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138 SANDY BEACH LN - TRI PLEX Tr, City of Atlantic Beach APPLICATION NUMBER 45�/ `.. Building Department (To be assigned by the Building Department.) ,.`� 800 Seminole Road /c-ScAri /290 r? Atlantic Beach, Florida 32233-5445 �� Phone(904) 247-5826 • Fax(904)247-5845 L -vs !),,.> E-mail: building-dept @coab.us Date routed: i/ / "... City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Lli Property Address: /31 5-21-7177 A itch Department review required Yes No ui ding Applicant: na t3h� /?, j7??7 annin &Zo 're e� nistra tor Project: —77/. /. /2k K' / uc W, ibUc Utilities 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: ❑Approved. ki Denied. (Circle one.) Comments: S,G Allti4, BUILDING /�// PLANNING &ZONING Reviewed by;, i^ y v A---' Date: C/Sf f r TREE ADMIN. Second Review: gApproved as revised. ['Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES � PUBLIC SAFETY Reviewed by: �/ /��XX----- - Date: ilip FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: iii Revised 07/27/10 -s% try City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Departmeennt.) .3 800 Seminole Road — c,47' /290 15.., ,, , 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://www.coab.us APPLICATION REVIEW AND TRACKING FORM Q L-4 Property Address: 13 S---A-7,17 �� (Lei) Department review required Yes No ui dint/ ,7 T anning &Zoni Applicant: gnA6Ais �/ J ree nistrator Project: / / /' p / 7 $14_ ublic Work J Utilities Public Safety Fire Services Review fee $ Dept Signature 1t� 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 ate: 41 Reviewed by: r'` ` Is— TREE ADMIN. Second Review: [ Approved as revised. ['Denied. iC WpR Comments: 'UBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. ['Denied. Comments: Reviewed by: Date: Revised 07127/10 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: 138 Sandy Beach Lane ,COAB, FL 32233 Permit Number: Legal Description 38-2S-29E-7.42 B De Castro Y Ferrer Grant PT RECD O/R 16531-2248 Parcel #2-3 Floor Area of Sq.Ft. Sq.Ft Valuation of Work$110,000. Proposed Work heated/cooled 1172 non-heated/cooled 188 Class of Work(circle one): New(X) Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s)(circle one): Commercial Residential (X) If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A Florida Product Approval# attached For multiple products use product approval form Describe in detail the type of work to be performed :Construct -2 story Three be 27bat STh le-Fa ml-y tached dwelling U LL Property Owner Information: JUN 2 Name: Beaches Habitat Address: 797 Mayport Rd City Atlantic Beach State FL Zip 32233 Phone: 904-241-1222 By - E-Mail or Fax#(Optional) - Contractor Information: Company Name: 201 Mayport Construction Management,LLC Qualifying Agent: Robert Peterson Address:2768 State Rd. AlA #701 City Atlantic Beach State FL Zip 32233 Office Phone 904-241-1222 Job Site/Contact Number 904-334-1202 Fax# 904-241-4310 State Certification/Registration#CGC-1506666 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 performed 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 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. 1 hereby certify that I ve read and examined thisplication and know the same to he true and correct. All provisions of laws and ordinances governing this type of work will be c,mplied with whether speci red herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other -deral,st' : or local law regulating construction or the performance of construction. Signature of Owner '- 4 i a i S gn ture of Contra �� �v Print Name ( - J ■./ Print Name Al, 4't cl- Swol-f and subscribe efore pie Sworn t�and subscribed before me this Day of (aY ,20/f this fiLiDay of et I ,20.1r Notafy Public :; �cY.3 J AY, l•Jo� :•• MY COMMISSION I EE185723 ' . ,a KYLE HURRAY '-.;.1!.r EXPIRES April 02,2016 •'e MY COMMISSION 0 EE1ffi�d 01.26.10 1'4071 3ue.a1a.1 w�,;e,w tanalw�.ti.. '. r• EXPIRES Arvi m �n+a BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: 138 Sandy Beach Lane ,COAB, FL 32233 Permit Number: /s SF`9 T` OYO Legal Description 38-2S-29E-7.42 B De Castro Y Ferrer Grant PT RECD O/R 16531-2248 Parcel #2-3 Valuation of Work $110,000. Proposed Work hl at d/cooled 1172 Sq.Ft. non-heated/cooled 188 Ft Class of Work(circle one): New (X) Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s)(circle one): Commercial Residential (X) If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A Florida Product Approval # attached For multiple products use product approval form Describe in detail the type of work to be performed :Construct -2 sto Three be4r� . tL x ,ylntiiim : tached dwelling � c 1 V Property Owner Information: JUN 2 _ . Name: Beaches Habitat Address: 797 Mayport Rd City Atlantic Beach State FL Zip 32233 Phone: 904-241-1222 E-Mail or Fax #(Optional) Contractor Information: Company Name: 201 Mayport Construction Management,LLC Qualifying Agent: Robert Peterson Address:2768 State Rd. AlA #701 City Atlantic Beach State FL Zip 32233 Office Phone 904-241-1222 Job Site/Contact Number 904-334-1202 Fax# 904-241-4310 State Certification/Registration#CGC-1506666 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. I certi6,that no work or installation has commenced prior to the issuance iffwork isnnot commenced nc work within (6)months,t omeet onst standards o of laws regulating or abandoned for ahpejurisdiction.period 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 YODUR NOTICE OF COMMENCEMENT. I hereby certify that 11 ve read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this type ofYwork will be c�•mplied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other -deral,st, or local law regulating construction or the performance of construction. Signature of Owner , Signature of Contra r � ,��. Print Name u ri� • - Print Name ede.„t !J t{ Swo o and subscrib efore e Sworn tand subscribed before me this ay of �Y , 20/f this 11 —Day of ,r;1 20.Jr- NotaPublic KYL Alf '• • MY COMON IY EE185723 No KYLE HURRAY • I -4'+t;. EXPIRES April 02,2016 *: -,_ MY COMMISSION ti male*;d 01.26.10 ,4071 39e.oi53 rww;e,tees,,,9,,,,,�,A cam � 'S. EXPIRES Mill m �fn+� DO NOT WRITE BELOW- OFFICE USE ONLY Applicable Codes: 2010 FLORIDA BUILDING CODE Review Result (circle one): Approved Disapproved Approved w/ Conditions Review Initials/Date: rn 7-as l c Development Size Habitable Space 11 yd S`V' Non-Habitable / 6 5, F Impervious area Miscellaneous Information Occupancy Group A-3 Type of Construction: (S Number of Stories 2 Zoning District 12 m 0- (3 Max. Occupancy Load Fire Sprinklers Required Flood Zone /l/)4 Conditions/Comments: of • ,,y� City of Atlantic Beach APPLICATION NUMBER rl t Building Department (To be assigned by the Building Department.) r 800 Seminole Road cc// Q ,.,.. Atlantic Beach, Florida 32233-5445 /�/5 - �2 I0 Phone(904)247-5826 Fax(904)247-5845 /©/� 1 �� E-mail: building-dept @coab.us Date routed: o City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM L Property Address: /3 Q 521-7,by A &eh Department review required Yes No uildinq &4 Applicant: 9J� #m6-jT?Ir ,, arining&z2 �� k � ���, I ree ammistrator Project: / / /' p C ublic Work Utilities 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: R pproved. ['Denied. (Circle one.) Comments: �' ( �, BUILDING Jt 1164 ,4 1 PLANNING&ZONING Reviewed by: a�/ ��/� Date: `//-1 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�\ CITY OF ATLANTIC BEACH PUBLIC UTILITIES 1200 Sandpiper Lane t1��a ATLANTIC BEACH,FL 32233 (904)270-2535 or(904) 247-5874 NEW WATER/SEWER TAP REQUEST Date: - 2 - / S Project Address: /3 8 S,vo` No. of Units: Commercial Residential / Multi-Family New Water Tap(s) &Meter(s) Meter Size(s) 33AV New Irrigation Meter Upgrade Existing Meter from to (size) New Reclaimed Water Meter Size New Connection to City Sewer Name: Applicant Address: City: State: Zip Phone Number: Cell Number: Email Address Fax: Signature: (Applicant) CITY STAFF USE ONLY Application# , -SF-4T-1 Z 9'0 Water System Development Charge $ / 06-t/ T Sewer System Development Charge $ - , Water Meter Only $ /85", NlclL i< -c,�V(r f�P4 - Reclaimed Meter Only $ /i/o S'D L' "S Iefa ,D Water Meter Tap $ Sewer Tap $ (notes) Cross Connection $ SO, Da Other $ TOTAL $ 23S 00 APPROVED: Kavle Moore,PE x 01-- (Deputy PW Director or Authorized Signature) ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES CAN RE ASSESSED