14 N. Saratoga Cir DWAY22-0048 paver, gravel driveway appOWNER:ADDRESS:CITY:STATE:ZIP:
HORN WILLIAM 14 N SARATOGA CIR ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171815 0000 ATLANTIC BEACH VILLA #
02
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
14 N SARATOGA CIR DRIVEWAY SINGLE OR TWO
FAMILY DRIVEWAY paver and gravel driveway $5000.00
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.
2 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
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: 9/19/2022
PERMIT NUMBER
DWAY22-0048
ISSUED: 9/19/2022
EXPIRES: 3/18/2023
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: $150.00
3 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL
Notes:
Roll off container company must be on City approved list. Approved list can be obtained at the Building Department at City Hall. Roll off container
cannot be placed on City right-of-way.
4 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration, including sod, is required.
5 PUBLIC WORKS RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site. Cannot raise lot elevation.
6 PUBLIC WORKS MAXIMUM DRIVEWAY INFORMATIONAL
Notes:
Maximum driveway width within the City right-of-way is 20 feet.
7 PUBLIC WORKS GRASS INFORMATIONAL
Notes:
Full site to be grassed.
8 PUBLIC WORKS REVISION INFORMATIONAL
Notes:
Any plan change must be submitted as a Revision to the Building Department.
9 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Owner.
10 PUBLIC WORKS OTHER PUBLIC WORKS CONDITION INFORMATIONAL
Notes:
New impervious area cannot exceed 250 sq. ft.
11 PUBLIC WORKS DEBRIS REMOVED INFORMATIONAL
Notes:
All construction debris must be removed from job site by Owner.
2 of 2Issued Date: 9/19/2022
PERMIT NUMBER
DWAY22-0048
ISSUED: 9/19/2022
EXPIRES: 3/18/2023
DRIVEWAY PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
5' ''"r4 Building Permit Application Updated 10/9/ 18
City of Atlantic Beach Building Department ALL INFORMATION
800 Seminole Road, Atlantic Beach FL 32233 HIGHLIGHTED IN GRAY
r''t~ IS REQUIRED.Phone: (904) 247-5826 Email:Buildingg--Dept@coab.us
Job Address: y s4iti 9d34 Cf.' e /VL,4is, /Permit Number'4/e
Legal Description 3/-/3 /7-2$ - z1'e 471-4,,A. 6e(. 4 Un,(2 Loft'?RE# /rg/'OO O
Valuation of Work(Replacement Cost)$ ,f inn)Heated/Cooled SF Non-Heated/Cooled
Class of Work: New Addition Alteration Repair Move Demo OPool 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 proiect? Yes(must submit separate Tree Removal Permit) No
Describe in detail the type of work to be performed:
4- -,!. ex'sal ' Ar(vewJ -e.e /ncc. 1,14 l yes Ai( "^.3Qv(tc j-,d4ktis F f7
Florida Product Approval#for multiple products use product approval form
Property Owner Information
Name hit AY", 4 5v' Address 3OZO ,4 3-611/s eke(
City ch3bnvt do State Zip 3Z2.-5.-0 Phone 4f 0-14 hl d 8¢1
E-Mail VG, nsr-n'zid a 1 -n/
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company 0/4,A.3., jtri Viei. -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 Insurer OR Exempt 0 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 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
REC• '•)IN UR OTI -OF O ENCEMENT.
Signature of Owner or A:ent)Signature of Contractor)
Signed and sworn to(or affirmed)before me this day of Signed and sworn to(or affirmed)before me this day of
s '4 A-4,/_asp-1 - _ - -, . i1..rh by
JENNIFER JOHNSTON 'I as%:11,.....1..,.I MY COMMISSION 1. l
Ii4
r of Notary) Signature of Notary)
i+;• p11 EXPIRES:Odober 27.202
ti'Baided Thru NolarY Pat lhiderwtNen
r ona y 'nown OR Personally Known OR
Produced Identification Produced Identification
Ty'e of Identification: OL Type of Identification:
DWAY22-0048
s=`1 REVOCABLE ENCROACHMENT AGREEMENT
City of Atlantic Beach ALL INFORMATION
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 un//d''er t(p jaws of the State of Florida, hereinafter referred to as "CITY" and
1 &... .tA k. 7 c•/ 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 A c,ve!J4I ferAfe"e"/
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 sha)t be given by certified mail,return
fiereceiptrequested,to the following address z/ 2t l, 474 c (' if#4,
74jer-
Arfi
37zi3
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.
Date 2d-22
Property Owner/Agent(signed in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this 1 day of ' 4' 7 k/v1 lerey , 20 a-d—,
1/4,*)tby `\) L -'
1 '[
r\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'7;it JENNIFER JOHNSTON Department Approval:
Signat re o(
i_
Notary Public,State of Florida MY COMMISSION#HH 057579
Personally Known EXPIRES:October 27,2024
4: . °.ThBondedu Navy Public
oduced Identification(Type) Ft_ 0 L— Williams, Public Works Director
H:\Applications&Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
DWAY22-0048
rt.a,Tr Owner Builder Affidavit ALL INFORMATION
HIGHLIGHTED IN
11_9 City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
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: t( /ia qp /6( rt.Ie. 1V df m'4h 1 fL EZ-23S
Owner Name: G(/'r-/I4.' 6C.' "(
Mid
AIN Phone Number: ?) 30g d l al
Mailing Address: 362 d $ , 1 dvis f?/v Gty: 5464S0 44 e ate: FLS Zip: 322.5-D
Notarized Signature of Owner
G
The foregoing instrument was acknowledged before me this I day of S 0 in the State of Florida, County
of OIAA u1
I
Signature of Notary Public vow
Z;i JENNIFER JOHNSTON I ] Personally Known OR VProduce. I.e,tification
t MY COMMISSIONS HH 057579
z• .-. V EXPIRES:October 27,2024 L-
r. i•" goodedn,r„ derNyPublic U,be.n;brs-me of Identification:I
Updated 10/24/18
DWAY22-0048
BOUNDARY SURVEY
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NOT VALID WITHOUT AN AUTHENTICATED ELECTRONIC
STATE OF 's,,• SIGNATURE AND AUTHENTICATED ELECTRONIC SEAL, 1........."*" LB#7893
P.:."t ORA RAISED EMBOSSED SEAL AND SIGNATURE.4,:R I C. SERVING FLORIDA4 ,..v..-- Digitally Signed byKennethKennethOsborne 6250 N.MILITARY TRAIL,SUITE 102
PALM
Date:2021.07.28 WESTEPHONE (56640-CH,F 0 07Osborne15:37:20-04'00' STATEWIDE PHONE (600)226- 4807SIGNED)
pp F nF Pp F STATEWIDE FACSIMILE(800)741-0576KENNETHJOSBORNE
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NOTES
CRE TE DRIVE CROSSING INTO R!W
ON NORTHERLY SIDE OF LOT.k 4
THERE ARE FENCES NEAR THE BOUNDARY
hi(-•S OF THE PROPERTY.
k q B R.I.BUILDING RESTRICTION LINES
4v No.6415 •\`SURVEYORS CERTIFICATE eTAR G ET
a l SURVEY PREPAREDCORRECT Rt RESEERMY
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HEREBY CERTIFY THAT THIS TAp
NORY
TASURVEYING,LLC
NOT VAUD WITHOUT AN AUTHENTICATED ELECTRONIC
V it i i.tL/
i SIGNATURE AND AUTHENTICATED ELECTRONIC SEAL. LB#7893
Op 00'o:' ORA RAISED EMBOSSED SEAL AND SIGNATURE.
FLORIDAio +i' Digitally signed byKennethKennethOsborne SERVING6250 N.MILITARY TRAIL,SUITE 102
i%
WEST PALM BEACH FL 33407
Osborne Date:2021.07.28 PHONE(561)690-4800
15:37:20 04' 00' STATEWIDE PHONE(800)2264807f1
4; p STATEWIDE FACSIMILE(800)741-0576KENNETHJ
SU
OSBORNE
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DWAY22-0048