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427 Inland Way DWAY19-0042 S�'''� DRIVEWAY PERMIT PERMIT NUMBER 'S rte S''` DWAY19-0042 J CITY OF ATLANTIC BEACH J� " ISSUED: 10/2/2019 800 SEMINOLE ROAD °1i»r V ATLANTIC BEACH. FL 32233 EXPIRES: 3/30/2020 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: 427 INLAND WAY DRIVEWAY SINGLE OR TWO DRIVEWAY $18000.00 FAMILY DRIVEWAY TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION: CONSTRUCTION: NUMBER: GROUP: 169463 1526 OCEANWALK UNIT 04 COMPANY: ADDRESS: CITY: STATE: ZIP: OWNER: ADDRESS: CITY: STATE: ZIP: TILLMAN STANLEY W 427 INLAND WAY ATLANTIC BEACH FL 32233-4682 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. 1 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: 10/2/2019 1 of 2 ,,5=-L`frr, DRIVEWAY PERMIT PERMIT NUMBER =�S''� � DWAY19-0042 ^.: µ CITY OF ATLANTIC BEACH ,iii '� ISSUED: 10/2/2019 800 SEMINOLE ROAD ��`'''��` ATLANTIC BEACH. FL 32233 EXPIRES: 3/30/2020 3 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL Notes: Roll off container company must be on City approved list(Advanced Disposal,Realco Recycling,Shapells,Inc.,Republic Services, Donovan Dumpsters, Phillips Containers,JDog/Dennis Junk Removal,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 and debris must be removed from job site by Contractor. 7 PUBLIC WORKS ADDITIONAL COMMENTS PUBLIC WORKS INFORMATIONAL Notes: Any damage done to infrastructure must be repaired by Contractor. FEES DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00 ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 $100.00 TOTAL:$125.00 Issued Date: 10/2/2019 2 of 2 EE .0,m-r, City of Atlantic Beach - I V APPLICATION NUMBER /✓ Building Department (To be assigned by the Building Department.) 800 Seminole Road SEI 6 -0� Atlantic Beach, Florida 32233 54 � ""t Phone(904)247-5826 • Fax(904 7-5845411 E-mail: building-dept@coab.us Date routed: r City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 4 Z ' Nara Department review required Yes No Building Applicant: 0LZ IAC—{. ala Hing &Zonis Tree Administrator Project: (Ma\vfec,o- yQcy �UG{2- s� 1Jublic 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: ❑Approved. 1enied. ❑Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING �/��/�j Reviewed by: � ate: / / TREE ADMIN. Second Review: Approved as revised. ❑Denied. fNot applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed . • y i /,� _ =.te:• FIRE SERVICES Third Review: nApproved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 Building Permit Application Updated 10/9/18 r,' . ' City of Atlantic Beach Building Department **ALL INFORMATION ',,:,.." , 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY of#swv IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us 1M a 1/ ' }Perm' it h Pc j 9 OC kZ- Job Address: �2- i n 1461,( �,.,v'�<1 � �1 f���1 z�- I,' ;a�� 1it Number: � /' Legal Description �y 1 RE# ' (nC 4-(OSS 1'3 Z(P Valuation of Work(Replacement Cost)$ I O 'Cl) Heated/Cooled SF Non-Heated/Cooled • Class of Work: ❑New ❑Addition 74Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial $Residential • If an existing structure, is a fire sprinkler system installed?: ❑Yes TogNo • Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ❑No Describe in detail the type of work to be performed: +( i'�e Platt t" y [S 1,1" (i i, l ' t 1,l A.,-/ A-I, lA,tJ kit'L 61W 144 P/ty'e r_S S . Florida Product Approval# for multiple products use product approval form Property Owner Information + ` ' Name ra..,,,,,,,,_ "�#1(vt1,6-✓1 _ Address 'Z-1 I VI l� W ACity }k1 . �' 6/,—.%1 State f-L Zip '32.7— Phone C1Dy -5---&')el E-Mail c(v1IC' -14IIk - -V Ci {4iSvl .6cvv1 Owner or Agent(If Agent, Po(ver of Attorney or Agency Letter Required) ®"ne &. 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 0 Expiration Date Application is hereby made to obtain a permit to 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 RECO YO NOTICE OF COMMENCEMENT. 7------7, _7 (Signature of Owner or Agent) ) (Signature of Contractor) �ned al sworn affi -' b-Akii me this 1'day of Signed and sworn to(• affirmed)before me this day of � ...y 1 1 ( • .4 .A. . , •y 4 L . r (Signature of Notary) ,j ,G;;At"y,, TONT GINDLESPERGER """IIILLL33'11, 'd k.`I•� •,- MY COMMISSION#FF 924951 IV• xP 0 er 6,2019 [ ]Personally Known OR 7-.• � t}y`At:��c Underwriters 1...., _, ,,_;_,:, ^^ - C / �7 [ ]Produced Identification Type of Identification: ` 4---t - 19—�o I �1U[ ' ivPe of Identification: 1 Revision Request/Correction to Comments **ALL INFORMATION rS /r HIGHLIGHTED IN r' 1 'Si City of Atlantic Beach Building Department GRAY IS REQUIRED. '0?- 800 Seminole Rd, Atlantic Beach, FL 32233 `-`-=i�� WAY19-0042 Phone: (904) 247-5826 Email: Building-Dept@coab,us PERMIT#: D Revision to Issued Permit OR Corrections to Comments Date:09125/2019 Project Address: 427 Inland Way Atlantic Beach, FL 32233 Contractor/Contact Name: Stanley Tillman Contact Phone: (904)509-5699 Email: stanleytillman@msn.com Description of Proposed Revision/Corrections: Modify the replacement paver driveway within the City right-of-way to maintain the same design as the existing driveway. I Stanley Tillman 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?-; ENo EYes(additional s.f.to be added: ) • ill proposed revision/corrections add additional increase in building valudto,original submittal? No 11*Yes(additional increase in building value: $ )(Contractor must sign if increase in valuation) *Signature of Contractor/Agent: -`° '41111,4110, (Office Use Only) Approved El Denied ❑ Not Applicable to Department Permit Fee Due$ Revision/Plan Review Comments Department Review Required: Building �- / � " `�� gPlanning&Zoning j A l "v a Reviewed By Tree Admmistrator. CFO sir VVOI --_, '; SEP 2 G 2019 1 i f-Jo.1 Public Utilities 1 7 Public Safety IW Date Fire Services Updated 10/17/18 0s.ut,..,, City of Atlantic Beach APPLICATION NUMBER e$ 6 Building Department (To be assigned by the Building Department.) - 800 Seminole Road _0/4 �. Atlantic Beach, Florida 32233-5445 _ filllPF Phone(904)247-5826 Fax(904)247-5845 ea it 91' E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 4 Z I 1 (-\\aV v ac- Department review required Yes No l Buildin Applicant: OC.sv kpe Z_ anning &Zonin j (� Tree Administrator Project: ►Th R\i ec,3 A(-1 i (�U�{L ¶ (ublic orks, -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: F4Approved. ❑Denied. ❑Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: ['Approved as revised. ❑Denied. Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. I INot applicable Comments: Reviewed by: Date: Revised 05/19/2017 fiA„rergz... m• m i NIN TATE Residence Tillman ^,, tom '"` I � { 427 Inland Way. Atlontic Beach,Florida 32233 - n'' 3Y8 ;� -a Provide bullnoee coping e iiii SCALE-va""I'-0" r ff;,` pavers at risers as shown. ( , 0 p d Approx.22 Linear Feet or . bulllnoee coptng pevcs. < r••e a� - O 3 rnl.o,...n•.w Entry u- i ❑ wlln•x u w Front Doors '� f 1 Xi ill Mose ❑ \ I id FW4 GOp N B e Existingriser♦ 1,i- h.',?.:.;:,. �, 3,1 iE Bullnose Gopl 1 - x1na. :z _.. g Split Leaf Philodendron Hoe.Bi. 4 21 r:.l, R 3' Cleyera �.` ren a°vl®�r►;MO 3' 21' Multi-trunk Crape Myrtles......-)„;,:,A:" Q ' g Sago Palm ♦ - MrG'ZEMP$ 451. eo 1 Garage Door m M Split Leaf Philodendron m(�ilklS$i�il�l _ 9 11N1l�RIII 3' `r=Ur=111 6 Plumbago u Pg,, r 1 3' Ir...�•I. `� '.;,1 � ��I .al • I- g ' mita3' 111091 MIMEO T Plemirlg 7 Pia Bullnose Coping at Risers m 0 • DV Palm Tree to be removed w _`rsi 2r Iii�i,ll���l�� H € Plant bed of Asiatic Jasmine in this area PRII•E 3,.1 Io-ai I(auuii a en §,:-,f, to be removed. Re- Grade this area. 11�� X111■1101 w Z Existing illiliMill TI - 75 a e S.21 Giant Liriope canter Llne./f��:�r. J�1■L�VBI�■II 4 1`p o W Existing Fern�� 4,:1� 1,�I €€ • o!; � 71■IO7►Ef■1�1 Approximate Area of pi u g_ ;a 40" Live Oa j R•e' l ���I.�I Woods 'tS 0 6 Transformer r - �� ��1111 U m 0_ gig 0 TE, c o�N I •1 •Palm �:N� •pproximate Line of Existing - c p 91 r1 =MEW Driveway and Walkway '0 Q to be removed. •(0 N Q a,; Existing Mexican Petunias Pol: Palm �:`1 • a 2 e" , •• Palm /®O</• 0 `Rt F;btl ° • ®fin Multi-trunk Crape Myrtle 3 F _ g� Green Utility Box �� ���• 0-0 U _� a a �i 111I�r `>3 `a I � ' �� ePalma DENIED l DE I hone'q 48" Live Oak �_ 4s0®i Multi-trunk Crape Myrtle a 66M Miami curb •��MiG■nE�� �i� ��Z Qa ' Edge of asphalt `,::: �, R +� Green Pittosporum p !i • Suggested Pavers - Roma terra -mi%� b • Property Line li Approximately 250 Ft.Pavers ��� }�, >B pp 5 -q Consult Surveyor P/Ni PR: Contractor is responsible for measuri•• �� 3 in the field and calculating the square f. age. �/7� 711, \ I. Irrigation Spray Head AIIII MIL AMINE-__ i a 4,S Provide installation cost estimate including all permi .'ng. d/7 _IEL ", - h- ' W1' Provide optional cost of sealer. 44' //, ,�7..�3' Water Meter s dor F o 97531 (/ `�ji 111 J 55n- II I I l Approximate Area of ager = Woods 4 I I I I Mailbox //De1t•e-21-2019 Q is eE 108642 1 0 20 30 40 l ) .' d ) SCALE IN FEET No Outlet Sign ( ~J Devin ) N W0 o � Provide a grading plan with minimum slopes for drainage. Consult a Fl. Reg. Engineer for grading. Green Utility Box u i si 4 Consult a Florida Reg. Land Surveyor for spot elevations according to directions from the engineer. w �, Stanley and Donna Tillman s y 3 427 inland Way, Atlantic Beach, Florida 32233 1 j RE# 169463-1526 a- 0 Disdness,: This drawing is for landscape planting purposes only. Consult a Florida Registered Engineer for dl structural work.civil work,and soi testing by others. } The location of an objects shown on this drawing ore approximate locations for landscape planting purposes only. Consult a Florida Registered Land Surveyor for actual locations of objects shown. Layout Plan Q 1 Revision Request/Correction to Comments **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#: DWAY19-0042 ElRevision to Issued Permit OR El Corrections to Comments Date:09/25/2019 Project Address: 427 Inland Way Atlantic Beach, FL 32233 Contractor/Contact Name: Stanley Tillman Contact Phone: (904)509-5699 Email: stanleytillman@msn.com Description of Proposed Revision/Corrections: Modify the replacement paver driveway within the City right-of-way to maintain the same design as the existing driveway. I Stanley Tillman affirm the revision/correction to comments is inclusive of the proposed changes. (printed name) • Will proposed revision/corrections add additional square footage to original submittay ENo E Yes(additional s.f.to be added: •ALill proposed revision/corrections add additional increase in building valud_to;original submittal? No Q*Yes(additional increase in building value: $ ) (Contractor must sign if increase in valuation) *Signature of Contractor/Agent. ��Alir 4// priinow-- (Office Use Only) pproved ❑ Denied ❑ Not Applicable to Department Permit Fee Due $ Revision/Plan Review Comments Department Review Required: f Building ani nim Zoning Reviewed By Tree Adminls ra or u Ic or cs C u c Utilities Public Safety Date Fire Services Updated 10/17/18 j'�'''�,. REVOCABLE ENCROACHMENT AGREEMENT t **ALL INFORMATION :.� w,i� City of Atlantic Beach 1 [ HIGHLIGHTED IN GRAY 800 Seminole Road,Atlantic Beach, FL 32233 IS REQUIRED. ..: vas.?• REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation organized and existing under the laws of th tate of Florida, hereinafter referred to as "CITY" and 51-'/,(P�, ( tL[ 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.. n This work is generally described as C,)I Ltail&(,LLt l'Udf4U (t 1 /. Any facility maintained, repaired, erected, and/or installed in the exercise of tfie privilege granted remains subject to relocation or removal on thirty(30)days'notice by CITY to USER,sai notic��tt�o p�US�ER shall e given by certified mail,return receipt requested,to the following address I- 2,�1 ( k 1 '(-ttGC. ft-j ftt'ij t-- L , C� - (�- 3 Z 2,33 • 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. 41w 2A___---- Date Cid« ( 9 Pro•• y Owner/Agent(signed in presence of Notary Public) STATE OF FLORIDA, COUNTY OF DUVAL The foregoing instrument was acknowledged this I (0 day of�) (DO , 20 C(1.- , 11 by iN t eki It I 1✓Vl 0"0 , who personally appeared before me and (pri ted name of igner) ackno -dged thi : e signed the instrumen # ,r t Eil ,t< ulas,;e>fpressed in it. {!�Y'lik.'' TONI GINDLESPERGER _ -� - MY COMMISSION#FF 92?951 ,, EXPIRES:October 6,2019 r r1: Bonded Thru Notary Public Underwriters Department A. •royal: Signature of Notary Public, State Florida ---3-- • [ ]Personally Known .((.e,/ , z _ [ ] Produced Identification(Type) , J � Scott Williams, Public Works Director H:\Applications&Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18 ff9.../f gt;:ii;v... RIGHT-OF-WAY/EASEMENT PERMIT APPLICATION **ALL INFORMATION 'r .\ City of Atlantic Beach HIGHLIGHTED IN GRAY IS l" 800 Seminole Road,Atlantic Beach, FL 32233 REQUIRED. PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES Job Address 42-1 L Ul la_fd ( v 0- Permit Number Contractor Information Company V t.e.)N C2 Qualifying Agent Address `i ? - eJ(krvd (.(,, City - Ivv"it;G % ,(_C State Zip Phone �[6� U l 9 1 Email S+yvN (i t i I I dVl / cJ Ems/v. C(.2,V . State Certification/Registration# Architect Phone Email Engineer Phone Email Workers Compensation Insurer OR ExemptExpiration 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 (Project Superintendent) with(Company Name) Phone • 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. • The P 31i Wo e" ector shall be notified 24 hours prior to starting work and again immediately upon ompleti n. �� Date 9 1/4---i Pern presence of Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL The foregoing instrument was acknowledged this I CST day of (` )' ,201 CT:( by w b'A( ` -' [ i t ✓ I OW ,whoersonall p y appeared before me and (printed name of Permittee) n^ae�r+a acknowledge. . he/she sign: the instrument voluntarily for the purpose expressed in it ' TONIC'I'vaLESPERGER MY COMMISSION#FF 924951 EXPIRES:October S,2019 Bonded Thru Notary Public Underwriters [ ]Personally,`K-ranw Signature of Notary Public,Sta e of Florida 1 [ ]Produced Identification(Type) H:\Applications&Forms\Word Documents\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18 Owner Builder Affidavit **ALL INFORMATION //f-'' i HIGHLIGHTED IN City of Atlantic Beach Building Department GRAY IS REQUIRED. 800 Seminole Rd, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU, AS THE OWNER OF YOUR PROPERTY, TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF $25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST 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. II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. . III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA"CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON ISA LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904- 247-5826 OR BUILDING-DEPT@COAB.US) IF IN DOUBT. V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. Job Address: I--}a n �// ` /-An�C� r4 ��-4 (/\vk�c_ (�C /x sac93 Owner Name: S- vNAL I el \ c ' VVI VAAl1 Phone Number: q.UCf Mailing Address: (-07-- -v(A�d bMALI- F ) - City: .� �� State: ( Zip: 3a).33 Notarized Signature of Owner�� —// The f egoing ins ument was acknow edged before me this (Oday • I : (n in the State of Florida, County of v',/o---1 44 _ i/L Signature of Notary Public ` , - [ ] Personally Known OR [ ] Produced Identification Type of Identification: / . C— ry., T , , TONI GINDLESPERGER Updated 10/24/18 !_:' f:s MY COMMISSION#FF 924951 <= EXPIRES:October 6,2019 :;'Rr:eo= Bonded Thor Notary Public Underwriters • - • s� s� cF 064.. 3 • ya b �. .� .•"•. .•....'7 04 u,5 :moi ?-_^'ss\\ of �,-•o.,-, . ' ` .O X-ate _4,... .....4:1 . ,1 0 f o l o .s.e. L'8 \ I 3 D 0 UJ a I n n In �L oiJ.,Ynro-rte N. 1 Z �.i✓�O/S.7a/ 'Z1, .,4a'NOvl v .<abls../ C 1Yw • W V/ ova/ „ �/ 1 07 • .csz /(o...-•. ,•, 46 • Q • N AA —--, . ___ .s.".••••,._ 1 ‘1 A• ,, //32) . . NI0 O. ON,7o1 G60.68 . _ - �A�;0%;POI 1 ig/ ��-,.7.,�s�d��2' vim >.-7v-,o•livv�oo ri/ 1 0 7 7N/M C7/7".0 den/ • j . • AiIE1 \ I 17,3 N W.1 811 w. z —t' Tillman Residence I •-‘••••'. l ra w4 �` 427 Inland Way, aua,u<too .nne.32233 ,r r; L • a e �'$ Prpvfdc bullnose coping '! 4 f �• pavers et risers as shown. J' - ( ) O SCALE-V8'•P_O• o i ;.rte, .- :: - n r I Aooro..22 ulnar rave[or ..�>TM-. _'^s - C 1 I I�ulrow caping paver*. 1 O I';4 ..o..a...... Entry �:° ant Doors - C ) } l3ulMw•e fir, _ / N r N Ey0y Case i �' 'K.. MIA..• -.. } ii' Split Leaf Philodendron--- I ,.‘„,..t.„,,_4' I Iff, 10;1_, j' Cleyerctu m„ I - pl. / ----Multi-trunk Crape Myrtle ,. >: Sago Poim�` �"� ar1F�1f�jg• I Garage Door • a Split Lecf Philodendron--------.., ,,/1 \ 4 n'. -"{f a+, .--,.-,..--4„,,,, - a. .n ✓. ``.,.� 'tv w'2' _—`t}. .�•13 I-l� '.::_--=- ..I� o, l._ ,umbago i St EXE t-4,r r . . i el • Ptenarg; 3'�4 - t.xa .-�I��r�r 6utVnoae Copino at RVs<_re rn . § PI Palm Tree to be removed `' • F'. . - -- 3 F€g Plant bed of Asiatic Jasmine in this area, w .] Z i@ to be removed. Re- Grade this area, "-,. __- s �;•�-j.-'••---I..1: , 41,16.--,-; d4 i ' P E 6 N a r Existing ) r:• I�irlrC 1 rr'�" t- D W ew'5 3 Giant Uriupe----'-----, ea,nnr _ 4"1- m ti 3 w ai Existing Fern" \` I r r _ ----i ti._.i_ � �_��-feel I Approximate Areo c lEll u°. Oolr�' � �\:-, ..,. .-_-. 71N Woods Q) H r mer-- - - \� 1. U iC i i VSEvoalkway � Q '�i j! to be removed. Q adE L r • ''-.: Existing Mexican Petunias Pali Palm / { • 1 ! I - • -ii 4 �. I-*'1-- '-i U ___ `` � t -•-ti �/ r•-Multi-trunk :;rape Myrtle �'2 its Sox r c i m i�. .7) CDaelm tD- Attf‘i tL v << F x` `l -" ��'"'-Muhl-trunk Crae tie ,A J ¢, a i 48 Live Oak f v�, i PSb 1 t1e�/r Miami:curb ..--. i.'i �W //""�� d Q tn1 fig / Edge of asphalt ��- -• �'+-•-- , �- r`,/� reen Pit tosparum '8 Suggested Pavers - Roma Sierra 11 V % Property Line t 5b Approximately 2250 5 I.Ft.Pay s �., ''�I ` Consuii Surveyor pEQ8 Contractor is responsible for meosuriyig., ,r, '' ' ��' J ' U r X r is the field and calculating the square f8adoge. 'P7/ ! ,gym rrigaticn Spray Heod F 5 Provide installation cost estimate including all permm'itttng. d� ti U oY 9 7$3 1 Provide optional cost of sealer. /, ,t` ‘"N.,,,,\/.11-Water Meter North r Bac .`'N ({/0ls�/\,\\ ��„ Approxima le Area c. (.c.ue^ o) `F idgQ 2 X� \' Montmj� Woods Q ° lose 4 z 0 10 20 30 40 ..,'\✓/ N �`��V//��� E -'' E P� 0 (°.Heil-.,-:,o,„.) >L _ SCALE IN FEET N� No Out gr. ('"' "''"' ) d� a.w an1Ti. Utility Box 1 b . Provide o grading pion with minimum slopes for drainage. Consult a ri. Reg. Engineer for grading. �� i+ u g; Consult a Florida Reg. Land Surveyor for spot elevations ccarding to directions from the engineer. \,:.....„, 'L ▪•▪ . , Stamey and Demo rcn,on 3 • ' eY/ski dvottui 427 Wood'Way. .(10.t.Nun. FIor ao 32233 w dpy 9noo.wr MN aw..,c i, «,o,doemo v,osms woos.oat, Con.,o nwvfe a.o.,rr.a o-sa,«for o�,�' o.,.:w,a,w, .,c o u+ "i )_ ` u ,n..000,w.or m.•pet,mown,n mi,d•o.,e or.o;oro.;r.o,.,.Moon.,ot w.c.o.po wont.)a='rose,«,r ..«..w.- .o...Aim..«..:o.a...,,rare«.o,.e.......,o,ostia,•,n..... ,� ��"a Si out piu� g Building Department City of Atlantic Beach, FL