Permit Driveway 2010 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 10-00000884 Date 8/12/10
Property Address . . . . . . 297 PINE ST
Application type description RIGHT-OF-WAY PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
ADD 208 SF OF CONCRETE TO EXISTING DRIVEWAY
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Owner Contractor
------------------------ ------------------------
LATIMER OWNER
297 PINE STREET
ATLANTIC BEACH FL 32233
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Permit . . . . . . DRIVEWAY PERMIT
Additional desc . .
Permit Fee . . . . 35 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 2/08/11
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Special Notes and Comments
Ensure all meter boxes, sewer cleanouts and valve covers
are set to grade and visible.
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 .
All concrete driveway aprons must be 51, thick, 4000 psi,
with fibermesh from the edge of pavement to the property
line . Reinforcing rods or mesh are not allowed in the
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.
City of Atlantic Beach APPLICATION NUMBER
(To be assigned by the Building Department.)
Building Department
800 Seminole Road
Atlantic Beach, Florida 32233-5445,
Phone(904)247-5826 - Fax(904),24715845 7,-
E-mail: building-dept@coab.us Date routed:
City web-site: hftp://www.coab.us
APPLICATION REVIEW A- IiACKING FORM
Property Address: ?**AAe_ Department review required Yes No
Building
Applicant: %k&AA�� Planning &Zoning
Tree Administrator
rks '
Project: GX PA-00 a-AV eMM13—wo >
909'-'64- Public Utilities
Public Safety
Fire Services
-20
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: []Approved. Q�enied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date:
TREE ADMIN. Second Review: XApproved as revised. FlDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES Reviewed by: Date:
PUBLIC SAFETY
FIRE SERVICES Third Review: F _]D
]Approved as revised. enied.
Comments:
Reviewed by: Date:
Revised 06/14/09
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Build* D artment.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845,-
Date routed:
E-mail: building-dept@coab.us
City web-site: hftp://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Department review required Yes No
Property Address: Z:?7 ??A� Building �o
Planning &Zoning
Applicant: %&Az�fo Tree Administrator
Project: Aw .&I A %74W Public Works
W�ad —ft - -
Public Safety
Fire Services
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: pproved. DDenied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by:
TREE ADMIN. Second Review: []Approved as revised. ODenied.
APU R P Comments:
I iLI
PUBC SA EOTY Reviewed by: Date:
FIRE SERVICES Third Review: []Approved as revised. FIDenied.
Comments:
Reviewed by: Date:
Revised 05/14/09
Public Ufihties Plan Review Comments
Date: 1,11 r, Initials:
Project Name/Address-c�97 PIA4E �_Pplicatil on -permit /0
:Check
ng Comments to A-Add
Application TriacU
CDIUMent
Avoid damage to underground water/sewer utilities, Vcrit7 vertical and hon-zontal
location of utilities. Hand dig if necessary. If field coordination is needed, call
247-5834.
Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and
visible.
A sewer cleanout must be-installed at the property lint. Cleanout must be covered
with an RTI concrete box mdth metal lid. Cleanout to be set to grade and visible.
A reduced pressure zone bachfiow preventer must be installed-if irrigation will be
provided or if there is a piivate,well on the property. Barh-LDWpreventer must be T7
tested by a certified t��ster and a copy of the results sent to Public Utilities.
Plans note the building will be unsprinkled. If plans change, any fire-line installed
must be metered with a Sensus toucb-read meter in a properly sized vault and an
appropriate back-flowpreventerinstalled. Baclzao-w preventer must be tested by a
certified tester and a copy of the-results sent to Public Utilities.
If fire sprin L- er system is providtd, contact Malcolm Clemons at 247-5839 for
bacl:Row requirements. At a minimum,will require double check backfiow
preventer.
Fire lines must be metered v��a Sensus touch-read meter. Metors larger than—')
must be installed in a vault as noted in JEA specifications.
/vw
CITY OF ATLANTIC BEACH SEMENTS
CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EA
904-247-5800
800 Seminole Road
UF I iir,_. Atlantic Beach,Florida 32233-5445 Fax 904-247-5845
PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION. -
Date PERMIT#
ISSUED BY THE CITY
Job Address
Permitee: Telephone D
Permittee Address:
RequestingPermi siontocQn�truct-
OJA
Location: (Reference to Cross-Street) .\MO(M
1 1 1V
1. Applicant declares that prior to filing this application he has ascertained. the location of all t' filitles;
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 (Vil-,No ( Date:
Bell South Telephone Company Yes (V�' No ( Date:
Ferrell Gas Yes (%,K 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 cqqOition 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 any increase in impervious area on owner's lot or in the city
Rilciht of Way are to be included with this application.
7. 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 perm' ittee must,.review the permit with the Director of
Public Works to make sure no changes have occurred in the area th6t 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, damagp, 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.
OWNER
�Ewi�H A.wHrrE
D
SS N 0 DD 634126
Signed Date: 0 ey 1 2011 6
Before this day of 101 tl�e ou 0 my COMMI 10 21 2011
EXPIRF&may
�u 10 U"0�dters
86nd6d nru NmMary Pubile Wdenwiters
rhru N
State f lorida,has personally appeared LA-t P-u
Nota ublic at Large,State of Florida,County of Duval.
My Comm g �� Personally Known:
T Produced Identifl�on:
R.O.W. Permit Attachment of for
R.O.W. Permit issued 200 Atlantic Beach,FL 32233
Owner's Name: le"Mc LOMW
Property Address: I V Vkl ��-
MOVir)121 -
Subdivision: \A
Lot 4/Block
R.E. #:
REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of
2040, by Atlantic Beach, Florida, a municipal corporation organized and exist*
.��g
unier th� laws of the State of Florida, hereinafter referred to as "CITY" and
of Atlantic Beach,Florida, hereinafter referred to as"USEW'.
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 (3 0) days notice by CITY to the USER, said notice to
USER shall be given by certified mail, returri receipt requested, to the following address:
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 inforined 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 maintainirig, repairing,
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, 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."
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 andJor 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 assumed by the USER.
DATED and SIGNED this day of 20�0.
By:
operty Owner
to be signed in presence of the Notary)
e!0 n r
op ZV
fto be gn ien presence of thoe Notary)
STATE OF FLORIDA
COUNTY OF DUV
On this �tda�y�of 20,k, personally appeared before me, a Notary
Public in and fqr .,sa' o n and State, the property owner of
Atlantic Beach, Floridalaown to me to be the person(s)
described in and who executed the foregoing fi-istrument; who acknowledged to me that he or she
executed the same freely and voluntarily and for the uses and purposes therein mentioned.
Notary Public in for'said County and State
My rOMMISSION#DD 634`126
CITY OF ATLANTIC BEACH,FLORIDA, a
EXPIRES:MaY 21,2011
municipal corporation: 004,d J'hw Notary Pubk UrderwItters
Approved:
Ricky L. Carper,Public Works Director
For Permits where city sidewalk is irnpacted,
City Manager approval required:
Jim Hanson, City Manager
Page 2 of 2
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CITY OF ATLANTIC BEACH
OWNER / BUILDER 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. 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 LICENSIN
ORDINANCES.
If. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
111. 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.
456-228(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.
AIT f-mc, \_�,
ADDRESS PHONE NUMBER
�emi W .
PRINT NAME
DATE
Sr17URE Id
-k the
a me this dayo ".,4 of
Duval,State of Florida,has per.. lly*P—.are-a2re7tn by himself herself and affirms that
all statements and eciarations tw and accurate' A. TFE
D
Notary Public at Large,State of County of ION#DD 634126
My(;OMMISI)
n,2011
EXPIRE&May UndarWrltsrs
0 Personally Known
3 S-� Bonded Thru Notary Pub"
BIr duced Identffication
Notary Signa
F/BLDG/0�ner-Builder Affadavit;REVISED: 4/16/2009