110 JACKSON RD - DEMO •11,4,
� !. ._.;,-u,.rill
.4' /*; . ' � CITY OF ATLANTIC BEACH
fkr,� � 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
*Ar.);tirP INSPECTION PHONE LINE 247-5814
DEMO - COMPLETE
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: DEMO17-0011
Description: complete demo of house
Estimated Value: 0
Issue Date: 6/28/2017
Expiration Date: 12/25/2017
PROPERTY ADDRESS:
Address: 110 JACKSON RD
RE Number: 172137 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.
li
0
I
City of Atlantic Beach APPLICATION NUMBER
\' Building
Building Department (To be assigned by the Building Department.)
800 Seminole Road Q EM Q ( O
Atlantic Beach, Florida 32233-5445 — d 1
� Phone(904)247-5826 Fax(904)247-5845 f
E-mail: building-dept@coab.us Date routed: D�1 D l t
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: IID 3 kk.CA SO/1 Q, . Department review required Yes No
ui ing
Applicant: OA ILO /1121-11 at /11 Planning &Zoning
Tree Administrator
Project: e,On,P\ ,��1_ �L mmt t volt . c'ubli or'
blit UtiI
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: Ii •pproved. ['Denied. . Not applicable
(Circle one.) Comments: r _ (
BUILDING 56- ' ! `-�'� t4
PLANNING &ZONING
Reviewed by: Date: 6 Z 1 l
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
sJawr,, City of Atlantic Beach flEGEVT
�• �, APPLICATION NUMBER
cs BuildingDe artment
' p (To be assigned by the Building Department.)
4 800 Seminole Road
9 Atlantic Beach, Florida 32233-5445 JUN 2 2017 O&A O - 0011
Phone(904)247-5826 • Fax(904)247-5845
>%' E-mail: building-dept@coab.us Date routed: Dtoi 1i
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I I 0 3 q..L SOf) Q4. Department review required Yes No
(EiraThg
Applicant: OA t.LO Q,.tL (J fl Planning &Zoning
'l Tree Administrator
Project: nirrl,P` O-L it Ma oP Vtoi SP C or
blic U i
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: f `/ 1 44044
BUILDING
PLANNING &ZONING / 1J
Reviewed bye1a 1��,� Date: tA2 7
TREE ADMIN. Second Review: ❑Approved as revised. Denied. .
❑ ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: QApproved as revised. ❑Denied. . ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
rs�vii--- City of Atlantic Beach " , � APPLICATION NUMBER
IL
.? Building Department
(To be assigned by the Building Department.)
sJ 800 Seminole Road JUN 2 1201r �A^
u +�' Atlantic Beach, Florida 32233-5445
Q Q (� �Q[�
Phone(904)247-5826 • Fax(904)247-5845
�%u;t}9% E-mail: building-dept@coab.us Date routed: D(Pi D 11-'4
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I I 0 .3 kt.0 -SO/) L . Department review required Yes No
ui mg
Applicant: QtI,t I.LD Q,t_LA1 a, fl,.. Planning &Zoning
'l Tree Administrator
Project: A) 4 L Oct_ it mcg 0. voikv. Publico�
blic Utilitiest
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. . I INot applicable
(Circle one.) Comments:
BUILDING
PLANNING & ZONING /
Reviewed by: iii )1-4----- Date:�C Z
TREE ADMIN. Second Review:
'Approved as revised. FIDenied. . ❑Not applicable
. P�;= WORKS Com encs:
BI.IC UTILITIES
rZ//-7
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: I 'Approved as revised. ❑Denied. . I Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
BUILDING PERMIT APPLICATION
ie CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845
Job Address: 110 Jackson Rd Permit Number: t&MO t '' f
Legal Description8-4
17 2S-29E.13 DONNERS SID PT LOT 15 RECD OIR 6096-420 Parcel# !-' / ? - 4 S 3 7
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$ 8,500 Proposed Work heated/cooled 900 non-heated/cooled 32
Class of Work(circle one): New Addition Alteration Repair Move Q?emolitic 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 4121
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: V- A1/i Scl1 /,t), /B14 5Address: I 3 $ ,5.E"/1/4 NWA /& -
City (3 State'-f41\., Address:
311133 Phone `704/- '-f 4, .3 7/
E-Mail or Fax#(Optional) a-r S /960e QO1 ,GoWl
Contractor Information:
Company Name: Realco Recycling Co Inc Qualifying Agent:Jery 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# CAC 05.51RR �
Architect Name&Phone# n/a t
Engineer's Name&Phone# n/a .Ji
Fee Simple Title Holder Name and Address n/a
Bonding Company Name and Address n/aJ N 2017
Mortgage Lender Name and Address Na
Application is hereby made to obtain a permit to do the work and installatio.ks heated. 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 1 regulating construction-in this jurisdiction. This permit becomes null
and void if work is not commenced within six(6)months,or if construction or wont 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 sawed for Electrical"IWork,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 hereby certify that I have read and examined this a plication 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 violate or cancel the
provisions of any other federal,state,or local law regulating construction or the'erformance of construction.
Signature of Owner • . _ '' .1. 4 Signature of Contracto 0 \.
Print Name V. Pt)/I'S tAA O. r,-th Print Name Jerry Doherty
Sworn land subscribed before me Swo o and subscribed before me
this 1,5Day of Sa(1-C k ,20 11 this ' Day of 'I th1' .L ,2011
\ _A AAA._.11 \.... t)..1,h.-
Not. ' Public Notary Pu.
r
Revised 01.26.10
4'''"r .4M%
JENNIFER JOHNSTON
., • MY COMMISSION#GG 042984 ;iii. JENNIFER CHAPIJN
w" ~: EXPIRES:October 27.2020
='A' ;-- MY COMMISSION It FF 098892
of o4 Bonded Thru Notary Public Urdervaltars °r;,,��.:t EXPIRES:June 29,2018
�• 1,Rf t BondedThruNotary Public Undecwriters
/
.
,:s LAIN-. , ATLANTIC BEACH BUILDING DEPT.
DEMOLITION — PROPERTY OWNER
t`� RELEASE FORM
,,,
________)
Date: 6 ` l4/ " / 7-
To Whom It May Concern:
I I We the current property owners of: Lot I ,ti
Block 8-4 17-2S-29E .13 DONNERS SID PT LOT 15 RECD OIR 6096-420
Legal Description of Property
AKA 110 Jackson Rd have contracted with to have
(Address of Property)
Realco Recycling Co Inc to remove the single 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 w, .
Signature1
Signature
THIS SPACE FOR RECORDER'S USE ONLY
OWNERk
I' �—
9C �Signed: ,I- 67-41-"A dk • /)�^1Date: p /,S
Before me this t,S14 day of at..t n•4._ tao t'}- in the County of Duval,State
Of Florida,has personally appeared b-k-tut-.1 M
Notary Public at Large,State of Florida,G,un of Duval.
My commission expires: .L�. _ -
Personally Known: tV 1 I •r
Produced Identification: 1
J ' -JOHNSTON
L x,44.' MY COMMISSION N GO 042984
EXPIRES:October 27,2020
�`"•O' Publc Underwriters
F o*•' Bonded Thru Notary
41 `S CITY OF ATLANTIC BEACH
i- iii, •;) 800 SEMINOLE ROAD
J. � ATLANTIC BEACH, FL 32233
ep (904) 247-5800
�J;311)�
PERMIT NOTES ,
RESIDENTIAL DEMOLITION
June 27, 2017
110 Jackson Road REVIEWED FOR CODEC BEACH NCE
BP # DEMO17-0011 CITY
SEE PERMITS OF ATLAN7
TIONS
1. It is the responsibility of the contractor to: E:DIZZ
a. Contact JEA to disconnect electric power. REVIEWEDREGiUIR BY: ENTS AND CODATN--
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. 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.
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