Permit R/W Driveway 380 Seminole 2012 I x _vi .' CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
J :r ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
".rli
Application Number 12- 00000422 Date 4/20/12
Property Address 380 SEMINOLE RD
Application type description RIGHT -OF -WAY PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
WIDEN DRIVEWAY WITH PAVERS
Owner Contractor
HINSON, ERIC V OWNER
380 SEMINOLE RD
ATLANTIC BEACH FL 32233
Permit DRIVEWAY PERMIT
Additional desc .
Permit Fee . . . 35.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 10/17/12
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 a RT1 concrete box with metal
lid. Cleanout to be set to grade and visible.
Other Fees STATE DCA SURCHARGE 2.00
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 4.00 4.00 .00 .00
Grand Total 39.00 39.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
LOT 260, AP OF SHOWING DARY RECORDED IN
PLAT BOOK 10, PAGE 15, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
c) 20 10 0 20 40
MINIM IIIMIIIMMIIIIIIIIIII
SCALE IN FEET CERTIFY TO:
1" = 20' ERIC V. HINSON AND AMBER L. HINSON
USAA FEDERAL SAVINGS BANK
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v- STEWART 777LE GUARANTY COMPANY
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NOTES:
1.) BEARINGS SHOWN HEREON ARE BASED ON THE NOR THWESTERLY
r RIGHT OF WAY LINE OF SEMINOLE ROAD BEING N 4500'00 "" E AND
ARE ASSUMED.
�' 2.) THIS SURVEY WAS PREPARED WITHOUT THE BENEFIT OF A 77 7LE
COMMI TMEN T OR REPORT, THEREFOR THERE MA Y BE ADDITIONAL
MA T IERS OF RECORD NOT SHOWN HEREON THAT MAY BE FOUND IN
J EFFREY H. WEINERT THE CURRENT PURIIr RFrnRns nr niive1 (VII in / TV r, nom
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: 30 Se \\fv ke.- - Atku(&1C. 6eac h Permit Number:
Legal Description Parcel #
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ 1 P X . ) Proposed Work heated /cooled non- heated /cooled
Class of Work (circle one): New '-Addition ; Alteration Repair Move Demolition pool /spa window /door
Use of existing/proposed structure(s) (circle one): Commercial Residentia,L)
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N
Florida Product Approval #
For multiple products use product appr form
Describe in detail the type of work to be performed: . )16 itt e ,011
Property Owner Information:
Name: En' L A- ' he)/ i hsan Address: . C � �C i l i lz i l :•� ,f%!�s W t +T1 j �h?�t %F EiS
City 6 1a tic G .I StateFLZip32233 Phone LIbS - y1 2- L023 `?
E -Mail or Fax # (Optional) Ck 1 f15011 1.1 @T A1-\00 ,C1))14
Contractor Information:
Company Name: Qualifying Agent:
Address: City State Zip
Office Phone Job Site/ Contact Number Fax #
State Certification/Registration #
Architect Name & Phone #
Engineer's Name & Phone #
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
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 ofa permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes mill
and void if work is not commenced within six (6) months, or if construction or work is suspended or abandoned for a period of six 6) months at any time oiler
work is commenced. 1 understand that separate permits must be secured for Electrical - Work, Plumbing, Signs, Wells, Pools, F urnaces, Bo Heaters,
Tanks and Air Conditioners, etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
. COMMENCEMENT.
I hereby certify that I have read and examined this a placation and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give author' to violate or cancel the
provisions of any other federal. state, or lo al law regulating construction or the performance of construction.
Signature of Ow'r r I / Signature of Contractor
Print Name / /`` Print Name
Swor • . • : • ib i' before .. - ii Sworn to and subscri • - d before me
this .. Day • i so r - ■ , 20/2- this Day of 20
J.i , .
Notary Pub ic f r.14 � SHIRLEY L. GRAHAM Notary Pu ic
: ..s MY COMMISSION OD 957760
L sla•,- - EXPIRES: February 14, 2014 Revised 01.26.10
J: R thso Bonded Thru Notary Public Underwriters
CITY OF ATLANTIC BEACH
--'t. - . / 11: 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 CENSERESPONSIBILITY REQD BBY STATE LAW SURE EMPLOYED
BY COUNTY OR MUNICIPAL LICENSING
NG
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. STATEMENT AND I ( COMPLY WITH ALL THE REQUIREMENTS FOR OF AN
OWNER- BUILDER PERMIT.
3e0 5e,MVe- 1 af*1c 60x) R 3213 3 L \ - L-\ 2 -1 2 31
ADDRESS PHONE NUMBER
PRINT E
X ,�/ A
� V DATE
SIG ATUR
Before me this / 2- day of � 4 2J' �. — in the county of
Duval, State of Florida, has perso ppeared herin by himself / herself and affirms that
all statements and declarations are true accurate.
Notary Public at Large, State of rr% , County of tlit
❑ P only Known i• �
roduced (den' .-,: •. 1 11JJJ ��"" " SHIRLEY L. GRAHAM
_.r !l . •+_. MY COMMISSION + 0D 957760
:;.y�.4 EXPIRES: February 14, 2014
`Z,Rf,t;,d''�` Bonded Thru Notary Public Underwriters
Notary Signatu ` _ `I ..
F:/BLDG/Owner-Builder Affadavit REVISED: • 16/200
R.O.W. Permit Attachment of for
R.O.W. Permit # issued , 200_ 4 J Atlantic Beach, FL 32233
Owner's Name: n f tt / 77 e. 7c/
Property Address: /fj A S o
Subdivision:
Lot # / Block #:
R.E. #:
REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of
, 200_, 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: 11 )1 so /1 1/ - ° J
Vi
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 tenns and conditions of this pennit 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 and SIGNED this day of T , 20' 2-
X By: ,�
roperty Ow er
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL JJ
On this / c day of ''- , 20A_?!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 be the person(s)
descri. - : a ,• who executed the foregoing instrument; who acknowledged to me that he or she
e < the sar , fre- 1 . ' • . , ily and for the uses and purposes therein mentioned.
.� CiSNIRLEY L. GRANAM
M Y COMMISSION % DD 957760
t ` EX February 14, 2014 Notary Pu. rc in fc� sar • ' o and State Bond Thru Notary Public Underwriters
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
R.O.W. Permit Attachment of for
R.O.W. Permit # issued , 200 Atlantic Beach, FL 32233
Owner's Name: l 'd
Property Address: / A/SPAl'
Subdivision:
)1A
of # / Block #:
.E. #: .40M11011
� r
REVOCABLE ENCROACHMENT PE 71'/C
THIS REVOCABLE ENCROACHMENT PERNT, issued on this day of
, 200_, by Atlantic Beach, Florida, a municipal corporation organized and existing
under the laws of the State of Florida, hereinafter referre to as "CITY" and
of Atlantic Beach, Florida, hereinafter referred to as "USER ".
• WITNFSSETH:
That the CITY does hereby grant the USER Iaermission on a revocable basis as described herein the
right to enter upon the property of the City of tlantic Beach for the purpose as described in the City of
Atlantic Beach Right- of- Way/Easement pe ss t numbers noted above (copies attached).
This work is generally described as: 1/ (4 .i7 ��1r / V d(' p y -- r) °J
7 :),A v�.eS
Any facility maintained, rep. ired, erected, and/or installed in the exercise of the privilege granted
remains subject to relocation • 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 s. d notice of cancellation in the United States mail shall constitute the notice of
cancellation and the b 4 den is upon USER to keep the CITY informed of USER's proper address.
The USER sh. promptly make any and all necessary repairs to any facility erected or maintained in
the exercise of ' privilege herein granted and shall at all times maintain said facility in good and safe
condition.
In the ent it is necessary for the CITY or the City's approved representative or other franchised
utility to - nter upon the above - described property of the CITY, the USER shall replace at the USER' s
sole e sense, any and all material necessarily displaced during the action of maintaining, repairing,
oper. mg, 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 and SIGNED this day of T J L-• , 2-
B 7
y.
• roperty O er
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL 4ar' O n this day of ' , 20p_z' 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 be the person(s)
descri • - _ , • who executed the foregoing instrument; who acknowledged to me that he or she
e ute• the sail fre-1 • ' • •i. ily and for the uses and purposes therein mentioned.
1111 :g ''
•. :Y :p'''
. SHIRLEY L. GRAHAM
.
— _`� � � r r •�� ,i. MY COMMISSION " DD 957760
� �
Notary Pu • is in for sal • o and State Ht ";,,; EXPIRES: February 14, 2014 Nd ' Bonded Thru Notary Public Undervmters
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
T 4 1
14 ADT 14
UST
r , 1 a
BAS 44 /
4 FCP �: _ - - 4..,,,
___,
L -.. __
380 SEMINOLE RD Atlantic Beach FL 32233
Building Type SOH - SFR 1 STORY
Year Built 1963
Type Gross Area Heated Area
Base Area 1020 1020
Addition 154 154
Unfinished Storage 66 0
Finished Carport 264 0
Unfin Open Porch 36 0
Total 1540 1174
Front 50.00
Depth 100.00
? s id City of Atlantic Beach APPLICATION NUMBER
¢i , E E
Building Department RcEI \EV� (To be assigned by the Building Department.)
A , 800 Seminole Road 2 2- Z
Atlantic Beach, Florida 32233 -5445
Phone (904) 247 -5826 Fax (904) 247 -5 5 APR 1 3 2012 � 1 Date routed: L Z -
E -mail: building- dept @coab.us / �� '
City web -site: http: //www.coab.us $Y. _.- Amy
APPLICATION REVIEW AND TRACKING FORM
Property Address: •-
6 ` / o /6 Rcl Department review required Yes No
Building
Applicant: nc_.: Planning & Zoning
Tree Administrator
Project: 4_ - 1 cAr i � Lt1Ary (Public Worke,;
blic Utilities)
p f i tick S Public Safety
Fire Services
Review or Receipt
Other Agency Review or Permit Required of Permit Verified By Date
Florida Dept. of Environmental Protection 1'1'3/
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. 1, ienied.
(Circle one.) Comments:
•
BUILDING
PLANNING & ZONING Reviewed by: x Date: 21
TREE ADMIN. Second Review: []Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
0 PUBLIC SAFETY Reviewed by: / �`_ Date:
FIRE SERVICES Third Review: [:]Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
City of Atlantic Beach RECEIVED APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
`'0 800 Seminole Road APR 13 2012 /2 _ 1 /2- Z
, ' ' Atlantic Beach, Florida 32233 -5445
Phone (904) 247 -5826 - Fax (904) • :45
_ r ? E -mail: building- dept @coab.us • --"' Date routed: L
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: -�
-SE`n / Q / . Xd Department review required Yes No
Building
Applicant: (EL)/I/_,e--, Planning & Zoning
Tree Administrator
Project: id/be-7) T i fr F zoil V 2 (Public Works
blic Utilitie
- p ft Public Safety
Fire Services
t '
: t ,,:. - ' d 4'4 p_ r y ,c, a h kt".. � �cr
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.) Comments:
BUILDING
PLANNING & ZONING Reviewed by: Date: ---1 7 - 12.--
THE AR MIN. Second Review: Approved as revised. ['Denied.
P d B W6 K Comments:
• (LIP • UT L Pff S
PU : LIC AFETY Reviewed by: Date:
FIRE SERVICES Third Review: Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10