395 SKATE RD DWAY23-0063 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
JOSEPH AND MICHELLE
VIEIRA 395 SKATE RD ATLANTIC BEACH FL 32233-3819
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171669 0000 ROYAL PALMS UNIT
02A3.00
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
395 SKATE RD DRIVEWAY SINGLE OR TWO
FAMILY DRIVEWAY
CONCRETE RIBBONS FOR
GRAVEL 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 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.
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 2Issued Date: 11/29/2023
PERMIT NUMBER
DWAY23-0063
ISSUED: 11/29/2023
EXPIRES: 5/27/2024
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
3 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.
4 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration, including sod, is required.
5 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.
6 PUBLIC WORKS MAXIMUM DRIVEWAY INFORMATIONAL
Notes:
Maximum driveway width within the City right-of-way is 20 feet, including ribbon. This will be verified at Inspection.
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 Contractor.
10 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Contractor.
2 of 2Issued Date: 11/29/2023
PERMIT NUMBER
DWAY23-0063
ISSUED: 11/29/2023
EXPIRES: 5/27/2024
DRIVEWAY PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
1,\iy- BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
sn, City of Atlantic Beach Building Department PERMIT# C06,3
800 Seminole Road, Atlantic Beach, FL
32233illil
information required to process
a,t"r
v
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address --2).°15 '5 L .1 RE# 17 ii.t .' _. 0000
Legal Description RES L L 3-'1 L1v,4s per- At.
Valuation of Work(Replacement Cost) $aq0c0 Heated/Cooled SF Non-Heated/Cooled SF
Class of Work: E New Addition *Alteration Repair Move Demo Pool Window/Door
Use of existing/proposed structure(s): •Commercial Residential • If existing structure, is a fire sprinkler system installed?:Yes No
Will tree(s)be removed in association with proposed project? Yes (Must submit separate Tree Removal Permit) No
Describe in detail the type of work to be perffoorme1d:
L Oe1L:¢1t r,6hon5 N.' O ..1ri.iaws,-. ComOrqu4-1.0 li,a÷ irN41t t Yt#L—
Florida Product Approval# For multiple products use Product Approval Information Sheet)
Property Owner Information Name je< ,JU,, 4--.* Phone x„44 502 5934
Address - `1 S S(c,,fi, e„.1 CityCity .4_}fqh-L,' It,/,‘ State S( Zip 32.2 33
Email )•0., Jr 2 t Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Informati011 Name of Company Phone
Address City State Zip
Qualifying Agent State Certific on/Registration#
Email Job Sit ontact 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 city/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. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE SITE OF THE IMPROVEMENT BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATT• ' EY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
4 0re of Owner or Agent) Signature of Cg'itractor)
Signed aid sw' fi 4)before •'a this day of ; Signed and sworn to(or affirme efore me this day of
C9VOZ'by 1 1L1 (`- by
Signature of Notary S2— '
C6,--signature of Notary
Personally Known
AOR [
I Produced Identification Personal) nown OR [ ] Produced Identification
Type of Identification: 1 - .. Type of Identification:
M`br"= TONI GINDLESPERGERe' MY COMMISSION#HH 407122
i '. ,.- EXPIRES.October 6,2027
Owner Builder Affidavit ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Departmentletk._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: 1
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: '3'1 Sk1,+w._ ...4
Owner Name: Josdrl-. v<,..,-..1 Phone Number: 'to'-i SJ,2 `_;134-1
Mailing Address: 39- Sd City: ] I,,„ri-r,. [,\ State: Ft_ Zip: . , 3
Notarized Signature of Owner
The f I ngn rumfent was acknow e•:-. •efore me this -4 day of 20 ,ir the State of Florida, County
of -1 C,/V C=.,I v
9'
Signature of Notary Public
Personally Known OR [ ] Produced Identification
Type of Identification: L_
Updated 10/ 24/18
r.vcoe.
70NIGINDLESPERGER
MY COMMISSION#HH 407122p' P EXPIRES:October 6,2027
REVOCABLE ENCROACHMENT AGREEMENT
City of Atlantic Beach ALL INFORMATION
800 Seminole Road,Atlantic Beach, FL 32233
HIGHLIGHTED IN GRAYISREQUIRED.
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
Vt krn of Atlantic Beach, Florida, hereinafter
referred to as "US R".
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 ( t."A,.j r','(mob,;
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 get r3;
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 assu n-d by the USER.
Date /////// /,2.3.///// /,2.3.
Property 44- gent (signed in presence of Notary Public)
STATE OF FLbRIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this day of IQ OV 20 G
by c c- L \,r c rc" printed name of Signer), who personally appeared
before me and acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
TONI
s Y COMMISSION#
HHGINDLESPERGER
407122
M
EXPIRES:October 6,2027
Depar - al:
Signature of Notary Public, State of Flori a
Personally Known
Produced Identification (Type) L_ Public Works Department Date
Revision Date:05/09/2023
SKATE ROAD
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