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715 Seminole Rd DWAY19-0053 Paver Driveway/Walkway rt1-. ./ DRIVEWAY PERMIT PERMIT NUMBER CITY OF ATLANTIC BEACH DWAY19-0053 J '` � ISSUED: 12/18/2019 800 SEMINOLE ROAD ".'..-t0.219'," ATLANTIC BEACH. FL 32233 EXPIRES: 6/15/2020 MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM OR-NEXT DA 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: 715 SEMINOLE RD DRIVEWAY SINGLE OR TWO PAVER DRIVEWAY AND $16300.00 FAMILY DRIVEWAY WALKWAY TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION: CONSTRUCTION: NUMBER: GROUP: 170404 0000 SALTAIR SEC 03 COMPANY: ADDRESS: CITY: STATE: ZIP: KETTELL INC. 1860 MAYPORT RD ATLANTIC BEACH FL 32233 ADDRESS: CITY: STATE: ZIP: BHATTI BABUR 715 SEMINOLE RD ATLANTIC BEACH FL 32233 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 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 12/18/2019 1 of 2 ,olA'�'' DRIVEWAY PERMIT PERMIT NUMBER � CITY OF ATLANTIC BEACH DWAY19-0053 ,� r 800 SEMINOLE ROAD ISSUED: 12/18/2019 ;0'3 : VATLANTIC BEACH, FL 32233 EXPIRES: 6/15/2020 3 PUBLIC WORKS f 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 RUNOFF INFORMATIONAL Notes: All runoff must remain on-site. Cannot raise lot elevation. 6 PUBLIC WORKS MAXIMUM DRIVEWAY INFORMATIONAL Notes: Maximum driveway width within the City right-of-way is 20 feet. 7 PUBLIC WORKS DECKING REMOVED INFORMATIONAL Notes: All old decking and debris must be removed from job site by Contractor. 8 PUBLIC WORKS INFRASTRUCTURE 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: 12/18/2019 2 of 2 41..A4-,, City of Atlantic Beach APPLICATION NUMBER s c, Building Department (To be assigned by the Building Department.) r800 Seminole Road C v j Atlantic Beach, Florida 32233-5445 J(J) �� CO Phone(904)247-5826 • Fax(904)247-5845 \•,,A2,011 9� E-mail: building-dept@coab.us Date routed: I, a-ice L_ l City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 7 1 IA I!c o Le j '-) Department review required Yes No Buildin Applicant: ming &Zonin Tree Administrator Project: t V' R.1vErl.)A L_( ublicWorks' Public Utilities \/ ) A UK.w l../ 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: roved. ❑Denied. ❑Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by:��� !/ Date: 1 `— 6— 1 Cr 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 i;•, City of Atlantic Beach APPLICATION NUMBER •;3. Building Department (To be assigned by the Building Department.) � 800 Seminole Road � .1 L --�( � C " `~ -' Atlantic Beach, Florida 32233-5445 DECOC134 2019 1—_J(-�.1��1 –w 5 3 `J Phone(904)247-5826 • Fax(904)247 5845 r'?,_);; �:- E-mail: building-dept@coab.us Date routed: 121 11.9 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Department review Property Address: / I � SEr 1'l I�(`�Le _, required Yes No� p Building Applicant: K(T`—G Li— / 1‘:.) arming &Zonin Tree Administrator Project: I U - U R t V EiA3 AL-t , ublic Works Public Utilities V'J A U< A)t c t 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. I 'Denied. ❑Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed b • /,,,%y4 , ,,, Bate: /2.--,K-/ 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. I 'Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 Building Permit Application2.(( Updated 4I ..; 1 City of Atlantic Beach Building Department **ALL INFORMATION 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY ':,_)_ IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us D , 1 Job Address: 7/5 ��t,�4')71..7C. C( � 'W QAd Permit Number: ` AV 1ci - D033 Legal Description ,V'/L' /6 " Z-.5- 2'11 /)t fir �I 3 t/ -!S RE# !7d yet/-000e-) Valuation of Work(Replacement Cost)$ I iii Heated/Cooled SF Non-Heated/Cooled • Class of Work: ❑New ❑Addition Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Qoor �� • Use of existing/proposed structure(s): ❑Commercial j�Residential 't,„,.,..- i1 . d ',. ,,.< ..,, C • If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No Approver.; by r-ermit Desk • Will tree(s) be removed in association with proposed project? ❑Yes(must submit�$yp�itaie.tre"6'ki re 7ti Permit) Iio FL Describe in detail the type of work to be performed: t ea ' PVIring 61tArdt AV&AAA 440 kW iZe- l,/ a.Ues. Florida Product Approval rt for multiple products use product approval form Property Owner Information Name �Lvetr El� i Address 115 /vri,n,,,! Aced City 4'/r,,.`f(, geott/) State p.._ Zip 37_733 Phone 103 E-Mail 50):,.r-- 13 I Gln,,,, i• (4s, Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information i i j j h f Name of Company 7/70; Qualifying Agent it )/ ;1 Address I, *P > ur e. t Ca, City 4410."4-t 8w4-- State r✓L Zip 3Z Z 3 3 Office Phone il,''r 37f' 7z.-Tz.Z.C, Job Site Con act Number box/a 444437 7 '',3)' State Certification/Registration# E-Mail j J C=, Kit un i;, 4 Architect Name&Phone# Engineer's Name&Phone# n Workers Compensation Insurer Am.To�Se "- do P OR Exempt❑ Expiration Date goof 21722 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 RECORDIF 1 • • : NOTICE OF COMMENCEMENT. :.- .r�-Owner or Agent) (Signature of Contractor) Signed and sworn to(or afflrm,d befor e this 'Z dal/ f Signed and sworn to(or affir :d) . . e ' e this ' day of g 1 i y�,� OEC— , 2o1 Gt ,b ;dei.AT :;.:4 1 1 ' , 70 ' . b '�-_i�_,elti . i 'i;: TONI GINDLESPERER ' ur- •. Notary), " . (Signature .f Notary) MY COMMISSION#GG 353178 176 '•`. ;,gid TONI GINDLESP,`rRGER n„ 1%. k..o`,: EXPIRES:October 6,2023 '• n •._ MY COMMISSION#GG 363178 '*,y,of y pray � [ ]Personally Known OR I+: _ :`�•vx.As ;o EXPIRES:October 6,2023 [ ]Produced Identification --z-t....•oe; II OD a 0 Q _7 9_ .•oF t;;,. Bonded Thru Notary Public Underwriters Type of Identification: 1 V' O ] Type of Identification: A ®,,,,ini . ZE3 - C i LLAN-- TREE & VEGETATION AFFIDAVIT FOR INTERNAL OFFICE USE ONLY ,=''r - City of Atlantic Beach PERMIT # Community Development Department f Y5 800 Seminole Road Atlantic Beach, FL 32233 •�0l;i9 (P) 904-247-5800 SITE INFORMATION 1 ADDRESS 7/\5 Sflh/(W /e � L�� SUBDIVISION 6/5—.�/; ,(-���� S�c 3 BLOCK LOT RE# 17D+/©u MOO 1D-4 14-zs" ZqE "RESIDENTIAL ❑ COMMERCIAL 0 OTHER APPLICANT INFORMATION NAME 61,bUr 3Ad-: PHONE# 703 k9 ‘‘',/3 ADDRESS '7/$ __ '11,1<1 d le- 80a,1 CELL# CITY A-R,,,,,i_:,, a „ t FL STATE FL ZIP CODE 322 3 3 EMAIL (3abo r 1-I6 R., 1n ,,,l/,efl� OWNER 17] 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 HFRVI3Y,ER Y THAT ALL INFORMATION PROVIDED IS CORRECT:Signature�urof Property Owner(s)or Authorized Agent i" V ;� u Iv Vtto. t ) z/z1( RE OF APPLICANT PRINT OR TYPE NAME DATE SIGNATURE OF APPLICANT(2) PRINT OR TYPE NAME DATE Iii Signed and sworn before me on this (---- day ofil\ 0 V f y State of — County of • i Identification verified: 1 )(__ i a_ �5 Oath Sworn: ❑ Yes ❑ No .�,YP:,,, TONT GINOLESPERGER � MYCOMMISSION#GG353178 N tary Signature -'; • - 1 .,,. ._,es EXPIRES:October 6,2023 •. •,. oP; °Fr,. Bonded'Nu Notary Public Underwriters Commission expires 04 TREE AND VEGETATION AFFIDAVIT 03.01.2018 . a =� REVOCABLE ENCROACHMENT AGREEMENT **ALL INFORMATION n\ City of Atlantic Beach 1 800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY IS REQUIRED. `..�J 9V REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation organized and existing under the laws of the State of Florida, hereinafter referred to as "CITY" and I / F bur (ekt--�I llI of Atlantic Beach, Florida, hereinafter referred to as "USER". WITNESSETH: That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon the property for the purpose as described in the City of Atlantic Beach. This work is generally described as 54J &'tk Pave..ei 1'1°N Ma— 01 L 4,2* ',/1.4.4 Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to relocation or removal on thirty(30)days' notice by CITY to USER,said notice to USER shall be given by certified mail, return receipt requested, to the following address 7/5 -i'fl,'1,/6 k Ao • 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 Habil. . s are hereby assumed by the USER. C\ - Date ' Z ( A Property Owner t(signed in presence of Notary Public) STATE OF FLORIDA, COUNTY OF DUVAL / The foregoing instrument was cknowledged this _ day of QQ , 20 L , b ---)hc:4_7{-4 ( Q. 0 (--- , who personally appeared before me and (p inted e of Signer) a ikno , edge tha h ,she sig -d the instrument voluntarily for the purpose expressed in it. 1 / i;�R '"•Ze= Tom ESPERGER • G-- I' ''' �; if Y COL6SSION8GG353178 Department Approval: Signature of Notary Public,Stat, of lorida 12'::::!,;______f:," aPB :G:tber8,2023 Baded"IN NctsyNicUndermiem [ ] Personally Known [ ] Produced Identification(Type) Scott Williams, Public Works Director H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18 /���/" '=:,:1-11h r.4 \ RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION rt, City of Atlantic Beach HIGHLIGHTED IN GRAY IS 9,1 1% 800 Seminole Road,Atlantic Beach,FL 32233 REQUIRED. PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES Job Address 7 1 !/Y)►nC/1•C &ad Permit Number DWA' ICI" OO5 3 Contractor Information Company iA4)?,//, Tile . Qualifying Agent /' - -e. l�, y� P� n Address !gip ' 7� + PQM' City &'4z4 `` C_State FL Zip 3Z2 13 9 Phone 371_ 1L? Email i'/'1c ,i,7 i <Q 7 State Certification/Registration # Architect Phone Email Engineer Phone /" Email Workers Compensation Insurer4 ✓.ci -- Drk 1IL OR Exempt ❑ 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 met � �ity of Atlan is Beach or Florida Department of Transportation Standards and be performed under the supervision of !jak i (Project Superintendent) /`� with(Company Name) ' ". " r X• /L . Phone 7BB�( 377 /008 • 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 expen es arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges. • T P 'c Works Director shall be notified 24 hours prior to starting work and again immediately upo.•�com etion. Date /Z ` / Ci Permittee(sign in presence of Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL The foregoing instrument was acknowledged this G�J _._ day of e 0 ,20 19 by )irk c4-44- ( 1-4 a`�-F C_ '" ..• ,who personally appeared before me and (printed name of Permittee) TONI GINDLESPERGER ack ledgedrathe/s a signed t e instrument voluntarily for the purpose expressed it it , ": 11YC0�pyIISSION#GG 353178 '•.: �.•P�= EXPIRES:October 6,2023 /� _ ''''•:?os n;?p. Bonded'Nu Notary Public Urde alters \ [ ] Personally Known Signature of Notary rublic,State of Flor [ ] Produced Identification(Type) B CO3 _O(,8-7 9 - Z l 3 -o H:\Applications&Forms\Word&Excel Document Originals\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18 18-Feb-2017 05:50 From Charles Parliment. 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