Permit 222 Pine Street "b\j,
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 10-00000452 Date 4/21/10
Property Address . . . . . . 222 PINE ST
Application type description RIGHT-OF-WAY PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
BRICK PAVER DRIVEWAY AND WALKWAYS
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Owner Contractor
------------------------ ------------------------
JOHNSON JOHN OWNER
222 PINE STREET
ATLANTIC BEACH FL 32233
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Permit . . . . . . DRIVEWAY PERMIT
Additional desc . .
Permit Fee . . . . 35 . 00 Plan Check Fee
Issue Date . 00
. . . . Valuation . . . . 0
Expiration Date . . 10/18/10
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Special Notes and Comments
Roll off container company must be on City approved list
and container cannot be placed on City right-of-way.
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 35 . 00 35 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 35 . 00 35 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Butiding Department
AP "NUMBER
PLICATION
300 Serninofe Fzoacf Q-o be assigned.by the Buf1dinq Departriient)
�antic Beach,Floricfa 32233-5A
AL .4S
PhOna(904)—747-5826 - Fax(,SG4)247_5845 0,9 /0
'SJR13 E-malk buffd1ng-deptgcDab.US .16'?
D roLded-
APPLICATION REVIEW AND T NG FORM
'MPSOY Address: 22-2 ?/Al-F &.
De No
oplicant: Jox 11� BtWdfdfn
Manning&Zoning
ircliect. Tras Administrator
Pubhr'Wo
Pubric utiriffe.
Public-Safe-,y
Fire Servfms
Other Agency Review or Pennft Required Review or aipt
Florida Dept_of Emqraninenfaf Protscaon of Perm rt Ve �d By Da
Florida Dept,n-F i
St Johns - r Wafer Management District
AmW corps of Eng-ineers.
Dhrislan of fjolels and Restauranft
DhFfSiOn Of Air-oftaffc BeVeMcfes and Tobacco
Other
APPLICAT 10N STATUS
WIM11119Deparlinent F-irstReview- [�A?Praved. DDenied.
(Circle one.) Comments:
BUILDING
LANNING&ZONING
TREE ADMIM Reviewed by-.
Slecond Rev!Lmw.- []Approved as revised. []Denied-
PUBLICWOP,KS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review.- DApproved as revised. ElDenied.
Comments:
Reviewed by. OLE COP
ised MWD-q
Public Works Plan Review Comments
Date: t-111410 Initials: �V/
Project Name/Address: 2--)-2- PIAJE- Application Permit#: /6-49-L
Check.Box
Application Tracking Comments to Add
'Comment
Provide impervious surface calculations.
Provide erosion and sediment control plans with installation details and maintenance
schedule.
Provide drainage plans showing site topography (flow arrows, etc.)
Provide construction site management plan, including Right-of-Way Permit if using
right-of-way for construction parking.
Provide a pre-construction topographic survey prepared by a Florida Licensed 7-
Professional Land Surveyor, showing V contours. 0
Section 24-66(b) of the Land Development Regulations requires on-site storage for
increased runoff. Provide Delta volume calculations and on-site retention required 0
per Section*24-66(b). (See attached info. Sheet)
If on-site storage is required, a post construction topographic survey documenting
proper construction will be required. 0
A Right-of-Way Permit must be obtained for use 0
A Revocable Encroachment Permit must be obtained. 0
Pool-Wellpoint(if used) must discharge into vegetated area 10' minimum from 0
street or drainage feature (swale, structure or lagoon).
All concrete driveway aprons must be 5 inches thick, 4000 psi, with fibermesh from
the edge of the pavement to the property line. Reinforcing rods or mesh are not
allowed in the ROW(Commercial driveways-6"thick).
Any utility cuts in the road must be repaired using COJ Standard Detail Case X and
must be overlaid 10 feet in each direction from the center of the cut. Repair must be 0
-shown on the plans.
P - Roll off container company must be on City approved list and cannot be placed
on City right-of-way. f
0
r Cop
CITY OF ATLANTIC BEACH
CONSTRUCTION P
ERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
800 Seminole Road
Atlantic Beach,Florida 32233-5445 904-247-:i5800
PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION. Fax 904-247-5845
Date_1 all a
PERMIT*
33 ISSUED BY THE CITY----------------
Job Address 2 d,916— SR7essr �M
Permitee: ___S_MkW-3�,=6--.t ti ,0 Telephone*
Permittee Address: 2-ZZ- An,6579�$�t7- 4_rZ4&,'2e- 44,-A- FC 3Z2�33
Requesting Permission to Construct:
Location: (Reference to Cross-Street)
or to filing this application he has ascertained. the location of all existing utilities,
1. Applicant declares that pri
both aerial and underground and the accurate locations are shown on the sketches.
A Letter of Notification was mailed to the following Utilities/Municipalities:
Jacksonville Electric Authority Yes ( ) No Date:
Bell South Telephone Company Yes( ) No Date:
Ferrell Gas Yes ( ) No Date:
Comcast Yes ( ) No Date:
2. 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 Director of Public
Works, any or all of 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 Director of Public Works, and at the expense of the Permittee unless reimbursement is
authorized.
3. All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be
performed under the supervision of (Contractor's Project
Superintendent) located at Telephone*
4. All materials and equipment shall be subject to inspection by the Director of Public.Works or his designee.
5. 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.
6. 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 anv increase in impervious area on owner's lot or in the city
7. Right of Way are to be included with this,aPPlication.
This permittee shall commence actual construction in good faith with days. If the beginning date is
more than 60 days from date of permit approval, then permittee musCreview the permit with the Director of
Public Works to make sure no changes have occurred in the area that would affect the permitted construction.
8. 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.
9. The Director of Public Works shall be notified twenty-four (24) hours prior to starting work and again
immediately upon completion.
0 ER
Sig 9
n d: —If_4*X- Jo
Before day f ate q 4
m let is 4 in he C u9ty of Duval, toll
State Of Fl rid as-personally appeare 86
.�,d — 1146 #DD6�4 copy
0110 le6
-ounty of L)uvai.
Notary Public at Large,State ul Florida,t
My Ir-450e xpires: —Personally K o n:
d(Lced Ident[ficltion:
R.O.W. Permit Attachment of for
R.O.W. Permit i�s_ued 200 Atl
antic Beach, FL 32233
Owner's Name:
Property Address:
Subdivision:
Lot 4/Block
R.E. #:
REVOCABLE ENCROAC11MENT PERMIT
HIS. VOCABLE ENCROACHMENT PERMIT, issued on this
��day of
20�d, by Atlantic Beach, Florida, a municipal corporation organized and existing
+undthe laws of the State of Florida, hereinafter referred to as "CITY" and
tl:tic e,
of lantic Beach, Florida,hereinafter referred to as "USER".
WITNESSETH:
That the CITY does hereby grant the USER pennission on a revocable basis as described herein the
right to enter upon the property of the City of Atlantic Beach for the purpose as described in the City of
Atlantic Beach Right-of-Way/Easement permit numbers noted above (copies attached).
This work is generally described as:
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 the USER, said notice to
USER shall be given by certified mail, return receipt requested, to the following address:
,2 7 Z I
_ __��IA e— 9 -
The depositing of said notice of cancellation in the United States mail shall constitute the notice of
cancellation and the burden is upon USER to keep the CITY informed of USER's proper address.
The USER shall promptly make any and all necessary repairs to any facility erected or maintained in
the exercise of the privilege herein granted and shall at all times maintain said facility in good and safe
condition.
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 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, repairmg,
operating,replacing, or adding to of the utilities and facilities of the CITY or franchise utility provider.
The facilities allowed by the pen-nit 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,,Ading
City Code Section 19-7 (h) which states "Driveways that cross sidewalks: City sidewalks b
replaced with other materials, but must be replaced with smooth concrete left natural in color etUl"iat ie
matches the existing and adjoining sidewalks."
Page I of 2
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. The
USER shall, at the discretion of the CITY, be requested to submit as-built drawings showing the change
within thirty(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
public rights-of-way 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 ass ed by the USER.
DATED and SIGN-ED this /S_��dav of 2M(k
7;:
By:
Pr
(tterty 04nel
be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OFYUVAL
On this day of 20/p, per onally appeared before me, a Notary
'f
Public in d f said and Stat�,__1'/n/?-_AJ p/HySOAJ the property owner of
or jtttyj 70,
Af 6CF Atlantic Beach, Florida, known to me to be the person(s)
described in and who executed the foregoing instrument; who acknowledged to me that he or she
executed the same freely and voluntarily and for the uses and purposes therein mentioned.
DESMAHA WHrrE
?
My COMMISSION#DD 634126
Notary Public in for said County and State FXPIA
18!May 27 2011
Notify public 4"61wft"
CITY OF ATLANTIC BEACH,FLORIDA, a
municipal corporation:
Approve .
K;dmer,P/lic Works DirLtor'
V -
For Permits where city sidewalk is impacted,
City Manager approval required:
Jim Hanson, City Manager
Page 2 of 2 *400
. . ........
Impervious Surface Calculations % Formula
Find square footage of the f0owing:
House fbotpri�
Driveway
All sidewafl&walkways
A/Cpads
Detached garagelsheds,
Pool Deckhig,
Patios,terraces and/or decks
Add tho total square footage of ffie areas fisted.above then, dmde the sum by
the total lot area of the property
5A412007
NOT ALL PAVERS ARE CREATED EQUAL
100% IMPERVIOUS (COAB LDR 24-17... Solid surface pavers. (e.g., brick or brick
appearing pavers as opposed to open grid pavers) do not qualify for any reduction in impervious
area, regardless of type of base material used.
50% IMPERVIOUS (COAB LDR 24-17... Surfaces using pervious concrete or other similar
open grid paving systems shall be calculated as fifty (50) percent impervious surface, provided
that no barrier to natural percolation of water shall be installed beneath such material.)
Products shown are examples, others may be eligible with Public Works Director approval.
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CITY OF ATLANTIC BEACH
(OWNER / 13UMDER AFFIDAVIT
1. 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. TBE 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 TEE CONSTRUCTION IS COWLETE, THE LAW WELL PRESUME TILAT YOU BUILT
rF 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 TBE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU RAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
[I. 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
013SERVE 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(l). 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. TELEPHONE THE
BUILDING DEPARTMENT(247-5826) 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.
7ej o �y
ADDRESS PHONE NUMBER
3-6)AY-�,
PRINT NAME
S—LJO
SIGN—fWRE
Before me thi 20Z
S_=dyf_ _ qthecountyof
Duval,State of Florida,has personally ared herin by himself herself and affirms that (k
all statements and declarations a t d accurate.
Notary Public at Large,Stat f County of
Q P rsonally Known 17.2
roducedldentficaflon--
)ESCRAH A.VMITE
Notary Signat MY
COMMISSION#DD e341
EXPIRES!M9Y 21,2011�26]
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