91 W 4th Street 3 - Driveway Permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
o ji 19 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: DWAY1 8-0011
Description: extend concrete driveway 5 feet
Estimated Value: 500
Issue Date: 4/17/2018
Expiration Date: 10/14/2018
PROPERTY ADDRESS:
Address: 91 W 4TH ST 3
RE Number: 1708240030
PROPERTY OWNER:
Name: Karim Portela
Address: 91 W. 4th Street
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.
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.
Permit Conditions
City of Atlantic Beach
J
Permit Number: DWAY18-0011 Description: extend concrete driveway 5 feet
Applied:4/9/2018 Approved:4/12/2018 Site Address:91 W 4TH ST 3
Issued:4/17/2018 Finaled: City,State Zip Code:ATLANTIC BEACH, FIL 32233-
Status: ISSUED Applicant: <NONE>
Parent Permit: Owner: PRETT DEVELOPERS LLC
Parent Project: Contractor:<NONE>
Details:
LIST OF CONDITIONS
REQUIRED DAT7
SEQ NO ADDED DATE E SATISFY DATE TYPE STATUS
DEPARTMENT CONTACT REMARKS
1 1 4/11/2018 1 DRIVEWAY APRON INFORMATIONAL
PUBLIC WORKS Scott Williams
Notes:
All concrete driveway aprons must be 5"thick,4000 psi,with fibermesh from edge of pavement to the property line. Reinforcing rods or mesh are
not allowed in the right-of-way. (Commercial driveways-6"thick).
2 1 4/11/2018 1 ON SITE RUNOFF INFORMATIONAL
PUBLIC WORKS Scott Williams
Notes:
All runoff must remain on-site during construction.
3 1 4/11/2018 RIGHT OF WAY RESTORATION INFORMATIONAL
PUBLIC WORKS Scott Williams
Notes:
Full right-of-way restoration,including sod,is required.
Printed:Tuesday, 17 April, 2018 1 of 1 001
I__
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road twi A\-(
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845 routed:
E-mail: building-dept@coab.us L Date
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
�_t A�l
Property Address: Department review requ—ired— Yes - No
Building
<:�Plannin - &zoningl
Applicant: CvC4 9
Tr d rn—in—i s FF-516—r
Project: (Ot (2u_9i'c_�Works��
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: FZApproved. E]Denied. E]Not appiicabie
(Circle one.) Comments:
BUILDING
PLANNING &ZONING F
Reviewed by. Date:
TREE ADMIN. Second Review: []Approved as revised. F]Denied. F]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: OApproved as revised. ODenied. RNot applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
"ECE, -,
APPLICATION NUMBER
APR 10 2018 (To be assigned by the Building Department.)
City of Atlantic Beach
Building Department
800 Seminole Road bw A\-(
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845 L Date routed: _t et
E-mail: building-dept@coab.us
City web-site: http://vnm.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: De.partment review required Yes No
e .
Planning &Zoning
a
pa
nn
rt
n
men
Z
t
Applicant: I g & on 1)
Tr Administrator
ic Works
Project: 11 Util t
Public Utilities
y
Public Safety
F I s
5ireServices
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 Hotel-and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: loApproved. [:]Denied. [:]Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed b Date:
TREE ADMIN. Second Review: FlApproved as revised. ElDenied. [:]Not applicable
PVBLIC WORKSi. Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: FlApproved as revised. [:]Denied. [:]Not applicable
Comments:
Reviewed by: Date:
Revised 05/1912017
Building Permit Application Updated 12/8/17
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233 APR - 9 2018
Phone:(904)247-5826 Fax:(904)247-5845
(A ��
—o C)I
Job Address: Permit Number: DWA\[ I
Legal Description —RE#
Valuation of Work(Replacement Cost) Heated/Cooled SIF Non-Heated/Cooled
Class of Work(Circle one): New Addition I�A=Iteratio Repair Move Demo Pool Window/Door
Use of exi sti ng/pro posed 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:
+ fv
Florida Product Approval# for multiple products use product approval form
Property Owner Information
'I 'S�'-
Name: c,- Address: ':21 1 U) 1�
city 1). State Fi Zip 3Z'Z_,33 —Phone C)r1,
E-Mail -V v-�tg \S C, ;�_,�nZ �
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/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 NOTICE OF COMMENCEMENT.
(Sig'n4ture of Owner or Agent) (Signature of Contractor)
(including contractor)
Sqnedd and sworn to(or affirmed)before me this 9 day of Signed and sworn to(or affirmed) before me this day of
i,-,
by K4,f tA by
gnatur (Signature of Notary)
elNgffi�5&NSTON
MY COMMISSION#GG 042984
Pr�ersonally Known OR EXPIRES:Odober27,2020 Personally Known OR
0 Bonded Thru Notary Public Underwiters
tio
Produced Identificatioril I Produced Identification
Type of Identification: Type of Identification:
qqA timigti �_mfblikjn
e,3&4.RF, Nil JIA
Se
f
_o,
!ivghji�j� 1k, !ojfp��,� e.-_j �t'j, L
10
J
14 O-Al :-,�t4
V -icoifq A �i-
AJ
,�-i a-) bri,A-f::'v lt A)n?
v:'e
A,
j 7 W ID P'.I- b ViA T �A:i T H P.3,J 0 12 `J A
vro;i�wa r��iQo
T,
N: ": -, �`J� ..:
G'w"�Iav� fir, tvftbrtz 9. x)s ;;s 101 A�
q.t �Jlj�
'k-ll 3391"� MO.D iO _331TCAA A U 0" lt';'r I,I IJJIA I 1;-i U'OY At`]V, 71ANJ OT ;)P, io,11 VJ
VAIM TW+ - :V-1
OWTIA! 140+,.�jIV'�!T :DAIVA' rl IUOY Vii IUZJZ3A
Jv
3%i 1101POITA il 'I Y i"IA 7JUM01 , "�,11:01-,11111 VIIATIM) OT
10 3:1,�mrjo 9.uoy
ol w? v: 9. liP ��ff!sm S-VISI tb-_*%(T�_.Mb 01,C-r!�-'Vff,LW":
................
jamm no A idc4mwba
Ao I-, esos.12 101*P tvp�a_ v p
Y-WaV,iMT 10
RIGHT-OF-WAY EASEMENT PERMIT
Permit#Issued by the City of Atlantic Beach
PERMITTEE RESPOASIBLE FOR NOTIFYING 811 AND OBTAE14ING UTILITY LOCATES
Job Address-91 46n-� c-, Phone 305`3�0 - 7S-f 'Z_
f_C_00� P�, 3ZZ-3_3
Permittee 1�ay_1'01 ycx_�kpll Email 0?
Requesting Permission to Construct
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 �R)f_ ar4e_�� (Project Superintendent)
with Company Name Phone 30Q- 7 S-1 2-
• 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 anid 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
V immediately"completion.
I— -
a f X n Date
Uj_(Sign'
mit e ed kn presence of Notary Public)
Pi 11
STATE OF FLORIDA,COUNTY OF DUVAL 9
The foregoing instrument was acknowledged this day of h��p 20
by Y_OL r Z IV\ �0( 0_�Ck who personally appeared before me and
(printed name of Permittee)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
nally Known
Signal@ o�jtary'TuTi_ic,State 0 H-1, SION Pro ced Identification(Type)
JENNIFE JOH r
29M
G
MyCOMMIs N#G 042984
So
Oe0b-r 21,2020
EXPIRES�
U
TEE
40
CC)
6 -
- n VOW
r-I V— VOW
V-
0 0
.js�
llj�ONC
.0
IA
VIM
or CY fif)—
(ro i t o*oz
m 90,VL IF a0z S
U6 0 j
-10
0
LLJ
lot 14
41A A-
VOW ON 4"
4". 1' 0
r) %
LA. c; vow VW* 411
IF
CL V
0 0 ""111�
46 1� J
Vk
X 3AIVA CX
�13LLVM
(fro) Moil - cn
0 33N3J 00 6*o Ck. a
om (ro
T10d
;.............. I I III 1,111�1111111111-,,IIII I'lli a 000 zo
Wd
oolv, .......... .......... ctootzl 70011
'AA 3 N 0.1)
..........
-MkrP.
"A
Vit't
'�%xs�.
JA
Ilk
14
14
Zcl
Wn�V
R-A�
h Asr
q4 1"aw
flt
CA,
'4ft
C
ANN".'
VT.41,;
At"
ow
It
Op
14
4L
44
I"011
AZ`A