369 10th St DEMO19-0029 complete demo permit 1',! ''\% DEMO PERMIT PERMIT NUMBER
y . s, DEM019-0029
CITY OF ATLANTIC BEACH
_ " 800 SEMINOLE ROAD ISSUED: 11/15/2019
19r ATLANTIC BEACH. FL 32233 EXPIRES: 5/13/2020
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:
369 10TH ST DEMO COMPLETE DEMO HOUSE $10000.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170086 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
MCANENY BUILDERS LLC 650 Park St JACKSONVILLE FL 32204
OWNER: ADDRESS: CITY: STATE: ZIP:
AYERS JOSEPH A & AMY L 369 10TH ST ATLANTIC BEACH FL 32233-5529
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.
1 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.
2 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
Issued Date: 11/15/2019 1 of 2
�,, DEMO PERMIT PERMIT NUMBER
11)411CITY OF ATLANTIC BEACH DEMO19-0029
ISSUED: 11/15/2019
r 800 SEMINOLE ROAD EXPIRES: 5/13/2020
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 RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site. Cannot raise lot elevation.
6 PUBLIC WORKS SLAB DRIVEWAY REMOVAL INFORMATIONAL
Notes:
Slab and driveway to be fully removed.
7 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Contractor.
8 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.
9 PUBLIC UTILITIES DISCONNECT AND CAP INFORMATIONAL
Notes:
Disconnect and cap water and sewer lines.
10 PUBLIC CHILI I IF> INSPECTION PRIOR TO DEMOLITION INFORMATIONAL
Notes:
MUST CALL the Inspection Line at 247-5814 to request an inspection of the disconnected and capped water and sewer lines prior to demolition.
FEES ., x- .-_. �a
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: 11/15/2019 2 of 2
i!..A8-4; City of Atlantic Beach APPLICATION NUMBER
`j r ? Building Department (To be assigned by the Building Department.)
800 Seminole Road• �M c) I ( -00 2
Atlantic Beach, Florida 32233-5445 1 ' ` t `l v 7
Phone(904)247-5826 • Fax(904)247-5845
—WI 9 E-mail: building-dept@coab.us Date routed: I /7 I
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 3( c 1 ( _Clenart�nt review required Yes o
Building
Applicant: C V l C R 1\36,(03�' (?)U (Lb 6____/2„,g Planning &Zoning
f 11 Tree Administrator
t1r� [
Project: IYAOOS
Publicwe
Public Utilitie�_��
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: [ 1 Approved. Denied. ['Not applicable
(Circle one.) Comments:
BUILDING �p
PLANNING &ZONING Reviewed by: /lir Date: //—7 1,/
TREE ADMIN. Second Review: ['Approved as revised. ❑Denied. ❑Not applicable
,EUBLIC WORKS- Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. I IDenied. Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
rS'`Lyri„ City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road EM o (9 —00
/ 0 GC)
Atlantic Beach, Florida 32233-5445 NOV 0 7 2019 1 t \ 11 7
Phone(904)247-5826 • Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: I
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 3(aG � V ( ment review required Yes No
Building )
Applicant: f V \c IV e t U (Lb G/2$ Planning&Zoning
Tree Administrator
Project: 1Th
�/Yl L4-0OSS �blie_1r^d�- 1,
�_ ublc 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: Approved. I 'Denied. fNot applicable
(Circle one.) Comments:
(UILDING��
PLANNING &ZONING �
Reviewed by: / i/� late:
TREE ADMIN. Second Review: Approved as revised. ❑Denied. ['Not applicable
c UBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. I (Denied. Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
PUBLIC WORKS PLAN REVIEW COMMENTS
Date: 7y' 9 Application#: 7)04e)/9—,0
Project Address: -369 /0
CONDITIONS OF APPROVAL TO PRINT ON PERMIT Check Box
to Select
All concrete driveway aprons must be 5"thick,4000 psi,with fibermesh from edge of pavement
Driveway to the property line. Reinforcing rods or mesh are not allowed in the right-of-way. 0
Apron (Commercial driveways—6"thick).
Full erosion control measures must be installed and approved prior to beginning any earth
Erosion disturbing activities. Contact the Inspection Line (247-5814)to request an Erosion and Sediment
Control
Control Inspection prior to start of construction.
Onsite All runoff must remain on-site during construction.
Runoff
Post Const. If on-site storage is required, a post construction topographic survey documenting proper
TOPO construction will be required. All water runoff must go to retention area and retention overflow 0
Survey must run to street.
Pool Pool—Wellpoint(if used) must discharge into vegetated area 10' minimum from street or drainage ❑
Wellpoint feature (swale, structure or lagoon).
Roll off container company must be on City approved list(Advanced Disposal, Realco Recycling,
Roll off Shapells, Inc., Republic Services, Donovan Dumpsters, Phillips Containers,JDog/Dennis Junk
Container Removal,All American Roll Off,WCA Waste Corporation). Container cannot be placed on City ROW.
ROW
Restoration Full right-of-way restoration, including sod, is required. �{
Utility Any utility cuts in the road must be repaired using COJ Standard Detail Case X and must be overlaid ❑
Road Cut 10' in each direction from the center of the cut. Repair must be shown on the plans.
Construction Provide construction site management plan, including location of silt fence, dumpster, portable ❑
Site Mgmt. toilet. Right-of-Way Permit is required if using right-of-way for construction parking.
Runoff All runoff must remain on-site. Cannot raise lot elevation.
Document Strongly suggest thorough documentation of impervious areas be recorded. 0
Impervious
Slab Slab and driveway to be fully removed.
Driveway
Maximum Maximum driveway width within the City right-of-way is 20'. 0
Driveway
Circular Maximum circular driveway width within the City right-of-way is 12'. 0
Driveway
Grass Full site to be grassed. 0
TOPO Must provide a topographic (TOPO) survey with water retention for final CO Inspection. 0
Survey
Revision Any plan change must be submitted as a Revision to the Building Department. 0
Fencing All old fencing and debris must be removed from job site by Contractor. 0
Removed
Decking All old decking and debris must be removed from job site by Contractor. 0
Removed
Infra- Any damage done to infrastructure must be repaired by Contractor.
structure
Revised 2/26/19
rS�Ady f, City of Atlantic Beach APPLICATION NUMBER
gBuilding Department (To be assigned by the Building Department.)
800 Seminole Road j 1 Ernq o l -0(D
/
- �-/Atlantic Beach, Florida 32233-5445 V
Phone(904)247-5826 Fax(904)247-5845 –7
J:3 yY v E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 3( 1 0 — ( Department review required Yes No
Building
Applicant: VY\C A Iv E40 1 (?)u (Lb G—p t Planning &Zoning
Tree Administrator
Project: Mt F-ry X3 I, 0,s • 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:
APPLIC ON STATUS
Reviewing Department First Review: Approved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
(BUILDING
PLANNING &ZONING
Reviewed by: ate: ��- a-I cf
TREE ADMIN. Second Review: ['Approved as revised. ['Denied. ['Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: _Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
11 PUBLIC UTILITIES PLAN REVIEW COMMENTS C,
Date: 1 t31 1 9 Application It: J (yi,o/'7 - O 0 Z I
Project Address: 5to 1
Check Box Check
APPLICATION TRACKING COMMENTS to Add Box to
Commen Print
Underground Avoid damage to underground water and sewer utilities. Verify vertical and
Water Sewer horizontal location of utilities. Hand dig if necessary. If field coordination is
Utilities needed, call 247-5878. _
Meter Boxes
Sewer Ensure all meter boxes, sewer cleanouts and valve covers are set to grade 0 0
Cleanout and visible.
A sewer cleanout must be installed at the property line. Cleanout must be
RT1 Sewer covered with an RT1 concrete box with metal lid. Cleanout to be set to grade ❑ ❑
Cleanout and visible.
A reduced pressure zone backflow preventer must be installed if irrigation will
RPZ be provided or if there is a private well on the property. Backflow preventer ❑ ❑
Backflow must be tested by a certified tester and a copy of the results sent to Public
Utilities.
Plans note the building will be unsprinkled. If plans change, any fire line
Sensus installed must be metered with a Sensus touch-read meter in a properly sized
Touch-Read vault and an appropriate backflow preventer installed. Backflow preventer 0 ❑
Meter must be tested by a certified tester and a copy of the results sent to Public
Utilities.
Fire BackflowSprinkler If fire sprinkler system is provided, call 247-5878 for backflow requirements. 0 0
Requirement At a minimum, will require a double check backflow preventer.
Fire Line Fire lines must be metered with a Sensus touch-read meter. Meters larger
Meter than 2" must be installed in a vault as noted in JEA specifications.
Utility Map See attached Utility Map. 0 / ❑
Disconnect 1
& Cap Disconnect and cap water and sewer lines. LSI
Inspection MUST call the Inspection Line at 247-5814 to request an inspection of the
Prior disconnected and capped water and sewer lines PRIOR to demolition.
❑ 0
❑ ❑
❑ ❑
O ❑
Building Permit Application Updated 10/9/18
�: 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: 2G 1072' STt« ATS{,mac Zkisclit FL �ZZn Permit Number: ['E C'�1(-) 00 Zc
Legal Description ...S.---CA l(.,'Z S —? i E ATC.AUTIC, l3Eectk Lot-3 . wC lZ RE# ()COR'(,,, —D(':C6
Valuation of Work(Replacement Cost)$ /C9 000 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ElAddition ❑Alteration ❑Repair ❑Move XDemo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial Xatesidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes %No
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) , No
Describe in detail the type of work to be performed:
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name SO-ZN A- + t•vv1'{ L. AVC-- Address 165 10" Stk.E.i
City AI-LA .rr lc !JC f' c_.4 State rt____ Zip 3ZZ 3-1 Phone 9O-i
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) //,, \
Contractor Information l k.. "1 `� 7 - 7 7 9 2
Name of Company IA-%GAN..Kk_ ( (LL,C75, I-LC Qualifying Agent LFc')ATCt 1..1. v.-%(A&)W`t
Address C. SC) PAW t! SrCt.CFT City S"6,0 UtLL.E State FL Zip 1Z.1.6(f
Office Phone 904 3) 4 Ds((. Job Site Contact Number R0L1 • Z19 . 3O0 )
State Certification/Registration# CGC lSOd 71) E-Mail L_W c- •-.,CANEAJi "Sulk_ E•__ .S • CO
Architect Name& Phone# ICES L�Ccrc-CTr 1(&J1\) SOU'-.o&) - 5 Dci • 3S'')- Cad I g
Engineer's Name& Phone#
Workers Compensation Insurer OR Exempt ❑ 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 NOTICE OF COMMENCEMENT.
2
.Gz-----'
(Signatytif Owner or Agent) (Signature of tractor)
Signed and sworn to(or affirmed) before me this LI day of Signed and sworn to(or affirrped)before me this Ll day of
VL; v , �L'I , by I'�Yvty +'a lbY, 1lq , byUcamsr b• MC YWV\y
(Signature of Notary) (Signa ure of Notary)
""gots. Notary Public State c'Florida " Notary Public Strata of Florida
[ Personally Known OR . Mildred Reyes Moreno [ ersonally Known OR ;P ' Mildred Reyes Moreno
c My Commission GG 383495 ciif My Commission GG 383495
[ J Produced Identificatiai Expires 08107,2023 [ )Produced Identification Expires 08/072023
Type of Identification: -. - Type of Identification: ' °,,
11f TREE & VEGETATION AFFIDAVIT FOR INTERNAL OFFICE USE ONLY
I\ City of Atlantic Beach PERMIT#
c) Community Development Department
\ ,/ 800 Seminole Road Atlantic Beach, FL 32233
-1_:.olti>,' (P) 904-247-5800 OFFICE COPY
SITE INFORMATION
ADDRESS ` ' I l O ^�-
V L(^N,Qc'\L SCS RC.I^A !-L 3 Z-M-D
SUBDIVISION BLOCK LOT
RE# ❑ RESIDENTIAL ❑ COMMERCIAL ❑ OTHER
APPLICANT INFORMATION (� lc,
NAME �(v1tC-r-k c i (SiCLL)� - M C(�Nk5 \(-edit PHONE# 9o`{ i-i--I -7--)6) Z,
ADDRESS CoSO .QF(-1(l .`SlV CELL# 909 L-11 1 ? cl Z
CITY k_v (.),,v\u_6-
Jiv /\(,(.-(S T--L 3zZO L( STATE C L ZIP CODE �ZOCi
EMAIL 6 VO a ,AN c /Sv\ S • a✓`1 ❑ OWNER LEGAL 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 HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IS CORRECT:Signature of Property Owner(s)or Authorized Agent
-2/ AILCWIE L Caw y \\' 1 ' ICI
SIGNATURE OF APPLICANT PRINT OR TYPE NAME DATE
SIGNATURE OF APPLICANT(2) PRINT OR TYPE NAME DATE /
Signed and sworn before me on this day of A',1)d ��'/ C --)I 9 by State of
County of f l..�I,/
ra___(
Identification verified: " - 4 0 - r -- r.
Oath Sworn: ❑ Yes F No
TONI GINDLESPERGER No Signature
MY COMMISSION#GG 353178
.,41 EXPIRES:October 6,2°23 My Commission expires
?o;lo: Bonded'Nu Notary PtlAC Under miters
04 TREE AND VEGETATION AFFIDAVI r
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