309 Magnolia St - Permit DWAY18-0005 \ilj
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: DWAY1 8-0005
Description: replace paver driveway &walkways with pervious pavers
Estimated Value: 8000
Issue Date: 4/19/2018
Expiration Date: 10/16/2018
PROPERTY ADDRESS:
Address: 309 MAGNOLIA ST
RE Number: 1704500000
PROPERTY OWNER:
Name: ARIEFF SAMULE A
Address: 309 MAGNOLIA ST
ATLANTIC BEACH, FL 32233-4027
GENERAL CONTRACrOR INFORMATION:
Name:
Address:
Phone:
Name: KETTELLINC.
Address: 1860 MAYPORT RD
ATLANTIC BEACH, FL 32233
Phone:
PERMrr 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.
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road - 000s-
Atlantic Beach, Florida 32233-5445 OwWK
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us L Daterouted.
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: '8() q �kckq at,�io Department review required Yes No
�,uilding
Applicant: -_P Fa n n i n g T-23-h—ing-,
__F
Tree Administra or
Project: QC&CCC J_ j3 ajt4 Public W�rk'S---��
Public Utilities
D\,k &Q�4 Public Safety
Fire Services
Review fee $ Dept Sig natAk_11_%����
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 Engi neers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: VApproved. DDenied. E]Not applicable
(Circle one.) Comments:
BUILDING
J
PLANNING &ZONING >
Reviewed by:'9 Date
TREE ADMIN. Second Review: DApproved as revised. E]Denied. F]Not appiicahlp
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: F]Approved as revised. E]Denied. E]Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
City of Atlantic Beach APPLICATION NUMBER
Building Department 'To be assigned by the Building Department.)
800 Seminole Road 000s—
Atlantic Beach, Florida 32233-5445 fth i K
9 Phone(904)247-5826 - Fax(904)247-f 1145
I FEB 2 8 2018 Date routed:
E-mail: building-dept@coab.us f i
Cityweb-site: http://www.coab.us by-
APPLICATION REVIEW AND TRACKING FORM
Property Address: ab(tq Department review re Yes No
,,J Building
Applicant: 14 k �_A(_ <=lanning_&Zon—in-g-,,
Tree Administrator
Project: �_tDVCCU- 0(kj" &Jt4(,A�l tAi4l&k, Public Works
Public Utilities
L)\,k Public Safety
A,04 S
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: [O/Approved. [:]Denied. ONot applicable
(Circle one.) Comments:
BUILDING /17
PLANNING &ZONING Reviewed bK J14
Date:
TREE ADMIN. Second Review: oApproved as revised. ElDenied. E]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: E]Approved as revised. FIDenied. E]Not applicable
Comments:
Reviewed by: Date:
Revised 05/1912017
E 0 E 0 V E_�
Building Permit Application F__ Updated 12
City of Atlantic Beach FEB 2 7 20181
800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845
Job Address: 3oq f�424,00// !q �:S� Permit Number:
Legal Description 10-16 L4-ZSf-i46 Q46�r c�eL, 3 b�- 306 RE# —10 q�o —(go OC)
Valuation of Work(Replacement Cost)$ Heated/Cooled SIF Non-Heated/Cooled zv_�
• Class of Work(Circle one): New Addition 63 Repair Move 001 Window/Door
• Use of existi ng/p ro posed structure(s)(Circle one): Commercial esidential
s
• If an existing structure,is a fire sprinkler system installed?(Circle oc�)ne ets NocK_NIA
• 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:
idt_ Poxzr
lei- 101 , Li
Florida Product Approval# for multiple products use product approval form
PropertV Owner Information
N a e: _c�a m -i, -ra kA Address: 3D cl MaJ4
Cit A44.-1�f &4�L� State zip 31133 PhonC' ?-()6 6 S,?4 3
E-Mail_TSk1.1,L h;a ; Q, !401,hby� toy—
Owner or Agent(If Agent, PWwer of Attorney or Agency Letter Required)
Contractor Information 1]-- 1.
Name of Company: �V,el lo/11 0 Qualifying Agent: �AAI
1) cmAohrt- VtwA city A,& State FL, zip
Address & - 37-733
Office Phone X1 39L 371& Job Site/Contact Nu ber !Ah YjXeL %tl-3-11-10,09-
State Certification/Registration# E-Mailirl�c_ gr ell
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation AN 911—
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
RECOT,OURrTI,CE OF COMMENCEMENT.
(Signature of Owner or Agent) (Signature of Contractor)
(including contractor)
Signed and sworn to(or affirmed)before me this C�10 day of Signed and sworn to(or affirmed)before me this"I: 10 day of
e ! r '_>9-)I ! 0
STOI —9i I �
JENNIFEIR JOHN JENNIFER JO Ow
%# TOII&�
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EXPiRES;Octob
ISSION#
42984
EXPIRES:Oct0ber MYCOMM er 2
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b4,Produced Identification )"Produced Identification
Type of Identification: VL a J��,SVk L e Type of Identification: F-1— IL" S 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 Florida,hereinafter referred to as"CITY"and
&r" 4- :I;s k4 A!P,* 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.
This work is generally described as re,P la t,'Q a ddawAm
Any facility maintained, repaired, erected,1 and/or fdtalled in the exerefs-24of the privilege granted remains 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 364 /h"abb"A -5�k44w
I C,
• 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
�V47;� %, USER. Date—
Property Owner/Xgent(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this [n day of i Lk k% 120 1
by 7 C15 VIA 4 m 6 x tj Ai L who personally VZALdjefgre me and
(printed name of Signer) JENNIFER JOHNSTON
acknowledged that he/she signed the instrument voluntarily for the purpose expressed i iV My COMMISSION#GG 042984
EXPIRES:October 27,2020
Bonded Thru Notary Public undenwiters
Signa
,j�e Wotary Public,State of Florida Department Approval:
Personally Known
Produced Identification(Type) FL6_�J#��A'tc AK
Sco�WT11i'ams',PubTic Moris_61i7e0tjr
Kayle Moore,Public Utilities Director
H:\Master Forms\Public-Utilities Works Forms\Revocable Encroachment Agreement 2.5.18.docx
Revision Date:2/5/18
RIGHT-OF-WAY/EASEMENT PERMIT
Permit#Issued by the City of Atlantic Beach 0 W A "'! I � —00o,
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address— Phone
Perrnitteea, Email_1 0& 0 In(, - co rri
Requesting Permission to Construct &k P", - (a1(yW,,
Location(Reference to Cross-Street)_ 15?a
• 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 1?epartment of Transportation Standards and be performed
under the supervision of &�— &4—,*// (Project Superintendent)
with Company Name_J�,/Z1 let& — Phone 3 7 7 MOk
• 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 harinless 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
iately upoyo,5�pletion.
Date —,;?o 1
Permjffee-(signed in 1#esenWot`No&y Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this f�k(O dayof Ftbacc,( 20
71 K&V'kcl 9,OL Vv-%0 A C1 V, C W
by ,who personally appeared before ine and
(printed name of Permittee)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
Personally Known
Signal oTMary POM Produced Identification(Type).F:-L Oi.J-4-i
JENNIFER JOHNSTO
�Ay co-MISSION#GG 04]2q84
0 0
October 27 2029
EXPI
't.'s
Bonded ThN No*,ary Public U
TREE & VEGETATION AFFIDAVIT
City of Atlantic Beach
Department of ommunity Development
9 Z Planning 81 Zoning Division
800 Seminole Road Atlantic Beach,FL 32233
(P)904 247-5800 (F)904 247-5845 PERMIT#
SECTION I-APPLICANT INFORMATION /Pl,Owner(s) I— Legal Authorized Agent*
NAME OF APPLICANT
NAME OF COMPANY
ADDRESS OF COMPANY
PHONE ZZ,�7 CELL EMAIL
7 7- 7W
CONTRACTOR CERTIFICATION NUMBER
ATLBCH BUSINESS TAX RECEIPT NUMBER
SECTION 11 -SITE INFORMATION
STREET ADDRESS OF PROPERTY 3M ON
(-q
If an address has not been assigned to this propen�6 contact the AB Building Department at(904)247-5826 to request an address.
LEGAL DESCRIPTION 16--J5- Zqs
n�LI
BLOCK C SUBDIVISION
LOT _ 506
REAL ESTATE NUMBER /70 LOT OR PARCEL SIZE: SQ FT AC
RESIDENTIAL COMMERCIAL OTHER(SPECIFY)
offirm that/ have reviewed the provisions of Chapter 23, "Protection of Trees and Native Vegetation"of the Municipal Code of
Ordinances for the City of Atlantic Beach, FL andlor/have participated in a pre-application meeting with the Administrator of those
regulations. Subsequently, /affirm that no regulated trees and no regulated vegetation will be damaged, destroyed andlor removed
from� 1-describe or adjacent properties in conjunction with this project.
SIGNATURE OF OWNER SIGNATURE OF OWNER
Signed and sworn before me on thisQq.,�Oay of by State of rL—
:7K County of 0"t
Identification verified:
--_ it L J', v S, el
=b 0s No
HN ON
JENNIFER JOH�S��M �
A 0 1 #
y COMMISSION#GG 042984
EXPIRES.October 276 2020 ters
. Thu Notary Pu Ic d _
Notag
EXPIRES:October 27,2020
Bonded Thru Notary Public undermiters
REV-7VA-v 10.12 My 0 ission expires: