541 Atlantic 2014 Demo CITY OF ATLANTIC BEACH
s) 800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
DEMOLITION PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 14-DEMO-491
Job Type: DEMOLITION
Description: demo structure
Estimated Value:
Issue Date: 12/8/2014
Expiration Date: 6/6/2015
PROPERTY ADDRESS:
Address: 541 ATLANTIC BLVD
RE Number: 170673-0000
PROPERTY OWNER:
Name: SABOL, RICHARD J
Address: 823 16TH AVENUE S
GENERAL CONTRACTOR INFORMATION:
Name: REALCO RECYCLING
Address: 8707 SOMERS RD QA JERRY J DOHERTY
Phone: - -
PERMIT INFORMATION: PUBLIC WORKS:
Full erosion control measures must be installed and approved prior to beginning any earth
disturbing activities. Contact Public Works (247-5834) for Erosion and Sediment Control
Inspection prior to start of construction.
FEES:
Demolition Fee $100.00
State Elec DBPR Surcharge $2.00
State Elec DCA Surcharge $2.00
Total Payments: $104.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845
Job Address: 541 Atlantic Blvd Permit Number:
Legal Description 10-8 21-25 29E Saltair SEC 01 Parcel# 170673.000
Floorea of—Sq. t. sq.Ft
Valuation of Work$ 16,850 Proposed Work heated/cooled 2,985 non-heated/cooled 0
Class of Work(circle one): New Addition Alteration Repair Move motif' pool/spa window/door
Use of existing/proosed structure(s)(circle one): er Residential
If an existing structure,is a fire sprinkler system mstalle trcle one): Yes ® N/A
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed: Demolition of P.XIStlna StruchirP._ SIAh.�
foundations
Property Owner Information:
Name: Address:
City State_Zip Phone
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: ReaICO RecycllnCJ CO IrIC Qualifyin Agent: Jerry Doherty
Address: 8707 omers Rd a0cryonyllie FLState322 6 Zip
OfficePhone Job Site/Contact Number 955-3581 Fax# 751-6611
State Certification/Registration# 055166
Architect Name&Phone# n/a
Engineer's Name&Phone#ten,/2
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations as indicated. !cert fy that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to mei!the standards of all laws regulating cons7ructron in this jurisdiction. This permit becomes null
and void f work is not commenced within s (6 months,or if construction or work is suspended or abandoned for apenod of six(6)months at any time after
work is commenced. l understand that separate permits muss be secured for Elecbica[Work,Plumbing,Signs,We!/s,Paols,Furnaces,Bailers,Henlers,
Tanks and Air Conditioners,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY.IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
/hereb certify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type op work will be complied with whether speci ted herein or not. The granting of a permit does not presume to give auth 'ty to violate or cancel the
provisions ofany other federal state,or local law regulating construction or the performance of construction.
–� Signature of Owq Z liL_A Signature of Contrac
Print Name Geo!'C eIV E• /Vat Print Name JerryDoherty
Sworn tq and subscribed befor e / Swor�►JT and subscr ed before me
this � Day of A-orerr,� .20 1 A this f ` Day of DV 20 1
N•' . )1�m
Not Pu c Pu w
Revised Ol.26.10 �
;S:pY'ry MARLENE D.TALLEY
MY COMMISSION#EE 860925 SANDRA V.JENKINS
dE EXPIRES:April 27,2017 Notary Public,State of Florida
Rf 4 ` Bonded Thru Notary Public Undetrmters My Comm.Expires May 26,2(116
Commission No.EE 187847
�'% ATLANTIC BEACH BUILDING DEPT.
DEMOLITION — PROPERTY OWNER
a RELEASE FORM
Y' �r
J
Date:
To Whom It May Concern:
I / We the current property owners of: Lot
Block
Legal Description of Property
AKA 541 Atlantic Blvd have contracted with to have
(Address of Property)
Realco Recycling Co Inc to remove the office bldg.
(Company Name) (Single Family, Dupre-x,Commercial,etc.)
Prior to the construction of : n/a
As a condition of issuing the permit we agree to the following:
1. All utilities are to be located and clearly marked.
2. Once house is removed, lot is to be graded and leveled.
3. All construction debris is to be removed from the property.
4. Affected area is to have grass or seed in place.
5. Erosion control devices will be put in place and will remain in place until grass
has covered affected area or new structure is completed and landscaping is in
place.
Signa
Signature
THIS SPACE FOR RECORDER'S USE ONLY
OWNER Q
SANDRA Y.JENKINS Signed: Date:
Notary Public,State of Florida Before met is Vd
Joe,]. rJ0 4 in the County of Duval,State
My Comm.Expires May 26,2016 Of Florida has personally
Notary Public at Large,Staterida,County of Duval.
Commission No.EE 187847 My commission expires: 0S—a7& - 14
Personally Known: ✓ or
Produced Identification:
Florida Department of DEP Form 62-257.900(1)
Oyu
Effective 10-12-05
Environmental Protection Page 1of2
AFLORIDA Division of Air Resource Management
NOTICE OF DEMOLITION OR ASBESTOS RENOVATION
TYPE OF NOTICE(CHECK ONE ONLY): ORIGINAL ❑ REVISED ❑ CANCELLATION ❑ COURTESY
TYPE OF PROJECT(CHECK ONE ONLY): DEMOLITION ❑ RENOVATION
IF DEMOLITION,IS IT AN ORDERED DEMOLITION? ❑YES ❑NO
IF RENOVATION:
IS IT AN EMERGENCY RENOVATION OPERATION? ❑YES ❑NO
IS IT A PLANNED RENOVATION OPERATION? ❑YES ❑NO
1. Facility Name Office bldg.
Address 541 A an is Blvd
city Jacksonville State FL zip 32233 county Duval
Site Consultant Inspecting Site AMEG
Building Size 3000 (Square Feet) #of Floors 1 Building Age in Years +15
Prior Use: ❑ School/College/University ❑Residence ®Small Business ❑Other
Present Use: ❑School/College/University ❑Residence ®Small Business ❑Other
IL Facility Owner Gate Petroleum Company Phone( ) 237-6718
Address
city State Zip
III. Contractor's Name Realco Recycling Co, lnrPhone(904 757-7311
Address 8707 Somers Rd
city Jacksonville State FL zip 32226
Is the contractor exempt from licensure under section 469.002(4),F.S.? ❑ YES 5d NO
IV. Scheduled Dates:(Notice must be postmarked 10 working days before the project start date)
Asbestos Removal (mm/dd/yy) Start: n/a Finish: n a Demo/Renovation(mm/dd/yy) Start: 1 1/20/14ish: 12/30/14
V. Description of planned demolition or renovation work to be performed and methods to be employed,including demolition or renovation techniques
to be used and description of affected facility components. UUP trat.k mmintP_CI exravator With VarlollS attainments.
Procedures to be Used(Check All That Apply):
❑ Strip and Removal ❑ Glove Bag F(] Bulldozer ❑ Wrecking Ball
Wet Method ❑ Dry Method ❑ Explode ❑ Burn Down
OTHER:
VI. Procedures for Unexpected RACM: Stop Work, have suspect material tested and abate if necessary
VII. Asbestos Waste Transporter: Name n/a Phone(____j
Address
City State Zip
VIII. Waste Disposal Site: Name Old Kings Rd, LLC Class
Address 8540 Old Kings Rd.
city Jacksonville State FL zip 32226
IX. RACM or ACM: Procedure,including analytical methods,employed to detect the presence of RACM and Category I and II nonfriable ACM.
Amount of RACM or ACM' X. Fee Invoice Will Be Sent to Address in Block Below:(Print or Type)
square feet surfacing material
linear feet pipe
cubic feet of RACM off facility components
square feet cementitious material
square feet resilient flooring
square feet asphalt roofing
'Identify and describe surfacing material and other materials as applicable:
I certify that the above information is correct and that an individual trained in the provisions of this regulation(40 CFR Part 61,Subpart M)will be on-site
during the demolition or renovation and evidence that the required training has been accomplished by this person will be available for inspection during
normal business hours. Jerry Doherty 11/5/14
(Print Name of Owner/Operator) (Date)
at%5/14
� u`L
(Signature of Owner/Operator) (Date)
DEP USE ONLY Postmark/Date Received ID#
Goty ofgHanfic Beach
Building Departmc--L'iiii APPLICATION NUMBER
800 Seminole Roado be aSSi ned by the Building D
"Ek TED partment.)
Atlantic Beach, Florida 322:33-5445 " IS
Phone(904)247-5826 - Fax(904)247-5VV
City web-site: http://www.ci:)ab.us
2 4 2014 Date routed:
APPLICATION REVIEW AND TRACKNG FORM
Properiry Address: I
oe Vd FDePari'x .gut review -ired Yes o
Applican-L BuildinaN
--
Planning Zoning
Project: Tree -listratol-
ublic W, <s
Public L-;' - �s
L_Public S-
LEire Sere. s'.
Review fee -2 Dept Signature
C�07 NTRACTOR EMAIL AOORESS
CONTRACTOR CONTAC-r #
APPMATION STATUS
Reviewing Department First Review: [Approved.
(Circle one.) Comments- []Denier!
BUILDING r— E C /A-.)
PLANNING &ZONING Reviewed by:
TREE ADMIN. -- Date: 11-2 'Y11 y
Second Review: E]Approved as revised. IlDenied-
PUBLIC WORKS Comments:
PUBLIC UTILITIES ;
PUBLIC SAFETY Reviewed by:
FIRE SERVICES
Third RevieVtf�. []Approved as revised. E]Denied.
Comments:
Reviewed by:
Date.
ISED 092520144
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