2021 SELVA MADERA CT - PAVER WALKWAY . �:\./`r''' sA CITY OF ATLANTIC BEACH
a,,k% 800 SEMINOLE ROAD
\.10/ ATLANTIC BEACH, FL 32233
\\ INSPECTION PHONE LINE 247-5814
M---JSi1S)
RIGHT OF WAY PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROW-2614
Job Type: RIGHT-OF-WAY PERMIT
Description: PAVER WALKWAY
Estimated Value: $11,429.00
Issue Date: 11/12/2015
Expiration Date: 5/10/2016
PROPERTY ADDRESS:
Address: 2021 SELVA MADERA CT
RE Number: 169506-1650
PROPERTY OWNER:
Name: BURBRIDGE, H CLINTON
Address: 2021 SELVA MADERA CT
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.
A Revocable Encroachment Permit was changed to only reflect landscaping in right-of-way.
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
Pp ity'IRrghtioffi y0(4.191]FoxecicAtitt raced tis oset;1 iicaico 1 1 liG: fx5.10 paKs ci; FLORIDA
BUILDING CODES.
. ri rL,Jr�„' ,
•
or
� ` ` , CITY OF ATLANTIC BEACH
I" A 0 800 SEMINOLE ROAD
J =" ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Waste Pro.)
Full right-of-way restoration, including sod, is required.
FEES:
Fence/ROW $35.00
Total Payments: $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY\' OF ATLANTIC BEACH ORDINANCES AND 771E FLORIDA
BUILDING CODES.
R.O.W. Permit Attachment of for
R.O.W. Permit# issued , 200_ Atlantic Beach, FL 32233
Owner's Name: CI int atubrly
Property Address: aaa,I Se(vo.. (1
6414.2 8c,cIt,Rc 37-233
Subdivision:
Lot#/Block#: Lp♦ $Q
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 C(irli $Nbe,
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: { j1/vim i,ZSiw.Qavhion , .SeA.4 ry c.4.1
L J c Pis 4 a
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:
n�� L 2.23
oa 1 (va (Ybd�ca C�• A1�(o► c h F , 3 3
a $e � ,
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
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 SIGNED this day of , 200_.
By: /7 —72t
Property Owner
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this day of WO 1.1 c m 6$1,Yj , 209 personally appeared before me, a Notary
Public in and for said County and State, /a. 0 v6r.44..„ the property owner of
oa l Se/vim /Y1(•re— , 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 freely and voluntarily and for the uses and purposes therein mentioned.
a =14 - CASSANDRA A.REA
ea,p.,42-r. . �-- y: • :%. MY COMMISSION t FF 222947
a• EXPIRES:May 10,2019
Notary Public in for said County and State A s Bonded 71w,, Undenvoters
_ r+mosilr BLS.
CITY OF ATLANTIC BEACH,FLORIDA, a
municipal corporation:
Approved:
Doug Layton, Public Works Director
For Permits where city sidewalk is impacted,
City Manager approval required:
Nelson Van Liere, City Manager
Page 2 of 2
`1-4' CITY OF ATLANTIC BEACH
- 0f`!' CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
MN -
K800 Seminole Road 904-247-5800
Fax`�?}% Atlantic Beach,Florida 32233-5445 904-247-5845
PLEASE SUB IT 3)COMPLETE SETS OF PLANS WITH APPLICATION.
Date l/ 9/2o15 (( Mask PERMIT#
Job Addr ss a Or?(/� Se, blo► f '101SJC(1G`, Cr ISSUED BY THE CITY
Permitee: Clink bet)66633- �n Telephone# q 0 LI_ ?Li ' 9 35
Permittee Address: pod.[ K5Ga
Iu . ' r'l, errs. C4 .
Requesting Permission to Construct: prole U,1o.IK V3 0.1 ,See-{ini W a..Ii +" Land Sca/0/A3 .
Location: (Reference to Cross-Street) aa +k S 1-Ace. -
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 Yes ( ) No ( ) Date:
Bell South Telephone Company 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
t 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 Transportati n Standards and be
performed under the supervision of 6Acrk Uf�rks tesli r/1'l1;nr(m..n h+ci)(Contractor's Project
Superintendent) located at IZ' c4 BtAC/1 aimm S.ckann'ille.Pc tn.Yc Telephone#: 90Y-4g6-o7/1.
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 upo completion.
OWNER
Signed: Date: C g
Before a this 2 day of I•'1 oV• in the County of Duval,
State Of Florida,has personally appeared I-I. G I irk ivn 6 r brid3 1:i
I Notary Public at Large,State of lorida,County of Duval. ;; "''8! CASSANDRAA REA
My commission expires: /u /`7 Personally Kn ~! MY COMMISSION#FF222947
Produced Identification: "�'
�•4-„57,41,7,,' EXPIRES:May 10,2019
Bonded Thru Notary Put*Underwriters
•
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233 h
Office (904) 247-5826 Fax (904)247-5845 IS- Ro vv - Z(o 1 .1k-
Job Address: o/OI ( &kS/a. e-0% C.-lr. Permit Number:
Legal Description LO+ 0 Parcel#
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$ Ili 4429 �O Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial 'esidential
If an existing structure,is a fire sprinkler system installed? (Circle one): •es 10
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to b e performed: po.vte UJo■(k ;n 5 4,, k#.on ,62.....ft uJw I I * (...ncLSCipit.
Property Owner Information: n n '
Name: G(inf BtJbctdte Address: aoa i &iVal. Iv►a ciero. CA'.
City {��nn�L.0 Qe.ik State ca Zip 32733 Phone 904- A42- 43Sa
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: &kaTN WORKS a.H Iha:n+.i' .. Qualifying Agent: Mo.r K l=ccirkl
Address: 1.5o1 it ch glad City Kaor,v;lik State cc- Zip 327A/
Office Phone gok•4?6-0712 Job Site/Contact Number cio4-751427 I Fax#
State Certification/Registration l
Architect Name&Phone# Kn: 'Reed Ica - 996 .0 71,2 ex;. /66
Engineer's Name& Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations as indicated I certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for aperiod of six(6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools, Furnaces,Boilers,Heaters,
Tanks and Air Conditioners,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 hereby certify that I have read an examined this wplica •. and know the same to be true and correct. All provisions of laws and ordinances governing this
type o work will be complied w h whet de‘00,
Mct ted h' ern . ot. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federa, •ate, . o • regulating cons - ction or the •'formance of construction.
.. 1 � �/
Signature of Owner I _ �` � � Signature of Contractor
Print Name ..._a.l;34,103,4...._ t tr.b..rr.Gl.f_eL Print Name Mr1 L
Sworn to and subscribed before me Sworn to and subscribed before me
this 2- Day of No v(-ry b∎-r ,20 1S- this `z Day of NoVern be,K ,20 /
e4a.1xLr,o4_, a, 1.lr'.o.0a„.1).- a i
Notary Public MY COMMISSION•FF222947 ' .tary Pu. is
V._ i?.i EXPIRES:May 10,2019
f,, Tin T Notary Pubic Underwriters Revised 01.26.10
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a
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i
rs +:'7 +, City of Atlantic Beach / -
r APPLICATION NUMBER
r �\ Building Department
1 800 Seminole Road NCl/O 4 � (To be assigned by the Building Department.)
r f)
1/�� Atlantic Beach, Florida 32233-5445 4• 20/5 1r5 _O ..- l� 1Z
Phone(904)247-5826 • Fax(904)247-5: /47"(%' E-mail: buildingdept coab.us Date routed: t I 3
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 202 ( S Ei-V fl- M f l ERA7 Department review required Yes No
Building_ _
Applicant: A(ZZ(-- AJO P-KS b C-- _ I 0.16
Project: 1— vc� — W (-KW A y Public Works
Public Safety
Fire Services
Review fee $ ` Dept Signature 5c,,v ..._.
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 Department First Review: L. pproved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING _
Reviewed by: Date: (/f //h.-
TREE ADMIN. Second Review: ['Approved as revised. ['Denied.
,
aki� IC WO' Comments:
rPU BL U I IF
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: QApproved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
1
s=u' - City of Atlantic Beach
r ��� Building APPLICATION��, g Department ATION NUMBER
�j' ;£� 800 Seminole Road /`/� . (To be assigned by the Building Department.)
� s Atlantic Beach, Florida 32233-5445 `?jam • x/115 O ` — I/I
Phone(904)247-5826 • Fax(904)247- l� (`'tom
`\J;i >%• E-mail: building-dept @coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
V ,
Property Address: Z02 S ELJ ! Abe a Department review required Yes
No
_ Building__
Applicant: A27( V-1.0 (�•-l�.S �> E .(Ct ' .
Project: 1 P /G2_ - WP,LK W/�L 4._Public Works
07-ublic t Itilities
u• is Safety ■�
Fire Services
Review fee $ 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 Department First Review: co.:'roved.
(Circle one.) Comments: C3Qenied.
omments: wee /i(f 74t` d :fi a
BUILDING
PLANNING &ZONING , �J /
Reviewed by: 4 , ' Date: // // /S"
TREE ADMIN. �����
Second Review: QApproved as revised. it enied.
JBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:
Date:
FIRE SERVICES Third Review: [Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Wised 07/27/10