962 OCEAN BLVD DWAY22-0005 PERMITOWNER:ADDRESS:CITY:STATE:ZIP:
HALVORSEN JOSEF DANIEL 1895 ATLANTIC BEACH DR ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
River City Pavers 10435 Midtown Parkway Suite 158 Jacksonville Fl 33246
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
170343 0100 ATLANTIC BEACH
PARKWAY
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
962 OCEAN BLVD DRIVEWAY SINGLE OR TWO
FAMILY DRIVEWAY PAVER DRIVEWAY $18475.00
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. ANY DIGGING REQUIRES CALLING 811 TO HAVE ALL PUBLIC UTILITIES LOCATED.
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: 3/4/2022
PERMIT NUMBER
DWAY22-0005
ISSUED: 3/4/2022
EXPIRES: 8/31/2022
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: $150.00
2 PUBLIC WORKS EROSION CONTROL INSTALLATION INFORMATIONAL
Notes:
Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line (904-247-
5814) to request an Erosion and Sediment Control Inspection prior to start of construction.
3 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
4 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL
Notes:
Roll off container company must be on City approved list. Approved list can be obtained at the Building Department at City Hall. Roll off container
cannot be placed on City right-of-way.
5 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration, including sod, is required.
6 PUBLIC WORKS MAXIMUM DRIVEWAY INFORMATIONAL
Notes:
Maximum driveway width within the City right-of-way is 20 feet.
7 PUBLIC WORKS DECKING REMOVED INFORMATIONAL
Notes:
All old decking and debris must be removed from job site by Contractor.
8 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Contractor.
9 PUBLIC WORKS OTHER PUBLIC WORKS CONDITION INFORMATIONAL
Notes:
New driveway can only be 20' wide in the City right-of-way.
2 of 2Issued Date: 3/4/2022
PERMIT NUMBER
DWAY22-0005
ISSUED: 3/4/2022
EXPIRES: 8/31/2022
DRIVEWAY PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Ott IS REQUIRED.Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 6 Z O(5 rSi UD Permit Number: D(,J A t z L `00x3
Legal Description /2_ 7 # A1.nrT OF ,p(1-1 VEINRE# 17D3'13-0100
Valuation of Work(Replacement Cost)$ /9; / y 7 S . ODHeated/Cooled SF Non-Heated/Cooled
Class of Work: New Addition likAlteration Repair Move Demo Pool Window/Door
Use of existing/proposed structure(s): Commercial '1Residential
If an existing structure,is a fire sprinkler system installed?: 6,Yes No
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: Ke-nj&E")(I JrC CON caege
P/1._I VentPwl PSD /LW L i-cervLge4T tAii-r44 pAv v-
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name P<}N/tZ t A'M`•l N f1 I VOitSeN Address /6 2- OCfA-N 1 SIG
City A— Tl-AM-L( X3 4 •tC44- State {Z Zip 3 2..2-3'h Phone y oy • 38 6 • 3 2/S
E-Mail /4-M4 - /-0*1 V City L- @ Co\A
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company /2-I ti 7 rf`1 ?f ' (—S INC. Qualifying Agent MIG/-I-ik- _ -J IM 61V
Address/01/ /IA/DT-OWN P/LWy ff 1 Qs City t.LEstate 1-L Zi P 3Z2`/6
Office Phone 90 y. '7 / 0• 07.61 Job Site Contact Number Toy • 7/D • 07&7
State Certification/Registration# 27-52_,/0'127 E-Mail /LCZ.LjJIV / f PlV 9v.-S g C',M f}/L . Gq'Vl
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt Rt.Expiration Date
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 1 O7E •MMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEME TS TO UR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING CONSULT WITH YOUR LE DER O' AN ATT•RNEY BEFORE
RE • ' r NG YOU • O OF COMMENCE ENT
Ma AC tE 14
Si.tur. of 0 ner or Agent) I (Signature of Contractor)
Signed and s orn to(or affirmed)before ahis 21 day of Sig . and sworn to(or affirmed)before me this day of11101;) ,by vOYS- 1:
t • by c,ke I rn nL'
v
u LEEN HICKEY Signature f
BRONSON VEALEMYCOMMISSION#HH 203374n Notary Public State of Flori5rno; EXPIRES:November 30,2025 Commission#HH 176789JersonallyKnownORF `op;, Bonded Thru Notary Public Underw[it*V sonally Known OR my Cemm.Expires Sep 20,20
roduced Identificatiork educed Identification
Type of Identification: rlLti\t4-- Type of Identification: I^[o ,ctcA Ue ier L,tc eilse
A,lt, REVOCABLE ENCROACHMENT AGREEMENT
at` .N City of Atlantic Beach ALL INFORMATION
I
lip
800 Seminole Road,Atlantic Beach,FL 32233
HIGHLIGHTED IN GRAY
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
4414 17_ 5 AM,4 14/1 LV O/L-S*7U 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 ,tA-CEA1`,N"T OF Ek1ST1N 4 CONCILEJ /Du-NEW Pq
Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege gran
eTF'
ltmafi sufje 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 9b2 CClarN & is / A pl^T7C 601C-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 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 ssumed by the USER.
1
t/ziilf.v.v i/S ' Date'. I i?l 20 2-202->
Property Owner/ t sig ed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this c:::)-IL day of \c\Jc,r-Li 20 a-D- ,
by Q-rv1h-er--k Jo Stc) who personally appeared before me and
printed name of Signer)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
I.T.
r t'•COLLEEN HICKEY
1 mak- 1,41 MYCOMMISSKNJMHH203374 Department Approval:1,— ,. EXPIRES:November 30,2025
Signature of Notary Public, State of Florida 0• Bonded TtruNotary Public Unds lens
Personally Known
c1.jIroduced Identification(Type) l-s \KNr LAUr) Scott Williams, Public Works Director
H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
t•71%RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION ALL INFORMATION
City of Atlantic Beach HIGHLIGHTED IN GRAY IS
R ;, ii j 800 Seminole Road, Atlantic Beach, FL 32233 REQUIRED.
L
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address 'L 2- OCA 3l vv. A-rE-A•1k71 C Permit Number
Contractor Information
Company /'_l VOL-C/11 / P Ji )L.S /I\fC.- Qualifying Agent
Address/ayS MIDT€I'VN P41A.1' /Skity `f AC(c.-_,$ar iv/LLE State lL. Zip 322/4,
Phone yo'-/ • "710 • O1 61 Email /Zi Lir/Airy PAvJL # (-)/Yl Alc. . ocei
State Certification/Registration # /t7 /e-hN 41- Z7 --S Z y 9 7 21
Architect Phone Email
Engineer Phone Email
Workers Compensation Insurer 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 Al/C/- E . J/M FV G L Project Superintendent)
with(Company Name) /I tfQ/1_,C,M-1 p!h/elt-.S Phone gel• 710' M471
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 an. ' e -s '. .• land to be entered upon and used by the holder,and the holder will,at all times,assume all risk of
and i oem . , defend an. ave harmless the City of Atlantic Beach from and against any and all loss,damage and cost of
exp: ses : •• ng in any man,er of the exercise or attempted exercises by the holder of the aforesaid rights and privileges.
Th: b , orks Direc , sh. I be notified 24 hours prior to starting work and again immediately upon completion.
Date ' / 1 eS/2.-2_
Permittee ;i ?.; - c: if Notary Public)
STATE OFF •'IDA, • '.TY OF DUVALjh
The foregoin: strument was acknowledged this 1) day of Jan 1 20 22_ ,
by M`U,e\ 1\ms c\2Z who perssen211v-arlap eci-haforP meansJ_ —
printed name of Permittee) I ro BRONSON VEALEIg1eLr
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.I Notary Public-State of Florida I
Commission:i'HH 176789o. ?:.
My Comm.Expires Sep 20,2025
i /
fli€IAk 1 Personally Known
Signature of Notary Public,State of Florida 44 Produced Identification(Type) Floe lac.,Oft ver Lt CCI '
H:\Applications&Forms\Word&Excel Document Originals\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18
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. ANY DIGGING REQUIRES CALLING 811. ALL PUBLIC
UTILITIES MUST BE LOCATED PRIOR TO ANY DIGGING.
Meter Boxes
Sewer
Cleanout
Ensure all meter boxes, sewer cleanouts and valve covers are set to grade
and visible.
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.
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.
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.
DWAY22-0005NOTICE OF COMM ENCEMENT
State of _e-1.c«Jd.P_,A-....,__ ____ _ Tax Folio No _____________ _
County of -"'"'-''-":...CJ...:-:: ______ _
To Whom It May Concern
The unders,gned hereby informs you that improvements will be made to certain real property, and In accordance with Section 713
of the Florida Statutes, the following Information IS stated in this NOTICE OF COMMENCEMENT
Legal Description of property being improved /l1c-m f1 v~ F){ 15T JN(... CQ\I c~
(
Pfl..t~'t'-1 A-N o /2-E?"'P'-:fre:e:w\w:r ~er!±-PA.lt!JU!. / &~ 10,yJVf'fL-H_g:,t\~
Address ol property being improved q I, '2.. OC f...l't"N Gil~ M'k l'rNII C.. G>ffi<,l:f: I PL-
General descripuon of improvements: _______________________________ _
Owner DA-N I@..~ /tN'':i He:1,.\/~(N Address·_9b'2-QC2,.{r:1\J '?>!VD , .A"fLA:"fI_JC..
Owner's interest in site of the Improvement 7H::€Jr2... /2-6 '0 "'irJ:::z:;/d:L HrMv 1:3, ~If
Fee Simple Titleholder (d other than owner) _____________________________ _
Name· ________________________________________ _
Contractor /?:I V l-'12-CI 1'1 P Avtzlr1S
Address: U Y 3 5 M IDTIJNN
Telephone No.. '1 [l\/ · 710 · 07 !-?I
IN c,,
e K:w'1 JJ-,se;;
Fax No: ____________ _
Surety (,f any)----------------------------------------
Address: _______________________ Amount of Bond S _________ _
Telephone No: __________ _ Fax No. ____________ _
Name and address of any person making a loan for the construction of the improvements
Name.-----------------------------------------
Address· _______________________________________ _
Phone No: ____________ _ Fax No. ____________ _
Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other documents may
be served Name I
Address· --------------------------------------·Jf-l..,.."-i :r ~-
Telephone No·____________ Fax No:------------;J f
In addition to himself, owner designates the following person to receive a copy of the L1enor's Notice as provided 1n '::i::1.J. j
713 06(2) (bl, Florida Statues (Fill In at Owner's option) _ ;, ~ i: Name.-------------------------------------cS s,:::
Address·------------------------------------
Telephone No: __________ _ Fax No: ___________ _
Expiration date of Notice of Commencement (the expiration date 1s one (1) year from the date of recording unless a d1ffere
specified) -----------------------------------
THIS SPACE FOR RECORDER'S USE ONLY
a1
.,~·-.
t~11 .. -,~/
OWNER~
~,gn~d -~ D.,i, ~ -2..1 -2c /,..-1.,..
Before~~~~-a~vfr:v\ in the l:'l'i'unly ol DuvJG L,te
Doc# 2022019379 OR BK 20109 Page 902
Number Pages 1
Recorded 01'24i202203 01 PM
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING S10 00
Florida, has personally appeared r.,.. ,_...,_ '1 ~ °',\ ,bJ,0<[)
llary Public at Large, State of Florida, County of Duval
y commirnon expires, bJw<ca.'!::hC ~ D ;)-Uc}S
nonally Known --:--T"i:-::::=--::--:=-----r~-:-::,--:--------
oduced Identification Of"lv{,r CC,,({\½,.
or
Revision Request/Correction to Comments ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
z -tJcosPhone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
geerevQ
250RevisiontoIssuedPermitOR
um
Corrections to Comments Date: Z •Z• Vi.
Project Address: gb 2 QC5PrN P 1 'JD. A-SLA-n(G µ /
PC,Contractor/Contact Name: /24 V C-/1 1i pf1'1 '4J
INC Contact Phone: %ri7 - 710 . 0717 Email: L a._-/ kms Al'.V A
Ali,,
CeM Description of Proposed Revision/
Corrections:Gr' P4l/y /7---e-714 0080 Etc Ls-r PA
S 4 Ccc' crr
ii eytSE Sle-iv sioN ToNE UV P? AE,— orz-I VE DEN LI
KJ affirm the revision/correction to comments is inclusive of the proposed
changes.printed
name)Will proposed revision/corrections add additional square footage to original
submittal?No 0 Yadditional s.f.to be
added:ill proposed revision/corrections add additio :I incre..e in bu. ding value to originalsubmittal?INNo Q*Yadditional increase in buildi •'value: Contractor must sign if increase in
valuation)Signature of Contractor/A:-
s : _,
V Office Use
Only)E Approved E Denied Not Applicable to Department Permit Fee
Due $Revision/Plan Review
Comments Department Review
Required:
Building Planning&Zoning Reviewed
By Tree
Administrator Public
Works Public
Utilities Public Safety
Date Fire Services Updated 10/17/
By Toni Gindlesperger at 4:21 pm, Feb 25, 2022
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By Toni Gindlesperger at 4:21 pm, Feb 25, 2022