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1820 Mayport Rd DEMO19-0008 Submittal ri��;ir, . City of Atlantic Beach APPLICATION NUMBER J' - '-:•:,, •jS Building Department (To be assigned by the Building Department.) �� 800 Seminole Road t t " t DOD ' Atlantic Beach, Florida 32233-5445 o �� Phone(904)247-5826 • Fax(904)247-5845 11 ' L %,�;,;� E-mail: building-dept@coab.us Date routed: 3 F� t City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: Ka O /t"1tut.00.1'\---e.A D ent review required Yew No ,(� /1 C Building t/ Applicant: i i�St.�t`Ct.1 11_ Cbn it.J (S Planning &Zoning Tre _ inistrator Project: O -Z. (Y1 U Q j ,b,.,l_,1�,�-tn <� cs -(2ublic Utiliti Public Safety Fire Services Review fee $ Dept Signature --- ) Review or Receipt ` Other Agency Review or Permit Required 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: [proved. (Denied ❑Not applicable (Circle one.) Comments: BUILD! 0. PLANNING &ZONING //y1 Date: //41/ze)19 Reviewed by: / r J 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 City of Atlantic Beach APPLICATION NUMBER sc)(r-.0,i-V1 r� Building DepartmentliAL:..---GEr (To be assigned by the Building Department.) r j 800 Seminole Road (�L .)t o 1 et 0�Q j., Atlantic Beach, Florida 32233-5445 P �} l.� Phone(904)247-5826 • Fax(904)247-5 5 MAR 1 2 201.E 1 �j;i E-mail: building-dept@coab.us Date routed: 3 (4 1�� City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: t Ka O ivicutpol'ke-tY • D ent review required Yes No �� Building Applicant: .\kC&c' D? I a1-(-t\(�-t )1G� bnic(,�C,--j)(S Planning &Zoning J Tre- :•1 inistrator Project: (1.L(IA V Q._a. taci-i t � �,:.:,_ s Public Safety Fire Services Review fee $ Dept Signature / -Th1 Review or Receipt Other Agency Review or Permit Required of Permit Verified By Date .ie ()C./ 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: E 'Approved. Denied. ❑Not applicable (Circle one.) Comments: BUILDING , PLANNING &ZONING Reviewed by' Date: (1-Mir TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: F 'Approved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 i.:Ly% City of Atlantic Beach APPLICATION NUMBER /s ii' Building Department (To be assigned by the Building Department.) �_ 800 Seminole Road Nb �t p CI ��Q Atlantic Beach, Florida 32233-5445 U J� ~~ Phone(904)247-5826 • Fax(904)247-5845 ,-,-6„,,_,,-, E-mail: building-dept@coab.us Date routed: 3 I 0" Ir K) City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: Kia O r1tt-Val-t- -L( • D�.papneent review required Yes No n t ` (Building) Applicant: ( i 61-4:(\� 1 1-1,_, bn- t c-fc 3 Planning &Zoning Treinistrator Project: (akin () Q Ad1:t/ll .P • .e erks Public Safety Fire Services Review fee $ Dept Signature i0C./. Review or Receipt Other Agency Review or Permit Required 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: I pproved. nDenied. ❑Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING C........--- 4.----/------Date: 31.3- 5 Reviewed by: , 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. nDenied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 OFFIUL UUI"Y %Siiiill Building Permit Application Updated 10/9/18 City of Atlantic Beach Building Department **ALL INFORMATION 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY �` Phone: (904) 247-5826 Fax: (904) 2475845 Email: Building-Dept@coab.us IS REQUIRED. Job Address: Pb A G (Ci - (-)coy /I�111/�O,C.T �C3AD Permit Number: O /O ) Legal Description /'J -ai- 1 y E : .:2 6, Rut / 7.20 15- . 674649 co ,..., .1 IP,-,-, D Valuation of Work(Replacement Cost) $ 5/ Deb— Heated/Cooled SF Noic k‘Weid/,Cgo e f;,.„ • Class of Work: ❑New DAddition ❑Alteration ❑Repair ❑Move El Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ✓®Commercial ❑Residential BAR 1 1 • If an existing structure, is a fire sprinkler system installed?: ®Yes l No LLI N • Will tree(s) be removed in association with proposed prosect?Wes(must submit separate Tree Removal Permit) Describe in detail the type of work to be performed: Building Departinet 2 \, City of Atantic Brty'1, ACM 6 o al/ i/II9 - 6 .5 Sai/o/.o q GtiA1-)/ W1 Florida Product Approval# NI4for multiple products use produ teOpp,r, .l4brmi r 0 n Property Owner Information Name df/ K/o/2 Lc- C- Address (OVS"/7)4yPO,eT 2d ieirz A Z p Q City ATLAtNT. C BEACI-, State 1:4- Zip 3:2.2 33 Phone 90 y .?y7- _.5-3.3(4 ":: u) r-..c N. E-Mail .T,C/e72 Lam' Ansr,AI= v 4 - 6dm CC d w Owner or Agent (If Agent, Power of Attorney or Agency Letter Required) n/a 0 i� a D UJ W is Contractor Information ❑ } a cc m W w ra Q Name of Company/7)4.5/-6ZBpi/D/� � �� T�C`7�leS Qualifying Agent 264X1 C, ../7044)../7044)..00hf1/ I- W p W Address S/f4 AJ/)1TiV�e C.-RNC City 9TG,g, , 86-40i State FL. Zip iiit20 Office Phone 9oY riP 3 • 7,195 Job Site Contact Number 9e V V 6 3 7S-)5 %' State Certification/Registration# CBt_/a 537)y3 E-Mail JEAu e,m/?NSo4" 99q C� 47,44.1 • 4Th cc Architect Name& Phone# ,0/(9 Engineer's Name&Phone# /(,/`A Workers Compensation Insurer///iAJOiL //),47 ON4/ ZA/Su,2//"-ice eO OR Exempt ❑ Expiration Date D iJc, / 2Oi9 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 PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER_OR AN AT ORNWY-BEfORE-- - RECORDING Y UR NOTICE OF COMMENCEMENT. c� C, r�` ( ignature of wneror A nt) (Signature of Contractor) Ca Signed and sworn to (or affirmed)before me this /9 T07day of Signed and sworn to (or affirmed) before me this. day of L/E_l'&A1 1 ,�U/,f , by t il=J ,C/0-7-aJAn.1:tA�_/ , a- /�j , by -J 4f4) C C. 7-i,hN5',.,;11/ v '(Signature of Notary) (Sips :Pre ofL 9,akt3INDER t4.® . NOTARY PUBLIC �Vr..,p LISA A.BINDER .? STATE OF FLORIDA :; NOTARY PUBLIC PersonallyKnown OR Known OR Ali [ ) aTATE OF FLORIDA )(Personally ,,.,,.... . Comms FF189043 [ ]Produced Identification e. 1 ` C®rtreVt FF189043 [ ) Produced Identification °CE le Expires 1/12/2019 PUBLIC UTILITIES PLAN REVIEW COMMENTS Date: 3/ I l Application#: lem 0/ [ - OOdes' Project Address: IS Z 0 PA01po( 1 Check Box Check APPLICATION TRACKING COMMENTS to Add Box to Commen Print Underground Avoid damage to underground water and sewer utilities. Verify vertical and Water Sewer horizontal location of utilities. Hand dig if necessary. If field coordination is I� Utilities _ needed, call 247-5878. Meter Boxes Ensure all meter boxes, sewer cleanouts ann'• ,set to grade Sewer Cleanout and visible. ❑ 0 A sewer cleanout must bo ' Iut must be RT1 Sewer covered with an p' I.set to grade 0 0 Cleanout and visible. a, Li A reduced pres \Cligation will RPZ be provided ori \\ � "reventer El ❑ Backflow must be tested b G`� �� Utilities. Public \' \• �\e Plans note the builtC 7 ,e Sensus installed must be m. \. 7 �t(�(�� /sized Touch-Read vault and an appropr, ?-3 der 0 0 Meter must be tested by a ce Utilities. \\ Fire Sprinkler �/ Backflow If fire sprinkler system is rr(� �,,�rements. ❑ 0 Requirement At a minimum, will require anter. Fire Line Fire lines must be metered\ touch-read meter. Meters larger 0 0 Meter than 2" must be installed in a _uit as noted in JEA specifications. Utility Map See attached Utility Map. 0 0 Disconnect &Cap Disconnect -nd cap water and sewer lines. 0 [r /" r Inspection , . t call the Inspection Line at 247-5814 to request an inspection of the \ fl , , Prior disconnected and capped water and sewer lines prior to demolition. --.) ❑ ❑ ❑ ❑ ❑ 0 O 0