1802 Hickory Ln DWAY20-0040 Paver Dway,Walkway Permit PacketOWNER:ADDRESS:CITY:STATE:ZIP:
JOHNSON SUSAN 1802 HICKORY LN ATLANTIC BEACH FL 32233-4515
COMPANY:ADDRESS:CITY:STATE:ZIP:
KETTELL INC.1860 MAYPORT RD ATLANTIC BEACH FL 32233
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
172020 1444 SELVA MARINA UNIT 12C
R/P
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
1802 HICKORY LN DRIVEWAY SINGLE OR TWO
FAMILY DRIVEWAY PAVER DRIVEWAY AND WALK $18891.00
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.
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.
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.
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.
1 of 2Issued Date: 11/5/2020
PERMIT NUMBER
DWAY20-0040
ISSUED: 11/5/2020
EXPIRES: 5/4/2021
DRIVEWAY PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
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
3 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL
Notes:
Roll off container company must be on City approved list. Approved list can be obtained at the Building Department at City Hall. Roll off 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.
2 of 2Issued Date: 11/5/2020
PERMIT NUMBER
DWAY20-0040
ISSUED: 11/5/2020
EXPIRES: 5/4/2021
DRIVEWAY PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $125.00
DWAY20-0040 Address: 1802 HICKORY LN APN: 172020 1444 $125.00
PUBLIC WORKS PLAN REVIEW $25.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
ZONING PLAN REVIEW $100.00
ZONING REVIEW SINGLE AND TWO FAMILY
USES 001-0000-329-1003 0 $100.00
TOTAL FEES PAID BY RECEIPT: R14041 $125.00
Printed: Thursday, November 5, 2020 9:19 AM
Date Paid: Thursday, November 05, 2020
Paid By: KETTELL INC.
Pay Method: CREDIT CARD 392543648
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R14041
I I I
I I I
I I I
~+; CENTRALSQUARE
DWAY20-0040
ft::,· Building Permit Application
~ L )] City of Atlantic Beach Building Department
-~ 800 Seminole Road, Atlantic Beach, FL 32233
Phone: {904) 247-5 826 Email: Building-Dept@coab.us
Updated 10/9/18
**ALL INFORMATION
HIGHLIGHTED IN GRAV
IS REQUIRED.
Job Address : I [01-hi,~ulL~ ~ Permit Number:
Legal Description ?7~ Zfl~ &qr 25~ tefE )e4A Y'tJ~-,,4 Jk;t-1Jv h.-l fq/td: ~J.-"l/ R-E#-/J_7__()_7..._0_· --/-¼-~-o/"-
Valuation of Work (Replacement Cost)$ } 8 1 g-q / Heated/Cooled SF ____ Non-Heated/Cooled ____ _
• Class of Work: □New ~ddition ~Iteration □Repair □Move □Demo □Pool □Window/Doo r
• Use of existing/proposed structure(s): □Com merc i al ~esidential
• If an ex isting structure, is a fire sprinkler system insta ll ed?: □Yes □ No
• Will tree s be removed in association w ith ro osed ro·ect? □Yes must submit se arate Tree Removal Permit 0
Describe in detail the type of work to be performed:
9'U1)0¥{__ U>{)WMf_ Wrf ,
Florida Product Approval # ___________________ for multip le products use product approval form
ion H,~~~
Phone ____________ _
Engi neer's Name & Phone# •
Workers Compensation Insurer :Iit,bno f ,pJ,_¼ OR Exempt □ Expiration Date 3//1'1/~
Application is hereby made to obta in 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 reg ulati ng
construction in this juri sdiction . I understand that a separate permit must be secured for ELECTR ICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BO ILER S, 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 AFF IDAVIT: I certify that all the foregoing infor mation is accurate and t hat all work w i ll 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, C NSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
Rr-=a-"""--D-I_N--;G~Y-O....,U<-<--R""5,,,.c._---,&---c-o_M_M_E_N_c_E_M_ENT.7~~
Signed and sworn to (or affirmed) before me this __ day of Signed and sworn to (or affirmed) before me this __ day of
----~---~by __________ _ ----~---~by __________ _
(Signature of Notary) (Signature of Notary)
[ ] Personally Known OR [ ] Personally Known OR
[ ] Produced Identification [ ] Produced Identification
Type of Identification: _____________ _ Type of Identification: _____________ _
DWAY20-0040
RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION
City of Atlantic Beach
800 Seminole Road, Atlantic Beach, FL 32233
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
-**ALL INFORMATION
_lj_l§_HLIGHTED IN GRAY IS
REQUIRED.
Job Address_~l8?) __ 1-___ rf____,_,_t~i_k'--"-~---.. -=~=--><-,:___:='------Permit Number _________ _
Contractor Information
Company if/;~ ;~
Address \ 0 th~+-&J
Phone cyr 17117..,'/_/~
Qualifying Agent }i;Je,_,, ~/~
City &•le &«b State fl Zip 3 Z?1J
Email jf'\-A, e MdL/nl ., UJA
State Certification/Registration# _________________________________ _
Architect __________________ Phone __________ Email __________ _
Engineer ___________ -==-------Phone __________ Email __________ _
Workers Compensation lnsurerPJ lethr7ti /~ OR ExemptOExpiration Date 'J/Jt,/l!Z,o
•
•
•
•
•
•
•
•
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 t he Public Works Director, any or all sa id poles,
wires, pipes, cables or other facilities and appurtenances authorized hereunder, shall be imm ed iately 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 Florid a Department of Transportation Standards and be performed under the
supervision of ,=i~ U----}k/t.vf/ (Project Superintendent)
with (Company Name)t ',6t±k (/ 1 m,. Phone {ioL/ '371 I OCJg-
AII materials and equ i pment shall be subject to inspection by the Public Works Director .
All ci ty property shall be restored to its o ri g inal 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 .
Th e permittee shall commence actual construction in good faith within _ti2.{2_ days. If the beginning date is more than 60
days from date of permit approval then permittee must r eview the permit with the Public Works Director to make sure no
changes have occurred in the area that would affect the permitted constru ction.
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 Bea ch from and against any and all loss, damage and cost of
expenses arising in any manne f the exerci se or attempted exercises by the holder of the aforesaid rights and privileges.
The Public Works D·•--""'•:..<liall notified 24 hours pri o r to starting work and again immediately /2~m~n.
+-=__:_---~-~.-<t,..,c..-~---------------Date /fl~~
STATE OF FLORIDA, CO UNTY OF DUVAL
The foregoing instrument was acknowledged this _____ day of _________________ _, 20 ---~
by __ c.,_ ___________________________ _, who personally appeared before me and
(printed name of Permittee )
acknowledged that he/she signed the in strument voluntarily for the purpose expressed in it.
[ ] Personally Known
Si gnature of Notary Public, State of Florida [ ] Produced Identificat ion (Typ e) _________ _
H:\Applications & Forms\Word Docum en ts\201801001 Right-of-Way Ea sement Perm it Application.docx Revision Date: 10/1/18
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
(904) 247-5800
SURVEY AGREEMENT
NOTICE
All new projects creating more than 250 Square Feet of impervious surface or requiring on-site storm water
retention, including swimming pools, will require pre-construction and post-construction topographic surveys,
as required by COAB, Section 24-66 and described in Bulletin 2-18, Surveys. The surveys must be new
original documents, from a licensed surveyor, signed, sealed, and dated.
Other small projects, such as fences and construction less than 250 SF, will not require a new topographical
survey, but a current original-size survey with all relevant details is still needed. These surveys, when included
as part of a building permit application, must be complete, up-to-date, and original size and scale, as produced
by the surveyor.
Copies of old surveys lacking details or copies not of original size cannot be accepted. Building permit
applications with unacceptable surveys cannot be reviewed and the application will be returned to the
applicant.
Thank you for your cooperation in this matter.
AGREEMENT
I have read and understand the Notice above and affirm that the outdated survey I am
submitting is still accurate and complete, and all structures and impervious surfaces on the
property are shown on the survey.
I further understand that, if the survey is found to be inaccurate or incomplete, a $50.00 Plan
Resubmittal Fee will be charged; or if the permit has been issued, a Stop Work Order will be
posted with the associated $110.00 Fee.
JOBADoREss \1)01. t\lL\bo-<A ~ , Af-lo.,..lit Betwk
OWNERorCONTRACTOR(Print) Be.a O\o~5Scro
Signature ~~ Date ;;;!2-7//C>
1
NOTICE OF COMMENCEMENT
St ate of~f------=)::=-O _r ~\ J..~(A,=--.,,.._ __
County of ___ g).......___..,,.v'-'{ ........ a~A+-, ----
Tax Fol io No. _____________ _
To Whom It May Concern:
The undersigned hereby informs you that improve ments will be made to certai n real property, and in accordance wit h Section 713
of the Florida Statutes, the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Descri tion of ro ert bein im roved: -1 Lf t./ 3] -1-9 0 q -ZS -l q f
Address of property being improved: 5 7. 7.. J
Genera I description of improvements: --;-l~;:;,i'~d.-4J"-----'--"''->-..L-=---=--L...L.--=+--"-=o:.a.e""'-\--=-----='-""'-"""-'L...!>...-""c..A..'+-"""'-u....:=,,,.__
~/)L 9ovfvS • 4-Jol
owner: ~ D/o,f;-s:SM Address: '»H
Owner's interest in site of the improvement: ______________________________ _
Fee Simple Titleholder (if other t han owner): _____________________________ _
Pl
Surety (if any) ________________________________________ _
Address : ________________________ Amount of Bond$ ________ _
Telephone No: __________ _ Fax No: ____________ _
Name and add ress of any person making a loan for the construction of the i mprovements
Name:---------------------------------------
Address: -----------------------------------------
Pho ne No: ____________ _ Fax No: ____________ _
Name of person within the State of Florida, other than hi mse lf, designated by owner upon w ho m notices or other documents may
b e se rved : Name:--------------------------------------
Address:-----------------------------------------
Telephone No: __________ _ Fax No : ____________ _
In ad dition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2) (b), Florida Statues. (Fill in at Owner's option)
Name:-----------------------------------------
Address: ----------------------------------------
Telephone No: __________ _ Fax No: ____________ _
Expira t ion date of Notice·of Commencement (the ex piration date is o ne (1) year from the date of recording unl ess a different date is
spec ified):------------------------------------------
THIS SPACE FOR RECORDER'S USE ONLY
OWNE~ , ~
Signed: . ✓ ~ Date: _______ _
Before ~ _____ day of _______ in the County of Duv al, State
Of Florida, has pe rso nally appeared ________________ _
Notary Public at Large, State of Florida, County of Duval.
My commission expires: ____________________ _
Personally Known: _____________________ or
Produced Identification: ____________________ _
MA
P
SH
O
W
I
N
G
BO
U
N
D
A
R
Y
SU
R
V
E
Y
OF
LO
T
21
B
L
O
C
K
_
~ _
_
A
S
SH
O
W
N
ON
MA
P
OF
S
E
L
f
A
_
MA
R
I
N
A
VN
I
T
NO
.
1
2
-
_
C
RE
P
L
A
T
A S
RE
C
O
R
D
E
D
IN
PL
A
T
BO
O
K
3
7
PA
G
E
S
__
_
_
2
_
9
CE
R
T
I
F
I
E
D
FO
R
:
BE
N
G
T
ON
O
F
S
S
O
N
&:
SU
S
A
N
JO
H
N
S
O
N
.
LO
T
2
2
\
q,'t
>
(\
~
·
~~ "
,
,
f
~
,~
~
~
o
-
1
ST
O
R
Y
WO
O
D
&:
ST
O
N
E
OF
TH
E
PU
B
L
I
C
RE
C
O
R
D
S
OF
DU
V
A
L
COUNTY, FLORIDA
HI
C
K
O
R
Y
LA
N
E
~l
o
<:
:
_
~
•
Co
(C
U
L
-
DE
-
S
A
C
)
c
f
p~
v
\
t
J
G
EQ
_
G
~
~
~~
~
LO
T
2
0
<::
>
~
~
oi
~
tt
1
..
.
.
.
~
9 .
5'
1
~
ALL CORNERS FOUND 1/2# /P'S NO ID. !
LO
T
J
,,
J
'
~
,<
~
-"
"
-
,
;
;
;
:
:
.!
,
~
..
~
..
.t
V
.
-
>
0
%
>
.
1
~·
'
~
.e
,
c
;
;
,
,
,
.
~
I
.t
-;
o
_
g
~
"_
'
-
7
,
LO
T
4
SE
;
L
V
A
MA
R
I
N
A
UN
I
T
NO
.
10
PB
36
PG
59
(T
Y
P
)
LO
T
5
0/
!
.
0/
1
.
TH
E
PR
O
P
E
R
T
Y
SH
O
W
N
HE
R
E
O
N
AP
P
E
A
R
S
TO
LI
E
WI
T
H
I
N
FL
O
O
D
HA
Z
A
R
D
ZO
N
E
X
A
S
SC
A
L
E
D
FROM FLOOD
IN
S
U
R
A
N
C
E
RA
TE
MA
P
4
0
7
FO
R
DU
V
A
L
CO
U
N
T
Y
,
FL
O
R
I
D
A
,
DA
TE
D
1
1
-
0
2
-
2
0
1
8
.
AN
D
I
S
SH
O
W
N
A
S
A
CO
U
R
T
E
S
Y
ON
L
Y
AN
D
DO
E
S
NO
T
CO
N
S
T
I
T
U
T
E
A
CE
R
T
/
F
I
C
A
TI
O
N
OF
SA
M
E
.
TR
I
-
S
T
A
T
E
LA
N
D
SU
R
V
E
Y
O
R
S
,
IN
C
.
5
8
7
5
MI
N
I
N
G
TE
R
R
A
C
E
#2
0
9
,
JA
C
K
S
O
N
V
I
L
L
E
,
FL
O
R
I
D
A
3
2
2
5
7
(
9
0
4
)
8
8
0
-
2
5
3
5
LE
G
E
N
D
CM
CO
N
G
.
MO
N
IP
I RO
N
P I PE
RB
RE
B
A
R
R
/
W
RI
G
H
T
-
O
F
-
W
A
Y
S
/
W
SI
D
E
W
A
L
K
D
/
W
DR
I
V
E
W
A
Y
GO
V
.
CO
V
E
R
E
D
AR
E
A
f
CE
N
T
E
R
L
I
N
E
A /
C
A IR
C ON
D
t
n
O
N
I N
C
PA
D
(R
)
R AD
I
AL
DI
ST
A
N
C
E
CO
N
G.
CO
N
C
R
E
T
E
ES
M
'T
E A
S
EM
E
N
T
B.
R
.
L
.
BU
I
L
D
I
N
G
RE
S
T
R
I
C
T
I
O
N
LI
N
E
PC
PO
IN
T
OF
CU
R
V
E
P
T
PO
I
N
T
OF
TA
N
G
E
N
C
Y
F.
B
.
ZJ
J
.
/
1
2
2
6
PG
.
-1
.
L
f
l
.
I
BE
A
R
I
N
G
S
BA
S
E
D
ON
RL
W
LI
N
E
A
S
SH
O
W
N
.
TH
I
S
SU
R
V
E
Y
DO
E
S
NO
T
RE
F
L
E
C
T
OR
DE
T
E
R
M
I
N
E
OW
N
E
R
S
H
I
P
.
NO
T
VA
L
I
D
WI
T
H
O
U
T
TH
E
SI
G
N
A
TU
R
£
AN
D
TH
E
OR
I
G
I
N
A
L
RA
I
S
E
D
SE
A
L
OF
A
FL
O
R
I
D
A
LI
C
E
N
S
E
D
SU
R
V
E
Y
O
R
AN
D
MA
P
P
E
R
.
TH
I
S
SU
R
V
E
Y
BA
S
E
D
UP
O
N
DE
S
C
R
I
P
T
I
O
N
A
S
FU
R
N
I
S
H
E
D
,
AN
D
WI
T
H
O
U
T
BE
N
E
F
I
T
OF
A
TI
T
L
E
BI
N
D
E
R
/
A
B
S
T
R
A
C
T
OF
TI
T
L
E
_AN
D
/
O
R
DE
E
D
RE
S
E
A
R
C
H
.
SC
A
L
E
:
1 "=
3
0
'
FI
E
L
D
WO
R
K
DA
TE
:
7
-
3
0
-
2
0
2
0
SI
G
N
A
T
U
R
E
DA
T
E
:
8
-
0
3
-
2
0
2
0
GL
E
N
N
M.
BR
O
A
D
S
T
R
E
E
T
,
P.
S
.
M
.
NO
.
58
1
4
~
~
~
l
!
t
:
:
-
RE
G
I
S
T
E
R
E
D
SU
R
V
E
Y
O
R
AN
D
MA
P
P
E
R
,
ST
A
TE
OF
FL
O
R
I
D
A
(L
B
#4
9
2
1
)
GD
F
:
99
-5
2
9
9
ORDER NO . 2020-478 ,:
LOT 3
LOT 22
.;-~
.;-~
.;-
LOT 4
.IV~~ ...
v~.1 ..
1 STORY WOOD
& STONE
# 1802
SE;L VA MARINA UNIT NO. 10
PB 36 PG 59
HICKORY LANE
4' WOOD O
(TYP)
LOT 5
(CUL-DE-SAC)
~ LOT 20
<::)
t'3 ~
ot'
to
~
0/2.
0/2.
I~ ,~oo srlf
-ie1/CllL{,;sH?f\ I) 3q ~
Sl~
C0vv-~e_
e, ~/~)~ '5~
LOT 3
LOT 22
"~
"~ " #?;~" v~.,~
LOT 4
1 STORY WO
de STONE
# 1802
SE;L VA MARINA UNIT NO. 10
PB 36 PG 59
HICKORY LANE
(CUL-DE-SAC}
0/!.
4 • woo O
(TYP)
LOT 5