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Selva Marina-1600 (13-3848)APPLICATION NUMBER (To be assigned by the Building Department.) /3 - .300".. Date routed: APPLICATION REVIEW AND TRACKING FORM Property Address: 0 (V Applicant:14 Project: A/s, dg 1 G.- L., iS2l�U o Y.6, .,I,, k- Qopa.EtLnent review required Yes No u' ' anning & Zor ree Ad is rator u lic Utilitie u lic Safety ire Service # Agency Review or Permit Required Review or Receipt Date of Permit Verified B 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 City of Atlantic Beach Approved. Building Department (Circle one.) 800 Seminole Road UF r Atlantic Beach, Florida 32233-5445 BUILDING Phone (904) 247-5826 • Fax (904) 247-5845 E-mail: building-dept@coab.us PLANNING & ZONING City web -site: http://www.coab.us APPLICATION NUMBER (To be assigned by the Building Department.) /3 - .300".. Date routed: APPLICATION REVIEW AND TRACKING FORM Property Address: 0 (V Applicant:14 Project: A/s, dg 1 G.- L., iS2l�U o Y.6, .,I,, k- Qopa.EtLnent review required Yes No u' ' anning & Zor ree Ad is rator u lic Utilitie u lic Safety ire Service # Agency Review or Permit Required Review or Receipt Date of Permit Verified B 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. (Circle one.) Comments: BUILDING PLANNING & ZONING Reviewed by: 1 Date: a TREE ADMIN. Second Review: ❑Approved as revised. ❑Denie . PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: DApproved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 PUBLIC WORKS PLAN REVIEW COMMENTS /��� Initials: PN ML Date: (j / Project Name / Address: 16-61) Q-.'407/l/a , WaV,'A C- Application Permit #:13 3 a Check Box Check Application Tracking Comments to Add Box to Comment "Print" IMPS Provide table of impervious surface calculations for entire lot (existing and post ❑ ❑ constructic n). ESCP Provide erosion and sediment control plans with installation details and maintenance ❑ ❑ schedule. DPLN Provide drainage plans showing site topography (flow arrows, etc.) ❑ ❑ CSMP Provide construction site management plan, including Right -of -Way Permit if using ❑ [3right-of-way for construction parking. TSUR Provide a pre -construction topographic survey prepared by a, Florida Licensed Professional ❑ ❑ Land Surveyor, showing 1' contours. LDCS Section 24-66(b) of the Land Development Regulations requires on-site storage for increased run-off if adding 400 SF or more impervious surface. Provide Delta volume ❑ ❑ calculations and on-site retention required per Section 24-66(b). (See attached information sheet.) PCTS If on-site storage is required, a post construction topographic survey documenting proper ❑ ❑ construction will be required. RWPM A Right -of -Way Permit must be obtained for use ❑ ❑ REPM A Revocable Encroachment Permit must be obtained. ❑ ❑ 1 PLWP Pool - Wellpoint (if used) must discharge into vegetated area 10' minimum from street or ❑ r_ ❑ drainage feature (swale, structure or lagoon). DAPR All concrete driveway aprons must be 5" thick, 4000 psi, with fibermesh from edge of pavement to the property line. Reinforcing rods or mesh are not allowed in the right -of- ❑ ❑ way. (Commercial driveways - 6" thick). URCT Any utility cuts in the road must be repaired using COJ Standard Detail Case X and must be overlaid 10 feet in each direction from the center of the cut. Repair must be shown on the ❑ ❑ plans. RWRS Full right-of-way restoration, including sod, is required. ❑ ❑ ROFF Roll off container company must be on City approved list and container cannot be placed on City right-of-way. (Approved: Advanced Disposal, Realco, Shappelle's and Waste ❑ ❑ Management) ECIN Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact Public Works (247-5834) for Erosion and Sediment Control ❑ ❑ Inspection prior to start of construction. MEET Recommend Owner/Contractor meet with Public Works Director to discuss proposed ❑ ❑ construction. Call 247-5834 to make an appointment. ❑ ❑ ❑ 0 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: Permit Number: Legal Description 4-` DEC 17 2 _ 0i3 � Valuation of Work $ 5,1371,0111 -(Do Proposed Work heated/cooled a&&z non-heated/cooled Class of Work (circle one): iNew Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proosed structures) (circle one): mercy Residential If an existing structure, is a fire sprinkler system installed. ircle one): Yes No N /A Florida Product Approval # For multiple products use product approval form Describe in detail the type of work to be performed: rw kr jn, t�, ` dAC~ Ej !Eu, rd -r Proaerty Owner Information: Name: Selya VYlamw, Oar ! n� Gum, \vim • Address: I W OO Safy a.. rf�c..v�v�cr. air. City Aila,n-tic, twxa n StateIuZip 32,%3 Phone OW4- A-iZ - Z7-?-7- E-Mail 2.ZZE-Mail or Fax # (Optional) Contractor Information: Company Name: RPC- C-►ev-g-_,rod C _+r �.v=a, tyc.. Qualifying Agent: Pette J - VQA•n"Ve,.s Address: _2J4 Sr beL1 ed . City t}4toun-tiC_ M State T- L_ Zip 4?2.33 Office Phone RUN- 241- Li41 Job Site/ Contact Number aot4- &45-soi t Fax # q OL1- 2}t►- i -f Li27 State Certification/Registration # CG , OtAOLn 1q Architect Name & Phone # C1t-9-F pecan (101-}) 3DZ- ONL4 9 Engineer's Name & Phone # -► MW Ylujan Ecjc tv-xePan v,c4 (1 04) 4 e.9 -152_C>0 Fee Simple Title Holder Name and Add ess Bonding Company Name and Address Mortgage Lender Name and Address Application is hereby made to to 0b a permit to do the work and installations as indicated. / cert 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 laws regulating construction in this jurisdiction. This permit becomes null and void f work is not commenced within six (6) months, or if construction or work is suspended or abandoned for aperiod of six 6) months at any time after work is commenced. / understand that separate permits must be secured for Electrical Work, Plumbing, Slgns, Wells, Pools,urnaces, Boilers, Heaters, Tanks and Air Conditioners, eta 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. / hereby cert fy that 1 have read and examined thisplication and know the same to be true and correct. All provrafans9f s ordina s verning this type o1 work will be complied with whether speci led herein or not. The granting of a permit does not presu»fe` t tv a ori to or cancel the provisions of any other federal, state, or local law regulating construction or the performance of construction. Signature of Owner 04 Signature of Contractor PrintName..................!..........VvdF........................................................ Print Name <i...... t.a�-� 5. J Swo to and subscribed before me this Day of /C'P/ti' , 20/-3 Notary Public W.� (ma, CATHERINE LEVAN =Notary Pubk - Side of Florida My Comm. Expires Apr 23.2017 y} os aid ' Commission # FF 011275 Sworn to and subscribed before me this Day of20 13 N Public,/ Revised 01.26.10 MAME fEeMMER W COMMISSION # EE045W8 EXPIRES November 28, 2014 tao ,s�ao�s3 ,tom City of Atlantic Beach i APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road 13 _D Atlantic Beach, Florida 32233-5445 Q Phone (904) 247-5826 - Fax (9D4) 247.5845 rt 9f' E-mail: building-dept@coab.us W _e, Date routed: City web -site: httpl www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: Applicant: Project L Qapadment review re uired Yes No u' jFra—nning & Zonin ree 8strator U=.1c t-liti afe v ire Sery }dei , ..alm /6101 i l • RVY1Q•. v� Other Agency Review or Permit Required .teceiptof Permit Verified By Date 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. Reviewing Department First Review: (Circle one.) Comments: BUILDING Reviewed by: j !o Second Review: QApproved as revised. QDeniea. Comments: PLANNING & ZONING TREE ADMIN PUBLIC PUBLICUTILITIES PUBLIC SAFETY FIRE SERVICES Revised 05/14/09 Approved. ODenied. Reviewed by: Third Review: QApproved as revised. ❑Denied. Comments: Reviewed by: Date: Date: CITY OF ATLANTIC BEACH PUBLIC UTILITIES 1200 Sandpiper Lane ATLANTIC BEACH, FL 32233 (904) 270-2535 or (904) 247-5874 NEW WATER/SEWER TAP REQUEST Date: 12/20/13 Project Address: 1600 Selva Marina Dr. No. of Units: 1 Commercial X Residential Multi -Family New Water Tap(s) & Meter(s) New meter for clubhouse & amenities New Irrigation Meter Upgrade Existing Meter from to New Connection to City Sewer X Name: RPC General Contractor -Pete Rodreaues Applicant Address: _248 Levy Rd. City: Atlantic Beach State: FL Zip: 32233 Phone Number: 241-4416_ Cell Number: Email Address Fax: Signature: (Applicant) CITY STAFF USE ONLY Application# 13-3848 Water System Development Charge Sewer System Development Charge Water Meter Only Water Meter Tap Sewer Tap Cross Connection Other TOTAL $ 11,400 $_40,500_ $ 200 $ $52,100 Meter Size(s)_K_ (size) New clubhouse and other buildings for ABCC. Based on 3" meter. There will also be a 6" fireline meter installed — no impact fees for that meter. (notes) APPROVED: Donna Kaluzniak 12/20/13 (Utility Director or Authorized Signature) ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT CAN BE ASSESSED BEFORE FEES PUBLIC UTILITIES PLAN REVIEW COMMENTS Date: /p< ' /O J Initials: Project Name / Address: 14© GILI' �ILVi/l4-1 L` Appli/ cation Permit #: MBSC Check Box Check . Application Tracking Comments to add Box to FUWSU Comment "Print" Avoid damage to underground water / sewer utilities. Verify vertical and horizontal RPZB A reduced pressure zone backflow preventer must be installed if irrigation will be location of utilities. Hand dig if necessary. If field coordination is needed, call 247-5834. provided or if there is a private well on the property. Backflow preventer must be tested MBSC I Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible. 1 �J RTIC A sewer cleanout must be installed at the property line. Cleanout must be covered with ❑ ❑ an RT1 concrete box with metal lid. Cleanout to be set to grade and visible. RPZB A reduced pressure zone backflow preventer must be installed if irrigation will 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. STRM Plans note the building will be unsprinkled. if plans change, any fire line installed must be metered with a Sensus touch -read meter in a properly sized vault and an appropriate ❑ ❑ backflow preventer installed. Backflow preventer must be tested by a certified tester and a copy of the results sent to Public Utilities. FOR if fire sprinkler system is provided, contact Malcolm Clemons at 247-5839 for backflow O ❑ requirements. At a minimum, will require a double check backflow preventer. FLM Fire lines must be metered with a Sensus touch -read meter. Meters larger than 2" must ❑ ❑ be installed in a vault as noted in JEA specifications.