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1021 ATLANTIC BLVD COMM WSTE MNFST . 8PREMIER } Manifest No. GREASE !OI 'ie se. Commercial Waste Manifest 0.IGINATOR INFORMATION Originator Name I 1 gIlit I. Contact Name fel I Address r `0'i'/.!ra1 ! ,/ Phone 0� e Irri City, State I//y%7,4 w i/_4 'ip ,/�/� G County , Customer# 'Wiwi 1 Type of Trap: '1 Grease Interceptor ❑Oil/Water Separator ❑Grit/Sand Trap Outside 0 Inside 0 Other: /�/� Trap Condition: i��Tank#1 6�C/ gallons Tank#2 gallons Service Frequency Weeks ‹... Tank#3 gallons Tank#4 gallons Generator Certifications:I hereby certify that the wastes listed under this consignment are not hazardous,.as defined in regulations promulgated by the State of Georgia,Dept.of Natural Resources,and that the type wastes and quantity indicated are fully accurate. Originator Name(Printed) Signature Date Time t TRANSPORTER INFORMATION Company Premier Grease,Inc. Driver Name Ee»isii4,88tThs Address 323 Beverly Lane. Phone( 800 ) 880-1142 City,State Jacksonville,FL Zip 32254 FOG Permit#: 291 Truck#: 014 Transporter Certification: I hereby acknowledge receipt of the above listed waste and will transport and dispose of it in accordance with all applicable laws. Driver Name(Printed) Signature Da Time RECEIVER/DISPOSAL INFORMATION Disposal Name Liquid Environmental Contact Name Address Solutions Phone( ) 1640 Talleyrand Av City, State Jacksonville FL 3220Vp County EPD Approval/Permit# tcl:904.265.2104 NPDES# LAS# Industrial Pretreatment Permit# eceived by this facility within the authorized property boundaries and will be �[ with all applicable laws. l K Td 1 v�Cp 4s `1 ure Date Time 1 1 0 Z( k-rLok.4 in C.. POSAI, GENERATOO COUNTY or INSPECTOR L V M t 6 _ v v CIi. O44 June 2005 rev.2 P.. i Florida De rtment of Business &Professional Regulation Rick Scott,Governor Jonathan Zachem,Secretary JUNE 16, 2018 ARE YOU READY FOR YOUR INSPECTION? EMAIL: DHR.DISTRICT5@MYFLORIDALICENSE.COM With your file number File #. 310878 2CM LLC 1021 ATLANTIC BLVD STES 1-3 ATLANTIC BEACH, FL 32233 Re: Division of Hotels and Restaurants Plan Review License Type: 2010 PERMANENT FOOD SERVICE Application No. 1093679 D517 Log No. HQ-18-5756 Dear Plan Review Applicant: Congratulations on your decision to operate a restaurant in Florida! I have approved the public food service establishment plans for JUMPIN JAX HOUSE OF FOOD, 1021 ATLANTIC BLVD STES 1-3, ATLANTIC BEACH, FL 32233, as of 06/06/2018, with the following condition(s): 1) HANDWASH SINKS MUST BE EASILY ACCESSIBLE AT ALL TIMES AND MAY NOT BE BLOCKED BY STORAGE RACKS OR TABLES. 2) PROVIDE LOCATION OF WATER HEATING DEVICE AT TIME OF LICENSING INSPECTION. 3) PLANS PROVIDED MUST ACCURATELY REFLECT ALL FOOD SERVICE EQUIPMENT AND ITS LOCATION IN THE ESTABLISHMENT. FAILURE TO PROVIDE ACCURATE PLANS COULD RESULT IN DELAYS AT THE TIME OF THE LICENSING INSPECTION. 4) ALL FLOORS, WALL, COVE BASE, AND CEILINGS IN ALL FOOD PREPARATION, FOOD STORAGE, AND WARE WASHING AREAS MUST BE SMOOTH, NON-POROUS, DURABLE, AND EASILY CLEANABLE. Please have the above information or proof of compliance with the conditions ready for the inspector at your opening inspection. The conditions listed above are required to pass your opening inspection. Please include the file number and log number listed above on any documents submitted. Your plans are only approved as submitted to us and with the above conditions. Changes in proposed operational procedures may require additional equipment and certain changes may require a new plan review. If you decide to change the menu, equipment or operation, please notify us immediately. Your plan approval is valid for one year from the date of this letter, so you must license the proposed establishment before then. If your plan approval expires after a year, you may have to complete the plan review process including fee payment again. If you are no longer in charge of this project, please forward this letter to the correct person or company. When the construction is complete, please email Dhr.district5@myfloridalicense.com to request contact from an inspector to schedule an opening inspection. Be ready to provide the file number located at the top of this letter. Please allow 1-2 days for the inspector to contact you to schedule the inspection. Good luck with your enterprise! Sincerely, Robert(vers, Plan Reviewer Robert.lvers@myfloridalicense.com 03).* 850.414.7421 Phone: 850.487.1395 Division of Hotels&Restaurants www.MyFloridaLicense.com Plan Review Office License Efficiently. Regulate Fairly. 2601 Blair Stone Road Tallahassee,FL 32399-1011 Florida Department(.t LOG NUMBER Busines C' Division of Hotels and Restaurants HQ 18 5756 Professional www.MyFloridaLicense.com/dbpr/hr FILE NUMBER Regulation 310878 PLAN REVIEW SPECIFICATION WORKSHEET Establishment must meet all standards of Chapter 509, Part I, Florida Statutes,and Chapter 61C-18.4, Florida Administrative Code 1 Establishment Name: JUMPIN JAX HOUSE OF FOOD 2 Review Type Current License Number: PENDING INSPECTION ® New/Conversion Previous License Number and/or Name(if applicable): ❑ Remodel ❑ Closed at least one year Previous Licensing Agency: ❑ Department of Agriculture and Consumer Services ❑ Change Owner with Remodel [' Department of Health ❑ Division of Hotels& Restaurants WORKSHEET CODE KEY: S= Satisfactory NA= Not applicable U = Unsatisfactory—a plan cannot be approved with an item marked in this manner C = Caution—item is operationally based or cannot be determined by review and will be verified during onsite inspection 3 Construction Finishes Floor Wall Cove Base Ceiling Food Preparation TILE FRP TILE VCT Food Storage TILE FRP TILE VCT Dishwash Area TILE FRP TILE VCT Bathrooms TILE PTD GYP TILE VCT Dry Storage TILE FRP TILE VCT Bar NA NA NA NA Note: Finishes in areas of moisture must be smooth, nonabsorbent and easily cleanable; Studs,joists or rafters may not be exposed in areas of moisture; Curved and sealed cove bases are required at floor/wall junctures. Sinks and Warewashing 4 S Manual washing, rinsing and sanitizing facilities provided: ® 3-compartment sink ❑ 4-compartment sink Location(s): ® Kitchen ❑ Bar ❑ Dishwash area ❑ Other 5 S Mechanical washing, rinsing and sanitizing facilities provided: ® Dishmachine ❑ Glasswasher Dishmachine/glasswasher sanitizing method: ® Chemical ❑ Hot Final Rinse 6 S Drainboards or shelving/table equivalent provided at each end of dishwashing facilities 7 S Handwash sink(s)provided/accessible in food prep and food dispensing area(s) 8 S Handwash sink provided/accessible in dishwashing area(s) 9 Total number of handwash sinks shown 2 10 Food prep sink(s): ❑ 1-compartment ® 2-compartment ❑ 3-compartment Number shown: 1 Comments: DBPR Form HR 5021-011 Page 1 of 3 Revised 2013 April 04 Fire Safety 11 S Hood automatic fire suppression shown over cooking equipment(grease laden vapors) 12 C Portable extinguisher(s)shown PER AHJ 13 Public exit access does not go through kitchen/storage rooms/bathrooms/other high hazard areas ® Yes ❑ No 14 Number of exits: Public: Employee: Total: 3 15 Square footage of establishment: 3125 16 Building fire sprinkler system installed ❑ Yes ® No Equipment and Storage 17 NA Ice machine installed in enclosed area with outer openings protected 18 C Displayed /exposed food effectively protected 19 S Food preparation area protected from environmental contamination 20 NA Running water dipper well installed for bulk ice cream service or equivalent handling 21 _ S Equipment installed for cold holding potentially hazardous (time/temperature control for safety)food 22 S Equipment installed for hot holding potentially hazardous (time/temperature control for safety)food 23 C Dry storage area designated 24 C Maintenance and cleaning equipment storage area designated 25 C Employee personal article storage designated Plumbing and Bathrooms 26 C Plumbing system installed 27 S Mop/service sink; can wash -shown Location(s): OUTSIDE 28 C Water heating device Location: SEE PROVISO 29 Establishment type: ❑ Stand alone ❑ Mall (strip/enclosed) ❑ Incidental ❑ Lodging associated ❑ Theme park/entertainment complex 30 S Public bathroom installed Type/Location Shown: ® Bathroom for each sex ❑ Unisex only ❑ Public bathroom(s)on same level ❑ Public bathrooms within 300 feet on same level 31 S Public bathroom(s)accessible to customers without going through food preparation, food storage or warewashing areas 32 S Employee bathroom(s)provided ® Same as customer bathroom(s) ❑ Separate from customer bathroom(s) Water Supply 33 S Type of supply: ® Municipal ❑ Onsite Well ❑ Other Public well permit number: 34 Provider name: CITY OF ATLANTIC BEACH 35 Written approval/verification via: ❑ Copy of bill ® Approval form ElProvider letter ❑ Permit ❑ Electronic account document ❑ Verbal ❑ Other HISTORIC Wastewater Disposal 36 S Type of system: ® Municipal ❑ Septic Tank ❑ Package Plant ❑ Other 37 Provider name: CITY OF ATLANTIC BEACH 38 Written approval/verification via: ❑ Copy of bill ® Approval form ❑ Provider letter ❑ Permit ❑ Electronic account document ❑ Verbal ❑ Other HISTORIC 39 Septic tank system Permit number: ❑ Restrictions (see provisos) Tank size: gallons Drainfield: square feet Grease trap: gallons 40 Seating capacity per plan: ❑ Inside seating ❑ Outside seating ® Total: 150 Projected number of seats contingent upon approval from local Authority Having Jurisdiction Comments: DBPR Form HR 5021-011 Page 2 of 3 Revised 2013 April 04 Plan Results 41 ❑ Plans approved without provisos 43 ❑ Plans denied (see provisos) 42 ® Plans approved with provisos (see provisos below) Provisos: 1) HANDWASH SINKS MUST BE EASILY ACCESSIBLE AT ALL TIMES AND MAY NOT BE BLOCKED BY STORAGE RACKS OR TABLES. 2) PROVIDE LOCATION OF WATER HEATING DEVICE AT TIME OF LICENSING INSPECTION. 3) PLANS PROVIDED MUST ACCURATELY REFLECT ALL FOOD SERVICE EQUIPMENT AND ITS LOCATION IN THE ESTABLISHMENT. FAILURE TO PROVIDE ACCURATE PLANS COULD RESULT IN DELAYS AT THE TIME OF THE LICENSING INSPECTION. 4)ALL FLOORS,WALL, COVE BASE, AND CEILINGS IN ALL FOOD PREPARATION, FOOD STORAGE, AND WARE WASHING AREAS MUST BE SMOOTH, NON-POROUS, DURABLE, AND EASILY CLEANABLE. ❑ Variance approved VW# Date: ❑ Plans approved without provisos ❑ Plans approved with noted provisos (see provisos above) The following general provisos apply to all public food service establishments. ALL ITEMS WILL BE VERIFIED BY AN INSPECTOR AT THE TIME OF INSPECTION. Water/Backflow Prevention 44 Hot and cold water supplied to all sinks where required (e.g., three-compartment, handwash, mop/service sinks) 45 If allowed by the local Authority Having Jurisdiction, warewashing sinks and machines may have a direct connection Lighting 46 Light fixtures shielded/coated /covered where food is stored /prepared /displayed or where single-service items are open /exposed Illumination—50 foot-candles in food preparation areas; 20 foot-candles in self-service areas, inside reach-in or under- 47 counter refrigerators, handwashing and warewashing areas, equipment and utensil storage, toilet rooms; 10 foot- candles in walk-in refrigerators and freezers, dry food storage areas Equipment Installation and Operation 48 Waste container(dumpster), grease receptacle, compactor, recycle bins on nonabsorbent surfaces (pad) 49 Local exhaust ventilation installed over cooking units releasing steam /grease laden vapors/smoke 50 Bathrooms ventilated/provided with windows; doors self-closing; doors/stalls constructed to insure privacy 51 Equipment, mop/service sink/can wash/compactor area properly drained to sanitary sewer; refrigeration waste piping discharges indirectly into floor drain or other approved receptor; Laundry facilities protected 52 Dishmachines have visual detergent and sanitizer delivery system or incorporate visual/audible alarm to signal if detergent and sanitizer are not delivered to the proper cycles 53 All hose fittings protected by backflow device; back siphonage/backflow protection if no air gap/break 54 Doors to exterior self-closing unless emergency exit Fire Safety Information (Requirements and Compliance by Local fire Authority Having Jurisdiction) 55 No mesh filters in hood with automatic fire suppression systems installed 56 All gas appliances have a nationally recognized testing laboratory seal such as AGA or UL 57 Class K and other portable fire extinguisher installed as required by NFPA 10 and/or local fire authority 58 Automatic sprinkler and fire alarm systems required for occupancies greater than 300 59 Exit doors open outward for occupancy greater than 49 60 Physical separation or vertical splash guard installed between fryer(s)and open flames of adjacent cooking equipment. Check with local fire authority for installment requirements Plan Reviewer: DUKE IVERS Date: 06/16/2018 Plans Returned via: ❑ Mail ® Email ❑ Shipping DBPR Form HR 5021-011 Page 3 of 3 Revised 2013 April 04 WALK—IN COOLr "" l • WALK—IN COnLER 7tITY STORAGE MEN K22 L�J K19 K19 K19 ��--- g� KITCHEN o❑ N6 K 4 L JJ ® DISHWASH K14 23 O O O COLUMN � OFFICE Kzo WOMEN HALL �w �o :.0 DIMING DINING u� © COPiRIGHT 2.018 GERARD VERMEY, ARCHITECT, FL. / 4630 DESIGHER, EXPRESSLY RESERVES HIS COP IGHT ::ND OTHER PROPEP,TY RIGHT IN THESE PLANS. THESE PLANS AND DRAWINGS ARE IJO TO BE REPRODUCED, CHhNGED OR COPIED. IN ANY FORM OR 015MANGER RD SD EVER WITHOUT FIRST OBTAINING THE EXPRESS WRITTEN CONSEI IT OF ERAP,D VERMEY, ARCHITECT, NOR PRE THEY TO BE ASSIGNEG TO AIJY PARTY WITHOUT FIRST OBTAINING SAID WRITTEN COEISEIJT. lip r �a • 06/16/2018 `iI ii U • • .•. • ••and • r. •• •state and z a U r• ger" •e r h�0 DINING z_ Q N ®.F.F. m BI ��p✓A,}i�t� �9gyT���d� � o �, COLUMN � a,'d L �w �o :.0 DIMING DINING u� © COPiRIGHT 2.018 GERARD VERMEY, ARCHITECT, FL. / 4630 DESIGHER, EXPRESSLY RESERVES HIS COP IGHT ::ND OTHER PROPEP,TY RIGHT IN THESE PLANS. THESE PLANS AND DRAWINGS ARE IJO TO BE REPRODUCED, CHhNGED OR COPIED. IN ANY FORM OR 015MANGER RD SD EVER WITHOUT FIRST OBTAINING THE EXPRESS WRITTEN CONSEI IT OF ERAP,D VERMEY, ARCHITECT, NOR PRE THEY TO BE ASSIGNEG TO AIJY PARTY WITHOUT FIRST OBTAINING SAID WRITTEN COEISEIJT. EQUIPMENT SCHEDULE � TAG OTY DESCRIPTION CONDITION 1 2 HAND SINK EXISTING 2 ? GASH REGCSTER PROPOSED z e e Tnoi VARIPP CHAR DECLARATIVE STATEMENT: IT IS PARTITION LEGEND TO THE BEST OF THE ARCHITECT'S KNOWLEDGE , THE PLANS AND SPECIFICATIONS CDIAPLY WITH THE PPLICABLE .mn caxren MINIMUM BUILDING CODES AND THE APPLICABLEE9 FIRE—SAFETY STANDARDS AS DETERMINED BY L CAL �� M AUTHORITY IN ACCORDANCE WITH 2017 FBC 6tEDITION nxn.x �„cl �" /✓ 110.8.4.4 AND CHAPTER 633, FLORIDA STATUTE 0 SCALE: �•-- EQUIPMENT PLAN lip r �a • 06/16/2018 `iI ii • • .•. • ••and • r. •• •state and r• ger" •e r EQUIPMENT SCHEDULE � TAG OTY DESCRIPTION CONDITION 1 2 HAND SINK EXISTING 2 ? GASH REGCSTER PROPOSED z e e Tnoi VARIPP CHAR DECLARATIVE STATEMENT: IT IS PARTITION LEGEND TO THE BEST OF THE ARCHITECT'S KNOWLEDGE , THE PLANS AND SPECIFICATIONS CDIAPLY WITH THE PPLICABLE .mn caxren MINIMUM BUILDING CODES AND THE APPLICABLEE9 FIRE—SAFETY STANDARDS AS DETERMINED BY L CAL �� M AUTHORITY IN ACCORDANCE WITH 2017 FBC 6tEDITION nxn.x �„cl �" /✓ 110.8.4.4 AND CHAPTER 633, FLORIDA STATUTE 0 SCALE: �•-- EQUIPMENT PLAN