832 Cavalla Rd ROW23-0008 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
Kourthey Olsen 832 Cavalla Rd Atlantic Beach FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171717 0240 ROYAL PALMS UNIT
02A3.00
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
832 CAVALLA RD RIGHT OF WAY SINGLE OR TWO
FAMILY RIGHT OF WAY
Landscaping from 832-846
Cavalla Rd $0.00
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 UTILITIES RPZ BACKFLOW INFORMATIONAL
Notes:
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. EACH UNIT IS REQUIRED TO HAVE A BACKFLOW
PREVENTER INSTALLED, TESTED AND INSPECTED. TESTER FORM ATTACHED TO PERMIT
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: 3/29/2023
PERMIT NUMBER
ROW23-0008
ISSUED: 3/29/2023
EXPIRES: 6/27/2023
RIGHT OF WAY 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 MULTIFAMILY USES PER DWELLING UNIT 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 DUMPSTERS/ROLL-OFF CONTAINERS INFORMATIONAL
Notes:
Dumpsters and roll-off containers must be used in compliance with Section 16-8 and must comply with all standards, per City code.
6 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration, including sod, is required.
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 DEBRIS REMOVED INFORMATIONAL
Notes:
All construction 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.
2 of 2Issued Date: 3/29/2023
PERMIT NUMBER
ROW23-0008
ISSUED: 3/29/2023
EXPIRES: 6/27/2023
RIGHT OF WAY 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
Landscaping from 832-846 Cavalla Rd
ROW23-0008
832 CAVALLA RD
---
Ut L DING C ac) br t/ J
RIGHT-OF-WAY/EASEMENT PERMIT APPLICATION ALL INFORMATION
City of Atlantic Beach HIGHLIGHTED IN GRAY IS
800 Seminole Road,Atlantic Beach, FL 32233 REQUIRED.
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
2
Job Address U32— B C IZD
i
37-2-33 Permit Number A32 ) g
Contractor Information
Company <3 WN6V--- Qualifying Agent
Address o32--9 ( CANNU A RC) City A 3 State R. Zip 327-33
Phone go`l-Co2e.-3F12-2- Email ge")6121.@ C>kjP,tc.• coM
State Certification/Registration#
Architect Phone Email
Engineer Phone Email
Workers Compensation Insurers 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 DepartTent ofTransportationStandards and be performed under the
supervision of D'I[-qN -1 JE- Project Superintendent)
with(Company Name) CEJ NE`2 Phone cr0-1)(oz(- z7-
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 5 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 an ••.nner of the exercise or attempted exercises • the holder of the aforesaid rights and privileges.
T•- •ublic W•)s P.rect. sha •e notified 24 hour • •r • ti g w.• .•• -•ain immediately upon completion.
3Date7,le 1 z
Permittee igned in . = ence of Lary Pub
STATE OF FLORIDA4 •UNTY OF bU 7 -7
The foregoing instrument was ac now dged this / . day of 20 _ ),
by -
4-Th Li 1 7 a_v-Qx-- who personally appeared before me and
inted name of Permittee)
ackno d d that he/s e sig • instrument voluntarily for the` ur b xpress'F1DtihatIDLESPERGER
MY COMMISSION#GG 353178
q,r..-o EXPIRES:October 6,2023
For -oP' nc c;+d 7 ru Notary Public Underwriters
jrp
Signature of Notary Public,State of Florida Produced Identification(Type)
H:\Applications&Forms\Word Documents\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18
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February 22 2023
Re: Authorization for Revocable Permit
To: Whom it may Concern
I John Reich owner of 836 Cavala Rd, authorize Dylan Beaver to submit a Right of Way/Revocable Permit
application for landscaping improvements on my behalf.
Sincerely,
A, 44
Jon M. Reich
836 Cavala Rd
Atlantic Beach, FL 32233
272-(723
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trAili,,---s\ REVOCABLE ENCROACHMENT AGREEMENT
City of Atlantic Beach ALL INFORMATION
HIGHLIGHTED IN GRAY
z 800 Seminole Road,Atlantic Beach, FL 32233
IS REQUIRED.
o is)
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
C AV ilk(...t A Tz*1Ns'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 L.AN95cNs>rhIcz. -- 51r1gt.tz5
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 aSy CAV AL LA (to/kD
I
32_L'3.5
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 areherebyassumed by the USER.
1 Date 1 Z3
Property Owner/AEI t(signed in presence •tary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this day of 20
by \ l P-Q C-u.S .7 a ?l('.Y.e.RI t3 who personally appeared before me and
printed name of Signer)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
Department Approval:
Signature of Notary Public,State of Florida
Personally Known
Produced Identification(Type) Scott Williams, Public Works Director
H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
r:Ly-,--)i, REVOCABLE ENCROACHMENT AGREEMENT
s ALL INFORMATION
1. „1 City of Atlantic Beach
HIGHLIGHTED IN GRAY
Irl 800 Seminole Road,Atlantic Beach,FL 32233
IS REQUIRED.
I
D.1
li
iv3.
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
v Cii kap, CZ.o/kb 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 L.ATNDSe t9PriG
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 iiCAJALLA. (ZoAtt 32233
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 ar- • -.y . . ed , , the USER.
Date 1.1Z-11Z3
Property Owner/ ig e' in pr Bence o ary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this 2'i day of UG&.(L, 20 02.3,
by 0 j( at- \- t who personallyappeared before me and
printed name of Sign
acknowledged that he/she stigcLtlig Wsirttn Lvnluntarilu r the purpose expressed in it.
4 ',4,,'v .TERRY HENDRY
Notary Public-State of Florida
Commission,f HH 188544 Department Approval:
Signature of Not ry Public,Ste ) 1 lot'fds°mm.Expires Nov 30,2025
I P rsonally Known
1,-/-Produced Identification (Type) 1"- Wry SLC Scott Williams, Public Works Director
H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
1:A`fir> REVOCABLE ENCROACHMENT AGREEMENT
t
Vic\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
kd C,$A L.A Cr-- 6 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 LAPQ,V)4C,4er34•C7
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 Q4O Cqv"U.A g-t' f 3 at-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 armless by the USER from any of the work herein under the terms of this permit and that all of said
lab' les are here. .ssumed by the USER.
Date 2 - 2,q . 2--2,
os -rty Owner/Agent(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL04n
The foregoing instrument was acknowledged this /Li day of e_.. 20 I b ,
by -56n0V NVUO. who personally appeared before me and
printed name of Signer)
acknow -',gee 'at - s,- signed the instrument voluntarily for the purpose expressed in it.
f'' ': BREAM CROSS
i o Commission#HH 270863 Department Approval:
Signature of Notary Public, State of Florida
E" Jun.4,2026
1 P sonally Known
l
Produced Identification(Type) Vt-Nt S Li'C6/1X___ Scott Williams, Public Works Director
H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
To whom it may concern,
I am the owner of 842 Cavalla Rd. In Atlantic Beach. I authorize Dylan Beaver to submit a
right of way/revocable permit application for landscaping improvements on my behalf.
Thanks
Stephanie Myers
842 Cavalla Rd
Atlantic Beach, FL 32233
41/ 0 ('k,
To whom it may concern,
Josh and Sabrina Puttbach, the owners of 844 Cavalla Road, approve of the planting project our
neighbors and us wish to do in order to maintain the yard of our property.
I, Chris Chamberlain, owner of 846 Cavalla Rd, authorize
Dylan Beaver to submit a Right of Way/Revocable Permit
application for landscaping improvements on my behalf.
4141vN%bh
ir\
Chris • . •er ain,
03/02/2023
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Customer: Title: Sheet:_of_
Project: By: Date: J ed son
En2ineerinE
City of Atlantic Beach—BACKFLOW PREVENTION ASSEMBLY TEST REPORT
902 Assisi Lane Jacksonville, Florida 32233 Phone: 904-247-5886
Name of Premises: _____________________________________________ Account No: ____________________________
Service Address: _______________________________________________________________________________________
Mailing Address (If Different): ____________________________________________________________________________
Contact Person: ________________________________________ Phone Number: __________________________________
Type of Service: Process Fire Domestic Irrigation Other: ________________
Type of Assembly: ___________________________________ Manufacturer: _____________________________________
Model: ____________________________________________ Serial No: _________________________________________
Size: ______________________________________________ Location: _________________________________________
Gauge Manuf: _________________________Serial No: ________________________ Date Calibrated/Verified: _____________
Remarks: ______________________________________________________________________________________
I certify that the data in this report is accurate.
Tester Name (print) : _______________________________________ Date: ________________________________
Tester Signature: __________________________________________ Phone: _______________________________
Affiliation: ________________________________________________Cert No.: ______________________________
Tester Company: __________________________________________ Address:______________________________
THIS ASSEMBLY PASSED FAILED
Email completed form to Ebrown@coab.us/jdsmith@coab.us Initial Repairs Final Check Valve #1 Check Valve #2 Relief Valve PVB or SVB
Closed tight
at __________ PSI
Leaked
Closed tight
at ___________PSI
Leaked
Opened at
__________PSI
Did Not open
Air inlet opened at _________ PSI
Did not open
Check Valve Held at _________PSI
Leaked
Cleaned only
Replaced:
Rubber Kit
CV Assembly
Disc
O-Rings
Seat
Spring
Stem/Guide
Retainer
Lock Nuts
Other, Describe
Cleaned Only
Replaced:
Rubber Kit
CV Assembly
Disc
O-Rings
Seat
Spring
Stem/Guide
Retainer
Lock Nuts
Other, Describe
Cleaned Only
Replaced:
Rubber Kit
CV Assembly
Disc
O-Rings
Seat
Spring
Stem/Guide
Retainer
Lock Nuts
Other, Describe
Cleaned Only
Replaced:
Rubber Kit
CV Assembly
Disc
O-Rings
Seat
Spring
Stem/Guide
Retainer
Lock Nuts
Other, Describe
Closed tight at
___________PSI
Closed tight at
___________PSI
Opened at _____PSI Air Inlet ______________PSI
Check Valve _____________PSI