1073 Little Cypress Key DWAY21-0046 Paver Driveway, PatioOWNER:ADDRESS:CITY:STATE:ZIP:
REAVES HOLLY C 1073 LITTLE CYPRESS KEY ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
172027 5826 SELVA LAKES UNIT 03
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
1073 LITTLE CYPRESS KEY DRIVEWAY SINGLE OR TWO
FAMILY DRIVEWAY
paver driveway and back
patio $6000.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 PUBLIC UTILITIES UNDERGROUND WATER SEWER UTILITIES INFORMATIONAL
Notes:
Avoid damage to underground water and sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is
needed, call 247-5878.
2 PUBLIC UTILITIES METER BOX SEWER CLEAN OUT INFORMATIONAL
Notes:
Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible.
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.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN
YOUR 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.
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
1 of 2Issued Date: 11/12/2021
PERMIT NUMBER
DWAY21-0046
ISSUED: 11/12/2021
EXPIRES: 5/11/2022
DRIVEWAY PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PU REVIEW BUILDING MOD OR ROW 001-0000-329-1007 0 $25.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 $100.00
TOTAL: $150.00
3 PUBLIC WORKS EROSION CONTROL INSTALLATION INFORMATIONAL
Notes:
Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line (904-247-
5814) to request an Erosion and Sediment Control Inspection prior to start of construction.
4 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
5 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL
Notes:
Roll off container company must be on City approved list. Approved list can be obtained at the Building Department at City Hall. Roll off container
cannot be placed on City right-of-way.
6 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration, including sod, is required.
7 PUBLIC WORKS MAXIMUM DRIVEWAY INFORMATIONAL
Notes:
Maximum driveway width within the City right-of-way is 20 feet.
8 PUBLIC WORKS REVISION INFORMATIONAL
Notes:
Any plan change must be submitted as a Revision to the Building Department.
9 PUBLIC WORKS DECKING REMOVED INFORMATIONAL
Notes:
All old decking and debris must be removed from job site by Owner.
10 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Owner.
11 PUBLIC WORKS OTHER PUBLIC WORKS CONDITION INFORMATIONAL
Notes:
This is Approved with Conditions for remove and replace "As Is" only.
2 of 2Issued Date: 11/12/2021
PERMIT NUMBER
DWAY21-0046
ISSUED: 11/12/2021
EXPIRES: 5/11/2022
DRIVEWAY PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
Final Plumbing
Final Electrical
Final HVAC
CC Final
Final Building*
Swimming Pool Steel
Swimming Pool Safety
Electrical Grounding & Bonding
Swimming Pool Final (Bldg)
Swimming Pool Final (PW)
Formed Columns/ Beams*
Masonry Cell Fill
Structural Steel*
OTHER:
OTHER:
OTHER:
OTHER:
OTHER:
Power Pole
Silt Fence
Piers/ Stem Walls
Underground Plumbing
Underground Electric
Foundation/ Footing
Slab**
Retaining Wall Footing
Driveway
Sewer (Building Dept)
Sewer Tap (Utilities Dept)
Rough Electric*
Rough Plumbing/ Top Out*
Rough Mechanical*
House Wrap
Wall Sheathing
Roof Sheathing
Tie-down Framing Connections
Rough Framing
Roofing In Progress
Window/Door In-Progress
Insulation Ceiling
Insulation Wall
Exterior Lath
Stucco Scratch Coat
Exterior Siding In-Progress
Brick Flashing & Ties
Early Power
Gas Rough
Gas Final*
* When all rough electric, plumbing, mechanical are complete but before any work is
covered up.
* When all gas piping is complete and wallboard is installed but before gas is
attached to any appliance. All outlets must be capped and pipe pressurized at a
minimum of 15 lbs.
* For new living space: When all construction work including electrical, plumbing,
mechanical, exterior finish, grading, required paving and landscaping is complete
and the building is ready for occupancy, but before being occupied
Additional inspections may apply to your project if your project
contains these elements:
INSPECTIONS REQUIRED FOR BUILDING PERMITS
To verify compliance with building codes, inspections of the work authorized are required at various points of the construction.
The following inspections are typically required for residential projects:
Date: Initial: Date: Initial:
_____________________________________________________
Permit Type
____________________________________________________
Permit No.
__________________________________________________________
Job Address
____________________________________________________
Contractor
POST THIS CARD WITH PERMITS AND PERMIT
DOCUMENTATION IN FRONT OF BUILDING
Construction Hours per City Code: 7am—7pm Weekdays; 9am—7pm Weekends
Building Department Public Works/Utilities Fire Department
Phone: 904-247-5826 Phone: 904-247-5834 Phone: 904-630-4789
Fax: 904-247-5845 Fax: 904-247-5843 Fax: 904-630-4203
* When forms and reinforcing steel, anchor bolts, sleeves and inserts, and all
electrical, plumbing and mechanical work is in place, but before concrete is poured.
* When all structural steel members are in place and all connections are complete,
but before such work is covered or concealed.
** FORM BOARD ELEVATION CERTIFICATE MUST BE ON-SITE FOR SLAB INSPECTION
ii%
Aillik
Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department ALL INFORMATION
uta V
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
o;:'9.`. IS REQUIRED.
Phone:
1 (
904) 247-5826 Email: Building-Dept@coab.us
Job Address: 10'1_3 I 11-i- Ie- C IP{SS Permit Number:
C R
Legal Description `"1 -A06 — — S'-a E Se .L 101_) Uni-f 3 10-1. 111RE# , '4 Q; 1 S V a LPyI
Valuation of Work(Replacement Cost)$ to 000. 9.D Heated/Cooled SF )(.1 D Non-Heated/Cooled
Class of Work: New Addition Alteration Repair Move Demo Pool Window/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? Yes(must submit separate Tree Removal Permit) No
e/PRscribe in detail the type of work to be performed:
J`
P
falai i Al 1 wc- Lv)1z\^r2(f 4 w(k-1 k a EA - j
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name //' i f?> Address 1013 I iTT- lf—
4n 1C$
1Ai
City I"T C I-1— 13.?&c- State (----L. Zip T22 3 Phone 9n4 9 I
E-Mail hp l ` r-e.-0 ,ec 0 re fl ve., CtA.l+ . Lam
Owner or Agent(If Agdnt, Power of Attorney or Agency Letter RequirecY
Contractor Information
Name of Company Qualifying Agent
Address City State Zip
Office Phone Job Site Contact Nu •:-r
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt o Expiration Date
Application is hereby made to obtain a permit to do •- work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit an. at 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 Fl £ NCING, •NSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORy . OURA IO ' CE OF COMMENCEMENT.
At. 4-'`-
Signature of Owner or Agent)Signature of Contractor)
Signed and sworn to(or affirmed)before me this S day of Signed and sworn to(or affirmed)before me th.day of
NOV , zo 1 ,by HOL L`I REAtV/by
C-
Signature of Notary) Signa ,re of Notary)
Personally Known OR CHRISTIAN I
nown OR
oduced Jentification
tsroduced Identification MY COMMISSION duff
Type of Identification:FL-ID•L-- „..._L j,4,66;
I en ication:
Bonded
yApril
1 ,2025
f Oc ct.
oP'
Bonded Thru •notary Public Underwriters
Owner Builder Affidavit
ALL INFORMATION
s f i,:
HIGHLIGHTED IN
s
117 City of Atlantic Beach Building Department GRAY IS REQUIRED.
I'llirr 800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT It:
I. FLORIDA STATUTES;CHAPTER 489, FLORIDA STATUTES, PART 1"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.
II. 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(1). 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. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.US ) 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.
Job Address: 101I -4-4-12. CA)pre-55 Ykkia r/ l " ,
Owner Name: i APhone Number:CO 13 1
Mailing Address: e i r-SSqty: IC, r hState: Zip: 31.,
I
Notarized Signature of Owner idio ,_,,---
The foregoing instrument was ackn•"'=dged before me this _day of NO V 20 2/ in the State of Florida, County
of O\) V FL
7SignatureofNotaryPublic /' v
4; CHRISTIANGILES Personally Known OR [Produced Identification
MY COMMISSION k HH 117153
13,2025EXPIR6S:April Type of Identification: FL- - D /
d ri;?": Bonded Thru Notary Public Underwriters Y I1
Updated 10/24/18
Lair REVOCABLE ENCROACHMENT AGREEMENT
City of Atlantic Beach
ALL INFORMATION
HIGHLIGHTED IN GRAY
800 Seminole Road,Atlantic Beach, FL 32233
IS REQUIRED.
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida,a municipal corporation organized and
existing under the laws of the State of Florida, hereinafter referred to as"CITY"and
1013 I . LO,f cr 5< of Atlantic Beach, Florida, hereinafter
referred to as"USER". l 3
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 Todecs
Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to
relocation or removal on thirty(30)days'notice b CITY to USER,said notice to U R shall be given by certified mail,return
receipt requested,to the following address IV 1 1r 1 _ ( I -
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 easement 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 requirements 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, must obtain written approval
from the City of Atlantic Beach Public Works Department, for said change within 30 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 terms 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 further 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 h eby assumed by USER.
e-/
Date //- -d%W/
Property- r/Agent(signed in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this 5 day of WO veni b ems' 20 2.1 ,
by HO 1 1 ue(M'.J 3 who personally appeared before me and
printed nam of Signer)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
G CHRISTIAN GILES
Department Approval:
Signature of Notary Public,State of Florida MY COMMISSION#HH117153
EXPIRES:AprIl13,2025
Personally Known o:no•'BondedTlruNomryPubliclfide -Williams,Public Works DirectoroducedIdentification(Type) f` . / _
H:\Applications&Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
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NOTICE OF
COMMENCEMENT
State ofO
q S
Tax Folio No.
7A, tl
County of
Rti)
Concern: property, and in accordance with Section 713
To Whom It May improvements will be made to certain real p P
of
The undersigned hereby informs you
nthot
imp
Statutes,the following
information is stated in this NOTICE OF
COMMENCEMENT.
Lgal
Florida
io being
improved:
S v
1 5
Legal
Description of property — '
S _ L
I I
being improved:
t. •
r'+'. .
A
Address of property
10 • G
improvements:
WO
3 II I I p ,
l ( t
General
description of imp
Pt '
S1 CJI
Owner:
nL
Address: \D'(3 1 I .i
5
I
Owner's interest in sit of the improvement:
le Titleholder(if other than owner):Fee Simp
n /
Name:11 f
Contractor:
Address: Fax No:
Telephone No.:
Surety(if any)
Amount of Bond$
Address: Fax No:
Telephone No: improvements
Name and address of any person making a loan for the construction of the
Name:
Address: Fax No:
Phone No: owner upon whom notices or other documents may
Name of person within the State of Florida,other than himself,designated by
be served:Name:
Address: Fax No:
In addition to himTelephhimself, owner designates the following personerson to receive a copy of the Lienor's Notice as provided in Sectionne
713.06(2)(b),Florida Statues.
Fill in at Owner's option)
Name:
Address: Fax No:1)year from the date of recording unless a different date iETelephonefNoticeNo
Expiration date of of Commencement(the expiration date is one
P
specified):
OWNER
Date: —
THIS SPACE FOR RECORDER'S USE ONLY
n the County of Duval,State
Signed: day of/V,
00 Page 1191' Before m h._
appeared
D#
2021295391,OR BK 2
Of Florida,has personally of Duval.
RecordedNumbePages:
1 Notary
Publica
at Large,State oFlorida,County
C A
11/05/2021 04:06 PM, M CHRISTIAP!GILES
JODY PHILLIPS
CLERK
CIRCUIT
COURT DUVALPe • wn:
COUNTY
Pre'1 .!.1.eeillgicpyCiE:
OMISSION;'{HH 117153 1
RECORDING $10.00 EXPIRSS:April 13,2025
Notary public Underwriters
Fp P' Bonded1i1W
PUBLIC UTILITIES PLAN REVIEW COMMENTS
APPLICATION TRACKING COMMENTS
Check Box
to Add
Comment
Check
Box to
Print
Underground
Water Sewer
Utilities
Avoid damage to underground water and sewer utilities. Verify vertical and
horizontal location of utilities. Hand dig if necessary. If field coordination is
needed, call 247-5878.
x x
Meter Boxes
Sewer
Cleanout
Ensure all meter boxes, sewer cleanouts and valve covers are set to grade
and visible. x x
RT1 Sewer
Cleanout
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.
x x
RPZ Backflow
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.
Sensus
Touch-Read
Meter
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.
Fire Sprinkler
Backflow
Requirement
If fire sprinkler system is provided, call 247-5878 for backflow requirements.
At a minimum, will require a double check backflow preventer.
Fire Line
Meter
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.
Utility Map See attached Utility Map.
Disconnect
& Cap
Disconnect and cap water and sewer lines at City Right of Way.
Inspection
Prior
MUST call the Inspection Line at 247-5814 to request an inspection of the
disconnected and capped water and sewer lines PRIOR to demolition.
Utility
Inspections
All water & sewer utility connections must be inspected prior to cover up.
Please call the inspection line at 247-5814 to schedule inspections 24 hours in
advance. Failure to schedule utility connections may result in failed
inspections and additional fees, and delays in utility services.
x x
System
Development
Fees
All fees must be paid for water & sewer connections before meters will be set.
Please call the finance department customer service line 247-5816 to
coordinate payment of fees.