1618 BEACH AVE - DRIVEWAY 041-t\-:+v-1:4,,,,,,
� , , CITY OF ATLANTIC BEACH
AiIv)j 800 SEMINOLE ROAD
Jr
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
DRIVEWAY PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-DWAY-3827
Job Type: DRIVEWAY
Description: remove existing driveway and replace with pavers
Estimated Value: $6,200.00
Issue Date: 5/3/2017
Expiration Date: 10/30/2017
PROPERTY ADDRESS:
Address: 1618 BEACH AVE
RE Number: 169547-0000
PROPERTY OWNER:
Name: ROBBINS, BRUCE
Address:
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.
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.
All old fencing must be removed from job site by Contractor.
FEES:
Fence/ROW $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL Cfl'1OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
, � 4:.:, ,t; CITY OF ATLANTIC BEACH
As 800 SEMINOLE ROAD
j F; :y ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Total Payments: $35.00
1
PERMIT IS APPROVED ONLY IN ACCORDANCE WI"I'H ALL CITY OF ATLANTIC BEACH ORDINANCES AND THF. FLORIDA
BUILDING CODES.
.0-tvirj City of Atlantic Beach ECEIVE ' APPLICATION NUMBER
J ,41k-, ' ',.\ Building Department (To be assigned by the Building Department.)
','1.*,:.‘;----,...:,, i 800 Seminole Road APR 25 2017 n Q
,� Atlantic Beach, Florida 32233-541I�r OWE �� `3 Ua�
Phone (904)247-5826 • Fax(90 ,47-5845
'*onisy= E-mail: building-dept@coab.us Date routed: C)y Ids la-0I1-
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1(Q VI tf(_' ka— Department review required Yes No
Building
Applicant: 00(11_,( Planning &Zoning
Tree Administrator
Project: i CS()002— Lyi S� 6,r►\ito all wc` c�0
Pad S �J �ublic Utilitie
Public Safety
Fire Services
Review fee $ ? Dept Signature L$ .
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: Approved. ❑Denied.
(Circle one.) Comments:
BUILDING /I
PLANNING &ZONING Reviewed by: � /41r —
,:(2417Date:
TREE ADMIN. Second Review: A roved as revised.
❑ pp ❑Denied.
1 P d 11. WOR Comments:
PUBLIC UTILITIES
V-2-5---17
PUIC SAFETY Reviewed by: . Date:
FIRE SERVICES Third Review: ['Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
L
Revised 05/14/09
0LANre• BUILDING PERMIT APPLICATION
c, A
J
A ''1 CITY OF ATLANTIC BEACH DATE
740V 800 Seminole Road,Atlantic Beach FL 32233
Office:(904)247-5826 • Fax:(904)247-5845
Job Address: POI f� ( .., , f . 1 Permit Number: 11"—DW All-3 l-
Legal Description 1-.. eo mac. w6 t�v. N•i 1j Pee$2 e E# 1699 7 —0611180 ,1 _ t , . ,
10
Valuation of Work(Replacement Cost)$ 6)2 Ji Heated/Cooled SF Non-Heated/Coole I
r 4
• Class of Work(Circle one): New Addition 1\lteratiO) Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial 1'esidentia
• If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
/471hvt ai` /1G� �1C ff' ki Lett. C(Dl i q-ves
Florida Product Approval# v lir multiple products use product approval form
Property Owner Information / /, /,�-�
Name: 5(Z ' . Ai r • /NS Address: j gj34 A 4j'�K- !/411) , ?3j
City -r/ ..tr. [ atJi StaterZip . Z.2-35 Phone ( o+) Co/3 — '//30
E-Mail race•robixAvs'P cflA;(, .Ll o7l
Owner or Agent (If Agent,Power of Attorney or Agency Letter Required)
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 NOTIdE OF COMMENCEMENT.
Contractor Information:
• 1St. -' 4 Am... _
Name of Company: '_►.�am.,020022o .iApPE_I. •ualifying Agent: ----7,- ---;-7
Address: City (E j t�ate Zip U \,,Office Phone Job Site/Contact Number f j I J 1
State Certification/Registration# E-Mail -'`
Architect Name&Phone# APR 4 2017
Engineer's Name&Phone# _ _
Worker's Compensation _______
Exempt I Insurer / Lease Employees / Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced
prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction.
This permit becomes null and void if work is not commenced within six(6 months, or if construction or work is suspended or abandoned or a
period o six(6)months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Pluming,
Signs, Wells,Pools,Furnaces,Boilers,Heaters, Tanks and it o ditianers,etc.
41.46c, 1Signature of Prope Owner: . Signature of Contractor:
Beforee
this Z-Day of tN L _ Before me this Day of
ay't 1 1c*1-
a
Notary Public: Notary Public:
IFER JOHNSTON
I hereby cert that I have i-a.', ,'�u,,, J i,{tt� irGtEt 429&tin ow the same to be true and correct. All provisions of laws and
ordinances governing this ,. ( m I #, tii, �1r�,. n 2b wh. er specified herein or not. The granting of a permit does not
presume to give authority t. iih•;'.pi c c,,, ,6c eIwrrnos7 other federal, state, or local law regulating construction or the
performance of constructio ;;o„ Bade Tiv Nd __
Rev.5/2/16
�ti j!
:,
C-s. ,
CITY OF ATLANTIC BEACH
(Pi WNER / BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "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 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 $5,000 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.
I1o18 6904 Ave 4/ '6 ii . clot to/3 -/l3O
ADDRESSPHONE NUMBER
arzoce- A-0 k �
PRIN AME 4, Air zr), Z017
SIGNATURE DATE
Before me this' —1 day of I i \ 20n in the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations aretrueand accurate.
tr
Notary Public at Large,State of f L .County of Oa OC L1
�❑q Personally,., Known .1 S."�'` \`Lp Yl
.Produced Identification- I V -) ` Q V--- JOHNSTON
";� ."'., JENNIFER T 0429b1
' • MY COMMISSION
(_*4;41:::,..1,i;;\
�(PIRES:October 27,Notary Signature: 1 - son�T►yt7Nohry ��
F:/BLDG/Owner-Builder Alfa 1;REVISED:4/16/2009
,r,�/
� ;..) City of Atlantic Beach - -. APPLICATION NUMBER
�- , �s\ Building Department , (To be assigned by the Building Department.)
j 800 Seminole Road APR 2 5 2017 11-DWA-H-3 gal
j `"�` +�,' Atlantic Beach, Florida 32233-5
\�nn Phone(904) 247-5826 • Fax( 4.)247-5845
OyIaS13-OI�
%�;;t�? E-mail: building-dept@coab.us +3Y: Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: i t° 1 i ►JQ kth Aa- Department review required Yes No
Building
Applicant: 021, GO(1..Q..( Planning &Zoning
Tree Administrator
Project: i CS()0�lL Lk/i SN t"\ ( ,,t ,4.)..J ay tat-b1 clic
Pad S �J CiDublic Utilitie
Public Safety
Fire Services
Review fee $ Dept Signature
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:
APPLICATION STATUS
IReviewing Department First Review: liZrApproved. Denied.
(Circle one.) Comments: lea 4jf /�vi,/�
BUILDING (. %L�(
I:-
PLANNING &ZONING
Reviewed b • ,, ��/_ Date: IS-/-7,-(7
TREE ADMIN.
Second Review: ❑Approved as revised. ❑Denied.
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
LOT 5, BLOCK I, OCEAN GROVE UNIT NO, I, ACCORDING TO THE PLAT THEREOF AS RECORDED IN
s :.0K 15 PAGE 82 OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY:FLORIDA.
LOT 14
Sao .t r
LOT 13
! `?,<, s .
Set
LOT 5 6C _ \2. /
- LOT 12
4
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t 11.7"___-a
I,.o• ". .,� ,) T
LOT 4 I .
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'� 9TOpY U'pOp
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LOT 6
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:1:.•,.:•••:::.:
CURVE DATA:
•?•• •
L. 27'33'20"
• R 103.00'
tYo T 25.26'
N 45'00'00" E 7°'` :t . A 49.54'
15.60' 9 -
nio
k's
1 57,9..
.
•
11/ 41 k4N ,. : _.
o'• 5' lo' re' eo
NOTES:
1. BEARINGS ARE ASSUMED. •RAFNIC SCA LI
I 2. BEARING OF BEACH AVENUE HELD FIXED.
flECEWE
R.O.W.Permit Attachment ofPR 2 7for 17- NM- 382'1
R.O.W.Permit# is • Atlantic Beach,FL 32233
Owner's Name: DC A , Pogmts
Property Address: `(,p Ib r%/�
Subdivision: i.otS, 14 I airlAW R.E.#: f(pt)rj- 47 .- QQ y
,¢ovg t
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).
Th's work is generally descji ed as: /h ; JEW kms,
te.p bite. (d)E T , - -
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." Q P R 2 6 2017
Page 1 of 2
Pir
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 1 'Lday of 7.(P ,20 17
By: 6/1axze A\
Property Owner
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this4�- d^
a(p day of A)(1 , 20 11- personally appeared before me, a Notary
Public in and for said County and State, t 4 q\ ankQri let , the property owner of
t$ &A AjLlt LA( , 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.
No Public ' fors ' County and State
e0:*:."'"; JENNIFER JOHNSTON
MY COMMISSION I GG 042964
' EXPIRES:October 27,2020
'4 of rtV:4= Bonded Thru Notary Public Underwriters
CITY OF ATLANTIC BEACH,FLORIDA,
a municipal corporation:
Approved:
Public Works Director
✓riot teAti i
File: 12/12/16
Page 2 of 2