1018 Big Pine Key ROW permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
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:
Jab ID: 16-ROW-1996
Job Type: RIGHT-OF-WAY PERMIT
Description: PAVER DRIVEWAY
Estimated Value: $6,000.00
Issue Date: 9/29/2016
Expiration Date: 3/28/2017
PROPERTY ADDRESS:
Address: 1018 BIG PINE KEY
RE Number: 172027-5062
PROPERTY OWNER:
Name: WALTERS,JERRY L & MARION NIXON, '
Address: 1018 BIG PINE KEY
PERMIT INFORMATION: PUBLIC WORKS: UTILITY DEPT.:
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 runoff 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 Recycling, Republic Services,Shapell's,Sunshine
Recycling and Waste Pro).
Full right-of-way restoration,including sod, is required.
Provide construction site management plan, including location of dumpster and portable toilet. Right-
of-Way Permit is required if using right-of-way for construction parking.
Maximum driveway width within the City right-of-way is 20'.
Any plan change must be submitted as a Revision to the Building Department.
l ,dsg,8 l fc dW@FN@8i4dlYfsFeWdg8l0✓646JTFs@FehTlM8�Fa88�F1d WlI81g1NCES AND THE n0MA
-S�Ilr
�s CITY OF ATLANTIC BEACH
's 800 SEMINOLE ROAD
- - ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
A sewer cleanout must be installed at the property line.Cleanout must be covered with an RT3
concrete box with metal lid. Cleanout to be set to grade and visible.
FEES:
Fence/ROW $35.00
Total Payments: $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BURRING CODES
/ City of Atlantic Beach APPLICATION NUMBER
Building Department ■ �-e (To be assigned by the Building Department.)
BOO Seminole Road �EECEi yYL-'� /
"I Atlantic Beach,Florida 3223&5445 Se7
i Phone(904)247-5828 Fax(904)247-5845
- - / E-mail: building-dept@ccab.us SEP 0 7 20 ,a routed: Z (o
-- City website: http://wuw.coab.us
APPLICATIONREVIEWREVIEW AND TRACKING FORM
Property Address: 10 V '�J l fJ Department review required Yes No
/I�� Building
Applicant: l )l AD Ili� Planning&Zoning
(� Tree Administrator
Project: �AU (�J �IJFIL) cwo s
c iii
Fire Services
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
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 6
Reviewing Department First Review: VAApproved. ❑Denied.
(Circle one.) Comments: Ju 4T1W / RK
BUILDING
PLANNING&ZONING Reviewed by: Date: -L/�-4
TREE ADMIN. Second Review: ied.
❑Approved as revised. ❑
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07W/10
City-of Atlantic-Beach---- - - ------APPLICATION NUMBER
Building Department �� t✓ (To be assigned by the Building Department)
r 800 Seminole Road
Atlantic Beach,Florida 32233-5445 SEP 0 7 2011 i 1 - - (0
- Phone(904)247-5826 Fax(904)2A 5 q
illE-mail: building-dept@coab.us BY. Date routed: Z
-- Cityweb-site: http//wvrw.wab.us ---
APPLICATION REVIEW AND TRACKING FORM
Property Address: 10 1 a E(C (N WPIan%ng&Zoning
t review re aired Yes No
Applicant: ning(� tratorProject: Pave ? 0 �1JE-et]
Review fee $ zgr— Dept Signature 5�=!!
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Army Caps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APP ATION STATUS
r
g Department First Review: Approved. ❑Denied.
cle one.) Comments:
ILDINGG&ZONING Reviewed by: Date:E ADMIN. Second Review:
❑Approved as revised. ❑Denied.
C WORKS J Comm is:
PUBL UTI�GLUTIEESS/
PU IC S71P Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07MI10
r
� � �m RMIT RPPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rond,Atlmtic Beach FL 32233 / n
`Oft o� Office:(904)247-5826 • Faz:(904)247-5845 16-ROW -1996V 6—"OW -`p Q /
Job Address: Iyit 8,jr z �,vc /Cer IFrta,dre Jwedlr Ft 3zr-31 Permit Number: l ]l0
Legal Description/or 3a - 5"v4440115 - ,4fr dm&Y/-Orbs RE# I'7Z 0Z 7 — Soca Z
6W-SS-4
Valuation of Work(Replacement Cost)S d.oao- •0 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition tempo Repair Move Demo Pool W indow/Door
• Use of existing/proposed structures)(Circle one): Commercial cisr en
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No /A
• 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 to be performed: Re Pe c,, f r=1r rsi.we aAle-Adr& ,r�✓als ,hr sUAty4/r}�r
Omit /DA-ve"
Florida Product Approval ff for multiple products use product approval form
Property Owner Information
Name: /lit/-rte Address: 1,9/8 Air/
City. rbc Ae.FCM State PLZip 3zz33 Phone
E-Mail 111A44-rg,*X4* cf `e 40~11 . iQ>-e
Owneror Agent (aAgem,PowerofAtbrm mAgencytzaer Requi,Wl OuiaeR-
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 NOTICEE OF COMMENCEMENT.
Contractor Information:
Name of Company: fp L'. Qualifying Agent: ICerre4L LLy I e
Address: Z6o $e,vv„✓ote. 40. City,{rsawre Bm.reN State Zip Ft 3zz33
Office Phone4ors-344-loos JobSite/ContactNumber9v(-31?-/oo8e.,-QtaY--¢62-9y8o
State Certification/Registration# fo-0000l3Yob E-Mail kll'r, -Trctc 0 dlm-tom, (:!,,w
Architect Name &Phone#
Engineer's Name&Phone#
Worker's Compensation
Exempt Eviore, j T,csse Employms Epimtao liste
"op to
is hereby made to obtain a permit to do the work and iula!latians as indicated f certify that no work or irutahatian har rommenced
poor to the issuance oja permit and that all work will be performed to meet the smMards ofal[(aws regulafing construction in[hu jurisdiction.
f'kis permit becomes mr(l and void if w�rkv not commehred within sic(6))months, or if consnuc(ion ar unrk is suspetided r abandoned/or.a
periodo//''six(6 months at any time ajler work is rommenced. lundersmndthat separate permits must be securedfor Hlecrr [Work,Plumbing,
Signs,IVeIls,Pools,Pummces,Boilers,Xeaters Tarrks aBnd Av Condkioners,etc.
Signature of Prop wnec ��?r�''T/S! Signature ofContrnc[or.
Befor e
this-Day of this TONGIN f
_ F924951
- EXMPES: �az 6,2019
Notary Public: n•' PobeU '
]hereby cert that I have read and examined this applicatio ow the same to bet a and correct. All provisions of(aws and
ordinances governing this type of work will be complied with whether so i ted herein or not The granting of a permd does not
presume to give authority to violate or cancel theprovisions of any other fe eral,state, or local law regulating construction or the
performance of construction.
Rev. 3/14/16
CITY OF ATLANTIC BEACH
® � n
CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
800 Seminde Road 904-247-5800
-o¢v, Atlantic Beech,Fladde 32233-5445 Fax 904-247-5845
EPEERMIT#
PLEASE SUBMIT(2)COMPLETE SETS OF PLANS WITH APPLICATION.Date � F OQ l r, S BY THE CIN
Job Addresses/8 6vP. �i iye yis. E-mail ��J .v6.T/Q 4r/e•(>',yqi�,
Permitee: `�yiAl��6¢-6T`.� ,o Telephone#(oU- 46Z-¢uPo
Permitee Address:/p/y_ . A�v-� /fT� p
c 4*cW fL 32Z33
Requesting TH issjontConstruct: v4& 04+e/Aleo CX t1,n ✓g d
IN4A�ne IQA7 ye.Jv fy x
Location: (Referenc to Cross-Street) sign4yif 14ic'-5 r^t/1L'LQ
1. Applicant declares that prior to fling this application he has ascertained the location of all existing utilities, both
aerial and underground and the accurate locations are shown on the sketches.
/1%Q,gy..vy T 6e
A Letter of Notification was mailed to the following Utilities/Municipalities /j� VoNe
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
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 or Florida Department of Transportation Standards and be performed
under the supervision ofe-G Z- (Contractor's Project Superintendent)
located at Setr.wQac ,� Telephone#: 904 ^t.0ZIe
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 Richt of
Way are to be Included with this application
7. This permittee shall commence actual construction in good faith with 7
jo 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,
,,, ssume all risk of and indemnify, defend, and save harmless the City of Atlantic Beach from and against any and
+ 'd} II loss, damage, and cost of expenses arising in any manner of the exercise or attempted exercises by the holder
..-a f the aforesaid rights and privileges.
9. he Director of Public Works shall be notified twenty-four(24) hours prior to starting work and again immediately
Q�. pon completion.
v
OWNER
� s �Z�
Si ned: Date:_.Before me this day
g of in the County of Duval, State Of Florida, has personally appeared
m Notary Public at Large, State of Florida, County of Duval. My
commission expir s: Personally Known:
W Produced Identification:
cl — rl Revised 7129115
t
Permit Attachment of for
Permit# issued 20_Atlantic Beach,FL 32233
Owner's Name: Property Address:
ILE.#:
Subdivision: Lot#/Block#:
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 of Atlantic Beach, Florida,
hereinafter re£emd 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: -Pi^OIAC�c ,sr.a�
AIP/ f 1-trv, .g 'Z
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:
!O!k /4 � �NL �, � aza33
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 CrrY,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/requircments 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 assumedby USER.
i
DATED and SIGNED this day of Ci V 20
ZR
By
perry Owner
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL�
On this-day of eV4 2d) ersonally appeared before me, a Notary Public in
and for 'd C artyd State, �"�o the property owner of
ic� n Atlantic Beach,Florida,known tome to bethe person(s)described in
and who execute foregoing ins ent;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:
Dwiald I fi Public
uc Works Director
fs, P.F.
For Permits where city sidewalk is impacted,
City Manager approval required:
Nelson Van Lim,City Manager
Page 2 of 2
omp
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 489.1030,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 Y'O cF 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 BUR DIN
UST He FORYy igc
MANDOCCUPANCY. ITMAY NOT BE BUILT FOR SALE OR LEASE.
1F YOU SELL OR LEASE A BUILDING YOU HAVE HUILT YOURSELF WITHIN ONE YEAR
AFTER THE 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
HI PAN 1HI I cPnPERSON AS YOUR OR YOUR CONSTRUCTION MUST
RE 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,
AOORESS PHONE NUMBER
PRINT NAME 2 -
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