1448 Camelia St RESO22-0055 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
BLAKELY MATTHEW ET AL 1448 CAMELIA ST ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171079 0030 ATLANTIC BEACH SEC H
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
1448 CAMELIA ST
RESIDENTIAL OTHER SINGLE OR
TWO FAMILY RESIDENTIAL
OTHER
ARTIFICIAL TURF, GRAVEL
PARKING & PATIO AND
RETAINING WALL
$1500.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 ZONING ZONING NOTES INFORMATIONAL
Notes:
Only work permitted in right-of-way is the retaining wall. No other work shall occur in city right-of-way.
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: 8/3/2023
PERMIT NUMBER
RESO22-0055
ISSUED: 8/3/2023
EXPIRES: 1/30/2024
RESIDENTIAL OTHER 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 $60.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $30.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
3 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
4 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL
Notes:
Dumpsters and roll-off containers must be used in compliance with Section 16-8 and must comply with all standards, per City code.
5 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration, including sod, is required.
6 PUBLIC WORKS RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site. Cannot raise lot elevation.
7 PUBLIC WORKS DOCUMENT IMPERVIOUS AREA INFORMATIONAL
Notes:
Strongly suggest thorough documentation of impervious areas be recorded.
8 PUBLIC WORKS GRASS INFORMATIONAL
Notes:
Full site to be grassed.
9 PUBLIC WORKS REVISION INFORMATIONAL
Notes:
Any plan change must be submitted as a Revision to the Building Department.
10 PUBLIC WORKS DEBRIS REMOVED INFORMATIONAL
Notes:
All construction debris must be removed from job site by Contractor.
11 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Contractor.
12 PUBLIC WORKS OTHER PUBLIC WORKS CONDITION INFORMATIONAL
Notes:
Provide quote/receipt showing approved artificial turf at inspection.
2 of 3Issued Date: 8/3/2023
PERMIT NUMBER
RESO22-0055
ISSUED: 8/3/2023
EXPIRES: 1/30/2024
RESIDENTIAL OTHER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.75
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.50
WORK WITHOUT PERMIT 455-0000-322-1000 0 $110.00
ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 $100.00
TOTAL: $381.25
3 of 3Issued Date: 8/3/2023
PERMIT NUMBER
RESO22-0055
ISSUED: 8/3/2023
EXPIRES: 1/30/2024
RESIDENTIAL OTHER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
l'- Building Permit Application
City of Atlantic Beach Building Department ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
i; IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: kLkk' GV.,YYtt-
t`
f.k. St `- Permit Number: R,EsC) z Z-0OSS
Legal Description S C. F 1\k1G&1( 5e ,Lvt b\K ei,eig RE# I, k 01 a - 0 030
Valuation of Work(Replacement Cost)$ I 5 K Heated/Cooled SF Non-Heated/Cooled
Class of Work: New Addition RATteration Repair Move Demo Pool Window/Door
Use of existing/proposed structure(s): Commercial Residential
S c.(*J-c c -11,14
C P rt gree,
If an existing structure,is a fire sprinkler system installed?: Yes No
0.V e r [/r 1 T'QVC
Will tree(s)be removed in association with proposed project? Yes(must submit separate"Tre0 Removal Permit) No
Describe in detail the type of work to/ be performe `^ p-r,
C- 'G .'1 l'1- vim+Wv ‘
V1.1 t- V eN e'l t/'-4-tn lei`c 3 cyc A- al ` 4
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name M(- (310hz Address ‘'AL1 ' e awl---AL-6' S<
City c^ink-IL ( r_c.-E1'\ State CI— Zip 3'VL 3) Phone ckc, A. •-1 \3 11 L co,
E-Mail fYl u.id-iD u. C';1 @ 01.44` - Co"'
Owner or Agent(If Agent, Power 4f Attorney or gency Letter Required)
Contractor Information
Name of Company Qualifying Agent
Address CityState Zip
Office Phone Job Site Contact N er
State Certification/Registration# E-Mail .%
Architect Name&Phone# i
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt Expiration Date
Application is hereby made to obtain a permit to do the ork and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and tha II work will be performed to meet the standards of all the laws regulating
construction in this jurisdiction. I understand that a s arate 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
RECORDIN O ' N SIZE OF COMMENCEMENT.
ii.
Signatur Own r or nt)Signature of Contractor)
Signed and sworn to(or aff' -d)befor this 'lay of Signed and sworn to(or affirmed)befo -me this day of
I. 1--\. i ' f'A 4 /it,. by
c lid,
s P TONI GINDLESPE' i nat . Signature ofhBag Notary)
MY COMMISSION#G _31 ; •i
r
EXPIRES:October 6,202r
F°
yrs {`iA] R.
Urerwrli ers
Personally Known OR
roduced Identification Produced Identification
Type of Identification: D C SSt- 4 Type of Identification:
Owner Builder Affidavit ALL INFORMATION
HIGHLIGHTED IN
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 THEREQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
Job Address: k,t4 c`k% 6-u"-
Owner
u' '
Owner Name: 1\' ` Phone Number: Rte' 1\3 11
1
Mailing Address: {
e1r
M S ACity: f - -( k State: Zip: 31 Z3`,
Notarized Signature of Owner 76',
egjin instrument was acknowledged be ore me this -ma
of
y 202 in the State of Florida, County
L a i`
Signature of Notary Public
11,
Personally Known OR [ ]] Produced Identificatio
cTypeofIdentification:
Th „,
4,ATONI GINDLESPERGER
Updated 10/24/18
F'1 :,. MY COMMISSION#GG 353178
yam:,- E"PIRES:October 6,2023
or ?° Bandea i hru P!"'^."Public Underwriters
roir;.;, REVOCABLE ENCROACHMENT AGREEMENT
ALL INFORMATION
1}City of Atlantic Beach
HIGHLIGHTED IN GRAY1) 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 der the laws of the State of Florida, hereinafter referred to as"CITY" and
C,,V-P, 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.
Q
This work is generally described as p 0'r y``,5 fkkt 6,`v' hi w vtAA
Any facility maintained, repaired, erected, and/or instaWed 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
kt-kqt (,c , -P.C'-tc 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
liabil'ties are hereby assumed by the USER.
47fI Z 22
Date lPropertyO /Ag (signed in nce of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this ZCU j
day of t ) 20 Z Z,
by Y V c 111.e c,v 4fri who personally appeared before me and
inted name of Signer)
ackno I ged tF, tt Rp/s _signed the instrument voluntarily for the purpose expressed in it.
trV4 TONI GINDLESPERGER
t•
k MY COMMISSION#GG 353178
EXPIRES:October 6,2023 Department Approval:
Signature of Notary Public,State of Florida j "•,,5),'P'
s''''' Bonded ThruNotary Public Underwriters
Personally Known
Produced Identification(Type) Q S S po f—Scott Williams, Public Works Director
H:\Applications&Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
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Revision Request/Correction to Comments ALL INFORMATION
C'-'-',
4
1,, HIGHLIGHTED IN
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ii City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
J Phone: (904) 247-5826 Email: Building Dept@coab.usPERMIT#: t<E.SOCZ'C./Ci—
Revision to Issued Permit OR lt'Corrections to Comments Date: 2// Z,5
Project Address: \ "A D C coevi e 1`c. Sc-
Contractor/ContactS--e---k--CContractor/Contact Name: V V V "f
Contact Phone:1 t3 1 1 \ kO Email: (ck Vc e`.-/ .1 @ °J
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Description of Proposed Revision/Corrections:
To•..lei pc„ ‘,0 c,r,s,,k-S C.).f-- `-ko pct x tok Pw}k o s kc>r,..,i .
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I M p,- '%1.kkC affirm the revision/correction to comments is inclusive of the proposed changes.
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Will oposed revision/corrections add additional square footage to original submittal?
o Yes (additional s.f. to be added:
VyillfrrOposed revision/corrections add additional increase in building value to original submittal?
Nifo *Yes (additional increase in building value: $ Contractor must sign if increase in valuation)
Signature of Contractor/Agent:
Office Use Only)
Approved 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 10/17/18
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