211 Beach Ave DWAY18-0016City of Atlantic Beach
Building Department
`Sr 800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone (904) 247-5826 • Fax (904) 247-5845
rJi31Y E-mail: building-dept@coab.us
City web -site: http://www.coab.us
APPLICATION NUMBER
(To be assigned by the Building Department.)
Date routed: �-
APPLICATION REVIEW AND TRACKING FORM
6(L�� Department review required Yes No
Property Address: , Building
Applicant: Tree Administrator
UbIZ OrTs
Project: Public Utilities
Public Safety
Fire Services
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 Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
First Review: Approved. ❑Denied.
❑Not apLable
[�Re�v*iewingDepartment
one.) Comments:
BUILDING
13
Reviewed by'.
Date:
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied.
❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
Reviewed by:
PUBLIC SAFETY
Date:
FIRE SERVICES Third Review: ❑App roved as revised. ❑Denied.
❑Not applicable
Comments:
Reviewed by:
Date:
Revised 05/19/2017
City of Atlantic Beach
a Building Department
800 Seminole Road
sy Atlantic Beach, Florida 32233-5445 MAY
Phone (904) 247-5826 • Fax (904) 247-5845
E-mail: building-dept@coab.us
City web -site: http://www.coab.us
APPLICATION NUMBER
(To be assigned by the Building Department.)
I_Ayv I _0C"(
Date routed: I (
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1l U kcy) hk
Applicant:S
Project:
Department review required Yes No
Building
& Zonin
Tree Administrator
Public Ufilities` .
Public Safety
Fire Services
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
7 w
PLANNING &ZONING
Reviewed by
Date:
TREE ADMIN.
Second Review:
" Approved as revised.
❑Denied.
❑Not applicable
Comments:
PUBLIC UTILITIES
ti
PUBLIC SAFETY
Reviewed by.
Date:
FIRE SERVICES
Third Review:
❑Approved as revised.
❑Denied.
❑Not applicable
Comments:
Reviewed by:
Date:
Revised 05/19/2017
ECEIVE",
JUN 0 6 2010
CITY OF ATLANTIC BEACH
k
`
BY, — 800 Seminole Road
Atlantic Beach, Florida 32233
REVISION REQUEST / CORRECTIONS TO PLAN REVIEW COMMENTS
Date 10 , ),I ° _ Revision to Issued Permit_ Corrections to Comments_ Permit 4T�`T �- Co i to
chi'0 _
Project Address a �'
Contractor/ Contact Name Jr -t- i uf' > i Z m 6TRL2cT 6 KJ
Phone
Description of Proposed Revision / Corrections:
Email N (" -'u "-v-5
I~l -V-(p EERVIbUn V 4 R
Permit Fee Due $
Additional Increase in Building Value $ -- —7 Additional S.F.
By signing below, I MaPT T . 4E)-= affirm the Revision is inclusive of the proposed changes.
(printed name)
Agent (Contractor must sign if increase in valuation) Date
Approved
Revision/Plan Review Comments
Department Review Required:
Building
Planning & Zoning
Tree-Adnaa riistrator
"��Public Works
Public Safety
Fire Services
Denied
(Office Use Only)
Not Applicable to Department
XVk,evie y
Dee
PUBLIC WORKS PLAN REVIEW COMMENTS
CITY OF ATLANTIC BEACH
Department of Public Works
1200 Sandpiper Lane
Atlantic Beach, FL 32233
(904) 247-5834
Date:
5/30/18
Applicant:
Cornelius Construction
Permit #:
DWAY18-0016
Email:
peRy corneliusconstruction.com
Review Status:
DENIED
Property Owner:
Richard Simmons
Site Address:
211 Beach Avenue
Email:
meiindapsImmons mall°com
THIS PLAN REVIEW IS ONE OF MULTIPLE DEPARTMENT REVIEWS
Correction Items must be submitted to the Building Department at 800 Seminole Road.
Submittals that respond to only one or a few correction items will not be accepted.
Revisions may not be submitted until ALL departments have completed their respective reviews.
Revisions must be submitted to the Building Department and must respond to EACH department review.
PUBLIC WORKS CORRECTION ITEMS: APPROVED
• Documentation shows impervious areas are over the 50% allowed by City code.
• Parking must be 20' from intersection.
PUBLIC WORKS CONDITIONS OF APPROVAL:
(The following comments will be printed on your permit as Conditions of Approval)
• 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.
• All runoff must remain on-site during construction.
• Roll off container company must be on City approved list (Advanced Disposal, Realco Recycling,
Shapell's, Inc., Republic Services, Donovan Dumpsters). Container cannot be placed on City
right-of-way.
• Full right-of-way restoration, including sod, is required.
• Provide construction 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.
Scott Williams, Public Works Director swilliams, co.us/ 904-247-5834
Page 1 of 2
0:\Public Works\ADMIN\PLAN REVIEW COMMENTS\DWAY18-0016 (Cornelius).docx
Resubmittal Notes: All revisions and changes shall clearly stand out from the rest of the drawing on the
sheet as a revision by way of completely encircling the change with "clouding". The revision shall also be
identified as to the sequence of revision by indicating a triangle with the revision sequence number within it
and located adjacent to the cloud. The revision date and revision sequence number shall also be indicated in a
conspicuous location in the title block for each sheet on which a revision for that sequence occurs. For
projects still in the initial review stage and permit pending, all sheets with revisions shall be inserted into each
set of drawings. The original sheets must be clearly marked "VOID" but are to be left within the set of
drawings. Complete new sets of drawings will not be accepted. ADDITIONAL ITEMS MAY BE REQUIRED
DEPENDING UPON NEW INFORMATION AND CLARITY OF FINAL PLANS SUBMITTED FOR REVIEW.
Page 2 of 2
O:\Public Works\ADMIN\PLAN REVIEW COMMENTS\DWAY18-0016 (Cornelius).docx
Building permit Application Updated 12/8/17
City of Atlantic Beach
WO Seminole Road, Atlantic Beach, FL 32233
47 5826 Fax 10041247-5845
Phone. (904) 2 - � W A \� 1 00 I
Lob Address: �'.��` � A Permit Number,
Legs! Description �-0 T t ).*� 2 17 U BI 1/ 1e 10 t � � RE# f -7 0 !&S, C)
Valuation of Work (Replacement Cost) $ ,- -- Heated/Cooled SF - Non- Heated(Cooied '
• Class of Work (Circle one): New Addition =AEteratio Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s) (Ckirele one): commercial 4isi
if an mcistiner structure. is a fire sprinkler system installed? (Circle ane): Yes No N A
QECEIVED
s Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of N Tree Removal
Describe in detail the type of work to be performed:
[PST -AL -L FA a aMovC 0"FLM " MAY 15 2016
k?
Florida Product Approval # N A ror Mi,nulae i,1 UUUs.0 uae r,c wua.a ovF.—.........
Prownty lir Inforltnadon BU1161M) Department
Name• t^ ` f � I'a � Address: t # =_lilt �„
City rt State rp SZ" -51S Phone
E -Mail 2 �h Sirnn MrAi `OWE
Owner or Agent (if Agent, Power of Attorney or Agency Letter Required)
Contractor Infwmation
Name of company . t ` t l Qualifying Agent: 01)'1 `'
Address{ a
..�# , GtY,1`130BCState t- Zip
Office Phone 1} ` Job Site/Contact Number
State Certification/Registration # C FSC ? ° _ E -Mail 612 6 ' � `� tog, GO �
Architect Name & Phone # —
Engineer's Name & Phone # ----
Workers Compensation Exempt insurer/ lease Empleayees /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 brat may be found in the public records of this county, and
there play be additions[ permits required from'other governmental entities such as water management districts; state agencies, or
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.
(Signature of Owner or Agent) (Signature of contractor)
(including contractor}
Signed and sworn to (or affirmed) before me this � ofnand sworn to (or affirmed) ffirmed) before me this day of
Z,v � by e 1 -erl e. Ti gns � W by u t r 04 Lt- E (A"A,S
Iv owl,
(Signature f N.,otary)..e�..+� ��»:� - JENNIFER JOHNSTON
' ` MY COMMISSION # GG 042984
0t ?ya .,
DONNA L. BARTLE 'N �__
{) P ally Known OR : a� ;� i F'`� «"anally Known OR EXPIRES: October 27, 2020
radttced Iderriificati MY COMMISSION # GG 078627 { ]Produced Iden#+fication �'•'�F'�
(� 5 '••,�;; Bonded TW Notary Public underwriters
Type of Identification: ;'t ir,,F�CPI a 1 ,$� Type of Identification:
a :gin its"
REVOCABLE ENCROACHMENT AGREEMENT
z
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
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 remains subject to
Any facility maintained, repaired, erected, and/or CITY o USER, nstalled in the sad notice to USER shall bexercise of the privilege granted given by certified mail,
relocation or removal on thirty (30) days' notice by
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 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
t
specifications, to include utilities locate requirements and use limitations/requirements of easements, pright-
of-ways
g
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
assumed by the USER.
Date_ S-)Lfa,/ PK
Property Owner/Agent (signed in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL -0-rda of / "r ° 20
The foregoing instrument was acknowledged this Y
by p dc�� who personally appeared before me and
jijk pc
(printed name of Signer)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
RIGHT -0F -WAY / EASEMENT PERMIT
Permit # Issued by the City of Atlantic Beach
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
C
Job Address1 ` I- Phone F:3(- 52- (- 0 2
' `✓ �t�� � 1-I �-- _
Permittee poiEi-1 U°S ttiC1'C`CD I Email
c
Requesting Permission to Construct' ` l
Sr
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
'' 1= "-'1 1
(Project Superintendent)
under the supervision of
i� N i C�"� i I L �1 Phone �l G` Pli
with Company Name �c� QMH 1( —T
• 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
immediately upon completion.
/J - _ ,V /... z ./,, —Date ' �V
presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL 20 —�`
The foregoing instrument was acknowledged this �' day of U'Ll
by�„ , who personally appeared before me and
AS
printed name of Permittee)
ent voluntarily for the purpose expressed in it.
acknowledged that be/she signed the instrum
Personally Known
Sig ure ary Public, State of Florida
Produced Identification (Type)
JENNIFER JOHNSTON
MY COMMISSION # GG 042984
EXPIRES: October 27, 2020
*s
Bonded Ttwu Notary Public Underwriters
00
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It— , -- . ic, k__/ —
77'
COMMUNITY DEVELOPMENT
APpROVED
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BEARINGS BASED ON � LINE AS SHOW
noDg jjjAZARD ZONE 9-** AS SCALED FROM FLOOD
1-7
FLORIDA, DATED .4-- -
SURTV7
EYORS�. INC
:XS5NfV7-LtLE, FLORIDA 32256 (904) 73I -72J5
PffRE SURVEYED UNDER MY
-pr7
4A T T"X A Pr Aln
51 r0A,
�W �
MAP SHOWING BOUNDARY SURVEY OF'
LOT BLOCK 7-7' AS SHOWNA.
�c._ �,,-r �..._.! o . ( �.J`' v �� r v r �� � � ><..J ,�-• • •�•--r'Y__-� �..r -u-. c.. l�`J � � r -.a
AS RECORDED IN PLAT BOOK !r PAGES r-Gt OF THE PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA
CER TIFI _ D FOR: S , �� `'l s
��-• c-- rte. r �..� r`1 �i '� x.._t �C-62___, � Tc -t, l �`, C -o . �"i rt_._S i C� rs 5'1"" ( i 'rL�. J l=. rL..y c_ c S
i
ME
NOT VA
00
Aj
,sS G 4-4
UNLESS EMBOSSED WITH SEAL OF THE UNDERSIGNED.
BEARINGS BASED ON LINE AS SHUM
THE PROPERTY SHOWN HEREON APPEARS TO LIE WITHIN FLOOD HAZARD ZONE X-` AS SCALED FROM FLOOD
W SU ANCE RATE MAP coo ( FOR THE CITY FLORIDA, DATED `k- - 1-7 - aC'f
�...
TRI --
'TATSURVEYORS,
'.
8411 BA YMEADOWS
WAY SUITE
#2, JACKSONVILLE, FLORIDA 32256
(904) 7,31-72J5
LEGEND / HEREBY CERTIFY THAT THE ABOI/E" LANDS WERE SURVEYED UNDER MY
n CONC. MON RESPONSIBILE SUPERVISION AND DIRECTION, THAT 77-JERE ARE NO
® IRON COR ENCROACHMENTS EXCEPT AS SHOWN 1 AND THAT THE SURVEY SHOWN
(SET VJ771 CAP �F LS 4144) HEREON MEETS 77 -IE MINIMUM TECHNICAL STANDARDS SET FORTH BY
x FENCE THE FLORIDA BOARD OF LAND SURVEYORS PURSUANT TO SECTION
O IRON ro/i-. (FOUND) 4.72, 027, FLORIDA STA TU TES.
0 CROSS CUT
S.R.L. BUILDING RES77?IC710N UNE
LARRY G. EDDY, P.L.S. No. 4144
ESM'T EASEMENTRIW
COV. RIGHT—OF—WA?EDAREA ,. ; 30 '
CO V. CO AREA SCALE: ,--
f CEN RUNE /
A/C AIR ' NDI77ONING PAD R ISTER VEYOR, TE OF FLORIDA
(R) RADIAL DISTANCE DA TE: / o L-1 - �`t- l�
0 CON ETE