134 SANDY BEACH LN - TRI PLEX r .s.` -,--ri,. City of Atlantic Beach APPLICATION NUMBER
1 Building Department (To be assigned by the Building Department.)
r s ' 800 Seminole Road /c_ 4W . /211
j.. s Atlantic Beach, Florida 32233-5445 v
Phone(904)247-5826 • Fax(904)247-5845 �/�
;,on 9� E-mail: building-dept @coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: La Smi i lifie/7 !�'7�f _ Department review required Yes No
p Bui . ;•,Applicant: 0 / / a`7 11 • - nine & •••••
Tree Administrator
Project: 7 / /w, ea-no Work
c C lic 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: ❑AWI/roved. Denied.
(Circle one.) Comments: Sbe, .[r_K!�
BUILDING /,(
PLANNING &ZONING Reviewed by: X+.�/✓ /'`/ Date: Ws.
TREE ADMIN.
Second Review: .2,Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES VX------PUBLIC SAFETY Reviewed by./,4'/ Date: i/1i r
FIRE SERVICES Third Review: ❑Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
City of Atlantic Beach APPLICATION NUMBER
1 Building Department (To be assigned by the Building Department.)
800 Seminole Road _ /' 1'
/2
r) Atlantic Beach, Florida 32233-5445 /" / (J v
o Phone(904)247-5826 • Fax(904)247-5845
-on E-mail: building-dept @coab.us Date routed: �4r
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: /31 ,s * kteA -4 Department review required Yes No
Bui
Applicant: Sf Q ehf a7) )g•7 nnin & •
Tree Administrator
Project: 7� /kio rblic Work
Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Review or Receipt
Other Agency Review or Permit Required 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:
APPLICATION STATUS
Reviewing Department First Review: Fqpproved. ['Denied.
(Circle one.) Comments:
:UILDIN
PLANNING&ZONING
Reviewed by: Yl1 Date: G-/7'1.-
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
BUILDING PERMIT APPLICATION FILE COPY
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 134 Sandy Beach Lane ,COAB, FL 32233 Permit Number: /.S- S E4 T`1 fr 8
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 1212 non-heated/cooled 172
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: A.8
Name: Beaches Habitat Address: 797 Mayport Rd g Nn r
City Atlantic Beach State FL Zip 32233 Phone: 904-241-1222 ' '
E-Mail or Fax #(Optional) 11 N a, _ V
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 certi 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 f 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 sane to be true and correct. All provisions of laws and ordinances governing this
type of work will be c. plied 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 ••eral,state,or local law regulating construction or the performance of construction.
Signature of Owner ( .1..
S Signature of Contractor .� ,/1
111.
Print Name 1 �(0 vt e---) Print Name e... -...--1-
Swgr tp and subscribed,efore the Sworn to and subscribed before me
this I (''t-Day of f-+�...VI ,2015 this 11 Day of Y; I ,2073
Notary Public ,t;,•e �KY MURRAY
Notilic KYLE MUR
MY COMMISSION M E2016723 ": V, •'e MY COMMISSION#►E
M1tcd01.26.10
,q.,;t EXPIRES April 02.2016 «'t 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: 1'h - G-17-00/S
Development Size
Habitable Space 11'// S. F. Non-Habitable F
Impervious area
Miscellaneous Information
Occupancy Group 12 -3
Type of Construction 6
Number of Stories 2
Zoning District Q ri 0- (3
Max. Occupancy Load
Fire Sprinklers Required
Flood Zone tV A
Conditions/Comments:
_:.0.1. City of Atlantic Beach APPLICATION NUMBER
4$ �- :.r\ Building Department (To be assigned by the Building Department)
' - Atlantic ticBeac Beach, Florida d /3rd/ 4T /Z 90
I�� Atlantic Beach, F 32233-5445
7
Phone(904)247-5826 • Fax(904)247-5845
'� .,;s»� E-mail: building-dept @coab.us Date routed: /..c.
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
L-4
Property Address: /31? SA-Ab/ j..C/p Department review required Yes No
ui din
Applicant: /Ift ag..< #6-7-n; c anning &Zoni
ree Amni
strator
Project: —T,/ J p IE 3e7 cfrr /_ 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: Approved. ❑Denied.
(Circle one.) Comments:
BUILDIN
PLANNING&ZONING )/"" G /7 15—
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
rSr 1"1-1,/.° City of Atlantic Beach APPLICATION NUMBER
:� Building Department (To be assigned by the Building Department.)
4 `,- 800 Seminole Road / f��l
�� Atlantic Beach, Florida 32233-5445 �5 Sr 1 ' /Z(J v
;tp; Phone(904)247-5826 • Fax(904)247-5845 if
��7 E-mail: building-dept @coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Lai! S if✓ & &4 Z---4 _Department review required Yes No
Bui
Applicant: A / _ • ( /i • - nin• & •••••
Tree Administrator
Project: 1, /gjo )ic Work
uhlic Utilities
Public Safety
Fire Services
Review fee $ cp Dept Signature )l-'-Irt
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: ved. ['Denied.
(Circle one.) Comments:
BUILDING ./
PLANNING &ZONING Reviewed by: Date: �D/2//r
TREE ADMIN. Second Review:
['Approved as revised. ❑Denied.
LrC WIORKS 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
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904)247-5845
Job Address: 134 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
Valuation of Work$110,000. Proposed Work heated/cooled 1212 Sq.Ft.
non-heated/cooled 172•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 story Three bed/2 bath Single Family Attached
dwelling
Property Owner Information: 48
Name: Beaches Habitat Address: 797 Mavport Rd g Nnf
City Atlantic Beach State FL Zip 32233 Phone: 904-241-1222
E-Mail or Fax #(Optional) a n 5 �r i r
•IMI V
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 certifil 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 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 cert�that I •ave read and examined this a plication and know the same to he true and correct. All provisions of laws and ordinances governing this
type of work will he c. plied 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 ••eral,state,or local law regulating construction or the performance of construction.
Signature of Owner 1 al , 1. Signature of Contractor ° _
1A ' gn ctor/�
Print Name . ,.e v U v)E-'5 Print Name e,,A + r
Swqrni to and subscribea efore ple Sworn to and subscribed before me
this I Day of r ci ,2015 this 17 Day of -1 I ,2075
Notary Public (. MURRAY Ni"gfic KYLE MUR
*0•: MY COMMISSION E EE165723 '.: MY COMMISSION#E leMed EXPIRES April 02,2016 's! `r EXPIRES 01.26.10
•..�*�..... .. .. ..------•-- - /►0�02.2016
1.1a4 4r City of Atlantic Beach
t.1 APPLICATION Department APPLICATION NUMBER
(To be assigned by the Building Department.)
4 �•� 800 Seminole Road
-. Atlantic Beach, Florida 32233-5445 /qc— r /26a
Phone(904)247-5826 • Fax(904)247-5845
„�j;EE-mail: building-dept @coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: !al ,s 4fl / Z---17 Department review required Yes No p Bui
Applicant: SfaeAc< /t nnin & •
Tree Administrator
Project: f /ifo "Sic Work
CL�itJlic Utilities
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:
APPLICATION STATUS
Reviewing Department First Review: ✓Approved. ❑Denied.
(Circle one.) Comments:
BUILDING �� g,, ad
PLANNING&ZONING 0/-r-
Reviewed Date:by:
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
111777 1..:; ?'''',.4
CITY OF ATLANTIC BEACH
:,.`. ' PUBLIC UTILITIES
1200 Sandpiper Lane
-'71.05111:A. ATLANTIC BEACH,FL 32233
(904) 270-2535 or(904)247-5874
NEW WATER/SEWER TAP REQUEST
Date: ‘- 2- / S` Project Address: /3 V ,j R.,vo y & i
No. of Units: Commercial Residential L Multi-Family
New Water Tap(s)&Meter(s) Meter Size(s)
3// ',
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# /s SF-4 r— / 2 S g
Water System Development Charge $
Se:: 0Pme1:1t r System Devel Charge $r Meter Only $ /8 5706
��luC T/- CIA/n— Pe®P t J
Reclaimed Meter Only $ /Vo f'DC (S 4S-62(6
Water Meter Tap $
Sewer Tap $ (notes)
Cross Connection $ 5-6. p v
Other $
TOTAL $ 2357 o
APPROVED: Kayle Moore,PE 7C'"
(Deputy PW Director or Authorized Signature) ALL TAP REQUEST MUST BE
APPROVED BY UTLITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED
s\ CITY OF ATLANTIC BEACH
• 800 SEMINOLE ROAD
J • ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
SINGLE FAMILY ATTACHED
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-SFAT-1288
Job Type: SINGLE FAMILY ATTACHED DWELLING
Description: SFAT TRI PLEX
Estimated Value: $110.000.00
Issue Date: 6/24/2015
Expiration Date: 12/21/2015
PROPERTY ADDRESS:
Address: 134 SANDY BEACH LN
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: BEACHES HABITAT OR HUMANITY
Address:
Phone: - -
PERMIT INFORMATION:
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
WATER CONNECT/TAP & METER $185.00
IpeAtTER GiReSSICONNENCVIONDANcE$9®Ifl0LL CITY OF ATLANTIC BEACII ORDINANCES AND THE FLORIDA
Bl'II_I)ING CODES.
CITY OF ATLANTIC BEACH
—44 �� 800 SEMINOLE ROAD
J �=" ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Total Payments: $1,165.30
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
1
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