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350 OCEAN BLVD - VOID NEW FAMILY iA'ir City of Atlantic Beach APPLICATION NUMQER �s _ Building Department (fo be assigned by the Building Dep ment.) 800 Seminole Road 0....,© (.3 `1--5 FQ -- 31 $- ;r Atlantic Beach, Florida 32233-54451` Phone(904)247 5826 Fax(904)247 5845 O 3 I (� i t II- City 'ir�;31�'r E-mail: building-dept@coab.us Date routed: web-site: http://www.coab.us L. VO f APPLICATION REVIEW AND TRACKIN FORM Property Address: ' S-CI OC.ea_0 e\od • D9partment review required Yes No CBuilding.) Applicant: AQ`\tt f S 'Qut\.cI.LL$ LLCPlanning&Zoning Tree Administrator Project: (\ e-+A) S t n V.-1�O.t'Rt 1.y \n 04Yq_ ublic Worcs �J lic Utilities Public Safety Fire Services Review fee [/cant Cinnfi irca lir Other Agency Review or Permit Requir Florida Dept.of Environmental Protection 35-j d(---eael (-ilk,/ Florida Dept. of Transportation St.Johns River Water Management District • - - - Army Corps of Engineers p�..A7 To a,Division of Hotels and Restaurants , /;� /� Division of Alcoholic Beverages and Tobacco C. C� 2 `on 0 r3 Jy / v i splay I Other: l/ J .# C A t c k G - 69r at' s (� ��aa�' APPLICATI --/4.-L.- / ,)-- 4a r -s--e, V- / n Cee' -v►1 Reviewing Department First Review: ❑Approves (Circle one.) Comments: Coi,),%(20,,„,."----, Cry 4-e 1-4 4 a BUILDING o �G��VGr � co Svt pi,, , PLANNING & ZONING R( b-Q... 4, f rally 804. led w r 'J A 4-A R TREE ADMIN. Second Review: Approve F'F e, /-e•frog 74brt Cox f-racio•- PUBLIC WORKS Comments: ra/) k /e, SS 6,..-a./(0,- Awa erJ PUBLIC UTILITIES C) PUBLIC SAFETY Ic FIRE SERVICES Third Review: [JApprovecl Comments: Re Revised 05/14/09 ,11Y114- C)s . ,N1.11 CITY OF ATLANTIC BEACH li , 800 SEMINOLE ROAD � ATLANTIC BEACH, FL 32233 Iftwi (904) 247-5800 BUILDING DEPARTMENT REVIEW COMMENTS Date: 3.16.2017 Permit#: 17-SFR-3382 Applicant: Phillips Builders, LLC Site Address: 350 Ocean Blvd. Site Address: 1250 Selva Marina Ct. AB Review: 1 Phone: 349-2999 RE#: Email: _phillipsbuilder(a,comcast.net_ Homeowner: Same. Correction Comments: These comments are from 1 of 4Departments that are reviewing this application. 1. 2 copies of the submitted site plans shall be initialed and dated by contractor after writing in the proposed finish floor elevation. 2. Tankless water heaters location, shown on the LEFT SIDE ELEVATION from the design drawings, page A4, are not acceptable. The exhaust vent on the heater shall be at least 4 feet away from an operable window. Submit 2 new copies of page Al showing the new location for the heaters. 3. Contractors signature needed on 2 of the ENERGY PERFORMANC LEVEL (EPL) DISPLAY CARD. 4. Read the AIR BARRIER AND INSULATION INSPECTION COMPONENT CRITERIA FORMS and verify by checking off in the boxes on that form. 2 copies. 5. Submit all information for the spray foam insulation to be used on this project. 6. Submit Manual S compliance report. R403.6.1 Equipment sizing. 2014 5th Edition FBC-Residential Energy Code. Mike Jones Building Inspector/Plan Reviewer City Of Atlantic Beach 800 Seminole Road L CI72Q'tf / i v Pig✓ (-001 rn.e#z' r 3/f6/17 7vtd 1 Atlantic Beach, FL 32233-5445 Ofc (904) 247-5844 Fax (904) 247-5845 2 • Pe r►ri i 4F- !7 — S'PR-- 3 38 a- NOTICtE OF COMMENCEMENT State of Fi..- County of I �fL►ra ( Tax Folio No. To Whom It May Concern: The undersigned hereby informs you that improvements will be made to certain real property,and in accordance with Section 713 of the Florida Statutes,the following information is stated in this NOT CE OF COMMENCEMENT. Legal Description of property being improved: <--(3-r ,S' tSi 0(.44. • • Address of property being improved: 'Rre) 0 C Cr it.,.., el vO -� General description of improvements: t O M Owner: CA V)at F=4(4) Address: 12.,S 0 Se t✓A Mop Owner's interest in site of the improvement: CL i�1/r� CAE • A• "rl.���L� .� F Simple Titleholder(if other than owner):• Name: X00 0 s 8 ' • ontractor: c t(),A es j ,k do rS LL L Otis ag•m • Address: i�-.S S('(�1(-� �I/ fxlA �.(� 0-<T o m Wcsc G Telephone No.:1 44 �' Z, jf�j Fax No: �, —6(j' & Surety(if any) o r b N S A)� a Address: X_ m :, •un $ n 3: Telephone No: Fax No: I i Name and address of any person making a loan for the construction of tl� . ,; ., Name: (1 - T BE C �' Address: 0 • ��k'.. O R o i c Phone No: y Fax No: EAC ' - ECTION Name of person within the State of Florida,other than himself,•designahfiby owner upon whom no ces or other documents may be served: Name: Address: . Telephone No: Fax No: In addition to himself, owner designates•the following person to receive a copy of the Lienor's Notice as provided in Section 713.06(2)(b),Florida Statues. (Fill in at Owner's option) Name: Address: Telephone No: Fax No: 0 Expiration date of Notice of Commencement(the expiration date is one(1) year from the date of recording unless a different date is specified): THIS SPACE FOR RECORDER'S USE ONLY OWNER Signed:- //7 Date:z 23 1 7 Beforei this 7.`' , day./ .. ` in the County Of Florida,has personally appeared • ...& of Duval,State Z 7 Personally Known: Produced Identification: ► or --,i-:. TONTGINDIESPERGER .��'�r r ��'' = MY COMMISSION#FF 92 51 Notary Public: .""" ���r-' \,•:,:':,,- .-....iisEXPIRES:October 6,2019My commission expires _ �'i ���'? � bonded Thru Notary Pubic Underwriters �J � ==L'41-,,. BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH DATE s; OFFICE COPY 800 Seminole Road,Atlantic Beach FL 32233 Office:(904)247-5826 • Fax:(904)247-5845 Job Address: 3 c"-C) OC—EA N I U1) • Permit Number: t i-s F 3 3$.4, Legal Description ^ I� RE; _ . Valuation of Work(Replacement Cost)$ 404 0OU Heated/Cooled SF '0= Non-Heated/Cooled 966 • Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercialsidential • If an existing structure, is a fire sprinkler system installed?(Circle one): Yes CM') 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: New fluA . Florida Product Approval# for multiple products use product approval form Property Owner Information Name: tti A+ILAP.- Address: l J O gse-IgAA M64244 Gj2. City A- ,3 _ Stat L-Zip 3 2-2.3_5' Phone aP 04 241 8 2 Z"1 E-Mail Pftl t,LPS Ott bi ef'S GAA[#cT• Nt"- Owner or Agent (If Agent,Power of Attorney 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: 114-1 uili aUt fs-s LLC, Qualifying Agent: Address:l 2.1'6 c I frets Met 6tA 0 2 City A P, State Zip Ft . ,3�21.33 Office Phone 1- 3k4 -?.9°1°f 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 coirmenced prtor to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this 'urisdiction. This permit becomes null and void if work is not commenced within six(6 rnonths, o-([construction or work s suspe dor -' one' or a period offsix(6)months at any time aft r work is mmenced. 1 understand that separate permits must be secu' :El=��rico! t P 1�i / Signs, Wells,Pools,Furnace Bo'e ,Heater d i Conditioners,etc. �� ���f Signature of Property Ow Signature of Contractor: UM_.�!.� g P nY g Before Ike �1 �� thisa.' ay of V ()-(`-t �� Before me this age Day of FL t t,QA L • Notary Public: \aw..'t �) ' ---Notary Public . -A I _ _'_ al ��_-_ :i4(4 R JOHNSTON I hereby certi that It e read and c'--;�+ a v the 'me to be r_• i torr•a '/�- b� of ai•.•and ordinances governing this type olive '3�` "; •s•on e* red herei '•.Thee btfe4t)cefyi0t do s not presume to give authority to violate o titan slat( Fo.`o att darypddasttti ten -the performance of construction. .,os' Bonded Thru Notary Public Urd• n j — ----- — ':. ev. 5/2/I6 OFFICE COPY DO NOT WRITE BELOW- OFFICE USE ONLY App zca. e Co es: 2111 - I ' 'ABM, IDE Review Result (circle one): Approved Disapproved Approved'w/ Conditions Review Initials/Date: /'1 - 31/4/17 • Development Size • Habitable Space 3o 90 .-r' Non-Habitable 9 g_S. F Impervious area • Miscellaneous Information Occupancy Group `e 3 Type of Construction V 5 Number of Stories 2_ 1) Zoning District £ S- Max. Occupancy Load • lire Sprinklers Required -food Zone X yonditions/Comments: • c p Ory ,n '-t "t i '"1 n O O .0 C0 V C\ t� w IJ -- G\ In .A u, I J h ^ n- '� f- o `O. r. W a —• iD• 1 ; Q.. cr -9 0 0 g y • -• _. Zrii "ova 0 c- G. y n ti = (D P fta CS n O D' •U C Oq IG �... CI)C O to _•�' ,.t y �� « eta 0 0 .� d 3 fJ Q 00 0 a- o o. (.1 `7 :� Q_ cip -1' Fit, C c T 6Q' pp c'1 'p t) 4 < rR 2 0 tyl �j -C) s• Q- � C �� �� . o 0 N - 'PJ C r r 1 1) n 0- O. ~ R C cc P z ;.1 •-v Q_ C -i Q- a � ° _ -- 4r 7 "d is '-c_� 0 = a -' 1 o C P Q, rD � ' o Tl Cl)z C> el Ca n ( —CD CA o C t71 Cri � � UJ o o-n � �W l`' O - �D !`) c -a b "� 3 �.�' w U4 r,' m - cD 5 (D -1 ~O ., O fD 0 �-. "11'"' c .b T..- 4,) ro O Q 3' = o g H I -- , 3 714%. CZ1 rl 4 Q Q o• w .o f7 ,•Q o CD C L o � < �' 1 O ./.y. � o0 -0 o m yco n- -. oQ. C w ! 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O Si A O O Q. z `� N r c 3 y ,, 3 o 4s• o p—'_ 0 O >C a- 0- Y CD c (.IQ 0t21w `71 `J CCD o o "d , P CD- 's 5 i 7d Q o ✓+� b 3 C q• C P) , Ra /fir r ,^O' . -o iv O L+, C. cn z . o 5-- H V (/) "C3 S:0 0 cp. go 0 — o n 0 >v � O- 3 g .1/ O % = A Is,"f c--9 .. '-. "! �Q .... O CD O r O r : O m '� l C A Z r C e - -C) a t 3 O al a `< 1. Cl. 6- n, w ,0. * 71 tiOMD �' CL CD CP r4 C — .-- N -- `o B 8) �o ° A7 O --f) At J �J 0 CCD "1•� go TS O I o �v�`J\ < 0 tra cA w 3 (A `�' c c cr ` C '1 (A v V o CD .z O aD R.: `O S CD O. 0 4t 3 O O. '+ tn C bo 3 oO 74; C lD 2� G.. I a H CD Q.. N " •`t3 Cat. 5 .1 Alm.. `O• O ?? n _ _ 5 w r* O = CCD CD CD H si - .__ - —_____.. 0.AAlk City of Atlantic Beach APPLICATION NUMBER jS _ilo Building Department r „� epar ;Yr) (To be assigned by the Building Department.) r 800 Seminole Road _ �1 Atlantic Beach, Florida 32233-5445', MA F 3- .8a. Phone(904)247-5826 • Fax(904),247-5.814`51 2017 O I E-mail:Email: building-dept@coab.us Date routed: 3 (7 I l (- City web-site: http://www.coab.us ''Y - APPLICATION REVIEW AND TRACKING FORM Property Address: ? 1J OCea.n li `t)d . D,9iartment review required Yes No Buildin Applicant: 'Q \tiVtfs% /2)U..act..uS LLC Planning &Zoning Tree Administrator Project: (\ LW Sst tl Atl VQ.—Pain; ti NA OMR pubcslic Wor4blic Utilities Public Safety Fire Services Review fee $ Dept Signature O h-r 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. gi-j17 (Circle one.) Comments: '' ,�;,� BUILDING J fl4 1 � ��rm PLANNING &ZONING Reviewed by: p/`. ` ./ Date: TREE ADMIN. Second Review: ['Approved as revised. ❑De- ed. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: • FIRE SERVICES Third Review: ['Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05114/09 Ave , I. ( ,_, - A( 1 /I - .1, --U42 Z t i- 1 //,i''.X ,Ce -, ,pre hi X Jz "- /9�- d(i Y oZ - qc > /9 f9 Ak;rJ 7 11 1 - _ 7 Pei-hdii‘441, c' Qt\r1( Afrr '4 //I: iv 45,wieft_f4447_60Z4(,2 aq._ §c, 4 4,11( J , --= / 9 Leif 4 1141luelf lt'k.3 y 4`f OGNitvi I - - ' - .:. cZ 1 -64fryta6ci 1/6 k 7 z viz 6ir--z : 3Y2_ 41,4,,,e4Pici 14f.risq ii igf I I ' Jett 7 t lo 0 3 - /7 _ &Igo /Awe in WA:- hi , a Or La( �.. �e0_! /Ym iimWe aralT/q 3.C'0 9Catn _141 ����,� � 33i.z Lp 7/,f'x /fa 41; IL A) //,r--,Y .fid tl) (0 0) N N O M 1` N 0 J CO .- O F- tl O O c wZz w z � N co0 m W wF- Z I avON 0118(ld 03AVd AVM JO 1H912a Z �. 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Lo A IZ O 1, " izLi U I CL mw w0 Q w z O w N0 0 3 0 (0 I 0 Ow I N/ J CO U 1 Q o 9) to 0 d 1— U') I J OI I 0 1.8' - N L- ---______ 0.9' 0.2: dVO ON '3dId O NOMI .4/f ONf103 0 N W I a 6Z 101 1 O U N -17 ]OVd ` L ] 3 d ] 1 H 3 V -0„tvi j� City of Atlantic Beach APPLICATION NUMBER -� i\ Building Department „� (To be assigned by the Building Department.) 800 Seminole Road _ �r Atlantic Beach, Florida 32233-5445 1 i S Ft— 33 $ 400) Phone(904)247-5826 • Fax(904) 247-5845M14R Q 2 2017• "Lr�;;�gr Email: building-dept@coab.usDate routed: 0-alp ( I (- City web-site: http://www.coab.us I i B1'`_ -- APPLICATION REVIEW AND TRACKING FORM Property Address: ' S'D OcQa_n t\.d . Dewartment review required Yes No • Buildin Applicant: -Q h t<<•t f 2t t' .6ttIS LLC (Planning &Zonin) Tree Administrator Project: (\ tA-J S•t 03 kQ—PQ-(YZt ly NAOdy1;e- (public Wor s PQ \ ( n�l�tc, j✓ 3-I�{-11 • Public Utilities yb y th Public Safety �Ob J; W7� �f e0\04SV � • uki`iAit5 hod' ilfli. en• Fire Services Review fee $ �p Dept Signature X-9/4i Review or Receipt Other Agency Review or Permit Required 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: APPLI ATION STATUS Reviewing Department First Review: Approved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING & ZONING !rr,�, � Reviewed by: i; Date: --Si( 2 TREE ADMIN. Second Review: ['Approved as revised. ❑ pp ❑Denied. WO KS Comm nts: PU:LIC UTILITIES~�� 3- Z - i7 PUBLIC SAFETY Reviewed by: Date: • FIRE SERVICES Third Review: 1 /Approved as revised. I 'Denied. Comments: Reviewed by: Date: Revised 05/14/09 L.. 2. pairimiiiiiii" limp, AMP 111111.1"1.. . ..l 4TN ST ilic 4 111 su' yy1. • r i 4 A ' t. - • ,k It' d .ismalr- ' .1i w t I € R i... liait. A vp iinte ,... .t.-7. , . . . , ‘ ., , _ta EXISTING WATER SERVICE • i. , I i Pit 3 © , i ;S .1,164 ONLY SEWER SERVICE AVAILABLE FOR THIS PROPERTY .' "t � " � 48, ! ,>> rib. f :',411 -4- ..,.. it ‘,4 it .. f % X r s' a # It ' i ..,,, 41% - t,1Le - ! , at. I 4 .. , . ...7 f� ^rye yr' A, .'- .. . „., , ,,..., . •r-. , . ' Y0040 0411 3z `'"' "� ,, Jl .,aka +® m, - . te, t . it ix,. . .w,.: 330 . 44, 4-.: lI_.. • z JI i lli i MAP SHOWING SURVEY OF LOT 5, BLOCK 24, SUBDIVISION "A" ATLANTIC BEACH AS RECORDED IN PLAT BOOK 5, PAGE 69, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. ll ., SCALE: 1" = 20' • FOURTH ST. LU I 40' RIGHT OF WAY PAVED PUBLIC ROAD 0 CC F 7 1 (-_,. I W I, <s) -81L, 1"-- d rn 1 W o , a I O Q \ V -Q no I^ U CL oz (115.10' FIELD) - 00 $ z . c 4' WOOD a 4' I o . E-a % 115.00' 1ENCE x"FENCE za z Q -E'r—-- 6' — 1.1..Q. 01 - 6' WOOD FENCE ..1' 0 x i7'..°171, 6' WOODW L�_I <I FENCE W O CONCRETE m db 6.1' 8.6. gw r----- 0'-'-':,-- • BUILDING PERMIT APPLICATION c; ,!+1,-,- ..)1 , A iiiir CITY OF ATLANTIC BEACH DATE J ton 1..)� 800 Seminole Road,Atlantic Beach FL 32233 Office: (904)247-5826 • Fax:(904)247-5845 Job Address: 3 SO CLLA N g(.UQ • Permit Number: t is F e.-3 3 8.4, Legal Description RE# Valuation of Work(Replacement Cost)$ 40df 666 Heated/Cooled SF '00 b Non-Heated/Cooled • Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercialsidential • If an existing structure, is a fire sprinkler system installed?(Circle one): Yes 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: NieRu, , . Florida Product Approval #_ for multiple products use product approval form Property Owner Information Name: l+iL t.PS Address: l ?....S-0 St?t MiW i4 Gia. City (- ,i3 Stat L-Zip 3 Z2 Phone ap oef• 2 -t V 2 2,ti E-Mail PhktU.4,PS ev;bl els t5ix, C_&AC-Ai1 NE-- Owner or Agent (If Agent,Power of Attorney 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: 14-1-11,k/ifs %(it kies-s- Luc Qualifying Agent: Address:12 n C.-el vm Mtr rie G P-. City A a , State Zip Fl . .3 22,33 Office Phone9d - Sic? -7. 9 ei°f 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 -urisdiction. This permit becomes null and void if work is not commenced within six(6) months, or if construction or work s suspe t,•d or,.aw one.for a period ofsix(6)months at any time aft r work is 'mmenced. 1 understand that separate permits must be secu . •r El: rical '%,7b7 Pariah: Signs, Wells,Pools,Furnac Bo'e ,Heater d, i Conditioners etc i,>, /�- Yi-• ' il `, Signature of Property 0 /,///1 Signature of Contractor: rfart41‘tAt Y Beforetrge Iv this ay of V.t.k) 0-0-tt n Before me this QC-4 Day of 52114 .a.(4 • Notary Public: �.d► .". ��I� .- -Notary Public' \_.1 • ____, •_I__- _ — — —-- ~g... ii R JOHNSTO I hereby cert that I 'ye read and c. - i. app u'/hi' me to b= •'r 1� ordinances overnin this e oftito �t;9 I Jd 1 M .*'he f,, '/' g1p1{' r64oea9�NatiI and %. % typeN•i.on �nic(; ted herei Ae �*`'he bfek MOW.do; not presume to give authorityto violte r, tr,:. 1''0 "'' i erformancof construction. -�: P > ? 41x'17: r'/ ral, stat i -:� • a i d >�6dlRs to wa the d.t�e�•••' Bonded MN Notary Public Undtrvrtiten _------ -- ---...--. - - 'ev. 5/2/16 CITY OF ATLANTIC BEACH :-� PUBLIC UTILITIES ` ►' 1200 Sandpiper Lane ATLANTIC BEACH,FL 32233 A011191' (904) 270-2535 or (904)247-5874 NEW WATER/SEWER TAP REQUEST Date: 3— 2 - /'7 Project Address: 556 �l l/✓) No. of Units: I Commercial Residential ✓ Multi-Family 3 „ / New Water Tap(s)& Meter(s) Meter Size(s) y 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) CITY STAFF USE ONLY Application#/7—SFR'— 33'Z Water System Development Charge $ Sewer System Development Charge $ V - 1—o Water Meter Only Reclaim Meter Only $ N S1 G I U Water Meter Tap $ (notes) Sewer Tap $ Cross Connection $ 5). 00 Other $ TOTAL $ so, oO APPROVED: Kayle Moore, PE 44 (Deputy PW Director or Authorized Signature) ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED CA City of Atlantic BeachBuilding Department APPLICATION NUMBER 800 Seminole Road (To be assigned by the Building Department.) N •r)s Atlantic Beach, Florida 32233-5445 1 1—s F — 3 3 $Phone(904)247-5826 • Fax(904) 247-5845 1119.• E-mail: building-dept@coab.us Date routed: 0.a101111- City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 3.51) OCeu.n e\ud . Dparttment review required Yes No Buildin Applicant: -Qhtt t•eS 'Qulacl..US LLC. Plannin &Zoning Tree Administrator Project: (\ LW Sst 05Q.—PO-Olt 11 h UM L ublic Wor<s ublic Utilities Public Safety Fire Services . • Review fee $ DeptSignature Other Agency Review or Permit Required Review or Receint I I of Permit Veri. 3 l 1-4.,r1 _ Florida Dept. of Environmental Protection Florida Dept. of Transportation c N ‘nok6. ra`b St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants V\Ct S n o* bL -n Division of Alcoholic Beverages and Tobacco ^ Other: ctkis ut APPLICATION STATUS Reviewing Department First Review: ❑Approved. ❑De (Circle one.) Comments: BUILDING PLANNING & ZONING Reviewed by: Date: 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 0 -tli'''/,, BUILDING PERMIT APPLICATION � `�� CITY OF ATLANTIC BEACH DATE ost >%' 800 Seminole Road,Atlantic Beach FL 32233 Office: (904)247-5826 • Fax: (904)247-5845 Job Address: 3 SU 0(.-1,A 1V (" LAX) Permit Number: t s F.—3 3 84, Legal Description RE# Valuation of Work(Replacement Cost)$ 4Oa,(Ob Heated/Cooled SF .000 Non-Heated/Cooled • Class of Work(Circle one): New Addition Alteration Repair Move emo Pool Window/Door • Use of existing/proposed structure(s) (Circle one): Commercial esidential • If an existing structure, is a fire sprinkler system installed? (Circle one): Yes<-1 b N/A • Submit a Tree Removal Pennit Application if any trees are to be removed or Affidavit of No Tree Removal Describe in detail the type of work to be performed: NieRu:tA . Florida Product Approval # for multiple products use product approval form Property Owner Information Name: rceb ISI+tud1.P.- Address: I ZS?J Sel✓s.:1 M . �144 G12. City f4 ,f3 Stat e-Zip 3 Z2-a' Phone et ertt 2.1-1 - g z z ei E-Mail PI1rU 1 tPS ev:bl erS c.A-cr, f4t,'- Owner or Agent (If Agent,Power of Attorney 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: 194I U.i if au, n- Luc, Qualifying Agent: Address:l 2_!'G S•e 03 M &ti,,ro CG P- City A P , State Zip Fl . . '2 LS? Office Phone9d f- Stsri -Z,9°l9 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 'urisdiction. This permit becomes null and void ifwork is not commenced within six(6) months, or if construction or work s susppe •d or,,>,,�:,a•ones for a period •o six(6 months at an time a t r work is 'mmence I understand that separate permits must be secu —r El ricat "�.rt P Abi Signs, ells,Pools,Furnaces,Bo'e ,Heater r. Id i Conditioners etc. r47 i-- Signature of Property Ow ` Signature of Contractor: , if i�� e b) � � Before rt_�e thisan'_ ay of Vt‘n U-(-t ap VA" Before me this Qi"-4- Day of F4i.t,44-4 Notary Public: \.�..;t ' ' Nota Public ‘_ .• ' _ , I ! - :1� -Notary .���a � 1...., — H i• R JOHNSTO 1 hereby cert�that I •,ve read and e --:,,,w,----�r ,... 1 ' •,/ , , pP , .,. ,� n the r me to b. r :•. .�rorr•.f,�,, ,• , Ib'¢ie+0e29,1f4/mi and. ordinances governing this type oJwo 'P'conutl ff ,•i`t.,,' y,, c , ted herei •j ry,. „via . !.girl Mihai dot t not presume to give authority to violate o c{n *p 4R tii�t s :fe.' •ral, stat . o a r ' performance of construction. ;�. 1,10;•-1::..,; t . 5/2/1; shiws 'the .,,o„.;�,•• Bonded Ttvu Notary Public Und•ra tern I -- --— - -- `'ev. 5/2/16 MAP SHOWING SURVEY OF LOT 5, BLOCK 24, SUBDIVISION "A" ATLANTIC BEACH AS RECORDED IN PLAT BOOK 5, PAGE 69, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. I LION COPY THIS PLAN MUST BE ON JOB SITE FOR 4 11(: 0 4� EACH INSPECTION SCALE: 1" = 20' FOURTH ST. w 40' RIGHT OF WAY PAVED PUBUC ROAD 0 F 7 . I c: I UJ <9 0 o cilL d' i \ I �) I 0 w 1 a6I i 2 c) no Imo oz (115.10' FIELD) - ,• wood I-o 0 z W o , w. 4 WOOD to FENCE Z • oz �a 1D 115.00' IENCE x h: Qtr__ 0.1 I6•WOOD FENCE • ..1 0 B iv eD 6' WOOD'! LLl Y < FENCE O 1s I CONCRETE co 0 CO CO w. l 63' 8.6. 5��5 • W 0 pQ I— I- O . �.9'ri r 3 c4 Ota. IX O -i 6.4' 8.6' a Q^ < K / � O \J 0_ a)In � S 0 \ m . <,, UJ R I--- fu< o W 3 D I+� 8 Z p 0.2' c 0 °. Q 115.00' 6,.., a • k (115.10' FIELD) ,, Z O J N ',lit I— .1-1 2_ Q o ' O o I 0 `° NOTES: 1. THIS IS A BOUNDARY SURVEY. 2. NO BUILDING RESTRICTION LINES AS PER PLAT. 3. INTERIOR ANGLES PER FIELD SURVEY AS FOLLOWS: A = 90'02'34" B = 89'57'07" C = 90'00'47" D = 89'59'32" 4. NORTH PROTRACTED FROM PLAT. THIS SURVEY WAS MADE FOR THE BENEFIT OF THE PROPERTY SHOWN HEREON LIES IN FLOOD ZONE "X" FORDPHILLIPS PROPERTIES, LLC. (AREA OUTSIDE THE 0.2% ANNUAL CHANCE FLOODPLAIN) AS WELL AS CAN BE DETERMINED FROM THE FLOOD INSURANCE RATE MAP NUMBER 12031C0409H, REVISED JUNE 3, 2013 FOR DUVAL COUNTY, FLORIDA. \\.. _.):. ,-- "NOT VALID WITHOUT THE SIGNATURE AND DONN W. BOATWRIGHT, P.S.M. THE ORIGINAL RAISED SEAL OF A FLORIDA FLORIDA UC. SURVEYOR and MAPPER No. LS 3295 UCENSED SURVEYOR AND MAPPER." FLORIDA LIC. SURVEYING & MAPPING BUSINESS No. LB 3672 CHECKED BY: DATE: DRAWN BY: PGP BOATWRIGHT LAND SURVEYORS, INC. OCTOBER 11, 2016 FILE: 2016-1223 1500 ROBERTS DRIVE, JACKSONVILLE BEACH, FLORIDA 241-8550 SHEET 1 OF 1 L_.L=1 35 0 O Le 0,,r1 to ct . 11- S Fe_--- 33 % o 050,00' O `-n U \I x: 5'-0' - N- CO ---) , o E c, p om N 1 GAR dARAdC nr MOCK 4 •t' L.. N — O j .1 \11 ' C 1 ,1 C16'-4' 7.-0' Q 5'-0' � CO1-0 a-0' •: M \1.-6. `Jb. o u I = Q r^ IA o _i 02S 11 I ATIO I !I �� l' 1\7___1<:( 1 'I I— ti II I i 0 O •,...-. n Ii( N o O 1'AMILY ROOM I ❖. 1 O o o O I I � I O tri — el f3 (2,1 ''. my.,N Os ' 9 q i, , ,,, , _, , i,, , arLex 0eooM - ELLattili N 0 (1) �— c et�rr�cY roe,ctd II co-. O 0 G " J CQ 1 20.00' 3 ,23 5'-0' N. © PAVERS 4 m\ ©© O Q TURF 6lOGC N C ✓ p -; 110 i a - 3. 2I 50.00' / I6-0' 0 p cs o OCEAN BLVD. o N `� •- 0_ 60' RI T OF WAY N - 0 S I PLAN NORTH TE________________________, to CSCALE: I' = IO'-O" o °co - m_ C �c)