1907 Creekside Cir DWAY19-0017 &Walk > " DRIVEWAY PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH DWAY19-0017
800 SEMINOLE ROAD ISSUED: 5/24/2019
t u ATLANTIC BEACH. FL 32233 EXPIRES: 11/20/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITIONr OF • ' • • BUILDING
CODE NEC, IPIMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
�LIL 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: VALUEOFWORK:
1907 CREEKSIDE CIR DRIVEWAY SINGLE OR TWO DRAVEWAY&WALK $13373.00
FAMILY DRIVEWAY
ZONING:TYPE OF REALESTATE SUBDIVISION:BUILDING USE
CONSTRUCTION: NUMBER: GROUP:
1720201212 SELVA MARINA UNIT 12
COMPANY: ADDRESS:
• ADDRESS:
WINTER ALANA E 1907 CREEKSIDE CIR ATLANTIC BEACH FL 32233-4505
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 I 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 Une(904-
-5814)
904-5814)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:5/24/2019 1 of 2
DRIVEWAY PERMIT PERMIT NUMBER
. CITY OF ATLANTIC BEACH DWAY19-0017
800 SEMINOLE ROAD ISSUED: 5/24/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 11/20/2019
3 PUBLIC WORKS POST CONSTRUCTION TORO SURVEY INFORMATIONAL
Notes:
If on-site storage is required,a post construction topographic survey documenting proper construction will be required. All water runoff must go to
retention area and retention overflow must run to street.
4 PUBLOWORKS ROLL OFF CONTAINER INFORMATIONAL
filches:
oll off container company must be on City approved list(Advanced Disposal,Reaico Recycling,Shapells,Inc.,Republic Services,Donovan Dumpsters,
hillips Containers,JDog/Dennis Junk Removal,All American Roll Off,WCA Waste Corporation). Container cannot be placed on Ory right-of-way.
5 PUBLICWORKS RIGHT OF WAY RESTORATION INFORMATIONAL
otes:
ull right-of-way restoration,Including sod,is required.
6 PUBLIC WORKS CONSTRUCTION SITE MANAGEMENT INFORMATIONAL
ones:
ovide construction site management plan,Including location of siltfence,dumpster,portable toilet. Right-of-Way Permit is required If using right.
-way for construction parking.
7 PUBLIC WORKS CIRCULAR DRIVEWAY INFORMATIONAL
Mes:
aximum circular driveway width within the City right-of-way Is 12 feet.
8 PUBLIC WORKS ADDITIONAL COMMENTS PUBLIC WORKS INFORMATIONAL
totes:
rcular driveway is not permitted until waiver is approved bythe City Commission.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PWREVIEW BUILDING MOD OR ROW 001-0000-319-1004 0 $25.00
WORK WITHOUT PERMIT 455-0000-322-1000 0 $110.00
ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 550.00
TOTAL:$185.00
Issued Date:5/24/2019 2 of 2
City of Atlantic Beach CS w o APPLICATION NUMBER
*.�e Building Department (To be assignIed, `by the Building Department.)
' r 800 Seminole Road IA L/ '9-1C01 '7
Atlantic Beach, Florida 322335445
Phone(904)247-5826 Fax(904)247-5845 �
E-mail: building-dept@coab.us Date muted: cJ
City web-site: http//www.ccab.us
APPLICATION REVIEW AND TRACKING FORM
l
Property Address: 90'70 r K S( ( a Department review required Yes No
Build in
Applicant: (DCA-) C— anning 8 Zoning
ree is r
is Works
Project: ' _ 1 C t U Q (.f..7 QJt `( ` V�4A
Public Utilities
Public Safety
Fire Services
Review fee $ De"'.,
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
SL Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: ❑Approved. enied. ❑Not applicable
(Circle one.) Comments:
BUILDING 7O -e,PJ
PLANNING&ZONING Reviewed by: Dater
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 0919120/7
CITY OF ATLANTIC BEACH
800 Seminole Road
Atlantic Beach, Florida 32233
40
Telephone(904)247-5800
FAX(904)247-5845
REVISION REQUEST SHEET OR
CORRECTIONS TO REVIEW COMMENT
Date: / Received by: Resubmitted:
Permit Number: C�) >n ] Rte( L —0c:> L
Original Plans Examiner:',-r wlC(,in S Plo ealame:
Project Address: I S G7 !oro Luna c,2
Contractor: Rra .,,r,n pogo rc_c, Contact Name: 7Zro
Contact Phone : Contact e-mail:
Revision/P Ch /Permit Fee(s) Due: $
Description of Proposed Revision to Existine Permit:
Additional Increase in Building Value: $ Additional S.F.
Site Plan Revised: Public W/U Approval:
By signing belor 1(p�m name) Jo r P4>0 ri e Lcy affirm that the above revision
is inclusive of[h proposed changes.
$Ignatareo On o /Agent(Cununnmmua sips irun;e in vnlwrion) Date
Oma Uu Only
Dae: Approved: RjccW: / Nmifim by
Plan Review Comments: �'
�y� S
Department review required Yes No
Bulltlin
tanning&Zonin Plans Examiner
I nee Administrator
e X21 - 19
Public Utilities
Public Safety Date a.wv,yo rn..r
Fire Services
CITY OF ATLANTIC BEACH
800 Seminole Road
r Atlantic Beach, Florida 32233
Telephone(91)4)247-5800
Y ,
FAX(904)247-5645
REVISION REQUEST SHEET OR
CORRECTIONS TO REVIEW COMMENT
Date: /if Received by: Resubmitted:
Permit Number: :)W R 41'i -pot'?
Original Plans Examiner: Sear L col �3 Project Name:
Project Address: v aF Z 3
Contractor: i3v4C.D 9,, .15 t.t.c, Contact Name:
Contact Phone : gad v-sr liar Contact e-mail:
vtsl /Plan Check/Permit Fee(s)Due: $
MAY 16 2019
Description of Proposed Revision to Existing Permit:
Building DOPaftprlt
- pit} of i-buai fi
Additional Increase in Building Value: S Additional S.F.
Site Plan Revised: Public W/U Approval:
By signijZf'
.I(pnm..m.) n V644 eiELy affirm that the above revision
is inclusa pr posed changes.
S"
Signature Co ra or/Agent(conu.clar man sign if incmw in valunion) Date i
Off=um Only
Uam: Appmmd:,�_ Rcjeded: Naiaed by:_ ___
Plan Review Comments:
DB orlmont raview required Yes No
Build' .. .
(LPlanning 8 Zoning Plans Examiner
ree Administrator _
u -tic Wo x-1'1—(elf
Public Utilities
Public Safety Date
Fire Services it
"ALL ON
Revision Request/Correction to Comments HIGHLIGHTEDIN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Deot(t@coab.us PERMITJI: DWAY19-0017
❑Revision to Issued Permit OR ❑' Corrections to Comments Date:5121119
Project Address: 1907 Creekside Cir
Contractor/Contact Name: Joseph Kiely,owner
Contact Phone: 9044653300 Email:loeyk230@yahoo.com aldna.winter97(rjtgmail.com
MAY 2019
Description of Proposed Revision/Corrections:
affidavit of no tree removal
I Joseph Kiely,owner affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
Will proposed revision/corrections add additional square footage to original submittal?
ONo ❑Yes(additional s.f.to be added: )
N proposed..revision/corrections add additional increase in building value to original submittal?
• o [3-Yes(additionalincrease in building value:$.)(contrador must sign a Increase In valuation)
-Signature of Contractor/Agent:
(Office Use Only)
Approved ❑Denied F Not Applicable to Department Permit Fee Due$
Revision/Plan Review Comments
Department Review Required:
Buidinar
Planning&Zonin Reviewed By
Tree Administrator
Public Works
Public Utilities 1 t
Public Safety Date
Fire Services upeate,110117118
City of Atlantic Beach S V v 0 APPLICATION NUMBER
Building Department - - (To be assigned by the Building Department.)
i 600 Seminole Road
Atlantictic Beach,Florida 322335445
Phone(904)247-5826 Fax(904)247-5845 (, i ) � jl!I,j
F--oil j. E-mail: buildingdept@coab.us Date routed: cJ
City web-site: http:/Aw .coab.us ,
APPLICATION REVIEW AND TRACKING FORM
Property Address: —I / �reekst d e De rtment review re uired Yes No
Buildin
Applicant: ��(.t� (� P /�' arming&Zoning
p ree ms or
Project: 1�l L) e L�-7ct� `ry`�� k is Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Reviewor Receipt Date
Other Agency Review or Permit Required of Permit Verified B
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
SL 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. enied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed r Dat
TREE ADMIN. Second Review: VApproved as revised. . ❑Denied. ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed hy Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Dale:
Revised 0511912017
` CITY OF ATLANTIC BEACH
Department of Public Works
1200 Sandpiper Lane
Atlantic Beach, FL 32233
F t) (904) 247-5834
PUBLIC WORKS PLAN REVIEW COMMENTS
Date: 5/15/19 Applicant: Alana Winter Kiely
Permit#: DWAY19-0017 Email: alana.winter970gmail.com
Review Status: DENIED Site Address: 1907 Creekside Circle
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 must be submitted to the Building Department and must respond to EACH department review.
PUBLIC WORKS CORRECTION ITEMS:
• 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.
• Provide erosion and sediment control plans with installation details.
• Section 24-66(b)of the Land Development Regulations requires on-site storage for increased run-off
if adding 250 SF or more impervious surface. Provide Delta volume calculations and on-site retention
required per Section 24-66(b).
• Maximum circular driveway width within the City right-of-way is 12'.
• Provide a detailed plan of water retention area and how water runoff gets to water retention areas
and then to street.
• According to Section 19-7(F), circular drives shall only be permitted on lots having at least 1100'
frontage. FAIRasnOVED
PUBLIC WORKS CONDITIONS OF APPROVAL:
(Thefollowing comments will be printed on yourpermit as Conditions of Approval)
• 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.
• All runoff must remain on-site during construction.
• If on-site storage is required, a post construction topographic survey documenting proper
construction will be required. All water runoff must go to retention area and retention overflow
must run to street.
• 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,All American Roll Off, WCA Waste Corporation). 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.
• Maximum circular driveway width within the City right-of-way is 12'.
Scott Williams, Public Works Director swllliams&coab.us/904247-5834
Page 1 of 2
0:\Public Works\ADMIN\PIAN REVIEW COMMENTS\DWAY19-0017(Owner-Kiely).docx
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 2 of 2
OAPublic Works\ADMIN\PIAN REVIEW COMMENTS\DWAY19-001](Owner-Klely).docc
?f) Lr) r fEC4IVE CITY OF ATLANTIC BEACH
O� 800 Seminole Road
stt Atlantic Beach,Florida 32233
f MAY 17 urlJ 0 Telephone(904)247-5800
t, FAX(904)247-5845
I REVISION REQUEST SHEET OR
CORRECTIONS TO REVIEW COMMENT
i
Date: / Received by: Resubmitted:
Permit Number: ®to )R�t I.G —C>C7 t•
Original Plans Examiner: carr WIU,to-s Project Name; _
Project Address: 19ol CAInEg;,oY cta.
Contractor: eg),. ,n oo1ELs rc-r, Contact Name:Wro 2oti Lo
Contact Phone :' eat Contact a mail:
Revision/P Che /Permit Fee(s) Duc: $
Description of Proposed Revision to Existing Permit
,�$PLr+NN{r SLn'TGO D,c ./4 vM� y_Vvo�Y___✓"J
1
Additional Increase in Building Value: $ Additional S.F.
Site Plan Revised: Public W/U Approval:
By signing belo I(primormo) Jor F#1 ri ekf a affmn that the above revision
is inclusive of 47d changes.
Signatureo on c[o /Agen[tConaeciormum sivti irincreme in vNuwion) Date
� omee u:<optr
i
Dae: Approved: R Ocd: Notified by:
Plan Review Comments:
940 4Z
De artment review required Yea No
Buildin -- —
lanning aZonio� dans Examiner
Public Utilities _ --
Public Safety Date ti�.auiva a..>
Fire Services
s-aa ���
ECEIVE
CITY OF ATLANTIC BEACH
MAY 22 2019 800 Seminole Road
Atlantic Beach,Florida 32233
BY, Telephone(904)247-5800
FAX(904)247-5845
REVISION REQUEST SHEET OR
CORRECTIONS TO REVIEW COMMENT
Dale: 1e Received by: Resubmitted:
Permit Number: 0 W k 41'l —W 'f
Original Plans Examiner: Sicr Project Name:
Project Address: 1101er=r-C tro- /'r,Li 3'ZZ3
Contractor: f26JaaD po..sy.s t.c(. Contact Name:
Contact Phone :�aJ !A-v i/ ys- Contact e
-mail:
vtst /Plan Check/Permit Fee(s)Due: $
MAY 16 2019
Description of Proposed Revision to Existing Permit:
Building Dqp2litMgmt
Additional Increase in Building Value: $ Additional S.F.
Site Plan Revised: Public W/U Approval:
By signing bel .I(Pdnt nave) 1 n csc p rIBLy affirm that the above revision
is inclusive of e p posed changes.
S"�G �i 1
Signature Co or/Agent(conunewrmua sign irin,n,.e in.luaana) Date—
omu a:e only
We Appmved'. Rej.wd: Notiaedby:
Plan Revicw Comments:
i W iV iS h i' yln�il WaiVd�0. PnV
Department review required Yes No
Bull
Plannin &Zoning Plans Examiner
ree ministrator
Qublic Work -- r v/�
Public UOR" L
Public Safety Date
Fire Services
rr> CITY OF ATLANTIC BEACH
Department of Public Works
1200 Sandpiper Lane
Atlantic Beach, FL 32233
(904) 247-5834
PUBLIC WORKS REVISION PLAN REVIEW COMMENTS
Date: 5/23/19 Applicant: Alana Winter Kiely
Permit#: DWAY19-0017 Email: alana.winter9709mail.com
Review Status: DENIED Site Address: 1907 Creekside Circle
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 must be submitted to the Building Department and must respond to EACH department review.
PUBLIC WORKS CORRECTION ITEMS:
• Circular driveway is not permitted until waiver is approved by the City Commission.
If The waiver must be applied for at the Building Department located at City Hall at 800 Seminole Road.
• Maximum circular driveway width within the City right-of-way is 12'.
• According to Section 19-7(F), circular drives shall only be permitted on lots having at least 100'
frontage.
PUBLIC WORKS CONDITIONS OF APPROVAL:
(The following comments will be printed on your permit as Conditions of Approval)
• 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.
• All runoff must remain on-site during construction.
• If on-site storage is required, a post construction topographic survey documenting proper
construction will be required. All water runoff must go to retention area and retention overflow
must run to street.
If 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,All American Roll Off,WCA Waste Corporation). Container cannot be placed on City
right-of-way.
If 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.
• Maximum circular driveway width within the City right-of-way is 12'.
Scott Williams, Public Works Director swilliams@coab.us/904.247-5834
Resubmittal Notes: All revisions and changes shall clearly stand out from the rest of the drawing on the sheet as a revision by way of completely encircling Me
change with"clouding'. The revision shall also be Wentihed as to the sequence of revision by indicating a triangle wily the reviebn sequence number within R 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. Th riginal shamst be clearly marked VOID"but are to be left within the [of d Complete newets of drawing,will not be accepted.
ADDRIONAL mMs MAY BE REQUIRED DEPENDING UPON NEW INFORMATION AND CIARM OF FINAL PIANS SUBMITTED FOR REVIEW.
Page 1 of 1
0:\Public Works\ADMI N\PLAN REVIEW COMMENTS\DWAY19-0017(Owner-Kiely REVISION).docx
Building Permit Application �� Jpdptad1019138
n City of Atlantic Beach Building Department "ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 J HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dent@coab.us F� IS REQUIRED.
Job Address: 5,907 Creekside Cir,AB, FL 32233 Permit Number: 1J w 4K lq "00 i /�7
Legal Description Paver Driveway - RER
Valuation of Work(Replacement Cost)513,373.50 Heated/Cooled SF Non-Heated/Cooled
• Classof Work: ONew ❑Addition ❑Alteration ORepair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ❑Residential
• If an existing structure,is afire sprinkler system installed?: Dyes ONO
• Will trr.(Si be removed in association Vith oroposedproject?❑yes(must submitra Tree m v I P21mill Quit
Describe in detail the type of work to be performed:
Replace current driveway with pavers and add additional parking and walkway in front of house
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name Aisne Winter Kiely Address 1907 Creekside Circle
City Mark Beach State fy_Zip 3, Phone 904465,3300
E-Mail Alene.winter9]®9mail cam
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) —
Contractor Information
Name of Company Beyond Pavers and Lighting LLC Qualifying Agent Amada Rivera/rrto Rivera
Address 2611 Sunny Apes Or North City Jackaonvllle State FL Zip 32209
Office Phone 901"ua"11gs Job Site Contact Number
State Certification/Registration# 1=1700004B514182-0804098 E-Mail b tl ars® 'I
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt 0 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
RECORq'Nf�,1.YOUR�OTICrI"� OFCOMMENCEMENT.
(Signaiure(� eootf Owner o ent) (Signature of CO or)
Signed and sworn to or affirme )before me p is day of Signed and swam to(Or affirm before me this_day of
C (Signature of Notary)
E Noury p.m.SUH 0 Fkxida
i Rosa Roberti
Personally Known OR � � Mr conarmilon GG mnto [ I Personally Known OR
Exp.01 OWN22 ( I Produced Identification
I Produced Identificatio Type of Identification:
of Identdicaiion'.
"ALL INFORMATION
Owner Builder Affidavit 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 a:
I. FLORIDA STATUTES;CHAPTER 489,FLORIDA STATUTES,PART 1"CONSTRUCTION CONTRACTING" REQUIRES
OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTI11 ON 411 811 9.103(7Ill)11,FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPUED
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 15 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 PERSONAS 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
RE UIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES.
it. INJURY LIABILITY;SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENT
SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED..
WITHH
III IRS WITHHOLDING;
FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENTRKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE TRADES.OLDING
TAXA AND/OR
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-DEPTODCOAB.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: 1907 Creekside Circle,Atlantic Beach FL 3223
Owner Name: Angel Rivera I Tito Rivera Phone Number: 904-258-1145
Mailing Address: y
2611 Sunny Acres Or North City: Jacksonville State: FI zip:..3 09 --
y
Notarized Signature of Owner +r
�--1(� 206 in the State of Florida, County
The fgoing igstrument was acknowledged before me this J_ _day of
of CrC 11 er`
;Z naan Puao supra Faaw nature of Notary Public
Rwa Rebanii
a � GG 161110
�qp 019W2o22 Personally Known OR I )Produced Identification
Type of Identification:
uvdored 10/24118
/ TREE &VEGETATION AFFIDAVIT FORINTERNAL OFFICE USEONLY
City of Atlantic Beach PERMIT#1fw�uV7f Community Development Department
800 Seminole Road Atlantic Beach,FL 32233
(P)904-247-5800
SITE INFORMATION
ADDRESS 190 L'A.aBK-SI OI= -IA— 3zZ3�
SUBDIVISION BLOCK LOT
RE# 907,9 17, RESIDENTIAL ❑ COMMERCIAL E3 OTHER
APPLICANT INFORMATION
J
NAME 055yl Cr ALU^t0 I<-L'I PHONE#
ADDRESS 1 c,03 G+L(;F,KS IOL C/I/L CELL#
CITY AG STATE _ ZIPCODE 32273
EMAIL Jpp ., b� ap'aJ �/n�xo•• e-^"� /ALnNA,{L,107—q7N 10 OWNER ❑ 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 1 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.
HEREBY RTIFY THATALLINFORMATION PROVIDED 15 CORRECT:Signature of Property Owner(s)or Authorized Agent
" J6SGP1� Ki�L.� � L1 I
SIGNA RE FA LICANT PRINTORTYPENAME DAT
SIGNATURE OF APPLICANT(2) 1 PRINTOR TYPE NAME hey�j DATE
Signed and sworn before me on this `�a ` dayof by State of Flbrltf
7cis x: h V-Za County of 111016II 't
Identification verified:
Oath Sworn: ❑Yes ❑ No
} fAy?.'y.;•`•., JENNIFEQN#G 0429Na I
MYCOMMI9910Np GG 0018&
tt a: EVIRES:@.b&f 2l.N yyC mission expires
1_ .•{n.A.^..' a ,&dR NPMry Pubf IM&Mpm
f:_-......
04TREEANDVEGETATIONAFFIDAVIT 0?.01.201 H
0 REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this /V day of 2019
by the City of Atlantic Beach,Florida,a municipal corpolation organized and existing under the laws the State of
Florida,hereinafter referred to as"CITY"and t,1 e-
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 Right-of-Way Permit#
This work is generally described as �� r P )o.-�::
Any facility maintained, repaired, erected, and/or installed a exercise of the pnvilege granted remains subject to
relocation or removal on thirty (30)days' notice by CITY to USER(y. notice o USER shall ba g ven by certified mail,
m
ter receipt requested,to the following address 19 G e g F. d 2 ` t"
• 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 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 most
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,most 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 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 fr any of the work herein under the terms of this permit and that all of said liabilities are hereby
assumed by t USE /
Date l
Properly Owner/ ge t(si ted in presence of Notary Public)
STATE OF FLORI ,COUNTY OF DUVAL p
The foregoing instrument was acknowledged this/-day of 0599Y .20l
by 5-,fgA t-,62-1 ,who personally appeared before me and
( ' ted name of Signer)
acknow ed ed t [h he igned the instrument voluntarily for the purpose expressed in it.
Signature of Notary Public, ty
Florida
Approved/Public Works Il01partmen[:
Personally Known (gyp 1
Produced Identification(Type)_J�� _ ` /fl
l��(Jl
Scon Wil riamis{� Pu lic Works Director
MV SOMMI T0. StESFEFMISSSICN p FF 9 924924951
EXPIFES'.October 6,2019
''%f„r'i�fl9°e' 9onGalLry Nc!ary Puollc W�ennters
RIGHT-OF-WAY/ EASEMENT PERMIT
Permit#Issued by the City of Atlantic Beach
PERIVIITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address t rttyy-S Qu C,(_ Phone Sly `f65J 55
Permittee Y_ e)q Email L?;e—47 Xa W 1,
Requesting Permission to Construct
Location(Referenceto 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 rre 2 �9c (Project Superintendent)
with Company Name R ^moo Op.m a5 ,r 6kor+^4 LG G Phone 9011 z s-f //✓t'
• 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 most review the rmit 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,
ass a all risk of and indemnify,defend and save harmless the City of Atlantic Beach from and against any and
all ss,damage and cost of expenses arising in any manner of the exercise or attempted exercises by the holder of
the oresaid rights and privileges.
• The pirector of Public Works shall be notified twenty-four(24)hours prior to starting work and again
im y u n completion.
Date LOA&�JZgl4
Pertain (si d i resence of Notary Public) /
STATE DA,torment was acknowledged this-COUNTY OF DWAL ))/�
The foregoing in day of ,2011
by C7 v he personally appeared before me and
(p . d name of Pertain
ackno dged[ at he/ signed the instrument voluntarily for the purpose expressed in it.
Personally Known
Si ore of No Produced Produced Identification(Type)
10ai v7tESPEGEa
} E GO\%ASSANMFP92� %PIPES--.Octobe16,20101 9
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MAP SHOWING BOUNDARY SURVEY OF ////��
LOT S. SELMA MARINA UNIT 12, AS RECORDED IN PLAT BOOK M. .� {{�G
PAGE 63, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, RORID.A. ,ly
CERTIFIED TO:
�._ _.. ALANA WINTER
LOANDEPOT. LLC.COM
RICHARD T. MOREHEAD TITLE k ESCROW, INC
OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY
CREEKSIDE CIRCLE
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Pa, Ray Thompson REVISIONS
SURVEYING, Iwo. ?kith GCL Q. +ABOCPhPAL Parz NEwmatrcn
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