775 Plaza Driveway pavers 2012 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
-5814
INSPECTION PHONE LINE 247
Application Number . . . . . 12-00001494 Date 10/23/12
Property Address . . . . . . 775 PLAZA
Application type description RIGHT-OF-WAY PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
concrete to pavers driveway
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Owner Contractor
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CRAWFORD GEORGE W OWNER
775 PLAZA
ATLANTIC BEACH FL 322333907
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Permit . . . . . . DRIVEWAY PERMIT
Additional desc - - CONCRETE TO PAVERS
Permit Fee . . . . 3S . 00 Plan Check Fee 25 . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 4/21/13
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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 .
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 35 . 00 35 . 00 . 00 . 00
Plan Check Total 25 . 00 25 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 64 . 00 64 . 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
CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
-247-5800
............. 800 Seminole Road 904
Fax 904-247-5845
Atlantic Beach,Florida 32233-5445
PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION.
Date ho//2— PERMIT
ISSUED BY THE CITY
Job Address- 77 25
Permitee: /A Telephone#
Permittee Address:
Requesting Permission to Construct: t,�JTI,
Location: (Reference to Cross-Street)
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:
X"-
Jacksonville Electric Authority Yes ( No ( ) Date:
Bell South Telephone Company Yes ( No ( ) Date:
Yes No Date:
Ferrell Gas
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 AtILantic Beach or Florida Depa ent of Transportation Standards and be
'c
T
performed under the supervision of (Contractor's Project
Telephone
Superintendent) located at
his designee.
4. All materials and equipment shall be subject to inspection by the Director of Public Works or ity specifications
5. All city property shall be restored to its original condition as far as practical, in keeping with c
and the manner satisfactory to the city. s, a copy of a recent survey shall be made a
6. A sketch of plans covering details of this installation, as well a
part of this permit. Calculations showing anV increase in impervious areg-on owner's lot or in the gity
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. ior to starting work and again
9. The Director of Public Works shall be notified twenty-four (24) hours pr
immediately u completion.
OWNER
Sig Date:
Be da of-in the County of Duval,
Flori as rson app
SLI L. l7i
N A V-U ly of Flor County of y#.111 MY G; 10
Ily nown:
M
d
iderviriters
'd-
R.O.W.Permit Attachment of for
B ach,FL 32233
R.O.W.Permit issued ) 200 Ad tic e
Owner's Name: N" it—,6—
Property Address: 77757
Subdivision:
Lot 9/Block
R.E.
REVOCABLE ENCROACHMENT PERNUT
THIS REVOCABLE ENCROACHMENT PERMff, issued on this day of
� 2002 by Atlantic Beach, Florida, a municipal corporation organized and existing
under the I ws 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: r
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 adjoinh-ig 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 pen-nit 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 lirnitations/requirements of
public rights-of-way and other public land. USER farther agrees that the CITY and its officers and
employees shall be saved hanriless 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.
DATF)6- ov-
�nd SIGNED this day of 20j
#p Owner
Ow
(t signed in presence of the Notary)
si s
LO M
SE OF FLORIDA
COUNTY OF DUVAL
On this / 'Z�Ksonally appeared before me, a Notary
6 . day of 20r the property owner of
Public in and for said County and State, —5
_' Atlantic Beach, Florida, known to me to be the person(s)
descr and who executed the foregoing instrument; who acknowledged to me that he or she
jhe,d_i.ki
('e-ulte 3irne d voluntarily and for the uses and purposes therein mentioned.
SHIP'LEY L GRA:HAM
MYCOMWSSIO:NO DO 9577"10
'y
Cxp�rzs:'FebruM 14.2014
r]
"r'�rs
o ary u lie for s County and St 13-nd.eld Ylal 140'2ry Public UnIewiters
CITY F AT ANT BEACH,FLORIDA, a
municipal corporation:
Approved:
Ricky L. Carper,Public Works Director
For Pen-nits where city sidewalk is impacted,
City Manager approval required:
Jim Hanson, City Manager
Page 2 of 2
CITY OF ATLANTIC BEACH
OWNER / BUILDER AFFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I "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 PERM[rF UNDER AN EXEM[PTION TO THAT
LAW. TEE EXENDTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST
S1 JPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR INIPROVE A ONE—OR
TWO FAMILY RESIDENCE OR A FARM OUTBUELDING. YOU MAY ALSO BUILD OR
MROVE A COMNIERCIAL BUILDING AT A COST OF$25,000-00 OR LESS. THE BUILDING
MI JST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
THIN
IF YOU sin6iEEASE A BUILDING YOU HAVE BUILT YOURSELF WI ONE YEAR
AFTER THE CONSTRUCTION IS COWLETE,THE LAW WILL PRESUNE THAT YOU BUILT
IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF THIS EXEM[PTION. YOU MAY NOT
ME AN I JNLICENSED PERSON AS YOUR C CTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONS113ILITY TO MAKE SURE THAT PEOPLE EMTLOYED By YOU HAVE
I ICENSES REOUIRED BY STATE LAW AND By COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
ill. 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(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.
-7 75- 7 (-/
ADDRESS PHZ)NE NUMBER
/A
NAM f
DATE
SIGNA
Befor s day of 4 lC4!FF 20)2�1 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. L
Notary Public at Large,State of County of
0 Pe
,;en—ally Known
%-Frroduced Identificatio
'?4RLEYL GRAHAM
'A
DD 95776o
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2014
Notary Signatur W�rd.11N I'dwy Public fji'IdOrwrilers
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City of Atlantic Beach OCT 112012 APPLICATION NUMBER
(To be assigned by the Building Department)
Building Department
800 Seminole Road 12
5 Atlantic Beach. Florida 32233-5445 L----
9 Phone(904)247-5826 - Fax(904)247-5W 2—
E-mail: building-deptacoab-us Date routed: 140 110
URI, City web-site'. http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Department review requiied Ye-s -No
&U ilding
-Planning&Zoning
Applicant: r
TtegqA�irnfistrator
(ILubWil;Works')
Project: Ic blit
u Ic filities')
Public Safety
Fire Services
Review fee $ Dept Signat
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:
A;LIC TION STATIUS
Appro�
v []Denied.
Reviewing Department First Review:
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by:_(2::____ —Date:
TREE ADMIN. Second Review: []Approved as revised. []Denied.
AP Mr��ORK Comments:
Pfff IC UTILITIU
+_�Z
�r�- +-/4-- Reviewed by: Date:
PUBLIC SAFETY
FIRE: SERVICES Third Review: nApproved as revised. RDenied.
Comments:
Reviewed by: Date:
fzevised 07127110
W - ,. - - - I
q APPLICATION NUMBER
City of Atlantic Beach
OCT 112017
Building Department (To be assigned by the Building Department)
800 Seminole Road
Atlantic Beach. Florida 32233-5445 12
Phone(904)247-5826 - Fax(904)247-5845 Date routed: 2,
E-mail: building-deptgcoab-us
Gityweb-site: http:/iv%ww.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 7-7 Department review required Yes No
Building
Applicant: Planning&Zoning
Tj�t�i�nistrator
Project: &-n �ub F �r k s�
�'l�ublic U�fifitles;�)
Public Safety
Fire Services
Review fee Dept Signature
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 I
Other: I i
APPLICATION STATUS_
Reviewing Department First Review: VApproved. FIDenied.
(Circle one.) Comments:
BUILDING f �J 0 J
PLANNING &ZONING yz� ���d by. —Date.
TREE ADMIN. Second Review: FlApproved as revised. FIDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: FjApproved as revised. DDenied.
Comments:
Revievied -,y:_ Date:
R-evised 07127110