360 12th St DWAY19-0052 Repair Concrete DRIVEWAY PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH DWAY19-0052
800 SEMINOLE ROAD
ISSUED: 1/2/2020
30 2020
ATLANTIC BEACH. FL 32233 EXPIRES: 6/
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:
•
DRIVEWAY SINGLE OR TWO
360 12TH ST FAMILY DRIVEWAY repair concrete driveway $2200.00
TYPE OF t REAL ESTATE BUILDING USE
ZONING: SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171928 0000 SELVA MARINA UNIT 01
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
MARIANI FRANK V 360 12TH ST ATLANTIC BEACH FL 32233-5514
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: 1/2/2020 1 of 2
DRIVEWAY PERMIT PERMIT NUMBER
r t? DWAY19-0052
CITY OF ATLANTIC BEACH
'�► ISSUED: 1/2/2020
800 SEMINOLE ROAD
ATLANTIC BEACH. FL 32233 EXPIRES: 6/30/2020
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 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 OTHER PUBLIC WORKS CONDITION INFORMATIONAL
Notes:
All old driveway,including debris,must be removed from job site 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: $125.00
Issued Date: 1/2/2020 2 of 2
/ 7:
Building Permit Application Updated 10/9/18
s
., _ City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
on o'' I' IS REQUIRED.
Phone: (904) 247-5826 Email: .'Building-Dept@coab.us
Job Address: _g(p e i Z-1;1.• •r C,1 . Permit Number: D k) kAt tel _ oo5a
Legal Description RE#
Valuation of Work(Replacement Cost)$ 2 `2 00' OV Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New DAddition ❑Alteration l 'Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• .Use r7xrfing, pr'o0 e fk6cV s): DCommercial C4esidential //
• If an'eestingsfr'�E'tlure is a)iret`sprinkler system installed?: ❑Yes 14o
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) Li4O
Describe in detail OlIppiil v0lf{go be performed: 1 Cet i - v,a47Apt� lit ?fid A f ile ,t,.
Florida ProdtrctApprover##'.- s -,r, t for multiple products use product approval form
Property Owner Information
Name rirp.44-4- SwjctiA t vk 04,1 t,(,U..- Address .., O (''t vi3- - �,1
City 4"•(S( *rte Q. Z3R State Fl-. Zip 3,Z. `—357 Phone e21-_Z,9 ._fc,r
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company ]3c.t,,k,us Sash (Ullik6re1�C.•Qualifying A ent I'dA L cCi
Address\T1_U. r-C4t4'1Cc,1 f
Cita-04 61/-44-1A. State "tZipi--2-_5--L'
Office Phone 7DL- *Z i, -z7 z0 Job Site Contact Number(0Y-it -Z1'LU
State Certification/Registration# E-Mail ,13 e_ct L t".e..Ctil.0660 AlleAr4 Cc44CFe c1.I.01`'#
Architect Name&Phone#
Engineer's Name&Phone# —
Workers Compensation Insurer OR Exempt a Expiration Date) /:21.2-0
Application
2' l-
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
RECORDIlti YOU NOTICE OF COMMENCEMENT.
(Signa. re of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this tC1 day of Signed and sworn to(or affirmed)before me this 11 day of
Noki LM� 3-DI GI,by FTS. Ma( ,d(1 �6Jt.MAu��, OU ,by 'a t,\ 61L4.( (0
G?►V awl i1 I i iirtr a _--...wA;!J.)
014::,1`...."-,° X 12984 •,��a:":; 'I e Mm iS I� ��G 042984
h1` 0, �1 II*
' 71 EXPIRES:October 27,2020 `. ' '' :._ EXPIRES:October 27,2020
."116•0W:5,'.' Bonded Puy Notary Public Underwriters =•','eoFF o; Bonded T ru NotaryPublic Underwriters
[ ]Personally Kno t_S_""_____ — [ ]Personally Known •+.
[Vrt5duced Identi ication ` [ oduced Identification i 'f
Type of Identification: €L d(ts LI S \t Ldu-� Type of Identification: F L t�Zn ll -���(1 (L6�(/I
,-,,-,7-,,,,„, Owner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
i— ' ' City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 Q
4,1-,,,,,19:>/ Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT 1—
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES bre 5 Z
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: 3 'o l d-fh 8
3(/ e f A" •�-1. 4,11 FL.
Owner Name: C12-2-4,-)k 4-_c-15.4f.) !-1r1-1-a'3 ' Phone Number:
Mailing Address: 36(> /d-ih S ' City: A(14/A‘- AA*I\ State: a_ Zip: 3aa39
Notarized Signature of Owner ru-'
The foregoing instrument was acknowledged before me this Z—day o III 4* (\ 20[9 in the State of Florida, County
of \/x,11 V OtY,
Signature of Notary Public G
V
[ ] Personally Known OR [ ] Produced Identification
Type of Identification: ' Y \ CO So — 7 8 V 4 C) - z- l O `C
r r - a
«Q'` TONI GINDLESPERGER Updated 10/24/18
f. • MY COMMISSION#GG 353178
',;r,�`•.{i;' EXPIRES:October 6,2023
"'•::i!. .‘• Bonded Thu Notary Pubic lhiderwttfers '
ytn- City of Atlantic Beach DECEw—
APPLICATION NUMBER
e4 Building Department (To be assigned by the Building Department.)
800 Seminole Road w1 Gt -rij'1('��
i,f Atlantic Beach, Florida 32233-5445 ft NOV 2 5 2019 "`�"
AllyPhone(904)247-5826 • Fax(904)247=5845 G�
�? E-mail: building-dept@coab.us Date routed: I L L ` I 19
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: �D Department review required Yes No
Buildin
Applicant: t-Q- A-S PULS ( ek-C-bnU Planning &Zoning
,p
Tree Admrnistra of�
Project: C t�Qt ( Co RU QJ L (X( QW (ublic Work
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Review or Receipt
Other Agency Review or Permit Required Date
of Permit Verified By
Florida Dept. of Environmental Protection C,fA�
Florida Dept. of Transportation l"
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: A pproved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING // 2k-
Reviewed by: ��' _ Date: �/� vr(((y
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
S�Ly;. , City of Atlantic Beach APPLICATION NUMBER
6s 4 � Building Department (To be assigned by the Building Department.)
''� 800 Seminole Road nn` � ,A �c
?..1. 1,,,jj I- Atlantic Beach, Florida 32233-5445 iJ w t —"
Phone(904)247-5826 - Fax(904)247-5845
o" 1r E-mail: building-dept@coab.us Date routed: I. L� 119
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: (Pp t ---.\- --5-\- • Department review required Yes No
�, n, CC6 Buildin
Applicant: £-e--WALS ``)"-1N d-C-bC\U� Planning &Zoning,
,p Tree Administrator
Project: C tc)0J I CcoRU Q L (yc(.l�c-,) 0.y CPubli Work
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Review or Receipt 13,q--
Other Agency Review or Permit Required Date
of Permit Verified By
Florida Dept.of Environmental Protection C��
Florida Dept. of Transportation n
St. Johns River Water Management District v
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: Approved. Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING �Z-2...— 19
Reviewed by:t � 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 'Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
„ r�`'r,:., Building Permit Application Updated 10/9/18j 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 �” `
Job Address: D 4`i' •i fr.t(at4D�C,? Permit Number: t kJ AY lei - OOS'
Legal Description RE#
Valuation of Work(Replacement Cost)$ 2 2 dO• a° Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration lAepair ❑Move ❑Demo [Pool ❑Window/Door
• pZelesCEstt. c�urr s): ❑Commercial LI esidential /• re,is ire sprinkler system installed?: ❑YesI oo
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) 19'No
II``�I vV VV
Describe in detail kypr ilwnligo be performed: l Le CpArtiei "� Y _ Q-'44U(� �
1N. 4 ffe f ilea,v
R
Florida Pro juitepI4ty3epartl eflt for multiple products use product approval form
Proper Aantr er C , i0Beach, FL,
Name riet4ci�w3C1{A M(WI o. ,- Address .jc70 e'er ek-
City R-.(s(4,41x6 Q neittit State FL- Zip ,...37_.2.-3S Phone 7e21-_-.,47_Z�h9__((s�$1
E-Mail _
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company 13c4.AetIciiihij ic. Qualifying A ent !(
Address OW e.G t41.CC.1 `L.Ck c City'�(/� it a-� State Zip Z l-ZS 0
Office Phone 7D4-t Z . - ? .b Job Site Contact Nurnberg0y—If Lit, `1-12Lv
State Certification/Registration# E-Mail �� e.ct Ih,eSP't.hsdal epilCre5�a144. o
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt Expiration Date) (21.2-C)
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
RECORDI Ci YOU NOTICE OF COMMENCEMENT.
(Signat re of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this A,Ciday of Signed and sworn to(or affirmed)before me this 11 day of
NaJ Lmbilc 3-DI GI, by Eta '� AA-flan N)b. Alt{ 5-0 l� ,by �.:Lc. I
l)r1 0 ;`o....... igP� 7 Oe"t�fS I�Nay�G 042984
: A11:.0 rVLs?. I 2..84 *; Iu�n :* EXPIRES:Ociober27,20?0
'k '*' EXPIRES:October 27,2020
} '°. --`:4077,...;P:.,,;.i-
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s�_;,c:' Bonded Thru Notary Public Underwriters
[ ]Personally Kno :"" [ ]Personally Known 16.... ---
[�r6duced Identi ication _ [ oduced Identification 'f
Type of Identification: f.(+S Jt- S\1(...4.41:1-t Type of Identification: F L 1�L-nkS L&t,AN�'n cif d
MAP SHOVING BOUNDARY SURVEY OF
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City of Atlantic Beach, FL
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,•r'er_cft7 k/y /i-- 36 P-/6-E 7- BEARINGS BASED ON PLAT AS SHOWN
I HEREBY CERTIFY THA r THE- 07 SHOWN HEREON IS IN THE SPECIAL FLOOD HAZARD ZONE AS SHOWN
ON FL 000 INSURANCE PA TE MAP O i FOR THE CITY OF JACKSONVILLE. FL OR IDA. DA 7 _` 2'-£* 4
ALL AMERICAN SURVEYORS, INC .
LAND SURVEYORS - 4220 HOOD ROAD - JACKSONVILLE. FLORIDA, 32217 - 904/268- 41!`5
LEGEND I HEREBY CERTIFY THA r THE ABOVE LANDS WERE SUAVE✓EG UNDER my
RESPONSIBLE SUPERVISION AND DIRECTION, THA T THERE ARE NO
O CONC MON ENCROACHMENTS EXCEPT AS SHOWN AND THAT THE SURVEY SHOWN . 4
HEREON MEETS THE MINIMUM TECHNICAL STANDARDS SET FORTH BY THE
• IRON COP FLORIDA BOARD OF LAND SURVEYORS PURSUANT TO SECTION 472.02/ , \ ^
(SET WITH CAP
FLORIDA, STATUTES ALL ✓�
ILB 31357) AMERICAN
JAMES D. HARRISON JR., P. L. S. No 2647 SURVEYOR
—X—FENCE :A PRY C ED Y, P L S Na 4144
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