73 Garden Ct 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 NE)IT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ROW-2708
Job Type: RIGHT-OF-WAY PERMIT
Description: REPLACE EXISTING CONCRETE DRIVE WAY WITH
PAVERS
Estimated Value:
Issue Date: 12/15/2016
Expiration Date: 6/13/2017
PROPERTY ADDRESS:
Address: 73 GARDEN CT
RE Number: 169716-0040
PROPERTY OWNER:
Name: SMITH, FRANKLYN C & BETH P,
Address: 73 GARDEN CT
PERMIT INFORMATION: UTILITY DEPT.: PUBLIC WORKS:
Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible.
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 the Inspection Line(247-5814)to request an inspection from Public Works 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(Advanced Disposal and Realco Recycling).
Container cannot be placed on City Right-of-Way.
Full right-of-way restoration, including sod, is required.
Maximum driveway width within the City right-of-way is 20'.
PERMU IS APPROVED ONLY IN ACCORDANCE WITH ALL CHW OF ATLANTIC BEACH ORDINANCES AND THE FLOMA
BUILDING CODES.
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Fence/ROW $35.00
Total Payments: $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORIDINANCES AND THE FLIDRIDA
BUILDING CODM.
City of Atlantic Beach
Building Department CEIVE APPLICATION NUMBER
800 Seminole Road (TO be assigned by the Building Department)
EC 0 6 2016 1 ' AOW - Z 00
Atlantic Beach,Florda 32233 5445 6, V'J 2 0c,
Phone(904)247-5826 - F�(904)247-
E-mail: building-dept@wab.us Date routed:
Cityweb-site: hfip:/A�.coalb.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I Department review re uired Yes No
Building
Applicant: Planning&Zoning
Tres Administrator
Project: u'c-� u lic Works
ic Utilities
Public Safety
Fire wSeNl�sF
Review fee $ ...21— Dept SignatLire 5r.�
Other Agency Review or Permit Required Review t Date
of Pemit=PBY
f-londa Dept.of Environmental Protection
Florida Dept of Transportation
St.Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaura���
Division of Alcoholic Beverages and T.b.cco
Other
APPIL TION STATUS
Reviewing Department First Review: [JA/pproved. ElDenied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date:
TREE ADMIN. Second Review: E]Approved as revised. F'
]Denied.
IqWOR Comments:
P2BLIC UTILITI S
7 -&-f
BLIC SRAFETY f Reviewed by: Date,
FIRE SERVICES Third Review: ElApproved as revised. E]Denled.
Comments:
Reviewed by: Date:
ReA�s,105114109
CRY Of Atlantic Beach
Building Department
800 Seminole Road BErEIVE
Atlantic Beach,Florida 32233-5445
Phone(904)247-5826 - Fax(904)24 841)EC 0 6 20M
E-mail: building-dept@mab.0
Citywelb-site: httjp/A�.00ah— n
f3y'.-�
APPLICATION REVIEW AND TRACKING FORM
ProPertY Address:—�Z3 Gagor—o (24 a nentreview— uired Yes No
2
ild g
Applicant: A.) Planning &Zoning
Tree Administrator
Project: uf--� u lic Works
ic tilitles
Public Safety
Fire Services
Review fee $
Dept Signature
Other Agency Review or Permit Required Review or Receipt
Florida Dept.of Environmental Protection of Permit Verified B D to
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: WrApprovecl. UlDenled.
(Circle one.) Comments:
BUILDING
rPLANNING&ZONING Reviewed by:
T M at/
TREEADMIN.
Second Review: E]Appr-ved as revised. Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: EIAPPrOved as revised. ElDemed.
Comments:
Reviewed by- Date,
ReAsedOW14109
CITY OF ATLANTIC BEACH
CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
0 Seminole Road 904-247-5800
Atlantic Beach,Florida 32233-5445 Fax 904-247�5845
PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION. 16,-Ro" -Z-7i
Date 2�ZJ-11 Ig
PE
IS:11i
Job Address ' 2,� 6&4l ---7- UE "THE CITY
permitee: f7vi 6, fm illit Telephone#
Parmittee Address: 7*3 "eii Z-r i�— k -r64
Requesting Pemnission to Construct la/le 1911 IAzV Ati :�J,VQ
Location: (ReferencetoCross-Street) ti OF'r— 6;-1 JeJ ,
1. Applicant declared; that prior to filing this application he has ascertained the location of all existing utilities,
both Banal and underground and the accurate locations am shown on the sketches.
A Letter of Notification was mailed to the following Utilities/Municipalides:
Jacksonville Electric Authority Yes( ) No Date:
Bell South Telephone Company Yei ) No Date:
Ferrell Gas Y:s( ) Noo (k) Date:
Comcast Y a ( ) N (XI 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 hemon 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 supeNision of (Contractor's Project
Superintendent)located at Telephoni a-gs-T19-3
4. All materials and equipment shall be subject to inspectimn—bythe Director of Public Works or his designee.
5. All city property shall be restored to its onginal 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 thit-S&
Right of Way are to be Included with this application.
7. This perninittere shall commerce actual construction in good faith with _J�i days. If the beginning date is
mom than 60 days from date of pennit 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, 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
Signi Date:
TO,2"Iou` FFV4Zl
'a he I. (Jay of In unty of Di myWS11111
Before 0 1
State FI do,has personally ad arad EXPIRE Octotaii
hichary I.aft L. Is,County of D 64
Ission,ex dres: to of Fri uvil Jill , 'p"'U'i
Produced Identhicatim:
CITY OF ATLANTIC BEACH
(OWNER / BUILDER AFFIDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I '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 CONSTRUCITUN YOURSELE. YOU MAY BUILD OR HOPROVE 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 YOUTL 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,WHICH IS IN VIOLAT10N 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.
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 ANDIOR 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.
S'
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SP"AMRE ,4 CATE
Hencnermtnit. 6-- dayof D� 20JL I.thecoontlof
Du'.1,State of Florda,has mraormfl��-Jnisy himself1hemelf and affirrostind
all statements and deswations am two and assums,
Nothary Pubil"Lame,&am of Counly of
r. I TONI GINDLESPERGER
E op=,=.-- 'et,
My COMMISSION#IT 924951
EXPIRES!O�toberfi,2019
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