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1 1st ST - SHADE STRUCTURE PERMIT ' ! , �s, CITY OF ATLANTIC BEACH J 800 SEMINOLE ROAD �� el ) KV ;r ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 -- ,-./-_0_219%P. COMMERICAL ALTERATION/OTHER MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 16-COTH-2849 Job Type: COMMERCIAL OTHER 0 Description: installation of shade structure Estimated Value: $15,900.00 Issue Date: 1/11/2017 Expiration Date: 7/10/2017 PROPERTY ADDRESS: Address: 1 W 1ST ST RE Number: 170716-0100 PROPERTY OWNER: Name: CITY OF ATLANTIC BEACH Address: 800 SEMINOLE RD GENERAL CONTRACTOR INFORMATION: Name: Terry Rogers Construction, Inc. Terry Alan Rogers, CBC1252594 Address: 4060 Edison AVE Phone: - - PERMIT INFORMATION: FEES: BUILDING PERMIT FEE $129.50 STATE DCA SURCHARGE $2.00 PLAN CHECK FEES $64.75 STATE DBPR SURCHARGE $2.00 Total Payments: $198.25 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA 11 BUILDING CODES. ?S.1-v.;J City of Atlantic Beach APPLICATION NUMBER N � eR- BuildingDepartment s� p (To be assigned by the Building Department.) iir800 Seminole Road 1 Cl I^ _ al-q _a I i't ei �.t. 2,/ Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845 / Jn yr E-mail: building-dept@coab.us Date routed: (a ) a-I I /6 J City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM V) S� Property Address: \ W LS V \ SA • Department review required Yes No Bui ina Applicant: k p_—tt(`l -1:N.Q./{S 41(lStM(.,-i) () (PlarlrliriS &ZoniEND Tree Adrainjstrator Project: \ nSAMA 5 Nak S i(uLC hk(Q Pu lic Wor Public Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review Receipt Date of Permit or 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: JZApproved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by:.....0--,,•.6/ r..-/-0,1c,_ Date: al149he TREE ADMIN. Second Review: A roved as revised. ❑ pp ❑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 :ilrinP,� TREE & VEGETATION AFFIDAVIT'_ 4 _! City of Atlantic Beach /?3l , Department of Community Development Planning&Zoning Division Du }. 800 Seminole Road Atlantic Beach,FL 32233 (P)904 247-5800 (F)904 247-5845 PERMITI SECTION I-APPLICANT INFORMATION E Owner(s) yegal Authorized Agent* NAME OF APPLICANT V t✓'NZ•fi t. -- • NAME OF COMPANY t--- �C/�)(. ` Cid` - I ADDRESS OF COMPANY 4.b(O73 e ,iSotil 4 je. PHONE CELL 4V 4 -S7,-9(M EMAIL 1 eretive SoVTAZ+Z".f CONTRACTOR CERTIFICATION NUMBER "jZE-crT1 ►4.t-r-)1,7 ATLBCH BUSINESS TAX RECEIPT NUMBER j SECTION II-SITE INFORMATION STREET ADDRESS OF PROPERTY 1 \JSV I -1- ZT lion address has not been assigned to this property,contact the AB Building Department at(904)247-5826 to request on address. LEGAL DESCRIPTION LOT BLOCK SUBDIVISION REAL ESTATE NUMBER LOT OR PARCEL SIZE: 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 ) t-r-----" SIGNATURE OF OWNER SIGNATURE OF-O NER--- Signed and sworn before me on thisZ,lay of1::) ..:__ , ZO , State of County of Identification verified: (i es Oath sworn: r Yes r No 2 / Notary Signature — --- a.�y TONI,•1N LESP AGER ;' `:F= MY COM ' FF924951 REV-TVA-v10.11 My Commission expires: "' i EXPIRES:October 6,2019 I,%A. ' •,',Ali k- Scnded Thru No:ay Publr„Underwrners t (iM City of Atlantic Beach APPLICATION NUMBER t Building Department (To be assigned by the Building Department.) " ic,`� 800 Seminole Road. '!' - j - ,- �� Atlantic Beach, Florda 32233-5445 110 C l q —a s Phone (904)247-5826 • Fax(904; tz �0;3 9y E-mail: building-dept@coab.us N :.;I i ,,.-._ Date routed: IQ- ) c)r-I I /b City web-site: http://www.coab.us ,�" 1,t DEC 2 2 2016 APPLICATION REVIEW AND TRACKING FORM S� Property Address: 1 `-, LS V \ SA Department review required Yes No Bui • Applicant: k 12-11(tel 'q-C) 4.3 0-0r1 StAitti)0n Planning &Zonin Tree Administrator Project: l (S\CtU 5 hu SA itkcht(Q Pu lic Wor Public Utilities Public Safety Fire Services Review fee $ Dept Signature 3C'1-\. 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. (Circle one.) Comments: /t)/4 BUILDING PLANNING &ZONING Reviewed by: /r1/**(/‘-- Date: /4/7 / ) TREE ADMIN. Second Review: A roved as revised. ❑ pp ❑Denied. 4,_ WORCo ments: UTILITIS / z —Z t (o PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ['Denied. Comments: Reviewed by: Date: Revised 05/14/09 s S.An-ri, City of Atlantic Beach APPLICATION NUMBER �s r Building Department (To be assigned by the Building Department.) ' J `i 800 Seminole Road • �1 Atlantic Beach, Florida 32233-5445 E cr '•_ ' 1 IV — CD l q —a s 't y 61 Phone(904)247-5826 • Fax(904)247-5845- EC 2 z Date routed: IQ- I a ;1 r-I I1(0 11 E-mail: building-dept@coab.us 2p�� City web-site: http://www.coab.us APPLICATION REVIEW ANE TRACKING FORM Property Address: , W LS\ \ — SA ' Department review required Yes No Bui • Applicant: 1;2_4 l � � � nPlanning &Zonin Tree Administrator Project: 1nS-kCUt tv-t6. __ ut._i;;h,t_(QPu licwor Public Utilitie—s") 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 �l(� Reviewing Department First Review: [Approved. ❑Denied. " 42,s -!G (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: I �% Date: (2-/2_p// �o TREE ADMIN. Second Review: ❑Approved as revised. ❑lenied. 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 tA, 4., City of Atlantic Beach APPLICATION NUMBER JS r ��; 9 Building Department (To be assigned by the Building Department.) 800 Seminole Road• V - C.I�T r Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845 a 1 ( I r49V E-mail: building-dept@coab.us Date routed: 16 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM " t- Property Address: W) LS\ 1 S� JA Department review required Yes No /� ` Bui ing Applicant: 1 'Q.-t{ (`l �� S Wr1S�MLfi�r\ �Planning &Zonirr V� ��p nn Tree Administrator Project: 1 n SA C It S \\Lt \'��(UJ tU.�Q Pull c Wor Public Utilities) Public Safety Fire Services Review fee$ Dept Signature Review or Receipt Date Other Agency Review or Permit Required 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: :UILDIN �/�i/ PLANNING &ZONING Reviewed by: �' / i Date: /— �^17 TREE ADMIN. Second Review: Approved as revised. ❑Deni . 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 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH OFFICE COPY 800 Seminole Road, Atlantic Beach, FL 32233 Office (904)247-5826 Fax (904)247-5845 Job Address: I fit=. ST I g} S ) Permit Number: I b-CCM - Legal Description Parcel # J, floor Area of Sq.Ft. Sq.Ft Valuation of Work$ I s,°l`» Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s)(circle one): ommer i. ► Residential If an existing structure,is a fire sprinkler system installe s . ircle one): Yes No N/A Florida Product Approval # For multiple products use product approval form Describe in detail the type of work to be performed: Mk 5T4L3._ATIor..1 cot= A s S'rre-v cTviZ Property Owner Information: Name: l'T4 ♦!~ TSA-n)'ft C- c 7I Address: i3X3V Selvit City Tt.Ar l"11c--E'll'<,?} State FtZip 32233 Phone 2.(P7-5 6 3`f E-Mail or Fax#(Optional) Contractor Information: Company Name: Reiter eS CON W. TP..J .. Qualifying Agent: t' alS Address: 40100 t=slw vr4 IWe• City SAY State FL Zip 3ZzWA* Office Phone goiF-S*7-413 90 Job Site/Contact Number ctow-s - q EM Fax# ato*-3e7- 43 9/ State Certification/Registration# C 13G 17-S Z.5' 1+ Architect Name& Phone# Engineer's Name& Phone# "QAM A. Goctr "(Z-T - /4Zo- q t y Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and Address Irrizyca 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 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 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 herebycertify that I have read and examined this a p 'cation and know the same to he true and correct. All provisions of laws and ordinances governing this type of ork will be complied ith whether specified.app erern or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other federal, ate, or loca law r••u •ting construction or the performance of construction. Signature of Owner _ Signature of Contractor Print Name Cj r 1A( Print Name Tern/ R LJ c.r-, Swp�d gr.) rid t- re / Sworn o,gnd subscribed before me1this ay . � _ / 20 this 2/ ^Day of r - ,20 (a GI SP .1 •W �t • SUSAN '7 • Notary Pubes • rLc�mdto ♦N;FF 5951 ` : �i t EXPIRES:October 6,2019 •�; LORIDABoded Boded m u Notary Public Urderwrtera ` Comm#EE865611 Revised 01.26.10 "" 1 Expires 3/22/2017 I a n D b n ; IU v v 0 0 .� fp g C� C) o n n .4 tib 3 q °� � . �, rd o ro s m 44<rr { 11) iii nx r A o Cbo o 0 4,, r N N f_. 0 .wp x li7 co pa w Ln CO 0 to rrr O W •w O (ID0 4 CO 7J 0 ..Y O O Js w -C ch 00.SZIs:and 11401 • !nn I i1 9��c 8 Z 030 ir ] A 070E AdOO 33 WO OO.SZI 1 1 I I 1 I I I 1 ZZZt'f I 1d6S1ddad I IOL lunowt, 1 oN3o4:1 I IlaluBip >luw f I Ralaa!oad33a1o�113poyasJl I oNp!sgns I laavio I laa!gOgns I apoaxapul I apojusay 6178Z-410a-91# " d Nog opus fV Joj 8ulums.lo,!go:uo!Id!JasaU tiZZ£13 XBf a^v uos!P3 09017:ssaJppd uop rulsuoo sia2og,Coal,:avow 43QIAOOId S3MIA213S 2IO 3331IVHS21VW 3111.1Jau•foogi,go.i f:Iowasaumf°13oi0:lash 910Z/8Z/ZI :aEu 56b56£a :oty lun000y ;dIaaag not;aatio3 I>;.iaua0 • ZOZZE in II!AtioS)aCf ( (SglKsaod 3I£Z lopaiioD xui ' uEhJ.IoD iaugaii,\ aillnuosmauf JO OD qiunoD IennU 130 I aced 561756E1DD :: 2u9uua