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Selva Marina-1600 (14-1008) RestroomCity of Atlantic Beach - LIGATION NUMBER Building Department (To 644&41ned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 JUN 4 ;' ,014 6;1 �_r Phone (90 4) 247-5826 • Fax (904) 247-5845 E-mail: building-dept@coab.us Date route City web -site: http://www.coab.us ---- APPLICATION REVIEW AND TRACKING FORM Property Address: ,l a� �LlV O/ 1&r1,4,C IT (' B Applicant: Plani Tree Project: v;.0�Zi,4759,6,0 rtrnent review required I Yes I No Public Saf( ire_ '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 Revised 05/14/09 Reviewing Department First Review: Approved. ❑Deni .. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by.- Date: a TREE ADMIN. Second Review:[ -]Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: [-]Approved as revised. ❑Denier:. Comments: Reviewed by: Date: Revised 05/14/09 Date: 6 PUBLIC WORKS PLAN REVIEW COMMENTS r Initials: PN it%" ML Project Name / Address : Od ��� D ///n v.'/I D , ,2 lam Annrr-+ern nor, ;+ ff. 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 construction). ❑ ❑ ESCP Provide erosion and sediment control plans with installation details and maintenance schedule. ❑ ❑ DPLN Provide drainage plans showing site topography (flow arrows, etc.) ❑ ❑ RMRO All runoff must remain on-site. Cannot raise lot elevation without measures to retain runoff. ❑ ❑ CSMP Provide construction site management plan, including Right -of -Way Permit if using right-of-way for construction parking. ❑ ❑ TSUR Provide a pre -construction topographic survey prepared by a Florida Licensed Professional Land Surveyor, showing 1' contours. ❑ ❑ Section 24-66(b) of the Land Development Regulations requires on-site storage for LDCS 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. ❑ ❑ PLWP Pool - Wellpoint (if used) must discharge into vegetated area 10' minimum from street or drainage feature (swale, structure or lagoon). ❑ ❑ All concrete driveway aprons must be 5" thick, 4000 psi, with fibermesh from edge of DAPR pavement to the property line. Reinforcing rods or mesh are not allowed in the right -of- ❑ ❑ way. (Commercial driveways — 6" thick). Any utility cuts in the road must be repaired using COJ Standard Detail Case X and must be URCT 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. ❑ ❑ Roll off container company must be on City approved list and container cannot be placed on ROFF City right-of-way. (Approved: Advanced Disposal, Realco, Shappelle's and Waste ❑ ❑ Management). Full erosion control measures must be installed and approved prior to beginning any earth ECIN disturbing activities. Contact Public Works (247-5834) for Erosion and Sediment Control ❑ ❑ Inspection prior to start of construction. Recommend Owner/Contractor meet with Public Works Director to discuss proposed MEET construction. Call 247-5834 to make an appointment. ❑ ❑ ❑ ❑ 0 0 City of Atlantic Beach x Building Department =3k 800 Seminole Road . Atlantic Beach, Florida 32233-5445 Phone (904) 247-5826 • Fax (904) 247-5845 E-mail: buildin de t@ coab.us 9- p City web -site: http://www.coab.us APPLICATION NUMBER (To be assigned by the Building Department.) JUN 1 4 ZOO APPLICATION REVIEW AND TRA�O-FORM Property Address: I��� �EIV4' mrmA' Applicant: E Project: v� 9 0011 dd Department review required I Yes I No I Planning & Zoni Tree Administrator Public Safety ire Ser77�s Review fee $ 61 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: pproved. ❑Deni ". (Circle one.) Comments: / BUILDING PLANNING & ZONING lOp�%/y Reviewed by Date: L TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. C,W Comments: I UTILI PU LIC S ETF Reviewed by: _ Date: Third Review: ❑Approved as revised. ❑DeniFaf. FIRE SERVICES Comments: Reviewed by: Date: Revised 05/14/09 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: 6/27/14 Project Address: 1600 Selva Marina Dr. — Golf Course Restroom No. of Units: 1 Commercial X Residential New Water Tap(s) & Meter(s) 3/4" Meter Size(s New Irrigation Meter Upgrade Existing Meter from New Connection to City Sewer 1 Multi -Family 3/4" Name: Atlantic Beach Partners/EFS Construction- Doug Maier Applicant Address: City: State: FL Zip: Phone Number: 759-1395 Cell Number: Email Address dou maier e,comcast.net Fax: Signature: (Applicant) CITY STAFF USE ONLY Application# 14-1008 Water System Development Charge Sewer System Development Charge Water Meter Only Water Meter Tap Sewer Tap Cross Connection Other TOTAL $ 1,140.00 $ 4,050.00 $ 185.00 $ 50.00 $ 5,425.00 to (size) New restroom building at Atlantic Beach Country Club. (notes) APPROVED: Donna Kaluzniak 6/27/14 (Utility Director or Authorized Signature) ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED PUBLIC UTELMES PLAN, REVIEW COMMENTS Date: 6 Initials: Project Name / Address: 16 � � % Xw—"j' � j�)/ Application Permit #: Check Box Check Application Tracking Comments to Add Box to Comment 'Print" UWSU Avoid damage to underground water / sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is needed, call 247-5834. M BSC Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible. rq RTIC A sewer cleanout must be installed at the property line. Cleanout must be covered with NO 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. FSBR if fire sprinkler system is provided, contact Malcolm Clemons at 247-5839 for backflow 13 ❑ 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. ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 0 0 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904)247-5841F1 � , „ _ Job Address: Legal Description tis-- rioor Area oT aq.rt. g �q.rt Valuation of Work $ !4O Proposed Work heated/cooled y Class of Work (circle one): �e Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s) (circle one):. Commerci Residential If an existing strucure, is a fire sprinkler system insta a 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: 5!�l. 67-M eAt f 49UMEX.) Y z .. .n .Z 1 --, If S T Property Owner Information: Name:_ Ar1,-rJr-;C,A��t PPi�T Ito%�'Address:� City i f4 Iwa '1j , Stated Zip Phone E -Mail or Fax # (Optional) Contractor Information: Company Name: 6175 m0r45f i Ci C -T! o --j L� Qualifying Agent: '1 t! • Afimf j 4 - ii Address:_ t0.0 -?56y-1 rr ®a lbw City -1 State 226( Zip ? � 6 Office Phone �'� Z- 5 ZC2 Job Site/ Contact Num er ( - 7`b Z Fax # S7 State Certification/Registration # Architect Name & Phone # (Z4�eC 4fL� c �21Z ` �7� .q -C Engineer's Name & Phone # Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and Address 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 issurtnce 0a 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 zf work isn't commenced within six (6) months, or if construction or work is suspended or abandoned for a_perzod ofsix _(6) months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters, Tanks and Air Conditioners, etc 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. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type work will be complied with whether speci zed herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other federal, state, or ocal law regulating construction or the performance of construction. 011 Signature of Owner461o�rle-)L Signature of Contractor ,VI.,. Print Name ............................... Print Name t°��I' G'?. ..... ................L�®......... ... Sword, to and subscribed before me Swornto an su this 'LI Day of WN , 2014 th' ay of r CHERIE E DUKE$ 20 (� i /� �/� �L� y PublicEx i State of 1`113, 2i 1 .Expires Jun f 3, 201 S Notary Public Notary -Public Commission ssion Bonded Through National Notary Assn. CHRISTINA P. CARLSON `wRee1 MY CONIMISSION # FF 072983 ;N; EXPIRES: November 25, 2017