171 CLUB DR - DECK PERMIT L-LV1r
, L CITY OF ATLANTIC BEACH
11
800 SEMINOLE ROAD
��� ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
ACCESSORY - SINGLE OR TWO FAMILY ACCESSORY
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: ACC18-0034
Description: Replace Wood Deck
Estimated Value: 71000
Issue Date: 9/10/2018
Expiration Date: 3/9/2019
PROPERTY ADDRESS:
Address: 171 CLUB DR
RE Number: 170246 0020
PROPERTY OWNER:
Name: HUGHES BRIAN P ET AL
Address: C/0 HEEDE DAG 0171 CLUB 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 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.
s,Al.krCity of Atlantic Beach APPLICATION NUMBER
6 Building Department (To be assigned by the Building Department.)
800 Seminole Road ��t Qay ,.. w
j,. �� Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
�? E-mail: building-dept@coab.us Date routed: V
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1 ` C LU5 cls Department review required Yes No
Applicant: 1r3VJ N)612... annin &Zonings
Tree Administrator
Project: 'KSP C ' EcK. 'ublic W. •
Utilities
Pu•lic Safety
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: ❑Approved. VQ.znied. ['Not applicable
(Circle one.) Comments:
BUILDING ok-�`K �..-c r�
PLANNING & ZONING Reviewed by: Date: (0 t Cl v
TREE ADMIN. Second Review: Approved as revised. ViQenied. Not applicable
PUBLIC WORKS Comments:
a.��6 c) +-4 •-4. 2
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date: 9 fo 1 ( (,
FIRE SERVICES Third Review: proved as revised. ❑Denied. ['Not applicable
Comments: 1.4 o 3 'vv ‘'r-v2.. 1�c-
14 0 \-16-S'r' Tt:2U o L-4c-
Reviewed by: L Date: 1 (40 6 if v
Revised 05/19/2017
``'c Building Permit Application Up t /17
f(
Cityof Atlantic Beach, JUN ` eld.'
800 Seminole Road,Atlantic BeachFL 32233
Phone:(904)247-5826 Fax:(904)247-5845 �/�
Job Address: 11 1 .1--t.1 6 b e 1 U t Permit Number: tg 063 4
Legal Description 5-(o 9 )(s 5 - 9 f:. 132 O/R 1(p I IN-- 5-3(a RE# 1 7C 46 -OC o2O
Valuation of Work(Replacement Cost)$1 11
Odo Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition(iteration Repair)Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial :-sidential
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
RCPLA CEN 6 N I of W00) 7Ecr_
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: PR )A Ni AO U(4-E-5 Address: 17 A4 CLU 6 D J ye'
city A 7114-N n c f5C' CI+ State FL_ Zip j a a 33 Phone q o t1-j c -1 -(a(/7 r
E-Mail 8/2/Afki 09ATL6-Z- kb-IF/A-t t—, COM
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Info ation
Name of Company: cuysieti cn or), LLC Qualifying Agent: f DµR5 C. KO(-hl
Address 15 6UAN A 1) City P1;' a State FL. Zip 32C82-
Office Phone 803 ,;?c,3 03 Job Site/Contact Number •
State Certification/Registration#CRC133 E-Mail 1toht'L:EIc M4 S L GN4A it-:c-OM
Architect Name&Phone#
Engineer's Name&Phone# DO U1-45 V t-.UM'$ 60 - , (pqQ
Workers Compensation
Exempt/Insurer/Lease Employees/Expiration Da
Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that o 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
RECORD! YOUR NOTICE OF COMMENCEMENT.
AgY j civ:"- .4.,, TONI GINDLESPERGER 0
(Signature of Ow�r or Agent) �.•. po EXPI• �:is obe?.,c 1•� )
(incl,ding . tractor) ''-;•`:.,...'.7".•••:%•:`.?
q:p ; Bonded Thru Notary Public Uncle, ers
Si ned and sw rn to(6a, 'tr •-. befo - met: d-y of Sig re this day of
01P, l� b �1 •_ ` .i o 02—S , ,by
illiMI PAIR
(Signature of Notary) 4 __ (Signature of Notary)
'' ;°?:a;. TONT GINDLE 'ERGER
[ ]Personally Known OR ) dY KIPR 0iSSION#FF 924951
WI
[ ]Produced Identification f 1 2 20__ 075__ -// f.:,,,,..., Id ggopctober6,2019
Type of Identification: [- T ,TgintifkIlteru Notary Public Underwriters
CIT\' (9 ATLANTIC' BLACII
•,i X
®WNER / BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489. FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW.
DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENS
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAI
LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE, YOU MUST
SUPERVISE THE CONSTRUCTION YOURSELF, YOU MAY lit III D OR IMPROVE A ONE—OR
TWO FAMILY RLSIDFN('I: OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMMILRCIAL BUILDING Al A COST OF$25,000.00 OR LESS. THE BUILDING
MUST 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 COMPEL F,THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE,WIIICII IS IN VIOLATION OF THIS EXEMPTION. 'YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. FL IS
YOUR RESPONSIBILITY TO MAKE SURF, THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE.
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO$5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN"OCCUPATIONAL LICENSE' 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(247-5826)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.
AIDS 1S1 CLu 6 [bgtvEi 11'TL  eq-- 9o4SMMB4`I- let-lg
PRINT/ R
, ME de2/0
API 6._/ 1 er
:G •TURE . C\ A DATE
Before me this day of•-...S 0 0/1'.g.„, ,2&'�,Ot the county of
Duval.State of F�has personally appear henn by himself I herself and affirms that
all statements and declarations are true and accurate
Notary Public at L: ., tate of 1 (. ,County of
O Pry Idienbl k�_ V, 0 7 _. _s -47.:D ,,,,,.,.,.,..„
4 7.
•► .
;� •''• TONT GINOLESPERGER
=': 't `.•_ MY COMMISSION#FF 924951
Notary Signature _ y:,
•
-; ,' EXPIRES:October 6,2019
Bonded Thru Notary Public Underwriters
F.NLUaY)wnn-nu.:d<r Attadar.t•REVISED 1.,162004
OR HB 12675 PAM 1476
Addendum A
MAP SHOWING BOUNDARY SURVEY OF:
A PART OF THE HOTEL RESERVATION AS SHOWN ON MAYPORT TERMINAL COMPANY'S MAP OF ATLANTIC
BEACH AND RECORDED IN PLAT BOOK 5. PACE 64. AND ALSO SHOWN ON PLAT NO. 1, SUBDMSpN A.
OF ATLANTIC BEACH AS RECORDED IN PLAT BOOK 5, PAGE 69 OF THE CURRENT PUBLIC RECORDS OF
DUNAL COUNTY, FLORIDA, SAID PART BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS:
FOR A POINT OF REFERENCE. COMMENCE AT THE NORTHWEST CORNER OF CLUB MANOR, AS RECORDED
IN PLAT BOOK 25. PAGE 62 OF THE CURRENT PUBLIC RECORDS OF SND COUNTY; THENCE NORTH
85.32'15-EAST ALONG THE NORTH LINE OF SAID CLUB MANOR. A DISTANCE OF 96.25 FEET TO THE
POINT OF BEGINNING; THENCE NORTH 06'15'15- WEST, DEPARTING SAID NORTHERLY UNE.A DISTANCE OF
99.84 FEET; THENCE NORTH 83'44'45'WEST, A DISTANCE OF 10.00 FEET. THENCE NORTH 85'32.15"
EAST. 65.00 FEET; THENCE SOUTH 06.15'15"EAST, A DISTANCE OF 100.15 FEET TO THE NORTHERLY
1TNE OF SAID CLUB MANOR; THENCE SOUTH 8532'15-WEST. ALONG SAIO NORTHERLY UNE. A DISTANCE
OF 75.00 FEET TO THE POINT OF BEGINNING. SUBJECT TO AN 12 FOOT EASEMENT FOR INGRESS AND
EGRESS ALONG THE NORTH 12.00 FEET OF THE ABOVE DESCRIBED LANDS.
4o .4, ATLANTIC BEACH.. RESERVATION
�T 800K. S ,,A6/6g09L99 99909 SiAPIPGE C ~)
II 0.9.9 /5298.PAGE 125
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1 t,r\i�r
_ ' "\ , CITY OF ATLANTIC BEACH
p 800 SEMINOLE ROAD
�� ATLANTIC BEACH,FL 32233
(904)247-5800
\fj3;19r
BUILDING DEPARTMENT REVIEW COMMENTS
Date: 7/01/18
Permit#: Acc18-0034 Applicant: Brian Hughes
Site Address: 171 Club Dr. Address: 171 Club Dr.
Review: 1 Phone: 294-6678
RE#: 170246 0020 Email: Brian229atl@hotmail.com
THIS BUILDING DEPARTMENT REVIEW IS ONE OF 4 DEPARTMENT REVIEWS.
PLEASE FIND ALL DEPARTMENT REVIEWS AND ADDRESS ALL COMMENTS.
Correction Comments:
Application is disapproved for the following issues:
1. There are conflicting surveys and site plans on file for this property. Please submit a current
survey,from a licensed surveyor, showing all structures, property lines and setbacks.
2. This project appears to be a continuation of previous, uncompleted permits. Please provide
elevations and all details for pavers, decks, stairs, and pergolas. Engineering plans, recently
submitted, do not match existing uncompleted work. Please clarify.
3. Engineering plans indicate Wind Exposure Category B. This site is Category D.
Plans refer to Page S-4. S-4 was not submitted.
Provide details of existing house construction and connection details as required by FBC-R 507.
4. Permit Application states Owner/Builder, but a contractor is listed. Please clarify.
5. Revised details may generate additional plan review comments.
Dan Arlington
darlington@coab.us
904-247-5813
1
's CITY OF ATLANTIC BEACH
a
800 Seminole Road
1.-.)-7,
Atlantic Beach,Florida 32233
ilif;
-J;tlr.
REVISION REQUEST/ CORRECTIONS TO PLAN REVIEW COMMENTS
Date 1 9 l 15 Revision to Issued Permit Corrections to Comments %ermit#Ac S" 00 3
l
Project Address rn C Ct.A I) �n l
Contractor/Contact Name n (/'`an t t'+` t.. , d.LL ;
Phone In3 —Z4;--6'395— Email 1oL-14.. fit,tc4e,5 e ,ry„v, ../. cea.t
Description of Proposed Revision/Corrections: Permit Fee Due$
Jl LOC -� ,i4.10,---,1�I 'PLPIC . (91141 kc e.t.+4 a owl T () t , o °"6 cper<,
-(.) (.4 s N 0) 5616 Ski.e,+- c►, v►Ae 6 f) Clvt,c)...
Additional Increase in Building Value $ -- 6 -- Additional S.F. O '
By signing below,I affirm the Revision is inclusive of the proposed changes.
(printed name)
Signature of Contractor/Agent(Contractor must sign if increase ere V) O U ly il2ev; e
(Office L kat y U U
Approved_ Denied
Revision/Plan Review Comments (67
Department Review Required:
Building sY/2 R'/Li
Planning & Zoning
Tree Administrator
Public Works .
Public Utilities
Public Safety )ate
Fire Services
4JCITo'
Y OF ATLANTIC BEACH
'� 800 Seminole Road
Atlantic Beach,Florida 32233
REVISION REQUEST /CORRECTIONS TO PLAN REVIEW COMMENTS
Date "i1 91 l5' Revision to Issued Permit Corrections to Comments 1V/Permit#134C1 el?" 00 311
Project Address h-1 I C 1,,(41) -Pr .
Contractor/Contact Name LotAv (gin srfuc_ , Li_L. ,
Phone $ 3 -1 3-b 3/5-- Email f-o(-fri 114.A.4e.5 C ey..ee.1. c o"----
Description of Proposed Revision/Corrections: Gel f'g (,, Permit Fee Due $
Art /Ecb1cII SU � :-i5 ce4- e- - 1'f,41(,'7t,0.
✓1cl41S ,`51 Nk+,-- f) ,vtc . (DGiOHk aI+GrttN r (}) c..io 7. obit
Additional Increase in Building Value $ -- D — Additional S.F. V —_
By signing below,I affirm the Revision is inclusive of the proposed changes.
(printed name)
Signature of Contractor/Agent(Contractor must sign if increase in valuation) Date
(Office Use Only)
Approved Denied :141 Not Applicable to Department
Revision/Plan Review Comments lttg- L0*A..-ti.G.e-4.--:5
Department Review Required:
Building
Planning &Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities Y e) 5 C _j
Public Safety ate
Fire Services
nsrur anvvvrivv ovv '4u/it l Juttvt r Vr:
A PART OF THE HOTEL RESERVATION AS SHOWN ON MAYPORT TERMINAL COMPANY'S MAP OF ATLANTIC
BEACH AND RECORDED IN PLAT BOOK 5, PACE 64, AND ALSO SHOWN ON PLAT NO. 1. SUBDIVISION "A".
OF ATLANTIC BEACH AS RECORDED IN PLAT 000K 5, PAGE 69 OF THE CURRENT PUBLIC RECORDS OF
DUVAL COUNTY, FLORIDA, SAID PART BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS:
FOR A POINT OF REFERENCE. COMMENCE AI IHE NORTHWESI CORNER OF CLUB MANOR. AS RECORDED
IN PLAT BOOK 25, PAGE 67 OF THE CURRENT PUBLIC RECORDS OF SAID COUNTY; THENCE NORTH
85'32'15- EAST ALONG THE NORTH LINE OF SAID CLUB MANOR. A DISTANCE OF 96.25 FEET TO THE
POINT OF BEGINNING; THENCE NORTH 06'15'15" WEST, DEPARTING SAID NORTHERLY LINE. A DISTANCE OF
99.84 FEET; THENCE NORTH 83'44'45" WEST. A DISTANCE OF 10.00 FEET; THENCE NORTH 85'32'15"
FAST. 65.00 FEET; THENCE SOUTH 06'15'15" EAST, A DISTANCE OF 100.15 FEET TO THE NORTHERLY
I INE OF SAID CLUB MANOR; THENCE SOUTH 85'32'15" WEST, ALONG SAID NOR IHERE Y LINE, A DISTANCE
OF 75.00 FEET TO THE POINT OF BEGINNING. SUBJECT TO AN 12 FOOT EASEMENT FOR INGRESS AND
EGRESS ALONG THE NORTH 12 00 FEET OF THE ABOVE DESCRIBED LANDS.
---\, °.o„
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it
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K wis�r`K,o —w 58532'15�W 75.00
1 hNIAIx••u�' CLUB DRIVE
— sA CITY OF ATLANTIC BEACH
.,, A s) 800 SEMINOLE ROAD
_____} ATLANTIC BEACH, FL 32233
(904) 247-5800
—0111�
BUILDING DEPARTMENT REVIEW COMMENTS
Date: 9/0518
Permit#: Acc18-0034 Applicant: Thomas Kohn
Site Address: 171 Club Dr. Address: 171 Club Dr.
Review: 2 Phone: 803-243-0395
RE#: 170246 0020 1 Email: Kohn.thomas@gmaiLcom
THIS BUILDING DEPARTMENT REVIEW IS ONE OF 4 DEPARTMENT REVIEWS.
PLEASE FIND ALL DEPARTMENT REVIEWS AND ADDRESS ALL COMMENTS.
Correction Comments:
Application is disapproved for the following issues:
1. There are conflicting surveys and site plans on file for this property. Please submit a current
survey, from a licensed surveyor, showing all structures, property lines and setbacks.
9/05/18—Plans show pergola on west side of residence. No dimensions are given; or type of
pergola,Detail A or B. Setback to property line and heights must be shown.
2. This project appears to be a continuation of previous, uncompleted permits. Please provide
elevations and all details for pavers, decks, stairs, and pergolas. Engineering plans, recently
submitted, do not match existing uncompleted work. Please clarify.
9/05/18—It is not clear where decks, pergolas, and third story decks are located or how they
relate. Please provide four elevation drawings,showing all structures, dimensions, and heights,
including stairs and openings into house. Existing windows may be in hazardous locations,due to
new structures. Safety glazing may be required. Show all work to existing structure.
3. Engineering plans indicate Wind Exposure Category B. This site is Category D.
Plans refer to Page S-4. S-4 was not submitted.
9/05/18—Completed.
Provide details of existing house construction and connection details as required by FBC-R 507.
4. Permit Application states Owner/Builder, but a contractor is listed. Please clarify.
9/05/18—Contractor.
5. Revised details may generate additional plan review comments.
Dan Arlington
darlington(a coab.us
904-247-5813
1
01.A.Nre, City of Atlantic Beach APPLICATION NUMBER
\JS ' •. Building Department ECJ i, (To be assigned by the Building Department.)
r °; 800 Seminole Road 0.� 11 Acct
�y^O
ca
r.. Atlantic Beach, Florida 32233-5445 b
Phone(904)247-5826 • Fax(904)247-5845 JUN 0 5 2018iii /,, / '
1j' V E-mail: building-dept@coab.us ate routed: (J[ 1t
City web-site: http://www.coab.us BY;s,_
APPLICATION REVIEW AND TRACKING FORM
Property Address: t i ` C LO5 II `` Department review required Yes No
Applicant: cV1/4.) N 5 annin.....91 &—Zoning)
_ Tree Administrator
Project: Rep CC C
1) CK 4 public W. •
.._' • is Utilities
Pu.lic Safety
Fire Services
Revwfee$ fa' l .. , ;..., ,r, Dept stigma te,, .:� ': ,:. . -::',.iil
Review or Receipt
Other Agency Review or Permit Required of Permit VerifiedDate By n I 1
Florida Dept. of Environmental Protectionj (J J
Florida Dept. of Transportation i \,)
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: nApproved. enied. fNot applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING 4110,
tiLiZ7cP___-- _
Reviewed b : ,/�/, _ Date:
TREE ADMIN.
Second Review: JApproved as revised. nDenied. fNot applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES �
PUBLIC SAFETY Reviewed by;---7 ,�. l Date:7-,,2—,
FIRE SERVICES Third Review: nApproved as revised. nDenied. fNot applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
CITY OF ATLANTIC BEACH
f Department of Public Works
fJ -? 1200 Sandpiper Lane
Atlantic Beach, FL 32233
-0E11, (904) 247-5834
PUBLIC WORKS PLAN REVIEW COMMENTS
Date: 6/14/18 Applicant: Brian Hughes
Permit#: ACC18-0034 Email: brian229atl@hotmail.com
Review Status: DENIED Contractor: Kohn Construction, LLC
Site Address: 171 Club Drive Email: kohn.thomas@gmail.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: APP R®R ( 7/e2 /Q
• Provide erosion and sediment control plans with installation details.
• A Revocable Encroachment Agreement must be submitted.
• Provide scalable plans.
• Building Department will be sending a detailed letter.
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.
• All runoff must remain on-site. Cannot raise lot elevation.
• All old decking must be removed from job site by Contractor.
Scott Williams, Public Works Director swilliams@coab.us/904-247-5834
Page 1 of 2
O:\Public Works\ADMIN\PLAN REVIEW COMMENTS\ACC18-0034(Owner-Hughes).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 2of2
O:\Public Works\ADMIN\PLAN REVIEW COMMENTS\ACC18-0034(Owner-Hughes).docx
ECEIVEn
r1 1 ,,' CITY OF ATLANTIC BEACH
. '
J �, JUN 152010 800 Seminole Road
�' ' Atlantic Beach,Florida 32233
BY•
REVISION REQUEST/CORRECTIONS TO PLAN REVIEW COMMENTS
Date ( //1 12oi' Revision to Issued Permit Corrections to Comments Permit#A66 I8 -66 37
,
Project Address } /1 / C 4_,Li 13 5 R I l/L , AMA am c bL cC 4/ L. 92.23 3
Contractor/Contact Name "4 S KO 1t N
Phone 90- ' 4303 lS Email KG/-1/\1, 11-173/14/15 CO 6 PA 1 i., 6-614
Description of Proposed Revision/Corrections: Permit Fee Due $
ca C 20Ac4mE'WT 4- k631s,IL)A >Jtg121111 i 1s,
Additional Increase in Building Value $ Additional S.F.
By signing below,I 6z/A N 141,46 pre, affirm the Revision is inclusive of the proposed changes.
(printed name)
/ilti
iL //c/fi
Signa re of Contractor/Agen (Contractor must sign if increase in valuation) Date
(Office Use Only)
Approved / Denied Not Applicable to Department
Revision/Plan Review Comments
Department Review Required:
Building \11,120\imege414:020
Planning &Zoning Reviewed By
Tre inistrator
ublic Works ?1 1 1,ublic Utilities oc
Public Safety Date
Fire Services
t \
'.v ' REVOCABLE ENCROACHMENT AGREEMENT
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach,Florida,a municipal corporation
organized and existing underthelawsof the State of Florida,hereinafter referred to as"CITY"and
Q e f Ai�1 ?. ,6 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 CGI.1S f tcc/ON "lb E. R..k.G WOOD 17IL-. .
Any facility maintained, repaired, erected, and/or installed in the exercise of 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 I I I CSU f3 "pa', /-TL¢fv nc g€ko'/ FL 3a22 .
• 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
he y assumed by / e USER.
/ j Date (0 J'J1B G
Pr erty Owner/Agent(si 4. in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this I day of L.7 a P ,20t B ,
by 6!`1 0,'\ (4 L)oNkes ,who personally appeared before me and
rinted name of Signer)
ac r. ledged t :iii: she • gned the i trument voluntarily for the purpose expressed in it.
11
00 0,4 _...."
Signature of Notary Public,State of Flor 4
Department Approval:
Personally Known ,.
Produced Identification(Type)
Scott ilhams,Pub is Works Director/
Kale Moore,Public Utilities Director
+�Y::^i�;. TONI GINDLESPERGER Y
H:\Master Forms\Public-Utilities Wor :40141'; 'e9 ca
.�, .� bµ�Elr�pppA1881mN�lt pygeQl9bknt: 5.18.doa
Revision Date:2/5/18 :,:��,;o EXPIRES:October 6,2019
-'"4.oF .. Bonded Thru Notary Public Underwriters
0RIGHT-OF-WAY /EASEMENT PERMIT
Permit#Issued by the City of Atlantic Beach
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address 1 l C('(,1 S 1W 1 t!(=, 46 a.33 Phone gO Lf .-c�qq, 'te6 7 S
Permittee egk( RVG 5 Email ate 1Ak a9 ATL ► T rrW i L sflV\
Requesting Permission to Construct W(Y)l) 17 EC K.
Location(Reference to Cross-Street) O(ERN BtX D'
• 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
under the supervision of _ (Project Superintendent)
with Company Name Phone
• 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 56 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
i ediately upo,. ' .letio 8 p'
8/ Date G//$/2 �1'
Permi (signed in pr sence of N.is Public)
STATE OF FLORIDA,COUNTY OF DUVAL 1 i O
The foregoing instrument was acknowledged this day of (.) (\ ,20 0 ,
by r` (kr. �1 V qe.S ,who personally appeared before me and
(printed name ofbPdrmittee)
ac ,* - ged that a s•.: ed the• strument voluntarily for the purpose expressed in it.
11
• ' AI ,----_ Personally Known
Signature of Not. Pub 1 •irEenN.11 Produced Identification(Type) (-E 2 7 C7 - 075-S g-4 Z C
TONT GINDLE R
Y PN' MY COMMISSION Y FF 924951
I. ;MEEXPIRES:October 6,2019
•,, q q;:•' Bonded Thru Notary Public Under/inters
a1f:L�\ City of Atlantic Beach APPLICATION NUMBER
S, Building Department (To be assigned by the Building Department.)
800 Seminole Road d�� p-r O^
-p, Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845 /
r;t �� E-mail: building-dept@coab.us Date routed: `/ l
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: t 1 ` C.L()5 b `? Department review required Yes No
carlIero
Applicant: )5 N annin &Zoning)
_ Tree Administrator
?Project: SP l.,-C-C� rtECK 4 •ublic W• •
4..._.°17.'7 is Utilities
Pu s lic Safety
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: ❑Approved. Denied. ['Not applicable
(Circle one.) Comments:
S /
BUILDING ie e`er,/
PLANNING &ZONING Reviewed by: "17 --- Date: C I -18
TREE ADMIN. Second Review: nApproved as revised. nDenied. Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. nDenied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
rS --L l:P f
#. CITY OF ATLANTIC BEACH
800 Seminole Road
Y ^ . �' Atlantic Beach,Florida 32233
REVISION REQUEST/CORRECTIONS TO PLAN REVIEW COMMENTS
Date .71 9 I Revision to Issued Permit Corrections to Comments_
Permit#ACc!`?' oaf
Project Address h 1 C �,c t I3 r, 1,e-
Contractor
<Contractor/Contact Name F'o(.th ( st'ruc��rj t t.a..C..
Phone 1. j -2 3-0315- Email Kof.f... 1-tb,,,„,,g, vur._�• r a•�-.
Description of Proposed Revision/Corrections: ! Permit Fee Due$
Potke tc Sur �I��,,,,-t5 se'f Gt g — 41(�5G J.
12.tvicluvisf .3-7L e) . Q oi+t k. a 1+4 atwi r t�v,, t9 b�''�'.
?( u s 1IN v) SG G s v6e r14'1 (ha t')
Additional Increase in Building Value $ b Additional S.F. v
By signing below,I affirm the Revision is inclusive of the proposed changes.
(printed name)
Signature of Contractor/Agent(Contractor must sign if increase in valuation) Date
(Office Use Only)
Approved /
PP Denied Not Applicable to Department
Revision/Plan Review Comments
Department Review Required: ✓.. `�
Building
Planning & Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities _ 13— )13.
Public Safety Date
Fire Services
�S,ay City of Atlantic Beach APPLICATION NUMBER
41 Aft �d Building Department (To be assigned by the Building Department.)
� 800 Seminole Road (� Q-
�; Atlantic Beach, Florida 32233-5445
flEjVE; ACC-1 0 D 43
Phone (904)247-5826 • Fax(904)247-584 /,,
E-mail: building-dept@coab.us JUN 05 2010 Date routed: 6[/ `'(//
City web site: http://www.coab.us
APPLICATION REVIEW AN-WI-RACKING FORM
Property Address: 1 ` (. LJ5 R.. Department review required Yes No
Applicant: YJ N v ^ annin &Zoning-)
Tree Administrator
Project: 'Kc-- ECK 'ublic W.
. is Utilities
Pu.lic Safety
Fire Services
ReyievifeeVA.= ; D J
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. liNot applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date: 617
TREE ADMIN. Second Review: Approved as revised. ❑Denied. ❑Not applicable
P WORKS Comments:
B C UTICTTIE�
PCTBLI7SAFgTY Reviewed by: Date:
FIRE SERVICES Third Review: I lApproved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017