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350 3RD ST - PERMIT ( syr �� r Si, CITY OF ATLANTIC BEACH j 800 SEMINOLE ROAD Jj= ... ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 ACCESSORY STRUCTURE NEW RES MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 16-ACST-2365 Job Type: DETACHED ACCESSORY STRUCTURE NEW Description: construct guest house Estimated Value: $37,100.00 Issue Date: 11/18/2016 Expiration Date: 5/17/2017 PROPERTY ADDRESS: Address: 350 3RD ST RE Number: 169784-0000 PROPERTY OWNER: Name: Henderson, Jacqueline Address: 350 3Rd ST GENERAL CONTRACTOR INFORMATION: Name: AMERICAN WINDOW PRODUCTS , CBC1251207 Address: 2633 S POWERS AVE QA KEITH ALAN GURR Phone: - - PERMIT INFORMATION: PUBLIC WORKS: All concrete driveway aprons must be 5" thick, 4000 psi, with fibermesh from edge of pavement to the property line. Reinforcing rods or mesh area not allowed in the right-of-way. (Commercial driveways- 6"thick). Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact Public Works (247-5834) for Erosion and Sediment Control Inspection prior to start of construction. All runoff must remain on-site during construction. If on-site storage is required, a post construction topographic survey documenting proper construction will be required. All water runoff must go to retention area and retention overflow must run to street. Roll off container company must be on City approved list and container cannot be placed on City Right- of-Way. (Approved: Advanced Disposal, Realco Recycling, Republic Services,Shapell's, Sunshine Recycling and Waste Pro). Full right-of-way restoration, including sod, is required. rHil�Ytd �t Efl�ttlf'f� l Ra.keeg ff4(11 ►1-Iri' 1A1AineilAci3fo,'MAIR'r ArdrAki9 laett . .qbi.oRInA Blai:lieay Pent* is required if using right-of-way for construction parking. Pr ie, CITY OF ATLANTIC BEACH 0 800 SEMINOLE ROAD X ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 All runoff must remain on-site. Cannot raise lot elevation. Must provide a topographic (TOPO) survey with water retention for final C.O. Inspection. Any plan change must be submitted as a Revision to the Building Department. FEES: PLAN CHECK FEES $117.75 BUILDING PERMIT FEE $235.50 STATE DBPR SURCHARGE $3.53 STATE DCA SURCHARGE $3.53 PW 2nd Submittal Plan Review $50.00 Total Payments: $410.31 FER11I'I IS :U'PROVED ONLIIN ACCORDANCE; 11'1111 :U,I. CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA 13l`II,DINC CODES. - 1y vi-i--; City of Atlantic Beach APPLICATION NUMBER ;' J Building Department (To be assigned by the Building Department.) 1 ) 800 Seminole Road• 1 �� Atlantic Beach, Florida 32233-5445 1 10r A G Phone (904)247-5826 • Fax(904) 247-5845 Date routed: 0 ` Azo;t»r E-mail: building-dept@coab.us IVO City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 3 SID -3 Si ' Department review required Ye No l Applicant: Ot.J(1 • &Zonin L Tree Administrator Project: ZS ILA 3kt..cST V\ t - C2liblic Work Public 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: ( 1N PLANNING & ZONING Reviewed by: Date: /('1716 TREE ADMIN. Second Review: I 'Approved as revised. ['Den d. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 s?s,.L� City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) ▪ A+ .p 800 Seminole Road I,, \▪1._ Atlantic Beach, Florida 32233-5445 �— tSt `�S– Phone(904)247-5826 • Fax(904) 247-5845 O 11-4/ \l'to;;is%= E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 3 (� • Department review required Yes No Applicant: Own ' ' -•• �• &Zonin• __- Tree Administrator Project: 0.--Ck1S &C 1k�S4-1(10illr • is Work _- ill Public 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 PLANNING & ZONING , � ��\ Date: //V if Reviewed by: 00 10 TREE ADMIN. Second Review: EiCpproved as revised. ['Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: _ _ / sate: /0/A i FIRE SERVICES Third Review: ['Approved as revised. (Denied. Comments: Reviewed by: Date: Revised 05/14/09 s�=���i;ir, City of Atlantic Beach APPLICATION NUMBER ;js r Building Department >'��; '; `"" (T_o be assigned by the Building Department.) • i,,1. 800 Seminole Road "- - Atlantic Beach, Florida 32233-5445 T 2 O 20 6 b� �� ^3-3�� Phone(904)247 5826 Fax(904)247 5 j ilk, '/- "�-0;i�9'r E-mail: building-dept@coab.us • Date routed: 1:3 l `yk7 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 3 3(-dDepartment review required Yes No 71#81. -11111111111 Applicant: 0wV2-1- ' • -I"U.. &Z01-112. 1 0. .� , ,.At_1 Tree_Administrator Project: - S�'1n 311.0_-S#1(16.0f2... • .. is Work 11 Public 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 PLANNING &ZONING , ,_____4 Reviewed by: Date: f(- 7--/j TREE ADMIN. Second Review: 17tApproved as revised.re ❑/'Denied. PUBLIC WORKS Comments: see ifiri hei4t ,i4 PUBLIC UTILITIES PUBLIC SAFETY Reviewed b Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: 4 Revised 05/14/09 .a s�a,��;y,, City of Atlantic Beach APPLICATION NUMBER ^s r Building Department : (To be assigned by the Building Department.) 1r 800 Seminole Road. OCT 2 0 2016lb---�c&.ST --a-3"oS j:. Atlantic Beach, Florida 32233-5445 Phone(904)247 5826 Fax(904)247-$845 P J;3 EE-mail: building-dept@coab.us Date routed: IL-G/ r ltb City web-site: http://www.coab.us —APPLICATION REVIEW AND TRACKING FORM Property Address: 3 3 r" ' Department review required Yes No Applicant: own-Q-1 &Zoni Tree Administrator Project: 0.lY1S'Ml.CA gu.ts-t-hc;)►A Q. CEu55iic Works' Public_Utilitie' Public Safety Fire Services fee $ Dept Signature 44" -- 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: APPL ATION STATUS Reviewing Department First Review: Approved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Ai* Bate: ////f/l 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 05/14/09 P • OFFICE CC 'ii. Ad00 33W0 • y'''r'� BUILDING PERMIT APPLICATION J r -, } CITY OF ATLANTIC BEACH 1 ,J •V 800 Seminole Road,Atlantic Beach FL 32233 OCT 1 9 2016 � c;:1�%' Office:(904)247-5826 • Fax: (904)247-5845 - Job Address: 5O 1 mmici .54,--,4 3l1ln'2' Je Permit Number: I7AC-STM)3S Legal Description Leir i'3 e fy 3ct )49`I ,(.o1'lt7 RE# _ /e)� 0 Valuation of Work(Replacement Cost)$ (C)00)NMHeated/Cooled SF Non-Heated/Cooled mi. C9 K O tizsle howse: 3y 3 1-0 • Class of Work(Circle one): ell Addition Alteration Repair v . emo Pool Window/Door • Use of existing/proposed structures) (Circle one): Commercial Residentia • If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N/A • Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal Describe in detail the type of work to be performed: CanSfct4c\ ae fVeuti . S zrye FrulL ii ciweIIsv, C1-Iniate Florida Product Approval#_ for multiple products use product approval form Property Owner Information .... p �_t Name: RiCkc,�,�1 �Jchc� 1' Address: 270 I �^�ra S+QT City tateR Zip 3d 3 Phone ` o4- - agos E-Mail Sekeo i; ,crnaZI •cclivi Own••or Agent (If Ageel'l,Power of Xttomey or Agency Letter Required) 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. Contractor Information: Name of Company: ©w Nei' 642,8txtitt 1164enualifying Agent: _ Address:SI N1 iduxly S-f• City!UCp#ttar t3 act, State Zip 3 afX(� .% Office Phone Job Site/Contact Number State Certification/Registration#ll E-Mail Architect Name & Phone # Engineer's Name&Phone# Worker's Compensation Exempt / Insurer / Lease Employees / Expiration Date 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 ofua 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, ori construction or work es sus Electrical abandoned for a period of six(6)months at any time after work i • menced, I understand that separate permits must be secured for Electrical Work,Plumbing, Signs, Wells,Pools,Furnaces,Boilers, .eate ., i ks and •it Conditioners,etc. Signature of Property Owner: / Signature of Contractor: Before tile this iw.i"Day of IX oseca of Before me this Day of 1,,t1p,.MU. - ,i,,-,- , . - Notary Public: :.. ± ..: MY COMMISSI• j FF 217841 I+ 4 o;i : Miff'.4 : ' 7e4119.(111( xamined this application and know the same to be true and correct. All provisions of laws and o li'Fle *ec .. -1411N121k5c Milk 1 •rk will be complied with whether specified herein or not. The grantin.g of a permit does not p c 1 1 • • • .r ► . I c r cancel the provisions of any other federal, state, or local law regulating construction or the performance of construction. Rev 1/l4/16 ii,1:LyiJr� CITY OF ATLANTIC BEACH � DEPARTMENT OF PUBLIC WORKS tt1200 Sandpiper Lane f Atlantic Beach,FL 32233-4318 '- r) TELEPHONE:(904)247-5834 !"4.0) , Z FAX:(904)247-5843 www.coab.us ~tt0i3191' OWNER: 4 DATE: 11-8-16 Richard Schooling PERMIT# 16-ACST-2365 350 3`d Street ADDRESS: 350 3rd Street Atlantic Beach,FL 32233 / >; g Atlantic Beach,FL 32233 Email: Rschoolin 65(a. mail.com /fr/ l PERMIT APPLICATION TO CONST UCT GUEST HOUSE Your permit application has been e ' y the Public Works Depa ent for the reasons listed below. Please submit this information at your earliest convenience in order that we may approve your application. If you have any questions,please contact Scott Williams, Deputy Public Works Director at 904-247-5834 or email swilliams@coab.us. PUBLIC WORKS CORRECTION ITEMS: (Submit the following information to the Public Works Department) ** Provide drainage plans showing site topography(flow arrows,etc.). ** Provide erosion and sediment control plans with installation details. ** Provide impervious surface calculations for entire lot(existing and post construction). ** Section 24-66(b)of the Land Development Regulations requires on-site storage for increased run-off if adding 400 SF or more impervious surface. Provide Delta volume calculations and on-site retention required per Section 24-66(b). ** All runoff must remain on-site. Cannot raise lot elevation. ** Provide a pre-construction topographic survey prepared by a Florida Licensed Professional Land Surveyor, showing 1' contours. ** Provide a detailed plan of water retention area and how water runoff gets to water retention areas and then to street. ** Provide detailed plans showing proposed water retention. ** Concrete sidewalk must continue through driveway. PUBLIC WORKS CONDITIONS OF APPROVAL: (The following comments will be printed on your permit as Conditions of Approval) ** All concrete driveway aprons must be 5"thick,4000 psi,with fibermesh from edge of pavement to the property line. Reinforcing rods or mesh area not allowed in the right-of-way. (Commercial driveways-6"thick). ** Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact Public Works(247-5834)for Erosion and Sediment Control Inspection prior to start of construction. ** All runoff must remain on-site during construction. ** If on-site storage is required, a post construction topographic survey documenting proper construction will be required. All water runoff must go to retention area and retention overflow must run to street. ** Roll off container company must be on City approved list and container cannot be placed on City Right-of-Way. (Approved:Advanced Disposal, Realco Recycling, Republic Services,Shapell's, Sunshine Recycling and Waste Pro). ** Full right-of-way restoration, including sod, is required. ** Provide construction site management plan, including location of dumpster and portable toilet. Right-of-Way Permit is required if using right-of-way for construction parking. ** All runoff must remain on-site. Cannot raise lot elevation. ** Must provide a topographic(TOPO)survey with water retention for final C.O. Inspection. ** Any plan change must be submitted as a Revision to the Building Department. cc: Toni Gindlesperger,Building Department Jennifer Johnston,Building Department Perrone, Jennifer C. From: Perrone, Jennifer C. Sent: Tuesday, November 08, 2016 2:54 PM To: 'Rschooling65@gmail.com' Cc: Williams, Scott; Gindlesperger,Toni; Johnston, Jennifer Subject: Plan Review Comments for 350 3rd Street Attachments: Plan Review Comments 16-ACST-2365.pdf Permit application#16-ACST-2365 for 350 3rd Street is currently denied by Public Works. Attached are the plan review comments. Please submit required information at your earliest convenience in order that we can process approval for our Department. Thank you, Jennifer Perrone, Administrative Assistant City of Atlantic Beach Public Works Department 1200 Sandpiper Lane Atlantic Beach, FL 32233 (904) 247-5834 jperrone@coab.us 1 I X31'0 3l--.**44Y— --16 '-'1r/1x3 ----4-* rn kf(6-424:7- 2- -/, ‘G-7 Art, i /tire° /46‘ _ry le 4 A/be 1ir,neit ..30 I(If' r 310 >itirf ---ta-itta:A-4--Z-/al. r * 440 I3X/a t /JO -- 11 4 /4 sy y hi ‘c IP, L2_ z gx etc , T 9 �.r' t � _ - --- f'ppjaaa .rufAve --- #.1.2- t — , Jo IV ..Z.0 / it_P4 y 0 _______t 6 it--4-i i 74v het itieVtere , ,1t, 'Ds/, --irg VY,z, ,(� _krta-_yam— Ard- -- No alki 1Q4a,t,,, 1 _ /(Tit,r�� s f CITY OF ATLANTIC BEACH �� s) 800 SEMINOLE ROAD j- %-. ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 —JR 9 SINGLE FAMILY DWELLING NEW MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 16-SFR-2364 Job Type: SINGLE FAMILY RESIDENCE Description: construct new family dwelling Estimated Value: $395,840.00 Issue Date: 11/18/2016 Expiration Date: 5/17/2017 PROPERTY ADDRESS: Address: 350 3RD ST RE Number: 169784-0000 PROPERTY OWNER: Name: Henderson, Jacqueline Address: 350 3Rd ST PERMIT INFORMATION: FEES: ENG REV RESIDENTIAL BLD $100.00 PLAN CHECK FEES $683.76 UTIL REV RESIDENTIAL BLDG $50.00 STATE DBPR SURCHARGE $20.51 STATE DCA SURCHARGE $20.51 SEWER TAP FEES $2,100.00 'MVP thl, `H`t `i`! :‘Y"('ORDANCE`t,A91 .:t'L`L CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA J�, 4'' ; k• J), CITY OF ATLANTIC BEACH .A�„, 800 SEMINOLE ROAD J ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 --1.01119 WATER CROSS CONNECTION $50.00 BD PLAN REV. 2ND $50.00 SUBMITTAL PW 2nd Submittal Plan Review $50.00 Total Payments: $3,924.78 PERMIT IS APPROVED ONLY IN ACCORDANCE. WY1771 ALL CITY OF ATLANTIC BE.AC71 ORDINANCES AND 771E FLORIDA BUILDING CODES. 1-------/ „t\,f;, City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) \ l 800 Seminole Road [- S�� a.3(D t( - Atlantic Beach, Florida 32233-5445 1 fir” Phone (904)247-5826 • Fax (904) 247-5845 i O I VI '—''.--c0.2-1-1- E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: s0 'i 54 . nt review required Yes No Applicant: 6WIn./2—` Planning &Zonin Tree A :trator Pub icl -Wof Project: I JY S (k4" 'nom S Q..— u is tali \n.OrvVL__ Public Safety Fire Services Carec mn �!� Pian Qeth e 4.Z �. { .........: ."r" .-. ...l,S.iWM1P fain 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 I First Review: I lApproved. []Denied. (Circle one.) Comments: BUILDING PLANNING & ZONING Reviewed by: Date://0-2H6 TREE ADMIN. Second Review: Approved as revised. ®Denied. PUBLIC WORKS Comments: E ftPr y Leve ! Ca)rd.i '-=(‘' n 04" :.15'e," PUBLIC UTILITIES PUBLIC SAFETY / Reviewed by:/11, Date:/I- ?-le FIRE SERVICES Third Review: nApproved as revised. Denied. Comments: n Reviewed by: ofil f Date: Revised 05/14/09 4j\ J e. V ,A CITY OF ATLANTIC BEACH — ;. 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 (904) 247-5800 r.J;319' BUILDING DEPARTMENT REVIEW COMMENTS Date: 10.28.2016 Permit#: 16-SFR-2364 Applicant: Richard Schooling Site Address: 350 3rd St,AB Site Address: Same Review: 1 Phone: 904-609-2905 RE#: Email: Rschooling65ngmail.com Homeowner: same Correction Comments: These comments are from I of 4 Departments that are reviewing this application. Application is disapproved for the following issues: 1. Energy Performance Level Display Card not filled out(4 cards). 2. Contractor shall sign and date on the site plan the Proposed Finish Floor Elevation. 2 sets to be signed. 3. Submit 2 copies of the Florida Product Approval Forms filled out completely. 4. Submit 2 copies of the Spray Foam Insulation information. 11 5. Homeowner needs to fill out the Homeowner Builder Affidavit at City Hall Building Department. Mike Jones / S r�U Building Inspector/Plan Reviewer S7`��)/ /70 City Of Atlantic Beach 800 Seminole Road (� //-746'Atlantic Beach, FL 32233-5445 rf Ofc (904) 247-5844 --_ . Fax (904) 247-5845 r F, (_2 t - `/ ! ,; r7S-11 i 11.03.2016 NOV - 4 2016 Second Review: 1 _ _ Y ! 1 1. T - - were 2 groups of 4 energy performance level display cards brought-in,One of the :roups were all signed, the other was not signed. Signatures are still needed on es not signed that belongs to the guest house. Thanks, Re C . /1-- 2- /6 fiyl(y Mike Jones, Coab. U E i'n Gi tie cJ ct rs!}! w..e A-i— J /- - /6 `'h 2 41 fJ' , CITY OF ATLANTIC BEACH ;, A s) 800 SEMINOLE ROAD Ail j ATLANTIC BEACH, FL 32233 (904) 247-5800 BUILDING DEPARTMENT REVIEW COMMENTS Date: 10.28.2016 Permit#: 16-SFR-2364 Applicant: Richard Schooling Site Address: 350 3rd St, AB Site Address: Same Review: 1 Phone: 904-609-2905 RE#: Email: Rschooling65(a gmail.com Homeowner: same Correction Comments: These comments are from 1 of 4 Departments that are reviewing this application. Application is disapproved for the following issues: 1. Energy Performance Level Display Card not filled out(4 cards). 2.—C-antraetor-shall-sign-and-d ite-plan-the-P-mp d-Finish-FloorElevation-2-sets to he signed. //'' '3-"/(s /1" 3�Submit=2=copies-ofthe Florida-Produc-t-. 1s-filed-out-completely.1/- 3-,0 rn - LL—Submit 2 copits-ufthirSpray--Foam Insufati rm //- 3—/6. /7" �/ 5r---Homeowner-needs-to-#ill-nut-tha-Momemwirer-Brifhl Aftidav-it-at-C--ity--H ll_B.uilding Department. j'Yy //- 7- /6 Mike Jones Building Inspector/Plan Reviewer City Of Atlantic Beach 800 Seminole Road Atlantic Beach, FL 32233-5445 Ofc (904) 247-5844 Fax (904) 247-5845 emai )eO� `P.oV; ew COV" Y''-\P/1fs Id131/ib �� 'fOl�r�^ / 1 ti 11.w' ` , CITY OF ATLANTIC BEACH e'v m 800 Seminole Road Atlantic Beach,Florida 32233 /, r Telephone(904)247-5800 . —« '� FAX(904)247-5845 iiit ' ' REVISION REQUEST SHEET OR CORRECTIONS TO REVIEW COMMENT Date: �J--3—, 2 Received by: Resubmitted: Permit Number: kG- SFl?- a 344. Original Plans Examiner: Project Name: Project Address: Q '3a-- S-ft`ecl Contractor: )6ea.dceQ.ag Contact Name: Contact Phone : 9O Lf. 601 (4citic Contact e-mail: j?Soih C5 e ra.)1 .Cor► Revision/ Plan Check/Permit Fee(s) Due: $ 5C2.O O Description of Proposed Revision to Existing Permit: D E -______ • ,at. 8,......., c.-4 >c if.. 11111 3 �o�. 11111 aY wt c�sc.r _ 14or'^t 6U • - IU/ - t Sa A p 1nF�nr�ftor' a 7luridk `Produ.ol ze-inP l-ocm s Additional Increase in BuildingValue: $ Additional S.F. Site Plan Revised: Public W/U Approval: By signing below. 1 (print name) affirm that the above revision is inclusive of the proposed changes. p 3//a Signature tt Contracto tractor must sign if increase in valuation) Date Office Use Only Date://—2`/6 Approved: Rejected: / Notified by:__ • Plan Review Comments: 1 J/ erns 1occ-eSTc/ Qxce p1f -1-JA-e_ P�er�y Level cards ; '# a -4--1,4kr Sir t�rt'1•r Lt a C'e n a 7 5-T5 nW/1-- De•artment review required Yes No •lanning&Zoning Plans Examiner Tree7k hinistrator Public Works /1' •16 _ Public Utilities — Public Safety Date Created 4/11/16 Rcv.3 Fire Services CITY OF ATLANTIC BEACH 1 $,,�� J 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 (904)247-5800 BUILDING DEPARTMENT REVIEW COMMENTS Date: 10.28.2016 Permit#: 16-SFR-2364 Site Address: 350 3rd St,AB Review: 1 RE#: Applicant: Richard Schooling Site Address: Same Phone: 904-609-2905 Email: r Homeowner: same Correction Comments: These comments are from 1 of 4 Departments that are reviewing this application. Application is disapproved for the following issues: 1. Energy Performance Level Display Card not filled out(4 cards). 2. Contractor shall sign and date on the site plan the Proposed Finish Floor Elevation.2 sets to be signed. 3. Submit 2 copies of the Florida Product Approval Forms filled out completely. 4. Submit 2 copies of the Spray Foam Insulation information. 5. Homeowner needs to fill out the Homeowner Builder Affidavit at City Hall Building Department. Mike Jones Building Inspector/Plan Reviewer City Of Atlantic Beach 800 Seminole Road Atlantic Beach, FL 32233-5445 Ofc(904)247-5844 Fax(904)247-5845 1 0 APl,' City of Atlantic Beach APPLICATION NUMBER Js .\., Building Department (To be assigned by the Building Department.) - 1s800 Seminole Road j.� „r Atlantic Beach, Florida 32233-5445 1 Phone(904)247-5826 • Fax(904)247-5845 .o I tc I 1 E-mail: building-dept@coab.us Date routed: 1 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 3 0' 54 . i - • • -nt review required Yes No : • . Applicant: 6WA.1/—` • - ' ' ' Tree tdmita rator • Public-W f Project: S (A- Att..) S� �-- tom. • . iciii - \n,OM�_ 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. NDenied. (Circle one.) Comments: see 4GL BUILDING / PLANNING &ZONING Reviewed by' L -� Date: ty1 !C TREE ADMIN. Second Review: Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: 10.0; FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 0,,,,,,7j... ZONING REVIEW COMMENTS Is City of Atlantic Beach 3toCommunity Development Department 800 Seminole Road Atlantic Beach, Florida 32233-5445 �401319 Phone: (904) 247-5826 Fax: (904) 247-5845 Email: dreeves@coab.us Date: 11/8/16 Permit: 16-SFR-2364 Applicant: Richard Schooling, Owner Review: 1st Address: 350 3`d St, Atlantic Beach, FL 32233 Site Address: 350 3`d St Phone: (904) 609-2905 RE#: 169784-0000 Email: Rschooling65@gmail.com ICorrection Comments 1. Outdoor Shower: The proposed outdoor shower is within setbacks of the house. This changes the applicable height requirements. The enclosure is considered fencing and must be 6 feet or less in height as measured from grade. Please revise accordingly. 2. Tree Removal: Section 23-21 requires a Tree Removal Permit for any trees removed within 2 years of this project. Please submit a Tree Removal Permit Application if any trees are to be removed or were removed in the last 2 years. If no trees are to be removed or were removed, then please fill out an Affidavit of No Tree Removal. Both forms are available on the city website under "Planning and Zoning" and at City Hall. Derek W. Reeves Planner dreeves@coab.us Y. ;- 4 Os i, ZONING REVIEW COMMENTS • ii ;� City of Atlantic Beach ,�- .:. . Community Development Department 800 Seminole Road Atlantic Beach, Florida 32233-5445 .v01310' Phone: (904) 247-5826 Fax: (904)247-5845 Email: dreeves@coab.us Date: 11/8/16 Permit: I 6-SFR-2364 Applicant: Richard Schooling, Owner Review: 1`` Address: 350 3rd St, Atlantic Beach, FL 32233 Site Address: 350 3"d St Phone: (904)609-2905 RE#: 169784-0000 Email: Rschooling65@gmail.com Correction Comments O tdoor Shower: The proposed outdoor shower is within setbacks of the house. This changes the •plicable height requirements. The enclosure is considered fencing and must be 6 feet or less in height as measured from grade. Please revise accordingly. 2. Tree Removal: Section 23-21 requires a Tree Removal Permit for any trees removed within 2 years of this project. Please submit a Tree Removal Permit Application if any trees are to be removed or were removed in the last 2 years. if no trees arc to be removed or were removed, then please fill out an Affidavit of No Tree Removal. Both forms are available on the city website under "Planning and Zoning"and at City Hall. Derek W. Reeves ( Ccs pc A.S Planner dreeves@coab.us I O n �� /` 3C5' r It nC�P , ln0 V l 4- \Du ,. VVV ,.s, 4. TREE & VEGETATION AFFIDAVJT__ , '#; '''44, 1‘ City of Atlantic Beach 11. r) Department of Community Development ,V ,_ - Planning&Zoning Division 800 Seminole Road Atlantic Beach,FL 32233 (P)904 247-5800 (F)904 247-5845 PERMIT# SECTION I-APPLICANT INFORMATIONr Owner(s) f Legal Authorized Agent* 1 I NAME OF APPLICANT '\ It 101x6, 3 - NAME OF COMPANY 31 I M tAt.ua.j . , ( p�..}.,� n ADDRESS OF COMPANY �`Z-V' ` `-VVQ. DOCt � F-6 of 3 t9C , PHONE CELL IOl4107a7o�EMAIL JWScAt b C�> af"o 1. CCSM I CONTRACTOR CERTIFICATION NUMBER ATLBCH BUSINESS TAX RECEIPT NUMBER SECTION II-SITE INFORMATION 1 STREET ADDRESS OF PROPERTY 2 0 •T').'./-d Ste(-ei 3` a�11a33 Ilan address has not been assigned to this property,contact the AB Building Department at(904)247-5826 to request an address. LEGAL DESCRIPTION S}- -fy Q CD ,v LJ1- i'3 607- /S r L 07- /7 LOT 45;i 9, ,..0--,ii BLOCK SUBDIVISION REAL ESTATE NUMBER LOT OR PARCEL SIZE: ) S�C.-)0C.: SQ FT AC RESIDENTIAL COMMERCIAL OTHER(SPECIFY) I affirm that I have reviewed the provisions of Chapter 23, 'Protection of Trees and Native Vegetation"of the Municipal Code of Ordinances for the City of Atlantic Beach, FL and/or I have participated in a pre-application meeting with the Administrator of those regulations. Subsequently,I affirm that no regulated trees and no regulated vegetation will be damaged,destroyed and/or removed from the above-described or adjacent properties in conjunction with this project. . (-2 P SIGNATURE OF OWNLE ) SIGNATURE OF OWNER Signed and sworn before me on this��day of I3 cD‘j /�,by State of r (c County of [) J 0.. c Identification verified: (2,c) Oath sworn: E Yes I— No tI 'eil TONITONI GI' NDLESFERGER I Notary Signature C2—(1)--6------ . CI `: :0,_ MY COMMISSION 0 FF 924951 I • . ?= EXPIRES:October 6,2019 My Commission expires: RFV-.".., .`:;', -s lr. life 126cndad Mr;Notay Pubic Underwriters 51.:�,�1 , City of Atlantic Beach APPLICATION NUMBER -i 1 •S\ Building Department (To be assigned by the Building Department.) o ` 800 Seminole Road �.a " _ ;� r� Atlantic Beach, Florida 32233-5445 "' 'EO' S F _ a 3(D Y Phone(904)247-5826 • Fax(904) 247-584 0 2016 ,, 1.p t� jib -° 0;„, E-mail: building-dept@coab.us �l, a Date routed: City web-site: http://www.coab.us Li --- - - APPLICATION REVIEW AND TRACKING FORM Property Address: �J ( 9 ' _nagingilabin. - • -nt review required Yes No p Y Applicant: V W A J-( Planning &Zonin• Tree A A.o`. frator Project: l'..�n.S-k(�(k �Ai.,) sl Q...- L, i Pub c-Wof . •u• Ic utili NnO - 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: ❑Approved. [enied. (Circle one.) Comments: BUILDING w PLANNING & ZONING — Reviewed by .i/ � , .,ft,,,,Date: n---7---4 TREE ADMIN. Second Review: Approved as revised. II Denied. 1 Al PUBLIC WORKS Comments: .See /, , , / i , /C . PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: /Q,‘ LDate: 1(40/4, FIRE SERVICES Third Review: ['Approved as revised. ['Denied. Comments: Reviewed by: Date: Revised 05/14/09 EACH 0 t I iJ f f' DEPARTMENT OF BLICBWO KS `)3 4 ;f 1200 Sandpiper Lane Atlantic Beach,FL 32233-4318 J 4 1) TELEPHONE:(904)247-5834 \\,,,....... 1.5--°E0F1--Z: FAX:(904)247-5843 www.coab.us / OWNER: / / DATE: 11-8-16 11,4 Richard Schooling ; I PERMIT# 16-SFR-2364 , 350 3rd Street l ADDRESS: 350 3'Street Atlantic Beach,FL 32233 I/1 of(0 Atlantic Beach,FL 32233 Email: Rschooling65(q'gmail.com PERMIT APPLICATION FOR NEW GLE FAMILY RESIDENCE Your permit application has been • by the Public Works Department for the reasons listed below. Please submit this information at your earliest convenience in order that we may approve your application. If you have any questions,please contact Scott Williams, Deputy Public Works Director at 904-247-5834 or email swilliams@coab.us. PUBLIC WORKS CORRECTION ITEMS: (Submit the following information to the Public Works Department) /" Provide drainage plans showing site topography(flow arrows,etc.). V** Provide erosion and sediment control plans with installation details. ** Provide impervious surface calculations for entire lot(existing and post construction). '�** Section 24-66(b) of the Land Development Regulations requires on-site storage for increased run-off if adding 400 SF or more impervious surface. Provide Delta volume calculations and on-site retention required per Section 24-66(b). ** All runoff must remain on-site. Cannot raise lot elevation. 1.-' Provide a pre-construction topographic survey prepared by a Florida Licensed Professional Land Surveyor, showing 1' co tours. fr Provide a detailed plan of water retention area and how water runoff gets to water retention areas and then to street. v** Provide detailed plans showing proposed water retention._ ** Concrete sidewalk must continue through driveway. PUBLIC WORKS CONDITIONS OF APPROVAL: (The following comments will be printed on your permit as Conditions of Approval) ** All concrete driveway aprons must be 5"thick,4000 psi,with fibermesh from edge of pavement to the property line. Reinforcing rods or mesh area not allowed in the right-of-way. (Commercial driveways-6" thick). ** Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact Public Works(247-5834)for Erosion and Sediment Control Inspection prior to start of construction. ** All runoff must remain on-site during construction. ** If on-site storage is required,a post construction topographic survey documenting proper construction will be required. All water runoff must go to retention area and retention overflow must run to street. ** Roll off container company must be on City approved list and container cannot be placed on City Right-of-Way. (Approved: Advanced Disposal, Realco Recycling, Republic Services,Shapell's,Sunshine Recycling and Waste Pro). ** Full right-of-way restoration, including sod, is required. ** Provide construction site management plan, including location of dumpster and portable toilet. Right-of-Way Permit is required if using right-of-way for construction parking. ** All runoff must remain on-site. Cannot raise lot elevation. ** Must provide a topographic(TOPO)survey with water retention for final C.O. Inspection. ** Any plan change must be submitted as a Revision to the Building Department. cc: Toni Gindlesperger,Building Department Jennifer Johnston,Building Department Perrone, Jennifer C. From: Perrone, Jennifer C. Sent: Tuesday, November 08, 2016 2:54 PM To: 'Rschooling65@gmail.com' Cc: Williams, Scott; Gindlesperger,Toni; Johnston, Jennifer Subject: Plan Review Comments for 350 3rd Street Attachments: Plan Review Comments 16-SFR-2364.pdf Permit application #16-SFR-2364 for 350 3`d Street is currently denied by Public Works. Attached are the plan review comments. Please submit required information at your earliest convenience in order that we can process approval for our Department. Thank you, Jennifer Perrone, Administrative Assistant City of Atlantic Beach Public Works Department 1200 Sandpiper Lane Atlantic Beach, FL 32233 (904) 247-5834 jperrone@coab.us ira X161 ao_ _40 7 . /:404111tPWA- Noec tie = ,ZibQ wow at,01.6 j11 ›.94(1 446 flarcA 37 K .6L 7 lf 11110,0 / /o t hyo p0;atc4' LrcP X a '" ` 16 FJ-5- (314-r /viva ti- ,--C-Aeie— _ .gym Yry y�2 0 ttriezr ; ol iFc UX. z 16 `LA/4'" CITY OF ATLANTIC BEACH _ CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF • ;�,,; 1 r Ill 800 Seminole Road u 4 \.,jtty� Atlantic Beach,Florida 32233-5445 904-247-5800 Fax 904-247-5845II i 14 OCT 1 • I . PLEASE SUBMIT(2)COMPLETE SETS OF PLANS WITH APPLICATION. PER 11 t V Date Q I1 3016 ISS Job Address fig) t.'c 5'+ E-mail- tnoaj,n n � Co SJ . 010-z I .Com Permitee: I divk:: all yl-jstNts Telephone# 90(f. 9 gcf Permitee Address: � ,i:cjitt 54.• 1 t 3 C Requesting Permission to Construct: Ck d R tlP Lull Location: (Reference to Cross-Street) 1 v,;c Sfi`•eei 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 (.if Date: Ferrell Gas Comcast Yes( ) No( Date: 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 Permitee unless reimbursement is authorized. 3. All work shall meet City ofAt,aitic Beach or FI d De artment of Transportation Standards and be performed under the supervision of •<%C)nc . p located at �'t} �c (Con actor s Project Syperintendent) SiS�( - ATti RAI &J d Telephone#: 10 (00c azo 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 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 Public Works shall be notified twenty-four(24) hours prior to s -. upon completion. !f* rn ._.`.__ nAYrun,�tnil:AINS :.= MY COMMISSION t FF 217841 ?`•- ..a= EXPIRES:August 7, OWNER '::s;lad" w BondednNaary 2019- UnO�nrlra Signed: 12--- Date:h09k, Before me this lq-al of OGtt €R in th y of Duval, State Of Florida, has personally appeared day •K'CiVIAP sett OL' Notary Public at Large, State of Florida, County of Duval. My commission expires: g.7-IA 1A , 1.2).1.4 _ __ ersonally Known: Ft PL entlfication: Revised 712911 c - - Permit Attachment of for Permit# issued ,20_Atlantic Beach,FL 32233 Owner's Name: Property Address: R.E.#: Subdivision: Lot#/Block#: REVOCABLE ENCROACHMENT PERMIT THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of by Atlantic Beach, Florida, a municipal corporation organized and existing under the laws of the State of Florida, hereinafter referred to as "CITY" and hereinafter referred to as"USER". of Atlantic Beach, Florida, 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: Ccs nerd DNVI `4-Pc4 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 e ' by cfieri mail, return receipt requested, to the following address: -Jet bez 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 sidewallcs 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 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. DATED and SIGNED this--l—day of O C f jam. ,201 By: Property O (to be Signeo i presence of the Notary) STATE OF FLORIDA COUNTY OF DUVAL On this NIA day of Ot tg2000 personally and for said County and State, � , appeared before me, a Notary Public in D . Ft©OL h the property owner of 350 1(fi 2b s-race-( ,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. 4}1 1 • MAYNA YD COMMISSION WAMS 41 Nota Public in for said County and State :' gs EXPIRES:August 7,2•319 4�!Rf Bonded Thru Notary Pubic Undpwbers 1 CITY OF ATLANTIC BEACH, FLORIDA, a municipal corporation: Approved: • - - • • ;re, blic Work,Director A. Qe060veriz P. For Permits where city sidewalk is impacted, City Manager approval required: Nelson Van Liere, City Manager 0 Page 2 of 2 S_,Aff City of Atlantic Beach APPLICATION NUMBER •JS r 'A Building Department ",__e (To be assigned by the Building Department.) � ;'t•-•0 800 Seminole Road C � ' p1 ;te �- 2 Atlantic Beach, Florida 32233-5445 `••' [1r l 16- SFS 'a-1(41 Phone(904)247-5826 Fax(904) _56)CT 2 0 2016 1.0 l L� I lk �% 4 E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: "% • I • • • -nt review required Yes No p Y / •u. .... Applicant: 6WA.12—` Planning &Zonin. Tree A..i.`.- trator Project: S , Att..) S 1 Public-Wof •uu.ciii 1NOnkk._ Public Safety Fire Services Review fee $ U 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: APP)ACATION STATUS Reviewing Department First Review: Approved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: S II ate: TREE ADMIN. Second Review: Approved as revised. Denied. 71 WORKS Comments: P BLI I 1�- 20 —',o PUBLIC SAFE Y Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 st-iQW I NG ' SURVEY OF 517. 4v2'OTi3 BLOCK_A_AS SHOWN ON MAP ,4 Tl A NT/C BLfACI CORDED TN PLAT !TOOK_ 5 rAOF 69 OF CURRENT PUBLIC RECORDS pro R_,eober/0. /Verend/no 2ADLEY & ASSOCIATES 1148 S. EDGEWOOD AVE., JACKSON TA//eD Ord) J'TREET • /44 14 50' ' j 4050jiol .!/o' To. S . lt Fenclng a 4 I . o i A /5.7 1-4) 61' \ t , a 17.239�' 1 , s, CITY OF ATLANTIC BEACH }' PUBLIC UTILITIES 1-11Y) v 1200 Sandpiper Lane ATLANTIC BEACH,FL 32233 Ji31 c'' (904) 270-2535 or(904) 247-5874 NEW WATER/SEWER TAP REQUEST Date: //- I 5-- 4, Project Address: 3SZ) 3ttoo ST,Z€ € / No. of Units: ( Commercial Residential V Multi-Family New Water Tap(s) &Meter(s) Meter Size(s) 3Aj ,I New Irrigation Meter Upgrade Existing Meter from to (size) New Reclaim Water Meter Size New Connection to City Sewer Name: Applicant Address: City: State: Zip Phone Number: Cell Number: Email Address Fax: Signature: (Applicant) 1TY STAFF USE ONLY Application# - 23 6, Water System Development Charge $ Sewer System Development Charge $ Water Meter Only $ Reclaim Meter Only $ Water Meter Tap $ (notes) Sewer Tap $2,l Ute , 00 Cross Connection $ SO, 60 Other $ TOTAL $ 2 I.SO.00 APPROVED: Kavle Moore, PE %--/1/L (Deputy PW Director or Authorized Signature) ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED • OFFICE COPY (5_---,:i '1'ri,i{ BUILDING PERMIT APPLICATION li. Tii) OCT192016 800SemeRoad,AtltachFL32233 Office: (904)247-5826 • Fax: (904)247-5845 L_.__ Job Address: 3s-0 1 w+Li I 1 `7 +001. Permit Number: 00--S F--a 1 Legal Description 1.4sy i3 ekkm eliiittly Sot , L5,LJ19RE# Valuation of Work(Replacement Cost) $ (000)000:Heated/Cooled SF 1401/0 Non-Heated/Cooled I ISO viou.S..- 3zia0 temb ■ Class of Work(Circle one): OOP Addition Alteration Repair emo Pool Window/Door • Use of existing/proposed structure(s) (Circle one): Commercial Residentia • If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A • Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal Describe in detail the type of work to be performed: COfS1Tt4cA et tvew Scr, e f c n, i y clweillh% cm-q G4-ket 1.4cA.44 Florida Product Approval# for multiple products use product approval form Property Owner Information .gyp Name: R i d-Cky Se--1crA Address: �r0 1 �^i fft S+R er City Cjtate Zip 39131 Phone 9o4- Go/ - ctas- E-Mail Sc.hc oi;t1se_ .l 'Ct a Ow - ►or Agent (If Agedf,Power ofey or Agency Letter Required) 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. Contractor Information: Name of Company: ©W Nc2 h 'Qualifying Agent: Address:SIci p ;:aux,y $-F• City!UC h aC 13481awL State Zip 3,20(4 RI. Office Phone Job Site/Contact Number State Certification/Registration# E-Mail Architect Name & Phone# Engineer's Name & Phone# Worker's Compensation Exempt / Insurer / Lease Employees / Expiration Date 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 i menced, I understand that separate permits must be secured for Electrical Work,Plumbing, Signs, Wells,Pools,Furnaces,Boilers eate , Tris and it Conditioners,etc. Signature of Property Owner: ' Signature of Contractor: Before me this (O'Day Day of OC OW. of Before me this Day of 1 ,. . __t Notary Public: ,,,•o,'''•-, DAYD0IPL` .t 4. MY COMMISSI' FF 217841 I 5:,..%4,• 11 f f'• , PlArand xamined this application and know the same to be true and correct. All provisions of laws and o I I F/ r� . '.c ' ' i44k Mkt it'rk will be complied with whether specified herein or not. The granting of a permit does not p t i 'i i i it cancel the provisions of any other federal, state, or local law regulating construction or the performance of construction. Rev. 3/14/16 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: /0 ,c g'/6 Development Size Habitable Space y/ 65" Non-Habitable /0 tO Impervious area Miscellaneous Information Occupancy Group Q-3 Type of Construction J Number of Stories Zoning District Q, S - `D- Max. DMax. Occupancy Load Fire Sprinklers Required Flood Zone A Conditions/Comments: I L41-/. CITY OF ATLANTIC BEACH 5 F!! F COPY 0.4 t�► WNER / BUILDER AFFIDAVIT I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE-OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES, II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826) IF IN DOUBT. V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. 3:5-0 -1—kTA S( , (104- • 6d9 - ago ADDRESS PHONE NUMBER c;n(30-d Scfneo f20h- PRINT.IIAME SIGNATURE DATE Before me this ; day of ND I Le\�J•� ,20 (()in the county of Duval,State of Florida,has personally appeared herin by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of FL- ,County of aN,lk _ ~•• ••• ersonallyKnown rswisulk JENNIFER JOHNSTON ❑Produced Identification- ►•' ; ;w2 MY COMMISSION#GG 042984 k t EXPIRES:October 27,2020 •.,f,,;,,,.. Bonded Tbru Notary Ptak Undefwfiters Notary Signature: \; , .L A` ' -d.- (1 F:/BLDG/Owner-Builder Affadavit;REVISED: 4/16/2009 '-rs y )-d b cnhRcpflp VO co J O\ -P w N O\ .A w N " . d 4 b > 'T1 d n0 :a x o C/) V] . O O d -� ~ Q CCD' ti Q.. 5. 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