2127 Beach Ave DEMO18-0027 demo permit "5"'%� DEMO PERMIT PERMIT NUMBER
,r`, `?i CITY OF ATLANTIC BEACH DEMOISSU8-0027
'. r 800 SEMINOLE ROAD
- EXPIRES:
��ir�" ATLANTIC BEACH. FL 32233
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property
that may be found in the public records of this county, and there may be additional permits required from other
governmental entities such as water management districts, state agencies, or federal agencies.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
2127 BEACH AVE DEMO COMPLETE COMPLETE DEMO $40000.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169515 0100 SECTION LAND
COMPANY: ADDRESS: CITY: STATE: , ZIP:
REALCO RECYCLING 8707 SOMERS RD JACKSONVILLE FL 32226
OWNER: ADDRESS: I CITY: STATE: ZIP:
PELHAM VIRGIL G 2127 BEACH AVE ATLANTIC BEACH FL 32233-5932
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR 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.
` LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
i
1 PUBLIC UTILITIES UNDERGROUND WATER SEWER UTILITIES INFORMATIONAL
Notes:
,Avoid damage to underground water and sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field
coordination is needed,call 247-5878.
2 PUBLIC UTILITIES DISCONNECT AND CAP INFORMATIONAL
1 Notes:
Disconnect and cap water and sewer lines.
Issued Date: 1 of 2
DEMO PERMIT PERMIT NUMBER
J + '` 1�
tr. CITY OF ATLANTIC BEACH DEMO18-0027
800 SEMINOLE ROAD ISSUED:
ATLANTIC BEACH. EXPIRES:
FL 32233
3 PUBLIC WORKS EROSION CONTROL INSTALLATION INFORMATIONAL
Notes:
Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line(904-247
-5814)to request an Erosion and Sediment Control Inspection prior to start of construction.
4 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
5 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL
Notes:
Roll off container company must be on City approved list(Advanced Disposal,Realco Recycling,Shapells,Inc.,Republic Services,Donovan Dumpsters,
Phillips Containers). Container cannot be placed on City right-of-way.
6 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration,including sod,is required.
7 PUBLIC WORKS RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site. Cannot raise lot elevation.
8 PUBLIC WORKS DOCUMENT IMPERVIOUS AREA INFORMATIONAL
Notes:
Strongly suggest thorough documentation of impervious areas be recorded.
9 PUBLIC WORKS GRASS INFORMATIONAL
Notes:
Full site to be grassed.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
DEMOLITION 455-0000-322-1000 0 $100.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $129.00
Issued Date: 2 of 2
,.S ��vr,J, City of Atlantic Beach APPLICATION NUMBER ��
js r „, ;a Building Department A (To be assigned by the Building Department.)
r ' - ',.J 800 Seminole Road J-+•
s� Atlantic Beach, Florida 32233-5445 VE �✓G r`018 –op l
•
. €'": ' ` Phone(904)247-5826 • Fax(904)247 5
w!�;11>r E-mail: building-dept@coab.us t SEP 2 4 201$ Date routed: 9 Z (18
City web-site: http://www.coab.us t
811.
APPLICATION REVIEW A KING FORM
Property Address: Z. t 17 lE= CL{. E Derpant review required Yes No
uilding_ __.)
Applicant: R CSA[.IO i • CL.(AG Planning &Zoning
Tree Administrator
Project: ikik P — _ . G(n 0 , 'ubIic Works
(.. 'I:icUiiies
oo L. -1,- ,-2_ ,„ v�.,� uric a ety
�
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: 1r
,/1Approved. ['Denied. Not applicable
(Circle one.) Comments:
UILDING
PLANNING &ZONING Reviewed by: Date: _N-
TREE ADMIN.
Second Review: Approved as revised. ❑Denied. Not applicable
PUBLIC WORKS Comments:
.(1511BLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date: •
FIRE SERVICES Third Review: ['Approved as revised. ['Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
;;51-Lvv-,:ir, City of Atlantic Beach APPLICATION NUMBER
JS Building Department (To be assigned by the Building Department.)
i' ' -., t, CE1VE '� Boz
J � 800 Seminole Road ��^ f
�r Atlantic Beach, Florida 32233-5445 r l d C 7
~�.. VJsEP242018
��'`' �'„” Phone(904)247-5826 • Fax(904)24 S�45
;110? E-mail: building-dept@coab.us 1 Date routed: 9 fz-t (i i
City web-site: http://www.coab.us $Y: 111
APPLICATION REVIEW AND TRACKING FORM
Property Address: Z I �-7 I E-A,CIL{ (I -i Department review required Yes No
�1 (Building_
Applicant: R rt 1--L0 —e, ( G Planning &Zoning
s Tree Administrator
Project: e_ oX11. p L t'--T(�- (� c- 0 Public Works
` r�liue
PoG (� �- � � tUCU� p 'Yubncbaety
1 ,b-,7-.--
Fire Services
Review fee $ ..6V Dept Signature ,
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection 1�',•
Florida Dept.of Transportation A
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLI ION STATUS
Reviewing Department First Review: Approved. I 'Denied. Not applicable
(Circle one.) Comments:
BUILDING )
PLANNING & ZONING y 9—Zr—kr
Reviewed b CA----2",--Date:
TREE ADMIN. Second Review: Approved as revi d. Denied. Not applicable
LIC WORKS Comments:
41 UBLIE
IC UTILITS
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: nApproved as revised. Denied. (Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
„0.,: `-rjr, City of Atlantic Beach APPLICATION NUMBER
js Building Department (To be assigned by the Building Department.)
ktil
`' .� 800 Seminole Road
Atlantic Beach, Florida 32233-5445 r
-r Phone(904)247-5826 • Fax(904)247-5845 w a'
E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Z ( Z7 Rie DDe�epartment review required Ye No
,
� i ildinC_2
Applicant: R Eipt L-c-O 2 f C L I/VG
Planning &Zoning
Tree Administrator
Project: - . V — — G M. 0 'ublic Wor s
P �[rts ic-t.T�illies�
OCA L "-•✓ (Uet,o p, `Puonc Satety
7 Fire Services
Review fee $ Dept Signature
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:
APPLICATION STATUS
Reviewing Department First Review: KApproved. ❑Denied. Not applicable
(Circle one.) Comments:
UILDING
PLANNING & ZONING Reviewed by: frlr Date:10
TREE ADMIN.
Second Review: Approved as revised. ['Denied. El Not applicable
UBLIC WORKS Comments:
UBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. I INot applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
BUILDING PERMIT APPLICATION
• CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845
Job .address: 2127 Beach Ave _..„
Permit Number: L/f'I770 AP—Oblv17
Legal Description 09-2S-29E 642 PT GOVT LOT IRECO O/R93031405BEING PARCEL A
Parcel# 169515-0000
Floor Area of Sq.Ft. Sq.t't U
Valuation of Work$ 40,000 Proposed Work heated/cooled 6406 non-heated/cooled 1026
Class of Work(circle one): New Addition Alteration Repair MoveCDemolitio)r pool/spa window/door L
Use of existing/proposed structure(s)(circle one): Commercial Residenti.10
If an existing structure,is a fire sprinkler system installed?(Circle one): • - I N/A
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed: Complete demolition of single family home \
0 ' %
Property Owner Information: Z I
Name: Virgil PelhamAddress: 2127 Beach Ave Q I -iZ
City Atlantic Beach State Flip 32226 Phone ' z 0
E-Mail or Fax#(Optional) 2 Lu O a 7 lii
Contractor Information: 0 03 U Q
Company Name: Realco Recycling Co Inc Qualifying Agent:Jerry Doherty U U a U O
Address:8707 Somers Rd City Jacksonville State FL zip 322 F— o 4...)
Office Phone 757-7311 Job Site/Contact Number 955-3581 Fax# 751-6611 0 I 0 <
State Certification/Registration# (:(;C:055156 U ,,j u- to
Architect Name&Phone# n/a F— H !—
Engineer's Name&Phone# n/a Q c� Z
Fee Simple Title Holder Name and Address n/a 0 I!_ '2 cw,-
Bonding Company Name and Address n/a Q UJ W
Mortgage Lender Name and Address n/a W GL lr• U)
1—
Application 0
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 Lu 0 LU
issuance ofa permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes (,) U7 w
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 a W
work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Beatet� CC
Tanks and Air Conditioners,etc. W j
WARNING TO OWNER:YOUR FAILURE TO RECORD A NOTICE OF CCcc
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 be true and correct. All provisions of laws and ordinances governing this
type ofworkwill be complied with whether s. 'red herein or not. The granting of a permit does not presume to give authority to folate or cancel the
provisions of any other federal,state,or localg,14egulating construction or the performance of construction.
Signature of Owner ( " e_ Signature of Contra
Print Name \I%(,9 i I c,.1),RAVtarl Print Name Jerry Doherty
Sworn to and subscribed before me Swo�rn to and sub bed before me
this Day of SQ.}kaM�.R ,20 I% this/A0 Day• r .201 g
i1/
•
NotaryNotary ' bli
Y'P, TARA L.AYOTTE
4 `� oho Notary Pubic State of Florida 1 �;F%►i JENNIFE R '6.10
f ,.;.
•� Commission M GG 068367 '�' My COMMISSION#GG 197225
iuii l -'i 4*o ;r
'; �� My Comm.Expires May 27,2021 =; EXPIRES:June 29,2022
°P Bonded through National Notary Assn. ( X1••0*.$
Asim. ———` ———��_f I '" °F pt t Bonded Tbru Notary Public Underwrter$
1
ATLANTIC BEACH BUILDING DEPT.
. ter- . it, DEMOLITION - PROPERTY OWNER
4 RELEASE FORM
ry.
UFFIrE COPY
Date: 9 ( f8 ( 1
R
To Whom It May Concern:
I / We the current property owners of: Lot
Block 09-2S-29E.642 PT GOVT LOT 1 RECD O/R 9303-1405 BEING PARCEL A
Legal Description of Property
AKA 2127 Beach Ave have contracted with to have
(Address of Property)
Realco Recycling Co Inc to remove the single family home
(Company Name) (Single Family,Duplex,Commercial,etc.)
Prior to the construction of : single family home
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.
1:4•T'
Signature
144/.
Signature
THIS SPACE FOR RECORDER'S USE ONLY
OWNER
•;rpv,.
TARA L.AYOTTE Signed: 3 G..s. "�U--�+� Date:CA I 1 bI 1 5
9 c' '\ Notary Public-State of Florida Before me this 1 day of StvAe,-r,bs� in the County of Duval,State
•,1 •; Commission*GG 068367 Of Florida,haspersonallyappeared c -\
My Comm.Expires May 27,202t PP V ou Duval. ti
'� Bonded t* ugi NaeonalNonryAssn,
Notary Public at Large,State of Florida,County of Duval.
�` My commission expires: Y''\ts.Q 02"t , .� t
Personally Known: pe.- or
Produced Identification:
•
,-"4
as 'vrt, TREE & VEGETATION AFFIDAVIT FORINTERNALOFFICEUSEONLY
s
_ City of Atlantic Beach PERMIT#
r ` ? Community Development Department
800 Seminole Road Atlantic Beach,FL 32233
"�J; V (P)904-247-5800
SITE INFORMATION''') '� `rte
ADDRESS 2 t Z ` ?JA Vi
SUBDIVISION BLOCK LOT ,1.
RE# \, (pC (5-0000 JZ[RESIDENTIAL ❑ COMMERCIAL ❑ OTHER
APPLICANT INFORMATION Q
NAME - 1 1.4491r. GQ (4& PHONE# i5 7 15 6 t
ADDRESS 01 D1 -i> f ,5 9 CELL# 5—3561
CITY ,iJcv--6/)"(et!L t.t-e._ STATE ZIP CODE ,Z 22,4
EMAIL '" �? 4- 7 )C,Gel ❑ OWNER IKLEGAL AUTHORIZED AGENT
I affirm that I have reviewed the provisions of Chapter 23, "Protection of Trees and Native Vegetation", of
the Municipal Code of Ordinances for the City of Atlantic Beach Florida and/or I have participated in a pre-
application meeting with the Administrator of those regulations. Subsequently, I affirm that no regulated
trees and no regulated vegetation will be damaged,destroyed and/or removed from the above-described
property and/or adjacent properties including right-of-way.
I HER :o RTIFY THA ALL INFORMATION PROVIDED IS CORRECT:Signature of Property Owner(s)or Authorized Agent
iidilipriiiiiirrai __AL....41 ___VeR)-c Doftv---r1/4( 611Z.LItS
SIG • UR •F • 'PLICA I PRINT OR TYPE NAME DATE
SIGNATURE OF APPLICANT(2) PRINT OR TYPE NAME DATE
Signed and sworn before me on this `' ' day of (---S L4 ,a-) (anyf"
State of
Cii
County of L
Identification verified:� .� IP
l
WPv gl, kAk6L
Oath Sworn: ❑ Yes . U ► . /
°�liH�P�� T3--------
,rQ.• � �, TONIGINDLESPEF2!ER Notary ignatur
c .- MY COMMISSION#FF:!?4951
'% . .:a EXPIRES:October 6,2019
r•••`�` MyCommission expires
P, ,�;;••° Bonded Thru he zry Public Underwriters tars P
04 TREE AND VEGETATION AFFIDAVIT 03.01.2018
EXHIBIT A. LETTER OF AUTHORIZATION DRTV 10_
OFFICE COPY
Realco Recycling Co Inc is hereby authorized to act on behalf of
Virgil Pelham the owner(s) of those lands described within
the attached application,and as described in the attached deed or other such proof of ownership as may
be required by the City of Atlantic Beach in applying for a development permit.
BY: A10,,
Ari � d A
Signature of Owner or Owner's Lega 'epresentative
Virgil Pelham
Printed Name
2127 Beach Ave,Atlantic Beach, FL 32233
Mailing Address
Cjli.1-L—5555 "t;r.LyQ01/4DL.Cci--s
Phone Cell Fax Email
State of: � co‘.
County
County of: +.,\ a,k.
Signed and sworn before me on this t8--h%
day of ?W-" , 2-016 ,by
v 1co\LLQA
Identification verified: I`aC. •p y 50,, %L __
Oath sworn: R Yes fl No
..,;;;;•;.....4, TARA L.AYOTTE
� •
Notary Public State of Florida
• Commission M GG 068367 CULS3 \—•
�^ g My Comm.er Expires May 27,2021 Notary Signature
gonthrough National Notary Assn,
My Commission expires: ,`Y\c an , 'a.oa.I
EXHIBITA_Letter of Authorization_vo5.io.io
OFFICE COPY
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