826 OCEAN BLVD - DRIVEWAY 4v;41-
� 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: DWAY17-0023
Description: construct crushed concrete driveway
Estimated Value: 300
Issue Date: 1/16/2018
Expiration Date: 7/15/2018
PROPERTY ADDRESS:
Address: 826 OCEAN BLVD
RE Number: 170337 0000
PROPERTY OWNER:
Name: PARKS SCOTT
Address: 309 ROSCOE BV N
PONTE VEDRA BEACH, FL 32082
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.
' yS .i City of Atlantic Beach APPLICATION NUMBER
r s Si, Building Department (To be assigned by the Building Department.)
800 Seminole Road /� 1 O A
-, Atlantic Beach, Florida 32233-5445 1:$14
Phone(904)247-5826 • Fax(904)247-5845 �O1.
"!unit)'" E-mail: building-dept@coab.us Date routed: 3lt "t
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: sa O D(_,Q_an 3J3 • Department review required Yes No
Build in•
Applicant: OW Planni ng Zoning-)
1 n Tree Administrator
Project: �r)s\itA LA l_i as\Adi 4ublic Works
,p Public Utilities
(-f+J Q (A-1 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. Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by:*`----- -- Date:( Z--(7
v'.5- 16. 2(, . /-7
TREE ADMIN. Second Review: A roved as revised. Denied.
❑ pp ❑ 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
t-�vb-�� City of Atlantic Beach APPLICATION NUMBER
�S r � Building Department (To be assigned by the Building Department.)
800 Seminole Road DIA)
1l--00�
�� -, Atlantic Beach, Florida 32233 5445 C1 2 2��1 GVW l �]
Phone(904)247 5826 Fax(904)247-584P 1�1�3 T
\a;3it E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 'a W Ou_an C ,k),A • Department review required Yes No
Building
Applicant: 0W (Planning T oni
\_ nn', Tree Ad im nistrator
Project: LA)r)s\ auk ti ash6 Wf it epublic Works
,p Public Utilities
.3_i: J Q (Al 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. I 'Denied. Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed byjateatekla Date —j7
TREE ADMIN. Second Review: Approved as revised. Denied.
pp ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: nApproved as revised. nDenied. I INot applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
'p�.y Building Permit Application Updated 5/5/17
City of Atlantic Beach
800 Seminole Road, Atlantic Beach, FL 32233
��'� ' Phone: (904) 247-5826 Fax: (904) 247-5845
Job Address: V6' 0 L-GA t3 L \ -!0. Permit Number: `0 W I1-0�3
Legal Description $Z( 6Ct'/+� (__Ni 0• RE#
Valuation of Work(Replacement Cost)$ ZOO 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 i detail the type of work to be oerfor, ed:
4 �� (lr ( CoN t77 c2L)SNe PCii►3LES
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: jc-o Pb¢fL 14- Address: `6 Z(P OCt ,� C-5L i)..64-T[-Al./7 t c- ',Cm r f State f L^ Zip . 2 Z-3) Phone_ 626 L) 4Q '/ c, 1 2 2—
E-Mail S�6i1`pRI2-1-(S e VA ►-5LOr.,_vE��Alvl6C--/z . 00---%,
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: i�vu'Ex-L Qualifying Agent:
Address City State Zip
Office Phone Job Site/Contact Number
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 NOTICEOF COMMENCEMENT.
Zlj
(Sig . e of Owner or Agent)
40 (Signature of Contractor)
cluding contractor)
Signed and sworn: . or affirmed)before me this a Qay of Signed and sworn to(or affirmed)before me this day of
l?C.'tbha, a�_,by _Sc04 4}A/KS , ,by
[`SYCO , �S�•N#GG04298A
(Signature of Notary)
ir:
•�' EXPIRES:October 27.2020
x, o?' Bonded 7hru NotaryPublic Unoervrrlters
[ ]Personally Known OR [ ]Personally Known OR
Produced I icatioication/ et1 i i t _ [ ]Produced Identification
ype of Identification: (4 �,(�k— Type of Identification:
cid
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. o CITY OF ATLANTIC BEACH
' OWNER / BUILDER AFFIDAVIT
-DB VP"
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.
i166C-c4,0 1SI.QQ RTL.Ai✓1- IC c3-Crit..ti- 6,6“ 470") . D (2Z
ADDRESS PHONE NUMBER
co—Cr ?a— —tq
PRINT NAME
SIGNAT• E f �.��Q� DATE
Before is ao day of `��"�/'�! ,20 an the county of
Duval,- -te of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate. Q
Notary Public at Large,State of �� ,County of V A I
' �"'C. JENNIFERJOHNSTON o
❑Personally Known < =`;��' '?
,Q Produced Identification- • J ,4 C _'*. �,��i ;#: tAY COMMISSION!R GG 042984 I
11
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F;4P' bonded ThR
' ' -6111111111.— Notary Public Underwriters
Notary Signature: ` J V _^���
F:BLDG/Owner-Builder Affadavil VISED. 4/16/200
rs `1, n
111
o ,
s REVOCABLE ENCROACHMENT PERMIT
on 9%'
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 Sipa P 6.1�S
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 up n the
property for the purpose as described in the City of Atlantic Beach Right-of-Way Permit# Dw AM 11-b Oa
This work is generally described as SPII6.190 i 1 G c oovc4E Te(92 oS tic n Petj6C.Es
Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted refrains 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
• 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
assu i.. s y the USER.
- Alir
Date /c;(2.V/ ?
Property"er/Agent(signed in presence of Notary Public)
STATE OFOFFLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this aO day of Oo())b...( ,20 (I" ,
by .S CD POI�S ,who personally appeared before me and
(printed name of Signer)
acknowledged th.t he/she signed the instrument voluntarily for the purpose ex•ressed in it.
Al :,Qir;P::P .; JENNIFERJOIir!=.'• :
r, ,a, '�" MY COMMISSION#::(:9'? •
/wow ;".j...o` EXPIRES:October 27.>. -
..
:'$---QP: Bonded Thru Notary Pubiic U
Signatur; •• 6 I:r Public, State of Florida
Approved/Public Works Department:
Personall 1 own K
Produced Identification(Type) C Ll ( (LEA-fi \k-C.cr d
Scott Williams, '" :f ',Public t or s Director
�f ,f
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• Pop.°,RIGHT-OF-WAY/EASEMENT PERMIT
r A sl
\-4/400,/ Permit # Issued by the City of Atlantic Beach -OW Al l'}—O('
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address 2 c ccA 0 t LU 0. Phone
Permittee 3-"�6 Qom- Kg Email Sco Tr M-vl- KS @ Vel u-ic v“-E-04-
(A u-'I.LCL•Cvii
Requesting Permission to Construct "5$ fL E-A D t N 6- L tL US i-1 EU c o#U C rz t r E P c hoc
is
Location(Reference to Cross-Street) i.. .ca c c_ ,.. t3 Ls)0,
• 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 c,ozr Sae . pR(i-
(Project Superintendent)
located at I0g6 }ow£ -a/re 60S v49NCO u,. 'rt CA ,-. Prah- 6/6Z aT ( .
• 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
immediatel •o • pletion.
Date to /no/i-t-
Permittee(signedesence of Notary Public)
STATE OF FLO'1 0A,COUNTY OF DUVAL
The foregoing instrument was acknowledged this b.D day of °C'tW ,20 i q ,
by S( P Cl.' -S ,who perso. , r•� rr
name of Permittee) .,-;',.?,..:4÷,,,-
(printed I - •- C 04
ti.4% ' = MY COMMISSION#GG 042984
acknowledged i at he/she signed the instrument voluntarily for the purpose expressed in it. ."4:407i.,;;;•'
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