1772 SEA OATS DR DWAY19-0006 DRWY PERM DRIVEWAY PERMIT PERMIT NUMBER
DWAY19-0006
CITY OF ATLANTIC BEACH
ISSUED: 3/12/2019
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233 EXPIRES: 9/8/2019
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:
1772 SEA OATS DR DRIVEWAY SINGLE OR TWO DRIVEWAY AND WALK WAY $9000.00
FAMILY DRIVEWAY
TYPE OF REALESTATE BUILDING USE
ZONING: SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1720200426 SELVA MARINA U NIT 08
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
SHERRILL PETER G 1772 SEA OATS DR ATLANTIC BEACH FL 32233-5829
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.
EROSION CONTROL INSTALLATION INFORMATIONAL
PUBLIC WORKS
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.
2 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
Issued Date: 3/12/2019 1 of 2
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road ID uu t9 -0 00
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: Z 9
City web-site: http://vvww.coab.us 11
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1-7 7 Z_ c—a C'Da—cs Department review required Yes No
Buil�m
Applicant: CfFanning
Tree72m[ri`isTr.1t6r
Project: _P,�olu_ tg�fficWor�ks
PubRc�fi i ies
Lk� Puv,uo 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. E]Denied. E]Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: ei�� A-11 Date:,01
TREE ADMIN. Second Review: E]Approved as revised. E]Denied. E]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: DApproved as revised. F]Denied. E]Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
ri ID L�j A��4, t9 -o rn
z Atlantic Beach, Florida 32233-5
Phone(904)247-5826 - Fax(9 �t;24f%& 4 2019
r;I J!)� E-mail: building-dept@coab.uE Date routed: Z
Cityweb-site: hftp://www.coab. V
APPLICATION REVIEW AND TRACKING FORM
Property Address: Department review required Yes No
Builcl�g__
Applicant: ("3&4z� (�anning &Zon6_9__,
Tree A_d_ffiFn_i§tMt(5r
Project: pomu_ P—kjp-") NL,/ _eUgEc�Works
IL
Public tilifies
L�� PL-V,Lo 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: VA-'pproved. ElDenied. E]Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed Date---
TREE ADMIN.
Second Review: [—]Approved as revised. ElDenied. E]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: [—]Approved as revised. F]Denied. E]Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department "ALL INFORMATION
800 Seminole Road, Atlantic Beach, FIL 32233 HIGHLIGHTED IN GRAY
7
Phone: (904) 247-5826 Fax: (904) 247-5845 Email: Build ing-Dept@coab.us IS REQUIRED.
Job Address: 7 Z_ _5�� 67,41-� /V.Z— 1�1' 14 4_Vr in 4`N u rn b e r: DW
Legal Description RE#
Valuation of Work(Replacement Cost)$ Heated/Cooled SF Non-Heated/Cooled
ClassofWork: eNew DAddition ElAlteration ORepair ElMove E]Demo E]Pool E]Window/Door
Use of existing/proposed structure(s):10commercial [3Resiclential
If an existing structure, is a fire sprinkler system installed?:FRIYes &o
Will tree(s) be removed in association with or000sed ProiectAkes(must submit seaarate Tree Removal Permit) 04-0----
Describe in detail the type of work to be performed:
, L-44-//C—4)--1 " 1"' 1-,4—e
Florida Product Approval# for multiple products use product approval form
Property Owner Information
N am e- /7/�4-z2 4 Z Y1117—r1_11 Address VZ_
city Z State zip 7z Z7
�H,_Lr_ 4yzz-�/,/- Phone 2 -7-/- 8- 5-e
E-Mail ,el i/ ,
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) n/a
Contractor Information
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 Ei 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 PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
Rk,�Cp D111,Nt)=UOTICE OF 0
MMENCEMENT.
(Signature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed) before me this'74kday of Signed and sworn to(or affirmed) before me this day of
(11),n 1 by A�-_J�t-A(V
I U U.� _r") by
(Signature of Notary)
.4 NNERS
�V I S
W R
Ar�l W COMWSSION#G 123203
dL
MIT -1 y 0 1
EXPIRES:July 114�.20211
�ipersonally Known OR BMW Ttft Personally Known OR
[ ]Produced identificat Produced Identification
Tvoe 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#:
1. 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. YOUHAVEAPPLIED
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
BE DONE 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.
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENT
SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. .
Ill. 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(l). 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: 1772 Sea Oats Drive
Owner Name:Margaret Sherrill Phone Number: 904-962-4041
Mailing Address: 1772 Sea Oats Drive City: Atlantic Beach State: fl Zip: 32233
A
Notarized Signature of Owner IL/I A
oreg ing i _O)Cdayof 20 County
Th f nstrument was acknowledged before me this in the State of Florida,
of
Signature of Notary Public /uh,
—4
4ersonally Known OR Produced Ide-itifi-rn±'
'NNERSD"
LAVONDA J,CONNERS
GG
myCoMwSSION OGG 123203
4A M71
Type of Identification: i EXPIRES*
Bonded Th(u NOWY Pubk W160MID""s
Updated 10124118
ORDERED BY
HILLEREST
lerec
I L 322 11
PROPERTY ADDRESS: 1772 SEA OATS DRIVE ATLANTIC BEACH,FLORIDA 32233 SURVEY NUAR:FL1412.2385
FIELDWORK DATE:1212212014 REVISION DATEM:(REv.o i2r"2D14)
Jr-
FL14122M
BOUNNRYSURVEY 110
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LOT A"M5 TO BE 5EFMCrD BY CITY WATM AND SEWER TA2BILE:
M%a OWNERSHIF NOT DETERMINED LI NOW'20PE21.10(F)
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ofProfe ona rvoy�j"44ap n Chapter 5J-17 of
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s uRv'Io GRAPHIC SCALE (In Feet)
I inch = 30' ft.
KEITH A.STEPHENSON
3mborpa PmbNIo'wIswvq/NvWMePW
Lkwm No.6521
U. ffh.�S—ey I.,P.r,--.1he,lh-1—ded,wthout wntten Verification,m1i he at the U—,Sol,Ri,k,,d Wah—Oabdily to the surYeyot
N,th,,g h,r,,n,h,li�C—t�to G—ANY R,ght, 8—M,1.Ar,,o—O'he,Ih..th—Cenofi�
FLOOD INFORMATION: OF INTEREST
BY PERFORMING A SEARCH WITH THE LOCAL GOVERNING VISIBLE
MUNICIPALITY OR WWW.FEMA.GOV,THE PROPERTY APPEARS TO BE
LOCATED IN ZONE X.THIS PROPERTY WAS FOUND IN THE CITY OF
ATLANTIC BEACH,COMMUNITY NUMBER 120075,DATED 0&W13.
CLIENT NUMBER:HC144)067 DATE:12/30/201 AFFILIATE
MEMBERS
BUYER:PETER AND MARGARET SHERRILL
SELLER:
AND TRUST;OLD REPUBLIC NATIONAL TITLE
CERTIFIED TO:PETER AND MARGARET SHERRILL,HILLCREST TITLE �ACTkk
INSURANCE COMPANY;JAX FEDERAL CREDIT UNION EK
Land Surveyors, Inc. —86SI 7 U-2,8 8-2
This is page 1 of 2 and is not valid without all pages. L6#7337 1 1940 F a—Y Lake�D—,SlIne I-Ft.MyeM FIL 33913
REVOCABLE ENCROACHMENT AGREEMENT
City of Atlantic Beach "ALL INFORMATION
HIGHLIGHTED IN GRAY
800 Seminole Road,Atlantic Beach,FIL 32233 IS REQUIRED.
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
Margaret Sherrill 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 Replace existing driveway with brick pavres
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 1772 Sea Oats Drive Atlantic Beach FL 32233
• 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 hereby assumed by the USER.
Date
Property Owner/Agent(signed in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this day of FrL4,ri 3 20
by c, r(A- �C T— who personally appeared before me and
(printe"ame of Signeri
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
MARLABUCHANAN
State of Florida
Notary Public
Department Approval:
Commission#GG 1693 11
Sig!�dture of Notary Public,State"ofFlorida My Comm.Expires Dec 19.202
Bonded through Nationa'Noary Ass^
Upersonally Known W W W 0 - - - )4-1.-X-4a
[ ] Produced Identification(Type) Sco�?Z�i(Ka;Ws, Pub-4-c'WdLrk'rn'T1r`ector
H:\Applications&Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18