603 Main St CIV20-0002 7 Yds Fill Dirt rt1,L\' , CIVIL AND SITE PERMIT PERMIT NUMBER
�F,j� J CIV20-0002
l- .. : s; CITY OF ATLANTIC BEACH
'y ISSUED: 3/18/2020
800 SEMINOLE ROAD
�'si�� ATLANTIC BEACH. FL 32233 EXPIRES: 9/14/2020
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:
603 MAIN ST CIVIL AND SITE SINGLE OR TWO 7 YARDS OF FILL DIRT $0.00
FAMILY CIVIL AND SITE
TYPE OFREAL ESTATE I ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170915 0410 ATLANTIC BEACH SEC H
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
LYDON FRUSCELLA 603 MAIN ST ATLANTIC BEACH FL 32233
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 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: 3/18/2020 1 of 2
i0t- i' CIVIL AND SITE PERMIT PERMIT NUMBER
�.
`` CITY OF ATLANTIC BEACH CIV20-0002
ISSUED: 3/18/2020
800 SEMINOLE ROAD
"`'3 9`. ATLANTIC BEACH. FL 32233 EXPIRES: 9/14/2020
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
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 INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Contractor.
FEES ":.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00'
TOTAL: $25.00
Issued Date: 3/18/2020 2 of 2
PINBuilding Permit Application Updated 10/9/18
a City of Atlantic Beach Building Department **ALL INFORMATION
4HIGHv 800 Seminole Road, Atlantic Beach, FL 32233
LIGHTED IN GRAY
``'jt ve IS REQUIRED.
Phone: (904), .247-5826 Email: Building-Dept@coab.usi
Job Address: 3 fio\` 1 5�f ec, 444 rmit Number: C I V ZO 0 OO z
Legal Description R -p e- tilt //1.[ Lv'L— Thdli ref/104 blioE#
Valuation of Work(Replacement Cost)$ (CO Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New Addition ❑Alteration Repair ❑Move ❑Demo ❑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
Describrin detail the type of work to be performed:
Ac+ (7 y L�`d,� 0.ici�r�4-.. �C `frovc a
b v Sher ✓1flou- o(e i S it.�i`�
Florida Product Approval# for multiple products use product approval form
Property,Owf er Information i /�,
Name 0411 Foci Blip-- Address o3 M 0..A 5 ,,e-el---
City /1 i State Zip 3z23`3 Phone 9D�— `1 - Y63�
E-Mail LEI aal T(uSCe1 +. / 4 1M� . Coal
Owner or Agent(If Agent, Power of At orney or Agency Letter Required)
Contractor Information
Name of Company Qualifying Age.
Address City State Zip
Office Phone Job Site Conta 'umber
State Certification/Registration# E-Mail
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt 0 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 PRCIP-E;R 14OIE END
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN AT1,. RNEY BEFO
REC DI O NOTICE OF COMMENCEMENT. i,...;: MAR 1 2 na
(Signature of Owner or Agent) l (Signatt�r�'of Contractor)
�gned and sworn to(or d) bef e eithis/ c y of Signed and sworn to(or affirmed)before me this day of
,zoZU .Z,sc-r 11 , by
,:Y. ,i • I I 'L "741e14_,0 na e of,t(ti.Fy) (Signature of Notary)
;,: ,,, -.,,"i MY COMMISSION#GG 353178
;� z•.a EXPIRES:October 6,2023
'''..F' ''. nded h ,N At, ili• -miters [ ]Personally Known OR
[ ]Produced Identification [/' �l /r 4-4// [ ]Produced Identification
Type of Identification: l` Z 69 _s 3S-9 4 - --EDe of Identification:
ri1- lri
�,s = ` Cash Register Receipt Receipt Number
?M, g p
�� /~ City of Atlantic Beach R12016
0.31»/
DESCRIPTION I ACCOUNT I QTY I PAID
PermitTRAK $25.00
CIV20-0002 Address: 603 MAIN ST APN: 170915 0410 $25.00
PUBLIC WORKS PLAN REVIEW $25.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
TOTAL FEES PAID BY RECEIPT: R12016 $25.00
Date Paid: Wednesday, March 18, 2020
Paid By: LYDON FRUSCELLA
Cashier: FJ
Pay Method: CREDIT CARD 8
S
Printed:Wednesday, March 18, 2020 2:34 PM 1 of 1 I
1LAPP,- City of Atlantic Beach APPLICATION NUMBER
Building Department C'^CM V (To be assigned by the Building Department.)
800 Seminole Road — �,
O O
I; U Atlantic Beach, Florida 32233-5445 '
Phone(904)247-5826 Fax(904)247 45 MAR 13 2020 �-+�,
it E-mail:0 building-dept@coab.us Date routed: 5/1 ' Z�/
City web-site: http://www.coab.us
BY:
APPLICATION REVIEW AND TRACKING FORM
Property Address: (Q03 r ' \ R-(0 ST Department review required Yes No
fC� ildin
Applicant: CO L.)((L- 7,1111111..��
Tr- •.••:_•• trator
Project: D ( R.T `t) ,L l „--toL s4 Public Works
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. ['Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING & ZONING
Reviewed •
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
601 MAIN STREET, ATLANTIC BEACH, FL. 32233
4
. I
LOT 4 LOT 4 m BLOCK 131 BLOCK 130 lilii.mg:_.
1.`
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0 TH_ENLINEOFLOT5,BLOCK131�- _ 1
> c,
Z AERIAL PHOTOGRAPH
SCALE:1"=30' G7 0 w
(n THE N 35'OF cn (NOT-TO-SCALE)
LOT5 0
BLOCK 131 FENCE
(NOT INCLUDED) 5.5'N FENCE LOT 5
5.6'N BLOCK 130
FOUND 1/2" N88° 56' 00"E ( 0.4'E
25.0' IRON PIPE 102.00'(P) `- --
` %
FOUND 1/2"
UTILITY N STORAGE N o IRON ROD
BOX �-i PLATTED l — —
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N. _ • Via.' 7o THE S 15'OF
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COVERED A
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6 6' BLOCK 131 W( �o (INCLUDED)DRIVEWAY /\ o c
RESIDENCE o NC
o = D COVERED �„ #601 O N LOT 6
o � Z SCREENED ` �' 28 6, 36.1' 0 8 BLOCK 130
0 0 H CO 37.3' I m BLOCK
o I m o N I o o W CORNER
- v o o IV < m N AT LOT 6
.02
O N >OA `'' * o FENCE BLOCK 130
1.0'E FOUND 112"
IRON PIPE
25.0' as 2WM _ — —A,---0. S88° 56' 00"W 102.00'(P)
BLOCK 102.00'(P)
I CORNER
FOUND 112" r (-2'GUTTER o
o
IRON PIPE W 6th STREET _
ASPHALTCROADWAY
50'RIGHT-OF-WAY
(----- 7,711.64 Square Feet
856.85 Square Yards
-ALL ANGLES AND DISTANCES SHOWN HEREON ARE BOTH RECORD AND MEASURED UNLESS OTHERWISE NOTED
SHEET 1 OF 2(SKETCH OF SURVEY)-SEE SHEET 2 OF 2 FOR LEGAL DESCRIPTION.AND OTHER SURVEY RELATED DATA SURVEY IS NOT COMPLETE WITHOUT ALL SHEETS
The survey map & report or the copies thereof are not valid without the digital signature and seal of a
Florida licensed surveyor and mapper
Date of Field Work : 01-03-2020
Drawn By: Oleg
Order #: 76559
Last Revision Date: 01-03-2020 ••
Boundary Survey prepared by: LB8111txGEN
of
8583 2883
NexGen Surveying, LLC
5601 Corporate Way, Suite #103
West Palm Beach, FL 33407 SURVEYING, LLC.
561-508-6272