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197 POINSETTIA ST - RIGHT OF WAY BRIDGE (pi. , . lip)f CITY OF ATLANTIC BEACH A s) 800 SEMINOLE ROAD \\,,,,, , t.uui. ,/' 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-2079 Job Type: RIGHT-OF-WAY PERMIT Description: FOOR BRIDGE TO MAILBOX OVER SWALE Estimated Value: Issue Date: 9/15/2015 Expiration Date: 3/13/2016 PROPERTY ADDRESS: Address: 197 POINSETTIA ST RE Number: 170641-0005 PROPERTY OWNER: Name: Hamilton, Kathy Address: 197 Poinsettia ST 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. Resident must keep flow area clean or remove bridge. Resident is to maintain 15" ditch clearance. Full right-of-way restoration, including sod, is required. Provide 2'6" minimum clearance from edge of road. FEES: —------ —Fence/ROW $35.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. f�S� CITY OF ATLANTIC BEACH :) 800 SEMINOLE ROAD K �,, ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 =0 i19f- Total Payments: $35.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. 1"--EC �I� T f . "4 . TII\/ SEP 1 0 2015 _ TOW — c .? Q 7s, Permit Attachment of LBY Permit# issued ,20 Atlantic Beach,FL 32233 Owner's Name: f J ?ffl P roperty Address: /9 7 ;z>,, f rr Q_, R.E. #: l4� 0 '= 'n' Lot#/Block#: D SEP 1 0 2 015 '�' REVOCABLE ENCROACHMENT PERMIT ! . ° • . ■ 41 OACHMENT PERMIT, issued on this day of 15- by Atlantic Beach, Florida, a municipal corporation SE.p of ,State o f P rp ganized d existing under the laws of the State of Florida, hereinafter referred to as "CITY" and r niy f h// 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: i 09 L 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, rq. .n reveipt . re ues d, to the f Rowing 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 1 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 insure 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 /OA. of 20/5— 0 -./1":"Al411. ifrRil:43:•:... /I/A..- "- Pr;r erty O s er (to be signed in presence of the Notary) STATE OF FLORIDA COUNTY OF DUVAL On this /Q day of • r 20 �. and for said County - p erso i y appeared before me, a Notary Public in ty a d State, . r A,/L I a •e • ••ert owner of ,Atlantic Beach, r orid. is own to me r•f-li a person(s • - ribed in and who execute 1 the foregoing instrument; who acknowledge. •• - i m and vo - y and •r the us-: ..1 ecut • the same freely purposes therein mentioned. L - _____ Notary Public in for s.i d Co , . ,d State ?tilt�'�Pvt Notary Public State of Florida Shirley L Graham CITY OF ATLANTIC BEACH, FLORIDA, a .d�°� Expires 02/14/2018 086990 municipal corporation: Appr• , -• Do j .yton,PT."' or Director For Permits where city sidewalk is impacted, City Manager approval required: Nelson Van Liere,City Manager Page 2 of 2 J -0 CITY OF ATLANTIC BEACH O '7 Ai-.:;`:1,i%-3� CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENT • WW1 .,.,f� EASEMENTS 800 Seminole Road "`I.�;sr�� z Atlantic Beach,Florida 32233-5445 904-247-5800 PLEASE SUBMIOCOMPLETE SETS OF PLANS WITH APPLICATION. Fax 904-247-5845 Date -CIF,�fe N-1 • it 0613 PERMIT# Job Address % �- ISSUED BY THE CITY Permitee: A ■ I Z / 4 Telephone# • Permittee Address: >A f- Requesting Permission to Construct: f-,1) 13,-/d , Location: (Reference to Cross-Street) .!.Jt . . W, 'ot 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 Bell South Telephone Company Yes( ) No ( ) Date: Ferrell Gas Yes( ) No ( ) Date: Comcast Yes( ) No ( ) Date: 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 y P 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 ' Superintendent) located at (Contractor's Project 4. All materials and equipment shall be subject to inspection by the Director of PublicpWork 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 showin. an increase in im.ervious area on owner's lot or in the cit Right of Way are to be included with this application. 7. This permittee shall commence actual construction in good faith with das.more than 60 days from date of permit approval, then permittee must review he perlm thwitth 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. OWNIT --- �—� ate: !/ Q /‹. P i .=rel PI.,c SIAM of Florida Before me th'. day of in t Count of Duval "� =rely 4,urdbam State Of Florida,has --rsonall a e tvly ctrn.+►t•an FF 088990 Notary Pub - y PP ared / �.ai 2ete ry - State of F orida,Cou f Duval. My co !.:,t 'on e . •-s: - =�._ Produced Identification:rsonally Known: LSLy j. 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. TI-IE 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. TIIE 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, TI-IE LAW WILL PRESUME TI-IAT 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826) IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. X17 `io — r- 9iW ADDRESS PHONE NUMBER �_ !S► 1 ( C P'INT NA E V PNA. AT , DATE Before me this day of _ �� ,20/ in the county of Duval,State of Florida,ha .ona y a.is-red erin by himself I herself and affirms that all statements and dec .do -are true and accurate. Notary Public at L- .e,S- of , oun •'Z•1,•� ••R • ❑Pe pally Known .Ar l _ , ar o • �fdf'p'dMkt�4N a Florida roduced Identification- 9rFi y L-(Wham •immw . r dEiftitfilibion FP 008990 wyy` AslFiii�pJi�llil0l<f 1✓,lJ.f./ . • • • Notary Signature: P.A31.DGRhvnt6I3uildrr Affidavit,REVISED. 4'16'2009 sY k { 3. r A ilkp ' 7. j .�� N11 ` ''',$•,-. $ 3 . a 4. CF *� + A b PPP i t 01-1)11:. - -e' a ,.� . : It" Itok -: -.:. - -. ',. "Sysr. 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J e? Q 71 Phone(904)247-5826 • Fax(904)247-5845 OP(' '!a;t ga E-mail: building-dept @coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: /9 1 71711717-7/ Department review required Yes No Building Applicant: Q ili 72 £4 Planning &Zoning Tree Administrator Project: Cdo r -Sr; dIL lic works- ublic Utilities ty Fire Services Review fee $ Dept Signature ›C-1".- - 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: APPL TION STATUS Reviewing Department First Review: Approved. ['Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING y,/,' �'" Reviewed by: Vii7F.-- Date: i1 3A.f TREE ADMIN. Second Review: ['Approved as revised. /, ❑ pp ['Denied. SIC WOR 4. OPP / Comments: - ' /1B MEW PU:LIC SAFE Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. ['Denied. Comments: Reviewed by: Date: Revised 07/27/10 - t.Ai; City of Atlantic Beach APPLICATION NUMBER ;3s�. Building Department ; '`�`�_, -- , ,a C ��r (To be assigned by the Building Department.) 800 Seminole Road /� �� w� Atlantic Beach, Florida 32233-5445 r- �Ued 020 71 Phone(904)247-5826 • Fax(904)247-5845 v 2 20/5 �o;t �r E-mail: building-dept @coab.us j v: Date routed: ______VIAtc______ City web-site: http://www.coab.us _�, APPLICATION REVIEW AND TRACKING FORM Property Address: 1 0f ./4 Department review required Yes No Building Applicant: 0 A) 72 £4 Planning &Zoning Tree Administrator Project: A , df L lic Works: ublic Utilities �h'c-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: 7.APPL CATION STATUS Reviewing Department First Review: 7.p CATION Denied. (Circle one.) Comments: JC2 �/,/ / J✓ BUILDING 'lti�( �J eG�T PLANNING &ZONING / Ofr Reviewed by: 4 Date:TR ADMIN. Second Review: Approved as revised. a j Denied. PUBLIC WORKS Comments: C����t PUBLIC UTILITIES _ E -- PUBLIC SAFETY Reviewed by..i, / ✓ Date: V6 /3 FIRE SERVICES Third Review: Approved as revised. -Denied. Comments: Reviewed by: Date: 11 Revised 07/27/10