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76 17th St (vault) ,S I IbIf CITY OF ATLANTIC BEACH M11 F" J 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 V INSPECTION PHONE LINE 247-5826 ` .moi r1ii1>r' Application Number . . . . . 09-00000666 Date 5/19/09 Property Address . . . . . . 76 17TH ST Application type description SINGLE FAMILY RESIDENCE Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 70000 --------------------------------------------------- Application desc finish new construction -------------------------------------------------- Owner Contractor - ------------------------ ----------------------- BELL, JR. , RICHARD REED BROTHERS CUSTOM HOMES & 76 17TH STREET REMODELING INC ATLANTIC BEACH FL 32233 11700 PHILLIPS HWY JACKSONVILLE FL 32256 --------------------- Structure Information 000 000 ---------------------- Construction Type . . . . . TYPE 5-A Occupancy Type . . . . . . RESIDENTIAL Flood Zone . . . . . . . . ZONE X ------------------------------------------------- Permit . . . . . . BUILDING PERMIT Additional desc . Permit Fee 340 . 00 Plan Check Fee 170 . 00 Issue Date . . . . Valuation . . . . 70000 Expiration Date . . 11/15/09 ------------------------------------------------ Special Notes and Comments *2007 FLORIDA BUILDING CODE W/ 105- 106 SUPPLEMENTS . 2007 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. ----------------------------------------------- Fee summary Charged Paid Credited ----Due--- ----------------- ---------- ---------- -- Permit Fee Total 340 . 00 340 . 00 . 00 . 00 Plan Check Total 170 . 00 170 . 00 . 00 . 00 Grand Total 510 . 00 510 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BLTILDING CODES. Ci of Atlantic Beach APPLICATION NUMBER (To be assigned by the Building Department.) g1 Building Department ,.� 800 Seminole Road 3 , Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: __J1 City web-site: http://www.coab.us IFFire ent review required Ye No .�J rn Property Address: /� 17 ��� ( g &Zoning ministrator Applicant: ��,�� �D��(S �TbWorks ri,AJi_SA UtilitiesProject: /V�l�j (��'sTr�`C� °' Public Safety rvices Review or Receipt ®ate Other Agency Review or Permit Requiredof Permit Verified BSI 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: APPLE ATiON STATICS Reviewing Department First Review: Approved. ❑Denied. (Circle one.) Comments: CB,UIL61N PLANNING &ZONING Reviewed by: Date: TREE ADMIN. PUBLIC WORKS Second Review: ❑Approved as revised. ❑Denied. Comments: PUBLIC UTILITIES PUBLIC SAFETY FIRE SERVICES Reviewed by: Date: Third Review: ❑Approved as revised. ❑Denied. Cammn�entss: r-ler:� fir.i Dat(.. — �i cd �;. PERMIT WORKSHEET Certificate of Occupancy Job Address: Type Work: ' Property Owner: I✓ Phone # 0 Contractor: Phone # Permit#: r 2 ,07 07 -7 Date Issued: a ^�� ✓ O Building Inspections: Footing . Z1, 0& Slab Tie Beam �•on� �(AhiAnBd - bS• /OOaB`{ Lintel 3102$ Nailing / Sheathing 7�p. Framing / Cover Up Insulation Final Building Tree Permit# YES NO Electrical Permit# D/ 12 Date/ Copy to �Q JEA Temp, Pole Permit# ��, 3�5n Q lP Date / Copy to 3' JEA Temp. Power Letter Received: YES NO Inspections: Rough Electric Released to JEA Temp. Power Released to JEA Temp. Pole Released to JEA Final Released to JEA Mechanical Permit# Inspections: Rough Final �— Plumbing Permit# 1 16 2, Inspections: Rough / Underslab (f Topout Water/ SewerZRrt-,t 32.535 Final Drainage Inspection: Pool Permit# Inspections: Steel Final Grounding Final Roofing Permit# j Inspections: Nailing / Sheathing Final Fire Inspection: Failed Inspections: Date Paid: Date Paid 3-3o ,01 �-T ZKILLIAN f � 1` GENERAL CONTRACTORS INC. 1404 674 Mike Griffin J City of Atlantic Beach, Building official 800 Seminole Rd. Atlantic Beach, F132202 Mr. Griffin, March 30, 2009 I am requesting the city cancel my permit#06-00032077 & #06-00032078. The property is owned by Hong Tu a person that is out of the country. Mrs. Tu's project has been delayed for a variety of reasons including a finish schedule & financing. My company, DS Killian General Contractors, will be closing @ the end of the month and can no longer maintain the property or insurance requirements. Please cancel my permit ASAP. The homeowner plans to find another contractor to finish the projects when he is in town. Thank you for your help. Sincerely, David S. Killian, Pres. DS Killian General Contractors Inc. 6973 Highway Ave, Suite 108 Jacksonville, F132254 ' l o �a 6973 Highway Ave. Ste.108 * Jacksonville, F132254 * Phone (904) 695-2422 Fax (904) 695-2102 * WWW.DSKGC.COM A✓6 7-11 zal�ei L `7)/9-7L 14-A 106, t 6h- L / o Pj -- ai X13 y//,q a/v _L711er� %7 ----_._.- n G � Obi /�� i -;�-ia 3ZZ o - 3 2 :5-0 4G . 2 07 12 k Ole - z l - Og - 12 /Ae, a� - ��a3 �✓ i i1 I i T-Z.S. KILLIAN 1` GENERAL CONTRACTORS INC. Mike Griffin ,� J17 s City of Atlantic Beach, Building official 800 Seminole Rd. Atlantic Beach, F132202 Mr. Griffin, March 30, 2009 I am requesting the city cancel my permit#06-00032077 &#06-00032078. The property is owned by Hong Tu a person that is out of the country. Mrs. Tu's project has been delayed for a variety of reasons including a finish schedule & financing. My company,DS Killian General Contractors, will be closing @ the end of the month and can no longer maintain the property or insurance requirements. Please cancel my permit ASAP. The homeowner plans to find another contractor to finish the projects when he is in town. Thank you for your help. Sincerely, David S. Killian, Pres. -7� 54-_ DS Killian General Contractors Inc. # tL - 3 '� 6973 Highway Ave, Suite 108 7 7 17"t-. 5 Jacksonville, F1 32254 6973 Highway Ave. Ste.108 * Jacksonville, Fl 32254 * Phone (904) 695-2422 Fax (904) 695-2102 * WWW.DSKGC.COM CITY OF ATLANTIC BEACH J 800 SEMINOLE ROAD r� ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 07-00001081 Date 9/11/08 Property Address . . . . . . 76 17TH ST Application type description ELECTRIC ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------- Application desc NEW SERVICE 200AMP/240V -------------------------------------------------- Owner Contractor - ------------------------ ----------------------- E-4 ELECTRIC, INC. Q/A: BEHNCKE, JAMES 1247 BOCA GRANDE AVE. ATLANTIC BEACH FL 32233 --------------------------------------------------- Permit ELECTRICAL PERMIT Additional desc . . Permit Fee . . . . 70 . 00 Plan Check Fee . 00 Issue Date . . . . 7/30/07 Valuation . . . . 0 Expiration Date . . 1/26/08 --------------------------------------------------- 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 is1 J 800 SEMINOLE ROAD J ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 08-00001217 Date 9/08/08 Property Address . . . . . . 76 17TH ST Application type description SINGLE FAMILY RESIDENCE Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc renew permit # 06 32077 ---------------------------------------------------------------------------- Owner Contractor - ------------------------ ----------------------- BELL, JR. , RICHARD D. S . KILLIAN GENERAL CONTRACT 76 17TH STREET 3898 DUPONT CIR ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32205 (904) 388-6604 --------------------- Structure Information 000 000 ---------------------- Construction Type . . . . . TYPE 5-A Occupancy Type . . . . . . RESIDENTIAL Flood Zone . . . . . . . . ZONE X ---------------------------------------------------------------------------- Permit BUILDING PERMIT Additional desc . . Permit Fee . . . . 35 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 3/07/09 -------------------------------------------------------------------------- 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. � CITY OF ATLANTIC BEACH i 800 SEMINOLE ROAD J ;r ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 08-00001226 Date 9/08/08 Property Address . . . . . . 76 17TH ST Application type description ELECTRIC ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ----------------------------------------------------- Application desc renewal permit 07 1081 --------------------------------------------------- Owner Contractor - ------------------------ ----------------------- BELL, JR. , RICHARD E-4 ELECTRIC, INC. 76 17TH STREET Q/A: BEHNCKE, JAMES ATLANTIC BEACH FL 32233 1247 BOCA GRANDE AVE. ATLANTIC BEACH FL 32233 --------------------------------------------------- Permit ELECTRICAL PERMIT Additional desc . . Permit Fee . . . . 35 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 3/07/09 ------------------------------------------------- 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. CI'T'Y OF AT'LAN'TIC BEACH T )}f 800 SEMINOLE ROAD -` ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 06-00032077 Date 3/10/06 Property Address . . . . . . 76 17TH ST Tenant nbr, name . . . . . . SINGLE FAMILY RESIDENCE Application description . . . SINGLE FAMILY RESIDENCE Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 388282 Owner Contractor ------------------------ ------------------------ TU, HONG D. S. KILLIAN GENERAL CONTRACT 76 17TH STREET 3898 DUPONT CIR ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32205 (904) 388-6604 ----------------------------------------------- Permit . . . . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 1327 . 00 Plan Check Fee 663 .50 ----Issue Date . . . . Valuation 388282 ------------- ---------- --- Other FeesCAPITAL IMPROVEMENT325 . 00 / ST CONSTRUCTION SURCHARGE 16.21 STATE RADON SURCHARGE 5 .45-' SEWER IMPACT FEES 1250 . 00" WATER IMPACT FEE 265 . 00 WATER CONNECT/TAP & METER 525 . 00 WATER CROSS CONNECTION 35 . 00 Fee summary Charged Paid Credited Due ----- ---------- ---------- ---------- Permit Fee Total 1327 . 00 1327 . 00 . 00 . 00 Plan Check Total 663 . 50 663 . 50 . 00 . 00 Other Fee Total 2421 . 66 2421 . 66 . 00 . 00 Grand Total 4412 . 16 4412 . 16 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDINI;'OFFICIAL CITY OF ATLANTIC BEACH j 800 SEMINOLE ROAD -fir ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 06-00032762 Date 4/12/06 Property Address . . . . . . 76 17TH ST Tenant nbr, name . . . . . . 18 FIXTURES Application description . . . PLUMBING ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 Owner Contractor - ------------------------ ----------------------- TU,HONG NELSON PLUMBING CO. , INC. 10895-1 OLD DIXIE HWY. ATLANTIC BEACH FL 32233 ST.AUGUSTINE FL 32095 (904) 262-4884 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING PERMIT Additional desc . . Permit Fee . . . . 161 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ----- Permit Fee Total 161 . 00 161 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 161 . 00 161 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING, DES. J` 4 BUILDING OFFICIAL CITY OF ATLANTIC BEACH PLUMBING PERMIT APPLICATION r s� �r r.nw Date: u 11/ 0 FProperty Address. Telephone wner: #: Contractor:lj '^ �� 1, Com. �rc, Telephone#:�°`I- aQ_4SSy �S�n "^` Contractor Address: o 'Fax $73 L S-r, A In consideration of permit given for doing1he 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, 19 New list the building permit number: \ o(o - aoo3�o77 ❑ Re-Pipe Number of Fixtures: Bath Tubs �_ Showers Closets Shower Pans Dishwashers Sinks Disposals Urinals Floor Drains i Washing Machine Lavatory Water Sewer Water Heaters Other Fees Permit Issuing Fee: $35.00 Total Fixtures: j�_ X$7.00 + $35.00= 800 Seminole Road • Atlantic each, Florida 32233-5445 Phone: (904) 247-5800 • Fax: (904) 247-5845• http:itwww.ci.atiantic-beach.fl.us zp� 06 08:30a DS KILLIAN GEN CONTRACTO 904-695-2102 p.4 NOTICE OF COMMENCEMENT Tax Folio No_ E 5 cg o oo� State of ( nn County of itAlar To Whom It May Concern: and in accordance with Section 713 of The undersigned hereby informs you that improvements will be made to certain real property, the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.� OGc y r00 Legal Description of property being improved: 5 S �C- ' L LLn-4 4- t.�o [ S Qe h. 3 a s 3 3 Address of property being improved General description of improvements- Address: — Rt11C{� �at `ll 1PAr���'� 1 , Owner: _ SDO� 3zz�� Owner's interes n site of the improvement: Fee Simple Titleholder(if other than owner): Name: pp Contractor: S Uan CL,� L 3 aS Address: S'--So ti 0 ; `J TelephoneNo.. �a-� Fax No: t�'lS XSurety(if any) Atnount of Bond$ qAddress: Z Telephone No: Fax No: Name and address of any person making a loan for the construction of the improYements `— Name: Address: Fax No: Phone No: f person within the Stake of Florida,other than himself,designated by owner upon whom notices or other documents ma}'� Name oPe served: Name: -- Address: Fax No: Telephone No: of the Lienor's Notice as provided in Section In addition to himself, owner designates the following person to receive a copy 713.06(2)(b),Florida Statues. (Fill in at owner's option) --- Name: 1 - 4 �L aS Address: S 30 t' 1 Facet Na Telephone No: Notice of Commencement(the expiration date is one (1)year from the date of recording unless a different date is Expiration date of specified): TS SPACE FOR RECORDER'S USE ONLY OWNER HIDate: 0 ----_------- -— -- - Signed: day of �Dp irz the County of DuvaL Stale i — Doc 2006041053,OR BK 13051 Page 9764. Before me this _ JA - Doc#2 1 Of Florida,has person ally appeared 2006 at 02:12 PM, Notary Public at Large,Sta of Florida Co „„ 4 FE10I L.ODOM Filed&Recorded 021031 �� a Co s JIM FULLER CLERK CIRCUIT COURT DUVAL COU NTY My commission exTires _+ _ 2 RECORDING$10.00 personally Known: _ - Produced Identification: r� xqf CITY OF ATLANTIC BEACH ELECTRICAL PERMIT APPLICATION Date: Property Address: -76 17 Owner: !;> 5 •��� /lieo Telephone#: Contractor: _ D yiV 67/6-6- L Telephone#: 7 Odd�o Contractor Address: 3? Z 0 �' 4W do d F RAH C Fax#: 2-60 —7 !;" 77 Contractor Signature: ^� 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. wilding: Building Type: ❑ Trailer S ice: If other construction is New Residence La Temp. /New being done on this building Or site,list the building ❑ Old ❑ Commercial ❑ Signs ❑ Increase permit number: ❑ Re-wire ❑ Addition Sq.Ft. ❑ Repair 04-0-0 6 3 2 D17 Conductor Size p AMPS: U COPPER ❑ ALUMINUM Switch or ,,// RACE Breaker 2&0 AMPS ZGl� PH W VOLTZ•7U WAY RACE Existing Service Size AMPS PH W VOL WAY Meter Number Feeders: NO. SIZE NO O S Lighting Outlets CONCEALED OPEN Receptacles CONCEALED OPEN n In AWS, 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 I O. OVER 1 H.P. PHS -r7 i JNDER600V 0VER600V 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• httn:iiwww.ci.atlantic-beach.fi.us Revised 1/04 Fk CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD r� ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 3IT. Application Number . . . . . 06-00032508 Date 3/14/06 Property Address . . . . . . 76 17TH ST Tenant nbr, name . . . . . . NEW SERVICE Application description . . . ELECTRIC ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 Owner Contractor - ------------------------ ----------------------- KILLIAN DYNAMIC ELECTRIC COMPANY 76 17TH STREET PO BOX 16351 ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32245 (904) 726-8144 ---------------------------------------------------------------------------- Permit ELECTRICAL PERMIT Additional desc . . Permit Fee . . . . 105 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 ---------------------------------------------------------------------------- Special Notes and Comments 200 AMPS 240 VOLT NEW SERVICE Fee summary Charged Paid Credited Due ----------------- -----=---- ---------- ---------- ---------- Permit Fee Total 105 . 00 105 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 105 . 00 105. 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDING OFFICIAL CITY OF ATLANTIC BEACH JS E r S:' PUBLIC UTILITIES DEPARTMENT s7 1200 Sandpiper Lane v~ Atlantic each,Florida 32233 (904)247-5834 (904)247-5843 Fax www.coab.us 3 PLAN REVIEW COMMENTS Permit Application # D(0— Property Address: �h Applicant: 6 (� � ��r Q b -gra c-f-d r Project: �.�� XYour application is approved as noted by the Public Utilities Department. Final application approval must come from the Building Department. o Your permit application has been reviewed by the Public Utilities Department and the following items need attention: 1l 11 LACED TO 5eujtp-e [AP 2,9 oa. do /ZJ'0 w P.J 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. Reviewed by Donna Kaluzniak, Public Utilities Director Date Signature Contractor Notified Date R E C L CITY 13F4T'._AN- 71U CITY OF ATLANTIC BEACH JAN 2 12006 PUBLIC UTILITIES DEPARTMENT 1200 Sandpiper Lane Atlantic Beach,Florida 32233 (904)247-5834 (904)247-5843 Fax C,I www.coab.us J AIN 0 9 2006 PLAN REVIEW COMMENTS By. Permit Application Property Address: Applicant: Project: xYour application is approved as noted by the Public Utilities Department. Final application approval must come from the Building Department. Your permit application has been reviewed by the Public Utilities Department and the following items need attention: Ad(0 :59U 10f i IA�i IA C: AJ C--Zc:Q' �krl 2 Vill lilre E:11-1- J �YQ C"-D �2 edv0 o oia 51 2 Ufa4V 4- Ve. wl' ly4 hC� 'p/d I Q 4n Qom i -72 / 12e,,' lAs�l 111o"'I Aebll '-e /11S'�IAII -Zc-,?,17 Please submit these requirements to �e 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. dka�Cl241'a-x-(9 'f 0 ?/0 ,u 5 Revie d by Donna Kaluzniak, Pulic Utilities DL'rec or —7 Dated o Signature Contractor Notified Date Graham Shirley From: Matthews, Carlene Sent: Tuesday, March 14, 2006 11:08 AM To: Graham Shirley Subject: FW: 72 &76 17th Street Shirley, this is what I would do and have Don review for approval. My opinion will be in red Permits issued are as follows with these charges; (blue is actual charges paid) 72 17th Street tt11 Water impact fee - $265.00 U Water Connect/Meter only $ 85.00 (remove already exists) y0 00 Water Cross Connection $ 35.00 (remove) Sewer lateral (half) $1450.00 V t➢ �/�0 Sewer impact fee $1250.00 Plan review comments indicate; 72 17th Street-water tap will be needed. Informed customer a sewer tap could be shared with 76 17th Street. Customer wishes to share sewer tap. 76 17th Street Sewer lateral (other half) $1450.00 Sewer impact fee $1250.00 p Water impact fee 265.00 Ogg 0 Water connect/tap/meter 525.00 Water cross connection 35.00 ` Plan review comments indicate; 76 17th Street-water services existing. No sewer lateral available will need to pay for sewer lateral $2900.00. will need to pay for sewer impact fee $1250.00 From: Matthews,Carlene Sent: Monday, March 13, 2006 12:29 PM To: Graham Shirley Cc: Cunningham, Kerri Subject: 72&76 17th Street Afternoon Ladies, I have permits for the above address. The previous house that was demolished already had city water but did not have city sewer. On 72 17th Street I see that you charged water meter, water impact and cross connection fees but did not charge for sewer. A meter already exists from previous house. On 76 17th Street I see that you charged full amount for all connection fees. Let me know your opinion please. Thanks, Carlene 1 4,H CITY OF ATLANTIC BEACH BUILDING PERMIT APPLICATION • 1AIN 0 204 (New/ Residential & Commercial) Date: Zo& Job Address: I'lo 1-1-4e" T i►` l[51 cEL 3 d.) 3 3 Owner's Name: Address: 6-00 t JQ. PC)I'.-rf 1 L Phone: `J - Lf a4-- Legal Description:'' //Block Number: I Lot Number: Zoning District: V 1< Contractor: � < (l qn 6kn.C%*ii, ( VI's State License Number: 1 !5 0 14(-6 ip Address: J 3D 611 1.S • S. ste- a0( Phone: 5 V cI- 0 9`7 n City:JQC ks0 aV; Ijf, State: V- Zip: 3v2�Fax: (A]5 - a-1 0 1 Describe proposed use and work to be done: .&Ii 0 k ct�t acz. Present use of land or building(s): duple ` q_5 �ee-4/' .'"�✓1.1��/P [� �P�, ��'��� � Valuation of proposed construction:1 [7Cl 006 Is approval of Homeowner's Association or other private entity required?1A% If yes,please submit with this application. Will this project involve changes in elevation, site grade or any use of fill material, addition of 5% or more to the original impervious area or the removal of any trees? I O. Applicant certifies that no change in site grade, impervious area or fill material will be used on this project. ❑ YES. See Step 2 below. Approval of the Public Works Department is required prior to issuance of a Building Permit. [p' 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. Verify zoning designation and proper setbacks for the proposed construction. If you are unsure of this info tion, please contact the Planning and Zoning Department at 904-247-5826. In order to correctly verify zoning designation, please have Property Appraiser's Real Estate Number available. STEP 2. Contact the City of Atlantic Beach Department of Public Works to determine if a pre-construction or post-construction topographical survey or grading plan is required. (If not required, written verification must be provided with this application.) The Department of Public Works is located at: 1200 Sandpiper Lane,Atlantic Beach,FL 32233 Telephone:(904)247-5834 STEP 3. Submit Tree Removal Application if trees are to be removed or relocated. STEP 4. Please submit Building Permit Application, Energy Code Forms, Notice of Commencement, Owner/Contractor Affidavit if owner is contractor, and four(4)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)247-5826 800 Seminole Road •Atlantic Beach,Florida 32233-5445 Phone: (904)247-5800 • Fax: (904)247-5845 • http://www.ei.atlantic-beach.fl.us Page 2 Revised 8/04 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 clear and legible manner. 1. Current survey showing the property boundary with bearings and distances and the legal description. 2. Location of all structures, temporary and permanent, including setbacks, building height, number of stories and square footage. Identify any existing structures and uses. 3. If required by the Department of Public Works,a pre-construction topographical survey. 4. Any significant environmental features,including any jurisdictional wetlands,CCCL,natural water bodies. 5. Impervious Surface area calculations. Include driveways,sidewalks,patios and other Impervious Surfaces. Swimming pools may be excluded from total Impervious Surface. 6. Provide drainage plans. 7. Provide erosion and sediment control plan. 8. Any other documents requested by Building Dept.,Planning Dept.,Public Works and Public Utilities. Address and contact information of person to receive all correspondence regarding this application(please print). Name: D11714"ro S lcli t-C iA'v Mailing Address: /ll 5 klr_g(, r ;2 D Telephone: �vt( �t L(� (, Fax: ''/o L( G Ci S"a 10,-J, E-Mail: a 5 e 661(S6001. He-t I hereby certify that I have read and examined this application and attached documentation 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. Signature of Owner: Date:TT AS TO OWNER: Sworn to and subscribed before me this day of- Xaa 20 ®(P. State of Florida,County of Duval Notary's Signature: pu ODOM CrPersonall known Neon Notaryp�yc.SfaM of Florida YSp27. ❑ Produced identification 4 Type of identification produced 8W�Signaactor: Date: !�b AS TO CONTRACTOR: Sworn to and subscribed before me this �"� day of Jaw, ,20 � State of Florida,County of Duval Notary's Signature: Vs e6 HEIDIL.ODOAA personally known PubYc-State d Fbrfda ►Mary ❑ Produced identification •duly Corrrnissior►Expxes Sep 27,20Q9 Type of identification produced '=� Comm"ion IC DD 476634 Ba►ded By National Notary Agar. 4 of N,•,,` e mole Road •Atlantic Beach,Florida 32233-5445 Phone: (904)247-5800 Fax: (904)247-5845 • http://www.ei.atlantic-beach.fl.us Page 3 Revised 8/04 of for R.O.W. Permit Attachment . 2005 Atlantic Beach,FL 32233 R.O.W. Permit# issued Owner's Name: Property Address: -7 th <-y Q c-f Subdivision: C�CP� n C-► fv�e Lot#/Block#: Lof SLK R.E. #: �I REVOCABLE ENCROACHMENT PERMIT day of THIS REVOCABLE ENCROACHMENT PERMIT, issued on this organized and existing b; , 200 , by Atlantic Beach, Florida, a municipal corporation ' vAd- under the 1�SofeState of Florida, hereinafter referred to as "CITY" and �-�' of Atlantic Beach,Florida,hereinafter referred to as "USER". WITNESSETH: That the CITY does hereby grant the USER permission on a revocable basis as described herein the purpose as descrbed in the City of right to enter upon the property of the City of Atlantic Beach for the pies attached). Atlantic Beach Right-of-Way/Easement permit numbers noted above(cop This work is generally described as: aired, erected, and/or installed in the exercise of the privilege granted Any facility maintained, rep days notice by CITY to the USER, said notice to remains subject to relocation or removal on thirty (30) y requested, to the following address: USER shall be given by certified mail, return receipt X30 II,5 (ad. S sfe ael d ositin of said notice of cancellation in the United States of USERil shalI proper addressconstitute the notice of The ep g cancellation and the burden is upon USER to keep the CITY informe tl make any and all necessary repairs to any facility erected or maintained in The USER shall promp y good and safe the exercise of the privilege herein granted and shall at all times maintain sand facility in condition. roved representative or other franchised In the event it is necessary for the CITY or the City's Y the USER shall replace at the USER's utility to enter upon the above-described property of the CITTY, repairing, sole expense, any and all material necessarily displaced during the action of maintaining, atin r lacing, or adding to of the utilities and facilities of the CITY or franchise utility provider. oper g,rep The facilities allowed by the permit shall meet the current requirements of the City Code, Building Codes,Land Development Code, and all other land use and code requirements of the CI TY changes from the approved plans and/or method, must obtain The USER, prior to making anyDepartment, for said change. The Witten approval from the City of Atlantic Beach, Public Works Dep Page 1 of 2 USER shall, at the discretion of the CITY,be requested to submit as-built drawings showing the change within thirty (30) days after the day of completion. This permit shall inure to the benefit of, and be binding upon, the USER and their respective successors and assigns. ble State and CITY USER shall meet the terms and conditions of this permit and and f thuseslimitations /requirement of h laws and/or specifications, to Include utilities locate requirements gr es that the CITY and its officers and public rights-of-way and other public land. USER further from any ohs work herein under the terms of this employees that of said liabilities 11 tsaved ies are hereby ass by the ssumed by he USER. permit and ha DATED and SIGNED thisiday of �{�f� �1-- 12006. CITY OF ATLANTIC BEACH,FLORIDA, BY: a municipal corporation: roperty Owner By: Jim Hanson, City Manager Attest: Rick Carper,Public Works Director STATE OF FLORIDA COUNTY OF DUVAL f 4 2006 ersonally appeared before me, a Notary On this 3 day of r the property owner of Public in and for said County and State, Atlantic Bea , Florida, known to me to be the persons 7(o 7 `eefcuted the foregoing who acknowledged to me that he or she described in and whel ex d voluntarily and for he use sand purposes herein mentioned. efre executed the sem Y . Y, r rte/ By t •r. �.r�c petty Owner Notary Public in for said County and State (to be signed in presence of the Notary SDI L.ODOM Notary Pubic-sere of Fbft CowA aim Expires Sep 27,206Y Cmnbs&1e OD 4711834 on A-dewNe1f011e1 AWL Page 2 of 2 RECL . CITY OF ATLANTIC BEHUH LD!NG & 7,1NJ:NG CITY OF ATLANTIC BEACH JAN 2 3 2006 i PUBIUC WORKS DIE?ARTMENT — 1200 Sandpiper Lane -- Atlantic Beach,Florida 32233 B13 L - A' G T (904)247-5834 __Gl1 (904)247-5843 Fax - www.coab.us 101 n 4 M6, MAN pEVREw CCO MIE 7S L;C/ Permit Appfication N Pro P a rtY Address: r-7 G Applicant: Project: l a Your application is approved as noted by the Public Works Department. nna� appficaten app>rovafl must rWne url- the B»M>m9 Depa>rti;n¢1mLL. L] Your permit application has been reviewed by the Public Works Department and the following items need attention: Drainage plan shows lot draining west to Seminole right-of-way. Spot elevations on 72 17th Street survey show right-of-way higher than lot . Provide grading plan. - Also provide flow lines for perc pipe. Sediment protection (filter cloth) required for inlet in 17th Street right-of-way. Proposed retention volume calculation incorrect . Pipe holding volume incorrect . Different depths in retention basin calculation. Right of Way and Revocable Enchroachment Permits required for pavers in right-of-way. 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 by k Carper, P.F., Public Works Director Date ?,C/�C, Signature Contractor Notified Date CITY OF ATLANTIC BEACH PUBLIC WORKS DEPARTMENT w- - - 1200 Sandpiper Lane Atlantic Beach,Florida 32233 (904)247-5834 (904)247-5843 Fax c, n www.coab.us IF ��7 �j�,v��7 �?�� �a }��}��{�{,�}�7r� W 1C LL��1`V REV E VV 11.O1�J11F71i1�.'rl� 11 S — Permit A1ppfacatiOu � ���gy Property Address: �lX lh �4-f-C-e+ Applicant: �-�- �-.� I l i o n d I�l- QC� Project: - ❑ Your application is approved as noted by the Public Works Department. yine application aipp rovafl wast come bona the BuDdinng Department. ❑ Your permit application has been reviewed by the Public Works Department and the following items need attention: U Al Si �t/LC r1�cNf� I•"'¢�NT&I Alt 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 by Rick Carper, P.10., Public Works Director Date Signature Contractor Notified Date RECL CITY OF AS&�ObN6ri NZONING ` CITY OF ATLANTIC BEACH PUBLIC UTILITIES DEPARTMENT JAN 2 3 2006 r ' j ,! 1200 Sandpiper Lane ! 1 Atlantic Beach,Florida 32233 — �� r (904)247- 834 CI It BFT ^ �, - 904 247-3843 Fax www.coab.us JAN 0 9 2006 PLAN REVIEW COMMENTS BY Permit Application # Property Address: Applicant: Project: 1 Q i YYt� Your application is approved as noted by the Public Utilities Department. ry Final application approval must come from the Building Department. Your permit application has been reviewed by the Public Utilities Department and the following items need attention: AJLS ICS — i �s e; our s e� evv! ori Me CKS s !, ow +✓vett-e/' �' a.�i`l6ri Gc G� o e �v�j( ;lj be a�o�•irea/ i 10-1eC Ccs Le✓!i� usf jlcede /J oGcf e Gt 4�dog W ells /I of i/�s // ire"/yRfl on 4 lNl//i/15fd// cfea/laufs Z Cam �.�ib e 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. U/Sq/GI z (f /0 '"5 Revie d by Donna Kaluzniak. Public Utilities Director Date Signature Contractor Notified Date I"�dcPG�' i �y�106.-'i75-- 11,ld— CITY OF ATLANTIC BEACH BUILDING PERMIT APPLICATIO l - / (New/Residential & Commercial) JAN 23 2006 l . f"' Date: Job Address: �� � fi L &A FL- as 33 Owner's Name: Address: 50©t def�C) 1T� ��. L 3 a a�� Phone: 0 s' a'I-(a a- Legal Description:,, /Block Number: D Lot Number: Zoning District: Contractor: DS k, < <I an (im.Co&4*1,S State License Number: ( 110 Cos �O Address: 5 3a ELI s Ad- S &e- a.0( Phone: 5 a q- 8 q. 0 City: State: Ft- Zip:_5Rgy Fax: (gr/i - ��0 P, Describe proposed use and work to be done: . It J4-e('1 Present use of land or building(s): �-Ju ple y kGCS 6 ee-0 fZo-'14 v `le,4 -Cl Valuation of proposed construction:-q(20 0 oon Is approval of Homeowner's Association or other private entity required?AD If yes, please submit with this application. Will this project involve changes in elevation,site grade or any use of fill material,addition of 5% or more to the original impervious area or the removal of any trees? [1NO. Applicant certifies that no change in site grade, impervious area or fill material will be used on this project. ❑YES. See Step 2 below. Approval of the Public Works Department is required prior to issuance of a Building Permit. Q'NO. 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. Verify zoning designation and proper setbacks for the proposed construction. If you are unsure of this info tion, please contact the Planning and Zoning Department at 904-247-5826. In order to correctly verify zoning designation, please have Property Appraiser's Real Estate Number available. STEP 2. Contact the City of Atlantic Beach Department of Public Works to determine if a pre-construction or post-construction topographical survey or grading plan is required. (If not required, written verification must be provided with this application.) The Department of Public Works is located at: 1200 Sandpiper Lane,Atlantic Beach,FL 32233 Telephone:(904)247-5834 STEP 3. Submit Tree Removal Application if trees are to be removed or relocated. STEP 4. Please submit Building Permit Application, Energy Code Forms, Notice of Commencement, Owner/Contractor Affidavit if owner is contractor,and-four(4)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)247-5826 800 Seminole Road -Atlantic Beach,Florida 32233-5445 Phone: (904)247-5800 - Fax: (904)247-5845 - http://www.ci.atiantic-beach.fl-us Revised 8/04 Page 2 T 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 clear and legible manner. 1. Current survey showing the property boundary with bearings and distances and the legal description. 2. Location of all structures, temporary and permanent, including setbacks, building height, number of stories and square footage. Identify any existing structures and uses. 3. if required by the Department of Public Works,a pre-construction topographical survey. 4. Any significant environmental features,including any jurisdictional wetlands,CCCL,natural water bodies. 5. Impervious Surface area calculations. Include driveways,sidewalks,patios and other Impervious Surfaces. Swimming pools may be excluded from total Impervious Surface. 6. Provide drainage plans. 7. Provide erosion and sediment control plan. 8. Any other documents requested by Building Dept.,Planning Dept.,Public Works and Public Utilities. Address and contact information of person to receive all correspondence regarding this application(please print). Name: _LW10 S /<<LL 1AA1 rJ Mailing Address: 5'3j 5 F,11�S /j/7 a Telephone: 1�0C-( 5D!2 k L(-7 Fax: GIU�( 6 cl�a 10�E-Mail: a 5 Hed I hereby certify that I have read and examined this application and attached documentation 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. Signature of Owner: Date:—T AS TO OWNER: Sworn to and subscribed before me this day of 1��� 920 QC0• State of Florida,County of Duval Notary's Signature: HE! L'00W [personally known •�•��r n ••s- f P< . S%%of Fb W • :� S027,20811 ❑ Produced identification Com" fl 4 Type of identification produced Signat a on -to . Date: T— AS TO CONTRACTOR: �Yl. Sworn to and subscribed before me this — day of J a"\-, ,20 0 V . State of Florida,County of Duval Notary's Signature: HEKI L.ODOM EB"'P'ersonally known Notary PW*-soft of Fbride ❑ Produced identification Commi Wm ExpkW S9P 27,2= Type of identification produced ?, Commimion fl DD 476634 Banded By Naftw No"AM. mi"eininole Road •Atlantic Beach,Florida 32233-5445 Phone: (904)247-5800 Fax: (904)247-5845 • http://www.ci.atiantic-beach.fl.us Revised 8/04 Page 3 `r CITY OF ATLANTIC BEACH ?j' D. F BUILDING / ZONING DEPARTMENT ord;�S VW 1 1` 800 Seminole Road . Doe (� Atlantic Beach,Florida 32233 (904)247-5800 (904)247-5845 Fax t: www.coab.us JAN 0 9 2006 PLAN REVIEW COMMENTS Permit Application # Property Address: / 6 Applicant: �� l 6 l �V�. P-5`C Project: v ,O F ATLAN i IC ntr�r! Ci�'I � This permit application has been: 6' ' ElA roved ,JAN 2 2 2006 - PP ❑ Reviewed and the following items need attention:, Please re-submit your application when these items have been completed. Reviewed By: Date: Date Contractor Notified: CITY OF ATLANTIC BEACH f, r BUILDING / ZONING DEPARTMENT D. For QW i ins l s/ 800 Seminole Road . DoerrLk Atlantic Beach,Florida 32233 ;.� (904)247-5800 (904)247-5845 Fax www.coab.us PLAN REVIEW COMMENTS Permit APP lication # (10J✓��� `� Property Address: t�k Applicant: Il/ K- Q �/l� l ) �-n�I� QL( l yu� Q�� Project: �� a(Yt i 7 U This permit a plication has been: i Approved z JAN 2 3 2006 Reviewed and the following items need atteition: Iu� F j Please re submit yo applicati hen these items have been completed. Reviewed By: Date: Date Contractor Notified: RECD . clrr of ATI_arybN F3UILDWG & 7. CITY OF ATLANTIC BEACH ZO ONING BUILDING PERMIT APPLICATION JAIL 2 3 2006 (New/Residential & Commercial) a (� Y - Date: �CU Job Address: c A FL_ 3 2D 3 3 Owner's Name: -I-Lx nn I 67c)C) ` ,/erP6�.gf RS. -`L 3a��� Phone: [off J �4D� Address: Legal Description:,, /Block Number: I Lot Number: Zoning District: Contractor: DS k, 16,CLn CICn•Cgs 4*r 1 State License Number: Cas �p Address: 5 3D EI I s Ad S &tf- ac)( Phone: S �(' 9`� D City:�Q.0�5� iZ V i I� _State: F1- Zip:3i2jW Fax: D D- Describe proposed use and work to be done: vt� f0Lz• Present use of land or building(s): _ e v / zrS Valuation of proposed construction: (2G , 00C� — Is approval of Homeowner's Association or other private entity required?11V If yes,please submit with this application. Will this project involve changes in elevation, site grade or any use of fill material, addition of 5% or more to the original impervious area or the removal of any trees? IKO-. Applicant certifies that no change in site grade, impervious area or fill material will be used on this project. ❑ YES. See Step 2 below. Approval of the Public Works Department is required prior to issuance of a Building Permit. VIVO. 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. Verify zoning designation and proper setbacks for the proposed construction. if you are unsure of this info tion, please contact the Planning and Zoning Department at 904-247-5826. In order to correctly verify zoning designation, please have Property Appraiser's Real Estate Number available. STEP 2. Contact the City of Atlantic Beach Department of Public Works to determine if a pre-construction or post-construction topographical survey or grading plan is required. (If not required, written verification must be provided with this application.) The Department of Public Works is located at: 1200 Sandpiper Lane,Atlantic Beach,FL 32233 Telephone:(904)247-5834 STEP 3. Submit Tree Removal Application if trees are to be removed or relocated. STEP 4. Please submit Building Permit Application, Energy Code Forms, Notice of Commencement, Owner/Contractor Affidavit if owner is contractor,and four(4)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)247-5826 800 Seminole Road -Atlantic Beach,Florida 32233-5445 Phone: (904)247-5800 • Fax: (904)247-5845 - http://www.ci.atlantic-beach.fl.us Page 2 Revised 8/04 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 clear and legible manner. 1. Current survey showing the property boundary with bearings and distances and the legal description. 2. Location of all structures, temporary and permanent, including setbacks, building height, number of stories and square footage. Identify any existing structures and uses. 3. If required by the Department of Public Works,a pre-construction topographical survey. 4. Any significant environmental features,including any jurisdictional wetlands,CCCL,natural water bodies. 5. Impervious Surface area calculations. Include driveways,sidewalks,patios and other Impervious Surfaces. Swimming pools may be excluded from total Impervious Surface. 6. Provide drainage plans. 7. Provide erosion and sediment control plan. 8. Any other documents requested by Building Dept.,Planning Dept.,Public Works and Public Utilities. Address and contact information of person to receive all correspondence regarding this application(please print). Name: _,� (� S K i L (A"' / Lam, �^ Mailing Address: 5-3 L� f✓/ll S 0-1, r C � 0 ( � r L Telephone: %Ut( 15-01 Fax: IU�( (o c1 S�o� �U E-Mail: a 5 k �1 L [��ed(56J-11 Net I hereby certify that I have read and examined this application and attached documentation 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. Signature of Owner: Date:_T AS TO OWNER: Sworn to and subscribed before me this day of ail 20 0(p. State of Florida,County of Duval Notary's Signature: HEIDI L.ODOM [�Personall known V"Q ••' Notary Public Slate of Fbtida Y ' s: :° ConMr>Msabr� Sa027,2009 ❑ Produced identification 4 Type of identification produced P. hooded Signat a on ractor: 'l Date: AS TO CONTRACTOR: 0 Sworn to and subscribed before me this �`' day of J GUS, 120 (., State of Florida,County of Duval Notary's Signature: t G6 HEIDI L.DOW Dr-Personally known .: Notary Public-Stale of Fbrida ❑ Produced identification Comms &ExpkwSep27.2W9 Type of identification produced Conw ission$DD 476634 �''�`%��•` Banded By Natieonal Notary Asn. 900-Neininole Road •Atlantic Beach,Florida 32233-5445 Phone: (904)247-5800 Fax: (904)247-5845 • http://www.ci.atiantic-beach.fl.us Page 3 Revised 8/04 REC� CITY OF ATLANTIC BEACH • t_ CITY OF ATLANTIC BUILDING PERMIT APPLICATION (New/ Residential & Commercial) JAN 2 3 2006 --7 I Y C-5+. f'" Date:l ©(O Job Address: &oe4 k6_G &A EL_ 3 as 33 Owner's Name: Address: 570() —? ` ve o 3 aa7 Phone: Legal Description: Block Number: Z Lot Number: Zoning District:T Contractor: V k% I Gan (—ic0tr&4 1,S State License Number: i ti O 14 ('0.5 Address: �� �I I S S e ao( Phone: 5 b q' S q"- 0 City:,Ja �SO rL V I j L State: F� Zip: Fax: (y�S - a�0 Describe proposed use and work to be done: S/f, /C,t YI-CW Present use of land or building(s): mac) le hq5 6eew O'e.�u `le�r`t`` Valuation of proposed construction:, qoo . wo Is approval of Homeowner's Association or other private entity required?AD If yes, please submit with this application. Will this project involve changes in elevation,site grade or any use of fill material, addition of 5% or more to the original impervious area or the removal of any trees? [�1�10. Applicant certifies that no change in site grade, impervious area or fill material will be used on this project. ❑ YES. See Step 2 below. Approval of the Public Works Department is required prior to issuance of a Building Permit. ['110. 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. Verify zoning designation and proper setbacks for the proposed construction. If you are unsure of this info tion, please contact the Planning and Zoning Department at 904-247-5826. In order to correctly verify zoning designation, please have Property Appraiser's Real Estate Number available. STEP 2. Contact the City of Atlantic Beach Department of Public Works to determine if a pre-construction or post-construction topographical survey or grading plan is required. (If not required, written verification must be provided with this application.) The Department of Public Works is located at: 1200 Sandpiper Lane,Atlantic Beach,FL 32233 Telephone:(904)247-5834 STEP 3. Submit Tree Removal Application if trees are to be removed or relocated. STEP 4. Please submit Building Permit Application, Energy Code Forms, Notice of Commencement, Owner/Contractor Affidavit if owner is contractor,and four(4)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)247-5826 800 Seminole Road •Atlantic Beach,Florida 32233-5445 Phone: (904)247-5800 • Fax: (904)247-5845 • http://www.ei.atlantic-beach.fl.us Revised 8/04 Page 2 h 7� 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 clear and legible manner. 1. Current survey showing the property boundary with bearings and distances and the legal description. 2. Location of all structures, temporary and permanent, including setbacks, building height, number of stories and square footage. Identify any existing structures and uses. 3. If required by the Department of Public Works,a pre-construction topographical survey. 4. Any significant environmental features,including any jurisdictional wetlands,CCCL,natural water bodies. 5. Impervious Surface area calculations. Include driveways,sidewalks,patios and other Impervious Surfaces. Swimming pools may be excluded from total Impervious Surface. 6. Provide drainage plans. 7. Provide erosion and sediment control plan. 8. Any other documents requested by Building Dept.,Planning Dept.,Public Works and Public Utilities. Address and contact information of person to receive all correspondence regarding this application(please print). Name: _,V/`f'V [Q S. K 14,L/114 A/ (� Mailing Address: 5_3 Cj Fi/l!.S /gr, f e ;2 D [ JA Telephone: eJUf-( �('1 Cg Fax: ''/DtC 6 ct 5�7a IU E-Mail: a C 56,14. Neff I hereby certify that I have read and examined this application and attached documentation 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. Signature of Owner: Date: O AS TO OWNER: Sworn to and subscribed before me this day of 4 20 (p. State of Florida,County of Duval Notary's Signature: L:re,c.HEIN =o c• Notary L.SODDM Fla personally known Sep 27,2009 ❑ Produced identification C istitin ft 4 Type of identification produced �. Cormr � Barded °;,;,•• 'Natio ry ,� Signate on Tactor: Date: lIZ51 D b AS TO CONTRACTOR: Sworn to and subscribed before me this J`— day of J A P,, 120 0 (� State of Florida,County of Duval ,� / Notary's Signature: LSL G(,CY�- -`joi'py P4�`o• HEIDi L.ODDM [personally known Notary Put>fic State d Florida ❑ Produced identification qty Comrrussw Expires Sep 27,2009 Type of identification produced •: ,� tea;= Comrrftsion 0 DD 476634 Bonded By National Notary Astra. e inole Road •Atlantic Beach,Florida 32233-5445 Phone: (904)247-5800 Fax: (904)247-5845 • http://www.ei.atiantic-beach.fl.us Page 3 Revised 8/04 CITY OF ATLANTIC BEACH PUBLIC WORKS DEPARTMENT 1200 Sandpiper Lame Atlantic Beach,Florida 32233 (904)247-5834 (904)247-5843 Fax www.coab.us PLAN REVIEW COMMENTS Permit ApplicatiOn # Property Address: Applicant: !i� t� 1 Q V� l Vl� Q I ( �.► r �C� �� Project: Your application is approved as noted by the Public Works Department. Finai application approval must come from the Building Department. 3l Iu� ❑ Your permit application has been reviewed by the Public Works Department and the following items need attention: t �- 3/l/06 -- Overflow pipe must be connected at inlet, not into Ipe (future maintenance issue) . Change grading plan to increase area flowing into catch basin. Pipe gutters down spouts into retention area. Please submit these requirements to the Public Woo eDo emelt, 12n0 If you have any r Lane, Atlantic Beach, FL 32233 in order that we can app y PP questions,please call(904) 247-5834. lteviewe y Carper, P.E., Public Works Director Date Signature Contractor Notified Date CITOF ATLANTIC BEACH � b� PUBLIC WORKS DEPARTMENT y � � � C E i 1200 Sandpiper Lane 1v " Atlantic Beach,Florida 32233 CITY OF Ll1.ra i( ntHt;H 1 g ; , �: (904)247-5834 FEB(904)247-5843 Fax p www.coab.us U 20U6 PLAN REVIEW COM 'I'S BY Permit Application # 3a d Property Address: Applicant: Project: Y ur application is approved as noted by the Public Works Department. F' 1 application approval must coarse from the Budding Department. our permit application has been reviewed by the Public Works Department and the following items need attention: RESUBMITTAL 2/7/06 -- 1) Insufficient cover to install perc pipe and inlets per plan, e. g. flow line 9 . 2 (center west) + 12" pipe + 12" cover = ground elevation 11 . 2 would require 1 foot of fill over lot - rear retention basin would not flow to street . 2) Use of right-of-way for deepest portion of retention basin is not approved. Okay for side slopes, etc. to be in right-of-way, not major portionof basin. 3) Revocable Enchroachment Permit submitted. Right-of-way permit still required. 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 by Rick Carper,P.E., Public Works Director Date Signa Contractor Notified Date 100�- WATER IMPACT FEE WORKSHEET ADDRESS: 12 Z,-/O(p (DRAINAGE FIXTURE UNIT Fln""i URE TYPE VALUE AS LOAD FIXTURES UNITS Automatic clothes washers, commercial 3 Automatic clothes washers, residential 2 Bathroom group consisting of water closet, lavatory, Bidet, and bathtub or shower 6 Bathtub (with or without overhead shower or whirlpool attachments) 2 Bidet 2 Combination sink and tray 2 Dental lavatory 1 Dishwashing machine, domestic 2 Drinking fountainllcemaker Y Floor drains 2 Hose bib 1 Kitchen sink, domestic 2 Kitchen sink, domestic with food waste grinder and/or dishwasher 2 Laundry tray (1 or 2 compartments) I 2 Lavatory 1 Shower compartment, domestic 2 Sink 2 Urinal 4 Urinal, 1 gallon per flush or less 2 Wash sink (circular or multiple)each set of faucets T- 2 Water closet,flushometer tank, public or private ::4 / Water closet, private installation 4 Water closet, public installation 6 TOTAL NUMBER OF UNITS= 3 MULTIPLIED X 20 TOTAL$ K, —� rjr'!`1fl'' CITY OF ATLANTIC BEACH = PERMIT CALCULATION SHEET -ter Date: Address Heated Square Footage @ $. per sq ft= $ Garage/ Shed @$ per sq ft= $ Carport/Porch @$ per sq ft= $ Deck @$ per sq ft= $ Patio @$ per sq ft = $ TOTAL VALUATION: $ Total Valuation 1 s` $ Remaining Value $ . per thousand or portion thereof CONSTRUCTION TYPE: TOTAL BUILDING FEE $ ZONING: + `/2 Filing Fee $ FLOOD ZONE: ( )Fireplaces @$35.00 $ IMPERVIOUS SURFACE: BUILDING PERMIT FEE $ Q � C Rc77i?"�JCrS�. —�WATER IMPACT FEE $ ,S -383 SEWER IMPACT FEE $ o� 5 WATER METER/TAP $ rnel onl�J CAPITAL IMPROVEMENT$ SEWER TAP $ C ( ) RADON HRS .0050 $ SECTION H PAVING ( ) $ CROSS CONNECTION $ 3 ST( ) SURCHARGE $ OTHER $ GRAND TOTAL DUE: $ 1/13/03 3 1 ts CITY OF ATLANTIC BEACH PERMIT CALCULATION SHEET f1iS1 J�' Date ' 06 Permit Number Address -7 7 LC ST — /SlF0 Contact Name D4 Q - t�f L L( *f /, Phone Sro ��/ 70 Heated Square Footage 3/ 66 @ $ /0 7 per sq ft=$ 33 2� 3 412- Garage 2Garage/Shed L/9 Y @ $ S 7 per sq ft=$ 81 if 3 F(o Carport/Porch @ $ 416 per sq ft=$ 7, S"SY Deck @ $ per sq ft=$ Patio @ $ per sq ft=$ TOTAL VALUATION: $ 3ok-Y. 2 Total Valuation 1St $ Remaining Value $ per thousand or portion thereof CONSTRUCTION TYPE: TOTAL BUILDING FEE $ ZONING: 0:?6 -r + t/2 Filing Fee $ FLOOD ZONE: >/- - ( )Fireplaces @$35.00 $ D MERVIOUS SURFACE: SOS AB CONSTRUCTION SURCHARGE .$— CAPITAL CAPITAL IMPROVEMENT $ ? 2 CITY RADON SURCHARGE $ SECTION H IMPACT FEE $ SEWER MACT FEES $ --A AS O ' Od SEWER TAP FEES $ o - a9oo ST CONSTRUCTION SURCHARGE 3Coo $ STATE RADON SURCHARGE i/ $ WATER CONNECT/METER ONLY $ C� — WATER CONNECT/TAP&METER $_ Ia�„�_ WATER CROSS CONNECTION $ 3S� WATER IMPACT FEE $ S� OTHER $ GRAND TOTAL DUE: $ 1/13/03