627 SELVA LAKES CIR - DRIVEWAY vL.,..,..„,�
,�� ' CITY OF ATLANTIC BEACH
'°. -) 800 SEMINOLE ROAD
J� xATLANTIC BEACH, FL 32233
a
;o;si9'? 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: DWAY17-0017
Description: PAVER DRIVEWAY
Estimated Value: 0
Issue Date: 10/19/2017
Expiration Date: 4/17/2018
PROPERTY ADDRESS:
Address: 627 SELVA LAKES CIR
RE Number: 172027 5556
PROPERTY OWNER:
Name: **CONFIDENTIAL **
Address: **CONFIDENTIAL ****CONFIDENTIAL **
**CONF **, XX 11####
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: CITYSTONE, INC
Address: 5023 Bowden RD
JACKSONVILLE, FL 32216
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.
irU
Permit Conditions
11
City of Atlantic Beach
Permit Number: DWAY17-0017 Description: PAVER DRIVEWAY
Applied:8/25/2017 Approved: 10/17/2017 Site Address:627 SELVA LAKES CIR
Issued: 10/19/2017 Finaled: City,State Zip Code:Atlantic Beach, Fl 32233
Status: ISSUED Applicant: <NONE>
Parent Permit: Owner: **CONFIDENTIAL**
Parent Project: Contractor:<NONE>
Details:
LIST OF CONDITIONS
SEQ NO ADDED DATE REQUIRED DATE SATISFY DATE TYPE STATUS
DEPARTMENT CONTACT REMARKS
1 8/29/2017 EROSION CONTROL INSTALLATION INFORMATIONAL
PUBLIC WORKS Scott Williams
Notes:
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 Erosion and Sediment Control Inspection prior to start of construction.
2 8/29/2017 ON SITE RUNOFF INFORMATIONAL
PUBLIC WORKS Scott Williams
Notes:
All runoff must remain on-site during construction.
3 8/29/2017 ROLL OFF CONTAINER INFORMATIONAL
PUBLIC WORKS Scott Williams
Notes:
Roll off container company must be on City approved list(Advanced Disposal,Realco Recycling,Shapell's, Inc.,Republic Services). Container cannot
be placed on City right-of-way.
4 8/29/2017 RIGHT OF WAY RESTORATION INFORMATIONAL
PUBLIC WORKS Scott Williams
Notes:
Full right-of-way restoration,including sod,is required.
5 8/29/2017 ADDITIONAL COMMENTS PUBLIC INFORMATIONAL
WORKS
PUBLIC WORKS Scott Williams
Notes:
This permit is for replacing existing concrete driveway and existing concrete walkway only.
Printed:Thursday, 19 October,2017 1 of 1 •
(--
, .:,,
Syvif , City of Atlantic Beach
APPLICATION NUMBER
�� Building Department
„ (To be assigned by the Building Department.)
;-. Atlantic8tla SeminolecRoad «L&J 100 f 7
Beach, Florida 32233-5445 L( 7 - 1
- Phone(904)247-5826 • Fax(904)247-5845
'- ri;;lr)%- E-mail: building-dept@coab.us Date routed: c/Z 5/i 7
City web-site: http://www.coab.us —
APPLICATION REVIEW AND TRACKING FORM
Property Address: COZ / S /,qLdesC( Department review required Yes No
Building
Applicant: t 'y L(SA-01\..)G. /� - Manning &Zona g-.)
Tree Administrator
Project: r PsUe rct. D z.lV>v voic\L- L Public Work
/ Public Utilities
Public Safety
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: ❑Approved. Denied.
❑ t applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by: c �^ 'k Date:
TREE ADMIN. Second Review: A roved as revised.
,� pp ❑Denied. ['Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:/�_17-( 7
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
SJA'i City of Atlantic Beach ,r APPLICATION NUMBER
l
Js ;�\ Building Department , A' .� (To be assigned by the Building Department.)
800 Seminole Road
� . Atlantic Beach, Florida 32233-5445 AUG [8 2017 ��}f`� 7 -w 17
•
Phone(904)247-5826 Fax(904)247-5845 y� /
-- j1��q'r E-mail: building-dept@coab.us Date routed: 8/z 5/1 1 7
City web-site: http://www.coab.us ` -- ///
APPLICATION REVIEW AND TRACKING FORM
Property Address: ( Z7 L VL \fEsA C(/2Department i� review required Yes No
ff Building
Applicant: i 7`-(S-"USC— ( N _ nning & oni
Tree Administrator
Project: Pc\ve-`'�. D zlVecv� blic Works j
/ Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Review or Receipt
Other Agency Review or Permit Required of Permit Verified By Date
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. I 'Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by r Date: j9--,-,2,17
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
,;yP� REVOCABLE ENCROACHMENT PERMIT
ir
o;t !)r
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of 20
by the City of 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 for the purpose as described in the City of Atlantic Beach Right-of-Way Permit# .
This work is generally described as (0 21 5elva La Ke s Ct rclf,
Any facility maintained, repaired, erected, and/or installed in the exercise of the priv ege granted remains subject to
relocation or removal on thirty(30)days' notice by CITY to USER, said notice to USE shall be given by certified mail,
return receipt requested,to the following address Power- Driveuloy
• 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 terms of this permit and that all of said liabilities are hereby
assumed by the USER.
_/.0,44)::..., c" Date OIZS ( 7
Property Owner/Age t(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged thisZS day of 20
I--7 ,
by L J[ Q n C. Stevens OR who personally onally appeared before me and
(,rinted name of Signer)
ackno :ed tha she sign the instrument voluntarily for the purpose expressed in it.
Signature of Notaryy ublic, of Florida
Approved/Public Works Department:
Personally Known
Produced Identificatio ,.-. -A- 6 5(-0c'�3-�
•-
/
P TONT GINDLESPERGER —!.f
' MY COMMISSION#FF 924951
4I EXPIRES:October 6,2019 Scott I hams, Interim Public Works Director
yi ;; c;;�ndedThruNotsPublicUnderwriters
I
,t c;1 RIGHT-OF-WAY / EASEMENT PERMIT
Permit # Issued by the City of Atlantic Beach
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address X077 5E2 V-
/9 4.9 F: CI R Phone *)41-75-9-c978" Ce-ZL
Permittee Email 049-CZ--- C//7-57-04/e,( coo-1
Requesting Permission to Construct PZRet' Cyt—a24eieerr ph)ifewny 4,c pifwe'
Location(Reference to Cross-Street)
• 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 (,Uk22/i/ ZJ'/' A/G* Na? - (Project Superintendent)
located at 9339 Cgfy Veit) Jepi Tipc )fir?
• 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 Director of Public Works shall be notified twenty-four(24)hours prior to starting work and again
immediately upon completion.
:0, r4-... . s Date g iZ,5 7,7
Permittee(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL `J ,
The foregoing instrument was acknowledged this day of , ....-7,
20 (
l
by'ice€. C ,S T even S or ho personally appeared before me and
(printed name of Permittee)
ac owldge i
i,t he/she sign•d the instrument voluntarily for the purpose expressed in it.
_A
`� Personally Known
�
�
Signature of Notary Public,S iiii�;Florida Produced Identification(Type) V F(q C
4:',AcZ:,, TONT GINDLESPERGER
'; MY COMMISSION#FF924951
,�—,4 EXPIRES:October 6,2019
, ed Thru Notary Public Unaerwnters
. � ,,, Building Permit Application Updated 5/5/17
r u 1 City of Atlantic Beach
800 Seminole Road, Atlantic Beach, FL 32233
i3 9' Phone: (904) 247-5826 Fax: (904) 247-5845
Job Address: b027 54:L 144 Lit- s,-,C/tf,e Permit Number: D W AL W 7 — 001 7
Legal Description Re IL 1'k .E V) l V�i4y RE#
Valuation of Work(Replacement Cost)$ ?8U
O C 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: geek lak- £c Pir✓G- (04.icR rz DR j l/C=7r1,/151
Fort VER Vi0as 2It v Rs .
Florida Product Approval# for multiple products use product approval form
Property Owner��// Informationq
Name: p//jf 3/�1n/ 7L? €2 ✓ Address: 6,77 St2,thi- L/IkES u1-
City ' . i C ! ell State '�.L Zip Phone p O - ' 39` 7�8'
E-Mail c2i-Fzc _ /Ty-511/1/6,, 6.0/n 9`/- a J/, a/a a '',2-`)
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: C>772/..5171)4/6,_.JAIG Qualifying Agent: IUFILI/14-1t/L /1J�/l e,
Address q33') aze-y N gfp City 1-29.-}'" State k- Zip 3225?
Office Phone $96:(24f - 75. -1/2 8'7 Job Site/Contact Number 'OZ/- 7_5?-0 7e-2 4-6z L
State Certification/Registration# E-Mail
Architect Name& Phone#
Engineer's Name& Phone#
Workers 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
commenced prior to the issuance of a permit and that 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
RECORDING YOUR NOTICE OF COMMENCEMENT. -
,V.."_. 2../-t; -L:.- - ._.24}.2 .4-a•6.)-
(Signature of Owner or Agent) ( gnature • Contractor)
(inclu ,contractor)
ned and sworn to(or of rmei) . ire me thi day of Signed and sworn to or affirmed) before me this2+ day of
U 1 b A�1 ,2-011 , by Wt I t;►`9+w, A icv,n i� J
MAW _-_ ,-------- - ---------
(Sign. .re of otary) • 1ir
i'ltCimawra.of�Lntir�il
,.uu `
r -'--..,2---,:-., .. .:-.:._,.:_-_--.. -2-2L_.._-!---.....-,
_ gam. ,..-. :° r P�°`�i BRANDON PAULSEN
'k'0 fONMMISSION#ERGEri I - •1 ? Notary Public-State of Florida
' MYPIRE COMMISSION ' f`My p,
'•:; 7:: EXPIRES.October 6,2019 o, Comm.Expires May 20,2018
[ ] Personally Known OR I •;:f„ t°' Bonded ThruNotayPublic Urderwnters [ I Personally Known OR 0 -"%:(81.;):V Commission#FF 125068
[ ] Produced Identification s r [4Produced Identification
Type of Identification: 0-4- i'->'410Type of Identification: 'rte __