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303 ATLANTIC BLVD - COOP 303 - STOCK AND TRAIN APPLICATION -;1,-tJij- `i; 800 Seminole Road i_-: ,4i �' Atlantic Beach, Florida 32233 Telephone (904) 247-5800 -0169 FAX (904) 247-5845 Application for Permission to Stock and Train (PST) Date: 7/17/18 Permit#: 17-CADD-3210 Name of Business: Coop 303 Address of Project: 303 Atlantic Blvd. Occupancy Type: A-2 Property ID No.: BK 6610-1725 Contractor Info: Name: River City Contractors License No.: CGC060512 Address: 1510 Montana Ave. Phone: 904 399-8846 Email: troy@rivercity-contractors.com Owners(all, partners, CEO, or board members): Alan Cottrill Address: 1510 Montana Ave. Phone: 904 399-8846 Email: Alan@rivercity-contractors.com Associated permits 77,c7-v-k--Zr-'` O ?4 (r- 7 Description of PST event/activity Stocking Restaurant and Training of Restaurant Employees Starting date requested 7/18/18 End date 8/18/18 Please submit the following items with the Permission to Stock and Train Application. 1. Site plan, indicating areas where stock and train activities will occur and employee on-site parking. 2. Proof of premise Liability Insurance and Worker's Compensation. Conditions: 1. Building must pass a Building Safety Inspection, from the City Building Inspector. 2. Building must pass a Fire Safety Final Inspection, from the Jacksonville Fire Marshal's Office. Inspection includes, but not limited to: - Fire sprinklers and alarm systems complete and approved. - Emergency lighting functional - Kitchen fire suppression systems functional and approved. 3. Job fairs and activities involving other than employees of the building contractor and business owner cannot be included in this PST. 4. Temporary signs should comply with provisions of AB Sign Ordinance or PUD (where applicable) Page 1 of 2 5. All merchandise, display, tents, supplies, furniture, etc. shall be placed in such a manner as to not impede pedestrian or vehicular traffic and shall not impede an exit or fire lane. 6. All areas approved for stock and train shall provide accessible restroom facilities within a reasonable distance. 7. All employee parking must be on site. This agreement is not a Certificate of Occupancy. The Certificate of Occupancy must be issued before opening for business and before the general public can be allowed on site. The City of Atlantic Beach reserves the right to revoke this agreement and disconnect service utilities if the above conditions are not adhered to, or unsafe conditions exist. I HEREBY CERTIFY THAT I UNDERSTAND AND AGREE TO THE ABOVE CONDITIONS, AND ALL INFORMATION IS CORRECT: Signed By: Contractor: / 3. Date 7— / ,_ / 23 Owners: Alt , A Date Approvals: Building and Zoning Directo .,.,,4.. _ ` Date i '/ 0moi• i Fire Marshal d lit 1,1% .�dMA ' / ,.%Ai i Inti Date 1 1 U I r Building Official -k--e........%.4. C.r—rb.A. Date Z it t;(i t, v1e.C_m- T 0-E-A rt.-rte )►Cr•4 ►-r-tlT.d-S Public Works Date MEGh9•v+<-A- L La...-d S.0&1 c 1-'L,,,,i,,,,5 ZU s..),r5 Cons fuhi,< <,✓oLk5 eLcL1-e.cCA-L Page 2 of 2 F,A-4- St if 0'A) 1-4o od 5 Range Hood Systems Report DATE OF SERVICE TIME A.M. P.M. FIRST COAST o 7- ze_ ,r i_ iir41 ANNUAL SEMI-ANNUAL RECHARGE INSTALLATION RENOVATION VI X Jo LOCATION OF SYSTEM CYLINDERS / , FIRE & SAFETY EQUIPMENT Ee, d .2)-F ii 0.d MANUFACTURER MODEL NUMBER WET DRY CHEMICAL 5905 Macy Ave. • Jacksonville, Florida 32211 AAs ,2_,0 X (904) 346-0111 • Fax (904) 346-0112 CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE email: firstcoastflre@aol.com <-•as-'-Q Lic. #: 41880800012003 3 6 .,(s. 3 Gam-(s. /1'2 Get a FUSE LINKS 360°F. FUSE LINKS 450°F. FUSE LINKS 500°F. CO2 CARTRIDGE CUSTOMER if- ..-'- Name Crn© P 303 FUEL SHUT-OFF ELECTRIC GAS SIZE Address 3 03 A4-1a..A-c e IV CL X /4 11 SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE City A 4- 1c......4 ic. t , FL 3. 33 g-7 4-4--/ Zoe,- a ov 8' CERTIFIED E-LITES UL-300 i� Telephone Store No. X x Owner or Manager MANUFACTURERS MANUAL REFERENCE COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT PAGE NUMBER: DRAWING NUMBER: /6" Fa'l ar 42" 2 fr i- 34" Fro,-4- Gt-•\) 36 4 C,i.o.r13ro►1ie_r- 0 /0" Vrterj 3C5 , - 1.All appliances properly covered w/correct nozzles / 20. Replaced fuse links _.G 2. Duct and plenum covered w/correct nozzles 21. Check travel of cable nuts/S-hooks 3. Check positioning of all nozzles 22. Piping &conduit securely bracketed 4. System installed in accordance w/MFG UL listing / 23. Proper separation between fryers&flame 5. Hood/duct penetrations sealed w/weld or UL device / 24. Proper clearance-flame to filters 6. Check if seals intact, evidence of tampering / 25. Exhaust fan in operating order 7. If system has been discharged, report same At) 26.All filters replaced 8. Pressure gauge in proper range (If gauged) 27. Fuel shut-off in on position 9. Check cartridge weight(If applicable) / 28. Manual &remote set/seals in place 10. Hydrostatic test date 29. Replace systems covers 11. 6 year maintenance date N4 30. System operational&seals in place 12. Inspect cylinder and mount 31. Slave system operational / 13. Operate system from terminal link -- 32. Clean cylinder& mount / 14.Test for proper operation from remote 33. Fan warning sign on hood 15. Check operation of micro switch ° 34. Personnel instructed in manual operation of system 16. Check operation of gas valve / 35. Proper hand portable extinguishers / 17. Clean nozzles i 36. Portable extinguishers properly serviced l 18. Proper nozzle covers in place 37. Service&Certification tag on system / 19. Check fuse links and clean44NOTE DISCREPANCIES OR DEFICIENCIES BELOW COMMENTS: N11 0 ,t:SC1-e._PQvici es Al r On this date, the above system was tested and inspected in accordance with procedures of the presently adopted editions of NFPA 17, 17A, 96 and the manufacturer's manual and was operated according to these procedures with results indicated above.1 )1213-%241(716?/091Docii_e,oy L.-7,7-04 / : 1 SERVICE TECHNICIAN PERMIT NO. DATE: TIME: AM PM C TOMERS AUTHORIZED AGENT The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report. WHITE - CUSTOMER COPY YELLOW- DISTRIBUTOR PINK-AUTHORITY HAVING JURISDICTION Range Hood Systems Report sys+e_w„.-#*i DATE OF SERVICE TIME A.M. P.M. FIRST COgST 7-ANNUAL 8� a1-ANNUAL RECHARGE r INSTALLATION LOTION RENOVX LOCATION OF SYSTEM CYLINDERS X FIRE & SAFETY EQUIPMENT End cs.-F tioed MANUFACTURER MODEL NUMBER WET DRY CHEMICAL 5905 Macy Ave. • Jacksonville, Florida 32211 (904) 346-0111 • Fax (904) 346-0112 �'JC -ie X CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE email: firstcoastflre@aol.com Lic. #: 41880800012003 3 G.-Is. 3 6-4.- . 3G'c.Ls- FUSE LINKS 360°F. FUSE LINKS 450°F. FUSE LINKS 500°F. CO2 CARTRIDGE CUSTOMERif Name COO f 3453 FUEL SHUT-OFF ELECTRIC GAS SIZE -C x X t* s.I. Address 3©,j A+IQ..1��C '..RI✓ t. / A+I SERIAL NUMBER LAST HYDRO TEST DATE LAST R HARGE DATE City AT 14,.ti-��c e C.L FL 3 2233 7 2 -33 go!Fj ;z 018' r CERTIFIEDE-LITESUL-300 ALARM Telephone Store No. `„ x Owner or Manager MANUFACTURER'S MANUAL REFERENCE COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT PAGE NUMBER: DRAWING NUMBER: /6'.r e....,-- SC" Gee. R..-yam +1 1 I-f-- St.-1 len-- 1.All appliances properly covered w/correct nozzles / 20. Replaced fuse links / 2. Duct and plenum covered w/correct nozzles 21. Check travel of cable nuts/S-hooks 3. Check positioning of all nozzles 22. Piping &conduit securely bracketed 4. System installed in accordance w/MFG UL listing ./ 23. Proper separation between flyers&flame 5. Hood/duct penetrations sealed w/weld or UL device / 24. Proper clearance-flame to filters 6. Check if seals intact, evidence of tampering / 25. Exhaust fan in operating order 7. If system has been discharged, report same AO 26.All filters replaced 8. Pressure gauge in proper range (If gauged) 4R 27. Fuel shut-off in on position 9. Check cartridge weight(If applicable) _,Z28. Manual & remote set/seals in place .....-- 10. 10. Hydrostatic test date /8' 29. Replace systems covers 11. 6 year maintenance date A fit 30. System operational &seals in place 12. Inspect cylinder and mount -� 31. Slave system operational 13.Operate system from terminal link 32. Clean cylinder&mount 14.Test for proper operation from remote 33. Fan warning sign on hood 15. Check operation of micro switch 34. Personnel instructed in manual operation of system 16. Check operation of gas valve / 35. Proper hand portable extinguishers _G 17. Clean nozzles / 36. Portable extinguishers properly serviced 18. Proper nozzle covers in place 37. Service&Certification tag on system / 19. Check fuse links and clean Al/i( NOTE DISCREPANCIES OR DEFICIENCIES BELOW COMMENTS: 0 b i BSc r e_paviGi cS ,e-fed� On this date, the above system was tested and inspected in accordance with procedures of the presently adopted editions of NFPA 17 17A, 96 and the manufacturer's manual and was operated according to these procedures with results indicated above. 4 e_a6(- 1C 7ttAosso2vesci e7Zo-�(Y(: 04'SERVICE T CHNICIAN PERMIT NO. DATE: _ TIME: AM PM CU� ERS AUTHORIZED AGENT The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report. WHITE - CUSTOMER COPY YELLOW - DISTRIBUTOR PINK -AUTHORITY HAVING JURISDICTION ,��- ALSPI-2 OP ID: LDB Irma" DATE(MMUIDDIYYYY) 1/4........----- CERTIFICATE OF LIABILITY INSURANCE 07n7i2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 904-296-3390 CONTACT Linda Beasley Vandroff Insurance Agency Inc. PHONE — Faz 9 y 904-296-3390 904-296-6144 5150 Be!fort Road#200 (ac,No,Ext): (AIC,No): Jacksonville,FL 32256 E-MAIL linda@vandroff-Insurance.com Vandroff Insurance Agency ADDRESS: INSURER(S)AFFORDING COVERAGE -__ NAICM_____ _INSURER A_Zuric_h Insurance(-croup__ INSURED Al's Pizza,Inc. INSURER B: 246 3rd St —._.. Neptune Beach,FL 32266 INSURER C: INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL UBR I I POLICY EFF I POLICY EXP LTR TYPE OF INSURANCE WSD WVD i POLICY NUMBER 4IMMIDD/YYYY) /61M/DDIYYYY) LIMITS GENERAL LIABILITY j ( I EACH OCCURRENCE_ S 1'00 '�_ A X ! Liquor Liability. I DAMAGE TO RENTED 100,000 CLAIMS-MADE X OCCUR y I CP00507783-00 103/01/2018103/01/2019 PREMISES-(Eaoccurrence'__ $ ____.___ A x q CP00507783-00 03101/2018103/01/2019 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY S _ 1,000,000 L.GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY I JE I LOC I PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: 1 S COAUTOMOBILE LIABILITY ! (a accident) enntNED�INGLE LIMIT S ANY AUTO BODILY INJURY(Perperson) S OWNED ^SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident'_S__ HIRED i NON-OWNED PROPERTY DAMAGE AUTOS ONLY _AUTOS ONLY (Per accident) S S A X ;UMBRELLA LIAB i OCCUR EACH OCCURRENCE S 5'000`000 —I EXCESSLIAB H CLAIMS-MADE AUC0507784.00 (03/01/2018 03/01/2019 5,000,000 __-- ' -----____-- I AGGREGATE DED i ,RETENTION S I I S WORKERS COMPENSATION PER 0TH- AND EMPLOYERS'LIABILITY . STATUTE ER Y/N I OFFICER/MEMBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE 7 NIA ' E.L.EACH ACCIDENT S I(Mandatary in NH) I 1 _EEL.DISEASE-EA EMPLOYEES IIf yes,describe under DESCRIPTION OF OPERATIONS below 1 ! E.L.DISEASE-POLICY LIMIT S A ;Property Section CP00507783-00 03/01/2018.03/01/2019 j I I1 C1044 II DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may he attached if more space is required) Al's Pizza, Inc.dba Coop 303 303 Atlantic Blvd Atlantic Beach,FL 32233Pilh CERTIFICATE HOLDER CANCELLATION CITY-11 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Atlantic Beach ACCORDANCE WITH THE POLICY PROVISIONS. 800 Seminole Road Atlantic Beach, FL 32233 AUTHORIZED REPRESENTATIVE 6 7)1 (: ACORD 25(2016/03) N 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD