1763 PARK TER E - DECK PAVERS ,Ly
rirl
's CITY OF ATLANTIC BEACH
A
s) 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
t01119
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-DECK-1000
Job Type: DECK/PATIO
Description: PAVERS - SIDEWALK AND PATIO
Estimated Value: $3,000.00
Issue Date: 5/23/2016
Expiration Date: 11/19/2016
PROPERTY ADDRESS:
Address: 1763 E PARK TER
RE Number: 172020-0412
PROPERTY OWNER:
Name: Williams, Daniel
Address: 1763 Park PARK
PERMIT INFORMATION: PUBLIC WORKS: UTILITY DEPT.:
All concrete driveway aprons must be 5" thick,4000 psi, with fibermesh from the edge of pavement to
the property line. Reinforcing rods or mesh area not allowed in the 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 City Right-
of-Way. (Approved: Advanced Disposal, Realco, Republic Services, Shapell's,Sunshine Recycling and
Waste Pro).
Full right-of-way restoration, including sod, is required.
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.
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH Al I CITY OF ATI ANTIC RFACII neral ' IDA
BUILDING CODES.
�1'.
SI) CITY OF ATLANTIC BEACH
A j 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
FEES:
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
BUILDING PERMIT FEE $65.00
PLAN CHECK FEES $32.50
Total Payments: $101.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WTI II ALI. CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
.o.LANr , City of Atlantic Beach
,�� Building Department APPLICATION NUMBER
til : 800 Seminole Road I atCEIVF� !(To be assigned by the Building Department.)
,.- -r Atlantic Beach, Florida 32233-5445 1G - EC K{^ 1000 000
f,,,, T Phone(904)247-5826 • Fax(904) 247-58451APR 2 9 2016 I
j;; �' E-mail: building-dept@coab.us Daterouted: 4/2.9/J
City web-site: http://vuww.coab.us
BY - -
APPLICATION REVIEW AND TRACKING FORM
Property Address: ' 7G 3 PRRK`Te..,Ri E Departme 1 review required Yes No
Applicant: -I I l LIA-m S — Ovj rve .. ot=tinning &Zo i
■��:�2Gliill�ltiyiru��
Project: PpVER . - 3tosiopt(,< 4 Public WorFjIIIIIIIIIIIIIIIII
Public Utilities _-
R7ib Public 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: VAApproved. Denie
❑ d.
(Circle one.) Comments: //,,��� /
BUILDING S4' Aieki� d 41'if0/4
PLANNING &ZONING
Reviewed by: Date: '� •dr-4.
TREE ADMIN.
Second Review: DApproved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:
Date:
FIRE SERVICES Third Review: DApproved as revised. ❑Denied.
Comments:
Reviewed by: Date:
evised 05/14/09
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rs�_.t>>`i�,J, City of Atlantic Beach
APPLICATION NUMBER
t' / Building Department
`i 800 Seminole Road (To be assigned by the Building Department.)
��' r" Atlantic Beach, Florida 32233-5445 I ���{ OQ O
Phone(904)247-5826 • Fax(904)247-5845
'��J;319' E-mail: building-dept@coab.us Date routed: 4/ z-9/1 (o
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 17G PRcT€R(Z E Departme review required Yes No
Applicant: AA.ILL 1pt-mS - 6 1\pek-- (—Planning &Zo
—T-7-06-7\ rr iP115trat
Project: PVER-S, — SiCle,OALAKC Public Wort
�` Public Utilities
Z' ?�-1-t CD 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: Approved. ['Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by: _ Date: �j/,,�f/(
TREE ADMIN. Second Review: A roved as revised.
pp ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
0=-vprie., City of Atlantic Beach
r.i' 1., , Building Department
�E APPLICATION NUMBER
J
" 800 Seminole Road (To be assigned by the Building Department.)
Il s' APR 2 9 2016
y Atlantic Beach, Florida 32233 5445
Phone(904)247-5826 Fax(904)247-5845 �C�{^ 00 O
' 791 E-mail: building-dept@coab.us : /
City web-site: http://www.coab.us Date routed: / Z9/1 f cO
APPLICATION REVIEW AND TRACKING FORM
Property Address: 17G 3 PraRti:TER E Departme• review required Yes No
Applicant: VC.I,ILLItotrAS --- OVLjIVe '---- anning &Zo
-- A•
Project: PPt VeR-S - 3t0F ,q 4 Public Work
Public Utilities
i. P X71 d Public Safety
Fire Services
Review fee $
Dept Signature 7(4 i
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:
APPLI ATION STATUS
IReviewing Department First Review: Approved. p
❑ enied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING > -
Reviewed by: !�Date: Z Jt
L
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied.
A„ m' IC WOR .. Comments:
'UB UTILITIES
P LI SAF�f-Y
Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
evised 05/14/09
MAP SHOWING BOUNDARY SURVEY OF
LOT 8, BLOCK 14, SELVA MARINA UNIT No. 8, AS RECORDED IN PLAT BOOK 34,
PAGES 85, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO:
DANIEL WILLIAMS
SWBC MORTGAGE CORPORATION
PONTE VEDRA TITLE, LLC/HATHAWAY Sc REYNOLDS, PA
OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY
PARK TERRACE EAST
(60'MCNT OF WAY)
N 02'23'53" E 99.41'
(CHORD)(pLAT)
N 0213'16" E 99.67'
(CHORD)(MEASURED)
R •4744.65'
2.1'.;. L V9.41'
BLOCK
�� ... CORNER
3°e".(PLATxpmORO
New Sidewalk
X80 prEASUREoxacne)
C3 if'x/4 _>
W
','Z' . la,✓ip, w �;
ace
ts
• i "I ,New Patio N Q,.
.d o ^`' _._c 13.3' —15.4' a F= m
Wcc
ENTRY
•co .., .,._ A/c ONE STORY - - Q
T7 :• •. FRAME & I CO
} .HELL ° ar POSTED #1763 c0 r`O)
LOT 7 1•:1' M
BLOCK 14 1 35.6'
0.6'
II^ 4, LOT 9
0/8°- 11BLOCK 14
� � 1
Os ,.. ' ' W w
PO
TODD/.i.
/p�
pOj Pin Las' 21.1' /7` ' :. N
N
. m•01 POOL POOL 01
N CO I EOUPMENT
PAD Ep W
I LOT 8
BLOCK 14 ;
1 1• I
0.2' --- - -.----- 1.4'
S 01'08'00" W S 01'39'24" W 0.3'
31.62' (MEASURED) 66.46' (MEASURED)
S 01'00'18" w S 01'42'24" W
31.70' (PLAT) 66.25' (PLAT)
LOT 16
BLOCK 14 LOT 14
BLOCK 14
LOT 15
BLOCK 14
LEGEND:
O - SET 1/2'REHAB PC - POINT C CORVATURE
STAMPED PSM/6116
J • -r 1/2 MION PiE PT - POINT Of'TAN°ENCY
NO IDE T61CA11QN PRC - POINI OF REVERSE
(UNLESS ODIUM(NOTED) CURVATURE
■. 4'x4'CONCIETE 110NUM[NT PCC - POINT CF COLiO11ND
A/C - AR COMMONER CURVATURE
—x— - FENCE CD - CONCRETE
' Ray Thompson REVISIONS
SURVEYING, Inc. DAZE DESCRIPTION
' ilkGoing the DISTANCE for You
4613 Philips Highway,Suite 210 PONTE VEDR TITLE, L.L.C.
Jacksonvile.Florida 32207
II (Phone)904-448-5125
(Fax) 904-448-5178
:SL:1�yj/„ -
J °' CITY OF ATLANTIC BEACH
.s
IJ%WNER/ 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 WITI-IIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE,TFIE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WI-UCH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT
II 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN"OCCUPATIONAL LICENSE"IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826)IF IN DOUBT.
V.ACKNOWLEDGEMENT;I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
ADDRESS 7 .I Park eetaf'G F u‹,:1- S )Q.-- S i`l- •& �1
PHONE NUMBER
On, W�/Il(f 0-mc
PRINT NAME
--e-.7-4 4-44,...4.-- nY/a/zok
SIGNATURE DATE
c
Before me this�� Pip day ofr I I 20j in the county of
Duval,State of Florida,has personaappeared herin by himself/herself and affirms that
all statements and declarations are true and accurate. Mill--
(
Notary Public at Large,State of TL ,County of I U�l
11K-sonny Known :p.:'t1 CYNTHIA GUESS
❑Produced Identification- 3*; _ MY COMMISSION#FF 118059
;'; '; EXPIRES:June 2,2018
''‘:•.'0::t:?c'' Bonded Thru Notary Public Undenvrters
.
Notary Signature:
E9AN. ci 6 LlS2 '
F:/BLDG/Owner-Builder Affadavit;REVISED:4/16/2009
VI;.t-�' BUILDING PERMIT APPLICATION
1.1
1 CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
�.J';3�~ Office:(904)247-5826 • Fax:(904)247-5845
Job Address: 1711.3 Pew k 1 c°rru c2 k S r Permit Number: —Ds ECK.] 0 Q
Legal Description RE#
Valuation of Work(Replacement Cost)$ Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one):CI�e� Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Residential
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No C.1\11A)
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work tope performed: - �^
s i ,,, ,iik 1 4- pac i v w, fear-./S,
Florida Product Approval#_ for multiple products use product approval form
Property Owner Information
Name: DO ri,f ( L,i, II, ein s Address: 1763 Poi k Terrace res /•
City 4�/6,,,1, L be a c 11 State FL Zip 3123`5 Phone g so - /'i- 20 4 9
E-Mail di)t,'SU4 e9mn,/ corn
Owner or Agent (If Agent,Power of Attorney or Agency Letter Required) 0 I.rrl.e r
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.
Contractor Information:
Name of Company: Qualifyin ent:
Address: City State Zip
Office Phone Job Site/Conta umber
State Certification/Registration# E-Mail
Architect Name &Phone#
Engineer's Name&Phone#
Worker's Compensation
Exempt / Insurer / Lease Employees / Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated. I certifil 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 a
period 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 Au.Conditioners,etc.
Signature of Property Owner: /144.:.r!`' .: Signature of Contractor:
Beforeme y�
z'D of I ...mi.-pis aY ['t1�1 C • 6.471(0 �:Kr''i%• a� CYNTHIA GUESS Day of
=+: t :Y MY COMMISSION#FF 118059
Notary Public: 1,QL (11_,(Agq,p ,� • i EXPIRES:Julti�tg�2,,�p.�g
A Bt bPr—�o'broJi rteerusb .c:
I hereby certin,that I have read and examined this application and know the same to be true an, correct. All provisions of laws and
ordinances governing this type of 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 of any other federal,state, or local law regulating construction or the
performance of construction.
Rev. 3/14/16
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Permit Attachment of for
Permit# issued • ,20_Atlantic Beach,FL 32233
Owner's Name: Octni ( ti/.iL ,v5 Property Address: 1763 Par k 1 c//are. ;S
R.E.#: j� 0 k� -o4 I:L
Subdivision: 03 134 SC(Vu ttie,M Lot#/Block#: Lc i S f 11Df('c k Ill
REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT,issued on this day of ,20_,
by Atlantic Beach, Florida, a municipal corporation organized and existing under the laws of the State of
Florida, hereinafter referred to as "CITY" and 04.1.el A/,11f. aM s 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: s 64?
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:
1743 fair k •reefacc Leri F) te-c2c /1 // , 32 133
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 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 2q day of f)pr i l 20L
By: \ / //✓4
Property wner
• (to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this A dayifkof
1r' ( , 2016, personally appeared before me, a Notary Public in
and for said County and State, nen,e l if,//c , the property owner of
(Wt.3 fia/L re race 1.;4,S f- ,Atlantic Beach,Florida, known to me to be the person(s)described in
and who executed the foregoing instrument; who acknowledged to me that heor she executed the same freely
and voluntarily and for the uses and purposes there1p.r. io„r,d -
(I ',,,�„4/ _ _ /�_ ' • „ A """"'•• CYNTHIA GUESS
MY CO #FF 118059
EXPIRES:MJune 2 2016
Bonded Thru Notary Public Underwriters
Notary Public in for said County and State r " •-�► -
CITY OF ATLANTIC BEACH, FLORIDA, a
municipal corporation:
Approved:
Kayle Moore,Public Works Director
For Permits where city sidewalk is impacted,
City Manager approval required:
Nelson Van Liere,City Manager
Page 2 of 2