1804 ATLANTIC BEACH DR - PERMIT tr-
. :: \s CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
\J;31�r
SINGLE FAMILY DWELLING NEW
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-SFR-2033
Job Type: SINGLE FAMILY RESIDENCE
Description: NEW SINGLE FAMILY RESIDENCE
Estimated Value: $450,000.00
Issue Date: 9/30/2016
Expiration Date: 3/29/2017
PROPERTY ADDRESS:
Address: 1804 ATLANTIC BEACH DR
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: RIVERSIDE HOMES OF N FL
, CBC1254135
Address: 414 OLD HARD RD STE 502 MATTHEW ROBERTS
Phone: - -
PERMIT INFORMATION:
FEES:
ENG REV RESIDENTIAL BLD $100.00
PLAN CHECK FEES $765.00
UTIL REV RESIDENTIAL BLDG $50.00
BUILDING PERMIT FEE $1 ,530.00 CU
%4°
STATE DCA SURCHARGE $22.95
SEWER SDC-SYSTEM DEV $4,050.00
CHG 22 9j
IAWAsDAIAFi ��IUA�1-1AIV �RDANCE �"(TIf ,iLL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORID.�
BUILDING CODES.
'- Vs, CITY OF ATLANTIC BEACH
..� 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
WATER CONNECT/TAP & $370.00
METER
WATER CROSS CONNECTION $50.00
WATER SDC-SYSTEM DEV $1,140.00
CHG
Total Payments: $8,100.90
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Vis► , •�� City of Atlantic Beach APPLICATION NUMBER
.-il4,`� Building Department y 'k (To be assigned by the Building Department.)
•-i 'l•:, 800 Seminole Road � C D 2
pf Atlantic Beach, Florida 32233-5445 I 0 _ V Ftp - `���`�J3
Phone(904)247-5826 • Fax(904)2 5843EP , 2 2016
,o E-mail: building-dept@coab.us Date routed: a a. l
City web-site: http://www.coab.us
BY:
APPLICATION REVIEW AND TRACKING FORM
E 2
Property Address: 18;04 / rL &y ,cc..__pa{ Department review required Yes No
uildin
Applicant: R 1 VF_g..st 06:2_ arming &Zonis
re Administrator
I Project: NDGh P K , ublicWorks
blic Utilitie
Public Safety
Fire Services
Review fee $ cb Dept Signature c-t\
11 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 _ _fic_
Reviewed by: ) ' k/' Date: 13
TREE ADMIN. Second Review:
❑Approved as revised. ❑Denied.
gi1C WOR S Co ments:
Pla.IC 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
os iir ',t1 Building Department (To be assigned by the Building Department.)
k )9 800 Seminole Road 1 ^ C �� _ 2033
d Atlantic Beach, Florida 32233-5445 J
Phone(904)247-5826 • Fax(904)247-5845 •
�r E-mail: building-dept@coab.us Date routed: t 1_ l
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I &Ad 'rt.- r Department review required Yes No
:uildin•_
Applicant: R l VL�S(�C_ ' anning&Zoning
ree Adminis rator
Project: Gh K ublic Works
ublic Utilitie
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
PLANNING&ZONING — — Ams. . ��_�ate: '7,4 iI
Reviewed by: �`
C �
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
flECE1VE
rS;a,��; City of Atlantic Beach �� APPLICATION NUMBER
04 �.� Building Department SEP 1 2 2016 li
(To be assigned by the Building Department.)
! ' 800 Seminole Road / D Z-033��
il
7:111,4' Atlantic Beach, Florida 32233-5445 I l O — 1 f� - w 33
Phone(904)247-5826 . Fax(904)247-5B 5__�__ -- RI
,0109r E-mail: building-dept@coab.us Date routed: 9 1 c)
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
D 2
Property Address: 1E304 I-Lk 1 , I. Department review required Yes No
uildin
Applicant: R l vase c c_ anning&Zoning
ree A mmistrator
Project: J\)&e T S_ Public Works_7
ublic Utii
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: [ pproved. ['Denied. ' N2-4
(Circle one.) Comments: ,ieC f diej too/lia
BUILDING PLANNING&ZONING /61 /��//c.
Reviewed by: Date }
TREE ADMIN. Second Review:
['Approved as revised. [11 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
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City of Atlantic Beach APPLICATION NUMBER
�, Building Department (To be assigned by the Building Department.)
:: '''' -..) 800 Seminole Road ` -
��'�j 2
�,`- ' Atlantic Beach, Florida 32233-5445 - _ vF� '—`-� �✓
Phone(904) 247-5826 - Fax(904)247-5845
o,t»,• E-mail: building-dept@coab.us Date routed: t L l
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I Cwt- I rL.40-r rC 2)C.10,6( Department review required Yes No
uildin - �
Applicant: R l VEL,-st c,'_ anning &Zoning
R ree dminis rator
Project: J\-3 P R , -ublic Work'
''ublic Utilitie
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: ( proved. ❑Denied.
(Circle one.) Comments:
BUILDING (,�
PLANNING &ZONING Reviewed by: '/�11 Date: `-d o-16
TREE ADMIN. nApp ,
Second Review: roved as revised. Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: I 'Approved as revised. I 'Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
BUILDING PERMIT APPLICATION
OFFICE COPY CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845 I _ S F-R _ 2.033
Job Address: 1804 Atlantic Beach Drive Permit Number:
Legal Description Lot 64 Atlantic Beach Country Club Unit 2 67-132 08-2S-29E.185 Parcel # 169505-1615
Floor Area of Sq.Ft. Sq.-Ft
Valuation of Work$ 450,000 Proposed Work heated/cooled 2846 non-heated/cooled-12# /0Q
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed stru re(s) (circle one): Commercial : - identi
If an existing structure,is a fire sprinkler system installed? (Circle one): 'es tem N/A
Florida Product Approval#
For multiple products use product approvalTorm
Describe in detail the type of work to be performed: New construction- SFR
Property Owner Information:
Name: Riverside Homes of N. FL,Inc Address: 12276 San Jose Blvd., Ste. 120
City Jacksonville State FL Zip 32223 Phone 904-503-7055
E-Mail or Fax(Optional) lbishop@myriversidehome.com
Contractor Information:
Company Name: Riverside Homes of North Florida,Inc. Qualifying Agent: Matthew Roberts
Address:12276 San Jose Blvd., Ste. 120 City Jacksonville State FL Zip 32223
Office Phone 904-503-7055 Job Site/Contact Number_Same Fax#N/A
State Certification/Registration# CBC1254135
Architect Name&Phone#NE FL Design,Inc 904-260-3319
Engineer's Name&Phone#Apex Technology 904-821-5200
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 sus ended 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, Healers,
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 VOTTR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH
7��rTn t�7llmT/ T 11L�
OFFICE COPY
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: /I? 9.020-,202/6
Development Size
Habitable Space (`/b s.FNon-Habitable /00q5 S-r
Impervious area
Miscellaneous Information
Occupancy Group 12. - 3
Type of Construction V 5
Number of Stories
Zoning District /4/. G
Max. Occupancy Load
•
Fire, Sprinklers Required
Flood Zone X
Conditions/Comments:
r
s ; �L`I
J - .,, A
_ „ _, - f CITY OF ATLANTIC BEACH
si PUBLIC UTILITIES
J V 1200 Sandpiper Lane
ATLANTIC BEACH, FL 32233
�-tJf319' (904)270-2535 or(904)247-5874
NEW WATER/SEWER TAP REQUEST
Date: c_ / 3 -/(o Project Address: 180V - 1 C (32k Dr.
No. of Units: I Commercial Residential ✓ Multi-Family
New Water Tap(s)&Meter(s) Meter Size(s) 4/
New Irrigation Meter ✓ Upgrade Existing Meter from to (size)
New Reclaim Water Meter ✓ Size '7 New Connection to City Sewer V
Name:
Applicant Address:
City: State: Zip
Phone Number: Cell Number:
Email Address Fax:
Signature:
(Applicant)
CITY STAFF USE ONLY
Application# /(o 5FZ- 2.03 3
Water System Development Charge $ 1,/VO' 00
Sewer System Development Charge $ ' 53V.c .7
Water Meter Only $ /83-,000
> 1
Reclaim Meter Only $ /8,S;OD
Water Meter Tap $ (notes)
Sewer Tap $
Cross Connection $ ASO. DO
Other $
TOTAL $5,(ev 0,OD
APPROVED: Kavle Moore, PE N-
(Deputy PW Director or Authorized Signature)
ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES
CAN BE ASSESSED
•
OFFICE COPY
CITY OF ATLANTIC BEACH
-, ,''` CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
`\ 800 Seminole Road 904-247-5800
.c;siyr Atlantic Beach,Florida 32233-5445 Fax 904-247-5845
PLEASE SUBMIT(3) COMPLETE SETS OF PLANS WITH APPLICATION.
1
Date C&11 1/kao PERMIT# /
1,, -1�,,,� ISSUED BY THE CITY /G� SF�Z—•=703'3
Job Address IStA k ut, C _ lin 0"L l 2
Permitee: �1vQrsk eta --1omeS cC N. VL.1 INC. Telephone# q04. 3-io5S
Permittee Address: Ic1(.Q SoLNJOSe.. [31Vc%1 4 l&( i 1C' 3ONV i 11Q1 cL 3.)aa3
Requesting Permission to Construct: No...k. CQN *rixcA2rON- IK.
Location: (Reference to Cross-Street)
1. Applicant declares that prior to filing this application he has ascertained the location of all existing utilities,
both aerial and underground and the accurate locations are shown on the sketches.
A Letter of Notification was mailed to the following Utilities/Municipalities:
Jacksonville Electric Authority Yes ( ) No ( ) Date:
Bell South Telephone Company Yes ( ) No ( ) Date:
Ferrell Gas Yes ( ) No ( ) Date:
Comcast Yes ( ) No ( ) Date:
2. Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation,
alteration or relocation of all, or any portion of said street or easement as determined by the Director of Public
Works, any or all of said poles, wires, pipes, cables or other facilities and appurtenances authorized
hereunder, shall be immediately removed from said street or easement or reset or relocated hereon as
required by the Director of Public Works, and at the expense of the Permittee unless reimbursement is
authorized.
3. All work shall meet City of Atlantic Beach • Florida De.artrient of Transportation Standards and be
performed under the supery ion of ,4_ . a f (Contractor's Project
Superintendent) located at k'tVeL3i 2- °roes Telephone#: 03'..-10S5
4.
4. All materials and equipment shall be subject to inspection by the Director of Public Works or his designee.
5. All city property shall be restored to its original condition as far as practical, in keeping with city specifications
and the manner satisfactory to the city.
6. A sketch of plans covering details of this installation, as well as, a copy of a recent survey shall be made a
part of this permit. Calculations showing any increase in impervious area on owner's lot or in the city
Right of Way are to be included with this application.
7. This permittee shall commence actual construction in good faith with 30 days. If the beginning date is
more than 60 days from date of permit approval, then permittee must review the permit with the Director of
Public Works to make sure no changes have occurred in the area that would affect the permitted construction.
8. It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the
City's right, title and interest in the land to be entered upon and used by the holder, and the Holder will, at all
times, assume all risk of and indemnify, defend, and save harmless the City of Atlantic Beach from and
against any and all loss, damage, and cost of expenses arising in any manner of the exercise or attempted
exercises by the holder of the aforesaid rights and privileges.
9. The Director of P :lic Works shall be notified twenty-four (24) hours prior to starting work and again
immediately u.. o, pletio .Ili
,
OWNER � .� ,� ' �
Signed: AAD te: �(--i1 IW 66
Before m is ~i day of . in the County of Duval,
State Of Florida,has personally appeared %S tAkneiri
Notary Public at Large,State of Florida,County of Duval. •`': "4:%,, Looser M.BISHOP
My commission expires: Person I ••a+ t i spy Pot&•Rats of Florida i
Produced Identification: - •'
,, �� Commission 0 FF 946204 �
„,°.ss My Comm.Expires Jan 19,2020 0
•
OFFICE COPY
R.O.W. Permit Attachment of for
R.O.W. Permit# issued , 200_ Atlantic Beach, FL 32233
Owner's Name: (RtJWdc. +64 OF NI• 0-
Property Address: mit AtictAi L e Dr;
M-tctn+i G 32�
Subdivision: (� Call it el(410
Lot#/Block#: IQ't _
R.E. #: !(0o5- '(lgl6
REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this - day of
, 200 by Atlantic Beach, Florida, a municipal corporation organized and existing
unde the laws of the State of Florida, hereinafter referred to as "CITY" and RivQxrs e a A-1001W
of Atlantic Beach, Florida,hereinafter referred to as "USER".
WITNESSETH:
That the CITY does hereby grant the USER permission on a revocable basis as described herein the
right to enter upon the property of the City of Atlantic Beach for the purpose as described in the City of
Atlantic Beach Right-of-Way/Easement permit numbers noted above(copies attached).
This work is generally described as: N Q_W CSN.5'krLC_*\c* -
Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted
remains subject to relocation or removal on thirty(30) days notice by CITY to the USER, said notice to
USER shall be given by certified mail, return receipt requested, to the following address:
I 0D-Ko aari Jose SWci , 3uuk lao, Jackwm i Ile, Ft_ 3aaa3
The depositing of said notice of cancellation in the United States mail shall constitute the notice of
cancellation and the burden is upon USER to keep the CITY informed of USER's proper address.
The USER shall promptly make any and all necessary repairs to any facility erected or maintained in
the exercise of the privilege herein granted and shall at all times maintain said facility in good and safe
condition.
In the event it is necessary for the CITY or the City's approved representative or other franchised
utility to enter upon the above-described property of the CITY, the USER shall replace at the USER's
sole expense, any and all material necessarily displaced during the action of maintaining, repairing,
operating,replacing, or adding to of the utilities and facilities of the CITY or franchise utility provider.
The facilities allowed by the permit shall meet the current requirements of the City Code, Building
Codes, Land Development Code, and all other land use and code requirements of the CITY, including
City Code Section 19-7 (h) which states "Driveways that cross sidewalks: City sidewalks may not be
replaced with other materials, but must be replaced with smooth concrete left natural in color so that it
matches the existing and adjoining sidewalks."
Page 1 of 2
OFFICE COPY
The USER, prior to making any changes from the approved plans and/or method, must obtain
written approval from the City of Atlantic Beach, Public Works Department, for said change. The
USER shall, at the discretion of the CITY, be requested to submit as-built drawings showing the change
within thirty(30) days after the day of completion.
This permit shall insure to the benefit of, and be binding upon, the USER and their respective
successors and assigns.
USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY
laws and/or specifications, to include utilities locate requirements and use limitations/requirements of
public rights-of-way and other public land. USER further agrees that the CITY and its officers and
employees shall be saved harmless by the USER from any of the work herein under the terms of this
permit and that all of said liabilities are hereby assumed by the USER.
DATE P a , ( NED this � day of c __ 204
By r
Pr
• • signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this day of $G , 2040, personally appeared before me, a Notary
Public in and for said Co ty and State, ( nS liked , the property owner of
[ j 614 , Atlantic Beach, Florida, known to me to be the person(s)
described in and who executed the foregoing instrument; who acknowledged to me that he or she
executed the same freely and voluntarily and for the uses and purposes therein mentioned.
I1iB
Not cinsad State te of Florida ICITY OF ATLANTIC BEACH,FLORIDA, a ° My Comm.Expires Jan 19.2020
municipal corporation:
Approved:
Ricky L. Carper,Public Works Director
For Permits where city sidewalk is impacted,
City Manager approval required:
Jim Hanson, City Manager
Page 2 of 2
OFFICE COPY
Atlantic Beach Country Club lot 64
1804 Atlantic Beach Drive
Atlantic Beach, FL 32233
Single Family Detached-Group R3
2014 Florida Building Code
James Pozetta,Architect#AR96064
103 South 18th Street, Fernandina Beach, FL 32034
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