1022 MAIN ST - DRIVEWAY S��\,-*- DRIVEWAY PERMIT PERMIT NUMBER
�.�" S CITY OF ATLANTIC BEACH DWAY18-0041
\\r"
800 SEMINOLE ROAD ISSUED: 1/2/2019
,'2.o lg v ATLANTIC BEACH. FL 32233 EXPIRES: 7/1/2019
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:
DRIVEWAY SINGLE OR TWO
1022 MAIN ST FAMILY DRIVEWAY Widen Driveway $2500.00
TYPE OF REAL ESTATE ZONING: BUILDING USE ; SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170996 0000 ATLANTIC BEACH SEC H
COMPANY: ADDRESS: CITY: STATE: . ZIP:
RK BALLARD 10348 Sequoya Dr JACKSONVILLE FL 32257
CONSTRUCTION,INC.
OWNER: I ADDRESS: CITY: STATE: ZIP:
DUFFY JOHN A 1022 MAIN ST 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.
II 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.
Issued Date: 1/2/2019 1 of 2
rt' 14,,, DRIVEWAY PERMIT PERMIT/*• - \4
,S '*. -\,
CITY OF ATLANTIC BEACH
ISSUED: 1/2/2019
800 SEMINOLE ROAD DWAY18-0041
ri;tl'" ATLANTIC BEACH. FL 32233 EXPIRES: 7/1/2019 �!
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.
3 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
4 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL I
Notes:
Roll off container company must be on City approved list(Advanced Disposal,Realco Recycling,Shapells,Inc.,Republic Services,Donovan Dumpsters,
Phillips Containers,JDog/Dennis Junk Removal). 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 MAXIMUM DRIVEWAY INFORMATIONAL
Notes:
Maximum driveway width within the City right-of-way is 20 feet.
1
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.001,
TOTAL: $25.001
0
I
Issued Date: 1/2/2019 2 of 2
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
s1 800 Seminole Road !
1, _ 1�r Atlantic Beach, Florida 32233-5445 Ani I '
Phone(904)247-5826 • Fax(904)247-5845
".•-'- i E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: to 2-2_ I ► al i S t Department review required Yes No
I Building
Applicant: RK 1 cc.�C{ CPJanning &Zonirn
�( Tree Administrator
Project: W\ �C,1 e n 1 \J e IjcL (Public Work
Public Utilities
Public Safety
Fire Services
Review fee $ . -
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
PLANNING &ZONING 12- p-- 8
Reviewed by:/ Date: b
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 05/19/2017
Cit of Atlantic Beach APPLICATION NUMBER
City CE���� �
•, Building Department (To be assigned by the Building Department.)
. ` 800 Seminole Road iial / /
- -
Atlantic Beach, Florida 32233 5445 DEC 13 211:3 f
Phone(904)247-5826 • Fax(904)24 845 i
n� r E-mail: building-dept@coab.us Date routed: 1 Z (Z F IR'
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: to ZZ- Maly) S r Department review required Yes No
JRiiilding
Applicant: R.K. tcJc Q �C� (Planning &Zonin)
, Tree Administrator
Project: W vi e n V e uoct_ Public Work
Public Utilities
Public 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 I
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 by: Date: g
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 05/19/2017
�( ... .r. is,+ Building Permit Application Uod,ree10/9/t8
City of Atlantic Beach Building Department •'ALL INFORMATION
800 Seminole Road,Atlantic Beach, FL 32233 HIO•IUGH ED IN GRAY
?.,70 30 " Phone:(904)247-5826 Fax: (904)24/-5845 Email: Bullding-Dept)coab.us(J, IS REQUIRED.
lob Address: ( IL ' " 1'Tibtil Permit Number: ( ' 1k-00i
�
Legal Descnpsian Wide t,_ Or t v W`t(-/ Rte ..
Valuation of Work(Replacement Cost)$ �.c .°0 /Mated/Cooled SF Non-Heated/Cooled__
• Class of Work: QINew (]Addition []Alteration (]Repair 1. Move f7Demo (]Pool (T1Window/Door
• Use of existing/proposed structure(s). ✓aCommerclal IDtesidentiai
• If an existing structure,is a fire sprinkler system Installed?: []Yes [a/o
• Wi i treats)betty:ved ire as,sofntiun with r 000sed uraiect>EiYel(mustsubrrit Separate Tree Removal Permit! DO
Describe In detail the type of work to be performed,
f f' s eem j'.%-,.r i
Florida Product Approval M for multiple products use product approval form
Property[Owner Informatlotl
• Name ` '�4-J• tf ?f3r` p _ nddtess o 0h..� 1 4•"
City rii� r,t f r t,.f .egt State . Zip . w 5 Phone 4r'S Ai 7-YVT.-....
E Nal/ Lekk �1--it ..,._e lir Iv- G.L1[ ...5 ek*t . —
Owner or Agent Of Agent,flower of Atto•nev or Agency tatter Required)!YR___.._ .._ ____ r._ ..._.____._
c?V .L + inn . 4
Mame of Company (` 47u` eldirhwe4it 7/t[.'relltyirtgAgent _ C 40 ri
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Addfrsx c.� .Att4,41k).0 ..t r- t-ity Fe- _
Office Ptsone �Z1.�4 .__. . lob Site Contact Numbwr__ — . t 7 f{ 7.(2.‘,,A.:.._...________ .__
State Celtillcat}on/Regttttetion 0 E-Mail
Architect Nemo 3r Phone N
t ngineer's,Nam`&r'hc•rr p __..
Workers Compensation Insurer ... . , ,Khir,eton 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 wilt be performed to meet the standards of all the laws regulating
construction In this jurisdiction.I understand that a separate permit roust 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 MI
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
j
RECORDING YOUR NOTICE OF COMMENCEMENT. eC.- / /
• µ
_ .
Op—
tfSlgnetvro o1 Owner or Agent) �. (Signalises of tont'a.ai tl•.r
Signed and sworn to(or affirmed)before me this .j. of Signed and sworn to(or affirmed)before me this I rr day of
1.. Ftgl_", ;rFtt2 .._..sur ..a11sE,.jawt�. ur (), .• ,a, 7`'' :,; ti, le) �A!r�.,
.insult. f � �,.... _--____
(Wnature ofKoury) (Sig
+`:'h4 NOWT V,INMAN
t Commission I OG 125251
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( I Produced identification 1 n/ a �4 Produced Identlficatiee r%
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IAT 4, BLOCK 184, SFCTUX4 'H' marine Iwo! AS RSO n:op IN PLAT HOOK 18 PAGE. 34 IN7 CHF: ';li* •'V
PUBLIC RECORDS OF DIJVAL COUNTY. FLOE iIaA.
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HAZARD ROI 1NUARY MAP =t:)R AT;.ANTI.- HEACH, F1.A)4 IDA.
I HEREBY CERTIFY TO ►ZA1.PH 6 SALLY MILS CF:Ki, S"IT7CXCIUN VtHAT i.EY 4 DAv I N, ANI) 14).1ITY 1'!11.r: AND
RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION ••&11.INFORMATION
, City of Atlantic Beach RoGmitGHTED IN GRAY IS
1, a 800 Seminole Road,Atlantic Beach,FL 32233 R1QUIRED.
`
Job Address d �2
l cJPermit Number r ,___.L
Contractor Information
Company l; je !iA/4nrzfi CidaSIvc,�cIroo licr Qualifying r_ .flecf �t-c,, 1�J ,. .,�.,-r„
Address /D ?t/ y 5c(6,, az, cs jai- City j ,,L V State AL Zip i. '"7'
Phone
(9)4i (tf7'Y 64,9 2 Email r'k(0 Cvhcr•/c 77 S, Qr..‹,/ c Y'.
State Certification/Registration q
Architect Phone Email
Engineer Phone Email
Workers Compensation Insurers OR ExemptEZExpiration Date /Li. _/.i ,,-,14..:,,:l
• 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 Public Works Director,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 Public Works Director and at the expense of the
Permittee unless reimbursement is authorized.
• All work shall meet City of Atlantic Beach or Florida Depa, mens of Transportation Standards and be performed under the
supervision of It".1: a (Project Superintendent)
with(Company Name) P/4. 74 //' r _All s!f`-cf�a, Lit_ Phone (474/ 4 "7 -44el2
• All materials and equipment shall be subject to inspection by the Public Works Director.
• All city property shall be restored to its original condition as far as practical,in keeping with City specifications and the
0 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.
• 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 Public Works Director to make sure no
IS 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
expense's ansptg in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges.
• The Public.Works Director sh . e no e$24 hours prior to starting work and again immediately upon completion.
/ " C-, ...,,__,v., /r DatedZ�//f ��9
Permittee(signed in presence f Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoi instrument was acknowledged thishiday of fir'!€1.-1ie.' ,20 I ,
Y (...rby �uL l. i I( 1- e who personal) a eared before me and
(printed name of Permittee) ;» ANTHONY V.INMAN
acknowledged that he/she steed the instrument voluntarily for the purpose expressed in it. (.1
CCfM'istiOf104125251
. Expires l+,iy IT,2021
.;t1, ardcTn1,?my toil►edwvice*M•385.701t
244.4, 47,.....7,..- "" �� 1 I Personally Known
Signaturcr3f Notary Public.State of Florida l4 roduced Identification(Type) r-l- )L `its', 2'//v/lei,
t4:V pplitations&Forms\Word tltxuments\101001001 ii '.o1-War Casement Permit Appiicatiee.doca Revision Pate: 50/1/18
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