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571 Sailfish Dr 2014 pavers ' `1r CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD j ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . 14-00000267 Date 3/05/14 Property Address . . . . . . 571 SAILFISH DR Application type description RIGHT-OF-WAY PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 -------------------------------------------------------------- Application desc pavers at end of driveway -------------------------------------------------------------- Owner Contractor - ------------------------ ----------------------- JOY,TIMOTHY H OWNER 3029 NEW BERLIN RD JACKSONVILLE FL 32226 ---------------------------------------------------------- Permit . . . . . . DRIVEWAY PERMIT Additional desc . . Permit Fee 35 . 00 Plan Check Fee . 00 Issue Date . . . Valuation 0 Expiration Date . . 9/01/14 --------------------------------------------------------- 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. Full right-of-way restoration, including sod, is required. Street and gutter must be swept clean daily and after completion of installation. ---------------------------- 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 -------------------------------------------------- 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 79 . 00 79 . 00 . 00 . 00 Grand Total 114 . 00 114 . 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 DECEIVED APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road e Atlantic Beach, Florida 32233-5445 FEB 242014 2 Phone(904)247-5826 • Fax(904)24 -5845 E-mail: buildin de t coab.us Lp? pa 9- p @ BY: Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: ��� SDepartment review required Yes No /, 'n C� Building Applicant: l/V G Planning &Zoning p Tree Administrator Project: ��Vie6 b Q ublic Work Util, Public Safety Fire Services Review fee $ Dept Signature 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: pproved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: (� Date: TREE ADMIN. Second Review: A roved as revised. ❑ pp ❑Denied. W Comments: UBLIC UTILITI LIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 City of Atlantic Beach ' r Building Department APPLICATION NUMBER 11 (To be assigned by the Building Department.) 800 Seminole Road 1014 Atlantic Beach, Florida 32233-5445 Z Phone(904)247-5826 • Fax(904)247-58 FiE-mail: building-dept@coab.us --Date routed: !7� City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: S"71-S Department review required Yes No C Building Applicant: 4�j()/�G ye Planning &Zoning p Tree Administrator GIC_ Project: �V 6 L Q ublic Work Utili Public Safety Fire Services ;Review fee $ (S Dept Signature Other Agency Review or Permit Required Review or Receipt of Permit Verified By Date 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 DepartmentFFirstew: pproved. ❑Denied. (Circle one.) s: BUILDING PLANNING &ZONING Reviewed by: Date: /y TREE ADMIN. Second Review: QApproved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: DApproved as revised. ❑Denied. Comments: Reviewed by: Date: vised 05/14/09 CITY OF ATLANTIC BEACH FEB 2 2014 CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS Vr ' 800 Seminole Road 904-247-58111 1 Atlantic Beach, Florida 32233-5445 Fax 904-247-5845 PLEASE SUBMITOCOMPLETE SETS OF PLANS WITH APPLICATION. Date 1 _ PERMIT# Job Address J(r(II' ►s') �Q t�, ��L, 3)23-3 ISSUED BY THE CITY Permitee: /M 07%t y -H. ACU (1 Telephone# 70V 53 — 3 ok/7 Permittee Address: J 1/l s l�. 6C� J 2 2-3 Requestin �ermissiNaCo5struct: nVt S n C ! E A0 15 / rNio ti'=VV (/c C E 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 ��� L U � Yes (✓y No ( ) Date: Bell South Telephone Company �1� Yes ( No ( ) Date: Ferrell Gas Yes ( No ( ) Date: 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 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 tippy r� Notary Public State of Florida Signe Date: � ;t' : Shirley L Graham Before his day of in the County of Duval, V ` My commission FF 088990 Stat f Florid so y a ared dor r� Expires 02/14/2018 N Publ' at La4 rge,. to a of Flo tda,County of Duval. My com . io expir Personally Known: Produced Identification: R.O.W. Permit Attachment of for R.O.W. Permit# issued ,200_ Atlantic Beach,FL 32233 Owner's Name: llfn4Y Property Address: 15 514f IF( fia 6 Subdivision: K0"r4- 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 permitbers noted above (copies attached). This work is generally described as: 1Tt1VCk5 #Ta)aoF Ntww4t 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 snail, 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 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." 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 S NED this 65�Z/ day of By: Prop wn (to be signed in esence of the Notary) STATE OF FLORIDA COUNTY OF DUVAL On this day of 20� 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) described in and who executed the foregoing instrument; who acknowledged to me that he or she ]=T me fre untarily and for the uses and purposes therein mentioned. 1 to Public State o1 Florida s ry Notary Publi in for ounty and State Shirley L Graham a pa my Commission FF 086990 or P, Expires 02/14t201 8 CITY OF ATLANTIC BEACH,FLORID , 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 i ' yy ' 1 F gg • i � 3 • s 1 i ZL 71 1.1„1..f AM i3 iU �© r�74".iT✓r+•.•�j�1.3 J�1•ii 1:11 �I.w►' ;'�;. 'Y 40 � � .M?... J - , L t.1 �.0�►./ f G Ira+ .40 4••.._' e;,,n ...w E a �" -'k ap'i "'o -k Inno �:.L • i_` _..�CORPOY.€ ... .,t,r. •.•.... "_ 7'COPY •TM 1-4 X1 o i CITY OF ATLANTIC BEACH J/ OWNER / BUILDER AFFIDAVIT f ` 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 ORDMANCES. 11. 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. 5532�I SA;(f�s� fir. A-l�r�v�c 9® �— —3a0`2 ADDRESS y� l ONE NUMBER //' � X . 0 P NT T RE DATE !f Before me this y of 20 in the county of Duval,State of Florida, s personally appeared herin by himself/herself and affirms that all statements and declarations are true and accurate. `/ / Notary Public at Large,State of_ ,County of V� Y4/Personally Known roduced Identificati - qty Notary Public State of Florida Shirley L Graham Notary Signature: My Commission FF 088990 OFµ Expires 02/14/2018 RBLDG/Owner-Builder Affadavit REVISED: 4/6/2009