379 10th St DEMO20-0006 Single Story Home DEMO PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH DEM020-0006
800 SEMINOLE ROAD
ISSUED: 3/17/2020
ATLANTIC BEACH. FL 32233 EXPIRES: 9/13/2020
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:
379 10TH ST DEMO COMPLETE demolition of single-story $2400.00
home
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170090 0010 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
JAX DIRTWORKS INC 310 Mealy Dr Atlantic Beach FL 32233
OWNER: ADDRESS: CITY: STATE: ZIP:
FARBER RHETT 13989 CANOPY OVERLOOK CT JACKSONVILLE FL 32224
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:3/17/2020 1 of 2
%s"' N:r, DEMO PERMIT PERMIT NUMBER I
JS DEM020-0006
ii
` `' CITY OF ATLANTIC BEACH
)1, "
) ISSUED: 3/17/2020
800 SEMINOLE ROAD
'waft 99� ATLANTIC BEACH. FL 32233 EXPIRES: 9/13/2020
3 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL
Notes:
Roll off container company must be on City approved list. Approved list can be obtained at the Building Department at City Hall. Roll off container
cannot be placed on City right-of-way.
4 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL II
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 DOCUMENT IMPERVIOUS AREA INFORMATIONAL
Notes:
Strongly suggest thorough documentation of impervious areas be recorded.
7 PUBLIC WORKS SLAB DRIVEWAY REMOVAL INFORMATIONAL
Notes:
Slab and driveway to be fully removed.
8 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Contractor.
9 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.
10 PUBLIC UTILITIES DISCONNECT AND CAP INFORMATIONAL
Notes:
Disconnect and cap water and sewer lines.
11 PUBLIC UTILITIES 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
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: 3/17/2020 2 of 2
City of Atlantic Beach APPLICATION NUMBER
IJ/'r < `-• � Building Department (To be assigned by the Building Department.)
r 800 Seminole Road 0G OA"`l1 "(� '1 d -0/yy
o
j Atlantic Beach, Florida 32233-5445 C� (o
Phone(904)247-5826 • Fax(904)247-5845 r�
,..011 0, E-mail: building-dept@coab.us Date routed: ( I oa-V
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 3 1- t 10 t ST Department review required Yres -No
wilding v
Applicant: J bt.x 6 it -1-‘,01)1 . Planning &Zoning
L Tree Administrator
Project: C-00p\L t- ALTO DC Public A . .
1 Jr Public Utilities
SinOlL- Fuin( L ( JMt._ Public Safety
Fire Services
Review fee $ Dept Signature
Review or Receipt (,�
Other Agency Review or Permit Required Date of Permit Verified By L.
Florida Dept.of Environmental Protection C
Florida Dept.of Transportation W
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 De artment First Review: I 'Approved. ['Denied. Not applicable
(Circle on Comments: l'iChvi
// /�BUILD' Ver a /17 r)>r� ct PO C h 7e /34111114.
PLANNING &ZONING Reviewed by: 'Pi de Date:0435120
Cl
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. I Denied. I Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
,,,r� ' -, Building Permit Application Updated 10/9/18
t,,
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
�; r
y, � IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 3 7 r /V{'' 54 Permit Number: Q EM Da D 0000
Legal Description T-(,q /6'o95-a9 e Ai/anis &All La-3g- 81,k /3 RE# /10090- 00/(U
Valuation of Work(Replacement Cost)$ q7/. '0 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move /JDemo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial , Residential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes No FEB 1 3 2020 I i
• Will tree(s) be removed in association with proposed project? es(must submit separate Tree Removal Permit) jfilNo I
Describe in detail the type of work to be performed: `
p21+'�o D .�/ G S h(2r17
Florida Product Approval# _for multiple products use product approval form
Property Owner Information
Name Rhe**- -fw'Lc-r- Address /3989
-ar iso»Vi//f State FG ZipDad Pho �y e/ - woo-
Cl-
City
3 << � �1 �� - aoo- Gads
E-Mail g/7c-I-4- f i'ber&y1n4//• (O"-
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information J
Name of Company C0)C '
D TcuOrlc Qualifying Agent JG/)r4-0-- / /ae#-,12,,-7
Address 3/0 .,Mer?/y Dr- City .4 f-/Q,lijc State ,C4 Zip 1 J9
Office Phone G�� - 3/c24/ Job Site ContactNumber 3 8G- C/79- 'cF03
State Certification/Registration# C C /6-?Et331 E-Mail 1_,--4, e 3G,rG'/i/'h4n31 .s Cvn7
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer Fink Ge&„•,? OR Exempt❑ Expiration Date ////2/
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 A ,O' if Y BEFORE
RECORDI r Y•UR !T CE OF COMMENCEMENT
�_ / ' .614:.1.--- �/� _
(Signalre of Owner or Agent)
illr
(Signature of Contractor)
Si ned and sworn t (or affi ed)before me this A day of.N ai-d and sworn to(or affir -d)before me this,iii day• '�r
i/./. ,. , , by
'f! l I __ I/ i% . r
(Signature olI.tary) (Signature of Notary)
.0,„,, DAWN LEMIRE 'IN LEMIRE • Z
AAY CO 4I SION# 318950 iSSION#GG31 g
rsonally Known ORty
er tnRoypin.23 ir';_;:April 2,2023 ;
o.; 'ro� gac,ation [ •roduced Identification ;iui. i hruCAN Surety/N. Et 55
ys I of Identification: Type of Identification: 4 2 1 m
City of Atlantic Beach APPLICATION NUMBER
tBuilding Department (To be assigned by the Building Department.)
S 800 Seminole Road L M 11 (��(,,
Atlantic Beach, Florida 32233-5445 0 l.o"`.v a „-'
Phone(904)247-5826 Fax(904)247-5845 '1 Il , I���h
• U
,1119r E-mail: building-dept@coab.us Date routed: C7`
City web-site: http://www.coab.us --
APPLICATION REVIEW AND TRACKING FORM
Property Address: - ` O `Sr Deyartment review required Yes No
�ry I 1 cuilding
Applicant: U"x i it T W L}I LS Planning &Zoning
�t
(` Tree Administrator
Project: C-Or plLtL-- Atm () D Public �s?
Public.Utilities
S l R nit-
ito [rt' kor 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:
APPLI TION STATUS
Reviewing Department First Review: Approved. Denied. I 'Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: -Date: 2"2O"W
TREE ADMIN. Second Review: Approved as revised. ❑Denied. Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: I lApproved as revised. Denied. I Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
PUBLIC UTILITIES PLAN REVIEW COMMENTS
Date: 2 -2 - 2Q Application#: D /n J Zd — WOO
Project Address: 379 /Q 4
Check Box Check
APPLICATION TRACKING COMMENTS to Add Box to
Comment 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 ❑ 0
Cleanout and visible.
A reduced pressure zone backflow preventer must be installed if irrigation will
RPZ Backflow be provided or if there is a private well on the property. Backflow preventer ❑ ❑
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 0
Meter must be tested by a certified tester and a copy of the results sent to Public
Utilities.
Fire Sprinkler If fire sprinkler system is provided, call 247-5878 for backflow requirements.
Backflow 0 0
At a minimum,will require a double check backflow preventer.
Requirement
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 0
Disconnect
& Cap Disconnect and cap water and sewer lines.
Inspection MUST call the Inspection Line at 247-5814 to request an inspection of the 7
Prior disconnected and capped water and sewer lines PRIOR to demolition.
Utility All water & sewer utility connections must be inspected prior to cover up.
Inspections Please call the inspection line at 247-5814 to schedule inspections 24 hours in 0 0
advance.
System All fees must be paid for water& sewer connections before meters will be set.
Development Please call the finance department customer service line 247-5816 to 0 0
Fees coordinate payment of fees.
0 0
rsy�;yri City of Atlantic Beach APPLICATION NUMBER
`�,\, Building Department (To be assigned by the Building Department.)
' 800 Seminole Road C���V 0 G A� ,1
Atlantic Beach,Florida 32233-5445 "i V
\, Phone(904)247-5826• Fax(904)24 4fEB 19 202'J a l I I�(�.a--C.
!,r ti9r E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
BY:
APPLICATION REVIEW AND TRACKING FORM
014-
Property Address: `, � I S+ ' De•artment review required Yes No
�--(( L1 ' :uilding
V
Applicant: 0-x 6 t(T wif t-S Planning &Zoning
Tree Administrator
Project: C)(r,plat Atm U DC Publ c
S.i,n lL- �.�1-t \Il, M-Q_ Public Safety Public.Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date 1 ��
of Permit Verified By
Florida Dept.of Environmental Protection C
Florida Dept.of Transportation W
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. Denied. nNot applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: ate: tivAt,.,2G'
TREE ADMIN. Second Review: ['Approved as revised. nDenied. [Not applicable
PUBLIC WORKS .1,° Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: I 'Approved as revised. I 'Denied. I INot applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017