386 4th St driveway permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
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: 17-DWAY-3099
Job Type: DRIVEWAY
Description: REPAIR AND REPLACE PAVER DRIVEWAY
Estimated Value: $3,200.00
Issue Date: 2/15/2017
Expiration Date: 8/14/2017
PROPERTY ADDRESS:
Address: 386 4TH ST
RE Number: 169826-0050
PROPERTY OWNER:
Name: Rutkowski, Michael
Address:
PERMIT INFORMATION: PUBLIC WORKS: UTILITY DEPT.:
Full erosion control measuresmust be installed and approved priorto 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'(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.
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AM THE FLORIDA
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Fence/ROW $35.00
ENG REV BLDG MOD OR ROW $25.00
Total Payments: $60.00
PERNIFT IS APPROVED ONLY IN ACCORDANCE WITH ALL CIW OF ATLANTIC BEACH ORDINANCES AND ME FLORIDA
BUILDING CODES.
City of Atlantic Beach DECEIV APPLICATION NUMBER
Building Department (to be assigned by the Building Department.)
800 Seminole Road
Atlantic Ba,aGh,Florida 32233,15445 LI _�-�309
Phone(904)247-5826 - Fax(904)2+40 2 6 2017 1 1z5
E-mail: building-dept@coab.us Date routed:
Cityweb-site: http://�.mab.us By.--
APPLICATION REVIEW AND TRACKING FORM
-68� 4-1k S_ I— ____
Property Address: Department review required YesTNo
Building
Applicant: Planning &Zoning
Tree Administrator
Project: IREPR(k PLA Q r- ic Wo
ic It I le
�V LA_) Public Safety
Fire WSeNices
bept Signature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified By Date
Flonda Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management Dstnct
_�__y Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Bevewes,and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: Approved. E]Denied. 4k/—�11�/�
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date: ;7
TREE ADMIN.
Second Review: ElApproved as revised4. enied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ElApproved as revised. E]Denied.
Comments:
Reviewed by: Date:
Revised 05114/09
AukCity of Atlantic Beach APPLICATION NU BER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach,Florida 32233-54,15 -5845 ]AN 2 6 2017 4
Phone(904)247-5826 - Fax(904)247 Date routed: 1
E-mail: building-dept@mab.us
Cityweb-site: hittp1h�.coalb.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: -58;(o Department review required
Building
Applicant: 0 Lk) to 64�->- Planning &Zoning
Tree Administrator
Project: 'E Rfz-P( .Ac—r ic Wo a
-PUN—Ic Uti lffi-idli�
Public Safety
Fire Services
�.qept Signatui
Other Agency Review or Permit Required Review or eceipt Date
of Pernrit Verified By
Florida Dept,afEnvironmental Protection
Florida Dept.of Transportation
-iii.Johns River Water Manag
Amy Corps of Engineers
Division of Hotels and Reidauran�s
Division of Alcoholic Beverages and Tobacco
Other.
APPL15;ATION STATUS
Reviewing Department First Review: B/Approved. [-]Denied.
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed by: W—'V- Dat...21(11
TREEADMIN. Second Review: E]Approved as revised. ElDerried.
P W=ORKS,/ Comm ts:
�X,, ' 5h11mrdmR9,
UTILITIES
74-1 Reviewed by: Date:
PUBLIC SAFETY
FIRE SERVICES, T it Review: DApproved as revised. ElDenied.
C Com an
ornments:
Reviewed by: Date:—
Revised 05114109
BuILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH DATE
800 Seminole Road,Atlantic Beach Fl,32233
Office:(904)247-5826 - Fn:(904)247-5945
JobAddress: 4f4fA48_ ermitNumber: ITDWAY-5oc�j
Legal Description RE#
Valuation of Work(Replacement Cost)%:�O Heated/CooksISF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of cxisting/proposed structure(s)(Circle one): Commercial Residential
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No N/A
• Submit a Tim Removal Permit Application if any tmes are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be Performed,
c
r- b4ec-
Florida Product Approval# for cunhiple products use product approval ionn
Property Owner Information
Address:
city zep�r State&Zip 5gUZf Phone 7061- /,3�
.& 7
Name L
E-Ma-411mimo- !�Sal 646vem
Owner f�u�.q�,4-CT_LeWvRequi
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 NOTIEE OF COMMENCEMENT.
Contractor Information:
Name of Company: Qualifying Agent:
Yin
Address: city—State Zip
Offire Phone Job Sit ontact Number
State Certification�/Rjegistration_# E-Mail
Architect Name &Phone#
Engineer's Name&Phone#
Worker's Compensation
--Ecempt insurer I Employess Expiration Date
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W
Notary P.M.
tf
I hereby certly,that I hays read and exantmed this alpopp cation and know the same to be true and correct. Allprovisionsoflawsand
ordinances g?verm. �this type work will be complied with whether spe d herein or not. The granting of a permit does not
presume to give autTarity to vilas e or cancel the provisions of any otherfelleal, state, or local law regulating construction or the
performance ofcountruction.
CITY OF ATLANTIC BEACH
OWNER/ BUILDER A"IDAVIT
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I 'CONSTRUCTION
CONTRACTING'REQUIRES OWNER I BUILDER TO ACKNOWLEDGE THE LAW.
DISCLOSUP E STATEMENT FOR SECTION 499.103(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 RXFMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY.TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MU
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 NOTBE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONS]RUCTION IS COMPLETE,I HE LAW WILL PRESUME THAI YOU BUILI
IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF THIS EUMPTION. YOU MAY N
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOIL 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 HAY
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 WORKERS COMPENSATION INSURANCE BE
PURCHASED.
111. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX ANDUOR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER A
CIRCUMSTANCES. OWNERS BEING SUBJECT TO$5,000 PENALTY UNDER FLORIDA STATUTE NO.
45&228(l). AN-OCCUPATIONAL LICENSE'IS NOT ADEQUATE. THE OV%NER SHOULD PHYSICALLY
SEE THE COUNTY 'CERTIFICATE OF COMPETENCY' OR THE FLORIDA 'CONTRACTORS
CERTIFICATE' TO ASCERTAIN IF A PERSON IS A UCENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-6826)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.
MIDNE NUMBER
1,ZNAME��
N�ry PuNic W L"e.SRm 0
TOONI 01IRIOU'EROIR,
sz-z -�4 3 Sep My GOMMSSION#RF R24951
My COMN�SIO"�N 51
EXPIRES:0�10W,6,2019
PIR " 20"
F EX=E
R.O.W.Permit Attachment-of for
R.O.W.Permit# issued 20 Atlantic Beach,FL 32233
Owner's Name: elOA,61, L.�,
PropertyArldress;
Subdivision: R.E.
REVOCA13LE ENCROACHMENT PFRMRT
THIS REVOCABLE ENCROACHMENT 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 "CITY"and
of Atlantic Beach,Florida,hereinaft;referred to as"USER".
W)TNESSETH:
That the CITY does hereby grant the USER permission on a revocable basis w 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/Easementpermit nurnbers noted above (copies attached).
This work is gen bed as: ta W1-4r6---
Any facility maintained, mpah?A 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 o f
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 CM 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 orfarichise utility provider.
The facilities allowed by the permit shall meet the current requirements of the City Code, Budding
Codes,Land Development Code,and all other land use and code requirements of the CrrY,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
H10 USER, Prior to making any changes from the approved plans and/or method, must obtain
written approval fmm 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/oquirefnents of
public rights-of-way and other public land. USER fartber 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 -Z�' day ofAa—�2o' 17
B Y-'�
P, 0 'r
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this 2y day of —� 01— 20a personally appeared before me, a Notary
Public in uid, for said wt�e' E( o ' , the property owner of
�unty td State,
Atlantic Beach, Florida, known to me to be the person(s)
ed in and who executed the foregoing instrument; who acknowledged to me that he or she
ex led the c ely d voluntarily and for the uses and purposes therein mentioned.
i St
�Nj GTNMUPERGER
ubli,in afor as dl Cc and late
ay'1MMISSQN#FF�N'1
EXPIRES.0'tobK6.N19
��PubkU�m
CITY OF ATLANTIC BEACH,FLORIDA,
a municipal corporation:
Approved:
Doinaldi).Jacob itz,P..
Public Works Trector
File: 12/12/16
Page 2 of 2
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