457 Sargo DWAY18-0030 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: DWAY18-0030
Description: Paver Driveway&Walkway
Estimated Value: 6300
Issue Date: 10/3/2018
Expiration Date: 4/1/2019
PROPERTY ADDRESS:
Address: 457 SARGO RD
RE Number: 171499 0000
PROPERTY OWNER:
Name: FREEMAN JUANITA
Address: 457 SARGO RD
ATLANTIC BEACH, FL 32233-3815
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.
Permit Conditions Page 1 of 2
Enter Permit Number DWAYIB-0030 View Report
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Permit Conditions
City of Atlantic Beach
Permit Number:DWAY18-0030 Description:Paver Driveway&Walkway
Applied:9/27/2018 Approyed:10/1/2018 Site Address:457 SARGO RD
Issued:10/3/2018 Finaled: City,State Zip Code:Atlantic Beach,FI 32233
Status:ISSUED Applicant:<NONE>
Parent Permit: Owner:FREEMAN JUANITA
Parent Project: Contractor:<NONE>
Details:
Owner Pulled Permit
LIST OF CONDITIONS
SEQREQUIRED SATISFY TYPE: STATUS:
NO ' ADDED DATE' DATE DATE
DEPARTMENT: CONTACT: REMARKSO
1 10/1/2018 EROSION CONTROL INSTALLATION INFORMATIONAL
PUBUCWORKS Scott Wllllams
Notes:
Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line(904-247-
5814)to request an Erosion and Sediment Cmltml Inspection prior to start of construction.
2 1 10/1/2018 I SITE RUNOFF INFORMATIONAL
PUBLIC WORKS Scoft Williams
Notes:
All mno0 must remain on-site duringconstruction.
3 1 10/1/2018 ROLLOFFCONFAINER INFORMATIONAL
PUBUCWORKS Scoft Williams
Notes:
Roll off container company must be on any approved list(Advanced Disposal,Realco Recyclin&Shapeils,Inc.,Republic Services,Donoyan Dumpaters,
Phillips Containers). Container cannot b,placed on City rightof-way.
4 10/1/2018 RIGHT OF My RESTORATION INFORMAPONAL
PUBUCWORKS Scott Williams
Notm
Full right-of-way restoration,Including sod,is required.
510/1/2018 RUNOFF INFORMATIONAL
PUBLIC WORKS Scott Wllllams
Notes:
http://atlmticbenh.trakit.net/trakit/DocL entViewer.wpx?&report=/Documents/PERNUT... 10/3/2018
Permit Conditions Page 2 of 12
JAI]mnoff must remain on-site. Cannot raise IM elewtion. 4
Printed:Wednesday,03 October,2018
I oft
http://atlanticbeach.tmkit.net/trakit/DoctmnentV iewer.aspx?&report=/Docwncnts/PERMIT... 10/3/2018
,a vLvr,,r City of Atlantic Beachc^ APPLICATION NUMBER
Building Department
C4E� (To be assigned by the Building Department.)
800 Seminole Road �2
_. Atlantic Beach, Florida 32233-5445 V (II-063Z
Phone(904)247-5826 Fax(904)247-5 SEP 18 P018 Date routed: l Z7
E-mail: building-dept@wab.us
Cityweb-site: http://w .coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: S ni..r 0 _ Department review required Yes No
--'(� ll q�fIdin
Applicant: J�.l0.Q\[t� ` r2e1y�0.h tannin &Zoni
t Tree Administrator
Project: Cr-� �JQ �O'r �r112 u
� y4.1 yc W� 7"'I ublic War
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permu Verified B
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
PLANNING &ZONING Reviewed bxL Date:
TREEADMIN. Second Review: ❑Approvedas revised. ❑Denied. ❑Notapplicable
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 05119/2017
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
�1w.0.Vv[�'0. FYeema m 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 TQVW U Y l-,4 e 1,11a
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'[r�ITY to USER, said noticeto SER shall be given by certified mail,
return receipt requested,to the following address 't51 S01-4 D Kil
• 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 terns 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�reby assumed by the USER. /� !ry
Cy okY — ti-tiyL.y-�— Date 9' va, — "
Property Owner/Agent(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL � C^ y 6,W
6 1 p
The foregoing instrument was
acknowledged this Z I/ day of ,�cF Ieh ,W , 201,
by who personally appeared before me and
(printed name of Signer)
acknowledged that he/she signedthet-h1�e/�instrument voluntarily for the purpose expressed in it.
o ` r
i atme of NotaryPublic,State of Florida
Department Approval:
Personally Known
Produced Identifica i� ED.SYrtH
1 WCDtWISSI0N RG07S5331
i p? fig.Sap�em6ers 1022 Scott WilliKims, Pubh• cs Dreaor
y:
"'t°!!F%�'` eonaeanru MtaYnbk Undwartan
0:\Public Works\ADMIN\Re roc able Encroachment AK�eemen . ow
Re loon Dan!:8/31/18
RIGHT-OF-WAY /EASEMENT PERMIT
Permit#Issued by the City of Atlantic Beach
PERMYFTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Addre-ssPhone
24(c' 218"a
Permittee UV-&-,n = yeemah Emil
T
Requesting Permission to Constructs aver b r t
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
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 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.
�yy 26!" Date- 7— �d
Permittee(signed in presence otwy Public)
STATE OF FLORIDA,COUNTY OF DUVAL —I ��r• 20 p
The foregoing instrument was acknowledged this 21 day of C ,
by�ttiQh l0. ee �. ,who personally appeared before me and
(printed name of Permimee)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
Personally Known
S
.to ofN.tary Public, tateofFlorida Produced Identification DL—
;N�:irti:gt IAYLGMNISEDN=255331
1 lr EXPM'Sepember 5.2022
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T R E M R 0 N C 0 M
ORrCITY OF ATLANTIC BEACH
OWNER / 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 LICENSED
CONTRACTORS, YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTTON TO THAT
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 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 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 COMPLETE,THE LAW WILL PRESUME THAT YOU BUIL I
IT FOR SALE OR LEASE,WHICH 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. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVI
LICENSES REDUIBED 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN"OCCUPATIONAL LICENSE'IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE' TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826)IF IN DOUBT.
V.ACKNOWLEDGEMENT;I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
` S7 S2rcta 2d 780
ADDRESS PHONE NUMBER
C 141 AYL)`Tri� �" �tmK/l-
PRINTNAME
NATURE �1yy DATE
BefeardednXI aey of�2(II,_$In Ma many of
Dues.Stale M Flonaa,has personally vceerea nand by nimmn I herself one affirms that
ell sytemanm aha aealaanons.re weaha a«Date. ''� ���
Notary PUMk at Lame,Slate M ,CountyM-V
❑Pggaarr++nellYKmmI
B4ahr,rad lamlrc.um- 1�
a .?! . JAMED.SLIIIH
NYcoNNLseaNacauval
Notary Se '3 EXPIRE$:9eplembef5,2022
�QW„A.•• Bmak Thu BMW PMac IAMeIMNels
FIBLpCN r-Bwl I(1N+i.RhY15®:UIR2W9
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
600 Seminole Road bwN
Atlantic Beach, Florida 322335445 ��b3�
Phone(904)2475826- Fax(904)247-5845 G}
E-mail: building-dept@coab.us Date routed: l 21
Cityweb-site: htlp:1Avvrw.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: J 1 JQ 0 Department review required Yes No
l �'( B "'din
Applicant: C Iee1Yy.Q-�/-1 Plannin &Zoni
�i Tree Administrator
Project: C CW� 'bYIVCu/4.1c �/.���/c`-� ublic War
Public Utilities
Public Safety
Fire Services
Revlew'fee $,.... ... Dept Signature ...I
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
Florida Dept. of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco -
Other:
APPLICATION STATUS
Reviewing Department First Review: opproved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING J�
PLANNING&ZONING Reviewed by: O �� - Date: 1O�^�'I Op
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. ❑Not applicable
PUBLIC WORKS Comments: .
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable
Comments: -
Reviewed by: Date:
Revised 0511912017
I
Building Permit Application Updated 12/8/17
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845 jj�� ( p
Job Address: I-j6-7 1, TOA-0PermitNumberd/ e• IO — vc)30
-Legal Desalption. -W-17 -2S-2`(E of of'FT_ bq4 VaaMS L)Rit RE * 17
Valuation of Work(Replacement Cost)$ 00 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 esidemti
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No <0
• 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: ;7 .._ QiU5 6�t(s-V.N5 PN0
Florida Product Approval# for multiple products use product approval form
Property Owner Information C� ^ B
Name: /lxoa��r Address: NSr7 �LLO f-OAO
city /�.41 H..y6�'Lt+ler�lJ' state r=te zip as '3 Phone goy-ayL-.��go
E-Mail
Owner or Agent(if Agent,Power of Attorney or Agency Letter Required)
Contractor Informa I ('
Name of Company: r'x o tuarfying Agent:�V�eaN C:ANos1J\
Address�l� 53n SLS 'V flo City��State OL.. Zip a61<
Office Phone goy- �'1- lob Slte/CunI aH m �L got/- n�-_]S7� _
state Certification/Registration# Ol 1 I E-Mail __SU6 I3&:e PA orlLi—AA QAIri- Leat
Architect Name&Phone# 'N
Engineers Name&Phone If
Workers Compensation
Exempt/Insurer/4a pbyees/expiation pate
Application is hereby made to obtain a permit to do the work and nstalliatichIs 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 requitements 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
RECORDING YOUR NOTICE OF COMMENCEMENT.
(Signature of ner or Agent (Signature of Contractor)
(including contractor)
Signed andsworn to(or affirm d)before Rie hist? dayof Signed and sworn to(o rimed)before me this_day of
Se
.. -
1 2( by .LlPw1eL,Q b
S nat r (5 ure of Notaryl
JAMIE D.SMIfH
I ]Per Ily Known g'4' t MYCOM1A188pN#�,256361 ( ]Personally Known OR
roducedI entific ` S IJ E)PIRES:Septemtu 5,2022 ( ]Produced Identification
Type of identification '+'R t,.• Type of Identification:
MAP SHOWING I URVEY OF -
LO
RRPLIT OF PART OF ROYAL PALMS UNIT TWO
i RECORDED IN PIAT BOOK31
PAGE 161 PC RECORDS 0/ DW�CO.. FUS.
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I HEREBY CERTIFY TEAT I KAv. suRVEY TNs uxos u �xowx I E A.. cAln
AND THER!'-Axt-ND..ff <'OAcxtl�Jtxri
�FZ 6. ISL/c nse.xmm nuwrxeex xo.�nonlwl
SIONlD C
suA!
onoa xD
rrNOTICE OF COMMENCEMENT'
State of r��o Tax Folio No.
County of I ii ya I
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in accordance with Section 713 of
the Florida Statutes,the following information is sated in th�NOTICE OF COMME —pr
��{'(�
Legal Description of property being improved:, lle 2-& Ac 6— f'1—b��� � k'S
Lo 32233
Address of property being improved: AtfC f
General description of improvements: Paver
owner:e,,.lA.an`�a �-fPP MAAI Address: 45_ -1 59=q o
Owner's interest in site of the improvement: a W hey,
Fee Simple Titiehder(if other than owner):
Name:
Connector: 1
Address:
Telephone No.: 36 _ Fax No:
Surety(if any)
Address: Amount of Bond$
Telephone No: Far No:
Name and address of any person making a loan for the construction of the improvements
Name:
Address:
Phone No: Fac No:
Name of person within the State of Florida, other than himself,designated by owner upon whom notices or other documents may be
served: Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b),Fluids Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a diff8 id s
specified): a
THIS SPACE FOR RECORDER'S USE ONLY OWNE
Doc u 2018235977,OR I3K 18551 Page 1277, Signthe of Do
Number Pages:i Beforree me this _Tday of in County
Recorded 1¢03201801:27 PM, Of Florida,has personally appeared
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Notary Public at Large,Stale of Florida,County of Duval.
COUNTY My commission
RECORDING $10.00 Personally Kn0 . TAMED WM -
ProducedIdentifi JIM 2=1
s. DIPI 8:8eVemb r5,2022
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