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1079 Atlantic Blvd Unit 9 COMM20-004 Review .tIi;yv, City of Atlantic Beach APPLICATION NUMBER Building Department (To be,ssigned by the Building Department.) 800 Seminole Road ( �-�, ��+1 �'�co/� Atlantic Beach, Florida 32233-5445 --`M l.� l ` _ Phone(904)247-5826 • Fax(904)247-5845 Z /� on�? E-mail: building-dept@coab.us Date routed: I z 0 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM AL 9 Property Address: I C79 tL 4� tvd Delartment review required Yes No (Building Applicant: C� l ©ivs oC-TiCUAPlanning &Zoning Tree Administrator Project: I 61424©(2-- U(���� Public Works Public Utilities Public-Saf+ty (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 �/ J 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. F (Denied. ❑Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. fNot 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 Building Permit Application Updated 10/9/18 CitY of Atlantic Beach Building Department **ALL INFORMATION 4 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED. 107 Job Address:46415-7440/A.. 8/i,d itikoth goh PG 322?3 Permit Number: COI\ C) -06)(A" Legal Description 3i-2(.; 5)1 ;�i PEWV `(FE 6i% PT FEi . RE# /774-lb ►l, ;� i31;;1 Valuation of Work(Replacement Cost)$ 1500 Heated/Cooled SF Non-Heated/Cooled • Class of Work: ❑New ❑Addition klteration ['Repair ['Move ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): kCommercial ['Residential • If an existing structure, is a fire sprinkler system installed?: Yes ❑No • Will trees)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ' No Describe in detail the type of work to be performed: 12cmWL bit-/r;v # flzOM i,i;;W i.L -b w4 -iluft 5�t ipi 01,11.15-T51 5 w.Ti.4 S , tA/Re posit w/ 1" x Lou male,;«i Florida Product Approval# for multiple products use product approval form Property Owner Information Name `iv.:41N }I` F'S 5-ii,-i 1 1Q+v ('i'ZCP Address } V a ht v' y City kJ'/C"fq► 4 &Jet A State Zip )71:3; Phone TOIF E-Mail Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company et 51 CC�Ypfd1C7Qualifying Agent / f' 4 SjZ Address 5011 ' h f City //'f/► � J 1 State. �L Zip 3 Office Phone wy f /012 2 Job Site Contact Number % ;r1 75J /g73 State Certification/Registration# Ct3C /ZE'OZ13 E-Mail (Wnf"hcciih 16) yAt two • t % v` Architect Name& Phone# Engineer's Name& Phone# Workers Compensation Insurer fin ' ')e OR Exempt❑ Expiration Date C- 4/t? 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. permit,there may be additional restrictions applicable to this property that may be found in the public records of this county, there may be additional permits required from other governmental entities such as water management districts,state agencie 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 ATTORNEY BEFORE RECOR,PING YO OTICE OF COMMENCEMENT. (Signature of Owner or Agent) (Signature f Contractor) Signed and sworn to(or affirmed)before me this lb 4y day of Signed and sworn to(or affirmed)before me this )Z day of ,�/y , �Zc� ,by c Sa,*ct�kt - p k. W , 2 2-ti , by C12414 51� lfL) (Signature of Notary) :p,! SANDRA V. ANDERSON , ,_,;;;::'4;!‘„ '� k<g'sNotary Public-State of Florida ��"'���, SANDRA V. ANDERSON ". Commission#GG 913925 o`'"Y`B:'= b4 Personally Know 1 a.; ,a, KiPersonally Known aR. „ Notary Public-State of Florida �., oP,: My Commission Expires -•-'-''', Commission#GG 913925 [ ] Produced Identif cat?ok(,`, September 1 7,2023 [ ]Produced Identifica ByiF, , My Commission Expires Type of Identificati. . 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REV A b3 / 11 WALL V - = 5 SCALD 1 /4'1 = 1 ' 0" SHEET 3 OF 4 4 I \\\:\\\\ • 4. Remove electrical outlets Remove/relocate / cabinets f / -j Remove wall structure j to 2"below ceiling Remove/relocate Light switch Remove door header and Transom to 2"below ceiling 4 0 Remove wall structure 1'-5" to 2"below ceiling ;� . i . Install new studs \ as required at end , 1 . ° of modified wall O - Remove/relocate Thermostat POSSABILITIES TEAROOM MODIFICATIONS SIZE FSCM ND, WT GRP NAVSEA DRAWING NO. REV A 53711 WALL \/ - 2S SCALE: 1 /4" = 1 ' 0" SHEET 3 OF 4 A NOTICE OF COMMENCEMENT State of f L J'nll t Tax Folio No. County of DV'Ai, To Whom It May Concern: 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 stat d in this NOTICE OF COMMENCEMENT. /� Legal Description of property being improved: 1E �7 /lr U�e j �� ' 2_51� - 2-9 , G V CALM* V FE LT<Er�- G&M)7 . rfEi-b v)g- I 779 - 13v7 Address of property being improved: )d1 Ailarti-lL .13)c,I) 4 .5 !'t y4�I,C Drt((L -'�1 322.33 General description of improvements: - 'i�'I— ✓Y�1'1�Ail f n.,r� Nock, IDWAbectyl i`A�'1 A iv4. f VOcc�: r eyvtt - ks/ s•�)�C S I 1 Owner: 'DC wry, G �'Ci c lEy �►� Address: ? ',I-2s'; �'c,u'i,. i`;I�d ,- )L '372-50 Owner's interest in site of the improvement: Fee Simple Titleholder(if other than owner): Name: Contractor: C� � ) C lCr 91 Z) Address: ?e I Pirn I'el <1,14vv _ 73fitc -t- -7- it Telephone No.: got/ 751 LC1'3 Fax No: Surety(if any) _ Address: Amount of Bond$ _ Telephone 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: Address: Telephone No: Fax 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 Statues. (Fill in at Owner's option) Name: Address: Telephone 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): THIS SPACE FOR RECORDER'S USE ONLY OWNER Doc#2020014342,OR BK 19074 Page 1930, / Number Pages: 1 led: i_ .� __ _ •,,,oras, Date: /l/(o./4(2iC. Recorded 01,17/2020 11 36 AM, ore me this /6'/`' day of 79t,vitti,,i Cl in the County of Du .1 State RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL =lorida,has personally appeare• - • 40 COUNTY :ary Public at Large,State of Flc—idaN,Goupty3f AVAII�` • RECORDING $10.00 commission expires: `��Notary Public State at Finn . sonally Knownl. AWRItet. r Commission#GG 913925 or ri oduced Identification: ,, My Commission September 17,2023Expires fS1.A.o,-.), City of Atlantic Beach APPLICATION NUMBER ,,a Building Department (To be assigned by the Building Department.) m [..g A800tlanticSeBeachinole Road, Florida 32233-5445 >�lu�a •� +�YC� "�" Phone(904)247-5826 • Fax(904)247-5845 i J::.--- �Sj jr E-mail: building-dept@coab.us Date routed: I Z City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM -AL 9 Property Address: I `CI P4(0tA,Ciri,Q. O i� Department review required Yes No (Building1-12) Applicant: c.. C____01-2oCTioA') Planning &Zoning Tree Administrator Project: I (�-{Z4 012, 0 L t--,L0007- Public Works Public Utilities Public-Safety Cri-r-e Services'' Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date j r of Permit Verified By Florida Dept.of Environmental Protection #00 Florida Dept.of Transportation 4 i 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 &ZONINGDia Reviewed by: Date: 1 ;'23 2c 'c' TREE ADMIN. Second Review: ['Approved as revised. ❑Denie [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 Printing :: CR543939 Page 1 of 1 Duval County, City Of Jacksonville Jim Overton , Tax Collector 231 E.Forsyth Street Jacksonville,FL 32202 General Collection Receipt Account No:CR543939 Date: 1/23/2020 User:Dipierri,Miguel Email:DiPierri@coj.net FIRE MARSHALL FEE FOR SERVICES PROVIDED Name:CSI CONST Address: 1079 Atlantic by Description:fee plan review atlantic bch comm 20-0004 1079 Atlantic by TranCode I IndexCode I SubObject I GLAcct I SubsidNo I UserCode 1 Project I ProjectDtl I Grant I! GrantDtl ( DocNo 1 Amount 701 ( FRFP 159FI I 34222 I I I I I I I I 150.00 Total Due:$150.00 Jim Overton ,Tax Collector General Collections Receipt City of Jacksonville,Duval County Account No:CR543939F1RE MARSHALL FEE FOR SERVICES PROVIDED Date: 1/23/2020 Name:CSI CONST Address:1079 Atlantic by Description:fee plan review atlantic bch comm 20-0004 1079 Atlantic by Total Due: S150.00 https://tccr.coi.netlprinting.aspx?cr=CR543939 1/23/2020 Building Permit Application Updated 10/9/18 City of Atlantic Beach Building Department **ALL INFORMATION .:11411111 .y 800 Seminole Road, Atlantic Beach, FL 32233 K� HIGHLIGHTED IN GRAY ':-'" IS REQUIRED. icy 7� Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: ldiht;G /S/Yr.Z 1)5 g<dA PZ 522?3 Permit Number: CorC) 06)04 Legal Description J -25 Zit = `j)i . , PE 06-We'I Ff P(. Tei T6i D Glu- . RE# j 174lb Cat) R, T-75 Valuation of Work(Replacement Cost)$ t SCO Heated/Cooled SF Non-Heated/Cooled • Class of Work: ❑New :Addition YAlteration DRepair DMove [Memo :Tool DWindow/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? DYes(must submit separate Tree Removal Permit) No Describe in detail the type of work to be performed: Thoys- / y1 iwv'w i.Z `14 �R,tr tm1144.4 (5411F-1. tiripS151 5w,n45 , W1419 01ZI. ?L5 z' posit w/ 1'r x lc ,^Alen++/ Florida Product Approval# for multiple products use product approval form Property Owner Information Name 5...:44N PTF St,L-vivai4; IVO Address /i ?V Ai1a,:�rl. 91d #r ' _. City j7/e'w} . j:Trt State PL' Zip ;7-73 3 Phone WI/ 1/72-- 2 71 E-Mail Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information S Name of Company 1!5I CCr ,,z i v er, Qualifying Agent L ff�1J, f')l?I'f� Z Address J t.�! f 'f' ch /Vt,j City t /jt'fkfl State / 2,-� 2 Zip 3 `b Office Phone 701 Jy /00 Job Site Contact Number /i 1 75J /IZ3 State Certification/Registration# CM. i2E'oZ13 E-Mail kcri 16) yitl'u> r 1L^ Architect Name& Phone# Engineer's Name&Phone# // Workers Compensation Insurer (AJ 4 1e OR Exempt❑ Expiration Date ('f'! 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. - Odin the publlcrecords af.this cou)t 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 ATTORNEY BEFORE RECOFTING YO OTICE OF COMMENCEMENT. 0 (Signature of Owner or Agent) (Signature f Contractor) Signed and sworn to(or affirmed)before me this lb 411day of Signed and sworn to(or affirmed)before me this )Z day of 31`14"/1// , 0)&2 ,by c j/2.lct4 (,. 31.����:V JAW , 2A-;-2.Q , by f:'jz4l(1 }i;VKAITZ_J (Signature of Notary) �aA nye. SANDRA V. ANDERSON - ;�v ;t> <, Notary Public-State of Florida ,"u SANDRA V. ANDERSON Personally Know ;; ;,o` Commission#GG 913925 y Known R =°��Yue`�=Notar Public State of Florida KTPersonall v oa, My Commission Expires •/'"', Commission N GG 913925 [ ] Produced Identi?ca-ag,t„� September 17,2023 [ ] Produced Identifica (ice;, ,,o; Type of IdentificaticA . Type of Identification: p,;;,; 's MSP ommission Expires rtgmbar 7 7_ ?0?'2 Dipierri, Miguel COMM 20-0004 Returned for Corrections: The plans submitted for review have been returned for corrections. Please correct and or provide the additional requested information to obtain plans approval. When resubmitting corrected sheets, provide a type written itemized narrative letter responding to our comments and directing the plans reviewer to the sheets the changes have taken place. FAILURE TO SUPPLY RESPONSE LETTER "WILL" RESULT IN A RETURNED FOR CORRECTIONS PERMIT STATUS. Revised sheets should be clouded, clearly showing areas were changes or corrections have occurred and re-inserted with the original set of drawings with old sheets removed. Unbound plans will not be reviewed. If this is an electronic submission please make sure that written narrative is submitted under correspondence along with a"complete set" (not just the revised sheets) of electronic documents. When submitting electronic plans, each discipline shall upload a single PDF file containing multiple sheets rather than separate PDFs for each sheet. Please re-upload in this fashion. 1. Life Safety Floor Plan: The City of Jacksonville's Fire Marshal's Office requires the submittal of a Life Safety Floor Plan for building permits for all new construction and existing building alterations in order to ascertain if occupancy is currently code compliant and to assist fire inspector in performing Life Safety Inspections. Please provide a Life Safety Plan to include all the following information on one page. If Life Safety Plan was submitted and you are receiving this comment, it means that all of the required info listed below was not included in your original submittal. It is understood that all listed items may not apply in your situation. Required Occupant Load Calculation: • Provide design occupant load using table 7.3.1.2 of NFPA 101 2015 edition. Area calculations should be shown with graphic seating configurations or fixtures in order to substantiate occupant load chosen. Exit Locations: • Designate main entrance and all secondary exits. All required exits shall terminate at a"public way". Access to the public way shall be accessible and must be via a stable, firm, and slip resistant conveyance such as a concrete sidewalk with a min. 5'x5' landing and 44"walkway. Multi story buildings should designate area of rescue with required communication means. Separation of exits using the one half (non-sprinkled) or one third (sprinkled) the diagonal distance rule should be shown on plans. Required Egress Capacity: • Egress inches for means of egress components (doors, stairs, etc.) Required measurements: (Worst case only need be shown.) • Dead end corridors measurements. •Common path of travel measurements. •Total travel distance to exits. Required separation: •Show all fire barriers, smoke barriers, and smoke partitions. All rated walls per new directive from building official wall detail needs to include UL listing and needs to confirm by architect or engineer as being accurate. Required Lock Latch details: •Lock/Latch details: Panic Hardware, Thumb turn lock, Key Lock with indicator and required signage. Required Electrical Stop/Disconnect Details: •Any required Emergency stops or Shunt trips. • Main Electrical disconnects access/location. Required markings of means of egress: • Exit signs to include tactile exits signage. Required fire extinguisher Locations: • Locations per NFPA 10. Required Emergency lighting: •Show emergency illumination. Required Lightweight Truss Signage: • Location of lightweight truss signage per FAC 69A-60.0081 (if applicable). Please see below for clarification to requirement. http://www.col.net/Departments/Planning-and-Development/Docs/Building-Inspection-Division/bulletin-f-01-09-light-weight-truss-rule.aspx Also if occupancy is to have any permanent open flame devices such as fire pits, gas grills, patio heaters, gas lamps etc.they should be shown on life safety plan for approval. See NFPA 1 10.11 (separate fire permits will be required for installation of these features). 2. Floor Layout Plan: Document on plans the floor arrangement of furnishings or equipment to be used to substantiate the arrangement of means of egress and occupant load posting for each assembly area. Floor layout plan should show arrangement of means of egress per (NFPA 101 12.2.5). This layout shall constitute the only acceptable arrangement unless plans are revised, or additional plans are submitted. Temporary deviations from approved layout plans are allowed as long as occupant load is not increased and arrangement of means of means of egress is maintained per NFPA 101 12.2.5. 3. NEED FULL BLDG PLAN OF UNIT FOR REFERENCE OF SIZE AND LOCATION OF CHANGE. 2 \'x, 51 Pdlje 0i 7)11 rte+ /16 '3\!:Z MIGUEL Di PIERRI Fire Safety Inspector/ CDN Reviewer Hispanic Advocate MHAAB JFRD PREVENTION OFFICE 515 N.Julia St.,Jacksonville,Florida 32202 Office: 904-255-8561 cell: 904-763-1290—Email: DIPIERRI @ COJ.NET 3 \::\\\\.\\ ' Remove electrical outlets Remove/relocate • cabinets 4 \ , Remove wall structure to 2"below ceiling Remove/relocate Light switch r Remove door header and Transom to 2"below ceiling 4 Remove wall structure 1'-5" to 2"below ceiling —� ;fj Install new studs as required at end a of modified wall O Remove/relocate Thermostat POSSABILITIES TEAROOM MODIFICATIONS SIZE FSCM NO. WT GRP NAVSEA DRAWING ND. REV A X3 / 11 WALL V S SCALD 1/4'1 = l' O' SHEET 3 DF 4 A Iiir I Remove electrical Remove/relocate // outlets cabinets / / j Remove wall structure j to 2"below ceiling �/ i Remove/relocate i Light switch I Remove door header and Transom /11 to 2"below ceiling 14 0 . Remove wall structure — 1'-5"° to 2"below ceiling -- ;'rf,� ______ Install new studs as required at end ° of modified wall O a Remove/relocate Thermostat POSSABILITIES TEAROOM MODIFICATIONS SIZE FSCM Na WT GRP NAVSEA DRAWING Na REV A b3 / 11 WALL v IS SCALE: 1/4" = 1' 0" SHEET 3 OF 4 A NOTICE OF COMMENCEMENT State of r4 v 117t't Tax Folio No. County of Dt)V d- To Whom It May Concern: 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 statid in this NOT CE OF COMMS CEMENT. Legal Description of property being improved: C / 77 'lib (� � / , __ 2_5 '2-0 IG ; 063 CAW12-1) ' F E E72- �F4 JT ffc-b DO- R 17S 1 7 Address of property being improved: ICI 9A� lar4'!L Tulp � , 19�1�4 i_ V...1 4L- 7'2-773 General description of improvements: Tie"►9'1ti'V- Dryweiii fam NO4A+- ' 1 e(,4v, c Ai , i2e1.0Cde i•We Owner: ‘al'1'YIVA P*IC/ Lf ri�y � ► Address: 11255 „ rt.:;,, it 1'ir) SAY, )t- 322-50 Owner's interest in site of the improvement: Fee Simple Titleholder(if other than owner): Name: Contractor: e ) c i j Cr fr f 2-) Address: Ge) TANN yiitk_ ‘64,14et, — Telephone No.: qOL/ 7 5IY fal3 3 Fax No: Surety(if any) Address: Amount of Bond$ Telephone 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: Address: Telephone No: Fax 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 Statues. (Fill in at Owner's option) Name: Address: Telephone 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): THIS SPACE FOR RECORDER'S USE ONLY OWNER Doc#2020014342,OR BK 19074 Page 1930, led: Date: ,1/Le 40_2_0 Number Pages: 1 Recorded 01/17/2020 11:36 AM, ore me this /6/11 "'day day of -2of1/wYi/1'0,'o in the County of Du .1 State RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL -lorida,has personally appeare- 0 COUNTY :ary Public at Large,State of Fl. da �Gounty SfAl to V. A RECORDING $10.00 � �'"Y`o'' commission�}�xpires: :° �r=Notary Public-State of Florida sonally Knowny 4u/A4YE 4615 3• _ •` Commission#GG 913925 or oduced Identification: ;d;.' �Y Commission Expires September 17,2023 LOG NUMBER Busines ,(l5' Division of Hotels and Restaurants HQ 20 4454 Professionaldb r/hr FILE NUMBER www.MyFloridaLicense.com/ p Regulation 325398 PLAN REVIEW SPECIFICATION WORKSHEET Establishment must meet all standards of Chapter 509, Part I, Florida Statutes, and Chapter 61C-1&4, Florida Administrative Code 1 Establishment Name: POSSABILITIES PLUS INC 2 Review Type Current License Number: PENDING APPROVED ❑ New/Conversion Previous License Number and/or Name (if applicable): ❑ Remodel ❑ Closed at least one year Previous Licensing Agency: ❑ Department of Agriculture and Consumer Services ❑ Change Owner with Remodel ❑ Department of Health ❑ Division of Hotels & Restaurants WORKSHEET CODE KEY: S = Satisfactory NA = Not applicable U = Unsatisfactory—a plan cannot be approved with an item marked in this manner C = Caution —item is operationally based or cannot be determined by review and will be verified during onsite inspection 3 Construction Finishes Floor Wall Cove Base Ceiling Food Preparation SEALED CONCRETE PAINTED DRYWALL RUBBER WASHABLE TILE Food Storage LAMINATE PAINTED DRYWALL RUBBER WASHABLE TILE Dishwash Area SEALED CONCRETE PAINTED DRYWALL RUBBER WASHABLE TILE Bathrooms TILE PAINTED DRYWALL RUBBER WASHABLE TILE Dry Storage LAMINATE PAINTED DRYWALL RUBBER WASHABLE TILE Bar N/A N/A N/A N/A Note: Finishes in areas of moisture must be smooth, nonabsorbent and easily cleanable; Studs,joists or rafters may not be exposed in areas of moisture; Curved and sealed cove bases are required at floor/wall junctures. Sinks and Warewashing 4 S Manual washing, rinsing and sanitizing facilities provided: ❑ 3-compartment sink ❑ 4-compartment sink Location(s): ❑ Kitchen ❑ Bar ❑ Dishwash area ❑ Other 5 NA Mechanical washing, rinsing and sanitizing facilities provided: ❑ Dishmachine ❑ Glasswasher Dishmachine/glasswasher sanitizing method: ❑ Chemical ❑ Hot Final Rinse 6 S Drainboards or shelving/table equivalent provided at each end of dishwashing facilities 7 S Handwash sink(s) provided/accessible in food prep and food dispensing area(s) 8 S Handwash sink provided/accessible in dishwashing area(s) 9 Total number of handwash sinks shown 1 10 Food prep sink(s): ❑ 1-compartment ❑ 2-compartment ❑ 3-compartment Number shown: 0 Comments: DBPR Form HR 5021-011 Page 1 of 3 Revised 2013 April 04 Fire Safety 11 C Hood automatic fire suppression shown over cooking equipment(grease laden vapors) PER AHJ 12 C Portable extinguisher(s)shown PER AHJ 13 Public exit access does not go through kitchen /storage rooms / bathrooms / other high hazard areas ®Yes El No 14 Number of exits: Public: 3 Employee: 1 Total: 'f 15 Square footage of establishment: 2214 16 Building fire sprinkler system installed ❑ Yes ® No Equipment and Storage 17 NA Ice machine installed in enclosed area with outer openings protected 18 C Displayed/exposed food effectively protected 19 C Food preparation area protected from environmental contamination 20 NA Running water dipper well installed for bulk ice cream service or equivalent handling 21 S Equipment installed for cold holding potentially hazardous (time/temperature control for safety)food 22 S Equipment installed for hot holding potentially hazardous (time/temperature control for safety)food 23 C Dry storage area designated 24 C Maintenance and cleaning equipment storage area designated 25 C Employee personal article storage designated Plumbing and Bathrooms 26 C Plumbing system installed 27 S Mop/service sink; can wash -shown Location(s): BOH 28 S Water heating device Location: SEE PROVISO 29 Establishment type: ElStand alone ® Mall (strip/enclosed) ❑ Incidental ❑ Lodging associated ElTheme park/entertainment complex 30 S Public bathroom installed Type/Location Shown: El Bathroom for each sex ❑ Unisex only ElPublic bathroom(s)on same level ❑ Public bathrooms within 300 feet on same level 31 S Public bathroom(s)accessible to customers without going through food preparation, food storage or warewashing areas 32 S Employee bathroom(s) provided ® Same as customer bathroom(s) ❑ Separate from customer bathroom(s) Water Supply 33 S Type of supply: ® Municipal ❑ Onsite Well I Other Public well permit number: 34 Provider name: CITY OF ATLANTIC BEACH 35 Written approval/verification via: ® Copy of bill ElApproval form ❑ Provider letter {_.J Permit El Electronic account document El Verbal El Other Wastewater Disposal 36 S Type of system: ❑ Municipal ❑ Septic Tank ❑ Package Plant ❑ Other 37 Provider name: CITY OF ATLANTIC BEACH 38 Written approval/verification via: ® Copy of bill ElApproval form ❑ Provider letter II] Permit El Electronic account document El Verbal El Other 39 Septic tank system Permit number: [11Restrictions (see provisos) Tank size: gallons Drainfield: square feet Grease trap: gallons 40 Seating capacity per plan: ElInside seating ElOutside seating ®Total: 24 Projected number of seats contingent upon approval from local Authority Having Jurisdiction Comments: DBPR Form HR 5021-011 Page 2 of 3 Revised 2013 April 04 Plan Results 41 ❑ Plans approved without provisos 43 ❑ Plans denied (see provisos) 42 ® Plans approved with provisos (see provisos below) Provisos: 1) IF HAND WASHING VIOLATIONS ARE OBSERVED ADDITIONAL HAND WASH SINK(S) MAY BE REQUIRED. 2) PROVIDE LOCATION OF WATER HEATING DEVICE AT TIME OF LICENSING INSPECTION. 3) PLANS PROVIDED MUST ACCURATELY REFLECT ALL FOOD SERVICE EQUIPMENT AND ITS LOCATION IN THE ESTABLISHMENT. FAILURE TO PROVIDE ACCURATE PLANS COULD RESULT IN DELAY AT THE TIME OF THE LICENSING INSPECTION. 4) FLOORS, WALLS, COVE BASE, AND CEILING FINISHES IN ALL FOOD PREPARATION, FOOD STORAGE, AND WARE WASHING AREAS MUST BE SMOOTH, NON-POROUS, AND EASILY CLEANABLE. 5)THE THREE-COMPARTMENT SINK MUST HAVE DRAIN BOARDS ON EACH SIDE OR SHELF ABOVE SINKS. ❑ Variance approved VW# Date: ❑ Plans approved without provisos ❑ Plans approved with noted provisos (see provisos above) The following general provisos apply to all public food service establishments. ALL ITEMS WILL BE VERIFIED BY AN INSPECTOR AT THE TIME OF INSPECTION. Water/ Backflow Prevention 44 Hot and cold water supplied to all sinks where required (e.g., three-compartment, handwash, mop/service sinks) 45 If allowed by the local Authority Having Jurisdiction, warewashing sinks and machines may have a direct connection Lighting 46 Light fixtures shielded /coated /covered where food is stored / prepared / displayed or where single-service items are open /exposed Illumination—50 foot-candles in food preparation areas; 20 foot-candles in self-service areas, inside reach-in or under- 47 counter refrigerators, handwashing and warewashing areas, equipment and utensil storage, toilet rooms; 10 foot- candles in walk-in refrigerators and freezers, dry food storage areas Equipment Installation and Operation 48 Waste container(dumpster), grease receptacle, compactor, recycle bins on nonabsorbent surfaces (pad) 49 Local exhaust ventilation installed over cooking units releasing steam /grease laden vapors/smoke 50 Bathrooms ventilated / provided with windows; doors self-closing; doors/stalls constructed to insure privacy 51 Equipment, mop/service sink/can wash/compactor area properly drained to sanitary sewer; refrigeration waste piping discharges indirectly into floor drain or other approved receptor; Laundry facilities protected 52 Dishmachines have visual detergent and sanitizer delivery system or incorporate visual / audible alarm to signal if detergent and sanitizer are not delivered to the proper cycles 53 All hose fittings protected by backflow device; back siphonage/backflow protection if no air gap/break 54 Doors to exterior self-closing unless emergency exit Fire Safety Information (Requirements and Compliance by Local fire Authority Having Jurisdiction) 55 No mesh filters in hood with automatic fire suppression systems installed 56 All gas appliances have a nationally recognized testing laboratory seal such as AGA or UL 57 Class K and other portable fire extinguisher installed as required by NFPA 10 and/or local fire authority 58 Automatic sprinkler and fire alarm systems required for occupancies greater than 300 59 Exit doors open outward for occupancy greater than 49 60 Physical separation or vertical splash guard installed between fryer(s)and open flames of adjacent cooking equipment. Check with local fire authority for installment requirements Plan Reviewer: MONTRAIL HARRIS Date: 3/19/2020 Plans Returned via: ❑ Mail ® Email ❑ Shipping DBPR Form HR 5021-011 Page 3 of 3 Revised 2013 April 04 Florida Departmer r c Busines Division of Hotels and Restaurants `. Professional Reguiation www.MyFloridaLicense.com/dbpr/hr FIXED PUBLIC FOOD SERVICE OPENING/LICENSING INSPECTION CHECKLIST Please read all documents that are returned to you when your plans are approved. The Plan Review Specification Worksheet and the approval letter will list all items that you must complete before your establishment is ready for inspection and licensing. If you make any changes to the approved plans during the construction permitting process or during the build-out, you must immediately notify the Plan Reviewer. If you have alcohol beverage papers, they can be signed in the local district office once your plans are approved. Immediately after we received your plans, you were sent a letter advising you to mail your completed Application for Public Food Service License and correct license fee to Tallahassee. If you have not already done so, please attach a copy of the plan approval letter and send in your license application and fee at this time. Your application for license and license fee must be processed before an inspection can be scheduled. When construction is complete and your establishment has received all approvals for a Certificate of Occupancy from the local municipality (if applicable), you are ready for an inspection. If you have not already been contacted by your inspector, call the Customer Contact Center at 850.487.1395 to request an "Opening Inspection". You will be asked for your name, contact phone number, establishment name and address, and the plan review file number. Do not call to schedule an opening inspection unless you are absolutely ready. If all required items are complete, your inspection and licensing can proceed more quickly. Have the following at the time of inspection: Your copy of the division approved and stamped drawing (blue print)and specification worksheet Three-compartment sink installed and working properly. Drainboards provided (or equivalent shelving installed). All hot and cold holding units working correctly and provided with thermometers; stem thermometer, properly scaled (0 - 220°F) available to measure food temperature Portable and/or hood fire extinguishers provided with a current, valid tag; properly sized/mounted. Dumpster/grease barrel located on a nonabsorbent surface; drain plugs installed; tight-fitting lids. LP-gas/natural gas tanks properly installed and protected (if applicable); CO2 and helium tanks secured in place. Soap/paper towels/handwashing signs at handwash sinks; hot/cold water provided/functioning at all sinks. Consumer Advisory provided (serving raw/undercooked animal foods); oyster warning sign (serving raw shellfish) No bare hand contact with ready-to-eat food without an approved Alternative Operating Procedure. Backflow devices (vacuum breaker) installed on all threaded faucets; no utility lines installed horizontally on floor. Lights installed and functioning; light shields installed; no extension cords used. Chemical test kit provided (for manual sanitizing or wiping cloth containers), if applicable All floors, walls and ceilings smooth, nonabsorbent and easily cleanable; weather stripping installed (as necessary)around exterior doors; all raw wood sealed Exterior/bathroom doors self-closing; covered waste container in women's restroom Choking poster/information provided in area visible to employees DBPR Form HR 5024-017 2011 June 30 Florida d Pr Department of Business &Professional Regulation Ron DeSantis,Governor Halsey Beshears,Secretary MARCH 19, 2020 ARE YOU READY FOR YOUR INSPECTION? EMAIL: DHR.DISTRICT5©MYFLORIDALICENSE.COM With your file number File #. 325398 POSSABILITIES PLUS INC 1079 ATLANTIC BLVD SUITE 1 AND 2 ATLANTIC BEACH, FL 32233 Re: Division of Hotels and Restaurants Plan Review License Type: 2010 PERMANENT FOOD SERVICE Application No. 1227556 D517 Log No. HQ-20-4454 Dear Plan Review Applicant: Congratulations on your decision to operate a restaurant in Florida! I have approved the public food service establishment plans for POSSABILITIES PLUS INC, 1079 ATLANTIC BLVD SUITE 1 AND 2, ATLANTIC BEACH, FL 32233, as of 03/19/2020, with the following condition(s): 1)IF HAND WASHING VIOLATIONS ARE OBSERVED ADDITIONAL HAND WASH SINK(S) MAY BE REQUIRED. 2) PROVIDE LOCATION OF WATER HEATING DEVICE AT TIME OF LICENSING INSPECTION. 3) PLANS PROVIDED MUST ACCURATELY REFLECT ALL FOOD SERVICE EQUIPMENT AND ITS LOCATION IN THE ESTABLISHMENT. FAILURE TO PROVIDE ACCURATE PLANS COULD RESULT IN DELAY AT THE TIME OF THE LICENSING INSPECTION. 4) FLOORS,WALLS, COVE BASE, AND CEILING FINISHES IN ALL FOOD PREPARATION, FOOD STORAGE, AND WARE WASHING AREAS MUST BE SMOOTH, NON-POROUS,AND EASILY CLEANABLE. 5)THE THREE-COMPARTMENT SINK MUST HAVE DRAIN BOARDS ON EACH SIDE OR SHELF ABOVE SINKS. Please have the above information or proof of compliance with the conditions ready for the inspector at your opening inspection. The conditions listed above are required to pass your opening inspection. Please include the file number and log number listed above on any documents submitted. Your plans are only approved as submitted to us and with the above conditions. Changes in proposed operational procedures may require additional equipment and certain changes may require a new plan review. If you decide to change the menu, equipment or operation, please notify us immediately. Your plan approval is valid for one year from the date of this letter, so you must license the proposed establishment before then. If your plan approval expires after a year, you may have to complete the plan review process again. If you are no longer in charge of this project, please forward this letter to the correct person or company. When the construction is complete, please email Dhr.district5@myfloridalicense.com to request contact from an inspector to schedule an opening inspection. Be ready to provide the file number located at the top of this letter. Please allow 1-2 days for the inspector to contact you to schedule the inspection. Good luck with your enterprise! Sincerely, Montrail Harris, Plan Reviewer Montrail.Harris@myfloridalicense.com Phone: 850.487.1395 Division of Hotels&Restaurants www.MyFloridaLicense.com Plan Review Office License Efficiently. Regulate Fairly. 2601 Blair Stone Road Tallahassee, FL 32399-1011 Revision Request/Correction to Comments "ALL INFORMATION HIGHLIGHTED IN City of Atlantic Beach Building Department GRAY IS REQUIRED. - 800 Seminole Rd, Atlantic Beach, FL 32233 r Phone: (904) 247-5826 Email: Building-Dept@coLIb.uu, PERMIT#: L.- 061(t\ Z° 0004 — Vi Revision to Issued Permit OR /� n Corrections to Comments Date: 217 j i.J 2-V Project Address: �1 ) �7 4/�G4t- /-d Contractor/Contact Name: C-0167/14,Citjv 5C1zoal; /n.Nt�'f}Trcri It z.) Contact Phone: ICL/ 7 ' l I[r-13 Email: Description of Proposed Revision /Corrections: /-/ c cec �y f'lr n e:((1)!.S I C*Kt ()et rA)1Z ' affirm the revision/correction to comments is inclusive of the proposed changes. (printed name) • Will proposed revision/corrections add additional square footage to original submittal? tNo Yes (additional s.f. to be added: • Will propose_d revision/corrections add additional increase in building value to original submittal? �No .*Yes (additional increase in building value: $ ) (Contractor must sign if increase in valuation) •Signature of Contractor/Agent: / (Office Use Only) Approved ‘/Denied Not Applicable to Department Permit Fee Due Revision/Plan Review Comments ("c_. t v\ ./\"\ i `�'�r r t✓' It /L;D rs Department Review Required: Building Planning& Zoning ftl'CL--‘i'iewed By Tree Administrator Public Works Public Utilities 2 - y Lo 2,c) Public Safety Date c_Fire Services Updated 10/17/18 Dipierri, Miguel Comm 20-0004 Occupant Load &Capacity of Means of Egress: Please re-calculate occupant load as follows Occupant load is determined by the nature of the"use"of a building or space and the amount of space available for that"use".NFPA 101,Table 7.3.1.2 has established occupant load factors for each"use.The use of an area may differ from its occupancy classification.For example,a meeting room for fewer than 50 people in an office building is not assembly occupancy;it is business occupancy,but its occupant load is based on assembly. Fire Code specific code summary The building code and fire code differ on occupancy types,uses,and occupant loads and can make the proper application of the code difficult.For example the building code classifies restaurants under 50 as business where the fire code classifies them as mercantile,thus the need separate code summaries.Please provide in addition to normal building code summary a fire code specific summary based off the Florida Fire Prevention Code(current edition)to include all the following information listed below.Failure to provide accurate fire code summary may delay plans review approvals as we return plans for corrections and clarifications. Provide required Fire Code specific code summary:Please Reference 69'Edition Florida Fire Prevention Code Based on NFPA, 1 Fire Code 2015 Edition& NFPA 101 Life Safety Code 2015 Edition. •Occupancy type sub-classification(per NFPA 101 6.1) Life Safety Floor Plan: The City of Jacksonville's Fire Marshal's Office requires the submittal of a Life Safety Floor Plan for building permits for all new construction and existing building alterations in order to ascertain if occupancy is currently code compliant and to assist fire inspector in performing Life Safety Inspections.Please provide a Life Safety Plan to include all the following information on one page. If Life Safety Plan was submitted and you are receiving this comment,it means that all of the required info listed below was not included in your original submittal.It is understood that all listed items may not apply in your situation. Required Occupant Load Calculation: •Provide design occupant load using table 7.3.1.2 of NFPA 101 2015 edition.Area calculations should be shown with graphic seating configurations or fixtures in order to substantiate occupant load chosen. Exit Locations: •Designate main entrance and all secondary exits.All required exits shall terminate at a`public way".Access to the public way shall be accessible and must be via a stable,firm,and slip resistant conveyance such as a concrete sidewalk with a min.5'x5'landing and 44"walkway. Multi story buildings should designate area of rescue with required communication means.Separation of exits using the one half(non-sprinkled)or one third(sprinkled)the diagonal distance rule should be shown on plans. Required Egress Capacity: •Egress inches for means of egress components(doors,stairs,etc.) Required measurements:(Worst case only need be shown.) •Dead end corridors measurements. •Common path of travel measurements. •Total travel distance to exits. Required separation: •Show all fire barriers,smoke barriers,and smoke partitions.All rated walls per new directive from building official wall detail needs to include UL listing and needs to confirm by architect or engineer as being accurate. Required Lock Latch details: •Lock/Latch details Panic Hardware,Thumb turn lock,Key Lock with indicator and required signage. Required Electrical Stop/Disconnect Details: •Any required Emergency stops or Shunt trips. •Main Electrical disconnects access/location. Required markings of means of egress: •Exit signs to include tactile exits signage. Required fire extinguisher Locations: •Locations per NFPA 10. Required Emergency lighting: •Show emergency illumination. Floor Layout Plan: Document on plans the floor arrangement of furnishings or equipment to be used to substantiate the arrangement of means of egress and occupant load posting for each assembly area.Floor layout plan should show arrangement of means of egress per(NFPA 101 12.2.5).This layout shall constitute the only acceptable arrangement unless plans are revised.or additional plans are submitted.Temporary deviations from approved layout plans are allowed as long as occupant load is not increased and arrangement of means of means of egress is maintained per NEPA 101 12.2.5. Cooking Area Need to show equipment 2 Equipment list Three compartment sink 1 Tea bar 11 Hand wash sink 2 Coffee bar 12 Prep area 3 Microwave 13 Cabinets/ Storage 4 Refrigerator/ freezer 5 cabinet/storage 6 Table Chairs 7 Grease trap ( outside) 8 Dumpster ( outside) 9 Mopsink ( outside) 10 • MIGUEL Di PIERRI Fire Safety Inspector/CDN Reviewer Hispanic Advocate MHAAB JFRD PREVENTION OFFICE 515 N.Julia St.,Jacksonville,Florida 32202 Office:90.1-255-8561 cell:904-763-1290—Email:DIPIERRI@COJ.NET 3 Existing Power Panel (Typ)—\ FEXT 0 Exit l CD <0 ` Exit I Tea Roam ii Kitchenrr. __=__—__ ii __II .I[ J SmokeII Tea Room / Detector I i Tea Room II I Thrift and Break Room Resale Area I RI{ epurpose Room G' Smoke DComputer etector Office11 Room iExit `� Exit it I Secutity Panel FEXT SAFETY PLAN � .__ . __ PossAbilities Plus SCALE: 1 /0' = 1' -0' j SHE E T A Existing Power Panel (Typ) \ FEXT Exit 0) ® Exit zalIf ,, If _—__, Tea Room �� II Kitchenli y 3! _____ _JIliDSmoke Tea Room 1{. Detector----/ 1 11 Tea Room i .1{. 1 Thrift and Break Room Resale Area I Repurpose Room Smoke Computer s> \Detector Office I{ I[ Room Exit I Exit /- IV \Ill Secutity Panel - FEXT Secondary Exit Power Secondary Exit E of ' Panel (Typ) ® 40'` q - ;i • IIFEXT (o ,— :-. ; f Ic i...T Room 1_� i Kitchen 1 J L Smoke7 `~' Detector + c 11 '.Tea Room♦ t, I 3 i L Break Room 11°1 aS o Thrift and 4 Fa Resale Area 1) U o U Repurpose Room 1 Alarms--\ Computer Office Room FEXT Secutity Panel 1 1 ) 1 Irr `. ' ntrance/Exit Secondary Exit F 1 OD SERVI PLAN REVIEW 020 Reviewer yr� Date Plans are in compliance subject to: 1)Connection to approved water and wastewater systems. 2)Compliance with applicable state and local codes. P os sAb i liti e s P I u s 3)Compliance with all provisos on specification worksheet. _ -- -- Seeile# Commicents on Specification Sheet S( 1 /8'1 1 - SHEET A PRODUCED BY AN AUTODESK STUDENT VERSION Parking Secondary Exit Secondary Exit FEXT r '� �2 Power -TfE / O. < �,`� Panel (TYP) ,--, 10 00 r -� Tea Room c Break Room (15 Persons) ) l 0 (2 °' U 0' 0 0 ca 06 0 0 a) a`i Smoke Detector 0 "" U \ --1 ® 0 � Tea Room X n ��, (8 Persons) 17 Ce w w � ���� E .�iC LU �� Jacksonvllie Fire Prn_veniion Qi'' �[ f I— cr 2 MAY 1 S 20 2O CI l l I r 0 �/� p z W {>1 No EXCEPTIONS 1 CC r!'// = D EXCEPTIONS N�� n ' t I f O 1C • 1 i Break Room c' C Wcc al (3 Persons) cr o C 0 i cl, G ii Thrift and L. m _ Resale Area = w Q o cCA Z ~ � 8 C Repurpose Room C m (3 Persons) Z W C D Alarms--\ 77 O x < Computer Z 3. ; Office Room FEXT (2 Persons) (3 Persons) Secutity Panel Exterior Walkway Main Entrance/Exit Secondary Exit . Parking OCCUPANCY _ PLAN PossAbilities Plus