1370 Camelia St paver driveway permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
Z ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
DRIVEWAY PERMIT
MUST CALL BY 4PM FOR NEXr DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-DWAY-2592
Job Type: DRIVEWAY
Description: PAVERS ALONG SIDE OF DRIVEWAY
Estimated Value:
Issue Date: 11/23/2016
Expiration Date: 5/22/2017
PROPERTY ADDRESS:
Address: 1370 CAMELIA ST
RE Number: None
PROPERTYOWNER:
Name: Berseth, Thomas S
Address:
PERMIT INFOR14ATION: 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.
Full right-of-way restoration,including sod, is required.
Maximum driveway width within the City right-of-way is 20' (circular driveway width is 12'maximum).
Any plan change must be submitted as a Revision to the Building Department.
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.
FEES:
filkWIROWOVED ONLY IN ACCORDANCESQ610QLL CITY OF ATLANTIC BEACH ORDINANCES AND ME FLORIDA
BUILDING CODER.
Pill
l� CITY OF ATLANTIC BEACH
800 SENUNOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Total Payments: $35.00
PEMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH OMINANCES AMD THE FLOREDA
BUILDING CODE&
City of Atlantic Beach
Building Department
800 Seminole Read
Atlantic Beach, Florida 32233,-5445 nEC;E1V_,T7_.),
Phone(904)247-5826 Fax(1904)2
E-mail: building-dept@wb us t"INOV 17 2016
City web-site: hftp:/�www.
APPLICATION REVIEWAW07FZACKING FORM
Property Address: 1-3:70 CA M Department revieW required Yes No
Building
Applicant: _j lanning&Zoning
I ree Administrator
Project: ublic We
lie Utilities
blic Safety
Fire Services
WR
Review fee Dept Signature
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,
APPLICATION STATUS
Reviewing Department First Review: [;fApproved. ODemnielill
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Com
t
Rev
in
'w
Appr' ed
a
'e
e a in a art am Firs Re Ap,
P in t view
r Co _a
w
in
'Circle one'7N nts
BUI LDI NG
PLANNING &ZO ING
. v
e_'i_.'e_1 "'. - Date: ZL
lew d by
TREEADMIN S
PP
TREEADMIN. Second Review: PP
ElApproved as revised. EDDenied.
w at
PUBLGWORIKS L:::
Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:_
FIRE SERVICES Third Review: [I]Approved as revised. DDenled.
be
Comments:
Reviewed by: Date
Revised 05114109
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-54
11
Phone(904)247-5826 Fax(904)247
E-mail: building-dept@coalb.us Daterouted:
City web-site: hftp://�.wal) NOV 17 2MB
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1 -370 C�A nA u--L,(A Department review required Yes No
Building
AppliGant: (!��w r—D C-12� Planning&Zoning
Tree Administrator
Project: V e e-s ublic
lic Utilities)
lic Safety
Fire Services
Review fee $ OK Dept Signature
Other Agency Review or Permit Required Review=ceip' Date
of Permit ad By
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaurants
-61vislon of Alcoholic Beverages and Tb,=
Other.
APP YGATION STATUS
Reviewing Department First Review: E!(Approved. [-]Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: X"�Date: ItIrk
TREEADMIN. Second Review: E]Approvecl as revised. E]Denied.
4 P 'C"vo"KS Comments:
- t—14-16.4-1
AUBLIC�UTILITIES
//-/ 7-/(&
PUBLIC SAFETY Reviewed by: —Date:—
FIRE SERVICES Third Review: E]Appmved as revised. ElDenied.
Comments:
Reviewed by: —Date,—
Revised 004/09
WNW"
rnl �-m
IN M- -
Fill
I=
BUILDING PERmrr APPLICATION
CFrY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
Office:(904)247-5826 - Fax:(904)247-5845
Job Add�s: 0'a-'rella— Permit Number:
Legal Description RE#
Valuation of Work(Replacement Cost)$.Heated/Cooled SF_No,-Ilealed/Cmilld
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool WindowMaor
• Use of existing/proposed structurels)(Circle one): Commercial Residential
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
• Submit a Tree Removal Permit Application if any trees am to be removed orAffidavit of No Trei,Removal
Describe to detail the type of work to be performed: A&,4,& 'tW4r_WA-y Jr%rrjWVjV_-rk> .5riel'i5ids
Florida Product Approval 4
.__.jet multiple preducts use product approval Forni
Property Owner Information
Name: 71 M�j V�VA,, Jr-Asli Address: IX16 6AMS14W
City State 6�zip Phone 4".
E-Mail a W*4 -7 C�,jj�,
OwnermAgent (IfAg�i(,Po%wrorA,tom��rAgmcyWtor"ui
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTIa OF COMMENCEMENT.
Contractor Information:
Name of Com any: kwe"t- a Q uafiDfymg Agent:
(11_$ -City
Address: 'Mtl�_ IV 344 C _JA K State.
Offii;e Phone 75J?obS' Contact Number qpq -
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone 4
Worker's Compensation
,a,
mpt nSumrILnseEmployceSlExpinti-OnD�(c�
a 0.
Ora
Ang,
lhereby certify that I have read and examined this a ' ationandknow, previsions oflaws and
ordinances governing this ope k will be comp,e with whether�l Wall 41a person does not
preumme to give authority to viotle"orr cancel the p ishmsofanyolh 100 ting construction or the
perforatance ofconstruction. RESO��t'6�2019 I
.3114/16
CITY OF ATLANTIC BEACH
4OWNER / BUILDER AFFIDAVIT
I!*FLOR1DA 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 MUS
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 F R 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 THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, W111CH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY N
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTO& 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 1,110ENSIN
ORDINANCES.
11. 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 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.
/_�-70 IL 49741M-176
ADDRESS PHONENUMBER
i'�q16771Vf /? 13er6et-�
Wffl�N 141E�
SIGMWRE DAIE
a county of
Smam,n.this day a
Dul tateofFloncla,haspersonallya ata by insain,nenaerramanvTon.,
all statennents and dle�aadona are one am �cur
Noway Puty.at LmeE, County of
Op 11,.—n
.WP=d lde�on-
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Y7
My ASS
AIM,SS=
W# ROM
i EXPRESIaladal
PRE,
Notal Sugmaul
CITY OF ATLANTIC BEACH
CONSTRUCTION PERMITWITHIN CITY RIGHTS OF WAY AND EASEMENTS
800 Seminole Road 904 247-58OG
Atlantic Beach,Florida 32233-5445 Fax 904-247-5U5
Date [,PERMIT"
JobAddress MID CAt4214, SIr SSUEO 87THE CITY
Permitee: k�t�
Telephone# 9Dq tv
Permittee Address: 1!�*Mll �Pr. ATI.- ?XA-
Requesting Permission to Construct: ?PAW.&
Date
Job A
Perm
Perm
Requ,
Location: (Reference to Cross-Street) I'�10 4Mili
1. Applicant declares that prior to filing this application he has ascertained the location of all existing utilities,
both aerial and underground and the amurate locations are shown on the sketches.
A Letter of Notification was mailed to the following Utilities/Municipalities:
Jacksonville Electric Authority Yes No (-I Date:
Bell South Telephone Company Yes No (-I Date:
Fennell Gas Yes( ) No Date:
Corricast 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 Basement as determined by the Director of Public
Works, any or all of said poles, wines, 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 Transportation Standards and be
performed under the supervision
Superintendent) located at 14 (Contractor's Project
Telephone*
4. All materials and equipment shall be subject to inspection by the Director of Public Works or his designee.
5. All city praperly, 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
Riaht 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 permittere must re�ievv the permit with the Director of
Public Works to make sum no changes have ocicurred 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
Data-
ygf�
An the County of DunIal,
State(07fFlonithi has ajed�, A
y of
'Pe
Notary Public all Large7rsona f RIM k-c-�q EN. Uyo0k`VS=N#FF924951
Myo ,!as!. TONI G1NDLESPERGER
Pers, r
Prodaced Identilicattoru E,r-7- 1 _)I�w r 'XP'RES 0cle, ,I,
TO 1:
*:_; EFXy I-OR"E41-61 :1
R.O.W. Permit Attachment of for
R-O.W. Permit# issued 20— Atlantic Beach, Fl, 32233
Owner's Name: � �. ko 1-,
Property Address: ryto C&yPI4& sr
Subdivision: mrz, 2�* *4i� a.
Lot#/Block#: /X4.4
R.E. #:
REVOCABLE ENCROACHMENT PERMIT
THIS _1!VOCA] LE YENCROACHMENT PERMIT, issued on this _ day of
� 210
P-30%( �6 A antic 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 referred to as"USER7'.
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:
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 cc mal,Ze17 ece�ouestcd, to the following address:
The depositing of mid 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 my 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, my 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 mid liabilities are hereby assumed by the USER-
DATED and SIGNED this day of 20LLV
Property Owner
(to be signed in presence of the Notary)
STATE OF FLORIDA TONI GINMESPERGER
MYG0MM.ISS10N#,—FM�i
EXPIRES Octc�r 6,�19
COUNTY OF DUVAL
On this day of 20
� Many
Public in—arld for said County and State, the property owner of
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.
Notary Public in for said County and State
CITY OF ATLANTIC BEACH,FLORIDA,a
municipal corporation:
Approved:
*ct-,
Donald D.Jacobovitz,P.E. Public Works
Director
For Permits where city sidewalk is impacted,
City Manager approval required:
Nelson Van Liere, City Manager
Page 2 of 2
MAP SHOWING 5LISVEY OF
LOT 3. BLOCK 224, ALTANTIC BEACH SECTION 'H', ACCORDING TO THE PLAT THEREOF
RECORDED IN PLAT BOOK 18 PAGE 34, OF THE CURRENT PUBLIC RECORDS OF DUVAL
COUNTY, FLORIDA.
FOR: SOLAR HOME DEVELOPERS, LLC
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SDALFL�20' DAm-_10L1BL16 FIELD BOOK.741 PAGE 40 DRAFTSMM: j A 6 ORDER # 16-140-2-A