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388 4th St driveway permit I � /,99whk CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 DRIVEWAY PERMIT MUSTCALLBY4PM FORNEXT DAY INSPECTION: 247-5814 305 INFORMATION: lob ID: 17-DWAY-3061 Job Type: DRIVEWAY Description: PAVER DRIVEWAY Estimated Value: $2,000.00 Issue Date: 2/2/2017 Expiration Date: 8/1/2017 PROPERTY ADDRESS: Address: 388 4TH ST RE Number: 169826-0000 PROPERTYOWNER: Name: AYCOCK THOMAS J III & MARY ANN, Address: PERMIT INFORMATION: UTILITY DEPT.: PUBLIC WORKS: Ensure all meter boxes, sewercleanouts 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. FEES: Fence/ROW $35.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CIT'Y OF ATLANTIC BEACH ORDINANCES AND ME FLORIDA BUILDING CODES, CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 UTIL REV RESIDENTIAL BLDG $25.00 Total Payments: $60.00 PERNH I IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC REACH ORDINANCES AND THE FLORIDA BUILDING COD". City of Atlantic Beach APPLICATION NUMBER Building Department Cro be assigned by the Building Department.) 800 Seminole Road Atlantic Beach,Florida 32233-5445 -7 -F-) Vd A Y -_30& Phone(904)247-5B26 Fax(904)2,k7J5845 ' 4 J Date muted: -31 -7 E-mail: building-dept@coab.us city web4te: http:/hvwe,.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: D-e-p—a Ye—sTN-01 Building Planning &Zoning Applicant: La ea Tree Administrator Project: (A) 12" Public azt:'S�' ublic Utilitie PubAc-�S� Fire Services Dept Signature Review pit Date Other Agency Review or permit Required Of Pemalt= By Florida Dept.of Environmental Protection Florida Dept.of Transportation St.Johns River Water Management District hrmy Corps of Engineers Division of HoWs—andRestaurants, Division of Alcoholic Beverages and Tobacco Other: APPLI A STATUS Reviewing Department First Review: Approved. ElDenied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: /2 TREEADMIN. Second Review: F-JApproved as revised. ElDenied. 4 9 WORKS) Comments: 1110 UTJLITIES PU B L; 7--z3 r7�7 Date PUBLIC SAF z Reviewed by: FIRE SERVICES Third Review: FlApproved as revised, E]Demed. Comments: Reviewed by: Date Revised 05114/09 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department) 800 Seminole Road -5445 10 3 20,, Atlantic Beach, Florida 32233 Phone(904)247-5826 - Fax(904) Date=routed: 7 E-mail: building-dept@wab.us City web-site: http:/N�ww.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: De—partm Ye—s——No] Building Applicant: up Ka eg' Warming &Zoning Tree Administrator ablt Work -%blic UtilrtiLg� Project: b Pub7lc—SMfy_ Fire Services Review fee Dept Signature Review or Receipt Date Other Agency Review or Permit Required of Permit Verified By Florida Dept.of Environmental Protection Florida Dept.of Transportation I. hns River Water Management District ,�rmy Corp.ofE.gm-� Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: VApproved. E]Dimi.d. (Circle one.) Comments; BUILDING PLANNING&ZONING Reviewed by: Date: TREEADMIN. Second Review FlApproved as revised. E]De ed. PUBLICWORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: E]Approved as revised. ElDenied. Comments: Reviewed by: Date:— R.Ased 05114109 BUILDING PERmiT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach FL 32233 Office:(904)247-5826 - Fax: (904)247-5845 1-7 -OkAAky --5 0C, j ? 33 JobAddress:_ qh� S-1X'e'z4TXTk,iPT1' O'Ci;� PermitNumber- Legal Description I T _?/. ist�cr-C Al,,WAC 8(�klJ 5 Ka,,�'RE#_&ff�00-0 Valuation of Work(Replacement Cost)$ Heated/Cooled SF Non-Heated/Cooled vmi;"C) • Class of Work(Circle one): New Addition Alteration (Rj�j) Move Demo Pool Window/Door • Use of existinglpmposedstructure(s)(Circle one): Commercial G��) • If an existing structure,is a fire spritilder system installed?(Circle one): Yes No <ED • Submit a Tree:Removal Pennit Application if smy trees axe to be removed or Affidavit of No Tree Removal Describe in detail the type of work to be performed: 'RefOl?'r qN-9 )'Zep1,?4e zp-')L'�3 pave'K JrIve'J61t, Florida Product Approval# _fur multiple produas use product approval fona Property O�ner Infortmation Narric: Cock Address: 399 4_LkJ_)_Rf0T city AsCACH StatWL Zip 21L-33 Phone 17-Y-!2 q-9- '4 1-Z� E-Mail ejynggst.�ief OwnerorAgent _(DFA,.%Pe�srofAunu,�Ag.,L�. WARNING TO OWNFR: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TOYDUR-ELROPERTY. IFYOUINTEND TO OBTAIN FINANCING CONSUL, WIT ' OUR VWMR OR AN ATTORNEY BEFORE NT. RECORDING YOUR NOTOF OF COMITENCEHMEI Contractor Infortuation: Name of Company: Qualifying Agent: 4 Z Address: city State Zip Office Phone 7ZJb SitelCuirta ct Nuinber State Certification/Registration# E-Mail Architect Name&Phone# Engineer's Name&Phone# Worker's Compensation E.smpt motter I Less.lanployess I expiration Vate ix..esced . dsdiaic.. doned or a Plain . 91 UM8NS21GN1s INM I hereby certify that I have,ead and tuannined oin,.s application 11 wisionsaflawsand ordinances governiy this type�work will be complied with whether speciied erei o, n The grantink of a permit does not p,es....ic to give out ority to via ate or cancel the provWons of any otherfief.al, state, or lo I law regulating construction or the perforniance ofoonstruction. Rev.3/14/16 CITY OF ATLANTIC BEACH (OWNER/ BUILDER AFFIDAVIT 1. FLORIDA STATUTES; C14APTER 489, FLORIDA STATUTES, PART I "CONSTRUCTION CONTRACTING'REQUIRES OWNER I BUILDER TO ACKNOWLEDGE THE LAW. DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTE& STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONrRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEWTION 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 5UPLEVISE THE CONSTRUC71ON 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 FORlQWLLh5FAND OCCUPANCY. ITMAY NOT HE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU I IAVE BUILT YOURSELF Win IIN ONE YEAR AFTER THE CONSTRUCTION ISCOMPLEIT,IHELAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE,WH]CH IS IN VIOLATION OF THIS LMWIP1 ION. YOUMAYNOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR YOUR CONSTRUCTION MUSI BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAI PEOPLE EMPLOYED BY YOU HAV LJCF14SCS REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCE& 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 ANofoR 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 NQT 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. -zg �7 A131IRSSS: PHONENUMBER 116me;� _�3 PRIMYNAJhM i3elm me MIS Z(f)dey d 1� OL 2 Ivelowlilmselli "me IV Marmemis SM dWSW..Me 1." eats F( 0 r- I My y ..M .SMI Slgnaeme:� NWq R.O.W.Permit Attachment—of for R.O.W.Permit# issued 20 Atlantic Beach,Fl, 32233 Owner's Name: 17�~n6l j: C,!_,J _M7 PropertyAddress: 129 iAk A&ffiT A+L�Ilk ewcA, P— -32--33 Subdivision: R.E.#: 1("q ,8,LzC,0-0& REVOCABLE ENCROACHAMNT PERMIT TIHS REVOCA13LE ENCROACEMENT PERAHT, 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"CrIN" 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). This work is generally described as: Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subj.ect 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 my and all necessary repairs to my 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 I 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 CJTY and its afficers 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 by the USER. DATED and SIGNED this -Z� day of 20 1 By: :�� ProperYy Owner' (to be signed in presence of the Notary) STATE OF FLORIDA COUNTY OF DUVAL On this Z(:::)day of CL r" 20-u personally appeared before me, a Notary Public in anq,� sg__(omty and the property owner of :� � <b Col 4 Atlantic Beach, Florida, known to me to be the person(s) dfcrib�d in and executed the foregoing instrument; who acknowledged to me that he or she I the el� a= my=nd V ily and for the uses and purposes therein mentioned. OWbg NoMTPublic;in for said County andon c CITY OF ATLANTIC BEACH,FLORIDA, a municipal corporation: Approved: Dons JaqKovibrP.E. Public WorlefDirector File: 12/12/16 Page 2 of 2 bm k6 Ilk 16 4.1 -f�O(ZT� �-Tr 4 W&L 'SECTt�14 Townhouses &T�Iv, f-ri, UI I M LU