967 ATLANTIC BLVD - TENT20-0001 C' '%+ TENT PERMIT PERMIT NUMBER
,, CITY OF ATLANTIC BEACH TENT20-0001
r r, 800 SEMINOLE ROAD ISSUED: 2/26/2020
,itl,r ATLANTIC BEACH, FL 32233 EXPIRES: 8/24/2020
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: j PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
967 ATLANTIC BLVD TENT TENT- CULHANES IRISH PUB $0.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
177602 0040 SECTION LAND
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ; ADDRESS: CITY: STATE: ZIP:
EQUITY ONE ATLANTIC NORTH MIAMI
1600 NE MIAMI GARDENS DR FL 33179
VILLAGE INC BEACH
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.
j
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $55.00
STATE DBPR SURCHARGE 455-0000-208-07000 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$59.00
Issued Date: 2/26/2020 1 of 1
C:'''
-' ', Building Permit ApplicationUpdated l0/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Is 9>) IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: `t 6 -1 .1...Aa r• C- ��•.( I� Permit Number: ` e___� T Z0 0001
Legal Description RE#
Valuation of Work(Replacement Cost)$ t /At Heated/Cooled SF Non-Heated/Cooled f 00 S r'
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move :Memo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ❑Residential
• 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:�- r
1 iG.rAV C t7 —k—e-- 1 E•A'T'
Florida Product Approval# /4.N. for multiple products use product approval form
Property Owner Information
Name (���..1c F-
-5 •S1� \p
v� Address `( 6� �-r -.A..
tbc-r-t C...>
City State '�. Zip '5 Z 23 ) Phone 2 4 1 " ct S`j 5'
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company N/4\ Qualifying Agent
Address City State Zip
Office Phone Job Site Contact Number
State Certification/Registration# E-Mail
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt n 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
RECORD! G YsUR NOTICE OF C/ M/ NCEMENT.
-'
(Signature of Owner or Agent) / (Signature of Contractor)
ivied77
and sworn to(or ffir e916.- 1) .efore met is� day of Signeed amend sworn to(or affirmed)before me this day of
C? , zoZ v by '` �� .a i' i . if 41•V , , by
/�i «R
-11141':nat .f Ny (Signature of Notary)
]Personally Known ORr-,------------
aptr.1 ; TONI GINDLESPERGER [ ]Personally Known OR
‘•, :+: MY COMMISSION#GG 353178 [ ]Produced Identification
[ ]Produced Identificati. .;
Type of Identification: I= ; ��'4 EXPIRES:October 6,2023 Type of Identification:
•F.!. ed Thu u No)) >Nic Underwriters
INSTRUCTIONS FOR COMPLETING
DBPR ABT—6029
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
APPLICATION FOR EXTENSION OR AMENDED SKETCH OF LICENSED PREMISES
If you have any questions or need assistance in completing this application, please contact the Division of
Alcoholic Beverages& Tobacco's(AB&T) local district office. Please submit your completed application
and required fee(s) to your local district office. This application may be submitted by mail, through
appointment, or it can be dropped off. A District Office Address and Contact Information Sheet can be
found on AB&T's web site at the link provided below:
http://www.myflorida.com/dbpr/abt/district offices/licensinq.html
GENERAL REQUIREMENTS
This application must be submitted for approval when changes are made to the licensed premises
whether the extension is permanent or temporary.
Please complete all information. Incomplete applications will be returned. All questions are applicable
and must be answered fully and truthfully.
You must provide an original application and a copy of all supporting documentation. All signatures must
be original.
APPLICATION REQUIREMENTS
Applicants for Temporary Extension of Premises Permits must submit the application at least
seven (7)days prior to the first date of the event to insure the permit is issued by the event date.
Zoning Approval—Applies to Permanent or Temporary Extension of Premises Only
Zoning approval is executed by the city or county zoning authority in which the business to be licensed is
located. This application is to be taken to the Zoning Department(City or County)that governs the
location of your business.
Health Approval—Applies to Permanent Extension of Premises Only
Health approval is required on all applications for consumption on the premises. Businesses that serve
food or are located on premises licensed by the Division of Hotels and Restaurants, must obtain approval
from that division. Businesses that do not serve food must contact the County Health Authority or the
Department of Health. Food service establishments located in grocery and convenience stores, bakeries
or delicatessens must contact the Department of Agriculture and Consumer Services.
Note: Health Approval is not required for a temporary extension of the licensed premises or amended
sketch of the licensed premises.
Affidavit of Applicant
Read and sign in the presence of a notary. The affidavit must be signed by the individual applicant, each
partner of a general partnership, a general partner of a general partnership of a limited partnership, a
managing member, manager,or officer of a limited liability company, each partner of a limited liability
partnership, or one of the officers of a corporate applicant.
Sketch of Premises
A complete sketch of the premises, drawn in ink or computer generated (letter size)which includes all
permanent walls, doors, windows, counters, labeling each room and area. Include any outside areas
where alcoholic beverages will be sold, consumed, or served. Due to the difficulty of scanning, no
blueprints are accepted.
Auth.61A-5.0017 1
Amended Sketch of Premises
A complete sketch of the premises, drawn in ink or computer generated (letter size)which includes all
permanent walls. doors, windows, counters, labeling each room and area. Changes may be made to
the interior of the existing premises only; no additional rooms may be added.
Note: Zoning Approval is not required for an amended sketch of premises.
APPLICATION CHECKLIST
Select the appropriate transaction below and comply with the corresponding application requirements.
TRANSACTION APPLICATION REQUIREMENTS
U Complete DBPR ABT-6029 Division of Alcoholic Beverages and
Extension of Licensed Tobacco Application for Extension or Amended Sketch of Licensed
Premises Premises
Pay$100 fee for each temporary extension of licensed premises
requested (make check payable to the Division of Alcoholic
Beverages and Tobacco)
U Complete DBPR ABT-6029 Division of Alcoholic Beverages and
Amended Sketch Tobacco Application for Extension or Amended Sketch of Licensed
Premises
Auth.61A-5.0017 2
DBPR ABT-6029-Division of Alcoholic Beverages and Tobacco
Application for Extension or Amended Sketch of Licensed Premises
STATE OF FLORIDA DBPR Form
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ABT-6029
Revised 02/2013
If you have any questions or need assistance in completing this application, please contact the Division of
Alcoholic Beverages& Tobacco's(AB&T) local district office. Please submit your completed application
and required fee(s) to your local district office. This application may be submitted by mail, through
appointment, or it can be dropped off. A District Office Address and Contact Information Sheet can be
found on AB&T's web site at the link provided below:
http://www.mvflorida.com/dbpr/abt/district offices/Iicensing.html
SECTION 1 -CHECK TRANSACTION REQUESTED
Tr nsaction Type:
Temporary Extension ❑ Amended Sketch
Permanent Extension
4
SECTION 2 -LICENSE INFORMATION
Licensee (as listed on alcoholic bevera license)� � ' B
C,l 1 124.T t[ 7��
Business Name (D/B/A)
Cc0 s 2..i s l4- ataLt r -
Location Address (Street) `
-O 1 1.-14v.l1 c g L._J60
City County State Zip Code
L_A---h c CFL ��v' FL 3 Z Z 33
Alcoholic Bevera icense Number Series Type/Class
Business TelephoneGNumber Email Address(Optional) /�
-1 ext. 2`f at et s-9, is at_G--0,--[r �
cr c �
,--
FOR TEMPORARY EX ENSIONS ONLY: ' Co-o`~
Date(s)of Extension:
t/(aL{ 4 /'t 1k #(44 -r.IL !r- 2020 .
1
ABT District Office Received/ Date Stamp
Auth.61A-5.0017 1
SECTION 3- ZONING APPROVAL
TO BE COMPLETED BY THE ZONING AUTHORITY GOVERNING YOUR BUSINESS LOCATION
(This section only applies to a ermanent or temporary extension of licensed premises)
Location Street Address / A-ri_ L LA/2o
County Zip Code
../\ r� FL "?2- 1- 33
Are there outside areas which are contiguous to the premises which are to be part of the premises sought
to be licensed?" V1[es ❑ No
❑ The PERMANENT extension of the licensed premises as shown in the sketch complies with zoning
requirements for the sale of alcoholic beverages pursuant to this application.
be TEMPORARY extension of the licensed premises as shown in the sketch complies with zoning
requirements for the sale of alcoholic beverages pursuant to this application.
4 COI/Wile)
Signed(hinaiii, Title:7ILv!u Date: vC 'ppZ0
This approval is valid until lkal `� 1(6 .2-UG(/ O
SECTION 4- HEALTH
TO BE COMPLETED BY THE DIVISION OF HOTELS AND RESTAURANTS
OR COUNTY HEALTH AUTHORITY
OR DEPARTMENT OF HEALTH
OR DEPARTMENT OF AGRICULTURE &CONSUMER SERVICES
The above establishment complies with the requirements of the Florida Sanitary Code.
Signed Date
II
Title
Agency
This approval is valid until
Auth.61A-5.0017 2
SECTION 5-AFFIDAVIT OF APPLICANT
NOTARIZATION REQUIRED
Business Name (D/B/A) �-
V"t �.(`J /Inc% -S J,i2 l,1 et' C3L c p,.tJ
"I,the undersigned individually, or if a registered legal entity for itself, its officers and directors, hereby swear
or affirm that I am duly authorized to make the above and foregoing application and, as such, I hereby swear
or affirm that the attached sketch is a true and correct representation of the extended licensed premises and
agree that the place of business may be inspected and searched during business hours or at any time
business is being conducted on the premises without a search warrant by officers of the Division of Alcoholic
Beverages and Tobacco, the sheriff, his deputies, and police officers for the purposes of determining
compliance with the beverage and cigarette laws."
I swear under oath or affirmation under penalty of perjury as provided for in Sections 559.791, 562.45 and
837.06, Florida Statutes that the foregoing information is true and correct."
If applying for a temporary extension, check the box to confirm the following statement:
❑ "I understand that the premises must be restored to its original form at the conclusion of the
authorized temporary event."
STATE OF
COUNTY OF
MI/ /6-4/0-452 -
APPLICANT SIGNATURE
APPLICANT SIGNATURE
The foregoing was ( )Sworn to and Subscribed OR ( )Acknowledged Before me this jTh Day
Q/�C/ By I 1 l who is ( )personally
of 2 (� ��'� `��ii,�� ersonall
1 u�
(print name(s)of person(s) making statement)
known to me OR ( )who produced 1" (_ as identification.
r I 111611141Aa (..„( _93
1111111FfrAiNv4. Comui '.
Notary "I•lic ' T
,P. •.. CINDY I MCINTIRE
,�, ;*;Commission#GG 279801
Expires February 14,2 8110 1Aun14
Auth.61A-5.0017 3
•
SECTION 6— DESCRIPTION OF PREMISES TO BE LICENSED
Business Name (D/B/A)
1. Yes ❑ No Is the proposed premises movable or able to be moved?
2. Yes ❑ No Is there any access through the premises to any area over which you do not
have dominion and control?
3. Yes ElNo —Y Are there more than 3 separate rooms or enclosures with permanent bars or
counters?
Is the business located within a Specialty Center? If yes, check the applicable statute:
4. Yes ❑ No ❑ 561.20(2)(b)1, F.S. or❑ 561.20(2)(b)2, F.S.
Neatly draw a floor plan of t e premises in ink,including sidewalks and other outside areas which are contiguous to the
premises,walls,doors, counters,sales areas,storage areas, restrooms, bar locations and any other specific areas which
are part of the premises sought to be licensed. A multi-story building where the entire building is to be licensed must show
the details of each floor.
(1/0 C(0°/. 6Uvtl- dO .
P61166,(0._64 A-e )
►�, ' (o f°
Auth.61A-5.0017 4
'."-•-,'
1..... *
...
.... .4 .,..•
1 . •
•
.. _ t...
, _ • .
. ....._...
,
,.. 1... , ..
. .x•R • . . . ., ,...,. _ . . .
. ...„...z..,,:,y,...,„..., . ,
, ,.
__ill_
, • i .... .. .
! ...i, ..
. ....
.
. .
,4-04,.. ..
_ . .,..,14`0,,,,..!.4.1.: ..sr- . i.1. A:'.', - •-•r
. itl.
,%Air.' ,
. ,
i,-... ,-,ik7,%.",-: ',1,1....1:,,,•,„„5,„. ..,r, r.tie?}, '14.,::::1„-,;' , • . •.,. ,
,- 1
. ''." -' -• 1 ':.;:' ' ''')1..' '.: '...141? -• :. II .. .e
. Ph . , ...'•-- ,-•. ,. • •,-.:: .
' i ot
„A !
' ‘ , • --T—i r.l --c-
*.
\Ir \
. ., ,
IL •
i
'-1 r:'' .
re,
. ,
• -. .At, •-•,.. . 4A,,,,
. ,,. I I` 0: 4 0 le i 0 0, •
-0. , .- - .. .
, . Fiellii... ' ._ _ .
—, ..
.
- - A
71111111111.117.--- t ,,
... - ,. p _ = t 0 r Pk
• _ . - - 111-
e• e .. ‘ -t '.' , jf•Y! ...
I. r, IL 1., t. I• e e'• • .
am ,,,......anweem...v..11
•
. , : • .54-,.
t '' ' ,
• t%
--4,,M °A .1..4.))1161ICIL
. .4. . I II' (211Filliffiffil 1-':. Cr r': '''''...'—'' "' L.,... 114•P. ,,,,!IC ::F if *, Jo*. • • , •4 EF .r i -:
. .1021
-1.
, . t • , ' `, ., eitlfr.
: . --.• cf ., , • 1.•
. t .
P i M + - , 'MI ,,. _._, , ' .. •
Via ..E...., Irr —51. . • •.,, •
A' , r. . ....-:ii•
., _ .. :I. • . 1
.
' 4i; P. . a „...„...6., . . .. . :,....,.
ort PIT .11441. ----"46. i.:.,,lie . r r •-i-• 'r I
. 14 rilt".14i)..., I,' .' 'ELM r.:,tr...7: ,u; msr-r• p-, 3 - - ' vi, • . iitirp
'
,. ,-
I ' ' ' . -- ../'01:- •
''• , Mr
W.14 it 1r" INI•
lat.; r;d1L din ft C 14, eb, vilb •-',
. IWm.' tPr • ..AL le
• . , •
.„ , r4 ig*Tt, M 14.7.!_r' 41401Z frarr,71; r-r Ort ...ilt rf„,
m .., .
.,-
• • .0.-f
.
• F- ik ; -
. fri
...7'. ift ' r: • -
...,
....-.•., gli
40&- .svrt Wj_,
. 1.1" * ..,5'..
,
I. , - 1 4' rl'"' ',I .las. •
ir-i-, . .....•
... me, ttri,;
. ,
• _
' • - '. ' :, ' ' I.
7%7 - o.,.. g Ifr'•:- .0- ',.. 1'•
Va.• tia i F is. ..ir 1 - - NN .
• .
el....
, . ,
WO :4-VV. - '.-'..,1 ' - - ., ..
•
. i . -4441- Ila.a. sig
•44,r
^,.,',,,--4's,' 'PP% • . '
kP!"4
es ..ralt fi. et
.,. ,:.$4., -,-14- ' Ii. "'!,....I•'''• ' ' .
!Ir :-...:"., '1,,,..• • re
t , le ' '-• ..4 i ' • • GPOP, ( & NOWA/ h.-'.
• - - 1.1 •-; - .., ,•:• ..7:-..- ' ' *-' . - IT, i -•: 4
.* . 1 47..4. , 1 ''''. .. .
eme•. ,
,k...ki 1 14.40. • ‘ •' . ..se
' $. I --; - ',.•• de.•, !..,IP•": ..
. • ."" • V
I'214 ... .1. •, • ' ' .- • __....-
,..
. j . ,
_ .
. R L5 " •. .
. _ T • 1
% . '...:''.• • •.
, -... -r-
, eits . e35 - r
_
4,414 °11,
"k _ ; 4 r-
1 - kkir,
kik 1: 1 k- •..s. . . ___,_. ,. „c,, ,,. ,,, • 4,,,, ,, .. , i.,4 tii r - IL
!oil .
-77--- '•,,rf •-•• - 7: ."4 l,,,,(1, ., -!°` -. k •. 1 - ..
,-i--,_ , t 7 --- :-. . .... .i., ,_ .•.-. _.,..... . . - • . . ::
. a V ,-- ._. _ , k . „ —•
• -- Li
L.. :I.._ .,-,, 7,4 \
...
-.:— .'...',74^ I' • .. -i ,
...P.,. ,
- ...4,— .rt-A
if, •••i :.... . '746. , '
. 1
i.1.A. .....,
' ' -' 1, VS1/4""i ''' ' ...... • ..AMMIMALlik-- iadi" ' ......,•." it
., ' ...-/4.. . .,.N •-,,r,. •,,," 11,4 - * 1'), it,,' '
4$ :4)e
. , .,.. ..
„..,
•,.._ .- -
4 111111.11111
. . ,.
•
, 4,4 • • ,'• ___—_
-•-• --.. .. -•.•-•... 4-., -— 4:4-''' "I __. , 4, --..-,--7.— ,
4 - ".-r-•- ,..s. '---.\'',L '..- ,-- .., , Al LANT1 Btv0
,,.. rib , : - _
_v4 - _ 7' N
. ' ...4.'''' .‘"... * \ .,,,.. ....... +
'---. '''-'1'. i
'. . ''*. -' -'a. '''' ''.....,.. :\c , _,r.„___,7„........• ',V --, • . _' - sorr.rolorrom.
, ' -, .,_..
, .. ...2,'
---—- '.". :1'11P.'“ r - ,-• ,• ,.. , „. ..— .. _._. -11111111‘s. -
-.. . ,
. -- .•- '. - -4-'T ,..0 i ' ' ' :..) .1. \ '\ '' . •-
,/ 'Llt J . - .--.--.. ..0-et \-; -.;-o - • - - : --.:.• 1 . ic• ..,
-.. ., .
/... ; i
, •;
..,
. ...!,„.;: + ',--- ' •,,,-", -
. •
:,•., • ,
ilM14 •''.( ,, ri
.• ‘1r
ifr- ' )1 1425 ,,,„114441 ,
. )
" - -1.3 53 b.... 0. k CEO ail 4,
. i Pi
• 0 r . .. .
(-
,,,:1_,.271,,,,J..,,i,„
, Cash Register Receipt Receipt Number
City of Atlantic Beach R11841
\0;3i9�
DESCRIPTION I ACCOUNT QTY PAID
PermitTRAK $59.00
TENT20-0001 Address: 967 ATLANTIC BLVD APN: 177602 0040 $59.00
1
BUILDING $55.00
BUILDING PERMIT 455-0000-322-1000 0 $55.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R11841 $59.00
Date Paid: Wednesday, February 26, 2020
Paid By: CULHANE'S IRISH PUB, INC
Cashier: FJ
Pay Method: CHECK 2031
0
Printed:Wednesday, February 26, 2020 4:19 PM 1 of 1 i