360 3rdSt DWAY22-0062 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
CAMPBELL PATRICK H 360 3RD ST ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
169787 0000 ATLANTIC BEACH
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
360 3RD ST DRIVEWAY SINGLE OR TWO
FAMILY DRIVEWAY PAVER DRIVEWAY $2000.00
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 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.
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 3Issued Date: 4/12/2023
PERMIT NUMBER
DWAY22-0062
ISSUED: 4/12/2023
EXPIRES: 10/9/2023
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
WORK WITHOUT PERMIT 455-0000-322-1000 0 $110.00
ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 $100.00
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'; 26' maximum at road.
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:
Right-of-Way Permit is required if using right-of-way for construction parking.
11 PUBLIC WORKS DEBRIS REMOVED INFORMATIONAL
Notes:
All construction debris must be removed from job site by Owner.
12 PUBLIC WORKS OTHER PUBLIC WORKS CONDITION INFORMATIONAL
Notes:
No additional impervious area can be added to this property.
2 of 3Issued Date: 4/12/2023
PERMIT NUMBER
DWAY22-0062
ISSUED: 4/12/2023
EXPIRES: 10/9/2023
DRIVEWAY PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
TOTAL: $260.00
3 of 3Issued Date: 4/12/2023
PERMIT NUMBER
DWAY22-0062
ISSUED: 4/12/2023
EXPIRES: 10/9/2023
DRIVEWAY PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
Building Permit Application Updated 10/9/18J' r
City of Atlantic Beach Building Department ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
n s)r
IS REQUIRED.Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: SAO E aQ SA-. /4'I ce..c c eeaA ,i EL Permit Number: bpi RV 72- 6 L.
Legal Description LOT tq A .5`Y2 LOT gN1 ) glcck 4— RE# t69 7-81-- m
Valuation of Work(Replacement Cost)$ 2e0 Heated/Cooled SF N fi Non-Heated/Cooled kM
Class of Work: New DAddition NAlteration ®Repair Move Demo Pool Window/Door
Use of existing/proposed structure(s): Commercial laResidential
If an existing structure, is a fire sprinkler system installed?: DYes 7No
Will trees)be removed in association with proposed project? EYes(must submit separate Tree Removal Permit) fiNo
Describe in detail the type of work to be performed:
ie-P`ccc+- ,sfrl 6f1.ie (CCANCre"e) UO'f\y k)a.Vei .
I
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name Pcv.t c,c\c- Ca..4.,e ,Address 3 6.0 :3'"4 St-----•
City At-Q0,.t4,;c 3e,4-a c State F:I— Zip 32 2-3 3 Phone 90 L-1 - 3( - 7 aa
E-Mail t7eevrtck • -Cu.-.-.(4‘:4Q k\ cz L.'AVc . OGM P;Vd.e,r .C•u `pe1kC., 114 gni a,1 .alP
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Qualifying Agent
Address City State Zip
Office Phone Job Site Contact Numb-'
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 the wo and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that al ork 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 OBT N FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECO I YO tIC OF OMMENCEMENT.
1x,- 7 I t n 1F- 1\ .
ign re of Owner or Agent)Signature of Contractor)
ed and sworn to(or a it . d)before me this 1 Z_day of Signed and sworn to(or affirmed)before me this day of
i ' 0 b ' JAR_.,4 Cz 6ef4Q by
n t • . 6 _ ) \ Signature of Notary)
iR r f'. TOt]i1GI LESPERGER
1ersonally Known OR MY COMMISSION#GG 35317$Pe onally Known OR
1—iProduced Identification 7,,,-: EXPIRES:October 6,2024 ] P uced Identification
Type of Identification: c f°Ff`°' Bonded ThruWiry PubilcUnd f Identification:
Owner Builder Affidavit ALL INFORMATION
HIGHLIGHTED IN
i,,',1k. , 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: 160 'Z'(-* 5rt. -A'- .,,,t',c_ crQC\.‘ EL.3'x`2-3 3
Owner Name: l/aC r -r 1e-_ t- E``-e-Q-4\ Cse ,(c,l'Lt Phone Number: GfO-- 631 - --/-aa
Mailing Address: 52.vte City:State: Zip:
Notarized Signature of Owner G Ar
The fc eg ing instru ent was acknowledged before me this I 7 day of
da ESQ,202 61n the State of Florida, County
of LUVcL..-
Signature of Notary Public
Personally Known OR [ ] Produced Identification
Type of Identification: t_ _i { ,
1 /4'.••.. ONI GINDLESPERGER Updated 10/24/18
i? I
11:,,9 ?off•' EXPIRES:October 6,2023
4,'4. e:-:•:.Thru Notary Public Underwriters
r REVOCABLE ENCROACHMENT AGREEMENT
4' City of Atlantic Beach ALL INFORMATION
f 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
existiunder the laws of the State of Florida hereinafter referred to as "CITY" and
1-641-rs l'c. \ -4 '\ cp.esk. ( p klaGc 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 Be h.
This work is generally described as v e` r t f!?c.c..)4
Any facility maintained, repaired, erected, and/or installed in the exercise of the privi ege granted remains subject to
relocation or removal on thirty(30)days'notice by CITY to USER,said notice USER shall be given by certified mail, return
receipt requested,to the following address p Q Q
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
Iia ' ities
arer hereby ssum by the USER.
GX L ( Date /Z"/2- Zp2Z
Prop rty Owner/Ag t(sig e 'n presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this 1 2- day of e_C. 20 7 - e
by' ii\ LGc -e--(- who personally appeared before me and
ted name of Signer)
ackno •ged th• ]s.igned t 'instrument voluntarily for the purpose expressed in it.
i I TONIOINDLESPERGER
z MY COMMISSIONS GG 353176 I Department Approval:
Signature of Notary Public,State of Flori• - 1k , EXPIRES:Od 6•20
I Personally Known I'•'''t.t$-• somidyntootiripac
1 Produced Identification(Type) i--> .1._ . Scott Williams, Public Works Director
H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
N TBM 0501 SPECIFIC PURPOSE SURVEY OF:
MAG NAR.RAISK L56508
ELF,.e.0(NAW-66)LOT 19 AND EAST 1/2 LOT 21,BLOCK 4 ATALANTIC BEACH,ACCORDING TO THE
PLAT THEREOF,RECORDED IN PLAT BOOK 5,PAGE 69 OF THE CURRENT PUBLIC
Rp STREETY r WOOD RECORDS OF DUVAL COUNTY,FLORIDA
3R of WAY PON£R POE FOR:
C 40'
gL.IC
53 E
P)- ATT PATRICK CAMPBELL
rPU 53"E 75.0 ( n ArT___ Do=
N82'25'
II 66
I
LEGEND
ELECTRIC BRL BUILDING RESTRICTION LINE ID. IDENTIFICATION
VAULT A I I I ELEV. ELEVATION NAVD NORTH AMERICAN
VERTICAL DATUM
CONCRETE EX EXISTING ELEVATION
DRIv_ 20'SOL I FFE FINAL FLOOR ELEVATION
RE REAL ESTATE NUMBER
y TBM TEMPORARY BENCHMARK
0 10' 20' 40'
A , ,,,
c'4--,,... /
w
I N07.34'07"W 150.00 (P) I
GENERAL NOTES:
I 1. THIS NOT A BOUNDARY SURVEY.
2. THE PURPOSE OF THIS SURVEY IS TO DISPLAY TOPOGRAPHIC FEATURES IN ACCORDANCE WITH
THE CITY OF ATLANTIC BEACH POOL&SPA STANDARDS.
IJ ORE STORY I P.'I>1S764•du'''dr 3. ELEVATIONS SHOWN HEREON ARE REFERENCED TO THE NORTH AMERICAN VERTICAL DATUM OF
SO7'34'O7"E 1 SO.00 (P) F F.E..9 62 1988(NAV!)88).AND ARE BASED ON TOPOGRAPHIC SURVEY BY ASSOCIATES SURVEYORS INC..
y
1
O.F.F.E 8.78 0711 FILE NUMBER 65962-.
360 UU 4. UNDERGROUND IMPROVEMENTS AND UTILITIES WERE NOT LOCATED AS PART OF THIS SURVEY,
EXCEPT AS SHOWN HEREON.Iw' 5. MEASUREMENT METHODS USED FOR THIS SURVEY MEET STANDARDS OF PRACTICE FOR LAND
GENERATOR SURVEYING AS SET FORTH IN FLORIDA ADMINISTRATIVE CODE CHAPTER 5 J-17.050-.052
REQUIREMENTS.
a''La
te M1 I I 6. ALL DATA SHOWN HEREON ARE FIELD MEASURED UNLESS OTHERWISE NOTED.
PROPANE Li :/i ss:n.
6
N 7. NO BEARINGS SHOWN HEREON. PLAT OF RECORD DOES NOT CONTAIN ANY ANGULAR
A TANX5/2)
IM1, {
I INFORMATION.
POOL r 6.'...- IEQUIPMENTSTEP '
8.9r
8.89 HOT
EXISTING PAVERS II TUB I J REVISION: DATE.' BY:
TO BE REMOVED 7 I' JOB No. 22-009 ADJUSTED POOL DECK 03-02-22 TBHEziFILENo.A-147EE-8s e90 1p{s ADJUSTED DECK-BASIN 05-06-22 TBHI
J
Ex-8.5DE-s.7 (
9w 9.11441
s
DE-e.5 PARTY CHIEF.•B.OSBOURNE
1 e F.B. 1132-16
I Thu
9.01 1'• e6. a0 4 DRAWN BY: T.HODGE9.OS r,
MMM ON P N Ez_8.4 I CHECKED BY:JTHOMAS
I
ELEV..6.96(NAW-66] c DE-7.4 SURVEY DATE 02/12/20221368' PROPOSED POOL
I IOPOSEO. BEAM-9.50 Ex-0.SAOLAREAx_74 I CAD FILE: P:\22 SAM\22-009 102206 7955 COAG 360 3RD ST FOR IP\DWG\22-009 COAX 3
INHEX-8.7 \ \
STREET-POOL SURYEY.DWG
393
DE-7.4• I GHIOTTO & ASSOCIATES, INC.
a'PRo
Q5BASIN NATIONALLY CERTIFIED SURVEYORS & MAPPERS
Nal e
8.4
ELEV-7.4 4DE-zs) CERTIFICATE OF AUTHORIZATION No. LB 6508
I 2 L' 2426 PHILIPS HIGHWAY
Q=_ l JACKSONVILLE, FLORIDA 32207
I J GHIOTTO (
904)
AA B '-nr.,,
oti d flSSOtIITES (
90¢-QcdI
1,,c__,.:
1s:
r No.62?j
I
6 A`
TOTAL AREA 11250.00 Y l
EXISTING WPERVIWS 4563.64 40.5% TT^R Ts[J 0 ,
POST-ADDITION 4893.81 43.57[ t
o s'',Sp,.•, FHnq P.pNA. 6223
N82.25'53'E 75.00 (P) NOT VALID yc,fIk.i Al ,IND THE ORIGINAL RAISED
SEAL OF •IliU/, itNi>N® ITvoR AND MAPPER