2233 BAREFOOT TRAC - DRIVEWAY 1 J
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
4ATLANTIC BEACH, FL 32233
7.54' ="
'� INSPECTION PHONE LINE 247-5814
J131>�
DRIVEWAY PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-DWAY-3271
Job Type: DRIVEWAY
Description: REPLACE DRIVEWAY WITH PAVERS
Estimated Value:
Issue Date: 2/27/2017
Expiration Date: 8/26/2017
PROPERTY ADDRESS:
Address: 2233 BAREFOOT TRAC
RE Number: 169463-0638
PROPERTY OWNER:
Name: MARGOLIN, CHRISTOPHER
Address: 2233 BAREFOOT TRAC
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 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, Realco Recycling,
Shapell's Inc.). 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'.
Concrete sidewalk must continue through driveway, cannot be pavers.
PERNIFI' IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Vis, CITY OF ATLANTIC BEACH
I ) 800 SEMINOLE ROAD
J,` zr: ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Any damaged sidewalk due to construction must be replaced.
FEES:
Fence/ROW $35.00
,
Total Payments: $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH A1,1. CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
of-tiki City of Atlantic Beach APPLICATION NUMBER
Building Department
(To be assigned by the Building Department.)
800 Seminole Road ` .�r Atlantic Beach, Florida 32233-5445 17— D W py - 3 Z7 (
Phone(904)247-5826 • Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: Z/
1 Co 7( 7
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 22_33 a (,-- Department review required Yes No
Building
Applicant: OW A. p (--• Planning &Zoning
Pciver- Tree Administrator
Project: iis or
ue y
Fire Services
Review fee.$ 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: Rpproved. /��
❑Denied. 02-02/-1.�
(Circle one.) Comments:
BUILDING `lee 1#6(64 �`m
./ PLANNING &ZONING
Reviewed by: L� Date: 2/2-3//?
TREE ADMIN. Second Review: QApproved as revised. ❑Den ed.
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
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01..AVie, City of Atlantic Beach APPLICATION NUMBER
41Building Department (To be assigned by the Building Department.)
It 800 Seminole Road 17— D` . ,P v - 3 Z7
ti,/ Atlantic Beach, Florida 32233-5445 V�J�'C l
v J Phone(904)247-5826 • Fax(904)247-5845 /
x.21 jr E-mail: building-dept@coab.us Date routed: Z i & ic 7
City web-site: http://www.coab.us ttt
APPLICATION REVIEW AND TRACKING FORM
Property Address: 72.33 (.grerc--PO-A' Department review required Yes No
Building
Applicant: ( ) i , p r-- Planning &Zoning
j�
+ Tree Administrator
Project: P. V - 4 r lU °_t.o ct_ is or
ub e y
Fire Services
Review fee $ /-r- Dept Signature 27‘,1
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:
APP iCATION STATUS
Reviewing Department First Review: ICApproved. Denied.
(Circle one.) Comments:
BUILDING 47"---
PLANNING &ZONING /(.1� . )22-/I-7
Reviewed by: Date.
TREE ADMIN. Second Review: Approved as revised. jjjJ ['Denied.
PUBLIC WORKS Comments:
PAilie UTILITI
PUBL SAF C TY Reviewed by: Date:
2- 2/-17
FIRE SERVICES Third Review: ❑Approved as revised. ElDenied.
Comments:
Reviewed by: Date:
Revised 05/14/09
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. CITY OF ATLANTIC BEACH
gr A ", CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
kt. 800 Seminole Road 904247-5800
�P. Atlantic Beach, Florida 32233-5445 Fax 904-247-5845
PLEASE SUBMIT(3)(COMPLETE SETS OF PLANS WITH APPLICATION.
Date 13 -e-\Q a01'1 PERMIT#
Job Address 6,9,3 3 Sah-c- art' —\�C..e, ISSUED BY THE CITY
Permitee: f" -y-4.,.Q_N-- c m Qox.c�� g►-,c, Telephone# el 04- o_s-i-i- '( 3
Permittee Address: \ 2,1/4-kki 1 ,.,rn,(.0\c0., 7.'ft•r\`c s--e. a" .� Sc 1`( .. 1 5a2aa-5
Requesting Permission to Construct: e,`c c i r-e4- r.e,PtQ,ce. �r;,v
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/Municipalities:
Jacksonville Electric Authority Yes ( ) No ( ) Date:
Bell South Telephone Company Yes ( ) No ( ) Date:
Ferrell Gas Yes ( ) No ( ) Date:
Comcast 481 \ \--,0Cal ei _ S YeS j ) No ( ) Date:
P\`t cr -V O(,) 1(
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 Permittee unless reimbursement is
authorized.
3. All work shall meet City of Atlantic Bea h or Florida De artment of Transportation Standards and be
performed under the supervi Ion of am E .e1.r-Zer\ (Contractor's Project
Superintendent) located at �.c� �-. a5 c o'_ Telephone#: q 04-aS(1-x'13
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
Right 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 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
Signed:'' - _�f~ ` Date:
Before me this 15 day of I-t'Ipnc f-I in the County of Duval, , -----------_-.---_..
State Of Florida, has personally appeared '••• JACQUELYN FRIEDNER
•�{�(� i '°:.•.•••q•-
•
Notary Public at Large,State of Flor da,County of Duval. N 4. MY COMMISSION#GG 029424
n-ew commission exp 1 /IC.)laL 91 Personally Known; 1.,:::::.4:3.:,-/ EXPIRES:January 10,2021
.. .kr irOA ,--:— Produced Identification: _-_______--- °' Bonded ThruNotary Public Underwnte
a
R.O.W.Permit Attachment of for
R.O.W.Permit# issued ,200_ Atlantic Beach,FL 32233
Owner's Name:
Property Address:
Subdivision:
•
Lot#/Block#:
R.E.#:
REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of
, 200_, 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 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). JAI
f
This work is enerally described as: ____V ' e h's - `i �t e
�
?Z33 re +tet `rrace
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:
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 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 said liabilities are hereby assumed by the USER.
DATED and SIGNED this I) day of rpt cam. r�f ,2061
By.< - ��...-
Property 0 r
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this _a__ day ofV . a aN , 201 personally appeared before me, a Notary
Public in and for said County and $tate, Ch��S fl \1(-) , the property owner of
9)3 ( stVw- , Atlantic Beach, Flor Ila, 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.
li 111,,•- JACQUELYN FRIEDNER
rr+A�.•.�:ts MY COMMISSION#GG 029424
Notary lic in for said County and StateA• k../ EXPIRES:January 10,2021
s%f,d P` Bonded Thni Notary Public Underwriters
CITY OF ATLANTIC BEACH,FLORIDA,a
municipal corporation:
Approved:
=— __. . bl ' ' orks Director
For Permits where city sidewalk is impacted,
City Manager approval required:
Jim Hanson,City Manager
Page 2 of 2
n'StiTf Jy
V � CITY OF ATLANTIC BEACH
41
WNER / BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489. FLORIDA STATUTES, PART 1 CONSTRUCTION
CONTRACTING'. REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
I
I)ISCLOSURE 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 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
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 55.000 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.PERMIT. r 1/
;)-2-33 1 c. �� ��CJ i r6z ( j 0 `1 ' Z y 7(:C/r)
ADDRESS PHONE NUMBER
�-2.SS JCR' vyr S ` /hard-0r
P\-
,P,RINT NAME c ,
S NA E DATE (-1 1/ CV/
Before me this I 6day ofn 20� the countyof
Duval,State of Florida,has personally ed herin by hlms(3If!herself and afirs that
all statements and declarations are true and accurate. (�\
Notary Public at Large,State of r ( ,County of L.J U v a•
❑Personally Known
❑Produced Identification.- V . • — / 3 Co 7_ Q
ttr,•.'• TONI GINDLESPERGER
iru r MY COMMISSION it FF 924951
' EXPIRES:October 6,2019
Notary Signature: %t*Rfite Bonded Thru Wary Public Undenmters
F:1BLDGOwner•Builder Affadavit;REVISED:4/16/2009
.----
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