2160 S Fairway Villas Ln DWAY19-0021 Paver DRIVEWAY PERMIT PERMIT NUMBER
DWAY19-0021
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 7/23/2019
EXPIRES: 1/19/2020
ATLANTIC BEACH, FL 32233
_7_
MUST CALL INSPECTION PHONE LINE (go 4 -�5814 BY 4 PTFt)"EXT 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.
ENOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property
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t t
hat may be found in the public records of this county,and there may be additional permits required from other
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overnmental entities such as water management districts, state agencies, or federal agencies.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
2160 S FAIRWAY VILLAS LN DRIVEWAY SINGLE OR TWO PAVER DRIVEWAY $5600.00
FAMILY DRIVEWAY
TYPE OF REALESTATE BUILDING USE
ZONING: SUBDIVISION:
GROUP:
CONSTRUCTION: NUMBER:
1693981012 FAIRWAY VILLAS
COMPANY: ADDRESS: CITY: STATE: ZIP:
KETTELLINC. 1860 MAYPORT RD ATLANTIC BEACH FL 32233
OWNER: ADDRESS: STAT E: ZIP:
MILLSPAUGH 2160 FAIRWAY VILLAS LN S ATLANTIC BEACH FL 32233-4408
CHRISTOPHER L
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.
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
PUBLIC WORKS EROSION CONTROL INSTALLATION INFORMATIONAL
Notes:
Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line(904-247-
5814)to request an Erosion and Sediment Control Inspection prior to start of construction,
2 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
Issued Date: 7/23/2019 1 of 2
DRIVEWAY PERMIT PERMIT NUMBER
DWAY19-0021
CITY OF ATLANTIC BEACH
ISSUED: 7/23/2019
800 SEMINOLE ROAD EXPIRES: 1/19/2020
ATLANTIC BEACH, FL 32233
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,All American Roll Off,WCA Waste Corporation). 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.
5 PUBLIC WORKS MAXIMUM DRIVEWAY INFORMATIONAL
Notes:
Maximum driveway width within the City right-of-way is 20 feet.
6 PUBLIC WORKS DECKING REMOVED INFORMATIONAL
Notes:
All old decking must be removed from job site by Contractor.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
TOTAL:$25.00
Issued Date: 7/23/2019 2 of 2
APPLICATION NUMBER
Pi-i- City of Atlantic Beach
Building Department (To be assigned by the Building Department.)
800 Seminole Road ECEIVE
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)2 8
E-mail: building-dept@coab.us 4JUL-0 2 2019 Date routed:
Cityweb-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Z P—CAA f- V1 Department review required Yes No
B u 11
uildin_9_
Applicant: Eli L_L anning &Zoning--_�>
Tree Adrnini�straor
(-_77blic Worrs_-_-�
Pro'ect: ak�/C-
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:
APPLICATION STATUS
Reviewing Department First Review: VApproved. ElDenied. EINot applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed //61.�ate:
TREE ADMIN. Second Review: DApproved as revised. F]Denied. F]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: F]Approved as revised. E]Denied. E]Not applicable
Comments:
Reviewed by: Date:
Revised 05/1912017
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
Atlantic Beach, Florida 32233-5445
800 Seminole Road
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: �7 JZ
t,W1 I
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ZIGC) PC)Lk(,_lA-�QLtV1J to- Department review required Yes No
11
I Building
Applicant: E-T-T CL-(- anning &Zonin—g--_-_->
Tree Aclmin�is Hraor
Project: (-Public Worl_g:��
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:
APPLICATION STATUS
Reviewing Department First Review: 21A�pproved. ElDenied. E]Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by:,O��� Date:
TREE ADMIN. Second Review: F]Approved as revised. [-]Denied. [-]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ElApproved as revised. E]Denied. E]Not applicable
Comments:
Reviewed by: Date:
Revised 05/1912017
Building Permit Application Updoted 1019118
City of Atlantic Beach Building Department "ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
fall Phone: (904) 247-5826 Email: Build i ng-Dept@ coa b.us IS REQUIRED.
JobAddress: ZA00 �-�rwf_, XX14j L=±e_,L _50,1AL PermitNumber:
Legal Description 30-7-Z a-7 �-749 RE# M q 3q3_.161 7__
. I -
Valuation of Work(Replacement Cost)4T600- Heated/Cooled SF Non-Heated/Cooled
• ClassofWork: E]New OAddition "teration ORepair ElMove ODemo E)Pool E]Window/Door
'Nesidential
• Use of existing/proposed structure(s): OCommercial E
• If an existing structure,is a fire sprinkler system installed?: E]Yes ONo
• Will tree(s)be removed in association with proposed project? F]Yes(must submit separate Tree Removal Permit) N1\lo
Describe in detail the type of work to be performed:
PV/YV,c*— &oc,4 dilimo4a, + s rAL -4 A 0 141
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name A,-fl bi, Address 8 -t 1,.
city State Zip 3-103 —Phon'-e
E-Mail
Owner or Agent(if Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company vie,ffOl X, Quali ingAgent I've&
Address 1900 1/11-1104 C:�L A46i Cit
--2g-, 11,2__State Zip Z-7,T2
Office Phone To V j:7,L :I I" Job Site Conta t Numb r ki 11419'
State Certification/Registration# E-Mai,..... 2. �,ft? U -,
Architect Name&Phone#
Engineer's Name&Phone# A
VJ)I- OR Exempt 11 Expiration Date
Workers Compensation Insurer OL
Application is hereby made to obtai 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
REC MENT.
k.31g11dLU[t2 U1 UVVlltfl U1 /A61.-IlLI (Signature of Contractor)
_Z__day of Signed and sworn t (or affir e )before me this Z, day of
�Signecl and sworn to tor aff;irned)before me this
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4951
84—K r N8tk`r,�)__-N_
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My COMUISSION
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--[-I<r,onally Known OR . 6 Th- NOM PU'1�c
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Produced Identification I Viroduced IdOht�,
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TONI GiMIXESPEFIGER
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Type of Identificat n: pe of Identification:
EXPIRES:October 6,2019
T�Bonded Thruxe-mry Pubhc Undervritars
-OF TREE & VEGETATION AFFIDAVIT FOR INTERNAL OFFICE USE ONLY
City of Atlantic Beach
PERMIT#
Community Development Department
800 Seminole Road Atlantic Beach,FL 32233
(P) 904-247-5800
SITE INFORMATION
ADDRESS 71/
SUBDIVISION BLOCK LOT
RE# 16� Wy - lol 7, J�RESIDENTIAL COMMERCIAL OTHER
APPLICANT INFORMATION
NAME 011'111SOXY19 � PHONE#
V e-I
ADDRESS CELL#
CITY STATE ZIP CODE
EMAIL "LA C
LEGAL AUTHORIZED AGENT
OOWNER
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 HER BY CERTI �TW AL�INFORMATION PROVIDED IS CORRECT:Signature of Property Owner(s)or Authorized Agent
JIuMild 5�4;2 2,019
I AT6RE'0'F�`APPLfCANT" (J PRINT OR TYPE NAME DVE
SIGNATURE OF APPLICANT(2) PRI TYPE NAME DATE
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Signed'and sworn before-Tne on this day of ZO(q by State of
County of L)v
Identification verified:
Oath Sworn: Yes E] N o
TONI GINDLESPERGER Notary Signature
MY COMMISSION#FF 924951
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EXPIRES:October 6,2019
Bonded Thru Notary Public Underwriters
My Commission expires
04 TREEAND VEGETATIONAFFIDAVIT03.01.2078
REVOCABLE ENCROACHMENT PERMIT
REVOCABLE ENCROACHMENT PERMIT by the City of Atlantic Beach, Florida,a municipal corporation
organizeZA!nd existing under the laws of the State of Florida,hereinafter referred to as"CITY"and
A r6n&!ne_ 11!�004 V of Atlantic Beach,Florida,hereinafter
referred to as-"USEW'. _ V /4
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 Cho 14�u_ I IP61 14 1
lw,�nm I J I;� . W -
Any facility maintained, repaired, erected, and/or installed in the7xercis—e 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 24 A a Qdrisa;A Wlk J
I V
• 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 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 AtItntic 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 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 2,z �X19
roperty Owner/Agent(signed in pre ce of Ts�Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this day of, L 20
1
�es,VncegofVary
by ko rz_�Af W/ who personally appeared before me and
11 p nted name of Signer)
ac I ge 7 e signed:instrument voluntarily for the purpose expressed in it.
ed d h sh the
Signature of Notary Publick!ite of Florida Approved/Public Works Department:
Personally Known
Produced Identification(Type)
TONI GINDLESPERGER—— Scott WiTI i�m_S',Public_worrs�6 rector
"..'s M commiliSsION#FF 924951
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EXPIRES- tober6,20019
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-1� ", Bonded Thru;�tary Public Underwriters
RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION "ALL INFORMATION
City of Atlantic Beach HIGHLIGHTED IN GRAY IS
800 Seminole Road, Atlantic Beach,FIL 32233 REQUIRED.
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address 2A 6 o fA.rw" Q11cl Spuf IL, Permit Number
Contractor Information
Company �411 I 1-12L- QualifyingAgent J�J'Abe &A/Z
Address kVAI+ at� —City Aflm�r, 'State Zip
Phone qoq 3-7 77-&6 Email ;Ary
State Certification/Registration#
Architect Phone Email
Engineer Phone Email
Workers Compensation Insurer A3�11LS�L & & - ,OR Exempt o Expiration Date
• Permittee declares that prior to filing this application they have ascertained the location of all existing utilities,both aerial
and underground and the accurate locations are shown on the sketches.
• Whenever necessary for the construction,repair, improvement,maintenance,safe and efficient operation,alteration or
relocation of all,or any portion of said street or easement as determined by the Public Works Director,any or all said poles,
wires,pipes,cables or other facilities and appurtenances authorized hereunder,shall be immediately removed from said
street or easement or reset or relocated hereon as required by the Public Works Director and at the expense of the
Permittee unless reimbursement is authorized.
• All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the
supervision of t4al (Project Superintendent)
with(Company Nan�e) gne. Phone q 0 -7 loo&
"i T7
• All materials and equipment shall be subject to inspection by the Public Works Director.
• All city property shall be restored to its original condition as far as practical,in keeping with City specifications and the
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 Public Works Director 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 cost of
expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges.
• he Public Works Djrector shall be notified 24 hours prior to starting work and again immediately upon co I tion.
Date—W?7 9
Lac)
Permittee(signed in presence of No"tary Pu
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this_ P. — day of 1� 120
aL
by I Is 42 au who personally appeared before me and
(printed name of PermitteeV
ac wled7ha iea/shee ligned the instrument voluntarily for the purpose expressed in it. TONI GINDLESPERGER
My CoMmISSION#
EXPIRES:October 6.2019
F -d
F 924951
U -Witefs
BdedTtnN0taryPU�'r'C ne
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Signature of Notary�ublic,slate o\�6ricla ] Produced Identification(Type)
H:\Applications&Forms\Word&Excel Document Originals\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18
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