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2343 W Oceanforest Dr paver driveway CITY OF ATLANTIC BEACH \ 11 800 SEMINOLE ROAD j ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 tit Application Number . . . . 12-00001548 Date 11/01/12 Property Address . . . . . . 2343 W OCEANFOREST DR Application type description RIGHT-OF-WAY PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------- Application desc driveway pavers --------------------------------------------------------------- Owner Contractor - ------------------------ ----------------------- TROST, THOMAS J. OWNER 2343 OCEANFOREST DRIVE ATLANTIC BEACH FL 32233 ------------------------------------------------------------ Permit . . . . . . DRIVEWAY PERMIT Additional desc . . PAVERS Permit Fee 35 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 4/30/13 ------------------------------------------------------- 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. Street to be swept daily. Roll off container company must be on City approved list and container cannot be placed on City Right-of-Way. (Approved: Advanced Disposal, Realco, Shappelle ' s and Waste Management . ) Sidewalk must be plain concrete . --------------------- -------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 UTIL REV MODIF OR ROW 25 . 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 29 . 00 29 . 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. rfi:U r City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) r � 800 Seminole Road /Z ,/�� Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845 r y-OR E-mail: building-dept@coab.us Date routed: �� z� /2— City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: eilt5 j I),- Department review required Yes No Building Applicant: ( ,'( Y) / Planning &Zoning - -� Tree A ministrator Project: ublic Works lic Utilities _ Public Safety Fire Services Review fee $ Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B 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 GJ-�- PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: XDate:gy FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 City of Atlantic Beach APPLICATION NUMBER cs� Building Department OCT 2 2 2012 (To be assigned by the Building Department.) `lam 800 Seminole Road j Atlantic Beach, Florida 32233-5445 �' ' /Z —A X9 Phone(904)247-5826 • Fax(904)247-58 E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM I Property Address: (�_3`7J m( h z5zi,5 71 A r Department review required Yes No Building Applicant: ((�`�J Planning &Zoning Tree Administrator Project: ��V��S ublic Works lic Utilities Public Safety Fire Services Review fee $ 1 k{ g rs 4jv Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B 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: APPLITION STATUS Reviewing Department First Review: Approved. []Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: � TREE ADMIN. Second Review: ❑Approved as revised. [-]Denied. zo S Comments: (ZBLIC UTILITIES7 Date: F Reviewed by: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 CITY OF ATLANTIC BEACH CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS 800 Seminole Road 904-247-5800 Atlantic Beach, Florida 32233-5445 Fax 904-247-5845 Date �V' �� v PERMIT# ISSUED BY THE CITY Job Address Permitee: htM.� 'b Telephone# ��G- 0079 Permittee Address: d ,n Requesting Permission to Construct: 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 (A No ( ) Date: Bell South Telephone Company Y ( No ( ) Date: Ferrell Gas Yes No ( ) Date: r,oast. 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. OWNER Signed: c J 'ti Date: 2iZ 2'U4.'C/ Before me this day of in the County of Duval, State Of Florida, has personally?appeared Notary Public at Large,State of Florida, ounty o uval. My commission expires`. Personally Known: or Produced Identification: ��23 g3c� 4D zz I Permit Attachment of for Permit# issued ,200_Atlantic Beach,FL 32233 Owner's Name: Property Address: a :3 4 /5-e o-S 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: p k.�kA C A— S1 A rn A �t�� ®� ��Ey �C'ky L 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 and SIGNED this day of_ 204V, By. � � y Property Owner (to be signed in presence of the Notary) STATE OF FLORIDA COUNTY OF DUVAL On this LZ day of 0 C , 201Lpersonally 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) described in and who executed the foregoing instrument; who acknowledged to me that he or she executed the same freely and voluntarily and for the uses and purposes therein ment' ea. eti p SHIRLEY L GRAHAM . NV CV#413SION#DD 957760 € EXPIrIE5:February 14,2014 Sondad Thru Notary Public Underwriters No ublic info said C unty and State CITY OF ATLANTIC BE H,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 CITY OF ATLANTIC BEACH { OWNER / 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 REQUIRED 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. -{ ADDRESS PHONE NUMBER oW✓�� PRINT NAME DATE SIGNATURE Before me this 'Zday of 20_2m 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. J Notary Public at Large,State of ,County of �`"k''- SHIPLEY L GRAHAM ❑P cnally Known 'i�' roduced Identifi - I ?* * MY COfdMISSION r DD 957760 EXPIRES:February 14,2014 Bonded Thru Notary Public Underwriters Notary a F:BLDG/ow er-Builder Affidavit;REVISED: 4/16/2009 24 DAVID P.4.!, AUG 29 '93 19 I-L...,.... ... . — ,. . . MAP. SH.0 LNG SURVEY OF OCeX A z A C K U.c/iT 400,q j AS.. ECOHOED IN PLAT BOOK 4z PACES le.1g.('1,11f?19c OF THE CURHENI PUl1LIC REC6171oS OF 00-46 COU TY,FLORIDA, cutrwIEO t0 'G� K�V PU/C of,c>s T•60-7,41 an al L>afie/a. rt./, Trd S t, ,44,Gr.:?411 HOih a i F,vad;.y •1.10? . ,57 CW4ra 7•i yt/e. I v .. /J D ' 6 , /,r0 C_5 (R/� ✓Ali(ES) I . rJL /l1 •. Iiwe acknqwledae and accept this sur/ey. .� rW 4'c.�� 03 •at �3J Dgan) • tA K•OG:37' 1 , .• :•r �y' B.P.L. 21.5 - 4 / ✓E ' rre.I' ! ON N �, f,,• �.d 14,7 �'ry 4' r(. V93 _ �' J.Uy 13.0 3raoca i+ m B•�• N �. V h 31Kq;� N z sroeY oh 4 t1 ,5` rucc.o W �9 rn Q JI -� 0 zvL ckr xlwr dcdfll/alo�n IN W. 4 ~ 4.7 14,& v J N \ `4 rq' :4'n• •(l� . O14/000 Q W110 0 W000 oectr \ oeCK ' a 3 ti 0 j 0 4 qjmal. t/T/L. ¢ SCNE.PS 9/02/93 WE HEREBY ACCEPT & ACKNOWLEDGE THIS SURVEY & is I . A Poe 7-1aAl ac' L o r z� ' DiviTIO N .� . AMOR&H Oc')VeES 6,VAN7' I SEG• :�7 ��vv, 2 50., 47oe. Z1j CAST• I 1 'NEClf�o� Dec•7,/�08 70 ZWoW it,tpaaVE.c.lE,vrS (' LEGEND DATE Ar4Q.7„a9e(e__ ; a rl(Nulfs COACH[MONUMM SCALE . �• �Y'r '1 j; x->< 0(Nlll(S JFNG( Rr P �'• 0 rnalnllS IMM PIPE Nil JO�RpNO._gG ' _ _ )• � A i1fl1A1r.�.Y(III M%r 3.7,1(.n VJ•�/J,J Innt.(P,hasrrl nn •1,1t hichard k: milier ASSUCidte:S, inG- ;vaUons shown thu1,►iS.U, role N,.'V.U. 01 1929, Prolcssionar Land Surveyors btecl properly hes within Zone 'A” as shown on F.I.A.Flood H;itard Boundary �p�o7C3s.S, .Community No -tO�'' /1330.3 sl johns lnduilrlal Parkway North led /z .,,;k_0d3 ,jichsonvihe.Florida JZZ16 less olherwlso nuled;'any porhun of iho subjocl parecl Mal mJv be deem-d,a5 Wetlands 19041 649 �I31• 11 ��t,.,rtm�nl3� a;l;.r,,,rsc h_c n 11 h°an¢Plerminfd and dnl IIS?Iil(�r?c�111n.J 1:. •�. .�: :. :.,;nti -;:,; ,4 V.?;', '�f .!.•U:v reujin 1);lilt int fd$Nvns,01111y vi ibe u(1(;erj1q11cti. tl,. dt.. $!. ..Au. .a� ndl.n d/ bit rwMGA d•r ny • ' to/14. re nlaybeReslncllunsor Casemools of Record evidencod by title MM111auon That have Sll !1 IS.J' S N(IV Sl N 4/1 U:•i,}tONIDA$,A11/7Ls ;-( been shown hereon. 1 i NOT VALIO UNLESS EMBOSSED WIN A SU4VEY00•S SLAL I.HARD A. MILLER. I S. CFRT, 10. 3 8 CIIK. By F.B. 16 PG ;;�