The URL can be used to link to this page

1699 MARITIME OAK DR - BUILDING PERMIT / WATER SEWER TAP RECEI VP.. �s�s''`y'��ri City of Atlantic Beach JUN 0 1 2015 APPLICATION NUMBER 6 ,,•` • Building Department " 800 Seminole Road (To be assigned by the Building Department.) �� Atlantic Beach, Florida 32233-544 Y: _ �—��Q - �2 t(3 Phone(904)247-5826 • Fax(904)247-5845 ti:�r v E-mail: building-dept@coab.us Date routed: Z / � � City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: /( 99/1?nt, TzInt A. D-p. . ent review re uired q Yes No 4 Bu'Idi••• Applicant: Vy'� ,e arming&Zorn • _- h �GG f -- £ • israor Project: l V C � ,Yl m �r ublic �/1it:!IG��jiIIH[�-� 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: �rifi �� BUILDING 4e Ail' 1-/i 41 PLANNING&ZONING PeCc`!Reviewed by: Date: L t� TREE ADMIN. / Second Review: DApproved as revised. f`I nied. 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 I l6 Q q /nom; e dL /07,4 ir✓A€ -h.26,J I/f oie z y x j-/ = /a 4, xJ/ (37z /°6 l6x3� �'y� /0 at J T o1 lil23 J b 36 (e.rei,tQ,L ; 17, ,r k/0 71. 3/J`' Jo kb, 6 OD / kI R t d#4 :" 157 Aolet 0®6. 10 'Yev yz022 /a/001: yz BUILDING J ' - f c (l T Ft,'PERMIT APPLICATION ., CITY OF ATLANTIC BEACH .MAY 2 8 800 Seminole Road,Atlantic Beach, FL 32233 Office (904)247-5826 Fax (904) 247-5845 By Job Address: ci`\ r{\O r i*tl ft\e Rogr i V e. Permit Number: hi(ant ic., arckt. Da Legal Description (Di -13 d dS A E Lot-- q a Parcel# I L G 5 0 J "' 1 755 Floor Area of Sq.Ft. Sq.rt Valuation of Work$ ,*-5001 0 00 Proposed Work heated/cooled 37A051--- non-heated/cooled 13-13- 5F- Class of Work(circle one): Addition Alteration Repair Move Demolition pooUspa window/door Use of existing/proposed structure(s) (circle one): Commercial :- '.-, 'a If an existing structure,is a tire sprinkler system installed?(Circle one): es o N/A Florida Product Approval# For multiple products use product approval orm Describe in detail the type of work to be performed: c'veu a (`('St'da v„+i o,, (A n1 +r vet-l evi SE Property Owner Information: ��--' L N tye:O ('e� yeLO(`e+Q Address: M y Ia i CC•rnbri`dp PCI1(s COt�4 City 3RC.(450/I Vh c. tat�L.Zip 4 Phone .5 o I - Li 4 I "FS Da E-Mail or Fax#(Optional) b t,if(Q t/,vec 0"-..eS . co...‘ Contractor Information: CONTRACTOR EMAIL ADDRESS: Company Name: t 01-'05, QQVe(kp tv4 =hC, Qualifying Agent: @f el W h t i_ Address:TM • r i ._, ,. r( con! ok - CityT 3 c k5c wi`(le, State EL. - -Zip ��c�J(0 Office Phone ( t&1-'�5; Job Site/Contact Number 9 04-30'l -95410 Fax# q 04—c9 - 0304 State Certification/Registration# G [, i s 5'-to y 3 Architect Name& Phone#t,NOl tern er5 Cr—K (1Pa 4 is -1.1v, Engineer's Name&Phone# Ap d n o(03‘{ S.&I —5-3OC Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and Address t. G rt- i"7•11111171/2 ► OO M• 3 (:), A 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 mnst 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 LEND r OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. I hereby certify that ave read and:.•amined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will .e complied with v • meci ued herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of an other federal.st, , or local aw re: toting construction or the performance of construction. Si natur• of er b Signature of Contractor Print Name .Dertn.K D.Q,LOrt,-t0 Print Name Da-44-1,4: Before me Before me this Day of AV`I1 ,2015` this(JR" Day of A p r I 1 ,20 /5 Notary Publ ; e. X----_ ---•---- -• �•. Notary Public ..:B,l.ar L.ca-Ns DEBG p y ocrf/ l`uo� =?. . Notar. P,uiic-State of Florida ° . -.. 'e'.:.... rgy P V t ev Florida� f* �! My Comm Expires Jan 30,2019 ': '' : M Comm.C Ex pima,Jan 30 2019 '�''06'Oi a% Commission FF 165278 %*r '�_�, s yCnN111tNon/Fp 165270 °� �" Bonded thrlugn National Notary Assn. '��4d,,,' !", _ _ , _ _ __ _ _ _ Sotidtdtlrotgh National NotaryAssn. 0Ligii, City of Atlantic Beach APPLICATION NUMBER ,). , . Building Department _ ,�� (To be assigned by the Building Department.) r 800 Seminole Road R� ;� .3�7 1CD �_�� r �� Atlantic Beach, Florida 32233-54 5 �2 3 Phone(904)247-5826 • Fax(90 )247-505 I i 2015 E;t sw E-mail: building-dept @coab.us Date routed: / 2 9/i City web-site: http://www.coab.0 APPLICATION REVIEW AND TRACKING FORM Property Address: !l� f D`(. D ent review 99 /n� Utz view required Yes No Vi\/�4f Applicant: (r) ' (-Planning&Zoni Project: �C 1,0 n m nistrato r /JCublicW.2& c::513TEITtilifieb Public Safety Fire Services Review fee $ ..cNO Dept Signature wt 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 PLANNING&ZONING 14/r,— Reviewed by: Date: Date: TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. I WO KS omments: PU UTILITIES LIC 6`//`S PUBLIC SAF ET Y Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. ['Denied. Comments: Reviewed by: Date: Revised 07/27/10 ,s?. '7,-- " '', ' s� CITY OF ATLANTIC BEACH �� PUBLIC UTILITIES 1200 Sandpiper Lane � r�,� 1 c� ATLANTIC BEACH,FL 32233 (904)270-2535 or(904) 247-5874 NEW WATER/SEWER TAP REQUEST Date: -/-/5 Project Address: /6 97 /7/14€;-7404' E &0e 07- No. of Units: Commercial Residential 1/ ---Multi-Family New Water Tap(s)&Meter(s) Meter Size(s) `3/Y New Irrigation Meter ' Upgrade Existing Meter from to (size) New Reclaimed Water Meter Size 3/l 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- SFT -/Z 40_5 Water System Development Charge $ / / `/O, 60 Sewer System Development Charge $ `i,OSD, UU Water Meter Only $ MST oQ Reclaimed Meter Only $ /HS co Water Meter Tap $ Sewer Tap $ (notes) Cross Connection $ -5?). 06 Other $ TOTAL $s GAD. 00 APPROVED: Kayle Moore,PE (Deputy PW Director or Authorized Signature) ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES CAN RE ASSESSED BUILDING PERMIT APPLICATION I- — (c . f ON CITY OF ATLANTIC BEACH MAY 28 L 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 By.___ Job Address: 16 C N {\Q r i*l 11)e. Q o f jr�V e- Permit Number:A-M(antiC . I.Wc■ch r Legal Description . --1 . • ° . E Loi- l a Parcel# 1 Lo 9 0 0 J --• I .755 oor •sea of Sq.Ft. Sq.Ft Valuation of Work$ , QOt00O Proposed Work heated/cooled 37 0Si Sq.Ft Valuation of Work$ ,5001 0 00 Proposed Work heated/cooled 7E4)5 r' non-heated/cooled 137 S� Class of Work(circle one): 'New Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s) (circle one): Commercial r• Residentia If an existing structure,is a fire sprinkler system installed? (Circle one): Yes o N/A Florida Product Approval# For multiple products use product approval form Describe in detail the type of work to be performed:(1-e■ ) r`P5t•d e n+i a‘ (:11,5ir C}-i e'1 S� Property Owner Information: Name:O r"eI i ?ADP e+Q Address: I y lc)ii CQnnbri'd P(t((S Co ,-.-(-.v City 3Q c�11 t ?ADP tatEFL Zip a 4 Phone 5(o i - LI 4 1 '-g O c E-Mail or Fax#(Optional) 6.1,4,,K Q V,Vec or-.es , Lw..,‘ Contractor Information: CONTRACTOR EMAIL ADDRESS: Company Name: t k2.. O1rp5. D Ve(opl�rt+ Tic. Qualifying Agent: @rev\+ \A in t•k- Address:SaB 0 r■ .� Iii ( c(W u E - City-O t CrVi'(le, State pc, Zip 3()a5(( Office Phone9Ct'a lq—'355 i Job Site/Contact Number q 04-304 -95'410 Fax# q O4 '-{7- '304 State Certification/Registration# COL, l a 5 goy 3 Architect Name& Phone#,N2 rG►r , (hl ers Ct".e* W akr' �o iO- C Engineer's Name&Phone# AP Q.)( Bch no(oc�y Sol I —SaOn " Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and Address ;. !, '�i i ti'i tl MM t t L Sao, A 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 ElectricalWork,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 LEND ' OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. I hereby certify that ave read and:-ambled this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will .e complied with v 'willed herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of an other federal,sl. , or local aw re: kiting construction or the performance of construction. Signatur of 0 er IIIIIPIP g Signature of Contractor _'. Print Name s. _. D.Jortto Print Name 1 ( J9-1-.4 k Before me • Before me this Dv Day of ApCN∎1 .2015 tthiiskJ Day off Aprt 1 ,20 15 ib 4- 0 . , d Cc` Notary p . ` Notary .,_• y Pu �' ai`e�o�Honda . 1 .. .'i Noi r, P_ ho-State of Florida t-.: ':. Notar ` °' ..1: My Comm Expires Jan 30,2019 ' ,201 i. ( +,-%.- �:•' Commission#FF 165278 „• , •v MY Comm,Expire*Jan 30,2019 g �O c,op,, Bonded through National Notary Assn. '?)% . p= CoMmieeton r OF 165278 !lotttMdtleouph National Notary Assn.