1517 LINKSIDE DR - DRIVEWAY ° °` CITY OF ATLANTIC BEACH
AIL/ e
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J 800 SEMINOLE ROAD
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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-3341
Job Type: DRIVEWAY
Description: PAVER DRIVEWAY - REPLACE CONCRETE
Estimated Value: $2,100.00
Issue Date: 4/20/2017
Expiration Date: 10/17/2017
PROPERTY ADDRESS:
Address: 1517 LINKSIDE DR
RE Number: 172374-6045
PROPERTY OWNER:
Name: CARLIN, MICHAEL J
Address: 1700 SELVA MARINA DR
PERMIT INFORMATION: PUBLIC WORKS: UTILITY DEPT.:
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.
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.
FEES:
PERMIT IS APPROVED ONLY IN ACCORDA\CF: WITh I ALL CITY OF ATI.ANTIC IWACII ORDINANCES AND TIIE FLORIDA
BUILDING CODES.
XvJriel
, CITY OF ATLANTIC BEACH
A s) 800 SEMINOLE ROAD
Ott! ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Fence/ROW $35.00
UTIL REV RESIDENTIAL BLDG $25.00
Total Payments: $60.00
•
PERMIT IS APPROVED ONI.Y IN ACCORDANCE, WIT11 AI.I. CITY OF A J ANTIC BEACH ORDINANCES AND 11W FLORIDA
111 ILDINc CODES.
ot-u1\ City of Atlantic Beach •. .,,, . _ r APPLICATION NUMBER
r: Building Department r-
�� � � _ (To be assigned by the Building Department.)
r �' 800 Seminole Road I
Atlantic Beach, Florida 32233-5445 FEB 27 2011 -7— Qw �U/`334
ff1!)
Phone(904)247-5826 • Fax(904)247-5845 /'E-mail: building-dept@coab.us `-I Date routed: Z 4 I 1 7
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1 S. 7 L l lOKS [OC [' t2 Department review required Yes No
Building
Applicant: C9(.A )k_DC Planning &Zoning
P Tree Administrator
Project: R\f6-1- , D R\\/e Gu(ct-c(• ublic Works )
is iii
P bfic bate y
Fire Services
Review fee $ 2 5--- 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:
APP ATION STATUS
Reviewing Department First Review: Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: 11S7(14 )14-f'---- Date: 3/7A 7
TREE ADMIN. Second vA roved as revised. ❑Denied.
❑ pp
G WORKS Comments:Reiew:
PUBLIC UTILITIES
'2- Zg -/7
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: (Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
City of Atlantic Beach APPLICATION NUMBER
� Building Department (To be assigned by the Building Department.)
•A, ` 800 Seminole Road
rI ` QW _334 Atlantic Beach, Florida 32233-5445 (
Phone(904)247-5826 • Fax(904) 247-5845 1
A2,0;;j9r E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I Si / L l i S (QC [ t2 Department review required Yes No
Building
Applicant: 0 w&D _ Planning &Zoning
P Tree Administrator
Project: RV R \ R kve(,O(V-- ublic Works
( 1=1161is iii
Public Satety
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: [pproved. ❑Denied. 4•11.22een
(Circle one.) Comments: o ��Q�
BUILDING -see M% u4e4469ami�'V!�
PLANNING &ZONING ? /
Reviewed by: ; / i Date:J/�J�
TREE ADMIN. Second Review: ['Approved as revised. ❑D;�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
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH DATE
800 Seminole Road,Atlantic Beach FL 32233
Office: (904)247-5826 • Fax:(904)247-5845 17- Nuo At-(- 331 j
Job Address: /573 h1 //C1 ('c 4iz.L4.- #4-</-4464-C 89,40/Permit Number:
Legal Description RE#
Valuation of Work(Replacement Cost)$ (9/01) Heated/Cooled SF Non-Heated/Cooled
• Class of Work (Circle one): New Addition ati Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s) (Circle one): Commercial 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:lZ6101' e— 6-11'.3 %f CreG2b I& /JR.t v
114...x✓_5 (At Frit iwu O hi o ',i •Si t2 J2 4)
Florida Product Approval # for multiple products use product approval form
Property Owner Information
Name: Les- 64,2/,7✓ Address: /c/7 L/-,u/E 5,;1 -&-
City F44-1• ./'c /3 i/ State i/ Zip 7z z._33 Phone 9ok- 7 G - 14 27
E-Mail
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 NOTICE OF COMMENCEMENT.
Contractor Information:
Name of Company: , , ,40,/ 6.674, Qualifying Agent:
Address: 77 '( 1d.,e.//./a v z?off City 74,0i.sov,,.7//- State Zip // 32z416
Office Phone 94'/- 2.3%'- $1 Of Job Site/Contact Number gay 2 V- Sd
State Certification/Registration# _ E-Mail P647Z w//Q A"40"-1 /i el/1rl/G ,a aw
Architect Name & Phone#
Engineer's Name & Phone #
Worker's Compensation
Exempt / 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 menced
prior to the issuance of a permit and that all work will_work
to eet the standards of all laws regulating construction in:has
This permit becomes null and void if work is not co- menced w' i si (6 months, or if construction or work rs suspended or ''andoned for a
period of six(6)months at any time after work is c' e/ ed. • erst nd that separate permits must be secured for Electrical ' ork,Plumbing,
Signs, Wells,Pools,Furnaces,Boilers,Her.;opy at ond toners,etc.
Signature of Prop• t0 wner: .,/., 44 • s u
Befeexrgg 01. 70111 GINDLESPERGER
thisL- Day of P,• I'tl:' me'dmulssloui ,any
•
� �_u a: EXPIRES:October 6,2019 /
. I� 1 P,,t p BonddedThruNotaryPublicUnde ' •.
Notary Public. — .009
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I hereby certifr that I have read and examined this eis s lication and know the same to be true and correct. All provisions of laws and
ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisi
ons of any other federal, state, or local law regulating construction or the
performance of construction.
Rev.5/2/16
(-----V j,�
CITY OF ATLANTIC BEACH
\, OWNER / BUILDER AFFIDAVIT
_____,)
,:::,_,;0:)..,7
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 LICENSEE)
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
I YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUS1
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 MUS1
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. Jd
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ADDRESS PHONE NUMBER
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S: • .e•'' DATE
Before me this Z L/day of .201 in the county of
Duval,State of Florida,has personally appeare herin by himself/herself and affirms that
all statements and declarations are true and accurate./
Notary Public at Large,State of P l .County of J L7 VOL"
NPersonalty
roduced Iden tion-CV p / —r Co4 s• "��
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:'d TONI GINDLESPERGER
Nota Si nature: 4111, MY COMMISSION t FF 924951
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TECHNICAL STANDARDS FOR LAND SURVEYORS IN ACCORDANCE WITH CHAPTER 2111H-6.FLA ADMINISTRATIVE CODE I
(PURSUANT TO SECTION 472 027.FLORIDA STATUTES),AND FURTHER CERTIFY THAT THERE ARE NO VISIBLE ENCROACH CONCRETE MONUMENT
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I
r,,,,,,,.. CITY OF ATLANTIC BEACH
CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
Mr-
— --
800 Seminole Road 904-247-5800
I cm�• Atlantic Beach,Florida 32233-5445 Fax 904-247-5845
PERMIT#
PLEASE SUBMIT(2)COMPLETE SETS OF PLANS WITH APPLICATION.
Date 09-42i7/- ,'i ISSUES BY THE CITY
Job Address /S-/' I/N�LSide 4 Q. E-mail iit-041.1 /a 3 i‘C441/L. ecyji
Permitee: I&' 'S , &,lfie,L 1/t) Telephone# 44Y) 4' -6-5-6/
Permitee Address: /r/`") LiPaC4,dt iii-
Requesting Permission to Construct: 4 e dIit//a i-f 644((r) "/,‘,41)14,5.
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 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 Atlantic Beach or Florida Department of Transportation Standards and be performed
under the supervision of (Contractor's Project Superintendent)
located at Telephone#:
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,
v, - assume all risk of and indemnify, defend, and save harmless the City of Atlantic Beach from and against any and
ft' n all loss, damage, and cost of expenses arising in any manner of the exercise or attempted exercises by the holder
I .,' of the aforesaid rights and privileges.
'9':'.'Te Director of Public Works shall be notified twenty-four(24) hours prior to starting work and again immediately
uOon completion.
v m®�I
o �6 OWNER '
Tm Sign:d: Date: C. Before me this Lk ?o 7day
i--2 m . ,ty o Du ►1, State Of Florida, has personally appeared
a� A4111k
N Public at Large. State of Florida. County of Duval. My
• N commission expires: Personally Known:
(. ( 74( - C7? -) - -) Produced Identification:
Revised 7129115
I
.F'
R.O.W.Permit Attachment of for
R.O.W.Permit# issued , 20 Atlantic Beach,FL 32233
Owner's Name: te- 'c 4/1/../X-I
Property Address: /S7 GJI!'J/S/h6 40- I *Iff.vtse, /tC
Subdivision: a I4 6 / if dZ R.E. #: /'7-k 3')y- '0YS.
REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of
, 20by 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:
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 02 day of reatbrilly , 20 /1 .
By: '/ ,1
' o..�-", • . er
. b- signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL (_
On this ZT day of re Jt 20 1 7 personally appeared before me, a Notary
Public in and for said Co t and State, _ (cam_ , the property owner of
l , cc( "- IP t.---' , Atlantic Beach, Florida, known to me to be the person(s)
desc in and who executed the foregoing instrument; who acknowledged to me that he or she
exec -, the same-ly and v s,untarily and for the uses and purposes therein mentioned.
I ad 1111A glk
TONI
Notary Public in fid County an'' ip _ MY COMMISSIONSI #FF 28951
• o EXPIRES:October 6,2019
t ri:tt '` Bonded Thio Notary Public Underwnters
CITY OF ATLANTIC BEACH,FLORIDA,
a municipal corporation:
Approved:
OF/ .
Donald D. J.%•bovi/,P.E.
Public Wo',4 Director
File: 12/12/16 •
Page 2 of 2