2029 Duna Vista Ct Paver Driveway Submittal Building Permit Application Updated 10/9/18
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City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
4.,f p' IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: % ?t4 a lOt S t t �Y0'7' Permit Number: (�
Legal Description 40 37 Q ? -(.2S - 0517C Jftiw/ r2tt "7� fit# I ., qc (-' hi c›)?-
Valuation of Work(Replacement Cost)$ /o/cr tv Heated/Cooled SF Non-He-I ' -.,'a. _
• Class of Work: ❑New ❑Addition ❑Alteration yRepair ['Move ❑Demo ❑Pool ❑Win• /DEB 0 3 2022
• Use of existing/proposed structure(s): ❑Commercialtesidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No BY:
• Will tree(s)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:
OAKAI-e-- .040-10,1 Ozolak ceKeitaca, cUtk-,ocu,4_, cA4A-J A-cpcx(. (A)41-1- 104 Vel S
Florida Product Approval# for multiple products use product approval form
Pro•ert Ow :r Information
Name arA_ ` : Duki5 Address (000ze) / a V/•5 ezi... 4
City ig/ o IJA i State r� Zip 302d33 Phone Qo (o/ ti-23089
E-Mail ( ma rm 7 l_ 3/.eekrt-
Owner or Agent(If Agent, Poweqf Attorney or Agency Letter Required)
Contractor Informat'on
Name of Company ���a '1(� /�5ty{)• Qualifying Agent l
Address 5 Lt 3'•f'-ft_ Ave S (J cityt-;�/Lci t rite/, state) Zip 3D
Office Phone /09-4632(/- 14l3-l Job Site Contact Number
State Certification/Registration# ,2,2- 0 00/9 7C , E-Mail
Architect Name&Phone#____
Engineer's Name&Phone#
Workers Compensation Insurer 33.37 _730g OR Exempt❑ Expiration Date /0?-/ti -023
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 ATTORNEY BEFORE
RECOR G YOUR OTI OF COMMENCEMENT.
( nature of Owner or Agent) (Signature of Contractor)
• e and sworn to(or a it ed)before me this, day of Si nedffand sworn to(or affirmed)before me tliis,-3 day of
Z b At A A . t L� i . , 20212,lyllPC-1-i tt.,.✓
*WW2 Cmc,
t;� ► TONI GINDLESPERGER • gn lIoter J (Signature of Notary)
.„7 MY COMMISSION#GG 353178
••"''.�,� o: EXPIRES:October 6,2023
`: •� :':...v.e� CHRISTIAN GILES
,Fds��•� �, �� � [ ]Personally Known OR �,
- •
[,.} roduced Identification ,: MY COMMISSION#HH 117153
Type of Identification: (�---- Type of Identification: ',n....,11,7,... .., EXPIRES:April 13,2025
"••••°fn:,' Bonded Thru Notary Public Underwriters
RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION
yl City of Atlantic Beach HIGHLIGHTED IN GRAY IS
A s
800 Seminole Road,Atlantic Beach, FL 32233 REQUIRED.
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address „,'O 2-5) a,,..4 V/iST,l- Cr Permit Number
Contractor Information
Company W+A^ -w mm)Sc 2, _ (. CSS 7, Qualifying Agent 4%4 (/
Address S-2 Sf Y-74-4(1. City ,¢. ‘ States/4 Zip 3 Z24—o
Phone 90 / tiZY--y(s-7 Email m6 G,,,€_pv,.. 0 i4171 r-zs,
State Certification/Registration#
Architect Phone Email
Engineer Phone Email
Workers Compensation Insurer j2j - ^h am OR Exempt❑ Expiration Date
• Permittee 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.
• Whenever necessary for the construction,repair, improvement,maintenance,safe and efficient operation,alteration or
relocation of all,or any portion of said street or easement as determined by the Public Works Director,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 Public Works Director and at the expense of the
Permittee 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 (Project Superintendent)
with(Company Name) Phone
• All materials and equipment shall be subject to inspection by the Public Works Director.
• 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 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.
• The permittee shall commence actual construction in good faith within days. If the beginning date is more than 60
days from date of permit approval then permittee must review the permit with the Public Works Director to make sure no
changes have occurred in the area that would affect the permitted construction.
• 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,assume 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.
• The Public Wor s Direc .r shall be notified 24 hours presto starting work and again immediately upon completion.
//.+ Date 2"j � z '
Permittee(signed in • -sence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL Feb-he foregoing instrument was acknowledged this a day of leZZ ,20 2Z. ,
by / ICJ � :---- ,who personally appeared before me and
(printed name of Permittee)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. � �;..,
;•. . CHRISTIAN GILES
. ._ MY COMMISSION#HH 117153
A [ ] PPysonally Kn. •• O mac•Bondsal 13,2025
ublicUndenvrIt
ets
Signature of Notary Public,State of Florida [..J'Produced Identification y•
F� - P. L —
H:\Applications&Forms\Word&Excel Document Originals\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18
.,1.44 REVOCABLE ENCROACHMENT AGREEMENT
`1 +\ 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
rk /3 weirs 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 Pa s/CA— /)0.,,i✓ e.1_
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 by CITY to USER,said notice to USER shall be given by certified mail,return
receipt requested,to the following address 020x94 lav-'i -- Ceu-v t /#/€7 ail 61-4eA ,4 34,4z.)33
• 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 hereby assumed by the USER.
a- /Q - L- Date -3"d- )-
Property Owner gent(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this 3 day of re__. 20 z
of-\
by 02" 0 k 's ,who personally appeared before me and
(I inted nam4. of Signer)
ackno ;ged t at ,e a Signe. the instrument voluntarily for the purpose expressed in it.
�' llk� Department Approval:
: TONI GINDLESPERGER
Signature of Notary Public, State of Ft.('• 4., ` MY COMMISSION#GG 333178
[ ] Personally Known ' .•.?•—'•:?,:.,-::-Al EXPIRES:October6,2023
[ ] Produced Identification(Type) L '�fO'..t•,"'. Bonded This Notary Public Underwriters *cott Williams, Public Works Director
H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
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