303 ATLANTIC BLVD - DEMO (-----
-j1,J-V.1 ,as..
`S, CITY OF ATLANTIC BEACH
,.. , 800 SEMINOLE ROAD
j �`' ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
\t 05,19r'
DEMOLITION PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-DEMO-3624
Job Type: DEMOLITION
Description: commercial interior demo
Estimated Value: $5,000.00
Issue Date: 4/3/2017
Expiration Date: 9/30/2017
PROPERTY ADDRESS:
Address: 303 ATLANTIC BLVD
RE Number: 169729-0000
PROPERTY OWNER:
Name: JUNK, SHIRLEY
Address: 915 N 13TH ST
GENERAL CONTRACTOR INFORMATION:
Name: River City Contractors Inc
Alan David Cottrill, WAITING ON
Address: 3915 Hendricks AVE
Phone: - -
PERMIT INFORMATION:
FEES:
Demolition Fee $100.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $104.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND TUE FLORIDA
BUILDING CODES.
I
rst: !,,ii, City of Atlantic Beach APPLICATION NUMBER
;A .; Building Department (To be assigned by the Building Department.)
800 Seminole Road 11-_ QE Al O-_ 6r„4 k1
�� -•-- Atlantic Beach, Florida 32233-5445 U KJv
Phone (904)247-5826 - Fax(904) 247-5845
-':!J,ti9r E-mail: building-dept@coab.us Date routed: 1 I I Ir t
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 3a 3 A*lo.n- c_ `b-061 Dep ent review required Yes No
uildg
in
Applicant: L6)14 Lk k-y Con t-f&LkG( S Planning &Zoning
Tree Administrator
Project: \ 11\-t-'63 ( M-W1 -0ublic Works
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: 'pproved. I (Denied.
(Circle one.) Comments:
S6-'4— l'u-A.,, ,A 0-r-e. 5
BUILDING
PLANNING & ZONING
Reviewed by: �� Date: 30 t
TREE ADMIN. Second Review: Approved as revised. III 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
e, „ Building Permit Application
- i' City of Atlantic Beach
r,
800 Seminole Road,Atlantic Beach, FL 32233
Phone: (904) 247-5826 Fax: (904) 247-5845 i 9 {�
- /�C M 6_3(03-t
XL 3 �n3 NA- ,,¢ e- 4 fI 3zZ Yi
Job Address: Ca11/71/;•
. l
t/ Permit
Number:
Legal Description "P61 21-2.- 2.3 t I7'/71/6 8 L L' f ,2/1); to RE# 4'7,1”�D�'v'
Valuation of Work(Replacement Cost)$ 1J'` , "' Heated/Cooled SFRxo' Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Re•air Movers Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commer Residential
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes 4 N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal y/
Describe in detail the type of work to be performed: Lk4r,�f-- ,2 ' "
a��
_Li
Florida Product Approval# for multiple products use product approval form
Property Owner Information /n�
Name: S( tl TSU R 421, \L Address: "1 15 13`r". 5-1- " ti
CityTS,A 0No tktv2__ 1 State F 1 Zip 3 5`') Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) OW Y\V
Contractor Information �y
Name of Company: l zui&' r Cf)17 °�310K.7 .5 Qualifying Agent:
Address /�'/.v /1,11di/2it- Y#, City J.r fc5rsll State "/ Zip 3z2137
Office Phone 9iv/ X99-- K "S""'Mob Site/Contact„,,,� Number v J 3
State Certification/Registration#C64 CS 4p 5 2- E-Mail 7i:9/er;4>a-viy.CeWhi'►S .0,r3, '”
Architect Name&Phone#
Engineer's Name&Phone#
Workers 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 the laws regulationg
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES, BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
1 RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN AU* •NEY,BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
� /L
(Signa pUre of Ow r or Agent including Contractor) ( ':ere of Cont . tor)
Signed and sworn to r affirmed) before me thhis1ig day of S rued and sworn • sr affirm! �/before4 ,thhis/�T day of
ql O/A , f by 31M? .\01'N K GYfI%� by (an lr( t 1
tlotAi.1 cirl6k. --- ) ' s a vos4144A--
(Signature of Notary) (Signature at NQaii�)
,,,,:.,:,,,,,,,%;,,,,,
',,%;,,, KELUE M.VALASEK
1
P4,% ELAINE M.SILVER ( :r ' °- Notary Public-State of Florida
1. I.• ; MY COMMISSION#GG 072501 a My Comm.Expires Jun 4,2018
[personally Known OR ,;, ersonally Known �;s ..
; o EXPIRES:February 13,2021 „•
o-.� Commission N FF 129215
[ ]Produced Identification ,;o.i��F;�;Q,. � I I Produced Identific�ioR.; .
Type of Identification:_ - Type of Identification•.
IDEMO11-1-1y\ ATLANTIC BEACH BUILDING DEPT.
��r
LITION — PROPERTY OWNER
£s RELEASE FORM
'-•-•:_•01,319r.
Date:
To Whom It May Concern:
04-1 i La
I /We the current property owners of: Lot t
Block ----
3 Legal Description of Property
AKAu 2 Q 1\ ') have contracted with to have
(Address of Property)
\4u G t CADISAY2lCAbR-5 to remove the I S PI 2-2:2
(Company Name) (Single Family,Duplex,Commercial,etc.)
Prior to the construction of : aDO P 3 0
As a condition of issuing the permit we agree to the following:
1. All utilities are to be located and clearly marked.
2. Once house is removed, lot is to be graded and leveled.
3. All construction debris is to be removed from the property.
4. Affected area is to have grass or seed in place.
5. Erosion control devices will be put in place and will remain in place until grass
has covered affected area or new structure is completed and landscaping is in
place.
� L
Signature
�v2 /'''
\ 1151% J) r\ K<
Sigrettoe-Print
THIS SPACE FOR RECORDER'S USE ONLY
OWNER
Signed: 4/` '" a� /� Date:3-2 5v--77
----
Before me this d r f Mag-C'h in the County of Duval,State
Of Florida,has personally appeared 51'u e--Iket4 Sn 1< __
Notary Public atT ige,State of Florida.County of!Duval.
My commission ex ires:
Personally Ktiwvu: i� ., ELANE M.SILVER— or
Produced Identification: ,�, '• MYCOMMISSION#GG07250T -1
•rr
,, ,,•c EXPIRES:February 13 2021
'••f°`ft • Bonded Tixu Notary Public Underwriters
-1 rA,\J�
,��r ` Jv`S, CITY OF ATLANTIC BEACH
s 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
(904)247-5800
t
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PERMIT NOTES
COMMERCIAL DEMOLITION
REVIEWED
March 31, 2017 CITY OFgR DE COMPLIANCE CF
303 Atlantic Blvd. R QUrgEMEN S Foq ADDir!o CH
BP # 17-DEMO-3624 (Interior only) REVIEW D By: TS AND CONDITIONS
Y
DATE: -3 . 1 RI
1. It is the responsibility of the contractor to:
a. Contact JEA to disconnect electric power.
b. Locate and clearly mark all utilities.
c. Disconnect and cap off water, sewer, and gas lines.
2. Silt fences must be in place and approved by Public Works before beginning
demolition.
3. A water supply and hose may be required to control dust during demolition.
(Required for masonry structures and asbestos-containing materials.)
4. Removal of any trees requires a separate Tree Removal Permit, per COAB Code
Of Ordinances, Section 23-21.
5. Protection of trees and vegetation during construction is required, per COAB Code
Of Ordinances, Section 23-32.
6. Prior permission from the Building Department is required before blocking any part of the
Right-Of-Way.
opfrr
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' '' J'- CITY OF ATLANTIC BEACH
s) 800 SEMINOLE ROAD
+�'� ATLANTIC BEACH,FL 32233
ff`` (904)247-5800
r JI21 Jf:
PERMIT NOTES
RESIDENTIAL DEMOLITION
I :-f
March 31, 2017 �eklek
e/ts4r 0 PO C
303 Atlantic Blvd. '4 only) 9F`�E REq��9��Mi 3 LgN4Fc�
BP # 17-DEMO-3624 (Interior h,Fo r Fog /c 4 ,
ey SgNquo, F qN
��' OCOH�'04,�y CF
1. It is the responsibility of the contractor to: Oq 1O4
a. Contact JEA to disconnect electric power. ' 3
b. Locate and clearly mark all utilities. < <1
c. Disconnect and cap off water, sewer, and gas nes.
2. Silt fences must be in place and approved by P •lic Works before beginning
demolition.
3. A water supply and hose may be required o control dust during demolition.
(Required for masonry structures and as,estos-containing materials.)
4. Removal of any trees requires a sep. ate Tree Removal Permit, per COAB Code
Of Ordinances, Section 23-21.
5. Protection of trees and vegetat.•n during construction is required, per COAB Code
Of Ordinances, Section 23-3 .
6. Prior permission from the Building Department is required before blocking any part of the
Right-Of-Way. O0
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