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Property Address:
City of Tybee, Island, Geo,rg,
912-472-5030 912-786-95
1
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APPLICATION FOR BUILDING PI=RM
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Name affin Address Telpnhnnr4
Horne: �-J 64 4i z5-4
Owner
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Architect Off ice:
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Contractor t
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Check all that apply
Single Family Discovery/Tearout Demolition or Relocation
a'Duplex Q Footprint Changes Other
[] Multi-Family _ units ❑ additional square
E] * Commercial unit(s) feet heated /cooled
Estimated Cost of Construction: $ 0 9 (materials + labor + profit/overhead)
If. applicable, attach a copy of the certified elevation certificate and/or survey of the property. Depending upon
the scope of the work, two sets of construction drawings and/or a site plan may be required.
Year Built: Listed on National Historic Register or located within, a National Historic District? Y / N
• Buildings older than 50 years may be eligible to be listed on the State / National Register. With this designation, you
may be eligible to take advantage of various tax incentive programs while preserving the heritage of Tybee Island.
• Also see the Tybee Island Land Development Code Article 14: Historic Preservation
During construction:
On-site restroom facilities will be provided through
by by means of _
. Construction debris will be disposed
understand that I must comply with KQR!o flood
6ens, 1 r,ealize that I must en is prope y so a surrounding property is in no way
adversely affected as required by Article 16, Stormwater Management. I accept responsibility for any corrective actions
that may be necessary to restore drainage impaired by this permitted consiruction,
t5unaing umuw
Water/Sewer
Storm/Drainage
City Manager
LEAD-BASED PAINT RRP RULES
Ordinary renovation and maintenance activities can create dust that contains lead. Contractors who perform
renovation, repairs, and painting jobs in pre -1078 housing and child-occupied facilities Must, before beginning
work, provide owners, tenants, and child-care facilities with a copy of EPA's lead hazard information pamphlet
Renovate h , Im
portarLt Lead Hazard information for Families, Child Care Providers, and S ools
_qh .
Contractors must document compliance with this requirement. After April 22, 2010, federal law will require you
to be certified and to use lead-safe work practices, Georgia Environmental Protection Division Lead-Based
Paint and Asbestos Program (404) 363-7026.
Asbestos/Environmental Notification to Georgia EPD for
renovation
The undersigned hereby acknowledges that the issuance of this permit does not in any way grant permission
to the owner, owner's representative, or permit holder to proceed with demolition, wrecking, or renovation of a
structure prior to the filing of any required ten (10) day "Project Notification for Asbestos Renovation
Encapsulation or Demolition" form in accordance with the Georgia Asbestos Rules. The (3eorgia
Environmental Protection Division administers the rules. In most cases, the rules require both the owner and
the involved contractors to assure the portion of the building involved in the project is thoroughly inspected by
an Accredited Asbestos Inspector for materials that contain asbestos; and the removal of the asbestos before
renovation, wrecking, or demolition begins almost without exemption. Georgia EPD requires a completed
demolition notification from be submitted 10 workings days in advance even if no asbestos is present in the
building. Further guidance for regulatory compliance and contact telephone numbers are provided by the
brochures entitled Asbestos & Renovation and Asbestos and Demolition, Other environmental issues such
as asbestos removal techniques, lead abatement, ground contamination, or unusual site conditions may have
EPD regulations that could affect the project.
B fill Cg's
While BMP deficiencies are not necessarily the fault of the owner or his agent, BMPs are their responsibility.
rwo areas of deficiencies are in the most basic and common BIVIPs; Co — Construction Exit and Sdi _
Sediment Barrier. Correct installation information can be found in the Field Manual for Erosion and Sediment
Control in Georgia, Fourth Edition 2002, Georgia Soil and Water Conservation Commission;
hitp: w—ww.gaswcu.org:/docstfieid_rTiarival— d.pdf.
�4e
Problems with the Co is not limited to the installation, but to material, The stone will be a representation of
1 5"-3,5:" stone or larger,
Type A sediment barriers have been installed where Type C is required and shown on the permit drawings.
Where two rows are called for they will be installed with a separation that allows for the first one to fall (fall
over) without impacting the second one. The complete assembly and installation must be compliant; steel or
wood posts, post spacing, Type C or A.
re for receipt of Lead Paint, Asbestos, and BMP notices
Printed Name
Date
DATE ISSUED: 12-16-2014
OWNER nAME
ADDRESS
CITY, ST, ZIP
011�
F.
ADDRESS
CITY STATE ZIP
PROJECT VALUATION
CITY OF TYBEE ISLAND
ROBERT BERGI,UND
2 RIVERVISTA DR
CI-1ATTANOOGA TN 37405-4331
t
604 SUNCRESTBI,VD
SAVANNAH GA 31410
p
$ 70.00
4-0007-01-017
PERMIT #: 140817
TOTAI, BALANCE DUE: $ 70.00
It is understood that if this permit is granted the builder will at all times comply with the zoning, subdivision, flood control, building, fire, soil
and sedimentation, wetlands, niarNillands protection and shore protection ordinances and codes whether local, state or federal, including all
environmental laws and regulations when applicable, subsequent owners should be informed that any alterations to the property must be
approved by the issuance (if another building permil. Permit holder agrees to hold the City ofTybve Island harmless on any construction
covered by this permit.
This permit must be posted in a conspicuous location in the front of building and protected from the weather. If this perinit is not posted work
will be stopped. The building contractor will replace curb paving and gutter broken during construction. This permit will be voided unless
work has begun within six months of the (late of issuance.
Signature ol'Building Inspector or Authorized Agent:
P. 0, Box 2749 - 403 Ruiler Avenue, Tybee Island, Georgia 31328
(912) 786-4573 • FAX (912) 786-9539
Chatham County Board ol'Assessors: 2013 Pr, -ty Record Card 4-.,. hitp://bo t.ch�ithaiiicounty.org/DesklopMo(iiiles/Chathaii)Couiity/13oar...
1�
EXTRA FEALUnIES
ID#
BLDG# SYSTEM DE�SC
DIM 1 DIM 2 UNITS OF UNIT PRICE RCN AYB EYB DT ECON FUNC SP SP% FCNLD
MKT VALUE
85504 RESIDENTIAL ELEV 42"'
0 0 1.00 G 17,000 00 17,000 1996 1996 6R 14,790
14,800
ELEVATOR
LAND
ID#
USE DESC FRONT
DEPTH UNITS/TYPE PRICE ZONING LCTN TOPO OTHER ADJ1 ADJ2 ADJ3 ADJ4
MKT VALUE
109931
CONDOfTWNHN UNITS 31
75 31,00-FF 19000.00 R2 DP-30
412300
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Chatham County Board of Assessors; 2013 Pr, ity Record Card 4-.,, http://L)oi.cliathaiiicoutity.org/DesklopMocluies/Chithit-nCoujity/[3o,,ir...
2013 Chatham County Board of Assessors 4-0007-01-017'
Property Record Card 1 11TH ST UINIT A TYBEE ISLAND
BUILDING SECTION CONSTRUCTION TYPE RCN AY B EYB DEP TYPE PHYS ECON FUNC OBSV/'/. TOTAL DEP% ACNLD U.FACTOR M Kr VAL
85504-1-2013
1 Residential 267362 1996 MS
16.00 0.00 0.00 0.00 16.00
224,5'84
224,600
- - ----- ---------------
SECTION' TYPE
1 - Main
AREA
2344
TYPE
5 - Duplex
FRAME
I -Stud Frame
STYLE
2 - Two Story
QUALlTY
5,00
CONDrrjON
300
# UNITS
0
# OF BEDS j BATHS
31 2.10
COMPONENTS
Units
% QUAL
R1 109 Frame, Stucco
100.00
R2 208 Composition Shingle
100.00
R3 352 Heat Pump
100.00
R4 402 Automatic Floor Cover Allowance
�R6 601 Plumbing Fixtures
11.00
R6 602 Plumbing Hough-ins
1 M
[Click for larger picture]
:R6 622 Raised Sunfloor ( / or SF)
I
100,00
'R7 721 Carport, Fiat Roof (SF)
75200
H1 -11 ST UNIT A
F111 903 Wood Deck (SF)
24.00
R11 904 Slab Porch (SF) with Roof
9000
R11 904 Slab Porch (SF) with Roof
9000
R11 904 Slab Porch (S F) with Roof
9000
Rll 904 Slab Porch (SF) with Roof
45.00
Fill 904 Slab Porch (S F) with Roof
45.00
Fill 904 Stab Porch (SF) with Roof'
45.00
Fill 904 Slab Porch (SF) with Roof
45.00
Fill 904 Slab Porch (SF) with Roof
45,00
R11 904 Slab Porch (SF) with Roof
72.00
2 of 2 12/16/2014 10:07 AM