171 CLUB DR - DRIVEWAY '%>>\\ DRIVEWAY PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH DWAY18-0033
Ly
800 SEMINOLE ROAD ISSUED: 11/21/2018
_9si9� ATLANTIC BEACH. FL 32233 EXPIRES: 5/20/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
171 CLUB DR DRIVEWAY SINGLE OR TWO DRIVEWAY AND SIDEWALK $5100.00
FAMILY DRIVEWAY
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170246 0020 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
L AND H SERVICES 1649 E PARK TER ATLANTIC BEACH FL 32233
OWNER: ADDRESS: CITY: STATE: 1 ZIP:
HUGHES BRIAN P ET AL C/O HEEDE DAG 0 ATLANTIC BEACH FL 32233
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR 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.
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 PUBLIC WORKS DRIVEWAY APRON INFORMATIONAL
Notes:
All concrete driveway aprons must be 5 inches thick,4000 psi,with fibermesh from edge of pavement to the property line.Reinforcing rods or mesh
are not allowed in the right-of-way.
2 PUBLIC WORKS EROSION CONTROL INSTALLATION INFORMATIONAL
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 Control Inspection prior to start of construction.
Issued Date: 11/21/2018 1 of 2
''t.`.'rc.N DRIVEWAY PERMIT PERMIT NUMBER
o' Ito �
�t CITY OF ATLANTIC BEACH DWAY18-0033
uv r 800 SEMINOLE ROAD ISSUED: 11/21/2018
\`'ii9� v ATLANTIC BEACH. FL 32233 EXPIRES: 5/20/2019
3 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
4 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL
Notes:
Roll off container company must be on City approved list(Advanced Disposal,Realco Recycling,Shapells,Inc.,Republic Services,Donovan Dumpsters,
Phillips Containers). Container cannot be placed on City right-of-way.
5 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration,including sod,is required.
6 PUBLIC WORKS CONSTRUCTION SITE MANAGEMENT INFORMATIONAL
Notes:
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.
7 PUBLIC WORKS MAXIMUM DRIVEWAY INFORMATIONAL
Notes:
Maximum driveway width within the City right-of-way is 20 feet.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
TOTAL: $25.00
Issued Date: 11/21/2018 2 of 2
+ ��� Cityof Atlantic Beach I i
��-� �fig, APPLICATION NUMBER
6 kok A Building Department (To be assigned by the Building Department.)
J 4 -cj
800
Atlantic Seminole BeachRoadmy)
l- lA 18 _0033
9 Florida 32233 5445 1�
Phone(904)247-5826• Fax(904)247-5845
0131!.) E-mail: building-dept@coab.us Date routed: I j
City web-site: http://www.coab.us 1.11
APPLICATION REVIEW AND TRACKING FORM
Property Address: 0 t C—LV i--- ---- Department review required Yes No
Building
Applicant: L sr « SGg_ft O G Zoning
Tree Administrator
Project: 0 R._\ve'Lk..)AS(DEt()A( is Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature Iiiiiinati
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: I Denied. I Not applicable
(Circle one.) Comments: )7rAPProved.
BUILDING
PLANNING & ZONING Reviewed by:X.6--
Date: /�—1- (�
TREE ADMIN. Second Review: pp
)A roved as revised. Denied. Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: Approved as revised. ElDenied. I 1Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
A--ii-m:,-.4_, City of Atlantic Beach APPLICATION NUMBER
tit ,� Building Department �) (To be assigned by the Building Department.)
J ,� � 800 Seminole Road �,�,�r�� � n, = i �-i �^C�
33
5r Atlantic Beach, Florida 32233 5445 ' J -PfLf 0
Phone(904)247-5826 Fax(904)247 5 5 218
'71-1-J1310' E-mail: building-dept@coab.us to
Date routed: 1tc----1l.P)
City web-site: http://www.coab.us
BY:
APPLICATION REVIEW AND TRACKING FORM
Property Address: ' / i ei ) E Le_-- Department review required Yes No
Building
Applicant: L - H S Cg_ t c-c_S Zonin _
Tree Ad imm strator
Project: -, 21�'E��� LDr c,,j 4 c_K , is Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature 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. I 'Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed byi`„4 0 -��(74 .9 Date:/7---6-/
TREE ADMIN.
Second Review: I lApproved as revised. I (Denied. Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: nApproved as revised. Denied. ❑Not applicable
Comments:
Reviewed by: Date:
'19/2017
it.7;,,r
:dr
�� • REVOCABLE ENCROACHMENT AGREEMENT
..tilt 1
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
r i' la..,.s1.-x.S 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 ----0-r- ...%.,r,a1 / s1- N.—IA-LI( f's• r!a 1\AA,i 0,4--t .
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 .
• 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 I9-7(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
hereby assumed by the SER.
�..-----7,.....6,( /I Date /1/1.—//,,)-7
Property Owner/Agent(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
___5 1 C_,..2.,,
The foregoing instrument was acknowledged this day of IQ 20
by t - //- „4 r ,who personally appeared before me and
(pri •-d name .f Signer)
.ckn.\• Aged th.d 'a si:-ed the in trument voluntarily for the purpose expressed in it.
i
L_ A
Si: - of Notary Public,State of Florid%
r - Department Approval:
Personally Known ..
Produced Identification(Type) T04^INDLESPERCF.R
--. MY COMMISSION#FF 924951 �/
a' EXPIRES:October 6,2019 colt "i lams, Public 'or-�Director�
''...C.0,". Bonded Thru Notary Public Underwriters
O:\Public works\ADMIN\Revocable Encroachment Agreement.docx •
Revision Date:8/31/18
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Building Permit Application Updated 12/8/17
M City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845
1--.‘. n /' 3
Job Address: /7/ C/< c�', �G Permit Number: Lfo Ck' (t E 003
Legal Description P I4O el, Res (ZU'AT cam,.; RELe :� d/l%% RE# 170 b Z4 CO - UozO
of I �� S 5c
Valuation of Work(Replacement Cost)$ S/elt7. Heated/Cooled SF NOP d/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Residential
• 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:
/Y,STA / f� ' rc �c.�`-G1,,.. ...5-,,..z. �.r�L��Lg7
Florida Product Approval# for multiple products use product approval form
Property Owner Information C/ _
In
Name: &''i:a.Y //e..5 dee5 Address: /7/' �. Z 9`f ! C G 713
City ./I49 v/.ti Q<<i. State !P'/. Zip 3. n,3 3 Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information J
Name of Company: 4-a-9 �erv.. :e 1 Qualifying Agent: —b) .A.1,--,//e,."---
Address /feY9 /iia--r( Tc."-. c—, City .41L- Qt,* State `L Zip 32.z3 3
Office Phone 233-4)-08 Job Site/Contact Number
State Certification/Registration# E-Mail o ji C 4 ,,,,,,l A Se.-,,,;(--e• • (--+ri-1
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation S t1n /�
L S ////244#
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.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
RECORDING YOUR NOTI E F COMMENCEMENT.
/ /a - -;--e/( Altge-----
(Signature of Owner or Agent-)7 (Signature of Contractor)
(including contractor)
Si ned and sworn to(o affir milk beforea& is S•:y of Signed and sworn to(or of -•)befe e th's S day of
QV ( t, by M /! uIW4c 4. �f)V (b,b 1 ob \t�l�l . i_ 211
. .,gnaturero t;fr @I_ RERC.• i
i MY COMMISSION 6 FF 9 TONT GINDL ►�
a EXPIRES:October 6,2019 ;,; MY COMMISSION# • 4951
]Personally Known OR ^,,of Bonded Thr:Notary Public Under ri?ers [ 1 �Crsonally Known OR EXPIRES:October 6,2019
[ ]Produced Identification . [ ] "%' `�` T
--? Produced Identification -F�,,;�.• Gonded,hmNoaryPuClicUnderrriters
Type of Identification: Type of Identification: .
1 ,�
•J� EXHIBIT A. LETTER OF AUTHORIZATION
DRTV 10-
7 • 4 [, _ ___ is hereby authorized to act on behalf of
I Ag1/3211 P 1-L1 Eilf- the owner(s)of those lands described with'n
the attached application,and as described in the attached deed or other such proof of ownershi as m
be required by the City of Atlantic Beach in applying for a development permit. p ay
i
,
' BY: ter:
gnature of Orr er or Owner' e; �__.___,.,
dal Representative
Prince fBLAA.L.Ei-ftg4ame
I'1 ( &uPS 1)2i lie 4- A, =&/.../ 3;),).3 =?
Mailing Address
P tone CeU --------_ _ �/tir----7" ' ��07` i'
i rax' ma - �L.r..o++tj
State of: .,
County of
tufk
Signed and sworn before me on this.22- day o -AIL&
•
('-"" (.. `rt (� t ' 4-4i i I-42\ _ _ _----
identification yenified: {-, , bE t
L . DUC -'�L_ L 1.
i Oath Sworn; i Yes r No _ _
ll
,au.urnm►hr•p
i {��P,O t,AZ7. ,Eay�i
_'4*;5 o s
i 1
Notary ' ure`--F '
�` 1s : ----
F
My Commission expires: 6'•., ,'s' _ - '.l
%,',„.Irlrrrt•t` )
F.XHIBIT/I Letter ofAuthorrzatioryros to.'o
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. d Z 4 0C ac)
State of County of
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 stated in this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: PT 140T E.L- RESEg_V f-T t 0 N E C�
R Int,gp, E c ,
zc--)Et 77 A /'
Address of property being improved: 11 1 C L u 6 bC L E- tt T A n1Tt C I S&I i�L 3 a-a 33
General description of im r vements: KE-A461 L'G'4�1 0 F 0 tZ t tJGJ//) f A fJ 0
ai LW r PQ t1W-5
Owner B 214N P. 1+x( 4 14
Address rt( c-u-t fs 22• A71401 c P C I-F L 3 aa-33
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor (9 )\(C12 L PCU t C D&( I t(f 5 .U L CCS
Address 1,l04'q EPA-1 K'T(�Y�f�•t t4-ftANTlC4t'(i-cCl/ a.2_5?
Phone No. '1 Dtt-333-6505r Fax No.
Surety(if any)
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name
Address
Phone No. Fax No.
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other
documents may he served:
Name
Address
Phone No. Fax No.
In addition to himself,owner designates the following person to receive a copy of the Lienot's Notice as provided in
Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option).
Name
Address
Phone No. Fax No.
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY ' • NER 7 /1,
Signed: , , � DATE '1 \ V
Before me is day of OI' • ` In the
Cryof D State of Florida,he personally appeared
t.]� t) ��JC herein by
himself/h rself a affirm tat mens and de Iarations herein
Doc#2018275397,OR BK 18605 Page 1698, are true a a rate
Number Pages: 1
Recorded 11/21/2018 03:53 PM, ] -\
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL `a GG
COUNTY
RECORDING $10.1)0 Notary Public at Large,State of ai , County of !!1 Ftc_
My commission expires:
Personally Known or
^""Y I TONI GINDUESPERGER
• , ,: MY COMMISSION It FF 924951 r
r -z= EXPIRES:October 6,2019
'4$r, °oP' Bonded Thru Notary Public Underwriters 0