325 17th St driveway permit S �j rLl ren
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
DRIVEWAY - SINGLE OR TWO FAMILY DRIVEWAY
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: DWAY17-0024
Description: REPLACE CONCRETE DRIVE WAY WITH NEW CONCRETE
Estimated Value: 4500
Issue Date: 11/20/2017
Expiration Date: 5/19/2018
PROPERTY ADDRESS:
Address: 325 17TH ST
RE Number: 172020 0242
PROPERTY OWNER:
Name: WHITTINGSLOW JOHN D
Address: 325 17TH ST
ATLANTIC BEACH, FL 32233-5822
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name:
Address:
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB
SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500. For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
Vii. City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
r x' 800 Seminole Road I\� (� `-�
V(� b 04/f
Atlantic Beach, Florida 32233-5445 �J t'C i
Phone (904)247-5826 - Fax(904)247-5845 ) (� ZS l
E-mail: building-dept@coab.us LDate routed:
City web-site: http://vwm.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: �Cj + -- Department review required Yes No
n B
Applicant: �(�1' Planning & Zoning
Administrator:
Project: C-0Jt2s, C51v C &-C_ Public Wor
Public Utilities
Public Safety
Fire Services
Review fee $ De S aur ,, AM
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. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed b .� Date: r6/ 3�- 7
J I C . L"7. Z(,,I Y
TREE ADMIN. Second Review: ❑Approved as revised. [—]Denied. ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
City of Atlantic Beach APPLICATION NUMBER
�S Building Department (To be assigned by the Building Department.)
800 Seminole Road AY
� j
�r Atlantic Beach, Florida 32233-5445 OCT 2 6 2017 (� �'C t "b� /�
Z�t
Phone(904)247-5826 • Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: ) v Z cJ t
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ZCj �``-- Department review required Yes No
� n� Bi
Applicant: L'i l�CIS-- Planning &Zoning
istrat-of
Project: ��lV�t/�{� aN C p C— _ Public W o rib
Public Utilities
Public Safety
Fire Services
Review 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
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. []Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed byDate:2-z�� o
TREE ADMIN. Second Review: []Approved as revised. ❑Denied. ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. []Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
y'' Building Permit Application Updated5/5/17
City of Atlantic Beach
800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Fax: (904)247-5845
-1 L C D VJ-44 _ v 0 z4
Job Address:_ �,�� � 1� 5���,�►'�''L�IC. I,�t7i"t'(;�I �'f , Permit Number:
Legal Description RE#
Valuation of Work(Replacement Cost)$ 5 tv Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition AlterationRepair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercialesidenti
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No No/
• 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:
kefleve, crkcb4 pwr Ow Avlve"�'J t,% skqje
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: k 1f41•►4, '%A/ Address: 14- ( 14A, S �
City +y% t_ ij,ackn State_ Zip^3 LZ" Phone
E-Mail u1414 f1 ii tt k C iu,"
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) CkJ *%L,f
Contractor Information
Name of Company: " K . em.,.144' Qualifying Agent:
Address City e Zip
Office Phone Job Site/Contact Number
State Certification/Registration# E-Mail
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation
Zparate
/Lease Employees/Expiration Date
Application is hereby made to obtain a permit tnd installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit awill be performed to meet the standards of all the laws regulationg
construction in this jurisdiction. I understand thrmit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, , CONDITIONERS,etc.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
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.
1
(Signatur of O n or Agen (SignatuZContra(including ontractor) 7�`Signed and swornto(oraffir a beforemethisday of Signed and sworn to(or affiris day of
b
—_- igna - - - (Signature of Notary)
r =,. MYOO�,?M15SI 924951
EXPIRES:October 6,2019
Personal) Known OR
[ ] y � ._.,��.�...n.��.�....�.,..,.� [ ]Personally Known OR
[ ]Produced Identification //�� [ ]Produced Identification
�
Type of Identification: 11��57i-4 -32"'L/ Type of Identification:
REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERNW,issued on this day of 2p
by the City of Atlantic Beach,Florida,a c municipal oration organized anexistingunder the laws of the State of
Florida,hereinafter referred to as"CITY"and p "� At
l+� �{'kiN ��+�,U
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 for the purpose as described in the City of Atlantic Beach Right-of-Way Permit#
This work is generally described as „ Ir
Any facility maintained, repaired, ere c d, and/or instal din the exercise of the rivilege granted remains subject to
relocation or removal on thirty(30)days' notice by CITY to USER, said notice to USER shall be given by certified mail,
return receipt requested,to the following address�5 r 7�'1; S�-, �-F-�qh , (14ch
• 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.”
• 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 within 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 right-of-ways 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.
Date �U Z� � �
Property ner/Agent(si ed in presence of Notary Public)
STATE O FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this day of 20
who personally appeared before me and
(printed name of Signer)
acknowl d ed Je/sheignedt instrument voluntarily for the purpose expressed in it.
Signature of Notary Public, State lorida
Approved/Public Works Department:
Personally Known
p
Produced Identification(Type) ,
$' tr ti,GIP.DLE°pEci3 { Scott Williams' Public Wor s Director
j s iY C(Dkl'QISSICN P FF 925661
— _ EXFiR_S:October 6,2019
F; Eandcd Thr-"„c3--y Putlic Underwnters
RIGHT-OF-WAY / EASEMENT PERMIT
Permit#Issued by the City of Atlantic Beach
PERMITTEE RESPONSIBLE FOR NrrOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address 3x 1-1111 s free r Phone_ Oq '110 500
Permittee
__,Jh!j 1A)h 1 f+,N A(Ili l) Email-70h., 00 3 P (V"ill
Requesting Permission to Construct C e f14t C r1iLW ty;#0i!!1 Air(,fi�;r:y �,;,��'(,, �� CeKe.t�,
Y
Location(Reference to Cross-Street)_i 710A+J
• Permittee declares that prior to filing this application they have ascertained the location of all existing utilities,
both aerial and underground and the accurate locations are shown on the sketches.
• 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 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 Permittee unless reimbursement is authorized.
• All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed
under the supervision of U W, W+%of �t(a t (Project Superintendent)
located at 3�-� �'� �Jxel •, "A„1
• All materials and equipment shall be subject to� inspection by the Director of Public Works.
• 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.
• 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. W
• The permittee shall commence actual construction in good faith within*�s. 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.
• 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.
• The Director of Public Works shall be notified twenty-four(24)hours prior to starting work and again
i m diately upon completion.
Date 2 -
Permitte signed in prese a of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing insent was acknowledged this day of 20
by t L O cO who personally appeared before me and
(printed name of Permittee)
Zacknoledgethat a signed the instrument voluntarily for the purpose expressed in it.
erso Ily Known
otary lic, tate of Flo WNIGINf)�ESP' Fxodu d Identification T e
MycOMMiSSION ( 3; )
EXPIRES:October 6,2019
'%;c` � ended Thru Notary Public Underxrters
r +', CITY OF ATLANTIC BEACH
OWNER / BUILDER AFFIDAVIT
U;i1�r
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. THAT I HAVE READ THE ABOVE
STATEMENT LAND E THAT I(COMPLY WITH AHEREBY LL L THEREQUIREMENTS FOR THE ISSUANCE OFURE AN
OWNER-BUILDER PERMIT.
PHOME NUMBER
ADDRESS I
PRINT ME
DATE
SIGNAT RE CC
Before me this 7v day of 20t in the county of
Duval,State of Florida,has personally appeared herin by him elf/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of
f��,County of V JC
❑Pe sonally Known ��p —VJ _3 Z-7� o
roduced Identification- TONI GiIJ)LESPEo;.R
MY COh1Mi;SIGN 4 FF 524951
_= EXPIRES:October 6,201,9
' fi' ocn cd Thn Dy Put iic underamier
E ta
Notary Signature: `._:,— ..s�.::u
F:BLDGIO—er-Builder Affadavit;REVISED:4/16/2009
MAP SHOWING BOUNDARY SURVEY OF
LOT 23, BLOCK 14, ACCORDING TO THE PLAT "SELVA MARINA UNIT NO. 6" AS RECORDED IN PLAT
BOOK 34, PAGES 51, 51A AND 51B OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO:
EAGLE ROCK INVESTMENT CORP. ,
FIDELITY NATIONAL TITLE INSURANCE COMPANY
AND WATSON & OSBORNE TITLE SERVICES, INC.
lP s.;¢ SES' 0,4 TS D/2r !/E �Go'.e�H•� � '�A.ks. �4 0
.� Ste•
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R S 9EN�AL NOTE$$
hJ 1. BEARINGS ARE BASED ON GA mak' W �aGE $/ r�• ,
A :s S O C I AT E D SURVEY 0 R 3 I N C i 2.STRUCTURE NO. s2 6 SHOWN HEREON LIES WITHIN FLOOD ZONE x AS BEST
LANb ENGINEERING SURVEYS DETERMINED FROM F.E.M.A. FLOOD MAPS PANEL NO. / DATED04•i7-B9 .
Lu S.THIS IS A SURFACE SURVEY ONLY. THE EXTENT OF UNDERGROUND FOOTINGS,
►- 3848 BLANDING BOULEVARD PIPES AND UTILITIES, IF ANY, NOT DETERMINED.
S JACKSONVILLE, FLORIDA 32210 4.JURISDICTIONAL AND/OR ENVIRONMENTALLY SENSITIVE AREAS IF ANY, NOT
? 904-771-6468 LOCATED BY THIS SURVEY.
J 5,THIS SURVEY WAS BASED ON LEGAL DESCRIPTIONS FURNISHED AND THE
CERTIFICATE OF AUTHORIZATION NO. LB 0005488 PUBLIC RECORDS WERE NOT SEARCHED BY THIS SURVEYOR FOR EASEMENTS, TITLE,
p S S d `--vi6dwm �. COVENANTS OR RESTRICTIONS THAT MAY AFFECT THIS PARCEL.
I HEREBY CERTIFY THIS SURVEY WAS DONE UNDER MY 6.UNLESS OTHEROSE STATED ALL IRON PIPES FOUND HAVE NO IDENTIFICATION.
DIRECT SUPERVISION AND MEETSTHE MINIMUM TECHNICAL
STANDARDS FOR LAND SURVEYING°.PURSUANT TO CHAPTER x—X- FENCE LEGEND/AWREVIATIONTI R) - RECORD
6TG17-6 FLORIDA AbMINISTRATICI�CODi=, CHAPTER 472, F,S, -SET IRON PIPE OR REBAR MARK P.C.- POINT OF CURVE �M)-MEASURED
ASSOC. SURVEY " OR L.B. 5480 P.T.-POINT OF TANGENCY A - CENTRAL
FOUND IRON PIN OR PIPE C/L - CENTERLINE ANGLE
BY: ,xb ■ - FOUND CONCRETE MONUMENT I.P.- IRON PIPE OR PIN L-ARC LENGTH
CHARLES B. HATCHER FLORIDA RT KATE NO. 1 X - CROSS CUT OR DRILL HOLE R/W - RIGHT OF WAY R RADIUS
CHARLES L. STARLING FLORIDA CER IFICATE NO. 4579 P.R.C.- POINT OF REVERSE CURVE ELECT.- ELECTRIC CHb)- CHORD
p.C.C.- POINT OF COMPOUND CURVE CONC.- CONCRETE
RAYMOND J. SCHAEFER FLORIDA CERTIFICATE NO. 6132 REF. COR.-REFERENCE NSD- NAIL AND
_ B.R.L. = BUILDING RESTRICTION LINE DISK
JOB NO, 3017 DA i E /Z l�G•, 200 Z ORV - OFFICIAL RECORDS VOLUME (C&R)= COVEONRANTS AND P•B• = PLAT K
SCALE: T" -�o GRAFTER .• F.Je. J.E.A. -JACKSONVIILLE ELECTRIC CORDS KALmionry RESTRICTIONS
�OU--OVERHEAD UTILITIES
NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER