313 OCEANWALK S DR DRIVEWAY CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
DRIVEWAY PERMIT
MUST CALL I3Y4PM FOR NEXT DAYINSPECTION: 247-5814
30B INFORMATION:
Job ID: 15-DWAY-1 192
Job Type: DRIVEWAY
Description: DRIVEWAY PATIO REPLACEMENT
Estimated Value:
Issue Date: 5127/2015
Expiration Date; 11123/2015
PROPERTY ADDRESS:
Address: 313 S OCEANWALK DR
RE Number: 169463-0578
PROPERTYOWNER;
Name: PARK, STEPHEN, '
Address: 313 OCEANWALK DR S
GENERAL CONTRACTOR INFORMATION:
Name: EARTH WORKS DESIGN &
Address: 11111 -70 SA SAN JOSE BLVD APT 297 11111-70 SAN
JOSE BLVD#297
Phone: - -
PERMIT INFORMATION: UTILITY DEPT.: PUBLIC WORKS:
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 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.
All silt must remain on-site during construction.
Roll off container company must be on City approved list and container cannot be placed on City Right-
of-Way. (Approved:Advanced Disposal, Realco, Republic Services,Shappel's and Waste Pro.)
Full right-of-way restoration, including sod,is required.
FEES:
Fence/ROW $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CTrY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
A&L CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Total Payments: $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH O"MANCES AND THE FLORIDA
BUILDING CODES.
City of Atlantic Beach
c Building Department AP Ll ATI N NUMBER
800 Seminole Road east n by the Building Department)
tiantic each, 1011 a 32233- RAY 0 (To be
hone(9 7 2 11 Fax( .. . �015 12,
-mail u I ing-do mab,us
ItY we -site ht I web LIS Date routed..
APPLICATION REVIEW AND TRACKING F ORM
Property Address: 313 Department review required Yes No
Applicant" Bu, *
Planni Zonin
Project: Public Wo I r nus rotor
J
L! IC I
R� 6#1 IF Pu Ic afetv
Fire Services
Review fee $ 2 r—
Dept Signature Zz�
Other Agency Review or Permit uired Review Or Receipt
Florida Dept.of Environmental pmt 0 Of Permit Verified 8 Date
Flonda Dept. Of Transportation n
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:
(Circle one.) Comments: Uprl�ed. oDenied.
BUILDING
PLANNING&ZONING
TREE ADMIN. Revievved by:
Second Review: EIAPProved as revised. Date lu
OR Comments: UlDenied
U U LITIES
ef, "I
,51- f
PUBLIC SAFET4 Reviewed by:
FIRESERVICES Th
Comments:: ened.
Reviewed by:--------�Date:
iSed 071VII0
CITY OF ATLANTIC BFACH
MIMI CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
800�hnola R.M 9�247-5M
M&nic liea�,RcxWa 322�5 Fa� 9�247�
PLEASE SUBMR(3)COMPLETE SETS OF PLANS WITH APPLICATION.
Date. 5� —
Job Address 13 6buxi woax b 1. 131 1
Permitee: ve PrK Telephonte#
PermlitteeAddrem: 313 ea-At,.^W�,Ix br.'7-
RsquestlngParmjssiontoConmuct:-��,,e' Aeve "
Location: (nn,�,47or&r�k -Ve, 6�+ 1174
1� Applicant declares that prior to Ming this application he has ascertained ft location of all existing utilities,
both aerial and underground and the accurate locations am shown on the sketches.
A Letter of Notifiaafion was mailed to the following Utilifies/Municipalifies:
Jacksonville Electric Authority Ym( ) No ( Date:
Bell South Telephone Company Yes( ) No ( Date:
Ferrell Gas Yes( I No ( Date.
Comcast Yes( ) No ( Date:
2. Whenever necessary for the construction. repair, improvement, maintenance, safe and efficient operation,
afteration or relocafion of all.or any portion of said street or eamment as determined by the Director of Public
Works, any or all of said poles, wines� pipes, cables or other facilities and appurtenances authorized
hereunder, shall be immediately removed from mid stmat or easement or reset or relocated hereon as
required by the Director of Public Works, and at the expense of the Permiltse unless reimbursement is
authorized.
3. All work shall meet City of Atlantic Beach or Florida Oeparbnent of Transportabon Standards and be
performed under the supery...... —(Contracbes Prcject
Superintendent)located at jBil" —latermonew. 76V-IU�7idt.
4. All materials and equipment shall be subject To Inspection by the Director or Pubbe wom 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.
A sketch of plans covering details of this installabon, as well as a Copy of a recent survey shall be made a
part of this Calculations shmina any Increase in impervioujis am on owner's tRt or In the clity
Right of W=tq be included with this supliollition.
7. This permittes shall Commerce actual Construction in good faith with _days� If the beginning date is
mom then 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 harem set out are granted only to the extent of the
City's right, tide 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 oetx 5--1(-'5-
Belkx."U" we
state Of Flon Is,luo pm�ly�
N.I.ry PW.M Large,SaID.Of fl�' or�
My nNnssion exPirs, —Pmm*Krx� ca".-a—
CASSIVADRA K REA
MYX)httI0OI#FZ?N47
EXPIRES:Wy 10.W19
BUILDING PERMrr APPIUCATION
CITY OF ATLANTIC BEACH
goo Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5945
JobAddress; PertaftNumlam
Legal Description &r 39 Floor PAIrcal#
Arco til Ft aq.rx
Valuation of Work S (a Proposed 4fork catd1co,led— min-beate"DOWIL—
Class of Work(circle one): Alteratim Repair Move Demolition pooVspa. win dow/door
Uft of eltiatin structure(s) mleone)* Commercial
If an existingir1cm-dis a fire spring,r system installed?(Circle onc)d��- o NIA
Florida Product proval#
For multiple paucts use product approval tom
Describe in detail the type of viork to be perfbrmed�����!�-
e��Ire. �Prj
Propyrry Ovvner Inforland—ow.
E-Mail orFax#(Option
Contractor Informatiout
Company Name:Cay#AdvtrqS Dc5V t Rl"*kt- Qualifying Agent
Address: lac�l bve�A N94. urty mwx�"I� State Pf, —zip 3�yw
office;Phone$Plwk 7?A-P7'a- Job Siod Contact Number IoY-7S?-j;a 7o Faxf lqi-"A-0T1V
State Certification/Registrafion#
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and
Bonding Company Narne and
Mortgage Under Narne and Address
.4pplimlin,is hereby mde to obtain opemite,dodo war*andubstallatiourar haeficaea: I eardfy that nowark or installation has t,ouneenoadinlo,to the
hwallwa,kwillbepa,
for7uett to met ob,standarde ofall laws regulanitumveruation in th4rjurisdictrom Thisperaul becomes null
wo,kiscanumoond jur�de���t�a���mwlbes�df�EJft*i W&*P&uhfrSi9au, elhuPbah,
Tank mdAlr Cvufidau�de,
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMUENCEMLENT MAY RESULT IN YOUR PAYING TWICE FOR IWROVFN%NTS
TO YOUR PROPERTY.IF YOU INTEND TO OBTAIN FINANCING CONSULT WITII
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING Y6M NOTICE OF
COADIENCEMENT.
"n'
k
Signature of 0--
?r.tNume
Sworp,to and subscr me Sviont to and subscribed belbre an,
this I I Day of .20 1 f' this I I Day of
iew, blic
MYC0W1Ss0N#FFWa7
ExPRES:maylo,mig Revised0116.10
R.O.W.Permit Attachinent of for h 419e��7
R.O.W.Permit#-issued 1200 Atlantic Bzf 3,j�pj
Owner's Name: 9talw,n 't
ft-
Property Addrt a: 314 oe�.d
Subdivision:
Lot#/Block#: 46�-37
R.E. #:
REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of
f?29W 200Eby Atlantic Beach, Florida, a municipal corporation orgaruzed 'Ing
under tl�laws of the State of Florida, hereinafter referred to as '�CITY-and �)'*4&7
of Atlantic Beach,Florida,hereinafter referred to as;"USEW'.
VVIJNESSETH:
That the CrrY 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: T- em*iv
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 CrrY 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 ofUSER's proper address.
The USER shall promptly make my 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, my and all material necessarily displaced during the action of maintaining, repairing,
operating,replacing, or adding to of the utilities and facilities ofthe 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 we and code requirements ofthe CITY,including
City Code Section 19-7 (h) which states "Driveways dud =as sidewalks: City sidewalks may not be
replaced with other materials, but must be replaced with smooth orricrete left =rural in color so that it
matches the existing and adjoining sidewalks."
Page I of2
The USER, prior to making my 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 beriefit o� and be binding upon, the USER and their respective
successon;and assigns.
USER shall meet the terms arid 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 my of the work herein under the terms of this
permit and that all of said liabilities are hmby assurned by the USER.
DATED and SIGNED this t 4 day of 20OX7
By: Z�'-/- -
Property Owner
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this 14 day of Mat, 200_,rpersonally appeared before me, a Notary
Public in and for said County and State, � 'Pkrj� I 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 fireely and voluntarily and for the uses and purposes therein mentioned.
Notary Public in for said
i ounty and State EXPIRES:May 10,21119
CITY OF ATLANTIC BEACH,FLORIDA,a Rai m=.,Y
municipal corporation:
Approved:
Doug Layton,Public Works Director
For Permits where city sidewalk is impacted,
City Manager approval required:
Nelson Van Lim,City Manager
Page 2 of 2
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ZONING REVIEW COMMENTS
City of Atlantic Beach
Building and Zoning Department
800 Seminole Road Atlantic Beach,Florida 32233-5445
Phone: (904)270-1605 Fax: (904)247-5845 Email: dreeves@coab.us
Permit: 15-DWAY-1 192 Applicant: Earth Works
Review: I st Address: 12501 Beach Blvd, Jacksonville, FL 32246
Site Address: 313 Oceanwalk Dr S Phone: (904)996-0712
RE4: 169463-0578 Email: N/A
Correction Comments
1. Tree Removal: Please submit a Tree Removal Permit Application if any trees we to removed. If no
trees are to be removed,then please fill out an Affidavit of No Tree Removal. Both finnis are available
on the city website under"Planning and Zoning"and at City Hall.
512j,p -5pa)ct- -to 1DOU9
Derek W. Reeves re�rfl- qf)\�+rtcs-
Zoning Technician CvvrldooAto
dreeves@coab.us
City of Atlantic Beach
Building Department
Se"'inole Road
Plant1 Besc jor
c h, F ida 32233- 445
E hone(9 247�5 F8X(59W)247-5845
_",I 1, ildl, _ ,
City a _'It, I g filn,�b
b '10 7 Cost,
APPLYCATPON REVIEW AND TRACKYNG FORM
PrOPerty Addre 09
Z14&ah A�,C _s Department r
Applicant* Buildin law required Ye. fqo
annin &Zonin
Project- ree Hustrator
Public Wor
U Ic
eii&tm r Public
Fire SeNicas
Review fee $ Dept Signature
Other Agency Review or Permit Required REvieW or Receipt
Florida t of Environm,, I P,,Laclirr Of Permit Verified Date
Florida I.of Transportaff,
St Johns River Water Me"ago'hent District
Army Curtis of Engineers
Division of Hotels and Restaurarth
Division OfAlwholic Bwaregas and Tobacco
Other.
Reviewing DOPRItment First Review: APPLICATION STATUS
(Circle one.) Comments: EIAPProved Aerved,
BUILDING fe,e 414Az4,)
�LANNING&ZONING
TREEADMIN. Reviewed by:-A 4"A-1
Second Revie : CIAPProved as revised. Date:
PUBLIC WORKS Comment,, DDenjed.
WORKS
PUBLIC UTILITIES
PUBLIC SAFETY
Reviewed by
FIRE SERVCFS Third Review: [3Apprwed as Date
Comment,: revised, DDenied.
Rewevvecl by
Date-
107127/10
R.O.W. Permit Attachment of for
R-O-W. Permit# issued for 3 gg74�
200 Atlantic Beach 3,�
- 1? 4h
Owner's Name:
Property Address: 113
Subdivision:
MAY I Lot#/Block M: 1-61,-12,
R.E. tf:
By
M] REVOCABLE ENCROACHMENT PERMIT
THIS REVOCA13LE ENCROACHMENT PERMIT, issued on this tf day of
-77�v 200-firy Atlantic Beach, Florida, a municipal corporation organized�tex ting
under th�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: X y- --414 Wd�, �*-
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 my and all necessary repairs to my 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-descubed 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,replacin& 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 Ind use and code requirements of the CITY,including
City Code Section 19-7 (b) which states "Driveways that cross sidewalks: City sidewalks may not be
replaced with other materials, but most be replaced with smooth concrete left natural in color so that it
matches the existing and adjoining sidewalks."
Pagel of2
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, fbr 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 more 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 aral/or specifications, to include utilities locate requirements and use limitations/requirements of
public rights-of-way and other pubfic land. USER further agrees that the CITY and its officers and
employeea shall be saved harmless by the USER fiOm arY 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 t 4 day of 2004.7
By: 4, z—
FroPerty Uwner
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this J-4-- day of 200 ersonally appeared before me, a Notary
-Co�untymd Stae,
Public in and for said 4�p K the property owner of
7— Atlantic Beach, Florida, known to me to be the peraon(s)
described in and who ex�uted the foregoing instrument; who acknowledged to me that he or she
executed the same freely and voluntarily and for the uses and purposes therein mentioned.
IDRI fl
Notary Public in for said Counq
MYC=
t8so'IFFLI
.6XPIRES may 10,2019
and State
CITY OF ATLANTIC BEACH,FLORIDA,a
municipal corporation:
Approved:
Doug Layton,Public Works Director
For Pennits where city sidewalk is impacted,
City Manager approval required:
Kelson Van Licre,�City Manager
Page 2 of 2
CITY OF ATLANTIC BEACH
CONSTRUC]ION PERMIT WITHIN CITY RIGHTSOFWAYAND EASEMENTS
M Sendriole R*ad 9�247-58N
Mart.�di.R.rd.32233�5 904-247-SW
PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION.
Date S///115- p-IT
Job Add. ,�� 1-3 6b%AWOJX 01. ':R
Pe"Itee: S�e*, �LrK Telephortalli
Families Address: 313 Creli-W&AK br.f.
RequesfingP�issiontoConstmut:��e,
Location: (Reference to w-,4 - "F3--je-T-aoA Tr,,
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 locadons am shown on the sketches.
A Letter of Notification was mailed to the following 1.1filifiesimunicipalifies:
Jacksonville Electric Authority Yes( I No I I Date:
Bell South Telephone Company Yes( No Date.
Ferrell Gas Yes( No Date:
Gomcast Yes( No Data.
2. Whenever necessary for the construction, repair, improvement, maintenance safe and efficient operation,
afteration 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 met 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 Aflantic Beach or Florida 42-lartment of Transportation Standards and be
performed under the supervision of 11�1 IN (Contractors Prcject
Superintendent)located at C� �K% %*a Vft�wt, ---- Telephonelk. '10-TW-o7la.
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 conchon as far As practical, in keeping with cry,specifications
and the manner satisfactory to the city.
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 perrint. Calculations showima any Incrialism in imporyfous area an owner's lot"In the CAY
Pight of Way am to be Included with this opplicittion,
7. This pernnittee shall commience actual construction in good faith with _days. If the beginning date is
mom than 60 days from date of perinit approval,then permithee 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 am 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, darnAge, and cost of expenses arising in any manner of the exercise or attempted
exercises by the holder of the aforesaid(ights and privileges.
S. The Director of Public Woft shall be notified twenty-four (24) hours prior to starting work and again
immediately upon completion.
OWNER �0 /
Sf,niid /a^,,? - oets, $--I(-f5'
or vval'
sise wliift it. iirfty.�
NotuyPUbUCe�gB,S�gR�a,�n[YW�t.
slymnionissionexpim: personally KrD.:C4"'-'a—
Pmdu=1 Iderfiffimill.:
AAR
W
ISSION If AF 222947
EX?lflES:Mayl0,W9
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BFAcjEi
800 Seminole Road,Atlantic Beach,FL 32233
Offi�(904)247-5826 Fax(904)247-5845
Permit Numb":
JobAddress: , 's
Legal Description 1�r 3.? rworArea 'q Ft�dlcooledl parcelit 'u'o�'-theatetticoold
Valuation of Work S a 1,(b Proposed 4iork he�t
Class of Work(circle one): (94 <ig� Alteration Repair Move Demolition poollspa window/door
Use of exisfin=wd atructure(S�Zle one): Commercial es*denti
Iran existlog c reisafirespra er system installed. (Circle cme)(: N/A
Florida Product proval#
For multiple paucts use-product spp-M-M farm
Describe in detail the type of work to be performed:T�,,e v Ariveitwi3 �pAwer
Property Owner Information:
Name: Address: ';V?� (Oeft-ftw"r
StltiviLzlpl -Phone lcq -qqE!6�F73
City
E-Matloffax4
Contractor Information;
Company Name:CaHMAorPs &5* ftlo-hf. Qualifying Agem:
Addreas� IaLS&i &,�A PA,4- -city M��Qf. State Pl- Z' 3%ayd
Office Phone$Q97 �71jk. JobSite/ContactNuttber fay-v"-Ca7v Fax�
State Cerfification/Registration#
Architect Name&Phone#
Engineer's Namo&Phone 4
Fee Simple Tide Holder Name and Address
Bonding Company Name and Address
Mortgage tender Name end Addms
=o
,f,l=itandth�allworkwillbep.&Y�.dta�ettlwstandardsofagi�mgukdxgeonj&7�-tkn in Wsjurisoftenion. Thupmnit becomes null
not cmwo�dwfthho.,L,(6)n000lm,orif contmoaon orwo,kis fddor.b..doex(fbra oiad.f,&j6).o,uAat.,d.
T,anb .dAhr CVngdofi�do fl=
worko,,Zvn000�d W'.*,F&nobigS4hM whftiok rnw�,BoiZkff
WARNING TO OWNER. YOUR FAILURE TO RECORD A NOTICE OF
COMMIENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IWROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITTI
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING VO-M NOTICE OF
COADIENCEMENT.
"on
��kt th
ah-�P
Sigamma of 0_
PrmtNamc
Swona�to and mbscribo��fcsv me Sworn to end Subscribed before me
this H Day of rna'j 20 f' ffiis ) Day of A� .20
--- (111AA
Notary Public GOSSANDIRRAR 0 blic
MYCONNISS01#722MI
EXPIRES:May 10,�19 knised0l.26.10
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TREE & VEGETATION AFFIDAVIT
City of Atlantic Beach
Department of community Development
Planning&Zoning Division
800 Seminole Road Atlantic Beach,FL 32233
(P)904 247-5800 F)904 247-5845 PERMIT#
SECTION I-APPLICANT INFORMATION r— Owner(s) r— Legal Authorized Agent-
NAME OF APPLICANT —)er is )
NAME OF COMPANY VL)12ryC
ADDRESS OF COMPANY V.11
PHONE
_ d.7jr, CELL EMAIL
_,Wnrj<S 49 64�— .C',
CONTRACTOR CERTIFICATION NUMBER
ATLBCH BUSINESS TAX RECEIPT NUMBER
SECTION 11-SITE INFORMATION
STREET ADDRESS OF PROPERTY
ifanatliireu hmwt�n anigmdmffiisp�r�6�taOMeASBuilding��"mtat(PtQ247-5V6 toru;w0w�dn,'s.
LEGAL DESCRIPTION
LOT BLOCK SUBDIVISION
REAL ESTATE NUMBER LOT OR PARCEL SIZE: 50 FT AC
RESIDENTIAL COMMERCIAL OTH ER(SPECIFY)
I affirm that I have reviewed the provisions of Chapter 23, 'Protection of Tmes and Native Vegetation-of the Municipal Code of
Ordinances for the City of Atlantic Beach,FL andlor I have participated in a pre-application meeting with the Administrator of those
regulations. Subsequently,I affirm that no regulated trees and no regulated vegetation will be damaged,destroyed and(or removed
from the above-describ radjacc tp cony.unction with this project
SI ATUREOP&AWER� SIGNATURE OF OWNER
Signed and sworn before me on by State of
WIT"; I County of
Identification verified: F:�' )->L,
Oath sworn: r— Yes I-L-wo
ry jjgture U
EXPIRES.APA N.2017
My Commission expires:
CitY of Atlantic Reach 4f4Y,2
60ding Department
Aso A APPLICA I N U BET?
800 Smincle R,,d
Atlantic Beach, Florida 32233. assigned by th 81111110 D 0 ent)
Phone(904)247-S�M I,.0 --' (TO be
1. 4)24 -58 S -
ht"ding
5"�
'y' Efall -"ccob
CltYwc�b-site U5
oab,us Date muted:
APPLOCATUON REVIEW AND TRACKING FORM
i"rOPOrtY 7di�T?ss,
IeWre uired Yes
APplicant: it rev' No
Project: a nin &Zoni
e nwn,sh,to,
Public
if U JIC
Public fety
Fire Services
Review fee $__ Dept SignatUre
Other Agency Review or itRequird Review r elpt
Flo ,Dept of EnvnP of Permit Oriffed 8 Date
Flo Dept of T'Mrsportation Prot on
81, rS R ver Water Maragment District
C a of Engineers
Division Of Hotels and Restaurants
DhAsi-Of AlwhNic Bevwg.and Tobacco
Other.
APPLICATION STATUS
Reviewing Department —�, �I A I t
(Circle o,,,) First Re,i,,: �U. led
Comments:
BUILDING C-LC-Ao- L- 14-6-1 IJ
'LANNING&ZONING U444 7 t AJ .7 L)tXi F
TREEADMIN Reviewed by:
Date 2,1
Second Review. �3APProved as revised. d
PUBLICWORKS comments:
PUBLIC UTIL17JES
PUBLIC SAFETY
Reviewed by
9RE SERVICES
.Third
comments. L-166nied.
Reviewed by-
PUBLIC WORKS PLAN REVIEW COMMENTS
Date: -�-W I I�;- Application Permit#: IS- 4uliY �11qz
Project Name/Address: 31 -� DCO�o L-W kba= �, ,
,,0 Check Box to
Application Tracking Comments select
'ORRECTION ITE
MS:
C,M, �Provlde construction site management plan, including location of dumpster and portable toilet, Right-
f-Way Permit is required if using right-of-way for construction parking. 0
DPLN rovide drainage plans showing site topography(flow arrows,etc..)) 0
ESCP rovide erosion and sediment control plans with installation details. 0
IMPS rovide impervious surface calculations for entire lot(existing and post construction). 0
ection 24-66(b)of the Land Development Regulations requires on-site storage for Increased run-off if
LDCS dding 400 SFor more impervious surface. Provide Delta volume calculations and on-site retention 0
equired per Section 24-66(b). (See attached information sheet.)
MEET lRecommend Owner/Contractor meet with Public Works Director to discuss proposed construction.
PH 247-5834 to make an appointment. 0
REPM Revocable Encroachment Permit must be obtained. 0
RMRO It runoff must remain on-site. Cannot raise lot elevation without measures to retain runoff. 0
RWPIV1 Right-of-Way Permit must be obtained for use 0
TSUR rovide a pre-construction topographic survey prepared by a Florida Licensed Professional Land
urveyor,showing I'contours. 13
NDITIONS OF APPROVAL TO PRINT ON PERMIT:
It concrete driveway aprons must be S�thick,4000 psi,with fibermesh from edge of pavement to the
DAPR roperty,line. Reinforcing rods or mesh are not allowed in the right-of-way. (Commercial driveways— 0
"thick.)
rul!erosion control measures must be Installed and approved prior to beginning any earth disturbing
ECIN �ctrvities. Contact Public Works(247-5834)for Erosion and Sediment Control Inspection prior to start
PCORU�10
OSRO mus main on-site during construction. 0
PCTS f on-site storage is required,a post construction topographic survey documenting proper construction
Ill be re uIred. 0
PLWP ool—Wellpoint(if used)must discharge Into vegetated area 10'minimum from street or drainage
eature(swale,structure or lagoon). A separate pool permit Is required. 0
ROFF oil off container company must be on City approved list and container cannot be placed on City right-
_way. Approved:Advanced Disposal, Realco Recycling,Republic Services,Shappel's and Waste Pro).
RWRS ull right-of-way restoration,including sod,is required.
URCT ny utility cuts in the road must be repaired using COJ Standard Detail Caw X and must be overlaid 10
eet in each direction from the center of the cut. Repair must be shown on the plans.