800 Seminole Rd COMM19-0015 Restroom Remodel COMMERCIAL PERMIT PERMIT NUMBER
COMM19-0015
CITY OF ATLANTIC BEACH
ISSUED: 7/19/2019
800 SEMINOLE ROAD
ATLANTIC BEACH. FL 32233 EXPIRES: 1/15/2020
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:
800 SEMINOLE RD COMMERCIAL ALTERATION REMODEL BATHROOMS - $93200.00
COMMERCIAL JACK RUSSELL PARK
TYPE OF REALESTATE BUILDING USE
ZONING: SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1703890000 SALTAIR SEC 02
CITY: STATE: ZIP:
COMPANY: ADDRESS:
LASA CONSTRUCTION, INC 6734 GREENLAND INDUSTRIAL BLVD JACKSONVILLE FL 32258
CITY: STATE: ZIP:
OWNER: ADDRESS: I
CITY OF ATLANTIC BEACH 800 SEMINOLE RD ATLANTIC BEACH FL 32233-5444
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.
FEES
DESCRIPTION ACCOUNT PAID AMOUNT
BUILDING PERMIT 45S-0000-322-1000 0 $456.00
BUILDING PLAN CHECK 4S5-0000-322-1001 0 $228.00
STATE DBPR SURCHARGE 4SS-0000-208-0700 0 $10.26
STATE DCA SURCHARGE 4SS-0000-208-0600 0 $6.84
TOTAL: $701.10
Issued Date:7/19/2019 1 of 2
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be igned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us LDate routed:
Cityweb-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Department review required Yes No
Property Address:
ilding
'P,---�_7�72_oning
Applicant: L A�s ta, Co t-Ds-ozcx_) Ttut�,� 4 ou
r,� Q� Tree Administrator
Project: es� c—ty-\a 13 c Public Works
Public Utilities
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: V�4proved. ElDenied. [—]Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date:
TREE ADMIN. Second Review: FlApproved as revised. [—]Denied. []Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by.- Date:
FIRE SERVICES Third Review: [—]Approved as revised. E]Denied. F]Not applicable
Comments:
Reviewed by: Date:
Revised 05/1912017
Building Permit Application Updated 1019118
City of Atlantic Beach Building Department "ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 800 Seminole Road,Atlantic Beach FL 32233 Permit Number: MM19 – 00
Legal Description Jack Russell Park R es-r Rc�o RE# 170389-0000
Valuation of Work(Replacement Cost)$93,200.00 Heated/Cooled SF Non-Heated/Cooled 375
• ClassofWork: []New DAddition VAIteration ORepair DMove ODemo ElPool E]Window/Door
• Use of existi ng/pro posed structure(s): IZ[Commercial EIResidential
• If an existing structure, is a fire sprinkler system installed?: ElYes VNo
• Will tree(s) be removed in association with proposed promect? []Yes(must submit separate Tree Removal Permit) VNo
EDescribe in detail the type of work to be performed: cx_>6 co P L�
Ne
w plumbing layout and upgrade finishes in 2 existing gang restrooms
Florida Product Approval# for multiple products use product approval form
PropertV Owner Information
Name City of Atlantic Beach Address 1200 Sandpiper Lane
City Atlantic Beach State FL Zip 32233 Phone (904)247-5880
E-Mail pdrake@coab.us
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Lasa Construction, Inc. Qualifying Agent Ryan Hernandez
Address 6734 Greenland Industrial Blvd City Jacksonville State FIL Zip 32258
Office Phone (904)260-2381 Job Site Contact Number N/A
State Certification/Registration# CBC1 259648 E-Mail ryan.hemandez@lasa-usa.com
Architect Name&Phone# Applied Technology&Management Inc.(904)249-8009
Engineer's Name&Phone# Applied Technology&Management Inc.(904)249-8009
Workers Compensation insurer Builders Mutual Insurance Company OR Exempt o Expiration Date
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 the issuance of a permit and that all work will be performed to meet the standards of all the laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS,POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. 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.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
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 NOTI�C�� C IMMENCEMENT.
(Signature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this 6?_4ay of Signed ar4sworn to(or affirme before me this I ay of
o?017 b —F6c_ Ger-ri+ July 2019 Ava 'HernKdez
(Signature of Nota
KIMBERLY CAYE MCNEAL
MY COMMISSION#GG 127748
YVONNE C
ALVEU-y
EXPIRES:Noveatber 2Z 2021
My COMMISSION#FF 9
KIPersonally Known 76SM37 I Personally Known OR
Bwded Ttvu Notmy Pubic Wavftm
Produced Identifica ion EXPIRES:J*29,2om I Produced Identificatio ......
Type of Identification Illondod Thru W"pubk ftwMm
Undwwbm
�Dype of Identification:
NOTICE OF COMMENCEMENT
state of Florida Tax Folio No.
county of Duval
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713
of the Florida Statutes,the following information is stated in this N ICE OF COMMENCEMENT.
Legal Description of property being improved: Jack Russell Park RIC-ala'-T KCXD"vx ZZ-0 —
Address of property being improved: 800 Seminole Road, Atlantic Beach FL 32233
General description of improvements: Redo plumbing layout and upgrade finishes in 2 existing gang restroorns
Owner: City of Atlantic Beach Address: 1200 Sandpiper Lane, Atlantic Beach, FL 32233
Owner's interest in site of the improvement: —
Fee Simple Titleholder(if other than owner):
Name:
Contractor: Lasa Construction, Inc.
Address: 6734 Greenland Industrial Blvd Jacksonville, FL 32258
Telephone No.: (904) 260-2381 Fax No: (904) 260-0951
Surety(if any) Westfield Insurance Co.
Address: 3375-B Capital Circle NE, Tallahassee, FL 32308 Amount of Bond$ 93,200.00
Telephone No: (850) 205-7025 Fax No:
Name and address of any person making a loan for the construction of the improvements
Name:
Address:
Phone No: Fax No:
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may
be served: Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b), Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Signed:_%— AZ� Date: -7
Before me this
day of C in the County of Duval,State
Of Florida,has personally appeared 11—If Z�nrr-�N
Notary Public at Large,Stat
ir s�
F—. YVONNE CALVERLEY
My commission expires:
---WION 0 IFF
Personally Known: My 6DMM o r
Produced Identification: EWRES:J*29,z=
�e PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FLORIDA (*REQUIRED)
*Project Address: 800 Seminole Road, Atlantic Beach FL 32233 Permit#:
*Owner/Project Name: City of Atlantic Beach/ Jack Russell Restroom Remodel
As required by Florida Statute 553.842 and Florida Administrative Code Rule 913-72, please provide the information and product approval number(s)for
the building components listed below as applicable to the building construction project for the permit number listed above. You should contact your
product supplier if you do not know the product approval number for any of the applicable listed products. Information regarding statewide product
approval may be obtained at:www.floridabuilding.org.
r Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
A. EXTERIOR DOORS
1.Swinging Ceco Door ProdUCtS Flush Pairs of Commercial Steel Doors 16355.2
2. Sliding
3.Sectional
4. Garage Roll-Up
5.Automatic
6. Other
B.WINDOWS
1.Single hung
2. Horizontal slider PGT Industries Aluminum Horizontal Roller Window 242.9
3. Casement
4. Double hung
5. Fixed
6.Awning
7. Pass-through
8. Projected
9. Mullion
10. Wind breaker IV
11. Dual action
12. Other
Page 1 of 4 Updated 10/17118
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
C. PANEL WALL
1. Siding
2. Soffits
3. ElFS
4.Storefronts
S. Curtain walls
6. Wall louvers
7. Glass block
8. Membrane
9. Greenhouse
10. Synthetic stucco
11. Other
D. ROOFING PRODUCrS
1. Asphalt shingles
2. Underlayments
3. Roofing fasteners
4. Nonstructural metal
roof
5. Built-up roofing
6. Modified bitumen
7.Single ply roofing
8. Roofing tiles
9. Roofing insulation
10. Waterproofing
11. Wood shingles/shakes
12. Roofing slate
13. Liquid applied roofing
14. Cement-adhesive
coats
15. Roof tile adhesive
16. Spray applied
polyurethane roof
17. Other
Page 2 of 4 Updoted 10117118
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
E.SHUTTERS
1.Accordion
2. Bahama
3. Storm panels
4. Colonial
5. Roll-up
6. Equipment
7. Other
F.STRUCTURAL
COMPONENTS
1. Wood
connector/anchor
2.Truss plates
3. Engineered lumber
4. Railing
5. Cool ers-f reeze rs
6. Concrete admixtures
7. Material
8. Insulation forms
9. Plastics
10. Deck-roof
11.Wall
12. Sheds
13. Other
G. SKYLIGHTS
1.Skylight
2. Other
H. NEW EXTERIOR
ENVELOPE PRODUCTS
1.
2.
Page 3 of 4 Updated 10117118
In addition to completing the above list of manufacturers, product description and State approval number for the products used on this project, the
Contractor shall maintain on the job site and available to the Inspector, a legible copy of each manufacturer's printed specifications and installation
instructions along with this Product Approval Sheet.
I certify that this product approval list is true and correct to the best of my knowledge. I further certify that use of different components other than the
ones listed in this document must be approved by the Building Official.
,. Ryan Hernandez
*Contractor Name (Print Name,. - *Contractor Signature-
*Company Name: Lasa Construction, Inc.
*Mailing Address: 6734 Greenland Industrial Blvd.
*City: Jacksonville *State: FIL *Zip Code: 32258
*Telephone Number: (904) 260-2381 *E-mail Address: ryan.hernandez@lasa-usa.com
Cell Phone Number: (904) 382-9538 Fax Number: (904) 260-0951
Page 4 of 4 Updated lOI17118
PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FLORIDA (*REQUIRED)
. 800 Seminole Road, Atlantic Beach FIL 32233
*Project Address. Permit#:
*Owner/Project Name: City of Atlantic Beach/ Jack Russell Restroom Remodel
As required by Florida Statute 553.842 and Florida Administrative Code Rule 913-72, please provide the information and product approval number(s)for
the building components listed below as applicable to the building construction project for the permit number listed above. You should contact your
product supplier if you do not know the product approval number for any of the applicable listed products. Information regarding statewide product
approval may be obtained at:www.floridabuilding.org.
— Category/Subcategory Manufacturer Product-Description Limitation of Use State# Local#
A. EXTERIOR DOORS
1.Swinging Ceco Door Products Flush Pairs of Commercial Steel Doors 16355.2
2.Sliding
3.Sectional
4. Garage Roll-Up
5.Automatic
6. Other
B.WINDOWS lie
1.Single hung
2. Horizontal slider PGT Industries Aluminum Horizontal Roller Window 242.9
3. Casement
4. Double hung
5. Fixed
6.Awning
7. Pass-through
8. Projected
9. Mullion
10.Wind breaker
11. Dual action
12. Other
Page 1 of 4 Updated 10/17118
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
C. PANEL WALL
1.Siding
2.Soffits
3. EIFS
4.Storefronts
5. Curtain walls
6.Wall louvers
7. Glass block
8. Membrane
9. Greenhouse
10. Synthetic stucco
11. Other
D. ROOFING PRODUCIS
1.Asphalt shingles
2. Underlayments
3. Roofing fasteners
4. Nonstructural metal
roof
5. Built-up roofing
6. Modified bitumen
7.Single ply roofing
8. Roofing tiles
9. Roofing insulation
10.Waterproofing
11.Wood shingles/shakes
12. Roofing slate
13. Liquid applied roofing
14. Cement-adhesive
coats
15. Roof tile adhesive
16. Spray applied
polyurethane roof
17. Other
Page 2 of 4 Updated 10/17118
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
E. SHUTTERS
1.Accordion
2. Bahama
3.Storm panels
4. Colonial
5. Roll-up
6. Equipment
7. Other
F.STRUCTURAL
COMPONENTS
1.Wood
connector/anchor
2.Truss plates
3. Engineered lumber
4. Railing
5. Coolers-freezers
6. Concrete admixtures A,
7. Material v
8. Insulation forms C)
9. Plastics 0
10. Deck-roof Fw
11.Wall
12. Sheds
13. Other
G.SKYLIGHTS
1. Skylight
2. Other
H. NEW EXTERIOR
ENVELOPE PRODUCTS
1.
2.
Page 3 of 4 Updated 10/17118
In addition to completing the above list of manufacturers, product description and State approval number for the products used on this project, the
Contractor shall maintain on the job site and available to the Inspector, a legible copy of each manufacturer's printed specifications and installation
instructions along with this Product Approval Sheet.
I certify that this product approval list is true and correct to the best of my knowledge. I further certify that use of different components other than the
ones listed in this document must be approved by the Building Official.
Ryan Hernandez
*Contractor Name (Print Name): *Contractor Signature:
*Company Name: Lasa Construction, Inc.
*Mailing Address: 6734 Greenland Industrial Blvd.
*City: Jacksonville *State: FL *ZiP90,60�2258
*Telephone Number: (904) 260-2381 *E-mail Address: ryan.hernandez@lasa-usa.com
Cell Phone Number: (904) 382-9538 Fax Number: (904) 260-0951
Page 4 of 4 Updated 10/17118