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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 tb I —j - f,-- 'j, ;, , — It— , -- . ic, k__/ — 77' COMMUNITY DEVELOPMENT APpROVED 4 k I ,LP �p IL D- Y2 Clio cm - V1 4 k I ,LP �p QD dl - co a 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