275 4TH ST 2015 DRIVEWAY CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RIGHT OF WAY PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROW-445
Job Type: RIGHT-OF-WAY PERMIT
Description: 4 x 4's on the City Right-of-Way
Estimated Value:
Issue Date: 3/12/2015
Expiration Date: 9/8/2015
PROPERTY ADDRESS:
Address: 275 4TH ST
RE Number: 172555-0000
PROPERTY OWNER:
Name: YEAGER, GIRARD ALAN & ROSE M,
Address: 275 4TH ST
PERMIT INFORMATION: PUBLIC WORKS:
All runoff must remain on-site during construction.
Full right-of-way restoration is required.
This approval is to back up existing landscaping timbers 1 foot away from centerline of
street.
6x6 also allowed for this permit only.
FEES:
Fence/ROW $35.00
Total Payments: $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
MAP SHOWNG BOUNDARY SURVEY OF
LOTS 30 AND 31, ATLANTIC BEACH TERRACE; AS RECORDED IN PLAT BOOK 15, PAGE 34,
OF THE CURRENT PUBLIC RECORDS, DUVAL COUNTY, FLORIDA.
CERTIFIED TO:
WILLIAM YEAGER
107
ce
EAST COAST DRIVE
(30.0- RIGHT OF WAY)
I-P
100.00' (PLAT) FOUND 1/2-REBAR
QREBAR N 74*59'30" E 99.97- (MEASURED) NO IDIN-TIFICAM
STAMSPEETD I'A L9 6702*
th
LOT 31 LJ
2 -0
17.7'
STEPS
< in
< . x
20.6' 0.4'�
0
0 LOT 32
c; 80
Lij
ui
V%
ONE STORY
t4
FRAME
POSTED # 273
DAL-
_0 w
p
U) go
MT
0
17.8'
10 z
LOT 30
-�A cn
2Z3'
FOUND I'IRON PIPE -1 a, 0.2'--FOUND 1/2- IRON PIPE
NO IDENTIFICATION 5. X NO IDENTIFICATION
S 74*59'30" W
x 99.97' (MEASURED)
100.00- (PLAT)
LOT 1 LOT 2
BLOCK 23 BLOCK 23
LEGEND: ATLANTIC BEACH, PLAT BOOK 5, PAGE 69
R RADIUS —X—X= FENCE
ts-
Li
All runoff must remain on-site during construction.
Full right-of-way restoration is required.
This approval is to back up existing landscaping timbers 1 foot away from centerline of
street.
6x6 also allowed for this permit only.
1-> 44(1?
City of Atlantic Beach
APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445 15 - Row - L+14
Phone(904)247-5826 - Pax(904)247-5845 -
E-mail: building-dept@coab.us Daterouted: 31 2-11
Cityweb-site.- http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
e)-1 C' Lft�-\ &�
Property Address: 4- 1 Department review required Yes No
-Building
Applicant: le co Cr Planning &Zoning
Tree Administrator
Project: q Kow �-!�u_bli�Works")
_Fu_ff—icUtili 7ie-s
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
Other:
APPLICATION STATUS
Reviewing Department First Review: E�Approved. []Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by.- Date:,.�/�
TREE ADMIN.
Second Review: ElApproved as revised. QRenied. t/
Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: F]Approved as revised. ElDenied.
Comments:
Reviewed by: Date:
Revised 07127110
BUILDING PERMIT APPLICATION � T @ E� 0 T T
CITY OF ATLANTIC BEACH M R 2
800 Seminole Road, Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904) 247-5845
- FV
Job Address: Z�W.44,44*V4 —PermitNumber:
Legal Description Parcel#
Floor Area Of sa.-Ft. Sq.Ft
Valuation of Work$ Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of e�i�ting/pro osed structure(s) circle one): Commercial Residential
If an existing strucrure,is a fire sprinMr system installed? (Circle one): Yes No N/A
Florida Product Approval#
For multiple products use product app—r—o—vaTform
Describe in detail the type of work to be performed: 'Y -0
Property Owner Information:
f _", '�r'7,_
Name:Afe � L��,,-y ye4ac-.4— Address:
city 141�AIW7_/C_ 1949clq StatO�j' Zipj
12-39 Phone a3pj—
E-Mail or Fax#(Optional) C�,C"r,
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: Qualifying Agent:
Address: city State Zip
Office Phone Job Site/Contact Number Fax#
State Certification/Registration#
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
A lioal here ade 0 ina ermit'o do the worl and installations a"indica or installation has commencedprior to the
, e e 0 ed om t the an a d a law., thisjurisdiction. This permit becomes null
a rk pi r so ' is sus
0 0 k i fsiT) fter
n f rdr . a erodo months at any time a
0 1 et'lea If/Is, ul
8s r f rm s d E e Pools, urnaces,Boilers,Reaiers,
), t or
1 (6 c str c
w p
w t in
p p 0 is by"d t 0'
ance a ermi an 'at a' 0
u'a'd 0 ,Pk s'at c 'n d h
a d 0 i I om T rs c' six on on ' t'o
�j t , t t s P p r is m, t s cu
f d d, d b
'k i'c 'ece a a e arate e e e re r e
0
T . Co i io rs
ank a ulAjr n ne ,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I herelb certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
q work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions ofany otherfederal,state, or local law regulating construction or the peiformance of construction.
Signature of Owner Signature of Contractor
Print Name Print Name
A "W ........................................................................................................................................
Befo Before me
this�&ay of ff)&rCkN. ' 20145 this Day of 20
NokQLP JENNIFTRW L Notary Public
My cOMMISSION#FF 01100
EXPAP6124,9011
IRES Revised 01.26.10
Bonded Thfu QN RAW wfid@fw&�§
DO NOT WRITE BELOW- OFFICE USE ONLY
Applicable Codes: 2010 FLO 11) BUILDING CODE
Review Result (circle one):
Approved Disapproved Approved w/ Conditions
Review Initials/Date:
Development Size
Habitable Space Non-Habitable
Impervious area
Miscellaneous Information
Occupancy Group
Type of Construction
Number of Stories
Zoning District
Max. Occupancy Load
Fire Sprinklers Required
Flood Zone
Conditions/Comments:
800 Seminole Road
Atlantic Beach,Florida 32233
Telephone(904)247-5800
FAX(904)247-5805
djils)
Construction Site Management Plan Compliance
A construction site management plan conforming to Atlantic Beach City Code Sec 6-18
has been approved as a part of this building permit. The Construction site management
plan was approved based upon the following information.
1. Parking plan—parking plan showing how site will be accessed and all onsite
and abutting street parking areas.
2.
3. Location of construction trailers, loading/unloading area and material storage
area.
4. Location of chemical toilet area.(chemical toilets must be kept out of City
right-of-way and not ftirther than 15 feet from structure under construction)
5. Location of dumpster. Dumpster must be from an approved waste company
(in accordance with Chapter 16 City Code) as of 2009 the permitted
dumpsters are Advanced Disposal,Realco Recycling, and
Shappells. Dumpsters will have tarp covers or rigid covers on windy days.
Dumpsters must be removed prior to issuance of Certificate of Occupancy.
6. Traffic control plan, showing access with dimensions, area to be stabilized,
narrative on phasing of construction with adequate parking and delivery of
materials.
7. Site cleanliness. Contractor must have the entire construction site cleaned by
Friday of each week. This means removal of scrap lumber, concrete remnants
and other such construction debris including cans, metal,plastic and paper.
8. Erosion and Sediment Control. Contractor must maintain all elements of the
approved Erosion& Sediment Control Plan(silt fence, catch basin filters, etc.)
until sod or other stabilization has been placed and approved by Public Works.
9. Other activities,where special conditions are identified by the Building
Official.
Failure to comply with the Construction Site Management
Ordinance may result in a Stop Work Order being issued in
accordance with City Code Sec. 6-17 (3)
Revised 5/2009
CITY OF ATLANTIC BEACH
2 -
-A
OWNER BMDER AYFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I "CONSTRUCTION
CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENTFOR SECTION 489.103(7),FLORIDA STATUTES:
STATE LAW PEQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU I LAVE APPLIED FOR A PERNflT UNDER AN EXEMPTION TO THAT
LAW. THE E,-�EMPTIONI 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 CONS FRUCTION YOURSELF. YOU MAY BUILD OR HAPROVE A ONE—OR
TWO FAIVULY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
EVIPROVE A CONRVIERCIAL 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 WITT-TIN ONE YEAR
AFTER THE CONSTRUC-11ON IS CONIPLETE, THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEAS—,"'- WFUCH IS IN VIOLATION OF THIS E)CEWTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR- YOUR CONSTRUCTION MUST
BE DONE ACCORDINoTo THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSLBLLITY TO MAKE SURE THAT PE013LE EMPLOYED BY YOU HAVE
LICENSES REQUIRED-,3Y STATE LAW AND BY COUNTY OR MUNICIPAL LICENSINCf
01'DINANCES.
it. 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.
W. 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 COLIN TY "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
OWNIER-BUILDER PERMIT.
el,
2
ADDRESS PHONyegJR,,�
PRINT NAME
.2
SIGNATURE DATE
A' Y\A
Before me this
,�day of 2 in the county of
Duval,State 0, torida,has personally;,,F�pep.i�)d herin Jimself/herself and affirms that
all statements and declarations are true an-.��,ccura'a-
Notary Public at Large,State of. County o�,
JENNIFER WALKER
My COMMISSION#FF 011480
1�1 rPonally Known
EXPIRES:April 24,2017
,.,.,;a Bonded Thru Notary Public Underwriters
d Identification-
wre:
Notary Siona
AMd-it;REVISED: 4/1 ;19