1019 BIG PINE KEY DRIVEWAY PERMIT ,( fel
�0 �irL�1 '�
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- CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
DRIVEWAY PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-DWAY-1418
Job Type: DRIVEWAY
Description: REPLACE DRIVEWAY AND WALKWAY WITH PAVERS
Estimated Value: $5,000.00
Issue Date: 6/30/2016
Expiration Date: 12/27/2016
PROPERTY ADDRESS:
Address: 1019 BIG PINE KEY
RE Number: 172027-5072
PROPERTY OWNER:
Name: GEIB, LOUISE
Address: 1019 BIG PINE KEY
/6' 3 ()// C2.
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, Shapell's, Sunshine Recycling and
Waste Pro).
Full right-of-way restoration, including sod, is required.
FEES:
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
( SA'' `t) CITY OF ATLANTIC BEACH
r
A el 800 SEMINOLE ROAD
\� ' � ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
J,SI)r
1Otai Payments: $U.UU
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
i!-A.v-,, City of Atlantic Beach APPLICATION NUMBER
r.
-.* _, Building Department -2-0-;— (To be assigned by the Building Department.)
- 4 800 Seminole Road ' �' �~!
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)24 84$i N 2 ' U1b /_ 1
'• omit- E-mail: building-dept@coab.us J V `t� Date routed: V 0( I Air
City web-site: http://www.coab.us
BY:
APPLICATION REVIEW AND TRACKING FORM
Property Address: ( On t3cs IROE kc /• Department review required Yes No
Building
Applicant: Oc,�") kjc-�— C1 L ( � Planning &Zoning
• Tree Administrator
Project: PA v eg - 13 R(0tAa4-L Public Wor. ks —
/ Public Utilities
�( K(,� �}� Public Safety
Fire Services
Review fee $ Z S-- Dept Signature )Ct
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: Loved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: 'i °1---t--""----- Date: ))L3)(
6
TREE ADMIN. Second Review: A roved as revised.
❑ pp ❑Denied.
yU:1
C WORKS Comments:
BLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
revised 05/14/09
-,-2, BUILDING PERMIT APPLICATION
y•-_,..._ s� 1� CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
<1-°"1�r- Office:(904)247-5826 • Fax:(904)247-5845
I CO— ak RLI -14-(8
Job Address: (01 ` ad ) e' ''- - l< Permit Number:
Legal Description �✓ RE# ,•�c S-e I tic- Let Ind
Valuation of Work(Replacement Cost)$ 6l V vU Heated/Cooled SF Non-Heated/Cooled
■ Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Citcle one): ' ommercial esidential)'
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A n ,,
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal 1 v
Describe in detail the type of work to beperformed: i
�Q.IO�C�C� C� ire CtMG�- ...A -��
o -c,.v.rOt- 4.,3#01._( ik-o C,L W k t " e ay.V_FS
Florida Product Approval# for multiple products use product approval form
Property Owner Information
•
Name: l -
W U 1 Se- �,� � 6--� Address: � � ( +s`j �►frN e. VC9-'J
City P-V StateFL Zip 3z i43 Phone go/ `1 l 3 ci5 L
E-Mail c *t 0 9 +,�,. - r.,v,,,, ..
Owner or Agent rif Agent,Power of Attorney or Agency Letter Required) Sc-t. --
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: Qualifying Agent:
Address: City State Zip
Office Phone Job Site/Contac , r III er
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 o, air a permit to do the work and installations as indicated. I certify that no work or installation has commenced
Thinor 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.
s 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 o fsix(6)months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,
Signs, Wells, ools,Furnaces,Boil rs, ters,Tanks and it nditioners,etc.
Signature of Property Owner/� "�-'Y �'
Befor me P --7 Signature of Contractor:
this i 6 Day of U1 : C U j COBefore me this Day o
Notary Publi �� ` ;�t''i%,i T0,1 QLESPERGER
` _{ :. of a ;cr1JaF 92
=a•. 2-:as EXPIRES:October '19
V Bonded Thni Notary PA Underwrters
I hereby certijj,that I have read and examined this application --•-•-•--••----•• t. ect. All provisions of laws and
ordinances governing this type of work will be complied with w ether specjfied herein or nota The grantin, 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
51.mr,,; City of Atlantic Beach /-� APPLICATION NUMBER
r , ECEIVE's
Building Department (To be assigned by the Building Department.)
800 SeminoleRoad JUN 2 1 2016 r 1 lJ' — 0 (
Atlantic
AtlanticticBeach, Florida 32233-544
Phone(904)247-5826 • Fax(904 7-5845 //--
• ,;ilg%- E-mail: building-dept@coab.us BY: Date routed: V ZL tI AI
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: O(9 P)WS Ptioc kEi kY7Department review required Yes No
Building
Applicant: t!)0,-) „,Dc_1�_- F, ( (2 Planning &Zoning
Tree Administrator
Project: P R,oe_ ap
Works'
j
Public Utiliti_e:
/3-10 0 (10 K_w Pt L-( Public a e�y
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: `J L41 ,4# J � 4/1744
BUILDING7`%" h(�
PLANNING &ZONING Reviewed by: � Date: 5/// 6
TREE ADMIN. Second Review: ['Approved as revised. ❑D led.
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
- - - - Permit Attachment of for - - - - - - - - -
Permit# issued ,20_Atlantic Beach,FL 32233
Owner's Name: Property Address:
R.E.#:
Subdivision: Lot#/Block#:
REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT,issued on this day of ��e ,204,
by Atlantic Beach, Florida, a municipal corporation organized and existing under a laws of the State of
Florida, hereinafter referred to as "CITY" and C ov,e 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: f4V€4 447,iCV
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:
ir E7 rieh •
The depositing of said notice of cancellation in the Uf�ited States it 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
p
nib USER, prior to making any changes from the approved plan s 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 V.0 day of 3 (\ € ,201
7(47
By: .r
•roperty Owner CO GINDLESPERGER
eek.
MY COMMISSION►FF 924951
(to be signed in presence of the Notary) ;'.ice:a EXPIRES:October 6,2019
• R,R Bonded Thru Notary Pubic Underwriters
STATE OF FLORIDA MIN
COUNTY OF DUVAL -
On this t Co day of 7 O e , 20geRrsonally appeared before me, a Nota• P 'lie in
and f fpi ,said County and State, FL O r , the property • • -r of
C) `'j fD t f �n Q.. Ke ,Atlantic Beach,Florida,known to me to be the person(s)described in
and who executed e foregoing instuument; who acknowledged to me that he or she executed the same freely
and voluntarily and for the uses and purposes therein mentioned.
Notary Public in for said County and State ,
CITY OF ATLANTIC BEACH, FLORIDA, a
municipal corporation:
Approved:
• • .. Public /Trio Director
PO hal• .►. eco 1o_ &
For Permits where city sidewalk is impacted,
City Manager approval required:
Nelson Van Liere,City Manager
Page 2 of 2
--f------
- `s��`' ''BUILDING PERMIT APPLICATION
Js
r' CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
-.`J,'il>>" Office: (904)247-5826 • Fax:(904)247-5845
1 — Du•IflLt-14(8
Job Address: ( 0 / / at ) PE K(- I<°'4 Permit Number:
Legal Description 6-1.61-)0
RE# ,3 S 5' 1,J . c a L
Valuation of Work(Replacement Cost)$ `�I v vO Heated/Cooled SF Non-Heated/Cooled L f
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Windoww//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 N/A) n ,,
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal 1 v/A...
Describe in detail the type of work to be performed: R��\a s_, co Fre tn-- c'CcMG03Q ✓�, (
O� -c-v-ov-,A ‘,.)Ck.l IA-a CA.- w t i�,. e o`ve rS
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: W U\SZ �C e kk' Address: ( O ( 9 6 is") el"`e- V-9-)1
City i / Staten-Zip 3z 2-33 Phone q 01 2'4 1 S q S (�
E-Mail bC9 3 0 1 v - Gc.r,-•.
Owner or Agent 'Of Agent,Power of Attorney or Agency Letter Required) .5-'61. t"•••-<---
WARNING
.•,-<-`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: Qualifying Agent:
Address: City State Zip
Office Phone Job Site/Contac , r ii 1 er
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 o• ain a permit to do the work and installations as indicated. I certifr that no work or installation has commenced
Tnor to the issuance of a permit and that all if work will be performed to meet the standards of all laws regulating construction in this jurisdiction.
his permit becomes null and void work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a
period of six( months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,
Signs, Wells,Pools,Furnaces,Boil rs, ters,(Ta�nks and it nditioners,etc.
Signature of Property Owne v `� Signature of Contractor:
8n P rh' gr►
Beforeg me
this I lo Day of a) Aa 7 0 1 (p Before me this Day o
TO QtESPERGER
Notary Publi • _1110.4 �� _= `'t'. k10 �IGAt a R sa
`�" . "" . ' EXPIRES:October-, 019 '
�•.a��.:or 1
:':•hQ:' Bonded Thru Notary P .c Underwriters
I hereby certify that I have read and examined this application • ••------------------ ---------••-:----- ect. 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
CITY OF ATLANTIC BEACH
14 ®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 WITHIN ONE YEAR
AFTER TI-LE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT 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.
Al 9 161� �,�� r� qoL , zf� - 3i 5 L
PHONE NUMBER
t3e C6 lo
•
•
PRINT E
c4,114,
•
SIGNATURE /� TE
n
Before me this I Co day of V Y 1 P .20)••• the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations aretrueand accurate. ^\
Notary Public at Large,State of 1 ( ,County of rt---)()VOL-
ID Personally Known I —S 7 Z—(2 - 7 2
CrProduced ItientRcation- V L G.J
' TONI GINDLESPERGER
MY COMMISSION#FF 9249E
Notary Signature:
e'' EXPIRES:October 6,2011:
1 l' d�` Thru No arY Public Ur1 1'
�i'Jr��h,..•` Bonded —__i
F:BLDG'Owner-Builder Affadavit;REVISED:4/16/2009
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