273 Magnolia St driveway permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD.
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
i 9
DRIVEWAY PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-DWAY-3242
Job Type: DRIVEWAY
Description: replace existing concrete with pavers
Estimated Value: $3,200.00
Issue Date: 3/7/2017
Expiration Date: 9/3/2017
PROPERTY ADDRESS:
Address: 273 MAGNOLIA ST
RE Number: 170544-0000
PROPERTY OWNER:
Name: JONES, CAROLYN R
Address: PO BOX 330903
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.
Any plan change must be submitted as a Revision to the Building Department.
FEES:
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORRE,
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 REACH ORDINANCES AND THE FLORIDA
BUILDING CODES
yswv City of Atlantic Beach APPLICATION NUMBER
Building Department (io be assigned,/b�y`.thIeA Building Department)
600 Seminole Road �e`@yf' ^"0 I�--llri/lyl- 3aLla
Atlantic Beach,Florida 32233-5445 7 j
Phone(904)247-5626 Fax(904) 247-5845I
E-mail: building-dept@mab.us 2017 Date routed: c��(aII�
Cityweb-site: hop:/Avww.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: (0 3 MQgAI)`, ti —S ' _ D
epartment review re uired Yes No
g
Applicant: 0W��Q.(- ng&Zoning
dministrator
Project: �e�p\aLL Ai -xi,JaV W 4W �1A.U4J( s
Safety
ervices
Review fee z �- Dept Signature
ftOth -.
gency Review or Permit Requiredceipt Date
ied Bept.of Environmental
51M
ept.of Transportation River Water Managerps of Engineersof Hotels and Restauraf Alcoholic Beverages
APPLICATION STATUS
Reviewing Department First Review: Approved. ❑Denied.
(Circle one.) Comments:
BUILDING / /n
PLANNING &ZONING 2I i
Reviewed by: r Date:
TREEADMIN. Second Review:
❑Approved as revised. ❑Denied.
P WOR Co ments:
UBLIC UTILITIES
O- 7
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. -
Comments:
Reviewed by: Date:
Revised 05/74/09
c�LCity of Atlantic Beach APPLICATION NUMBER
u' Building Department ... (To be assigned by the Building Department.)
800 Seminole Road .0.,ur ? r
Atlantic Beach,Florida 32233-5445 11—05//`\I— 3 4 q-
Phone(904)247-5826 - Fax(904)247-
F <P E-mail: building-dept@wab.us 1 8 Tdj? ) Date muted: 01I(.3II�
J.t 1
Cityweb-site: hdp:lMrvnv.coab.us N;
APPLICATION REVIEW AND TRACKING FORM
Property Address: a 3 Ma ci St • Department review required Yes No
T Building
Applicant: 00�� Planning&Zoning
,p Tree Administrator
Project: —LLPaL2 Af ryWaV W I-Vh plwq s
ubli
Public Safety
Fire Services
Feview fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
SL 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: [ZApproved. ❑Denied. �-I%/-17
(Circle one.) Comments: fQOd�G_ / .0L,0
BUILDING /l/�,t�[�'
PLANNING&ZONING
Reviewed by: Dat . 23
TREE ADMIN. Second Review: [:]Approved as revised. ❑De led.
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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R.O.W.Permit Attachment of for
RO.W.Permit# 14-trnl AY issued , 20 Atlantic Beach,FL 32233
Owner's Name: C Gro VU h Jo r�S <
Property Address: ZIh 3 Aa r,mpVa �k pt\ 0,N % C 0.C(, FL.
Subdivision: Z a C,� t- R.E.#: I q a,S g"(300
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 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: \�% `aur CC r o-", A t I OEW.J W t 900.1(e(5
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:
a-NI Mat�no\�q StfQetl A�\atrt�� &uChlf� l 3a33�
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
t
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 terns of this
permit and that all of said liabilities are hereby assumed by the USER.
DATEDD• and SIGNED this /.3 day of -F .20
By: l
Prope O r
(to be sign presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL 1
On this P ,,—day of f.0 h'Arry , 20«, personally appeared before me, a Notary
Public in and 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.
rwcvLa OL
App,g ""d, Id State
ROSSAARWCOMMSSMOFFSi
t' EXPIRES January 5,M
tk(.R•`f wbTnv NeY/Fudk
CITY OF ATLANTIC BEACH,FLORIDA,
a municipal corporation:
Approved:
Donald D.191%ovie.E.
Public Worlfs Director
File: 12/12/16
Page 2 of 2
BUILDING PERMIT APPLICATION FEB 13 2017
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
sf u% Office:(904)247-5826 • Fax:(904)247.5845
Job Address: 114SS4cc
at�O�t6kf- -'C Permit Number: Il- DWRY '�ya
Legal Description Lok rsD`1 -'2a\ c RE# I r7o. AA--o=
Valuation of Work(Replacement Cost)$y 4=9Q Herted/C000lled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition AlteratioE_� Move Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Cotnmereial esidential
• If an existing structure,is a Jim sprinkler system installed?(Circle one): Yes o N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detaff the type of work to be performed:�D Qglc I Pew c�z #ary nA-i N� Q 0 r\Vh A et-i
C�C�Jr �rJc�`I
Florida Product Approval# for multiple products use product approval from
Property Owner Information
Name: Address: 4-310 T)o.ViS -'�k reek
ro
�
Cityvze act\ Stater:jAp Phcme Ot04-(a55 -rl3tal
E-mail . Com-
OwnerorAgcml hfAga9,Pov ofAnamey Aaary Lena Rsquimd) Q4f
WARNING TO OWNER: YOUR FAILURE TO RECORD A OTICE 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 NOTICE OF COMMENCEMENT.
Contractor Information:
Name of Company: Qualifying Agent:
Address: City State Zip
Office Phone Job Site/Contact Number
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Worker's Compensation
Exempt I Imarcr a hriployese pinhan nine
A➢ ri o the is hereby made to oNaln a at all m da the work and ed miss the
tMdarals I arlaw shop no work or irrsmion in has commenced
Pr�Pr to the Issuance ofa pemdl and that all wank was be Ped rmed to meet moshi ,or
ofall laws regidmrk i ro,urnt dee In bandriankra.
rle permit (V mo null and void h er is not rom .d.d withln six(6 months.or ffronrnucdon or mock is sus nded or abandoned(ar a
pegnodolslx(6/momhs a(any lime ager work is rommenced. lundersmnd Ihalsepamle permits mull be secnredfar F.lecMm/Work,MumDtng,
51 ns, 1IYPdh"Ypan/s,Fra-aces,Boat HmferA,To aaf Alr Cendaionen,ea
SignalureofProperty Owner: /J Signaruro of Contractor.
Befo{�me
this_L.2,Day of _ 1 Before me this 0 fay of LALntA
Notary Public: " _ Ec.PEaaY Notary Public:
EXPIRE 5510NYFFa11tIBt1
dnin Januarys,tam
lydinan es go lhnl l hm r ae + ,}lhndarmlNnmylydAsaMwlaa ow rhe same la be rnr¢and correct Ail provisions it does and
ordinances sh,e sung this n' her speed ted herein or not. The granting ofo structi does not
presume to gnr mllhorlh'to rip pre nr cnnad the ptorisions ofnny olhrrf amt,slate,or/Deni law regulating eanarsucripn or the
prifomlan,e of ennslnlciion.
Rev.3l14/16
CITY OF ATLANTIC BEACH
CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
o
800 Seminole Road
un i� A9antic lic Beach,Florida 32233-5445904-247-5800
Fax 904-247-5845
[SRMIT#PLEASESUB��MIT(2)COMPLETE SETS OF PLANS WITH APPLICATION.Date ` 2 Y)CU 0.r °j ,ap)7 UES BY THE CITY
Job Address ti a q '6,}(fwt E-mail WAkpnV nJ Kp�P kl� Cont
Permitee: Nxro\yn , orae, Telephone# 9OAr g3(a
Permitee Address: 43(e `�QV\S 5-k fp ear �}vim '�4�(,� F(� 1311aa4 Lt
Requesting Permission to Construct: urt CMQTVVe t�C11My0.V 1\TA I�ri�l e.Y'S
Location: (Reference to Cross-Street)
1 I
1. Applicant declares that prior to filing this applictation 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 4 No ( Date: _( I-=� 7
Bell South Telephone Company Yes No ( ) Date: I -
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/{tlanti Beach`or Florida Department of Transportation Standards and be performed
under the superyision of ( Q(D un Yl'PDrJ (Contractor's Project Su erint dent)
located at ; Telephone#:Q�4- -(oCj�i-R3(n�
4. All materials and equipment shall b 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 Riaht of
Way are to be Included with this application
7. This permittee shall commence actual construction in good faith with 10 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 . I �/ . �z
Sign d: Date: me this N day
of the unty of Duval, State Of Florida, h personally appeared
n Large, State of Florid_ arCounty of Duval. My
commission expires r a ersonally Known:
't UPIRES- 5,top Produced Identification:
Revised 7/29/75
CITY OF ATLANTIC BEACH
M OWNER/ BUILDER AFFIDAVIT
I. 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 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 MUS 1
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.
IL 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455228(1). AN-OCCUPATIONAL LICENSE"IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY' OR THE FLORIDA "CONTRACTORS
CERTIFICATE' TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826)IF IN DOUBT.
V.ACKNOWLEDGEMENT;I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
43c �eyls �F tJ.� 3aatA� 4o4- �(� �
ADDRESS 3 PHONE NUMBERIhER
Caro\lAr 30L PS
PR TNAM
a- �a- 17
51 ATURE DATE
Deroremetbu 3reayw � LCM .200inmamuntyw
Duval,Stab d Flodda,has personally appealM beds by Ininamd/belseMand eHlms Met
all sMements and deaarsuons are tlue and a=mb.
NNary PUNisat L.W,Stateol FL coantya/� ,'. eti '
DPertmaly JENNIFER JOHNSTON
XPm osdloenuAmuon h s MY COMMISSION tGGp128p1
EX%RES:OsmM,r2T.20fi
V� 'tis.,isg':�; EmtlM Tlru xemry 111bfe UiWrvnMrs
Notary SienatN,$ MA �YReua
F IBLIX)Om,tt-BUIMAI(Wx SPD V16RW9
MAP SHOWING SOLIVDARY SLRVEY OF
LOT 505. PLAT OF SECTION NO. 3 SALTAIR,
AS SHOWN ON TT E PLAT TPEREOF, RECORDED IN PLAT BOOK 10
PAGE 16 OF ThE CURRENT PLELIC RECORDS OF DUVAL
COUVTY, FLORIDA.
CERTIFIED TO: CARUM R .%ONES. NEW SOUIFI FEDERAL SAVINGS BANK
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