475 Palmwood Ln DEMO19-0022 garage & walkway demo permit DEMO PERMIT PERMIT NUMBER
DEM019-0022
CITY OF ATLANTIC BEACH ISSUED: 7/22/2019
800 SEMINOLE ROAD
EXPIRES: 1/18/2020
ATLANTIC BEACH. I'L 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:
475 PALMWOOD LN DEMO COMPLETE DEMO - GARAGE AND $0.00
WALKWAY
TYPE OF REALESTATE BUILDING USE
ZONING: SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1720200194 SELVA MARINA UNIT 06
COMPANY: ADDRESS: CITY: STATE: ZIP:
REALCO RECYCLING 8707 SOMERS RD JACKSONVILLE FL 32226
OWNER: ADDRESS: STATE: ZIP:
JOHN DODSON 475 PALMWOOD LN ATLANTIC BEACH FL 32233-5607
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.
INFORMATIONAL
PUBLIC WORKS EROSION CONTROL INSTALLATION
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.
2 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
issued Date: 7/22/2019 1 of 2
DEMO PERMIT PERMIT NUMBER
DEM019-0022
CITY OF ATLANTIC BEACH ISSUED: 7/22/2019
800 SEMINOLE ROAD EXPIRES: 1/18/2020
ATLANTIC BEACH, FL 32233
3 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,JDog/Dennis Junk Removal,All American Roll Off,WCA Waste Corporation). Container cannot be placed on City right-of-way.
4 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration,including sod,is required.
5 PUBLIC WORKS DOCUMENT IMPERVIOUS AREA INFORMATIONAL
Notes:
Strongly suggest thorough documentation of impervious areas be recorded.
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
00
TOTAL:$129.00
)10
Issued Date: 7/22/2019 2 of 2
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445 0 00?-L
Phone(904)247-5826 - Fax(904)247-5845
r E-mail: building-dept@coab.us L Dale routed: L
City web-site: hftp://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 7E) P(:4LmL4)o(.)3 Lf-) Department review required Yes No
(-Buildina--)
Applicant: tAk Q L.L'6GrQ'—S- Planning &Zoning
Tree Administrator
Project:
�®rks
C':±�a�ic Uti gfW&->
t Public Safety
Fire Services
Review fee Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
Florida Dept. of Environmental Protection of Permit Verified By
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. ElDenied. E]Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date:
4
TREE ADMIN. Second Review: FlApproved as revised. DDen ieW F]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: E]Approved as revised. [:]Denied. FINot applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
I%.
-11—APi City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road 7 27—
V Atlantic Beach, Florida 32233-5 JUN 2 n 2019
Phone(904)247-5826 - Fax(9 47-5845
E-mail: building-dept@coab.us L ate routed: L
City web-site: http://vmw.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: � I S P F'�Lmw000 De Rrtment review required Yes No
v Buildin
Applicant: �Ak LU f?& U L Planning &Zoning
Tree Administrator
Project: 1c;
I�Utolliltls
t C�C� Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
Florida Dept. of Environmental Protection of Permit Verified By
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: [ifApproved. L:]Denied. [:]Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Date: Y
Reviewed by,,���
TREE ADMIN. Second Review: [-]Approved as revised. ODenied. F]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: E]Approved as revised. []Denied. FINot applicable
Comments:
Reviewed by: Date:
Revised 05/1912017
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
V Atlantic Beach, Florida 32233-5445 0c)?-L
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: �7 L iL
City web-site: hftp-://www.coab.us I
APPLICATION REVIEW AND TRACKING FORM
Property Address: PFALPAL-0003 Depatment review required Yes No
Building.-?
Applicant: _Pt-kkL'Q[?s' 6c) Planning &Zoning
Tree Administrator
Project: C
�,40iirtls
t C)&� Public Safety
Fire Services
Review fee Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
Florida Dept.of Environmental Protection of Permit Verified By
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. ElDenied. VNot applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed bv: Date:
TREE ADMIN. Second Review: FlApproved as revised. ODenied. E]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: [-]Approved as revised. E]Denied. E]Not applicable
Comments:
Reviewed by: Date:
Revised 0511912017
Building Permit Application Updated 1019118
5 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: H 15 L_e- - A�eJc Permit Number: -00 Z_Z�
Legal Description 5 1 og -.�t)- 0q I 15ekVC-_ (ACfA"L)AJ
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Valuation of Work(Replacement Cost)$ Heated/Cooled SF Non-Heated/Cooled q00
• ClassofWork: EINew ElAddition ElAlteration DRepair ElMove Vemo DPool L-JWindow/Door
• Use of existing/proposed structure(s): ElCommercial F�esi'dential
• If an existing structure,is a fire sprinkler system installed?: E]Yes RI'No oq?cmsek+ree
• Will tree(s) be removed in association with proposed project? F�ffes(must submit separate Tr2e Removal Permit) E]No
Describe in detail the type of work to be performed: So" A -�,ol 4-.-,p 4ar�
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Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name —50V\^IDL-A5no, Address S4
city State zip 3a�bb Phone 90L1—L(77A- 0(1
E-Mail 3bklel 00.6r, >_,QC
, r-�;�-
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of CompanyNIUA L(&MJt1&L_!� Qualifying Agent
Address %R -I-n(_FjL�4N,2.-,N�Jk city J!�, j?�, . State zip
Office Pho�ne'%A. 7�A�!q _'2-1 Job Site Contact Number
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State Certificati�n/14egistr ' ion# CALI 2-S—Li i 4 E-Mail PQ I"VYOS k efs;o Cam CAS 14 E-T
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt Expiration Date 1?-7-1(
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or instal on has rl�
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws re kiting
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SENS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE: In addition to the requiremeEfs=I*Z
CIZ
permit,there may be additional restrictions applicable to this property that may be found in the public records of this cou?&,%
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there may be additional permits required from other governmental entities such as water management districts,state agEMiqw Q 2i W
federal agencies. 0 M Z
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OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance wth
applicable laws regulating construction and zoning. 0 6_0 Cr Z
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WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT M �- Ch �-
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU IN&vj�. ZW
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TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AIETORNEY BEFORE 0 W W >-
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Type of Identification: Type of Identification:
EXPIRES.Ockaber 6,2
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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: 415 ;;R�mp 1,J Permit Number:
Legal Description RE4
Valuation of Work(Replacement Cost)$ 17 000 Heated/Cooled SF Non-Heated/Cooled
• ClassofWork: EINew [-JAddition LJAIteration EIRepair E]MoveKDemo LJPool []Window/Door
• Use of existing/proposed structure(s): ElCommercial &Residential
• If an existing structure,is a fire sprinkler system installed?: ElYes XNO
• Will tree(s) be removed in association with proposed proiect? E]Yes(must submit separate Tree Removal Permit) )<�o
Describe in detail the type of work to be performed:
61J044-6.)vl_
Florida Product Approval 4 for multiple products use product approval form
Property Owner Information
Name Address
City State Zip Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name off Compa 190k2�(,0J4 6D Qualifyin��A�gent
puany,F*43v�o
Aciclress46-1160- 50A 112--4-1,> city e_� —State--?-'7— Zip
Office Phone '775 77_�7�3�I Job Site Contact Number :7
State Certification/Registration E-M a i 1=4!���1, J4, 94AA,6%1_LtX (,-0�J
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt Ei 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 AN ATTORN BEFORE
IT
RECORDING YOUR NOTICE OF COMMENCEMENT
gnature of Contractor)
(Signature of Owner or Agent) 4��(Si ,
Signed and sworn to(or affirmed)before me this_day of Signed and sworn to(or affirmed)before me this!?a day of
by by
(Signature of Notary) '-�Sign�—ture of Notary
JENNIFER JOHNSTON
]Personally Known OR Uer�sonally Known OR My COMMISSION GG 042984
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AS RECORDED IN PLAT BOOK 34, PAGE(S) 51, 51A & 518 OF THE CURRENT
PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO:
RICHARD EDWARD NELLIS AND LAMARA JOY NELLIS JOINT REVOCABLE
LIVING TRUST,
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INSURANCE COMPANY.
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JACKSONVILLE, FLORIDA 32210 7.UNLESS OTHEIRWASE STATED ALL kAOM PPES FOUND HAVE NO WENTIFICArOM.
904-7"71-6468 L--AC AIR CONDITIOWIR
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