2243 Beachcomber Trl driveway 2012 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-OfO001068 Date 8/29/12
Property Address . . . . . . 2243� BEACHCOMBER TR
Application type description RIGHT-OF-WAY PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
CONCRETE TO PAVER DRIVE/WALK
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Owner Contractor
------ ----------------- ------------------------
STEVENS WARD F AND JANE E OWNER
2243 BEACHCOMBER TRAIL
ATLANTIC BEACH FL 32233
----------------------------------- ------------------------------------
Permit . . . . . . DRIVEWAY PERMIT
Additional desc
Permit Fee . . . . 35 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date 2/25/13
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Special Notes and Comments
Avoid damage to underground water/'sewer utilities . Verify
vertical and horizontal location oj� utilities . Hand dig if
necessary. If field coordinationi,is needed, call 247-5834 .
Ensure all meter boxes, sewer clea�,nouts 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 R�, i concrete box with
metal lid. Cleanout to be set and Visible .
Full right-of-way restoration, inc'�luding sod, is required.
Roll off container company must be� on City approved list
and container cannot be placed on ,�City right-of-way.
(Approved: Advanced Disposal, Real'�co, Shappelle ' s and Waste
Management)
Street to be swept daily/as needed to keep dirt out of
stormwater system.
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
ENG REV BLDG MOD OR ROW 50 . 00
STATE DBPR SURCHARGE 2 . 00
UTIL REV MODIF OR ROW 25 . 00
1�
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Fee summary Charged Paid Credited Due
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PERMIT ISPAWAIj4l)FUnY WX(96bRDANCE WIM AAPCITV OF �,TPATWBEACH ORDINANdSQ AND THE FLORHAO
BUILDING CODES.
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Page 2
Application Number . . . . . 12-00001068 Date 8/29/12
Plan Check Total . 00
. 00 . 00 . 00
Other Fee Total 79 . 00 79 . 00 . 00 . 00
Grand Total 114 . 00 �-14 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF AfrLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
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CITY OF ATLANTIC BEACH
CONSTRUCTION PERMIT WITHIN CITY RIqHTS OF WAYAND EASEMENTS
800 Seminole Road 904-247-5800
*It
All, Atlantic Beach,Florida 32233-5445 Fax 904-247-5845
PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION.
Date
PERMIT
IS UED BY THE GITY
JobAddress
Permitee: Z-1 X_ C'v,
Telephone
Permittee Address: 5--)
Requesting Permission to Construct:
vyv�
Location: (Reference to Cross-Street) c
1. Applicant declares that prior to filing this application he as ascertained. the location of all existing utilities,
both aerial and underground and the accurate locations a4l,shown on the sketches.
A Letter of Notification was mailed to the following UtilitiesIM, unicipalities:
Jacksonville Electric Authority No�A<Date:
Bell South Telephone Company Yes ( D
Yes( )11�N Date:
Ferrell Gas Yes,(� No Date:
Comcast No Date:
2. Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operaflon,
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 str4et 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 FloVda Department of Transportation Standards and be
performed under the supervision of Akp,C, n Factor's Project
C_*,�,_,e",� 1Z,_t C"t 1� 1 14
Superintendent) located at —Telephone 0 IL I I-(,. _S -�G
4. All materials and equipment shall be subject to inspection qy the Director of Public Works or his designee.
5. All city property shall be restored to its original condition a$far as practical, in keeping with city specifications
and the manner satisfactory to the city.
S. 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
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 pe-mittee must review the permit with the Director of
Public Works to make sure no changes have occurred in tt e area that would affect the permitted construction.
a. 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-fbur (24) hours prior to starting work and again
immediate n com I tion.
OWNER
Sign! Date:
Before me this day of P�;�ka-cQLeiv-& V L
State Of Flo * has person;�aAll eareq SHIREP L.GRAHAM
0 age Juval 'Ay COWAIS ON V DC,9r,77�
,St t
Notary X ic a ta f !rida, ountyofDu I
M y rx Kn rd 2s si Nloan 'xpiress: RS§�q 9; no
Aj.
CITY OF ATLANTIC BEACH
AVIT
OWNER / BULDER AFFID
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUT S, PART 1 'CONSTRUCTION
CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNC WLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7),F-ORIDA 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 OWDIER OF YOUR PROPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DQ NOT HAVE A LICENSE. YOU MUST
SUPERVISE THE CONSTRUCTION YOURSELF. YOU BUILD OR IMPROVE A ONE—OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILI iING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST 01 $25,000.00 OR LESS. THE BUILDING
MUST BE FOR YO &USE AND OCCUPANCY. IT MAN NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE B JILT 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 ONTRA�TOR., 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 q,01 TY OR MUNICIPAL LICENSIN
ORDINANC
11. INJURY LIABILITY; SINCE OWNERS MAY BE �R
_L!&@jE IES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKqR'S COMPENSATION INSURANCE BE
PURCHASED.
111. IRS WITHHOLDING;'OWNERS HIRING WORKERS B COME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 EQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CAqNOT BE EMPLOY D UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,00( PENALTY UNDER FLORIDA STATUTE NO.
455-228(l). AN-O�CUPATIONAL LICENSE' IS NOT ADE UATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LIC=_NSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826)IF IN DOUBT. 1;
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.
7)
HONE NUMBER
ADDRE�
PgWT-WME
� A
ET -6-A—TE
SIGN—AlUkE
Before me this_JtTday of the county(if
Duval,State of Florida,has personally a red herin by himself/herself anc affirms that
r
.u.
all statements and declarations are t5ke a d accurate.
Notary Public at Large,State of County f��.
aEl P rs nally Known
mdo.ced Identification-
M IRLEY L(3RAHAM
S: DD 957760
Notary Sig re- 11 ruary14 2014
N Notary Pbli,
FJBLDG/0�er-Builder Affadavit;REVISED: 16/2009
R.O.W. Permit Attachment of for
R.O.W. Permit# issued 200-1 L At. ritic Beach,FL 32233
Owner's Nab
2q_3 f- Tt-L-
Property Address: -2
Subdivision:
Lot 9/Block
R.E. 4:
REVOCABLE ENCROACHM*NT PERNUT
THIS REVOCABLE ENCROACHMENT PERTvRT, issued on this day of
) 200 ) by Atlantic Beach, Florida, a mu�nicipal 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).
V C 6--b i
This work is generally described as: �rj,
Any facility maintained, repaired, erected, and/or instal�d in the exercise of the privilege granted
li
remains subject to relocation or removal on thirty(30) days �otice 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 Unit�d States mail shall constitute the notice of
cancellation and the burden is upon USER to keep the CITY�nfbrmed of USER's proper address.
The USER shall promptly make any and all necessal y re airs to any facility erected or maintained in
the exercise of the privilege herein granted and shall at all ti�nes maintain said facility in good and safe
condition.
In the event it is necessary for the CITY or the City's �pproved 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 facilitie�,,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 de requirements of the CITY, including
City Code Section 19-7 (h) which states "Driveways that 4-oss sidewalks: City sidewalks may not be
replaced with other materials, but must bc. replaced with sm�looth concrete left natural in color so that it
matches the existing and adjoining sidewalks."
Page I of 2
The USEF, prior to making any changes from the approved plans and/or method, must obtain
ity of Atlantic Beach, Public Works Department, for said change. The
written approval from the C r
USER shall, at the discretion of the CITY, be requested to s4bmit as-built drawings showing the change
within thirty(30) days after the day of completion.
'11-iis pen-nit shall inure to the benefit of, and be binding upon, the USER and their respective
successors and assigns.
d CITY
USER shall meet the tenns and conditions of this permit'.and to all of the applicable State an
laws and/or specifications, to include utilities locate require", ments, and use limitations/requirements of
public rights-of-way and other public land. USER C agrees that the CITY and its officers and
n ,
employees shall be saved harmless by the USER froML a 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 20do
I ki A i
B
Prope 0
(to b� signed in presence of the Notary)
STATE OF FLOREDA
COUNTY OF DUVAL
On this day of 2 F-versonally appeared before me, a Notal
i the property owner of
Public in and for said County State, i 5
Atlantic Be lorida, known to me to be the person(s)
descri��in and who executed the foregoing ins=�'; who acknowledged to me that he or she
e e ame fr e d voluntarily and for the uses a�d purposes therein mentioned.
fill
Notary Pu lie in r s ounty
14 014
CITY OF ATLANTIC BEACH, N tary P
ljfi� lvldter�
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
City of Atlantic Beach APPLICATION NUMBER
AMk Building Deparbwnt (To be assigpned by the BLd*v Dewh")
SW Sen*xAe Road
Aflanbc Beach, Flonda 32233-5445
Phone(904)247-SM - Fax(904)247-5845
E-mail: bukgrq-dept@coab.us Date routed:
cilymob-cife! MIAAWM.emb.us
APPLICATION REVIEW ANO TRACKING FORM
PropertyAddimss: gmmmr Department review required Yes No ,
Building
Applicant Planning&Zoning
Tree AdministraW
WublicWo
Project rer" Utir
-Fu-51-i—cSafety
-Pf- 1 V u lic
Fire Services
0
Other Aaency Review or Permit Required ne-view or Receipt Date
O&F ft Verified By
Fbrida Dept of Enviromented Protection
FWft Dept.of T
St Johns Rhw Water Management District
Arnly Corps of Engineers
DIvWon of Hotels and Restaurants
Division of Ab9mlic Beverages and Tobacco
Omer.
APPLICATION STATUS
RevWMng Department First Review: *Proved. E]Denied.
(Circle one.) Comments:
BUILDING
y:_ Date:ph 9))
PLANNING&ZONING Reviewed
TREE ADMIN. Second Review: EjApproved as revi�ed. E]Denied.
PUBLIC WORKS Comments:
puBUC UTILITIES
PUBLIC SAFETY Reviewed 3y: Date:
FIRE SERVICES Third Review: E34proved as revi�ed. [:]Denied.
Comments:
Reviewed �Iy:_ Date:—
RNWW 071H118
City of Atlantic Beach APPLI ON NUMBER
Building Deparbnent (ro be=*Wmd�by tdtw SuM.m D8PmftWQ
SW Seminole Road
Beach,Florida 32233Z445
Phom(904)247-5M - Fax(904)247-5845 i Date routed:
E-mail: buHdkV-dept@coab.us
Oily ws&aife! WA~embma
APPLICATION REVIEW Ak P TRACKING FORM
Yes No
Property Address: Deparovient review required
Building
Applicant Planning&Zoning
Tree AdminisbaW
Project: 156blic World_>
a ft
944t'6 &)Rlitio, _P551—ic Safew
I-r2re Services
;1�mq"IX
Odw Agency Review or Permit Required Poviaw or ReceW Date
Of termit Veriflied
Fbrida DepL of Enviromm"Protection
Florida DepL of TmroPoft*m
SL Johns Rnrer Water Management District
Affny Corps of En*mm
Dmm of Hotels arW Restaurarft
Divisim of AWKft Beverages arW Tobacco
Other
APPLICATION STATUS
RevWming Deparbitent Fimt Review: UJApproved. E]Denied.
(Cirde one.) Cominents.
BUILDING
PLANNING&ZONING Reviewed by:_ Date:
TREE ADMIN. Second Review: []�Approved as revL-01d. [:]Denied.
R menft:
P
U ES
k
Reviewed Y: Date:
C WSAFETY
PU
E]Approved as revi��. E]Denied-
FIRE SERVICES Third Revkm:
commenft:
F
R&i�ewed by: DMe:
RWmd 0=18