286 POINSETTIA ST. DRIVEWAY PERMIT rty''`Jr� DRIVEWAY PERMIT PERMIT NUMBER
l' DWAY19-0001
v
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED:
'F ATLANTIC BEACH. FL 32233 EXPIRES:
MUST CALL INSPECTION PHONE • ' 247-5814 BY 4 • • • NEXT 1 INSPECTION.
ALL WORK CONFORM CURRENT • EDITION FLORIDA i 1
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS • PERMIT
• • • PLEASE • ,
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.
• : • OF •
DRIVEWAY SINGLE OR TWO ADDING CRUSHED STONE TO
286 POINSETTIA ST EXISTING CONCRETE $0.00
FAMILY DRIVEWAY
DRIVEWAY
TYPE OF
ZONING: :D •
• • GROUP:
170568 0010 SALTAIR SEC 03
COMPANY: ADDRESS: CITY: STATE: ZIP:
• ADDRESS:
John R. Shaw 13028 Biggin Church Road South Jacksonville FL 32224
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 • .
;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 ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
Issued Date: 1 of 2
DRIVEWAY PERMIT PERMIT NUMBER
1.r p CITY OF ATLANTIC BEACH DWAY19-0001
y 800 SEMINOLE ROAD ISSUED:
O j19" EXPIRES:
ATLANTIC BEACH. FL 32233
3 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,JDog/Dennis Junk Removal). Container cannot be placed on City right-of-way.
4 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration,including sod,is required.
S 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.
6 PUBLIC WORKS RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site. Cannot raise lot elevation.
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: $25.00!,
Issued Date: 2 of 2
Building Permit Application Updated 10/9/18
SO
r City of Atlantic Beach Building Department "ALL INFORMATION
V 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Jjt�r IS REQUIRED.
Phonee, *�
:,(904) 247-5826 Email: Building-Dept@coab.us
Job Address: v�_3 !(/ f d,/ �1-7�w `!�i Permit Number: UWAY(9 -QQO OO
Legal Description �� ,4WZ k� ���5��� I'sl. 3 / RE# 1 -7 0-S(,, <5 --00 I
Valuation of Work(Replacement Cost)$ , ,moo. !I Heated/Cooled SF I Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair A&ove ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will trees be removed in association with proposed ro'ect? ❑Yes must submit separate Tree Removal Permit ❑No
Describe in detail the type of work to be performed:
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name Address r/` `% &WAZIZ f� I-9A_ S
City State ✓L- Zip one
E-Mail
Owner ortWnt(If Agent, Power of Attorney or Agency Letter Require
Contractor Information
,/f
Name of Company /'/ 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 Insurer OR Exempt❑ 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 regulating
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 PAY T ICE FOR IMPROV MENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINAN CO SULT ITH YOU LENDER OR AN ATTORNEY BEF
RECORDICE C E ENT.
(Signature of Owner or Agen ) (Signatur of Contractor)
gned an sworn to(or ffi ed)before r
this day of Signed and sworn to(or firmed)before me this day of
by
70NIGINDL SP
MY COMMISSION#FF 924951 (Signature of Notary)
- EXPIRES:October 6,2019 ' n o
r
Bonded Thru Noary public Underen
f L"4-
Pi N.•`
[ J Personally Known OR [ ]Personally Known OR
[ ]Produced Identification [ ]Produced Identification
Type of Identification: Type of Identification:
Owner Builder Affidavit "ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
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 EXEMPTION 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 BUILT 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
BEDONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS.
IT IS YOUR RESPONSIBILITY TO MAKE SURE 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. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.US) 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.
Job Address: ;� �� r��S(:'��/>� s�". �_%�� �� ' E� C�� f'✓G 3Z�Y
OwnerName: Phone Number:
Mailing Address: ty: —State: Z✓�Zip: Ali %7
Notarized Signature of Owner 47j
of e f oinginstr ent was ac o edged before me this �day of 20 1�in the State of Florida, County
CLA
Signature of Notary Public
[ ] Personally Known OR [ ] Produced Identification
Type of Identification: 7- 0
�''r-Apdated 10124118
agiiL�
70NI GINDLESPERGER
MMISSION#FF 92,tier 5,20 i9RES:Octohru"!ovary?ublic l,nderwn!ers
City of Atlantic Beach APPLICATION NUMBER
3S �� Building Department (To be assigned by the Building Department.)
800 Seminole Road /�L)w 19 ,OOO
Atlantic Beach, Florida 32233-5445 1—J i't / 1
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: Z[ < l
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: O�P P IgL Department review required Yes No
06
Applicant: D L� �&�� ning &Zonin
Tree Administrator
Project: (! Rostie� S `CO10 c— (D eis wr
Public ti ities
�S 7f C Public Safety
Fire Services
Review fee $ Dept Signature
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: Approved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by o��Z— 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: Date:
Revised 05/19/2017
ALL
=Nt y/ Revision Request/Correction to Comments **HIGHLI HIGHLIGHTED
IN HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
s
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: l �d(
❑ Revision to Issued Permit OR ff Corrections to Comments Date:
Project Address: / �l7�i r7-/R /r
Contractor/Contact Name:
Contact Phone: % F/ �� `� Email: ( 5h a-w C-7&h'a�wl/i6,w `
Description of Proposed Revision/Corrections: 4
a/f �_
I_►p(�!y �L SCT affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
• V4Il.,proposed revision/corrections add additional square footage to original submittal?
❑ Yes (additional s.f.to be added: )
• V(Vi}�proposed revision/corrections add additional increase in building value to original submittal?
go El*Yes (additional increase in building value: ) (Cau � ctormustsignifin ease in valuation)
*Signature of Contractor/Agent: 44
U L
(Office Use Only)
Approved ❑ Denied ❑ Not Applicable to Department Permit Fee Due$
Revision/Plan Review Comments
Department Review Required:
Building
< arming&Zorfl Reviewed By
Tree Administrator
ublic Wor
Public Utilities
Public Safety Date
Fire Services Updatedl0/17/18
r51 , �f City of Atlantic Beach , APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road /� C� /
f� Atlantic Beach, Florida 32233-5445 JAN 14 2019 L)W-Ay 1 1 —000 1
s
Phone(904)247-5826 • Fax(904)247-
- qr E-mail: building-dept@coab.us Y:_. _ _ Date routed: I
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Q 22 Ikf SE:—( -r( ODepartment review required Yes No
Applicant: �J I (--��. <'—'Manning&Zomn
Tree Administrator
Project: �����{C-� -POND E- t_0 u is wor
Publicti ities
GO ( (2)C-10 lS`C t �k_D C AL 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
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 Date: i
TREE ADMIN. Second Review: A roved as revised.
[ pp ❑Denied. [—]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed b r Date: g
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
CITY OF ATLANTIC BEACH
Department of Public Works
1200 Sandpiper Lane
Atlantic Beach, FL 32233
U; 1>r (904) 247-5834
PUBLIC WORKS PLAN REVIEW COMMENTS
Date: 1/15/19 Applicant: John Shaw
Permit #: DWAY19-0001 Email: jshaw07@hotmail.com
Review Status: DENIED Site Address: 286 Poinsettia Street
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:
• Maximum driveway width within the City right-of-way is 20'.
• Must have a 2' concrete apron between roadway and crushed stone.V/
PUBLIC WORKS CONDITIONS OF APPROVAL:
(The following comments will be printed on your permita Conditi s of Approval)
• All concrete driveway aprons must be 5" this , 4000 psi, with fibermesh from edge of
pavement to the property line. Reinforcing rods or mesh are not allowed in the right-of-way.
• All runoff must remain on-site during construction.
• 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.
• Full right-of-way restoration, including sod, is required.
• 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.
• All runoff must remain on-site. Cannot raise lot elevation.
• Maximum driveway width within the City right-of-way is 20'.
Scott Williams, Public Works Director swilliams@coab.us/904-247-5834
Resubmittal Notes: All revisions and changes shall clearly standout from the rest of the drawing on the sheet as a revision byway
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 1 of 1
0:\Public Works\ADMIN\PLAN REVIEW COMMENTS\DWAY19-0001(Shaw-Owner).docx
CITY OF ATLANTIC BEACH
Department of Public Works
;? 1200 Sandpiper Lane
Atlantic Beach, FL 32233
(904) 247-5834
PUBLIC WORKS PLAN REVIEW COMMENTS
Date: 1/15/19 Applicant: John Shaw
Permit#: DWAY19-0001 Email: jshaw07@hotmail.com
Review Status: DENIED Site Address: 286 Poinsettia Street
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:
" • Maximum driveway width within the City right-of-way is 20'.
✓• Must have a 2' concrete apron between roadway and crushed stone. /✓�� /
PUBLIC WORKS CONDITIONS OF APPROVAL: ! l
(The following comments will be printed on your permit as Conditions of Approval)
• All concrete driveway aprons must be 5" 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.
• All runoff must remain on-site during construction.
• 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.
• Full right-of-way restoration, including sod, is required.
• 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.
• All runoff must remain on-site. Cannot raise lot elevation.
• Maximum driveway width within the City right-of-way is 20'.
Scott Williams, Public Works Director swiIliams@coab.us/904-247-5834
Resubmittal Notes: All revisions and changes shall clearly standout from the rest of the drawing on the sheet as a revision byway
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 MAYBE REQUIRED DEPENDING UPON NEW INFORMATION AND CLARITY
OF FINAL PLANS SUBMITTED FOR REVIEW.
Page 1 of 1
O:\Public Works\ADMIN\PLAN REVIEW COMMENTS\DWAY19-0001(Shaw-Owner).docx
BOUNDARYSURVEY
FOUND 1/2"
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BLOCK
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STATEOF e` ORARSIGNATISE EMBOSSND E TICATED ELECTRONIC SEALANDSIGNATURESEAL, SERVING FLORIDA
poOR A RAISED EMBOSSED SEAL AND SIGNATURE.sa I' " Digitally signed by 6250 N.MILITARY TRAIL,SUITE 102
Kenneth Kenneth Osborne WEST PALM BEACH,FL 33407
Date:2018.11.18 PHONE (561)6404600
Osborne 18:55:42-05'00' STATEWIDE PHONE (800)226-4807
STATEWIDE FACSIMILE(800)741-0576
KENNETH J OSBORNE mg & I) WEBSITE:hHpJltargetsurveying net
PROFESSIONAL SURVEYOR AND MAPPER#6415
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STATE OF a�
R l C o j OR A RAISED EMBOSSED SEAL AND SIGNATURE
W CY4�
Digitally signed by SERVING FLORIDA
62MILITARY TRA.,SUITE 102
Kenneth Kenneth Osbome
WEST
T PALM BEACH,FL 33407
Date:2018.11.18 PHONE (561)840.4M
(sICNED) - Osborne F�1 p8:555.42e-05'00' STATEWIDE PHONE(800)22&4807
KENNETH J OSBORNE �tvrit(bt Ti l+A q STATEWIDE FFA�C,,SU�,L,,E�(,N„,�O)�7,4,w1-M
PROFESSIONAL SURVEYOR AND MAPPER#6415 WSSITE F�f MMAVM
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7\1REVOCABLE ENCROACHMENT AGREEMENT
,_. 28(o Pol-llse4i0i
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida,a municipal corporation
organized and existing under the laws of the S ate of Florida,hereinafter referred to as"CITY"and
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 G' L "/
Any facility maintained, repaired, erected, and/or installed in the ex cise of the privile 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 3 Q Zig /a4VA/
G.,�,,�/vim�
• In the event it is necessary for the CITY or the City's app presentat�Ve � to her firan6his�utiliy to enter
t
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 pub 'c nd. SER further agrees that the CITY and its officers and employees shall be saved
harmless by the USER f any f the work herein under the terms of this permit and that all of said liabilities are
hereby um t> e S R.
Date
Property ner Agent(sig e i presence of Notary Public)
STATE O FL IDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this day of 20
by S o-w ,who personally appeared before me and
( rinted n ie of Signer)
ac no edge hat e/s igned the i ment voluntarily for the purpose expressed in it.
Signature of Notary Public, State of Florida
Personally Known b Department Approval:
j `
Produced Identification(Type) (f
Scott ili Pb oisi7cctr
F .y•= 70NIGINDLESPERGER
-1-el October 6,2019MY COMMISSION#FF 924951
oBonded Thru bia�YPubGcUndextesO:\Public Works\ADMIN\RevocableLoa
Revision
r(�Ii1
RIGHT-OF-WAY/ EASEMENT PERMIT
Permit#Issued by the City of Atlantic Beach
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address / �(� f 47 fjV✓��%�/ �,l Phone Ff l 7-2i f 490,002
Permittee_' /l "�7 ���,, Email
l
Requesting Permission to Construct /,)
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_ /�- 6 " (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 cos exp es arising in any manner of the exercise or attempted exercises by the holder of
the aforesaid rights privileges.
• The Dir ctor of P 1 Works shal be notified twenty-four 4)hours prior to starting work and again
immedi tely p p tion.
Date
Permit (sign(i in presence otNQt6y Public)
STATE F FLO DA,COUNTY OF DUVAL
The fore ing i ment was acknowledged this day of a 20
JbyJ kQ�l-J ,who personally appeared before me and
( 'nted name of Permittee)
ledged at h /s signed the'nstrument voluntarily for the purpose expressed in it.
Personally Known
Signature of No ary Public,State of Flori a Produced Identification(Type)
ts+ TONI GINDLESPERGER
MY COMMISSION#FF 924951
= . EXPIRES:October 6,2D19
�7 y Bonded Thru Notary Public Underwriters
Revision Request/Correction to Comments **ALL INFORMATION
HIGHLIGHTED IN
jd City of Atlantic Beach Building Department GRAY IS REQUIRED.
i
800 Seminole Rd, Atlantic Beach, FL 32233 W'14`Olt /'Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT � '
❑ Revision to Issued Permit OR E7 Corrections to Comments Date: ?/3
Project Address: ( � �7Z: LZZI l
Contractor/Contact Name:
Contact Phone: i�% f/ D �` Email: ( Jh a—w t'/7&
Description of Proposed Revision/Corrections:
RL J affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
• ANIWI roposed revision/corrections add additional square footage to original submittal?
LJT�p ❑ Yes (additional s.f.to be added: )
•proposed revision/corrections add additional inc rea a in building value to original submittal?
o ❑*Yes (additional increase in building value: )(c r ctor must sign if in ease in valuation)
*Signature of Contractor/Agent:_ U
�_/ (Office Use Only)
Ltd Approved ❑ Denied ❑ Not Applicable to Department Permit Fee Due$
Revision/Plan Review Comment
Department Review Required:
Building
arming&Z -+ _ eviewe By
Tree Administrator
ublic Worl '` 2013
Public Utilities JAN 2 4
Public Safety Date
Fire Services ��� _ Updated 10/17/18
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APOR APPR®VED