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2321 MAYPORT RD DEMO 2015 CITY OF ATLANTIC BEACH l 800 SEMINOLE ROAD 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: 15-DEMO-695 Job Type: DEMOLITION Description: DEMO EXISTING BUILDING AND SITE PAVEMENT Estimated Value: $100.00 Issue Date: 4/3/2015 Expiration Date: 9/30/2015 PROPERTY ADDRESS: Address: 2321 MAYPORT RD RE Number: 169398-0410 PROPERTY OWNER: Name: AMERADA HESS CORP. Address: PO BOX 696419 PO BOX 696419 GENERAL CONTRACTOR INFORMATION: Name: THE LANEY COMPANY Address: 2905 CORINTHIAN AVE APT 3 QA ASHLEY LANEY 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. Full right-of-way restoration, including sod, is required. FEES: STATE DCA SURCHARGE $2.00 Demolition Fee $100.00 STATE DBPR SURCHARGE $2.00 Total Payments: $104.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. I BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach,FL 32233 Office(904)247-5826 Fax(904)247-5845 cc Job Address: 2321 Mayport Road Atlantic Beach,FL 15- �C V Legal Description Lot 7.Section 8,Township 2 South,Range 29 East Parcel# Floor Area of Sq.Ft. Sq.Pt Valuation of Work$ 29,780 Proposed Work heated/cooled non-hes LF ' D Class of Work(circle one): New Addition Alteration Repair Move Demolition poo window/door Use of existing/proposed structure(s) circle one): Commercial Residential MAR 2 5 If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A Florida Product Approval# For multiple products use product approve orm Y Describe in detail the type of work to be performed:Demoilition of existing building and site pavement Property Owner Information: c_ Name: r'e i Address: ✓©� �0��`� P°t�-'-ty C AChIAp-I'K V14 City ' _ Stat Zip cW Phone — 12 E-Mail or Fax 0(Optional) M Contractor Information: C V , ,MA A'HV4CO) L&,k,P/�J� U� -UyyN Company Name: The Laney Company LC Qualifying Agent:? an l�hley Ley " _J Address:2905 Corinthian Ave City Jacksonville State FL Zip 32210 Office Phone 904-389-6752 Job Site/Contact Number_904-8380690 Fax#904-381-9125 State Certification/Registration# CUC1224248 Architect Name&Phone# Engineer's Name&Phone# Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and Address Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has commenced prior to the issuance of a permit and that all work will be peormed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6 months,or if construction or work is suspended or abandoned jot a pervod ojsix(6)months at any time a ter work is commenced. /understand that separate permits must be secured for E/ecMca Work,Phtmbtitg Signs Wigs Pools Furnaces,Boilers,Hea Tonks and Air Coadidaners,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. I hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions oflaws and ordinances governing this type o work will be complied with whether specified herein or not. The granting of a permit does not presume to uve `o v, late or cancel e provisions ofany other federal,state,or local law regulating construction or the perform nce�f pstr v{in. ((tt(tVV��JJIJ 3 Signature of Owner Signature of C(onntrtracto Print Name Print Name AH.ley.. 4__....................... Sworn to and subscribed before me Sw and subscribed bef rem 5 this Day of .20 thi Day of 20 ' Notary Public Notvublic Revised 01.26.10 :'o a JENNIFER WALKER meq. MY COMMISSION#FF 0114PA0 ra EXPIRES:April 24,201-1 E�QV Bonded Thru Notary Public Underwriters f I Walker, Jennifer From: Walker, Jennifer Sent: Wednesday, March 25, 2015 10:56 AM To: ashley@LaneyLLC.com' Cc: Arlington, Daniel Subject: 2321 Mayport Rd. Good morning Ashley, Per our conversation this morning regarding your Demolition permit application for 2321 Mayport Rd., please submit the following: A statement stating you have verified that the following are turned off: Water Gas Sewer Electricity Also, you were going to request another Asbestos affidavit and forward that to us. Please let me know if you need anything further, Jev,vuU WcOzer Administrative Assistant Building Department City of Atlantic Beach 904-247-5826 i PUBLIC WORKS PLAN REVIEW COMMENTS Date: /� Application Permit#: Project Name/Address A3 c�2-/ f Check Box to Application Tracking Comments Select CORRECTION ITEMS: CSMP Provide construction site management plan, including location of dumpster and portable toilet. Right- ❑ of-Way Permit is required if using right-of-way for construction parking. DPLN Provide drainage plans showing site topography(flow arrows, etc.) ❑ ESCP Provide erosion and sediment control plans with installation details. ❑ IMPS Provide impervious surface calculations for entire lot (existing and post construction). ❑ Section 24-66(b) of the Land Development Regulations requires on-site storage for increased run-off if LDCS adding 400 SF or more impervious surface. Provide Delta volume calculations and on-site retention ❑ required per Section 24-66(b). (See attached information sheet.) MEET Recommend Owner/Contractor meet with Public Works Director to discuss proposed construction. ❑ Call 247-5834 to make an appointment. REPM A Revocable Encroachment Permit must be obtained. ❑ RMRO II runoff must remain on-site. Cannot raise lot elevation without measures to retain runoff. ❑ RWPM Right-of-Way Permit must be obtained for use ❑ TSUR Provide a pre-construction topographic survey prepared by a Florida Licensed Professional Land 13urveyor, showing 1' contours. CONDITIONS OF APPROVAL TO PRINT ON PERMIT: II concrete driveway aprons must be 5" thick,4000 psi, with fibermesh from edge of pavement to the DAPR property line. Reinforcing rods or mesh are not allowed in the right-of-way. (Commercial driveways— ❑ 6"thick.) Full erosion control measures must be installed and approved prior to beginning any earth disturbing ECIN activities. Contact Public Works (247-5834) for Erosion and Sediment Control Inspection prior to start of construction. OSRO All runoff must remain on-site during construction. ❑ PCTS If on-site storage is required, a post construction topographic survey documenting proper construction ❑ will be required. PLWP Pool—Wellpoint (if used) must discharge into vegetated area 10' minimum from street or drainage ❑ feature (swale, structure or lagoon). A separate pool permit is required. ROFF Roll off container company must be on City approved list and container cannot be placed on City right- ❑ of-way. (Approved: Advanced Disposal, Realco Recycling, Republic Services, Shappel's and Waste Pro). RWRS Full right-of-way restoration, including sod, is required. URCT Any utility cuts in the road must be repaired using COJ Standard Detail Case X and must be overlaid 10 ❑ eet in each direction from the center of the cut. Repair must be shown on the plans. 7 City of Atlantic Peach RFC-P'TN7FD Building Department EPLICATION NUMBER 800 Seminole Road r gned by the Building Department.) I MAR G 6 2015 Atlantic Beach, Florida 32233-5445 S Djy►/�/`� / �,/ Phone(904) 247-5826 - Fax(904)2 45 y--``yy ((pp I E-mail: building-dept@coab.us _.!= City web-site: http://www.coab.us d: 3 �S I s APPLICATION REVIEW AND TRACKING FORM Property Address' Z_052l a Department review required Yes BVo Building Applicant' Ci �C _ Planning &Zoning �� r✓I U�J�1 V, 'I' Tree Ad � istrator — Prc�Je�'i' Public Work � �-- Public Utilities tt�� Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt of Permit Verified By Date 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. APPLI ATION STATUS Reviewing Department First Review: Approved. []Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewedby: 3 Zfr fS� TREE ADMIN. ate: Second Review: []Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: []Approved as revised. ❑Denied. Comments: Reviewed by.- Date: avised 07/27/90 U//11/2U14 at 1U:U4 At.], Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $35.50 DEED DOC ST $0.70 Recording Requested By: Hess Corporation RECORD &RETURN TO 25417 CT l p�71 ONS Glandal%CA 07209-6077 4001540°c31�r�l Instrument Prepared By: Kirkland&Ellis LLP 601 Lexington Avenue New York,New York 10022 Attention: Taryn Reynolds,Esq. SPECIAL WARRANTY DEED KNOW ALL MEN BY THESE PRESENTS: THAT, Hess Corporation, a Delaware corporation ("Grantor"), formerly known as Amerada Hess Corporation, successor by merger to Hess Realty Corporation, whose mailing address is I Hess Plaza, Woodbridge, NJ 07095, for and in consideration of the sum of TEN DOLLARS(SIO)and other good and valuable consideration in hand paid to the undersigned by Hess Retail Stores LLC, a Delaware limited liability company ("Grantee"), whose mailing address is c/o Hess Corporation, I Hess Plaza, Woodbridge, NJ 07095, the receipt and sufficiency of such consideration being hereby acknowledged, has GRANTED, SOLD AND CONVEYED, and by these presents does hereby GRANT, SELL, CONVEY and CONFIRM unto Grantee that certain real property being more particularly described on Exhibit "A," attached hereto and made a part hereof for all purposes, together with all improvements and fixtures situated thereon(collectively,the"Property");SUBJECT TO all real estate taxes not yet delinquent; covenants, conditions, restrictions, easements, rights of way and other matters of record;applicable laws,ordinances, statutes,orders, requirements and regulations to which the Property is subject;and all matters disclosed by an accurate survey of the Property. TO HAVE AND TO HOLD the Property, together with all and singular the rights, hereditaments,and appurtenances thereto in anywise belonging,unto Grantee,its successors and assigns, in tee simple forever, and Grantor hereby agrees to WARRANT AND FOREVER DEFEND all and singular the Property unto Grantee, its successors and assigns, against every person whomsoever lawfully claiming, or claim the same, or any part thereof, by, through,or under Grantor but not otherwise. Store#09377•2301 Mayport Road,Atlantic[leach FL r � EXECUTED this day of April,2014. Witnesses: GRANTOR: HESS CORPORATION,a Delaware corporate P Vitn s B . Printed Name of First Witness Name:Nicholas P.Brountas Title:Vice President i Address: Second Witness Hess Corporation &-•th V) Associate General Counsel Printed Name of Second Witness I Hess Plaza Woodbridge,NJ 07095 Store#09377•2301 Mayport Road,Atlantic Beach FL STATE OF New York § COUNTY OF New York § On April 0 2014, before me personally appeared Nicholas P. Brountas, personally known to me to be the person who executed the foregoing insimment as the Vice President of Hess Corporation, a Delaware corporation, and acknowledged to me that he executed said instrument for the purposes and consideration therein expressed, and as the act of said corporation. WITNESS my hand and official seal. Notary Public-Slate of Printed Name My conunission expires: [Notary Seal] APRIL$A9state 01 oW York Notary PUd�c• O1A950309c County Store N09377-2301 Mayport Road,Atlantic Beach FL Exhibit A Tax ID No. (legal description) A portion of Government Lot 7, Soction 8, Township 2 South, Range 29. Elt9t, Duval County, Florida, being more particularly described as follOMe: Vor a point of reference COMMBNCB at the Nortrhwest corner of Fairway Vill&$ as recorded in Plat Book 79, pagan 32 and 22h of the Current Public Records of said Countyl thence North 01'42110" hest, 810nq the Easterly right of way line of Hayport Road (State Road AIA, a 100.00 f00t right of way) a distance of 50.00 feet t0 the POINT OF BEGINNING) thence continue along said Easterly right of way line North 01'42110' west, a distance of 270.00 feetto a point s1-tptate on said Easterly right of dray Liner thence North 88'17'50` East, 30o.00. feet; thenga South 01'42'10" East .270.00 feet$ thence South 88'17'50." West 300.00 feet to the Point of Beginning. "GETROR WITH the easement rights granted to Grantdt in instrument recorded..at- Official Records Volutait-6111, page 148, current public records. of Duval.County, Florida. Store 409377-2301 Mayport Road,Atlantic Beach FL l LEGAL DESCRIPTION: ALL THAT CERTAIN LOT, PIECE OR PARCEL OF LAND, WITH THE BUILDINGS AND IMPROVEMENTS THEREON ERECTED, SITUATE,LYING AND BEING IN THE CITY OF JACKSONVILLE,COUNTY OF DUVAL, STATE OF FLORIDA. TRACT I: FEE SIMPLE A PORTION OF GOVERNMENT LOT 7, SECTION 8,TOWNSHIP 2 SOUTH, RANGE 29 EAST,DUVAL COUNTY,FLORIDA,BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS: FOR A POINT OF REFERENCE COMMENCE AT THE NORTHWEST CORNER OF FAIRWAY VILLAS AS RECORDED IN PLAT BOOK 39, PAGES 22 AND 22A OF THE CURRENT PUBLIC RECORDS OF SAID COUNTY; THENCE NORTH 01°42'10" WEST,ALONG THE EASTERLY RIGHT OF WAY LINE OF MAYPORT ROAD (STATE ROAD AIA,A 100.00 FOOT RIGHT OF WAY)A DISTANCE OF 50.00 FEET TO THE POINT OF BEGINNING; THENCE CONTINUE ALONG SAID EASTERLY RIGHT OF WAY LINE NORTH 01042'10" WEST,A DISTANCE OF 270.00 FEET TO A POINT SITUATE ON SAID EASTERLY RIGHT OF WAY LINE;THENCE NORTH 88° 17'50" EAST,300.00 FEET;THENCE SOUTH 01'42' 10" EAST 270.00 FEET;THENCE SOUTH 880 17' 50" WEST 300.00 FEET TO THE POINT OF BEGINNING. TRACT II: EASEMENT TOGETHER WITH THE EASEMENT RIGHTS GRANTED TO GRANTOR IN INSTRUMENT RECORDED AT OFFICIAL RECORDS VOLUME 6411,PAGE 148, CURRENT PUBLIC RECORDS OF DUVAL COUNTY,FLORIDA. Property Appraiser - Property Details Page 1 of 2 HESS RETAIL STORES LLC Primary Site Address Official Record Book/Page Tile# 1 HESS PLAZA 2321 MAYPORT RD 16841-01445 9408 WOODBRIDGE, NJ 07095 Atlantic Beach FL 32233 2321 MAYPORT RD Property Detail Value Summary RE# 169398-0410 2014 Certified, 2015 In Progress Tax District USD3 r Value Method CAMA CAMA Property Use 1493 STORE,CONV.PREFAB GAS Total Building Value $158,286.00 $3,989.00 #of Buildings 1 Extra Feature Value $23,438.00 $23,438.00 08-2S-29E 1.85 Land Value(Market) $445,500.00 $445,500.00 Legal Desc. PT GOVT LOT 7 RECD r Land Value(Agric.) $0.00 $0.00 Subdivision 00000 SECTION LAND Just(Market)Value $627,224.00 $472,927.00 Total Area 80350 Assessed Value $627,224.00 $472,927.00 The sale of this property may result in higher property taxes.For more information go Cap Diff/Portability Amt $0.00/$0.00 $0.00/$0.00 to Save Our Homes and our Property Tax Estimator.'In Progress'property values, Exemptions $0.00 See below exemptions and other supporting information on this page are part of the working tax roll and are subject to change.Certified values listed in the Value Summary are those Taxable Value $627,224.00 See below certified in October,but may include any official changes made after certification Learn how the Property Appraiser's Office values property. Taxable Values and Exemptions—In Progress If there are no exemptions applicable to a taxing authority,the Taxable Value is the same as the Assessed Value listed above in the Value Summary box. County/Municipal Taxable Value SJRWMD/FIND Taxable Value School Taxable Value No applicable exemptions No applicable exemptions No applicable exemptions Sales Hist�or r _ Book/Page Sale Date Sale Price Deed_Instrument Type Code Qualiffied[Unqualified Vacant/Improved 16841-01445 4/24/2014 $100.00 SW-Special Warranty Unqualified Improved 06641-01920 1/4/1989 $285,000.00 SW-Special Warranty Unqualified Improved Extra Features LN Feature Code Feature Description Bldg. Length Width Total Units Value I 1 PVAC1 Paving Asphalt 1 0 0 21,791.00 $13,042.00 2 PVCC1 Paving Concrete ( 1 10 10 2,821.00 $3,216.00 3 I LPMC1 Light Pole Metal 11 0 0 6.00 $2,229.00 4 I LITC1 (Lighting Fixtures ( 1 ,0 0 16.00 $1,122.00 5 WMCC1 Wall Masonry/Concrt 1 10 (0 1,924.00 $3,829.00 Land &Legal Land Legal LNf Code Use Description Zoning Front Depth Category Land Units Land Tvce Land Value LN Legal Description 1 1000 COMMERCIAL ACG 0.00 0.00 Common 81,000.00 Square Footage $445,500.00 1 08-2S-29E 1.85 12 PT GOVT LOT 7 RECD 3 1 O/R 16741-1445 Buildings Building 1 Building 1 Site Address Element Code Detail 2321 MAYPORT RD Atlantic Beach FL 32233 Exterior Wall 16 i 16 Frame Stucco Roofing Structure ( 10 10 Steel Fr/Trs Building Type 1403-STORE PREFABGASA Roofing Cover (4 4 Built Up/T&G Year Built 1989 I Interior Wall 18 8 Decorative Cvr Building Value $3,989.00 I Int Flooring 11 11 Cer Clay Tile I Heating Fuel '4 4 Electric L���C�` T h Type Gross Heated ' Effective I Heating Type 14 4 Forced-Ducted Area Area Area Air Conditioning 4 4 Packaged Unit Base Area 325 325 325 1 Ceiling Wall Finish 5 5 S Ceil Wall Fin Canopy 1440I 0 432 ( Comm Htg&AC ( 1 I 1 Not Zoned Detached i ;Comm Frame 5 5 S-Steel http://apps.coj.net/pao_propertySearch/Basic/Detail.aspx?RE=1693980410 3/23/2015 ATLANTIC BEACH BUILDING DEPT. ' ..i DEMOLITION — PROPERTY OWNER !f "�r RELEASE FORM Date: To Whom It May Concern: I /We the current property owners of: Lot 7 Block c�'-j z /c3•�J.0 �'/ijp Legal Desafplion of Property IV AKA o P have contracted with to have (Andress operty) f /' .0'. FL /t 4:�"C2L I o remove the ( ompany Mom) (Skgle Fatuity,Duplex,Commerclal,etc.) Prior to the construction of: ? er /� .-5 r'o- 4 -e 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 pla e. 3-.2d -% e Signature THIS SPACE FOR RECORDER'S USE ONLY OWNER Signed: pate: 3-ao-I! Before me Nis :(O day of A-tdue.e . . in[he firA,6 �-Ey-6 c-'&5-,v4 Hf {e+rieM,lays personally appeared^C�1^s�r ._ Yv,.e z ,DII u(ry;>+ Naary Public at L.vgc, '. Uig I-.#0. My commission expires: q'v� ' !"7 Personally Kno%m: v' _ _ _ or Produced Identification: -- STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 A �.� 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 LANEY,ASHLEY T THE LANEY COMPANY 2905 CORINTHIAN AVE #3 JACKSONVILLE FL 32210 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range: STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, #—' DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFESSIONAL REGULATION Every day we work to improve the way we do business in order to CUC1224248 ISSUED: 08/20/2014 serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information CERT UNDERGROUND&EXCAV CNTR about our divisions and the regulations that impact you, subscribe LANEY,ASHLEY T to department newsletters and learn more about the Department's THE LANEY COMPANY initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! Expiration date AUG 31 2016 L1408200001951 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CUC1224248 The UNDERGROUND UTILITY 8 EXCAVATION CO Named below IS CERTIFIED fig. Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 LANEY,ASHLEY T THE LANEY COMPANY ti 2905 CORINTHIAN AVE i #3 ' JACKSONVILLE FL 32210 �• .1 ISSUED: 08/20/2014 DISPLAY AS REQUIRED BY LAW SEa# L1408200001951 AC"R ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDO/YYYY) ��. 19/19/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsenlen s . PRODUCER CONTACT NAME: Sherri Barrett All Lines Insurance Agency, Inc. PHONE904-384-0783 1AICFAX 904-384-0550 4828 Blanding Blvd Suite 1 -MAIL Jacksonville FL 32210-7390 sbarrett@all-lines.com INSURER(S) AFFORDING COVERAGE NAIL 8 INSURER A:Southem-Owners Insurance Co 10190 INSURED INSURERB:SOUthem Insurance Company 19216 The Laney Company, LLC INSURERC:Travelers Insurance Company 2905 Corinthian Ave#3 Jacksonville FL 32210 INSURER D: INSURER E: INSURER F: COVERAGES _CERTIFICATE NUMBER:2119855231 _ _ REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR rypE OF INSURANCE POLICY EFF POLICY EXP L N WVD POLICY NUMBER MMIDDIYYYY MMID LIMITS A X C.OMMERC1ALGENERALLIABILITY 78115152 0/5/2014 1015/2015 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTE15- CLAIMS-MADE Lx] OCCUR PREMISES Ea occurrence $300,000 X Hired Auto MED EXP(Any one person) $10,000 X Non-Owned Auto PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 JFE O. LOC PRODUCTS-COMP/0P AGG $2,000,000 POLICY� OTHER: HMO Auto $1,000,000 AUTOMOBILE LIABILITY Ea accident $ _ ANY AUTO BODILY INJURY(Per person) $ ALLOOWNED SAUTEDULED - BODILY INJURY(Per accident) $ NON-OWNED $ HIRED AUTOS AUTOS (Per accident) $ A X UMBRELLALIAe X OCCUR 4413801802 0/5/2014 10/5/2015 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED i X I RETENTION$10,000 $ B WORKERS COMPENSATION PWC009197-14 19/2014 /19/2015 X PTT H AND EMPLOYERS'LIABILITY Y/N E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED?ANY PROPRIETOR/PARTNER/EXECUTIVE ❑NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $1,000,000 H yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Equipment 6604708X287 4/2014 4/2015 Rented/Leased 200,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLM CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Atlantic Beach ACCORDANCE WITH THE POLICY PROVISIONS. 800 Seminole Rd Atlantic Beach FL 32233-5444 AUTHORIZED REPRESENTATIVE �- 'z. ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD TREE & VEGETATION AFFIL' 4 VIT 1.st, City of Atlantic Beach r Department of Community Development Planning&Zoning Division 800 Seminole Road Atlantic Beach,FL 32233 �"J'f1>'' (P)904 247-5800 (F)904 247-5845 PERMIT# SECTION 1-APPLICANT INFORMATION (— Owner(s) /Legal Authorized Agent* NAME OF APPLICANT AWey L,--,,'4 NAME OF COMPANY l Lq J �jy„� - L Le/ ADDRESS OF COMPANY PHONE qoq-)b 1- 7%1'tELL EMAIL CONTRACTOR CERTIFICATION NUMBER ATLBCH BUSINESS TAX RECEIPT NUMBER SECTION II-SITE INFORMATION � STREET ADDRESS OF PROPERTY o� q�����• If an address has not been assigned to this property,contact the AB Building Department at(904)247-5826 to request an address. LEGAL DESCRIPTION LOT BLOCK jBDIVISION REAL ESTATE NUMBER LOT OR PAR SIZE: SQ FT AC RESIDENTIAL COMMERCIAL OTHER(SPEC' 1 affirm that I have reviewed the provisions of Chapter 23, "Protection of Trees and N Vegetation" of the Municipal Code of Ordinances for the City of Atlantic Beach, FL and/or I have participated in a pre-applicc neeting with the Administrator of those regulations. Subsequently,I affirm that no regulated trees and no regulated vegetation )e damaged,destroyed and/or removed from the abov - scribed o adjacent properties in conjunction with this project. lac � .��..� TUR ER SIGNATURE OF OWNER Signed and sworn before me on this)q day of c f l apl� State of,by (� ��CSY r c, County of _b" :1 Identification verified: v'1 Oath sworn: r— Yes No Efp%j Notary Public State of Florida 1�ly�ignature Beth-Ann K Werre ` My Commission EE 111 82 Expires 03/25/2016 My Commission expires: /'' THE LANEY COMPANY LLC Ak rl, -,t CARTM WORK UTI LITIC9 PAVING 2905 Corinthian Ave. #3 Jacksonville, Fl 32210 904-389-6752 F:904-381-9125 March 24th, 2015 Atm: Jenny Walker Atlantic Beach Building Department Permitting 800 Seminole Road Atlantic Beach, FL 32233 Jenny, Here are the documents and the site plan for the Demolition of the existing Hess station on Mayport road. Than sh e r r, �S �rfr Ny, - :. PNI ENVIRONMENTAL 'w= Risk Well Manacled r -mrir«iit�� ntal cox rli)IilE'l I'I?l :] Ivir.,cs N-itior7���licle i t Yl • x Old F 1" , f � ry i. µ IN M MWO fi i ENVIRONAiENTAL SERVICES BUILDING ARC�IITECTURf, BNGINffRlNG�SCIENC� PRE-DEMOLITION ASBESTOS DUSTRIAL"YGIENEsEvlCEs CONTAINING MATERIALS SURVEY BROWNFIELI)S ECONOMIC INCENTIVES,CONSULTING 2321 Mayport Road Atlantic Beach, Florida = PM Project Number 18-3242-2 Prepared for: CDA Holdings, LLC One Columbus Center, Suite 600 Virginia Beach, Virginia 23462 ..................... ....................... ...........: Prepared by: Know Your Risk. Take Control, PM Environmental, Inc. Work with the Experts. 2131 Hollywood Boulevard, Suite 503 Hollywood, Florida 33020 www.pmenv.com ' Tampa Miami Orlando PM 4897 W.Waters Ave., 2131 Hollywood Blvd., 801 International Pkwy., Suite C Suite 503 Suite 500 Tampa,FL 33634 Hollywood,FL 33020 Lake Mary,FL 32746 ENVIRONMENTAL f:877.884.6775 f:877.884.6775 f:877.884.6775 Risk Wet( Managed t:813.731.1177 t:954.924.1801 t:800.313.2966 November 12, 2014 Mr. D. Richard Bushey CDA Holdings, LLC One Columbus Center, Suite 600 Virginia Beach, Virginia 23462 Re: Pre-Demolition Asbestos Containing Materials Survey For the Proposed Dollar Tree Property Located at 2321 Mayport Road in Atlantic Beach, Florida PM Environmental, Inc. Project No. 18-3242-2 Dear Mr. Bushey, PM Environmental, Inc. (PM) was retained by CDA Holdings, LLC to perform a NESHAP compliant Asbestos Inspection of the Proposed Dollar Tree property located at 2321 Mayport Road in Atlantic Beach, Florida that is scheduled for demolition. The inspection for asbestos containing materials (ACM) was performed in accordance with 40 CFR 61 (NESHAPs or National Emissions Standards for Hazardous Air Pollutants) and followed the sampling requirements specified in 40 CFR 763 (AHERA or the Asbestos Hazard Emergency Response Act) in preparation for the building's demolition/renovation. Ms. Candace E. Chin Fatt (AHERA Certified Building Inspector, Certification No. 156256) of PM inspected the buildings and collected samples on August 15, 2014. AHERA considers "Asbestos Containing Materials" or ACM as materials containing more than one percent asbestos. According to NESHAP, all friable regulated asbestos-containing r materials (RACMs) must be removed from a facility being demolished or renovated before any wrecking or dismantling that would break up the materials. RACM is defined as friable asbestos containing material or materials that may become friable if subjected to sanding, grinding, cutting, or abrading during demolition. RACM also includes asbestos containing materials with a high possibility of becoming crumbled, pulverized, or reduced to a powder during construction. ACM, which is determined to be non-friable asbestos containing material, must be classified as Category I or Category II non-friable asbestos. This classification then determines, based on handling procedures, whether the material must be removed prior to renovation or demolition and the preferable means to remove the ACM. The subject property is occupied by an approximate 900 square foot single-story convenience store building and an approximate 325 square foot storage and restroom building. The convenience store interior consists of ceramic tile floor, metal sheet and gypsum board panel walls, and suspended ceilings (ceiling tile) present throughout the building. The interior of the storage and restroom building consists of ceramic and vinyl floor tile, gypsum board walls, and suspended ceilings (ceiling tile). The exterior of both buildings consists of poured concrete and cinderblock walls with a flat membrane rolled asphalt roof. ASBESTOS SITE INSPECTION/METHODOLOGY According to AHERA, suspect asbestos containing materials are categorized as thermal, surfacing, or miscellaneous materials. AHERA requires that at least three samples of thermal ENVIRONMENTAL i£ ENGINEERING SERVICES NATIONWIDE I WWW.PMENV.COM 1 1.800.313.2966 Pre-Demolition Asbestos Inspection for the Proposed Dollar Tree Property Located at 2321 Mayport Road in Atlantic Beach,Florida PM Environmental,Inc.Project Number 18-3242-2,November 12, 2014 materials (i.e. pipe wrap) must be collected and analyzed. Surfacing materials (i.e. plaster, textured ceiling material, fireproofing, etc.) samples need to be collected according to the quantity present. If less the 1,000 square feet is present, a minimum of three bulk samples must be collected and analyzed. If between 1,000 and 5,000 square feet is present, a minimum of five bulk samples must be collected and analyzed. If greater than 5,000 square feet of the material is present, a minimum of seven samples needs to be collected. According to AHERA, Miscellaneous materials (i.e. floor tile, mastics, roofing materials, drywall, ceiling tile, etc.) need to be sampled "in a matter sufficient to determine"which is determined by the inspector. PM collected samples of suspect ACM throughout the entire building. PM entered all accessible areas and performed visual inspection for suspect materials as well as performed some invasive inspection into wall and ceiling cavities. Sampling for ACM was conducted within homogenous areas, defined as suspect asbestos containing building materials that appear to be similar based on color, texture, and date of application or installation. i ASBESTOS SURVEY RESULTS PM collected a total of 48 samples from 16 different homogenous areas. The samples were placed inside laboratory provided sealed bags and submitted to EMSL Analytical, Inc. of North Miami Beach, Florida under chain of custody for Polarized Light Microscopy (PLM) laboratory analysis. Analytical results are attached. Results are summarized below: Table No. 1: Summary of Asbestos Bulk Sample Results Sample Id. Material Type Location Condition Estimated %Asbestos No. Quantity HA1:1-3 Floor Tile-Green Interior— GoodNone Convenience store 100 SF Detected i Interior— None HA2:1-3 Floor Tile-White Convenience store Good 600 SF Detected j HA3:1,1 A,2 Floor Tile—Tan and Interior— Good 200 SF None 12A,3,3A Mastic Convenience Store Detected HA4:1-3 Ceiling Tile Entire Interior— Good 900 SF None Convenience Store Detected HA5:1-3 Tile Grout Entire Interior— Good 900 SF None Convenience Store Detected HA6:1-3 Baseboard Mastic Sales counter Good 25 LF None Detected HA7:1-3 Roof Roof—Convenience Good 900 SF None store Detected HA8:1-3 Gypsum wallboard Entire Interior— Good 1,400 SF None Convenience store Detected i PM Environmental,Inc. Page 2 ` i Pre-Demolition Asbestos Inspection for the Proposed Dollar Tree Property Located at 2321 Mayport Road in Atlantic Beach,Florida PM Environmental,Inc.Project Number 18-3242-2,November 12,2014 Sample Id. Material Type Location Condition Estimated %Asbestos No. Quantity HA9:1,1A,2 Concrete brick and Exterior Wall Good 700 SF None 12A,3,3A grout Detected HA10:1-3 Roof Roof--Storage and Good 325 SF None bathroom building Detected HA11:1-3 Ceiling tile Storage Room Interior Good 125 SF None Detected HAl2:1,1A, Floor Tile—grey and Bathroom Interior Good 200 SF None 2,2A,3,3A Mastic Detected HA13:1-3 Gypsum Wallboard Storage Room and Good 900 SF None Bathroom Interior Detected HA14:1,1A, Vinyl Floor Tile and Storage Room Good 125 SF None 2,2A,3,3A Mastic Detected HA15:1-3 Floor Tile Grout Bathroom Good 200 SF None Detected HA16:1,1A, Concrete Brick and Exterior Wall—Storage None 2,2A,3,3A Grout and Bathroom Building Good 820 SF Detected Notes: HA—Homogenous Area;LF-Linear Feet;SF—Square Feet The highest percentage of asbestos Identified by the laboratory was reported within the table. The results of the laboratory datasheets indicate that none of the sampled and analyzed suspect ACM was identified to contain asbestos in concentrations that exceed the analytical method detection limits. As noted in the summary table, the suspect ACM was also assessed to be in good condition at the time of the inspection. CONCLUSIONS AND RECOMMENDATIONS: i Based on the results of the ACM Survey, the following conclusions and recommendations were identified and are presented below. • A total of 48 bulk materials samples from 16 separate homogeneous areas of suspect ACM were identified during the conduction of the survey. Analytical results showed all sampled building materials to be non-asbestos containing. PM notes that if additional materials that could be considered suspect ACM are identified during demolition activities, that these materials should be sampled to determine their characteristics (i.e. whether they must be treated as ACM or not) or presumed to be ACM and handled accordingly prior to their removal and disposal. PM's reporting of quantities of materials are to be interpreted as good faith estimates for contractors inspecting and bidding on project abatement and/or demolition activities; however, contractors should use their own estimates of material quantities as a basis for their project cost estimates. PM Environmental,Inc. Page 3 Pre-Demolition Asbestos Inspection for the Proposed Dollar Tree Property Located at 2321 Mayport Road in Atlantic Beach,Florida PM Environmental,Inc.Project Number 18-3242-2, November 12,2014 This report has been reviewed for its completeness and accuracy. Please feel free to contact our office at (954) 924-1801 to discuss this report. REPORT PREPARED BY: REPORT REVIEWED BY: PM Environmental, Inc. PM Environmental, Inc. (a�-- - - J rr't 4., Candace E. Chin Fatt Jon M. Balsamo Project Manager Manager- Industrial Hygiene Services Certification No. 156256 ;; .r 46004_ John M. Stump, P.G. Florida Licensed Asbestos Consultant FLAC No. AX42 APPENDICES Appendix A: Photo Log Appendix B: Laboratory Analytical Data and Chain of Custody Documentation Appendix C: Inspector Building Inspector Certificate Appendix D: Florida Asbestos Consultant License Appendix E: Laboratory NVLAP Certification f i i PM Environmental,Inc. Page 4 Appendix A 3 I Environmental 1 , & Engineering PAR ENVIRONMENTAL Services PARPhotographs From Site Reconnaissance ti PM Project No. 18-3242-2 ENVIRONMENTAL. Location: 2321 Mayport Road, Atlantic Beach, Florida Photograph 1 � 1 F t d � „� = Interior view of the subject properly. t f Photograph 2 f nc � � t l VERT.. ,rna��9'il C �3 r dfr j View of the floor tile at the subject property. 3 f•- �r Photographs From Site Reconnaissance PM Project No. 18-3242-2 ENVIRONMENTAL Location: 2321 Mayport Road, Atlantic Beach, Florida Photograph 3 CSV F Interior view of the subject property. 'a s d FF i Photograph 4 I� i IN lr View of ceiling at the subject property. � , afs•J 3�- PARPhotographs From Site Reconnaissance PM Project No. 18-3242-2 ENVIRONMENTAL Location: 2321 Mayport Road, Atlantic Beach, Florida Photograph 5 ;7 it r a+r View of the roof at the subject property. i Photograph 6 i Storage and Bathroom building at the subject - property. r 1 I I Photographs From Site Reconnaissance 0 PM PM Project No. 18-3242-2 ENVIRONMENTAL Location: 2321 Mayport Road, Atlantic Beach, Florida Photograph 7 M I� I Interior view of the bathroom at the subject property. rr a `J��w��f ��lj�tn f' �+") r,! �`•�i�"✓"�3�!Y ikp (y rys+ rt f, r "fi.,,• Tr,��"�-' �.� ?7:r�.rr „'s'.•t�� �����kY�"n �.?� ""'k�,!.�"-�;,��i �-_.k;2,�".X ,� Photograph 8 Interior view of the storage room at the subject property. i i i STATE OF FLORIDA `\ DEPART.%MN']' Or At7�INSOy AND 1'E201~'IaUSIOt7AL REGULATION J ASBESTOS LICENSTM TMIT (85n) 4ft7-1395 1940 NORTH MONRQi'R STREET TALLAHASSEE rL 33399-0783 gTiTMtP, JOAN N 26919 LAKE LENA f,ANE MUUNT DflRA FL 32_ / STATE orrLORIDA CongrslulAions! V'/jUn this license you beonms me of the neary one rrillicn � � DEPARTMENT OF: BUSINESS IWD Fiuiitllaos lctl�su�!by the De _,it 19usineti:>ifd Pl:n`zssipa�l Regut�ticn. l �1 PR0FESS1g1.JAL REGQLATICN Our professioriais and bus'nessN range from arehitaets to yacht brekors<from t tomirs to harbarx'm ra8}auaan s,and that'kF);p Flari:la`s econ3my strong. / A 127017,1350 Every day we vrork b�lnprvC the%vay Ire do bvsin+as in crdor to serve you tettar. `_ • For uifr(matinn About our san'iCa:s, Se li)g orit)tvwvi.myfloridaGcense.com ASBESTOS.f -!0 There you can rind mora irifurtna:ion about our derisbris and the rectalations that STIRIP, Impact•ym,suhscri0e to iiep2rtmant neivs attars and team mare about the Da arlmenYs inilvGves. - f`" Our missicrt at the Oepartrient is:Licersa Efficiently,Rsq late Fairly.We wilblaully Mtivm to milut%you t)Cltnl 266)thm ytu romi buivil yuuf I.Ustortlers, r,5, �,ICB i$t't) UA,*t the pgovisioas o.0.464 FS- Thank you l for Bring business in Florida,and rrngratui2Uons nn your new3r-an-int rsplYa-:nb d :e: HUV_ i! 2014 1,:d1U15417ti1 E i i i t Ii i DETACH HERE 7 5TATE OF FLORIDA { AC# ��i � DLPART•DENT OFpp ,iNSS t�j�pp PROFESSIONAL GUI TION I S .. "' VS 0S LIGBNSING UNIT SEQ#L121t326[t27b� LICtgov NBA; 10/26 2012 112701785o AX00000425 The._ASEESTOS 'CONSMTANT f _ Naned_ below YS LICENSED Under fare proviaiona of Chaptik'x 469 F8 Bxpiratioia date: NOV 30, 2G14:` STUMR, JOHN.bt 2 6 919..LAKE LEM LANE t MOUNT voRA RICK. `SCOTT KEN LAWS OI j GOVERNOR DISPLAY AS REOUIRED BY LAW SECRETARY Appendix E { 1 , i - Environmental & Engineering M4 Services ENVIRON ENTAL o o LO c U CDI N N ° ® it CJ ro o U oN j 72 V ° � W E E � ® o ` ° row �, V � �O u U.Q'� U C � o f: N w r� p N ® ® A y, P CL Cf) �y ro CU N C z U U o W Com'b ro b W ro o L o rW N V eAINSAT OF 00 Voluntary LfL,Nati,onal Laboratory Accreditation Program STa rEs of SCOPE OF ACCREDITATION TO ISO/IEC 17025:2005 EMSL Analytical,Inc. Skylake Executive Industrial Park 19501 N.E. 10th Ave., Bay A N. Miami Beach, FL 33179 j Ms. Kimberly A. Wallace I Phone: 305-650-0577 Fax: 305-650-0578 E-Mail: kwallace@emsl.com URL: http://www.emsi-com AIRBORNE ASBESTOS FIBER ANALYSIS (TEM) NVLAP LAB CODE 200204-0 NVLAP Code Designation/Description 18/A02 U.S. EPA's "Interim Transmission Electron Microscopy Analytical Methods-Mandatory and Nonmandatory-and Mandatory Section to Determine Completion of Response Actions" as E found in 40 CFR,Part 763,Subpart E, Appendix A. I i i 2014-04-01_ through 2015-03-31 Effective dates For the National Institute of Standards and Technology Page I of 1 NVLAP-OiS(REV.2005-05-19) o ' 0 1 o fi U LO C N ` Q L to O � ro N CU o o V _ o cC� ® dt ocua O N ® N 00 C Q PQ o W fes.. ja ■® C, Rj "-� � Q � Nay�,� "yy , '` y cn CO US cn a � M C C GQ roc o O ; N Z � SEN o � Tull �t � U � W t)�v OF 00 National Voluntary all Laboratory Accreditation Program SCOPE OF ACCREDITATION TO ISO/IEC. 17025:2005 E MSL Analytical, Inc. Skylake Executive Industrial Park 19501 N.E. I Oth Ave., Bay A N. Miami Beach, FL 33179 Ms. Kimberly A. Wallace Phone: 305-650-0577 Fax: 305-650-0578 E-Mail: kwallace@ernsl.com URL- littp://www.emsl.com BULK ASBESTOS FIBER ANALYSIS (PLM) NVLAP LAB CODE 200204-0 NVLAP Code Designation/Desctiption I 81A0 I EPA 600/M4-92-020: Interim Method for the Determination of Asbestos in Bulk Insulation Samples 18/A03 EPA 600/R-93/116:Method for the Deterrr�ination of Asbestos in Bulk Building Materials 2014-04-01 through 2015-03-3 t Effective dates For the National Institute of Standards and Technology Page I of I NVLAP-01 S(REV,2005-05-19) Arlington, Daniel From: Dan Arlington [darlington@sjcfl.us] Sent: Tuesday, December 30, 2014 11:46 AM To: Arlington, Daniel; danarlington@comcast.net Subject: FW: Building Officials Association of Florida 2015 Membership Renewal Invoice From: Celeste Roman [mailto:CelesteCcbboaf.net] Sent: Thursday, November 20, 2014 9:14 AM To: Dan Arlington Subject: Building Officials Association of Florida 2015 Membership Renewal Invoice v11�G 0FF1�,I 2015 Membership Dues Invoice Aql Federal ID No. 59-1831377 B Member ID Number: 2394 A _ F �ti4 Current Membership Expires: OCJ�TION OF �1'� 12/31/2014 Building Officials Association of Florida Statement Date: 11/20/2014 3697 Lake Emma Rd Lake Mary,FL 32746 Purchase Order Number: Below is your primary contact information. Please verify and note any changes (or attach business card): Daniel J Arlington St. Johns County 4020 Lewis Speedway St. Augustine, FL, 32084 Work Email: darlington sicfl.us Home Email: Work Phone: 9048276834 Other Phone: Fax: 9048276849 Annual Membership Dues Category Amount Due BOAF State Membership Active $50.00 Add ICC Membership N/A $0.00 Chapter Membership N/A $0.00 Total Due for 2015 $50.00 Payment: Check Check No. Visa Card No. MasterCard Expiration date Please fax credit card payment to 407-804-0308 or email to tiackson@boaf.net Or print and return this copy with payment for proper processing,to: Building Officials Association of Florida, 3697 Lake Emma Road, Lake Mary FL 32746 2