1822 Hickory Ln 2014 paver driveway 1
CITY OF ATLANTIC BEACH
1 j 800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
4 C j3
Application Number . . . . . 14-00000507 Date 4/10/14
Property Address . . . . . . 1822 HICKORY LN
Application type description RIGHT-OF-WAY PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
paver driveway
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Owner Contractor
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ADHIKARI, RESHAM R OWNER
1822 HICKORY LANE
ATLANTIC BEACH FL 32233
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Permit . . . . . . RIGHT OF WAY PERMIT
Additional desc . . PAVERS
Permit Fee . . . . 35 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 10/07/14
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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 .
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 . . . . . . . . . ENG REV BLDG MOD OR ROW 25 . 00
UTIL REV MODIF OR ROW 25 . 00
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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 50 . 00 50 . 00 . 00 . 00
Grand Total 85 . 00 85 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
s+- r��, City of Atlantic Peach 1 ,(� �J F j� FDate
LICATION NUMBER
�s i+ Building Department
ned by the Building Department.)
800 Seminole Road APR 032014
!a �r Atlantic Beach, Florida 32233-5445 y Q 7
Phone(904)247-5826 • Fax(904) 45
E-mail: building-dept@coab.us — d: Z
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: IJ 2 Z 'Q1 Lyt Department review required Yes No
Building
Applicant: Planning &Zoning
Tree Administrator
Project: r/ WServices
P
F
;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
Other:
APPLICATION STATUS
Reviewing Department First Review: VApproved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by: Date: —9
TRE ADMIN. Second Review: A roved as revised.
❑ pP []Denied.
P B W&K Comments:
TILIT E
PU IC SAF Y Reviewed by: Date:
FIRE SERVICES Third Review: []Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
wised 05/14/09
PUBLIC UTILITIES PLAN REVIEW COMMENTS
Date: Initials:
Q / - 7
Project Name/Address: U G 0 ✓ �� Applica ion Permit#:
Check Box Check
Application Tracking Comments to Add Box to
Comment "Print"
UWSU 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.
M BSC
Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible.
RTIC A sewer cleanout must be installed at the property line. Cleanout must be covered with
an RTI concrete box with metal lid. Cleanout to be set to grade and visible.
RPZB A reduced pressure zone backflow preventer must be installed if irrigation will be
provided or if there is a private well on the property. Backflow preventer must be tested ❑ ❑
by a certified tester and a copy of the results sent to Public Utilities.
STRM Plans note the building will be unsprinkled. If plans change, any fire line installed must be
metered with a Sensus touch-read meter in a properly sized vault and an appropriate ❑ ❑
backflow preventer installed. Backflow preventer must be tested by a certified tester and
a copy of the results sent to Public Utilities.
FSBR if fire sprinkler system is provided, contact Malcolm Clemons at 247-5839 for backflow
requirements. At a minimum, will require a double check backflow preventer.
FLM Fire lines must be metered with a Sensus touch-read meter. Meters larger than 2" must
be installed in a vault as noted in JEA specifications.
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
• I ,
CITY OF ATLANTIC BEACH nL CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND
800 Seminole RoadLJU
4
"' f Atlantic Beach,Florida 32233-5445 Fax -5
PLEASE SUBMI COMPLETE SETS OF PLANS WITH APPLICATION. By
Date
/ PERMIT#
ISSUED BY THE CITY
Job Address
' r
Permitee: �/ ' Telephone
Permittee Address: /S�—
Requesting Permission to Construct
Location: (Reference to Cross-Street) �r
1. Applicant declares that prior to filing t is 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(./j�o ( ) Date:
Bell South Telephone Company Yes( +�I" N ( ) Date:
Ferrell Gas Yes (� o ( ) 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��Q?r Florida Department of Transportation Standards and be
performed under the supervision of 5c`/ (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: Date: I-X— 7
Before m this 4sy o in the County of Duval,
State O oria,
has ersonally a red
Nota u c has
,State o loud Co ty of Duval. +µ'r Notary Public State of Florida
M m sio exp res: Pers n:Shirley L Graham
Produced Identification: My Commission FF 086990
M Expires 02/74/2078
i
r'
R.O.W.Permit Attachment of for
R.O.W. Permit# issued 3200_ Atlantic Beach,FL 32233
Owner's Name:
Property Address:
Subdivision:
Lot#/Block#:
R.E. #:
REVOCABLE ENCROACHMENT PERMIT. ff
THIS REVOCABLE ENCROACHMENT PERMIT, issued on- A �5jday of
�-; , 200y, 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: 1ATg gve
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 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
a
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(3 0)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 „Z day of i�r ,20¢
By:
Property Owner
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this o� day of +ut—yi
; I , 20 j4personally appeared before me, a Notary
Public in and for said dState, 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
exec u the same freely 1}antarily and for the uses and purposes therein mentioned.
Notary Public State of Florida
:4
Notary Pu is for said o ty and State Shirley L Graham
My Commission FF 086990
M Expires 02/14/2018
CITY OF ATLANTIC BE CH,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
ALTER 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.
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.
STATEMENTLANDETHAT I( HEREBY COMP Y WITH ALL THEETHAT I HAVE REQUIREMEN REQUIREMENTS DISCLOSURE
IISSUANCE OF AN
OWNER-BUILDER PERMIT.
PHONE NUMBER
ADDR SS
MA
PRIN
DATE
S RE
Before me this day of Irl 1 201 in the county of
Duval,State of Florida,has personally aplbeared herrn by hims If/herself and affirms that
all statements and declarations are true d accurate.
Notary Public at Large,State of_ County of
yxr o� Notary Public State of Florida
yersonally Known d�roduced Identficati Shirley L Graham
y ` My Commisslon FF 086990
or t� Expires 02/14/2018
Notary Signet
F-BLDG/0Km -Builder Afradavi�REVISED: 4/16/2009 6 '�
MAP SHOWING A SURVEY OF
LOT 23, SELVA MARINA UNIT 12—C RET AS ECORDS OFCDUDVALD IN COUNTY, BLOORIDAOOK ? PAGE
29 OF THE CURRENT PUBLIC R
LOT 24 I >
D
103.97'(FIELO) I `-
S89'35'33"W I m
S89'35'07"W 103.91'
p_g• FOUND 3/4" IRON II
rN3./C4 3/4- IRON PIPE, NO CAP
- N
PUMP PAD STORAGE BIN O
5' W000 FENCE A/C — Z
PA x O O O
Uc7l ^�3.3 ul O o
(no 20.0'. 2 �' 21 .3' N
o O
Q N
O BAY W
v ! WINDOW
W N CONCRETE (Jl �
r DRNE C�
�N
rq1 � TWO STORY
A;r � N FRAME
Tz RESIDENCE _ 22 5'LOT 1o r1r�'�oPOSTED "1822" 21 .2' V
� m
U' WOOD WALK
O ; v
v8.0'
-q 12.0' 31 .6'
M Z l
rn m CONCRETE P FOUND 3/4" IRON
r PIPE. NO CAP
RETAINING
OWALL N
K: O 35.5'
D 7\
x W ❑
Z Cn A/C
D PAD
- - x
W , CHORD BEARING=N26"09'01"E
CHORD DIST=44.72'
Fn� x N25-51'42"E 44.63'(FIELD)
RADIUS=50.00
LENGTH=46.36'
ou D 3/a" IRON _X 6w3OD FENCE X_XI X-X�j 53'07'48"
'IP NO CAP t RAIL ROAD TIE
N 8935'07"E 83.24 0.4' HEADWALL 0-3*
N89'35'07"E 83.22'(FIELD) 1
LOT 10 FOUND 1/2" IRON
* LOT 22 PIPE. JLB3672
HICKORY LANE
(CHORD = N 22'54'33" W 38.28' FIELD) \ CUL—DE—SAC (PA•r'ED)
I CHORD= S 22'54"53" E 38.27' x\
RADIUS = 50.00' ARC = 39.27
DELTA 45'00'00"
,h\V
=Q=O
J<v-
NOTES:
1.) THIS^IS^A BOUNDARY SURVEY_