1435 Linkside DWAY18-0023 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: DWAY18-0023
Description: Replace Driveway with Pavers
Estimated Value: 1000
Issue Date: 7/31/2018
Expiration Date: 1/27/2019
PROPERTY ADDRESS:
Address: 1435 LINKSIDE DR
RE Number. 172374 5335
PROPERTY OWNER:
Name: KELLEY MICHELLE L
Address: 1435 LINKSIDE DR
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 a encies, 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.
r
Permit Conditions Page I of 2
Enter Permit Number DWAYIB-0023 Vlew Report
Y4 9 =of 1 Find I NW K• (AJ lig
Permit Conditions
City of Atlantic Beach
Permit Number:DWAY18-0023 Description:Replace Driveway,with Payers
Applied:7/3/2018 Approved:7/11/2018 Site Address:1435 LINKSIOE DR
Issued:7/31/2018 Flnaled: City,State 21p Code:Atlantic Beach,11132233
Status:ISSUED Applicant:4NONI
Parent Permit: Owner:KELLEY MICHELLE 1
Parent Project: Contractor:4NONEa
Details:
Homeowner Builder
LIST OF CONDITIONS
SEQADDED DATE' REQUIRED SATISFY TYPES STATUS:
NO DATE DATE
DEPARTMENT a CONTACT. REMARKS C
1 7/9/2018 EROSION CONTROLINSTALIATION INFORMATIONAL
PUBUCWORKS Scoft WBllams
Notes:
Full erosion mntrol measures and be installed and approved prbr to beginning any earth disturbing aRiyltles. Canted the Inspection une(247-5814)
to request an Edison and Sediment Control Inspection prior to start 0 maltmction.
i 7/9/NI38 ON SITE RUNOFF INFORMATIONAL
PUBUCWORKS Scott Williams
Notes:
Al runoff must remain on-site curial,construction.
3 7/9/1018 ROIL OFF CONTAINER INFORMATIONAL
PU8UCWORK5 Scall Williams
Notes:
Roll off container company must be on City approved list(Advanced Disposal,Realm RerydlnR 5hapelPs,Inc.,Republic Services,DOI Dumpstersl.
Container cannot be placed an City rlghtof-way.
4 7/9/2018 :1311 OF WAY RESTORATION INFORMATIONAL
PUBUCWORKS Scott L......ms
Notes:
FUII dghtof-way national Including sod,K required.
5 7/9/3018
RUNOFF INFORMATIONAL
PUBUCWORKS Scott WilliamsuBIs
Notes:
http://atlanticbeaCh.trakit.net/trakitIDocumentViewer.aspx?&report=/DocumentsIPERMIT... 7/31/2018
Permit Conditions Page 2 of 2
All runoff must remain onsite.cannot raise lot ele,n lum.
8 )/9 2018 MA%IMUM MINMAY INFORMATIONAL
AUCMESwtt Williams
Notes:
Maximum d,N.W width wNEln tIR CRY r19M-of-way Is 20'.
Printed:Tuesday,31 July,2018
I Of
http://atlmticbeach.trakit.net/trakitfDocument V iewer.mpx?&report=/DocumentstPERMIT... 7/31/2018
sn,y i City of Atlantic Beach APPLICATION NUMBER
+ �+ Building Department (To be assigned by the Building Department.)
`i 800 Seminole RoadHp ' — 06
r.' Atlantic Beach,Florida 32233-5445
V Phone(904)247-5826 Fax(904)247-5845 ate muted:
-r rs 9P E-mail: building-dept@wab.us JULI o5 Lrt
City web-sae: hmp:/Mw .coab.us
APPLICATION REVIEW A ING FORM
Property Address: ( 1(,35 w Ks 0e, Department review reghad Yes No
Building
n &Zonin
Applicant: (yy, 'p ree Administrator
Project: —R late- V—W At4 L01 a P °
Public Utilities
Public Safety
Fire Services
R „
Review or Receipt Date
Other Agency Review or Persil Required of permit Verified B
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Arany Corps of Engineers
Division of Hotels and Restaurants
DMsion of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: Approved. [—]Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed b : Date: '
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Dale:
Revised e911e/2017
ar City of Atlantic Beach APPLICATION NUMBER
jr Building Department (To be assigned by the Building Department.)
` r 800 Seminole Road nil�.' OQ
rt
Atlantic Beach, Florida 32233-5445
Phone(904)247-5828 Fax(904)247-5845
rip E-mail: building-dept@mab.us Date routetl:
City web-site: http:1Awvw.coab.us
APPLICATION REQ/VIEW AND TRACKING FORM
Property Address: 11
( 35 L( KS jf�e Department review re wired Yes No
Building
Applicant: n 1A) fin _&Zomn
1 . f Tree Administrator
Project: Replace ��In�11 W1 B01) &9c or
Public Utilities
Public Safety
Fire Services
Review fee$ Dept Signature
R
gency Review or Permit Required Review or Receipt Dateof Permit Verified Bept.of Environmental Protectionept.of Transportation River Water Management Districtrps of Engineersf Hotels and Restaurantsof Alcoholic Beverages and Tobacco
APPLICATION STATUS
Reviewing Department First Review: yJAr proved. ❑Denied. ❑Not applicable
(Circle one.) Comments: t
BUILDING
PLANNING &ZONING Reviewed by:v v Date: 7 a 'y
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY
Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. []Not applicable
Comments:
Reviewed by: Date:
Revised 0511912017
Building Permit Application ^' V Updated 5/5117
City Atlantic Beach
Road,
800 Seminole Road,Atlantic Beach,FL 32233
//Phone:(904)247-5826 Fax:(904)247-5845
rJob : ly3S Li ksiiAe 0n'YC Permit Number:ption RE#
f Work(Replacement Cost)$ /(/Gd. GO Heated/CooledSF N/p Non-Heated/Cooled 13//A
• ss of Work(Circle one): New Addition teration Repair Move Demo Pool Window/Door
e of existing/proposed structure(s)(Circle Commercial Reside• an existing structure,is afire p ' kler system installed?(Circle one), Yes No
• 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:
Remove ClaCrele driveway • Riff IA re wA Paverl
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: Mit lie k?LlfV Address: /cl;S G lel s/s O C
City Afl .4'e R,m,A State F4 ZIP 32233 Phone 90V— 404_ 6614
E-Mail Yh cAel e ke 2 s
Owner or Agent(if Agent,Power VAttorne r Agency Letter Required)
Contractor Information �^/
Name of Company: �ZA 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.
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) nt) (Signature of contractor)
(including contractor)
d sworn to(or affirmed)before me this a day of Signed and sworn to(or affirmed)before me this_day of
M; by - by
(Signature of Notary) (Signature of Notary)
BRENNA D PIGEON ( ]personally Known OR
] ]Pe�rsonally Known MY COMMISSION#FFg94gy1
Iv]'Produceit Identifi a Fl(pIREg May tg,I020 1 Produced IdeMifiwdon
Type of ldentifcatio rwr"' Type of ldemificadon:
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® BENCHMARK (HIGH POINT USED TO DETERMINE A.B.M.) 26" A.B.M.
ADDRESS: 1435'LINKSIDE DRIVE GRADE TYPE: A =COMMU
1
NItt: SELVA LINK SIDE SOD: 5677 SQ.Ff.LOT: 66 UNIT 1 13 PALLETSDWG.: 665L7 .DWG FENCE: N/A DATE: 11/21/95 F1ArnK: s26 SB.Ft.
DRAWN BY: R.A.M. 13 Cu.Yd,
SCALE: 1'= 20.00' FNOTN. ttPE:MONO
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SURVE
aA p SHOVHHa BOUNDARY Y
LO} 66, lFS��A RLo s���� ACyiyveB'� SHE OF%AT OF
AS RECORDED M ^ T BOOP µ RAGE(S) 33 ANO RSA OF THE CJRREI}T
pOBOC RECO DS OF DMA COVMT'' FEOIBOA
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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
mic I e il? �e fey 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 a r ' c i
re+e t;(& wilts
Any facility maintained, repaired, erect , an installed ' the exercise of the privilege granted remains subject to
relocation or removal on thirty(30)days' notice by CITY to USER said nplice to USER shall be given by certified mail,
return receipt requested,to the following address N15 l.' 12 e D c B l &
120)
• 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 pertnit 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,most 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 thebenefit 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 limifations/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
hereby assumed by the USER.
Date
Property Owner/Agent(signed in presence o o[ary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this ?IJ day of Jv J .20 /,f' ,
by rn'c f /19 kl e I t ewho personally appeared before me and
(printed name of Signer)
aca
knowledgeti-N eine, he¢ EON instrument voluntarily for the purpose expressed in it.
,��p.'•v BRENNAFF
MV 130MMISSlON FrN93622
O
lorida
Department Approval:
Personally Known_ /t
Produced Identification(Type) Vr,y+rr 4/cense
Scott iia rs,Pu sic c mectm
Kayle Moore,Public Utilities Director
H:\Master FormAPubllc-ntilaies Works Forms\Revocable Encroachment Agreement 2.5.I8.dmx
Revision Date:2/5/18
RIGHT-OF-WAY/EASEMENT PERMIT
Permit#Issued by the City of Atlantic Beach
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address /43S LinKridy nr;.a A4b..+:r . I FZ Phone 9o#- Va4- !!LS
3221)
Permittee Email m I 11e Ir 11 r�Y_2 3 Lf J .1 ra^+
Requesting Percussion to Construct red) cant e1e .�rlreWao ✓+aL eaw.r
Location(Reference to Cross-Street) L' )cf'o% 17
• Pernittce 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 P6.1 111 js < (Project Superintendent)
with Company Name N n Phone 904- 2 1— 41G I
• 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 he 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 most 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 comple n. C
Date 7' -L d
Permittee(sign m presence of Notary Pubu
STATE OF FLORIDA,COUNTY OF DUVAL , pp
The foregoing insItrument was acknowledged this Z.n•( day of Ts.�)( —,20 -
by /• / G h l �)P (�a I I� ,who personally appeared before me and
(printed name of Permittee)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
Signature � B ✓�I�
� N MY I:OMMISS10N4 FF8aaa
.:-„WS9a822 EXPIRES Mey 18.2020
LAYiRE5 May 18,2040 narwtsa m^'
'..Wl]9x{� fblaRaYrvSwwe.aom
CITY OF ATLANTIC BEACH
i, (OWNER / BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 'CONSTRUCTION
CONTRACTING"REQUIRES OWNER I BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 459.103(7),FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT
LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACC AS
YOUR OWN Va VG A !V`GNCE—YQU—A4UST
SUPERVISE THE CONSTRUCTION YOURSELF, YOU MAY BUILD OR IMPROVE A ONE-OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUH DING
MI IST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT
HIRE ANL LICENSED PERSON AS YOUR CONTRACTOR YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
STATELICENSES ",0111RED BY LAW AND BY COUMIY OR MUNICIPAL LICENSING
ORDINANCES.
^
I. INJURY LIABILITY; SINCE ^'"JNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
111. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX ANDIOR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
N. PENALTY; UNLICENS D CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES, OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN"OC PATIONAL 1, ENSE"IS NOT ADEQUATE THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY 'CERTIFICATE OF COMPETENCY" OR THE FLORIDA 'CONTRACTORS
CERTIFICATE' TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(2475826)IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
l q35- L' ks'�e dry 0 9o4- 4a4- 66 5
ADDRESS PHONE NUMBER
PRIM NAME I i
712/2o/,F
SIGNATU� �
ATE
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elamMaMdOamWnl.remreen
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Netaly Public M Lege,Stab of
•jL� ' S„- 13RENNA D PIGEON
DP�9�a°S afONT MY COMMISSIDNY cm
94loe�wammervuoe. i 822
EXPIRES May 18,202,
WF15M015] F rvo.[an
Notary Slgmwm
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