120 JACKSON RD - DEMO CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
''2-01119r INSPECTION PHONE LINE 247-5814
DEMO - COMPLETE
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: DEMO17-0010
Description: complete demo of house structure
Estimated Value: 8500
Issue Date: 6/28/2017
Expiration Date: 12/25/2017
PROPERTY ADDRESS:
Address: 120 JACKSON RD
RE Number: 172140 0000
PROPERTY OWNER:
Name: FORSYTH VIRGINIA ALLISON W
Address: 1738 SELVA MARINA DR
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: REALCO RECYCLING
Address: 8707 SOMERS RD QA JERRY J DOHERTY
JACKSONVILLE, FL 32226
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.
�tyi� City of Atlantic Beach APPLICATION NUMBER
} :. -.i Building Department (To be assigned by the Building Department.)
800 Seminole Road.
06711011 - 00
! M�+ _ O� '
�F4 ). . ?) Atlantic Beach. Florda 32233-5445 iV l�
,� Phone(904)247-5826 • Fax(904)247-5845 f
0
'''.-74.c.);69'," E-mail: building-dept@coab.us Date routed: 01416OI 1'4-
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: a 0 U(CADLcOn L • Department review required Yes No
Building
Applicant: tl 1 C o cLiiNiGetn Planning & Zoning
Tree Administrator
Project: CO m,pk bk Q.. t&tI 7 o-F Ii16.1.Se public Works
Ga-blic Utiiiie
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: tekpproved. ❑Denied. . [ 1Not applicable
(Circle one.) Comments:
BUILDING 'e.— T�'~•4 ry V ,—�4
PLANNING &ZONING
Reviewed by: Date: (2.1 f‘1
TREE ADMIN. Second Review: Approved as revised. ❑Denied. . ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: Approved as revised. ❑Denied. . Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
i_A,,;. City of Atlantic Beach APPLICATION NUMBER
rs r� Building Department `T .1''''!'""+!
11. 800 Seminole Road ""'`` '` x (To be assigned by the Building Department.)
-',f Atlantic Beach, Florida 32233-5445 p E M 011- 00 1-0
t
Phone(904)247-5826 • Fax(904)247-5845 7 2017 D 1v1DI l�
gs' E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: t a O �GIC.kSon Ld, Department review required Yes No
(uildirfg
Applicant: a 1 C 0 9.2c.mc,etAPlanning &Zoning
`J Tree Administrator
Project: Cly fY19k tk Q. (ILIAD o.F h 04Se (ublic Works
lic Uti i ie
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. . ❑Not applicable
(Circle one.) Comments: /4e Att44 r
BUILDING
PLANNING &ZONING
Reviewed b : a4Date: i .-iy
TREE ADMIN. Second Review: A roved as revised.
❑ pp ❑Denied. ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. . [Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
City of Atlantic Beach
15. f� APPLICATION NUMBER
f- .r. : Building Department (To be assigned by the Building Department.)
4 ,-.) 800 Seminole Road
Deign 01 1 - 00 IC)
0 Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845 OW��� l�
Aof y E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: t a 0 3Ctoizon V.4. Department review required Yes No
Cuildirlg)
Applicant: n i.\ C 0 K•Q(.,vl(,t;an`J� Planning &Zoning
Tree Administrator
Project: COM,PILA 1 (1. 17 ().t' 11)04Se. ublic W
lic Uti i ie
Public Safety
Fire Services
Review fee $ Dept Signature 4141it
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:
APPLIC TION STATUS
Reviewing Department First Review: re,pproved. ❑Denied. . [Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING _ /
Reviewed by: tit iy — Date: 23 (2
TREE ADMIN. Second Review: A roved as revised.
❑ pp ❑Denied. ❑Not applicable
P WORKS) Comments:
BLIC UTILITIES
(p-2 /—t7
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: QApproved as revised. ❑Denied. . ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
iL
BUILDING PERMIT APPLICATION
► CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845 L
Job Address: 120 Jackson Rd Permit Number: .0 6 M O 1-i'Co Ib
Legal Description 17-2S-29E.13 DONNERS SIO PT LOT 15 RECD O/R 4219-766 Parcel# Al ( - 4-8 (5"
8,500 Floor Area of Sq.Ft. 1294 Sq./.t 383
Valuation of Work$ Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Moveemoli' pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial 4:.-ide ' '
If an existing structure,is a fire sprinkler system installed?(Circle one): 'es No Go
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed: Complete demolition of house structure
Property Owner Information:_ `
Name: (• fid,'S cy,G� 614 t. Address: / 13 8 ,J t,/1/A O Zit - /la
City 8 StateFLZip 3D,1 Phone qD'1 - Az7(4 - 9 7-
E-Mail or Fax#(Optional) A foe S /du,tic cX0/.eery)
Contractor Information:
Company Name: Realco Recycling Co Inc Qualifying Agent:Jerry Doherty
Address:8707 Somers Rd City Jacksonville State FL zip 32226
Office Phone 757-7311 Job Site/Contact Number.._ 955-3581 Fax# 751-6611
State Certification/Registration# Ct;C 055186 i `
Architect Name&Phone# n/a -
Engineer's Name&Phone# n/a
Fee Simple Title Holder Name and Address n/a
Bonding Company Name and Address n/a
Mortgage Lender Name and Address n/a JUN 2 n ?711
Application is hereby made to obtain a permit to do the work arid 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 l'he standards of all h...,... sla#ngeousiruction in this jurisdiction. This permit becomes null
and void if work is not commenced within six(61 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 Electrics 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 plication and know the.same to he tate and correct. All provisions of laws and ordinances governing this
type ofworkwill be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,state,or local law regulating construction or t e performance of construction.
l
Signature of Owner , —.
/ Signature of Contract /ti--7
Print Name V• a i 1't+S IAA _ l / Print Name Jerry Doherty
Sworn to and subscribed before me Swo o and sub bed before me
this l�� •Day of ,t.tl _ ,20 t 1- this ' Day of )U.A... .20(1
)1fAi __, `iZt
Not U Public Notary Pu li \►
Revised 01.26.10
,Y" JENNIFER JOHNSTON :�S4•'it'•r ;; JENNIFER CHAPI.it
MY COMMISSION tt GG 042984 : �' '+Y MY COMMISSION it_4.i3?59,
M`o' EXPIRES 0 '3••-'- 4. EXPIRES:June 29,2018 VI:;.,;,,,..
"'%°, `Qa', Bonded Ttw Notary Public l'ktderwlltets Alla``'��, Bonded Thru Notary Public Underwh tens
.5, ,,, ATLANTIC BEACH BUILDING DEPT.
"., .0' s„\ DEMOLITION - PROPERTY OWNER
RELEASE FORM
JiiSJi•
Date: ('y ' /`'J- / ` -
To Whom It May Concern:
I /We the current property owners of: Lot Pan{ o f LO-f l5" -t- g 0 c k 5'LT I(
Block 8-4 17-2S-29E.13 DONNERS SID PT LOT 15 RECD 01R 4219-766
Legal Description of Property
AKA 120 Jackson Rd have contracted with to have
(Address of Property)
Realco Recycling Co Inc to remove the siny-Ie family
(Company Name) (Single amily,Duplex,Commercial,etc.)
Prior to the construction of : n/a .
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.
V
Signature
Signature
THIS SPACE FOR RECORDER'S USE ONLY
OWNER
/ �/� III
l
Signed: V- "w� n 1J�• l E '"."9/., Date: - /5-•/7-
B e fo r e
-
Before me this i51-A- day of 3,L.0 0011 in the County of Duval,State
Of Florida,has personally appeared ' .L-l- 1.� M t.
Notary Public at Large,State of Flori ,County of val
My commission expires: �/i'----_-'---
Personally Known: or
Produced Identification:
r _
� r�y'4••. JENNIFER JOHNSTON
..r.4,,,,,‘
M ,.. MY COMMISSION#GG 042984
,,`:;; EXPIRES:October 27,2020
'%\d Me Bonded Pau Notary Public Undenwdters
s ,, _ `;1, CITY OF ATLANTIC BEACH
ir)
A s 800 SEMINOLE ROAD
J F ,, ATLANTIC BEACH, FL 32233
(904) 247-5800
' 1...-1•01119
PERMIT NOTES
RESIDENTIAL DEMOLITION
June 27, 2017
120 Jackson Road
BP # DEMO17-0010 REVIEWED FOR CODE COMPLIANCE
CITY OF ATLANTIC BEACH
1. It is the responsibility of the contractor to: SEE PERMITS FOR ADDITIONAL
a. Contact JEA to disconnect electric power. REQUIREMENTS AND CONDITIONS
b. Locate and clearly mark all utilities. REVIEWED BY: :t`r DATE: 6`21k%1
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. All underground tanks, concrete slabs and foundations must be removed with the
buildings, unless otherwise approved by the City. The site should be left graded and
clean for Final Inspection..
4. A water supply and hose may be required to control dust during demolition.
(Required for masonry structures and asbestos-containing materials.)
5. Removal of any trees requires a separate Tree Removal Permit, per COAB Code
Of Ordinances, Section 23-21.
6. Protection of trees and vegetation during construction is required, per COAB Code
Of Ordinances, Section 23-32.
7. Adding fill dirt to the lot is prohibited, until approved by Public Works.
8. Prior permission from the Building Department is required before blocking any part of the
Right-Of-Way. O
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