�S 0 -0. 0.4':� lu, 50' (R) 300.00' -1 (R & M) 4' CONC. WALK 1/2" BANKS EDGE OF-1 L.B. 6476 EDGE OF PAVEMENT 100.11' (M) PAVEMENT -100.00' ()?) YH 5 TRE, T (4 0' RIW) 1> 4 r I :F, M -0 N 7� RBC Homes LLC 5rA Larry A Rice Ponte Vedra, Florida 904-280-0204 rbc-homes.com APDITION TO THE Kll-CUl-l-F-N'5 Fj-=51r->Ez7NC wa- LOTS 14 AND 16,5LOC:K 1 OF ATLA4TZ 5EACA4 M-AT BOOK 5,PAGE 613 Or-PUVAl-C.0J%ITr icvim GRAY DESIGN GROUP, I NC. City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 3 Jre it z7 _p1partment review required Ye-s-,7—No Applicant: Ines terb—nning &Zo Project: Ab 7—ree Administrator e—u blic�W�� 12�ubric U�filiti Public Safety Fire Services 71711�T- Other Agency Review or Permit Required Review or Receipt Date Florida Dept. of Environmental Protection of Permit Verified By Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: FrApproved. FIDenied. (Circle one.) Comments: �,,BUILDI G PLANNING &ZONING Reviewed by: Date:—?/2/0 TREE ADMIN. L Second Review: FlApproved as revised. oDenied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: FlApproved as revised. F�Denied. Comments: Reviewed by: Date: Revised 05114/09 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 09-00001241 Date 8/31/09 Property Address . . . . . . 81 5TH ST Application type description RESIDENTIAL OTHER Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 1451 ---------------------------------------------------------------------------- Application desc garage door ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ C. HOLMES, ELIZABETH OWNER 81 5TH STREET ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit . . . . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 40 . 00 Plan Check Fee 20 . 00 Issue Date . . . . Valuation . . . . 1451 Expiration Date . . 2/27/10 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 40 . 00 40 . 00 . 00 . 00 Plan Check Total 20 . 00 20 . 00 . 00 . 00 Grand Total 60 . 00 60 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CY-r dCq 5 L) Z CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD,ATLANTIC BEACH,FL=33 OFFICE:(904)247-5826 0 FAX NO.:(904)247-5845 09 BUILDING-DEPTCCOAB.US BUILDING PERN!T�i�_-ICATION DUVAL COUNTY Z'VALI.16TIONOF, R FT.UNDER oeclq 90 V" E GA ,,,4.,LE LD SCRIPTION. CLASS QF,,VVORK!-t,;. N 6.,USE,OF STRUCTURE�' SUB DIVISION 13 NEW BUILDING 11 DEMOLITION �RZESIDENTIAL 11 ADDITION 11 CONVERTING USE 11 COMMERCIAL 11 ALTERATION 11 ACCESSORY BLDG. a.FIRE SRRINKLER;;__ 7 11 REPAIR 0 POOL/SPA 0 YES OR:NZA OMOVE 13 OTHER 13 NO LZ��OWNE CON7RAC'rOR.,.7�".�"'I"'�,",'-,i,-,,". 9.NAT. +,L , � _ I !�ARCHITECT ENGINEEER-.�:,�,,, 77777 L4 15.WMPANY NAME 23.COMPANY NAME-- V 18. 24.LICENSEE NAME, e't -- e _'e_� "Ll'S4 elc 10.ADDRESS: 17.STATE OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.: 9-) 'i-ri4 /77;1,4^�77C_ rl- 78.ADDRESS: 26.ADDRESS: 11.OFFICE PHONE: 12.FAX NO.: 19.OFFICE PHONE: 2 FAX NO.: 27.OFFICE PHONE: 28.FAX NO.: 13.18111111L PHONE: 21.CELL PHONE: 29.CELL PHONE- - QNA ko q 10 % U 14.EMAIL ADDRESS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS: SIMPLE TITLE HOLDE C 0 t'� B NDING OMPA N OWNER),:,.:, LENDER- 31.NAME: 33.NAME: 35.NAME: 32.ADDRESS: 34.ADDRESS: 36.ADDRESS: Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six(6) months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks, Air Conditioners,etc. OWNER'S AFFIDAVIT-I certify that all the foregoing information is accurate and that all work Will be done in compliance with all applicable laws regulating construction and zoning.I will not occupy or use the referenced building or any part therof,unfil all inspections are finaled and pnor to obtaining a certificate of occupancy or completion issued by the building official,as required by law. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AWTORNEY-BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. :�,'],CONTRACTOR" �:�,:'�IfAg'e't' ower0*hI*tIf My 41'r-RRequired) aronly) Signed A4V'd Uate: Signed: -41111641.this' day of 2009 in the county of Before me this dayof �Qtf&usl- I ol 2009 in the county of Duval,State of Florida,has personally appe ed Duval,State of Florida,has perso'n;Ily appeared _Xb14K1 140LMes 6"k. A 8REei- INJIt-A A4 LL herin by himself/herself and affirms that all statements and declarations are herin by himself/herself and affirms that all statements and declarations are true and accurate. true and accurate. Notary Public at Large,State of FLOt County of QILLVA Notary Public at Large,State of FLO(Q(-%4,County of b(A VA L- 0 Personally Known 0 Personally Known Vproduced Identification qsa D U(Produced Identification- 1<s :170 *0 0 1 Notary Signature:,9 --- Notary Signature:j'All AW.-C 4ZP kll Qln3n'. SUSAN SPEAKS GORMAN T M comml 8 Y COMMISSION#DIDM643668 PI ruary 5 0 11 '01 x""0% SUSAN' 01 EXPIRES:February 25,2011 MY COMMISSION#DD643668 co Discount Assoc,Co. BLDG01 Permit Application L EXPIRES:February25,2011 't 1-goW�NOTARY Fl,Notary Discount Assoc.Co. p r2 Va. 9m .......................... 'Fri - ,I, POO.". 1 Wisp sal all sifA lt dill er i re site I ski Qj1j- �A CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 -5826 INSPECTION PHONE LINE 247 Application Number . . . . . og-00001237 Date 8/28/09 Property Address . . . . . . 81 5TH ST Application type description ELECTRIC ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 -------------- ------------------------------------------------------------- Application desc HOOK UP AC ---------------------------------------------------------------------------- Owner Contractor ------------------------ FIRST CHOICE ELECTRIC 716 VALLEY FORGE RD. N. NEPTUNE BEACH FL 32266 (904) 241-1331 ---------------------------------------------------------------------------- Permit . . . . . . ELECTRICAL PERMIT Additional desc . - . 00 Permit Fee . . . . 70 . 00 Plan Check Fee Issue Date . . . . Valuation . . . . 0 Expiration Date . - 2/24/10 --------------- ------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 70 . 00 70 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 70 . 00 70 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CITY OF ATLANTIC BEACH 09- 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 -5845 OFFICE:(9(A)247-5826 0 FAX NO.:(904)247 BUILDING-DEPTQCOAB-US DUVAL COUNTY ELECTRICAL PERMIT APPLICATION z.Iti I HIS A SUB PERMIT: 14. i.'JOB ADDRESS. ONO q1 6 0 YES PERMITM 2-qAIA PROPERTY OWNER.' ADDRESS IF DIFFERENT FROM JOB ADDRESS: PH 4.NAME: ELECT DR: 8.ADDRESS.: 7.NAME OF COMPANY' c, -71 \k, -i R'5 y-q- 11.13X NO.: 9,STATE OF FLORIDA LICENSE NO: 10,C:ELL PHONE: 0 0 PH NE 14. 12.EMAIL ADDRESS: �113.OFFICE PHONE: 83 1 L4 II- 1 :33 1 15.Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6) months,or if construction or work is suspended or abandoned for a period of six(6)months at any time after work is commenced. CONTRACTORS SIGNATURE: 16.CLASS OF WORK: ff.—SERA110E.- 18.METER NUMBER: C3 MULTI FAMILY-#OF UNITS: CWESIDENTIAL XSINGLE FAMILY 0 TEMP SERVICE [I COMMERCIAL [3 ADDITION 0 TRAILOR 19.BUILDING: I -19.CURRENT CODE: [3 ALTERATION 0 SIGN 0 OLD 0 NEW 0 108 NATIONAL ELECTRICAL CODE 0 REPAIR []POOL/SPA 113 REWIRE 0 OTHER: LIST ALL ELECTRICAL WORK. - OOVERHEAD 0 UNDERGROUND 0 UNDERGROUND UP POLE 20.TYPE OF SERVICE: CONDUCTORS PER PHASE: 0 POWER IS ON 0 POWER IS OFF 21.NEW SERVICE: AMPACITY: OCOPPER 0 ALUMINUM 22.SIZE OF CONDUCTOR: AMPS: PH: W: VOLT: RACEWAY SIZE: 23.SWITCH OR BREAKER SIZE: 24.EXISTING SERVICE SIZE: AMPS: PH: W:_ VOLT:_ RACEWAY SIZE: 26.FEEDERS: #OF_ AMPS: #OF_ AMPS:— #OF— AMPS: 26.LIGHTING FIXTURES: INCANDESCENT: FLUORESCENT&M-V-: 27.FIXED APPLIANCES: 0-30 AMPS: - -- 31-100 AMPS: OVER 100 AMPS: 28.FIRE ALARM: 0 YES 0 NO AV-T1 DO NOT APPLY TO NEW SINGLE FAMILY,MULTI-FAMILY AND ROOM IONS 29.SMOKE DETECTORS: NUMBER: 30.RECEPTACLES: 0-30 AMPS: 31-1 1 00 AMPS: OVER 100 AMPS: 0-30 AMPS: 31-100 AMPS: OVER 100 AMPS: 31.SWITCHES: - - 32.AIR CUNDITIONING: #OF UNITS: COMP. MOTOR HP RATING: AMPS: HEAT KW: 9 OF UNITS: COMP. MOTOR HP RATING: AMPS: HEAT KW. 33.MOTORS:. NUMBER: VOLTAGE: HP: KVA: NUMBER: VOLTAGE-:- HP: KVA: 34.TR—ANSFORMERS: UNDER 60OV: NUMBER: KVA-.- OVER 60OV: NUMBER: KVA: 1 36.MISCELANEOUS REPAIRS: DESCRIBE IN DETAIL: 11 � 11�4J BLDG02 Permit Application Elec:REVISED:07/20/2009 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 -5826 INSPECTION PHONE LINE 247 Application Number . . . . . 09-00001236 Date 8/31/09 Property Address . . . . . . 81 5TH ST Application type description MECHANICAL HVAC ONLY Property Zoning . . . . . . . To BE UPDATED Application valuation . . . . 0 ----- ---------------------------------------------------------------------- Application desc 1 CU 1 AHU ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ HWK MECHANICAL INC 45492 DIXIE HWY CALLAHAN FL 32011 ---------------------------------------------------------------------------- Permit . . . . . . MECHANICAL HVAC PERMIT Additional desc - - Permit Fee . . . . 61 . 00 Plan Check Fee . 00 Issue Date . . . . 8/28/09 Valuation . . . . 0 Expiration Date . . 2/24/10 ------ --------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 61 . 00 61 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 61 . 00 61 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. 08/28/2009 14:00 9048796996 HWK MECHANICAL PAGE 02/02 CITY OF ATLANTIC BEACH 9W SEMINOLE ROAD,ATLANTiC BEACt'.FL 3ZM 09-1 OFFICE:�WJI)20-SW 0 PAX WO.:(904)247-W45 BUILD 1NG.DRPT@COA8.US MECHANICAL PERMIT APPLICATION DUVAL COUNTY 13 r1n 0 N. ES PERMIT#: ADDRESS IF DIFFERENT FROM JOB ADDREft -11 C%." AM. 11 ADDRESS. ; olyucrw' &tbtw5a011 FAX OM CELL PHONE: NO." FOE F FLO MONSS7q 14. I&OFFICE P RE D AppfiCgtion is hereby made to obtain a permit to do the work and instaliations,as indicated. I Csr*that all work will be pefforrned to meet the standards of all IMS f9gul&ting 00AStfuctiOn in this jurisdiction. This permit becomes null and void if work is not Commenced within six(6) months,or if Construdlon or work is suspended or abandoned for a period Of.sIx(6)mOnths.4t8p timeafterwork' cornmenced. ARI CONTRACTORS SIGNATURG: Z� —�4/'1' ///JA5;1 J6, -inFNTIA' SW FLORIDA WILDING CODE- 0 N INSTALLATION f-W C3 REPLACEMENT OF EXISTING SYSTEM )"fXl ISTING COMMERCIAL MECHANICAL 13 ALTERATION/AoorTION TO EXIST SYSTEM 0 OTHER 101 REPAIR 70 11 7 - I --- M �� 'FACE 0 RECESSED 0 CENTRAL 0 FLOOR BURNERS: 9.HEAT; OOM 0 CENTRAL I;t CONJ IR CONDITIONING, 20.A 7 MAX CAPACITY; 2, I IrT mv ?M AL. THICKNESS: 1.nDUCT SYSTEM: MATERL .22.REFRIGERATION: MAX CAPACITY, drn 23.COOUNG TOWER: CAPACITY: 9PM 24.FIRE SPRJNKLER: NUMBER OF HEADS: — 25.UFT SYSTEM: ELEVATOR; MANLIFT: ESCALATOR: AUTOLIFT; 26.COMMERCIAL WOOD NUMBER: 27.FIREPLACE: PREFABRICATED: MASONRY: 2B.IRRIGATION: a PUMP 0 WELL 0 PIPING 29.GAS PIPING: 0 OF OUTLETS: 0 GAS AHU: 13 GAS WATER HEATER: 30.OTHER-SPECIFY: SOLAR HEATING, BOILERS.UNFIRED PRESSURE VESSEL HGAT EXCHANGER OR COIL IN DUCTS ETC. IVALLIE FOR OTHER ITBASc TONS APPRCMNG OF UNITS DescpivnON MODEL MANUFACTURER AGENCY F-Q ga-5U. -7S U1, 1CT I Cr UNIT3 DEWFUIPTION MODEL# MANUFACTURER BTU IN29"Gy +C';U Fu 011-�Su triERAL 10 ULI Typt LIQUIU NUMI3ER. GALLONS CQg-&NED MANUFACTURER A BLD604 Pwml APPkawn Mach:REVISEM 1211&20M CITY OF ATLANTIC BEACH 09- 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 OFFICE:(904)247-5826 0 FAX NO.:(904)247-5845 BUILDING-DEPT(MCOAB.US DUVAL COUNTY BUILDING PERMIT APPLICATION 777 TI ot?RVVORI� VALL16-914 6.10SE,OF TC-LASS OFW. [I NEW BUILDING [I DEMOLITION P(RESIDENTIAL 7 BLOCK 0 ADDITION 11 CONVERTING USE 11 COMMERCIAL E_- , "- - LO SUB DIVISION BLDG. gi-FIR SPRINKLER.��"."'. DESCRIPTION OF.VVDRr:,! 13 ALTERATION UACCESSORY 11 REPAIR 0 POOL/SPA 0 YES 0 NZA F4-1 47- Q MOVE WTHER r4no CT. ff IENGINEg ,.ERTY,QWNgR"',�4' PROP NAME COMPANY NAME: 23.COMPANY NAME: ptLL,A�v4 NAME. P,6 C 0 OV4 LL-C— 24.LICENSEE NAME'-----T- A ADDRESS: LV STATE OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.: 5 Cj C) 333 ST��Eel' S ADDRESS: C;,- 26.ADDRESS: .4 -P,jjAt4-XjC 3 LOO Jt Z- 0.OFFICE -AX NO.: 19.OFFICE PHONE: 12 .FAX NO.: 27.OFFICE PHONE: 28.FAX NO.: N - NA apo -02-0 '?'�D 29.CELL PHONE: CELL PHONE: 21.CELL PHONE: Q-0- 4,LRPS 5 9 036;1(0 EMAIL ADDRESS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS: M RT EN TITLE H0LD.ER-..�':;�1,';", NY' # E L FEE SIMPLE M (IFDTHERTHA, NAME: 33.NAME: NAME: ADDRESS: ADDRESS: 34.ADDRESS: Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six(6) months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks, Air Conditioners,etc. OWNEWS AFFIDAVIT-I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. I will not occupy or use the referenced building or any part therof,until all inspections are finaled and prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. CONTRACTOR lim"E�,6eAGENT7' ey.A;.Ar,g-e,n.4 Letter R squired),- (Qualifier only),. kfAgent, Signed: Date: Date S 4 2009 in the county Of Before �dayof 20P�in thlb county of Before me this day of Duval,State of Florida,has personally appeared Duval,State of Florida,has personally appeared ��Va,-� 4 \-A "6C4!a-V-- herin by himself/herself and affirms that all statements and declarE rtions are herin by himself/herself and affirms that ail statements and declarations are true and accurate. true and accurate. Notary Public at Large,State of County of Notary Public at Large,State of County of g',�6rson8lly Known [I Personally Known Produced Id tficarib El Produced Identification a�Notary SigT t Notary Signature: V "H DONNA CP My OM SSfO #4may MI N DD 783649 My COMMISSfO.H. ON#DD 783649 Augilst 29 01 F PlRES:AU9'jst29 2012 9 Th BLDG01 Permit Application BIdA R /lwq ,a 2 P N U, T1,u Notary p,jb or lic Underw�to, TM-4 C%7VIr-33 Atlantic Beach APPLICATION NUMBER A City of 'C;'�N PPLI o be assign SP 2 7-009 (T :ed by the Bu�ilding Department) Building Department 4/5 800 Seminole Road Atlantic Beach, Florida 32233-5445 Fax(904)9;�S_ Phone(904)247-5826 a r Date routed. e ro) I E-mail: building-dept@coab.us City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 33 So De. ent review required Yes No Applicant: Ine a nin & ree Administrator Project: F77—M ublic Utiliti Public S!afety Flire Services k P Review or Receipt Date Other Agency Review or Permit Required of Permit Verified By Florida Dept.of Environmental Protection Florida Dept.of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: A(Approved. MDenied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: FlApproved as revised. ODenled. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: FApproved as revised. DDenied. Comments: Reviewed by: Date: Revised 05114109 APPLICATION NUMBER M A City of Atlantic Beach LC;'�N UL (To be assigned by Ithe Bu��ilding Department.) Building Department 800 Seminole Road 12 Z/. Atlantic Beach, Florida 32233-5445 -5845 Phone(904)247-5826 Fax(904)247 r o" E-mail: building-dept@coab.us [D]ate oputped: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM A -_ -VeWs N o Property Address: -�rgalr — De. ent review required Applicant: an in & RreeAdminiFstrator 7— VIC W ublic W Project: ublic Utilikics> I-Public Safety FF�ire Services Review or Receipt Other Agency Review or Permit Required of Permit Verified By Date EFlorida Dept. of Environmental Protection Florida Dept. of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: geppIroved. [—]Denied. (Circle one.) Comments: of =LANNING &ZONIN Reviewed by: Date: TREE ADMIN. Second Review: FlApproved as revised. DIDenied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: FlApproved as revised. F]Denied. Comments: Reviewed by: Date: Revised 05114109 _0 _VF RE 4!3 D APPOcATION NUMBER A I N UM City of Atlantic Beach A I LC;ZL 1 (To:beassigned by the Bu��ilding Department.) SEP 0 2 2009 Building Department 800 Seminole Road 12 Atlantic Beach, Florida 32233-5445 Fax(904)21. t r Phone(904)247-5826 [D a e o putpe d. E-mail: building-dept@coab.us City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM A -_ Property Address: 33 So -�rgttZ7 De ent review required Yes No Applicant: lIvInis annin &Zo ree Administrator Project: L7- ublic Utiliti Public Safety Fire Services U Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation — St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco --Other: APPLICATION STATUS Reviewing Department First Review: KApproved. FIDenied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed b Date: TRE D ,4W Second Review: ElApproved as revised. ElDenied. PUB IC 0 S Comments: I PUB I ILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: DApproved as revised. [—]Denied. Comments: Reviewed by: Date: Revised 05/14/09 CITY OF ATLANTIC BEACH 09- BOO SEMINOLE ROAD,ATLANTIC BEACH,FIL 32233 OFFICE:(904)247-5826 e FAX NO.:(9D4)247-5645 BUILDING-DEPT@COAB.US DUVAL COUNTY BUILDING PERMIT APPLICATION TALU��-nQWOFVVOR ;u DER)RPOE FT N 4060 .00 R 6AIJSE.OF STRUICTURE�,��7T U91C�IPTIOI, 6.CLASS WC �DES 0 NEW BUILDING 0 DEMOLITION P(RESIDENTIAL LOT/TBILOCK 7SUB DIVISION 0 ADDITION 0 CONVERTING USE 0 COMMERCIAL [I ACCESSORY BLDG. 6&�FIRE SP�RIN KLE ALTERATION -TION OF vy �,17,,PESCRIP EIPOOL/SPA 0 YES 13 N/A REPAIR WTHER El MOVE -':��I�ARCHITEqTl CON. YA TRAM PROPERTY. NAME V.COMPANY NAME 23.COMPANY NAME: NLLAT4 ORYW- - 'P,-6 C— VA 0&V4 Lk— 24.LICENSEE NAME' (3 PTAME Urrj A. -?�:Lj- STATE OF 25.STATE OF FLORIDA LICENSE NO.: ADDRESS: 91 FLORIDA LICENSE NO.: Ci lz� 3*33 C;� :51?,erT g—ADDRESS: Pj ftjr, a.. Ci/- 26.ADDRESS: -Loo&Z- OFFICE PHONE: FAX NO.: 19.OFFICE PHONE: 120.FAX NO.: 27.OFFICE PHONE: 28.FAX NO.: NN r- NA 0-F0 -02-0'-� 1 J#D CELL PHONE: 21.CELL PHONE: 29.CELL PHONE: C,I'L—(,,�o— HLYPS 59( CaGo 30.EMAIL ADDRESS: EMAIL ADDRESS: 22.EMAIL ADDRESS' LEN IMPLE TITLE H FEE S PpElk J(IF OTHER THA NE 01 N,AME: 33.NAME: NAME: 14 DRESS: —5.ADDRESS 34.ADDRESS: Application is hereby made to obtain a pegit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six(6) months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,HGatem,Tanks, Air Conditioners,etc. OWNEWS AFFIDAVIT-I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning.I will not occupy or use the referenced building or any part therof,until all inspections are finaled and prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. M ITIRACTOR"....- O. e GENT4 C 0 tftAg nt 9f Zqmelf.' ncy 9f A,9., r Required) (Qualifier Only)': I/ .. Data 11 Date: S11 'kee�� /,K 'V / / Signed: day of 2009 in the county of Before thj��k-;� day of 14- ,200 in tht county of Before me this Duval,State of Florida,has personally appeared Duval,State of Florida,has personally appeared 11 statements and declarations are herin by himself/herself and affirms that all statements and declarations are herin by himself I herself and affirms that a true and accurate. true and accurate. Notary Public at Large,State of County of Notary Public at Large,State of_,County of rs nally Known 11 Personally Known d Ident El Produced Identification- P,.d' Potary Signature: 'C'. DONNA MyCOMMISSIG,HAMBy ON#DD 783649 BLDG01 Permit Application Bid RW; �"A PIPES:Augtjst 29 2012 ThruNotryp I _0 lic Underwriters CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 -5826 INSPECTION PHONE LINE 247 Application Number . . . . . 09-00001256 Date 9/04/09 Property Address . . . . . . 333 5TH ST Application type description INSPECTION FEE BUILDING Property Zoning . . . . . . . RESIDENTIAL SINGLE FAMILY Application valuation - - - - ---------0------------------------------ ------------------------------------ Application desc DEMO DRIVEWAY ONLY-APP TO MAKE SURE SILT FENCE INS --------------- ------------------------------------------------------------- Owner Contractor-------------- ---------- ------------------------ BRYANT, ALLAN OWNER 333 5TH ST ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit . . . . . . INSPECTION FEE BUILDING Additional desc . - INSTALL SILT FENCE-APP PW . 00 Permit Fee . . . . 35 . 00 Plan Check Fee 0 Issue Date . . . . Valuation . . . . Expiration Date - - 9/04/09 -------------------------------- -------------------------------------------- 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. ATLANTIC BEACH BUILDING DEPT. ON PROPERTY OWNER DEMOLITI 1dr 7 RELEASE FORM Date: 9" �-f C)q To Whom it may Concern: I /We the current property owners of-. Lot Block Legal Description of Property to have AKA 3 S4-k have contracted with (Addrm of Property) 73c oy,-�> L L-C to remove the (Company Name) (Single Family,DuplexlCommercial,eir Prior to the construction of (20 T �O/�+ As a condition of issuing the permit we agree to the following: I Once driveway is removed, lot is to be graded and leveled. 2 All construction debris is to be removed from the property. 3 Affected area is to have grass or seed in place. 4 Erosion control devices will be put in place and will remain in place until grass has covered affected area or new structure is completed and landscaping is in place. via, signaft ime Signature TWS SPACE FOR RECORDEWS USE ONLY ONVNER a4l�-- Date: Ll r-Lf—'�-o Signed: 0 Before mn;e this day of in the County of Duval,State Of Florida,has personally appeared Notary Public at Large,State of Florida,County of Duv my commission expires: TiZRAXND-st as &ZILI —Or Personally-Knuwg ildentifi SUSAN SPEAKS GORMAN My COMMISSION#DD643668 '0 EXP 1: I :Feb-ry 25,2011 I-MMOTARY F1,Notiry Discount Assoc Co. IW4 UILDING DEPARTMONT OF 6 CITY OF ATLANTIC BEACH LOCATION INFORMATION ITERKIT IffF0 1'0" Address: 8 1' FIFTH STREET -7851 Pemi� Number -2233 pr, R ATLANTIC BEACH, rLO IDA 3 Perloit, T e RE ROOF of Wo 17 NEW LZOAL' DESCRIPTION B lo Ck section'. Lot: Type. WOOD FRAME Township: � RNO 0 , U' e SINGLE, �FAMILY e :C ' '0 ubdivision: ATLANTIC BEACH ngs E ted Value $3500 -00 mpr ,v Cost: ,00 0 0 tail Feet . $22 .50, A*Du 8/94 ROOFL WITH NEW tk es I Off FF APPLICAT T PERRI. P A 922 . 0 N oie V -�, I I I I IMPACT FEE $0.00 r REET WATER, CT E $ nox I pA SEWS MPA 0�00 CHI� 'A 9, y 3', 'VAT*, A 0 0 S owt $0 00 'AB 5% FORMAT,I M RADON, C, 'CAPITAL I U �R ING, MPROVZ. to .bo Addli E N STI SEWER-TAP -IMA �FL � 32250 HYDRAULIC -411-11�--1111`1- SHARE $0 .00 JACKS 49' CROSS CONNECTION $0.00 Type,: 7 PACT E 100 SO .06� -CONST. SURCHARGE .4q NOTES:'� NOT ICE,-ALL CONC KETE'Fo 0 AND,FOOTINGS MUST,Bf.,INSPOCTEDOEFORE POURING PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE LACED IN PUBLIC SPACE,AND MUST BE ' UlLbiNG,,MATERIAL,RUBBISH ORK MUSTNOT BE P B AND DEBRISFROM THIS W Le REDU T ERCON A P ANO'HAULEDAWAY BY El +4 TR CTOR OR OWNER C -A 'M MECHANJCS' LIENLJ�W SULT F J IRS10 d0l PLY WITH TH E IN NO PAYI C u NO tWI 'ILDING IMPROVEMENT'S. HICHARE PART OF THIS'PERMIT AC0 ING TO APPROVED PLANS,W AND SUBJECT TO AEVOCATION,,.fQR.,, ORD, 0 APPLICABLE PROVISIONS OFLAW VIOL "PACT A 0 M 14 FACH BUILDING DEPARTMENT 4- owl" "'t OM5 Do=* 2/w to f CITY OF ALANTIC BEACH ROOFING PERMIT APPLICATION owner(s) : Address: Phone: Lot # Block or Unit # Subdivision: Contractor: S-r-z I Address:----- 2 Phone_.,.��, city, State and Zip 1 7 State License # Describe work to be performed: Valuation of Proposed Construction: Materials to be used: Signature of Owner;_ 42- Signature of Contractor: Liability Insurance Supplied--,�'�---"c Workers Compensation Insurance Supplied--a��,!— License Information_—Zsj:L— DEPARTMENT OF BUILDING CITY OF ATLANTIC BEACH.FLORIDA PERMIT NO. 9902 PERMIT TO BUILD THIS PERMIT MUST BE POSTED ON JOB Date jiII)g 5, 19—gg- 0.01U TL 10.00 Valuation$. -Fee$ This pertnit not valid until above fee has been paid to City Treasurer,and is U L, *01rAC( subject to revocation for violation of applicable provisions of law. This is to certify that I. N_ NjllinmS has permission to Classification Zone Owned by 'John. Kgiw&S Lot Block S/D House No. 81 rth st-eat According to approved plans which are part of this permit NOTICE—ALL CONCRETE FORMS AND FOOTINGS MUST BE IN- SPECTED BEFORE POURING. PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE 00 0 Building material,rubbish and debris 4 from this work must not be placed in public space, and must be cleared up and hauled away by either con- tractor or owner. Building Official. FOR OFFICE PERMIT DATE CONTRACTOR USE ONLY NUMBER PLUMBING ELECTRICAL SEWER WATER FEE $10.00 A-PPLICATION FOR WEM PERUT CITY OF AUANTIC MACH Twp� 1� Nam: ___Pay Phone Addresst zip�� APPLICAME, 'IF OTHER THAN OWNER, Nmie: ____Pay Phone_E�,,Fjk",p Address,, JOB Address or Location, Legal Description-, Is well to be used for drinking purposes? -t�/b Any person, individual, corporation or other entity receiving a permit as provided in Section 22-40 of the Atlantic Beach Code, and who plans to use water from the permitted well for drinking purposes, M.1st first obtain a bacteriological test report from the State of Florida Health Department, furnishing *a certified copy thereof to the building departinent of the City of Atlantic Beach. A certificate of occupancy will not be issued until said report is on file with the build�% department. Departiment Notes: agree to comply with regulations stated herein: '�/ Sitrfature -7- Date