1957 Beach Ave POOL19-0014 Pool/Spa City of Atlantic Beach APPLICATION NUMBER
1 Building Department (To be assigned by the Building Department.)
j +� 800 Seminole Road (i' C_ ��
r" .,t.." .�) Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
v E-mail: building-dept@coab.us Date routed: 3
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: t _l S� Q-tc 1&JJ - Department review required Yes No
tuilding�
Applicant: `ik6k S t~LC_ lanrtirr&Zn�ng)
�(' ` Tree Administrator
Project: \ n {l�✓�-Rd Di) ` `� S Public Work
f ' 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
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPL ATION STATUS
Reviewing Department First Review: Approved. Denied. fNot applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by: Date: S--.7 -/9
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
a-t'-'''' ;, Building Permit Application OFFICECOPY Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
'.54111r. 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
urs`9'' IS REQUIRED.
Phone: (904) q 247-5/��8�� r26 Email: Building-Dept@coab.us
Job Address: t Ci 5-1 (-•tt•cl-• )-'�vt..Avt Permit Number: P0o1_� t- Od 1 `I
Legal Description 1551 O Y .2S am L= /V 4'.H P,,,i, U,i f-k f-1--- L0-1' RE# j G ? (t 1 t-- ()TAW
Valuation of Work(Replacement Cost)$ AJC) . W Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New Addition DAlteration ❑Repair ❑Move ❑Demo DPool I Windswx/Door, •
• Use of existing/proposed structure(s): ❑Commercial tkesidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes •694e MAR qq
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal PermitQ�0Plp
Describe in detail the type of work to be performed:
T t-
Florida Product Approval# for multiple products use product approval fbrhi--.
Property Owner Information
Name 31Q, V'c,,,\ j1✓1Aa Address I4c5 S-e4-C � /rV-e-
City Q--FI P cc, State pi...- Zip 32233 Phone 70'-1 _c1.—() Lag
E-Mail 0 e r 5l,..._...I pozi(c .-O
Owner or Agent(If Agent, Power of Attorne�or Agency Letter Required)
Contractor Information r
Name of Company $ C,Lv� (:)(7c5\5 LLL Qualifying Agent ?CrJ 0s 1 d G-c o, y
Address/5`1(, )-i nA r c, Le 0 r City IT ri p,, k State rt- Zip 3 2-Z 3 3
Office Phone C/0 1 3-- `-I Sofa j Job Site Contact Number 5"- L-1 S-c-1A.J
State Certification/Registration# CDC I`1 5-1 Ll D-CIE-Mail rci-e i S /CA-ct pc0Ti(S — () r
.
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer -(-Q,,,P4- ,-- -62-1 OR Exempt❑ Expiration Date Li —,.D.
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
RECORD! G Y UR NO E OF COMMENCEMENT. = �
i a ure of Owner or Agent) (Signature of Contractor)
g g ) ,`
Signed and sworn to(or affirmed)before me this /Clay of Signed and sworn to(or affirmed)before me this 16 day of
nature of Notary) ( nature of Notary)
.;VNYFZP., KAY KEEL SMITH —
•? ,A, P� KAY KEEL SMITH
:.. :Commission#GG 129904
onally Known OR 1,,„ mil ''D `'ersonally Known OR '�4'' c:@ Commission#GG 129904
;,, ^�a;Expires November 30,2021 [ ] roduced Identification ;•i 6!„
[ ]Produced Identification FOFf°••'` Bonded Thru Fain Insurance 800.385-7 7. h
Troy j���••o• Expires November 30,2021
Type of Identification: of Identification: �' ru roy am tnsurance800.3857019
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Alirr, TREE & VEGETATION AFFIDAVIT FORINTERNALOFFICEUSEONLY
`.11 City of Atlantic Beach75
PERMIT#
, Community Development Department
F,
800 Seminole Road Atlantic Beach,FL 32233
n �" (P)904-247-5800
OFFICE COPY
SITE INFORMATION Q
ADDRESS / q5-1 eji ,, c ,...,_ I \ v-L-
SUBDIVISION ! ✓ 4- 4-1 p) , I, BLOCK 1 LOT 5-:(____
RE# i 6 CrV tJ 0Ei RESIDENTIAL ❑ COMMERCIAL ❑ OTHER
APPLICANT INFORMATION
NAME ,Q /6,,(I\N PHONE# 3 �I c(/ p)—i
ADDRESS I ! os \„. >�c 2 CELL#
CITY f ( \)� c STATE Rr✓ ZIP CODE L L 3
EMAIL c.0 NER ❑ LEGAL AUTHORIZED AGENT
I affirm that I have reviewed the provisions of Chapter 23, "Protection of Trees and Native Vegetation", of
the Municipal Code of Ordinances for the City of Atlantic Beach Florida and/or I have participated in a pre-
application meeting with the Administrator of those regulations. Subsequently, I affirm that no regulated
trees and no regulated vegetation will be damaged, destroyed and/or removed from the above-described
property and/or adjacent properties including right-of-way.
I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IS CORRECT:Signature of Property Owner(s)or Authorized Agent
--M) U /`v ) \r'Tt 3 - 1 ei -'/
SIGNA U OF AP NT PRINT OR TYPE NAME DATE
SIGNATURE OF APPLICANT(2) 0 PRINT OR TYPE NAME DATE
/
Signed and sworn before me on this / day ofatk,' C- .,---20) y by State of F C
County of O(/ l,•O
Identification verified:
a
Oath Sworn: s'❑ No )61 • / �
Notary gnature
..;";7 y; KAY KEEL SMITH
=0......•.�C`, ,
My Commission expires E.7,:.:;..`..•
.. ;•.. •.= Commission#GG 129904
'''' yp' Bonded Ttuu Troy Fain Insurance 800.385-7019
04 TREE AND VEGETATION AFFIDAVIT 03.01.2018
;La DePart4,P
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OFFICE COPY
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PERMIT NUMBER: DU-547
PERMITTEE
Beach House 1492,LLC
c/o Kevin Partel, President
Coastal Consulting&Restoration, P.A.
4230 Myrtle Street
St. Augustine,Florida 32084
NOTICE TO PROCEED AND PERMIT FOR CONSTRUCTION OR OTHER ACTIVITIES
PURSUANT TO SECTION 161.053,FLORIDA STATUTES
FINDINGS OF FACT: An application for authorization to conduct the activities seaward of the coastal
construction control line that are indicated in the project description,was filed by the applicant/permittee named
herein on December 5, 2018, and was determined to be complete pursuant to rule on December 5, 2018. The
proposed major structure is to be located landward of the 30-year erosion projection and the existing line of
construction established by major structures in the immediate area. There is no uniform line of construction
established by major structures in the immediate area.
CONCLUSIONS OF LAW: After considering the merits of the proposal and any written objections from
affected persons,the Department finds that upon compliance with the permit conditions,the activities indicated
in the project description of this permit are of such a nature that they will result in no significant adverse impacts
to the beach/dune areas or to adjacent properties; that the work is not expected to adversely impact nesting sea
turtles, their hatchlings, or their habitat; that the work is expendable in nature and/or is appropriately designed
in accordance with Section 62B-33.005,Florida Administrative Code. The direct and cumulative impacts to the
beach and dune system that will be caused by the seaward location and shore-parallel width of the proposed
construction represent the maximum such impacts that are acceptable to the Department. Therefore, future
construction on the site seaward of the coastal construction control line shall not extend further seaward of, or
increase the shore-parallel coverage occupied by, the proposed structures approved pursuant to this permit.
Based on the foregoing considerations,the Department approves the application;authorizes construction and/or
activities at the location indicated below in strict accordance with the project description, the approved plans(if
any) and the General Permit Conditions which are by this reference incorporated herein, and any additional
conditions shown below,pursuant to Section 161.053(4),Florida Statutes.
EXPIRATION DATE: March 1,2022
LOCATION: Between approximately 324 feet and 374 feet south of the Department of Environmental
Protection's reference monument R-43,in Duval County. Project address: 1957 Beach Avenue,Atlantic Beach.
PROJECT DESCRIPTION:
Swimming Pool with Attached Spa
1. Location relative to control line: A maximum of 111.3 feet seaward as measured to the southeast corner.
2. Exterior dimensions: The pool shell is approximately 27.0 feet in the shore-parallel direction by
approximately 23.0 feet in the shore-normal direction.
PERMITTEE: Beach House 1492,LLC OFFICE COPY
PERMIT NUMBER: DU-547
PAGE 2
3. Type of foundation: Piles.
4. Deck elevation of swimming pool: +10.8 feet(NAVD).
5. Bottom elevation of pool shell: +3.7 feet(NAVD).
6. Maximum depth of swimming pool: 6 feet.
Excavation/Fill
1. Total volume of excavation: Approximately 101.1 cubic yards seaward of the control line. Volume of
•
net excavation: None;excavated material to be placed as fill on the project site.
2. Location of excavation: From 89 feet to 112 feet seaward of the control line.
3. Maximum depth of excavation: All excavation is associated with the swimming pool,piles, and grade
beams.
4. Volume of fill to be placed: Approximately 101.1 cubic yards.
5. Location of fill to be placed: From 77 feet to 132 feet seaward of the control line. See Special Permit
Condition 2.
Other Structures/Activities
1. Demolition. See Special Permit Condition 3.
2. A frangible CMU patio with steps on the seaward side of the dwelling.
3. A paver pool deck seaward of the patio steps, varying in width from 3 feet to 16.8 feet wide around the
pool,extending approximately 124.6 feet seaward of the control line as measured to the southeast corner.
4. A deck drain between the patio and the paver pool deck.
5. Sod plantings.
6. Pool lighting. See Special Permit Condition 5.
SPECIAL PERMIT CONDITIONS:
1. Prior to commencement of construction activity authorized by this permit,a preconstruction conference
shall be held at the site among the contractor, the owner or authorized agent, and a staff representative
of the Department to establish an understanding among the parties as to the items specified in the special
and general conditions of the permit.The proposed locations of the structures shall be staked out for the
conference. Contact Trey Hatch at 904/655-1765 or trey.hatchna,dep.state.fl.us to schedule a
preconstruction conference.
2. Prior to commencement of construction activity authorized by this permit, a temporary construction
fence shall be erected along the perimeter of the permitted activity. The fence shall remain in place until
the construction authorized by this permit is complete. The optimum siting of the construction fence
PERMITTEE: Beach House 1492,LLC OFFICE COPY
PERMIT NUMBER: DU-547
PAGE 3
shall be determined during the preconstruction conference by the staff representative so as to provide
maximum protection to the existing native vegetation and dune features located on the site.
3. Any rubble and debris existing on the lot or resulting from new construction shall be removed and
disposed of in a location landward of the coastal construction control line. Rubble and debris shall not
be buried by fill material.
4. All fill material shall be obtained from a source landward of the control line and shall consist of sand
which is similar to that already on the site in both grain size and coloration. This fill material shall be
free of construction debris,rocks, or other foreign matter. A sample of the sand shall be provided to the
staff representative of the Department during the preconstruction conference.
5. All lighting shall be installed and maintained as depicted in the approved lighting schematic.All fixtures
on the seaward and sides of the dwelling shall be shielded and equipped with black baffles. Underwater
pool lighting shall be amber or red LED or equivalent and provide no more than'/2 foot candle per square
foot of pool surface area. There may be a decrease in the wattage of each approved lamp and a decrease
in the total number of each approved fixture without submitting a modified lighting plan for review and
approval. However, if a fixture or lamp is changed to a different type,manufacturer or catalog number
for any reason,or if the location of any fixture is changed it shall be submitted for review and approval
by the Department prior to installation.No additional permanent exterior lighting is authorized.
6. Permittee shall submit compliance reports as specified in Special and General Permit Conditions of this
permit. General Permit Condition 1(r) pertain to a written report which must be submitted to the
Department of Environmental Protection at specified times. The form for the report: 1(r) Final
Certification (DEP Form 73-115B) is available by clicking on the following link
http://www.dep.state.fl.us/beaches/forms.htm#CCCL. The form may be submitted electronically.
GENERAL PERMIT CONDITIONS:
(1) The following general permit conditions shall apply, unless waived by the Department or modified by
the permit:
(a)The permittee shall carry out the construction or activity for which the permit was granted in accordance
with the plans and specifications that were approved by the Department as part of the permit. Deviations
therefrom, without written approval from the Department, shall be grounds for suspension of the work and
revocation of the permit pursuant to section 120.60(7), F.S., and shall result in assessment of civil fines or
issuance of an order to alter or remove the unauthorized work,or both.No other construction or activities shall
be conducted.No modifications to project size,location,or structural design are authorized without prior written
approval from the Department. A copy of the notice to proceed shall be conspicuously displayed at the project
site.Approved plans shall be made available for inspection by a Department representative.
(b) The permittee shall conduct the construction or activity authorized under the permit using extreme care
to prevent any adverse impacts to the beach and dune system,marine turtles,their nests and habitat,or adjacent
property and structures.
(c) The permittee shall allow any duly identified and authorized member of the Department to enter upon
the premises associated with the project authorized by the permit for the purpose of ascertaining compliance
with the terms of the permit and with the rules of the Department until all construction or activities authorized
or required in the permit have been completed and all project performance reports, certifications, or other
documents are received by the Department and determined to be consistent with the permit and approved plans.
(d) The permittee shall hold and save the State of Florida, the Department, and its officers and employees
harmless from any damage, no matter how occasioned and no matter what the amount, to persons or property
that might result from the construction or activity authorized under the permit and from any and all claims and
PERMITTEE: Beach House 1492,LLC
PERMIT NUMBER:DU-547
PAGE OFFICE COPY
judgments resulting from such damage.
(e)The permittee shall allow the Department to use all records,notes,monitoring data,and other information
relating to construction or any activity under the permit,which are submitted,for any purpose necessary except
where such use is otherwise specifically forbidden by law.
(f)Construction traffic shall not occur and building materials shall not be stored on vegetated areas seaward
of the control line unless specifically authorized by the permit. If the Department determines that this
requirement is not being met, positive control measures, such as temporary fencing, designated access roads,
adjustment of construction sequence, or other requirements, shall be provided by the permittee at the direction
of the Department. Temporary construction fencing shall not be sited within marine turtle nesting habitats.
(g) The permittee shall not disturb existing beach and dune topography and vegetation except as expressly
authorized in the permit.Before the project is considered complete,any disturbed topography or vegetation shall
be restored as prescribed•in the permit with suitable fill material or revegetated with appropriate beach and dune
vegetation. When required for mitigation,dune vegetation will be considered successfully established if within
180 days of planting, a minimum of 80 percent of the planting units survive, a minimum of 80 percent of the
planted area is covered with native species and the vegetation is continuous without gaps along the shoreline.
(h)All fill material placed seaward of the CCCL shall meet the requirements of subsection 62B-33.005(7),
F.A.C. All such fill material shall be free of construction debris, rocks, clay, or other foreign matter; and shall
be obtained from a source landward of the CCCL.
(i)If surplus sand fill results from any approved excavation seaward of the control line, such material shall
be distributed seaward of the control line on the site,as directed by the Department,unless otherwise specifically
authorized by the permit. Sand fill placed seaward of the frontal dune,bluff or coastal armoring in marine turtle
nesting habitat shall be configured such that it does not interfere with marine turtle nesting.
(j) Any native salt-tolerant vegetation destroyed during construction shall be replaced with plants of the
same species or,by authorization of the Department,with other native salt-tolerant vegetation suitable for beach
and dune stabilization. Unless otherwise specifically authorized by the Department,all plants installed in beach
and coastal areas — whether to replace vegetation displaced, damaged, or destroyed during construction or
otherwise — shall be of species indigenous to Florida beaches and dunes, such as sea oats, sea grape, saw
palmetto, panic grass, saltmeadow hay cordgrass, seashore saltgrass, and railroad vine, and grown from stock
indigenous to the region in which the project is located.
(k) All topographic restoration and revegetation work is subject to approval by the Department, and the
status of restoration shall be reported as part of the final certification of the actual work performed.
(1) If not specifically authorized elsewhere in the permit, no operation, transportation, or storage of
equipment or materials is authorized seaward of the dune crest or rigid coastal structure during the marine turtle
nesting season. The marine turtle nesting season is May 1 through October 31 in all counties except Brevard,
Indian River, St. Lucie, Martin, Palm Beach, and Broward counties where leatherback turtle nesting occurs
during the period of March 1 through October 31.
(m)If not specifically authorized elsewhere in the permit,no temporary lighting of the construction area is
authorized at any time during the marine turtle nesting season and no additional permanent exterior lighting is
authorized.
(n)All non-opaque walls,balcony railings, deck railings,windows and doors visible from any point on the
beach must be tinted to a transmittance value (light transmission from inside to outside) of 45 percent or less
through the use of tinted glass or window film.
(o) The permit has been issued to a specified property owner and is not valid for any other person unless
formally transferred. An applicant requesting transfer of the permit shall sign the permit transfer agreement
form, agreeing to comply with all terms and conditions of the permit, and return it to the Department. The
transfer request shall be provided on the form entitled "Permit Transfer Agreement" — DEP Form 73-103
(Revised 1/04),which is hereby adopted and incorporated by reference.No work shall proceed under the permit
until the new owner has received a copy of the transfer agreement approved by the Department. A copy of the
transfer agreement shall be displayed on the construction site along with the permit.An expired permit shall not
be transferred. Copies of the "Permit Transfer Agreement" form are available at the following website:
PERMITTEE: Beach House 1492,LLC OFFICE C O P Y
PERMIT NUMBER: DU-547
PAGE 5
https://floridadep.gov/water/coastal-construction-control-line/content/coastal-construction-control-line-cccl-
forms.
(p)The permittee shall immediately inform the Department of any change of mailing address of the permittee
and any authorized agent until all requirements of the permit are met.
(q) For permits involving habitable major structures, all construction on the permitted structure shall stop
when the foundation pilings have been installed. At that time the foundation location form shall be submitted to
and accepted by the Department prior to proceeding with further vertical construction above the foundation.The
form shall be signed by a professional surveyor,licensed pursuant to chapter 472,F.S.,and shall be based upon
such surveys performed in accordance with chapter 472, F.S., as are necessary to determine the actual
configuration and dimensioned relationship of the installed pilings to the control line. The information shall be
provided to the Department using the form entitled"Foundation Location Certification"—DEP Form 73-114B
(Revised 9/05), which is hereby adopted and incorporated by reference. Phasing of foundation certifications is .
acceptable. The Department shall notify the permittee of approval or rejection of the form within seven (7)
working days after staff receipt of the form.All survey information upon which the form is based shall be made
available to the Department upon request. Permits for repairs or additions to existing structures with
nonconforming foundations are exempt from this condition.
(r) For permits involving major structures and exterior lighting on major structures, the permittee shall
provide the Department with a report by a registered professional within 30 days following completion of the
work. For permits involving armoring or other rigid coastal structures, the permittee shall provide the
Department with a report by an engineer licensed in the State of Florida within 30 days following completion of
the work. The report shall state that all locations specified by the permit have been verified and that other
construction and activities authorized by the permit, including exterior lighting, have been performed in
compliance with the plans and project description approved as a part of the permit and all conditions of the
permit; or shall describe any deviations from the approved plans,project description, or permit conditions, and
any work not performed. Such report shall not relieve the permittee of the provisions of paragraph 62B-
33.0155(1)(a),F.A.C. If none of the permitted work is performed,the permittee shall inform the Department in
writing no later than 30 days following expiration of the permit.The report shall be provided on the form entitled
"Final Certification" DEP Form 73-115B (Revised 9/05), which is hereby adopted and incorporated by
reference. Copies of the "Final Certification" form are available at the following website:
haps://floridadep.gov/water/coastal-construction-control-line/content/coastal-construction-control-line-cccl-
forms.
(s) Authorization for construction of armoring or other rigid coastal structures is based on an engineering
review and assessment of the design and anticipated performance and impact of the structure as a complete unit.
Construction of any less than the complete structure as approved by the Department is not authorized and shall
result in the assessment of an administrative fine and the issuance of an order to remove the partially constructed
structure. Modifications to the project size, location, or structural design shall be authorized by the Department
in accordance with rule 62B-33.013,F.A.C.
(2) The permittee shall not commence any excavation, construction, or other physical activity on or
encroaching on the sovereignty land of Florida seaward of the mean high water line or,if established,the erosion
control line until the permittee has received from the Board of Trustees of the Internal Improvement Trust Fund
the required lease, license,easement, or other form of consent authorizing the proposed use.
(3) The permittee shall obtain any applicable licenses or permits required by Federal, state, county, or
municipal law.
(4)This permit does not authorize trespass onto other property.
(5) In the event of a conflict between a general permit condition and a special permit condition, the special
permit condition shall prevail.
(6)Copies of any forms referenced above can be obtained by contacting the Department of Environmental
Protection, 2600 Blair Stone Road, MS 3522, Tallahassee, Florida 32399-2400, at
haps://floridadep.gov/water/coastal-construction-control-line/content/coastal-construction-control-line-cccl-
forms or by telephoning(850)245-8336.
PERMITTEE: Beach House 1492, LLC �C I CL. copy
PERMIT NUMBER: DU-547 O
PAGE 6
CAVEAT:
Due to potential adverse impacts to the beach and dune system that may result from additional development on
the property,the seaward extent of the permitted structures shall not be increased,nor will any additional major
structures be permitted which would exceed the limits established by the permitted construction seaward of the
coastal construction control line.
Approved plans are incorporated into this permit by reference.
NOTICE OF RIGHTS
This action is final and effective on the date filed with the Clerk of the Department unless a petition for an
administrative hearing is timely filed under Sections 120.569 and 120.57,F.S.,before the deadline for filing a
petition. On the filing of a timely and sufficient petition,this action will not be final and effective until further order
of the Department.Because the administrative hearing process is designed to formulate final agency action,the
hearing process may result in a modification of the agency action or even denial of the application.
Petition for Administrative Hearing
A person whose substantial interests are affected by the Department's action may petition for an administrative
proceeding(hearing)under Sections 120.569 and 120.57,F.S. Pursuant to Rules 28-106.201 and 28-106.301,
F.A.C.,a petition for an administrative hearing must contain the following information:
(a) The name and address of each agency affected and each agency's file or identification number,if
known;
(b) The name,address,and telephone number of the petitioner;the name,address,and telephone number
of the petitioner's representative,if any,which shall be the address for service purposes during the
course of the proceeding; and an explanation of how the petitioner's substantial interests are or will be
affected by the agency determination;
(c) A statement of when and how the petitioner received notice of the agency decision;
(d) A statement of all disputed issues of material fact. If there are none,the petition must so indicate;
(e) A concise statement of the ultimate facts alleged, including the specific facts that the petitioner
contends warrant reversal or modification of the agency's proposed action;
(f) A statement of the specific rules or statutes that the petitioner contends require reversal or modification
of the agency's proposed action, including an explanation of how the alleged facts relate to the specific
rules or statutes; and
(g) A statement of the relief sought by the petitioner, stating precisely the action that the petitioner wishes
the agency to take with respect to the agency's proposed action.
The petition must be filed(received by the Clerk)in the Office of General Counsel of the Department at 3900
Commonwealth Boulevard,Mail Station 35,Tallahassee,Florida 32399-3000,or via electronic
correspondence at Agency_Clerk@dep.state.fl.us. Also,a copy of the petition shall be mailed to the applicant
at the address indicated above at the time of filing.
Time Period for Filing a Petition
In accordance with Rule 62-110.106(3),F.A.C.,petitions for an administrative hearing by the applicant and
persons entitled to written notice under Section 120.60(3),F.S.,must be filed within 21 days of receipt of this
written notice. Petitions filed by any persons other than the applicant,and other than those entitled to written
notice under Section 120.60(3),F.S.,must be filed within 21 days of publication of the notice or within 21
days of receipt of the written notice,whichever occurs first. The failure to file a petition within the appropriate
time period shall constitute a waiver of that person's right to request an administrative determination(hearing)
PERMITTEE: Beach House 1492, LLC I(�
PERMIT NUMBER: DU-547 V�j F F I V LC� COPY
PAGE 7
under Sections 120.569 and 120.57,F.S.,or to intervene in this proceeding and participate as a party to it.Any
subsequent intervention(in a proceeding initiated by another party)will be only at the discretion of the
presiding officer upon the filing of a motion in compliance with Rule 28-106.205,F.A.C.
Extension of Time
Under Rule 62-110.106(4),F.A.C.,a person whose substantial interests are affected by the Department's
action may also request an extension of time to file a petition for an administrative hearing. The Department
may,for good cause shown,grant the request for an extension of time. Requests for extension of time must be
filed with the Office of General Counsel of the Department at 3900 Commonwealth Boulevard,Mail Station
35,Tallahassee,Florida 32399-3000,or via electronic correspondence at Agency_Clerk@dep.state.fl.us,
before the deadline for filing a petition for an administrative hearing.A timely request for extension of time
shall toll the running of the time period for filing a petition until the request is acted upon. •
Mediation
Mediation is not available in this proceeding.
Judicial Review
Once this decision becomes final, any party to this action has the right to seek judicial review pursuant to
Section 120.68,F.S.,by filing a Notice of Appeal pursuant to Florida Rules of Appellate Procedure 9.110 and
9.190 with the Clerk of the Department in the Office of General Counsel(Station#35, 3900 Commonwealth
Boulevard, Tallahassee,Florida 32399-3000)and by filing a copy of the Notice of Appeal accompanied by the
applicable filing fees with the appropriate district court of appeal. The notice must be filed within 30 days
from the date this action is filed with the Clerk of the Department.
EXECUTION AND CLERKING
Executed in Tallahassee,Florida.
STATE OF FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
David A. Kriger,Permit Manager
Coastal Construction Control Line Program
Division of Water Resource Management
CERTIFICATE OF SERVICE
The undersigned duly designated deputy clerk hereby certifies that this document and all attachments were
sent on the filing date below to the following listed persons:
Kevin Partel,Coastal Consulting&Restoration, P.A.,kevinpartel@gmail.com
Trey Hatch,FDEP CCCL Field Inspector,trey.hatch( dep.state.fl.us
Dan Arlington, City of Atlantic Beach Building Official, darlington(allcoab.us
PERMITTEE: Beach House 1492,LLC OFFICE c O P"
PERMIT NUMBER: DU-547
PAGE 8
FILING AND ACKNOWLEDGMENT
FILED, on this date,pursuant to Section 120.52,F. S.,with the designated Department Clerk,receipt of which
is hereby acknowledged.
03/01/2019
Clef ' Date
• vP-
's ! `j =� Cash Register Receipt Receipt Number
.11,.. - City of Atlantic Beach R11462
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DESCRIPTION I ACCOUNT I QTY I PAID
PermitTRAK $55.00
POOL19-0014 Address: 1957 BEACH AVE APN: 169696 0000 $55.00
POOL FINAL BUILDING 01/07/2020 RBE $55.00
POOL FINAL BUILDING 01/07/2020 RBE 455-0000-322-1002 0 $55.00
TOTAL FEES PAID BY RECEIPT: R11462 $55.00
Date Paid: Monday, January 13, 2020
Paid By: ISLAND POOLS,LLC
Cashier: CT
Pay Method: CREDIT CARD 63974P
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Printed: Monday,January 13, 2020 2:41 PM 1 of 1 4