50 17th St ACC20-0074 COAB Permit Form with Conditions - RenewedOWNER:ADDRESS:CITY:STATE:ZIP:
DUGGER JULIA C 50 17TH ST ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
KETTELL INC.1860 MAYPORT RD ATLANTIC BEACH FL 32233
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
169587 0100 OCEAN GROVE UNIT 01
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
50 17TH ST ACCESSORY SINGLE OR TWO
FAMILY ACCESSORY
DRIVEWAY, WALKWAY,
PATIO AND PERGOLA $26000.00
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.
2 PUBLIC UTILITIES METER BOX SEWER CLEAN OUT INFORMATIONAL
Notes:
Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible.
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: 7/13/2023
PERMIT NUMBER
ACC20-0074
ISSUED: 7/13/2023
EXPIRES: 1/9/2024
ACCESSORY PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BLDG 2ND PLAN REVIEW FEE 455-0000-322-1006 0 $50.00
BUILDING PERMIT 455-0000-322-1000 0 $185.00
BUILDING PERMIT RENEWAL 455-0000-322-1000 0 $46.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $92.50
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $4.91
STATE DCA SURCHARGE 455-0000-208-0600 0 $3.28
ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 $100.00
TOTAL: $506.69
3 PUBLIC UTILITIES RT1 SEWER CLEANOUT INFORMATIONAL
Notes:
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.
4 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.
5 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.
6 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration, including sod, is required.
7 PUBLIC WORKS MAXIMUM DRIVEWAY INFORMATIONAL
Notes:
Maximum driveway width within the City right-of-way is 20 feet.
8 PUBLIC WORKS DECKING REMOVED INFORMATIONAL
Notes:
All old decking and debris must be removed from job site by Contractor.
9 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Contractor.
10 PUBLIC WORKS OTHER PUBLIC WORKS CONDITION INFORMATIONAL
Notes:
No additional impervious area can be added to this property, as it is already past it's maximum impervious area.
2 of 2Issued Date: 7/13/2023
PERMIT NUMBER
ACC20-0074
ISSUED: 7/13/2023
EXPIRES: 1/9/2024
ACCESSORY 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
Building Permit Application
:..,: City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, Fl 32233
Phone: (904) 247-5826 Email: Bui1ding-0ept@coab.us
Job Address: So y-, 1h_ ~·t(.f .,(5
Updated 10/9/18
**ALL INFORMATION
HIGHLIGHTED IN GRAY
IS REQUIRED .
Legal Description ~'-=S--........:'---=--o<l ..... --"'.__.~'r-'l,..a:.l<l==~""---1,~L.::=_!c!LLL_ __ RE# I ' Cf 5" 8:J -0000
Valuation of Work (Replacement Cost) $._....c.,"'-4--=..:~=---Heated/Cooled SF ____ Non-Heated/Cooled ____ _
• Class of Work: □New □Addition ~ration □Repair □Move □Demo □Pool □Window/Door
• Use of existing/proposed structure(s): □Commercial ~esidential
• If an existing structure, is a fire sprinkler system installed?: □Yes □No
• Will tree s be removed in association with ro osed ro·ect? Yes u te Tre Removal Permit No
Describe in detail the type of work to be performed : (M Sf< J l.,-t-U Gt 6--1
.(~u J(e,,, ~Sk{I (~'>JUh~
Florida Product Approval# __________________ for multiple products use product approval form
U-Address __;;;5i_0~_\.,_°1_,_·n-_-=S,;....·~---'----~~~--
City ~,._._---';;'--'-'---'l.;x.&=~----State £ Zip T Z..l-,T; Phone U>7. '7..--J / 6t1G t/
E-Mail ~t @.i.yll.r <£. ~J7,f.1 , ( .:n--.
Owner or Agent (lfi'i~nt, Powe~~f Attorney or Agency Letter Required) __________________ _
Contractor Information / !t~t-/ / I / jJ_ f
Name of Cov?ny }(1t ~> ~ ;7-d1 l Qualify~9 Agent /(]&,tr, V:{;J,/t'vf
Address ~D (ha ,rw:._____ )[dt:. City _ _M'l&:ib~ State FL Zip.~__,]c..,·2,"'--"Ct.:.:·.'J,:__:,:3'--
0ffice Phone q 0'1.1 Ti::i 1 "l,, 7-C. Job Site s~mta~t N~m ~r ~ ~. <fO ti z .. ., 10()
State Certification/Registration# · · E-Mail · ;.) 1--, Ir+?.'. I.,:-'\\,.,• 6, ,.-. .
Architect Name & Phone# ________________________________ _
Engineer's Name & Phone "---,f--,'1-------------------------7-r--,-----
Workers Compensation Insurer /'fn Th;tt: OR Exempt D Expiration Date 1/ ;,O 1 ·z..i@
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 ~TTORNEY BEFORE
RECO ING Y R NOTICE OF COMMENCEMENT. .~ /,::?~--~"½r---
~ ~~ ;,
(Signature of Contractor)
·--Sig~~d ;nd sworn to (or affirmed) before me this .l. l day of Signed and sworn to (or affirmed) before me this~ day of
0, ~ , l c: • J ")--. by k., \-..q_ ';.,::tt, II
:i------
.Os-\ •k , J. • ~ 0 , by -s' vi:• VYJJ' e
c:;,.,,) e:::::: .,,...,__ ·•c:::::=== (Signature of Notary)
~) Personally Known OR
,,,~~~11,,, TABITHA MESHAW l~~'I:; Notary Public-State of Flo ride \; •'J Commiss1~n ! HH 2~,er nally Known OR
I ) Produce d Identification
Type of Identification:
-,,,t~ •~~-My Commission Exlf\1f"ro 1Jced Identification
"" July 22·· 2024 -dentification : _____________ _
ACC20-0074
Job Address !:>O
RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION
City of Atlantic Beach
800 Seminole Road, Atlantic Beach, FL 32233
"'"'ALL INFORMATION
HIGHLIGHTED IN GRAY IS
REQUIRED.
PER MI TTIEE]· B:ONSIBLQO,R NOTIF~ING 811 AND OBTAINING UTILITY LOCATES
__ ]____Q c.21f?2e1/= Permit Number -----------
State Certification/Registration # --------------------------------
Architect _________________ Phone _________ Email _________ _
Engineer ____________ -.+-----Phone. _________ Email
Workers Compensation Insurer Fl &nn'-<,.(r OR ExemptOE_x_p-ir-a-ti-on-D-at_e_t:/_1/'f_~..,.1.-/2-;~-?& 1:/-I
• Permlttee 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 Atla tic aeach or Florida Department of Transportation Standards and be performed under the
supervision of . 1 1/ ',j · · (Project Superintendent)
with (Company Name) ' £ Phone qvvi 'll 7 Joog
• 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.
~lculations showing any increase in im perviom area o n owner's lot or in the City right-of-way are to be included with
this applicat ion. . . . . . &.if) . .
• The permittee shall commence actual construction in good faith within _£µ!LL_ 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 Pu_p.k ~.!:~s_ Dire(:,tor s all ____ n~tified 24 hours prior to starting work and again immediately upon completion ..
< ~~A . Date \ 0/vi/-zo lo
,ttee (signe · presence of Notary Public)/
sTATE oF FLORIDA, couNTY oF DUVAL , \ s..\. ~ t b ,
The foregoing instrument was acknowledged this D( day of ___ c.._.:,._<::1 __ f~r _____ .:,._ __ ___, 20 o(. 0
by kq_-\-~ k-\\~ l / , wh-
~inted name of Permlttee) ••~V"',,, TABITHA MES HAW_ . . . . l°m~ \ Notary Public-State of Florida
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. :• •; Commission # HH 22744
/'\ ~1>; ~:~ My Commission Expires O(~ ,,,,,r,.,•,\,•'' July 22 -, 2024
~ ~ Personally Known
Signature of Notary Public, State of Florida I) Produced Identification {Type) ________ _
H:\Applications & Forms\Word Documents\201801001 Right-of-Way Easement Permit Appllcation.docx Revision Date: 10/1/18
ACC20-0074
/.!Wi"?r h ...i ~ r {_:,. 1~ ;:;\ \0 _,, __ 7 1
,✓~✓
---. .:,::...,--
REVOCABLE ENCROACHMENT AGREEMENT
City of Atlantic Beach
800 Seminole Road, Atlantic Beach, FL 32233
••ALL INFORMATION
HIGHLIGHTED IN GRAY
IS REQUIRED.
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation organized and existiog under the laws of the State of Florida, hereinafter referred to as "CITY" and :t, 11\'.1 C (D,~~U--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 , 1.-'i
Any facility maintained, repaired, erect d, and or installed in t e 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 r;o /'7 fl Sb:-e,.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 assumed by the USER.
tary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this day of __ O_c..._t....:"=-=t....=-------' 20 ) ,.._ •
by -s lAt~ l, D '-' ,s_;V
(printed name of Signer)
• who personally appeared before me and
acknowledged that he/she signed the instrument voluntarily for the ournnsP py Mn rr d in it. I'\ ,,,1111,,, TABITHA MESHAW cJ... m~ Notary Public-State of Florida --=~../'--~=--~·=======::_ _____ _. =• •= Commission# HH 22744 \~, rl . .l My Commission Expires Signature of Notary Public, State of Florida
,;:{,(,) Personally Known
'•t.f':,:~,,, July 22, 2024
Department Approval:
[ J Produced Id entification (Type) _____ _ Scott Williams, Public Works Director
H:\Applications & Forms\Word Documents\20180831 Revocable Encroachment Agreementdocx Revi sion Date: 8/31/18
ACC20-0074
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANfIC BEACH, FL 32233
(904) 247-5800
SURVEY AGREEMENT
NOTICE
All new projects creating more than 250 Square Feet of impervious stuface or requiring on-site storm water retention, including swimming pools, will require pre-construction and post-construction topographic surveys, as required by COAB, Section 24-66 and described in Bulletin 2-18, Surveys. The surveys must be new original documents, from a licensed surveyor, signed, sealed, and dated.
Other small projects, such as fences and construction less than 250 SF, will not require a new topographical. survey, but a current original-size survey with all relevant details is still needed. These surveys, when included as part of a building permit application, must be complete, up-to-date, and original size and scale, as produced by the surveyor.
Copies of old surveys lacking details or copies not of original size cannot be accepted. Building permit applications with unacceptable surveys cannot be reviewed and the application will be returned to the applicant.
Thank you for your cooperation in this matter.
AGREEMENT
I have read and understand the Notice above and affirm that the outdated survey I am submitting is still accurate and complete, and all structures and impervious surfaces on the property are shown on the survey.
I further understand that, if the smvey is found to be inaccurate or incomplete, a $50.00 Plan Resubmittal Fee will be charged; or if the permit has been issued, a Stop Work Order will be posted with the associated $110.00 Fee.
JOB ADDRESs__....._Sc ........ 1'----__._\____.1_R_Sk.-----=.wr=-....,-------
OWNER or CONTRACTOR (Print)_--'j"--'U""'-\----'-':~_,1 __,{ ____ -_1)_, ,,<--U_,.? •-·~..,,.· __ e,c _____ _
Signaturd~x "-e #"-= ' Date L ,.,.1~~ 12:'v
1
ACC20-0074
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Digitally signed by
KENNETH OSBORNE K£NNETH OSBORNE
Date: 2020.06.14
16:09:11-04'00'
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SERVING FLORIDA
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Olgllally signed by
KfNNfTH OSBORNE
KENNETH OSBORNE Date: 2020.06.14
16:09 :1 J ~-oo·
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SERVING FLORIDA
6?IOH.IIUTAIIY IRAll.Sl.ffl 1(1!
WEST PAlM BEACH. Fl l3'07
PHOIIE 1561164IMIOO
STA IEI\IOE PHONE 11001226417
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WEBSITE: ••p.Mll'9'fS.IW)"91'f'
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ACC20-0074
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ACC20-0074
RESO20-0019RESO20-0019
SITE PLAN FROM A JOB PREVIOUS
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $460.69
ACC20-0074 Address: 50 17TH ST APN: 169587 0100 $460.69
BLDG SUBSEQUENT PLAN REVIEW FEES $50.00
BLDG 2ND PLAN REVIEW FEE 455-0000-322-1006 0 $50.00
BUILDING $185.00
BUILDING PERMIT 455-0000-322-1000 0 $185.00
BUILDING PLAN REVIEW $92.50
BUILDING PLAN CHECK 455-0000-322-1001 0 $92.50
PUBLIC WORKS PLAN REVIEW $25.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
STATE SURCHARGES $8.19
STATE DBPR SURCHARGE 455-0000-208-0700 0 $4.91
STATE DCA SURCHARGE 455-0000-208-0600 0 $3.28
ZONING PLAN REVIEW $100.00
ZONING REVIEW SINGLE AND TWO FAMILY
USES 001-0000-329-1003 0 $100.00
TOTAL FEES PAID BY RECEIPT: R14295 $460.69
Printed: Friday, December 4, 2020 4:00 PM
Date Paid: Friday, December 04, 2020
Paid By: Julia Dugger
Pay Method: CREDIT CARD 401074587
1 of 1
Cashier: JJ
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R14295