171 Club Dr dway permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
DRIVEWAY PERMIT
MUST CALL BY 4PM FOR NEXr DAY INSPECTION: 247-5814
JOB INFORMATION:
3ob ID: 16-DWAY-1735
Job Type: DRIVEWAY
Description: paver driveway
Estimated Value:
Issue Date: 8/24/2016
Expiration Date: 2120/2017
PROPERTY ADDRESS:
Address: 171 CLUB DR
RE Number: 170246-0020
PROPERTY OWNER:
Name: HUGHES, BRIAN P
Address: 171 CLUB DR
PERMIT INFORMATION: UTILITY DEPT.: PUBLIC WORKS:
Ensure all meter boxes,sewer clearouts 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. Clearout 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.
Maximum driveway width within the City right-of-way is 2(Y(circular driveway width is 12t maximum).
PftWjpIjrXhVV9DQs&be ftWIXV#ftAMft%T1*lId9#N!1BWdkWQe"It0l1 ORDINANCES AND THE FLORIDA
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
FEES:
Fence/ROW $35.00
Fence/ROW $25.00
Total Payments: $60.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILIHNG CODES.
CITYOE TLANTICBEACH
illillillic A
CONSTRUCTIONPPR
MIT WITHIN C[Ty RIGHTS OF WAY AND EASFIVENIS
800 Semihole Rcnad �90�247-5800
Nientic Beach,FlWda 32233-5445 Fax 904-247-5845
PLEASE SUBMIT(2)COMPLETE SETS OF PLANS WITH APPLICATION. PERMIT# 1(0- ()%\)Al- 14%S-
Date__2//�.. ISSUES BY THE CITY
Job Address (f��s E-mail
Permitee Telephone#_�fev) 3sr_4,roP
Permitee Address: —'e, e.4
Requesting Permission to Construct
Location: (Reference to Cross-Street) I�611 �1 I
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 I Municipalities:
V'ry_ Jacksonville Electric Authority Yes (I No ( Date:
Bell South Telephone Company Yes No ( Date:
Ferrell Gas Yes( No( Date:
Comcast Yes( e No( ICBM
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 ea�enrhent 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 reset or relocated hereon as required by the
Director of Public Works, and at the expense of the Permitee unless reimbursement is authorized,
3. All work shall meet City of Atlantic Beach
under the supervision of =4 C�Fk
,. 'Vepartment of Transportation Standards and be performed
located at LqZ I;:�4_4: Z_ —(Contractor's Project Superintendent)
.Telephone#: 372-4X0,P
Mil Materials ano equipment shall be subject to inspection by the Director oTPublicWor�s 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 thi installation, as well as, a copy of a recent survey shall be made a part of
this pernnit. �Calcuulatlons Showing anys increase in Impervious area on ownelfs lot or In the clity Right of
Way are to be......d— —.1......Pulicarion.
7. 1 im pemnittee snail commence actual construction in good faith with /0 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 wrill,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 sterling work and again immediately
upon completion.
OWNER
Signed
Date: Before me this day
of Z
_intheCountyof Duval, State Of Florida,-has personally appeared
commission ex Notary Public at Large, State of Florida, County of Duval. My
1A SZ12 —Personally Known:
Produced Identification:
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City of Atlantic Beach
0 Building Depariment--— ---APPUCATI0N-NLIMBE-R----
(To be assigned by the Building Department.)
f) 800 Seminole Road
Atlantic Beach,Florida 32233-544
Phone(904)247-5826 - Fax(90,145
E-mail: building-dept@coab us 1 247-5 ff AUS 2 20 Data routed: 0110-..%116
City web-site: http.-JA�.coab.us BY..
APPLICATION REVIEW AND TRACKING FORM
16
Property Address: 11-1 MAO De artMentreVieWre uIred Yes No
Building
Applicant: 101111 Miko0aU Planning&Zoning
Tree A ministrator
Project: p&\J" d if t vi wo- Public Works
Pub ic i I ies
Public Safety
Fire Servic�es
Review fee$
Dept Signature Y s,,
Other Agency Review or Permit Required Review or Receipt
Florida Dept.of Environmental Protection of Permit Verified 13 Date
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
Reviewing Department First Review: pproved. DIDenied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Date:
TREE ADMIN, Second Review: ElApploved as revised. [3Denled,
P WbRKS Comme ts:
V
T41LITIES
W—Z—/[O
PUBLIC SAFETY Reviewed by: Date:
�.Ue.
FIRESERVICES Third Review: DApproved as revised. E]Denled.
Comments:
Reviewed by: Date:—
Ifsed 051W09
City of Atlantic Beach APPLICATION NUMBER
Building Department BE GE IVE (ro be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach,Florkla 32233-f�445 AUS 0 2 2016 1b- VWA4 -i-43S-
Phone(904)247-5826 - Fax(904)247- 5
or"' E-mail: building-dept@mab.us BY, Daterouted: 0110-alit,
Cityweb-site: hftp./A�.coalb.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: lil-% CkiAlo Ofik Department review required Yes No
Building
Applicant: -To Planning &Zoning
Tree ministrator
Project: ___P0L\JU CU't9W& Public Works
Pub x; i ities
Public Safety
Fire Services
Review fee Dept Signature
C'E'V'2
UG 0 2 2016
Other Agency Review or Permit Required Review or Receipt
Of Permit Verified B Date
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other.
It-M
APPLICATION STATUS
Reviewing Department First Review: 54pved. []Denied.
(Circle one.) Comments:
BUILDING
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PLANNING &ZONING
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Reviewed by: O'll
T TREEADMIN S dR v E]App, 4
REEADMIN. Second Review F_]Approved a.1evIsed=0D7,ed
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
T a , w 0 p1p,
FIRE SERVICES Third Review: ElApproved as revised. ElDemed.
C,
T,
, be
Comments:
Reviewed by: Date*-
Revised 05/14/09
CITY OF ATLANTIC BEACH
CONSTRUCTION PrRMIT W[THIN CITY RIGHTS OF WAY AND EASEMENTS
800 Serninde Road
Atlantic Beach,Fl.nda 32233-5445 904-247-5800
Fax 904-247-5845
PLEASE SUBMIT�2)COMPLETE SETS OF PLANS WITH APPLICATION. [PERMIT# Ilo- C)\W\)Al- il%s-
ISSUES:BYTHE CITY_
Job Address—/-71 (f�_�a E-mail
Permitee:. 1-0101) 10�//1�Z Telephone# �f,,Y) 333-al
Permitee Address: //,919 r
Requesting Permission to Construct
T4V`lCr OLI rK<A�Ivei L 44t .CIO
Location: (Reference to Cross-Street)
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 I Municipalities:
Jacksonville Electric Authority Yes No ( Date:
Bell South Telephone Company Yes No ( )ate
D
its
Ferrell Gas Yes( No( Da
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 detemnined 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 raset or relocated hereon as required by the
Director of Public Works, and at the expense of the Permitee unless reimbursement is authorized.
3. All work shall meet City of Atlantic Beach c�Flo
-7;-4.4 / e (Contracto t Superintendent)
under the supervision of Vepartment of Transportation Standards and be performed
located at t7l (fe" ]:I,- elephone#:
4. All materials and equipment shall be subje_T
ct 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 an 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 /P days. If the beginning date is more
than 60 days from date of permit approval, then permittee must revie�v-th—epermit 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
upon completion.
OWNER
Signed,7-," Date: L Before me this 1_)�_day
of 7n I Uounty of Duval, State Of Florida, has personally appeared
COMT;i!xp Notary Public at Large, State of Florida, County of Duval. My
(�S: Personally Known:
_jA 1 -4 1(c, Produced Identification:
Re�j.ed 7/29115
Permi
permit issued 20_Atlantic Beach,FL 32233
Owner's Name: 91 Al-i PropertyArldress:
R.E.#:
Subdivision: Lot#/Block
REVOCA13LE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this_day of 20�
by Atlantic Beach, Florida, a municipal corporation organized and misting under the laws of the State of
Florida, hereinafter referred to as "Cur, and of Atlantic Beach, Florida,
hereinafter referred to as-USEW'.
W]TNESSETH:
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: CR%r(M A,5
4V(A (k
Any facility maintained, repaired, crected, 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 any and all necessary repairs to my facility crected or maintained in the
exercise of the privilege herein granted and shall at all times maintain mid 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-deacribed property of the CITY, the USER shall replace at the USER's sole expense,
my and all material necessarily displaced during the action of maintainin& repairing, operating, replacing, or
adding to of the utilities and facilities of the CrrY or fianchise 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 my 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."
Pagel of2
- - - - - - - - - -
- - - - - - - - - - - - -
The USER, prior-to-making-any-chnng-e-S-from--the-gp-V-w- ycd plans and/nr wedgA, �st obtain written
approval from the City of Atlantic Beach,Public Works Department,for mid 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 me 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 hereby assumed bythe USER.
DATED and SIGNED this day of 20 C�
.1, TONI GINDLEVERGER
MYCOWMA RGR#FFM51
By: EXPIRES:oci�rs.mlg
-t"( A44--- ....
Property Owner A-rt�4 ,
STATE OF FLOPJDA
COUNTY OF DUVAL
On this day of 201(
,.orsonally appeared before me, a Notary Public in
and fOr said County and-) State, Q r- ( , the property owner of
1-7 � 0 o L i&pg5tic'iaN.im-'.—.1 to me to be the pmon(s)described in
and who executed the foregorug; tratrument, who acknowledged'to me that he or she executed the same freely
and voluntarily and for the us�and purposes therein mentioned.
Notary Public in for said County and State
CITY OF ATLANTIC BEACH, FLORIDA, a
municipal corporation:
Approved:
4mlftPub9c WorMAXIII
.''T-�16*v'�
For Permits where city sidewalk is impacted,
City ManI approval required:
Nelson Van Lien, City Manager
Page 2 of2
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CITY OF ATLANTIC BEACH
OWNER/ BUILDER AFFIDAVIT
#711 9.
1. 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, TIES EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MOB
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 S25,000.00 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 SUET YOURSELF WITFUN ONE YEAR
AFTER TIM CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUIL I
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NO
FIRE AN UNLICMED PEMQN AS YOUR CQNTRACTOR. YOUR CONSTRUCT70N MUSI
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS, IT Is
YOUR RESPONSIBILITY To MAKE SURE THAT PEOPLE EMPLOYE
,p By yoG HAVE
LICENSES REQUIRED BY STATE LAW AND By COUNTY OR MINIMAL LICENSING
ORDINANCES
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE.
THE BUILDING DEPARTMENT SUGGESTS WORKERS COMPENSATION INSURANCE BE
PURCHASED.
Ill. 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 AN
CIRCUMSTANCES. OWNERS BEING SUBJECT TO$5.000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(l), 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,
-3 - &fps
A..RESS PHONE NUMBER
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PRINT NAME
SIGNATURE DATE
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IFJ EXHIBJT A. LETTER OF AUTIJORIZATION
DRTV lit-
#4(1 la-A IDLAz,�_, is hereby authorized to act on behalf of
the owner(s)of those lands described with n
the attached aPPlicatlen,and as described in the attached deed or other such Proof If om,rship as may
be required by the City of Atlantic Beach In applying for a development permit.
By.
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Signed and 5mm belo'eme,Onthfs,21�dai,4�4� by
Identifianicnwified!
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