1 W 1ST ST VET PARK 'rS�r�J�J f•
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
X ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
COMMERICAL ALTERATION/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-COTH-934
Job Type: COMMERCIAL OTHER
Description: foundations and walkways for vet park
Estimated Value:
Issue Date: 4/27/2015
Expiration Date: 10/24/2015
PROPERTY ADDRESS:
Address: 1 W 1ST ST
RE Number: 170716-0100
PROPERTY OWNER:
Name: CITY OF ATLANTIC BEACH
Address: 800 SEMINOLE RD
GENERAL CONTRACTOR INFORMATION:
Name: S BAGBY & COMPANY INC
Address: 4965 Long Bow RD
Phone: - -
PERMIT INFORMATION: PUBLIC WORKS:
Roll off container company must be on City approved list and container cannot be
placed on City Right-of-Way. (Approved: Advanced Disposal, Realco, Republic Services,
Shappel's and Waste Pro.)
Full restoration, including sod, is required.
FEES:
Total Payments: $0.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
FILE COPY
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City of Atlantic Beach APPLICATION NUMBER
ds � Building Department (To be assigned by the Building Department.)
r 800 Seminole Road _ A
Atlantic Beach, Florida 32233-5445 Q
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: ZZ
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: / De PArtment review required Yes No
Applicant: .�. (,� p la in
Tree Administrator
Project: t!fublic Works
//��
{ q'� i' u ti i i04 �` Public Safety
Mi M , A /X 1s 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: Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING 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 APPLICATION NUMBER
` Building Department (To be assigned by the Building Departmen _)
�- X41 • 3
800 Seminole Road
Atlantic Beach, Florida 32233-5445 / ZZ /�
Phone(904)247-5826 Fax(904)247-5845 Date routed ff
E-mail. building-dept@coab.us
City web-site httpJ/www coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address:
/ /ST OT De artment review required Yes No
�' I in
Applicant: Tree Administrator
ublic Work
Project: /�W ti
v/ Public Safety
Fire Services
Review fee $ Dept Signature
- Review or Receipt Date
Other Agency Review or Permit Required 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
Date.
PLANNING&ZONING Reviewed by: — --
TREE ADMIN Second Review: ❑Approved as revised. enied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
Reviewed by:
Date:
-
PUBLIC SAFETY
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by
Date:
Revised 07127110
City of Atlantic Beach APPLICATION NUMBER
S Building Department (To be assigned by the Building Departmen.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed:
City web-site: http://vvww.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: / /s Jr De artment review required Yes o
Applicant: �. zaab la Q n in
� I /� �/ Tree Administrator
Project: 1 //�/C.�A)1 Q� ublic Works
Loil in,
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: MoApproved. []Denied.
(Circle one.) Comments:
(SE31
PLANNING &ZONING
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
s!,=L�r City of Atlantic BeachAPPLICATION NUMBER
Building Department DECEIVED (To be assigned by the Building Departmen.)
r '! 800 Seminole Road ! APR 2 a 2015
3
Atlantic Beach, Florida 32233-5445
Phone(904) 247-5826 • Fax(90 1247-5845
4 Date routed: Z Z ��
E-mail: building-dept@coab.us L...._. -
City web-site: http://www.coab.us ----=f
APPLICATION REVIEW AND TRACKING FORM
Property Address: / /s T Jr De artment review required Yes No
Applicant: �• la in
Tree Administrator
Project: &I4W/9 pyo ublic Works
u tiii
O/Z 5g ✓I• Public Safety
�`'' Fire Services
Review fee $ Dept Signature
Review or Receipt Date
Other Agency Review or Permit Required 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: ®Approved. @Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING �- Date:
Reviewed by:
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied.
IC WO K§, , Comments:
C UTI IES
UBLICZ AFET Reviewed by: Date:
L :
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH FILE
800 Seminole Road, Atlantic Beach, FL 32233 COPY
Office (904) 247-5826 Fax (904)247-5845
Job Address: LFV441 M'S I�1 hrjVz_14. PlP?k _ 1 Nz.S'E j S'i ermit Number: jS"GO TjV
Legal Description S, ,,-d7 N, /c,• j1- 12jk 1-3 Parcel #_ t? I 0 ) C""()
Floor Area o q. t. 't
Valuation of Work p. Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Residential /�I�j�J 1c w1k. /-'/}�e ).
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No Q�
Florida Product Approval#
For multiple products use product approva orm
Describe in detail the type of work to be performed: c�� `i �,,r(1 kl�e-1 �;,�,y f fr�� c Cp�
Q )I- A 06-3 lo" '),
Propert
y Owner Information: l
Name: l F G j 1. l� �AC.� P�lAddress:
City 4?C1,71C State(-Zip Phone
E-Mail or Fax#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: Qualifying Agent: 5)-,kV,N
Address:_ /6� i��i_c L 4,.eS� City i&I �,�_ State Al-L Zip '2.2 c,
Office Phone Job Site/Contact Number Fax-#
State Certification/Registration#
Architect Name&Phone# 7" ' ! -/,A -
Engineer's Name&Phone# P/4
Fee Simple Title Holder Name and Address '. .
Bonding Company Name and Address
Mortgage Lender Name and Address X/,4
Application is hereby made to obtain a permit to do the work and installations as indicated. I cert that no work or installation has commenced prior to the
issuance of a permit and that all work well be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void of work is not commenced within six(6)months, or if construction or work is suspended or abandoned for aperiod of six_(6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools, Furnaces,Boilers,Heaters,
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.
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
type o1 work will be complied with whether speci eed herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,s or local law regulating construction or the performance of construction.
Signature of Owner •- f
� C ' Signature of Contractor
?rint N .....e..✓.G..4 A 5...........r...' `' ........... Print Name
...... (k�..,...... .. . . ..1......................................................................
3r�for ' Before mp
his Da o1✓ this 2L[-�Day of .20LS
• o ry Public State of Florida NG A V.$O BOROUGH
fOt \< y omr ission FF 086990 Nota Ltb IC , - 931
orr�� Expi 02/1412018 %� ;,;,�•'� IRES March 14,2019
1-W)398.0+53 11!!11
CC:trl