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1303 Ocean Blvd DWAY23-0038 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP: BURGESS ROBERT CARTER 1303 OCEAN BLVD ATLANTIC BEACH FL 32233 COMPANY:ADDRESS:CITY:STATE:ZIP: TYPE OF CONSTRUCTION: REAL ESTATE NUMBER:ZONING:BUILDING USE GROUP:SUBDIVISION: 171835 0000 MANDALAY JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK: 1303 OCEAN BLVD DRIVEWAY SINGLE OR TWO FAMILY DRIVEWAY Driveway and walkways $7000.00 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. State Law requires calling Sunshine 811 to have ALL public utilities located BEFORE beginning the work. 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 3Issued Date: 8/14/2023 PERMIT NUMBER DWAY23-0038 ISSUED: 8/14/2023 EXPIRES: 2/10/2024 DRIVEWAY PERMIT CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 3 PUBLIC UTILITIES ADDITIONAL COMMENTS PUBLIC UTILITIES INFORMATIONAL Notes: See Revocable Encroachment Agreement regarding driveways/pavers and public utilities in the ROW 4 PUBLIC UTILITIES SEE ATTACHMENT INFORMATIONAL Notes: Revocable Encroachment 5 PUBLIC WORKS DRIVEWAY APRON INFORMATIONAL Notes: All concrete driveway aprons must be 5 inches thick, 4000 psi, with fibermesh from edge of pavement to the property line. Reinforcing rods or mesh are not allowed in the City right-of-way. 6 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. 7 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL Notes: Full right-of-way restoration, including sod, is required. 8 PUBLIC WORKS CONSTRUCTION SITE MANAGEMENT INFORMATIONAL Notes: Provide construction site management plan, including location of silt fence, dumpster, portable toilet. Right-of-Way Permit is required if using right-of- way for construction parking. 9 PUBLIC WORKS MAXIMUM DRIVEWAY INFORMATIONAL Notes: Maximum driveway width within the City right-of-way is 20 feet. 10 PUBLIC WORKS GRASS INFORMATIONAL Notes: Full site to be grassed. 11 PUBLIC WORKS REVISION INFORMATIONAL Notes: Any plan change must be submitted as a Revision to the Building Department. 12 PUBLIC WORKS DEBRIS REMOVED INFORMATIONAL Notes: All construction debris must be removed from job site by Owner. 13 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL Notes: Any damage done to infrastructure must be repaired by Owner. 2 of 3Issued Date: 8/14/2023 PERMIT NUMBER DWAY23-0038 ISSUED: 8/14/2023 EXPIRES: 2/10/2024 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 14 PUBLIC WORKS IMPERVIOUS AREA INFORMATIONAL Notes: No additional impervious square footage area can be added to this property. 3 of 3Issued Date: 8/14/2023 PERMIT NUMBER DWAY23-0038 ISSUED: 8/14/2023 EXPIRES: 2/10/2024 DRIVEWAY 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 Driveway and walkways 1303 OCEAN BLVD N/A DWAY23-0038 ti-ANY- BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY y° City of Atlantic Beach Building Department PERMIT# Cl;J-p'2 --f OYth 800 Seminole Road, Atlantic Beach, FL 32233 ALL information required to process r ' v Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address l jO 0 Ge OJ t l \IA • O tom; (j p.ci RE# 0 I ta3—OCC) Legal Description t 0 I 1 (V! _c— a e—flanda tc LD - I B) - c 3 Valuation of Work(Repla ement Cost) ()0 0 Heated/Cooled SF Non-Heated/Cooled SF Class of Work:New Addition Alteration •epair Move Demo E Pool Window/Door Use of existing/proposed structure(s): Commercial i Residential If an existing structure,is a fire sprinkler system installe•.: g Yes No Will tree(s)be removed in association with proposed proje t? Eyes(Must submit separate Tree Removal Permit) QS[No Describe in detail the type of work to be performed: Ci,Ir V12.way WHi— Urn e Z rink ( —& s. / ,.>,) 2, VI 0.-U—Vli COI (x49-143 4-Or ro a.. ,,,,INV4.\A)cA-INC to -1.\/.-e-ofr- Florida Product Approval# For multiple products use Product Approval Information Sheet) Property Owner Information Name i' lLu'&is • 'i S S Phone ,l Address Ai C'tyt State Zip ec S SEmail r • - . 1Age"•gen , 1: ower of Attorney or Agency Letter Required Contractor Information Name of Company Phone 0 Address City State Zip Qualifying Agent State Certification/Registration# Email Job Site Contact Number Worker's Compensation Insurer OR Exempt Expiration Date Architect's Name Email Phone Engineer's Name Email Phone 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 YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN ATTORN BEFO E ECORDING YOUR NOTICE OF COMMENCEMENT. Signatur of Owner or Agent) Signature of Contractor) Signed and sworn to(or affirmed)before me this g) day of Signed and sworn to(or affirmed)before me this day of ail U 2-02-S by 44 ' tj 6 &r`C ..-S by Signature of Notary Signature of Notary I Personally Know OR [ :]'Produced Identification Personally Known OR [ ] Produced Identification Type of Identification:fi. Cl— Type of Identification: e.* '•: VANESSA ANGERS i*i MYCOMMISSION 8HH244118 ro:EXPIRES:March 23,2026 oi F.4E " ALL Owner Builder Affidavit HIGHLI HIED I ON HIGHLIGHTED IN City of Atlantic Beach Building Department GRAY IS REQUIRED.i' 800 Seminole Rd, Atlantic Beach, FL 32233 u Pc 0031Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT D 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 i 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: 1 03 3( O..YI \j1v4, . Owner Name: a, 'l Yl- '- e, V SSS Phone Number: —1a7—t--IcK - • ( Mailing Address: 01); 0(7e03.ev kj /'r r City:aA,klt. (94.)11 State: - Zip: -pZ Notarized Signature of Owner (_AAA-1 —VY----) The foregoing instrument was acknowledged before me this I day of ' ki 20 -", in the State of Florida, County of ;FSI/ :i. Signature of Notary Public Personally Known OR [ Produced Identification VANESSA ANGERS MYCOMMISSION#HH244118 Type of Identification: rl C < Irl P yP Art-i- \ e arC}-PS 1 Foy EXPIRES:March 23,2026 J Updated 10/24/18 r.; RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION ALL INFORMATION 4I 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 . Job Address &7 l GC,t,-l YU 'Ara ' Permit Number Dv\J-"`/l 002 V) Contractor Information Company Y 'L,( ' li -Or Qualifying Agent n 1 6 Address , ) U j,,-e_L 0 V a ' City nb(.`itin State Zipipf)--r. Q3 Phone /), c'lI Email h\iiYcf > v-+ U\ l.i"," ' 6&`i{ ffl State Certification/Registration# V v C'\ l k Architect \ G Phone Email Engineer NM 1:1' Phone VA h Email Workers Compensation InsurerV\A. I\ 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 Department of Transportation Standards and be performed under the supervision of : t._1L_ ' ' n , c Project Superintendent) with (Company Name) e,UPhone oT —LAC I 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. 0Thepermitteeshallcommenceactualconstructioningoodfaithwithin 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,public Works Director shall be notified 24 hours prior to starting work and again immediately upon completion. 11\4_ Date 7/ /? Permittee(signed in prese ce of tary Public) STATE OF FLORIDA,COUNTY OF DUVAL The foregoing instrument was acknowledged this -' '•( day of AI/ 20 ? _7 , by A yytc,i n eti eg1.:YCi ' who personally appeared before me and printed- ame of Permittee) PY Pfle'•, acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. gilt VANESSA ANGERS MY COMMISSION#HH 244118 ice'/ / EXPIRES:March 23,2026 I FLOP: Personally Known Signature of Notary-Public, taS to of Florida oduced Identification(Type) °L- H:\Applications L- H:\Applications&Forms\Word Documents\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18 REVOCABLE ENCROACHMENT AGREEMENT r., , ''= City of Atlantic Beach ALL INFORMATION lc)HIGHLIGHTED IN GRAY 5,800 Seminole Road,Atlantic Beach,FL 32233 IS REQUIRED. REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation organized and existin under the laws f the Sta of Florida, hereinafter referred to as"CITY" and tit e 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 AtlantictiBeach. This work is generally described as iV 1i v bi1 (vri r' .\i‘J tk_ ,afi 5v 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, USsaid notice to USERshall be given by certified nm ],, return receipt requested,to the following address `lin t,,tXn WI/1 " -' '(111`&V K_.UI 1l 1 Y1-' • 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 7/171/2 3 Property Owner/Agent (signed in presence of Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL The foregoing instrument was acknowledged this 31 day of '` I 20 2 by Yr1(we, 1,.t ';}CJ printed name of Signer),who personally appeared before me and acknowledged that Ie/she signed the instrument voluntarily for the purpose expressed in it. YD•• VANESSA ANGERS fo MYCOMMISSION8HH244118 o; P; EXPIRES:March 23,2026 FoF Flo: Department Approval: Signature o„ft-Id6 afy Public,State of Florida Personally Known k roduced Identification (Type)f L— /A- Public Works Department Date Revision Date:05/09/2023 i,P.11-13-V LAri p .-.)--1".y. „I/ 1 re 1/4-1{0 PTV 0, _ , •. , 1 ___:__ 1 i ._.,_ 5 bz 1--;LN, 1-_-----. s:Ka v\-A.,. • . 7:.t.2.---, -, Y I-Aalt6 it' r-- 71 i_4_ , ui/53. 1 4,_ l____I 612S / Oboe-1- ) S ' -'4"4 acl 001 -.hlx) Pv0V;AO t 1 . . 9_ _.int NI ay- 't•Pom He - Veil, j___I 4 . 0. _all, Of ei 0 a ...• - . , , , rk,i vLa • 1 , 1 , 1 g i'''- , sr I . - I 'r 1 1"I, 1 1 •,, il , A i . , 11 1- 1111 1 I 41.A 0 4. 1. Aril:•.- 1111 _ ' 71r 1 12-/NACA X09:70 C14 1-C-)--rCA- Q-S 1YkakiA' 1 • .•f)4--,- A 1 !-- 1 1 t I 11)NS V tAej5Uajl 1 11,. 55 4 -,r)k IAA 1.0 IAA y\ 1 • ,.. , t-H 1 1 I 14-1-1 AN -, • , 9-i' • ; . rio., • 1._ _______1 i_ 1 , AO */-d*O—1(7 115 II ' I I• .1f' 1----,-I' 1 _.. 1.. 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