70 W 5th St (vault) CITY OF
r�!�'aKt�c �iacl - �l Kilo
SW SEMINOLE ROAD
-- - ------ -- --_-_------ ATLANTIC BEACH,FLORIDA 32233-5145
TELEPHONE(904)247-5500
FAX(904)247-5805
NOTICE
TO: Water Department
FROM: Building Department
DATE: // _ / 7
Please be advised that the final building inspection has been
completed on each of the following addresses and construction water
is no longer needed:
Permit !lumber Address
/ '^ � (j).
7s' elT,
uilding Department
..$d..,:ru, .
�L\jrJr�
r r J I , CITY OF ATLANTIC BEACH
� l 800 SEMINOLE ROAD
r ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
c
Application Number . . . . . 09-00001298 Date 9/25/09
Property Address . . . . . . 70 W 5TH ST
Application type description RIGHT-OF-WAY PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
------------------------------------------------------------------------
Application desc
DRIVEWAY ADDITION
-------------------------------------------------------------------
Owner Contractor
-
------------------------
-----------------------
QUAST OWNER
ATLANTIC BEACH FL 32233
-----------------------------------------------------------------
Permit . . . . . . DRIVEWAY PERMIT
Additional desc . .
Permit Fee 35 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 3/24/10
--------------------------------------------------------------
Special Notes and Comments
Ensure all meter boxes, sewer cleanouts and valve covers
are set to grade and visible .
Concrete width at edge of pagement - 2116" .
-----------------------------------------------------------
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.
,: . > .�_A
fit + I
City of Atlantic Beach
" y' APPLICATION NUMBER
Building Department SEP I a 1 (To be assigned by the Building Department.)
1 800 Seminole Road Q 9 _ /p�g
Atlantic Beach, Florida 32233-5445 -.
- Phone(904)247-5826 • Fax(904) Date routed: f d
E-mail: building-dept@coab.us
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: �� �/C/ Department review required Yes No
Building
Applicant: QW S r Planning &Zoning
. / Tr ministrator
Project: ���YT7 }
��W A � Iy P - or
Public Utilities
Public afety
lin Cl'f-Ti el)l Y Fire Services
De t St nature -
Review fee $ ___..p...... 9..._...
Other Agency Review or Permit Required Review or Receipt Dateof 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: [Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date: r
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied.
PUBLI WO KS Comments:
PUBL C U I S
PUBLIC SAFETY
Reviewed by: Date:
FIRE SERVICES Third Review-: as revised. ❑Denied.
Comments: : ❑
Reviewed by: Date:
Revised 05/14/09
,. .
�..._.�,. E. ,_ ., . �,
r�'�,rt,rjri
CITY OF ATLANTIC BEACH
% CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
800 Seminole Road 904-247-5800
Atlantic Beach,Florida 32233-5445 Fax 904-247-5845
PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION.
Date ?Z/
PERMIT#
Job Address L�/a ISSUED BY THE CITY
7D
Permitee: c,r';4-- _ Telephone# C70 y'
Permittee Address: 70 4/.z /_"` {-
Requesting Permission to Construct: r,ve-^- Ni Cori, 0�
Location: (Reference to Cross-Street)
1. Applicant declares that prior to filing this application he has ascertained. the location of all existing utilities,
both aerial and underground and the accurate locations are shown on the sketches.
A Letter of Notification was mailed to the following Utilities/Municipalities:
Jacksonville Electric Authority Yes No ( ) Date:
Bell South Telephone Company Yes (1 No ( ) Date:
Ferrell Gas Yes No ( ) Date:
Comcast Yes ( No ( ) Date:
2. Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation,
alteration or relocation of all, or any portion of said street or easement as determined by the Director of Public
Works, any or all of said poles, wires, pipes, cables or other facilities and appurtenances authorized
hereunder, shall be immediately removed from said street or easement or reset or relocated hereon as
required by the Director of Public Works, and at the expense of the Permittee unless reimbursement is
authorized.
3. All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be
performed under the supepision of fce h �'.�s� (Contractor's Project
Superintendent) located.at Telephone*.
4. All materials and equipment shall be subject to inspection by the Director of Public Works or his designee.
5. All city property shall be restored to its original condition as far as practical, in keeping with city specifications
and the manner satisfactory to the city.
6. A sketch of plans covering details of this installation, as well as, a copy of a recent survey shall be made a
part of this permit. Calculations showing anv increase in impervious area on owner's lot or in the city
Right of Way are to be included with this application.
7. This permittee shall commence actual construction in good faith with 3 C-) days. If the beginning date is
more than 60 days from date of permit approval, then permittee must review the permit with the Director of
Public Works to make sure no changes have occurred in the area that would affect the permitted construction.
8. It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the
City's right, title and interest in the land to be entered upon and used by the holder, and the Holder will, at all
times, assume all risk of and indemnify, defend, and save harmless the City of Atlantic Beach from and
against any and all loss, damage, and cost of expenses arising in any manner of the exercise or attempted
exercises by the holder of the aforesaid rights and privileges.
9. The Director of Public Works shall be notified twenty-four (24) hours prior to starting work and again
immediately upon completion.
OWNER /� ,.► ,,. HAL1 AVENER
°' PAY COMMISSION#DD866144
EXPIRES March 02,2013
Signed: Date:
Before me i day of S� i in the County of Duval, (407)393.0153 F Nope service.c=
State Of Florida, h s personally appeared ht- ';eP Z Zel ('
i�(✓7�
Notary Public at Large,State of Florida,bounty of Duv �j
My commission expires:M4r , Personally no
Produced Identification: ��"���� 1 I�C✓I.s�
I'll 11 1 ORIN,
Sep 13 Uy U4:4bp jALLY Ut-A,v =LL r
MAP SHOrIIMiG BOUNDARY 31WAVEY OF
LOT 2 BLOCK 75 ACOORDING TO THE PLAY OF
Onlil-CmiH ATLAHM RUCH
AS RECORDED IN PLAT ROOK 16 , PAGE(S) ' 34 OF THE CURRENT
PliMJC RECORDS OF DUVAALL COUNTY, FLORIDA.
CERT;CI m Y0:
SALLY S. CWPELL. CASEY QUAST,
OLD REPUBLIC NATIONAL TITLE INSETM= MWANT,
KEITE WATSM TITLE SELVICES, INC,
Stan NOXTHEIM TxXs•r BANK, N.A. wEgr amR srAwRT
60.OQ��Pf
OWE
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1 CAT 2, BLOCK 76
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emmm qOMNI" NOT"
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70/70 7C1H.1 7,71Lnn n-y�AINARLd ��.•�.«".^ �•.•^^ -_,_ ._- •-- .
S
R.O.W. Permit Attachment of for
R.O.W. Permit# issued , 200_ Atlantic Beach,FL 32233
Owner's Name: �us Qu-ls7` ,
Property Address: 7p5 -'`
Subdivision:
Lot#/Block , 7
R.E. #:
REVOCABLE ENCROACEMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of
, 200_, by Atlantic Beach, Florida, a municipal corporation organized and existing
under the laws of the State 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
right to enter upon the property of the City of Atlantic Beach for the purpose as described in the City of
Atlantic Beach Right-of-Way/Easement permit numbers noted above (copies attached).
This work is generally described as: ,dam
Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted
remains subject to relocation or removal on thirty (30) days notice by CITY to the USER, said notice to
USER shall be given by certified mail, return receipt requested, to the following address:
The depositing of said notice of cancellation in the United States snail shall constitute the notice of
cancellation and the burden is upon USER to keep the CITY informed of USER's proper address.
The USER shall promptly snake any and all necessary repairs to any facility erected or maintained in
the exercise of the privilege herein granted and shall at all times maintain said facility in good and safe
condition.
In the event it is necessary for the CITY or the City's approved representative or other franchised
utility to enter upon the above-described property of the CITY, the USER shall replace at the USER's
sole expense, any and all material necessarily displaced during the action of maintaining, repairing,
operating,replacing, or adding to of the utilities and facilities of the CITY or franchise utility provider.
The facilities allowed by the pen-nit shall meet the current requirements of the City Code, Building
Codes, Land Development Code, and all other land use and code requirements of the CITY, including
City Code Section 19-7 (h) which states "Driveways that cross sidewalks: City sidewalks may not be
replaced with other materials, but must be replaced with smooth concrete left natural in color so that it
matches the existing and adjoining sidewalks."
Page 1 of 2
The USER, prior to making any changes from the approved plans and/or method, must obtain
written approval from the City of Atlantic Beach, Public Works Department, for said change. The
USER shall, at the discretion of the CITY, be requested to submit as-built drawings showing the change
within thirty(3 0) 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.
USER shall meet the terms and conditions of this pen-nit and to all of the applicable State and CITY
laws and/or specifications, to include utilities locate requirements and use limitations/requirements of
public rights-of-way and other public land. USER further agrees that the CITY and its officers and
employees shall be saved harmless by the USER from any of the work herein under the terms of this
permit and that all of said liabilities are hereby assumed by the
USER.
DATED and SIGNED this 6h day of S�' ( '►��/ , 200_.
� .
By: .
Property ner
(to be sijfned in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this day of PA200 personally appeared before me, a Notary
Public in and for said Co my and State, C c the property owner of
70 Itl _ f S4�1 Atlantic Beach, Florida, known to me to be the person(s)
described in and who executed the foregoing instrument; who acknowledged to me that he or she
executed the sigior
ely andiFand
ily and for the uses and purposes therein mentioned.
HAU AVENER
"A MMISSION#DDS66144
Notary Publ caid CoState =; MY CO
rch 02,201
EXPIRES ma
3
I "l , Florklallotaryservlce.com
98.016�
407)S
CITY OF ATLANTIC BEACH, FLORIDA, a
municipal corporation:
Approved:
Ricky L. Carper,Public Works Director
For Permits where city sidewalk is impacted,
City Manager approval required:
Jim Hanson, City Manager
Page 2 of 2
City of Atlantic Beach
7REEDAPPLICATION NUMBER
Building Department d (To beassigned by the Building Department.)
800 Seminole RoadAtlantic Beach, Florida 32233-5445Phone(904)247-5826 • Fax'�LJtI>' E-mail: building-dept@coab.us Date routed: f d
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: �j W 57N 17-ttt IC Department review required Yes No
Building
Applicant: QW Planning &Zoning
TIgeAdministrator
P
Project: ��W�W � � Public Utilities
Public a ety
14n C'M7_1 an I y Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
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: ❑Approved. Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date:
TREE ADMIN. Second Review: AApproved as revised. ❑Denied.
f�
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
qA !/ff
For
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
Advanced Concrete Construction
120 LEE ROAD •JACKSONVILLE,FLORIDA 32225
W W W.ADVANCEDCONCRETECONMLICTION-COM
PH; 904 997 1112 • FAX: 904 997 1514
Fax Transmittal Form
Date: y Total Pages: II
ATTN:
Phone Number:
Fax Number: 2 LY 7 C(3
E-mail:
From: /<-.e �. ��',� —6 7
❑Urgent
❑For Review
❑Please Comment
❑Please Reply
Message:
GCote 16��
Z0/Z0 39dd 313ON00 G30NVAGV VTSTL66b06 EZ:60 600Z/EZ/60
0 m mom W."" 11 wol NO m ,1,."Mm a
DATE: 9/23/09 PLAN REVIEW CORRECTXON'S REPORT PAGE 1
CITY OF ATL=TIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH PL 32233
_ --- - w .,
--__ -------__-_-----------------
APPLICATION NBR 09-00001298
ADDRESS 7C W 5TR ST
APPLICATION DATE 9/16/09
APPLICA'T'ION TYPE _ RIGHT-OP-WAY PERMIT
---- - . - -- --,".------------ ----------------------------
OWNER QOA
ATLANTIC )BEACH FL 32233
CONTRACTOR .
----------"-___-",.,,,-----------____--
AGENCY NAME; PL7ELZC WORKS
DATE ACTION ACTION" BY
-----------------------------------------------
---------------
9/17/09 DISSApPROVEI) - IST REVIEW LISA SHOWMAN
Prov de impervious surface calculations .
Provide erosion and sediment control plans with
installation details and maintenance schedule.
All concrete driveway aprons must be 5 inches thick, * 000
Psi, with fibermesh from the edge of pavement to the
property line. Reinforcing rods or mesh are not allowed
in the right-of-;gay.
Provide dimensions of proposed driveway_ Maximum width
through right-of-way is 22 feet, with 3" flare at pavement.
-7 ell
eel
(/rte
�'d 0 ,W Oswews u011aw03ul eLt7'60 60 a day
Z0/Z0 39dd 313ON00 G30NVACV VT9TL66b06 ET:60 6002/EZ/60
♦ y
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
0 ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
06-00033372 Date 6/26/06
Application Number 70 W 5TH ST
Property Address . . • . . . INSTALL CU
Tenant nbr, name • • . . . MECHANICAL ONLY
Application description . . . TO BE UPDATED
Property Zoning . • • . • . • 0
Application valuation . . .
Contractor
Owner ----
- SNYDER HEATING & AIR
p.0. BOX 16826
JACKSONVILLE FL 32245
(904) 641-0600
----- ------
Permit---- -
• _ MECHANICAL PERMIT
Additional desc . Plan Check Fee . 00
Permit Fee . . . . 51. 00 0
Issue Date . . . Valuation
Fee summary Charged Paid Credited
Due
----------
- . 00 .00
Permit Fee Total 51 . 00 51 - 00 00 . 00
Plan Check Total • 00 . 00
Grand Total 51 . 00 51 . 00 . 00
PERMIT 15 APPROVED ONLY IN ACCORDANCE WPPH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
� ,A
CITY OF ATLANTIC BEACH
MECHANICAL PERMIT APPLICATION
Date: O
Property Address: J-D t,J
Owner: V,k e ►M C_ Telephone#: 351- S L l-SZ
Contractor: Telephone#: cep-(l-Q u an
Contractor Address: ED .. x 1 u XZ u, Fax#: (pk-k l-112-9
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 ordinances and standards of
good practice listed therein.
Type of Heating Fuel: If other construction is being done on this building
or site,list the building permit number:
p• Electric
❑ Gas: _LP _Natural _Central Utility
❑ Oil
❑ Other—Specify
MECHANICAL EQUIPMENT TO BE INSTALLED NATURE OF WORK
Heat _Space _Recessed X Central _Floor Residential
�- Air Conditioning: _Room Central
❑ Duct System: Material Thickness ❑ Commercial
Maximum capacity cfm
E3 Refrigeration ❑ New Building
❑ Cooling Tower: Capacity gPm Existing Building
❑ Fire Sprinklers:Number of Heads
❑ Elevator: __ Manlift Escalator (Number) Replacement of Existing System
❑ Gasoline Pumps (Number)
Li Tanks (Number) ❑ New Installation
L3 LPG Containers (Number) (No system previously installed)
❑ Unfired Pressure Vessel ❑ Extension or Add-on to Existing System
❑ Boilers
❑ Gas Piping ❑ Other-Specify
❑ Other—Specify
LIST ALL EQUIPMENT
AIR CONDITIONING,REFRIGERATION EQUIPMENT&CONDENSOR'S Approving
Number Units Description Model# Manufacturer Ton's Agency
,0 4`
HEATING—FURNACES,BOILERS,FIREPLACES&AIR HANDLER'S Approving
Number Units Description Model# Manufacturer BTU's Agency
TANKS Nominal Capacity Type Liquid Serial Approving
How Many &Dimensions Contained Manufacturer No. Agency
800 Seminole Road•Atlantic Beach,Florida 32233-5445
Phone:(904)247-5800• Fax: (904)247-5845• http•//www.ei.atiantic-beach.fl.us Revised 1/04
1 �►
ADDRESS ! ���� z
BUILDING PERMIT NUMBERcy `
INSPECTIONS : FOOTING
UNDER SLAB PLUMBING
SLAB
FRAMING
COVER—UP
INSULATION
FINAL BUILDING r —�
CERTIFICATE OF OCCUPANCY
ELECTRICAL PERMIT # 9D 6 a
INSPECTIONS ROUGH
FINAL
—y/
MECHANICAL PERMIT #
PLUMBING PERMIT # Y� 3
NOTES :
N153U6
MAP. SOHO WING BOUNDARY SURVEY OF
LOT 2 BLOCK 7 (,-' AS SHOWN ON HAP OF
cECT/On/ "W" ATCaNT/C f�EAG�
AS RECORDED IN PLAT BOOK PAGES _OF THE PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA
CER T7FIED FOR: --Z:)OST/ C//e. G 7 OC
S �n
WEST 5 rw 9TRE 6T
71-1 IP gEay
= Zzo 00' So 00 , 171934
Building and Zonirt�
,v
p1Z.o`p
. o
Pc = 13. 1OF;::
3
so. 00
LOT 3 mor z LOT /
B 7 7 13-oCK 7 7
BLOG,� 7 7
,.10. g 3o -Ga- ClA-
N ov S E 5'T,o, T 3 - ,O -G 4-, G mac-- - 3 3
NOT VAUD UNLESS EMBOSSED WITH SEAL OF THE UNDERSIGNED. ,ILL
THE PROPERTY SHOWN HEREON APPEARS TO LIE WITHIN FLOOD HAZARD ZONE AS SC LSD FROM FLOOD
INSURANCE RATE MAPO00I FOR 4T�1'47 �E4C�FLORIDA, DATED — J
TRI—STATE LAND SURVEYORS, INC.
8411 BAYMEADOWS WAY SUITE #2, JACKSONVILLE, FLORIDA 32256 (904) 731-7235
LEGEND I HEREBY CERTIFY THAT THE ABOVE LANDS WERE SURVEYED UNDER MY
■ CawC. waw RESPONSIBILE SUPERVISION AND DIRECTION, THAT THERE ARE NO
• WON COM ENCROACHMENTS EXCEPT AS SHOWN AND THAT THE SURVEY SHOWN
(-%T WM CAP /LS 4144) HEREON MEETS THE MINIMUM TECHNICAL STANDARDS SET FORTH BY
—x—nwcE THE FLORIDA BOARD OF LAND SURVEYORS PURSUANT TO SECTION
o ~ COA(FDLWD) 472.027, FLORIDA STATUTES
® CROSS CUT
B.R.L BUKDwC RESMCnON LwE LARRY G. EDDY, P.L.S. No. 4144
ESNT EA.SaWiT
R/W MWT-OF-WAR SCALE: � ZO
COV. OOM?O AREA -
f CINMWrE
A/C AN CONDMOINWG PAD GIS TER VEYOR, S A OF FL ORI DA
(R) RADIAL DISTANCE DATE-: -7
ORDER NO. -
hIJJVO
MAP ,SHO WING BOUNDARY SURVEY OF
LOT 2 BLOCK 7 AS SHOWN ON MAP OF
c l 'ECT/On/ 4 Tl1In/T/C �E4GW
AS RECORDED IN PLAT BOOK PAGES OF THE PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA
CERTF/ED FOR: __DOLS'T!E C,IlP• t`�la2o.,/ LET7-0 A EGD
FP�113//C4zar ?n=
%VEsT 6' rN 9T2EE T
ZZO 00' SD 00 '
AJ
v
4b V
0
\\ O
Z5 .�
3
Lor 3 LOT z
gLocK 7 7 LoT I
13&ocK 77 Bootee 77
,a. 8 30 C-i
1-1 ov 5 S-rA �T 3 _ 10 _C14-, G4- -5-S--:53
NOT VALID UNLESS EMBOSSED WITH SEAL OF THE UNDERSIGNED. aLL -00 '0-0
THE PROPERTY SHOW HEREON APPEARS TO LIE WITHIN FLOOD HAZARD ZONE AS SC D FROM FLOOD
MA
INSURANCE RATE P FOR A T L-414 T/G _3E4 C FLORIDA, DA 7FD -
TRI-STATE LAND SURVEYORS, INC.
8411 BAYMEADOWS WAY SUITE #2, JACKSONVILLE, FLORIDA 32256 (904) 731-7235
LEGEND I HEREBY CERTIFY THAT THE ABOVE LANDS HERE SURVEYED UNDER MY
■ Ca40 MAN RESPONSIBILE SUPERVISION AND DIRECTION, THAT THERE ARE NO
• RON Coa ENCROACHMENTS EXCEPT AS SHOWN AND THAT THE SURVEY SHOWN
(SWT WM CAP i LS 4144) HEREON MEETS THE MINIMUM TECHNICAL STANDARDS SET FORTH BY
FENCE THE FLORIDA BOARD OF LAND SURVEYORS PURSUANT TO SECTION
0 MN Mt(FDVND) 472.027, FLORIDA STATUTES
0 QWSS CDT
&ILL BL*.DWG RES7RlC770N LAME
Esu? EASELEWT LARRY G. EDDY, P.L.S. No. 4144
R/1r MaiT-AF WAY SCALE: " ZD '
COV. 00MVED AREA
f a<T/IE7PL.YIE
A/C AN Cavana.WG PAD 4GIIIS TER .VFYOR, S A OF FLORIDA
(R) RADML DISTANCE DA TE: -/¢-
Q C0NQRE7L
o ��-�
or- I ORDER NO. -
11 CITY OF
Ogice of Building Ofificial 9O3 5m v
'fiEGUE T IFOR l�lsp=CT 1t7N
5�
Permit No.
Date
Time
Received
Locality
Job Addr s
Owner's ( Q Ccntractor �?—
p, r n P UA�BI IG Iv1EC,yAtJICAL
�U{ CONCRETE �L'ECt--IC L _1
n _ Rough Air
— Fcotno g - , Heating
Framing -- Slab = T rnp Pel- = Top Out :j Fire Place r
R� Roeling Final Sevier
Insulation
Lintel Pre Fab
READY ;-nom L„.a
PECTION' A.M.
Tues Wed.
Friday PM•
Mon.
c C A.^1:.
Inspection Made -------- — F:raI Ins
.l is p
?CtC'------ ---__--��--�__ __------ .•.�.r;!ficate c!Occupancy
t
DATES
PRE-SERVICE DIVISION
JACKSONVILLE ELECTRIC AUTHORITY
233 WEST DUVAL STREET
JACKSONVILLE, FLORIDA 32202
THE FOLLOWING FINAL INSPECTION(S) HAVE BEEN MADE AND ARE
SATISFACTORY:
-------------------------
60 ,
-----------------
GJ _ ---------------------
��'� - '
------------------------
-;IiC)6 _� --c.J------ --/& =--------------------------
------------------------------------------------
Enclosed are the blue copies of the permits.
SINCERELY,
BUILDING INSPECTION DIVISION
cc:FILE
CITY OF
BeaeA-4k`
Office of Building Official
REOUEST FOR INSPECTION �v
Permit No.
Date— /// AM
Time
Received
Locality
Job Address
Owner's Contractor
Name PLUMBING MECHANICAL
CONCRETE ELECTRICAL Air Cond. &
BUILDING Rough Wiring C� Rough ;-, Heating
Framing
❑ Footing _ Temp Pole Top Out
❑ Slab �_ Sewer ❑
Re Roofing Fire Place
�J�`(- Lintel Final Pre Fab
insulation
READY FOR INSPECTION A.M.
Wed. Thurs.
Friday_ --P.M.
Mon. Tues
Inspection Made — Final Inspection I
- -
— �— — - Certificate of Occupancy
inspector
na,
7' CITOF
Y
office of Building Official
�g35f'
REQUEST FOR INSPECTION
9� Permit N T
Date x A.M
Time /� V PM. —
Received
ality
Job
dr ss
Owner's
0 -S < _ r ++A L -
Name CTRICAL PL MBING d. &
CONCRETE C
UILDI — in9 = ICY Heating
Footing Pole
Top Out /-- Fire Place —
Framing Temp ewer `'
Slab Final f Pre Fab
Re Roofing = --
Insulation 7 LintelA.M,
READY FOR INSPECTION Thurs. Friday P.M.
Wed.
Tues. A.M.
Mon.
P.M.
spection .-
Inspection Madeanc C
Certificate of Occup Y
--
"� Date ___----�—
�0� � ` r `�
� �
t
TRANSMITTAL DOCUMENT FOR JEA
DATE: V,_/ q-91
The following permits have passed "rough" inspection:
Permit No. Address
se&mxaxxxax*txlmo*= pdxmxwofxxkkoxVuzmd*w. Please update
your records accordingly.
i
Thaou
BUILDIN CLERK
CITY OF ATLANTIC BEACH
/vcb
t
�.& CITY OF
1 Office Of Building Official • �� ��
REQUEST FOR INS
Date PECTION
f
Time
Received -- A.M. Permit No.
Job Address
Owner's /
Name Locality
BUILDING
CONCRETE Contractor
Framing ELECTRICAL
Re Roofing � Footing
Insulation C Slab ❑ Rough Wiring P SING
C Lintel C Temp pole ou h MECHANICAL
C Final C Top ut C Air Cond. $
❑ Sewer C Heating ❑
Mon. READY FOR INSPECTION C Fire Place
Tu ECTION Wed. Pre Fab C
Inspection Made
Inspector a ^� (.�J Friday
PM
i
Final Inspection C
Certificate of Occupancy
Date
e ,,�
t i
I
I
CITY OF Al'I...ANTIC BEACH, FLORIDA
Ar,IOv ,by APPLICATION FOR ILICTRICALI PIRMIT
0 (4
TO THE CHIEF FLECTAICAL INSPECTOR: -
s
IMI'ORTf1NT NOTICE:
IN CONSIDERATION OF PERMIT GIVEN FOR DOING THE WO , -1 AT7ACNEP�pLANB AND SPECItt) IN 114 E CA ToNg
IIFREBY AGREE TO rERFQRM SAID WORK IN ACCORDANCE WITH
WHII`N ARE A PART HEREOF, AND IN ACCORDANCE WITH THE ELECTRICAL REGULATIONS, CODES AND CITY Of
ATIANtIC REACH ORDINANCES.
p cO q®
. 1-k C C
LECTn� E
c. � _ fiQ88:��l.l� • S� �� • --pK0.—.SOX_._....
NnME 0Ome�h� n ADDRESS:
BETWEEN:
tlLt>O.Sli!
) PUBLIC ( 1 INDUS. ( 1 NEW (0" OLD ( 1, 11151W.1
AM. 1 COMM, l 1
TEMr. I I MONS I ! _BU. FT.
nUc,iTl(lN I I TnnILFn ( ! ra
RFRVICF. NEW (1� INCnEA$E ( 1 WIPAIn ( I '�
�Mre corren ALUM.,!4_--_
`mss ' Uv
pnTCt10R B _
EXibT.BEfiV.SITE AMrB -
FH W VOLT iiACEW
SIZE E N O.
SIZE NO. !SIZE_
f E E D_E n$ _ Nd• �-------•-----
T
CONCEALED OrEN TOTAL
llGlitlNG OUTLETS -- ��
CONCEALED- OPEN TOTAL
nECEi`TACLE6 a,.toa AMri,•
■WiTCHM+, -
INCANDESCENT
fLUonEBCENT N M.Vtoo 1F 7
rixio BEl.l.tgAN!>F.
Arf LIANCFS_ --
Alp H.P. RATING H.P.,nATINO
CONpIT10NINd COMP.MT OTOR_ OTHEn MOTORS AMPS CEIL HEATz KW-HEAL
0.1 .1 N�t,VOLTAGE I'Hs
MOTORS H,F, VOLTAGE rH8 ND•
r
IS(:ELLAN 0
1
T RANSFOnMETIS: UNDER sup V. OVER NOV. -
NO. KVA NO. I KVA
NO, NEON TRANSF. NO, VA. MA. MOTOR SIZE. i _ •��
I �=
FOnWARDED _
T
��
�OtAL FEES
r
i
PSR-3844 8935
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
PERMIT INFORMATION ------- -------- LOCATION INFORMATION
Permit Number : 8935 Addrers : 70 WEST FIFTH STREET
Permit Type : PLUMBING ATLANTIC' BEACH , FLORIDh 32231-
,-lass of Work' NEW ---------- LEGAL DESCRIPTION -----------
Constr - Type : WOOD FRI'44E Block - Section'
Proposed Use : SINGLE FAMILY Township: RN:-* 0
Uwellinas : 1. 'ode 0 sec h
Estimated Value ; 0
Improv . �'ost :
Total f e ep,
u oivfd +5 4
APPL1!-'RT1t-111 FLES
PERM 1 T
FIFTH STREET1MPkCT FEE $ 0
C A;-H , FL")vTr 3F*�!k -,L*PPvCT FEE
P
Wp N` jiV4*iE1k4 TAP
lopf
RADON GAS-H . R. S .
T T A NFORMA71,,0N RADON CAB 5%
CTI," SONS r-T r'APITAL IMPROVE. o
SEWER TAP
71LLE, FL . 32216 e'-'R 0 S S ^NNECT110N 00
Type : Iq SEC H IMPACT FEE SD.
CONST . SURCHARGE
$n
NOTES:
NOTICE —ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING
PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE
BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE
CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER
"FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN
THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS."
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW.
ATLANTIC BEACH BUILDING DEPARTMENT
By: ;�'
0�
�ajo
CITY OF ATLANTIC BEACH
APPLICATION FOR PLUMBING PERMIT
JOB LOCATION: VD Al F77-1 c5 7 AJ t-75/-
PLUMBING CONTRACTOR. J ✓AU61 � C)t �OAl5 ;)ta, 'IIS/x/G- c7V G
LICENSE NUMBER: 3J8�0
OWNER: 6111 � INOS f7L
BUILDING CONTRACTOR: I)�oS/7 4--
TYPE OF BUILDING:
SINKS SHOWERS
LAVATORY WATER HEATERS
BATH TUBS DISHWASHERS
URINALS DISPOSALS
o� CLOSETS WASHING MACHINE / /
FLOOR DRAINS OTHER �.5e b4k-S
TOTAL FIXTURE COUNT: / , ,3j-G} + $15.00 ��D�
-------------------------------------------------------------------------------
INSTALLATION OF PLUMBING AND FIXTURES MUST BE IN ACCORDANCE WITH THE MOST
RECENT EDITION OF THE SOUTHERN STANDARD PLUMBING CODE.
PSR-3844 9035
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
PERMI ? LOCATION INFORMATION -----
i-erm-it Number : 70 FIFTH STREET WEST
Permit Type: MECHANICAL ATLANTIC BEACH , FLOFIDZ'M
Class of Work : NEW
---------- LEGAL DESCRIPTION --------
Constr . Type: WOOD FRAME L Block : Sect; on '
Fropc,sed Use, SINGLE FAMILY Township ! RNG ,
Dwellings : 1 Code: 0 Subdivision: SECTION H
Estimated Va,iue :
Iffprov . C"Ost : .1 n n r11
Total Fees ,
Amount Paid:
D a t,e"",
_'A 171 ON FEE--
OMZS,-BY 'PMN E
PERMIT
WATER TMFACT FEE
r7, STREET
Fl-�F.T, a SEW;R IMPACT FEE
W A11g, M1
_F.TgRjTAF
R.
%
CON TRACTQR_ !NFORMAT ICIADCN CAB 5
�
APITAL IMPROVE
F'S T-w- —
N a m e
¢sr- '109411 tEz'_1 '�f BLIr SEWER TAP
322-1 CR 1SS CONNECTION
MHAR C{1, SEC H IMPACT FEE
CONST . SURCHARGE
NOTES:
NOTICE —ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING
PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE
BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE
CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER
"FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN
THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS."
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW.
0000wow oc�oowoo 346.00 14
ATLANTIC BEACH BUILDING DEPARTMENT Date: 9/02/94 01 Rcpt: 0078071
CASH
� y
(
/� � �
BUILDING AND ZONING INSPECTION DIVISION
CITY OF ATLANTIC BEACH
ATLANTIC BEACH, FLORIDA 92239
APPLICATION FOR MECHANICAL PERMIT CALL-IN NUMBER
IMPORTANT — Applicant to complete all items in sections I, II, III, and IV.
fLOCATION Street Address: Lj
F Intersecting Streets: BeweanAn
BUILDING
Subdivision
II. IDENTIFICATION — To be completed by all applicants ,
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 attacflgd plans and specifications which are a port hereof and in accordance with the City of Jacksonville ordinances and standards
of good.practice listed therein.
Name of Mechanical _ Contractors / q
Contractor (Print) V� c Master G r
Name of
Property Owner t C
Signature of Owner Signature of
or Authorised Agent Architect or Engineer
III. GENERAL INFORMATION
A' Type of heating fuel: B.
IS OTHER CONSTRUCTION BEING DONE
❑ E*tric THIS BUILDING OR SITE7
❑ Gas—❑ LP ❑ Natural ❑ Central Utility
IF YES, GIVE ILLYBER OF CONSTRUCTION
Cl Oil PERMIT �'
❑ Other — Specify
IV. MMHANiCAL EQUIPMENT TO SE INSTALLED NATURE OF WORK
(Provide complete list of componenh on back of this form) /$ Residential or ❑ Commercial
,Heat ❑ Space ❑ Recessed -�Centnsl O Flow New Building
,�ilir Conditioning: [3 Room �entrel C3 Existing Building
�ct System: Material Thicknou ❑ Replacement of existing system
Maximum capacity c.f.m. A New Installation(No system previously Installed)
❑ Refrigeration — ❑ Extension or add-on to existing system
❑ Cooling ?ower. Capacity q.p.m. EJ Other — Specify
❑ Fire sprinklers: Number of heeds
❑ Hevator ❑ Manlift ❑ Escalator (number)
THIS SPACE FOR OFFICE USE ONLY
❑ . Gasoline pumps (number) (Rec�ved)
❑ Tanks, (number)
Remarks
❑ LPG containers (numbar)
❑ Unfired pressure vessel
❑ Boilers Permit Approved by Data
0 Other — Specify Permit Fee
LIST ALL EQUIPMENT
AIR CONDITIONING AND REFRIGERATION EQUIPMENT pp
Number Unite Description Model Number Manufacturer (Was)y App Jnr
DATING • FURNACES, BOILERS, FIREPLACES
Capacity Approving
Number Units Description Yodel Number Anufacturer (BTU) Agency
TANKS
Row Many Nominal Capacity Type Liquid Name of Serial Approving
and Dimeusloce Contained Manufacturer No. Agency
CIT`r' -O`F
Office of Building Official
EQUEST FOR INSPECTION
Permit No. �`' ��
Date
Time A.M.
Received P.M.
2� Locality
Job Address
Owner's Contractor
Name MECHANICAL
NCRETE ELECTRICAL PLUMBING
BUILDING r; Rough ❑ Air Cond. &
Framing ❑ F Rough Wiring g ❑ Heating
Temp Pole ❑ Top Out
Re Roofing ❑ lab Final ❑ Sewer ❑ Fire Place
l Insulation ❑ Intel Pre Fab
READY FOR INSPECTION
Mon Tues.
Wed urs. Friday_--
A.M.
—'2 t7��� —P.M.
Inspection Made — final Inspection ❑
Inspector Certificate of Occupancy ❑
r
Date
PSR-3844 8640
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
_ --- PERMIT INFORMATION ------ -------- LOCATION INFORMATION
a
Permit Number : 8640 Address : 70 FIFTH STREET WEST U
Permit Type: BUILDING ATLANTIC BEACH . FLORIDA 32133
Class of Work: NEW ---------- LEGAL DESCRIPTION ---- -----
Constr . Type : WOOD FRAME Lot : 2 Block : 76 Section:o u
Proposed Use4;, SINGLE FAMILY Township : RNG: A
Dwellinas : 1 Code: 0 Subdivision: SECTION H
Estimated Value : 548002 .00 "`
Improv . Cost $0 . 00
Total Fees : $3248 . 78 A�
Am—nt Paid : 53248 . 78
Paid : 4/94
"4EW HOME PER- PLANS - HSF 1128
OWNER INFORMATION ----- --- APPLICATION FEES -----
- a.:rrie * -BENE DOSTIE PERMIT $382 . 50
?jddr-.. 90900LFSIDE DRIVE WATER IMPACT FEE 5410 .00
JA,'– S0NVILLE . FLORIDA 32215- SEWER IMPACT FEE $1250 .00
PKon ; t -+s; 4 +737-!;960, WATER METER/TAP 885 . 00
RADON GAS-H.R . S . 55 . 36
- - - CONTRACTOR INFORMATION ---- RADON CAB 5% $0 . 28
Address : `09�' GOLFSIDE DRIVt SEWER TAF.--
JAt*KSONVILLE . FLORIDA 3225 CROSS CONNECTION 535 .00
Type : 1 SEC.'. H IMPACT FEE $7 50 .00
V CONST . SURCHARGE $5 .08
'CHARGE/A'TL .BCH . fi0 . 5'f,
NOTES:
NOTICE –ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING
PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE
BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE
CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER
"FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN
THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS."
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW.
j00("* R",
,
ATLANTIC BEACH BUILDING DEPARTMENT oate: 7/18/99 01 licit, t ` i`w`'4,
r t
CITY OF ATLANTIC BEACH PERMIT CALCULATION SHEET
Address 6 C l F(ST
Date P/
Heated Square Footage @ $_19-00 per sq ft = $ 43.992
Garage/Shed @ $ ^^O per sq ft = $ 3,41 C
Carport/Porch Co @ $-1-01D per sq ft = $ �9�f
Deck @ $ g per sq ft = $
Patio @ $ L�,0D per sq ft = $
TOTAL VALUATION: $ y�� 00 '?
00 Z $
Total Valuation 1st ,J
Remaining Value $ per thousand
or portion thereof
TOTAL BUILDING FEE $ �
+ 1/2 Filing Fee $
( ) Fireplaces @ $15 . 00 $ _d
BUILDING PERMIT FEE $ 3 J�
WATER IMPACT FEE
SEWER IMPACT FEE $ / .S-0•CCS
WATER METER/TAP $ 3, 04
CAPITAL IMPROVEMENT $
SEWER TAP $ d
Qf( ?) RADON (HRS) .0050 $ 6
SECTION H PAVING (SD ) $ �
HYDRAULIC SHARES $
CROSS CONNECTION $ �—
(1/).f) SURCHARGE .0050 $ "�
OTHER $
GRAND TOTAL DUE $
ADDITIONAL PERMITS OR FEES: Mechanical Plumbing
Electric/New Electric/Temp ; SwimmingPool
Septic Tank ; Well Sign Finish Floor Elevation
Survey Other
CALCULATIONS and/or NOTES:
I
CITY OF
•ii.2;'ck7Y DESCRIPTION
97 +
�•=bCs�' f riRo�t.�tI�1�I 1. ttll�t+
u. J � f)lcck I_� `(�__Section aY___�___ •1 ', ��t�1llfll• Is} 1t li, tlUhlli� i_.il �-•`
1994 ITLEt+t tl)\t�:I V113I 24"."(111
14
;ubdivivion:----- c ��Onf�----------------
building and Zoning
street Name �O ,j S r� S DESCRIPTION OF WORK
Ir Address:---------------------
--------------
If in a FLOOD HAZARD
lcol x-----------nreo complete page 3. Brief
Description:_S
11'�E
Clavas of Work; 2
(Nov/Remodel/Addition)
O)IING INFORMATION
Type of
• Construction:_______________________
o;,i ng Proposed S�
istr�ct uses______ ____�____ Estimated Value 0____________________
xceptiona or - , - `` S` Int
�-----y------
oriances Grenteds___ = .........
Solid or (Y\01J0-SAPrb 3 Tr}b
------------------------------- Filled 5�+
----------- Grounds
-------------Root ----- � -
OWNER INFORMATION
Method of Heating:___ t_kcc C
Property Ovllers ���� ���_ ___________ Phones
`ley-'131-(6c -b
--------------
Moilino-------_--__--- �%0 6d1 ��� _
Address ____-- _____
c
— �
--------------
CONTRACTOR INFORMATION
: 2-7
Contractor:---- _e.1_lamv_S T� ------------ Phone:
Mailing a f1G 0 �01 �
Addrepas.......-----l-V--O------^-----
--------- c,Aksoo�� �e
------------------
C Expiration
License Numbers----------- ���O�d------------- Dotes------------ --
I HEREay CERTIFT TWAT I HAVE READ AND EXAMINED THIS A LIGATION AND MIIOW THE SAME !c' E'E TFJ�
f AND CORRECT. ALL PROVISIONS OF THC LAMS DIN CES GOVERNING THIS TYPE GF WOrIt .i; : Ii:
COMPLIED WITH, WHETIIE1s SPECIFIED HEREIN :101.7" T GRANTING U A PERMIT DOL; NIT rra' -`
GIVE AUTHORITY TO VIOLATE OR CANCE H6 PR ISS S OF ANY FE ERAL. STATE Ok LCA-AL, f.
REGULATIONS. ORDINANCFS� OR LAWS IN Y MAN R. If LUDIHn THE VFRH:NCI (rF CON:;TR;,'TI["+
�,w.- ,r ;c-t• PERFORMANCE OF CONSTRUCTION O/ THC ROJECT U+ULRLTAND Tr T THE IS::UANCE OF n,i:: PLr-'r.:'
CONTIIIOEfIT UPON THE ABOVE INFORMA ON BE O AND CORR ' AND THAT THE PLAMS AND :%J-1-Crr:N.
DATA HAVE BEEN OR SHALL BE PROV]k ED AS D /
Ovner Signatur ' _ - _-- - ----._.________Uate_ _--
�/,���
` Contractor aignatu
./� • '.•1`...�-�.--_sem-�_.r �
k. ., ::......
CITY OF ATLANTIC BEACH
Fixture Unit Worksheet for Water Impact Fee
FIXTURE UNITS ARE ESTABLISHED AS THE MEASUREMENT OF WATER DEMAND FOR
EACH WATER FIXTURE UNIT INSTALLED AND CONNECTED TO THE CITY WATER
SYSTEM. THE WATER SUPPLY CHARGE IS HEREBY FIXED AT TWENTY DOLLARS
PER FIXTURE UNIT CONNECTED TO THE CITY WATER SYSTEM.
'2-
BATHROOM GROUP CONSISTING OF SERVICE SINK TRAP STAND
WATER CLOSET, LAVATORY & BATH (8)
TUB OR SHOWER STALL (6) ( Z
WATER CLOSET
WATER CLOSET, TANK OPERATED (4) VALVE OPERATED (8)
BATHTUB/SHOWER (2) URINAL WALL LIP (4)
SHOWER GROUP PER HEAD (3) FLOOR DRAIN (1)
SHOWER STALL DOMESTIC (2) LAUNDRY TRAY (2)
LAVATORY (1) COMBINATION SINK AND TRAY (3)
/ WASHING MACHINE (3) POT, SCULLERY SINK (4)
L �LDISHWASHER (2) Z WASH SINK EACH SET OF
/ FAUCETS (2)
KITCHEN SINK (2) DENTAL LAVATORY (1)
KITCHEN SINK WITH WASTE DENTAL UNIT OR CUSPIDOR (1)
GRINDER (3)
BIDET (3)
URINAL STALL, WASHOUT (4)
FLUSHING RIM SINK (8) COMBINATION SINK AND TRAY WITH
FOOD DISPOS. (4)
URINAL, PEDESTAL, SYPHON JET DRINKING FOUNTAIN (1/2)
BLOWOUT (2)
LAVATORY, BARBER/BEAUTY _ICE MAKER (1/2)
SHOP (2)
SURGEONS SINK (3) LAVATORY, SURGEONS (2)
JACUZZI (2) URINAL STALL, WASHOUT (4)
TOTAL FIXTURE UNITS - @ $20.00 EACH
L r
JOB INFORMATION Q [_)Ccs T �` J
t
FLOODPLAIN DEVELOPMENT INFORMATION
Type of Developments /N c% �G¢f"
------------------
Flood Zone: -
Required Lowest Floor Elevations
If building is located within a flood 'hazard zone, a survey* must
be made AFTER THE SLAB HAS BEEN POURED, certifying that the
LOWEST FLOOR ELEVATION is equal to or above the bate flood
elevation established for that zone.
No final inspection will be made and no certificate of occupancy
will be issued until the survey is on file with the Building
Department.
COMMENTS:
Applicant Acknowledgements I understand that the issuance of
this permit In contingent upon the above information Luing
correct and that the plans and supporting data have been or shall
be provided as required. I agree to comply with all pliable
provisions of Ordinance No. 25-7-11 and all oth law 01
ordinances affecting the proposed development.
Date_ - I _ ` __ �l _Applicant's Signatu ! ________ ___________
-----------------------------------------------------
Department Use
Required Lowest Floor Elevation
As Built Lowest Floor Elevation
Survey Filed Filed with Building Deportment ___________
-----------------------------------
Building Department Representative
page 3
mo Milo 0,A.
CITY HHLL ATL BCH TEL No . /-A 5805 .1U, 1 9 , 18 N0 .001 P .01
OWNER BUILDER PER"It AFFIDAVIT
tMty 4f Florid• � '
CAtr of Atlentl4 6e4hct•
9EFORE«r)ME, We upder_slgn+d authority, per«ΡonrlXy apFFMarvd
.._w__.�... ' n.!.._ �.��� _..• who upon first bolrou duty
avor n. 4epcjweo and says r
to .« .. � .. �..� ,. �_.._�..- .._..• and the legal
owner of the SollowAng propertys
Subdivision
Block
AKA � . _.......1�.,.......� . ... w. .. .. . . .�
I so Opplying for a building peratt pursuant to %to* Owner
Builder eKeoption not forth in Florida Xtrtwtes Sectian 469. 103.
Florida low requires that. I have been provided vittj ttjv followiny
DISCLOSURr STATEMEIITr
DISCLOSURE STATEMENT
4
3tetr lav requires construction tt• be dune by lit*need
contractors. You have eppli*d for a perr.it under an
exemption to that low, the exampticin allow* you, as
the owner of your property* to ,Art air Your own
contractor even though you do not have a license. You
must pupervIse the construction yourself. You may
build or iwprove a ane, - or two tatwily arwoldena* or a
term outbuilding. You way oleo build or Impreov* a
commercial buiidino at s Coot of 025,000- 00 or less.
The building Murat be for your use and occupapcy. It
may not be built dor solo or lease. It you pall or
look* more than one building you have built yourself
within one year after thr construction is complete, the
lav will prwpum& that you built it for pale Or lease,
which Aw a vi,olwtiwr of this a,meoption. Yowr
construction sunt be done according to hvAldioc coda•
r �
I
AS RECORDED IN PLAT ROOK I Z> ,
PAGE ?:74- OF TIAL CU1=MENT PUBLIC
RECORDS OF DUVAL COUNTY , FLORIDA
lot
,.5
n �.5 - V
o PL17►o _
loin =0 Q
.9 t�
K�
a F�c.►� # 112 Q
o
faA
V d ri
SITE PLAN
SCALA.
ItIN1�NCIN►�•VUII�111J1r t!.JM1Ww
,ly
�llolicc v[
4ratr A"t IN oUr LICA7t)
To whom It may concern: r erty, and In
The undersig)red hereby informs You that 1mt��'�1Ve11ti1e°tollowl gwill be r' certain
bilorrnativlilestatedreal lto tills NOTICS
accordance with section 713.13 of the Florida Statutes,
OF COMMENCEMENT.
ro erty ------
llescriptlorr of pb ---
- _ -------------
p � �- _ 7� C...___ l--------------___----------••----_•
1011 t✓C+�(.- --1- -�-
--------------- ---------------------------------------"_ }_ -;e.=_`, r��- ` -------------------------------------
tlenetal descriptlou o1 in)proveu)e'lla
------------------------------------------------------
-52 .. ..... _____.__---------u`---------------------------------
Owner
"VAddress --------------------- ` --------------
u- rest !n elle of isle bnprove)uent _r-- -l�"------------------------------
Owner's into ___.
'1'Itl holder (If other ll)an u.v)ier•) ••----__....------------------------------------------------�--
Fee Simple a ho ------------------------------------
1� -------------------- ----------------------•-------------
c Name --------- --------
y Address ----- --------------- ..... ._. ... -- . ..- �C C�1"?GUiJ�_ ----------------------
Contractor -- ?.- -----------
go8o GC-11 c - --
Address ---------------------------
------------------------ ---------
Surety (if any) --------------- Alnoout of bond $--------------
------------------------------------------------------
J
Address ---------------
ursou mskh)g a Ioan for the consutuctiotr of the ia)ptovemen, s• ------------------
Nanre and address of any 1 _____________
Name ----------------------------------------------------...-------------------------------------------------
(�F Address ----------------
of I'loriila, other than hin)sel(, designated by owuer upon whom notices or othe[ oCurueu a
Nellie of IKrson within the State
,,Isy be served: -'--"
------------------------------------- Notice as
Address ------------- the Llel;lor's
nates the Iollowlug person to receive a copy-
7I3.ue [11 l 1, t- -------__-
in addition to Ilirnself, owner desig
provided Its section b Florida Statutes. (Flll 111 at Owner's op ---------
- -_----_-- .
Natne ----------------------------- -----------------------------
Address --------------- uea ONr-r
aconuan's
tltls sr^ci FOR n -------
owner
Swol•tt to and subscribed before ane tills _--_--_-__C'i-
dayof ----------- 1. ---
o ry Yubllo
' r
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tatifirate of Mrrupauq
Tity of
Atlantic +S=4 — Nloriba
Department of +.wilding kspertion
This Certificate issued pursuant to the requirements of Section 103.8 of the Southern Standard
Building Code certifying that at the time of issuance this structure was in compliance with the
carious ordinances regulating building construction or use. For the following.
Use Classification Single Family Residence Bldg. Permit No. 8640
Group W•z raiiie Type Construction $ f Fire District Atlantic Beach
Rene Dostie 9 Go y�i e Drive
Owner of Building Address Sn`ivj lle, FL 3 256
Bui ih�Address 70 W- 5th Street Locality"-tlantic Beach, FL. 32233
By: DON Q. FORD
Building Official Date: 1 I "
POST IN A CONSPICUOUS PLACE
1: 111'' 111111��Rhjjijl
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