130 SANDY BEACH LN - TRI PLEX tr I City of Atlantic Beach APPLICATION NUMBER
} r17" ' , Building Department (To be assigned by the Building Department.)
r
�"� 800 Seminole Road /5-4,4r /2 (7
I s� Atlantic Beach, Florida 32233-5445 C
Phone(904)247-5826 • Fax(904)247-5845 _ L
; y? //E-mail: building-dept @coab.us Date routed: `1
City web-site: http://www.coab.us /
APPLICATION REVIEW AND TRACKING FORM
Property Address: / 3 d S/??lIy � j1� (�'� Department review required No
uildina�
Applicant: 6t4.e 1£s ,T in &Zoning
Tree Administrator
Project: friitakK wSk,g r Crublic wor
ltblic_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: f pproved. ❑Denied.
(Circle one.) Comments:
UILDI
PLANNING &ZONING
Reviewed by: /71 Date: 6'/7—1 S
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
BUILDING PERMIT APPLICATION r^ �
CITY OF ATLANTIC BEACH �M �•✓r I
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 130 Sandy Beach Lane ,COAB, FL 32233 Permit Number: /5 -Si /2 T—/a k 7
Legal Description 38-2S-29E-7.42 B De Castro Y Ferrer Grant PT RECD O/R 1 653 1-2248 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 bed/2 bath Single Family Attached
dwelling
Property Owner Information:
lji f • ('� f
Name: Beaches Habitat Address: 797 Mayport Rd 1✓� �J 1
City Atlantic Beach State FL Zip 32233 Phone: 904-241-1222 JUN 2 1]
E-Mail or Fax#(Optional)
Contractor Information: BY�__
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 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 a_period of six(6)months at any time after
work is commenced. I understand that separate permits must be secured for ElectricalpWork,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 ave 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 omplied 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 othe ederal, at• •r local law regulating construction or the peiformance of construction.
Signature of Owner ,,,` -� Signature of Contr or `�F
Print Name -( e. Print Name
Sworn to and subscri ed before me. Sworn to and subscribed before me
this I/ Day of / eti k , 20
I this 11 Day of Alin l 20 �
-- -�- -
`--
c
Notary Public �t' w MURRAY
is KYLE HURRAY
`' MY COMMISSION#EE183723 p` ;M My COMMISSION p EE1
!.•t , EXPIRES April 02,2016a3i;ed 01.26.10
,��]QL$1� con, ,. EXPIRES April 02,2016
DO NOT WRITE BELOW- OFFICE USE ONLY
Applicable Codes: 2010 FLORIDA BUILDING CODE
Review Result (circle one):
Approved Disapproved Approved w/ Conditions
Review Initials/Date: /fil' 0)-()0/
O1 SJ
Development Size
Habitable Space 1 i L d S F. Non-Habitable / 76 s: fi
Impervious area
Miscellaneous Information
Occupancy Group r -3
Type of Construction 31 6
Number of Stories c-
Zoning District R. m 0 -' 1
Max. Occupancy Load
Fire Sprinklers Required
Flood Zone iv l4
Conditions/Comments:
}�i�A , City of Atlantic Beach APPLICATION NUMBER
�,&. Building Department (To be assigned by the Building Department.)
800 Seminole Road
1 c$ Cr
�.. Atlantic Beach, Florida 32233-5445 � c4C4 /2 Q 7
\ , Phone(904)247-5826 Fax(904)247-5845
\:„ :11111,5/ E-mail: building-dept @coab.us Date routed: �/1�
City web-site: http://www.coab.us f
APPLICATION REVIEW AND TRACKING FORM
Property Address: / 3 6 S enb G� Department review required Yes No
uildina>
Applicant: & tM� ��]L . 7 'n &Zoning
Tree Admini or
Project: / / / ublic Wor<s
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. Denied.
(Circle one.) Comments: fe,,t ,"g `
BUILDING /
PLANNING &ZONING Reviewed by: �i ./ v /"� Date: � r�,f
' TREE ADMIN.
Second Review: Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by; jr►�-+ /� — Date: aft�ff
FIRE SERVICES Third Review: ['Approved as revised. ['Denied.Comments:
Reviewed by: Date:
Revised 07/27/10
r City of Atlantic Beach R C}JV}r APPLICATION NUMBER
-_ ,r;, Building Department (To be assigned by the Building Department.)
rr 1` 800 Seminole Road JUN 0 2 2015 /$�/29 /2 (7
, ,� Atlantic Beach, Florida 32233-5445
\. Phone(904)247-5826 • Fax(904)2 5
;,rsi�' E-mail: building dept @coab.us ____— Date routed: 4/2-//3--
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: / 3 4 Sit-nby 4 al h G'� Department review required Yes No
_,, Q uil •
Applicant: Biaehis /441 1 ),7 I in &Zoning
Tree Administrator
Project: Tri / .3f/1 r ublic Wor<s
Utilities
Public Safety
Fire Services
Review fee $ 3 o Dept Signature v
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
il Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: vlApproved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed b : 4/-1-- Date: `[ 2 k
Y
' TREE ADMIN.
Second Review: ❑Approved as revised. Denied.
I WQRKS Comments:
q.11?
UBLIC UTILITIES
PUBLI SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
City of Atlantic Beach RE������ APPLICATION NUMBER
r ; Building Department (To be assigned by the Building Department.)
.�* `n, JUN 0 2 2015
i 800 Seminole Road /5-469/ . /2 D 7
��I Atlantic Beach, Florida 32233-5445 Q
Phone(904)247-5826 • Fax(904)247-03&:__
�11 EE-mail: building-dept @coab.us T—'Date routed: 47/2'
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: / 34 Sirniy �� a-L 4 (�'�1 Department review required Yes No
u Applicant: •a, is ,4 DI 7 ng
Tree Adminis�iator
Project: Tri /i
� ublic Wor<s
ublic 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. ❑Denied.
(Circle one.) Comments:
BUILDING fee 4WtchJ
PLANNING &ZONING Reviewed by: � - Date: 04f-
' TREE ADMIN.
Second Review: ❑Approved as revised. L 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
/Jo i 'ad'e 11' • Mi(1T- /02-17
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"n `S CITY OF ATLANTIC BEACH
, - w; �, PUBLIC UTILITIES
1200 Sandpiper Lane
ATLANTIC BEACH, FL 32233
`"AJJil9f' '
(904) 270-2535 or(904) 247-5874
NEW WATER/SEWER TAP REQUEST
Date: 6- 2--/S Project Address: /30 t s./MuIti-Family No. of Units: Commercial Residential
3 `,
New Water Tap(s)&Meter(s) Meter Size(s) 7�
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# /5 - S F-Atr — /Z S 7
Water System Development Charge $ 4-D
G-tl go t_0 P� r Er System Development Charge $ '�T/ -(4", _ P20
7i_
Water Meter Only $ / gS. 07
Reclaimed Meter Only $ NP s Of if /Z£Ge b
Water Meter Tap $ (notes)
Sewer Tap $
Cross Connection $ Sej, o 0
Other $
TOTAL $ 2E5, v
APPROVED: Kavle Moore,PE 5(r'"----
(Deputy PW Director or Authorized Signature) ALL TAP REQUEST MUST BE
APPROVED BY UTLITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED
s 01.'Ly,r��,
"
400)s CITY OF ATLANTIC BEACH
A s 800 SEMINOLE ROAD
j: ATLANTIC BEACH, FL 32233
c\ INSPECTION PHONE LINE 247-5814
k J131 t�
SINGLE FAMILY ATTACHED
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-SFAT-1287
Job Type: SINGLE FAMILY ATTACHED DWELLING
Description: SINGLE FAMILY TRI-PLEX
Estimated Value: $110,000.00
Issue Date: 6/24/2015
Expiration Date: 12/21/2015
PROPERTY ADDRESS:
Address: 130 SANDY BEACH LN
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: BEACHES HABITAT OR HUMANITY
Address:
Phone: - -
PERMIT INFORMATION: UTILITY DEPT.:
Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible.
A sewer cleanout must be installed at the property line. Cleanout must be covered with an RT1
concrete box with metal lid. Cleanout to be set to grade and visible.
FEES:
ENG REV RESIDENTIAL BLD $100.00
PLAN CHECK FEES $255.00
UTIL REV RESIDENTIAL BLDG $50.00
BUILDING PERMIT FEE $510.00
STATE DCA SURCHARGE $7.65
STATE DBPR SURCHARGE $7.65
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
s f CITY OF ATLANTIC BEACH
A 800 SEMINOLE ROAD
s) ATLANTIC BEACH, FL 32233
J�°
INSPECTION PHONE LINE 247-5814
'4'.4 r i319�
WATER CONNECT/TAP & METER $185.00
WATER CROSS CONNECTION $50.00
Total Payments: $1,16530
1
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND 771E FLORIDA
BUILDING CODES.
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