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Permit ROW 1251 Gladiola St 2013 CITY OF ATLANTIC BEACH j s) 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 HSM_. Application Number . . . . . 13-00001916 Date 2/15/13 Property Address . . . . . . 1251 GLADIOLA ST Application type description RIGHT-OF-WAY PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc Pipe & improve drainage at ditch in front of prop ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ BLANKENBAKER MYRON K ET AL OWNER BLANKENBAKER PATRICIA 1251 GLADIOLA ST ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit . . . . . . RIGHT OF WAY PERMIT Additional desc . . Permit Fee . . . . 35 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 8/14/13 ---------------------------------------------------------------------------- Special Notes and Comments Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities . Contact Public Works (247-5834) for Erosion and Sediment Control Inspection prior to start of construction. Must install silt fence at south end of property before beginning. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . 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 25 . 00 25 . 00 . 00 . 00 Grand Total 60 . 00 60 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. t R.O.W. Permit Attachment of for R.O.W. Permit# issued , 200_ Atlantic Beach,FL 321,33 Owner's Name: Property Address: LY / S 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 eferred to as"USER". WITNESSETH: That the CITY does her by ant tie USER permission on a revocable basis as described herein the right to enter upon the prop f the sty of Atlantic Beach for the purpose as described in the City of Atlantic Beach Right-of-Wa seme permit numbers noted a (copies a7 ttached). This work is generally de cribed as Any facility maintained, repaired, erected, and/ r installed ' the exercise of the privilege granted remains subject to relocation or removal on thirty 0) notic by CITY to the USER, said notice to USER shall be given by certified snail, re -receipt re uested, to the following address: zs� zZ3 The depositing of said notice of cancellatioi in the United tates mail shall constitute the notice of cancellation and the burden is upon USER to ke p the CITY in rmed of USER's proper address. The USER shall promptly snake any and al 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 pen-nit 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." E p p y' Page 1 of 2 FIL Ad03 3111 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 ,2043 By: At�i rope Owner (to be signed in presence of the Notary) STATE OF FLORIDA COUNTY OF DUVAL On this O� day of r {4—Y� 206 ersonally 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 91Wcuted the foregoing instrument; who acknowledged to me that he or she ex0euted the same freel and voluntarily and for the uses and purposes therein mentioned. SHIF1EY L.GRAHAM~~ t'�'COMMISSION rt DD 957750 No ubli in for d County and S xP+R :February 14,?_014 ' `J Vvided 7nni 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 a rsl�' n CITY OF ATLANTIC BEACH s; CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS ' 800 Seminole Road 904-247-5800 �S) Atlantic Beach,Florida 32233-5445 Fax 904-247-5845 PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION. Date PERMIT# Job Address ' ISSUED BY THE CITY Permitee: Telephone# 490'D y l C1SL Permittee Address: l,2-S/ �sG d�DG�A STiE'b'��` ,�J L 'rtG �4�cj A=L- Requesting LRequesting Permission to Construct:/ jOf Location: (Reference to Cross-Street) /'� j j1 L cj- l�li ✓ �G -y� 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/Munici alities: A vl- A7°i'Gf� GST- pv�rd Jacksonville Electric Authority GST BellSouth Telephone Company �/ TLtt - Yes Yes ( ) ( ) ate: S' Ferrell Gas /�� ( ) No ( ) Date: �e� P�f��ClrA Yes ( ) No ( ) Date: Comcast /�L Yes ( ) No ( ) Date: �5 /,c dCs.!-� �j�f/yl �G�CDL��✓ �C.4✓Y Ire%l, 2. Whenever necessary for the construction, repair, improvement, maintenance, safe and tfficient operation, alteration or relocation of all, or any portion of said street or easement as determined by the Director of Public ^ 1/_Lorks, any or all of said poles, wires, pipes, cables or other facilities and appurtenances aut orized 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. All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the supervision of 1NV p s+- woggu— l�rlLdddnActor's Project Superintendent) located at Telephone#: *4-y%0- �130('Ss - ✓4. All materials and equipment shall be subject to inspection by the Director of Public Works or his designee.Alvwe-ren 11-5, 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. ve 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., 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. '__18. 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 6/ Signed: 4_�Tv, Before m this day of± —in CoUrt�,p>gQuva, State to ' has personal ppearedr` " ' or;r Or,ems_ Not P is at ar e, tat of I da,Cour ty of Duukpl, ` O ;,,N 14,2014 M com ission re °' i un,ervldters rsonally Known: ro 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. IA-15-1 co" zip ?S" ADDRESS PHONE NUMBER /9Z PRINT NAME SIGNATURE DATE Before me this day 20 j3 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 r� County of ❑ap_ersonally Known '� (1 yf rroduced Identifica' - (S !!!��` Notary Sign {P,,,, SHIRLVL QHANANI �'= tdY C04�MISSION 3 OC,95?73s •; EXPiR£S:Febrd�ry 14,201 F:BLDG/Owner-Builder Affadavit,REVISED:4/16/2009 'i3lr., ".1 Banded( Notary Public Underwriters ",P , tssa.lyy+. City of Atlantic Beach JAiV � 2013FDaterotAed. PLICATION NUhABER Building Department 8010 Seminole Road gned by the Building Department) BY: Atlantic Beach, Florida 32233-5445' _— Phone(904)247-5626 - Fax(904)247-5845 -COORS, E-mail: buil�ng-dept@coab.us �� Cityweb-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: ff f rQ(, / '/I, Department review re uired Yes No Applicant: Building 1�1Q/i% Planning&Zoning Tree Administrator Project: (,� Public Works Public Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Permit Verified By Date Florida Dept. of Environmental Protection of 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: roved. ❑Denied. (Circle one.) Comments: BUILDING ®_ PLANNING&ZONING Reviewed by: Date: TREE ADMIN. Second Review: [Approved as revised. [--]Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FERE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: I Reviewed by: Date: Revisad 07127110 'a 54 City of Atlantic Beach 0 r Building Department asAPPLICATION IdUWIBER 800 Seminole Road ' -, (To be signed by the t3ukft Deperlrnent) Atlantic Beach. Florida 32233-5445 Phone(904)247-5826 • Fax(504)247-5845 �JSti, E-malt: building-deptQcoab_us Date routed: Cityweb-site. MtpJlwww.00ab.us APPLICATION REVIEW AND TRACKING FORM Property Address: !02�� nen Department review re uired Yes No Building Applicant: �\/ Planning&Zoning Tree Administrator Project: )C.Z ` Public Works Public Utilities 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 Transpottadon 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: roved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by /0Date: — TREE ADMIN. Second Review: [,Approved as revised. ❑Denied. P ORKS Comments: U IC 1 PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: (Approved as revised. ❑Denied. Comments: Reviewed by: Date: i Revised 07/27110 f