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63 W 4TH ST - EXTEND CULVERT c`'� r A CITY OF ATLANTIC BEACH i r f y.._-. , Vie: 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 ;t v%' INSPECTION PHONE LINE 247-5814 RIGHT OF WAY - SINGLE OR TWO FAMILY RIGHT OF WAY MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: ROW17-0024 Description: EXTEND CULVERT Estimated Value: 250 Issue Date: 11/22/2017 Expiration Date: 2/20/2018 PROPERTY ADDRESS: Address: 63 W 4TH ST RE Number: 170823 0010 PROPERTY OWNER: Name: GARCIA GUADALUPE Address: 63 W 4TH ST ATLANTIC BEACH, FL 32233 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. rSr�ir�J- City of Atlantic Beach APPLICATION NUMBER �s \ 1 Building Department (To be assigned by the Building Department.) 2 800 Seminole Road Atlantic Beach, Florida 32233-5445 I C7 1` 1 7— tJ cz 4 Phone(904)247-5826 • Fax(904)247-584NOI � - :- r 1t� E-mail: building-dept@coab.us � 2W/ Date routed: I I l t ( 7 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: Cy 6 \\ C - Department review required Yes No Building Applicant: D Lti 1� F (z___ Zi sot TreePlanning Administrator Public Works Project: k '}- 2r1 L.. sCJ(vQ s• 1 ublic UtilitiesL41 {v D c l S t • p - u • afety Fire Services {�tve cA'-I Review fee $ / 2_ Dept Signature K Review or Receipt \ Other Agency Review or Permit Required Date of Permit Verified By �j Florida Dept.of Environmental Protection \/� Q( Florida Dept.of Transportation tV 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: Eiopproved. nDenied. ❑Not applicable (Circle one.) Comments: BUILDING ANNING &ZONING--) WI Z Reviewed by: Date: / / TREE ADMIN. Second Review: Approved as revised. nDenied. I INot applicable p - T T•R Comments: 'UBLIC SAFETY Reviewed by: Date: /1-2—r7 FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 rlyLyjjj City of Atlantic Beach APPLICATION NUMBER �S �\ Building Department -- (To be assigned by the Building Department.) v 800 Seminole Road ,� r) Atlantic Beach, Florida 32233-5445 ��O V\i ( 7— ocz I Phone(904)24,7-5826 • Fax(904)247-5845 NOV 0 1 2017 aril9r E-mail: building-dept@coab.us Date routed: II It / City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: ((2 \ ) � � Department review required Yes No Building Applicant: 0 Lu vL Ea__. Planning &Zoning Tree Administrator Project: ;----; k i C ,:\ ci. Cu I V/ e f 4Public Works (Public Utilities U cJ Cc t 1\ S t d e Sc�� ' Public Safety Fire Services `_ (2._tv t Gly Ay Review fee $ Dept Signature 0C 3-- Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept.of Environmental Protectionc Florida Dept.of Transportation � St.Johns River Water Management District r' Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: 71Approved. ❑Denied. Not applicable (Circle one.) Comments: BUILDING e ANNING &ZONING /(!6,2177 Reviewed b : // Date:`(� TREE ADMIN. Second Review: Approved as revised. ❑Denied. fNot applicable P BLIe OR- Comments: BLIC UTILIT PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. ❑Denied. I !Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 iya,yf�J� City of Atlantic Beach APPLICATION NUMBER �s r S Building Department (To be assigned by the Building Department.) 4 r � 800 Seminole Road Row ' -7- /,0Z 1 '^ �' Atlantic •Beach, Florida 32233-5445 st/ Phone (904)247-5826 • Fax(904)247-5845 Jn1 - v E-mail: building-dept@coab.us Date routed: ii It 17 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM 211 L Property Address: 6-2 3 \\J 1 Department review required Yes No Building Applicant: Li (o ND C---Z___ Planning &Zoning , Tree AlrifiriiStratbr Project: x e i1ci. Cu(v P r `(---- Public Works Public Utilities U N b d` A t CI e S c% l' Public Safety Fire Services LTh i2._c v e vo A7 Review fee $ Dept Signature Review or Receipt 0( Other Agency Review or Permit Required of Permit Verified By Date 0 Florida Dept. of Environmental Protection \I) r� Florida Dept. of Transportation Q St.Johns River Water Management District VCA Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: i APPLICATION STATUS Reviewing Department First Review: ❑Approved. I iDenied. Not applicable (Circle one.) Comments: BUILDING CANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: Approved as revised. ❑Denied. Not applicable PUBLIC 1NORKS `� 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 3s"`''''` Building Permit Application Updated 5/5/17 J sd City of Atlantic Beach 800 Seminole Road, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Fax: (904) 247-5845 - Job Address: 6 <3 a) '� " � 1 0 W � 4 Permit Number: �_ `-' �� Legal Description RE# Valuation of Work(Replacement Cost)$ S d Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door • Use of existing/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 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: x end COI titerf r bt/'b c f' c or c/ri owet>' Florida Product Approval# for multiple products use product approval form Property Owner Information Name: j Jd1l() tJ v i-S Address: 1P33 W 4l 11 S City 44/ 44-1:L &C 44GL State F1— Zip 3-ea 33 Phone 904 ON s^J 3 k E-Mail J011Y\ NGrr;.S ll @ L- d'v►‘A+ 1+ tt'M Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company: Qualifying Agent: Address City State Zip Office Phone Job Site/Contac umber State Certification/Registration# E-Mail Architect Name& Phone# Engineer's Name&Phone# Workers Compensation Exem /Insurer/Lease Employees/Expiration Date Application is hereby made to obtain a permit to do tJa work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit andtliat all work will be performed to meet the standards of all the laws regulationg construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS, and AIR 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 RECORDI , Y. ' • NOTICE OF COMMENCEMENT. 4 gnature of Owner or Agent) (Signature of�tintractor) (including contractor) ] Signed a ! _ :. n to(or affi mei before m- this 1 day of Signed and sworn to(or affirfried)before me this day of U V ,70 1 7 by / &, C , , by 1111A I (Signature of Notary) // (Signature of Notary) Personal) Known OR �+Fr, [']� y iv.,;(,p;,,, [ ] Personally Known OR [ ] Produced Identification LE:;:-if.:- [ ] Produced Identification Type of Identification: G.,._:iTtii.iNc'wY �' j' Type of Identification: Y(��Lyr 4Zs,S 5v x REVOCABLE ENCROACHMENT PERMIT -on 91- REVOCABLE ENCROACHMENT PERMIT by the City of Atlantic Beach,Florida,a municipal corporation organized and e4isting ui}deraw o e tate 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 for the purpose as described in the City of Atlantic Beach. [�" �r This work is generally described as Wend t�Qni�f Uf2 beT/'/ Si alk (/TI dri 1/tWC(y 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 CITE'to USER,said 9ti e to ER shall be given by certified mail, (g return receipt requested,to the following address 4/411 . • 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 USER from any of the work herein under the terms of this permit and that all of said liabilities are hereby ass •dbyth:/1SER. i Date i1 /6 )i 7 Property Of ner/A ent(signed in presence of Notary Public) STATE OF I 4I A,COUNTY OF DUVAL / The fore oing instrument was acknowledged this C day of IQ 0 1 ,20 1 , IA C� by Q k r\ IA r t-1( S ,who personally appeared before me and (printed name of Signer) ac owle ed that /sh, signed the 4-trument voluntarily for the purpose expressed in it. c1.5- 4/f...." Signature of Notary Public, State of Florid Approved/Public Works Department: Personally Known r< Produced Identification(Type) _ / - // /// �� Scott Wil s, 'ublic Wor siirector qtr r !t N`t "1 ;. [,r,'cdlhta 'u;,ry' j } f ,. ') --. RIGHT-OF-WAY / EASEMENT PERMIT _,.- 1--/-01119.- FLli;1„.- Permit#Issued by the City of Atlantic Beach PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITTY LOCATES Job Address 603 eV 4M 5 Phone SOY 59 ' 5135 _ Permittee � t�� tI? I" s EmailJt11vif/41T?S 7/5-01C1414'ii' (641 Requesting Permission to Construct Ek{end L-d/vtir'' Of) St hf of&ye aitly Location(Reference to Cross-Street) IA) %1 • 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 (Project Superintendent) with Company Name Phone • 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. • The permittee shall commence actual construction in good faith within 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. • 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 Dir. tor of P t Works shall be notified twenty-four(24)hours prior to starting work and againimmediat- uponI pletion. Date (111 /XI Permittee(sig i 8 in pr: ence of Notary Public) STATE OF F ORIDA, OUNTY OF DUVAL I �] The foregoin: 'nstru 1- t was acknowledged this 1 day of ND CV ,20 1 / by V v C\ k Uk r f`( S ,who personally appeared before me and (printe. ame of Permittee) ac owle•ged that h:/she si: 4 ed the i .trument voluntarily for the purpose expressed in it. - S c Personally Known Signature of Notary Public State-ofPlorida "� Produced Identification(Type) C 1q 1? 1 - r-- - - B FEB 1 8 2004 11 BY �. __ • 20' BAL. (((777 . k viV/ A,6 /01e_ �� 1 X X 13TOR7 STRUCTURE q s 1i-fl0►,i l /4e14c .1 110,-0" 30-0_ 3Z'-m" �-- 10,-0. IY 1 I 6 0 Sc R,F-E-IV a f 20' 6.f2L. Y DRIVEWAY 3' WIDET • A i SIDEU1ALK II e. N � u Vis, .k 0(, ---_ -- x • _ ,4(. 0.001 J �o. CITY OF ATLANTIC BEACH IJ%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. ('/O Vv %-/h S4-, 141/ � &h1 6, 3433 q04-- 66e- 5931 ADDRESSPHONE NUMBER PRINT NAME ' .!►t ilk/ gOf'-) SIGNATU- DATE t r� Before m=this v day of k. o‘.7 ,2017n the county of Duval,Sta • 'orida,has personally appeared herin by himself/herself and affirms that all statements and declarations are true and accurate. tVOL-. Notary' Public at Large,State of F. om\ Y( ,County of , 0 OL- i1\ ._-I NPersonally Known /m, 0 Produced Identification- f •1 ++ m'°"jQj4"g`` •� griria,___ . .I :'s , pAY�''''.+.ieS:SDL M 4t_C,524?St Notary Signature: E?'i;FSEs:Grto6er E;,219 _ Al. a �� 13nr cdTta,!;n,', Puhl'cUr,deramier— F:BLDG/Owner-Builder Affadavit REVISED:4/16/2009 - - ,-4 Ns 't,f.: ../.:,...-1,'; . x5a • X 2 8 C. 6" PVC WATER MAIN. '' .1,4; ; TM ` yr •aU Xrrr�'zz.... is2 ,�" �' r. i-pr�Q i l 12r {9k J' ,3 �,tf � _;ms's' ,-,F.7,..-,=..-.,,.•--