Permit Paver Driveway 250 Beach 2011 !r 1'‘J
w's � r j:'
g CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
0 ;- �. �x.9 zw' .:e. ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002751
Property Address Date 10/13/11 BEACH AVE
Application type description RIGHT-OF-WAY PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
drive and walkway pavers
Owner Contractor
CRAVEN RICH AND WEED WENDY OWNER
250 BEACH AVENUE
ATLANTIC BEACH FL 32233
Permit DRIVEWAY PERMIT
Additional desc .
Permit Fee . . . 35.00 Plan Check Fee .00
Issue Date Valuation 0
Expiration Date . . 4/10/12
Special Notes and Comments
Avoid damage to underground water /sewer utilities. Verify
vertical and horizontal 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 line.
Cleanout must be covered with an RT1 concrete box with
metal lid. Cleanout to be set to grade and visible.
Roll off container company must be on City approved list
and container cannot be placed on City right -of -way.
Contact Public Works (247 -5834) for Erosion and Sediment
Control Inspection prior to the start of construction.
Other Fees STATE DCA SURCHARGE 2.00
ENG REV BLDG MOD OR ROW 50.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 35.00 35.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 54.00 54.00 .00 .00
Grand Total 89.00 89.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
" : CITY OF ATLANTIC BEACH
A 4s, CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
800 Seminole Road
n Atlantic Beach, Florida 32233 -5445 904- 247 -5800
Fax 904 - 247 -5845
Date / 3 , ''c' j /
I PERMIT#
Job Address 5 4; / 7 c - ISSUED BY THE CITY I
Permitee: (j t /N/
Telephone # / 9 ' liii3
Permittee Address: _ r r L
Requesting Permission to Construct: ft ✓r c `° ? f
Location: (Reference to Cross - Street)
1. Applicant declares that prior to filing this application he has ascertained the location of all existing utilities,
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 any increase in impervious area on owner's lot or in the city
Right 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 permittee must review 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.
/ ' R
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Signed: - ✓� �� Date: i 7 '20 I I
B fore me' "this - r` day of in the County of Duval,
5 afgOf Florida`, has (personally appeared
Notary Public at Large, State of Florida, County of Duv. , v t T., SHIRLEY L GRAHAM
My commission expires: =°�'.i, ''` '''- 1 r,Oh'MI5SION # DD 967750
Personally Known: j am' t •,: P l S. pbruary 14, 214
Produced Iderttific- on: _ 411 j ;e„S"Aa Coned nru otary Public underwriters
Permit Attachment of for
Permit # issued , 200_ Atlantic Beach, FL 32233
Owner's Name: veoL Property Address: 3 . f" fjL'E Ave
Subdivision: Lot # / Block #:
R.E. #:
REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of 201
by Atlantic Beach, Florida, a municipal corporation organized and existing under the laws of the State of Florida,
hereinafter referred to as "CITY" and 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 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: / '`'' " I/ r,Q � - V £ s R/ ; "L A.) 99- y
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:
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, 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."
Page 1 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 assumed by
the USER.
DATED SIGNED this ' 7 day of 4 1, , 200 I/
._......:. rly Owner
(to ,be` sigri'ed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this �/ day of () LT
Y , 201_, personally appeared before me, a Notary Public in and for
said County and State, , the property owner of
Atlantic Beach, Florida, known to me to • the person(s) described in and who executed the foregoing instrument;
who acl; . - • • • to me th. • executed the same freely and voluntarily and for the uses and purposes
thereifentioned.
Obral
Notary Pug rc m for s., d Coun ,e• State
CITY OF ATLANTIC BEACH, FLORIDA, a municipal
corporation:
Approved:
Ricky L. Carper, Public Works Director
For Permits where city sidewalk is impacted, City
Manager approval required:
Jim Hanson, City Manager
Page 2 of 2
; ,. ' k ;` ` CITY OF ATLANTIC BEACH
®WNER / BUILDER AFFIDAVIT
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 REOUIRED 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. 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.
ADDRES 6' PHONE NUMBER
i Ole fii d„ (! riiV Al
PRINT NAME
SIGNATURE DATE
Before me this day of 20i/ in the county of
Duval, State of Florida, has personally appeared herin by himself / herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large, State of , County of
❑ Personally Known . - ----,
❑ Produced Ide.. cati - n - '. 1
Notary Sig , e:
F: /BLDG / Owner - Builder Affadavit; REVISED. 4 , 6/2009
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.;11..A.0 44 City of Atlantic Beach '
0 APPLICATION NUMBER
Building Department
t s� a ,,� (To be assigned by the Building Department.)
;+ 800 Seminole Road cT D
j
v , .r Atlantic Beach, Florida 32233 4v1/ f - �e /
Phone (904) 247 -5826 • Fax , ,7 7 5845
..,
,..
r !..)Y. E -mail: building- dept @coab.us Date routed: d �1 f
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: &AeA Department review required Yes No
Building
Applicant: 6 10) Planning & Zoning
/�� Tre Administrator
Project: /V' ,� / V ,417 b G��
Public Safety
Fire Services
o
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: Approved. ❑Denied.
(Circle one.) Co ments: ' \
BUILDING
'
PLANNING & ZONING Reviewed by: Date: 1 °//j///
TREE ADMIN. Second Review: A roved as revised.
❑ pp DDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
S- 1 " A ' - / , 1 , - ,. City of Atlantic Beach
,' t Building Department APPLICATION NUMBER
,.. * : 800 Seminole Road � r (To be assigned by the Building Department.)
` --10-0-, Atlantic Beach, Florida 32233 -5445 OCT � �� '/
Phone (904) 247 -5826 • Fax (904) Cr //
J p @ -de t E-mail: Email: buildin co ab.us >' 5845 ?Oil ,
annw
City web -site: http: / /www.coab.us .1 Date routed: %e �f`
a _
APPLICATION REVIEW AND TRACKING FORM
Property Address: , _.-
e C' /7
7) C 8 ' . ' J �` � De • artment review required Yes No
Applicant: e ze ).� Building
Planning & Zoning
Project: / � V ( / J � � Tree is inistrator
4 b V / ,M
Public Safety
Fire Services
Review fee $
Dept Signature
Other Agency Review or Permit Required Rew Ret
of Permit vie or Verified ceip B Date
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:
(Circle one.) y�UApproved. ❑Denied.
Comments:
BUILDING
PLANNING & ZONING
Reviewed by: � Date:_ /p— /� //
TREE ADMIN.
Second Review: []Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY
Reviewed by: Date:
FIRE SERVICES Third Review:
[]Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09