662 Selva Lakes Circle DWAY18-0022 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 NE)rr DAY INSPECTION: 247-SS14
PERMIT INFORMATION:
PERMIT NO: OWAY18-0022
Description: REPLACE CONCRETE WITH PAVERS
Estimated value: 5000
Issue Date: 8/1/2018
Expiration Date: 1/2812019
PROPERTY ADDRESS:
Address: 662 SELVA LAKES CIR
RENumber; 1720275810
PROPERTY OWNER:
Name: HICKS STUART K III ET AL
Address: C/o STUART K HICKS 111662 SELVA LAKES CIR
ATLANTIC BEACH, FL 32233-4377
GENERAL CONTRACTOR INFORMATION:
Nam:
Address:
Phone:
Name: CITYSTONE, INC
Address: 9339 CRAVEN ROAD
JACKSONVILLE, FL 32257
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
Permit Number:DWAY18-0022 Description: REPLACE CONCRETE WITH PAVERS
Applied:7/2/2018 Approved:7/12/2018 Site Address:662 SELVA LAKES OR
issued:8/1/2018 Finaled: City,State Zip Code:Atlantic Beach,Fl 32233
Status:ISSUED Applicant:<NONE>
Parent Permit: owner:HICKS STUART K III I AL
Parent Project: Contractor:4NONE>
Details:
OWNER BUILDER
LIST OF CONDITIONS
SEQNOJ ADDEDDATE REQUIREDDATLI bAll�I-YUAlit STATUS
DEPARTMENT CONTACT REMARKS
1 7/12 2018 EROSION CO 4TROL INSTALLATION NFORMATIONAL
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 7/12 2018 ITE RUNOFF INFORMATIONAL
PUBLIC WORKS Scoftwilliams
Notes:
All runoff must remain on-site during construction. --i
3 7/1 /2018 1 ::���ROLL OFF�CONTAINER INFORMATIONAL
PUBLIC WORKS Scott Williams
N otes:
Roll off container company must be on City approved list(Advanced Disposal,Realco Recycling,Shapell's,Inc.,Republic Services,Donovan
Durniasters). Container cannot be placed on city right-of-way.
4 7/1 /2018 RIGHT OF WAY RESTORATION INFORMATIONAL
PUBLIC WORKS Scott Williams
Notes:
Full right-of-way restoration,including sod,is required.
CONSTRUCTION INFORMATIONAL
5 7/1 /2018 1 MANAGEMENT
PUBLIC WORKS �Iltt
Notes:
Provkle constructio site management plan,including location of silt fence,dumpster,portable toilet. Right-of-Way Permit is required If using right-
of-way for construction parking,
0
Printed:Wednesday,01 August,2018 1 of 2 1.,
Permit Conditions
City of Atlantic Beach
02:T
Printed:Wednesday,01 August,2018 2 of 2
City of Atlantic Beach R
APPLICATION NUMBE
Building Department CTo be assigned by the Building Department.)
r
77
800 Seminole Road Lo 0 CO-7
Atlantic Beach, Florid.32233-5445
Phone(904)247-5826 Fax(904)247-5845
E-mail: building-dept@mab.us Date routed:
city web-site: htIp:1Mww.coab.uS
APPLICATION REVIEW AND TRACKING FORM
Property Address: �262 7— S ELV A- L—PK—cs De artment review re uIred Yes No
Building
Applicant: ci TLts li— P &zo
Tree Adminis ra or
Project: AV&,P-- E(A pry Public Utilities
Public Safety
Fire Services I
Review or—Receipt
Other Agency Review r Permit Required of P,,,It VerW,,d By 06
Florida Dept.of Envimnmental Protection
Florida Dept.of Tmrsportation
St.Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Aloohollc Beverages o�Tnh—
Other
Yes
Fire WSeNM, 7
e A an MRRmdM
r g Cy "View or Permit "u
to'd.Dept of Env.mn..nt-I Prot.. on
d pt Tre P bon
nagement District
I'm Ds of re 0
t J Ims River Water M
Army Corp.of Eng"rears
Ztuon of Hotels and Restl
D.,s,.n of Alooholc Beverages a Toll
Other
APPLICATION STATUS
Reviewing Department First Review: pproved. ElDenied. ONot applicable
lewl g pa"Im nt
((Circile one.) Comments:
C rc
B L I r
UILDING
Ul
P I G &ZO
PLANNING &ZONING Reviewed by:AF_ 1_0� Date:
TPPF _)MI
TREE ADMIN. Second Review: ElApproved as revised. ElDenied. E]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:—
FIRE SERVICES Third Review: DApproved as revised. OlDenied. E]Not applicable
Comments:
Reviewed by: Date:—
Revised 05/1912017
Building Permit Application Updated 1218117
City of Atlantic Beach
ROD Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845
Job Address: k��Aj LjtA�� C_lg= PermitNumber: DWA�08 -00?'Z
Legal Description RE#
Valuation of Work(Replacement Cost)$5,-CPO Heated/Cooled SF Now Heated/Cooled_
Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
Use of exist!ng/proposed structure(s)JCIrc sidential
leone): Commercial Q�
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:
RCFZ#C a 6.�Wcgom- v1Z1 6wA� -S I Q&C/'9W Lo I rw l7AV&-?05
Florida Product Approval# for multiple products use product approval form
Property Owner Information 'Ll/
Name: 5 t- 5 Acldress:_�(02— S& 14
city M ic, LS1,fir Stat. Ziip 52�25.3 Phone
_&k /9,1
asr, I& M.
E-Mail— � �l ir"=Crf�
Owner or Agent(if Agent,Power of Attorney or Agency Letter Required)
Contractor Inforrouration
Name of Corn any: QuailfyU!9 Agem: W4!FUJA1&1V1V ALC,4*IV�&
Addressim 401rsg—�h —ci state Z p
Job Site/C �17 _7
Office Phone 170V-97�- $�wIYQ lea Nrnb1,, —0 7
State Cenification/Registration# E-Mi FK1959 CC "
Architect Name&Phone If
Engineer's Name&Phone#
Workers Compensation 516 5*0,2
Emian/insurer/ueme Emplo,ees/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[am 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 coun ty,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 ATTRRNEY BEFORE
RECORDINGUR NOTICE OF COMMENCEMENT.
re Contractor)
(Signature of Owneror Agent) gn.4�
(including contractor)
and sw (or a ed before me this day of SI ned and s orn to a r I b e "a of
6or
(Signature of Nota
(Signature of otarv)
rally Known OR M1.1. fly Known
RGUESPERGER
A uced Identification 'cL dc
Ident
Type Mimbfication
Identification:
Z-0z:) `79 1 G 6-4GO
City of Atlantic Beach
Building Department
800 Seminole Road
Atlantic Beach,Flonda 32233-
Phone(904)247-5826-Fax(904 AA
�-D�' E-mail: building-dept@mab.us
Cityweb-sfte: hftp:1hwm.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 6,�, F—L\(A- LAK-66-s Department review required Yes 0
Buildin
Applicant: P
—'�' P\y &f; Tree mini or
Project: Public Utilities
Public Safety
Fire Services
Review fee Dept Signati.] 11
Other Agency Review 0 Permit Required Review or eceipt Date
of Permit Verified By
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St Johns River Water Management Dilstdct
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages end Tobacco
Other:
APPILICATION STATUS
Reviewing Department First Review: VApproved. E]Denied. 1-1Not applicable
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed by: Date:
TREE ADMIN. Second Review: [JApproved as revised. DDemed. E]Not applicable
PUBLIGWORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:—
FIRE SERVICES Third Review: E]Approved as revised. F]Denied. E]Not applicable
Comments:
Reviewed by: Date:—
Revised 0511912017
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REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT,issued on this a__day of 20�)9
and existing 24Jaws of the State of
by the City of Atlantic Beach,Florida,a municipal Zrp:�;a�g7�d and
Florida,hereinafter referred to as"CITY"and
of Atlantic Reach,Florida,hereinafter referred to as"USER",
WITNESSETH:
That the CITY does hereby giant 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 6
Any facility maintained, repaired, ea�Ldlc�ljedl Lin tile exercise of the privilege granted remains subject to
relocation or removal on thirty (30)days' notice by CITY to USER, mid notice to USER shall be given by certified mail,
return receipt requested,to the following address C(.�k Sewa, La eS r( fC\e
• In the event it is necessary for the CITY or die 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, my and all
material necessarily displaced during the action of maintaining,mpairin&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 most
be replaced with smooth concrete left natural in color so that it marches the existing and adjoining sidewalks."
• The USER,prior to making any changes from the approved plans and/or method,must obtain written approval final
the City of Atlantic Beach Public Works Department,for mid change within 30 days after the day of completion.
• This permit shall mine 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 we limitationstrequirements of public right-of-ways and
other public land. USER father agrees that the CITY and its officers and employees shall be saved harmless by
the USER from my of the work herein under the terms of this permit and that all of said liabilities = hereby
assumed the USER.
Proper�ty owner/Agent tsigned in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this day of 20 Val
by��Cln ltkiCAS who person ly a�ppe�d before me and
r the purpose expressed in it.
Approved I Public Works Department:
Personally Known
Produced identification(Type) D C�
"?cmt`WiIliams,-Int&r
090
M=00" 1101"Ix,
octore,6,2D19
RIGHT-OF-WAY/EASEMENT PERMIT
Permit#Issued by the City of Atlantic Beach
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
JobAddressl(,2 16CLO& LAK0. Qk Phone
Permittee STVglZ7- tHICK5 Email
cog
Requesting Permission to Construct lzeytftce COA),�kETc �R I V�e_10*
Location(Reference to Cross-Stre
• Permittee declares that prior to filing this application they have ascertained the location of all existing utilities,
both serial 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,my 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 ofWEW)UG-t0,V ft6ftA,7Wf?,+ (Project Superintendent)
withCompanyName 141C� PhonepeO_75�—O
• All materials and equipment shall be subject to inspection by the Director of Public Works.
. All city prop" shall be restored to its original condition as far as practical,in keeping with City specifications
and the mourner 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 pertaittee 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 affict 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,
assurne all risk of and indemnify,defend mid 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
immedia y upon com letion.
A 2 Date ? 1,� b0l
P.rni�(adin presetibe o?Notary Public)
STATE OF FLORIDA,COUNTY OFDLTVAL, day.f
The foregoing instrument was acknowledged thi —201
by _�who�persally ppeared before me and
(printe nam fPermince)
in
ackn A gedthat a ' ed the instrument voluntarily for the purpose expressed in it.
Personally Known C_
ic,
SgioMotary Public,Snite o rida Produced Id tifi tion(Type)
M G1NDus?tRGER
n,0MM1S,,0N#FFV4V51
ax?,RE,ajotvG 2019
NOTICE OF COMMENCEMNT
(�Rrr`.E IN DUPI.ICAM)
Permit:No. Tax Follo No.
State of 11FL-- county
To sdoods it an"concern:
no Undersigned harster InfOrmor YOU Met Imprennesiments esill be made be contain nel property,and In
accoxiance wfth Section 713 of the Flodda Standee,the Mlowing Iniformation Is stated In this NOTICE OF
COMMENCEMENT.
L at dex�fpfiori Ofigp;��elipsoned' 1*et VD- lcl� P,
al L- 0+
F
ieyes ckvoe
General description,of hopmearn.rde: PVW12C &C�\le WGI
Onstner S
AMNON I
Gare,es Interest th She Of the IMPMereent
Fee Simple rdeholder(If other th an"ner)
Name <,�
Andrew
FL .7
C.:ddZ. R39 C&-^ %)eT\ QtlnC\ 1�0,C)A
phone NO. Q D I�Q—Fas NO,
So"(N any)
Adifters— AnwastdolUXIS
Ph"No. Fol,NO.
Name and address of an,perser making a Joan lbf Me emselsoolle,of Ma ImP�".
Name
Add..
Phone No. Fax No.
Name d person Whin the State of Florida,Other Man h1marelf.designated by omner Won Mom neffices or other
documents may be sersed:
Name
Address
Ph"NO. Fee Me
In addill..to Mosself,oemer dealginds.the follushmi,person W roosions a copy afft Usnorls Nuke as proUlded in
Secdon 713M(2)M),Rooda Statmes.(Fill In at OexW.option).
Name
Address
Phone No. Fax No. F!
Expiration ones d No5w Of Commencement Mw Oxidation data[a one(1)year Mom the data of 0 8 a ffilR-I
Meant dale Is Wacthol).—- - I t.t i 0
MIS SPACE FOR RECK)WER'S U89 ONLY ER
eya In
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Gofn�g&a,S.a M-6ft bes I..
DM#MI8155058,ORBK18441 PageI659, be.
Numbor Pages I
Reported 07IQ212DIS N:32 pM, so,
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL C44
COUNTY
Mary 1.N���'�.W.sa's
RECORDING $10.00
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