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176 PINE ST - DRIVEWAY ,), : . Ss1 ,/, ,,,,,,,,:,,, ,., CITY OF ATLANTIC BEACH ' 800 SEMINOLE ROAD , , ATLANTIC BEACH, FL 32233 t-1111, -,. 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: DWAY18-0004 Description: new paver driveway & back patio Estimated Value: 7500 Issue Date: 2/28/2018 Expiration Date: 8/27/2018 PROPERTY ADDRESS: Address: 176 PINE ST RE Number: 170628 0010 PROPERTY OWNER: Name: COMMANDER RONALD E Address: 240 INLAND RIDGE WY ATLANTA, GA 30342 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. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. * 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. 01.,m-fir,. City of Atlantic Beach APPLICATION NUMBER Js . Building Department (To be assigned by the Building Department.) - .- 800 Seminole Road ®C�v� Atlantic Beach, Florida 32233-5445 4-� l Phone(904)247-5826 • Fax(904)247-5845 13011�,` I + �4 �3 9%' E-mail: building-dept@coab.us Date routed: K) ( 1 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: I S Q P-- Department review required Yes No Building Applicant: O'.- —j /arming &Zonm Tree Administrator Project: ``) P 9-/ ( � �t.,Jc 4134 r ublic Worcs 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. ❑Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Dater a _ ee 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 ,f City of Atlantic Beach `Ec APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road P`E' \i _ ' Atlantic Beach, Florida 32233-544 2 1 2018 (Ai A �I I o��U ki Phone(904)247-5826 • Fax(904) -5845 + I I p,t10'' E-mail: building-dept@coab.us '�_.,.. Date routed. IcJU City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: I P't(\t_ 5-fQ L-- Department review required Yes No Building Applicant: Ct-J \--1 fanning &Zonin �Trreee dministrator Project: L' ) P� 04 � �) � (i j�,tk V "E �tt(l �. ublic Works 1 ((�� Public Utilities 0 0 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: APP !CATION STATUS Reviewing Department First Review: Approved. ❑Denied. ['Not applicable (Circle one.) Comments: BUILDING "" PLANNING &ZONING Reviewed b • Date: z-4,27-(ez-4,27-(e 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 :i:-------E---©-i„,, cv-- , L=.:r--------- AffkfrA Building Permit Application Updated 12/8/17 ,l City of Atlantic Beach FEB 2 0 2018 i'g n .r' 800 Seminole Road,Atlantic Beach,FL 32233 Phone:(904)247- 826 Fax:(904)247- 45 Job Address: /-7 6 *L aC•�/ r- ./. L/0ermltkdCimber: bW k ( � —0 o6Li Legal Description / < �2p� RE# Valuation of Work(Replacement Cost)$ 5 5 c 7 �Heated/Cooled SF 1/VP Non-Heated/Cooled • Class of Work(Circle one):4011r.dition Alteration Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commerci esidentia • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes oM 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: Ni Q— —4--V ci7 c.,- -- pc e-r—J-r/ IS - 't-----6e--4-2 c 2 Florida Product Approval# for multipleoducts use product approval form Property Owner Information ISG,•.{ r / � - , Namef s9 - /, �v i Address: /.. C.? T 7 pj' City 1s' _ --AP. State_EL Zip_enPho e - &� �� __C—t2/42.1. 6..--4). E-Mail - Cl -t(---(22_b -l1. -4e,I _71- 1& Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company: Y 27 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. NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and there may be additional permits required from other governmental entities such as water management districts,state agencies,or federal agencies. 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 NO ICE OF COMMENCEMENT. '-"?‘..-..- -lam ii (Signature of Owner or Agent) (Signature of Contractor) (including contractor) .•,..-• -• -------- �-- _---._-.L-. ed)before m(e/tJ1lr iis1�d day �oryff/���1Signed and sworn to(or affirmed)before me this day of .4.,:,1.7. , 1 VLM�RJ62445Q [ly I 1 . — L6( V.4'J 4 `}JI•\�•W.•\�� ■ , ,by ,�. PAY CCMMISSI•� : s. *. . ' .E� 9�^`„�;; EXPIRES:October 27,2020 N. -� %•;eon f;:V Bonded Thru Notary Public Und=- •..J - ( ignature of Notary) (Signature of Notary) [ ]Personally Known OR [ ]Personally Known OR [Produced Identification [ ]Produced Identification Type of Identification: C1 P �( 01 4.1 S\l ��` Type of Identification: .; CITY OF ATLANTIC BEACH sl ��%WNER / BUILDER AFFIDAVIT 0its ' _ 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. / 7 '5;4 kji c_1FK- 17-Z;9- 4-/&eZ-.12 ADDRESS PHONE NUMBER 'WD i(a"CCI / I4 PRINT NAME AlOP t ATUR S DATE OJAA-4 �- f/ :efore me this day of ,20_ in the county of Duval,State of Florida,has personally appeared herin by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of ` l- ,County of LJ�V ' ;PN::y0. JENNIFER JOHNSTONFt- 04 MY COMMISSION#GG 042984 ❑Personally Known /� _1 L EXPIRES:October 27,2020 .produced Identification- L . �r . L Q-( '•'.,Fo;F�o?'.' Bonded Thru Notary Public Underwriters Notary Signature: F:BLDG/Owner-Builder Affadavit;REVISED:4/16/2009 A ` _.-1W '4 ,rt• e ,� RIGHT-OF-WAY/EASEMENT PERMIT I'.6' Permit#Issued by the City of Atlantic Beach PERMITTEE RESPONSIBLE FOR NOT-IFYYING 811 AND OBTAINING UTILITY LOCATES Job Address I li 'Ft rf, - $A Phone dYr 0 Ili Permittee1. )Cad-d- Z(_.D Email co it,b ‘a�a q T-IC , 'Fv' L L 't. 4 ,vire Requesting Permission to Construct CIL i'"--A L _ � f• b N Location(Reference to Cross-Street) S--44-1,.._.--<-1 L t f'L....--,J1,1—' • 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 _ (--c (Project Superintendent) with Company Name a (lc' Phone VI ( £ 2 za.-)(Q • 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 •`'m`ed�ateli upolet�o Y 11 Date 01/ow Per ttee(signed in presence of Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL The foregoing instrument was acknowledged this a-0 day of f c�� ( 1 ,20 a g , by I-U(\Ct 4 tit,W Lr Ck CD(Y) ,who personally appeared before me and (printed name of Permittee) acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. • 1 /ik _ _ P- nown �+ Signature �` ,r �', lic,State of Florida 'feijuced .entification(Type) C-)k u i J Q,/t S li C Q-i1J Q v.f.,, JENNIFER JOH 2984 :,,,,,,,y,„; :"� BYo'= MY COMMISSION#GG 04 M.. A :w= October 27,2020 +t rani . ? EXPIRES: tars I'.7411 o<' Bonded ThN Notary Public Underv+ri `'\ c ' REVOCABLE ENCROACHMENT AGREEMENT REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach,Florida,a municipal corporation organized and existing under the laws of the State of Flo/-ida,hereinafter referred to as"CITY"and t ..CC� ( 7 —( 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 thew'' City of Atlantic Beach. This work is generally described as 4L it ( c. Q Ai Any facility maintained, repaired, erected, and/or installed in the e ise o he privilege granted remains subject to relocation or removal on thirty(30) days' notice by CITY to USER,said notice to SER s all be given ' certified mail, return receipt requested,to the following address i- N- t m. • 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 easement or 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 easements,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 SER. Date o? '�1J/79g, P operty Owner/Agent signed in presence of Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL The foregoing instrument was acknowledged this 8-O day of FLb I L&C Ctt ,20 \ , by (Z-an td &Cw Cra tom P'\„n V ,who personally appeared before me and (printed name of Signer) acknowledged t i t he/she signed the instrument voluntarily for the purpose expressed in it. AMU. Sign, e • s 'ublic, State of Florida Department Approval: Personally Known 1 • Produced Identification(Type) c 6-(\J QT'S `LLQ ii e_ �N'vbL•, JENNIFER JOHNSTON Scott Williams,Public Works Director/ MY COMMISSION#GG 042984 Kayle Moore,Public Utilities Director mei ��'� �F •ct be ],2020 •,Mast rm u jj�4 orms\Revocable Encroachment Agreement 2.5.18.docx "144 @`°fevisM te`$ t: LOT 656 •`� FENCED •� NORTHWESTERLY CORNER OF LOT 666. FOUND g7•X 49.87 )` � x ' O ( IRON PIPE (NO CAP) X >Li )2<5.49' u r n ��1 I 8 �i oy .> 243 o' x to x o m 89'55'13" o WOOD O FE °' COVE' a ' X COVERED 6' WOOD PORCH o , h PORC•, , Ti WOOD 0. (41 FENCE �.,. •a'.•10 , . ,,ITVAaitetit(ifDEVE��P ,� 1>.2' 4 10.8' e P R N4414 _ f3.4' y • • . X O V�` /moti �"" G r >.W G 6 q c4w" C. 0 CONCRETE X---L47 W��w o v 7.2. A/C PAD : 7:5' 3•ki r�� o co it N.- LOT 667 0 co O L, Ckr; 665 00 �°�4. Rcg� � o � oI,•Los PLASTIC a,O O E .E X s>d - : 3 : rtLt•44 f4 -grA ci4 - Tat" .c?' IP „3 444474,6 ,, , ii:.17,., nil , ” �i ae $ 45 , `',, .. „ ' �,�, 5E.0 % r y: a : 47 ` ' 8' 38'09" 0 Qt.-4. o) � POINT OF �..r,� '� ¢ l 0 : " �� meq:. /BEGINNING d • 89.59'28"til ••••• " •• •••• A / CORNER AOF ERLY 's-t-, -. 353.87' 9 2 ,Q7.`.:.••.-.-:• •.•.•;25. s o LOT 666 �� "5002' UTILITY POLE .. ... .. 50.00.'. CABLE RISER .,. ....... WATER METERS el a- w ,p 1.5' CONCRETE CURB & GUTTER MAILBOXES PINE STREET MAILBOX\__ 50' PUBLIC RIGHT-OF-WAY Cdrt-t _rc'1t4b NOTES: � ' v(� LEGEND:DENOTES FOUND 3/4" IRON PIPE (NO CAP) 1) THIS IS A BOUNDARY SURVEY. DENOTES LESSSO SET NOTED R D B.#58778 2) THIS PROPERTY APPEARS TO LIE IN FLOOD ZONE O.U.L. DENOTES OVERHEAD UTILITY LINE "X" WHICH IS THE AREA OUTSIDE THE 500 YEAR I HEREBY CERTIFY TO: RUSSELL A. JONES FLOOD BY FLOOD MAPS REVISED APRIL 17, 1989, COMMUNITY PANEL No. 120075 0001 D. 3) NO BUILDING RESTRICTION LINE BY PLAT. 4) ALL DISTANCES SHOWN THUS: (100.00') ARE BY PLAT, ALL OTHER ANGLES AND DISTANCES SHOWN THAT THIS SURVEY MEETS THE MINIMUM TECHNICAL N WERE FIELD MEASURED. STANDARDS AS SET FORTH BY THE FLORIDA BOARD 6) ABOVE LEGAL DESCRIPTION WRITTEN BASED OF SURVEYORS AND MAPPERS, PURSUANT TO SECTION ON FIELD MONUMENTATION. 472.027 FLORIDA STATUTES AND CHAPTER 61017-6 FLORIDA ADMINISTRA ION CODE. IZEMORE AND FLORIDA ROBERT EDTSMPKINSR NO. '63- ASSOCIATES INC. DATE: JUNE 29, 2007 _- SURVEYING & MAPPING SCALE: 1" = 20' -' 6282 DUPONT STATION CT. E. UNIT #.2 UNLESS IT BEARS THE SIGNATURE AND 771E ORIGINAL CENS-D BUS ESS 7- ; JACKSONVILLE FLORIDA 32217 RAISED SEAL OFA FLORIDA LICENSE SUR-�EYOR AND (804} 737-6767 MAPPER THIS MAP IS FOR INFORIEATIONAL PURPOSES AND IS NOT VALID , zi??76'/4 /7 6 )50,,../i4ve 46- Y- iso -u z�:• y � � otriy Hoare I r,1 Arr • zv, 6 1(