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538 ATLANTIC BEACH CT - PERMIT DWAY18-0019 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE.247-58-14 DRIVEWAY - SINGLE OR TWO FAMILY DRIVEWAY MUST CALL BY 4PM FOR NEXT D"INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: DWAY1 8-0019 Description: PAVER DRIVEWAY Estimated Value: 5000 Issue Date: 6/12/2018 Expiration Date: 12/9/2018 PROPERTY ADDRESS: Address: 538 ATLANTIC BEACH CT RE Number: 1695051400 PROPERTY OWNER: Name: HATCH KATHRYN A Address: 538 ATLANTIC BEACH CT ATLANTIC BEACH, FL 32233 GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Name: Address: Phone: PERMIT INFORMATION: Please see aftached conditions of approval. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. 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. * A notice of Commencement is only required for work exceeding an estimated value of $2,500. For HVAC work, a Notice of Commencement is only required when HVAC work exceeds and estimated value of$7,500. mgz�y_ City of Atlantic Beach NMI WA APPLICATION NUMBER a TAECrE1V —__-Uo e ass' ned by the Building Department.) Building Department it b ig 800 Seminole Road ea �N 00 P t ant c ch, Florida 32233-5445 JUN 0 5 2013 Phone(904)247-5826 - Fax(904)247-584 C E-mail: building-dept@coab.us Date routed- P, B Y.- City-web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM IDepartment review required Yes No Property Address: S3 P\4 C�_rA 6� Building i E Applicant: _0 ux�r\e C_ anning &Z�� T _56 Ad_m­i�nisrator re _u Ii Project: Wkd_e0(nQ C� (\1 Ci C00 ( J -C- -3 1 Public i i ie �_o (:).,—v(2 _s, [Public Safety I Fire Services R�V�, f6—e $. ----De—ot—Siq—n--a-t-u---re - 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 Departm ent First Review: VApproved OlDenied. [—]Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed b Date: TREE ADMI.N. Second Review: DApproved as revised. F]Denied. E]Not applicable ZP __l30C,-WQR-K-§--" Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: DApproved as revised. []Denied. []Not applicable Cornments: Reviewed by: Date: Revised 05/19/2017 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road flantic Beach, Florida 32233-5445 -5826 - Fax(904)247-5845 Phone(904)247 -mail: building-dept@coab.us uted: MS E Qatero City web-site: http://vmw.coab.us 11 APPLICATION REVIEW AND TRACKING FORM . (2-4, Property Address: s2)R r—\4 � c�_" 9, &c.c� Department review required Yes No Building _Z C:fEnn�iFg-&--�oning_:� Applicant: 0 L'or\p C_ 1 Tr&b Admin-is-fr—ator Project: Wk6P_n('/'\Q (V C-1 wo u -ic T or -3 PubI-ic7DTNFie_s_— + Public Safety L c"Y ec__ _S_ Fire Services 'Review fee $ Qinnt (zigRature 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: .,�Approved. ElDenied. [-]Not applicable (Circle one.) Comments: BUILDING RE-A N N I N G-&-Z 0 N I N T Reviewed by:AK Ai�! Date: TREE ADMI.N. Second Review: F]Approved as revised. E]Denied. F]Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: F]Approved as revised. [:]Denied. ONot applicable Comments: Reviewed by: Date: Revised 05/19/2017 Building Permit Application Updated 12/8/17 City of Atlantic Beach 800 Seminole Road,Atlantic Beach,FL 32233 Phone:(904)247-5826 Fax:(904)247-5845 D\NAGI 00 Job Address: 530 Ltyol Permit Number: Legal Description RE# Valuation of Work(Replacement Cost)$ �LD Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): (4� Addition Alteration Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial EE;�,al . • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A • Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal Describe in detail the type o work to be performed: I Uld-U)at W tj�?_(s, Florida Product Approval# for multiple products use product approval.forim Property Owner-information Name: Y,6,+�,,��, -A- <�01�ict- Address: City a.irAi C State Zip Phone D.TTO E-Mail i"gxte_� C6 w-, Owner or Agent(if Agent, Power%f Attorney or Agency Letter Required) Contractor Information Name of Company: Qualifying Agent: Address City_State Zip Office Phone Job Site/Contact Number State Certification/Registration# E-Mail Architect Name&Phone# Engineer's Name&Phone# Workers Compensation Exempt/Insurer Lease Employees E�piration Date Application is hereby made to obtain a permit to do the work and installations as�'inclicatecl.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 regulationg 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%N,'@]Til'.C*E-.11-nTa'dZiit-ionTtoTt�,h-elTq'gligLew-gn, girmil e e a iWIF—est-ra iQaalica5le E) e NMI -nW. e"ul5iiir6eco—r�-srofithiisiou 11" 11-3 Q I Q ;M it -17, 1 Men J_fiF_jLMI entiasswar,,erdimaMagemj2�[i:to,is-i-rii��-elage cie Q _9 ,;rieW=addiit',iU,n—a[Foer—fiM,i=e uiEdt�off.- & TLRIZ�allajgeLggs 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 RECORDING YOUR NOTICE OF COMMENCEMENT. Z (Signattlire of Owner or Agent) (Signat Contractor) (including contractor) (day o �70f day of Signed and sworn to(or affirmed)before me this c Signed and sw med)before me this iFNN FER JolimsToN �A 10 my 40P*1_11' COM�ISSION#GG 042984 (Signature of Notary) (Signature of Notary) F_)(PIRE.S:October 27,21320. v%I. ters d d lbru NGWry Public U B on ona y nown OR I Personally Known OR V-'roduced identification ]Produced Identification Type of Identification: co', Type of Identification: lci - -1 REVOCABLE ENCROACHMENT AGREEMENT REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach,Florida,a municipal corporation organized and existing under the h1ws of the State of Florida,hereinafter referred to as"CITY"and of Atlantic Beach,Florida,hereinafter referred to as "USER WITNESSETH: That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon the property for the purpose as described in the City of Atlantic Beach. This work is generally described as Any facility maintained, repaired, erected, and/or installed in the exercise o?the privilege granted remains subject to relocation or removal on thirty (30) days' notice by CITY to USER, said notice to USER shall be ' n by, certified mail, return receipt requested,to the following address 5 39, <g10"u\4, * In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter upon the above described casement or property of the CITY,the USER shall replace at the USER's sole expense, any and all material necessarily displaced during the action of maintaining,repairing,operating,replacing or adding to of the utilities and facilities of the CITY or franchise utility provider. * The facilities allowed by the permit shall meet the current requirernents of the City Code, Building Codes,Land Development Code and all other land use and code requirements of the CITY,including City Code Section 19-7(h) which states "Driveways that cross sidewalks: City sidewalks may not be replaced with other materials,but must be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks." * The USER,prior to making any changes from the approved plans and/or method,inust obtain written approval from the City of Atlantic B each Public Works Department,for said change within 3)0 days after the day of completion. * This permit shall inure to the benefit of,and be binding upon,the USER and their respective successors and assigns. * USER shall meet the terins and conditions of this permit and to all of the applicable State and CITY laws and/or specifications,to include utilities locate requirements and use limitations/requirements.of easements, public right- of-ways and other public land. USER ftirther agrees that the CITY and its officers and employees shall be saved harmless by the USER from any of the work.herein under the terms of this permit and that all of said liabilities are hereby assumed by the USER. Date Property Owner/Ageni(signed in presence of Notary Public) STATE OF FLORIDA, COUNTY OF DUVAL The foregoing instrument was acknowledged this day of 520 by ck�, who personally appeared before me and (printed narne oP Signer) acknowaged that he/she signed the instrument voluntarily for the purpose expressed in it. SignaturelyNotary Public, State of Florida Department Approval: Personally Known Produced Identification(Type) tf)-, Scoff W'1-1li'a*rn,s,Public Work�-Dfr(;dc�i-/ Kayle Moore,Public Utilities Director -R�n JENNIFER JOHNSTON WQ�r I'cindewwomwodgmDur Revocable Encroachment Agreement 2.5.18.docx -Date:MRFS:October 27,2020 8onded TKru Notary Public Undanyriters RIGHT-OF-WAY EASEMENT PERMIT Permit Issued by the City of Atlantic Beach PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES JobAddress 5.3!z Phone �A54- �t-31 ,20,9'qo Permittee Email C1 oq -3,7 J_- I % , F Requesting Permission to Construct �a\fex CzV Location (Reference to Cross-Street) ___!ak4 C Perinittee declares that prior to filing this application they have ascertained the location of all existing utilities, both aerial and underground and the accurate locations are shown on the sketches. Wlienever necessary for the construction,repair,improvement,maintenance, safe and efficient operation, alteration or relocation of all, or any portion of said street or casement as determined by the Director of Public Works,any or all said poles,wires,pipes, cables or other facilities and appurtenances authorized hereunder,shall be immediately removed from said street or easement or reset or relocated hereon as required by the Director of Public Works and at the expense of the Perinittee unless reimbursement is authorized. All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the supervision of V Q\k_1 (Project Superintendent) -A with Company Name Phone 0 All materials and equipment shall be subj ect to inspection by the Director of Public Works?o�- 0 All city property shall be restored to its original condition as far as practical,in keeping with City specifications and the manner satisfactory to the City. a A sketch of plans covering details of this installation, as well as a copy of a recent survey shall be made a part of this permit. Calculations showing any increase in impervious area on owner's lot or in the City right-of-way Are to be included with this application. 0 The permittee shall cornmence actual construction in good faith within days. If the beginning date is more than 60 days fi-om date of permit approval then permittee inust review the permit with the Director of Public Works to make sure no changes have occurred in the area that would affect the permitted construction. - 0 It is understood and,agreed that the rights and privileges herein set out are granted only to the extent of the City's right,title and interest in the land to be entered upon and used by the holder,and the holder will,at all times, - assurne all risk of and indemnify, defend and save harmless the City of Atlantic Beach from and against any and all loss,damage and cost of expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges. 0 The Director of Public Works shall be notified twenty-four(24) hours prior to starting work,and again immediately upon completion. <w� A � - 61� Date in presence'4 of Notary Public) Permittee(signe STATE OF FLORIDA,COUNTY OF DUVAL The fbregoing�nstrument was acknowledged this 0(4 day of 20 Jt_l by y) �a_R" () ,who personally appeared before me and (printed name of Permittee) ackno at he/she signed the instrument voluntarily for the purpose expressed in it. IL;; -— Personally Known Signat f Notary P u c, j5NNIFERJO1414ST014 Produced Identification(Type) 'FL . S L�c-a"Ui My COMMISSION#GG 042954 UU J Z IRES-october 27.2020 ubrvcUndervoite sonded Tnru NOtari F CITY OF ATLANTIC BEACH OWNER / BUILDER AFFIDAVIT 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I "CONSTRUCTION CONTRACTING"REQUIRES OWNER BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE—OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS ,YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. [I. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. III. IRS.WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(l). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826)IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. ADDRESS PHONE NUMBER PRINT NAME SIGNATURE DATE Before me this D uval. L day of 201 n the county of State of Florida,has personally appeared herin by I�Ammlf/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of County of Dpw C4 I'llp .11y Known MY 13 Person duced Idenfification- Q Notary Signature: F:/BLDG10%vner-Bufldu Affadavit;R SED:4/16/2009