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1175 Atlantic Blvd temp tralr 2015CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD r) .r ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 COMMERICAL ALTERATION/OTHER MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: ]Ob ID: 15-COTH-611 Job Type: COMMERCIAL OTHER Description: CONSTRUCTION TRAILERS FOR URBAN FARMS Estimated Value: $5,000.00 Issue Date: 3/31/2015 Expiration Date: 9/27/2015 PROPERTY ADDRESS: Address: 1175 ATLANTIC BLVD RE Number: 170709-0000 PROPERTY OWNER: Name: Address: ROBBINS NEST FARMS LLC, 1560 SELVA MARINA DR GENERAL CONTRACTOR INFORMATION: Name: CISSEL & COMPANY Address: 2554 Philips HWY Phone -904-759-4312 PERMIT INFORMATION: FEES: BUILDING PERMIT FEE $75.00 STATE DCA SURCHARGE $2.00 PLAN CHECK FEES $37.50 STATE DBPR SURCHARGE $2.00 Total Payments: $116.50 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC: BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. City of Atlantic Beach Building Department " �_ 800 Seminole Road Of) Atlantic Beach, Florida 32233-5445 Phone (904) 247-5826 - Fax (904) 247-5845 E-mail: building-dept@coab.us Cityweb-site: http://www.coab.us APPLICATION NUMBER (To be assigned by the Building Department.) Date routed: APPLICATION REVIEW AND TRACKING FORM Property Address: - I --1s �fiCan�i " Applicant: fil +— CLQ Project: 4 T-cY» { Ckk %S Review fee $ V D ment review required Yes No tanning &Zoning Tre Public Works Public Utilities Public Safety Fire Services Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATl1S Revised 07/27/10 Reviewing Department First Review: [�pproved. ❑Denied. (Circle one.) Comments: BUILDING LZONING Reviewed by' Date: TREE ADMIN. 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: Revised 07/27/10 City of Atlantic Beach -; Building Department 800 Seminole Road Atlantic Beach, Florida 32233-5445 Phone (904) 247-5826 • Fax (904) 247-5845 �;si" E-mail: building-dept@coab.us City web -site: http://www.coab.us APPLICATION NUMBER (To be assigned by the Building Department.) Date routed: APPLICATION REVIEW AND TRACKING FORM ► I -�� ��C anti �I �° PropertyAddress: rtment review required Yes No 11 Buildin Applicant: CSSr/I +— C�� Planning Zoning Project: L'}' -T-00? -� Public Works C A Public Utilities 1 ` WV Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: �pproved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING & ZONING Reviewed by: c TREE ADMIN. Second Review: ❑Approved as revised. [—]Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: FIRE SERVICES Third Review: DApproved as revised. ❑Denied. Comments: Reviewed by: Revised 07/27/10 Date: Date: i s - BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: 4 T -Z-41,177 C B LYD Legal Description 5u< ", /Z. 94 /3-rEcTo.,/ "/� 1""V D Valuation of Work $ 5.000 Permit Number: lvva t iivu vi �'•— -• Proposed Work heated/cooled non-heated/cooled Class of Work (circle one): New Addition Alteration Repair Use of existing/proposed structure(s) (circle one): If anexisting structure, is a fire sprinkler system cos�C�omme�cia one): Florida Product Approval # For multiple products use product approva orm 7--PI-1,001e,49-y � T�1_Z1CJ Move Demolition pool/spa window/door Residential Yes/A Describe in detail the type of work to be F, -)/Z /h/D 6;p&C.A 7 •oN S Property Owner Information: V) lCoalz �,fo ) eT Sy/ ( 8) ,CT Name:9041 /S WIJ7 t4`�4N 4 • L • e• Address: 1960 SEL vA MgAII /,1 3 D2/ 4/ City 47ZAt,/77c- ekAg4 State/"'--LZip 3 -xi -33 Phone 9oS/ 694 7573 E -Mail or Fax # (Optional) L n /� Contractor Information: S? e ✓-� Q 4, Company Name: C155 E C �` tc�t�P�� y Qualifying Agent: S7PH1 �� C/SSE L Address: 299`1` P6,/ � �✓4 Cit' ./4-cie- oWrI/1-c State �c Zip 3'A -'x-07 Office Phone 9,oY- 6 83 - SISSJ Job Site/ Contact Number qi?V - 7SY- Y 3 / _- Fax # 9oN- X39- -915Y State Certification/Registration # C& C 010/73 Architect Name & Phone # Sco f F24St!'2 p690 y ,s 7/ • Z3 73 fht oo/ 3o p i Engineer's Name & Phone # -✓RE LEE P6 ya y/ 3 ly 35/ 8 Fee Simple Title Holder Name and Address Avio /f ^/4.4- Av-f Z;4:4 1'5 60 .ftp✓� stiisrrt l�9 De. AT/ C1+- A Bonding Company Name and Address Mortgage Lender Name and Address N Application is hereby made to obtain or a permit to do the work and installations as indicaS.ted. 1 certify that no work or installation has commenced prior to the issuance of a permit and that all wcto ork will be perfoin rmed to meet the standards of all laws rpegulating construction in this jurisdiction(. This permit becomes null work �s� omwork menced.ot I understand tii hat separate permme ce its must bn ns e secured for Electrical Workl Plumb ng or abaer ndonSign , aWells, P ols,XFurnaces monthsBoilerat ys tHeaime iers, Tanks and Air Conditioners etc. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE O COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPRO ENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CO6 WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR ICE OF COMMENCEMENT. .. I here b 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 of work will be complied with whether sped ted herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other federal, state, or local law regulat^g construction or the performance of construction. / lI A I Signature of Owne1i ✓i dpi Signature of Contracto Y� /i/, ER J. ST iii Print Name S.! CISS ��` � •••• �� Print Name S R • CtSSE..- •O� 0t�ber 1J Fi o t Sworn, to and subscribed befo me = �� �'o� �, : Sworn to and subscribe e this Day of 100( Ir,tt^ = * 2� (� ; * = this _Ltp Day of L fj FF 048870 AkkN tary Publ %C �Ao\���`` Notary ubl CI'T'Y OF ATLANTIC BEACH OWNER / BUILDER AFFIDAVIT 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING' REQUIRES OWNER / BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 4}{9.103(7), FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO 13E DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU, AS THE OWNER OF YOUR PROPERTY, TO ACr AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT RAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE — OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF 525,000.00 OR LESS, THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT 41AY NOT 13E BUILT FOR SALE: OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL. PRESUME THAT YOU BUILT IT FOR SALE OR LEASE. WHICII IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE: ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. TT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE FMPL DYED BY YOU HAVF, I ICE,NSFS REQUIRED 13Y S'TA'1'F I AW AND BYC'OUNY OR MUNICIPAL. LICENSING ORDINANCES. 11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY `CERTIFICATE OF COMPETENCY' OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT (247-5826) IF IN DOUBT. V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER -BUILDER PERMIT. //7S Arm-,.�T� c 3 �►�D ADDRESS PRINT NAM I �,()y- 754- V312, PHONE NUMBER Befor me this day of 20 )4 in the county of Duvat, br da, has personally appeared herin by h7msel` / herself and atf,rms that all statements and declarations are true and accurate Notary Public at Large. State of Ft- , County of 11►Vi:L $a<�r,,,:ery Known Cl Produced Ide hkabon --- __ __ _ — ___ RiN tate of Florida EE 677614 017 Notary &gnaturc: QA DATE /. F.titD(M.nn-BwW.-r Altwta.u: REVISED 4,1t. -IM �tr:ary. �J 1 5 • ,. tl � 'J OWNER`S AUTHORIZATION FOR AGENT is hereby authorized to ata on behalf of C..C. L I hes the owner(s) of those lands described within the attached application ► as de cribed m the attached decd or other such proof of ownership ss may an application related to a Development be required, in applying to the - tty of Atlantic Beach, Florida, for Permit or other action pursuan' 'I Amendment ❑ Zoning 'v,• 'nee ❑ ❑ Comprehensive t an Zoning Map Amendment Use -by -E. option ❑ Plat, Replat or Lot Division Building to{mit ❑ Tree Permit ❑ Sign Porn, ❑ Other BY: Signa e of Owner 1 { 1 Print Name Signature of ONvn,r _ Print Name (, yZ, ,'g Telephone Num Staic of �L C►_�s\� County of-JDLa.�..l >lh i Signed and swornbcfarc rr n this --- day of, 3olNotary Pewfic State of Flo nda ,`,� app Kimberty A Billingsley MyComrn" , t94t20 By 1 m��:C_1��� U t a pd' E.M 1, 04, '2016 Identification vcrif►cd: _ No AOath sworn: --_ _- Yes •---""-. Votary Signature - 0� My Commission crpires: v� i �C WEST 1 ST STREET _ _ T --� lii AIL�� • I }( PATH OF N'A R STECt _ rA�OID TREE ROOTS JUSTED TO i� G ) x k I / / POND_ f fi GOG •�� t4�g , , CRUS+Eta i STONE t i �� '� �0�►P' SURFACE P TEMPORARY POWER WELL HEAD 5' PROPANE 8a TOILET i A. r. ( $TilBfYJT tH — �_�'•— — -----------n G PLUG—E\ .tt Is T,^ A:1 v _ _ _ N , r �� _ IV ROLL—UF r 1 -I 1 • . • DOOR p, a GATE VALVE - j alers OFTemporary TrANES + 6' CLEANOUTZ Construction _ l�3 4 LOADING AREA IJ 3 Storage & Operations 4ld0 b 1„ O (h T- CT. TO LF STUBOUT 4- VC FOR POSSIBLE `� w FUTURE CONNECTION i= i CRUSHED 5' SIDEWALK - --- -STONE i SURFACE • GREENHOUSE y I ! OFF SITE PARKING • CONSTRUCTION WORKERS Cissel & Company AMER. LEGION WEST LOT �i Certified General Contractor 904 759 4312 SECURITY ROLLING CXE (36 =T:) I �: i TO BE OPEN DURING BUSINESS y r' HOURS AND SHALL BE OPENED ' FROM THE ASIDE OF THE FACILITY 24 + F OF DOUBLE ---ter YELLOW CENTERLINE t _ STUBOUT ARD ' SNit#:; GATE AT S i:F %$A I AND PLUG ♦ i 1175 Atlantic Blvd + i:n3�Y 1 1� VMOGII- NOTICE OF COMMENCEMENT The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, + Florida Statutes, the following information is provide in this Notice of Commencement. 9 1. DESCRIPTION OF PROPERTY (Legal description of the property & street address, if a milable) TAX FOL IO NO.: 170709-0000 M SUBDIVISION _Atlantic Beach BLOCK 11,12,13TRACr-Section"H: LOT____BLDG____UNIT According to the Plat thereof, as recorded in Plat Book 18, Page 34 of the current public records of Duval County J 2. GENERAL DESCRIPTION OF IMPROVEMENT: b SQnstruction of 8,i}UO�l,rafe fooigteenhou;�;3�LasS4ciated suDRon_taCi(ity. ___ 3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPRO%'ENIEN?: a. Name and address: Robins Nest Farm LLC, 1560 Selva Marina Drive, Atlantic Beach, Florida 32233 b. lntcmt in property: fee simple C . Name and address of fee simple titleholder 1 i(diRcrem from Owner bsted above): Tracey Weser• 1560 Selva Marina Dr., Atlantic Beach, FL 32233 4. a. CONTRACTOR'S NAME: Atlantic Beach Urban Farm-LL- Contractor's armLLContractor's address + C 850 6th Ave. South Jacksonville Beach,FL 32250 b. Phone ntmtler 904-868-6957 w `� _ h 5. SURETY (if applicable. a copy orthe payment bond is attached). 0 a. dame and address: N/A o h Phone number. e. Amount of bond S 6. a. LENDER'S NAME: N/A Lender's address: __ - -- _-- _____b. Phone number:_. . 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13 (1) (a) 7., Florida Statutes: a Name and address: SR Cissel, POB 1875, PVB.,FL 32004_ �., o b. Phone numbers of designated persons: 904-759-4312 8. a. In addition to himself or herself, Owner designates Susan King of Atlantic Beach Urban Farms LLC ti o to receive a copy of the Lienor's Notice as provided in Section 713.13 (1) (b), Florida Statutes. in a 904-868-6957 r in U b. Phone number of person or entity designated by Owner: _ _ — ..— _ � CD U 9. Expiration date of notice of commencement (the expiration date will be I year from the date of recording unless a different date is 0: m Y. -T specified): Juno 1 2015 O a: 8 , w WARNING TO OWNER ANY PAYMENTS MADE BY THF OWNFR AFTFR THE UPIRATION OF THE NOTICE OF COMMENCE%tETvT AND CAN U �' r0 z ARF CONSIDERED IMPROPER PAYMENTS UND1�R CHAPTER 713 PART I SECTION 713 13 FLORIDA STATUTES, A NOTICE OF COMMENCEMFNT MUST BE a U_ > of F gFSULT IN YOUR PAYING TWICE FOR [MPROVFMNTS TO YOUR PROPERTY RECORDED AND POSTED ON THE JOB SfrF BEFORE T}IF FIRST INSPECTION IF YOU INTFND TO OBTAIN FINANCING CONSULT ` .2 a, z O ar E v c Z U oOw WrM YOUR LENDER OR AN ATTORNEY BEFORE COMMFNCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. / 0 z(r_tYUtY c— Tracey Westbrook ;,,kee) (Signa of Owner or ssee, or Owner's or Lessee's Auto rized Officer/Director/Partner/Manager) (Print M • s T�iie/ame and Provide Signato State of Florida County of Duval s+ � The foregoing instrument was acknowledged before me this __r , day of 20.1 by 1 rcwct�y w E S i G a (G, , as M p.�+A-V-r tti bar• (name of person) (type of authority,...e.g. officer, trustee, attorney in fact) 1- for Rep+rJ S At s+- FC%�" LV_ -_ (name of party on behalf of whom instrument was executed) Personally Known X or Produced Identification �� Notary Fabric State of Florida Kimberly A Billingsley +� pY My Ccmmission EE 194120 �1 jv,d Expires 04/302016 Type of Identification Produced (Signature of otary lic (Print, Type, or Stamp Commissioned Name of Notary Public)