Selva Marina-1600 (15-SHED-860)LKY of AtIan is E-neaciv
uiisiii�g I e far rnenx ` ± TVR-
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone (904) 247 5E32h Fnx (904) APR j 7(ll
E-mail: building-dept@bcoab.us
City web-sitehtrpJ/Mwvw coati. us
APPLICATION NUMBER
(To be assign d by the BuildingDepen- ni )
.5__-sheQ _ "0
Date routed: %/ / 6,)
711. ®errpaehrrevie d e ui�. @'
—_—_—_ q _ e� yes No
- Buildin
Applicant a ning &Zonr -
munrstrator '-- - -
f ublic Wor
• ,L� P blic Uti I -- -
�tf L Public Safety
Fire Services --
Review fee
Dept Signature
Other Agency Review or Permit Required
Florida Dept. of Environmental Proteciion
Florida Dept. of Transportation -
Si. Johns River Water Management District
Arany Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
I e °ie�uin DeE�ar�rraent First Review
(Circle one.) (',-'ornments:
BUILDING
PLANNING & ZOI\,iII\IG
TREE ADMIN
PUBLIC WORKS
PUBLIC UTILITIES
PUBLIC SAFETY
FIRE SERVICES
-Wscd 07/2760
Kev'ew or Receipt
o- Permit Verified B
APP@ IC ON STATUS
pproved.
n--- —Denied.
Denied.
Date
Reviewed by:
_ — ate: is /jam
Second Review: []Approved as revised. - --- - — - ----
_ .
Comments:
Reviewed by.
Date:
Third Review: ❑Approved as revised. []Denied - -- _-------_ --- _ _I
Comments:
Reviewed by: I
Date:
Date:r/��
Project Name / Address :
PUBLIC WORKS PLAN REVIEW COMMENTS
I
lication Permit #:
Application Tracking Comments
Check Box to
DAPR
ORRECTION ITEMS:
Select
CSMP Provide construction site management plan, including location of dumpster and portable toilet. Right -
f -Way Permit is required if using right-of-way
are not allowed in the right-of-way. (Commercial driveways —
thick.)
13"
for construction parking.
❑
DPLN Provide drainage plans showing site topography (flow arrows, etc.)
and Sediment Control Inspection prior to start
f construction.
❑
OSRO
ESCP
Provide erosion and sediment control plans with installation details.
PCTS
if on-site storage is required, a post construction topographic survey documenting proper construction
ill be required.
IMPS
Provide impervious surface calculations for entire lot (existing and post construction).
PLWP
LDCS
ection 24-66(b) of the Land Development Regulations requires on-site storage for increased run-off if
dding 400 SF or more impervious surface.
separate pool permit is required.
Provide Delta volume calculations and on-site retention
required per Section 24-66(b). (See attached information sheet.)
13
MEET
Recommend Owner/Contractor meet with Public Works Director to discuss proposed construction.
all 247-5834 to make an appointment.
Recycling, Republic Services, Shappel's and Waste Pro).
13
❑
REPM
Revocable Encroachment Permit must be obtained.
13
URCT
RMRO
II runoff must remain on-site. Cannot raise lot elevation without measures to retain runoff.
RWPM
Right -of -Way Permit must be obtained for use
TSUR
Provide a pre -construction topographic survey prepared by a Florida Licensed Professional Land
urveyor, showing 1' contours.
13
❑
ONDITIONS OF APPROVAL TO PRINT ON PERMIT:
DAPR
II 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 —
thick.)
13"
ECIN
Full erosion control measures must be installed and approved prior to beginning any earth disturbing
ctivities. Contact Public Works (247-5834) for Erosion
and Sediment Control Inspection prior to start
f construction.
❑
OSRO
II runoff must remain on-site during construction.
PCTS
if on-site storage is required, a post construction topographic survey documenting proper construction
ill be required.
❑
PLWP
Pool — Wellpoint (if used) must discharge into vegetated area 10' minimum from street or drainage
eature (swale, structure or lagoon). A
separate pool permit is required.
❑
ROFF
Roll off container company must be on City approved list and container cannot be placed on City right -
f -way. (Approved: Advanced Disposal, Realco
Recycling, Republic Services, Shappel's and Waste Pro).
13
RWRS
Full right-of-way restoration, including sod, is required.
13
URCT
ny utility cuts in the road must be repaired using COJ Standard Detail Case X and must be overlaid 10
eet in each direction from the center of the
cut. Repair must be shown on the plans.
0
u"Nab; of Atlantic Deac11
APPLICATION6
N�ilding DepartMer6: NUMBER
n be as�iglled by the BUildin De Zenf )
800 Atlantic Beach,
Ro 3d ^� C� +p��
Aiianiic Beach I Londa 32233-5445 Ie1�_ S G
j c xl h ---_
-- -
i "� I _ APR 1315
-hone JO 4/-tio�h I -n (UU4) ?47 tiR
t Ufar C nrw- lidding dcpi(ccoab. us ate routed:
Citi vveb-site hti7//www coah rrs --
A PG IL. Cin_ T�00 NN F�EVE� An I /ARAPD TRACKON\ G F0 R 5 N
i, N,i_u�uc: N`:ps Add
�9/jib I / / �tG/�%% A_-
14 _-
h
Review fee c 2 �_
��drtrnent reveevvNe �Noreu� F.:
ulldlrl
Inni�Mlnistrator____'
i
4-J.,
blicWor -----�---
4- -- ---
r UDIIC Safety
Fire Services
Dept Signature
u`rei'ree f„geruey Review e,r Permit Required
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
Si. Johns River Water Management District
Arany Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other. --
i ..
”"acv"iii\+'uVLiE,� t.r'i'.I�oa�N'ErtMeIrFN:
(Circle one.)
BUILDING
TRc - ADIViIIV
C WORT.
PUBI C UTILITIFS
P li�l_ IC AC�;�
FiRF SFRVICFS
NeevNew or Recei
of Permit Verified
Date
--- ---
APPLICATION ST'ATUS --
6'= irs>t Review: [_ pproved nDenied - ----- --- ----
d.'; c�Yirl Vau e rl cc; :
Reviewed by Daie.
t I
Second Review: FApproved as revised ]Denied
I
Reviewed by.
Third Review: [Approved as revised. nDenied.
a_ .om rincants:
(reviewed by:
Date.
_ Date:
-I
-------------- ----- - -
PUBLIC UTILITIES PLAN REVIEW COMMENTS
Date:
Initials:
1 / (pQ r� �/6�i%/�Cc Application Permit #:
Project Name Address: / S �"
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.
❑
❑
MBSC
Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible.
❑
❑
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.
FSBR If fire sprinkler system is provided, contact Malcolm Clemons at 247-5839 for backflow
requirements. At a minimum, will require a double check backflow preventer.
❑
E3
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.
[3
[3
❑
❑
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: SEW 'M(�Q (�� L ��.1(,, Permit Number:
Legal Description Parcel #
oor Area o q, t. t
Valuation of Work $ O Proposed Work. heated/cooled non-heated/cooled--
Class of Work (circle one): <2Addition Alteration
Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): A�cii
If an existing structure, is a fire sprinkler system installed? one)
Florida Product Approval #
For multiple products use product approva orm
Residential '�&'
Yes No
Describe in detail the type of work to be performed:_ I p V 'rtEiV ptMy,g), SiP
Property Owner Information•
NameLA6WNcil-48 Address: � 0 sfWfA
E -Mail or Fax # (Optional) Stat LZip Phone _ QtfL_(.� Z." 227 2
Company Name:
Office Phone Job S
State Certification/Registration #
Architect Name & Phone #
Engineer's Name & Phone #
Fee Simple Title Holder Name and Address_
Bonding Company Name and Address
Mortgage Lender Name and Address
Qualifying Agent:
City State
Number Fax #
Zip
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 wall be per formed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void if work is not commenced within six (6) months, or if construction or work is suspended or abandoned for a_period 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, FFurnaces, 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 hereb certify that I have read and examined this application and know the same to be trite and correct. All provisions of laws and ordinances governing this
type ofivork will be complied with whether specified herein or not. The granting of a permit does not presume to gave authority to violate or cancel the
Provisions of any other federal, state, or local law regulating construction or the performance of construction.
Signature of Owner ��`'� f`v—L
Signature of Contractor
Print Name /� j� /� . "Tl�c'�
.......................................................................................................................................
Print Name
Before me
this Day of
Notary Public
Revised 01.26.10
A
' S Oz
�equi.sed jEtar sbea� uuu�
found In tea p3.ac+ea In
d aLl.ty 11cen88
r X00 sq. fts
Flc vlda. Law .
i s LaoT _
This is
*Sectlon 553.80 (l) (d) dealing
with manufactured buildings And
*Section 489-103(21) wh:,ch is an
exemption from DBPR' s requirement
for a contractor' s llcense
�,a.1ty ll.c�+se -,...•
1VC3�r assembly, or tie -down of lawn
bild�ngs stossgc buildings not
storage the insign:.a of
ASCL ds nj 4LOO sq ft _ and beam- Affairs
approval f xom► the DQPart=d%nt of CcwM •,T„_ ty
sbox3.ng a=pl.:i.anc� with the Flor da BujI.ding
Code.
stvxage
t u;.le%xsgs srsd
��osa,ges shads waxing
Lawn
irxssgna-a
of appxcva3. of the +depaxt�ent ase
the
sct
to s.553-842-
Sticix bu3.lciings �t do
not
s'ubj
i,re
-pot
_-_
�r+aMdd,e1
�,a.1ty ll.c�+se -,...•
1VC3�r assembly, or tie -down of lawn
bild�ngs stossgc buildings not
storage the insign:.a of
ASCL ds nj 4LOO sq ft _ and beam- Affairs
approval f xom► the DQPart=d%nt of CcwM •,T„_ ty
sbox3.ng a=pl.:i.anc� with the Flor da BujI.ding
Code.
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No.
State of
To whom it may concern:
Tax Folio No.
County of
The undersigned hereby Informs you that improvements will be made to certain real property, and in
accordance with Section 713 of the Florida Statutes, the following information Is stated In this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: 1 U D O S S I V A AkA-a-i t j Ar
L,4
Address of property being improved: i %� DIEL '�� iiia L.{� kL&Q�,
General description of improvements: IV S" tLL
Owner P7x
Address1_ (Q VC,\A� Del&
Owner's interest in site of the improvement LI C.,
Fee Simple Titleholder (if other thp owner)
Name ' S�� 6 Cs
Address i
Contractor bk\i t S A 1.ti .) (-' L - -- -I r-: t A E% (% 6
Address 2-4-0 \Q -k Q LZAl% (,�, E )b6C� Lbt)C, �rL�RI
Phone No14p'-�\ SS QA -� Fax No.
Surety (if any)
Address Amount of bond $
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name
Address
Phone No.
Fax No.
Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other
documents may be served:
Name _ ED '7C S&< -L i4�PII? AL ft NP S
. -- -
Address
Phone No.
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in
Section 713.06 (2) (b), Florida Statutes. (Fill in at Owner's option).
Name ' S AMZ~' '
Address
Phone No,
Fax No.
Expiration date of Notice of Commencement (the expiration date is one (1) year from the date of recording unless a
different date is specified):
FHIS SPACE FOR RECORDER'S USE ONLY
Doc # 2015083424, OR BK 17130 Page 1612,
Number Pages: 1
Recorded 04/14/2015 at 03:44 PM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING $10.00
Signed:
Before me this day of 4
nimself/ herself and a
are true and accurate
of Llori a, has personally appeared
and
//X5-
�s�1�61n�,19,?pj���4't-
2i OF 76162 ?ra.,
My commission expires:
Personally Known
Produced Identification L or