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1 OCEN ANTENNA MOD 2017 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 RIGHT OF WAY - COMMERCIAL RIGHT OF WAY MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: 17-ROW-3345 Description: ANTENNA MODIFICATION Estimated Value: 65000 Issue Date: 5/30/2017 Expiration Date: 8/28/2017 PROPERTY ADDRESS: Address: 1 OCEAN BLVD RE Number: 170229 0000 PROPERTYOWNER: Name: Address: GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Name: Address: Phone: PERMIT INFORMATION: Please see attached conditions of approval. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. *A notice of Commencement is only required for work exceeding an estimated value of $2,500. For HVAC work,a Notice of Commencement is only required when HVAC work exceeds and estimated value of$7,500. All runoff must remain on-site during construction. Full right-of-way restoration, including sod, is required. ?Sys- City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road s Atlantic Beach, Florida 32233-5445 _ ovw -3-:�A S Phone(904)247-5828 - Fax(904)247-5845 E-mail: building-dept@wab.us Date routed: z Cityweb-site: hfip://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: ��GIY ly 1�LLAC( ) De artment review required Yes No (� \ ,� 1 Ildin Applicant: SAC V V L �c.Le..SS anning &Zoning Tree Administrator Project: fes] 01DI P( ( lic Works is Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Data of Permit h=Pty 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 ❑ 1 c Reviewing Department First Review: Approved. 1691anied. A� (Circle one.) Comments: A,V BUILDING PLANNING &ZONING t1 f Reviewed by: Date: 4L r'1 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 95/14/09 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 (904)247-5800 BUILDING DEPARTMENT REVIEW COMMENTS Date: 4/07/17 Permit#- 17-ROW-3345 A Ilcant: T-Mobile Site Address: 1 Ocean Blvd. Address: 7025 Skinner Pkw Review: 1 Phone: 912 577-9282 RE#: 170229 0000 Email: cad ettshiahandeom an .com THIS BUILDING DEPARTMENT REVIEW IS ONE OF 4 DEPARTMENT REVIEWS. PLEASE FIND ALL DEPARTMENT REVIEWS AND ADDRESS ALL COMMENTS. - Correction Comments: Application is disapproved for the following issues: 1. The engineering analysis,from Kimley/Horn specifies new antenna mounts,not shown on plans. 2. The engineering plans and engineering analysis do not specify Wind Exposure D,a multiplying factor affecting the wind pressures. Please provide wind pressure calculations. 3. Several pages of the engineering plans are marked"Draft'. Please submit final "for construction" plans. Dan Arlington, CBO darlin on(a)coab.us (904) 247-5813 1 y City of Atlantic Beach APPLICATION NUMBER Building Department (fc be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 — Phone(g04)247-5826 - Fax(904)247-5845 FES 2 J E-mail: building-dept@wab.us Date routed: z cityweb-site: http:/Aw .coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: _(��j (�L,r� De arlment review re uired Yes No n (� Ildin Applicant: SAC w lanning&Zoning Tree Administrator Project: I p9(Ft lic works Ic Ulm res Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B Florida Dept.of Environmental Protection Florida Dept.of Transportation St.Johns River Water Management District Amy Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other. APPLICATION STATUS r g Department First Review: Approved. ❑Denied. cle one.) Comments: ILDING G� G &ZONING p Reviewed by: Date:J ADMIN. Second Review: ❑Approved as revised. dDe .d. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/74/09 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assignedby the Building Department.) 800 Seminole Road ,�tt Atlantic Beach, Florida 32233-5445 17— ow —3�22l S Phone(904)247-5826 - Fax(904)247-5845 E-mail: buildingdept@coab.us Daterouted: z Cityweb-site: hftp:/Aw .coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: I ��.1�N t<-1L.y p ) De artmentreviewre uired Yes No uildin Applicant: SACyy [ R� ,SS arming BZoning Tree Administra or Project: __ N NN 6fltFt lic works is Utl ies Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B Florida Dept.of Environmental Protection Florida Dept. of Transportation St.Johns River Water Management District Any 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 Reviewed by: 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 05114/09 Shirah & Company A letter foo the desk of Ch IIs L.Padgett III February 20,2017 City of Atlantic Beach Building Department 800 Seminole Road Atlantic Beach,FL 32233 RE:T-Mobile Building Permit Application(91K0033A) To whom it may concern, Please find a City of Atlantic Building Permit Application and supporting documents for a T-Mobile Antenna Modifications located at 1 Ocean Blvd. If you have any questions or concerns in regards to this application,please feel free to contact me. We thank you for your assistance with permitting the proposed T-Mobile modifications. Best Regards, Charle �tt�� Shirah&Company, LLC Cell: 912-577-9282 cpadgett@shirahandcompany.com (912) 268-2083 202 Marina Drive Fax (404) 393.9311 St. Simons Island, GA 31522 2/15/2017 To Whom It May Concern: Please be advised that Shirah and Company,LLC is authorized by Su l i ta t�rVakpS of $f1F— W.+C.Ius to act as an agent on our behalf. Please allow Shirah and Company, LLC either Richard Shirah, Charles Padgett or Jay Shirah to make application and accept issuance of a building permit, including any required revisions,for a site located at 1 Ocean Blvd. Parcel# 170229-0 6 Signed: /7 STATE F COUNTY OF j�� The foregoing affidavit was sworn and subscribed before one this L of mP! .2017 by ^TU J , n 'Mf A OS who is personally/ known to me or has produced as identification. MARIA Ca0r Notary PoOIIc-Stale of Florida 5" rt, My Comm.Expires Nov 21,2677 .o Commission Y FF 069919 ��crz� i T • •Mobile T-Mobile Engineering South 7025A.G Skimler Parkway ka Wlk.rkriia32258 August 12,2014 To Whom It May Concern, Please be advised that Shirah and Company, LLC has been hired byT-Mobile South,LLC to act as an agent on our behalf.Please allow the following Shirah and Company, LLC personnel to make application for building or zoning permits,Including any required revisions.Also,please note that the below Shirah and Company,LLC personnel have the permission of T-Mobile South,LLC to sign any applications as the "Owner's Agent"that are necessary for the issuance of a building or zoning permit. Shirah and Company LLC Richard O.Shirah Jay P.Shirah Charles L.Padgett III Chad Caudill Regard Kelly Williamson Development Manager T-Mobile South, LLC Notary Public �r /� Sworn to and signed before me,a notary public,this J day of IA�Av- A' in the year ZbJJ-{ . �- Notary Public In and for the county ofstate of �=L ej **� has personally app^eared bef a me and affirms that all statements and declarations therein are true and accurate. po'm NokyvuMkskba FlonOe Denise Jac4ue8 qp MY Commlaebn EF 1]8]89 •aeF� EMIRa 09NH2O19 T Mnblle USA.i. OIIIce:1904t2514000 P.O.aux 551299 kcka Mle.FL 32255 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 9JK0033A Office (904) 247-5826 Fax (904) 247-5845 t 7 Row - 3345 • Job Address: 1 Ocean Blvd Permit Number: Legal Description 5-69 21-2S-29E 2.350 ATLANTIC BEACH Parcel# 170229-0000 65,000.00 Floor Area of Sq.Ft. Sq.Ft Valuation of Work$ Proposed Work heated/cooled 0 non-heated/cooled Existing Class of Work(circle one): New Addition (Alteration) Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s) (circle one): tCommercial Residential If an existing structure ,is a fire sprinkler system install rd' t...li Tone): Yes No N/A Florida Product Approval# For multiple products use product approval form Describe in detail the type of work to be performed: Antenna Modification to Existing Telecommunications Facility Property Owner Information: Name: T-Mobile South, LLC (Leasehold) Address: 7025 A.C. Skinner Pkwy OA.2 City Jacksonville State FL Zip 32256 Phone 91 Z-$17 r a g-z fel E-Mail or Fax#(Optional) cpadgett@shirahandcompany.com Contractor Information: Ei Company Name: SAC Wireless Qualifying Agent: Julio Davalos Address: 2504 NW 19th St City Pompano Beach State FL Zip 33069 Office Phone 5 6 1 . 3 3 7 . 0 1 0 1 Job Site/Contact Number 5 61 . 3 3 7 . 0101 Fax# State Certification/Registration# CGC 0 518 4 5 Architect Name& Phone# BRIAN DEITSCH (77073) KIMLEY-HORN, 904.828.3900 Engineer's Name&Phone# ARNOLD ARTILES-KIMLEY-HORN-1920 WEKIVA WAY, STE 200,WEST PALM BEACH. FL 33411 -561.845.0E Fee Simple Title Holder Name and Address ASHFORD ATLANTIC BEACH LLP,431 E HORATIO AVE,STE 120,MAITLAND,FL 32751 Bonding Company Name and Address N/A Mortgage Lender Name and Address N/A 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 is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing,Signs, Wells, Pools, urnaces, 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 hereby certify that I have read and examined thisplication and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to vi to or cancel the provisions of any other federal,state, or local law regulating construction or the performance of construction. Signature of Owner 1 W Signature of Contr�acto � Print Name C�c,r le-4 `I Q� ✓( -1 Print Name l o 'AVS S- Sworn to and subscribed before me Sworn to and subscribed befpre me this 7ay of — 20 17 this j Day of F (v ,20 } 7 Notalic- ,/a .. . ...._______-7 Notary Public ' Revised 01.26.10 __ _ �-�� _ w.� `ds,r,VpV9;,y MARIA CRUZ OtoZ'fil Kim ;?.' ,i, `..: Notary Public-State of Florida I seildx3 uolssiwwop Ani �� - AlNf1OO NNA1O U�:<. ' • My Comm.Expires Nov 21,2017 f � .411 ' -r. � o- elB�oop`ollgNd t(JeloN ' .� ''%;o,f,,,V� Commission # FF 069919 . :: : • HYtdIHS QUVHOld • .:.:..;, r e F,r ._.----- -z s� �; 4 1V3S'1VIOkIdO BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach, FL 32233 9JK0033A Office(904)247-5826 Fax(904) 247-5845 1 7-RpW Job Address: 1 Ocean Blvd Permit Number: Legal Description 5-69 21-2S-29E 2.350 ATLANTIC BEACH Parcel# 170229-0000 Valuation of Work$ 65,000.00 proposed Work heated/cooled 0 non-heated/cooled Existing Class of Work(circle one): New Addition era Ion Repair Move Demolition pool/spa window/door Use of existing/propposed structum(s)(circle one):, ommereta Residential If an existing structure,is a fire sprinkler system nista one): Yes No f N/A Florida Product Approval# For multiple products use product approval form Describe in detail the type of work to be performed: Antenna Modification to Existing Telecommunications Facility Property Owner Information: Name: T-Mobile South, LLC (Leasehold) Address: 7025 A.C. Skinner Pkwy City a sonvl a State FL Zip 32256 Phone Z• z. Z E-Mail or Fax#(Optional) cPadsewMsh1mhandmmy8mLoan Contractor InfainnAA : Company Name: SAC Wireless Quali ing Agent: Julio Davalos Address: 25 t t City Pompano Te-a-EH State Zip 33069 Office Phone 561 .337 . 0101 Job Site/Cmtact Number 561 .337 .0101 Fax# State Certi6cation/Regisnatim# CGC051845 Architect Name&Phone# BRIAN DEITSCH(77073)KIMLEY-HORN,904.829.3900 Engineer's Name& Phone# ARNOLD ARTILES-KIMLEV-HORN-1920 WEKNA WAV, STE 200,WEST PALM BEACH.FL 33411 -591.945.06 Fee Simple Title Holder Name and Address ASHFORD ATIANIIC BEACH LLP,401 E HOMM AVE,STE 120,MAITLAND,FL 52751 Bonding Company Name and Address N/A Mortgage Lender Name and Address NIA Applirntlon 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 afa permit and that all work will be pe armed to meet the smulards ofalllaws regulating construction in this jurisdiction. 7hispermit heroines null and void f work is cwt commenced within sir(6 months,or ifconsnuction or work is suryended or abandoned for a p�enod ofsic/6j months at any lime ager work u commenced. I understand that separate permhs most be securedfor Electrical Work, Plumbing,Slims, Wella, Pools,Furnaces,Enders,H em, Tams and Air Conditioners,ere. 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. Ihereby cert6 that l have read and esamined this,apptica0an and know the same to be trueandcomect. A/lpravlsions of/aws and ordinances gowming this type of work will be complied with whether spec Pea herein or not The grenling of a permit does not presume m give authority m vi to or cancel the prawstom ofany otherfederal,slate,or horn(taw regulating construction or the performance ofconstrucdon. Signature of Owner i, -- Signature of ContrJact Print Name C Print Name ✓✓ Sworn to and subscribed before me Sworn to and subscribed before me this ?�.l.")9iay of, 20 17 this/�Day of >°!> __2o-)-7 Notary'•AAPP�`u/uubliC otary Public Revised 01.26.10 -____��...................uear :�:�"�°"eY'.. MARIA CRUZ ps,ar�r City of Atlantic Beach APPLICATION NUMBER - 'J Building Department - (To be assigned by the Building Department.) r `n 800 Seminole Road 6W _?J2ii CS y s Atlantic Beach, Florida 32233-5445 _ �l Phone(904)247-5826 Fax(804) 247-5845 E-mail: building-dept@wab.us Date routed: z City web-site: http://w .coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 1 OCN 1. 1.,�0 ) De artment review required Yes No (� \ ,� , ulldin Applicant: SAC V j [ iz�.Le_s5 arming &Zoning Tree Administrator Project: Pk1 NN OD(P7( (O tic Works Ic Ub Ries Public Safety Fire Services p . 9 � ._ Reviewfee $ De t Si nature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B 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 f / PLANNING &ZONING Reviewed by: Date: 17/)7 TRE DMIN. Second Review: ❑Approved as revised. ❑Denied. W RKS Co ents: UBL�LIC 1z x-11 PUBLIC SAFETY SSETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 06/14/09 v - u� � 9� O AOL Fear- M mu Kimley>»Horn July 21,2016 T-Mobile Attn: Kelly Williamson 7025 AC Skinner Parkway Jacksonville, FL 32256 RE: Structural PE Letter Carrier Designation: T-Mobile Antenna Upgrade Carrier Site Name: Neptune Beach Carrier Site Number.. 9JK0033A Site Data: 1 Ocean Blvd, Atlantic Beach, FL 32233 Duval County Ms.Williamson: In accordance with our agreement, Kimley-Horn and Associates, Inc. (°Kimley-Horn'),has performed an evaluation of the existing antenna mount for the above referenced site for the addition ofT-Mobile antennas.The purpose of this evaluation is to compare the existing and proposed load conditions and determine if the existing mount is structurally capable of supporting the proposed T-Mobile equipment. The proposed antennas will be installed behind an existing screenwall facade. T-Mobile has specified the removal of three(3)TMBXX-6517(84"x12"x(i.5";44.4lbs)antennas and the addition of three (3) FASB antennas (96"x14.9"x13.4'; 108lbs). The addition of the proposed antennas results in an increase in weight of 143% and an increase in surface area of 42%. Based on the comparative analysis listed above,Itis Kimley-Horn's opinion that the proposed three (3) FASB antennas require new mounts. For this reason, we recommend a Connect-It Wireless WMA-238-H wall mount for hollow CMU or a WMA-238- S wall mount for grouted CMU as the proposed mount for each antenna. Contractor shall verify the type and condition of the existing wall prior to installation, and shall also protect the existing building, facade, and nearby equipment during removal of existing antennas and mounts and installation of the proposed antennas and mounts. The proposed wall mounts and antennas shall be installed behind the existing screen well facade. It is Kimley-Horn's opinion that if the proposed mount stated above is installed per the attached specification,the existing building should be structurally capable of withstanding the proposed antennas. E r 6aM16 r4Esy.Finatile.cpnpelaSh�IrPrirtaAl11d01]24 �pe� y�TXyw,; 9J1<0033A_1.1_1-700 732A Rot_W.N UM00 732h RUIJ_vXla U2100 i Section 1 - Site Information vsio.. 0 MA sn.x.R.: NapMne Beall leXl;:4: 3032921.x10 W Wa.. B WTaPW.u ' lX;/bM: d1.3B50S600 veLm: 1.1 bIUTIM: Bu9]IM AYn1e tOwi:Btd PreMniyw: OW(.d.) 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Qy J gQp W Z Z UIve A .v Ivey aw ai 1 °° g9 FJ W e p yay W p O: I W WOWU �b �Sg2p}� p C(D 0 la W w v a L Y � � o U ro 6� Shirah & Company A letter Sam the desk of0hadee L.Padgett III February 20,2017 City of Atlantic Beach Building Department 800 Seminole Road Atlantic Beach, FL 32233 RE:T-Mobile Building Permit Application(9JK0033A) To whom it may concern, Please find a City of Atlantic Building Permit Application and supporting documents for a T-Mobile Antenna Modifications located at 1 Ocean Blvd. If you have any questions or concerns in regards to this application,please feel free to contact me. We thank you for your assistance with permitting the proposed T-Mobile modifications. Best Regards, /� �v3� � Charles Padgett Shirah&Company, LLC Cell: 912-577-9282 cpadgett@shirahandcompany.com (912) 268-2083 202 Marina Drive Fax (404) 393-9311 St. Simons Island, GA 31522 2/15/2017 To Whom It May Concern: Please be advised that Shirah and Company,LLC is authorized by SU i n -PzV0,,kps of $fc- lJ "--kfl to act as an agent on our behalf.Please allow Shirah and Company, LLC either Richard Shirah,Charles Padgett or Jay Shirah to make application and accept issuance of a building permit, including any required revisions, for a site located at I Ocean Blv Parcel# 170229-0 Signed: STATE F COUNTY OF The foregoing affidavit was mom and subscribed before me this 1�r of TZpb ,2017 by -'Ut , u hAVA (oS .who ispersonally/ known to me or has produced as identification. -✓YO�aJy MARIA CRUZ c Notary Public-state o1 Florida ® My Comm.Expires Nov 21.2017 \1 Conn. k FF 069919 T • -Mobile T-Mobile Engineering South r025AC.S*in ,P.bW lncknonnlle,%kla32256 August 12,2014 To Whom It May Concern, I Please be advised that Shirah and Company,LLC has been hired byT-Mobile South,LLC to act as an agent on our behalf. Please allow the following Shirah and Company,LLC personnel to make application for building or zoning permits,Including any required revisions.Also,please note that the below Shirah and Company,LLC personnel have the permission of T-Mobile South,LLC to sign any applications as the 'Owner's Agent"that are necessary for the issuance of a building or zoning permit. Shirah and Company,LLC Richard O.Shish Jay P.Shirah Charles L.Padgett III Chad Caudill Regards Kelly Williamson Development Manager T-MobileSouth, LLC Notary Public �7 Sworn to and signed before me,a notary public,this J �J day of lA U1.cJ3T in the year ZbIL4 . Notary Public in and for the county of C.\ .state of tLk has personally appeared bef a me and affirms that all statements and declarations therein are true and accurate. Ii L _Qe 110,1(BBJ00W-E Mr*..0" ,z ee 1)0380 Expka006lOfl�l010 T Mobile US41w Oft.(9091251]000 P O.Box551299 i lnck.1W,PL32255